Abstract:Objective：To explore the urgent management strategy for quadriplegia following China Wenchuan earthquake under filed condition. Methods: The 57-year-old male patient was sent to the earthquake relief team of Changzheng Hospital,Second Military Medical University. He was hit by heavy object during the Sichuan earthquake 6 days ago. Physical examination revealed cervical spinal cord injury accompanied by incomplete paralysis. The patient underwent cervical 3-7 laminectomy under general anesthesia. Results: After surgery,the muscle strength of lower limbs recovered to grade four from grade one; the muscle strength of upper limbs recovered to grade five from grade three. Sensory loss was found below the nipple level and totally recovered after operation. Conclusion: Early surgery for quadriplegia following earthquake trauma can timely relieve compression to the spinal cord and therefore improve prognosis of patients. Under field condition where facilities are not readily available,decompression of spinal cord can be achieved by laminectomy via posterior approach. The key to successful operation is correct diagnosis and skillful manipulation.

Abstract:Objective：To study the rescue strategy for patients with severe multiple injuries after sudden disaster under field condition. Methods and results: A 53-year-old female patient was referred to us after hit on the pelvis in the China Wenchuan earthquake. Her symptoms included large volume of hematuria, difficult breath, tenderness of the whole abdomen, and bedsore. Portable B ultrasound revealed effusion of abdomen and left chest cavity, and bladder rupture.Portable blood-gas analyzer indicated severe anemia+hypoxemia+hypokalemia+acidosis. Drainage was done through left chest cavity aspiration and bladder aspiration. Abdominal examination found rectal rupture (perforation), which was managed by Harttman+cystostomy followed by anti-infection treatment. The patient recovered 18 days after operation. Conclusion: The rich experience and skillful surgical management,the full play of portable equipment, the help from the local hospital, together with timely anti-infection management, are the keys to successful rescue of patients with severe multiple injuries under field condition.

Abstract:Objective：To summarize our experience on perioperative anesthesia management of patients with crush syndrome caused by earthquake under field condition. Methods: The clinical anesthesia data of 10 patients with crush syndrome caused by China Wenchuan earthquake, who were treated under field condition, were retrospectively analyzed, and our experience on perioperative anesthesia management was summarized. Results: After volume therapy, urine alkalization, and stabilization of internal environment, the 10 patients underwent debridement, decompression by fasciotomy or amputation under epidural anesthesia or brachial plexus block plus psychological therapy and moderate tranquillizer. During the operation, the patients showed smooth respiratory and cardiovascular characteristics without pain. Conclusion: Under field condition, regional anesthesia can provide adequate analgesic effect during and after the surgery. Early fluid resuscitation and life support are vital to the safety and life of patients.

Abstract:Medical rescue is the most important step in the rescue action during grave disasters. Prompt and effective medical intervention is the key to decrease the death and disable rates in the salvage of the wounded. The authors participated in the medical rescue after China Wenchuan earthquake. Ultrasonography discovered the symptoms such as pleural effusion,pyoperitoneum,hepatic rupture,cystorrhexis,and so on,which contributed to the quick and accurate classification of patients. More emphasis should be given to ultrasonography examination during the on-spot medical rescue action after grave disasters,so as to timely differentiate patients and allow them to have timely and proper treatment,which can not only save time,but also improve the rescue efficiency.

Abstract:Epidemic diseases often occur following natural disasters, such as earthquakes. The most commonly seen epidemics after an earthquake include: enteric diseases (dysentery, typoid and paratypoid fever, cholera, hand-foot-mouth disease, hepatitis A, hepatitis E, etc), arthropod-borne infectious diseases (malaria, Kala-Azar, Japanese encephalitis, etc), zoonosis (plague, hemorrhagic fever with renal syndrome, anthrax, etc), soil and epidemic water transmitted diseases (tetanus, gas gangrene, leptospirosis, etc), respiratory diseases (measles, rubella, influenza, etc), food-borne diseases (food poisoning caused by bacteria or bacterial toxin). This article reviews the controlling principles and measures for major infectious pathogens and epidemic diseases after earthquake.

Abstract:1临床资料孕妇，23岁，因“停经39+5周，水肿月余，破水5 d”于2008年5月18日11时就诊于我院驻安县医疗所。据患者主诉，末次月经2007年8月13日，预产期2008年5月20日，2次流产史,孕期不定期产检，未发现明显异常，患者无头晕、眼花、视物模糊等不适主诉。2008年5月12日14时28分，四川汶川发生8.0级地震，患者当时处在离震中100 km的安县县城，感觉到强烈地震，迅速跑出家门，当晚住在临时搭建的帐篷里，19时许感觉到破水，未引起重视，后因地震后条件有限未得到及时收治，辗转5 d才来到我院驻安县医疗所。嘱其平卧在床，测血压150/100 mmHg(1 mmHg=0.133 kPa)，腹围103 cm,宫高34 cm,左枕前位(LOA),水肿，内裤湿，pH试纸变色，听诊器听胎心，约124次/min。立即与患者本人及家属谈话，说明胎膜早破的风险，若出现脐带脱垂，会危及胎儿性命；破水时间长，可引起宫内感染，危及孕妇及胎儿两条生命；且患者有妊娠高血压疾病（轻度）的表现，需立即剖宫产终止妊娠。手术在临时搭建的帐篷内展开，碘仿两遍消毒术野，常规铺巾，选择下腹正中切口，术中见皮下脂肪层水肿明显，色较苍白，腹腔积液约80 ml。羊水量中,Ⅰ°污染,以LOA位娩一活女婴,Apgar评分9~10分,胎盘、胎膜自娩完整，术中出血约200 ml。因条件所限，手术采用无齿卵圆钳及艾利钳代替了子宫钳，7号或10号丝线代替了1号进口肠线，术中使用缩宫素40 U，20 U子宫肌内直接注射，20 U静脉滴注，手术过程顺利，母子平安。术中、术后加强抗感染治疗，术后第1日，患者血压最高达150/100 mmHg，水肿仍较明显，术后6 h尿量200 ml，给予利尿、镇静药物治疗后好转，术后7 d，患者恢复良好，出院。[第一段]

