Adolescent ; Adult ; Aged ; Carbon Monoxide Poisoning ; blood ; diagnosis ; Female ; Humans ; Lactic Acid ; blood ; Male ; Middle Aged ; Prognosis ; Young Adult

Adolescent ; Adult ; Carcinoma, Small Cell ; pathology ; therapy ; Female ; Humans ; Ovarian Neoplasms ; pathology ; therapy

Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Stomach Neoplasms ; epidemiology ; surgery

Objective To compare the quadriceps strength and short-term outcome in patients who had undergone primary total knee arthroplasty (TKA) with minimally invasive (MIS) or conventional surgical technique.Methods Sixty-eight knees undergoing TKA were evaluated and they were randomly divided into two groups.One group included 34 knees which were undergone conventional approach,and the other group included 34 knees undergone MIS approach.The age,BMI,quadriceps strength,extension lag,American Knee Society Score (KSS),Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and visual analogue scale (VAS) of pain of all patients were evaluated at the day before surgery and the 1st,2nd,3rd,6th,and 12th months after surgery.Results At the 1st,2nd,3rd,6th,and 12th months after surgery,the quadriceps strength in MIS group was 0.59±0.12,0.74±0.18,0.86±0.16,1.02±0.17,1.05±0.04 N·m/kg respectively,while in conventional group was 0.46± 0.56,0.56±0.12,0.70±0.16,0.94±0.19,1.04±0.03 N· m/kg respectively.The extension lag in MIS group was 13.11°±6.56°,8.53°± 5.12°,4.79°±3.62°,1.53°±2.64°,1.62°±1.76° respectively,while in conventional group was 22.47°±8.41°,16.23°±6.26°,10.58°± 4.4°,2.58°±2.85°,1.62°±1.76° respectively.There were significantly differences in the two groups.Meanwhile,compared with conventional patients,MIS patients demonstrated significantly higher KSS scores at the 1st and 2nd months postoperatively.WOMAC scores were significantly lower in MIS group than in conventional group at the 1st month after surgery.During the first postoperative week,MIS technique significantly decreased VAS scores,showing significance.On the other hand,no significant difference was observed with respect to deep infection incidence and radiological outcome between two groups.Conclusion MIS TKA offers a significant improvement in extensor muscle strength over conventional surgery.These results suggest that the MIS approach results in better outcomes with regard to maintaining extensor strength than the conventional surgical approach.

Objective To make sure the psychological condition of patients with liver transplantation,and then make out certain effective nursing methods. Methods Investigated 94 patients with liver transplantation by MSSNS,analyzed the datum. Results The average score of the patients with liver transplantation was higher than the in-patients expected those in the department of psychology,P

Objective To analyze retrospectively the MR features of MELAS patients,in order to improve the early diagnosis of MELAS.Methods MR data of 1 6 MELAS patients confirmed by clinical diagnose and muscle biopsy were retrospectively analyzed. MR features of plain scan(n=1 6),ASL(n=3),MRA(n=1 5),DWI(n=14)and MRS(n=3)were analyzed.Results MRI data demonstrated brain lesions mainly distributed in posterior cerebral hemisphere extending to subcortical area,which was not consistent with the vascular supply territories.The lesions were observed as low signal on Spin-echo sequence of T1 WI,while high signal on T2 WI, FLAIR and DWI.The focal lesions showed increasing Lac peak on MRS.Fifteen of 16 patients underwent MRA and one showed increased arterial branches in lesion zones.Three patients had ASL scanning demonstrating high irrigation in lesion zones which would wander once relapsed.Meanwhile,old lesions showed encephalatrophy and cerebromalacia.All patients’muscle biopsy pathology showed ragged red muscle fibers.Under electron-microscopic,bioblasts were bigger and more than average level and muscle fibers atrophied.Mitochondrial DNA sequence of 3 patients showed mtDNA A3243G transgenation.Conclusion The DWI,MRS and ASL sequences show good ability in MELAS diagnosis and differential diagnosis.

