Objective To compare the effect and complications of lumboperitoneal shunt (LP) and ventriculoperitoneal shunt (VP) in treatment of posttraumatic hydrocephalus (PTH).Methods A retrospective study was made on 150 cases of posttraumatic communicating hydrocephalus managed with LP or VP from June 2013 to June 2015.There were 65 cases [36 males, 29 females;(47.2 ±8.2) years of age] in LP group and 85 cases [53 males, 32 females;(44.6 ± 7.3) years of age] in VP group.Therapeutic effect and complications were analyzed postoperatively.Results Period of follow-up was 3-27 months, which shoued Total effective rate of 97％ in LP group and 94％ in VP group (P ＞0.05).Postoperative complications were mainly hematoma, infection, shunt obstruction, shunt exposure, excessive shunt and inadequate shunt.At the follow-up, there were 3 subdural hematoma, 4 intracranial infection, 2 shunt obstruction, 3 excessive shunt and 1 inadequate shunt in VP group, but 1 subdural hematoma, 1 intracranial infection, 1 shunt exposure and l excessive shunt in LP group.Good results were achieved in the two groups after regulation of the shunt pressure or reoperation.In comparison, incidence of complications was 6％ in LP group versus 15％ in VP group (P ＜ 0.05).Rate of shunt removal and reoperation in LP group were both 2％, but were 7％ and 8％ respectively in VP group (P ＜ 0.01).Conclusions Both shunt procedures are effective for posttraumatic hydrocephalus, while LP is a better choice in clinical application for the lower complication incidence, shunt removal rate and reoperation rate.

OBJECTIVETo explore the effects of sacral canal injection on nerve root local inflammatory factors in rat model with lumbar disc herniation, in order to identify its mechanism of treatment.

METHODSForty-eight male SD rats were randomly divided into sham operation group(group A), model group (group B), Chinese medicine group(group C) and western medicine group(group D). There were 12 rats in each group. The model of lumbar disc herniation was established using compression and inflammatory stimulation in group B, C, D. All rats were given epidural catheterization and group A and B with physiological saline (1 ml/kg), group C with mixed liquor of 2% lidocaine and compound Danshen injections and physiological saline (2:2: 16) and group D with mixed liquor of 2% lidocaine and triamcinolone acetonide injection and physiological saline (2:2:16), once a week for a total of three treatments. Four rats were killed every 1 week after injection for once, and the inflammatory factors of tumor necrosis factor (TNF-alpha), prostaglandin E2 (PGE2), interleukin-l (IL-1) and interleukin-6 (IL-6) were detected by ELISA method.

RESULTSThe levels of TNF-alpha, PGE2, IL-1 and IL-6 in compressed nerve tissues in group B were increased than those of group A (P < 0.01). The levels of PGE2, IL-1 and IL-6 in group C and D were decreased than those of group B, and group D was much less(P<0.05). There was no significant difference in level of TNF-alpha among group B, C, D (P > 0.05).

CONCLUSIONCompound compression with inflammatory stimulation can lead to massive release of inflammatory mediators, such as TNF-alpha, PGE2, IL-1 and IL-6. Both injection with compound Danshen injections and triamcinolone acetonide injections by sacral canal can reduce the levels of part inflammatory mediators (PGE2, IL-1 and IL-6), and the effect of Glucocorticoid is better than Danshen (P < 0.05).

Animals ; Dinoprostone ; analysis ; Disease Models, Animal ; Injections ; Interleukin-1 ; analysis ; Interleukin-6 ; analysis ; Intervertebral Disc Displacement ; drug therapy ; immunology ; Lumbar Vertebrae ; Male ; Rats ; Rats, Sprague-Dawley ; Salvia miltiorrhiza ; Spinal Nerve Roots ; immunology ; Triamcinolone Acetonide ; administration & dosage ; Tumor Necrosis Factor-alpha ; analysis

