Objective:To investigate the clinical value of neuron specific enolase (NSE) and bispectral index (BIS ) in predicting the neurological prognosis in patients with severe intracerebral hemorrhage.Methods:Patients with severe intracerebral hemorrhage admitted to the ICU of Xiaolan Hospital of Southern Medical University from January 2019 to December 2020 were selected, and serum NSE detection and BIS monitoring were performed at an early stage. According to the Glasgow outcome scale (GOS) at 90 days after intracerebral hemorrhage, the patients were divided into the good neurologic prognosis group (GOS 4-5) and poor neurologic prognosis group (GOS 1-3). The levels of NSE and BIS between the two groups were compared. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive value of NSE, BIS and their combination in predicting neurological prognosis.Results:A total of 126 patients with severe intracerebral hemorrhage were enrolled in this study, and 32 patients (25.4%) had poor neurological prognosis. The level of NSC in the poor neurological prognosis group was significantly higher than that in the good neurologic prognosis group [28 (13.7, 50.4) ng/mL vs. 13.5 (9.6, 18.5) ng/mL, P < 0.05], while the BIS level was significantly lower than that in the good neurologic prognosis group [32 (25.2, 45) vs. 55 (48, 62.2), P <0.05]. For detection of poor neurologic outcome in patients with severe intracerebral hemorrhage, NSE and BIS yielded the AUC values of 0.768 (0.685, 0.839) and 0.866 (0.793, 0.920), respectively, with cut-off values of 21.7 ng/mL and 47, respectively. The combination of NSE and BIS yielded a remarkably higher AUC value of 0.927 (0.867, 0.966) for predicting poor neurologic outcome than each index alone ( P<0.05). Conclusions:Early monitoring of NSE and BIS can effectively predict the neurological prognosis of patients with severe intracerebral hemorrhage, and the combination of NSE and BIS can further improve the prediction efficiency.

Objective:To investigate the clinical effect of Dynamic neutralization system applied to the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle.Methods:From Jan 2015 to Dec 2017, a total of 53 patients of lumbar degenerative diseases with multifidus fatty infiltration treated by Dynesys in our hospital were analyzed, included 21 males and 32 females, aged 66.2±7.4 (range 48-81) years. There were lumbar spinal stenosis in 37 casesand lumbar disc herniationin 16 cases; the index level included L 2-S 1 in 3 cases, L 3-S 1 in 13 cases, L 2-L 5 in 5 cases, L 4-S 1 in 17 cases, and L 3-L 5 in 15 cases. The pedicle screws were inserted at the point of intersection of the outer edge of superior articular process and the midline of transverse process. After discectomy of herniated disc and hyperplastic ligamentum flavum, the distance between the upper and lower pedicle screws was measured and then the spacer of the corresponding length was cut out. Finally, the spacer was placed and fixed between the upper and lower pedicle screws by the elastic rope. The degree of multifidus fat infiltration, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slop (SS), range of motion (ROM), intervertebral height (IH), Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), the MOS 36-item short-form health survey (SF-36) and visual analog scale (VAS) were evaluated postoperatively. Results:The operation was performed successfully in all the patients. The operation duration was 173.5±64.7 (range 125-240) min. Intraoperative blood loss was 469.5±118.2 (range 380-620) ml. The patients were followed up for 47.9±6.7 (range 38-62) months averagely. At the last follow-up, the degree of fatty infiltration of the multifidus muscle showed no further progress by MR scan. There was no significant difference in ROM and IH at different time points preoperativelyand postoperatively. The LL recovered from 37.6°±8.8° to 43.2°±9.1°, the PT decreased from 24.7°±9.3° to 20.5°±5.1°, and the SS increased from 22.1°±7.7°to 26.3°±8.0°. The JOA score increased from preoperative 6.4±1.2 to 20.6±2.8, ODI decreased from preoperative 50.6%±11.3% to 13.0%±3.4%, SF-36 increased from preoperative 81.5±3.6 to 95.5±4.2, and the VAS decreased from preoperative 4.2±1.0 to 1.1±0.6. One patient experienced loosening and displacement on the left side pedicle screw of the L2 vertebral body 3.5 years after operation, and herclinical symptom improved significantly after conservative treatment.Conclusion:Dynesysis is safe and effective for the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle, and it can restore the complete structure and function of tension band at lower back and prevent the progress of multifidus muscle fat infiltration combined with postoperative rehabilitation training.

