Objective:To discuss the pathogenic factors,prevention and treatment of fulminant epidemic of acute tonsillitis and acute pharyngitis.Method:We investigated and analysed the cases of twice fulminant epidemic of acute tonsillitis and acute pharyngitis.Result:In the first time,91 patients among 518 persons were attacted,the sick rate was 17.6%.In the second time,39 among 295 persons were attacted,the sick rate was 13.2%.The main symptoms were pharyngodynia and fever.Bacterial culture of throat swab of 20 cases of the first time and 17 cases of the second time were carried out.The positive rate of β-hemolytic streptococcus was 82.5% and 85.3% respectively.Conclusion:Environment and individual health condition are important factors in the fulminant epidemic of acute tonsillitis and acute pharyngitis.

To meet the requirements for the development of marine resources and military operations, divers usually dive deeper than the depth at which narcosis is present during air diving.Under this condition, heliox is required for this div-ing.Sofar, some countries have developed their own decompression tables for routine heliox diving.The best-known is tables from USA and France.In the preceding century, tables of Former Soviet Union and France used for routine heliox diving were introduced into China.On the basis of both types of tables,Chinese Navy developed their own tables for this purpose. In this paper, we summarized the characteristics of these tables from 5 countries and compared them in terms of structure, oxygen use, total decompression time, first stop and other features.This may provide a basis for future modification of ta-bles used in China and the development of new tables for routine heliox diving.

Objective To investigate the efficacy and safety of 3D-laparoscopic surgery in adrenalpheochromocytomas /paragangliomas.Methods From December 2012 to July 2014,23 cases of adrenal pheochromocytomas/paragangliomas were treated by 3D-laparoscopic surgery.Among them,7 cases were male and 16 cases were female,whose mean age are 47 (32-68) years old.Their clinical symptoms including sustained hypertension in 11 cases,intermittent hypertension in 8 cases,sustained hypertension with intermittent progression in 2 cases and asymptom in 2 cases.All tumors were diagnosed by endocrine examination,image test and nuclear medicine.Mean diameter of tumors are 8 cm,ranged from 3-14cm.In order to adjust the blood pressure,patients took α-receptor blocker for 2-4 weeks preoperatively.Under the general anesthesia,19 patients received the 3D-laparoscopic surgery via retroperitoneal approach and 4 cases received the procedure via peritoneal approach.Results All operations were completed successfully.There were no major intraoperative complications.Mean operating time was (78 ± 21) min and mean estimated blood loss was (54.8 ± 36.3) ml.Mean hospital stay after operation was (3.8 ± 1.4) days.The pathological diagnosis included pheochromocytomas in 15 cases and paragangliomas in 8 cases.During the 3 to 18 months following up,no recurrence or metastasis was found in this study.Conclusions 3D-laparoscopic surgery has obvious advantage in spatial location and the sense of depth for adrenal pheochromocytomas /paragangliomas,which shortens the operation time and increase the safety obviously.

Objective To develop a practical image acquisition strategy using intermittent breath?hold cone beam computed tomography (CBCT). Methods A breathing phantom was used to simulate the movement of tumor near the diaphragm during free breathing and breath hold and scanned by conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. In the conventional breath?hold CBCT, scan paused and free breathing occurred at the break of breath hold and free breathing was not included in the scan. In the intermittent breath?hold CBCT, one scan covered several breath holds separated by free breathing in a ratio of 3 vs1. Image quality and three?dimensional registration accuracy were quantitatively compared between conventional breath?hold CBCT and type Ⅰ/Ⅱ intermittent breath?hold CBCT. Comparison of image quality parameters between conventional breath?hold CBCT and intermittent breath?hold CBCT was made by paired t test. Results Motion artifacts arose in type I and Ⅱ intermittent breath?hold CBCT scans. There were no significant differences in the reconstructed pixel value or uniformity between intermittent breath?hold CBCT and conventional breath?hold CBCT ( P>0. 05, and P= 0. 02, 0. 53 ) . Compared with conventional breath?hold CBCT images, the signal?to?noise ratios of type I andⅡintermittent breath?hold CBCT images were reduced by 30% and 60%, respectively ( P<0. 05 ) . The registration error was up to 0 . 4 cm in the anterior?posterior direction and less than 0 . 1 cm in other directions . Conclusions The phantom study shows that intermittent breath?hold CBCT does not significantly reduce image quality or registration accuracy compared with conventional breath?hold CBCT. The feasibility of intermittent breath?hold CBCT in clinical application needs to be further validated among a large number of patients.

