Objective To evaluate the efficacy and safety of percutaneous radiofrequency ablation combined with immunotherapy in the treatment of hepatocellular carcinoma .Methods A total of 124 patients with liver cancer were randomly divided into the two groups .60 cases in the control group were given immunity treatment alone ,while 64 cases in the observation group were treated by percutaneous radiofrequency ablation combined with immune therapy . The middle and long term curative effect of two groups was observed .Results After treatment,the tumor diameter, serum alpha fetoprotein (AFP) and carcino-embryonic antigen (CEA) levels in the two groups were significantly decreased(t=4.867,P=0.005;t=5.175,P=0.004;t=3.155,P=0.025;t=4.845,P=0.005;t=4.031,P=0.010;t=2.668,P=0.044),but the declining degree of the observation group was better than the control group (t=4.119,P=0.009;t=3.621,P=0.015;t=3.492,P=0.017).The total effective rates and disease control rates of the observation group were 53.1%,78.1%,which were significantly higher than 28.3%,46.7%in the control group (χ2 =11.290,P=0.010;χ2 =21.290,P=0.000).The 1-year,3-year,5-year survival rates of the observation group were 60.9%,31.3%,12.5%,those of the control group were 21.7%,5.0%,0.0%,the middle and long term sur-vival rates of the observation group were significantly higher than the control group (χ2 =21.935,P=0.000;χ2 =56.452,P=0.000;χ2 =40.516,P=0.000).No statistically significant differences in the CD 4+,CD8+,CD4+/CD8+, IL-12 and other indicators between the two groups before treatment ,but these indicators in the observation group were significantly improved after treatment (t =4.515,P =0.006;t =10.014,P =0.000;t =5.217,P =0.003). Conclusion Combination of percutaneous radiofrequency ablation and immunotherapy in the treatment of hepatocell-lular carcinoma has exact effect and with advantages of less adverse reaction , good safety , which can significantly improve the quality of life and survival rate of patients ,it has good clinical application value .

BACKGROUND:Clinical effects and the recovery of hip function after total hip arthroplasty via different approaches are quite different.
OBJECTIVE:To observe total hip arthroplasty through lateral approach and posterolateral approach, and to evaluate the difference in hip function during 2-year fol ow-up.
METHODS:Total y 93 patients who treated with total hip arthroplasty from March 2009 to March 2012 in the Department of Orthopedics, Yangjiang Municipal Traditional Chinese Medicine Hospital were enrol ed in this study. They were randomly divided into lateral approach group (45 cases, 60 hips) and posterolateral approach group (48 cases, 60 hips).
RESULTS AND CONCLUSION:Al patients were fol owed up for averagely 2 years. No significant difference in operation time, postoperative complications, and the recovery of hip function in the middle and late phases of replacement was visible (P>0.05). However, perioperative blood loss, operative length, blood transfusion rate, postoperative hemoglobin levels, and early postoperative hip joint functional recovery were better in the posterolateral approach group than in the lateral approach group (P<0.05). In the 2 years after replacement, no significant difference in therapeutic effects was detectable between the two groups (P>0.05). Moreover, no significant difference in the incidence of adverse reactions was visible such as postoperative infection, dislocation, loosening, bone cement reaction, intraoperative fractures of proximal end of the femur and venous thromboembolism between lateral approach and posterolateral approach groups (P>0.05). Results indicated that posterolateral approach in total hip arthroplasty is helpful to early recovery, but long-term effects are similar to lateral approach.

