Objective To explore the efficacy and safety of greenlight photoselective vaporization of prostate(PVP) in high-risk older patients with benign prostatic hyperplasia(BPH).Methods A total of 96 high-risk older patients with BPH underwent PVP.The operative time,blood loss,indwelling catheterization and operative complications were observed.The variables such as IPSS,QOL,uroflowmetry,post-void residual urine volume(RUV) were recorded and calculated pre-and post-operatively.Results All the 96 patients safely got through perioperative period.The mean operative time was(24.8?6.5)min,intraoperative blood loss was(55.4?16.8)ml and postoperative indwelling catheterization was(1.6?0.7)d.IPSS and QOL scores decreased form preoperative 29.8?5.2 and 5.2?0.8 to postoperative 8.4?2.3 and(1.4?)0.5,respectively.Qmax increased from(5.6?2.8)ml/s to(16.7?3.2)ml/s,and RUV decreased from(168.0?22.5)ml to(24.6?5.81)ml.There were significant differences of these parameters between pre-and post-operation(P

Objective:To study the clinical characteristics and classification of gastric neuroendocrine neoplasm(NEN) and prognostic factors of mixed adenoneuroendocrine carcinoma (MANEC) and gastric neuroendocrine carcinoma(NEC).Methods:A total of 148 gastric NENs were divided into type Ⅰ, type Ⅱ and type Ⅲ based on the classification of European Neuroendocrine Tumor Society (ENETS). Kaplan-Meier test and Cox regression model were used in univariate and multivariate survival analysis in 108 cases with pathological G3 gastric NEN.Results:In this study, the percentages of type Ⅰ, type Ⅱ and type Ⅲ were 25.0%(37), 3.4%(5) and 71.6%(106) respectively. Among type Ⅰ patients, 28(75.7%) lesions were located in gastric fundus or body, 29(78.4%) had bumps. Lymph node involvement was found in 4 (10.8%) patients. Twenty-six (70.3%) patients received endoscopic treatment and 11 (29.7%) with surgery. All 5 type Ⅱ patients presented lesions in gastric fundus or body, including 4 with ulcers, who were all treated by endoscope. Three type Ⅱ patients had gastrinoma, and 2 combined with multiple endocrine neoplasmⅠ. In type Ⅲ patients, 56(52.8%) showed ulcerative lesions. The majority of patients (102, 96.2%) had a single lesion, 94(88.7%) with lymph node or other organ metastasis. In this study, no deaths were reported in gastric NEN with a pathological grade of G1 or G2. The mortality rate was 38.9%(42/108) in patients with G3 NEN. Survival analysis suggested that age, metastasis of tumor were associated with poor prognosis ( P=0.041, 0.025). Conclusions:Patients with gastric NEN have heterogenous clinical presentations according to gender, age, endoscopic features, infiltration and metastasis, and pathological grade. Aging and metastasis are negative prognostic factors of G3 gastric NEN.

Objective To evaluate the clinical value of endoscopic submucosal tunnel dissection ( ESTD) for treatment of large gastric angle superficial neoplasms. Methods A retrospective analysis was performed on data of 87 patients with superfical neoplasms in gastric angle, including 32 cases undergoing ESTD and 55 cases undergoing endoscopic submucosal dissection ( ESD) in 6 institutions between July 2014 and July 2016. The dissection time, dissection speed, en bloc resection rate, curative resection rate, adverse events, and prognosis were compared between the two groups. Results The ESTD group showed a shorter dissection time ( 87. 3 ± 32. 6 min VS 136. 7 ± 64. 5 min, P<0. 01 ) , a higher dissection speed ( 0. 18 ± 0. 07 cm2/min VS 0. 08±0. 05 cm2/min, P<0. 01), a higher en bloc resection rate[100％ (32/32) VS 87. 3％ (48/55), P=0. 035], and a higher curative resection rate[100％ (32/32) VS 85. 5％ (47/55), P=0. 024] compared with the ESD group. The intraoperative bleeding rate[59. 4％ (19/32) VS 100. 0％( 55/55) , P<0. 01] and muscular injury rate[ 0 ( 0/32) VS 14. 5％ ( 8/55) , P=0. 024] were lower in the ESTD group than those of the ESD group. There was no statistical difference on recurrence rate between the two groups[0 (0/32) VS 1. 9％ (1/54), P=0. 443]. Conclusion ESTD has a higher dissection speed and greater security on treatment of large gastric angle superficial neoplasms, and is worthy to be generalized.

