Objective To investigate the effectiveness and surgical techniques of the improved laparoscopic treatment of ovarian dermoid cyst to prevent the occurrence of intraoperative rupture of teratomat, so to preserve the ovarian function at the maximum. Methods The modified laparoscopic extra-cavity and cavity outside the teratoma removed surgical suture treatment from February 2005 to February 2009,39 cases with large dermoid cyst were trea-ted by improved surgery and 45 cases treated by normal removal of laparoscope. The rupture, surgery time, bleeding volume,frequency of use of electrocoagulation and the effect of body temperature on intestinal canal and hospitaliza-tion day after operation as well. Results 39 cases of dermoid cyst were successfully managed by improved laparo-scopie surgery, during which no cyst contents broke into the abdominal cavity, no one was placed on electrocoagula-tion to stop bleeding, bleeding volume was (35.13±5.49) ml, operative time was (36.07±12.53) min, significantly leas than that of normal laparoscopic surgery group [the cyst rupture rate was 46.7% (21/45), the frequency of elec-trocoagulation was (5.0±3.0) times, the duration of electrocoagulatian was (5.5±2.5) s, bleeding loss was (40.73±6.04) ml and the time for operation was (67.47±20.73) min], with significant difference between the two groups (P<0.05 or 0.01);howevere, there was no remarkable difference in the effect of the two types of surgery on postoperative body temperature,anal exhaust time,postoperative hospitalization day. Conclusions In addition to minimally invasive laparoscopic surgery in the treatment of gastro-intestinal effects of small, quick recovery, the im-proved laparoscopic surgery for dermoid cyst shortens the operation time. The improved abdominal cavity and suture outside the strip surgical method can effectively prevent the complication caused by intraoperative tumor capsule rup-ture,reduce electrocoagulation injury,and preserve the ovarian function at the maximum.

Objective To investigate the expression and distribution of 5-hydroxytryptamine 7(5-HT7)receptor in brain and intestine of rats with different subtype of irritable bowel syndrome(IBS).Methods Forty-five SD rats were divided into healthy contral.diarrhea-predominant(IBS-D)and consti pation-predominant(IBS-C)IBS groups.IBS-D and IBS-C models were established by either colonic instillation of acetic acid and restraint stress or stomach irrigation with cool water(0-4℃).The expression and distribution of 5-HT7 receptor at brain and intestine were determined by immunohistochemistry and real-time PCR.The tissue concentration of cyclic AMP(cAMP)was examined by radioimmunoassay.Results Immunohistochemistry study demonstrated that the staining of 5-HT7 receptor at hippocampus and hypothalamus were strong in IBS-C and IBS-D groups compared to control group(P＜0.01),The staining of 5-HT7 receptor at ileum,proximal colon and distal colon were higher in IBS-C group than those in control group(P＜0.05).Real-time PCR revealed that the expression of 5-HT7 receptor at hippocampus and hypothalamus were higher in IBS-C and IBS-D groups than those in control group(P＜0.05).and the expression at ileum and colon were remarkably higher in IBS-C group compared to control group(P＜0.05).The concentration of cAMP at hippocampus and hypothalamus were higher in IBS-C and IBS-D groups than those in control group(P＜0.01,P＜0.05).The cAMP level at proximal and distal colon in IBS-C group was higher than those in control group(P＜0.05).Conclusion The upregulation of 5-HT7 receptor in brain and intestine may be related with the dyskinesis and visceral paresthesia of IBS-C.