Abstract:This paper is to analyze the characteristics of psychological intervention after China Wenchuan earthquake based on the previous studies of the former earthquakes in China,and to provide evidence for future psychological intervention under similar conditions.Psychological intervention was immediately provided to the victims of Wenchuan earthquake,the rescuers and journalists in the field.Compared with the former earthquakes in China,Wenchuan earthquake proposed new challenges to psychological professionals: not all the counselors or educators were suitable to provide psychological support in the earthquake field;the intervention to earthquake victims was totally different from that to those receiving traditional counseling;and long-term psychological intervention should be planned.The psychologists should be selected carefully and well-trained before working in a field condition;psychologists should be organized as a team when they work in the field so that they can get support from other team members;psychologists could not presume that “everyone who experienced the earthquake would have psychological disorders or posttraumatic stress disorder”;psychologists should serve as a guider to other people as how to correctly treat the victims,especially the wounded,the children and the orphaned;finally,psychologists should incorporate research work in their psychological intervention process.

Abstract:Objective：To compare post-orthotopic liver transplantation(OLT) survival rates between patients with recurrent HCC after partial hepatectomy and those with de novo OLT for HCC,and to screen for the risk factors associated with post-OLT mortality.Methods: From July 2003 to August 2005,77 consecutive HCC patients underwent OLT,including 15 patients with recurrent HCC after partial hepatectomy for tumor resection(the rescue OLT group) and 62 patients with de novo OLT for HCC(the de novo OLT group); the post-operation survival rates were compared between the 2 groups.Thirty-three demographic,clinical,histological,laboratory and intra- and post-operative variables were analyzed.Cox proportional hazards regression model were used to screen for the factors associated with the survival rate.Results: The median age of the patients was 48.6 years and the median follow-up period was 20 months.Three patients(20.0%) in the rescue OLT group and 15 patients(24.2%) in the de novo OLT group died during follow-up(P=0.73).The 30 day-mortality of OLT was 6.7% for the rescue OLT group vs.1.6% for the de novo OLT group(P=0.27).Cox proportional hazards model showed that the presence of pre-OLT hyperbilirubinemia,requirement of post-OLT transfusion,size of the largest tumor,tumor macroembolism and family history of HCC were significantly associated with a higher hazard for mortality.Conclusion: No significant difference is found in the survival rates between OLT as de novo therapy and OLT as a rescue therapy for patients with HCC.Pre-OLT hyperbilirubinemia,post-OLT requirement of transfusion,size of the largest tumor,tumor macroembolism,and family history of HCC are associated with a poor survival outcome.

Abstract:Objective:To explore the surgical techniques of liver transplantation(LT)for a hepatic cancer patient with complete situs inversus (CSI) and to discuss the post-operation management of complications.Methods: A patient with CSI suffering from hepatocelluar carcinoma underwent LT in June 2005.LT was performed orthotopically using the clockwise 90° rotation technique with all vessels end-to-end anastomized.The post-operation complications were actively managed and the patient was followed up.Results: Post-operatively,the patient recovered well without major complications,except for a bile duct anastomotic stenosis during the 5th post-operative month,which was dealt with endoscopic retrograde biliary drainage and percutaneous transhepatic cholangial drainage.Liver function was stable and no tumor recurrence was found during a follow-up period of 30 months.Conclusion: It is feasible to perform LT in patients with CSI.Bile duct anastomotic stenosis is one of the most important complications after LT,which can have a good long-term prognosis if promptly managed.

Abstract:Objective：To summarize our experience on right hemihepatectomy for treatment of hepatolithiasis.Methods: The clinical data of thirty-nine patients suffering from intrahepatic bile duct stones,who had undergone right hemihepatectomy in our hospital from Jan. 2000 to Dec. 2006,were retrospectively analyzed. The outcomes of operation,complication,and the follow-up findings were analyzed;and the clinical experience was summarized.Results: The 39 patients included 8 males and 31 females,with an age range of 23-65 years old and a mean of (44.2±10.5) years old.All patients had various degrees of hepatobiliary stricture.All cases underwent right hemihepatectomy plus choledochotomy and T-tube drainage,including 28 also had cholecystectomy,1 had additional left lateral hepatectomy,1 had choledochocystomy plus hepatojejunostomy,and 1 had demolishment of anastomotic stoma of choledochoduodenostomy.The post-operation complications included pleural effusion (17.9%), subphrenic infection (12.8%),liver failure (7.7%),biliary fistula (5.1%),and infection of incisional wound (5.1%).Two patients (5.1%) died of liver failure during the hospital stay.One was indicated of having intrahepatic cholangiocarcinoma and died of recurrence of cholangiocarcinoma 6 months after operation.Thirty-six patients (92.3%) received long-term follow-up (a median of \[42.5±2.5\] months) and 34 (94.4%) of them were symptom free.Excellent outcomes were achieved in the 31 patients with isolated right intrahepatic bile duct stones.Conclusion: Right hemihepatectomy is effective for right hepatolithiasis,especially for patients combined with right hepatic duct stricture.However,it should be noted that the operation is very difficult and has many complications,so the indications and contraindications of right hemihepatectomy should be strictly selected.