Objective To analyze the safety of laparoscopic splenectomy for traumatic splenic rupture.Methods The clinical data of 62 patients with traumatic splenic rupture treated by laparoscopic splenectomy in our hospital from Jan 2013 to Jan 2018 were retrospectively analyzed.Results All 62 patients successfully underwent laparoscopic surgery except for 1 case who was converted to open surgery.One case suffered from postoperative bleeding.There was no infection,serious pancreatic leakage and other major complications.The total amount of intraoperative bleeding was 1 600 ml on average,the average operation time was 135 min,the average splenectomy time was 55 min,and the average hospital stay was 12.5 d.Conclusion Laparoscopic splenectomy is a safe and reliable minimally invasive operation for traumatic splenic rupture.

Objective To analyze CT findings in adhesive intestinal obstruction caused by different adhesion pattern.Methods Clinical data of 83 adhesive intestinal obstruction cases proved by laparotomy were reviewed.Before surgery two experienced abdominal radiologists randomly double blindly inspected and evaluated the CT findings,as to whether there was intestinal obstruction,the severity of obstruction,the site of obstruction,the adhesion type of obstruction and the diagnosis of strangulated intestinal obstruction,the consensuses were accomplished by discussion.Results The accuracy of diagnosis was 100％ for the existence of obstruction,the severity of obstruction and the site of obstruction.There were intra-abdominal hernia caused by intestinal adhesion (44 cases),a cluster of loop (12 cases),bowel twisted angle (8 cases),the intestine and abdominal adhesions (6 cases),intestinal adhesion contracture stenosis (5 cases),adhesive band compression (4 cases),intestinal volvulus caused by adhesion (1 case).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of CT in diagnosing strangulated intestinal obstruction were 78％,47％,100％,100％,73％,respectively.Conclusion CT can clearly diagnose different adhesion pattern leading to ileus and ensuing strangulation.

Objective:To invest the risk factors associated with delayed hemorrhage after pancreaticoduodenectomy occurred.Methods:A retrospective analysis was performed from January 2012 to June 2015 Shengjing hospital 511 cases of patients who accepted pancreaticoduodenectomy.Results:The incidence of PD postoperative delayed hemorrhage was 8.81％ (45/511).Univariate analysis shows:Preoperative bilirubin levels,pancreatic fistula,biliary fistula,postoperative abdominal infection are all the meaningful related factors(P＜0.05).With the application of multivariate logistic regression analysis,pancreatic fistula (OR=2.158) and abdominal infection (OR=3.051) were independent risk factors for postoperative delayed hemorrhages (P＜0.05).Conclusion:Dealing with the postoperative complications of PD like pancreatic fistula,abdominal infection and others,early detection and rapid diagnosis and correct treatment can effectively reduce the incidence of delayed hemorrhage.

Objective To investigate the correlation between serum level of insulin growth factor 1 (IGF-1) and the degree of liver fibrosis in patients with chronic hepatitis C (CHC) complicated to type 2 diabetes mellitus (T2DM). Methods The cases were divided into CHC with T2DM (39 cases), CHC (96 cases), T2DM (60 cases), and healthy control (60 cases) groups. Their human data were collected and the fasting blood glucose, insulin and insulin-like growth factor-1 levels were detected, and the insulin resistance index ( HOMA-IR) wwer calculated. The serum levels of alanine transaminase ( ALT) , aspartate transaminase ( AST) , hepatitis C virus ( HCV) RNA load and HCV genotypes were detected simultaneously in patients with hepatitis C, and liver stiffness were measured ( LSM) by transient elastography ( TE) and aspartate aminotransferase-to-platelet ratio index ( APRI) score was performed. Results ⑴ There was no significant difference between CHC with T2DM group and CHC group in diabetes family history(P>0. 05), but two groups were significantly lower than that of T2DM group (P<0. 05). ⑵The levels of fasting insu-lin (FI) and HOMA-IR in CHC with T2DM group and T2DM group were significantly higher than those in the other two groups (P<0. 05), while the levels of IGF-1 in two groups were significantly lower than those in the CHC group, and were more lower than the control group (P<0. 05). ⑶Compared the serum ALT, AST and HCV RNA load between CHC with T2DM group and CHC group, there had no significant differ-ence (P>0. 05);however, the proportion of 1b genotype, LSM and APRI score of CHC with T2DM group were significantly higher than those in CHC group(P<0. 05). ⑷ The level of serum IGF-1 was negatively correlated with HOMA-IR, LSM and APRI in CHC with T2DM group (r= -0. 71, -0. 75, -0. 69, P<0. 01). Conclusions The degree of hepatic fibrosis and the damage of IGF-1 synthesis in CHC patients with T2DM were significantly higher than those in non T2DM patients, which might be related to the insulin resistance caused by 1b genotype HCV infection.

