Objective To improve the understanding of osteoarticular pain presented as rheumatic syndromes of cancers and malignant skeleton metastasis associated. Methods To analyse the clinical data of 32 patients initially manifested as osteoarticular pain. Results Forteen patients of 32 cases was diagnosed as cancer associated rheumatic syndromes, characterized by gradually deteriorated chronic recurrent vague pain. The effect of non-steroid anti-inflammatory drugs (NSAIDs) and glucocorticoid was not satisfactory. Pain subsided after removal of carcinous mass. Eighteen patients had malignant skeleton metastasis, vague pain at onset, but gradually progressed to be, severe persistent pain. NSAIDs and glucocorticoid were ineffective. Narcotic analgesics could produce short time relief. The nature and distribution of tumour were comparatively extensive. The clinical misdiagnosis rate was high. Conclusion Clinical doctors often neglect the coexistence of tumor because they are not familiar with the relation between osteoarticular pain and tumor. So patients who is over sixty and is not sensitive to commonly used analgesics and glucocorticoid with osteoarticular muscular pain should be considered the possibility of malignant tumor after excluding diffuse connective tissue disease.

Objective:To investigate the changes of serum neopterin (NPT) level in adults patients with Kashin-Beck disease (KBD) in Qinghai Province.Methods:In July 2018, according to the "Diagnosis of Kashin-Beck Disease" (WS/T 207-2010), in KBD endemic region of Xinghai and Guide counties in Hainan Tibetan Autonomous Prefecture of Qinghai Province, adult KBD patients and healthy people over 20 years old were selected as KBD group and internal control group, respectively. At the same time, healthy people over 20 years old were selected as the external control group in non-KBD endemic region of Xunhua County with similar production scale and lifestyle. Fasting elbow vein blood samples of the 3 groups of people were collected, serum NPT levels were determined by enzyme linked immunosorbent assay (ELISA).Results:Totally 272 people were enrolled in the study, 104 cases (50 males and 54 females) in KBD group, aged (47.61 ± 12.72) years old; 95 cases (35 males and 60 females) in internal control group, aged (48.28 ± 14.87) years old; and 73 cases (35 males and 38 females) in external control group, aged (51.88 ± 13.93) years old. There were no significant differences in gender composition and age among the 3 groups (χ 2 = 3.135, F = 2.236, P > 0.05). The serum NPT levels of KBD, internal control, and external control groups were (504.35 ± 413.92), (417.34 ± 109.90) and (397.49 ± 118.07) ng/L, respectively, and the difference among the 3 groups was statistically significant ( F = 4.129, P < 0.05). Among them, the serum NPT level of KBD group was significantly higher than that of internal control group and external control group ( P < 0.05); there was no significant difference in the serum NPT level between internal control group and external control group ( P > 0.05). Conclusion:The serum NPT level of adult KBD patients in Qinghai Province is elevated.

Objective:To investigate the effects of celecoxib and anti-osteogenesis tablets on urinary biomarkers pyridinoline (PYD) and deoxypyridinoline (DPD) in adult patients with Kashin-Beck disease (KBD) in Qinghai Province, and to provide scientific basis for treatment of adult KBD.Methods:According to the "Diagnosis of Kaschin-Beck disease" (WS/T 207-2010), in July 2017, 120 cases of adult KBD that were selected from the KBD area in Qinghai Province were divided into non-drug treatment group ( n = 66) and drug treatment group ( n = 54), and 89 healthy adults were selected as control group. The drug treatment group was taken celecoxib and anti-osteogenesis tablets for 6 months. Morning urine samples were collected from the three groups. The contentss of PYD and DPD in urine were detected by enzyme linked immunosorbent assay (ELISA), and the test results were corrected with creatinine (Cre). Results:There were no statistically significant differences in gender ratio and age among non-drug treatment group, drug treatment group and control group (χ 2 = 0.820, F = 0.379, P > 0.05). The medians of urinary PYD in the three groups were 1 106.39, 812.18, 702.53 ng/μmol Cre, and the medians of DPD were 1 325.58, 802.54, 752.38 ng/μmol Cre, respectively. The differences were statistically significant among the three groups ( H = 13.849, 34.621, P < 0.01). The contents of PYD and DPD in drug treatment group were lower than those in non-drug treatment group ( P < 0.05). Conclusion:Celecoxib and anti-osteogenesis tablets can reduce the urinary levels of PYD and DPD in adult patients with KBD.

