Objective To explore morphological changes in evolution of colorectal pit patterns and their relation with polyp development by observing the uhrastructure of colorectal polyps. Methods Analy-ses were based on data from 50 subjects with colorectal polyps diagnosed with magnifying colonoseopy. Colonoscopy comb/ned with endoscopic lesions staining was employed to determine the pit pattern of colorec-tal lesions, according to Kudo classification. Colorectal lesions were removed through endoscopy or surgery. All samples were analyzed with histopathology, scanning and transmission electron microscopy. Results The pit pattern of 50 samples included 10 cases of type Ⅰ , 8 eases of type Ⅱ, 15 eases of type Ⅲ, 9 cases of type Ⅳ, 5 cases of type Ⅴ and 3 eases of mixed-type. The positive predictive rate and the accuracy rate of differential diagnosis of neoplastic polyps, verified with histological diagnosis, were 86% and 94%, re-spectively. Under scanning electron microscopy, crypt morphology in type Ⅰ and type Ⅱ exhibited regular round hole shape, with epithelial cells in uniform size, abundant absorptive cells with rich microvilli and goblet cells. Crypt in type Ⅲ, type Ⅳ and type Ⅴ appeared gradual deformation accompanied by increasing-ly atypical hyperplasia in the epithelial eells and heterotypic tissues. Transmission electron microscopy re-veahd epithelium of type Ⅰ and type Ⅱ ananged regularly and connected closely, with neat microvilli at the top of cells, affluent mitochondria and endoplasmic reticulum in the cytoplasm, oval nuclear at the base, and smooth and continuous basement membrane. While the epithelium of type Ⅲ, type ⅣV and type Ⅴ was char-acterized by sparse and irregular villi, swelling mitechondria and expanded endoplasmic reticuhm, lysosomes of increased number, heterotypic nuclear and mitotic nuclear, and broken and disappearing substrate. Con-dusion Morphological changes in pit pattern of colorectal polyps is affected by sudaee structure of glandular epithelial cells, the proportion and composition of the crypt surface cellsn. Ultrastrnetural changes in epithe-lial cells are the material basis of morphological changes in pit pattern and polyp development.

Objective To investigate the efficacy of frontoparietal drill versus parietal drill in the burring hole and drainage for chronic subdural hematoma(CSDH),and provide an evidence for clinical application.Methods A total of 82 patients with CSDH from January 2013 to January 2016 in our hospital were randomly divided into observation group and control group.The observation group chose frontoparietal drill which located at the front 1/4 point at the axial view with the thickest hematoma.Control group chose parietal drill which nearby the parietal tuberodties at the axial view with the thickest hematoma.The postoperative residual hematoma volume,intracranial gas volume,recurrence rate,neurologic function and mental state between two groups were compared.Results The postoperative residual hematoma volume,intracranial gas volume,the recurrence rate and CSS were lower compared with the control group,the differences were significant(P<0.05).The MMSE score of observation group were higher that of the control group,the difference was significant(P<0.05).Conclusion The frontoparietal drill has a better effect to remove the hematoma and promotes neural functional recovery.

Objective: To evaluate the effect of partial liquid ventilation with perfluorocarbon on the static lung compliance in rat with smoke inhalation injury. Method: Partial liquid ventilation (PLV)and mechanical ventilation (MV)were set up on rat's model,total static lung compliance (C_(2.94))and low volume static lung compliance (C_(0.49))were measured with hydraulic pressometer,the expansion index(EI)of lung was calculated. Result: There were significant decrease in C_(2.94),C_(0.49) and EI after 6 hours of smoke inhalation injury as compared with control values (P0.05), but in partial liquid ventilation group C_(2.94).C_(0.49) and EI increased obviously compared with those in smoke inhalation injury and MV groups (P

Objective Evaluate the feasibility of PTCA and stents by radial artery. Methods we had operated PTCA for 25 cases by radial artery from July 2004 to April 2005. The average age is 63 years old including 40 men and 15 women. Results 67 stents were implanted in 55 patients including 30A cases, 26 B cases and 11C cases. These stents is about 8mm to 33mm in length and 2.5mm to 4.0mm in width. The successful rate is 96%(53/55), and two case was failed, because the guiding wire can not pass by chronic obstruction in LAD all. There is no case by femoral. All the procedures have no heart complications, obstruction of radial artery and vascular complications. Conclusions The way is good for PTCA by radial artery. Its advantages are mild injury, high successful rate and few complications, and the salted hospitals can use the technology successfully.

Objective To explore the clinical value of high frequency ultrasound combined with serum tumor specific growth factor in diagnosis of thyroid cancer.Methods 155 patients with thyroid tumor received preoperative high frequency ultrasound and the detection of TSGF content,the histopathologic examination was given after operation.The clinical value of high frequency ultrasound and TSGF detection in diagnosis of thyroid cancer was analyzed.Results The sensitivity of high frequency ultrasound in diagnosis of thyroid carcinoma was 82.54％,the specificity was 81.52％.The sensitivity of TSGF in diagnosis of thyroid cancer was 79.37％,the specificity was 78.26％.The sensitivity of high frequency ultrasound combined with TSGF in diagnosis of thyroid cancer was 92.06％,the specificity was 93.48％.And the coincidence rate of combined detection was significantly higher than the two methods used alone,the difference was statistically significant (P ＜ 0.05).Conclusion High frequency ultrasound combined with TSGF detection can make up the shortage of the two methods,which has important value in improving the diagnosis of thyroid carcinoma.