Objective To evaluate efficacy,safety and complication of percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) in≥90 years patients.Methods Clinical data of 56 cases aged ≥ 90 years with osteoporotic vertebral compression fracture undergoing percutaneous kyphoplasty were retrospectively analyzed.Visual analog scale (VAS) score,analgesics administration score,locomotor activity score,bone cement leakage and incidence of refracture were evaluated before and 3 days after treatment,and at the last follow-up.Results The mean follow-up was 18.6 months (6-32 months) in all patients.The mean VAS score was (7.1 ±2.1) before treatment,(2.6±1.1) at 3 days after the procedure,and (1.8±0.7) at last follow-up,respectively (F=455.794,P＜0.001).Analgesics administration score were (2.0±1.7),(1.4±0.5) and (1.1±0.7) respectively before and 3 days after treatment,and at the last follow-up (F=9.631,P＜0.001).Locomotor activity score were (2.5±0.6),(1.2±0.5) and (1.0±0.3)before and 3 days after treatment,and at the last follow-up (F=63.254,P＜ 0.001) respectively.Bone cement leakage occurred in 10 cases(17.9％),recurrent fracture in 6 cases(10.7％),cerebrospinal leak in 3 cases (5.3％),and nerve root stimulation in2 cases(3.6％).Total complication rate was 33.9％(19/56),and all complications were transient and well tolerated.Conclusions Kyphoplasty for osteoporotic vertebral compression fracture in the very elderly is effective and safe.It alleviates fracture-induced pain,reduces analgesic drug use and improves spinal activity,and provides a better choice for minimal invasive treatment for nonagenarian OVCF patients.

Objective:To compare 2 modalities of Kirschner pin fixation for severely displaced (Campbell type Ⅱ) juxta-epiphyseal fracture of the proximal phalanx in children.Methods:A retrospective study was conducted to analyze the clinical data of 69 children with severely displaced (Campbell type Ⅱ) juxta-epiphyseal fracture of the proximal phalanx who had been treated at Department of Orthopaedics, Shenzhen Children's Hospital from January 2018 to December 2020. Clinical data: 41 boys and 28 girls; (7.6±3.2) years in age; 34 left hands and 35 right hands affected; 4 thumbs, 4 middle fingers, 5 ring fingers, and 56 little fingers injured. The patients were divided into 2 groups according to surgical modalities. Group A (35 fingers in 35 cases) was treated by closed reduction, longitudinal intramedullary fixation with a single Kirschner pin, and external plaster fixation while group B (34 fingers in 34 cases) by closed reduction, crossing fixation with 2 Kirschner pins, and external plaster fixation. The 2 groups were compared in terms of preoperative fracture angulation, operation time, postoperative fracture angulation, hospitalization days, and postoperative functional recovery.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All fractures got united after 3 to 6 weeks. There was no statistically significant difference between the 2 groups in terms of preoperative fracture angulation, operation time, or postoperative fracture angulation ( P>0.05). The hospitalization days in group A were significantly shorter than that in group B ( P<0.05). Fifty children (24 cases in group A and 26 cases in group B) were followed up for (54.3±10.5) months. By the trial criteria for upper limb functional evaluation of the Hand Surgery Society, the hand function was evaluated at the last follow-up as excellent in 24 cases in group A, giving an excellent rate of 100% (24/24), and as excellent in 26 cases in group B, giving an excellent rate of 100% (26/26) too, showing no significant difference between the 2 groups ( P<0.05). No postoperative complications such as Kirschner wire breakage, needle tract infection, significant angular deformity, rotational deformity, or bone bridge formation occurred in any of the patients. Conclusion:For children with severely displaced (Campbell type Ⅱ) juxta-epiphyseal fracture of the proximal phalanx, longitudinal intramedullary fixation with a single Kirschner pin and crossing fixation with 2 Kirschner pins may achieve comparable efficacy in terms of fracture stability and function, but the former may result in shorter hospitalization days.

