Objective To explore the difficulty and strategy of percutaneous transheptic stenting for the junction of malignant hepatic duct obstruction. Method Twenty-three patients with highly malignant biliary obstruction received percutaneous transheptic biliary drainage (PTBD) by placement of stent and/or internal-external drainage tube. All the 23 patientws were followed up to determine the successful rate of surgery, the incidence of complications, decreased serum level of bilirubin, patency time of biliary stent and survival time. Results The initial operation was sucessful in 22 cases, accounting for 95.65%. Twenty-one patients had significant decline in total bilirubin (60%) and 2 had not (10%). The levels of alanine aminotransferase (GPT) and aspartate aminotransferase (GOT) decreased markedly and returned to nomral in an average of 18 d. After operation, 2 patients had fever,1 biliary tract bleeding, 6 pain in the right upper abodminal region, 1 localized peritonitis around the puncture point, 3 GPT increase and 1 drainage tube slip. There were no serious complications such as hemorrhea and biliary fistula etc. The symptoms of all these complications disappeared in 2 to 5 days through haemostasis, anti-inflammatory therapy and liver function protection. The median survival time was 8.5 months. Conclusion Although the merging of malignant hepatic duct obstruction stenting is difficult, try to pass through the obstruction by guide wire and master the right methods of operation can significantly improve the successful rate of surgery.

Objective To study the effect of interventional treatment of iliac and femoral vein stenosis concomitant with deep venous thrombosis. Method Fifty-three patients were divided into 5 groups. In group A after placing into inferior vena cava a filter,11 patients adopted Amplatz Trombectomy Device for thrombolysis or ORSIS thrombolysis and persistent thrombolysis through popliteal vein. In group B thrombus was taken out through guiding catheter and then persistent thrombolysis through popliteal vein after placing into inferior vena cava filters in 9 cases. In group C 13 patients adopted persistent thrombolysis through femoral arteries. In group D 8 patients received persistent thrombolysis through popliteal vein. In group E persistent thrombolysis through foot veins was carried out in 12 patients. Seventeen patients received implanted stents and balloon-expansion in iliac and femoral veins. Results Symptoms disappeared in 26 patients(49.0%), significantly improved in 21 patients (39.6%), improved in 3 patients (5.7%), did not improve in 3 patients (5.7%), respectively. The repatency of iliac and femoral vein was achieved in more than 80% of the 17 patients. Complications developed in 3 cases in the course of thrombolysis. Conclusion The effect of mechanical removal of thrombus, persistent thrombolysis through catheter and transluminal angioplasty is safe and satisfactory.

Objective To investigate the photodynamic antitumor activity and chemical characteristics of pheophorbide A (PPBa)in vitro. Methods Breast cancer cells (MCF-7), lung cancer cells (A549), cervical cancer cells (HeLa), and three kinds of hepatoma cells (HepG2, hep3B and sk-Hep1) were planted in 96-well plates.The effects of light and dark toxicity, light intensity, and drug concentration on the phototoxicity of PPBa were investigated by MTT, and the uptake of PPBa was observed by Hoechst staining under a confocal microscope.The production of singlet oxygen was observed by flow cytometry and confocal microscopy with the reactive oxygen species detection kit.The photobleaching of PPBa was investigated by measuring the absorbance by a microplate reader according to the luminescence characteristics of PPBa. Results PPBa showed strong phototoxicity and low dark toxicity to six kinds of cancer cells, and IC₅₀ values to cancer cells were as follows: MCF-7:1.033 μmol/L, A549:1.911 μmol/L, HeLa: 2.319 μmol/L, HepG2:2.015 μmol/L, Hep3B: 2.089 μmol/L, sk-Hep1:2.467 μmol/L.The main uptake site of PPBa was the cytoplasm.The production of singlet oxygen was strongly dependent on the administration concentration, and photobleaching was very low. Conclusion For the six kinds of cancer cells, PPBa has the highest phototoxicity to breast cancer cells (MCF-7), with excellent properties and ideal photosensitizer characteristics.

Objective:To observe the effect of functional electrical stimulation (FES) combined with an ankle-foot orthosis (AFO) and gait training on lower limb motor function, gait parameters and the joint angles of hemiplegic stroke survivors.Methods:Thirty-two stroke survivors who met the inclusion criteria were selected and randomly divided into a control group ( n=10), an orthosis group ( n=10), and a combination therapy group ( n=12). In addition to routine medication and rehabilitation, the control group received only gait training, the orthosis group received gait training and an AFO and the combination therapy group was given FES, an AFO and gait training. All three groups were treated for four weeks. Then, the Fugl-Meyer lower extremity assessment (FMA-LE), the Brunnstrom lower extremity assessment (BRL), and Functional Ambulation Categories (FACs) were used to evaluate the lower limb motor function and walking ability of the three groups. The gait parameters of the three groups were quantified using a three-dimensional gait analyzer, and the changes in the hemiplegic gait before and after treatment were compared among the three groups. Results:After the treatment the average FMA-LE, FAC and BRL scores, time-space parameters, and joint angle parameters of all three groups had all improved significantly. After the intervention the average indicators in the combined therapy group (including stride frequency, stride length and walking speed) were all significantly better than in the other two groups.Conclusions:Adding FES to gait training with an AFO can effectively improve lower limb motor function and the walking ability of hemiplegic stroke survivors.

