Objective To evaluate the clinical effect of surgical operation for recovering the function of ulnar nerve with large segment defect. Methods Twentycases with the large segment defect of ulnar nerve were retrospectively analyzed from September 1999 to December 2006 in the hospital.All the patients were treated by the operation of nerve end-to-side neurorrhaphy . The broken end of ulnar nerve was anastomosed with the median nerve. And observed the recovery of the sensation and motion function of the little finger, interosseous muscles and claw hand, then compared with before. Results All cases were followed up for 8 to 36 months. The mean was 16 months. The sensation and motion function of the little fingers had better restoration after operation. No incision infection, anchylosis or myatrophy was occurred.Excellent(M4 + S4 +) ,Good (M3S3), moderate (M2S2), and poor effects (M1S1) were achieved respectively in 6, 4,2 and 0 cases based on the scale of XU' s grading standard.The excellent and good rate was 83.3%. Conclusion The nerve end-to-side neurorrhaphy was a effective treatment for the patients with large segment defect of ulnar nerve.

Objective:To investigate the effect of poly (lactic acid)(PLA)electrospun membranes loaded with cisplatin and chloroquine on the oral squamous cell carcinoma CAL-27 cells,and to explore the method to prevent the recurrence of oral cancer.Methods: The DDP/PLA membranes, CQ/DDP/CQ/PLA membranes and CQ/DDP/PLA membranes were prepared by electrospinning.Then the micro morphology of three kinds of membranes were observed by scanning electron microscope (SEM);the degradation rate of PLA membrane was measuredby UV spectrophotometric.The LC3-Ⅱ expression level in CAL-27 cells was detected by laser scanning confocal microscope.The survival rate of CAL-27 cells was detected by MTT method.Results:The SEM results showed that the nanofibers of DDP/PLA,CQ/DDP/PLA and CQ/DDP/CQ/PLA membranes were continuous and smooth with uniform diameters.The degrated time of membranes was about 21 d.The MTT result showed that compared with control group,at first,the effects of cell killing of DDP/PLA membranes,CQ/DDP/CQ/PLA membranes and CQ/DDP/PLA membranes were not obvious;as the extension of time,the survival rates of CAL-27 cells in DDP/PLA membranes group,CQ/DDP/CQ/PLA membranes group and CQ/DDP/PLA membranes group were decreased (P <0.05).The immunofluorescence results showed that the fluorescence intensity of LC3-Ⅱ in CQ/DDP/CQ/PLA membranes group and CQ/DDP/PLA membranes group were lower than that in DDP/PLA membranes group.Conclusion:CQ/DDP/PLA membranes with sustained-release effect can increase the sensitivity of CAL-27 cells to DDP and enchance the killer effect of DDP on the CAL-27 cells.

Objective: To use autophagy inhibitors combined with radiation to treat the oral squamous cell carcinoma CAL-27 and KB cells,and to explore the influence of autophagy in the oral cancer radiation sensitivity and its mechanisms. Methods:The human oral squamous cell carcinoma CAL-27 and KB cells were divided into control group,CQ group,3-MA group,IR group,CQ+IR group,and 3-MA+IR group. The survival rate was detected by MTT method and the autophagy of CAL-27 cells was observed by immunofluorescence method and laser scanning confocal microscope.The expression levels of LC3 and beclin-1 were detected by Western blotting method. The apoptotic rate was determined by flow cytometry with Annexin Ⅴ/PI doulde staining. Results:Compared with IR group,the survival rates in 3-MA + IR and CQ+ IR groups were signifcantly decreased (P < 0.05 ).The autophagy levels of cells in IR group were significantly higher than those in control group, CQ group, 3-MA group,CQ+IR group,and 3-MA+IR group (P <0.05).The expression levels of LC3 and beclin-1 proteins in IR group were significantly higher than those in control group,CQ+ IR group,and 3-MA+ IR group (P < 0.05). The apoptotic rates in IR,3-MA+ IR,and CQ+ IR groups were markedly higher than those in control group. Compared with IR group,the apoptotic rates in CQ+IR and 3-MA+IR groups were significantly increased (P <0.05).Conclusion:Radiotherapy can induce the increase of autophagy level of oral squamous cell carcinoma cells. Inhibiors of autophagy can increase the radio-sensitivity of oral squamous cell carcinoma cells by inhibiting the proliferation and inducing the apoptosis.

