Cord lipoma is a trite lipoma, it is a protrusion of extraperitoneal fatty tissue through the internal inguinal ring. The incidence is between 20% to 30%.It is often caused by a protrusion of extraperitoneal fatty tissue through the internal inguinal ring, lobular retroperitoneal fat insinuates itself through the internal ring and over time dilates it. Patients with a higher BMI are more prone to having a cord lipoma. Incidence of lipoma associated with Type II and Ⅲ hernias was bigher. it is suggest that the incidence of lipoma assoeiated with the type of hernias and patients with a larger hernias are more prone to having a coM lipoma. The cord lipoma is difficult to diagnosis before surgery,because it is similar to hernias in symptom. Ultrasound is safe and useful in finding hernias and cord lipoms, the overall accuracy is 92%. It is necessary to resect lipomas and repair as long as the extraperitoneal fatty tissue through into the inguinal canal.

To investigate the gene typing, molecular characteristics of virulence and resistance associated gene of Clostridium difficile from clinical isolates in China, the genes tcdA,tcdB of toxin A and B, cdtA,cdt B of binary-toxin, and erm B of clindamycin resistance were detected by conventional PCR. Genotyping of toxic C. difficile were conducted by means of analysis of 16s-23s internal spacer region polymorphism with PCR assay. Then the antibiotic resistance of toxic C. difficile to ampiciline, clindamycin, metronidazole and vancomycin was conducted with E-test. It was found that 8 toxic C. difficile strains were demonstrated out of 12 clinical isolates, in which 5 strains were tcdA+ and tcdB+, and 3 strains tcdA- and tcdB+, accounting for 62.5% and 37.5% respectively. Binary-toxin genes detection were negative in all the strains. Clindamycin resistance associated gene ermB was positive in 4 out of 8 toxic C. difficile strains, accounting for 50%. 8 toxic isolates were typed into 4 gene types, the dominant type was ZR I,accounting for 62.5%. Resistance rate of 8 toxic C. difficile strains against ampiciline(AC), clindamycin(CM), metronidazole(MZ) and vancomycin(VA) was 37.5%,87.5%,12.5%, and 0 respectively. No isolates belonged to ribotype 027 or 078. Isolation rate of toxic C. difficile is high to 66.7%. There is obvious gene polymorphism in clinical isolates of Chinese toxic C.difficite, and ZR I is preponderant genotype in 4 genotypes. C. difficile shows some resistance to ampiciline, clindamycin, metronidazole, but susceptive to vancomycin.

Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.

Objective To design a multiplex PCR for simultaneous identification and toxigenic type characterization of Clostridium difficile isolates. MethodsThree pairs of primers were designed for the amplification of a species-specific internal fragment of the tpi( triose phosphate isomerase) gene, an internal fragment of the tcdB ( toxin B) gene, and an internal fragment of the tcdA ( toxin A) gene. Twenty-one standard strains including Clostridium difficile ATCC 9689 and 47 isolates of Clostridium difficile were applied for the assessment of detection limit, specificity and detections of the multiplex PCR, respectively. Toxin A and Toxin B of 47 isolates were analyzed by ELISA. ResultsThe detection limit for DNA concentration of the multiplex PCR was 0.5 pg/μl. The specificity was determined to be 100％. Among the results of 47 isolates detected by multiplex PC R, 37 strains were tpi ( + )/tcdA (+)/tcdB ( + ), 10 strains were tpi ( + )/tcdA (-)/tcdB ( - ). Tpi ( + )/tcdA ( - )/tcdB ( + ) was not found. The toxin detection of 47 isolates by ELISA showed that 20 isolates were positive and 27 isolates were negative. Twenty isolates of toxin (+) by ELISA were all tpi( +)/tcdA( +)/tcdB(+) by multiplex PCR. ConclusionThe multiplex PCR method combined diagnosis and toxigenic type characterization contributes to the diagnosis for Clostridium difficile infection.

