Objective To evaluate the feasibility of retroperitoneal laparoscopic adrenalectomy for large (≥6 cm in diameter) adrenal tumors. Methods Between June 2002 and June 2008,30 patients with large adrenal tumors underwent retroperitoneal laparoscopic adrenalectomy in our hospital. With the patients being placed in the lateral position at the uninjured side,a self-made balloon was used to dilate the retroperitoneal space. Afterwards,3 trocars were inserted via the costal margin at the posterior axillary line and the anterior axillary line,and 2 cm above the anterior superior iliac spine at the middle axillary line to remove the tumors. After resection of the tumor,an drainage tube was indwelled. Results Retroperitoneal laparoscopic surgery was performed successfully in the 30 cases without conversion to open surgery. The mean operation time was 100 min (range,65 to 185 min),and the mean blood loss was 80 ml (range,50 to 250 ml). Over a mean of 18.5-month follow-up (range,3 to 36 months) was achieved in the cases,during which no one had local recurrence. Conclusions Retroperitoneal laparoscopic adrenalectomy is feasible and safe for patients with large adrenal tumors as long as no contraindication of the surgery is found. The diameter of the tumor does not play a role when determining the surgery.

Objective Observe the changes of cytokine and immunoglobulin in children with Hand-foot-and-mouth disease (HFMD) infected by Enterovirus 71 (EV71),to explore the significance of inflammation and immunological mechanisms.Methods A total of 65 cases of children with HFMD by EV71 were taken as the observation group,and 65 cases of healthy children were as the control group in June 2015-August 2016.The serum levels of IL-6,IL-8,TNF-α were detected by enzyme-linked immunosorbent assay (ELISA),and the levels of IgA,IgG,IgM were detected by immune scattering turbidimetric.Results Compared with control group,the levels of IL-6,IL-8 and TNF-α in observation group were significantly increased (t=7.94,6.87,9.56,P ＜ 0.01),the levels of IgA,IgG and IgM also increased,differences were statistically significant (t =6.71,7.96,8.39,P ＜ 0.01).Conclusion The inflammatory cytokines and immune imbalance in the development of HFMD play an important role,observe the dynamic changes of IL-6,IL-8,TNF-α,IgA,IgG and IgM levels has certain clinical application value in preventing and judging the state of HFMD.

Objective To investigate the correlation of bone mineral density (BMD) with plasma Klotho levels and its related factors in type 2 diabetic patients (T2DM) . Methods BMD was measured by Dual-energy X-ray absorptiometry (DEXA) in 159 T2DM patients. The patients were divided into three groups:normal bone mass, reduced bone mass and osteoporosis. The fasting plasma levels of Klotho were detected in these patients using enzyme linked immuno sorbent assay (ELISA), clinical and biochemical parameters also were tested, the difference and related factors were compared and analyzed in each group. Results Plasma Klotho levels were not significantly different among the three groups (4.95±0.48 vs 4.96±0.47 vs 4.91±0.49,P>0.05) . BMD at the first, second, third, fourth and total lumbar spine, femoral neck, trochanter and total body were not associated with plasma Klotho levels in these patients (P>0.05) . Age, diabetic duration, HDL-C and BMI were independent determinants for BMD in T2DM patients. Conclusions BMD might be not associated with plasma Klotho level in T2DM patients. But age,diabetic duration,HDL-C and BMI are associated with reduced BMD and osteoporosis in T2DM patients.

Objective To investigate the mechanisms of fluconazole resistance in clinical and experimental induced isolates of C.glabrata.Methods Efflux of rhodamine 6G was performed to evaluate the effects of efflux pumps.The expression levels of transporter genes CDR1,CDR2,SNQ2 and ERG11 were examined by real-time RT-PCR.Meanwhile,sequence of PDR1 was determined by PCR based DNA sequencing.Results Efflux pumps of all fluconazole-resistant isolates had stronger effects than that of susceptible isolates,consistently with significant upregulation of CDR1,but no obvious difference was found in CDR2 or SNQ2.Also,no notable change in the expression level of ERG11 between susceptible and resistant isolates.PDR1 mutations existed in both clinical and experimental induced isolates of C.glabrata,among which P927S,L543P and S947L haven't been reported previously.Conclusion Mutations of PDR1 were induced by fluconazole both in vivo andin vitro,which will result in overexpression of CDR1 and strengthen the effect of efflux pump.

Objective To develop a special seismic trauma database that could record and analyze the data including injuries, trauma cares and outcomes. Methods (1) The items and content of the database were determined based on the method of evidence-based medicine. (2)The fields, tables, items and options of the seismic trauma database were designed. (3) The database software was developed based on dot net framework platform, with C# as programming language. (4)The database was used to record and manage data of injuries caused by 5.12 earthquake. Results The Seismic Trauma Database Version 1.0 was developed with 728 fields (including 380 inner fields) and normative content and structure. The database software could record 10 aspects of the seismic patients including basic information, injuries, transfer and evacuation, clinical medical care, outcome and discharge. The database software had combination, custom queries and meta-analysis functions. Conclusions This database software can conveniently and normally record and manage the information of the seismic patients, can systemize and analyze the data conveniently and is an excellent data platform for trauma care research and epidemiologic study of seismic injuries.