Objective To investigate the effects of enteral immunonutrition supplemented with omega-3 polyunsaturated fatty acid (ω-3 PUFA) on inflammatory response,intestinal mucosal barrier function and the prognosis in patients with severe traumatic brain injury (sTBI).Methods 122 patients of sTBI hospitalized between January 2015 and December 2016 were randomly divided into experimental group (ω-3 PUFA,n=61) and control group (n =61).The serum levels of tumor necrosis factor-α (TNF-α),interleukin (IL)-6 and neuron specific enolase (NSE) were tested with enzyme linked immunosorbent assay.Meanwhile,D-lactate acid and intestinal fat acid binding protein (I-FABP) were evaluated by enzymology spectrophotometer method.After 14 days of treatment,the Glasgow Coma Scale (GCS) scores,Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores and prognoses of both groups were compared.Results The serum levels of inflammatory factors (TNF-α and IL-6),intestinal mucosal barrier function indicators (D-lactate acid and I-FABP) and NSE proteins significantly increased after sTBI (P =0.01).Compared with the control group,the experimental group on day 3 had significantly lower serum levels of inflammatory factors [TNF-α:(107.77± 19.79) μg/Lvs.(151.76±21.65) μg/L,P=0.01;IL-6:(76.85±7.15) μg/Lvs.(105.27±10.12) μg/L,P=0.01] and intestinal mucosal barrier function indicators [D-lactate:(69.81 ±6.32) μg/L vs.(89.80± 8.75) μg/L,P=0.03;I-FABP:(40.81±6.73) μg/Lvs.(56.60±8.58) μg/L,P=0.01].On day 7,the experimental group had significantly lower expression of NSE proteins than the control group [(13.63± 2.53) μg/L vs.(19.12±3.00) μg/L,P=0.02].The experimental group received better prognosis compared to the control group on day 14 [GCS scores:(9.74±0.76) vs.(8.44±0.53),P=0.04;APACHE Ⅱ scores:(14.67±1.37) vs.(17.53±1.47),P=0.03].The experimental group also had fewer days in hospitalization [(19.37±2.27) d vs.(25.42±2.61) d,P=0.01].Conclusion Enteral immunonutrition supplemented with ω-3 PUFA can effectively regulate the inflammatory response,and reduce impairment to the intestinal mucosal barrier function and damage to neurons in patients with sTBI.

OBJECTIVE: To detect pathogenic variant in a neonate suspected for Cornelia de Lange syndrome (CdLS). METHODS: Potential mutations of CdLS-related genes (NIPBL, SMC1A, SMC3, RAD21 and HDAC8) were detected by high-throughput target region capture and next-generation sequencing. Suspected variants was verified by Sanger sequencing. RESULTS: The child was found to harbor a heterozygous splice site variant, c.6109-1G>A, of the NIPBL gene. Sanger sequencing suggested that neither parent has carried the same variant, suggesting that it was de novo. The variant was unreported by HGMD and ExAC database, and was predicted to alter an acceptor splicing site. No pathogenic variants of SMC1A, SMC3, RAD21 and HDAC8 genes were detected. CONCLUSION The heterozygous c.6109-1G>A splicing variant of the NIPBL gene may underlie the disease in this child. Above finding has expanded the variant spectrum of the NIPBL gene.
Cell Cycle Proteins ; genetics ; De Lange Syndrome ; genetics ; Genetic Testing ; Genetic Variation ; High-Throughput Nucleotide Sequencing ; Humans ; Infant, Newborn ; Mutation ; Phenotype