OBJECTIVE: To investigate the clinical manifestations and diagnostic method of hyperparathyroidism due to parathyroid tumors and to evaluate the intra-operative detection of parathyroid hormone in surgical treatment. METHOD: Thirty-seven cases with functional parathyroid tumors from January 2003 to October 2012 were retrospectively analyzed. The clinical manifestation, examination and operation method, changes of parathyroid hormone before and after operation were collected. RESULT: All cases were definitely diagnosed before operation. The sensitivity and the positively predictive values of neck ultrasonography were 86.5% and 97.6% respectively, and the same data of Tc-99m-MIBI was 97.2% and 100.0%. The PTH levels declined by 84.9% ten minutes after tumor resecting compared with the level before operation. The serum calcium and PTH returned to normal levels and symptomatic relief occurred after operation. CONCLUSION Recurrent bone disease, long-term urinary calculus and obscure gastrointestinal symptoms were common symptoms of hyperparathyroidism due to parathyroid tumors. The neck ultrasonography and Tc-99m-MIBI were suitable for location of parathyroid tumors. Surgical operation was an effective treatment for parathyroid tumor. Intra-operative PTH assay would be able to ensure the radical excision and the operative safety for functional parathyroid tumors.
Adult ; Aged ; Female ; Humans ; Hyperparathyroidism ; etiology ; surgery ; Male ; Middle Aged ; Monitoring, Intraoperative ; Parathyroid Hormone ; blood ; Parathyroid Neoplasms ; complications ; surgery ; Retrospective Studies

Objective To analyze the causes of misdiagnosis and mistreatment of Dravet syndrome. Methods Patients with Dravet syndrome diagnosed according to clinical features and SCN1A gene mutation detection were recruited within recent 3 years. The patients were grouped into correct diagnosis-treatment group and misdiagnosis-mistreatment group according to whether the patients had ever been misdiagnosed and mistreated by sodium channel blockers. The clinical features were compared between two groups. Results Thirty-five cases with Dravet syndrome were collected and the rate of misdiagnosis reached 40%, Nine cases were misdiagnosed as symptomatic focal epilepsy, 4 as Lennox-Gastaut syndrome and 1 as Doose syndrome. The average age of onset in misdiagnosis-mistreatment group was (5.50 ± 3.56) months,and the age of confirmed diagnosis was (83.57 ± 105.62) months. The percentage of abnormal EEG, onset seizure with partial seizure, the seizure frequency within the first year from onset, onset with afebrile seizure, patients with status epilepticus or cluster seizures was higher in misdiagnosis-mistreatment group but it showed no significant statistical significance when compared with that of correct diagnosis-treatment group. The percentage of patients with mental retardation and focal neurological signs was significantly higher in misdiagnosis-mistreatment group (P=0.005 and 0.002, respectively). Conclusions Dravet syndrome is frequently misdiagnosed as symptomatic focal epilepsy. The appearance of focal neurological signs and mental retardation before confirmed diagnosis are important factors for misdiagnosis. Gene mutation screening will be helpful for differential diagnosis of Dravet syndrome.

OBJECTIVE This study was to investigate the carrier and infection of Clostridium difficile in clinic feces specimen,to analyze clinic characteristics,and to improve isolation rate and to provide basis on efficient prevention.METHODS C.difficile toxin A&B kit and anaerobic culture was conducted in 20 cases with diarrhea.Colonies suspected to be C.difficile,on the basis of their macroscopic appearance and characteristic odor,oxygen tolerance experiment,were confirmed by their biochemical characteristics(API 20A,bioMerieux).RESULTS After C.difficile selective culture,8 suspected colonies from 20 feces specimen were conducted by feces smear and oxygen tolerance experiment.6 of 8 was G+ rod bacteria with positive oxygen tolerance experiment.4 stains of C.difficile were identified by API 20A,positive rate was 20%;toxin detect was positive in 1 specimen(5%).CONCLUSIONS Infection of C.difficile Is associated with the basic disease.Watery feces specimen was prone to culture positive.

