@@

Objective:To study the role of adhesion molecules in the pathogenesis of polymyositis. Methods:The abnormal expression of adhesion molecules on T cells in peripheral blood and muscle fibers from patients with myositis was analyzed by two colour immunofluoresence and RT PCR methods respectively. Results:The expression of adhesion molecules including lymphocyte function associated antigen 1(LFA 1 ),very late antigen 4(VLA 4) on T cells in peripheral blood and intercellular adhesion molecule l(ICAM 1) on muscle fibers from patients with myositis was markedly higher than that in the healthy control group. Conclusion: These findings suggested that adhesion molecules may be responsible for the migration of T cells and destraction of muscle fibers.

Objective To discuss the application value of transesophageal echocardiography (TEE) in occluding procedure with cardiopulmonary bypass (CPB) for children muscular ventricular septal defects (mVSD).Methods Forty-nine mVSD patients for occluding procedure with CPB were performed guided and monitored by TEE,9 cases were simple mVSD,40 were mVSD combined with other cardiac malformations.The location,size,number,scope and the surrounding anatomy of mVSD were carefully observed before going into cardiac arrest,preparing the operator to choose appropriate occluder devices.The procedure was evaluated after the recovery of heart beat using TEE.Results In all of the 49 patients underwent occluding procedure,44 cases were implanted into one occluder,5 implanted into two occluders.The results of TEE after operation showed that the positions of all occluders were not shifted,2 had trace residual shunt,there were no complications worsening,such as mitral and aortic regurgitation,etc.One patient abandoned treatment for serious infection,the other patients' occluders were all in normal position followed up at 6 months to 2 years after operation,there were no tiny residual shunt and valves regurgitation except 1 patient.Conclusions The technique that TEE guiding and monitoring in occluding procedure with cardiopulmonary bypass for children muscular ventricular septal defects can shorten the time of cardiopulmonary bypass,significantly reducing complications and risks of the surgery,improving the successful rate.

Objective To investigate the short-term surgical effect and complications of posterior dislocation of the hip with femoral head fractures.Methods Twenty-two patients with posterior dislocation of the hip with femoral head fractures treated surgically from December 1999 to December 2008 were reviewed retrospectively.All the patients were males aged from 23-52 years (mean 39.2 years).According to Pipkin classification,fractures were type Ⅰ in nine cases (41％),type Ⅱ in seven (32％),type Ⅲ in two (9％) and type Ⅳ in four (18％).Different surgical approaches and treatment methods were employed together with a periodic follow-up.Harris score and Thompson & Epstein score were used as measurement standard in postoperative clinical and radiological follow-up.Postoperative complications were analyzed as well.Results All the patients were followed up for mean 36 months.Clinical outcome as assessed by Harris criteria was excellent in 10 cases,good in seven,fair in two and poor in three,with excellent-good rate of 77％.Complications included femoral head avascular necrosis in four cases and traumatic arthritis in six.Heterotopic ossification of the hip did not occur.One case complicated with idiopathic injury of sciatic nerve was recovered at one year after operation.Conclusions Posterior dislocation of the hip with femoral head fractures should be operated as soon as possible.Operational modalities should depend on the type of fractures for the sake of reducing complications.

Objective To evaluate the clinical outcome of transesophageal echocardiography(TEE) in guiding and monitoring min-invasive transthoracic hybrid procedure for intracristal ventricular septal defects (VSD) using eccentric occluders.Methods 13 patients with intacristal VSD successfully underwent the min-invasive hybrid procedure using eccentric occluders were analyzed retrospectively.They were all carefully examined by transthoracic echocardiography (TTE) preoperatively and were diagnosed as intracristal VSD.There were no obvious aortic valve prolapse and no severe regurgitation.The entire process was guided and monitored by TEE.The condition of VSD occlusion was assessed by immediate postoperative TEE.Results All cases were occluded successfully.The results of postoperative TEE showed that the occluder was coincided closely with the edge of VSD,no aortic valve regurgitation worsen.2 had tiny residual left-to-right shunt (＜1.5 mm),which disappeared 1 and 3 months respectively after operation.No occluder dislocated followed-up at 6 months to 2 years postoperatively,and no major complications occurred.Conclusions The min-invasive hybrid procedure for intracristal VSD using eccentric occluders guided and monitored by TEE is easy to manipulate,which is safe,less invasive,and has excellent early-term results.

Objective To investigate the clinical value of ultrasonic diagnosis for neonatal annular pancreas,analyze the reasons of missed diagnosis and misdiagnosis,and improve diagnostic accuracy of ultrasonography for this disease.Methods Clinical data of 98 newborns with annular pancreas confirmed by gastrointestinal contrast and surgery were analyzed retrospectively.Preoperative ultrasonogram were compared with the result of gastrointestinal contrast and surgery.Ultrasound images failed to be correctly dignosed were further studied to summarize diagnostic points for this disease.Results Among the 98 cases, 75 were correctly diagnosed by ultrasound with a diagnostic accordance rate of 76.5%,1 8 were missed diagnosed and 5 were misdiagnosed with a total misdiagnosis rate of 23.5%.Ten cases associated with other congenital gastrointestinal tract anomalies were missed diagnosed due to ignoring scanning pancreas.Five cases were missed diagnosed due to obvious intestinal cavity flatulence.Three cases were missed diagnosed due to lack of awareness of the disease.Five cases were misdiagnosed for duodenal stenosis or duodenal atresia.Conclusions Ultrasound has important diagnostic value for neonatal annular pancreas,providing the dignostic evidences for clinical treatment.Thus it can be used as the preferred auxiliary examination of the disease.Since annular pancreas is often accompanied by other gastrointestinal malformations and can be interfered by abdominal gas,missed diagnosis and misdiagnosis occurred easily.To improve the accuracy of ultrasonic diagnosis,all causes of neonatal gastrointestinal tract obstructions should be considered during the examination.