Objective To explore the spatial-temporal characteristics of influenza epidemic in Hubei from 2009 to 2020, and make short-term prediction to provide reference for influenza prevention and control strategies. Methods Time series seasonal decomposition model and geographic spatial analysis method were used to analyze spatial-temporal evolution characteristics of influenza prevalence in Hubei during 2009-2020. LSTM neural network model was used to predict the monthly influenza incidence from 2020 to 2023. Results Influenza was mainly prevalent in the end of winter and the beginning of spring (December to March) were periods of high influenza incidence. In recent years, the influenza pandemic has shown an increasing trend. Influenza epidemic was characterized by significant spatial differentiation, with ^“A-shaped point-axis structure^” surrounding counties were more severe . The epidemic center of gravity experienced a spatial evolution process from west to east and from north to south. LSTM neural network model predicted that although the influenza incidence rate from January 2020 to December 2023 is lower than that in 2019, it is still at a high level, and shows a peak epidemic in winter and spring. Conclusion Influenza epidemic in Hubei is characterized by a high epidemic period in late winter and early spring, and the southeast of Hubei is the key epidemic area. It is suggested that publicity and prevention and control should be strengthened according to people, time and place, and key populations and areas should be encouraged to receive influenza vaccines in advance.

Objective: To investigate the feasibility and significance of modified Killian(MK) method in the clinical diagnosis of congenital pyriform sinus fistula(CPSF) by electronic laryngoscopy. Methods: The following examinations were performed for 30 suspected cases of CPSF, including the traditional electronic laryngoscopy, MK examination(modified Killian position+ head rotation+ the Valsalva maneuver), barium swallow X-ray(BSX) and CT , and a prospective comparison among them were done. Patients were divided into two groups according to their age: young age group(≤14 years old) and older age group (>14 years old). The results of MK examination from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ² tests. Results: Sinuses in 20 of 30 patients were depicted from pyriform sinus in BSX, and the PDR was 66.7%(20/30). The PRD of CT was 83.3%(25/30). The presence of air bubbles around the upper lobe of the thyroid gland or at the inferomedial edge of cricothyroid joints, morphological changes of thyroid grand as well as pseudo-fistula formation on lower neck were detected clearly on CT. Comparing to the traditional electronic laryngoscopy, the effect of exposing piriform fossa fistula by MK examination is significant(χ²=17.05, P<0.05), with the PDR of 13.3%(4/30) and 76.7%(23/30) respectively. Nevertheless, comparing to BSX and CT, there were no statistically significant differences in the effect to diagnose CPSF (χ²=0.31, χ²=0.10 respectively, P>0.05). The PDR of MK in older group is significantly higher than younger group(χ²=6.68, P<0.05). Conclusions MK examination can clearly reveal the hypopharyngeal anatomical structure and detect the sinus of CPSF .It could be a safe, feasible, convenient and economical method as an application in preoperative diagnosis and follow-up examination of clinical suspected CPSF.

Establishing an effective three-dimensional (3D) culture system to better model human neurological diseases is desirable, since the human brain is a 3D structure. Here, we demonstrated the development of a polydimethylsiloxane (PDMS) pillar-based 3D scaffold that mimicked the 3D microenvironment of the brain. We utilized this scaffold for the growth of human cortical glutamatergic neurons that were differentiated from human pluripotent stem cells. In comparison with the 2D culture, we demonstrated that the developed 3D culture promoted the maturation of human cortical glutamatergic neurons by showing significantly more MAP2 and less Ki67 expression. Based on this 3D culture system, we further developed an disease-like model of traumatic brain injury (TBI), which showed a robust increase of glutamate-release from the neurons, in response to mechanical impacts, recapitulating the critical pathology of TBI. The increased glutamate-release from our 3D culture model was attenuated by the treatment of neural protective drugs, memantine or nimodipine. The established 3D human neural culture system and TBI-like model may be used to facilitate mechanistic studies and drug screening for neurotrauma or other neurological diseases.

Objective: To investigate the anatomic tract of congenital pyriform sinus fistula (CPSF). Methods: A total of 90 patients with CPSF undergoing open surgery between August, 2007 and March, 2017 at the Department of Guangdong General Hospital were retrospectively analyzed. Results: The tracts of all the fistulas actually walked far different from those of theoretical ones. A whole fistula may be divided into 4 segments according to adjacent anatomy of CPSF. The posterior inner segment to the thyroid cartilage was initial part of the fistula. It originated from the apex of pyriform sinus, then piercing out of the inferior constrictor of pharynx inferiorly near the inferior cornu of the thyroid cartilage (ICTC), and descended between the lateral branch of the superior laryngeal nerve and the recurrent laryngeal nerve. The ICTC segment was the second part of the fistula, firstly piercing out of the inferior constrictor of pharynx and/or cricothyroid muscle, and then entering into the upper pole of thyroid. The relationship between fistula and ICTC could be divided into three types: type A (medial inferior to ICTC) accounting for 42.2% (38/90); type B (penetrate ICTC) for 3.3% (3/90); and type C (lateral inferior to ICTC) for 54.5% (49/90). The internal segment in thyroid gland was the third part of fistula, walking into the thyroid gland and terminating at its upper pole (92.2%, 83/90) or deep cervical fascia near the upper pole of thyroid (7.8%, 7/90). The lateral inferior segment to thyroid gland was the last part of the fisula, most of which are iatrogenic pseudo fistula, and started from the lateral margin of thyroid gland. Conclusions CPSF has a complicated pathway. Recognition of the tract and adjacent anatomy of CPSF will facilitate the dissection and resection of CPSF in open surgery.

Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.