Objective To explore the early diagnosis and proper treatment for pancreas injuries. Methods 31 patients with pancreatic injury were treated from Oct. 1997 to Nov. 2008 in the Third Hospital of Yanzhou Mining Group. The early clinical signs and characters, treatment and causes of death of the 31 cases of pancreas injuries were studied retrospectively. Results All 31 cases with blunt pancreatic injury underwent operation. 28 patients were cured, 2 died from the pancreatic fistula and 1 multiple organ dysfunction syndrome.Pancreatic fistula and pancreatic pseudocysts were the main complications. Conclusions The preoperative diagnosis is difficult. Surgical exploration is the main method to guarantee accurate diagnosis of pancreatic injuries.Selecting proper surgical operation according to the situation of pancreatic injuries during the exploration can elevate successful rate.

To study the significance of the expression of splice variants of CD44 (CD44v) in tu-m0r-adjacent tissue of the patients with primary liver cancer(PLC). Methods: To research into the signifi-cance of the expression of CD44v mRNA in tumor-adjacent tissue of 30 patients with PLC by RT-PCR andfollow-up. Results: In the patients that the expression of CD44v mRNA of tumor-adjacent tissue washigher than those of tumor tissue(group I ), clinical pathological indexes were higher than in the patientsthat the expression of CD44v mRNA was higher than the tumor tissue(group I ). The recurrent rate ofgroup I was higher than that of group n (P

Hepatitis C virus (HCV) infection is the leading cause of chronic liver diseases worldwide.There is no vaccine to prevent HCV infection.Current standard of care (SOC) for hepatitis C is pegylated interferon-α (pegIFN-α) in combination with ribavirin (RBV).However,the efficacy of pegIFN-α and RBV combination therapy is less than 50％ for genotype 1 HCV,which is the dominant virus in human.Additionally,IFN and RBV are highly toxic,causing severe side effects.Therefore,it is urgent to develop safer and more efficacious anti-HCV drugs.Over the last decade,a number of HCV-specific inhibitors have been discovered with many of them reached to late stages of clinical trials.Recently,2 HCV NS3 protease inhibitors,telaprevir and boceprevir,have been approved by the Unite States Food and Drug Administration (FDA).This opens up a new era for anti-HCV therapy.Several new classes of antiviral drugs targeting HCV NS3 protease,NS5A and NSSB RNA-dependence RNA polymerase (RdRp) are currently at various stages of preclinical and clinical studies.Upon approval of more NS3 protease,NS5A and NS5B polymerase inhibitors,future clinical studies will lead to optimal combination therapies which will have desirable parameters such as IFN-free,higher efficacy,safe,one daily dose and short duration.

Objective:To study the correlation of leucocyte level of peripheral blood with degree of pyretic pulmonary syndrome in different bacterial pneumonia patients and to provide evidence in clinical practice.Methods:To observe pneumonia patients that had been healed in our respiration department of The Jiangxi Province Chinese Medicine Hospital from January,2006 to December,2007 years,incorporating the non-foundation disease or the chronic obstuctive pulmonary disease or chronic cor corpulmonale,We were to summarize relation degree of pyretic pulnonary syndrome to the white blood cell countingthe neutral granular cell percentage relevance.Results:From the non-foundation disease's pneumonia patients group,degree of pyretic pulnonary syndrome and the peripheral blood white blood cell counting and the neutral granular cell level had obvious relevance(P

Objective To evaluate the clinical feasibility of laparoscopic cool-tip radiofrequency ablation (LCRFA)for renal cell carcinoma. Methods Twelve selected cases of primary renal, ceil carcinoma underwent LCRFA. Of them, 4 cases of left renal carcinomas, 7 cases had right renal carci-nomas and 1 case had bilateral renal carcinomas. The maximum diameter of the tumors was 2.1-8. 5 era. Eleven cases were T, No M0 and the other one was T2 N0 M0. Results The mean operation time was 92±24 min, and the mean blood loss was 50±29 ml. None of the cases need blood transfusion post-operation. No laparoscopic operative complications were observed. Six weeks after operation, complete ablation was achieved in 12 lesions and partial ablation in 1, with a complete ablation rate of 92.3%(12/13). There was no statistic change of Hb. ESR. SCr and GFR after operations (P>0.05). Ten cases underwent CT examination 3 months after the treatment ,9 cases showed complete necrosis of tumor,1 case showed partial necrosis. No recurrence was found. All of the 12 cases remained sur-vived during the follow-up for 1-16 months(median,7.8 months). Conelusions LCRFA for renal cell carcinoma is an accurate and effective intervention with a low incidence of complications, and is more accurate than ultrasound-guided pereutaneous radiofrequency ablation.