Abstract:Objective：To summarize our experience on surgical treatment of caudate hepatolithiasis,so as to improve the diagnosis and treatment of caudate hepatolithasis.Methods: The clinical data,mode of operation,post-operation complications, and follow-up findings were retrospectively analyzed in 19 patients with caudate hepatolithasis from Jan.2000 to Dec.2006.Results: The 19 cases included 8 males and 11 females.Totally they had undergone 30 times of operation,with 12 cases only had once,4 had twice,2 had thrice,and 1 had 4 times.All cases received B ultrasound,CT, MRCP or ERCP and were confirmed to have caudate hepatolithiasis.Fourteen cases were complicated with opening stonosis of caudate bile duct.Eleven cases received caudate lobe resection.Eight cases received caudate expansion of the bile duct or plastic repair of duct + caudate duct exploration and calculus extraction, with a success rate of 100% and the patients were stone-free after surgery.Eighteen patients (94.7%) were followed up for a mean of (17.6±2.3 ) months.Two cases had stone recurrence.The excellent and good rate was 88.9% in the present cohort; all those who received resection of the caudate lobe had excellent or good outcomes.Conclusion: It is very complex and difficult to treat caudate bile duct stone; caudate duct exploration and calculus extraction usually have unsatisfactory outcomes.Caudate lobe resection can clear the lesions and has a good long-term effect,which is largely dependent on the rich experience and the skillfulness of the surgeons.

Abstract:Objective：To summarize our experience on the diagnosis and treatment of unsuspected gallbladder carcinoma (UGC)．Methods: The clinical data of 15 patients with AGC,who were treated in our hospital from January 2000 to December 2007, were retrospectively analyzed; and the clinical diagnosis and treatment experience was summarized．Results: Preoperative diagnosis showed that the 15 cases included gallstone in 12 cases,gallbladder polypi in 2,and gallstone associated with polypi in 1.All cases were incidentally discovered during operation,with 5 during open cholecystectomy and 10 during laparoscopic cholecystectomy.All 15 cases were confirmed of gallbladder carcinoma by pathological examination after operation．The tumor stage included Nevin stage Ⅰ in 3 cases,stage Ⅱ in 7,stage Ⅲ in 4 and stage Ⅳ in 1．The patients with UGC at Nevin stage Ⅰ were closely followed up; those at Nevin stageⅡ,Ⅲ underwent radical correction of gallbladder carcinoma; and those at Nevin stage Ⅳ received extended radical resection of gallbladder cancer.The median follow-up time was 5.0 years.Two patients died and 13 survived; 5 patients survived for more than 5 years,with a 5-year survival rate of 84.8%.Conclusion: It is difficult to diagnose early gallbladder carcinoma before operation．The surgeons should be alert to the possibility of gallbladder carcinoma before and during the operation．Routine examination of the resected gallbladder tissues and frozen sections are necessary for suspected lesions．Immediate radical resection is an effective measure to improve the prognosis of UGC.Re-exploration and radical resection should be performed on UGC of Nevin stageⅡ-Ⅳ.

Abstract:Objective： To investigate frequencies of microsatellite instability (MSI) and loss of heterozygosity (LOH) in renal cell carcinoma (RCC),and to discuss the relationship of clinicopathological characteristics of RCC with MSI and LOH.Methods: Twelve microsatellite markers located at chromosomes 3p,9p and 14q were selected to investigate microsatellite alterations (MSI and LOH) in 31 RCC specimens and their paired metastasis specimens by polymerase chain reaction-polyacrylamide gel electrophoresis-ethylene dibromide (PCR-PAGE-EB) staining and sequencing.Results: The frequency of MSI could reached 61.3% and that of LOH could reach 54.8%.The highest frequency of MSI was at locus of D9S168 (32.3%); the highest frequency of LOH was at locus of D3S1289 (21.4%). No correlation was found between MSI or LOH and the patients’ age,sex,pathology type and metastastis,except that MSI was correlated with TNM stage of RCC (P<0.05). Conclusion: MSI and LOH of 12 microsatellite markers,except for D3S1566,might be risk factors for RCC.D9S168 and D3S1289 are two sensitive loci in RCC,and they might be close to RCC-associated oncogenes or anti-oncogenes,which may influence the development and progression of RCC.

Abstract:Objective：To study the influence of Wnt5a gene silence on the proliferation,migration and invasion of lung squamous carcinoma cells.Methods: A recombinant plasmid pH1-siRNAWnt5a- was constructed and used to deliver small interference RNA (siRNA) targeting Wnt5a in SK-MES-1 cells; the transfected cells were screened to establish a stable transgenic cell line.MTT,cell cycle and Transwell assays were employed to evaluate the effect of Wnt5a gene silence on the proliferation,migration and invasion of lung squamous carcinoma cells.Results: Western blotting assay revealed that Wnt5a was lowly expressed in SK-MES-1Wnt5a-(13.6%).The proliferation index (PI) of transgenic cell line was slightly lower than that of the control cell line (\[28.3±3.8\]% vs \[30.5±5.2\]%).The migration and invasion capabilities of SK-MES-1Wnt5a- cells were (47.3±9.2)% and (39.7±11.7)% of the control cells,respectively.Conclusion: Low Wnt5a expression can significantly inhibit the migration and invasion capabilities of SK-MES-1 cells,indicating that Wnt5a might be a potential target for gene therapy of lung squamous carcinoma.

