Objective To observe the changes of autonomic nervous function in elderly patients with coronary heart disease (CHD) accompanying anxiety or depression, and to explore their clinical significance. Methods The 85 elderly inpatients with CHD, diagnosed by selective coronary angiography, were divided into anxiety group (32 cases), depression group (28 cases) and control group (simple CHD without anxiety or depression, 25 cases). The heart rate variability (HRV) was analyzed according to electrocardiograph detected by dynamic cardiograms. Results Compared with the controls, the standard deviation of normal to normal intervals (SDNN), the rate mean square of the differences of successive RR intervals (rMSSD), the percentage of RR intervals differing ＞ 50 ms (PNN50) and the high frequency (HF) decreased markedly in patients with CHD accompanying anxiety or depression, and the low frequency (LF) increased significantly in anxiety group than in control group [(348. 2 ± 70. 6) Hz vs. (295.4+70.0) Hz, t=2.78,P＜0.05], while the HF decreased significantly [(65. 5±14. 4) Hz vs. (77.9± 13. 7) Hz, t=3.16,P＜0. 05]. There were no significant differences between the anxiety group and depression group in the corresponding parameters. Conclusions The injury of vagus nerve function, also autonomic nerve system dysfunction are more seriously in patients with CHD accompanying anxiety or depression than with simple CHD. Actively treating patients with CHD accompanying anxiety or depression may improve their prognosis.

Objective To investigate the expression of programmed death-ligand 1 (PD-L1) and programmed death-1(PD-1) in the kidney tissue of acute allograft rejection (AR) and the correlation between PD-L1 expression and PD-1 expression and the degree of tubulointerstitial lesions.Methods Immunohistochemistry and in situ hybridization were used to detect the expression of PD-L1 and PD-1 in renal tissue of normal control and AR confirmed by biopsy.Results Both PD-L1 and PD-1 expression were significantly higher in AR than in the normal renal tissue (P

Objective To identify the availability of video-assisted thoracoscopic thymectomy. Methods Retrospectively analyzed 68 patients with myasthenia gravis who underwent thymectomy including 34 cases of video-assisted thoracoscopic thymectomy and 34 cases of transsternal thymectomy,and the patients were followed up for 16 years. Results Patients of the VATS group were given video-assisted thora-coscopic thymectomy. The mean operative time was (90. 1 ± 15. 0) min,mean blood loss was (45. 0 ± 5. 5) mL,mean chest tube drainage time was (2. 5 ± 1. 2) days and mean postoperative hospital stay was (7. 0 ± 1. 2) days in VATS group,and there was no serious complica-tions and surgical death. The mean operative time was (98. 0 ± 12. 5) min,mean blood loss was (118. 5 ± 17. 5) mL,mean chest tube drain-age time was (4. 5 ± 1. 3) days and mean postoperative hospital stay was (11. 0 ± 2. 5) days in transsternal thymectomy group. 3 patients de-veloped MG crisis. There was no significant difference in mid-and long-term effects between the two groups(P>0. 05). ConclusionVideo-as-sisted thoracoscopic thymectomy for MG is safe and feasible with the advantage of less invasion,less surgical trauma,lower rate of complica-tion,and good curative effect compared with transsternal thymectomy.

Computer based patient records(CPR) are an inevitable trend in the process of building digital hospitals. The authors offer an analysis of the implications and functions of CPR, arguing that in essence computer based patient records are first of all "records", which must carry all the attributes of traditional records and that their "electronic" form of expression and means of implementation are only of secondary importance. The following viewpoints are set forth: ①management of CPR data by means of databases rather than the text mode; ②adoption of authorization by doctors and the scheme of security control; ③implementation of the supplementary subensemble scheme.

