0.05. Conclusions Radical nephrectomy remains the cardinal method for the treatment of primary renal cell carcinoma. Extensive retroperitoneal lymphadenectomy does not improve the survival.

Objective To evaluate the diagnosis and treatment of pheochromocytoma in children. Methods Eighteen children with pheochromocytoma were diagnosed and treated from 1980 to 2000.The primary clinical manifestations included severe headache,blurring of vision,palpitation,excessive perspiration.Sustained hypertension occurred in 10 cases,sustained hypertension accompanied by episodic exacerbation in 7 and episodic hypertension in 1.The mean blood pressure was 185/130 mmHg(1 mmHg=0.133 kPa),with the highest up to 260/190 mmHg.VMA was increased in 89% (16/18) of the cases,and blood and urinary catecholamine was increased in 92% (12/13).Retroperitoneal pneumography was performed in 3 cases,CT in 14 cases and MRI in 2 cases,with all positive findings.B-ultrasonography showed positive in 94%(15/16). Results This series of 18 cases accounted for 11.6% of the pheochromocytoma cases admitted homochronously (18/155).All the 18 cases underwent surgery with the help of proper peir-operative management.The pheochromocytomas (comfired by pathology) were successfully extirpated with the tumor weight ranging from 40 to 150 g.All the cases were followed up for 1 to 20 years.Their blood pressure returned to normal in 94%(17/18).Only 1 case had relapse 2 years later with diagnosis of malignancy,and died in the following year. Conclusions Since the clinical manifestations of pheochromocytoma in children are atypical,endocrinological and imaging examinations are necessary to children with hypertension.Surgical excision is the best option,and oppropriate perioperative management is extremely important.The outcome of surgical management in children is better than that in the adults.

Objective:To study the expression and significance of cyclinD 1 in 45 cases of transitional cell carcinoma of bladder.Methods:The expression of cyclinD 1 was detectde by immunohistochemistry(SP).Results: Expression of cyclinD 1 was found in 55.56% of TCCs and none of controls,and 78.57% of T a～T 1,11.76%of T 2～T 4.Approximately,85% of G 1,46.67% of G 2 and 10% of G 3 with the progress of tumors clinical stages and grades ,and the positive rates of cyclinD 1 expression decreased. There was no significant correlation between cyclinD 1 expression and number of lesions and postoperative reccurance.Conclusions: CyclinD 1 overexpression can play an important role in the early stage of bladder tumorgenesis.There was significant relativity between cyclinD 1 expression and the biological behaviour of bladder TCCs.

Extraction process plays an important role in Chinese herbal medicine applications. Traditional extraction method has some disadvantages, such as long processing time, high solvent consumption and low efficiency. Thus, some new technologies and methods have been introduced in this paper, including ultrasonic extraction, microwave extraction, supercritical fluid extraction. On the basis of advantages and disadvantages of traditional Soxhlet extrac-tion, this paper mainly described the principles, characteristics, influencing parameters and applications.

Objective:To investigate the mechanism of nape cluster acupuncture in the treatment of acute cerebral infarction. Methods: Eighty patients with acute cerebral infarction were selected and randomly allocated to group A and B. Group B was given routine treatment for acute phase and Group A was added with the nape cluster acupuncture based upon the treatment for Group B. The treatment was given twice daily, with 15 d as a course of the treatments, to observe the decreasing situation in the score of the nerve function defects and changes in plasma ET content. Results:There were significant differences in the score of the nerve function defects and plasma ET content before and after treatments in two groups (P＜0.05), but there was significant difference between Group A and Group B after treatment (P＜0.05), indicating the curative effect was better in Group A than in Group B.Conclusion: Nape cluster acupuncture can be used to effectively treat acute cerebral infarction and obviously decrease plasma ET content and reduce the score of the nerve function defects. The findings also proves that the therapeutic effect was obviously better than single medication, if nape cluster acupuncture was combined in the treatment of the acute cerebral infarction.

Objective To investigate the predictive value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) calculated from 18F-FDG PET-CT results for postoperative recurrence and prognosis in patients with resectable pancreatic cancer. Methods From may 2009 to December 2015, 30 patients with pancreatic cancer who underwent curative resection after PET-CT examination were enrolled, and the clinic pathological data and 18F-FDG PET-CT data were retrospectively analyzed. The prognostic value of SUVmax, SUVmean, MTV, TLG and other prognosis factors were analyzed. Results In 30 patients with pancreatic cancer, preoperative 18F-FDG PET-CT detected all primary lesion (10 0%). 29 patients were recurrence or metastasis, and 26 patients were died with median of 17.8 months (2.6-39.6 months) follow-up. The median progression-free survival (PFS) time was 6.5 months and the median overall survival (OS) time was 11.6 months. The multivariate analysis revealed the histological differentiation and MTV were the independent influencing factors for PFS (both P<0.05). The lymph node metastasis, MTV and TLG were the independent influencing factors for OS (all P<0.05). Conclusion The MTV and TLG of PET-CT may be predicting the recurrence and survival of patients with pancreatic cancer after curative resection, suggesting that it can be used to guide the individual treatment.

