AIM: To investigate the epidemiological character of white without pressure(WWOP)in the healthy adolescents by fundus examination and provide theoretical support for air force recruitment and health examination. METHODS:A total of 461 middle school graduates and 71 junior middle school graduates, who participate in the air force cadets' medical selection, were selected as subjects. The ultra-wide-angle laser fundus scanning system, direct ophthalmoscopy and three-sided mirror were used to check the fundus. The χ2 test was used to analyze the incidence and distribution of fundus abnormalities.RESULTS: The prevalence of WWOP in healthy adolescents was as high as 2.63%. There was no significant difference in the prevalence of WWOP among junior middle school graduates(P>0.05). The lesion was more common in the temporal quadrant, especially the lower temporal quadrant. In the eyes with WWOP in high school graduates, the proportion of retinal degeneration was as high as 18.18%, which was significantly higher than that without WWOP. CONCLUSION:WWOP is not uncommon in adolescents and is more common in the temporal quadrant. The proportion of retinal degeneration in eyes with WWOP is significantly higher. Thus, in order to avoid missed diagnosis, the surrounding retina should be carefully examined if WWOP was founded in aviation physical examination.

目的 探讨快速康复外科(fast track surgery,FTS)理念在结肠癌合并肠梗阻病人围手术期的应用价值与安全性.方法 结肠癌合并肠梗阻病人72例,采用随机数表分为传统组(36例)与FTS组(36例),传统组按照传统外科理念行围手术期管理,兀S组按FTS理念行围手术期管理.比较两组病人术后VAS评分、首次离床时间、首次排气排便时间、首次进流食时间、住院时间、术后并发症等情况.结果 F髑组术后1天、3天VAS评分低于传统组(P＜0.05),术后7天两组病人VAS评分比较差异无统计学意义(P＞0.05).FTS组与传统组首次离床时间分别为(17.66±12.10)小时和(26.37±10.70)小时,首次排气时间分别为(47.54±15.30)小时和(57.95±18.40)小时,首次排粪时间分别为(98.26±27.10)小时和(115.63±27.50)小时,首次进流质时间分别为(48.72±13.50)小时和(57.75±17.00)小时,出院时间分别为(5.85±2.20)天和(8.73±3.50)天,两组比较差异有统计学意义(P＜0.05).FTS组病人术后肺部感染、切口感染的发生少于传统组,术后腹胀、呕吐的发生多于传统组,两组比较差异有统计学意义(P＜0.05).两组病人术后腹腔内出血、腹腔内感染、吻合口狭窄等并发症以及并发症总体发生率比较无明显差异(P＞0.05).结论 FTS理念在结肠癌合并肠梗阻病人中安全有效,并未增加并发症的发生,有利于术后康复,缩短住院时间.

目的 研究胃袖状切除术联合空肠旁路术(sleeve gastrectomy plus jejunal bypss,SG+ JJB)对2型糖尿病(type 2 diabetes mellitus,T2DM)大鼠血糖及胰高血糖素样肽1(glucagon-like peptide 1,GLP-1)的影响,探讨SG+ JJB对T2DM大鼠的降糖效果及机制.方法 将24只T2DM大鼠按随机数字表法分为两组,各12只,分别为SG+ JJB组、假手术组.测定两组T2DM大鼠术前,术后2周、1个月、2个月、3个月的体质量、空腹血糖(fasting blood glucose, FBG)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(glycated hemoglobin,HbA1c)、GLP-1水平的变化.结果 与术前比较,SG+ JJB组在术后2周、1个月、2个月、3个月体质量均较术前明显下降(P均＜0.01),术后2周FBG亦较术前显著下降,并于术后3个月趋近正常水平(P均＜0.01),术后3个月HbA1c较术前显著降低(P＜0.01)、FINS较术前显著升高(P＜0.01).与术前比较,SG+ JJB组术后2周、1个月、2个月、3个月的空腹GLP-1水平均显著升高(P均＜0.01).相同条件下,假手术组T2DM大鼠术后上述各项指标均无统计学意义(P＞0.05).结论 SG+ JJB通过促进大鼠GLP-1释放,增加胰岛素分泌,对降低血糖起着关键作用.

