Objective To assess the usefulness video-assisted mediastinoscopy (VM) for diagnosis of disease characteristic with mediastinal mass. Analyze the correlations of clinical features of the disease with the pathologic diagnosis. Methods Between July 2000 and March 2006, 97 undiagnosed patients with mediastinal mass in chest radiography underwent biopsy of mediastinal lesions by either cervical mediastinoscopy (n=69) or parasternal mediastionoscopy (n=28). We also analyzed the correlation of symptoms, location and extent of the lesion with the pathologic diagnosis. Results All 97 patients recovered smoothly without postoperative complications. Histologic diagnosis was obtained in 96 patients. Patients with hoarse, dysphagia and superior vena cava obstruction syndrome indicate malignant lesions (26/26). The most common diseases in the super-anterior mediastinum are lymphoma(7/19), thymoma(4/19) and small cell lung cancer(SCLC) (4/19);The most common disease in the middle mediastinum are metastasis of non small cell lung cancer(11/37), sarcoidosis (9/37)and SCLC(7/37); The most possible disease involved both mediastinum and lung hilar lymph-node are scalerdosis(32/41) and SCLC(5/41). Conclusion Mediastinoscopy is effective and safe methods to establish a histologic diagnosis in patients with mediastinal mass. It is possible to make primary evaluation on some of these patients according to the typical symptoms and location, extent of the mass involvement.

Objective To evaluate the practicability of video-assisted thoracoscopic lower esophageal myotomy in the treatment of achalasia. Methods A series of 21 consecutive patients with achalasia received video-assisted thoracoscopic lower esophageal myotomy between June 1997 and June 2005. The operation was performed under general anesthesia with double-lumen endotracheal intubation. The patient was positioned in the right lateral decubitus. Four thoracoscopic ports were introduced into the left hemithorax. A 6~11 cm incision at the lower esophageal sphincter with an extension to the gastric wall for 0.5~1 cm in length was made, to the depth of the submucous layer. A flexible gastroscope was inserted to check the integrity of the esophageal mucosa intraoperatively. No anti-reflux procedures were conducted. Results All the procedures were accomplished smoothly. The intraoperative hemorrhage volume was 50~100 ml (mean, 58 ml) and the operation time, 60~270 min (mean, 137 min). Esophageal mucosal perforation occurred in 3 patients, in 2 of whom the perforation was repaired thoracoscopically and in 1 of whom, through open thoracotomy. All the patients were recovered uneventfully, without severe complications. Follow-up checkups for 1~80 months found recurrence of dysphagia in 2 patients at 2 and 4 months after operation, respectively. Out of the 21 patients, the relief of dysphagia was classified as “excellent” results in 8 patients, “good” in 10 patients, “fair” in 1, and “poor” in 2, respectively. Conclusions Video-assisted thoracoscopic lower esophageal myotomy is a surgical approach with simple performance, minimal invasion, quick recovery and good efficacy. It can be employed as the first of choice for the management of achalasia.

Objective To elucidate the molecular basis for induced resistance of N. gonorrhoeae to ceftriaxone in vitro. Methods The reference strain ATCC49226 and clinical isolate ZSSY00205 of N. gon-orrhoeae were exposed to subinhibitory concentration of ceftriaxone for the induction of resistance. Then,suppression subtractive hybridization was performed with the pre-induction parent strains as drivers and post-induction mutant strains as testers to create a subtractive cDNA library. Following that, a total of 192 clones were randomly selected from the library, and arrayed by spotting onto nylon membranes. Finally, dif-ferentially expressed genes were screened by hybridization with labeled-RsaI restriction fragments from the sensitive and resistant N.gonorrhoeae strains respectively, and analyzed by sequencing and homology research using Blast program. Results A subtractive library for these resistant N.gonorrhoeae strains was generated by SSH technique. Microarray analysis and homology research confirmed 5 genes related to ceftriaxone resistance, i.e. mtrR, mtrC, gyrB, rpsJ and PJD1. Conclusions The induced resistance of N. gonorrhoeae to ceftriaxone may be associated with mtrR, mtrC, gyrB, rpsJ and PJD1 genes which probably mediate the resistance by enhancing the activity of efflux pump system.

Objective To explore the clinical new ways to repair the soft tissue defect of upper lip.Methods The soft tissue defect of upper lip caused by various reason were repaired with the buccal region of nasolabial groove flap.The size of flap was designed based on the range of soft tissue defect and located in the buccal region along nasolabial groove.The maximum scale of flaps between the length and width were 2∶1 and slit to the SMAS layer.The soft tissue defect of upper lip was repaired by direct vicinity aversion of the flap.The wound after the flap diversion was direct sut in favour of propulsion of the flap and relief the tension of flap pedicle.Results The flaps completely survived in 15 cases without obviously scar accrementition.The cosmetic result were satisfactory.Conclusion The buccal region of nasolabial groove flap is characterized by simple designation,easy dissection,reliable blood supply with the vascular net of fascia without well-known blood vessel damaged and repaired by direct vicinity aversion.Therefore,it is an ideal new method to repair the soft tissue defect of upper lip.

OBJECTIVE: To observe the inhibiting effect of Interferon-alpha 1b(IFNa-1b) on proliferation of human tenon capsule fibroblasts. METHODS: Human tenon capsule fibroblasts were cultured in vitro and MTT method was used to detect the inhibiting effect of IFNa-1b on human tenon capsule fibroblasts. RESULTS: There was significant difference in OD values between 10~6IU/ml group(0. 1 109?0. 0 585) and control group(0.2535?0. 0502), the inhibition rate in IFN group was 56.25%. CONCLUSION: IFNa-1b has significant effect on inhibiting proliferation of human tenon capsule fibroblasts.

