Objective To discuss the surgical treatment of primary pigmented nodular adrenocortical disease(PPNAD).Methods twenty-four cases of PPNAD were treated in our hospital from January 2005 to December 2017.Clinical data of these patients were reviewed.It included 8 males and 16 females with a mean age of 23 years old (range 14 to 58).23 cases presented with typical symptoms of Cushing syndrome, 1 case presented with hypertension.Eight cases could be diagnosed with Carney complex.All cases were confirmed as ACTH-independent Cushing syndrome.Adrenal imaging showed bilateral multiple nodules in 11 cases, unilateral multiple nodules in 4 cases, unilateral single mass or nodule in 3 cases, normal adrenals in 6 cases.Results All of the 24 cases received laparoscope unilateral adrenalectomy or laparoscope unilateral mass resection.After the operation, 8 cases underwent secondary operation because of symptom recurrence and the elevated 24-hour urinary free cortisol.Among them, 5 cases received contralateral subtotal adrenalectomy, 3 cases received contralateral total adrenalectomy.Seven cases with a slightly elevated 24-hour urinary free cortisol but a good recovery of Cushing symptoms were followed-up.Nine cases recovered well after the first operation and they didn't undergo secondary surgical treatment, but 1 of the 9 cases needed glucocorticoid replacement.Conclusions Bilateral adrenalectomy followed with long-term glucocorticoid replacement is the standard treatment of PPNAD.Unilateral adrenalectomy or subtotal adrenalectomy may be suitable for elected patients, but appropriate criteria need to be explored.

Objective To retrospectively analyze the clinical data of 3 middle-aged and elderly cases with inflammatory myofibroblastic tumor (IMT) of the kidney,in order to improve its diagnosis and treatment.Methods The records of 3 patients who were diagnosed as IMT of the kidney by pathology in our hospital from Jan 2005 to Jun 2014 were reviewed to identify the characteristics including age,gender,clinical manifestation,tumor imaging and pathological features,treatment and prognosis.Results The mean age of the patients was 60 years.One patient underwent partial nephrectorny,1 patient underwent radical nephrectomy,and another patient received nephroureterectomy with bladder cuff excision.Patients were followed up for 8 months to 10 years,and no tumor recurrence was found.Conclusions IMT of the kidney is the tumor of low malignant potential with a good prognosis.Surgery is the first choice for the diagnosis and treatment.

Objective To study the relationship between the washout speed in the contrast-enhanced ultrasound (CEUS) and the differentiation grading in pathology in patients with hypervascular hepatocellular carcinoma (HCC).Methods Totally 271 patients who underwent complete resection for hypervascular HCC from April 2009 to December 2014 at Nanchong Central Hospital were included in this study.CEUS examinations were perfomred in all patients 2-3 days before liver resection.A timer on the ultrasound screen displayed the time elapsed since the saline flush was used to determine time to washout.The washout rate were categorized into four levels based on enhancement in portal venous phase and delayed phase.The differentiation grade and the washout speed were compared using Kruskal-Wallis test.Results All 271 (100％) lesions were arterially enhanced with different washout rate.Washout speed 1 was found in 19 patients (7.0％),while speed 2 in 157 patients (57.9％),speed 3 in 65 (24.0％),and speed 4 in 30,respectively.The washout speed had a significant correlation with the differentiation (x2=179.8238,P ＜ 0.001).The faster washout speed,the higher differentiated.Washout speed 1 could distinghuish well-differentiated from the poor and moderately differentiated tumor.The sensitivity and specificity of preoperative washout speed 1 to identify well histologic grade were 98.0％ and 77.8％,the positive predictive value and negative predictive value were 96.0％ and 48.8％,and the positive likelihood ratio and negative likelihood ratiowere were 1.9 and 0.01.Washout speed 4 could distinghuish poor differentiated from well and moderately differentiated tumor The sensitivity and specificity of preoperative washout speed 4 to identify poor histologic grade were 24.3％ and 97.0％,the positive predictive value and the negative predictive value were 65.3％ and 61.3％,and the positive likelihood ratio and negative likelihood ratiowere were 3.2 and 0.7.Conculsions Washout speed can reflect the degree of differentiation roughly.Washout speed can effectively diagnose the well-differentiated HCC,but it is difficult for moderate and poor differentiated HCC.