Objective To report the clinical results of managing distal tibial fractures with a hybrid external skeletal fixator.Methods From January 2006 to June 2013,39 patients with distal tibia fracture were managed with limited-close or limited-open reduction and a hybrid external skeletal fixator.They were 26 men and 13 women,with an average age of 40.1 years (range,from 23 to 65 years).According to AO classification,15 fractures were of type A3,8 of type B2,10 of type B3,2 of type C2 and 4 of type C3.According to Gustilo classification,of the 12 open fractures,8 were of type Ⅱ,3 of type Ⅲ a and one of type Ⅲ b.According to Tscherne classification of soft tissue injury,4 cases were of grade l,24 of grade 2,and 11 of grade 3.Open fractures were managed first with radical debridement.Those complicated with fibular fracture were managed first with open reduction and internal fixation of distal fibula followed by close or limited-open reduction and minimal internal fixation depending on the position of distal tibial fracture.Next,the hybrid external skeletal fixation was applied.Five cases were immobilized with trans-articular fixators.The data were recorded regarding interval from injury to surgery,operation time,perioperative blood loss,hospital stay,time of external fixation,time of bony union,and complications.The ankle function was evaluated clinically with the Maryland Scale system at the final follow-ups.Results The 39 patients were followed up for 12 to 18 months (average,14.5 months).Primary incision healing was achieved in 37 cases,but the other 2 patients with open fracture suffered delayed wound healing which was cured by dressing changes for 4 weeks.Altogether,38 cases achieved normal fracture union and their average time of external fixation was 13.5 weeks.The time for complete infusion of fracture lines on X-rays averaged 19.7 weeks.Delayed union occurred in one case whose fracture united after removal of the external fixator,internal fixation with a locking plate and autogenous bone grafting.One case was complicated with pin track infection which was healed after debridement,drainage for 8 weeks and removal of the external fixator.No neurovascular complications were observed.According to the Maryland Scale system,the ankle function was excellent in 8 cases,good in 24 and fair in 7,with an excellent and good rate of 82.1％.Conclusions The hybrid external skeletal fixator is good for distal tibial fractures,because it can cffectively protect the skin and minimize invasion to the soft tissues,reducing incidences of skin necrosis and wound infection.Moreover,since it is flexible in screwing and structure formulation,it facilitates wound management,eslpecially in the management of open fractures.

s and no restenosis was found in 3 patients according to cerebral angiography. Preliminary results show that PTAS in the management of the vertebrobasilar arterial stenosis is a safe and effective method.

Objective To investigate the effects of CD24 on CCl4-induced murine liver fibrosis and to analyze the possible molecular mechanism.Methods Wild type (WT) and CD24 knockout (CD24-/-) C57BL/6 mice were treated with CCl4 through intraperitoneal injection.Levels of ALT in serum samples were detected and liver tissues were stained with hematoxylin and eosin (HE) to assess liver tissue injury.Sirius Red staining was used to observe liver fibrosis.Real-time PCR was performed to detect the expression of α-SMA (α-smooth muscle actin), Col1a1 (Collagen, typeⅠ, alpha 1), TGF-β1 (transforming growth factor-β1) and CD24 at mRNA level in liver tissues.Western blot was performed to analyze the expression of α-SMA and Col1a1 at protein level.Flow cytometry analysis was used to detect the macrophages in liver tissues.ELISA was used to detect the expression of TGF-β1 in the culture supernatants of M1 and M2 macrophages.Results The expression of CD24 at both mRNA and protein levels were up-regulated in mice with CCl4-induced liver fibrosis.HE staining showed that liver inflammation in CD24-/-mice was more severe than that in WT mice after treated with CCl4.Sirius Red staining of paraffin-embadded liver sections revealed that compared with WT mice, CD24-/-mice presented with more severe liver fibrosis.Moreover, α-SMA and Col1a1, indicators of liver fibrosis, in CD24-/-mice were significantly higher than those in WT mice.Flow cytometry analysis showed that murine hepatic macrophages significantly increased in CD24-/-mice than in WT mice following CCl4 treatment.Real-time PCR analysis also confirmed that significantly enhanced expression of TGF-β1 at mRNA level in liver tissues was observed in CD24-/-mice than in WT mice.TGF-β1 secreted in the culture supernatant of M2 macrophages derived from CD24-/-mice group was more than that of the WT mice group.No significant difference in TGF-β1 secretion in culture supernatant of M1 macrophages was observed between the two groups.Conclusion Taken together, these data suggest that CD24 plays an important role in attenuating CCl4-induced chronic inflammation and hepatic fibrosis in mice.The mechanism of CD24 in alleviating liver fibrosis might be through regulating intrahepatic macrophages, inhibiting the secretion of TGF-β1 by M2 macrophages and suppressing the activation of hepatic stellate cells.

