[Abstract ] Objective Pulmonary sequestration (PS) is a congenital development malformation of the lungs .This study aimed to explore the diagnosis and surgical treatment of PS . Methods We retrospectively analyzed the clinical data on 18 PS pa-tients (8 males and 10 females, aged 20-68 [42.34 ±14.63] years) treated in our department from September 2009 to September 2014.Medical imaging manifested tumors in 11 cases and cystic lesion in the other 7.All the patients underwent surgical resection . Results The diseased pulmonary lobes were removed for the 17 cases of the intralobar type and local resection was performed for the 1 case of the extralobar type .Fourteen of the cases were confirmed to be PS , 3 misdiagnosed, and 1 case missed at diagnosis .The pa-tients were followed up for 8-18 months after treatment , all recovered without surgery-related complications . Conclusion Pulmona-ry sequestration is a rare congenital malformation of the lungs and the lack of specific clinical manifestations makes it easy to be misdi -agnosed.Surgery is the main strategy for its treatment .

Objective To investigate the correlation between 6 common triggers and ischemic stroke.Methods The demographic and clinical data of the consecutive inpatients with acute ischemic stroke were collected.A questionnaire survey of the triggers of the disease was conducted within 4 d after admission.A case cross-over study was used to compare the exposure of the 6 potential triggers (overeating,anger,negative emotion,heavy physical activity,sudden posture changes as response to a startling event,drinking coffee) at 2 h before onset (dangerous period) and at 1 d before onset during the same period (control period),and exposures to potential triggers in patients according to gender,age and etiological subtypes were further analyzed.Results A total of 369 patients were enrolled.They aged 24-93 years old (mean 61.75 ±13.57),220 patients were male (59.6％) and 149 were female (40.4％).A total of 91 patients (24.7％) exposed to at least one of the triggers at 2 h before onset (odds ratio [OR] 6.1,95％ confidence interval [CI] 3.7-9.9);OR for exposure to the sudden posture change in response to a startling event was 12.0 (95％ CI 2.4-59.3),for heavy physical activity 10.7 (95％ CI 4.2-27.6),for anger 8.0 (95％ CI 2.3-27.5),and for negative emotion 4.9 (95％ CI 2.3-10.3).There was no exposure to drinking coffee.There were no significant differences in the exposure to various triggers among the different gender,age,and etiological subtypes.Conclusions Sudden posture changes as response to a startling event,heavy physical activity,anger,and negative emotion are the triggers for ischemic stroke,attention should be paid to the influence of triggers in the prevention of ischemic stroke.

With a low incidence and a non-specific clinical manifestation, medial medulary infarction (MMI) can often be misdiagnosed or missed diagnosis. Magnetic resonance imaging(MRI) played a major role in diagnosing the MMI. This article reviews the epidemiology, etiology, pathogenesis, clinical and imaging manifestations, diagnosis and differential diagnosis, and prognosis of MMI.

Objective To explore the mechanism of down-regulation of regulatory T cells (Treg) by immunization with attenuated activated autologous T cells. Methods Aulologous T cells were activated with ConA in vitro. Mice were immunized subcutaneously and inlraperitoneally every 5 days for 3 times (5 ×10~6 per time for each mouse), and the number and function of Treg were examined. PBS was subcutaneously injected for control group. Serum level of anti-mouse CD25 antibody was measured by ELISA. The number and function of Treg was detected by serum adoptive transfer and proliferation and inhibition assays. Results Compared with control group, there were less CD4~+ CD25~+ Foxp3~+ Treg in the mice after immunization (P < 0. 01), the immunosuppression ability decreased (P<0. 01), and the level of anti-CD25 antibody increased (P <0.01). Adoptive transfer of serum from immunized mice to naive mice led to a significant decrease in Treg population and function in recipient mice (P<0. 01). Conclusion Immunization with attenuated activated autologous T cells induces more anti-CD25 antibody, which may further down-regulate CD4~+CD25~+Foxp3~+ Treg expansion and function in vivo.

Objective To observe the effect of γ-ray irradiation on CD4 + CD25 + regulatory T cells (Tregs),and to investigate the mechanism of immune injury induced by irradiation.Methods The thymus and spleen of C57BL/6 mice were taken and weighted 1-28 d after γ-ray irradiation,and the organ coefficients were calculated.The amount of mouse peripheral WBC measured,CD4 + T cells and Tregs in peripheral and splenic were analyzed by flow cytometry.Results Coefficients of mouse thymus and spleen decreased significantly 1 d post irradiation,and reached to the bottom at 7 d.Coefficients did not recover to control level 28 d after radiation.Peripheral WBC continuously decreased and reached the bottom at 7 d,and did not recover to control level up to 28 d postirradiation.Peripheral CD4 + T lymphocyte temporally reduced at 1 d,while it increased at 7 d,and it approached to control level at 28 d after radiation.Splenic CD4 + T cells slightly reduced at 7 d however,they basically maintained as the same level as control 14 d and 28 d after radiation.Peripheral Tregs ascended at 1 d and reached the peak at 7 d,and reduced at 14 d and 28 d postirradiation,although they still were significantly higher than those of control group.At the same time,splenic Tregs increased significantly and achieved peak value at 1 d,and then gradually decreased and reached the minimum at 28 d after irradiation,which were significantly lower than those of control group( t =2.731,P ＜ 0.05).Conclusions Mouse thymus and spleen were injured severely,and the number of immunocytes decreased after 6 Gy whole body γ-ray irradiation.However,Tregs with immunosuppressive action increased significantly postirradiation,revealing that Tregs were closely correlated with immune function depression and immunomodulation imbalance induced by ionizing radiation.

