Objective To improve the diagnostic rate of laparoscopy for malignant peritoneal mesothelioma (MPM) and enhance acquaintance with this disease. Methods The appearance of laparoscopic detection was retrospectively analysed in 25 patients with pathologically proved MPM. Results Hyperemia, edema and faint vascular net in parietal peritoneum were seen in all patients, and the thick or thin callus-like thickened parietal peritoneum was also observed. There were some grey nodes of various size, distribution and number in parietal and visceral peritoneum in all patients. The purplish red masses with hyperemia and edema were seen in abdominal cavity in 21 patients (21/25,84%). Several small masses cold be connected each other to become one big mass. All patients had yellow turbid or bloody ascites. Conclusion MPM had special characteristics under laparoscopy. Laparoscopic detection possesses the advantages of safety, little trauma, less hurt and high diagnostic rate. Laparoscopic detection and biopsy may be the best method for diagnosis of MPM.

Objective To evaluate the preoperative diagnosis and treatment of primary duodenal adenocarcinoma ( PDA). Methods Clinical data of 89 PDA cases undergoing laparotomy from 1985 to 2009 in three hospital in Beijing and Zhengzhou were analyzed retrospectively. Results The prevalence rate of PDA is comparatively low and its clinical manifestations are not specific. The correct diagnostic rate of auxiliary examination were 93% by endoscopy,90% by gastrointestinal X-ray air barium double radiography,82% by MRCP,42% by BUS,70% by CT/MRI. The most common location of the adenocarcinoma(65% ) was at the second portion of the duodenum. Among 67 PDA cases 48 cases underwent pancreatoduodenectomy, 19 cases received segmental deodenectomy. The 5 year's survival rate was 47% and 50% respectively. Conclusions Endoscope and X-ray radiography are mainstays for the diagnosis of PDA. Early diagnosis and radical operation are the key to improve the resection rate and the long term survival.

Some questions like the hardship of treatment and lacking of standard on diagnosis are existing in steroid-resistant nephritic syndrome(SRNS).This article make an ethical analysis on these questions and assumes that we should persist in treating the patients carefully with humanism,carry on informed consent principle,implement the optimal treatment and perfect the standard of diagnosis and treatment,carry on clinical ethics education and promote the judgment level of clinical ethics.

Case teaching has evident characteristics compared with traditional theory teaching. This article expound the purpose,significance,teaching process and the noticeable problems of case teaching in medicaI ethics teaching.

Objective To investigate the significance of non-bronchial systemic collaterals (NBSCs) in supplying bronchial hemoptysic lesions,and to study the morphological features of bronchial artery (BA) when NBSCs become the predominant supplying vessels. Methods Multi-slice helical CT angiographic findings in 124 patients with bronchial hemoptysis were retrospectively analyzed. 3D reconstruction of thoracic systemic arteries,including BAs and NBSCs,was performed at the console work station with the help of real-time thin-slice enhanced helical CT scanning. The number of NBSCs and BAs was calculated,and the internal diameter of the arteries and the thickness of pleura in the vicinity of the pulmonary lesion were measured. According to the presence or absence of NBSCs,the patients were divided into NBSCs group and non-NBSCs group. The relevant data was statistically analyzed. Results NBSCs group included 36 cases,the mean internal diameter of BA was (1.850 ? 0.631)mm and the pleura adjacent to the pulmonary lesion was obviously thickened in 22 cases (61%) with a thickness of 2.7-16.0 mm [mean(7.71 ? 4.12) mm]. In the non-NBSCs group (n = 88),the mean internal diameter of BA was (2.200 ? 0.528) mm and the pleura adjacent to the pulmonary lesion was obviously thickened in 7 cases (8%) with a thickness of 1.1-2.4 mm [mean(1.7 ?0.53) mm]. The differences in both internal diameter of BA and the thickness of lesion's adjacent pleura between two groups were statistically significant (P