BACKGROUND:Currently, it is stil controversial about the border, surrounding fascia, space of pelvic cavity, distribution of nerves and lymph nodes of the mesorectum, and the development of new technologies makes a progress in related anatomic research.
OBJECTIVE:To summarize the previous studies so as to describe clearly the progress of mesorectal anatomy and to discuss its clinical value.
METHODS: Using “rectum; mesentery; fascia; space; nerve; lymph node; total mesorectal excision (TME); clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the mesorectum and surrounding fasciae, space of pelvic cavity, distribution of nerves and lymph nodes.
RESULTS AND CONCLUSION:Fresh or frozen specimens are often used for studying the mesenterium, fascia, nerves and lymph nodes by using traditional pelvic and perineum anatomical methods. Computer-assisted anatomical dissection can combine immunostaining with computer imaging. A three-dimensional model can wel reflect the relationship among the different anatomical structures, as wel as nerve traveling and spatial location. Mesorectum is located behind the denonviliers and in the front of the sacral fascia of the rectum. Pelvic splanchnic nerve of the mesorectum is derived from the anterior sacral nerve root, runs through the presacral fascia, and enters into the neuro-fascial layervia the pesacral space, which is divided into the upper and lower parts according to the peritoneum. There are more folds in the rear of lymph nodes within the mesorectum within and near the peritoneum. There are stil a lot of controversies about anatomical relationship between the mesorectum and surrounding structures, and to elaborate these issues can provide an objective basis for guiding clinical work.

BACKGROUND:The pelvic nerves innervate the pelvic viscera as wel as bring sensory information to the central nerve system, including splanchnic nerves and spinal nerves. Each of them comprises both motor fibers and sensitive fibers. Mostly, the key part of splanchnic plexus is pelvic plexus. Total mesorectal excision proposed by Heald in 1982 has been the “gold standard” for diagnosis and treatment of colorectal cancer. However, it carries a high risk of nerve damage during surgery, which results in urinary retention, sexual dysfunction and other complications. OBJECTIVE:To summarize the former researches so as to get a precise understanding of the pelvic fascia and nerve structure. METHODS:Using “splanchnic nerves, superior hypogastric plexus, pelvic plexus, pelvic splanchnic nerve, total mesorectal excision (TME), clinical anatomy” as key words, a computer-based search of PubMed was done for articles related to the pelvic nerves, including its pathway, consistent, ganglia, and reflection in pelvic viscera, published from 2000 to 2015. RESULTS AND CONCLUSION:The main splanchnic plexus in the pelvic cavity includes superior hypogastric plexus (it is located in the triangle formed by left and right common iliac artery and the sacral promontory), and pelvic plexus (hypogastric nerve, pelvic splanchnic nerve and sacral splanchnic nerve converge at the bottom of rectum, formed pelvic plexus, also known as the inferior hypogastric plexus). It is flattened against the lateral aspect of the rectum, the dorso-lateral bladder wal and the seminal vesicles. Nerves come from the plexus contain the sympathetic nerve, parasympathetic nerve and sensory nerve. They are in charge of the motions and sensations of the pelvic organs. The definite knowledge on the anatomy of pelvic fascia and nerve structures can avoid nerve damage during operation, which can help to improve the life quality of patients.