Objective To establish an easily reproducible rabbit model of acute pulmonary embolism (APE) with right ventricular dysfunction (RVD).Methods Two gelfoam strips (5 rnm×5 mm× 10 mm) were squeezed and were introduced into the pulmonary arteries of each healthy rabbit (n=12).Pulmonary and systemic hemodynamic function were recorded.All rabbits underwent CT pulmonary angiography (CTPA) and pathological examination after the introduction of APE.Results All gelfoam strips located in the bilateral lower lobe arteries.Compared with baseline mean pulmonary artery pressure (mPAP) ([9.75±1.75] mmHg),mPAP increased to (20.58 ± 5.86) mmHg immediately after embolism (P ＜ 0.001),and then decreased to (18.78 ±4.80) mmHg 1 h after embolism (P＜0.001).Right ventricle/left ventricle diameter ratio (RV/LV) increased from baseline (0.67±0.09) to (1.90±0.28) 45 min after embolism (P＜0.001).Conclusion An easily reproducible rabbit model of APE with RVD are established and may be suitable for study of APE pathophysiology.

A scaffold fabricated with lysine/nerve growth factor (NGF)/poly (lactic acid coglycolic acid) copolymer (PLGA) and acellular pigskin was evaluated in vitro as a potential artificial nerve scaffold. Properties of the scaffold such as microstructure, mechanical property, degradation behavior in PBS and water, Schwann cell adhesion property, and release of NGF were investigated. Results showed PLGA had permeated into the porous structure of acellular pigskin; its breaking strength was 8.308 MPa, breaking extensibility was 38.98%, elastic modulus was 97.27 MPa. The porosities of the scaffold ranged from 68.3% to 81.2% with densities from 0.62 g/cm3 to 0.68 g/cm3. At 4 weeks of degradation in vitro, maximum mass loss ratio was 43.3%. The release of NGF could still be detected on the 30th day, and its accumulative release rate was 38%. Lysine added into the scaffold neutralized the acidoid preventing degradation of PLGA to maintain a solution pH value. Schwann cells had grown across the scaffold after co-cultivation for 15 days. These in vitro properties of the pigskin based composite might indicate its potentiality to be an artificial nerve scaffold.
Acellular Dermis ; Animals ; Biocompatible Materials ; Guided Tissue Regeneration ; Lactic Acid ; pharmacology ; Lysine ; pharmacology ; Nerve Growth Factors ; chemistry ; pharmacology ; Nerve Regeneration ; Polyglycolic Acid ; pharmacology ; Swine ; Tissue Engineering ; Tissue Scaffolds

Objective To evaluate percutaneous transampulla stent implantation in treating lower malignant obstructive jaundice, and to discuss the related factors that may influence the stent patency time. Methods The clinical data of a total of 104 patients with lower malignant obstructive jaundice, who received percutaneous transampulla stent implantation during the period from January 2010 to March 2016, were retrospectively analyzed. The parameters, including gender, age, primary tumor type, preoperative external drainage, total bilirubin (TBIL), albumin (ALB), glutamic-pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), white blood cell (WBC) count, platelet (PLT) count, hemoglobin (HGB) and length of biliary stricture, were used to evaluate the risk factors related to postoperative patency time. Results Single Cox regression analysis showed that primary tumor type, ALB, WBC count, length of biliary stricture were the related factors that significantly affected the stent patency time. The Cox regression analysis further indicated that primary tumor type and length of biliary stricture were the important related factors that significantly affected the stent patency time. Conclusion In treating lower malignant obstructive jaundice with percutaneous transampulla stent implantation, primary tumor type and length of biliary stricture may be the important related factors that affect the stent patency time. These parameters are of great value in estimating the stent patency time.