Objective To explore the effect of continuing nursing care in home management for elderly cancer patients , so as to provide a more comfortable home management for aged patients with cancer . Methods A total of 208 elderly cancer patients were chosen by convenience sampling from August 2012, and Omaha system was used to make intervention measures .Follow-ups were conducted before and after discharge on the first chemotherapy , after discharge of the second chemotherapy and two weeks after discharge of the third chemotherapy in order to evaluate their home life .Results The cognition score of elderly cancer patients before and after discharge on the first chemotherapy , after discharge of the second chemotherapy and two weeks after discharge of the third chemotherapy was respectively (2.91 ±0.57),(3.92 ±0.54),(6.58 ±0.56),(7.39 ± 0.59), and the difference was statistically significant (F=351.05,P=0.001).Their behavior score was respectively (3.45 ±0.47),(4.30 ±0.48),(6.44 ±0.49),(7.00 ±0.52)with statistically significant difference (F=363.45, P=0.000).And their score of current situation was respectively (2.64 ±0.49),(4.17 ±0.48),(6.40 ±0.51), (7.20 ±0.53) with statistically significant difference (F=405.07,P=0.000).Conclusions Continuing nursing care affects patients from four aspects including environment , social psychology , physiology and health , which can effectively improve the quality of life in elderly patients with cancer , so as to promote and maintain their health.

Objective To explore the quality management activities on improving nursing satisfaction of pain in patients with tumors .Methods Totals of 494 patients with cancers were randomly divided into control group ( n=247 ) that received routine pain nursing ,and study group ( n=247 ) that received the intervention of quality management activities .That set up the quality control circle ( QCC ) , established “improving patients pain nursing satisfaction” as the topic , conducted investigation , analyzed the causes , formulated corresponding measures and organized the implementation , and then examined the effect .Then, pain nursing knowledge awareness rate, patients’ satisfaction and pain degree of patients in two groups were observed and compared . Results Awareness rate of pain nursing knowledge (97.21% vs 87.53%), and patients’ satisfaction with pain nursing (98.40%vs 91.42%) in study group were significantly higher than that in control group , and the differences were statistically significant (χ2 =4.356,7.983,respectively;P<0.05).After the intervention,the number of no pain patients increased to 13 in study group with heavy pain patients decreased to 14, and the difference of pain degree of two groups was statistically significant (Z=-2.425,P<0.01).Conclusions The QCC can significantly improve the cancer patients ’ satisfaction with nursing care , and improve the effect of cancer pain treatment .

Objective To discuss the clinical characteristics,pathogenesis,diagnosis and treatment of preterm ovarian hyperstimulation syndrome (POHS).Method The process of diagnosis and treatment of a test-tube female baby were summarized.She was deliveried at 32+2 weeks of gestation,diagnosed with POHS,and born in the First Affiliated Hospital of Wenzhou Medical University(in 2015).Retrieval of related literature in PubMed database and Wanfang database was performed using the key words "ovarian hyperstimulation syndrome" and " preterm infants or newborns" from 1980 to 2015.Result The patient developed labial hyperemia and edema,ectropion of vaginal mucosa and plica,swelling of the hypogastrium and upper legs at 41 days (38+1 weeks post-conception).The child was continuously observed because diagnosis was not clear.The pelvic and abdominal ultrasonography examinations revealed a cyst in the right ovary and laboratory evaluation of the baby showed high concentrations of gonadotropin and estradiol at 49 days (39+2 weeks post-conception),and thus the baby was diagnosed with POHS.With no special intervention measures,the baby became normal at 169 days (4 months post-conception).Six papers from foreign literature were retrieved and none from Chinese literature,which reported 12 cases of POHS.They all characterized prematurity,ovarian cyst/cysts,labial hyperemia and edema,swelling of the hypogastrium and upper leg,high serum gonadotropin and estradiol levels at 35 to 39 weeks post-conception,including 3 cases with breast enlargement,1 case with vaginal bleeding and 1 case with ectropion of vaginal mucosa and plica.The treatments included in 1 case combined surgery with pharmacological intervention,in another case only pharmacological intervention,and in the others no interventional measures were taken but were only followed up.As for the results,the baby with the surgical treatment had recurrence,but the symptoms,ovarian cyst and hormone concentration of the other babies gradually became normal in 4-5 months.Conclusion POHS is a rare and self-limiting disease.The common clinical features of this disease are prematurity,ovarian cyst or cysts,labia hyperemia and edema,swelling in the hypogastrium and upper legs,high serum gonadotropin and estradiol levels at 35 to 39 weeks post-conception.It does not require treatment if there is no complication,but follow-up is necessary.