Objective To investigate the safty and proper concentration of using the sufentanil combined with ropivacaine in patient-controlled epidural analgesia (PCEA) under lower limb surgery in elderly. Methods Eighty patients scheduled for lower limb surgery were divided into 4 groups by random digits table with 20 cases in each. The concentration of the sufentanil were 0.1,0.2,0.3 and 0.4 μ g/ml in group A, B, C, D respectively. The concentration of the ropivacaine were 0.125% in each group for the PCEA.R-VAS, C-VAS , Bromage score, Ramsay score, press times ,dosage and side effects were monitored and recorded at 4,10,24 and 48 h after operation. Results Compared with those in group C, D, C-VAS,dosage of the analgesia,press times of PCEA were higher in group A,B (P＜0.01 or ＜ 0.05),the efficacy of press was lower in group A, B(P＜0.05), but there was no significant difference between group C and group D(P＞0.05 ).The Ramsay score 10,24 h after operation in group D[(4.5 ± 0.5 ), (4.6 ± 0.6) scores] was higher than that in group A,B,C [(2.7 ±0.8), (2.7 ±0.8) scores vs.(2.9 ± 0.9), (2.7 ± 0.9) scores vs. (3.0 ±0.7), (2.9 ±0.5) scores] (P ＜0.05). There were no case with hypotension and respiratory depression.Conclusion PCEA of four methods are safe and effective in elderly which 0.3 μ g/ml sufentanil combined with 0.125% ropivacaine have good analgesic effect and less side effect.

Objective To investigate the value of remnant stomach-jejunal dual pathways reconstruction after laparoscope-assisted radical proximal gastrectomy in the treatment of upper gastric cancer. Methods Twenty-five patients with upper gastric cancer underwent laparoscope-assisted radical proximal gastrectomy and the remnant distal stomach was preserved for side-to-side remnant stomach-jejunal anastomosis and end-to-side jejuno-jejunal anastomosis to reconstruct dual pathways. Results The mean operation time was (240±35) minutes, the mean number of lymph nodes dissected were 22±5, and all the incised margins were negative. No anastomotic leakage, obstruction or stenosis occurred. All patients received postoperative barium meal examination. A large amount of barium directly entered the jejunum, leaving a small amount of barium entered the jejunnum via the route of remnant stomach-duodenum, and was detained in the remnant stomach for 30-60 minutes. No esophageal reflux of barium was observed. All the patients were followed up for 4-18 months, no reflux esophagitis was detected and the short-term life quality was satisfactory. Conclusions Remnant stomach-jejunal dual pathways reconstruction prevents the reflux esophagitis and dumping syndrome, preserves the pathway of duodenum and promotes the life quality of patients.

Objective:To investigate the expression of Survivin and it's relationship with the expression of Bcl-2 in sinonasal inverted papilloma (SNIP).Method:Immunohistochemical method was used to determine the expression of Survivin and Bcl-2 in 30 cases of SNIP,10 cases of sinonasal squamous cell carcinoma(SCC) and 10 cases of normal inferior concha tissues.Result:Survivin was expressed in 22 of 30(73.3%)cases of SNIP,8 of 10(80.0%)cases of SCC and not expressed in 10(0%)cases of normal inferior concha tissues.Expression of Survivin was significantly higher in SNIP and SCC than in normal tissues.Bcl-2 was expressed in 9 of 10(90.0%)cases of SCC and 2 of 10(20.0%)cases of normal inferior concha tissues.Expression of Bcl-2 was significantly higher in SCC than in normal tissues.Bcl-2 was expressed in 14 of 30(46.7%)cases of SNIP,higher than normal tissues.Expression of Bcl-2 was positively related to expression of Survivin.Conclusion:Survivin may play an important role in the pathway of progression of SNIP and SCC.It may be identified as a new therapeutic target.Bcl-2 may play a synergic role with Survivin in progression of SNIP.

Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients,and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients.Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival (OS) and disease-freesurvival (DFS) rates,incidence of recurrent and metastatic disease were compared between the two groups.Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P ＜ 0.05).Nevertheless,the incidence of postoperative mortality was not significantly different (6.0％ vs 0％,P ＞ 0.05).The median survival was 22.5 months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2％,82.4％ and 30.3％ respectively,and 6-month,1-year,3-year DFS rates were 81.3％,54.7％ and 27.3％.The 1-year OS and 6-month DFS rates were higher than those of staged group (both P ＜ 0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different (38.1％ vs 29.4％,P ＞ 0.05).Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage.Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.