Objective To investigate the prevalence of hyperglycemia in patients with primary aldosteronism.Methods Thirty two patients diagnosed as primary aldosteronism(PA) in our hospital from 2010 to 2013 (PA group),and 40 patients as essential hypertension (EH group).Two groups were measured and compared,including blood pressure,plasma aldosterone,urine aldosterone,and plasma potassium.Oral glucose tolerance test (OGTT) was performed and homeostasis model assessment-insulin resistance index(HO-MA-IR) were calculated.Results The prevalence of hyperglycemia was 43.75％ in PA group,including 25％ patients of glucose intolerance and 18.75％ patients of diabetes mellitus,which was significantly higher than those of EH group (25％,12.5％,and 12.5％,respectively).PA group's fasting and 2-hour postprandial insulin levels and insulin resistance index were higher than that of EH group.Conclusions The present study indicated that patients with PA had a significantly high prevalence of glucose metabolism disturbance and insulin resistance.Screening test should be performed and avoid missed diagnosis.

Objective To investigate the expression of histone acetylated H3 and H4, methylated H3K4 and H3K9 in diffuse large B-cell lymphoma (DLBCL). Methods The expression of histone acetylated H3 and H4, methylated H3K4 and H3K9 were examined by SP immunohistochemistry technique in lymphoid tissue of 40 cases with DLBCL and 16 cases with proliferative lymphadenitis. Results The expression of histone acetylation of H3 and H4 were lower than that in proliferative lymphadenitis. Histone methylated H3K4 was lower in expression and H3K9 was in higher expression. There was a positive correlative expression between the global histone acetylation of H3 and H4, the global histone acetylation of H3, H4 and histone methylation of H3K4. Conclusion Improper modification of histone acetylations and methylations may play an important role in pathogenesis in DLBCL.

Objective To evaluate the diagnostic value of the early rheumatoid arthritis (RA) classification criteria for early RA and to assess the clinical efficacy of knee arthroscopic synovectomy for RA.Methods A total of 62 patients who had arthritic complaints with disease duration less than one year were treated with knee arthroscopic synovectomy.Patients were diagnosed as RA confirmed by changes of synoviomorphous under arthroscopy,synovial biopsy,immunological biochemical laboratory and MRI,and compared with the preoperative ERA diagnosis.The efficacy was assessed at the third months and more than 12 months after operation,including Health Assessment Questionnaire (HAQ),Lysholm score,laboratory parameters of erythrocyte sedi-mentation rate (ESR) and C-reactive protein (CRP).Results The sensitivity and specificity in the early RA classification criteria for RA diagnosis were 81.58％ and 91.67％.38 patients diagnosed as RA and the remaining 24 patients were significantly improved of HAQ,Lysholm score,ESR,CRP compared with preoperation,showed statistical difference (P ＜ 0.01).There were still statistical differences between the follow-up results of the group of patients with RA in different period after operation (P ＜ 0.01).Conclusion The early RA classification criteria is worthy of clinical application,because it has the advantages of simple,practical,and is beneficial to early diagnosis of RA.The early RA patients should be treated with knee arthroscopic synovectomy as far as possible.It can improve not only the knee function,but also the general symptoms,and it can interrupt the RA pathological process,effective maintain curative effect after operation.

Acute Coronary Syndrome ; chemically induced ; Anesthetics, Dissociative ; adverse effects ; Humans ; Ketamine ; adverse effects

Objective To analyze the delay in diagnosis and treatment lung cancer expressed as solitary pulmonary nodules (SPN) found by physical examination,and to discover the relative reasons and consequence for future improvement.Methods From January 2000 to August 2011,162 patients (93 males,69 females,ranging 33-82 years,median age 63.9 years) with SPN found by physical examination and diagnosed lung cancer by surgical pathology subsequently were enrolled to this study.Depending on the interval between the date when finding SPN and the date of surgery,these cases were divided into 6 groups,including the group with interval less than 1 month (74 patients),1-3 months (48 patients),3-6 months (10 patients),6-12 months (7 patients),12-24 months (8 patients),and more than 24 months (15 patients).Factors which impact the delay interval between SNP finding and surgery were discussed.The change of tumor' s diameter during observation period,and the pathological characters were also analyzed among each group.Results Of all the delay cases,30.2％ were attributed to doctor,30.9％ attributed to patients themselves,and 38.9％ attributed to hospitals.51.0％ (25/49) of the cases delayed by doctors were misdiagnosed as inflammation,16.3％ (8/49) misdiagnosed as tuberculosis,and 16.3％ (8/49)misdiagnosed as old lesions,which were three common reasons.Patients delayed more than 3 months were more likely to be related to doctor's misdiagnosis than those delayed less than 3 months[70.0％ (28/40) vs.36.8％ (21/57),x2 =10.338.P =0.001].Moreover,the possibility of SPN enlargement was positively correlated with the delay interval.In groups with delay interval more than 24 months or between 12 and 24 months,the percentage of SPN enlargement were 73.3％ (11/15) and 87.5％ (7/8) separately.The proportion of patients with stage IV disease in groups whose delay interval exceeded 12 months (13.3％ for more than 24 months and 12.5％ for 12-24 months) also significantly surpassed others groups with shorter delay interval.Conclusion There exists obvious delayed diagnosis and treatment in lung cancer initially expressed as solitary pulmonary nodules (SPN) during physical examination.Nearly 1/3 patients were delayed by doctors and half of them were misdiagnosed as inflammation.Increase of observation time could result in enlargement of SPN and advancement of disease staging.Thus,patients and doctors should pay more attention and clarify the diagnosis through surgery in less than 3 months after finding SPN,which could remarkably benefit early treatment.