Objective To study the pathogenetic characteristics of tertiary hyperparathyroidism. Methods The diagnosis and treatment of a male patient with tertiary hyperparathyroidism were reviwed. Results The patient who had had chronic renal failure underwent excision of the adenoma of parathyroid gland 5 year ago.After that,the total parathyroidectomy and autografting were performed because of his recurrent hyperparathyroidism.The patient began hemodialysis therapy 3 years ago and then underwent allogeneic kidney transplantation 2 years ago.Two months after the operation,symptomatic hyperparathyroidism relapsed.The autonomic parathyroid grafts were removed three times (one part of the grafts resected each time) with relapse occurring three times.Later the hyperparathyroidism was cured by itself after the patient was mentally irritated. Conclusions Tertiary hyperparathyroidism may have already developed before kidney transplantation.

Objective To study the bladder function after internal iliac artery chemotherapy for bladder carcinoma. Methods Internal iliac artery chemotherapy was undertaken for 38 cases of bladder carcinoma comprehensively treated by TURBt,partial cystectomy or paliative TURBt.12 were T 1 carcinoma,14 T 2 and 12 T 3. Results The urinary bladder has been preserved in 33 patients.Of the 12 T 1 carcinoma,repeated recurrence occurred in 4.TURBt was undertaken on each occasion whereas total cystectomy was finally carried out in 2 of them.The bladder has been preserved in 10 of 14 and the 10 are still alive;of 14 T 2 (regional infiltrating carcinoma)patients,1 died of metastasis 2 years after surgery and another complicated by renal failure due to chemotherapy and has been on hemodialysis.The bladder has been preserved in 13 of the 14 and the 13 patients are still alive;of the 12 T 3 patients,8 were high risk patients,2 of them died of the cancer 2～3 years after the operation.Tumors vanished in 3 patients with negative multiple randomized biopsy.Tumors became smaller in 7 and partial cystectomy was performed for 3 of them.Of another 4 with shrunken tumors,hematuria has been controlled,the bladder capacity increased and the general condition of the patients improved.The bladder has been preserved in 10 of the 12.The mean survival time has been 58 months. Conclusions Internal iliac artery chemotherapy is effective and useful for some bladder cancer with the bladder function preserved.

Objective To study the diagnosis and treatment of ectopic testes. Methods 7 cases of ectopic testes were reviewed and studied. Results 5 cases of ectopic testes were diagnosed and located by physical examination and/or type B ultrasonography before operations whereas the ectopic testes was atrophic in the other two.All the ectopic testes were found successfully during surgical exploration.Orchidopexy was performed for 5 patients,and orchiectomy for the other 2 because of marked atrophy.Postoperative follow up has been 2 months to 8 years.All the patients have normal growth.In the 5 cases with reposited testes no displacement,atrophy or malignant change has been noted. Conclusions The diagnosis of ectopic testes should be mainly depended on physical examination and type B ultrasonography.Surgical exploration should be carried out through the inguinal canal and via the pathway of spermatic cord.

The manifestation of clinical symptoms of cerebral small-vessel disease (SVD) is cognitive disorders. Its pathological changes are manifested as leukoaraiosis and/or lacunar infarction. However, it is not clear whether cognitive disorders caused by SVD is correlated with the severity of white matter damage. Magnetic resonance spectroscopy analysis can noninvasively detect metabolite concentrations of brain tissue in vivo and directly reflect cerebral metabolism; Diffusion-tensor imaging is a novel noninvasive technique for specific observation of white matter through different parameters such as mean diffusivity and anisotropy for quantitative evaluation of the abnormalities of fine structure of white matter. The combination of magnetic resonance spectroscopy analysis and diffusion-tensor imaging may more sensitively reveal the severity of white matter damage, and provide a research tool for cognitive disorders caused by SVD.resonance imaging

AIM:Researches have shown that musculocutaneous flap or fascial flap could well treat refractory bedsore in a long term. This study observed the clinical experience in the treatment of sacrococcygeal ulcers. METHODS:From January 2000 to January 2006,19 patients with sacrococcygeal ulcers,who received myocutaneous flap transposition in Department of Burns and Plastic Surgery,West China Hospital of Sichuan University,were selected. The informed consent was obtained from all patients. The surgery included two stages. At the first stage,debridement and eschar excision were performed. At the second stage,the surgery was undergone after selecting the myocutaneous flap type according to the patients' age,ulcer position,and ulcer extent. Twenty-one wounds were repaired by gluteus maximus myocutaneous flaps,and the flap size was 13 cm ?11 cm-17 cm?14 cm;8 by long-head of biceps femoris flaps of 10 cm?6 cm-13 cm?6 cm. After operation,the patients were placed on turn-over bed for 14 days and followed regularly. RESULTS:All flaps survived and the wounds in 18 cases healed at the first stage. Hematocele underlying flap occurred in one patient with urinemia,and healed by dressing exchange. After a follow-up of 5 months to 3 years,no patient had a recurrence;the color and texture of the flaps were good,and he appearance was satisfactory. CONCLUSION:The technique of two period operation treatment of myocutaneous flap transposition can accelerate the healing of sacrococcygeal ulcers and improves the success rate of operation.