!" +˜<=>?@A™8D#š›œž Foxp3 iŸ ¡ 2 3 ¢£¤w(indoleamine 2 3 dioxygenase IDO)K š¥# ›œ Foxp3 IDOg¦§ ̈© r mn# N C57BL/6¦§Ta= BALB/c¦§T=«¬ ­® ̄V#° 30± BALB/c¦§2@3T 3 ́$ 6±μ 12±μ· ̧1o» 12±# 1⁄41⁄23⁄4.¿ÀÁμ· ̧1o» 1⁄41⁄23⁄4· ̧1ÂÃÄ 10 mg/kg 3Åp 0 2 4 6 8 10 dÆÇÈÂÃ1⁄2É#nÊËÌ ÍÎ ̈©ÏÐ †¤ÑÒÓ 5Ô ÕÖI×Ø Real-time PCRÒÓ 5Ù Foxp3 mRNA IDO mRNA ×Ø# Ú· ̧1o» >. ̈© ÛÜ(20.667±1.033) d ) (14.833±1.472) d89Ý U(P < 0.05)μÞ ß 14à 5ÙÔ ÕÖI` Foxp3 mRNA IDO mRNA ×Ø)· ̧1o» 89áâ(P < 0.05)μãäåæç Ô ÕÖI` Foxp3 IDOg ̈© LMr> jY mn :; 5Ô ÕÖI` Foxp3 IDO×؀ašèpé # ! Foxp3 IDO " !

Objective To observe the effect of ileal transposition(IT) surgery on fasting blood glucose(FBG),glucagon-like peptide-1 (GLP-1),glucagon-like peptide-2(GLP-2),D lactate and diamine oxidase(DAO) expression,and intestinal barrier in type 2 diabetes mellitus(T2DM) rats and the possible mechanisms.Methods T2DM rats were randomly divided into IT surgery group(n =30) and sham operation group(n =30).The FBG,GLP-1,GLP-2,D lactate and DAO levels in the two groups were determined before and 3 days,1 week,2 weeks,4 weeks,6 weeks,8 weeks after operation.Results There was no significant difference in FBG,GLP-1 and GLP-2 before and at 3rd day after operation in IT group(P＞0.05).FBG levels were significantly decreased (t1w =6.148,P1w ＜0.001;t2w =8.650,P2w＜0.001;t4w =9.569,P4w＜0.001;t6w =11.201,P6w＜0.001;t8w =12.424,P8w＜0.001),and GLP-1 and GLP-2 levels were significantly increased at 1w,2w,4w,6w,8w in IT group[(GLP-1:t1w =-12.794,P1w＜0.001;t2w =-18.477,P2w＜0.001;t4w =-24.252,P4w＜0.001;t6w =-27.378,P6w＜0.001;t8w =-40.056,P8w＜0.001) and (GLP-2:t1w =-12.305,P1w＜0.001;t2w =-14.708,P2w＜0.001;t4w =-28.142,P4w＜0.001;t6w=-27.378,P6w ＜0.001;t8w =-40.056,Psw ＜0.001)].As compared with preoperation,D lactate and DAO levels were significantly increased at 3rd day after operation in IT group[(DAO:t3d =-46.223,P3d ＜0.001);(D lactate:t3d =-6.439,P3d＜0.001)].There was no significant difference in D lactate and DAO levels before and at 1w,2w,4w,6w,8w after operation in IT group(P＞0.05).Under the same conditions,there were no obvious changes in the above indexes in sham group(P＞0.05).Conclusions IT surgery has a significant hypoglycemic effect and can protect intestinal barrier function by stimulating the secretion of GLP-1 and GLP-2.

