This paper summarized professor ZHANG Zhen's clinical experience in treating rheumatoid arthritis （RA） complicated with anemia using self-formulated Yisui Shengxue Decoction （益髓生血汤） with modifications. It is proposed that the core pathogenesis of this condition is rooted in spleen and kidney depletion with insufficiency of essence and blood， while pathogenic dampness obstruction and internal blood stasis accumulation are the branches. The treatment principle focuses on tonifying the spleen and kidney， replenishing essence and nourishing the marrow， and enriching and generating blood， while simultaneously removing dampness and unblocking collaterals， activating blood and dissolving stasis. Based on this approach， Yisui Shengxue Decoction is used as the basic prescription， with flexible modifications according to syndrome patterns and clinical manifestations. For deficiency of both qi and blood combined with damp turbidity syndrome， medicinals that tonify qi and nourish blood， fortify the spleen and eliminate dampness， and mildly disperse obstruction are added. For wind-cold-dampness bi （痹） syndrome， medicinals that dispel wind and disperse cold， remove dampness and unblock the collaterals are incorporated. For wind-dampness-heat bi syndrome， medicinals that clear heat and eliminate dampness， unblock the collaterals and relieve bi are selected. For blood stasis obstructing the collaterals syndrome， medicinals that activate blood and resolve stasis， unblock the collaterals and relieve pain are combined. For yin deficiency with internal heat syndrome， medicinals that nourish yin and clear heat， cool blood and unblock the collaterals are prescribed.

This paper summarized professor ZHANG Zhen's clinical experience in treating rheumatoid arthritis （RA） complicated with anemia using self-formulated Yisui Shengxue Decoction （益髓生血汤） with modifications. It is proposed that the core pathogenesis of this condition is rooted in spleen and kidney depletion with insufficiency of essence and blood， while pathogenic dampness obstruction and internal blood stasis accumulation are the branches. The treatment principle focuses on tonifying the spleen and kidney， replenishing essence and nourishing the marrow， and enriching and generating blood， while simultaneously removing dampness and unblocking collaterals， activating blood and dissolving stasis. Based on this approach， Yisui Shengxue Decoction is used as the basic prescription， with flexible modifications according to syndrome patterns and clinical manifestations. For deficiency of both qi and blood combined with damp turbidity syndrome， medicinals that tonify qi and nourish blood， fortify the spleen and eliminate dampness， and mildly disperse obstruction are added. For wind-cold-dampness bi （痹） syndrome， medicinals that dispel wind and disperse cold， remove dampness and unblock the collaterals are incorporated. For wind-dampness-heat bi syndrome， medicinals that clear heat and eliminate dampness， unblock the collaterals and relieve bi are selected. For blood stasis obstructing the collaterals syndrome， medicinals that activate blood and resolve stasis， unblock the collaterals and relieve pain are combined. For yin deficiency with internal heat syndrome， medicinals that nourish yin and clear heat， cool blood and unblock the collaterals are prescribed.

Objective: To quantitatively assess biochemical alterations in the cartilage of the subtalar and midtarsal joints in chronic lateral ankle instability (CLAI) patients with isolated anterior talofibular ligament (ATFL) injuries and combined calcaneofibular ligament (CFL) injuries using MRI T2 mapping. Materials and Methods: This study was performed according to regulations of the Committee for Human Research at our institution, and written informed consent was obtained from all participants. Forty CLAI patients (26 with isolated ATFL injuries and 14 with combined ATFL and CFL injuries) and 25 healthy subjects were recruited for this study. All participants underwent MRI scans with T2 mapping. Patients were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system. The subtalar and midtarsal joints were segmented into 14 cartilage subregions. The T2 value of each subregion was measured from T2 mapping images. Data were analyzed with ANOVA, the Student’s t test, and Pearson’s correlation coefficient. Results: T2 values of most subregions of the subtalar joint and the calcaneal facet of the calcaneocuboid joint in CLAI patients with combined CFL injuries were higher than those in healthy controls (all p < 0.05). However, there were no significant differences in T2 values in subtalar and midtarsal joints between patients with isolated ATFL injuries and healthy controls (all p > 0.05). Moreover, T2 values of the medial talar subregions of the posterior subtalar joint in patients with combined CFL injuries showed negative correlations with the AOFAS scores (r = -0.687, p = 0.007; r = -0.609, p = 0.021, respectively). Conclusion CLAI with combined CFL injuries can lead to cartilage degeneration in subtalar and calcaneocuboid joints, while an isolated ATFL injury might not have a significant impact on the cartilage in these joints.