Clopidogrel is an essential drug for the treatment of ischemic stroke.It has been recommended by the multinational stroke treatment guidelines and has been widely used in clinical practice.Many patients with ischemic stroke may still have stroke recurrence after the standard treatment of clopidogrel; therefore,we must pay attention to the phenomenon of clopidogrel resistance.This article reviews the biochemical mechanisms,gene polymorphism,laboratory testing,and response measures of clopidogrel resistance.

Objective:To survey the status quo of job burnout among rural general practitioners and to analyze its influencing factors.Methods:A total of 2 805 rural general practitioners in three counties in southwest Shandong province were enrolled in the study. The survey was conducted with a basic information questionnaire and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). The influencing factors of job burnout were analyzed by Pearson chi-square test (χ2) and binary logistic regression model.Results:A total of 2 272 rural general practitioners completed the survey with a completion rate of 81.0%. The rates of middle or high job burnout in the dimensions of emotional exhaustion, depersonalization and reduced personal sense of achievement were 55.1%(1 251/2 272), 34.0%(772/2 272) and 91.3%(2 075/2 272), respectively. Binary logistic regression model showed that working hours/week ≥ 60 h ( OR=1.341, 95 %CI:1.057-1.702, P<0.05), monthly shift times ≥20 ( OR=1.434, 95 %CI:1.182-1.739, P<0.05), daily consultation time≥13 h ( OR=1.294, 95 %CI:1.055-1.589, P<0.05), daily consultation of 11-20 patients ( OR=1.317, 95 %CI:1.075-1.614, P<0.05), no part-time job ( OR=1.583, 95 %CI:1.201-2.087, P<0.05), insomnia ( OR=2.638, 95 %CI:2.225-3.128, P<0.05), feeling depressed at work ( OR=3.170, 95 %CI:2.661-3.776, P<0.05) were risk factors for emotional exhaustion; participation in public health services ( OR=1.485, 95 %CI:1.155-1.910, P<0.05), being married ( OR=2.273, 95 %CI:1.198-4.313), no part-time jobs ( OR=1.677, 95 %CI:1.276-2.203, P<0.05), insomnia ( OR=1.487, 95 %CI:1.211-1.827, P<0.05), and feeling depressed at work ( OR=1.642, 95 %CI:1.339-2.015, P<0.05) were risk factors for depersonalization; working hours/week ≥ 60 h ( OR=2.089, 95 %CI:1.454-3.002, P<0.05), daily consultation time ≥ 9 h ( OR=2.495, 95 %CI:1.748-3.561, P<0.05), insomnia ( OR=2.061, 95 %CI:1.519-2.796, P<0.05), and feeling depressed at work ( OR=1.894, 95 %CI:1.383-2.593, P<0.05) were risk factors for reduced personal achievement. Protective factors included monthly income ≥3 000 Yuan ( OR=0.589, 95 %CI: 0.353-0.982, P<0.05) and monthly shift of 10-19 times ( OR=0.581, 95 %CI:0.411-0.820, P<0.05). Conclusion:The overall job burnout among rural general practitioners in southwest Shandong province is serious, especially the depersonalization and the reduction of personal sense of achievement. It is suggested to improve the salary, reduce the working intensity, optimize the working hours, and pay attention to their physical and mental health for rural general practitioners to alleviate the current situation of their occupational burnout.

Objective To identify the imaging features of pancreatic acinar cell carcinomas.Methods Eleven patients of pancreatic acinar cell carcinomas proven surgically and pathologically were included.We retrospectively evaluated the CT and MR findings including the location, size, shape, margin, necrosis , calcification, hemorrhage, enhancement degree, enhancement pattern, invasion to other organs, perilesional lymph nodes, metastasis, recurrence.Results The tumors were distributed in the head(n=4), body and tail(n=4),tail(n=3) of pancreas.The median tumor size was 97 mm(27 to 180 mm).Nine cases presented with a well-defined enhancing capsule.Tumor vessels could be seen in 9 cases.Seven cases were hypovascular while the other 4 were hypervascular.Different extents of necrosis could be seen in all masses as a swirling or cleft low density in the enhanced tumors, with an median of 10％ (2％ to 25％).The hypovascular masses more frequently demonstrated a lobulated tumor, heterogeneous enhancement pattern, with a larger necrotic component and were more common invasion to other organs.Conclusions Pancreatic acinar ccll carcinoma typically presents as a sizable pancreatic mass with a well-defined enhancing capsule.