Abstract:Objective:To investigate the mechanism responsible for lost sensibility of tyrosine aminotransferase (TAT) to dexamethasone(Dex) in human hepatoma cell line SMMC-7721 through examining the cDNA sequence of TAT and the status of glucocorticoid receptor (GR) pathway. Methods: The TAT cDNA fragment containing the full length of coding sequence was amplified by reverse transcription-polymerase chain reaction (RT-PCR) and was sequenced.The expression of TAT mRNA was determined by real-time quantitative PCR to observe the influence of Dex on expression of TAT mRNA in SMMC-7721 cells.The experiement with HepG2 cells was performed as the control.Reporter genes (GRE-tk-LUC and GRE-MMTV-CAT) were transiently transfected into SMMC-7721 cells by electroporation.The induction efficiencies of LUC and CAT genes expression by Dex were examined and compared between SMMC-7721 cells and HepG2 cells.Results: The results showed that there was a same-sense mutation (Gln576Gln) in TAT cDNA sequence.TAT mRNA could be induced by Dex,with the maximal induction level being 2.22-folds in SMMC-7721 cells,which was significantly lower than that in HepG2 cells (15.1-fold increase,P＜0.01).Dex induced the expression of LUC and CAT genes in SMMC-7721 cells as well as the HepG2 cells.Conclusion: The induction efficiency of Dex for expression of TAT mRNA is decreased in SMMC-7721 cells,which might be due to the unchanged activity of TAT.

Abstract:Objective：To investigate the effects of oxymatrine(OM) on the apoptosis of human hepatoma HepG2 cells and its possible mechanisms.Methods: HepG2 cells were treated with different concentrations of OM.The proliferation inhibition was measured by MTT assay and the apoptosis of HepG2 cells were examined by Hochest staining method.Flow cytometry was used to analyze the cell cycle distribution and apoptosis rate. The expression of caspase-3,Bcl-2,Bcl-xL and Bax proteins was assayed by Western blotting assay.Results: OM inhibited HepG2 cells growth in a time- and dose-dependent manner.After treatment with OM for 24 hours,some cells appeared typical apoptotic characteristics and the apoptosis rate was increased.Treatment with OM also increased caspase-3 activity and Bax expression in HepG2 cells,and decreased the expression levels of Bcl-2 and Bcl-xL.Conclusion: OM can induce HepG2 cell apoptosis,which may be related to the down-regulation of PI3K/Akt signal pathway,suppression of Bcl-2 and Bcl-xL activity,and activation of caspase-3.

Abstract:Objective:To study the relationship between CXCL12/CXCR4 expression and the neural invasion of salivary adenoid cystic carcinoma (SACC).Methods: Totally 41 SACC specimens,30 tongue cancer specimens,20 pleomorphic adenoma specimens and 20 normal nerve specimens were included in the present study.The specimens were made into sections of 4 μm and EnVision method was used to detect the expression of the chemokine receptor CXCR4 in SACC sections and the expression of the chemokine CXCL12 in the peripheral nerve tissue sections.Results: The chemokine receptor was highly expressed in ACC cells.The positive rate of CXCR4 was 63.41% in the SACC sections,which was significantly higher than those in the tongue cancer group (36.67%) and the pleomorphic adenoma parotid group (35%) (P<0.05).The expression of CXCL12 was not significantly different between the nerve tissues of SACC,tongue cancer and the normal nerve tissues.Conclusion: The chemokine CXCL12 is elevated in the SACC cells and its receptor CXCR4 is elevated in the peripheral nerve tissues,indicating a role of the biological axis of CXCL12/CXCR4 in the neural invasion of salivary adenoid cystic carcinoma.

Abstract:Objective：To investigate the roles of donor alveolar macrophages and the recipient circulating neutrophils in early-stage reperfusion injury of lung allograft,and to study the interaction between the 2 kinds of cells.Methods: Twenty pairs of size- and weight-matched adult mongrel dogs were randomly assigned to 4 groups: C (control),D (leukocyte-depleted blood reperfusion),M (macrophage inhibition) and DM (leukocyte-depleted plus macrophage inhibition).The 20 cases of left lung transplantations were performed by the same surgeon.All procedures were identical,except that the donors in Group M and DM received the macrophage inhibitor gadolinium chloride (14 mg/kg) intravenously 24 h before operation,and that the recipients in Group D and DM underwent initial 10 min reperfusion with leukocyte-depleted blood collected from donors' inferior vena cava.All lung allografts were reperfused for 2 h.Results: Compared with Group D and C,macrophage inhibition ameliorated PO2/FiO2 and mean pulmonary arterial pressure (mPAP) consistently after 30 min reperfusion in Group M and DM; the parameters of lung reperfusion injury (malonaldehyde activity,wet/dry ratio) at 120 min after reperfusion were also significantly improved (P<0.05).Initial leukocyte-depleted reperfusion had no remarkable influence on allograft reperfusion injury,although it reduced pulmonary leukostasis (myeloperoxidase activity) significantly at 120 min after reperfusion.There were no significant interactions between leukocyte-depletion and macrophage inhibition in oxygenation,mPAP,wet/dry ratio,malonaldehyde and myeloperoxidase activity.Conclusion: It is the donor alveolar macrophages,not the recipient circulating neutrophils that can aggravate the inflammatory cascade in lung allografts during 2 h after reperfusion and no interaction is detected between them.