Objective To investigate the risk factors of central lymph node metastasis and significance of prophylactic central lymph node dissection for clinical N0 (cN0) patients with papillary thyroid carcinoma (PTC).Methods The clinical data of 315 patients with cN0 PTC in Department of General surgery,the Second Affiliated Hospital of Dalian Medical University from Jan.2012 to Jan.2014 were analyzed retrospectively.Results (Iumor size,infiltration of thyroid capsule,and tumor number were associated with central lymph node metastasis in patients with cN0 PTC(P＜0.05),and the high risk factors of central lymph node metastasis were infiltration of thyroid capsule and multiple lesions (P＜0.05);()The overall complication rate was 3.17％ (10/315),the rate of transient recurrent laryngeal nerve paralysis was 0.63％ (2/315),and the rate of transient hypoparathyroidism was 2.54％ (8/315).All patients with complications recovered after treatment.No patient developed permanent recurrent laryngeal nerve paralysis or hypoparathyroidism;()The follow-up time was 6 to 30 months,and 2 cases were lost.No patient developed local tumor recurrence,distant metastasis,or death.Conclusions The high risk factors of central lymph node metastasis in patients with cN0 PTC were infiltration of thyroid capsule and multiple lesions.No patient developed local tumor recurrence,distant metastasis,or death.It is preferable and necessary to perform prophylactic central lymph node dissection in patients with cN0 PTC.

Objective To develop a new-type animal dental stent for the experiment of canine pulp regeneration.Methods The stent was composed of an upper support frame,an oral limit bracket and a lower support frame,which were aligned from top to bottom.A sleeve joint was made for the connection structure of the bracket,and the height and the width both could be adjusted to adapt to different animals' mouths.The rubber dam could be spread into tension and concave form by rotating the upper and lower support frames' ends.Results By resizing the animal dental stent based on the structure of animal facies maxillaris,medical staffs could proceed the examination and treatment to animals effectively,including the throat examination,oral examination,oral care,dental treatment (such as root canal therapy and dental filling) and other medical behaviors.Conclusion The experimental result shows the feasibility of utilizing the stent in the process of animal experiment or diagnosis and treatment.Moreover,the stent proves the capacity in protecting the soft tissue,widening the vision of operation field,getting rid of the saliva contamination,which is worthy popularizing in animal experiments and animal medical care.

Objective To investigate the effect of posterior operation for thoracolumbar burst fractures combined with dislocation. Methods The study involved 22 patients with thoracolumbar burst fractures combined with dislocation admitted into our hospital from October 2005 to March 2008. There were 17 males and 5 females at age range of 18-56 years. The fractures were located at T12-L2. The fractured vertebrae lost its height by 1/4 to 3/4 of the normal height. The upper vertebral dislocation ex-tent was from 25% to 50%. All operations were accomplished within two weeks after injury. The patients were randomly divided into two groups, ie, Group Ⅰ (implanted with 4 pedicle screws in upper and lower vertebrae adjacent to the fractured vertebrae) and Group Ⅱ (implanted with 6 pedicle screws in 2 upper and 1 lower vertebrae adjacent to the fractured vertebrae). The operation time, volume of blood loss, ky-photic angle, neurological function and Low Back Outcome Score (LBOS) were compared between two groups. Results All patients were followed up for 12-36 months. The duration of operation in Group Ⅱ was longer than Group Ⅰ (P < 0.05), with no increase of intraoperative blood loss. Group ⅡI was su-perior to Group Ⅰ in aspects of correction rate, correction loss and implant failure rate (P < 0.05). There was no statistical difference in aspects of neurological function recovery and low back outcome score be-tween two groups. Conclusion Fixation with three vertebrae and six pedicle screws through posterior approach is an effective, feasible and safe procedure for treatment of thoracolumbar burst fractures com-bined with dislocation.