BACKGROUND:Once lumbar degenerative diseases merge with lumbar spinal stenosis, lumbar instability and degenerative scoliosis, surgical therapy is required for corresponding clinical symptoms, and the usage of internal fixators cannot be inevitable. Osteoporosis is rather common in the elderly. Therefore, how to implant stable pedicle screw fixation system in serious osteoporosis patients wil be a big difficulty. In recent years, some studies have proven the biomechanical stability of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw in the vertebral body, so it becomes very hot in the spine surgery. OBJECTIVE: To explore the clinical efficacy of the use of polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation for the treatment of lumbar degenerative disease accompanied with osteoporosis. METHODS:Thirty-one patients with lumbar degenerative disease accompanied with osteoporosis from Jun 2008 to Jan 2013 were selected, including 11 males and 20 females with an average age of 73.5 years (range, 65-86 years). There were 14 cases of lumbar degenerative stenosis, 9 of lumbar intervertebral disc herniation combined with segmental instability, 6 of lumbar degenerative spondylolisthesis, and 2 of lumbar degenerative scoliosis. The patients were treated with lumbar canal decompression, fusion and polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation according to their clinical features and imaging data. Visual analog scale for pain evaluation was used before and after fixation, the Japanese Orthopaedic Association (JOA) scale was used for assessment of neurological function and life skils before internal fixation and during folow-up. RESULTS AND CONCLUSION:Al cases were folowed up for 40 months (range, 36-48months). No screw breakage, rod breakage, screw extraction, loosening, pseudoarticulation formation, or incision infection was found. The postoperative visual analog scale score and the JOA score was remarkably improved (P < 0.05). For patients suffering from lumbar degenerative disease accompanied with osteoporosis, polymethylmethacrylate augmentation of a cannulated and fenestrated pedicle screw fixation is helpful for increasing the stabilization of screw and preventing from loosening and dislocation of the screws, and thereby beneficial for improvement and maintenance of clinical efficacy.

Background Choroidal neovascularization (CNV) leads to blindness in many fundus diseases.Study showed that naringenin suppresses CNV,but it presents with poor bioavailability because of its poor solubility in water.β-cyclodextrin (β-CD) can increase the water-solubility of drugs, however, whether the inhibitory effect of naringenin on CNV can be improved after clathrated with β-CD remains unclear.Objective This study was to compare the inhibitory effects of naringenin with naringenin/β-CD compounds on CNV in rats.Methods Naringenin/β-CD clathrate compounds were prepared with saturated solution,the solubility of naringenin in water was calculated based on standard curve.Thirty-two male Brown Norway rats were randomized into normal control group, model control group, naringenin group and naringenin/β-CD group.Laser-induced CNV models were created in the right eyes of rats from the model control group, naringenin group and naringenin/β-CD group.Naringenin and naringenin/β-CD clathrate compounds were intraperitoneally injected at a dose of 20 mg/kg in the rats of naringenin group and naringenin/β-CD group since the day after modeling, respectively, once per day for 4 weeks, and equal volume of DMSO was injected in the same way in the model control group.Fluorescein isothiocyanate dextran (FITC-D) was injected via rat hypoglossal vein for the preparation of flatmounts of choroid in the fourth week,and the areas of CNV were measured and compared among the groups.The retinal pigment epithelium (RPE)-choroid-sclera tissues were isolated from the rats, and the relative expression levels of vascular endothelial growth factor (VEGF) , cyclooxygenase-2 (COX-2),phosphatidylinositol-3-kinase (PI3K),p38mitogen-activated protein kinase (p38MAPK), matrix metalloproteinase (MMP)-2, MMP-9 mRNA and their proteins in RPE-choroid-sclera tissue were detected using real-time PCR and Western blot.Results The solubility of naringenin in water increased by 11.8 folds after encapsulated with β-CD.The CNV areas in the model control group, naringenin group and naringenin/β-CD group were (34.56± 1.67), (20.90± 1.47) and (13.20± 1.38) × 103 μm2 , respectively, showing significant reduces in the naringenin group and naringenin/β-CD group compared with the model control group (t =3.973 ,P＜O.05;t =5.532, P＜0.01) ,and the CNV area in the naringenin/β-CD group was significantly smaller than that in the naringenin group (t =3.605,P＜0.05).The relative expression levels of VEGF, COX-2, PI3K, p38MAPK, MMP-2, MMP-9 mRNA and their proteins were significantly declined in the normal control group,naringenin group and naringenin/β-CD group in comparison with the model control group (all at P＜0.05).In addition, the expression levels of VEGF mRNA and COX-2 mRNA and their proteins were significantly lower in the naringenin/β-CD group than those in the naringenin group (all at P＜0.05).Conclusions The naringenin/β-CD clathrate compounds can improve the water solubility of naringenin and enhance their inhibitory effect on rats CNV.The inhibitory effect of naringenin on rats CNV probably is associated with anti-inflammatory pathway.