Objective To study the clinicopathological features,diagnosis and treatment of carcinoid tumors of the urinary bladder. Methods The clinical,histopathologic data of 4 carcinoid tumors of the urinary bladder were retrospectively analysed.The bladder carcinoid was diagnosed in 3 male patients and 1 female patient with age from 54 to 79 years.All patients were presented with gross hematuria,but with no clinical manifestations of the carcinoid syndrome such as flush,tachycardia,diarrhea.Cystoscopies showed 5 mm?5 mm to 25 mm?30 mm sessile polypoid masses. Results One patient received radical cystectomy followed by radiotherapy,3 patients received partial cystectomy.Two patients died of the tumor metastasis at survival interval 5 years and 3 months,respectively;other 2 patients were still alive 19 years and 8 months following the surgical treatment.Two cases were stage Ⅱ,and other 2 cases were stage Ⅲ.Histologically,tumor cells exhibited strong argyrophilia and electron microscopy revealed characteristic dense-core granules. Immunohistochemical testing showed the cancer cell was positive for chromogranin A and keratin. Conclusions Carcinoid of the urinary bladder is uncommon,the diagnosis depends on histopathological and immunohistochemical tests.Based on the degree of infiltration,size,location,lymph node metastasis,different surgical intervention can be choosed.

Objective To inject PPTA into the cochlea of guinea pigs through scala tympani fenestration ,to study the protective effect of PPTA injection on the cochlear damage induced by gentamicin and mechanism of oxy-gen free radical .Methods Randomly divided were the guinea pigs with normal hearing into three groups :the con-trol group ,GM group and PPTA group .We injected the artificial perilymph 10μl /d into cochlea through scala tym-pani fenestration on control group for 3 days ,injected GM 160 mg · kg -1 · d-1 on GM group for 3 days ,injected the PPTA 10 μl /d into the cochlea through scala tympani fenestration and injected GM 160 mg · kg -1 · d-1 at the same time on PPTA group for 3 days .We tested ABR and analyzed the hearing changes .We tested the OFR level reacted by SOD and GSH of the cochlea tissue .SEM and TEM were performed to observe the change of cell mor-phology .Results For ABR ,the control group was 12 .75 ± 3 .796 ,GM group 28 .230 ± 4 .953 ,PPTA group23 .47 ±9 .211 dB SPL(P<0 .05) .For SOD ,the normal group was 50 .241 ± 9 .080 ,GM group 28 .230 ± 4 .953 ,PPTA group 43 .089 ± 4 .587 U/mgprot(P<0 .05) .For GSH ,the normal group was 3 .03 ± 0 .33 ,GM group 1 .51 ± 0 .13 ,PP-TA group 2 .50 ± 0 .16 Ggsh/L(P<0 .05) .The changes of hair cells of PPTA group were obviously less severe than that of GM group .For TEM ,the changes of spiral ganglion and stria vascularis of PPTA group were obviously less severe than that of GM group .Conclusion Injecting PPTA through scala tympani fenestration can protect cochlea by generating the excess of OFR when confronting against GM .

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of Neer three-part fractures of the proximal humerus in young adults. Methods A retrospective analysis was performed of the 46 patients aged < 65 years with Neer three-part fracture of the proximal humerus from March 2010 to December 2016. MIPPO with locking proximal humerus plate ( LPHP ) was used in 23 of them who were 12 men and 11 women with an average age of 41. 6 ± 1. 2 years; open reduction and internal fixation ( ORIF ) with LPHP was used in the other 23 patients who were 14 men and 9 women with an average age of 42. 2 ± 1. 6 years. The 2 groups were compared in terms of operation time, intraoperative bleed-ing, fracture healing time and shoulder function by Neer scoring at the last follow-up. Results The average follow-up ( 13. 4 ± 1. 2 months ) for the MIPPO groups was not statistically different from that for the ORIF group ( 14. 2 ± 2. 4 months ) ( P > 0. 05 ) . The MIPPO group reported significantly shorter operation time ( 105 ± 15 min ) , significantly less intraoperative bleeding ( 140 ± 50 mL ) , significantly shorter fracture healing time ( 4. 2 ± 0. 6 months ) , and significantly higher shoulder Neer scores ( 88. 6 ± 3. 4 ) than the ORIF group ( 120 ± 20 min, 320 ± 40 mL, 5. 4 ± 1. 2 months, and 81. 6 ± 2. 2, respectively ) ( P <0. 05 ) . The complication rate ( 4. 3％, 1/23 ) for the MIPPO group was not significantly different from that for the ORIF group ( 17. 4％, 4/23 ) ( P >0. 05 ) . Conclusion MIPPO with LPHP may be obviously advantageous over ORIF with LPHP in the treatment of proximal humeral fractures in young adults.