Patients with brain injury are often accompanied by emotional disorders, which can cause a variety of mental disorders, and mental disorders will continue to exist after rehabilitation, seriously affecting the ability of patients to adapt and integrate into society, greatly reducing the quality of life.Therefore, the research on the mechanism of emotional disorders after brain injury is of great significance to the clinical prevention and treatment of mental disorders related to emotional disorders.Functional magnetic resonance imaging (fMRI) provides a more intuitive and accurate research method for the study of emotional regulation, so many scholars have conducted in-depth research on emotional disorders after craniocerebral injury from different perspectives.In this paper, the functional MRI studies of emotional disorders were reviewed after craniocerebral injury in the past decade and most of the resting MRI studies showed that the mechanism of emotional disorders after craniocerebral injury is related to the imbalance of interaction among the resting default network, executive network and salience network, while the task MRI studies found that the amygdala, dorsolateral prefrontal lobe and anterior Cingulate gyrus and right inferior frontal gyrus played an important role in attention distribution, cognitive reappraisal, expression inhibition and other emotional regulation strategies, and the damage of these brain regions will cause corresponding emotional regulation disorders.In this paper, the neural mechanism and research progress of emotional disorders after brain injury were systematically reviewed, summarize the existing problems, and propose possible solutions from the perspective of resting and task state functional MRI.

Objective:To evaluate the role of aquaporin 4 (AQP4) in dexmedetomidine-induced reduction of blood-brain barrier permeability in mechanically ventilated mice and the relationship with protein kinase C (PKC).Methods:One hundred and fifty clean-grade healthy male C57BL6 mice, weighing 20-25 g, aged 8-12 weeks, were divided into 5 groups ( n=30 each) using a random number table method: control group (group C), mechanical ventilation group (group V), LY317615 group (group L), dexmedetomidine group (group D), and dexmedetomidine+ PMA group (group DP). Group C spontaneously breathed air for 6 h. The animals were mechanically ventilated for 6 h in group V. PKC inhibitor LY3176 15 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation in group L. Dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation in D and DP groups. PKC activator PMA 15 μg/kg was intraperitoneally injected at 60 min before mechanical ventilation in group DP. Mice were anesthetized at 1 day after mechanical ventilation, then sacrificed and hippocampal tissues were taken for microscopic examination of pathological changes in the hippocampal CA1 and CA3 areas (with a light microscope). Brain tissues were also taken to measure the water content and content of Evans blue (EB) and to detect the expression of PKC and AQP4 (by Western blot). The cognitive function was evaluated using a novel object recognition task at 3 days after mechanical ventilation. Results:Compared with group C, the water content and EB content of brain tissues were significantly increased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was up-regulated, the percentage of novel object exploration and discrimination index were decreased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was aggravated in group V and group DP. Compared with group V, the water content and EB content of brain tissues were significantly decreased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was down-regulated, the percentage of novel object exploration and discrimination index were increased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was significantly attenuated in group D and group L. Compared with group D, the water content and EB content of brain tissues were significantly increased after mechanical ventilation, the expression of PKC and AQP4 in brain tissues was up-regulated, the percentage of novel object exploration and discrimination index were decreased ( P<0.05), and the histopathological damage in the hippocampal CA1 and CA3 areas was aggravated in group DP. Conclusions:AQP4 is involved in dexmedetomidine-induced reduction of blood-brain barrier permeability in mechanically ventilated mice, and the mechanism is related to inhibiting activation of PKC.

