Management of adrenocortical tumor are developing vigorously,from diagnostic treatment to precisely therapy with endocrine lab test and radiology examination improving.The prevalence rate of incidental adrenal mass is 7％.Update researches show that surgical treatment is beneficial in subclinical hypercorisolism patients combined with adrenal incidentaloma.Histopathology improves the evaluation of prognosis in primary aldosteronism patients.For adrenocortical cancer patients,mitotane with combination of etoposide,doxorubicin and cisplatin after surgical treatment was recommended,while adjuvant radiotherapy needs more study to conform the efficacy.

Objective To observe the effectiveness of lactobacillus acidophilus combined with electroacupuncture on gastrointestinal function in patients with traumatic brain injury. Methods A total of 167 patients with traumatic brain injury treated in our hospital from June 2013 to December 2016 were randomly divided into combining treatment group (n=84) and lactobacillus acidophilus group (n=83). The lactobacillus acidophilus group was given routine treatment and lactobacillus acidophilus. The combining group was given the routine treatment, electroacupuncture treatment and lactobacillus acidophilus. Data of gastronintestinal function, infection, pH of gastric juice, serum two amine oxidase (DAO) and D-lacticacid level were compared between two groups. Results Compared with lactobacillus acidophilus group, the incidence rates of reflux (χ2=7.948), vomit (χ2=7.514), diarrhea (χ2=4.521), abdominal distension (χ2=5.968), pulmonary infection (χ2=4.521) and enterogenic infection (χ2=4.531) were significantly decreased in the combining treatment group (P<0.05). After 20-day treatment, pH value of gastric juice (t=8.125) was significantly increased, the serum DAO value (t=6.383) and D-lacticacid level (t=6.745) were decreased, in combining treatment group than those of lactobacillus acidophilus group (P<0.05). Conclusion Lactobacillus acidophilus combined with electroacupuncture can improve the gastrointestinal function, stimulate gastric acid secretion and decrease serum levels of DAO and D-lacticacid.

With the emergence of new technologies such as brain imaging, bio-sensing, human-computer interaction, cloud computing and large data, the treatment of traumatic brain injury has entered a new era. However, it must be clearly recognized that the central nervous system (CNS) trauma remains a worldwide medical problem. Based on the existing medical knowledge, it is important for promoting CNS trauma treatment levels including nerve trauma standardized treatment, professional management team, multi modal monitoring and data analysis, actively participating in domestic and international multi-center clinical research. Medical workers should dare to explore and innovate, keep up with the pace of the times, and truly achieve the overall improvement of nerve trauma.

BACKGROUND: The ulcer wound is hard to heal in diabetic patients,and it is believed to be caused by the microcirculatory disorder of wound and decreased contents of endogenous growth factors in patients with diabetes mellitus.OBJECTIVE: To observe the biological effects of adeno-associated virus (AAV) mediated transforming growth factor beta1 (AAV-TGFβ1) and vascular endothelial growth factor (AAV-VEGF) in promoting the dermal ulcer healing of diabetic rabbits.DESIGN: A randomized controlled animal experiment.SETTINGS: Medical College, Qingdao University; Affiliated Hospital of Medical College, Qingdao University.MATERIALS: The experiments were carried out in the gynecological laboratory, Affiliated Hospital of Medical College, Qingdao University from July 2004 to January 2006. Twenty-four healthy adult New Zealand rabbits were randomly divided into co-transfection group (n=12) and control group (n=12).METHODS: ① The dermal ulcer models of diabetic rabbits was established by injecting alloxan (130 mg/kg) via ear vein, and the ulcer wound was made by operation. ② In the co-transfection group, the wound was locally infiltrated, and injected with AAV-TGFβ1 virus and AAV-VEGF virus (the concentration was 9×106 virus granules/mL respectively). The rabbits in the control group were treated with injection of saline.MAIN OUTCOME MEASURES: ① The levels of TGFβ1 and VEGF gene transcription in the healing tissue were detected with polymerase chain reaction (PCR) at 1 month postoperatively. ② The capillary density in the wound margin was counted with microcirculation microscope at 3 weeks postoperatively. ③ The collagen Ⅰ and Ⅲ were isolated and detected with Western blotting by protein gel electrophoresis and semi-dry electrophoretic transfer. ④ The content of collagen in the ulcer healing issue was detected at 1 day, 1, 2 and 3 weeks, 1, 2, 3, 4, 5 and 6 months postoperatively. ⑤ The thickness, color and quality of the wound healing were observed postoperatively.RESULTS: All the 24 rabbits were involved in the analysis of results. ① The expressions of TGFβ1 and VEGF gene transcription in the co-transfection group were increased as compared with those in the control group. ② The capillary density at the wound margin in the co-translection group was higher than that in the control group [(19.18±3.56), (6.43±1.52)/mm2,t=3.21, P ＜ 0.05]. ③ The content of collagen Ⅰ in the ulcer healing tissue in the co-transfection group was obviously increased, and the proportion of collagen Ⅰ in the constituent ratio of collagen Ⅱ and Ⅲ was increased.④ The contents of collagen in the ulcer healing tissue at 1 day after transfection were close without significant difference between the two groups (t=1.55, P ＞ 0.05). After that, the contents of collagen in the cotransfection group were all significantly higher than those in the control group (P ＜ 0.05). ⑤ The ulcer healing in the control group was obviously lagged with bad quality.CONCLUSION: The combination of AAV-TGFβ1 and AAV-VEGF can efficiently transfect the dermal ulcer wound in diabetic rabbits, obviously increase the capillary density in ulcer tissue, markedly improve the proportion of collagen I in the constituent ratio of collagen Ⅰ and Ⅲ in healing tissue, and obviously ameliorate the condition of ulcer healing.

