Objective To evaluate a modified pyelo-u re teroplasty in treating long segment of ureteropelvic junction (UPJ) stenosis. Methods 26 cases were treated with the designed pyelo-ur eteroplasty,on which the dilated pelvic was incised vertically and the pelvic fl ap was turned down to form a new infundibulas tube with running suture and was a nastomosed to the ureter stem,the long stenosis segment being cut off. Results The symptoms vanished in the follow-up period of 1～3 ye ars.It was showed by B-ultrasonography,IVU and RP (retrograde pyelography)that the anastomosis site in all the cases was smooth.3～12 months after operation,G FR(glomerulus filtration rate) was found to be improved markedly,and 20 minutes excretive rate in the operated kidneys was all above 50%. Conclusio ns The troublesome hydronephrosis due to complicated long stenosis o f UPJ and upper ureter can be effectively treated by the modified pyelo-uretero plasty.

Objective To investigate the therapeutic effect of ambroxol hydrochloride on severe pneumonia, and the influence on the inflammatory cytokines of TNF-alpha and hs-CRP etc.MethodsThe clinical data of severe pneumonia patients treated in ningbo city medical treatment center Lihuili hospital from December 2014 to August 2016 were retrospectively analyzed.According to the treatment methods are divided into control group and observation group, the control group was given routine treatment, the observation group in the conventional treatment based on the given of ambroxol hydrochloride.To observe the therapeutic effect of two groups, the differences of serum levels of inflammatory cytokines, pulmonary function, cough and expectoration symptom scores of the two groups were compared before and after treatment.ResultsThe effective rate of the observation group was 97.50%, which was significantly higher than that of the control group;Two groups of patients before treatment serum inflammatory cytokines level no difference, after treatment, the observation group IL-6, IL-8, hs-CRP and TNF-alpha water average lower than the control group;Two groups of patients before treatment pulmonary function index no difference, after treatment, the observation group FVC, FEV1 and FEV1/FVC levels were higher than the control group;Two groups of patients with symptoms of no difference before treatment after treatment, observation group cough, sputum volume, cough ease and wheezing scores were lower than the control group.ConclusionAmbroxol hydrochloride has a good therapeutic effect on severe pneumonia can be significantly reduced in patients with TNF-hs-CRP alpha, inflammatory cytokine levels, improve the symptoms and signs, has good application value.

[Objective] A randomized control ed trial of traditional Chinese medicine recipe Gujing Tang treatment of premature ejaculation was studied. [Methods] The subjects: 60 patients with premature ejaculation form department of andrologic outpatient, the patients were randomly divided into two groups, Integrated TCM-WM Groups and paroxetine Groups. 30 cases in each group. The Integrated TCM-WM Groups were given Gujing Tang , with paroxetine 10mg, oral, Qd at the same time; The paroxetine groups were given paroxetine 10mg, oral, Qd. Both groups were treated for 3 months. Ejaculation status was evaluated at the timepoint:before treatment, 3 months after treatment,and fol ow-up evaluation of six months after treatment. Evalu-ate parameter including Intravaginal ejaculation latency(IELT) and score of sexual function and Chinese patients with premature ejaculation evaluation -5 (CIPE-5). [Results] After 3 months, both groups were significantly improved, and Integrated TCM-WM Groups improved more significantly. After 6 months of fol ow-up, IELT, motion times and CIPE-5 score of Integrated TCM-WM Groups decreased slightly, but stil had significant difference com-pared to before treatment, and this parameter of Paroxetine groups was returned to the level of baseline, and had no significant difference compared with baseline. [Conclusion] Traditional Chinese medicine Recipe Gujing Tang combined with paroxetine, could not only have rapid onset, enhance patient confidence, improve the psychological state, but also improve the long-term efficacy and avoid recurrent disease after treatment, therefore can achieve ef-fective treatment of premature ejaculation.

Objective To describe the clinical curative effects of surgical treatment of female stress urinary incontinence by tension-free vaginal tap.Methods Surgical treatment of 17 women suffering from stress urinary incontinence whose average course are11years by tension-free vaginal tap.Then,observe the complications and how symptome improved after operation.In this 17 cases,one had a failure experience of bladder neck ventrofixation,another had an operation of pelvic cavity in the past.Results All operations were successed,the mean operative time was about 30 minutes,the mean amount of bleeding was 40ml.No case had the complication of bladder perforated and dysuria after operation.The urinary incontinence symptomes were disappered within 5 days after operation.During a follow up of 3～12 months,no SUI recurred.Conclusions Our result demonstrates that TVT has the virtues of small trauma、simplely manipulate and less complications.Patients recover well and have a high rate of curing.It can also be use in such patients who had operations of pelvic cavity and failure operation for SUI in the past.