Objective To study the protective effect of peperphentonamine hydrochloride (PPTA) on the cochlea afferent nerve system damage induced by gentamicin (GM) of guinea pigs. Methods Thirty-six health guinea pigs were randomly divided into three groups:the normal group with saline; GM group with muscle injection of GM [100 mg/(kg·d),14 d] and PPTA group with peritoneal injection of PPTA [10 mg/(kg·d),14 d] on the ABR was analyzed , and the expression of Caspase-3 was tested by Western blot. TUNEL (after coloration)was performed to observe the apoptotic index,and its morphological changes were observed by TEM. Results After trial, the threshold of control group, GM group, PPTA group were 14.58 ± 1.16, 65.95 ± 1.17, 36.13 ± 1.17;the apoptosis index: 1.09 ± 0.14, 23.17 ± 0.88, 8.84 ± 0.49; the Caspase-3:1.09 ± 0.11, 2.55 ± 0.20, 1.67 ± 0.07. There were significantly difference among three groups (P<0.05). Morphological changes: cells apoptosis and the synapase were damaged seriously in GM group; the injury was less serious in PPTA group. Conclusion PPTA plays a protective role on GM-induced cochlea afferent nerve system damage of guinea pigs.

Objective:To determine the effect of Chuju total flavonoids (CJTF) on the secreted frizzled-related protein 4 (SFRP4) expression in Wnt pathway in rheumatoid arthritis (AR) model rats. Methods:hTe role of CJTF in the treatment of AR model rats was evaluated by rat arthritis score and paw edema score. The expression regulation of the SFRP4,β-catenin and C-myc in Wnt pathway in AR model rats was detected by RT-PCR and Western blot atfer CJTF gavage treatment. Results:Atfer CJTF treatment, the rat arthritis score and paw edema score in AR model rats were signiifcantly decreased when the AR model rats were treated with CJTF, the SFRP4 expression was signiifcantly up-regulated, while theβ-catenin and C-myc gene expression were signiifcantly down-regulated in AR model rat synovial tissues. Conclusion:CJTF has significant therapeutic effect and inhibitory effect on Wnt pathway activation by targeting SFRP4 in AR model rat synovium.

The cutaneous arteries of the forearm and their anastomoses in skin and subcutaneous tissue were invetigated on 35 upper limbs.1. The average length of the radial artery is 215.3 mm. This artery can be divided into a covered part and a exposed part. Their lengths are 117.7 mm. and 101.4 mm. respectively. The calibers of the upper end, the intermediate point, and the lower end of the radial artery are 2.7mm, 2.3 mm and 2.4 mm respectively.2. The exposed part of the radial artery sends out more cutaneous branches (9.6 branches) than the covered part (4.2 branches), While their muscular branches are nearly equal in number. The calibers of the cutaneous and muscular branches of the radial artery varies from 0.3～0.5 mm.The fine anastomoses of the cutaneous branches exist between the radial and ulnar arteries and between the radial and ulnar arteries and the dorsal interosseus artery and they form an arterial networks in the subcutaneous tissue of the whole forearm. For blood supply a skin flap may be cut from the whole forearm from the standpoint of morphology.4. The calibers of the radial and cephalic veins at the level of middle part of the forearm are 1.3 mm and 2.8 mm respectively. As the vasular pedicle both the veins should be anastomosed during transplant operation in order to increase the volume of the draining blood.5. The skin flap of forearm blongs to a type of blood supply of arterial trunk network, which have been distinguished with that of some other skin and myocutaneous flaps according to the anatomical characteristics of the radial artery.

The outbreak of the novel coronavirus pneumonia (NCP) has become a public health emergency in China. Chinese authorities and health agencies had devoted great efforts to control this disease. As surgeons specialized in the treatment of gastrointestinal tumors, we should always be aware of the prevention for NCP and incorporate this awareness into every detail of clinical practice. For the patients with gastrointestinal tumors, pre-admission screening should be done in order to rule out NCP. Real-time RT-PCR panel and chest CT scan should be conducted for patients with fever (>37.3℃), travel history to Hubei Province within 14 days, or contact history with residents from Wuhan district within 14 days. Prevention measures for both medical staffs and the screen-negative admitted patients should also be enhanced because false negative is possible. Medical instruments should be properly discarded or disinfected according to standardized procedures established by the local center for disease control and prevention (CDC). Surgical operation should be reduced at a minimal level to prevent cross infection in this special period.Surgical intervention for benign tumor should be postponed. For malignant tumor, multidisciplinary therapy (MDT) is recommended and non-surgical anti-tumor therapy should be selected with higher priority. Neoadjuvant therapy is highly recommended for gastrointestinal cancer at advanced stages that meet the indications of NCCN guideline (gastric cancer T stage ≥ 2/rectal cancer T stage ≥ 3/unresectable colon cancer). Gastric or esophagogastricjunction (EGJ) malignant tumor with obstruction can be managed with gastric tube decompression or stent placement to relieve the symptoms. Transnasal enteral feeding tube intubation/percutaneous endoscopic gastrostomy could be adopted to ensure enteral nutrition supply. For colorectal malignancy with simple intestinal obstruction, stent placement can achieve a high success rate, which not only helps avoid emergency surgery, but also creates a better condition for subsequent surgery. Transcatheter arterial embolization for hemostasis is an alternative choice for gastrointestinal tumor with bleeding. However, emergency operation still must be performed for patients with acute uncontrolled bleeding, obstruction or after other alternative treatment measures fail. All cases with suspicious or confirmed with NCP must be reported to the local CDC department. All invasive intervention must be performed in a designated isolation area. Tertiary prevention measure must be adopted for all anesthetists with additional face mask or medical goggle protection to prevent respiratory droplet transmission. Preventive enterostomy is preferable in lower digestive tract surgery. Thoroughly disinfecting the operating room after surgery is necessary. Fever after surgery must be carefully differentiated whether it's caused by post-surgery abdominal infection/inflammation or NCP. Single-room isolation and related examinations should be performed according to the standard procedures. We believe that with the unprecedentedly joint efforts of doctors and patients, we will eventually win this war against NCP.