Objective To investigate the value difference of high-sensitivity modified glasgow prognostic score (HS-mGPS) and modified glasgow prognostic score (mGPS) on the prognostic predict of patients with gastric cancer.Methods The clinical data of 552 patients who were diagnosed with gastric cancer and accepted surgery treatment in our department were respectively collected.And all the patients were scored according to the score criterion of HS-mGPS and mGPS.Compare the difference of clinicopathological characteristics of tumors and prognostic between patients with different scores.Results The score results for 552 patients are mGPS 0 score 494 cases,mGPS 1 score 34 cases,mGPS 2 score 24 cases;HS-mGPS 0 score 411 cases,HS-mGPS 1 score 75 cases,HS-mGPS 2 score 66 cases,the 2 score systems are all correlate with patients' age,tumor TNM stage,local lymphatic metastasis and vascular invasion [mGPS (Age:t =10.292,P =0.000;Sex:x2 =0.140,P =0.942;Tumor differentiation grade:x2 =0.260,P =0.883;TNM stage:x2 =8.326,P =0.000;Lymph node metastasis:x2 =13.574,P =0.000;Venous invasion:x2 =13.501,P =0.000) vs.HS-mGPS (Age:t =10.095,P =0.002;Sex:x2 =1.195,P=0.329;Tumor differentiation grade:x2 =0.512,P=0.778;Lymph node metastasis:x2 =7.060 P =0.000;Lymph nodemetastasis:x2=13.468,P =0.000;Venous invasion:x2 =13.974,P =0.000)].The results of univariate and multivariate analysis of risk fators of death after surgery manifest that,age,tumor differentiation,tumor TNM stage,lymphatic metastasis,vascular invasion,mGPS and HS-mGPS are all independent risk factors of death after surgery [Single factor analysis:Sex:P =0.187,odds ratio (OR) =0.869;Age:P =0.000,OR =1.474;Tumor differentiation grade:P =0.000,OR =3.121;Lymph node metastasis:P =0.000,OR =4.059;Venous invasion:P=0.000,OR =3.535;Tumor differentiation grade:P =0.000,OR =2.974;HS-mGPS:P =0.000,OR =4.578;mGPS:P =0.000,OR =2.331 and Multiple factors analysis:Age:P =0.000,OR =1.319;Tumor differentiation grade:P =0.010,OR =1.235;Lymph node metastasis:P =0.017,OR =1.213;vascular invasion:P =0.020,OR =1.306;tumor TNM stage:P =0.000,OR =2.909;HS-mGPS:P =0.007,OR =3.845;mGPS:P =0.000,OR =1.883].Conclusion Compared with mGPS,the HS-mGPS download the score level,expanded the potential risk of poor prognosis of patients with gastric cancer,and may have a certain reference value in improve the prognosis of these patients.

Objective To investigate the difference in the curative effectiveness of single-hole vs.three-hole laparoscopy for inguinal hernia repair.Methods The clinical data of 205 patients diagnosed as having inguinal hernia undergoing laparoscopic inguinal hernia repair in our department from June 2011 to June 2016 were retrospectively collected.205 patients were divided into single-(129 cases) and three-hole (76 cases) groups,and the differences in patients' sex structure,age distribution,the average BMI,operation time,transit operation rate (conversion of single-hole method to three-hole method or laparoscopy to the traditional open surgery) and the incidence of postoperative complications were compared between two groups.Results There were no significant differences in gender structure,average age,average BMI and hernia type (unilateral or bilateral) (P＞0.05 for all) between two groups.The operation time in the single-hole group was relatively long (single-hole group vs.threehole group:55.3 ± 22.8 vs.49.4 ± 14.9 main),but the difference showed no statistically significant difference between two group (P =0.06),and there was no significance difference in conversion rate between two groups (P =0.98).There was no significance difference in postoperative urinary retention and infection of incision between two groups,but postoperative pain degree was milder,and postoperative hospital time was shorter in the single-hole group than in the three-hole group with the difference being statistically significant (P＜0.05).There was no significant difference in general hospitalization cost between two groups (single-hole group vs.three-hole group:2.21 ± 0.65 vs.2.55 ± 0.89) (P＞0.05).There was no significant difference in the incidence postoperative hematoma formation,subcutaneous emphysema,and chronic pain between two groups (P＞0.05),but as compared with the three hole group,incidence of complications in single-hole group had a decreased trend.Conclusions Single hole laparoscopic inguinal hernia repair is relative safe,and has more advantages on health economic indicators and minimally invasive surgery,which matches the concept of fast track surgery better and is worth of further clinical study.