Objective To summarize the diagnosis and treatment experience of the pancreatic fistula secondary to abdominal operations.Methods The clinical data of 27 patients with pancreatic fistula due to abdominal operations were analyzed retrospectively.Results 25 patients were diagnosed by the amylase concentration of the drainage fluid and 2 patients were diagnosed by the percutaneous puncture fluid amylase concentration.Four patients underwent percutaneous puncture drainage by BS-guide.Five patients underwent re.operation drainage.Enteral feeding,total parenteral nutrition,total parenteral plus oral nutrition were applied to 15,6 and 6 patients,respectively.Altogether 3 patients died,all of these patients were in the total parenteral nutrition group.13 cases were discharged with draining tubes,including 2 patients who developed Dseudocyst and received surgical treatment,and the others 1 1 patients were discharged with tubes for(9.0±3.2)months.The mean hospital stays for oral feeding,jejunum tube nutrition and total parenteral nutrition groups were(36.3±10.2)d,(57.6±17.3)d and(63.3±33.4)d,respectively;and difference was statistically significant(F=3.49,P=0.049).The mean hospital stays for patients with or without somatostatin treatment were(53.5±20.3)d and(51.5 ±21.0)d,and difference was not statistically significant(t=0.207,P=0.838).Conclusions hereasingthe understanding ofpancreaticfistula,adequate drainage and rational nutrition phyed a key role in impmving the treatment effects of pancreatic fistula.

Objective To investigate the apoptosis of HepG2 cells and their sensitivities to the ciglitazone after inhibiting the activity of nuclear factor-kappa B (NF-kB) by NF-kB decoy oligonucleotide. Methods After transfecting HepG2 cells with NF-kB decoy oligonucleotide, the activity of NF-kB was observed by electrophonetic mobility shift assay and the protein expression of Bcl-2 and Fas by Western blot. The transfected and untransfected HepG2 cells were processed with 100 umol/L of ciglitazone for 1 to 4 days, and the growth curve and cell cycle of HepG2 cells were observed. Results After transfecting NF-kB decoy oligonucleotide to HepG2 cells, the activity of the NF-kB was inhibited, the Bcl-2 protein expression decreased and the Fas protein expression increased. The inhibition effect of the ciglitazone on the growth of HepG2 ceils was strengthened and more HepG2 cells were arrested at G1/G0 phase. Conclusions NF-kB decoy oligonucleotide could accelerate the apoptosis of HepG2 cells and enhance the inhibition effect of ciglitazone on HepG2 proliferation, the mechanism of which might be attributable to the increased expression of Fas protein and the decreased expression of Bcl-2 protein after NF-kB decoy oligonucleotide inhibiting the activity of NF-kB.

Internal fixation is one of the most important treatments for fractures.The stability of screws in internal fixation can be influenced by bone mineral density,quality of pilot holes,improper structure and surface characteristics of screws chosen,insertion torque,insertion angle,and screws unfit for the bone holes.Internal fixation of fractures can fail due to the instability of screws.This paper,on the basis of a comprehensive review of the studies on all the above factors influencing the screw stability,proposes effective methods to enhance screw stability so as to improve surgical outcomes of fracture internal fixation.

OBJECTIVETo explore the mechanism and strategies of prevention and treatment of vision deterioration after transsphenoidal surgery for removal of pituitary adenoma.

METHODSFrom January 1980 to February 2001, 1 412 patients were operated on by transsphenoidal surgery to remove pituitary adenoma. Fourteen patients experienced vision deterioration after operation. Clinical data from the 14 patients with vision deterioration were analyzed retrospectively.

RESULTSIn this group, the incidence of vision deterioration was 0.99%. Over packing of the adenoma bed was seen in 5 patients, apoplexy of residual tumor in 3, high intracranial pressure in 2, vascular spasm in 2, injury of the optic nerve in the cannel in 1 and unknown reason in 1.

CONCLUSIONSVision deterioration is a severe complication after transsphenoidal surgery. Early diagnosis and treatment can greatly improve the vision.

Adenoma ; surgery ; Adult ; Aged ; Female ; Humans ; Ischemia ; complications ; Male ; Middle Aged ; Optic Nerve ; blood supply ; Optic Nerve Injuries ; etiology ; prevention & control ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Retrospective Studies ; Sphenoid Sinus ; Vision Disorders ; etiology ; prevention & control

Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.

Objective To explore the feasibility and effectiveness of peer-assisted learning (PAL) in the clinical probation teaching of orthopaedics in excellent doctors classes. Methods Forty students in the 2014 excellent doctors class in Inner Mongolia Medical University were selected and randomly divided into the experimental group and the control group. The experimental group adopted the PAL teaching mode, and the control group received the ordinary teaching mode . At the end of the internship , theoretical knowledge and practical skills tests were conducted, and self-evaluation and course evaluation were completed in the form of questionnaires. Results The scores of the experimental group in theoretical knowledge and practical skills were higher than those of the control group, and the differences are statistically significant [theoretical scores (97.2±0.7) vs. (90.2±1.3); practical operation scores (98.5±2.4) vs. (89.2±1.5); case analysis (98.1 ±0.8) vs. (92.3 ±2.8), P<0.05]. Students in the experimental group were generally satisfied with their mastering of the basic theoretical knowledges and clinical practice skills of orthopaedics. Conclusion The application of the PAL model in clinical probation teaching not only stimulates students' enthusiasm for learning, but also enhances their eagerness in self-learning;it helps students master the basic theoretical knowledge and clinical skills better in clinical probation.