Objective To study the risk factors for children with acute central nervous system(CNS)viral in-fection,so that pediatrician may identify children with poor prognosis at early stages of the disease,and provide them with a theoretical basis for clinical treatment. Methods The clinical data of a cohort patients of acute CNS viral infec-tion who were hospitalized at the First Affiliated Hospital of Fujian Medical University between January 2010 and June 2013 were retrospectively collected and analyzed. According to Glasgow outcome scale on discharge,children were di-vided into good prognosis group and poor prognosis group. Clinical data and outcomes were analyzed by using univariate analysis and binary Logistic regression multivariate analysis. Results Three hundred and one cases were enrolled,278 (92. 36% )patients were assigned to the good prognosis group,and 23(7. 64% )patients were assigned to the poor prognosis group. By univariate analysis,the patients in the poor prognosis group had longer duration of sickness before admission,longer time of fever,lower white blood cell count in cerebrospinal fluid,a relatively lower calcium level,con-scious disturbance at the early stage,multiple seizures,convulsive status epilepticus,meningeal irritation sign,muscle weakness,severe changes in electroencephalogram(EEG),and abnormal neuroimaging findings(computed tomography or magnetic resonance imaging,or both)had significant differences between the good prognosis group and the poor short - term outcome groups(all P < 0. 05). By binary Logistic regression multivariate analysis,factors indicating a poor prognosis during the early stage were conscious disturbance at the early stage(0R = 4. 885,95% CI:1. 523 - 15. 670, P = 0. 008),multiple seizures(0R = 6. 352,95% CI:1. 905 - 21. 178,P = 0. 003),severe changes in EEG( 0R =4. 269,95% CI:1. 708 - 10. 666,P = 0. 002),and abnormal neuroimaging findings( 0R = 9. 740,95% CI:2. 360 -40. 192,P = 0. 002). Conclusions Conscious disturbance at the early stage,multiple seizures,severe changes in EEG and abnormal neuroimaging findings are risk factors for acute viral infection of CNS in children.

【Objective】 The characteristics of syndrome patterns of osteoporosis(OP) in traditional Chinese medicine (TCM) were investigated by cluster analysis,thus to supply evidences for the prevention and treatment of OP.【Methods】The data of 246 OP patients collected by four diagnostic methods were classified into items by cluster analysis.Thenthe principal component analysis was usedtosummarizethe TCMsyndrome patters of OPbyanalyzing the representativeness of eachitem.【Results】Forty-sevenitems were obtained after cluster analysis,andtheitems of short of breath withreluctancetotalk,lassitude and weakness,soreness of thelower back,white coating,vertigo,pale and enlargedtongue had a higher incidences.Whenthe items of OP were classified into four patterns of deficiency of liver and kidney yin,deficiency of spleen and kidney yang,deficiency of Qi and blood,and Qi stagnation and blood stasis,the patterns distribution was clear and had a good representiveness.The patterns of deficiency of liver and kidney yin,and deficiency of spleen and kidney yang had higher incidences of 34.7 %and 30.1 %respectively.【Conclusion】OP classifiedintofour patterns of deficiency of liver and kidney yin,deficiency of spleen and kidney yang,deficiency of Qi and blood,and Qi stagnation and blood stasis is practical in clinic,and most of OPpatients have the manifestations of kidney deficiency.