Objective To investigate the clinical manifestation,therapeutic methods and treatmenteffectiveness of hand contracture due to extravasation injury from peripheral intravenous therapy in children.Methods Data of 6 children who had received treatment for hand contracture in our hospital from March 2004 to September 2011 were retrospectively analyzed.There were 3 boys and 3 girls,aged from 24 to 51 months (average,38 months).Two children underwent extensor tenolysis and dorsal capsular release at the metacarpophalangeal (MCP) joints.The other 4 children received conservative treatment,including physical therapy (ultrasound and medium frequency pulse) to reduce the hand swelling and peritendinous adhesion,active and passive functional exercise of digital joints and night splint protection.Results The MCP joint could be passively flexed to 90° intraoperatively in 2 children who underwent operation; however the contracture recurred at 2 months and 6 months after operation,respectively,and then the MCP joints were fixed at 0° position.For 4 children who received conservative treatment,although the active flexion of their MCP joints ranged from 30° to 45° during the rehabilitative procedure,recurrence of hand contracture was observed after the cessation of the rehabilitation in all children,and the range of active MCP joints flexion varied from 0° to 15°.Conclusion The mechanism underlying hand contracture due to extravasation injury from peripheral intravenous therapy remains elusive.Either simple conservative or surgical management results in poor functional outcomes.Combined therapy based on different indications for conservative and surgical management may improve the outcomes.

Objective To evaluate the clinical feasibility of radiofrequency ablation (RFA) for renal cell carcinoma in functional solitary kidney. Methods Five selected cases of primary renal cell carcinoma in a functional solitary kidney were retrospective analyzed. Three cases of left renal cell carcinoma and 2 cases of right renal cell carcinoma were diagnosed by B ultrasound and CT scanning. The maximum diameter of the tumors were 3.0- 6.0 cm. Three cases of which were T1a N0 M0 and the others Were T1bN0M0. All patients were followed up with enhanced-CT and contrast-enhanced ultrasonography. Results The mean time of the operation was 100.0+28.5 min, and the mean blood loss was 95.0±30.5 ml. No patients accepted blood transfusion post-operation. All patients after operation had fever (38.2±0. 7 ℃ ). All the lesions were completely ablated on contrast-enhanced ultrasonography. There was no statistic change of hemoglobin, serum creatinine (SCr), ECT-GFR and creatinine clearance after operation (P>0.05). All of the 5 cases survived. No recurrence were found by enhanced-CT and contrast-enhanced ultrasonography and SCr was retaining in the normal level during follow-ups (median, 11.5 months). Conclusion Radiofrequency ablation for renal cell carcinoma in a functional solitary kidney could be a treatment choice with a relatively low incidence of complications.

Objective:To observe the size changes under ultrasound of 4C type thyroid micronodules classified by 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS)during follow-up.Methods:In this cross-sectional study, the data of thyroid ultrasonography in physical examination center in the Affiliated Zhongshan Hospital of Dalian University between December 2017 and December 2021 were retrospectively included, thyroid nodules were classified according to C-TIRADS, to observe the changes by ultrasound of maximum diameter and volume of 4C type thyroid micronodules during follow-up.Results:A total of 102 subjects receiving physical examinations with 103 thyroid micronodules were enrolled in this study. The maximum diameter and volume of thyroid micronodules at initial examination was 5.0 (4.0, 7.0) mm and 52.5 (25.2, 113.4) mm 3 respectively, and it was 6.0 (4.0,7.0) mm、65.6 (25.2,147.0) mm 3 at the last examination, respectively. Of the thyroid micronodules, 79 (76.7%) remained stable, 14 (13.6%) magnified and 10 (9.7%) shrunk during the follow-up. The cervical lymph nodes in all physical examiners were normal. There were significant changes in the maximum diameter and volume in the thyroid micronodules between the initial and last examination in subjects whose micronodules shrunk or magnified during the follow-up (all P<0.05). Conclusion:Size of most C-TIRADS 4C thyroid micronodules remains stable or even decreases during ultrasound follow-up observation, for such thyroid nodules, follow-up observation appears to be a safe and feasible way to postpone surgery.

Objective To evallhte factors affecting blood loss during mini-percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal lithotripsy(MPCNL). Methods 1156MPCNL procedures in 885 patients from July 2002 to October 2006 were reviewed. Various patientrelated and intraoperative factors were assessed for association with total blood loss using multivariate regression analysis. ResuIts The average hemoglobin drop was(14.2+8.3)g/L.The overall blood transfusion rate was 1.5%. Approximately 0.6%of patients required angiography embolization to control intractable bleeding. Multivariate regression analysis showed that the occurrence ot operative complications(6=0.496,P＜0.001),size of the tract(b=0.405,P＜0.001),mature nephrostomy tract(6=0.377,P＜0.001),multiple tracts(6=0.326,P=0.005),size of stone(b=0.210,P=0.015),operative time(6=0.139,P=0.027),renal parenehymal thickness(b=0.128,P=0.035),prior stone intervention(b=-0.121,P=0.038),diabetes(b=0.110,P=0.051),and bacteriuria(b=-0.095,P=0.058)were significant predictors of blood loss.Factors such as age,sex,side,obesity,hypertension,renal function,operating surgeon,anaesthesia,calix of puncture,number of attempts to successful puncture,urine from puncture needle may not affect the blood loss. Concluslons Maneuvers that may reduce blood loss include reducing the operative time,decreasing the occurrence of intraoperative complications, reducing the tract size and tract number, and staging the procedure.Staging the procedure of MPCNL is a judicious decision in case of a large stone burden,intraoperative complications,multiple-tract,lager tract or diabetes.

