Objective To summarize the experiences in the diagnosis and treatment of delayed rupture of spleen.Methods The clinical data of 26 patients with traumatic delayed rupture of spleen who were admitted to the Dachang Hospital from January 2005 to December 2013 were analyzed retrospectively.The medical history,clinical presentation,results of laboratory examinations were analyzed,and the splenic trauma was graded.Surgical procedures were selected according to the condition,severity of the splenic trauma and time of injury.Patients were followed up via outpatient examination or telephone interview till June 2014.Results Twenty-six patients had the history of injury of the left hypochodriac region,and were accompanied by slight abdominal pain and a short period of pain alleviation,and then pain in all regions of the abdomen at postoperative hour 48.All thepatients had pale face,tenderness,rebound tenderness or tonus.The pulse above 100 per minute was observed in 20 patients,and 15 patients had blood pressure under 90/60 mmHg (1 mmHg =0.133 kPa).The level of hemoglobin under 5 g/L was observed in 3 patients,and 5-10 g/L in 21 patients.All the 26 patients received abdominal paracantesis,non-coagulating blood was extracted in 25 patients.Twenty-six patients received B ultrasonography,and 24 had splenic rupture.Nineteen patients received computed tomography (CT),and 19 had splenic rupture.Ten patients had type Ⅰ splenic rupture,12 had type Ⅱ splenic rupture,3 had type Ⅲ splenic rupture and 1 had type Ⅳ splenic rupture.All the 26 patients received operation,including 2 received suture of the ruptured spleen,2 received resection of the lower part of the spleen,9 received total splenic resection,and 13 received total splenic resection + autogeneous transplantation of greater omentum.Two patients died of hemorrhagic shock intraoperatively,and the other 24 patients were cured.The operation time and volume of hemoperitoneum were (90 ± 15)minutes and (1 500 ± 700) mL,respectively.Twenty-four patients received blood transfusion,with the volume of transfused blood of 1 200 mL.The mean duration of hospital stay was 16.7 days.Two patients had complications after the operation,which were left pleural effusion and splenic fossa effusion,and they were cured by symptomatic treatment.No infection or other complications were observed.All the 24 patients were followed up for 6-108 months (median,46 months).One patient died of myocardial infarction at postoperative year 5,and the other 23 patients survived.Conclusions B sonography and computed tomography are important methods for the treatment of delayed rupture of spleen.Traumatic delayed rupture of spleen should be considered when the patient had symptoms including history of injury of the left hypochondriac region,the course of abdominal pain,abdominal pain alleviation,abdominal pain recurrence,time for abdominal pain alleviation longer than 48 hours,interperitoneal hemorrhage and the signs of splenic rupture indicated by B ultrasonography and computed tomography.The indication of spleen-preservation surgery or splenectomy for patients with delayed rupture of spleen should be strictly controlled and optimal surgical procedure should be designed according to the condition of the patient.

Objective To investigate the N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration in the difference myocardial wall motion after essential hypertension. Methods 326 patients with essential hypertension and normal heart function and 265 control subjects were measured with their NT-proBNP. According to Canau's categories, the ventricle geometries of patients with high left ventricular mass index were divided into 2 groups. Results NT-proBNP was significantly higher in patients with hypertension than in controls. After grouped by different myocardial wall motion, the patients with concentric hypertrophy were highest among all the groups; the groups with eccentric hypertrophy was secondly highest; concentric remodeling and normal geometric pattern were not significantly higher than the controls. Conclusion NT-proBNP is different in patients with different myocardial wall motion before heart failure, which may play an important role in myocardial remodeling.

Objective To investigate the correlation between human papilloma virus(HPV) 16/18 infection and the expression of Rb and p16 protein in bladder cancer tissue,and to analyze the relationship between HPV infection and the incidence of bladder cancer.Methods The expression of HPV16/18 E6 and E7 gene encoded protein,RB and p16 were detected by immunohistochemical method in 40 cases of bladder cancer and 40 cases of normal bladder tissues,and the correlation between them and pathological grading,stage of international union of cancer(UICC),whether recurrence or not after receiving surgery was analyzed.Results In bladder cancer tissues,HPV16/18 E6 and E7 gene encoded protein,RB and p16 positive rates were 65%,47.5%,42.5%,compared with the positive rate of normal bladder tissue samples(22.5%,92.5%,87.5%),the differences were statistically significant(P<0.05).The expression of HPV16/18 E6 and E7 gene encoded protein,Rb and p16 proteins were associated with pathological grading and staging of bladder cancer(P<0.05),but were not related to the tumor recurrence(P>0.05).The expression of HPV16/18 E6 and E7 gene encoded protein and Rb,p16 protein were not significantly correlated(P>0.05),The expression of Rb and p16 protein were negatively correlated(P<0.05).Conclusion HPV 16/18 infection is related to the occurrence and development of bladder cancer,but its mechanism might not be related to the abnormal expression of Rb and p16 protein.

