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.

ObjectiveTo investigate the diagnosis value of intracardiac echocardiography in cesarean section scar pregnancy. MethodsCavity ultrasound was applied in patients of cesarean scar pregnancy with sonographic features and treatment. ResultsIn 52 patients, ultrasound diagnosed accurately in 45 cases, diagnosis accurate rate was 86.5％ (45/52). Sonogram showed gestational sac simply type in 16 cases, mixed echo-type( or mass-based) of 36cases. In 52 cases of CSP, according to their clinical and sonographic features ,2 cases of uterine scar lined laparotomy and the uterus excision repair;three cases of laparoscopic removal of uterine scar pregnancy lesion repair. 6 patients to methotrexate;five cases of abdominal surgery;36 routine uterine arterial embolization in the ultrasound monitor after curettage. ConclusionUltrasound could apply in cesarean scar pregnancy timely,and accurate diagnosis was made;sonographic features according to the patients,help choose the appropriate clinical treatment,and assess efficacy.

Objective To explore the pharmacokinetic characteristics of telmisartan in Chinese healthy volunteers. Methods 9 Chinese male healthy volunteers were divided into receiving orally a single dose of 40, 80, 120 mg telmisartan tablets respectively, in latin square design study. After administration of telmisartan tablets, the plasma concentration was determined by HPLC with fluorescent detection. The pharmacokinetic parameters were analyzed by 3P97 program. Results It was found that plasma levels increased after orally increased dosages of telmisartan in the healthy volunteers in a nor-dose-dependent manner. The pharmacokinetic parameters were calculated the follows: AUC 0-96 of three different dosages (40, 80,120 mg) were (895.03?364.53), ( 3 030.34? 1 454.80) and ( 13 570.44? 3 551.54) ?g?h -1?L -1; and C max were (60.71?28.10), (214.05?74.14) and (978.32?234.89) ?g?L -1. There were significant differences in AUC 0-t/dose, C max/dose between the groups (P

Objective To explore the clinical manifestation of a patient with hypoparathyroidsmsensorineural deafness-renal dysplasia (HDR) syndrome and to sequence the related GATA3 gene of the patient.Methods A 22 year old person with HDR syndrome was reported in regard to clinical manifestation,laboratory examination,and genetic mutation.Some related literatures were reviewed.Results The patient showed tetany,deafness,and positive Chvosteks' and Trousseau' s signs.The initial laboratory studies showed that serum concentration of calcium was lowed and the iPTH level were lower than normal.Binaural pure tone audiometry showed Binaural sensorineural deafness.Colour doppler ultrasound revealed that his right kidney was not observed and the level of creatinine was increased,indicating renal insufficiency.GATA3 mutations on DNA sequence analysis indicated that the 6 exon IVS6-1G-A (G/A heterozygosis splicing),showed the mutation of G to A is in the upstream of the first base in the six exon.After treating with calcium carbonate and vitamin D,the symptoms and signs were improved.Conclusion HDR syndrome is a rare endocrine disease,that should receive more attention in order to avoid missing diagnosis;The IVS6-1G-A as a novel mutation of GATA3 gene,has not been reported so far.

Objective To evaluate the clinical efficacy and safety of a fractional bipolar radiofrequency device for the treatment of wrinkles of the face and neck.Methods This study enrolled 39 volunteers (including 37 females and 2 males aged 35-60 years) with Fitzpatrick skin type Ⅳ-Ⅴ and Fitzpatrick wrinkle scale score of 4-6.All the subjects received three sessions of treatment with a fractional bipolar radiofrequency device at intervals of 4-6 weeks.Follow-up visits were scheduled at one month after each treatment session for evaluation of efficacy (using standardized photography),subjective satisfaction and adverse effects.Results After three sessions of treatment,all the subjects experienced a significant decrease in Fitzpatrick wrinkle scale compared with baseline values,and wrinkle improvement score increased with the increase in treatment sessions.The Fitzpatrick wrinkle scale score for forehead wrinkles,glabella wrinkles,fishtail lines and neck wrinkles in these subjects after three sessions of treatment significandy differed from that before treatment (all P ＜ 0.01).Significant differences were also observed in the wrinkle improvement score for forehead wrinkles between these subjects after two sessions and one session of treatment (P ＜ 0.01),and observed in that for glabella wrinkles,fishtail lines and neck wrinkles between these subjects after three sessions and one session of treatment (P ＜ 0.05 or 0.01).Side effects were mild with no significant downtime.Conclusion Fractional bipolar radiofrequency may be a safe and effective option for the treatment of wrinkles of the face and neck in individuals with Fitzpatrick skin type Ⅳ-Ⅴ.

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 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.