We investigated the common diseases in patients from village clinics and compared them to those of the general population in rural areas of Jiangsu Province.We found that the treatment rates of chronic diseases such as hypertension and diabetes mellitus were quite low.Village clinics should play a more active role in health record management,healthcare education,and management of chronic diseases for the farmers.

OBJECTIVETo investigate the relationship between IL-1β and TNF-α mRNA and Fas protein expressions and cochlear ischemia reperfusion injury and investigate the protective mechanism of PPTA against cochlear reperfusion injury.

METHODSSixty-four guinea pigs were randomly divided into normal control group, blank control group, ischemia/reperfusion (by clamping the bilateral vertebral artery and right common carotid artery for 1 h) control group, and ischemia/reperfusion with PPTA treatment group. In PPTA group, PPTA was injected via the femoral vein immediately after reperfusion, and ischemia/reperfusion control group received saline injection. In 6 guinea pigs from each group, the cochlear tissues were removed after 24 h of reperfusion for examination of expressions of IL-1β and TNF-α mRNA by real-time PCR, and the rest animals were used for immunohistochemical detection of Fas protein.

RESULTSCompared with those of normal group and blank control group, the expressions of IL-1β and TNF-β mRNA increased significantly after cochlear ischemia/reperfusion (P<0.001), but were lowered significantly by PPTA (P<0.001). Positive expression of Fas protein expression was detected in the Corti organ, spiral ganglion and stria vascularis in ischemia/reperfusion control group with significantly higher IOD values than those of the other 3 groups (P<0.05). The IOD value showed no significant difference between PPTA-treated group, normal control group, and blank control group (P>0.05).

CONCLUSIONSPPTA can suppress the expression of Fas protein and IL-1β and TNF-β mRNAs in the cochlea of guinea pigs with cochlear ischemia/reperfusion. The protective effect of PPTA against cochlear ischemia/reperfusion is mediated probably by inhibition of inflammatory responses and cell apoptosis.

3,4-Methylenedioxyamphetamine ; analogs & derivatives ; pharmacology ; Animals ; Cochlea ; blood supply ; metabolism ; pathology ; Female ; Guinea Pigs ; Interleukin-1beta ; genetics ; metabolism ; Male ; Neuroprotective Agents ; pharmacology ; Organ of Corti ; metabolism ; RNA, Messenger ; metabolism ; Random Allocation ; Reperfusion Injury ; metabolism ; Spiral Ganglion ; metabolism ; Stria Vascularis ; metabolism ; Tumor Necrosis Factor-alpha ; genetics ; metabolism ; fas Receptor ; metabolism

OBJECTIVETo study the protective effect of peperphentonamine hydrochloride (PPTA) against gentamicin-induced cochlear damage and its mechanism to inhibit cell apoptosis.

METHODSGuinea pigs with normal hearing were randomized into control, gentamicin, and PPTA treatment groups, and the guinea pigs models of gentamicin-induced cochlear damage received intraperitoneal injection of PPTA. The changes of hearing of the guinea pigs were evaluated with auditory brainstem response (ABR) test, and the protein expression of caspase-3 in the cochlear tissue was detected using Western blotting. TUNEL staining, scanning and transmission electron microscopy were performed to observe the morphological changes of the cochlea.

RESULTSThe threshold in ABR in PPTA treatment group was significantly higher than that in the control group (P<0.05) but significantly lower than that in gentamicin group. Western blotting showed a significantly increased caspase-3 expression in gentamicin group (P<0.001); caspase-3 expression in PPTA group was obviously higher than that in the control group but much lower than that in gentamicin group (P<0.001). TUNEL assay and electron microscopy revealed serious damages of the hair cells in gentamicin group with numerous apoptotic cells in the organ of Corti, stria vascularis and spiral ganglion, and such cochlear damages were obviously alleviated in PPTA group.

CONCLUSIONPPTA can protect against gentamicin-induced cochlear damage in guinea pigs by decreasing the protein expression of caspase-3 to inhibit cell apoptosis.

3,4-Methylenedioxyamphetamine ; analogs & derivatives ; pharmacology ; Animals ; Apoptosis ; drug effects ; Caspase 3 ; metabolism ; Cochlea ; drug effects ; pathology ; Evoked Potentials, Auditory, Brain Stem ; Gentamicins ; adverse effects ; Guinea Pigs