Objective To study the clinicopathologic features,immunophenotype,diagnosis and differential diagnosis of solid papillary carcinoma (SPC) of breast.Methods A retrospective study was performed to analyse the clinicopathologic features and immunophenotype of 31 cases of SPC with or without invasion.The cytokeratins (CK),myoepithelial markers,neuroendocrine markers,proliferation marker Ki-67,estrogen receptor (ER),progesterone receptor (PR),HER2,ect were detected by immunohistochemical staining,and HER2 was detected by FISH.All patients were followed up.Results All the patients were females with a mean age of (67.0±12.5) years.The presenting symptom was a painless mass with or without nipple discharge.In 19 cases who had undergone axillar lymph node dissection,only one metastasis was observed.General observation showed that tumors had substantive and nodular lesions,accompanied by cyst formation.Microscopy examination showed that tumors had swell and substantive nodules with only fine fiber vascular axis,and lacked obvious nipples and screen structure.The cells were lack of atypia,adhesive in cells nest.20 patients were accompanied by mucus secretion.Immunohistochemical study showed that the tumor cells expressed CK8/18,ER,PR,but didn' t express basal cell CK5/6,34β12.The positive rates of CK5/6,34β12,p63 were 3.23 ％ (1/31),9.68 ％ (3/31),6.45 ％ (2/31) in the myoepithelial layers of axis of papillary,and were 19.25 ％ (6/31),38.71％ (12/31),16.13 ％ (5/31) in peripheral cell nests and tumors,respectively.The positive rates of CgA,Syn,NSE,Cd56 were 83.87 ％ (26/31),87.10 ％ (27/31),93.55 ％ (29/31),90.32 ％ (28/31),respectively.The staining of HER2 oncoprotein was negative mostly,and the FISH detection outcome of 15 cases were all negative.The average positive index of Ki-67 was 4.12 ％.28 cases (90.23 ％) received follow-up,only 1 patient died,and the rest patients were without tumor recurrence or metastasis.Conclusions SPC of breast,a rare pathologic type,usually occurs in old females.The diagnosis depends on pathological characteristics and its unique immune phenotypic characteristics.SPC of breast has close relationship with mucinous carcinoma and neuroendocrine carcinoma,with a relatively inert biological behavior.

Objective To study the clinicopathologic features,immunophenotype,diagnosis and differential diagnosis,prognosis and treatment of solid papillary carcinoma(SPC)of breast.Methods A retrospective study was performed to analyse the clinicalpathologic features and immunophenotype of 52 case of SPC,with or without invasion. The cytokeratins(CK),myoepithelial markers,neuroendocrine markers,proliferation marker Ki -67,estrogen receptor (ER),progesterone receptor(PR),HER2,ect were detected by immunohistochemical staining,and HER2 was detected by FISH.All patients were followed up.Results All the patients were females with a mean age of (66.76 ±10.19)years. The incidence of SPC among all the breast cancers in this department was 0.99%.The presenting symptoms was a painless mass with or without nipple discharge in the central of breast.All of them accepted surgical resection,13 cases were administrated with chemotherapy after surgery,6 cases were radiotherapy.Metastasis was observed four in 34 cases who had undergone axillar lymph node dissection.General observation tumor was substantive and nodular lesions,may be accompanied by cyst formation,microscopy tumor for swelling,substantive nodules within only fine fiber vascular axis,and lacked obvious nipples and screen structure.The cells were lack of atypia,adhesive in cells nest,35 patients were accompanied with mucus secretion.Immunohistochemical study show that the tumor cells experssed CK8 /18,ER and PR,but not basal cell cytokertin CK5 /6 and 34βE12.Positivity for CK5 /6,34βE12 and P63 were 5.78%, 9.62% and 7.69% in the myoepithelial layers of axis of papillary,and were 21.15%,38.46% and 19.23% in cell nests and tumor peripheral myoepithelial,respectively.Positivity for CgA,Syn,NSE,CD56 were 82.69%,88.46%, 94.23% and 90.38%,respectively.The staining of HER2 oncoprotein was most negative,and 23 cases of FISH detection were all negative.The average positive index of Ki -67 was 4.28%.47 cases received follow -up of patients(90.38%),only 1 case death,1 case recurrence the rest were no tumor recurrence or metastasis,disease -free survival.Conclusion SPC of breast,a rare pathologic type,usually occurs in old females.The diagnosis depends on pathological characteristics and its unique immune phenotypic characteristics,is closely associated with mucinous carcinoma and neuroendocrine carcinoma,and the treatment is given priority tosurgery with a relatively inert biological behaviour.