Objective To investigate the oncological prognosis, prosthesis survival rate and other related factors after limb salvage surgery for distal femoral malignant bone tumors. Methods A total of 42 patients who received the surgery of resection of malignant bone tumor of distal femur and prosthesis replacement of knee joint tumor in the Second Hospital of Shanxi Medical University from January 2008 to December 2013 were retrospectively analyzed. The patient's oncological prognosis, prosthesis survival rate and related influencing factors were analyzed. Results The follow-up period was 18-97 months. Of 42 patients with malignant bone tumors, 21 cases (50％) survived without tumor, 7 cases (16％) survived with tumor, and the 5-year overall survival rate was 66％. The overall survival rate of patients with Enneking stage ⅡB tumor was 55.4％, and that of patients with stage ⅡA tumor was 75.0％, and the difference was statistically significant (χ2= 4.350, P= 0.037). The survival rate of artificial prosthesis was 78.6％ (22/28), the different length of osteotomy affected the survival rate of prosthesis (χ2= 4.248, P= 0.039), but the different types of prosthesis did not affect the survival rate of prosthesis (χ2= 2.177, P= 0.140). Conclusions The distal femoral malignant bone tumor has a good oncological prognosis after limb salvage surgery, Enneking staging is an important factor affecting the oncological prognosis. The different length of osteotomy at the distal femur affects the survival rate of the prosthesis, the longer the prosthesis, the lower the survival rate of the prosthesis.

Objective: To discuss the efficacy of pelvic region Ⅰ-Ⅲ malignant bone tumor resection and function reconstruction. Methods: A retrospective study was performed on 23 patients with pelvic malignant bone tumors who underwent limb salvage surgery in the Second Hospital of Shanxi Medical University from January 2010 to December 2018, including 12 males and 11 females, aged 19-78 years old. There were 22 cases of primary tumors, and 1 case of metastatic carcinoma. The tumor of 13 cases located in region Ⅰ, 2 cases in region Ⅱ, 5 cases in region Ⅲ, 1 case in region Ⅱ+Ⅲ, and 2 cases in region Ⅰ+Ⅱ. The surgical methods included resection + allograft, resection + pedicle screw reconstruction, resection + ipsilateral iliac bone graft reconstruction, and artificial hemipelvic replacement. The complications, outcomes, survival, and function recovery of patients were analyzed. Results: None of the 23 patients died in the perioperative period. Five patients with tumor invasion region Ⅱ underwent hemipelvic replacement, and no serious complications occurred after operation; 15 patients underwent allogeneic bone graft or autologous bone graft after tumor resection, 2 of them had milder wound infection, and no serious complications were found in the others; 3 cases underwent pedicle screw reconstruction after tumor resection, and no obvious complications occurred after operation. By the end of follow-up, 12 patients died of local recurrence or lung metastases after surgery, including 4 patients who underwent hemipelvic replacement. The gait of 23 patients was changed to some extent, most of them were claudication; One patient needed to walk with two crutches. Conclusions The malignant bone tumors in the pelvic region Ⅰ and Ⅲ can achieve satisfactory postoperative results after extensive resection in the boundary of security. For pelvic region Ⅱ malignant bone tumors, the postoperative curative effect of half pelvic prosthesis reconstruction after resection in the boundary of security is acceptable.

Objective:To observe the clinical effects of resection and different reconstruction methods of malignant tumors around the ilium (Ⅰ region, Ⅰ+Ⅱ region and Ⅰ+Ⅳ region).Methods:The clinical data of 23 patients with resection and reconstruction of malignant tumors around the ilium in the Second Hospital of Shanxi Medical University from January 2012 to December 2017 was retrospectively analyzed. All patients received pelvic tumor resection and screw-rod system fixation, and some patients received bone graft or cement reinforcement at the same time. The clinical effect, survival rate, complications and limb function score were statistically analyzed.Results:All cases were followed up for 10-79 months (median 42 months). Eleven patients survived, the 1-year overall survival (OS) rate was 82.6% (19/23), the 3-year OS rate was 65.2% (15/23), and the 5-year OS rate was 52.2% (12/23). The 3-year OS rate was 70.6% for the patients without acetabulum involvement, and 57.1% for those with acetabulum involvement, and the difference between the two groups was statistically significant (χ 2 = 4.182, P = 0.041). Seven cases complicated with wound nonunion, dislocation and other complications. The postoperative functional score of patients with pedicle screw-rod fixation and reconstruction was (23.6±1.3) points, and the postoperative functional score of patients with ordinary semi-pelvis and nail-rod semi-pelvic reconstruction was (18.1±1.4) points, and the difference between the two groups was statistically significant (t = 9.42, P < 0.01). Conclusion:For the bone defect after resection of tumors around the ilium, the clinical effect of pedicle screw-rod fixation is better than that of nail-rod semi-pelvic reconstruction.