Objective To study medial umbilical ligament in the prevention of recurrence of indirect inguinal hernia with large sac by laparoscopic treatment in children.Methods The clinical data of 178 cases of indirect inguihal hernia with large sacs in children were retrospectively analyzed.After high suture ligation of the internal ring with pediatric laparoscopy,all of the internal tings were covered with the same side of medial umbilical ligament to further strengthen.Results All cases were discharged from hospital 1～2 days after surgery.No recurrence and no any other complications could be found after following up 3～18 months.Conclusion Pediatric laparoscopic application of medial umbilical ligament to further cover the internal ring could significantly reduce the rate of recurrence for indirect inguinal hernia with large sac.This method of operation waft safe and feasible.It Was worth promoting.

Background:Detection and removal of colorectal polyp by colonoscopy is of great importance for prevention of colorectal carcinoma. Aims:To investigate whether the clinical symptoms of patients undergoing colonoscopy may hint colorectal polyp and carcinoma,and provide reference for candidate selection in colonoscopic screening. Methods:A total of 2 366 patients undergoing colonoscopy were recruited and the history information such as symptoms at outpatient visits, site and nature of the lesions was collected for analyzing the detection rates of colorectal polyp and carcinoma and the correlations of clinical symptoms with the risk and site of the disease. Results:The overall detection rates of colorectal polyp and carcinoma were 20. 5% and 5. 4% ,respectively,in 2 366 patients. The detection rates were significantly higher in symptomatic patients than those in asymptomatic patients(24. 2% vs. 4. 5% for polyp and 6. 4% vs. 0. 9% for carcinoma,P all = 0. 000). Moreover,when patients were classified by major symptoms,the detection rate of colorectal polyp was significantly increased in patients with diarrhea(OR = 1. 213),hematochezia(OR = 2. 076),and changing of stool consistency(OR = 1. 503)(P all < 0. 05),and the detection rate of colorectal carcinoma was significantly increased in patients with abdominal pain( OR = 1. 568),hematochezia( OR = 2. 837),changing of stool consistency( OR =2. 206),and tenesmus( OR = 1. 735)( P all < 0. 05). The major symptoms being hematochezia,changing of stool consistency and tenesmus were associated with lesions locating at rectum or left hemicolon(P all < 0. 05). Conclusions:Diarrhea, hematochezia and changing of stool consistency hints risk for colorectal polyp, while abdominal pain, hematochezia,changing of stool consistency and tenesmus hints risk for colorectal carcinoma. Colonoscopy is strongly recommended for patients with these symptoms.

Objective To evaluate the value of diffusion weighted imaging in differential diagnosis of endometrial carcinoma stagedⅠa.Methods A retrospective analysis of 18 patients with endometrial carcinoma staged Ⅰ a which was confirmed by pathology. Other 22 patients with benign endometrial diseases were also enrolled in the study including endometrial hyperplasia in 9,endometrial polyp in 8 and degenerative submucous myoma in 5.DWI with b value of 0 s/mm2 and 1 000 s/mm2 was performed with single shot sequence of EPI,and the ADC values were measured.Results The mean ADC values of endometrial carcinoma staged Ⅰa,endome-trial hyperplasia,endometrial polyp and degenerative submucous myoma were (0.89±0.21)×10 -3 mm2/s,(1.45±0.19)×10 -3 mm2/s, (1.29±0.32)×10 -3 mm2/s and (1.32 ±0.29)× 10 -3 mm2/s,respectively.There were statistical significant differences between them (F =48.021,P =0.00).Furthermore,statistically significant differences also existed between endometrial carcinoma and other groups (P <0.05).Conclusion ADC value shows a good value in differential diagnosis of endometrial carcinoma staged Ⅰa.