BACKGROUND: Schizophrenia is substantially heritable, but specific susceptibility genes remain difficult to be identified. Therefore, it is necessary to explore hereditary markers first.OBJECTIVE: To investigate the relationship between schizophrenia and related vWA allele genes based on the analysis of microsatellite DNA vWA polymorphism.DESIGN: A case-controlled study with schizophrenic patients and randomly selected population as subjects.SETTING: Ward of Dalian Seventh People's Hospital and Molecular Biological Laboratory of Dalian Medical University.between March and July 2002 at Dalian Seventh People's Hospital which specializes in schizophrenia. Schizophrenia was diagnosed according to the diagnostic standard of the third edition of "the American Diagnostic Statistical Manual for Schizophrenic Diseases", and their clinical manifestations were predominantly negative signs. Altogether 123 normal blood samples were collected from random population at the Blood Center of Dalian Red Cross. They all denied psychological ailments and severe systematic diseases, and they had no kinship with each other.METHODS: Heparin anti-coagulation blood samples were collected and PCR compound amplification was carried out with the aid of PE Profiler plus system. Then the products were subjected to electrophoresis and gene detection with ABI310 type gene analysis system so as to calculate the frequency of allele genes; Hardy-Weinberg equation law was used to make coincidence test and linkage analysis of the theoretical frequency and actual one. Schizophrenic patients and random population were compared and relative risk was calculated with RR=Pd × (1-Pc)/Pc × (1-Pd) in order to assess the statistical significance (RR: relative risk; Pd: gene frequency of schizophrenia; Pc: gene frequency of random population). RR ＞ 1 was considered of higher susceptibility while RR ＜ 1 was considered of anti-susceptibility. In this way, we could find out vWA allele genes that had susceptible linkage or anti-linkage with schizophrenic related genes.MAIN OUTCOME MEASURES: Major outcome: Correlation analysis of vWA allele genes in schizophrenic patients and random population. Secondary outcome: The coincidence of vWA allele gene frequency in patients with schizophrenia and random population with what was calculated by Hardy-Weinberg law.RESULTS: Data of the two groups were processed according to the objective and statistically analyzed.① vWA allele gene frequency in patients with schizophrenia and in random population was found to coincide with HardyWeinberg law(P ＞ 0.05).② The positive rate of vWA-14 in schizophrenic patients (17.2%) was obviously different from that in random population (33.3%) (RR=0.415, P=0.014). The positive rate of vWA-17 in schizophrenic patients (31.3%) was found to be significantly higher than that in random population (19.5%) (RR=1.866, P=0.043) while it did not differ significantly in other allele genes (P ＞ 0.05).CONCLUSION: The positive rate of vWA-14 was significantly lower in schizophrenic patients than in random population, indicating that vWA-14locus may be negatively selected in schizophrenia due to some reasons,which may be approximate to anti-schizophrenia genes. Moreover, the higher expression of vWA-17 in schizophrenic patients than in random population suggests that vWA-17 locus is correlated with schizophrenia,which may be approximate to schizophrenia-susceptibile genes.

BACKGROUND:The exact pathogenesis of ossification of ligamentum flavum has not been elucidated yet. And osteopontin may be an important factor involved in the ossification of ligamentum flavum. OBJECTIVE:To clarify the expression and significance of osteopontin and its receptors, CD44 and integrin-β3, in ligamentum flavum cels between normal controls and patients with ossification of ligamentum flavum.METHODS:Ligamentum flavum tissues were obtained from normal adult controls and adult patients with ossification of ligamentum flavum (n=8 per group) who underwent thoracic/lumbar posterior decompression surgery. Ligmentum flavum cels were separated, cultured and identifiedin vitro, and osteopontin, CD44, integrin-β3 were stained using immunocytochemistry method and observed under inverted phase contrast microscope. And the mRNA expressions of osteopontin, CD44, integrin-β3 were measured by RT-PCR. RESULTS AND CONCLUSION: Immunocytochemistry results showed that the stronger positive staining for osteopontin, CD44, integrin-β3 was observed in the ossification of ligamentum flavum group than the control group (P < 0.01). The mRNA expressions of osteopontin, CD44 and integrin-β3 were also higher in the ossification of ligamentum flavum group than the control group (P < 0.05). These findings indicate that osteopontin and its receptors, CD44 and integrin-β3, in ligamentum flavum cels may play an important role in ossification of ligamentum flavum.