Objective:To evaluate the clinical performance of postoperative deformity after the release of simple syndactyly, and to discuss the corresponding method for repair.Methods:Clinical data of 25 children with postoperative deformities after simple syndactyly releasing were reviewed retrospectively in the past 5 years, including 13 males and 12 females, with an average age of 3 years and 2 months. The possible causes leaded to postoperative deformity were analyzed by investigating the data of the first operation, including the age of the first operation, whether there was skin graft and whether there was postoperative infection. The common types of postoperative deformities were summarized through morphological observation, and the main methods of reoperation repair were reviewed. During follow-up, the improvement of postoperative deformities after repair was evaluated from the four aspects of webbed shape, finger shape, fingernail shape and skin color difference, so as to propose an effective repair plan for such postoperative deformities.Results:The average age of the first operation was 1 year and 5 months, 15 cases had no skin graft with tense skin, and 4 cases had a history of wound infection. The postoperative deformities of simple syndactyly can be summarized in four main categories: web deformity in 27 webs, finger deformity in 53 fingers, nail deformity in 46 nails and skin color difference in 15 fingers. During the revision surgery, for web deformity, Z-plasty technique were used to widen narrow webs, the flaps were used to reconstruct the recurred webs and the double wing flap were used in 13 webs. For finger deformity, in all cases, most of scar skin was reserved and released by multiple Z-plasty incisions to extend and straighten the fingers, while full-thickness skin grafting was employed if lacking of enough skin to close wound. For nail deformity, using the adjacent flap pushed forward to wrap the nail margin in 14 crooked nail cuticles and others remained untreated. For skin color difference, using z-plasty incision to break the large piece of dark skin into small one and remove the overly dark skin as much as possible. The average follow-up time after reoperation was 33 months, and all webs reached the normal depth and width. Except for the incomplete correction of the lateral deviation in 1 finger, the deformity of the other fingers hand was corrected completely. There was no improvement in other nail deformity except for 10 skew nail cuticle being improved. The skin color difference were improved in all cases.Conclusions:The occurrence of postoperative deformity of simple syndactyly may be related to the tight stitching (should have skin grafting) and the wound infection during primary surgery. The reconstructive operation should be performed about one year after the initial operation when the scar is softened. The flaps for construction of web space, especially double wing flap, can be used widely in all kinds of web deformities, which could result in excellent web shape. The area of skin grafting can be reduced dramatically by reserving softened scar skin. Multiple Z-plasty technique can make use of the transverse excess skin to extend the longitudinal skin and corrected enlarged finger bodies. When should be used to reduce the color difference. But the repair of most of nail deformity were too difficult to improve.

Objective:To evaluate the clinical performance of postoperative deformity after the release of simple syndactyly, and to discuss the corresponding method for repair.Methods:Clinical data of 25 children with postoperative deformities after simple syndactyly releasing were reviewed retrospectively in the past 5 years, including 13 males and 12 females, with an average age of 3 years and 2 months. The possible causes leaded to postoperative deformity were analyzed by investigating the data of the first operation, including the age of the first operation, whether there was skin graft and whether there was postoperative infection. The common types of postoperative deformities were summarized through morphological observation, and the main methods of reoperation repair were reviewed. During follow-up, the improvement of postoperative deformities after repair was evaluated from the four aspects of webbed shape, finger shape, fingernail shape and skin color difference, so as to propose an effective repair plan for such postoperative deformities.Results:The average age of the first operation was 1 year and 5 months, 15 cases had no skin graft with tense skin, and 4 cases had a history of wound infection. The postoperative deformities of simple syndactyly can be summarized in four main categories: web deformity in 27 webs, finger deformity in 53 fingers, nail deformity in 46 nails and skin color difference in 15 fingers. During the revision surgery, for web deformity, Z-plasty technique were used to widen narrow webs, the flaps were used to reconstruct the recurred webs and the double wing flap were used in 13 webs. For finger deformity, in all cases, most of scar skin was reserved and released by multiple Z-plasty incisions to extend and straighten the fingers, while full-thickness skin grafting was employed if lacking of enough skin to close wound. For nail deformity, using the adjacent flap pushed forward to wrap the nail margin in 14 crooked nail cuticles and others remained untreated. For skin color difference, using z-plasty incision to break the large piece of dark skin into small one and remove the overly dark skin as much as possible. The average follow-up time after reoperation was 33 months, and all webs reached the normal depth and width. Except for the incomplete correction of the lateral deviation in 1 finger, the deformity of the other fingers hand was corrected completely. There was no improvement in other nail deformity except for 10 skew nail cuticle being improved. The skin color difference were improved in all cases.Conclusions:The occurrence of postoperative deformity of simple syndactyly may be related to the tight stitching (should have skin grafting) and the wound infection during primary surgery. The reconstructive operation should be performed about one year after the initial operation when the scar is softened. The flaps for construction of web space, especially double wing flap, can be used widely in all kinds of web deformities, which could result in excellent web shape. The area of skin grafting can be reduced dramatically by reserving softened scar skin. Multiple Z-plasty technique can make use of the transverse excess skin to extend the longitudinal skin and corrected enlarged finger bodies. When should be used to reduce the color difference. But the repair of most of nail deformity were too difficult to improve.