Objective To investigate the degree and the mechanism of brain damage induced by cardiac arrest and resuscitation in rats.Methods A total of 16 male Sprague Dawley rats were randomly divided into the sham group and cardiac arrest/cardiopulmonary resuscitation (CA/CPR) group.The model of cardiac arrest induced by asphyxia was established and CPR was performed.Serum protein neuron specific enolase (NSE) and S100β was detected by enzyme linked immunosorbent assay (ELISA).The levels of B cell lymphoma/leukemia-2 associated X protein (bax),B cell lymphoma/leukemia-2 (bcl-2),Caspase-3 protein were measured by Western boltting.Neuronal apoptosis was examined by TdT-mediated dUTP nick end labeling (TUNEL) method and morphological changes of rat brain were ob served.Results S100β levels in CA/CPR group were (4.488 ± 0.762),(6.003 ± 0.718) and (5.913 ± 1.817) ng/ml at 0,3,6 h after resuscitation respectively,statistically higher than in sham group (P =0.010,0.000,0.038).The levels of NSE were (15.628 ± 3.750) ng/ml in CA/CPR group and (9.376 ±2.865) ng/ml in the sham group at 6 h after resuscitation,with the difference being statistically significant (P =0.038).Serum proteins NSE and S100β were on a rise,and there was significant differ ence in the S100β protein levels at 0,3 h was statistically significant (P =0.031,0.012).As compared with sham group [for bax,(0.326 ±0.041);for Caspase-3,(0.394 ±0.038);for bcl-2,(0.212 ± 0.039)],the bax [(0.731 ±0.018)],and Caspase-3 (0.445 ±0.028) protein levels were increased,and bcl-2 [(0.125 ± 0.036)] levels were reduced in CA/CPR group with the difference being statistical ly significant (P =0.000,0.001,0.003).The changes in brain tissue morphology were more obvious in CA/CPR group than in sham group.The apoptosis rate of neurons in CA/CPR group was (29.72± 6.29) ％,higher than that in sham group (P =0.000).Conclusion Five minutes of cardiac arrest in rats causes significant damage to brain tissue,and the damager gradually aggravates over time,whith may be related to the triggering of apoptosis.

Objective To investigate the prognostic value of McGill Brisbane symptom scores(MBSSs)on pancreatic head carcinoma.Methods The clinical data of 83 patients diagnosed with pancreatichead carcinoma and accepting surgical therapy in our department were respectively collected.Gender,age,basic diseases,weight loss situation,abdominal pain,jaundice,smoking history,operationcondition (R0 or not R0),the merger of local nerve and vascular invasion,lymph node invasionand the survival rate at the point of follow-up of 2 years were recorded.Single factor analysis was usedto compare difference of indicators above mentioned between groups.And indicators with significantdifference between groups were selected for further multivariate analysis to determine the risk factorsof postoperative poor prognosis for pancreatic head carcinoma.Results All the 83 patients were dividedinto low MBSSs group (n =37)and high MBSSs group (n =46).There was no significance differencebetween groups in average age,gender structure,combination of basic diseases,tumor differentiationdegree,peripheral nerves,blood vessels and lymph node invasion (P >0.05 for all).In highMBSSs group,the tumor was relatively larger,tumor stage was later,and no-R0 resection rate andaverage MBSSs were higher than in low MBSSs group (P <0.05 for all).Tumor size,stage,operationmethod and MBSSs were 4 independent risk factors for poor postoperative prognosis for pancreatichead cancer (OR>1 .0 for all,and P <0.05 for all).And at the point of MBSSs=9.0,the sensitivityand specificity for predicting poor postoperative prognosis for pancreatic head cancer were 80.44% and 85 .23 % respectively.Conclusions MBSSs are associated with postoperative prognosis for patientswith pancreatic head carcinoma.High MBSS is an independent risk factor for poor prognosis,and atthe point of MBSSs>9,the sensitivity and specificity of predicting poor postoperative prognosis forpancreatic head cancer were relative high,which is worth of further clinical research.