Occupational chromium rhinopathy is chronic nasal damage caused by chromic anhydride, chromate and dichromate 6-valent chromium compounds. In 2016, 700 people who were exposed to chromium slag in steel plant were checked out. 24 people were found to have nasal injuries. The expert group confirmed 1 case of occupational severe chromium rhinosis and 23 cases of occupational mild chromium rhinosis.There was no significant difference in the incidence, type of work and duration of injury among 24 patients (P>0.05) . Active measures should be taken to prevent chromium rhinopathy and the technological process should be reformed. Occupational health education and occupational health monitoring should be strengthened to avoid exposure of chromium and its compounds through nose and respiratory tract, and to reduce or eliminate the occurrence of chromium rhinosis.

Gastric cancer with liver metastasis (GCLM) is the leading cause of death in patients with advanced gastric cancer. Multiple metastasis was common in GCLM and usually complicated with lesions outside the liver, especially peritoneal metastasis. Most of liver metastasis lesions could not be resected radically. Currently, main treatments for GCLM included radical operation, palliative resection of gastric cancer, ablation of metastatic lesions, intervention and systemic chemotherapy. Based on the current progress in the treatment for GCLM and our clinical experience, the general status of patients, the type of gastric cancer and the degree of liver metastasis should be analyzed, and a cooperative multidisciplinary team (MDT) should be applied to conduct and to choose active and suitable comprehensive treatment for GCLM patients based on individualized therapy principle.
Humans ; Liver Neoplasms ; secondary ; therapy ; Stomach Neoplasms ; pathology ; therapy

Objective To analyze the clinical characteristics of connective tissue disease related interstitial lung disease (CTD-ILD).Methods The demographic data,clinical manifestations,blood gas analysis,lung function,chest high resolution CT (HRCT),histopathology of 186 patients with CTD-ILD admitted in Jinhua Central Hospital from January 2013 to December 2017 were retrospectively analyzed.Results In 186 patients with CTD-ILD,70 were males and 116 were females,with a mean age of 56.22± 12.27.Among them,61 cases were polymyositis/dermatomyositis (DM/PM)-ILD,44 cases were rheumatoid arthritis (RA)-ILD,26 cases were interstitial pneumonia with autoimmune features (IPAF),16 cases were systemic sclerosis (SSc)-ILD,14 cases were Sjogren syndrome (SS)-ILD,11 cases were overlap syndrome (OS)-ILD,7 cases were systemic lupus erythematosus (SLE)-ILD,5 cases were undifferentiated connective tissue disease (UCTD)-ILD,and 2 cases were mixed connective tissue disease (MCTD)-ILD.The incidence of respiratory symptoms was higher than that of systemic symptoms,and the incidence of systemic symptoms was higher than that of skin symptoms.Cough was the most common symptom of respiratory system,and arthralgia was the most common symptom of systemic symptoms,accounting for 54.9％(101/186) and 48.9％ (91/186)respectively.Blood gas analysis showed that hypoxemia accounted for 56.5％(83/147) and type Ⅰ respiratory failure accounted for 26.5％(39/147).The proportion of restrictive ventilation dysfunction in pulmonary function tests was 70.9％(105/148) and the diffuse dysfunction was 81.1％(120/148).The manifestations on HRCT were reticular linear shadow (44.1％),ground-glass opacity (54.3％),consolidation (23.1％),nodules shadow (20.9％) and cystic low density shadow(9.1％).The histopathological diagnosis mainly was non-specific interstitial pneumonia (NSIP,43.0％) and usual interstitial pneumonia (UIP,40.0％).Conclusion The arterial blood gas analysis,lung function and chest HRCT screening,and lung histopathological examination are important for early identification and diagnosis of CTD-ILD.

OBJECTIVETo assess the value of gastric and hepatic surgical treatment in gastric cancer patients with liver metastasis and its prognostic implication.

METHODSLiterature search was performed in pubmed, Embase, Ovid, Springer-Link, Web of Science, CNKI, CBMdisc for clinical research published before March 2013 that compared gastrectomy alone to gastrectomy and hepatectomy. Inclusion criteria and exclusion criteria were performed. Quality assessment was based on NOS scale. Stata12.0 was used for statistical analysis.

RESULTSNine studies including 431 patients were enrolled for analysis, among whom 189 underwent gastrectomy and hepatectomy and 242 underwent gastrectomy alone. Gastrectomy and hepatectomy group had better survival(HR=0.50, 95%CI:0.34-0.72, z=3.66, P=0.000). There was a subgroup analysis. Gastrectomy with hepatectomy group had significant advantages in prognosis in four foreign studies(HR=0.28, 95%CI:0.18-0.44, z=5.77, P=0.000). There was no significant difference in five domestic studies (HR=0.74, 95%CI:0.55-1.00, z=1.95, P=0.051).

CONCLUSIONGastrectomy and hepatectomy in gastric cancer patients with liver metastasis improves long-term survival in select patients.

Gastrectomy ; Hepatectomy ; Humans ; Liver Neoplasms ; secondary ; surgery ; Prognosis ; Stomach Neoplasms ; pathology ; surgery