Eighteen cases of primary tumors of the duodenum were reported. There were four cases of benign tumors, and fourteen cases of malignancy. The tumor was located in the bulb of the duodenum in seven cases, the descending part in nine cases and the transversepart in two cases. Five cases were complicated with intestinal perforation. Four cases with hemorrhage, four cases with obstruction and five cases with choledochal obstruction. The pathology, diagnosis and treatment of primary duodenum tumors are discussed.

Objective To evaluate the role of clinical features,radiography and histopathology in differential diagnosis between chronic necrotizing pulmonary aspergillosis(CNPA)and aspergilloma.Methods Thirty-four patients including 8 cases of CNPA and 26 of aspergilloma comfirmed by operation and histopathology in First Affiliated Hospital,Zhejiang University were investigated retrospectively.The clinical manifestations,radiological and pathological findings of all the patients were analyzed and related references were reviewed. Results The age of onset was not significantly different between CNPA and aspergilloma.Obsolete pulmonary tuberculosis and lung abscess were predisposing factors of them.Productive cough was presented in all 8 cases of CNPA,haemoptvsis in 7,and 5 were presented with constitutional symptoms.The most common symptom of aspergilloma was haemoptysis, which was presented in 25 cases.The less common symptoms were cough and sputum,which was presented in 17 cases.Only two cases were presented with constitutional symptoms."Air crescent"sign at radiography was typical and suggestive of diagnosis in both CNPA and aspergilloma,but the wall of cavity in CNPA was thicker and irregular,infiltrates were often to be seen around the cavity.Histologically,CNPA and aspergilloma both showed septate fungal hyphae branching at an acute angle.CNPA was characterized with the presence of tissue invasion by aspergillus,tissue necrosis and granulomatous inflammation. Fungal hyphae ware only found in a preexistent cavity or ectatic bronchus without tissue invasion in aspergilloma.Conclusions Histopathology is gold standard of differential diagnosis of CNPA and aspergilloma. Meanwhile, clinical features and radiological findings appear to be valuable for the diagnosis.

Objective To explore the clinico-pathological features, immunophenotype, treatment and prognosis of urologic primary primitive neuroectodermal tumor (PNET). Methods The clinical data of 3 patients with urologic PNET were analyzed retrospectively. All patients were male, aged 29, 32 and 75 years respectively. Two of the lesions were located in the kidney, and the third was located in the bladder. The sizes of renal tumors were 7.7 cm×6.2 cm and 12.6 cm×9.4 cm respectively. Imaging examinations revealed a well-defined mass with inhomogeneous echo inside. The size of bladder tumor was 10.0 cm×10.0 cm. CT scan demonstrated irregular thickening of the bladder wall, and the density of the wall was inhomogeneous. In the 2 cases of renal PNET radical surgery was performed, while an emergency palliative surgery to remove a blood clot and biopsy were performed in the bladder PNET case. Results In light microscope, the tumors were characterized by uniform small round or oval cells and nest-like or dense sheet structures surrounded by sparse fibrovascular stroma. Homer-Wright rosettes or pseudorosettes were observed, as well as mitoses. Immunohistochemical study revealed that all cases showed positive staining for CD99, synaptophysin and vimentin. One of the renal tumor cells showed positive for CD56, and the other renal tumor and urocystic tumor cells were focally positive for chromogranin A. Additionally, in 1 of the cases of renal tumor there was a high positive rate of 80% for Ki67 staining while the other case showed less than 5%. All 3 cases were eventually diagnosed as PNET. The first renal tumor case was not treated with radiotherapy and chemotherapy postoperatively, and the patient died of recurrence 14 months after surgery. Both the second renal tumor case and the bladder tumor case underwent chemotherapy postoperatively, and they died 4 and 6 months after surgery respectively. Conclusions The urologic primary PNET is a very rare, highly malignant soft tissue tumor, and the diagnosis must be based on pathologic findings and immunohistochemical phenotypes. The multimodal treatment for urologic primary PNET consists of surgery, chemotherapy and radiotherapy.