Abstract:Objective：To investigate the effects of estradiol on 60Co γ-ray induced apoptosis of bone marrow hematopoietic cells of mice,and to discuss the related anti-irradiation mechanism.Methods: KM mice were randomly divided into 3 groups (15 mice/each group): control group (without radiation),pure radiation group and estradiol + radiation group (ER group).The pure radiation group was irradiated by 4.0 Gy γ-ray at a dose rate of 1.15Gy/min; the ER group was administered with 0.1 mg estradiol (IM) at 10 days before 4.0 Gy γ-ray radiation; and the control group received no special treatment.The apoptotic DNA segments of bone marrow hematopoietic cells were analyzed by DNA agarose gel electrophoresis; flow cytometry was used to examine the apoptosis rate of cells and expression of Fas and Bcl-2 at 4 h,8 h,and 12 h after irradiation.Results: Eight hours after radiation,the apoptotic DNA segments were obviously increased and apoptotic DNA ladder appeared,which was not seen in the other 2 groups.The apoptosis rate of bone marrow hematopoietic cells in ER group was significantly lower than that in the pure radiation group at 4,8, and 12 h after irradiation(P<0.01).Fas expression was only slightly elevated in the ER group than in the control group, but was markedly lower than that in pure radiation group(P<0.01),and showed no typical crest-time； Bcl-2 expression was significantly higher in the ER group than in the pure radiation group(P<0.01).Conclusion: Estradiol can decrease the apoptosis of mice bone marrow hematopoietic cells induced by γ-ray,probably through down-regulation of Fas and up-regulation of Bcl-2 expression.

Abstract:Objective：To evaluate the protective effect of N-acetylcysteine(NAC) on the small intestine of male rats after X ray irradiation of the whole abdominal region.Methods: Sixty male Spraque-Dawley rats were divided in normal control group (n=12),irradiation group(n=12),and NAC groups(50,200,and 300 mg/kg,n=12).Irradiation injury was induced with X ray at a single dose of 1 000 cGy(source-to-skin distance 80 cm) for the abdominal regions after the animals had been anesthetized with sodium thiopental(40 mg/kg,i.p.).NAC was started 3 days before irradiation and administered for 3 more days after irradiation,and then rats were euthanized after 12 h fasting.The terminal ileum samples were collected for crypt survival assay and counting in ileal villi.The blood samples were collected for examination of superoxide dismutase(SOD) activity,and the contents of malondialdehyde(MDA) and glutathione hormone(GSH) in the small intestine.The plasma levels of D-lactate and diamine oxidase(DAO) were also measured.Results: The mucosal structure of the terminal ileum was damaged after irradiation.The plasma levels of D-lactate,DAO and the content of MDA were significantly increased;the activity of SOD and the content of GSH were significantly decreased(P<0.01).NAC at different dosages increased crypt survival rates and the number of ileal villi in the terminal ileum(P<0.05,P<0.01),enhanced the activities of SOD and content of GSH(P<0.05,P<0.01),and deceased the concentrations of D-lactate,DAO and MDA(P<0.05,P<0.01).Conclusion: NAC may protect the small intestine from irradiation-induced injury by protecting the intestinal mucosal barrier,eliminating oxygen free radicals,and maintaining the internal oxidative balance and the structure and function of intestinal mucous.

Abstract:Objective：To observe the changes of visual evoked potential (VEP) in diabetic rats and the influence of nerve growth factor (NGF) and aminoguanidine (AG) on VEP.Methods: Diabetes was induced in adult male Wistar rats with streptozotocin (STZ).Rats were divided into normal control group (CON),diabetes model group (DM),NGF-treated group (D+N) and AG-treated group(D+A).VEP was measured during the 3rd month,6th month, 9th month,and 12th month.Results: Compared with the CON group,all rest groups had longer latencies and lower amplitudes (P<0.01).During the 6th and 9th months, the latencies in group D+N and group D+A were significantly decreased (P<0.05) compared with DM group, and the amplitude was partially recoved during the 6th month.The changes during the 12th month were similar to those of the 9th month, except that the amplitude in D+A group was slightly higher than that in the DM group.Conclusion: NGF and AG can improve DM-induced elongation of VEP latency and decrease of VEP amplitude.

Abstract:Objective：To observe the changes in the anatomy of anterior segment before and after phacoemulsification for treatment of angle-closure glaucoma by Pentacam system,so as to assess the efficacy of phacoemulsification combined with artificial lens implantation(ALI) in treatment of early- and middle-stage angle-closure glaucoma.Methods:Forty-two patients with early- and middle-stage angle-closure glaucoma(44 eyes) were included in the present study.The central anterior chamber depth,anterior chamber volume and peripheral anterior chamber angle were examined by Pentacam system pre-operatively and 1 day,1 week and 3 months post-operatively.Meanwhile,A ultrasound was used to examine the anterior chamber depth before and 3 months after operation,and the results were compared with those by Pentacam system.Results: Pentacam system could clearly demonstrate the 3-dimensional structures of the anterior eye segment before and after operation.The central anterior chamber depth,anterior chamber volume and anterior chamber angle were increased significantly after operation(P<0.01); the intraocular pressure was significantly decreased(P<0.01); and the visual acuity was improved(P<0.01).The values of central anterior chamber depth and the dispersion coefficient obtained by Pentacam were smaller than those by A ultrasound.Conclusion: Pentacam system can directly demonstrate the increase of anterior chamber depth,anterior chamber volume,and anterior chamber angle after phacoemulsification combined with ALI in treatment of early- and middle-stage angle-closure glaucoma.It is a safe method for early examination after operation.

