Objective To investigate the factors affecting pulse transit time during anesthesia. Methods Sixty cases of gastrointestinal surgery under general anesthesia were investigated.The pulse transit time (PTT),BP and HR were measured at the time before and after intravenous anes-thesia induction,and at the time before and after the injection of vasoactive drugs,respectively. Results Compared to at the time before injection,HR,SBP and DBP increased significantly,and PTT decreased significantly (P <0.01 )at the time after injection of atropine and ephedrine.Com-pared to at the time before injection,HR and PTT increased significantly,while SBP and DBP de-creased significantly (P < 0.01 )at the time after injection of nicardipine.While HR and PTT de-creased significantly,and SBP,DBP increased significantly (P <0.01 )with the injection of pheny-lephrine.Obvious negative correlation between SBP and PTT was observed before and after induc-tion;meanwhile,only weak correlation between DBP and PTT was observed,and no obvious correla-tion between HR and PTT was detected.SBP and PTT were well negatively correlated with the injec-tion of atropine,ephedrine,nicardipine or phenylephrine.Conclusion All the PTT changes during anesthesia were found to be negatively correlated with the systolic blood pressure.

1. The blood supply of the tensor fascia lata myocutaneous free flap comes chiefly from the ascending branch of the lateral circumflex artery (76.74％) or its ascending and the transverse branches (23.26％). In most cases the ascending branch may be served as the vascular pedicle of myocutaneous free flap in transplatation. In a few cases the transverse branch my be used instead of the ascending one.2. The projection of the origin of the lateral circumflx artery on the body surface is at a point averaging 96.5mm below, and 49.2mm medial to the anterior superior iliac spine. This point is the surface landmark of the lateral circumflex artery. 3. The branches of the lateral circumflex artery may be classified into four types. Type 1—32 cases, 74.42％; Type Ⅱ—3 cases, 6.98％; Type Ⅲ—7 cases, 16.28％; Type Ⅳ—1 cases, 2.33％.4. The tensor fascia lata is chiefly supplied by the ascending branch of the lateral circumflex artery, it divides into a short superior and a long inferior twigs. Both twigs enter the muscle and form abundant anastomoses in the subcutaneus tissues. In order to reduce the thick ness of the free flap for the use in plastics, the superior twig with its supplying muscle is cut away and the inferior one's left to supply myocutaneus flap.5. The angle between the ascending branch and the inner surface of the tensor fasca lata varies between 44? to 120?, with an average of 66.5?. The original angle must be kept in transplantation, which favours the survival of the myocutaneus free flap.

Objective To evaluate the role of endorectal ultrasonography with coupling gel intrarectal filling in preoperative T stage of rectal cancer. Methods One hundred and fifteen patients with rectal cancer underwent endorectal ultrasonography with coupling gel intrarectal filling. The preoperative T stage according to ultrasonic manifestations was compared with histological findings. Results The total diagnostic accordance rate of preoperative T stage by endorectal ultrasonography with coupling gel intrarectal filling was 89.57%. The sensitivity of ultrasonography for T1, T2, T3 and T4 was 93.10%, 61.11%, 96.61%, 88.89%, while the specificity was 97.67%, 96.91%, 89.29%, 99.06%, respectively. The overstaging rate of ultrasonography was 6.96% (8/115), and the understaging rate was 3.48% (4/115). Conclusion Endorectal ultrasonography with coupling gel intrarectal filling is a valuable diagnostic method for T stage of rectal cancer.