Objective To compare the influence of whole sevoflurane inhaling and target-controlled infusion of propofol for the myocardial protective effect on patients with heart valve replacement surgery. Methods 30 adult patients who went through heart valve replacement surgery with cardiopulmonary by pass were selected, including ASA staging II-III and cardiac function classification (NYHA) II-III. All patients were randomly divided equally into sevoflurane group (Group S) and propofol group (Group P) . Patients were monitored before anesthetic induction. Group S got 1%sevoflurane (fresh gas flow 6 L/min) with concentration of the vaporizer increased from 1%to 3%with 1 minute interval during anesthetic induction. Group P got target-controlled infusion of propofol during anesthetic induction,the initial target plasma concentration was set at 0.8μg/mL,and the concentration increased 0.5 μg/mL every minute until intubation. All the patients got fentanyl 5 μg/kg and rocuronium 0.6 mg/kg, and intubation was conducted when BIS decreased lower than 60 and mean arterial pressure (MAP) <20%basic MAP. During anesthesia maintaince,patients got 0.5-2 MAC sevoflurane inhaling or target-controlled infusion of propofol 2-4μg/mL with discontinuous intravenous fentanyl and rocuronium, and maintained BIS 40-60, MAP<±20%basic MAP, central venous pressure 5-15 cm H2O. Outcome variables included demographic characteristics of patients. The following parameters were also recorded, including cardiac troponin I (cTnI), creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and lactate (LAC) in before anesthetic induction (T0), aortic inbation (T1),30 minutes after aorta opening (T2), 6 hours after aorta opening (T3) and 24 hours after aorta opening (T4) . Results There was no statistical significance in demographic characteristics during peri-operation between the two groups ( > 0.05) . The pre-opertaive cTnI, CK, CK-MB and LAC were within the normal range, but increased siginicantly on T2, T3 and T4, and was more significant on T3 ( < 0.01) between two groups, and the intra-group comparison showed no difference on other time points. Conclusion When myocardial injury markers used as myocardial protection outcome variables, whole sevoflurane inhaling could not reduce the release of cTnI compared to propofol TIVA in heart valve replacement surgery.

Objective To explore the application of mini-laparoscopy in the diagnosis and management of nonpalpable undescended testis in children.Methods 38 cases of impalpabal testes(46 testicular) had been operated by mini-laparoscopy in children with cryptorchidism.Results 38 children with nonpalpable undescended testis (46 testicular) had been operated by mini-laparoscope.Results After laparoscopic exploration,inguinal probe and postoperative pathology,it had been confirmed that 2 testicular were absent,34 testicular were found in high inguinal location,10 testicular were located in intraperitoneal cavity.In addition to the absent testicular,the rest had been performed with mini-laparoscope:one period descent fixation 41 testes,Fowler-Stephens (F-S) installment orchiopexy three testes.Follow-up with side testicular atrophy 2,including one period orchiopexy a testis,F-S installment fixation a testicular; Testicular rebound 1,who had been operated with one phase of testicular descent fixtion.Conclusion For inguinal failed to find the testicular,children with cryptorchidism should be done by laparoscopy because of its positioning accuracy,and most children can do a period drop fixed,but for those really intraperitoneal more exalted person,stage surgery should be needed.Its overall treatment effect is satisfactory and is worth popularizing.