Objective To investigate the feasibility of differentiating lymph node metastases of four types of primary tumors (lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma) using gemstone spectral imaging (GSI) . Methods Three cases with lymphoma (28 lymph node), five cases with lung adenocarcinoma(30 lymph node), four cases with lung squamous cell carcinoma(24 lymph node) and two cases with cholangiocarcinoma( 10 lymph node) were evaluated by germstona spectra imaging CT scans. Imaging protocol included unenhanced conventional CT scan (120 kVp) ,enhanced GSI (80/140 kVp) on arterial phase and conventional CT scan (120 kVp) on portal phase. CT attenuation values of lymph nodes in the monochromatic images at 11 sets of keV levels (40-140 keV, 10 keV step) and the iodine and water contents of these lymph nodes were measured. All results were analyzed with ANOVA and t test. Results The optimal monochromatic level was 70 keV for the optimal contrast-noise ratio (CNR) of metastatic lymphadenopathy. The CT attenuation values of metastatic lymphadenopathy were (81.36 ±9. 81 ), (58.33 ± 21.55 ), (56. 47 ± 10.62) and (73. 57 ±4. 43 ) HU,respectively, at 70 keV( F = 17.29, P ＜0. 01 ). There were significant differences in CT attenuation values between lymphoma and lung adenocarcinoma, between lymphoma and lung squamous cell carcinoma and between lung squamous cell carcinoma and cholangiocarcinoma (P ＜ 0. 05 ). The differences in CT attenuation values were significant between cholangiocarcinoma and lung squamous cell carcinoma, between cholangiocarcinoma and lymphoma ( P ＜ 0. 05 ). There was no difference in CT attenuation values at all 11 sets of keV levels between lung squamous cell carcinoma and lung adenocarcinoma ( P ＞ 0. 05 ). The iodine contents of lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma were ( 1. 93 ± 0. 04 ), ( 1.16 ± 0. 15 ), ( 1.25 ± 0. 21 ) and ( 1.44 ± 0. 04 ) g/L, respectively. The water contents of lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma were (1029.40 ± 20. 85), (1024.98 ± 11.19), (1022.12 ± 12. 94) and (1030.87 ± 10.10) g/L,respectively. Except between lung squamous cell carcinoma and lung adenocarcinoma, the differences in the iodine contents of metastatic lymphadenopathy were significant among tumors ( P ＜ 0. 05 ). There was no difference in the water contents of metastatic lymphadenopathy among tumors ( P ＞ 0. 05 ). Conclusions Although CT spectral imaging fails to differentiate metastatic lymphadenopathy of lung adenocarcinoma and lung squamous cell carcinoma, it is also a promising method of distinguishing metastatic lymphadenopathy of malignant tumors by CT attenuation values in monochromatic images and iodine contents in material density images. The optimal monochromatic level was determined to be at 70 keV for providing the optimal CNR of metastatic lymphadenopathy.

Objective To explore issues of the human tissue biobank, ranging from its establishment, collection and preservation of samples, quality control, management and application. Methods Development of standardized operational procedures, collection of such samples as fresh frozen tissues from the surgery, paraffin-embedded tissues, whole blood, serum, plasma, and cerebrospinal fluid. Specimens were classified and made aliquots according to different requirements, and then stored at room temperature, -80℃ refrigerator or in liquid nitrogen. Microsoft Access database system was used in the management of these specimens. Results From September 2004 to September 2008, a total of 11 872 samples from patients with benign and malignant diseases were collected and preserved. Among them, 4360 tubes of fresh frozen tissue samples from 2500 cases were provided within and beyond the province. These samples were also applied to DNA, RNA, protein extraction and tissue microarray, and immunohistochemistry-related research. Conclusion Human tissue biobank is highly useful in sharing human tissue resources effectively, as it can provide high quality specimens from benign and malignant diseases and normal control. In addition, it plays a very important role in exploring pathogenesis, developing new technologies for early detection of disease and new therapeutic strategies.