Objective: To preliminarily investigate the influence of recombinant human growth hormone (rhGH) on the immune function of younger children with severe burn injuries. Methods: A total of 30 younger children with severe burn injuries, conforming to the study criteria, were admitted to our hospital from July 2016 to July 2018. They were enrolled in the prospective, randomized, double-blinded, controlled trial and divided into group rhGH [n=15, 10 boys and 5 girls, aged (22±10) months] and control group [n=15, 8 boys and 7 girls, aged (21±7) months] according to the random number table. The patients in control group received anti-shock, anti-infection, and wound caring therapies, etc. On the basis of above-mentioned treatment, the patients in group rhGH were subcutaneously injected with rhGH once every night before bedding, with a dosage of 0.2 IU·kg^-1·d^-1, from the 3rd day post injury for 7 consecutive days. Before and on the 3rd and 7th day of rhGH treatments, the fasting peripheral venous blood was collected from patients in both groups. Blood glucose level was detected by glucometer. Percentages of CD4⁺ T lymphocytes, CD8⁺ T lymphocytes, CD3⁺ T lymphocytes, CD19⁺ B lymphocytes, and ratio of CD4⁺ T lymphocytes to CD8⁺ T lymphocytes were determined by flow cytometer. Mass concentration of serum immune globulin (Ig) A, IgG, and complement C3 were detected by enzyme-linked immunosorbent assay. Data were processed with Fisher′s exact probability test, independent sample t test, analysis of variance for repeated measurement and Bonferroni correction, and Mann-Whitney U test. Results: (1) The blood glucose levels of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=0.474, 1.652, 1.997, P>0.05). The glucose levels of children in group rhGH on the 3rd and 7th day of rhGH treatment [(6.9±1.0) and (7.7±1.1) mmol/L] were significantly higher than (5.9±0.9) mmol/L before rhGH treatment (P<0.05). The glucose level of children in control group on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). (2) The percentages of CD4⁺ T lymphocytes of children in group rhGH before rhGH treatment and on the 7th day of rhGH treatment were (35.1±2.0)% and (38.5±2.2)%, which were close to (36.2±2.0)% and (33.6±2.2)% in control group, respectively (t=0.371, 1.553, P>0.05). The percentages of CD4⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment[(44.7±2.2)%] was significantly higher than (36.5±2.2)% in control group (t=2.624, P<0.05). The percentage of CD4⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than that before rhGH treatment (P<0.05). The percentages of CD4⁺ T lymphocytes of children in control group on the 3rd and 7th day of rhGH treatment were both close to the percentage before rhGH treatment (P>0.05). (3) The percentage of CD8⁺ T lymphocytes of children in group rhGH on the 3rd day of rhGH treatment was significantly lower than that in control group (t=2.107, P<0.05). (4) The ratio of CD4⁺ T lymphocytes to CD8⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment (2.36±0.20) was significantly higher than 1.72±0.20 in control group (t=2.285, P<0.05). The ratio of CD4⁺ T lymphocytes to CD8⁺ T lymphocytes of children in group rhGH on the 7th day of rhGH treatment was significantly higher than 2.04±0.19 before rhGH treatment (P<0.05). (5) The percentages of CD3⁺ T lymphocytes and CD19⁺ B lymphocytes of children in the two groups were similar before and on the 3rd and 7th day of rhGH treatment (t=1.913, 0.552, 1.327, 1.465, 1.587, 0.407, P>0.05). The percentages of CD3⁺ T lymphocytes of children in group rhGH on the 3rd and 7th day of rhGH treatment were significantly higher than the percentage before rhGH treatment (P<0.05). (6) The mass concentration of serum IgA, complement C3, and IgG of children in the two groups was similar before and on the 3rd and 7th day of rhGH treatment (t=-1.596, -0.100, 1.263, -0.220, 1.378, 1.631, Z=0.228, 0.519, 1.182, P>0.05). The mass concentration of serum IgA and complement C3 of children in group rhGH on the 3rd and 7th day of rhGH treatment was significantly higher than that before rhGH treatment(P<0.05). Conclusions rhGH has little effect on humoral immunity of younger children with severe burn injuries with limited influence on CD19⁺ B lymphocyte, mass concentration of serum IgA, IgG, and complement C3. It may improve the cellular immunity function mainly through promoting the release of CD4⁺ T lymphocyte, reducing the release of CD8⁺ T lymphocyte. It can be used in clinical treatment of younger children with severe burn injuries.