Objective To analyze the clinical treatment effect of non-gland-derived mass on the neck,and discuss the distribution types and the best treatment options.Methods A total of 76 cases with non-gland-derived mass on the neck were analyzed retrospectively,and the treatment effect was analyzed.Results In the 76 cases,25 cases were benign tumors,19 cases were malignant tumors,32 cases were non-rumors.Surgical treatment was preferred to tumors.According to the nature of the lesions,non-tumors mass shoud choose surgical treatment or medication.Conclusion Non-gland-derived mass on the neck with multiple presentations,it is necessary to choose personal therapies according to the characteristics of masses.

ObjectiveTo explore the relation between personality and depression in elderly,particularly to investigate mediating effect of positive psychological resource.MethodsThe eysenck personality questionaire-revised short scale for Chinese(EPQ-RSC),self-rating depression scale(SDS) and scales for positive psychological resource were performed by 270 elderly in community of Tianjin.Then correlation analysis,regression analysis and path analysis were accomplished to explore association between those variables.Results Neuroticism and Psychoticism personality correlate positively with depression ( r=0.45,0.48) and contribute about 30％ variance of it (F=49.95 ).Positive psychological resource such as optimism,resilience and self-efficacy correlated negatively with depression ( r =- 0.41,- 0.39,- 0.20 ) and contributed 19％ variance of it (F =30.02 ).The results of path analysis showed positive psychological resource mediated the relation between personality and depression also.ConclusionNeuroticism and Psychoticism are important risk factors of depression in elderly.Positive psychological resource such as optimism,resilience and self-efficacy are key protecting factors for depression and they mediate the relation between vulnerable personality and depression.

BACKGROUND: The therapeutic effect of mild hypothermia in the treatment of severe brain injury has been recognized in spite of the poor understanding of its mechanism. Until now, no reports have been available to describe the changes in cerebral oxygen metabolism following serious brain and during mild hypothermia treatment.OBJETCIVE: To observe the patterns of cerebral oxygen metabolism changes during mild hypothermia treatment for severe brain injury, and explore the mechanism of the therapeutic effect of mild hypothermia.DESIGN: A clinical observation of factorial design.SETTING: Mild Hypothermia Treatment Center of Tianjin Huanhu Hospital.PARTICIPANTS: From August 1998 to January 2000, 13 patients with severe brain injury were treated in Mild Hypothermia Treatment Center of Tianjin Huanhu Hospital, including 11 males and 2 females aged 18-65 years. Diagnosis of brain contusion and laceration with subdural hematoma was established in 6 cases, epidural hematoma in 1 case, subarachnoid hemorrhage in 4 cases and diffuse axonal injury in 2 cases. Of these cases 7 were treated with conservative therapy, and 6 with internal/external decompression after surgical hematoma removal.METHODS: A blanket for controlling the body temperature was applied to induce whole-body hypothermia in the patients in the mild hypothermia treatment room with continuous intravenous infusion of chlorpromazine (100 mg), promethazine (100 mg) and atracurium besilate (400 mg) administered in 500 mL normal saline. Neurotrend-7TM multi-parameter monitoring system was used to for monitoring the dynamic changes of cerebral PO2,PCO2, pH and brain temperature to evaluate their changes after treatment.The correlation between cerebral oxygen metabolism and the scores of Glasgow Coma Scale was analyzed.MAIN OUTCOME MEASURES: Dynamic changes of cerebral PO2,PCO2, pH and brain temperature.RESULTS: All the 13 patients entered the final analysis. Eighteen hours after hypothermia, the PO2 [(2.23±1.29) kPa] was obviously increased in comparison with that before hypothermia [(1.29±0.57) kPa, t=2.449, P ＜ 0.05], and PCO2 exhibited significant decrease at hypothermia 6 hours to (7.32±0.92) kPa from the pre-treatment level of (7.75±1.07) kPa (t=2.446, P ＜ 0.05). Significant elevation of pH and descension of intracranial pressure occurred upon the achievement of hypothermia [7.06±0.15 vs 6.83±0.20 for pH, t=5.164, P ＜ 0.05;(2.03±1.01) vs (2.57±0.93) kPa for intracranial pressure, t=2.948, P ＜ 0.05].Six hours after hypothermia, the cerebral perfusion pressure was obviously higher than that before hypothermia [(9.40±1.80) vs (7.80±1.59) kPa, t=2.365,P ＜ 0.05]. PCO2 was found inversely correlated with Glasgow Outcome Scale (GOS) scores at 24 hours of hypothermia (r=-0.699, P ＜ 0.05). The variations of cerebral oxygen metabolism indices before and after mild hypothermia were positively correlated with GOS scores.CONCLUSION: Dynamic monitoring of cerebral oxygen metabolism is safe and effective, and may help in early detection of cerebral hypoxia and acidosis following severe brain injury. Mild hypothermia treatment can effectively alleviate hypoxia and acidosis following severe brain injury to improve the prognosis of the patients.