Abstract:Objective：To evaluate the efficacy and safety of microemulsified cyclosporine (Neoral) and tacrolimus (FK506) for immunodepression after liver transplantation.Methods: According to the including criteria,fifteen randomized controlled trials were enrolled in this analysis.The data of trial design,characteristics of the subjects,and findings of the studies were reviewed and analyzed by RevMan 4.2.8 software.Results: The patient survival rate,graft survival rate,incidence of nephrotoxicity,and incidence of infection were not significantly different between Neoral and FK506 groups,with the relative risk and (95% CI,P) being 0.99(0.96-1.02，0.37)，0.97(0.92-1.03,0.30)，0.99(0.87-1.13，0.86) and 1.08(0.97-1.20，0.16),respectively.The incidences of hypertension (1.34\[1.15-1.55,0.000 1\]) and acute rejection (1.15\[1.06-1.25,0.001\])were significantly lower in the FK506 group,with no significant difference found in the degree of acute rejection (1.00\[0.92-1.22\],0.98).Interestingly,the incidence of diabetes was significantly higher in the FK506 group within 1 year after the operation,but was similar to that of the Neoral group thereafter,with relative risk(95%CI，P)being 0.72(0.62-0.83,<0.000 1) and 1.47(0.98-2.20,0.06)，respectively.Conclusion: The 2 drugs have comparable patient/graft survival rates and incidences of nephrotoxicity and infection.FK506 can better reduce the incidence of acute rejection,but can not alleviate the degree of rejection.FK506 should be recommended for patients suffering from hypertension after liver transplantation and Neoral should be recommended for patients with diabetes.

Abstract:Objective：To investigate the factors affecting the intrahepatic infection after percutaneous radiofrequency ablation (PRFA) for liver cancers.Methods: The clinical data of 1 567 patients with intrahepatic infection after PRFA for liver cancers (from Dec.1999 to Oct.2007) were retrospectively summarized.Logistic regression method was used to analyze the possible affecting factors. Results: Twenty-eight person-times of intrahepatic infection occurred in 1 635 patients who received a total of 2 035 times of PRFA,with the infecting rate being 1.38%.The intrahepatic infection-related mortality was 0.13%(2/1 567).Univariate analysis indicated that the intrahepatic infection was significantly correlated with metastatic liver cancer,pattern of past abdominal operation,tumor location,tumor size and tumor numbers(P<005).Multivariate analysis showed that the types of liver cancer,tumor number,tumor location and pattern of past abdominal operation were independent risk factors for intrahepatic infection after PRFA for liver cancers(r=3.647,P=0004; r=1.155,P=0042; r=1.701,P=0019; r=2.213,P=0010,respectively).Conclusion: Our findings suggested that patients with metastatic liver cancer(especially for the patients who have received gastroenterostomy or cholangioenterostomy),multi-liver cancer,and cancers locating near the cavity organs are liable to intrahepatic infection after PRFA.

Abstract:Objective：To investigate the effectiveness of irbesartan in combination with ramipril for treatment of chronic heart failure in patients with rheumatic heart disease (RHD).Methods:A total of 120 RHD patients with chronic heart failure were randomized into treatment group (n=60) and control group (n=60) after valve replacement.All patients received regular ramipril treatment (5 mg/d); treatment group were also given irbesartan (150 mg/d).The patients were followed up for 6 months.The indices of observation included cardiac function (NYHA Class),6-Minute Hall-Walk distance,and echocardiographic parameters.Results:Six months later the cardiac function in the treatment group was obviously improved compared with the control group; the patients in the treatment group had significant increase in 6-Minute Hall-Walk distance and improvement in echocardiographic parameters (left ventricle end-systolic diameters,end-diastolic diameter,ejection fraction,fractional shortening,P<0.05).Conclusion:Irbesartan in combination with ramipril can obviously improve the cardiac function and reverse ventricle remodeling in RDH patients with chronic heart failure.

Abstract:1临床资料患者男性，74岁，近1年来出现反复心慌，多次在外院就诊，心电图提示快速房颤，未予特别治疗，能自行转为窦性。1周前，再次心慌发作入院。查体：脉搏125次/min，血压 100/60 mmHg(1 mmHg=0．133 kPa)，两肺呼吸音清，未闻及干湿性音，第一心音强弱不等，心率150次/min，心律不齐，各瓣膜听诊区未闻及杂音，双下肢无水肿。心电图提示快速房颤。入院后即给予乙胺碘呋酮150 mg稀释后静脉推注，并以1 mg·kg-1·min-1静脉微泵输入6 h后，改为0.5 mg·kg-1·min-1 微泵输入18 h，同时口服利尿剂。患者自诉心慌有所好转,心电监护提示：房颤节律，心室率较前减慢，波动在110～150 次/min。停用乙胺碘呋酮针剂，给予乙胺碘呋酮片0.2 g 口服,3 次/d。查血、尿、粪常规，肝、肾功能,血糖,电解质,甲状腺功能均未见明显异常。心脏彩超显示：(1)主动脉少量反流(瞬时量：1.73 ml)，(2)左房偏大，(3)二尖瓣、三尖瓣少量反流，(4)左室肌顺应性下降，(5)左室收缩功能正常。入院第4日上午，复查血钾：5.4 mmol/L，心电图仍为房颤，心室率 110次/min。入院第5日凌晨患者排便时突然出现晕厥，数分钟后自行苏醒。动态心电图提示夜间房颤转为窦性，随即出现室性早搏，自发性室颤，近45 s后自行恢复窦性心律。[第一段]