Objective To explore the role of body fat distribution in the pathogenesis of obesity-related asthma.Methods Totally 125 patients with stable asthma were recruited and were divided into non-obese group (n =51),peripheral obesity group (n =34) and central obesity group (n =40) according to body mass index and waist circumference.The FEV1％,FVC,FEV1/FVC ratio,IL-6,and hs-CRP levels in peripheral blood,eosinophil and neutrophil percentage in induced sputum,as well as exhaled NO levels were determined,and asthma control test (ACT) scores were calculated.Both one-way analysis of variance and analysis of covariance were used for statistical analysis.Results The values of FVC in the central obesity group and the non-obese group were [3.98 (3.99) ±0.99] L and [4.51 (4.51) ±1.00] L,while the levels of IL-6 and hs-CRP in peripheral circulation and the percentage of neutrophils in induced sputum were [33.63 (33.28) ± 14.04] ng/L and [21.22 (21.33)±11.23] ng/L,[2.12 (2.15) ±0.73] mg/L and [0.92 (0.91) ±0.61] mg/L,52.58 (52.81) ± 14.14 and 45.41 (45.34) ± 12.84,respectively (all P ＜ 0.05).After adjusting for inhaled corticosteroids (ICS) doses,the ACT scores were also significantly higher in central obesity group (22.10 ± 1.68 vs.23.01 ± 1.62) (P ＜ 0.05).Only the hs-CRP level was found significantly higher in peripheral obesity group than in non-obese group [(1.54±0.68) mg/Lvs.(0.91 ±0.61) mg/L] (P＜0.05).Conclusion Central obesity may play the leading role in the pathogenesis of obesity-related asthma.

OBJECTIVE To investigate the factors that result in lower respiratory tract infection by Candida albicans and the situation of drug resistance in geriatric inpatients.METHODS Clinical samples were collected from the geriatric inpatients with lower respiratory tract infection in our hospital from Jan 2004 to Dec 2006,and among them,146 patients were found containing C.albicans in their sputum.Meanwhile retrospective analysis was made.RESULTS There were many factors resulting in lower respiratory tract nosocomial infection by C.albicans in geriatric inpatients,and the detection rates of C.albicans increased year by year in the past three years were 25.2%,36.9% and 39.9%,respectively.The drug resistance of C.albicans raised obviously at the same time was 20.6%,41.8% and 34.2%,respectively.CONCLUSIONS It is necessary for reducing lower respiratory tract infection rates to efficiently control the C.albicans infection factors and to properly use antibiotics.

Objective To evaluate the feasibility of using the posterior approach with cervical pedicle screw fixation technique for the treatment of lower cervical spine fractures and dislocations.Methods Thirty patients suffered lower cervical fractures and dislocations were retrospectively analyzed,and they were underwent cervical pedicle screw system fixation surgery from January 2010 to December 2012.There were 22 males and 8 females,with an average age of 41 years (range,24-61 years).Eight injuries were located at C4,5,12 at C5,6,and 10 at C6.7.According to the American Spinal Cord Injury Association (ASIA)impairment scale,8 cases were grade A,12 were grade B,5 were grade C,3 were grade D,and 2 were grade E.Results Reduction and fixation of the injured segments were performed via a posterior approach in all 30 patients.One hundred and forty pedicle screws were inserted successfully in all patients on the postoperative radiographic and CT scans.All the patients were followed up for 3-23 months,with the average of 11 months.According to the ASIA impairment scale,eight cases with grade A were still grade A,but the feeling and movement improved obviously.Ten grade B improved to grade C and the rest cases were complete recovery after operations.During the course of the follow up,solid bone union was achieved in all patients,and there were no hardware failures.All the patients' postoperative MRI showed disappearance of the spinal cord compression after reduction in all cases.Conclusion For the patients of lower cervical fractures and dislocation,the first choice of operation should be the posterior approach reduction and fixation with cervical pedicle screw.The correct lengthwise traction method could unblock the locked facet effectively,and prevent the retrusion of disc and the further injury of spinal cord.For the patients of disc disruption,the posterior approach could be used only.The cervical pedicle screw system could provide three-dimensional reduction of the injured cervical segments and the adequate mechanical strength.The posterior approach combined with pedicle screw fixation is feasible and effective for the treatment of lower cervical fractures and dislocation.