The arterial source of the flap,the anastomoses of cutaneous arteries in theskin and subcutaneous tissue and nervous distribution in the flap were observed andsurveyed in 42 upper limbs of adult cadavers.1.The arterial source of the flap comes mainly from the cutaneous branches ofprofund brachial artery,radial collateral artery,lateral humeral cutaneous artery andcutaneous branches of the posterior circumflex humeral artery.In most cases theprofund brachial artery and radial collateral artery may be served as the vascularpedicle of the flap of lateral brachium in transplantation.2.The cutaneous arteries in this flap anastomose each other to from a networkin the skin and subcutaneous tissue.Cutaneous arteries arising from the medial brac-hial region and the upper part of forearm also participate in the formation of thisvascular network.3.The veins of the flap contain both superficial and deep groups:The superfi-cial group is the cephalic vein of brachium which goes upward along the lateralsulcus of m.biceps brachii and its outer caliber is somewhat wider;the deep groupfollows the profund brachial artery or radial collateral artery as their venae comit-antes.Both groups may be sutured together or separately with veins of the recipientin skin grafting.4.The lateral brachial cutaneous nerve and posterior antebrachial cutaneousnerve pierce through the lateral intermuscular septum at various levels,and innervateover the skin in lateral brachial and posterior forearm regions.Since the posteriorbrachial cutaneous nerve is accompanied closely by the radial collateral artery,muchattention should be paid to it in cutting skin flap.5.The extent of cutting a skin flap in lateral brachial region can be enlargeddue to free anastomoses with arteries of adjacent regions which was demonstrated byperfusing red ink into profund brachial artery.The flap of lateral brachium maybe subdivided into following three parts:the upper,middle and lower,the vascularpedicle of which are the cutaneous branch of posterior circumflex humeral artery,lateral humeral cutaneous artery and profund brachial artery(or radial collateralartery)respectively.

The cutaneous arteries of the forearm and their anastomoses in skin and subcutaneous tissue were invetigated on 35 upper limbs.1. The average length of the radial artery is 215.3 mm. This artery can be divided into a covered part and a exposed part. Their lengths are 117.7 mm. and 101.4 mm. respectively. The calibers of the upper end, the intermediate point, and the lower end of the radial artery are 2.7mm, 2.3 mm and 2.4 mm respectively.2. The exposed part of the radial artery sends out more cutaneous branches (9.6 branches) than the covered part (4.2 branches), While their muscular branches are nearly equal in number. The calibers of the cutaneous and muscular branches of the radial artery varies from 0.3～0.5 mm.The fine anastomoses of the cutaneous branches exist between the radial and ulnar arteries and between the radial and ulnar arteries and the dorsal interosseus artery and they form an arterial networks in the subcutaneous tissue of the whole forearm. For blood supply a skin flap may be cut from the whole forearm from the standpoint of morphology.4. The calibers of the radial and cephalic veins at the level of middle part of the forearm are 1.3 mm and 2.8 mm respectively. As the vasular pedicle both the veins should be anastomosed during transplant operation in order to increase the volume of the draining blood.5. The skin flap of forearm blongs to a type of blood supply of arterial trunk network, which have been distinguished with that of some other skin and myocutaneous flaps according to the anatomical characteristics of the radial artery.

Objective:To explore the method and effect of free thining anterolateral thigh perforator flap (ALTP) in repairing soft tissue defect of scar contracture deformity after hand trauma.Methods:From March, 2015 to August, 2019, 12 patients who suffered scar contracture after hand trauma were repaired with thin ALTP. First, completely resected the scar contracture tissue from the hands and restored the normal bone structure and force line of the hand. The area of hand wound defects were 5.0 cm×6.0 cm-8.0 cm×10.0 cm. The wound was repaired by free ALTP, and the flap was micro-thinned for the first time. The flaps did not carry broad fascia, and the donor sites were directly sutured. The wound healing, the flap appearance, texture, sensation, scarring of the donor area, and functional recovery of the affected hand were observed regularly after surgery. The patients were followed-up by outpatient review and WeChat.Results:All the flaps survived well after the operation. Two cases suffered crisis because hematoma entraps vein cause by bleeding from perforator branch. After surgical exploration, the flaps survived successfully. All 12 flaps were followed-up successfully, including 6 cases reviewed in outpatient clinic, 4 cases followed by WeChat video and 2 cases by telephone consultation. The follow-up time was 3-20 months, with an average of 11 months. The flaps were not bloated, soft, non-pigmented, and beautiful in appearance. Only linear scars remained in the donor sites. The gripp function, palm function, thumb opposition function and finger function of the affected hand were largely restored. According to the TAM method of Upper Limb Function Evaluation of the Chinese Medical Association: 7 cases were excellent, 4 cases were good, and 1 case was fair.Conclusion:The thinning ALTP can be used to repair the scar contracture deformity after hand trauma. It can carry different tissues for 3-dimensional repair. After operation, the flap has a beautiful appearance, the donor site can be closed directly, and the damage of donor site can be reduced. It is an effective method to repair the hand contracture deformity.