Abstract:Objective：To study the causes of misdiagnosis of patients with POEMS syndrome and to discuss the clues for its early diagnosis.Methods: The clinical and laboratory data of 26 inpatients with POEMS syndrome, who were treated in Changhai hospital over the last decade, were retrospectively analyzed.Results: The misdiagnosis rate of our group was 100%.The misdiagnosis was made in (3.31±0.97) hospitals and in (3.31±0.93) clinical departments; the misdiagnosis period was (19.42±10.86) months and it had been misdiagnosed as 18 other diseases.The initial symptoms included polyneuropathy in 21 (80.8％) cases, edema of lower extremity in 22 (84.6％) cases, and body weight loss in 8 (30.8％) cases.The typical clinical symptoms included polyneuropathy in 26 (100%) cases and organomegaly in 24 (92.3%).Two cases had newly-identified uterine hypertrophy, one had adrenal gland hypertrophy, and one had gastric wall thickening mimicking advanced gastric cancer.Hypothyroidism, impotence, skin pigmentation and sclerosis occurred in 76.9％ (20/26), 60% (6/10), 92.3％ (24/26) and 65.4% (17/26) cases, respectively.Monoclonal plasma cell proliferation was documented in 18 (81.8%); M proteins were positive in 14 (63.6%) cases by serum immunofixation, and only 2 (9.1％) cases also positive by serum protein electrophoresis.One patient was positive of M protein by urine immunofixation and one had abnormal infiltration of plasma cells in the gastric wall.Lymph node biopsy were performed in 8 patients and 3 were found to have Castleman disease; the other 5 cases had lymphocyte infiltration, with 3 complicated with plasma cell proliferation.Nerve biopsy in 4 cases all revealed axonal degeneration and one patient complicated with demyelination.Bone marrow biopsy in 5 cases revealed plasmacytosis in 2 cases and myeloma in one.Excessive radioactivity resorption was found in 10 of the 16 cases (62.5％) and abnormal plasma cells were detected in 2 cases by bone aspiration guided by radioisotope bone scan. Conclusion: Misdiagnosis of POEMS syndrome is very common.Polyneuropathy,edema of lower extremity and body weight loss are the common early symptoms of POEMS syndrome.Early diagnosis can be made by having an intimate knowledge of the progression of the disease and by detecting M protein through various approaches.

Abstract:Objective:To observe the signal changes of blood-oxygen-level-dependent functional MRI (BOLD-fMRI) in brain tissue after inhalation of oxygen. Methods: Fifteen volunteers,9 males and 6 females,were included in the present experiment.The fMRI was conducted using 1.5T Singna Double-gradient Super Conducting Magnetic Resonance Imaging system (GE Inc).Bold-fMRI scanning was conducted using GRE-EPI sequence and data analysis was done using SPM2 software. Meanwhile,the BOLD-fMRI T2 signal changes after 15 s and 6 min inhalation of pure oxygen were observed and compared with those after inhaling normal air.Results: No obvious activation of BOLD-fMRI was observed in the whole brain after inhaling normal air.Fifteen seconds after inhaling pure oxygen,the signal changes in the whole brain mainly manifested as the signal decrease in the gray matter,with average signal change being (-0.041±0.31)% in the gray matter and about (0.056±0.26)% in the white matter; the changes were significantly different from those of the normal air group (P<0.001). Six minutes after inhaling pure oxygen,signal changes in the whole brain mainly manifested as the signal increase in the white matter,with the average signal change being about (0.015±0.365)% in the gray matter and (0.14±0.278)% in the white matter; the changes were significantly different from those of the normal air group (P<0.001).Conclusion: Inhaling oxygen for different time periods can cause different BOLD signal changes in brain tissues. BOLD T2 signal in grey matter is decreased after short-time inhalation and is increased in white matter after long-time inhalation.

Abstract:Objective：To investigate the value of magnetic resonance cholangiopancreatography(MRCP) in the diagnosis of pancreas divisum by comparing with endoscopic retrograde cholangiopancreatography (ERCP).Methods: The MRCP and ERCP images of 8 patients with pancreas divisum were retrospectively analyzed. The diagnostic accuracy and findings by MRCP were compared with those by ERCP. Results: MRCP had a diagnostic accuracy of 87.5%（7/8） based on the result of ERCP. ERCP displayed the dominant dorsal pancreatic ducts in all 8 cases and ventral pancreatic ducts in 6 cases; MRCP also displayed the dominant dorsal pancreatic ducts in all 8 cases, but the ventral pancreatic ducts only in 3 cases.Conclusion: As a non-invasive technique,MRCP has important clinical value in the diagnosis of pancreas divisum.