BACKGROUND: Increasing evidence identifies the immune system not as an isolated system with automodulations, but one that interacts with the central nervous system.OBJECTIVE: To investigate the distribution of c-fos expression in the lung and brain tissues of asthmatic rats and explore is significance.DESIGN: Randomized controlled study.SETTING: Department of Oncology, Southern Hospital, and Department of Neurosurgery, Zhujiang Hospital, Southern Medical University.MATERIALS: The experiment was conducted Department of Oncology,Southern Hospital, and Department of Neurosurgery, Zhujiang Hospital,Southern Medical University, between January and August 2004. Fourteen healthy male rats were randomized into experimental group (n=10) and control group (n=4).METHODS: On the first day of experiment, the rats in experimental group received intraperitoneal injection of 2 mL of the suspension containing 10 mg albumen, 200 mg aluminum hydroxide powder and inactivated pertussis vaccine (5×109), and subjected to inhalation of ultrasonically atomized 10 g/L albumen from on the 15th day, 2 times per hour for totally 3 days, to induce asthma in the rats. The rats in the control group received intraperitoneal injection of 2 mL normal saline on the 1st day and inhalation of ultrasonically normal saline on the 15th day, 30 mL a day for totally 3 days. The lung and brain tissues of all the anesthetized rats were fixed by perfusion, and immunohistochemical method with ovin-biotin-peroxidase complex and imaging analysis system were used to observe the distribution of Fos protein in the lung and brain.MAIN OUTCOME MEASURES: Distribution of c-Fos protein in lung and cerebrum.c-Fos in the lung and brain tissues was obviously higher in asthmatic group than in the control group (P ＜ 0.05), located mainly in the parietal-fontal cortex, limbic forebrain (cingulum cortex, pyriform cortex and central amygdaloid nucleus and so on), thalamus paraventricular nucleus, hypothalamus paraventricular nucleus, supraoptic nucleus, lateral region of the hypothalamus, hypothalamus periventricular nucleus, nucleus of solitary tract,area postrema and ventrolateral medulla. No obvious Fos expression was observed in the cerebellum. A large number of c-Fos-positive cells were observed in the wall of the airway and lungs in asthmatic rats, mainly distributing in the mucous membrane and submucous layer and around the smooth muscles; in the control rats, no positive cells or only occasional cells with weak c-Fos positivity were found in the wall of the airway and lungs.CONCLUSION: c-Fos expression increases obviously not only in the lungs of asthmatic rats, but also in medullar and its ascending projecting nuclei (hypothalamus, amygdala and so on), suggesting that the expression of protooncogene c-fos might be closely related with neuroimmunomodulation in asthma.

ObjectiveTo compare the clinical results of small surgical incision of bilateral spinous process and traditional open surgical incision in posterior single level lumbar interbody fusion,and assess the application value of the small surgical incision of bilateral spinous process in posterior single level lumbar interbody fusion.MethodsFrom December 2006 to June 2008,70 patients with lower lumbar vertebral diseases underwent single segment posterior lumbar interbody fusion.Patients were randomly divided into small surgical incision of bilateral spinous process group(Hereinafter referred to as small incision group) of 36 cases and 34 cases of conventional open group.Small incision group included 20 males and 16 females with an average age of 52.0 years.Traditional open group included 16 males and 18 females with an average age of 53.2 years.Two groups of operative time,blood loss,postoperative drainage,X-ray projection operation frequency,hospital stay,complication rate,creatine phosphokinase (CPK) level,multifidus cross-sectional area,postoperative low back pain visual analogue scale(VAS),Oswestry disability index(ODI),interbody fusion rate were compared,respectively.ResultsAll of 70 cases were followed up for 12-24 months (average,16).There were no statistically differences in the operation time,the number of X-ray projection,complication rate,and fusion rate between the two groups (P＞0.05),but there were significant differences in blood loss,postoperative drainage,the first day and the third day of postoperative the level of CPK,postoperative multifidus muscle cross-sectional area,postoperative low back pain VAS,hospital stay,and postoperative ODI between the two groups(P＜0.05).ConclusionSmall surgical incision of bilateral spinous process and traditional open surgical posterior lumbar interbody fusion were satisfied with the efficacy,but small surgical incision of bilateral spinous process with less trauma,shorter hospital stay,and rapid postoperative recovery.