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

Objective To observe the changes of CD+8CD+28,CD+8CD-28 and CD+4CDhigh25CDlow127 regulate T (Treg)cellsin peripheral blood of lung cancer patients,and to analyze the correlation between CD+8CD-28 and CD+4CDhigh25CDlow127 Treg cells to reveal the role and clinical significance of them in lung cancer patients.Methods Flow cytometry was applied to evaluate the level of CD+8CD+28,CD+8CD-28 and CD+4CDhigh25CDlow127 Treg cells in peripheral blood of 60 untreated lung cancer patients and 60 healthy controls group.The association of each term with clinical features was analyzed.Results The percentage of CD+8CD-28 and CD+4CDhigh25CDlow127 Treg cells in lung cancer group[(58.430:15.749) ％,(7.365±2.025) ％]was significantly higher than those in healthy group [(41.057±15.436)％,(6.648±1.669)％,(t=6.102,P＜0.05;t=2.115,P＜0.05)],while the percentage of CD+8CD+28cells is lower(41.570±15.739)％ than that in healthy group[(58.700±15.298)％,(t=-6.043,P＜0.05)].No close associations were found between three index and gender,age,and biological characteristics.With the increase of TNM stage,The percentage of CD+4CDhigh25 CDlow127 Treg cells increased gradually,which was remarkably higher in patients rith stage Ⅳ than that with stage ⅢA(t=-3.898,P＜0.05).The percentage of CD+4CDhigh25 CDlow127 Tregcells was uncorrelated with CD+8CD-28 cells(r=-0.169,P＞0.05).Conclusion The higher percentage of CD+8CD-28 and CD+4CDhigh25 CDlow127 Treg cells,the lower percentage of CD+8CD+28 cells may be the important reasons of immune suppression in lung cancer patients.Though there is no correlation between CD+8CD-28 and CD+4CDhigh25 CDlow127 Treg cells,it is may be helpful to understand immunologic function and it may look for more specific therapy and provide a new reference in the prognosis of lung cancer.

We applied a new teaching mode,combining problem-based learning (PBL) with extended teaching in clinical internship and case discussion,in order to adapt to the new situation in infectious diseases.The teaching efficacy was evaluated by questionnaire and classroom effect.The results showed that the new mode cultivated the students' self-learning ability and broadened their professional perspective.

Purpose To investigate the value of 3.0T MR T1ρquantitative analysis in early detection of disc degeneration. Materials and Methods Conventional T2WI and T1ρwere collected in 35 healthy volunteers (male 16, female 19) on 3.0T MRI, and the classification of disc nucleus was performed by Pfirrmann classification. T1ρvalue of nucleus pulposus was measured and analyzed for the relationship among Pfirrmann classification, segmental and gender. Results There was a significant negative correlation between T1ρvalue and Pfirrmann grade (r=-0.542, P<0.001). T1ρvalue in L5/S1 segment (94.80±26.60) ms was significantly lower than that in L2/L3 (117.18±25.64) ms and L3/L4 (115.52±28.53) ms (P<0.01), and there was no significant difference among other segments (P>0.05);there was no gender differences among the T1ρvalue of each segment (t=0.006, 0.042, 0.797, 1.022, 0.038, P>0.05). Conclusion T1ρ value is closely related to the degree of disc degeneration, and T1ρimaging can be used as an objective, sensitive and effective tool for early detection of disc degeneration.

Objective To investigate the effects of isoflurane and sevonumne on apoptosis and expression of CD44 and CD54 in human lung cancer cell line A549.Methods Human lung cancer A549 cells were obtained from Shanghai Cell Biology Medical Research Institute,Chinese Academy of Sciences,and inoculated in 24 well culture plate.After being cultured for 24 h the cells were randomly divided into 3 groups:group Ⅰ control(group C);group Ⅱ isoflurane (group Iso) and group Ⅲ sevoflurane (group Sev).A 549 cells were exposed to 1.7% isoflurane and 2.5%sevoflurane for 4 h respectively in group Iso and Sev respectively,and were then cultured for another 24 h.Apoptosis and expression of CD44 and CD54 in A549 cells were detected with flow cytometer at 0 (T0),2 h(T1) and 4 h(T2) of and 24 h after(T3) exposure to isoflurane and sevoflurane.Results The percentage of apoptotic cells wag significantly higher at T2 and T3 in group Iso than in group C.The percentage of apoptotic cells was significantly higher at T1,T2 and T3 in group Sev than in group Iso and C.The expression of CD44 and CD54 at T1,T2 and T3 was significantly decreased as compared with the baseline at T0 in group Iso and Sev and was significantly lower in group Iso and Sev than in group C.Conclusion Isoflurane and sevoflurane can induce apoptesis of human lung cancer cell line A549, and sevoflurane is more effective. Isoflurane and sevoflurane can inhibit the expression of CD44 and CD54 of human lung cancer cell line A549.