Objective To investigate the risk factors of postoperative urinary retention (POUR) after laparoscopic inguinal hernia repairs.Methods The clinical data of 340 patients who were diag-nosed as having inguinal hernia and accepted laparoscopic inguinal hernia repairs in our department from January 2010 to May 2015 were respectively collected,and all the 340 patients were divided into POUR group and non-POUR group according to the existence of POUR or not.The differences in age distribution (<50 years,≥50 years),gender composition (male/female),the existence of benign prostatic hypertrophy or not,preoperative void bladder or not,intraoperative catheterization or not, intraoperative fluids,operative time and the postoperative use of narcotic analgesics were compared, and ROC and multivariate Logistic regression analysis were used to define the risk factors of POUR af-ter laparoscopic inguinal hernia repairs.Results There was no significant difference in gender compo-sition (male/female),the existence of benign prostatic hypertrophy or not,preoperative void bladder or not,intraoperative catheterization or not,intraoperative fluids and operative time between two groups (P>0.05 for all).The results of univariate and multivariate Logic regression analysis revealed that older than 50 years (OR=3.0,95%CI 1.3-6.9,P=0.01)and postoperative use of narcotic an-algesics (OR=2.7,95%CI 1.2-6.1,P=0.01)were independent risk factors of POUR after laparo-scopic inguinal hernia repairs (OR>1 for all,P<0.05 for all).Conclusions Older than 50 years (OR=3.0,95%CI 1.3-6.9,P=0.01)and postoperative use of narcotic analgesics (OR=2.7,95% CI 1.2-6.1,P=0.01)are independent risk factors of POUR after laparoscopic inguinal hernia repairs.

目的 对比分析回肠转位术(ileal transposition,IT)与Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RYGBP)对非肥胖型2型糖尿病(type 2 diabetes mellitus,T2DM) GK大鼠模型的血糖控制效果及其对胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)表达的影响.方法 采用随机数字表法将30只雄性正常体质量GK大鼠随机分为IT组、RYGBP组和Sham组,每组10只,记录大鼠术后的并发症发生情况和死亡情况.3组大鼠均于术前,术后1周、2周、1个月、2个月、3个月及6个月检测空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)及GLP-1水平.结果 ①并发症发生和死亡.术后Sham组及IT组大鼠均未见并发症发生及死亡.术后仅RYGBP组有5只大鼠发生并发症,其中3只死亡.与Sham组和IT组比较,RYGBP组大鼠的并发症发生率和死亡率均较高(P＜0.05).②FBG.同组内与术前比较,RYGBP组和IT组大鼠术后1周、2周、1个月、2个月、3个月及6个月时的FBG水平均较低(P＜0.05);术后1周、2周、1个月、2个月、3个月及6个月时,RYGBP组和IT组大鼠的FBG水平均低于Sham组(P＜0.05),但各时点RYGBP组和IT组比较差异均无统计学意义(P＞0.05).③FINS及HbA1c.同组内与术前比较,RYGBP组和IT组大鼠术后3个月及6个月时的FINS水平均较高(P＜0.05),但HbA1c水平均较低(P＜0.05);术后3个月和6个月时,RYGBP组和IT组大鼠的FINS水平均高于Sham组(P＜0.05),HbA1c水平均低于Sham组(P＜0.05),但同时点RYGBP组和IT组比较差异均无统计学意义(P＞0.05).④GLP-1.同组内与术前比较,RYGBP组和IT组大鼠术后1周、2周、1个月、2个月、3个月及6个月时的GLP-1水平均较高(P＜0.05);术后1周、2周、1个月、2个月、3个月及6个月时,RYGBP组和IT组大鼠的GLP-1水平均高于Sham组(P＜0.05),但同时点RYGBP组和IT组比较差异均无统计学意义(P＞0.05).结论 IT与RYGBP对非肥胖型T2DM GK大鼠均具有显著的降糖作用,但与RYGBP比较,IT的并发症更少,更安全有效.