Objective To study the efficacy of sacral nerve stimulation combined with tolterodine in patients with female idiopathic overactive bladder (IOAB).Methods A total of 200 female patients diagnosed with IOAB from January 2005 to January 2011 were included in the study,and according to random number table method were divided into treatment group and control group with 100 cases in each.Each group was divided into 3 subgroups according to urinary frequency and urgency,urge incontinence,and both of them together.In the treatment group,patients received percutaneous sacral nerve stimulation and tolterodine 2 mg orally,1 time/d,while in the control group,only given tolterodine 2 mg orally,1 time/d,treatment for 3 months.The voiding diary and urodynamics parameters were observed between the two groups before and after treatment and application of self-rating depression scale (SDS) and self-rating anxiety scale (SAS) to evaluate the psychology of concomitant depression and anxiety score.Results After treatment,the average number of urination,daily average unit urine,the single biggest urine and urine feel capacity (FDV),the maximum capacity of the bladder pressure (MCBC),maximum urinary flow rate (Qmax) in two groups were improved,and the daily average unit urine,single biggest urine and FDV,MCBC,Qmax in treatment group after treatment were higher than those in control group [daily average unit urine:urinary frequency and urgency (248 ± 46) ml/times vs.(150 ± 77) ml/times,urge incontinence (249 ± 69) ml/times vs.(144 ± 81) ml/times,both of them together (247 ± 69) ml/times vs.(170 ± 46) ml/times; the single biggest urine:(320 ± 87) ml/times vs.(212 ± 44) ml/times,(315 ± 65) ml/times vs.(211 ± 56) ml/times,(333 ±59) ml/times vs.(201 ±66) ml/times;FDV:(176 ±64) ml vs.(142 ±44) ml,(190 ±69) ml vs.(142±55) ml,(188 ±60) mlvs.(138 ±49) ml;MCBC:(265 ±46) ml vs.(203 ±50) ml,(288 ±48) ml vs.(197 ± 41)ml,(287 ± 43) ml vs.(189 ± 44) ml],there were significant statistical differences (P ＜ 0.01).The SDS and SAS scores were reduced in two groups after treatment,and the SDS and SAS scores in treatment group after treatment were significantly lower than those in control group [SDS scores:urinary frequency and urgency (33.0 ± 6.2) scores vs.(44.0 ± 5.9) scores,urge incontinence(31.1 ± 6.2) scores vs.(41.6 ± 6.1) scores,both of them together(33.4 ± 7.2) scores vs.(44.5 ± 5.0)scores;SAS scores:(30.3 ± 4.4) scores vs.(41.3 ±4.4) scores,(33.3 ±5.8) scores vs.(42.5 ±6.4) scores,(31.9 ±4.7) scores vs.(43.5 ± 5.6) scores],there were significant statistical differences (P＜ 0.01).Conclusions The combined treatment of tolterodine and sacral nerve stimulation can not only improve the voiding dysfunctions symptoms but also the concomitant depression and anxiety in patients with female IOAB,thus improving the patient's quality of life.

Objective To investigate the effects of Kruppel-like factor 6 (KLF6) on the apoptotic and migration ability of HepG2 cell, and the developmental role of KLF6 on zebrafish liver.Methods Constructed plasmid with shRNA-KLF6 was transfected in HepG2 and L-02.The impacts of loss of KLF6 on HepG2 was investigated by Western bolt, apoptosis analyses, cell cycle detection and scratch experiment;KLF6 morpholino oligonucleotides was microinjected into the Tg(lfabp:eGFP) transgenic zebrafish embryos.The morphant phenotype of the liver was imaged and the protein expression of KLF6 after knockdown of KLF6 was analyzed by Immunofluorescence staining.Results The expression of KLF6 in L-02 was significantly higher than in HepG2.After knockout of KLF6, KLF6 protein expression and apoptosis were significantly reduced.In addition, the cell cycle mainly stated in S phase and the migration ability of HepG2 was enhanced.After klf6 knockdown in transgenic zebrafish larvae, the development of zebrafish liver was delayed and KLF6 expression was obviously decreased in the liver.Conclusions The reduction of KLF6 expression increased the proliferation and migration ability, and reduced the apoptosis of HepG2.Loss of KLF6 affects the development of zebrafish liver, which may open a possibility to use zebrafish as a liver cancer model and for anti-liver cancer drug screening.