Objective To explore the clinical significance of lymph node micrometastases in stage Ⅱ rectal cancer patients. Methods Forty-two patients with rectal cancer underwent total mesorectal exci-sion between January 2000 and August 2001 were included, 484 lymph nodes were studied in paraffin blocks that had previously been considered free by conventional histopathological examination. These lymph nodes were submitted to immunohistochemical analysis using cytokeratin 20 (CK20) monoclonal antibodies to identify micrometastases. Five-year follow-up information was obtained on these patients. Observed survival rates and assessed respectively in the patients with and without micrometastases. Results Micrometastases were detected in 33 lymph nodes (6.8% ,33/484) of 15 cases (35.7%, 15/42). The five-year survival rate was 40.0% in the patients with micrometastases, whereas in the patients without micrometastases, the survival rate was 92.6%(P = 0.000,by the Log-rank test). By multivariate Cox regression analysis, lymph node mi-cromctastases was closely correlated with post-operative recurrence or metastases, the value of RR was 11.435. Conclusions Detection of micrometastases is an important prognostic tool in stage Ⅱ rectal can-cer. In this study, lymph nodes micrometastases is an independent prognostic factor for overall survival. These patients maybe get benefit from adjuvant chemotherapy.

Objective To provide new information for treatment and prognosis of blastic plasmacytoid dendritic cell neoplasm (BPDCN).Methods Through one case report and literature review of 48 BPDCN cases were reviewed retrospectively.The clinical characteristics,treatment choices and prognosis were analyzed.Results BPDCN patients were mainly elderly males,mostly presented as skin rash and bone marrow infiltration.Immunophenotype was characteristically expressed as CD4,CD56 and CD123.Lymphoid-like regimens could induce higher response rate,lower relapse rate and longer overall survival compared with myeloid-like regimens.Allogeneic hematopoietic stem cell transplantation may provide long-term survival.At the onset of the disease,The counts of white blood cells (WBC) and blood platelet (Plt) may be correlated with inferior overall survival.Conclusions BPDCN is a disease with distinct clinical characteristics and immunophenotype.Lymphoid-like regimen may be the better treatment of choice,while allogeneic hematopoietic stem cell transplantation should be taken into account in the first complete remission for longterm survival.

Objective To evaluate preoperative multislice CT angiography (MSCTA) in guidance for laparoscopic right colon cancer the complete mesocolon resection (CME).Methods From September 2014 to May 2016 data of 24 patients undergoing laparoscopic CME right colon cancer surgery,were reviewed for the guidance of MSCTA over operative surgery.Results Preoperative MSCTA clearly showed superior mesenteric vascular anatomical variation and its branch,which was in closely consistent with that seen during the operation.The superior mesenteric arteries and veins (SMA/SMV) and the ileum colon arteries and veins (ICA/ICV) were seen in all the 24 cases.There are four main types anatomic variation of gastrocolic trunk (Henle trunk),of which most often consisting of three branchs (type B),accounting for about 46％.The time of completely dissecting anatomical Henle trunk was significantly longer than that for the ileum colon vessels and the middle vessels dissection (P ＜ 0.05).Conclusion Preoperative MSCTA can clearly present anatomic variation of SMV/SMA and its branch,precisely navigate the laparoscopic right colon cancer CME surgery,reducing the incidence of intraoperative vascular complications and improving the quality of surgery.