Objective:To compare the effect of pressure‐controlled ventilation‐volume guarantee(PCV‐VG) with that of vol‐ume‐controlled ventilation(VCV) in patients undergoing spinal surgery in prone position .Methods:A total of 60 patients under‐going selective spinal surgery in prone position ,who were classified as GradeⅠto GradeⅡby American Society of Anesthesiolo‐gists(ASA) criteria and weighed 43‐80 kg ,were randomly divided into VCV group and PCV‐VG group with 30 cases in each . In VCV group ,the ventilation mode was VCV with tidal volume of 8 mL/kg and Inspiration/Expiration ratio of 1∶2 ,respira‐tory rate of 12 breaths/min and pressure limit of 30 cmH2 O .In PCV‐VG group ,the ventilation mode was set as PCV‐VG and the other settings were same as those in VCV group .Heart rate ,mean artery pressure ,tidal volume ,minute volume ,mean air‐way pressure ,airway peak pressure ,end‐tidal pressure of carbon dioxide were recorded immediately after tracheal intubation (T1) ,immediately before the patients were turned to prone position(T2) ,30 min after the patients were turned to prone posi‐tion(T3) ,immediately after the end of surgery(T4) and immediately after the patients were turned to supine position(T5) ,and dynamic lung compliance was calculated .Results:Compared with those in VCV group ,mean airway pressure and airway peak pressure in PCV‐VG group significantly decreased at T2 ,T3 and T4 ,while dynamic lung compliance increased(P< 0 .05) . Conclusions:Compared with VCV ,PCV‐VG can guarantee the effect of mechanical ventilation ,reduce the risk of airway pres‐sure injury ,and impact less on respiratory function ,in patients undergoing spinal surgery in prone position .

Pancreatic cancer is one of the common gastrointestinal malignancies,the incidence of which is increasing year by year and has become one of the most important public health problems worldwide.At present,tumor treatment has entered the era of immunotherapy,but the response of pancreatic cancer patients to immune checkpoint inhibitors is not ideal.In addition,there is a lack of effective and validated biomarkers to stratify patients who may benefit from immunotherapy.This review has summarized the current research advances of immunotherapeutic biomarkers in pancreatic cancer,hoping to help clinicians understand relevant biomarkers systematically and guide the precise treatment of pancreatic cancer.

OBJECTIVETo study the heat processing technics of Nanhanshuishi.

METHODTo find the best processing technic, the single factor experiments and orthogonal experiments were designed basing on the processing technics summarized by consulting documents, scriptures and investigating some Tibetan hospitals, meanwhile, the content of Ca, Fe, Mn, Zn, and Cu in the processed Nanhanshuishi in single factor experiments and orthogonal experiments were detected.

RESULTThe best processing technic of Nanhanshuishi was as follows: Nanhanshuishi was crashed to 10-20 mm in diameter, the ratio of the weight of Aconiti Kusnezoffii Radix and potassium nitrate was 1: 2, and the boiling time was 3 h.

CONCLUSIONThe work in this article provided a basic processing technic data for clarifying the mechanism of processing and establishing the perfect processing technics of Nanhanshuishi.