Objective To explore the techniques and strategies for the retrieval of the retractable inferior vena cava filter (IVCF).Methods Celect IVCF retrieval was not removed successfully with Gtünther Celect recovery device in 9 cases and exchange-wire-loop removal of inferior vena cava filter method were applicated.Results The longest implanted time of 9 patients was 142 days,the shortest implanted time was 37 days,and the average time was (88.67±33.85)days.Eight fil ters were successfully removed and one failed due to severe bending of inferior vena cava.Filter retrieval rate was 88.89％ (8/9).The average retrieval time was (69.89± 12.12)min (57-162 min).No perforation of the wall and contrast agent were found in all patients after the inferior vena cava angiography.Conclusion For the retrieval of the hook heavily atta ched to the IVCF,the retrieval technique of using the exchange wire into the loop method can effectively improve the retrieval rate and has a certain clinical value.

Objective In the traditional laboratory zoology lecture environment,there is less teacher-student interaction,less student interest,and less engagement in learning.To improve the teaching quality of laboratory animal science,this teaching and research department was based on different teaching environments of multimedia and intelligent classrooms,theoretical course teaching of Medical Laboratory Animal Science as the research object,the course lecture format,teaching mode,teaching method,and other aspects of innovation and exploration.Methods This study used questionnaires to understand changes in student engagement in learning and preferences for smart classroom use,and NVivo qualitative analysis software was used to code student classroom behavior.Results The smart teaching environment resulted in higher student interest and more frequent teacher-student interaction in the classroom.Students were significantly more engaged in learning than in traditional teaching with higher correct rates on in-class and post-lesson exercises and a better grasp of concepts related to laboratory animal science.Conclusions A smart teaching environment brings students a better feeling and experience,improves their interest in laboratory animal science,increases classroom learning engagement,and achieves good teaching result.

Objective To discuss the feasibility of the establishment of a Y-shaped channel with windowing technique in treating the stent shunt obstruction occurring after transjugular intrahepatic portosystemic shunt (TIPS).Methods From February 2012 to December 2016,puncture windowing technique was employed in 7 patients to establish a Y-shaped channel in order to treat the stent shunt obstruction complicated by gastric varices bleeding or ascites due to recurrent portal hypertension.The preoperative Child-Pugh scores of liver function ranged from 5 to 10 points,with a mean of (6.85±1.56) points.The blood flow in both the portal vein and the shunt was determined before operation as well as at 5 days and 1,3,6months after operation;the post operative results were compared with preoperative ones.Results Y-shaped channel was successfully reconstructed in all 7 patients.The patients were followed up for a mean of 11months.Neither death nor hepatic encephalopathy occurred.Conclusion For the treatment of post-TIPS stent shunt obstruction,Y-shaped channel reconstruction within the occluded stent by using windowing technique is safe and effective,the operation is simple and easy.Therefore,this technique has certain clinical value.