Objective: To understand HIV infection status and characteristics of non-remunerated blood donors in Hangzhou. Methods: HIV antibody test were conducted for non-remunerated blood donors in Hangzhou and their demographic and epidemiological information were collected from 2008-2017. χ² test for trend (liner by liner association chi square test) was used for the comparison of the HIV infection trends in each year. Results: A total of 1 461 129 non-remunerated blood donors were surveyed in Hangzhou during 2008-2017, and 260 blood donors were HIV positive. Most HIV infected blood donors were males (96.5%, 251/260) and aged 18-34 years (72.7%, 189/260). Among 260 HIV positive blood donors, those reporting repeated non-remunerated blood donation accounted for 36.9% (96/260), those reporting homosexual transmission accounted for 53.5% (139/260) and those reporting heterosexual transmission accounted for 44.6% (116/260). The HIV infected persons reporting homosexual behaviors were mainly aged 18-34 years (82.0%, 114/139) and unmarried (71.2%, 99/139). Most HIV infected students reported homosexual transmission (88.4%, 23/26). The crude HIV positive rate was 0.8/10 000-2.5/10 000, the differences in annual HIV positive rate had no significance (trend χ²=2.355, P=0.125). The crude HIV positive rate in male blood donors aged 18-24 years increased from 1.1/10 000 in 2008 to 3.7/10 000 in 2017, the difference was significant (trend χ²=5.175, P=0.023). Standardized HIV positive rate was 0.9/10 000-2.4/10 000. Conclusions HIV infection rate was low in non-remunerated blood donors in Hangzhou during 2008-2017. Most HIV infected persons were males and aged 18-34 years. Heterosexual and homosexual contacts were the major transmission routes. The HIV positive rate in males aged 18-24 years showed an increase trend.

Objective To explore the application effect of four integrated nursing model in rehabilitation nursing of elderly patients with lung cancer .Methods Eighty-four elderly patients with lung cancer were chosen and were randomly divided into the control group and the intervention group , each with 42 cases.The control group received the routine holistic nursing mode , and the intervention group received the four integrated nursing model on the basis of the control group .The nursing effect was evaluated by the FACT , self-rating depression scale ( SDS ) and self -rating anxiety scale ( SAS ) in two groups .Results No differences were found in the scores of FACT , SDS, SAS between two group before the intervention (P>0.05). The scores of every scales of FACT were respectively (69.99 ±1.45), (69.87 ±2.54), (70.24 ±1.36), (69.25 ±2.02), (68.24 ±1.41) in the intervention group after the intervention , and were higher than those of the control group and those before the intervention (P<0.05).No differences were found in the scores of every scales of FACT in the control group before and after the intervention (P>0.05).The scores of SDS and SAS were respectively (33.893 ±4.257), (29.754 ±3.896) in the intervention group after the intervention , and were lower than (39.450 ±5.058), (34.639 ±5.785) in the control group, and the differences were statistically significant (t=-1.023,1.903, respectively;P<0.05).Conclusions The four integrated nursing model has a positive significance on the improvement of the overall quality of life in patients with lung cancer , and is worthy of the clinical promotion .