Objective To study the feasibility of stem cell transplantation under mild hypothermia so as to provide a prerequisite for stem cell transplantation in patients with traumatic brain injuries (TBI) during mild hypothermia treatment. Methods After transfecting plasmid containing temperature-sensitive simian virus 40 large T-antigen (tsSV40LT) into temperature-sensitive umbilical cord mes-enchymal stem cells (tsUCMSCs) , the changes of cell morphology, nuclear proliferation index (PIx) and telomerase activity were detested when the tsUCMSCs were cultured at 33℃ and 37℃. After the mouse model with tTBI treated with mild hypothermia was established, tsUCMSCs were transplanted into semi-injury area to detect survival rate, proliferation and apoptosis indices and perform neurological deficit scoring. Results When cultured at 33℃, the tsUCMSCs displayed long spindle-shaped and highly refractive, with higher proliferation index and telomerase activity than those cultured at 37℃. Compared with control group (non-temperature-sensitive UCMSCs transplantation), tsUCMSCs in semi-injury area showed much higher cell survival and proliferating cell nuclear antigen expression ( P < 0.05 ) , with fewer apoptotic cells and better neurological function (P < 0.05). Conclusion The establishment of temperature-sensitive stem cell line enables stem cell transplantation during treatment of TBI with mild hypothermia, as provides us a new direction for treatment of TBI.

Mesenchymal stem cells (MSCs), which are regarded as the promising option of cell replacement therapy, are able to regulate immune response after tissue damage caused by traumatic brain injury (TBI). Secondary neuroinflammation following the mechanical injury is the essential factor of neural cell necrosis and apoptosis, even after the intracranial pressure has returned to normal. Their immune environments caused by neuroinflammtary response determine the outcome and long-term behavior function of TBI in survivors directly. MSCs modulate macrophage/microglia, drive them to polarize into alternative M2-like cells through releasing soluble cytokines, such as prostaglandin E2 (PGE2), tumor necrosis factor-stimulated gene 6 protein (TSG-6), IL-1 and TGF-β, which limits the progression of inflammation and maintain micro-environment stable. Meanwhile, macrophage/microglia exerts significant effects in MSCs survival, proliferation, differentiation and activation. It provides a novel approach as a practical anti-inflammatory therapy in clinical treatment.

Objective To explore emergency treatment strategies for the patients with brain hernia combined with hemorrhagic shock after severe traumatic brain injury and their effect on prognosis.Methods A retrospective analysis was made on 54 patients (study group) with brain hernia combined with hemorrhagic shock treated with selective treatment strategies from May 2006 to May 2009. Another 48 patients with the same injuries treated with no selective treatment strategies from April 2003 to April 2006 were used as control group. The mortality within one week and the GOS six months after injury were compared in two groups. Results There was no statistical difference in aspects of sex, age, injury mechanism, GCS and blood loss in both groups (P＞0.05). Thirteen patients died in the study group within the first week, with mortality rate of 24.1%. While 16 patients died in the control group at the first week, with mortality rate of 33.3% (P＜0.05). GOS half year after injury in the study group was better than that in the control group (P＜0.05).Conclusion Early selective treatment strategy based on degree of shock may obtain better outcome for patients with brain hernia combined with hemorrhagic shock after severe brain injury.