Objective To investigate and analyze the characteristics of blood physiological and biochemical parameters of Tibetan chickens bred in Guangzhou. Methods Blood samples of Tibetan chickens bred in Guangzhou were collected,and the physiological and biochemical parameters were measured. Results (1)The blood RBC,PLT,PDW, RDW-SD and P-LCR were not significantly different in the males than females(P > 0.05).(2)HCT(P < 0.05), MCHC(P< 0.05),MPV(P< 0.05),HGB(P< 0.01),MCV(P< 0.01)and MCH(P< 0.01)were significantly higher between the males and females.(3)RDW-CV was significantly lower in the blood physiological parameters of males than females.(4)AST,TRIG,ALKP,ALT,Ca,CHOL,CREA,GLU,PHOS and TBIL were not remarkably different in the blood of males than females(P > 0.05).(5)The blood AMYL(P < 0.05)and TP(P < 0.01)were significantly higher in the males than females.(6)The blood ALB(P< 0.01),UREA(P< 0.05), and GLOB(P<0.01)were significantly lower in the males than females. Conclusions The essential data of blood physiological and biochemical indexes of Tibetan chickens bred in Guangzhou are obtained.

Objective To study the portal venous systemic thrombosis (PVST) in early acute pancreatitis (AP) and its correlations with the classification and severity of AP. Methods A total of 396 patients with AP were admitted to the affiliated hospital of north sichuan medical college from January 2013 to May 2017 and underwent MRI in the early stage of AP. PVST was evaluated on the T1WI, T2WI fat-suppression, and dynamic-enhancement sequences. Evaluating the MR imaging, AP was graded as mild, moderate, and severe AP based on the MR severity index (MRSI) and was also classified into interstitial edematous AP and necrotizing AP. According to the New Revised Classification of AP 2012, AP in the clinic setting was graded as mild, moederately severeand severe AP. χ2 test or Fisher exact test calculated the differences of the prevalence of PVST in different severity and classification of AP, Mann-Whitney U test calculated the difference of hospitalization time between patients with PVST and those without PVST. Results Among the 396 patients with AP, PVST was detected in 30 patients (7.5％,30/396), it formed most frequently in splenic vein(73.3％, 22/30), followed by portal (30.0％, 9/30) and superior mesenteric(16.7％, 5/30) veins. According to MRSI, there were 205, 177, and 14 patients with mild, moderate, and severe AP, respectively;among mild, moderate, and severe AP, there were 2, 21, and 7 patients with PVST, respectively (χ2=41.455, P<0.01), there were also statistical differences in the prevalence of portal and splenic vein thrombosis (P<0.05), but there was no statistical difference in the prevalence of superior mesenteric vein thrombosis (P>0.05). Three hundred and eleven patients had interstitial edematous AP and 65 patients had necrotizing AP, among which there were 11 and 19 patients with PVST(χ2=48.447,P<0.01), the prevalence of portal, splenic and superior mesenteric vein thrombosis in necrotizing AP were all higher than that in interstitial edematous AP (P<0.05). Based on the New Revised Classification of AP 2012, there were 194, 184 and 18 patients with mild, moderately severe, and severe AP, respectively; among mild, moderately severe, and severe AP, there were 0, 25, and 5 patients with PVST, respectively (χ2=42.130, P<0.01), there was no statistical differences in the prevalence of portal, splenic and superior mesenteric vein thrombosis (P>0.05). Patients with PVST and those without PVST in the early AP, the hospitalization time [median (interquartile range)] were 18 (13 to 22) days and 13 (10 to 19) days (Z=-2.913, P=0.004). Conclusion PVST in early AP presented more frequently with the increase in severity of AP based on both the MRSI and Newly Revised Classification of AP 2012, along with longer duration ofhospitalization.