Objective ToevaluatetheefficacyandsafetyofCT-guidedmicrowaveablation (MWA)forstageIVlungcanceraccompanied withcontrolledsingleintracranialmetastasis.Methods From November2011toOctober2016,78patientsinourhospitaldiagnosed withstageIVnon-smallcelllungcanceraccompaniedwithcontrolledsingleintracranialmetastasiswerestudied.Patientsweredividedintotwo groupsaccordingtowhethertheywerewillingtoacceptlocalMWAtreatmentornot:thegeneralgroup (groupA)with42cases, and MWAgroup(groupB)with36cases.Aftertheintracranialmetastasiswascontrolled,patientsingroupAweretreatedwithGP regimenforsimplechemotherapy,whilepatientsingroupB weretreatedwithlocalMWAcombinedwithGPregimen(gemcitabine combinedwithcisplatin).Allthepatientswerefollowed-upevery3monthsafterthesurgerytoassesstheefficacyandsafetyofthe correspondingtreatment.Thedeadlineofthefollow-upwasJune2017orwhenthetumorrestarteditsdevelopment.Results Thesuccessrateof theMWAofthe39lesionsinthe36patientsingroupBwas100%.TheKaplan-Meiersurvivalanalysisofthefollow-updataofthe twogroupsshowedthattheaverageprogressionfreesurvival(PFS)ofgroupA was(9.9 ± 0.8)monthsandthemedianPFSwas (8.0±0.5)months,whilethePFSofgroupB was (14.1±1.1)monthsandthe medianPFS was (15.0±1.5)months.The Log Rank testshowedthatχ2=8.780andP=0.03<0.05,whichreflectedthatthereweresignificantdifferencesinsurvivaltimebetweenthe twogroups.Theoverallsurvival(OS)ofgroupA was(20.5±1.1)months,andthemedianOSwas(21.0±1.3)months.TheOSof group B was (24.1±1.5)months,andthe median OS was (25.0±3.6)months.The Log Rank testshowedthat χ2=10.57and P=0.02<0.05, whichprovedthattheOSdifferencesbetweenthetwogroupshadstatisticalsignificance.ThemainadverseeffectsofMWA werepain,pleural effusion,pneumothorax,hemoptysis,infectionandsoon.There werenoseriouslife-threateningcomplicationsingroupB.Conclusion LocalMWAtreatmentforstageⅣnon-smallcelllungcancer withcontrolledsingleintracranialmetastasisisasafeandeffective method.Itisworthyofporularizing.

Objective The aim of this study was to compare the short-term and long-term prognostic significance of dif-ferent systemic inflammatory scores in patients with gastric cancer:neutrophil lymphocyte ratio(NLR) and platelet lymphocyte ratio ( PLR). Methods The clinical data of 240 patients with gastric cancer who underwent radical surgery were retrospectively analyzed. The relationship between NLR,PLR,glasgow prognostic score( GPS) and clinicopathological characteristics and perioperative compli-cations were compared. Survival analysis was performed using Kaplan-Meier survival analysis. The Log-rank methods were used to test the difference significance,and the multivariate analysis was performed using the Cox regression risk model. Results Patients in the high NLR and PLR groups were older,had a high GPS,deep tumor infiltration,more lymph node metastasis,and a late TNM stage (P<0. 05). The rate of positive margin in the high NLR group was higher(P<0. 05). Patients in the high NLR and PLR groups re-quired significantly higher transfusion rates than those in the low NLR and PLR groups(P<0. 05),and the high NLR group had more postoperative complications(P<0. 05). Univariate analysis showed that age,GPS,tumor location,tumor infiltration depth,lymph node metastasis status,TNM stage,vascular tumor thrombus,nerve infiltration,NLR and PLR were associated with postoperative survival of gastric cancer patients(P<0. 05). The overall survival(OS)in high NLR and high PLR groups was lower than that of low NLR and low PLR groups(P=0. 018 and P<0. 001). Cox regression analysis showed GPS and lymph node metastasis were independent prog-nostic factors of OS(P<0. 001 and P=0. 002). Conclusion Preoperative systemic inflammatory scores NLR and PLR are prognos-tic factors affecting the preoperative clinical outcomes of gastric cancer. It is recommended to be used in combination with other prog-nostic indicators for routine use in the prognosis of patients undergoing radical gastrectomy.

Accurate source localization of the epileptogenic zone (EZ) is the primary condition of surgical removal of EZ. The traditional localization results based on three-dimensional ball model or standard head model may cause errors. This study intended to localize the EZ by using the patient-specific head model and multi-dipole algorithms using spikes during sleep. Then the current density distribution on the cortex was computed and used to construct the phase transfer entropy functional connectivity network between different brain areas to obtain the localization of EZ. The experiment result showed that our improved methods could reach the accuracy of 89.27% and the number of implanted electrodes could be reduced by (19.34 ± 7.15)%. This work can not only improve the accuracy of EZ localization, but also reduce the additional injury and potential risk caused by preoperative examination and surgical operation, and provide a more intuitive and effective reference for neurosurgeons to make surgical plans.
Humans ; Scalp ; Brain Mapping/methods* ; Epilepsy/diagnosis* ; Electroencephalography/methods* ; Brain

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.