OBJECTIVETo construct enterohemorrhagic Escherichia coli (EHEC) O157:H7 strains with delection espF gene and its nucleotide fragment and with espF gene complementation.

METHODSA pair of homologous arm primers was designed to amplify the gene fragment of kanamycin resistance, which was transformed into EHEC O157:H7 EDL933w strain via the PKD46 plasmid by electroporation. The replacement of the espF gene by kanamycin resistance gene through the PKD46-mediated red recombination system was confirmed by PCR and sequencing. The entire coding region of espF along with its nucleotide fragment was amplified by PCR and cloned into pBAD33 plasmid, which was transformed into a mutant strain to construct the strain with espF complementation. RT-PCR was used to verify the transcription of espF and its nucleotide fragment in the complemented mutant strain.

RESULTS AND CONCLUSIONWe established EHEC O157:H7 EDL933w strains with espF gene deletion and with espF gene complementation. Both espF and its nucleotide fragment were transcribed in the complemented mutant strain. The two strains provide a basis for further study of the regulatory mechanism of espF.

Carrier Proteins ; genetics ; DNA Primers ; Escherichia coli O157 ; genetics ; Escherichia coli Proteins ; genetics ; Gene Deletion ; Plasmids ; Polymerase Chain Reaction

Objective:To investigate the relationship between the positive surgical margin and clinical factors such as neoadjuvant hormonal therapy after robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk patients with prostate cancer.Methods:The clinical data of 164 patients with high-risk prostate cancer being performed RARP by one surgeon were analyzed retrospectively in our hospital from January 2016 to January 2022. The mean patient’s age was (65.3±6.2) years old, mean body mass index (BMI) was (25.6±3.0) kg/m 2, the median value of total prostate specific antigen (tPSA) before operation was 18.6(11.3, 31.3)ng/ml, the median value of Gleason score before operation was 7 (7, 8), the median value of prostate volume was 29.3 (22.4, 40.2) ml, and the clinical stage was T 2aN 0M 0-T 4N 0M 0. 80 patients with prostate cancer were treated with neoadjuvant endocrine therapy. All of them were treated with complete androgen blockade with a median course of 3 months. Univariate analysis was used to analyze the correlation between age, BMI, prostate volume, neoadjuvant hormonal therapy, preoperative tPSA, clinical stage, Gleason score before operation and positive surgical margin. Then multivariate logistic regression was used to further analyze the independent risk factor of positive surgical margin after RARP. Results:The postoperative pathological diagnosis included pT 2 stage in 111 cases (67.7%), pT 3a stage in 15 cases (9.1%), pT 3b stage in 25 cases (15.2%), pT 4 stage in 13 cases (7.9%). No lymph node metastasis was noticed in all patients. The Gleason scores included 6 in 11 cases (6.7%), 3+ 4 in 26 cases (15.9%), 4+ 3 in 36 cases (22.0%), 8 in 17 cases (10.4%), 9-10 in 24 cases (14.6%), un-evaluation due to endocrine therapy in 50 (30.5%). The positive surgical margin of high-risk patients with prostate cancer was 44.5% (73/164). Univariate analysis showed that the neoadjuvant hormonal therapy, tPSA and clinical stage were correlated with positive surgical margin ( P<0.05). Multivariate logistic regression analysis showed that non-neoadjuvant hormonal therapy, preoperative tPSA>20ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of high-risk patients with prostate cancer. Stratified analysis showed that when the preoperative tPSA was 10-20 ng/ml(21.1% vs.55.9%, P=0.014), the clinical stage was T 2c(29.6% vs.49.1%, P=0.040), the Gleason score before operation was 7(19.4% vs.54.1%, P=0.003), the positive surgical margin of high-risk patients in the neoadjuvant hormonal therapy group was significantly lower than that in the non-neoadjuvant hormonal therapy group ( P<0.05). Conclusions:Non-neoadjuvant hormonal therapy, preoperative tPSA>20 ng/ml and clinical stage>T 2b were independent risk factors for positive surgical margin of RARP in the high-risk patients with prostate cancer. For high-risk patients with preoperative tPSA of 10-20 ng/ml, clinical stage of T 2c and Gleason score before operation of 7, neoadjuvant hormonal therapy has important clinical significance in reducing the positive surgical margin of RARP.