Objective To research the clinical significance of acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients.Method Fifty-nine sepsis patients were divided into two groups:lactic acid Ringer solution and hetastarch (group A,27 cases)and acetated Ringer solution and suecinylated gelatin (group B,32 cases),compared the fluid resuscitation and other parameter.Results There were no significant difference in the central venous pressure,mean arterial pressure and the dose of noradrenaline (P ＞ 0.05).The activated partial thrombeplastin time in group A was longer than that in group B[(58±10),(74±13)s vs(48±7),(54 ±11) s in 6,24 hours],fibrinogen concentration was lower than that in group B [(3.3 ±0.8),(1.6±0.3)g/L vs (4.2±1.1),(2.1±0.2)g/L in 6,24 hours] (P＜0.05).Serum lactic acid,creatinine,calcium concentration in group A [(6.9±0.8)retool/L,(289 ~ 27)μ mol/L,(2.1 ±0.3)mmol/L]were higher than those in group B [(3.2 ±1.1)mmol/L, (193 ±42)μmol/L, (1.7±0.2)mmol/L](P＜0.05),there was no difference in APACHE Ⅲ scores on the third day between two groups (P＞0.05).Conclusions Acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients has the same effect,but fewer impacts on serum coagulation,serum lactic acid and renal function than lactic acid Ringer solution and hetastareh.They may be more suitable for fluid resuscitation of sepsis patients,but hypecalcemia is easy to happen,and there is no significant evidences proving the prognosis.

Objective To investigate the effects of different concentrations of sevoflurane on Survivin expression in human adenocarcinoma cell line A549. Methods A549 cells were obtained from Shanghai Cell Biology Medical Research Institute, Chinese Academy of Sciences and inoculated in 96 well culture plate. After being cultured for 24 h, the cells were randomly divided into 4 groups: Ⅰ , Ⅱ , Ⅲ and Ⅳ groups exposed to 95 % O2 -5 %CO2,1.7%, 3.4% and 5.1% sevoflurane respectively. A549 cells were exposed to sevoflurane for 2, 4 and 6 h respectively and then cultured for another 48 h in Ⅱ , Ⅲ and Ⅳ groups. Proliferation of A549 cells were measured by methyl thiazolyl tetrazolium (MTT) assay, and apoptosis was detected with flow cytometer at 48 h after 2, 4 and 6 h sevoflurane exposure. The expression of Survivin in A549 cells was determined by Western blot analysis at 48h after 4 h sevoflurane exposure. Results The rate of proliferation inhibition and percentage of apoptotic cells were significantly higher while the expression of Survivin was significantly lower in a concentration-dependent manner in Ⅱ , Ⅲ and Ⅳ groups as compared with group Ⅰ . Conclusion Sevoflurane can inhibit proliferation and induce apoptosis of A549 cells by inhibition of Survivin expression.

Objective To investigate the anti-fatigue and anti-hypoxia effect of fermented Paecilomyces hepiali myceli-um (PHM) and to explore its mechanism.Methods Seventy-two naive Kunming male mice were randomly divided into Home, vehicle, modafinil( Mode) , low-dose PHM, moderate-dose PHM, and high-dose PHM groups.All mice were ad-ministrated with the drug or vehicle twice a day during a 14-day period.Except for the Home group, each groups was forced into the wheel fatigue device to receive a climb-run training at the time points of 40 min, 8 h, 24 h and 48 h, and to re-ceive an exhaustive training at the time point of 72 h after the last administration.The number of electric shocks was recor-ded during each training and the levels of muscle glycogen, liver glycogen, serum urea nitrogen, serum lactic acid, serum creatine kinase and blood ATP were detected after the exhaustive training using commercially available kits.In addition, 96 naive Kunming male mice were randomly and equally divided into the vehicle, low-dose, moderate-dose and high-dose PHM groups.Twelve mice in each group were chosen for the normal pressure anti-hypoxia experiment and the other 12 mice were used for the NaNO3 poisoning experiment.Results Compared with the vehicle groups, the PHM group showed a sig-nificant decrease in the number of electric shocks, improvement in biochemical parameters associated with fatigue, and an increased survival time in the anti-hypoxia and the NaNO3 toxicity tests.Conclusion PHM is potentially an effective alter-native for wild Cordyceps in the treatment of fatigue and hypoxia.