目的 观察回肠转位术(ileal transposition,IT)对非肥胖型2型糖尿病GK大鼠的血糖及胰高血糖素样肽-1 (glucagon-like peptide-1,GLP-1)的影响,探讨IT对GK大鼠的降糖作用及其可能的机制.方法 随机数字表法将20只雄性正常体质量GK大鼠分为回肠转位术组(IT组)和假手术组(Sham组),每组10只.观察并测定两组GK大鼠术前及术后1周、2周、1个月、2个月、3个月、6个月的体质量、空腹血糖(fasting blood glucose,FBG)、血清胰岛素(fasting insulin,INS)、糖化血红蛋白(glycosylated hemoglobin,HbA1c) 、GLP-1水平的变化.结果 IT组与Sham组手术前后体质量比较无统计学差异(P＞0.05).与术前比较,术后1周～6个月IT组GK大鼠FBG明显降低(P＜0.05),空腹GLP-1明显升高(P＜0.05),术后3个月和6个月HbA1c明显降低(P＜0.05)、INS水平明显升高(P＜0.05).Sham组上述指标均未见明显变化.结论 IT对GK大鼠有明显的降糖作用,其机制可能是食物提前进入回肠,刺激GLP-1分泌增加,从而促进胰岛素释放,促进β细胞增生并抑制其凋亡.

目的 探讨新损伤严重程度评分(new injury severity score,NISS)与损伤严重程度评分(injury severity score,ISS)对腹部损伤病人预后预测价值的差异.方法 自2010年1月至2015年5月,按照连续采样的方法收集就诊的腹部损伤病人的临床资料,根据病人是否死亡将所有病人分为死亡组和生存组.比较组间病人年龄、性别、入院时脉搏、收缩压、NISS、ISS以及受伤机制的差异,多元回归分析法判定腹部损伤病人死亡的相关危险因素,并绘制相关危险因素预测病人死亡的ROC曲线,以比较两种评价体系对病人预后预测价值的差异,并确定相关危险因素预测病人死亡的临界值.结果 组间病人入院情况相比,生存组病人入院时平均脉搏相对较慢,收缩压相对较高,ISS、NISS评分相对较低,就病人致伤因素分布情况来看,死亡组病人交通事故伤病人比例相对较高,以上组间相比差异均有统计学意义(P均＜0.05).病人死亡危险因素的多元回归分析结果显示,病人入院时收缩压、ISS、NISS评分是腹部损伤病人死亡的独立危险因素(OR值均＞1.0,P值均＜0.05).ISS、NISS预测病人死亡的对比分析结果显示,NISS[曲线下面积(AUC)=0.96,95％置信区间(CI):0.57～1.93,P＜0.001]预测病人死亡风险的AUC较ISS(AUC=0.75,95％ CI:0.92～1.00,P=0.003)相对较大,准确性相对较高,在NISS=14时,其预测腹部损伤病人死亡的敏感性和特异性分别为90.2％和88.6％.结论 ISS、NISS两种评分体系均是腹部闭合性损伤病人死亡风险的独立危险因素,但在病人死亡风险预测上,NISS评分的预测价值相对较大,值得临床进一步研究证实.

胸腔镜下胸交感神经干切断术因其创伤小、暴露好、定位准确、安全可靠、效果满意且持久等特点，已成为目前治疗手汗症唯一有效的微创手术方法［1］。2008年11月至2015年9月，我科共为66例手足多汗症患者施行手术治疗，取得了满意效果，现总结报道如下。