Objective To explore the feasibility of laparoscopic resection of large uterus .Methods Patients with large uterus ( volume such as 12~20 weeks pregnant size ) by the implementation of laparoscopic hysterectomy were collected in our hospital and Dongguan Tung Wah Hospital from January 2010 to December 2012 .The uterus was carried out a complete hysterectomy through intra-operation by upward into the abdominal puncture point , ligation cutting tumor , and reduction of the uterine body method .Results A total of 38 patients was carried out hysterectomy operation .According to the size of uterus , the lens opening and operating hole was cor-responding upward to expand the horizons and operating space under microscope , and the use of stepwise ligation method to gradually cut reduced uterine body and release the operation space for overcoming the narrow operation space .Each hysterectomy operation was smoothly completed , and no case was converted to laparotomy .Conclusions Laparoscopic hysterectomy with the puncture point , and moving after ligation cutting shrink small palace body method can effectively create space for operation , and safety and feasibility of lap-aroscopic resection is helpful to improve the large uterus .

One hundred and forty-two patients on maintenance hemodialysis were enrolled in the study.According to the guideline of American Society of Echocardiography 97 patients (68.3％) were classified as pulmonary artery hypertension [PAH,pulmonary artery systolic pressure (PASP) ＞ 35 mmHg (1 mmHg =0.133 kPa)] and 45 patients (31.7％) as non-PAH (PASP ≤ 35 mmHg).High sensitivity Creactive protein (hs-CRP) and tumor necrosis factor-α (TNF-α) were measured by automatic analyzer and enzyme linked immunosorbent assay (ELISA),respectively.There were significant differences in CRP and TNF-α levels between PAH and non-PAH patients (P ＜ 0.05).Multivariate linear regression showed that TNF-α and interdialytic weight gain were positively correlated with PAH and left ventricular ejection fraction was negatively correlated with PAH (P ＜ 0.01).In the multivariate Cox proportional hazards models,PAH and TNF-α level were independently associated with higher risk for all-cause death (HR =1.06,95％ CI:1.03-1.09 and HR =1.31,95％ CI:1.17-1.46,respectively).In Kaplan-Meier survival analysis,the risk of all-cause mortality increased in parallel with PASP.The risk of death in patients with PASP ＞45 mmHg was higher than that in patients with PASP ≤45 mmHg (log-rank test:x2 =6.58,P =0.010),the risk was 2.82-fold (HR =2.82,95％ CI:1.38-5.77,P =0.004).

Objective To select the strains which can produce tanshinone ⅡA like its host plant Salvia miltiorrhiza bung. Methods A total of 50 strains of endophytic fungi were isolated from healthy, living and symptomless tissues of Salvia miltiorrhiza bung, among which 29 strains were obtained from the root, 14 from the stem, 3 from the leaf, 3 from the flower and 1 from the seed. Their antimicrobial activities against nine different bacteria, including both Gram-negative and Gram-positive bacteria, were measured by Oxford plate agar diffusion bioassay. Results Our data showed that all but four strains had significant antibacterial activities on at least one indicator bacterium to some extent, and five strains (DR1, DR4, DR16, DR18 and DF2) manifested quite prominent antibacterial activities against certain pathogenic bacteria. In some degree, it might indicate that this endophytic fungus isolated from the tissues of Salvia miltiorrhiza bung has a potential value as a natural antibacterial medicine as well. Thin layer chromatography (TLC) and high-performance liquid chromatography (HPLC) were carried out to test selected strains, both inside and outside of the cell to see if any strain can produce tanshinone ⅡA. The result showed that extracts from three strains, labeled as DR12 (outside cell), DR21 (inside cell) and DF3 (inside cell), had a component with the same Rf value in TLC assay as that of authentic tanshinone ⅡA. The extract from DR12 (outside cell) and DR21 (inside cell) had a peak at retention time identical to that of authentic tanshinone ⅡA in HPLC. Conclusion The fungi appear to produce the bioactive compound tanshinone ⅡA, and they could be used to produce tanshinone ⅡA by fermentation. It provides a new way to synthesize this natural medicine.