Objective:A single-center analysis was performed to assess the significant clinical features and prognostic factors of TFE3-rearranged renal cell carcinoma (TFE3 rRCC).Methods:The clinical data of 85 confirmed cases of TFE3 rRCC patients at the Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2007 to February 2023 were analyzed retrospectively. Among these patients, there were 39 males and 46 females, with a median age of 32 (26, 45) years. All patients underwent preoperative CT scans, 21/85 cases (24.7%) of TFE3 rRCC exhibited the characteristic feature of "circular calcification" with plain CT imaging, and enhanced CT scan showed that the tumor enhancement during the arterial phase was lower than the adjacent renal cortex. Among the 85 patients in this cohort, the median tumor diameter was 4.8(3.2, 6.5). Thirty-two patients underwent partial nephrectomy (NSS), while 51 patients underwent radical nephrectomy (RN). Two patients with distant metastasis at the time of diagnosis received only sunitinib therapy. Forty-three patients received adjuvant treatment, including 14 patients who received targeted therapy. There were 29 patients in AJCC stage Ⅲ/Ⅳ, with 10 patients presenting with venous tumor thrombus and 14 patients with lymph node metastasis. Histopathology, TFE3 immunohistochemistry, and break-apart TFE3 FISH probe detection were performed on all 85 cases, while 52 patients underwent RT-PCR and/or DNA sequencing. By combining the clinical and pathological data, we summarized the diagnostic Methods for TFE3 rRCC, evaluated the impact of surgical approaches (RN and NSS) on the survival outcomes of cT 1a/b patients, and assessed the influence of genetic subtypes (ASPL, NONO, PRCC, SFPQ, and others) on the survival outcomes of all patients. Furthermore, we analyzed the risk factors for disease progression. Results:TFE3 rRCC exhibited variable histopathological features, and the presence of acinar-like structures with psammoma bodies may be a relatively typical characteristic. All 85 patients showed positive TFE3 immunohistochemical staining. In 6 cases of TFE3 rRCC, break-apart TFE3 FISH probe yielded negative results. However, final confirmation was achieved through genetic sequence, with 5 cases diagnosed as NONO-TFE3 subtype and 1 case as RBM10-TFE3 subtype. Among the 85 patients, 52 underwent RT-PCR and/or DNA sequencing, revealing a total of 8 TFE3 fusion subtypes, including 11 cases of ASPL-TFE3, 8 cases of PRCC-TFE3, 10 cases of NONO-TFE3, 15 cases of SFPQ-TFE3, 1 case of CLTC-TFE3, 2 cases of LUC7L3-TFE3, 4 cases of MED15-TFE3, and 1 case of RBM10-TFE3. The survival analysis results revealed that among the 12 patients with cT 1b stage tumors who underwent radical nephrectomy (RN), the progression-free survival (PFS) was 35 (14, 109) months, which was significantly better than the NSS group ( P=0.041). However, for the 14 patients with cT 1a stage tumors who underwent RN, there was no statistically significant difference in overall survival (OS) and PFS compared to the NSS group, with OS being 55(27, 134) months and PFS being 71(41, 134) months. Stratifying according to TFE3 fusion subtypes, it was found that patients with ASPL-TFE3 fusion had a significantly lower PFS compared to those with non-ASPL-TFE3 fusion subtypes ( P=0.029). Survival analysis revealed that tumor diameter, surgical approach, adjuvant therapy, AJCC staging, venous tumor thrombus, and lymph node metastasis were associated with OS and PFS( P<0.05). The results of the multivariate Cox regression analysis showed that AJCC stage Ⅲ/Ⅳ( HR=2.393, 95% CI 1.418-4.039, P=0.001) and venous tumor thrombus ( HR=3.543, 95% CI 1.159-10.827, P=0.026) were independent risk factors for progression-free survival (PFS). Conclusions:During the non-enhanced phase of CT scan, TFE3 rRCC tumors can exhibit a circular calcification. TFE3 immunohistochemistry is an important screening method for TFE3 rRCC.Break-apart TFE3 FISH probe detection is considered the diagnostic gold standard, and gene sequencing, if feasible, can provide the subtype diagnosis of TFE3 rRCC. For cT 1a stage TFE3 rRCC, partial nephrectomy (NSS) is a viable option, while caution should be taken in selecting NSS for cT1b stage patients. Patients with ASPL-TFE3 fusion subtype have a worse prognosis. AJCC stage Ⅲ/Ⅳ and venous tumor thrombus indicate poor prognosis in TFE3 rRCC.