目的 探讨腹腔镜Roux-en-Y胃旁路术(Laparoscopic Roux-en-Y gastric bypass,LRYGB)对2型糖尿病(type 2 diabetes mellitus,T2DM)及其并发症的长期临床疗效.方法 回顾性分析我院收治的48例T2DM患者的临床资料.术后随访4年,分析术前及术后体重指数(BMI)、腰臀比(WHR)、糖脂代谢指标的变化.同时观察T2DM相关并发症的改善情况.结果 48例手术均在腹腔镜下顺利完成,无一例中转开腹,随访期间,无死亡病例及严重手术并发症发生.48例T2DM患者的BMI及WHR在术后3个月、6个月、1年、2年、3年、4年均较术前显著下降,差异有统计学意义(P＜0.05).同时,糖代谢相关指标空腹血糖(FPG)、标准馒头餐后2h血糖(2h PG)、空腹C肽(FC-P)、糖化血红蛋白(HbA1c)于术后各时间点均较术前明显下降(P＜0.05).与术前比较,脂代谢相关指标TC、TG、HDL、LDL于术后各时间点均较术前明显改善(P＜0.05).48例接受LRYGB的T2DM患者有效率达100％.结论 腹腔镜Roux-en-Y胃旁路术是治疗2型糖尿病的一种安全有效的手术方式,完善的术前评估、围手术期规范化的管理及长期随访是保证手术疗效的关键.

OBJECTIVETo investigate the surgical methods and effectiveness to use the iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect.METHODSBetween January 2013 and January 2016, iliac flap combined with anterolateral thigh flap was used to repair the first metatarsal bone and large skin defect in 9 patients. There were 5 males and 4 females, with a median age of 15 years (range, 10 to 60 years). The causes included traffic accident injury in 6 cases and crush injury of machine in 3 cases. The average time from injury to operation was 3 hours to 14 days (mean, 7 days). The size of skin soft tissue defect ranged from 10 cm×6 cm to 20 cm×10 cm. The size of first metatarsal bone defect ranged from 2 cm×1 cm to 5 cm×1 cm. The size of iliac flap was 3.0 cm×1.5 cm to 6.0 cm×1.5 cm, and the size of anterolateral thigh flap was 10 cm×6 cm to 20 cm×10 cm. The donor site was directly sutured or repaired by free skin graft.RESULTSAfter operation, the composite flaps survived with primary healing of wound; the skin grafts at donor site survived and the incision healed by first intention. All patients were followed up 6 months to 2 years (mean, 1.6 years). X-ray examination showed that the bone healing time was 3.5-5.0 months (mean, 4 months). The flap had soft texture, good color and appearance. All patients could normally walk. According to the American Orthopaedic Foot and Ankle Society (AOFAS) standard, the foot function was excellent in 6 cases and good in 3 cases, and the excellent and good rate was 100% at last follow-up.CONCLUSIONSThe iliac flap combined with anterolateral thigh flap for repair of the first metatarsal bone and large skin defect is a practical way with good shape at one stage.

Objective To investigate effects of penehyclidine hydrochloride (PHC)protects a-gainst acute lung injury (ALI)in heart valve replacement patients with cardiopulmonary bypass (CPB).Methods Thirty rheumatic heart disease patients,eighteen males and twelve females with NYHA Ⅱ or Ⅲ,with cardiac valve replacement undergoing CPB were enrolled in the study.All pa-tients were randomly divided into group P and group C (fifteen in each group).Patients in group P re-ceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in group C received the same volume of normal saline.Blood samples were collected to monitor the concentrations of IL-6,TNF-αand NF-κB at the following time points:before anesthesia induction (T0 ),the end of the operation (T1 ),6 hours (T2 ),12 hours (T3 )and 24 hours(T4 )postoperatively,arterial blood gas analyses were detected and oxygenation index (OI)was calculated at the time of T0 ,T1 and T4 , as well as lung dynamic compliance of patients adopt at the time of soon after anesthesia induction and the end of the operation.The outcomes included duration of intubation (DOI),length of intensive care unit stay (LOI)and length of hospital stay after the surgery (LOH).Results The DOI,LOI and LOH in group P were shorter than those in group C,but there was no statistical significance between groups.The plasma levels of IL-6,TNF-α and NF-κB were higher at T1-T4 than T0 in both groups (P <0.05),and those in group P were statistically lower than group C at T1-T4 (P <0.05).The val-ues of OI at T0 and T1 were obviously lower than T4 in both groups (P <0.05),and that in group P was slightly higher than group C at T4 but without statistical significance.The lung dynamic compli-ance of patients in group P at the end of operation was obviously higher than that in group C (P <0.05).Conclusion PHC inhibits systemic inflammatory response,improves lung compliance,amel-iorates tissue oxygen supply and encourages postoperative rehabilitation in valve heart replacement pa-tients with CPB,and its mechanisms is relevant to the regulation of NF-κB signal way on the produc-tion of such proinflammatory cytokines as IL-6 and TNF-α.