Objective To investigate the effects of salmeterol/fluticasone (seretide) combined with community intervention on lung function and quality of life of chronic obstruetive pulmonary disease (COPD) patients in the stable period.Methods 96 cases with COPD in the stable period were divided into two groups randomly:Group A was treated only by seretide for six months,group B was treated by seretide combined with community intervention (health education,psychological intervention,exercise training,and nutritional guidance).6 months later,the lung function was determined and the quality of life was assessed by SGRQ.Results The lung function and the score of the quality of life in two groups after treatment [Group A:(1.78 ±0.16)L,(65 ±9)％ and 40 ± 18,36 ± 16,125 ±40;group B:(2.05 ±0.28)L,(73 ±9)％ and 21 ± 10,20 ± 11,58 ± 28,respectively] were improved than those before treatment [Group A:(1.59 ±0.15),(58 ±7) and 63 ±22,50 ±24,167 ±68;group B:(1.61 ±0.14)L,(58 ± 8)％ and 62 ±22,48 ± 22,163 ± 67,respectively] (P ＜ 0.05 );The lung function and the score of the quality of life in B group were improved than those in A group after treatment ( P ＜ 0.05 ).Conclusions Using community intervention combined with seretide in treatment of COPD patients has better effect than the single use of seretide therapy,it improves lung function and quality of life.It is a safe treatment method and worthy to spread widely.

Based upon the measure of depression as defined by Hamilton depression scale (HAMD)scores ＞ 17,120 patients with chronic obstructive pulmonary disease (COPD) were classified into 2 groups:COPD patients with or without depression.According to the mini-mental state examination (MMSE),the cognitive functions of all patients were evaluated.Meanwhile,oxygen saturation and pulmonary function were measured by blood gas analyzer and spirometer respectively.Fifty-four COPD patients were complicated with depression.HAMD scores were significantly negatively correlated with oxygen saturation and pulmonary function (P ＜0.05).Multiple regression analysis revealed that gender,oxygen saturation and MMSE scores were risk factors of depression (P ＜ 0.05).MMSE scores decreased more obviously in the COPD patients with depression and were positively correlated with oxygen saturation (P ＜ 0.01).A negative correlation existed between MMSE scores and HAMD scores (r =-0.549,P ＜ 0.05).

Objective To investigate the influences of depression on exercise capacity of patients with chronic obstructive pulmonary disease (COPD) in 6-minute walk test (6MWT).Methods One hundred and twenty COPD patients,whose acute exacerbation was controlled,were enrolled in the study from September 2009 to April 2011.According to Hamilton depression scale (HAMD) scores,48 patients with HAMD scores ＜ 7 were classified as non-depression group (control),60 patients with HAMD scores ≥17 were classified as depression group,patients with 7 ≤ HAMD scores ＜ 17 were classified as uncertain depression and not included in the experiment.Six-minute walk testing was performed in patients.Blood pressure,heart rates,respiratory rates,Borg scores were measured before and after 6MWT; body mass index and lung function were also measured in all patients.Results The distances of walk in the depression group and control group were (259 ±91) and (312 ±71) meters,respectively (P ＜0.05).Heart rates,svstolic blood pressure,respiratory rates and Borg index in depression group after testing were (108± 11)/min,(148.7 ± 15.4) mm Hg(1 mm Hg =0.133 kPa),(23.3 ±3.9) /min and (4.65 ± 1.67),respectively;those for control group were (95 ±9) /min,(141.8±8.9) mm Hg,(20.2 ±3.7) /min and (2.59±1.52),respectively.There were significant differences between two groups (all P ＜ 0.05).Conclusions Depression may affect the exercise capacity of COPD patients,the psychological status of the patients should be under consideration when conventional treatment is taken.

A total of 185 hospitalized patients with chronic obstructive pulmonary disease (COPD) were recruited.And the questionnaire of COPD Assessment Test (CAT) was used to evaluate the CAT scores and Hamihon Depression Scale to evaluate HAMD scores.Lung function,body mass index,smoking and medication were measured and recorded in details.According to the HAMD scores,65 cases had depression and 120 cases no depression.Comparing with the no-depression group,the results show that HAMD and CAT scores were higher significantly in the depression group and there was a lower proportion of long-term domiciliary oxygen therapy.According to the logistic regression analysis,the CAT scores were associated with global initiative for chronic obstructive lung disease (GOLD) stages Ⅳ and HAMD scores.These results suggest that poor lung function and depression affect greatly the quality of life for stable COPD patients.