Objective: To investigate the effects of denatured collagen type Ⅰ on differentiation of human fibroblasts into myofibroblasts. Methods: A small amount of normal skin donated by burn patients undergoing scar surgery was collected. Human fibroblasts were obtained by method of explant culture and then sub-cultured. The fourth passage of cells were used in the following experiments. (1) Fibroblasts were divided into normal collagen group and denatured collagen group according to the random number table, with 10 wells in each group. Fibroblasts in normal collagen group were cultured on normal collagen type Ⅰ coated coverslips. Fibroblasts in denatured collagen group were cultured on denatured type Ⅰ collagen coated coverslips. Expression of proliferating cell nuclear antigen (PCNA) was detected by immunohistochemical method, and the percentage of PCNA positive cells was calculated. (2) Another batch of fibroblasts were grouped and treated as in (1), with 12 wells in each group. Proliferation activity of cells was determined with methyl-thiazolyl-tetrazolium colorimetry method. (3) Another batch of fibroblasts were grouped and treated as in (1), and the microfilament morphology of cells was observed by rhodamine-phalloidin staining. (4) Another batch of fibroblasts were grouped and treated as in (1). Expression of α smooth muscle actin (α-SMA) of cells was detected by immunohistochemical method, and expression of OB-cadherin of cells was detected by immunofluorescence method. (5) Another batch of fibroblasts were divided into normal collagen, denatured collagen, and common coverslips groups according to the random number table, with 6 wells in each group. Fibroblasts in normal collagen and denatured collagen groups were treated as in (1), while fibroblasts in common coverslips group were cultured on coverslips without collagen coating. Expressions of α-SMA and OB-cadherin of cells were determined with Western blotting. (6) Another batch of fibroblasts were grouped and treated as in (5), and then the mRNA expressions of collagen type Ⅰ, collagen type Ⅲ, and α-SMA of cells were determined with real-time fluorescent quantitative reverse transcription polymerase chain reaction. Data were processed with t test, one way analysis of variance, and least-significant difference test. Results: (1) The percentage of PCNA positive cells in denatured collagen group was (83±9)%, significantly higher than (29±9)% in normal collagen group (t=13.53, P<0.01). (2) The proliferation activity of fibroblasts in denatured collagen group was 0.32±0.06, significantly higher than 0.25±0.05 in normal collagen group (t=3.06, P<0.01). (3) The microfilament of fibroblasts in normal collagen group was arranged vertically and in parallel way, paralleling the long axis of cells. The microfilament of fibroblasts in denatured collagen group was denser and thicker. (4) Most fibroblasts in normal collagen group showed long shuttle-like shape typically. Morphology of fibroblasts in denatured collagen group changed, and cells were obviously spreading. Expressions of α-SMA and OB-cadherin of fibroblasts in denatured collagen group were stronger than those in normal collagen group. (5) Expressions of α-SMA of fibroblasts in denatured collagen, normal collagen, and common coverslips groups were respectively 1.69±0.41, 0.89±0.27, and 1.46±0.42. Expression of α-SMA of fibroblasts in denatured collagen group was significantly higher than that in normal collagen group (P<0.01). Expressions of OB-cadherin of fibroblasts in denatured collagen, normal collagen, and common coverslips groups were respectively 5.17±0.28, 2.21±0.10, and 4.01±0.56. Expression of OB-cadherin of fibroblasts in denatured group was significantly higher than that in normal collagen group (P<0.01). (6) There was no significant difference in mRNA expression of collagen type Ⅰ of fibroblasts in denatured collagen, normal collagen, and common coverslips groups (F=2.71, P>0.05). The mRNA expressions of collagen type Ⅲ and α-SMA of fibroblasts in normal collagen group were significantly lower than those in denatured collagen group (P<0.01). Conclusions Denatured collagen type Ⅰ may influence the activity of fibroblasts, thus inducing fibroblasts differentiating into myofibroblasts.