目的 探讨早期死亡风险评分(early mortality risk score,EMRS)对胰腺癌患者术后预后的预测价值,寻找胰腺癌术后预后不良的早期预测方法.方法 收集就诊并接受根治性手术治疗的370例胰腺癌患者的临床资料,记录患者的性别,年龄,体质指数(BMI),肿瘤部位、大小,合并基础疾病情况,术后生存时间,EMRS评分结果等信息.根据患者术后1年的临床结局(生存,死亡)将患者分为生存组和死亡组.单因素分析法比较组间上述指标的差异,选取单因素分析当中有差异的指标进一步进行Logistic多元回归分析,以确定胰腺癌患者术后预后不良的相关危险因素,并评价EMRS对胰腺癌患者术后预后的预测价值.结果 本组370例患者,根据随访1年时的临床结局分为生存组(252例)和死亡组(118例),两组患者平均年龄、性别构成、合并基础疾病、既往吸烟史、近期体重变化、肿瘤分化程度、是否合并淋巴结转移、周围神经转移、血管转移、及术后并发症发生率比较,差异无统计学意义(P＞0.05);死亡组患者肿瘤相对较大,切缘阳性率、平均EMRS评分较高,组间比较差异有统计学意义(P＜0.05);且肿瘤大小,切缘阳性率、EMRS评分3项指标进行多元Logistic回归分析,结果显示,该3项指标均为胰腺癌患者术后早期预后不良的独立危险因子(OR均＞1.0,P均＜0.05);在EMRS=3.0时,其预测患者术后早期预后不良的敏感性和特异性分别为77.4％和82.3％.结论 EMRS与胰腺癌患者术后早期预后有关,高EMRS评分是胰腺癌患者术后早期预后不良的独立危险因子,EMRS评分＞3时,其预测胰腺癌患者术后早期预后不良的敏感性和特异性均较高.

Objective To investigate the prognostic significance of preoperative fibrinogen levels and explore a new prognostic predictor for colon cancer patients. Methods From January 2007 to Decem-ber 2008,the clinical data of colon cancer patients with radical were reviewed retrospectively. Patients were divided into different groups according to BMI,tumor size,stage,differentiation degree,gross type,vascular infiltration,CEA and mGPS score. Differences in preoperative fibrinogen concentration and overall survival were compared between groups. Results A total of 255 patients were enrolled in this study,the mean pre-operative fibrinogen concentration of enrolled patients was(3. 17 ± 0. 88)g/ L. There were significant differ-ences in And preoperative fibrinogen concentration among patients with different tumor size,stage,differen-tiation degree,gross type,vascular infiltration,CEA and mGPS(P < 0. 05). Moreover,result of univariate analysis manifested that the level of preoperative fibrinogen concentration was associated with the overall survival rate. Conclusion Preoperative fibrinogen concentration is associated with the clinicopathologic features of patients with colon cancer,which can serve as a new prognostic marker for prognosis evaluation.

Objective:To design and produce an adjustable rib fracture fixation belt with supporting function which could meet the needs of rib fixation, especially for flail chest. Methods: An elastic adjustable rib fracture fixation belt with usable ribs supporting function was designed(ZL 201120266136.9) and produced according to clinical needs. The clinical application was performed on patients with closed thoracic trauma with single or multiple rib fracture. The pain scores were compared with those whom traditional chest belt were used. Results: The rib fracture fixation belts can be used conveniently and the operating time was significantly reduced, compared with the time of traditional chest belts(P<0.01). The pain scores of patients with fixation belts were significantly lower than the scores or patients with traditional chest belts(P<0.05).Conclusion: The adjustable rib fracture fixation belt with rib supporting function can reduce pain of rib fracture and improve patients’ recovery. It is worth of clinical extension.