OBJECTIVE:To investigate clinical efficacy and safety of recombinant human tissue type plasminogen activator (rt-PA) intravenous thrombolytic in the treatment of elderly patients (over 75 years old) with acute cerebral infarction (ACI). METHODS:78 elderly ACI patients,on the basis of routine treatment,were divided into thrombolysis group (40 cases) and non-thrombolysis group (38 cases) according to the will of patients or family members. Non-thrombolysis group received aspirin 200 mg,qd;thrombolysis group was given rt-PA 0.9 mg/kg(maximum dose of 90 mg)by intravenous push of 10% dose within 1 min,and intravenous dripping of residue dose within 60 min;receiving aspirin 200 mg,qd,24 h after thrombolytic therapy with-out contraindications. Both groups were treated for 14 days. The effective rate,NIHSS score before treatment and 24 h,7 d and 14 d after treatment,prognosis after 90 d were compared between 2 groups,and the occurrence of ADR was observed in 2 groups. RE-SULTS:The total effective rate was 67.50% in thrombolysis group and 52.63% in non-thrombolysis group,with statistical signifi-cance(P<0.05);there was significant difference in NIHSS score between 2 groups 24 h,7 d,14 d after treatment(P<0.05);90 d prognosis of thrombolysis group was superior to that of non-thrombolysis group,there was statistically significance (P<0.05);there was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLUSIONS:4.5 h time window rt-PA intravenous thrombolytic therapy is safe and effective for elderly patients with ACI,and can reduce disability and fatality,im-prove prognosis.

Objective To compare the clinical effects of HC video laryngoscope and fiberoptic bronchoscope (FOB)in guidance of endotracheal intubation for patients undergoing cervical surgery.Meth-ods A total of 50 patients (ASA I or II)with cervical vertebra injury,nerve root cervical spondylopathy or cervical spondylotic myelopathy in the first affiliated hospital of Wenzhou medical university were selected, all of whom were undergone selective cervical operations between March 2014 and June 2015.The patients were randomly divided into two groups (n =25):HC video laryngoscope group (group H)and FOB group (group F).After induction of anesthesia,HC video laryngoscope and FOB were used for tracheal intuba-tion.⑴ Intubation time and success rates of intubation were recorded,and visual analogue scale (VAS) was used to evaluate the difficulty of intubation;⑵ Mean arterial pressure (MAP),heart rate (HR),and rate-pressure product (RPP)before incubation (Tb),immediate after intubation (T0),and 1min after in-cubation (T1)were recorded;(3)Intubation-related complications were recorded.Results ⑴ The dura-tion of intubation (19.7 ±7.1 )s in the group H was significantly shorter than that of group F (51.9 ± 19.2)s (P <0.05).The one-time success rate of intubation in group H (92%)was higher than that of group F (64%),with statistically significant differences (P <0.05).Intubation was easier in group H (P <0.05).⑵ MAP,HR and RPP of group H at T0 were higher than those of group F.And at T1,there were no statistical differences between groups in MAP,HR and RPP (P >0.05).⑶ The incidence of complications (sore throat)was lower in group H (P <0.05).Conclusions Compared to FOB,HC vid-eo laryngoscope-guided selective cervical operation has the characteristics of higher success rate of intubat-ion,shorter operation time,and easier operation,more stable hemodynamics and lower incidence of intuba-tion complications.Therefore,HC video laryngoscope is a safe and effective method in the intubation for pa-tients undergoing cervical surgery.

Objective To observe the histopathological and ultrastructural changes of the supraspinal ligaments in ankylosing spondylitis (AS).Methods The supraspinal ligaments were stained with HE,Sirius Red/saturated carbazotic acid and then observed nuder microscope,electyonic scanning microscope and transmission electron microscope respectively.The density of blood vessel and collagen fibril were analy-zed.Statistical analysis was carried out by using t test.Results In the AS group,under the microscope,the arrangement of in collagen fibers was in chaos,and hyalinosis,fatty infiltration could be seen.Vascular proliferation was predominant.Collagen-Ⅲ expression could be detected in this group.Under electron microscope,the distribution of collagen fibril was sparse,and the periodic strita was indistinct,the matrix was degraded,and some matrix vesicle could be seen.While in the control group,orderly arrangd collagen fibrils could be seen,and no change of blood vessels could be seen.The density of vascular structures in the AS group was (6.8±0.7)/HP,and (1.0±0.4)/HP of the control group.The density of collagen fibrils in the AS group was (122±22)/μm2,and that of the control group was (218±10)/μm2,the difference between the two groups was statistically significant (P＜0.05).Conclusion A series of histopathological changes have occurred in the supraspinal ligaments in AS patients.

Objective To investigate the effect of low molecular weight heparin (LMWH) on the prevention of deep venous thrombosis in patients with lower limb fracture.Methods 213 cases of peripherally inserted central venous catheter after deep venous thrombosis of lower extremity fractures from February 2014 to October 2016 in our hospital orthopedic surgery were retrospectively analyzed,according to whether patients with low molecular weight heparin were divided into two groups,which did not use low molecular weight heparin in patients with 104 cases as control group,using the low molecular weight heparin in 109 patients as study group,with seven days of treatment as the observation period, the blood rheology indexes of the two groups of patients and the incidence of deep vein thrombosis were analyzed.Results After treatment, the blood viscosity, fibrinogen, and plasma D-dimer levels of the whole blood decreased in both groups, and the levels of plasma D-dimer were significantly lower in the study group than in the control group (P<0.05);the plasma viscosity of the study group was significantly lower than that of the control group (P <0.05).After treatment,the recurrence rate of deep venous thrombosis in the study group was significantly lower than that in the control group ( P<0.05 ); The effective rate of treatment group was 96.33%was significantly higher than the control group 76.92%(P<0.05);study group incidence of adverse reactions 1.83%was significantly lower than the control group 7.69%( P <0.05 ) .Conclusion Low molecular weight heparin can effectively improve the indexes of Hemorheology in patients with lower limb fracture after central venous catheter puncture, reduce the risk of deep vein thrombosis, and have a clear preventive effect.