Objective:To evaluate the role of transient receptor potential vanillic acid 4 (TRPV4) in dexmedetomidine-induced improvement in cognitive function in mice with mechanical ventilator-caused brain injury.Methods:Ninety clean-grade healthy male C57BL6 mice, weighing 20-25 g, aged 8-12 weeks, were divided into 5 groups ( n=18 each) using a random number table method: control group (group C), mechanical ventilation group (group V), HC-067047 group (group H), dexmedetomidine group (group D), and dexmedetomidine+ GSK1016790A group (group DG). In group C, the animals breathed air spontaneously for 6 h without mechanical ventilation. In group V, the animals were mechanically ventilated for 6 h. In group H, TRPV4 blocker HC-067047 10 mmol was injected into the cerebral ventricle at 3 and 6 h of mechanical ventilation. In D and DG groups, dexmedetomidine 50 μg/kg was intraperitoneally injected at 30 min before mechanical ventilation. In group DG, TRPV4 agonist GSK1016790A 5 μmol was injected into the cerebral ventricle at 60 min before mechanical ventilation. Morris water maze test was performed on 6 mice in each group at 1 day before mechanical ventilation and 3 and 7 days after mechanical ventilation. Six mice in each group were randomly selected and sacrificed at 1 day after mechanical ventilation, and the brain tissue was taken for determination of the neuronal apoptosis in hippocampal CA1 area by TUNEL method, and the apoptosis index was calculated. Six mice in each group were randomly selected and sacrificed at 1 day after mechanical ventilation, and the hippocampal tissues were taken for determination of the expression of TRPV4, serine-threonine protein kinase (Akt), phosphorylated Akt (p-Akt), Bcl-2, Bax and caspase-3 by Western blot. Results:Compared with group C, the escape latency was significantly prolonged and the number of crossing the original platform was reduced at 3 and 7 days after mechanical ventilation, the expression of TRPV4 and caspase-3 was up-regulated, the ratio of Bcl-2/Bax was decreased, and the apoptosis index of neurons was increased in group V and group DG ( P<0.05). Compared with group V, the escape latency was significantly shortened and the number of crossing the original platform was increased at 3 and 7 days after mechanical ventilation, the expression of TRPV4 and caspase-3 was down-regulated, the expression of p-Akt was up-regulated, the ratio of Bcl-2/Bax was increased, and the apoptosis index of neurons was decreased in group D and group H ( P<0.05). Compared with group D, the escape latency was significantly prolonged at 3 and 7 days after mechanical ventilation, the number of crossing the original platform was reduced, the expression of TRPV4 and caspase-3 was up-regulated, the expression of p-Akt was down-regulated, the ratio of Bcl-2/Bax was decreased, and the apoptosis index of neurons was increased in group DG ( P<0.05). Conclusions:TRPV 4 is involved in dexmedetomidine-induced improvement in cognitive function, which is related to up-regulation of p-Akt expression and inhibition of apoptosis in hippocampal neurons in mice with mechanical ventilation-caused brain injury.

Objective To retrospectively analyze the therapeutic effect of endoscopic ablation combined with metal stent implantationon biliary obstruction caused by unrespectable cholangiocarcinoma. Methods Fourty-seven patients with unrespectable cholangiocarcinoma were enrolled in this study ,who were treated in our department from June 2013 to June 2016. Patients in the experimental group(n = 24)underwent ERCP combined with metal stent implantation for biliary tract ablation. Patients inthe control group(n=23)underwent ERCP with simple metal stent implantation. Liver function indicators,complications,patency rate and survival rate were analyzed between the two groups. Results A total of 51 patients were satisfactorily performed the operation of metal stent implantation. One week after operation,the levels of total bilirubin(TBIL),alkaline phosphatase(ALP),gamma-glu-tamyltransferase(GGT)and alanine aminotransferase(AST)in the experimental group were much lower than those in the control group(P<0.05,respectively). After 3-month follow-up,the patency rate in the experimental group was significantly greater than that in the control group(P<0.05). The patency and survival time of patients in the experimental group were significantly higher than thosein the control group ,with 8.56 ± 1.12 vs 5.73 ± 0.81 months and 13.88±1.45 vs 9.48±1.38 months,respectively(P<0.05). No postoperative bleeding,perforation and other se-rious complications were found in all cases,8 patients with postoperative biliary tract infection and the increased blood amylase received anti-infective treatments,such as inhibition of symptomatic improvement after treatment. Conclusion The results of endoscopic radiofrequency ablation combined with metal stent implantation for the treatment of unrespectable cholangiocarcinoma were significantly better than those of simple metal stent implantation.