Objective To provide reference for exploring the senile chronic disease health management new model by apply‐ing the chronic disease health management model into the practice of home‐based care service center in community .Methods The chronic disease health management team was established and the management platform of home‐based care service centers in com‐munity was applied to implement the chronic disease health management service .The senile chronic disease management and service situation were compared between before and after implementing chronic disease health management ,and the difference of service be‐tween the home‐based care service center and community health service center after implementing the chronic disease health man‐agement was compared as well .Results The service content implementation in the home‐based care service center was significantly improved after senile chronic disease health management (P<0 .01) ,and the chronic disease management satisfaction was increased by 39 .66% .Meanwhile ,the management rate and control rate of chronic diseases in the community home‐based care service center were superior to those in the community health service center (P<0 .01) .Conclusion Applying the chronic disease health manage‐ment model into the platform of the home‐based care service center can provide more comprehensive ,specific and efficient chronic disease health management service ,w hich provides a new model of senile chronic disease management application .

Objective To explore the correlation between hyperlipidemia and colorectal polyps by compare the level of serum lipids in patients with colorectal polyps.Methods The levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein-cholesterol (LDL-C) of 159 patients with colorectal polyps and 138 controls were tested.The serum lipids between colorectal polyps group and control group,of colorectal polyps with different pathological type,of adenomatous polyps with different pathological type,of adenomatous polyps with different location,colorectal polyps of different gender were compared.Chi square test or t test were performed for data analysis.Results The incidence of hyperlipidemia of colorectal polyps group was 41.5％ (66/159),which was higher than that of control group (16.7％,23/138) and the difference was statistically significant (x2 =36.56,P＜0.01),its levels of TG,TC and LDL-C were all higher than those of the latter ((1.52±0.56) mmol/L vs (1.06 ± 0.42) mmol/L,(5.22±0.86) mmol/L vs (4.52±0.96) mmol/L,(2.85±0.66) mmol/L vs (2.52± 0.35) mmol/L; t=4.23,4.02,3.72,all P＜0.01).There were no significant differences in the levels of TC,TG and LDL-C between colorectal polyps with different pathological type (all P＞ 0.05).The incidence of hyperlipidemia of tubular villous adenoma and villous adenoma (progressive adenomas) was 60.0％ (15/25),which was higher than that of tubular adenoma group (33.3％,20/60) and the difference was statistically significant (x2=5.18,P＜0.05).The incidence of hyperlipidemia of left colon and rectal polyps group was 46.2％ (49/106),which was higher than that of right colon polyps group (28.6 ％,12/42) and the difference was statistically significant (x2 =3.87,P＜0.05).The incidence of hyperlipidemia of male colorectal polyps group was 47.2％ (51/108),which was higher than that of female group (29.4％,15/51) and the difference was statistically significant (x2 =4.53,P＜0.05).The level of TG of male colorectal polyps group was higher than that of female group ((1.84 ± 0.73) mmol/L vs (1.55±0.65) mmol/L) and the difference was statistically significant (t=3.98,P＜0.05).Age (r=0.766,P=0.009),TG level (r=0.535,P=0.012) and TClevel (r=0.688,P=0.025) were positively correlated with genesis of colorectal polyps.Conclusion There is a significant correlation between hypertriglyceride,hypercholesteremia and colorectal polyps.

ObjectiveTo investigate the effect of massage therapy on cerebral palsy children with strabismus.Methods60 cerebral palsy children with strabismus were divided into the treatment group (30 cases) and control group (30 cases). Children of the treatment group were treated with massage therapy "YangGan RouJin Fa", those of the control group were not given any treatment, 30 strabismus children without cerebral palsy were treated with massage therapy "YangGan RouJin Fa" as the observation group.ResultsEffect of the treatment group was significantly different from the control group (P<0.01), and observation group (P<0.05).Conclusionmassage therapy "YangGan RouJin Fa" is a efficient method to strabismus in cerebral palsy children.

In the practice of building its humanistic environment of a research hospital,Nanjing Drum Tower hospital adheres to such humanistic characteristics of the hospital as humanistic concept,planning, environment,management,service,and quality.Furthermore,the hospital upholds such keys as learning, innovation, cooperation, undertaking, competition and development. High focus, high starting point planning,persistence,and down-to-earth efforts,effectively promoting hospital development.