Abstract:Objective：To design and prepare a fiberoptic bronchoscopy training box and to study its primary application.Methods: According to the length of optical fiber,the height,the length and the width of the box were set at 400 mm,200 mm and 200 mm.The box contained 6 layers from the top to the bottom:the top-layer,layer-A,layer-B,layer-C,layer-D and the bottom-layer,with the area of each layer being 200 mm×200 mm and the distance between each 2 layers was about 80 mm.According to the diameter of optical fiber,the diameter of the holes was set at 6 mm.Except for the bottom-layer,the other 5 layers had different numbers of holes:the top-layer and layer-A only had a central hole(central hole in every layer was defined as hole-0),layer-B had 5 holes(hole-0 to 4),layer-C had 9 holes(hole-0 to 8),layer-D had 17 holes(hole-0 to 16).The training started from the top-layer.The orders were given according to the layers and the numbers of the holes and the orders were executed,then the box was open to examine the outcome of the execution.Results: We successfully designed a fiberoptic bronchoscopy training box.If the training instruction order was A0-B2-C4-D7,the trainees should manipulate the optical fiber via the central hole in top-layer and layer-A,hole-2 in layer-B,hole-4 in layer-C,and hole-7 in layer-D.The results of manipulation can be examined after opening the door.Conclusion: The fiberoptic bronchoscopy training box is a easy-to-operate and practical tool for training of fiberoptic bronchoscopy manipulation.

Abstract:Hepatic stem cells transplantation might be an important treatment strategy for patients with end stage liver diseases and related research has become a focus of recent studies. Hepatic stem cells of different sources have great therapeutic potential in clinical practice, but much research still need to be done before it can be used as a routine method in clinical practice. This review discusses the characteristics of hepatic stem cells and its role in liver regeneration after liver damage.

Abstract:Hepatic ischemia-reperfusion injury (IRI) is a critical problem of liver surgery,especially when comes to liver transplantation.Presently,there are no effective measures for diagnosis,prevention and therapy of IRI,as the mechanisms of IRI still remain unclear.This review summarizes several new hepatic ischemia-reperfusion markers related to cell signal transduction pathway,including transcription factor STAT，HIF-1 and PPARs,transmission factor MAPK， membrane receptor TLR4 and PARs,and iNOS.Animal studies have indicated that IRI was ameliorated by activating or blockading these markers, which might serve as targets for diagnosis,prevention and therapy of IRI.

Abstract:Sleep plays an important role in the modulation of endocrine function and energy metabolism;hormone levels are markedly different during a sleepless night compared with a night of normal sleep.Sleep deprivation may change the levels of cortisol,growth hormone (GH) and thyrotropin (TSH) at night.In addition,sleep curtailment disturbs the balance of anorexigenic (leptin) and orexigenic (ghrelin) factors,and does harmful to glucose tolerance.

Abstract:Objective：To develop a new quantitative method without calibration set for near-infrared spectroscopy (NIR). Methods: The new calibration-free NIR method was based on a spectrum of the sample and a spectrum of the mixture. The similar intervals between the spectra of the sample and the mixture were obtained through second derivation, differential spectra and calculation of similarity. Then statistical quantitative analysis was performed. Results: The contents of 3 components in 3 samples were determined with the new method; the average recovery was 100.9% and the relative standard deviation was 6.1% (n=9). Conclusion: Satisfactory results can be obtained by this new method without traditional calibration set. The new method provides an alternative for the quantitative analysis in NIRs and has a promising future.

Abstract:颈椎病是中、老年人的常见病和多发病，随着现代社会计算机的广泛使用、社会的老龄化和长期伏案工作，颈椎病的发病率越来越高，严重威胁了广大人民群众的身体健康\[1-3\]。研究发现：引起颈椎病的原因是复杂的，但睡眠时枕头使用不科学，使颈椎长期处于非正常状态是其重要的发病原因之一\[4-5\]。每个人一生中超过1/3的时间是在睡眠中度过的，而枕头又是绝大多数人睡眠不可缺少的，如果睡眠时枕头过高，则颈椎往往会长时间处于过屈的位置，而枕头过低，则又会使颈椎处于过伸的状态。这两种情况都会使睡眠时颈椎和周围软组织长期处于一个不良的姿势，导致颈椎及肌肉劳损，从而诱发或加重颈椎病，而俗称的“落枕”就是由于睡眠姿势不正确所引起的\[6-7\]。因此在颈椎病防治中十分重要的一点就是在睡眠中要尽量维护颈椎的生理状态，让颈椎处于放松状态。所以说，选择适合自身高度的枕头在颈椎病的防治中具有十分重要的意义，但长期以来，人们对于枕头的合适高度仍存在争议。为了进一步研究人体睡眠时适宜的枕头高度，我们在2006至2007年对80例成人的枕高相关数据进行了测量分析，现将其结果报告如下。[第一段]

Abstract:肾输尿管全长切除及经同侧输尿管开口周围壁瓣切除是治疗上尿路肿瘤的标准术式\[1\]，但传统的手术方法需腰部和下腹部两个切口，该术式损伤较大、患者心理负担重、恢复慢且并发症较多。1992年Gaur\[2\]首创了球囊扩张术成功分离后腹膜，使后腹膜途径成为可能。现腹腔镜技术已广泛用于泌尿外科手术。由于此术式具有损伤小、恢复快等优点，越来越被广大患者所接受。2006年5月至2007年4月，笔者应用后腹腔镜下根治性肾切除联合下腹部斜形小切口治疗上尿路肿瘤12例，效果满意，现报告如下。[第一段]