Insertional mutagenesis is a widely used method to determine the function(s) of a gene. To study the function(s) of the gene nsdAmgh in Streptomyces roseoflavus, a homologous recombination vector pSRNA2500 was structured in this paper. The recombination donor vector was then transformed into Strempomyces roseoflavus strain Men-myco-93-63 by conjugative transfer. The transformants were subjected to selection under the pressure of high temperature and appropriate antibiotics. As a result, several disrupted mutants of nsdAmgh gene, with a phenotype of Am(s)Km(r), were isolated and verified using PCR and Dot-blotting and Southern blotting hybridization methods. Functional analysis showed that the disrupted mutants of nsdAmgh had a two-fold higher inhibition against Verticillium dahlia Kleb than that of the wild strain Men-myco-93-63, which all will provide a new study route for future research about positive and negative regulator in Men-myco-93-63.
Genes, Bacterial ; Genetic Vectors ; Mutagenesis, Insertional ; Polymerase Chain Reaction ; Streptomyces ; genetics

Objective To study the diagnosis and surgical treatment of adrenal cavernous hemangi -oma. Methods The data of one case with adrenal cavernous hemangioma was retrospectively reviewed .A 62-year-old female patient admitted in out hospital on 18th June, 2013 due to the paroxysmal hypertension for 10 years and finding the left adrenal mass for 2 months.Her highest blood pressure was 175/55 mmHg and the response for the drug treatment was poor .In recent 6 months, her blood pressure was unstable .Ab-dominal ultrasound showed a hypoechoic mass in left adrenal .Enhanced CT examination showed an irregular mass in the left adrenal gland , with the size of 4.5 cm ×2.5 cm ×3.9 cm,peripherally enhanced in arterial phase , contrast agent filling in portal venous phase , and high density in delay phase .Abdominal MR exami-nation showed a mass before abdominal aortic , with clear and smooth edge .The mass showed low signal in T1WI phase and high signal in T 2WI phase, which was considered as pheochromocytoma .24h urinary cate-cholamines showed that norepinephrine was 103.0 nmol, epinephrine was 9.8 nmol and dopamine was 18.9 nmol.Octreotide (99Tcm-TOC) showed slight high expression of somatostatin receptor .Preoperative diagnosis was left pheochromocytoma . Results After the preoperative medical preparation of phenoxybenzamine for 3 weeks, her blood pressure was maintained at 120-132/50-70 mmHg, with stuffy nose, warm hand and foot, and the weight gain of about 1 kg.The patient was undergone laparoscopic resection of left adrenal tumor under general anesthesia on June 24, 2013.The postoperative blood pressure returned to normal .And the left adrenal pathology was cavernous hemangioma .Following up for 5 months, the patient had normal blood pressure without the tumor recurrence . Conclusions The adrenal cavernous hemangioma is extreme-ly rare with high rate of misdiagnosis .For adrenal tumor with typical hemangioma imaging , the diagnosis of cavernous hemangioma should be considered .For tumors larger than 6 cm, surgery is recommended .The first choice of operative approach is laparoscopic resection of adrenal tumor , and normal adrenal tissue should be retained as far as possible.

Objective To study the application of proteomics in detecting differentially expressed proteins in renal clear cell carcinoma (RCCC) patient's urine in order to improve the diagnosis rate of RCCC.Methods From Mar.2010 to May.2010,the urine samples of 11 RCCC cases were collected,including 10 males and 1 female with average age of 63 (46-78) years.All patients were finally diagnosed as RCCC by post-operative or biopsy pathology.The normal control urine samples were collected from 10 males with average age of 29 (25-32) years.WCX beads combined with matrix assisted laser desorption ionization time of flighl mass spectrometry (MALDI-TOF MS) technique was applied in detecting differentially expressed proteins in RCCC patient's urine to find out differentially expressed proteins.And genetic algorithm was utilized to establish a diagnosis model.Results 160 differentially expressed proteins in RCCC patient 's urine were detected,and 1 was in significant difference,P=0.0304.ClinProTools 2.2 software was utilized with genetic algorithm to find out 13 differentially expressed proteins to establish a diagnosis model,and the sensitivity and specificity rate was 100％ after cross validation.Conclusions The diagnosis model established by genetic algorithms has high sensitivity and specificity rate,and can improve the diagnosis of RCCC.