Objective To investigate the application of modified negative pressure closure drainage in early stage of snakebite .Methods 60 patients with early bite ulcer were selected as study objects ,and they were randomly divided into two groups according to the digital table .30 patients in the observation group received vacuum sealing drainage(VSD) combined with chymotrypsin continuous rinsing treatment .30 patients in the control group were given conventional dressing bandaging treatment .The two stage skin grafting time,wound healing time,complications,disa-bility rate,hospitalization time and C reactive protein ( CRP) levels of the two groups were observed .And the treatment effect was analyzed .Results The incidence rates of complications and disability in the observation group were 0.00％and 3.33％,respectively,which were significantly lower than 16.67％and 26.67％in the control group ,and the differences between the two groups were statistically significant (χ2 =4.356,6.405,all P<0.05).The CRP levels of 3 d and 7 d in the observation group were (15.8 ±1.7)mg/L,(6.9 ±1.6)mg/L,respectively,which in the control group were (18.6 ±2.3) mg/L,(13.8 ±1.9) mg/L,respectively,there were statistically significant differences between two groups(t=5.362,15.214,all P<0.01).The two stage skin grafting,wound healing,hospital stay of the observation group were (9.5 ±1.8) d,(24 ±1.8) d,(25.3 ±1.9) d,respectively,which were significantly shorter than those of the control group [(16.2 ±2.6)d,(32.0 ±3.2)d,(33.2 ±3.7)d],the differences were statistically significant(t=11.604,11.93410.403,all P<0.01).Conclusion For patients with injury of cobra bite to early ulcer,using VSD technology combined with chymotrypsin continuous irrigation ,can significantly reduce the level of CRP and the occurrence of complications and disability rate ,shorten the time of two stage skin grafting ,wound healing time,hospitalization time,reduce the pain of patients,it is the best treatment to accelerate recovery .

Objective To analyze the risk factors of fevers after percutaneous nephrostolithotomy (PCNL) and to determine a more effective prophylaxis method.Methods A retrospective analysis of 320cases who underwent PCNL for renal calculi from 2008 to 2011 (men 233,women 87,age between 22 years to 72 years) was made.The average age of the patients and the average diameter of the stones were 42 years and 3cm(0.8 -6 cm),respectively.We analyzed factors such as age ( ＞60 years and ≤60 years),stone size ( ＞2.0 cm and ≤2.0 cm),operative time ( ＞60 min and ≤60 min),irrigation pump pressure ( ＞120 mm Hg and ≤ 120 mm Hg),obstructive conditions,preoperative urinary tract infection and fever.Wethen compared the fever rate with each of the risk factors.Results There were 59 cases with fever after PCNL; 18.4％ of the cases had a temperature over 38 ℃.There were two cases of pyemia.The patients whose stone diameter ＞ 2 cm had a post-operative fever rate of 22.4％.The fever rate in patients whose stone diameter ≤2.0 cm was 10.4％.The fever rate in patients with an operative time ＞60 min and ≤60 min was 27.2％ and 10.4％,respectively.Patients with irrigation pump pressure ＞ 120 mm Hg and ≤ 120mm Hg had post-operative fever rates of 28.3％ and 11.0％,respectively.There was statistical significance between each post-operative fever risk factor group.Conclusions The post PCNL fever risk factors are stone diameter ＞ 2.0 cm,operation time ≤60 min and irrigation pump pressure ＞ 120 mm Hg.The effective prophylaxis policy of post-operative fever are the pre-operative using of broad-spectrum antibacterial agents,shorter operative time and lower irrigation pump pressure.A two-stage operation procedure will also reduce the post-operative fever.