ObjectiveTo compare inhalational anesthesia with sevoflurane and intravenous anesthesia with propofol-sufentanil in patients undergoing gynecological outpatient surgery.MethodsOne hundred and forty ASA Ⅰ or Ⅱ patients,aged 18-35 yr,weighing45-65 kg,undergoing outpatient painless abortion,were randomly divided into 2 groups ( n =70 each):intravenous anesthesia with propofol-sufentanil group (group Ⅰ ) and inhalational anesthesia with sevoflurane group (group Ⅱ ).In group Ⅰ,sufentanil 0.2 μg/kg was injected intravenously,and 1％ propofol was infused at 2-3 mg·kg-1 ·min-1,followed by a rate of 3-4 mg·kg-1 ·h-1 after loss of eyelash reflex.In group Ⅱ,8％ sevoflurane was inhaled and the oxygen flow rate was 6 L/min,and after loss of eyelash reflex,the oxygen flow rate was adjusted to 3 L/min,and the concentration of sevoflurane was adjusted to 2％-3％.The time of induction of anesthesia,emergence time,operation time,intraoperative hypoxemia,body movement and related adverse events were recorded.ResultsCompared with group Ⅰ,the time of induction of anesthesia was significantly prolonged,the incidence of agitation,nausea and vomiting was significantly increased,and the incidence of sexual hallucinations was significantly decreased ( P ＜ 0.05),while no significant change was found in the operation time,emergence time,and incidence of shivering,intraoperative hypoxemia and body movement in group Ⅱ ( P ＞ 0.05 ).ConclusionIntravenous anesthesia with propofol-sufentanil is more helpful in improving the quality of emergence from anesthesia and more suitable for gynecological outpatient surgery than inhalational anesthesia with sevoflurane.

OBJECTIVE: To investigate the clinical and pathological features of solitary pterygoid benign lesions, as well as the treatment and outcome of endoscopic surgery. METHOD: We retrospectively analyzed clinical data of 4 patients with pterygoid benign lesions in our department. High resolution CT and enhanced MRI were performed before the operations, then endoscopic surgeries were carried out under the circumstance of general anesthesia. After a follow-up in 12 months to 48 months, nasal endoscopy and MRI examination were performed. Therefore we are able to understand the situation of operations and postoperative recurrences, and to inquire about the changes of symptoms and the relief of symptoms before and after surgery. RESULT: From the Pathological diagnosis, it showed 2 cases of cystic lesions, 1 case of spindle cell lipoma, 1 case of inflammatory lesion. Postoperative follow up showed scar formation, smooth surface, no recurrence, and no new symptom. Nasal obstruction is relieved after the surgery, and no changes in the sympotoms of headache were observed. CONCLUSION The combination of high resolution CT with enhanced MRI isimportant for ascertaining the location, extent and nature of the pterygoid lesions. Endoscopic surgery is a minimally invasive, safe, and effective method for the treatment of solitary pterygoid benign lesions.
Cysts ; diagnosis ; surgery ; Endoscopy ; Headache ; Humans ; Lipoma ; diagnosis ; surgery ; Magnetic Resonance Imaging ; Nasal Obstruction ; diagnosis ; surgery ; Nasal Surgical Procedures ; Neoplasm Recurrence, Local ; Nose ; Postoperative Period ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To investigate the difference of two models of respiratory failure in preterm infants with nasal continuous positive airway pressure(nCPAP)and nasal biphasic positive airway pressure (nBiPAP).Methods Comparative analysis of 81cases of premature infants with respiratory failure requi-ring respiratory support was needed.They were applied nCPAP and nBiPAP ventilation mode treatment.The use of breathing machine and total oxygen inhalation time,the number of treatment failures,the PEEP param-eters of the ventilator,the total number of recent complications and secondary infections were compared.Re-sults In the nBiPAP treatment group,the average time of noninvasive ventilation was(96.34±31.5)h,the total time of oxygen inhalation was(10.11 ±9.39)d,3cases of treatment failure,the incidence of severe complications was 5.56%(2/36),PEEP (4.08±0.73)cmH2O (1cmH2O =0.098kPa ).In the nCPAP group,the average time of noninvasive ventilation was(114.14±41.69)h,the total time of oxygen inhalation was(17.53±15.96)d,15cases were failed,the incidence of severe complications was 15.56%(7/45), PEEP(5.11±1.01)cmH2O.There were significant differences between the two groups(P﹤0.05).But there were no significant differences in infection control and patent ductus arteriosus (P ﹥0.05).Conclusion nBiPAP as one of the first choice treatment for premature infants with respiratory failure significantly better than nCPAP,as soon as the proper use can avoid invasive ventilation.

Objective To investigate the role of PDR1 gene in azole-resistant Candida glabrata (C.glabrata).Methods Thirty-eight clinical isolates of C.glabrata were collected from five different hospitals.The minimal inhibitory concentrations (MIC) of azole antifungals including fluconazole,itraconazole and voriconazole against C.glabrata were determined by broth microdilution.Sequencing and amplification of PDR1 gene was achieved by real-time quantitative polymerase chain reaction (PCR).The mutation was cloned into an expression plasmid and then transferred into C.glabrata.The efflux of rhodamine 6G and drug sensitivity test were performed,and expressions of CDR1 and CDR2 were examined to verify function of mutation.Results Among these 38 isolates of C.glabrata,17 were resistant to at least one of azole antifungals.Moreover,mutations of PDR1 gene existed in every resistant isolates.Results of phenotyping test showed that in the isolate that expressed PDR1P927S,the expression of CDR1 and CDR2 were increased by 20.53 and 4.03 fold,respectively.And the fluorescence intensity of rhodamine 6G was decreased to 0.62 in efflux experiment.Conclusion P927S mutation of PDR1 gene could induce azole resistance of C.glabrata by increasing the expressions of CDR1 and CDR2,which results in drug resistance due to enhanced effect of efflux pump.