Objective To assess the long-term outcome of unilateral adrenaletomy in patients with adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The data from 82 cases of AIMAH were reviewed and summarized including clinical manifestations, endocrinological data, imaging findings and postoperative follow-up.Fouty-nine males and thirty-three females with a mean age of fifty years composed our series.Among the 82 cases, 41 demonstrated Cushing syndrome (CS), 74 presented with hypertension, 38 manifested diabetes mellitus, 35 complicated of osteoporosis and 11 of them with bone fracture, 39 complained of edema.Laboratory tests showed low ACTH plasma levels (＜ 2.2 pmol/L) in 62 of 79 cases.High level of 24-hour urinay free cortisol excretion(＞ 284.2nmol/L) was found in 67 of 79 cases.Elevated serum cortisol with loss of the circadian rhythm was presented in 55 of 60 cases.Failed to suppress cortisol secretion was observed in 61 of 63 conducted with low-dose dexamethasone suppression tests and in 47 of 53 implemented with high-dose dexamethasone suppression tests.Bilateral massively enlarged multinodular adrenal glands were found in all cases with CT or MR imaging.Unilateral adrenalectomy was performed in the larger side of adrenal gland in all 82 cases.All adrenalectomies were carried out including 47 in right sides and 35 in left sides, with 77 by retroperitoneoscopic approach and 5 by open retroperitoneal approach.Results Histopathological examination confirmed nodular hyperplasia of the adrenal cortex for all specimens.After a mean duration of 48.5 months, 80 of 82 patients were available for follow-up.Most clinical symptoms resolved within 6 months after operation.Cushingoid features disappeared in 58.5％ (24/41)of patients who initially presented with typical signs of Cushing Syndrome.Weight loss was seen in 56.3％ (45/80).Improvement of hypertension and diabetes was observed in 63.5％ (47/74) and 76.3％ (29/38) respectively.All the eyelids swelling and edema of the limbs subsided within 3 months.In long-term follow-up (more than 6 months), 82.9％ (63/76) had clinical and biochemical recurrence within a mean time of 14.6 months and 46.0％ (29/63) received contralateral adrenal surgery.Two patients died, one died from heart attack and another one died from pulmonary infection, 2 years and 7 years after unilateral adrenalectomy, respectively.Conclusions Unilateral adrenalectomy just has transient efficiency for AIMAH.Most patients will experience clinical and biochemical recurrence for a long period,and have to receive another operation for the contralateral hyperplastic adrenal gland.

Objective To investigate the diagnosis and treatment of renal neoplasm with calcification .Methods Retrospectively summarized the clinical data of the 2 patients with calcific renal neoplasm admitted in our hospital from the May to July in 2014, then analyzed and discussed the clinical manifestations , diagnosis and treatment com-bined with the literatures .Results The two cases were both suspected of renal malignant tumor preoperatively .The case 1 was a 32-year-old male , laparoscopic partial resection of the left kidney was performed , and the postoperative pathology was clear cell carcinoma (Fuhrman levelⅠ).The case 2 was a 18-year-old male, partial resection of the right kidney was performed because of the tumor size , and the postoperative pathology was adult nephroblastoma . Conclusions The calcific renal neoplasm is a rare disease , the property determination depends on postoperative pa-thology, and as to the choice of surgical method , the patients'age, the tumor size and the tumor location should be taken into consideration , and intraoperative frozen should be performed when necessary .

Objective To report outcomes of patients with PSA ≥ 30 μg/L with initial negative transperineal template-guided saturation biopsy (TTSB). Methods From 2003 to 2010,a total of 1824 patients underwent transperineal saturation biopsies with the prostate template at the Peking Union Medical College Hospital.44 of them had initial negative biopsy with PSA ≥ 30 μg/L were reviewed in this study.The mean age was 68 years old (range,51 to 80).The mean biopsy cores were 28.7 (range,11 to 44).The median PSA level was 40 μg/L (range,30 to 128),and the median prostate volume was 73 ml (range,30 to 190).They were divided into four groups:TURP group,chronic prostatitis group,repeat biopsy group and miscellaneous group. Results Patients were followed up for a mean of 49 months (range,12 to 91).All patients of TURP group (15 cases) were identified as prostatic hyperplasia by postoperative pathology.2 of them had a second TTSB for PSA ＞ 10 μg/L after TURP,which were negative.5 patients of chronic prostatitis group had a declining PSA level after antibiotic therapy for 3 to 4 weeks.One patient took a second biopsy,which was identified as prostatitis.All patients of repeat biopsy group (18 cases) showed no significant decrease in PSA level during follow-up and undertook biopsies 2 to 4 times,6 of which were proved to be prostate cancer.All patients of the miscellaneous group (6 cases) had a declining PSA and didn't take a second biopsy. Conclusions Close follow-up and regular PSA testing for patients who had a high PSA level with initial negative biopsy would be help to avoid both false negative of prostate cancer and unnecessary biopsy.