Objective To discuss the feasibility of non-invasive quantitative evaluation of hepatic fibrosis by contrast-enhanced ultrasonography (CEUS) parameters. Methods CEUS of liver and liver biopsy were performed in 86 patients. CEUS parameters including area under curve of portal vein/hepatic artery(Qp/Qa) ,perfusion intensity of portal vein/hepatic artery(Ip/Ia), decreasing rate of liver parenchyma perfusion (β) and perfusion time of portal vein (Tp) were calculated based on CEUS images. Differences of the four parameters among stages of hepatic fibrosis were analyzed by ANOVA and Spearman rank correlation test was applied to analyze correlation between parameters and hepatic fibrosis stages. Areas under receiver operating characteristic (ROC) curves were calculated to evaluate the diagnostic accuracy of parameters. Results Tp and β had increasing tend while Ip/Ia and Qp/Qa had declining tend from S0 to S4.They were significantly correlated with fibrosis stage( P ＜0.05＝. The areas under ROC curves of Ip/Ia were 0.931 (≥S1) ,0.884(≥S2 ) ,0.820(≥S3 ) and 0.846(S4 ) respectively. The areas under ROC curves of Qp/Qa were 0.914(≥S1),0.813(≥S2),0.845(≥S3) and0.869 (S4) respectively. Conclusions CEUS parameters of liver parenchyma Ip/la, Qp/Qa, Tp and β are related to fibrosis stages. Ip/Ia and Qp/Qa provide a reliable,non-invasive method for evaluating fibrosis stages.

BACKGROUND:Conventional ophthalmic delivery of ciliary neurotrophic factor (CNTF) is extremely difficult to pass the blood-retinal barrier, resulting in a very low bioavailability and the need of long-term drug delivery. To solve the problem, the CNTF can be encapsulated in a semi-permeable membrane to form a microcapsule, which may then achieve the release of bioactive substances encapsulated, or bioactive molecules secreted by living cels and smal molecular metabolites through semi-permeability of the special membrane.
OBJECTIVE:To prepare a special structural CNTF sustained-release microcapsule.
METHODS: A selected poly(ether sulfone) holow fiber was cut into 1 cm long with its two ends sealed by 1181-M medical adhesive using UV curing. To prepare CNTF encapsulated microcapsule, one end was first sealed, and then the CNTF was loaded to poly(ether sulfone) microcapsule from the other end which then was sealed. The leaching liquor of sustained-release microcapsule was co-cultured with mouse fibroblast L929, to observe the cytotoxicity of the microcapsule. The sustained-release microcapsule was co-cultured with mouse retinal pigment epithelial cels, to observe the celladhesion ability of the microcapsule. The CNTF sustained-release microcapsule was immersed in physiological saline, to observe the degradability. Moreover,in vitro release behavior of immunoglobulin and CNTF were evaluated.
RESULTS AND CONCLSION:The CNTF sustained-release microcapsule had an inner diameter of about 398 μm and a membrane thickness of about 145 μm. The microcapsule presents a lot of macropores in the outer wal and many 10
nanometers micropores in the inner wal. The sustained-release microcapsule was not degraded in saline within
4 months, indicating good cellcompatibility. The microcapsule can selectively release CNTF while protecting against invading of antibodies (IgG), showing its good selective permeability. Meanwhile, the sustained-release microcapsule improved the initial burst release of traditional drug delivery vesicles. The microcapsule presents a mild sudden release in the middle stage, and then a sustained release.

OBJECTIVE To evaluate the drug resistance of Candida isolated from patients' specimen in clinic.METHODS The minimal inhibitory concentration(MIC) test to 243 Candida strains was performed using ATB-Fungus drug susceptibity plate provided by Bio-Merieux.RESULTS The most popular species of Candida in clinic was Candida albicans(64.6%),C.glabrata(14.4%),C.tropicalis(11.1%),C.parapsilosis(5.8%)and C.krusei(4.1%).There was a certain resistance to the 4 kinds of common antifungals including flucytosine,amphotericin B,fluconazole and itraconazole.The resistance status of C.krusei was the most serious,Its resistance rate to 4 kinds of antifungals was 20.0%,50.0%,30.0% and 40.0%,respectively.The drug resistance rate of 5 species of Candida to itraconazole was higher than that to fluconazole.CONCLUSIONS The commonly encountered Candida produce particular resistance to common antifungals,and it is very necessary to detect and control them.