Objective To investigate the appropriate age of primary and secondary school students for cardiopulmonary resuscitation (CPR) training.Methods A total of 437 students aged 9-15 years at 3 to 6 grade in the primary schools or 1 to 2 grade in the secondary schools were selected from 2 Yuyao primary and secondary schools by stratified random sampling between March 2017 and January 2018.The numbers of students with the age of 9,10,11,12,13,14 and 15 y were 61,62,66,64,63,63 and 58,respectively.All students received chest compression training provided by Yuyao emergency department People's Hospital according to the 2015 Cardiopulmonary Resuscitation Guidelines.The training included 30 min theoretic teaching and 6 min practice in the simulator.The quality of chest compression performed by students was assessed;the depth,rate,position and retention of chest compression were recorded.Results The mean depth of chest compression in the students aged 9-15 years was 3.8,4.1,4.6,5.1,5.2,5.6 and 5.6 cm,respectively;the accuracy rate was 24.6％(14/61),25.8％ (16/62),50.2％ (33/66),70.5％ (45/64),79.4％(50/63),88.9％(56/63) and 91.4(53/58),respectively.Compared with the students aged 9-11 years,the mean depth of chest compression was significantly increased and accuracy rate was significantly improved in the students aged 12-15 years (Compared with 9-y students,t=-8.936,-9.502,-10.640 and-11.370;x2=35.019,47.599,63.013 and 65.671;compared with 10-y students,t=-6.927,-8.179,-10.70 and-11.047;x2=24.977,35.967,50.916 and 52.727;compared with 1 1-y students,t=-3.095,-4.177,-6.785 and-6.995;x2=5.586,12.114,22.786 and 24.870;all P＜0.05).The mean rate of chest compression was 110-116/min and its accuracy rate was 86.4％-95.2％;the accuracy rate of chest compression position was 90.9％-96.8％ in all students,there were no significant differences among the 7 groups.The mean retention rate of chest compression in the 7 groups was 81.3％(122/150),67.3％(101/150),64.7％ (94/150),48.0％(72/150),48.7％(73/150),33.3％(50/150) and 27.3％(41/150),respectively.Compared with the students aged 9-11 years,the mean retention rate of chest compression was significantly decreased in the students aged 12-15 years (compared with the 9-y students,x2=36.472,35.179,70.64 and 119.92;compared with 10-y students,x2=11.483,10.728,34.682 and 72.150;compared with 11-y students,x2=6.528,5.927,25.855 and 59.11;all P＜0.05).Correlation analysis showed that the depth (r=0.96,0.89,0.91 and 0.86;P＜0.01) and retention rate (r=-0.99,-0.90,-0.93 and-0.86;all P＜0.01) of chest compression were significantly associated with the age,body weight,height and body mass index of students.Conclusion The students with an age of 12 years or more are able to effectively perform chest compression;thus,12 years and above might be the appropriate age for CPR training.

Objective:To observe any therapeutic effect of combining early pulmonary rehabilitation training with acupuncture at the back-shu and front-mu acupoints in treating stroke-associated pneumonia (SAP).Methods:Eighty SAP patients were randomly divided into a treatment group and a control group, each of 40. Both groups were given routine symptomatic treatment for pneumonia, nutritional support, lipid-lowering and anti-infection measures, as well as acupuncture at the back-shu and front-mu acupoints. The treatment group additionally received pulmonary rehabilitation training. Before and after 14 days of the treatment, both groups were evaluated in terms of their forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak flow rate (PEF), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT). Chinese medicine (TCM) scores for expectoration of phlegm, shortness of breath, pulmonary rales, cough, fever and weakness were also assigned. The duration of antibiotic use and intensive care unit (ICU) stay were compared between the two groups.Results:Treatment efficacy was significantly higher in the treatment group (97.5%) than in the control group (85.0%). The treatment group′s average duration of antibiotic use and ICU stay were significantly shorter than in the control group. The treatment improved the average FVC, FEV1, PEF, WBC, CRP and PCT of both groups significantly leaving the average FVC and PEF of the treatment group significantly higher than the control group′s average, but its average WBC, CRP, PCT and the total TCM syndrome score significantly lower.Conclusions:Combining early pulmonary rehabilitation training with acupuncture at the back-shu and front-mu acupoints has a definite therapeutic effect on SAP patients. It can significantly shorten the use of antibiotics and ICU stay, promote the recovery of lung function, reduce inflammation and relieve clinical symptoms.