Objective To investigate the replantation and postoperative rehabilitation methods for simultaneous amputation of 10 fingers and both forearms.Methods A case of replantation for simultaneous amputation of both forearms and 10 fingers was carried out with microsurgery method in September,2014.The replantation involved 3 teams over 11 hours and 55 minutes to consequently conduct alternate anterograde and retrograde replantation and accurate blood vessels,nerve anastomosis and further followed with physical therapy and occupational therapy treatment in 2 weeks of the surgery.Results All the amputated arms and fingers revived after the surgery.After 14 months follow-up,function of wrist flexion and expansion was normal,superficial and deep sensory functions on hands were good,function of thumb and finger grip,pinch and opposition had partially recovered,the two-point discrimination was 8-10 mm,and all of above rated good according to the temporary criteria of the upper limb functionality set forth by Hand Surgery Branch of China Medical Association.Conclusion For the case of simultaneous amputation of both forearms and 10 fingers,it is very likely to carry out successful replantation as well as achieve satisfactory function restoration with excellent teamwork and accurate vessel and nerve anastomosis under microsurgery as well as rehabilitation treatment afterwards.

Objective To summarize clinical experiences for the management of upper cervical fracture associated with mild to moderate craniocerebral injury in order to improve the outcome of patients with craniocervical injury.Methods Twenty-two cases (13 males and 9 females) of non-nerve damage treated surgically from June 2008 to June 2012 were enrolled.Mean age was 41 years (range,23-68 years).Mechanisms of injury were traffic accidents in 12 cases,high falls in 7 cases and violence or others in 3 cases.Dens fractures were noted in 7 cases,Jefferson fractures in 5 cases and axial vertebral arch fractures in 4 cases,and combined atlas and axis fractures in 6 cases.Admission Glasgow Coma Score (GCS) was 12-14 points in 10 cases and 9-11 points in 12 cases.All cases suffered some degree of brain damage including brain contusion and laceration,and epidural,subdural or intracerebral hematoma.Three cases of cervical fractures were misdiagnosed in the early stage.Twelve cases required emergent craniotomy due to the primary craniocerebral injury and had elective upper cervical spine surgery until the medical condition was stabilized.Another 10 cases underwent conservation treatment of craniocerebral injury and had cervical spine surgery within 1 week due to the severe dislocation of the upper cervical spine.Operation time,blood loss,hospital stay,hospitalization cost and perioperative complications were analyzed.Outcome was evaluated with Glasgow Outcome Scale (GOS) at discharge.Fracture union,bone fusion and cervical stability were assayed with X-rays and CT films.Results All were followed up for a mean period of 18 months (range,12-36 months).Among the 12 cases of primary craniocerebral injury,operation time was (115 ± 22) min,blood loss was (280 ± 72) ml,hospitalization period was (23 ±7)d and overall cost was 88,000 yuan;one case sustained wound infection cured two weeks after debridement and dressing and two cases sustained pulmonary infection cured after antibiotic treatment;discharge GOS was grade Ⅳ in 2 cases and grade Ⅴ in 10 cases.Among the 10 cases of primary cervical injury,operation time was (125 ± 38) min,blood loss was (330 ± 90) ml,hospitalization period was (17 ± 6)d and overall cost was 61,000 yuan;no perioperative complications occurred;discharge GOS was grade Ⅳ in 1 case and grade Ⅴ in 9 cases.Pain radiating to occipital region,limited neck mobility and other clinical symptoms were alleviated at discharge.X-rays verified good healing of the bone and no malposition of the screws.Conclusion For cervical fracture associated with craniocerebral injury,cervical examination and protection are important.Once medical condition becomes stable,early surgery can be performed for upper cervical fracture.