Objective To design a questionnaire on factors that affect diagnosis of irritable bowel syndrome for physicians, and determine the retest reliability. Methods The questionnaire was completed after literature review, and 9 experts were invited to revise the questionnaire. Thirty-four physicians filled the questionnaire for pre-test and did it again for re-test 4 weeks later. Kappa value of each question of the questionnaire was calculated. Results Content validity and face validity were assured by experts. Kappa values were over 0.61 in all items, which achieved substantial level. Conclusion The questionnaire designed has fairly good reliability and validity, and can be used in investigation of irritable bowel syndrome for physicians.

Objective To study the technique of lumbar cathetering in lumbosacral vertebral canal operation and its effect on prevention of postoperative cerebrospinal fluid leakage.Methods Retrospectively analyzed the clinical data of patients who underwent lumbosacral ver-tebral canal surgery and suffered from difficult dural repair during the operation in Department of Neurosurgery from August 2015 to October 2015.These patients were divided into the observation group (11 cases)and the control group (12 cases)according to whether lumbar cathe-ter were placed during the operation or not.Volume of drainage was strictly controlled after surgery.Remove the epidural drainage after primi-tive healing of the dura mater.The lumbar catheter was removed after 7 to 10 days.The indwelling time of each patient was collected and sta-tistical analyzed.Results The observation group got obvious shorter epidural drainage indwelling time than the control group(P <0.05). Short-term postoperative complications did occur in some cases in observation group,however,there was no obvious increase of infection rate in patients with lumbar continuous drainage indwelling.Conclusion Lumbar cathetering during the operation could be an effective method to solve difficult problem of placeing a lumbar drainage after lumbar puncture and to prevent cerebrospinal fluid leakage after operations of lum-bosacral vertebral canal.But it can not replace the delicate operation and tight dural suture.Drainage should be used only as a remedial measure of dural repair failure.

Objective To investigate physicians' awareness of diagnostic criteria for irritable bowel syndrome (IBS). Methods Questionnaire was used to investigate awareness of diagnostic criteria for IBS among 782 physicians in 34 hospitals in Shanghai during August 2008. Results Overall, 82. 7 percent (647/782) of physicians surveyed thought they knew or partly knew diagnostic criteria for IBS. More than 70. 0 percent of physicians knew Rome criteria, but less than 25.0 percent knew other criteria. Awareness of current Rome criteria, whether mental symptoms included in it, and its time frame differed significantly among physicians in varied specialties (P ＜ 0. 01 ). Gastroenterologists had more knowledge about Rome criteria than other specialists, but most physicians, including gastroenterologists, did not fully understand its applicability. Conclusions Although gastroenterologists knew more about diagnostic criteria for IBS, their knowledge still needed to be perfected and updated. Awareness of diagnostic criteria for IBS was poor in nongastroenterological physicians and general practitioners knew it to certain extent.

Objective To evaluate MRI or CT appearance and clinicopathologic features of dysembryoplastic neuroepithelial tumor (DNT). Methods MRI or CT appearance and clinicopathologic features in 12 cases of histopathology confirmed DNT were retrospectively studied. Results There were 6 men and 6 women, and the age ranged from 12 to 68 years with the average age of 36.7 years. Most patients had partial seizures, but the neurological deficits were absent. All lesions were located in the supratentorial region and involved the cerebral cortex on MRI scan. Localization of lesions was predominantly in the frontal (n=4) and temporal (n=3) lobes. The maximum lesion diameter ranged in size from 2 cm to 5 cm, and the lesion showed round, lobular- or irregular-shaped. The white matter was involved in 2 cases, and 7 were with cystic change (58.3%). All lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images as well as devoid of peritumoral edema or mass effect. MRI signal intensity of cystic lesions was homogeneous on T1-weighted images which was equal to or slightly higher than that of cerebrospinal fluid. CT scan of 6 cases disclosed moderately hypodense lesion, 2 of which were markedly hypodense cystic-lobular shaped, and foci of calcification was observed in 1 case. Contrast enhancement was absent in 4 cases and only 1 case showed slight enhancement unevenly. Histologically, the DNT were classified into three subtypes: simple form (n=4), complex form (n=6), and non-specific variant (n=2). All patients experienced lesion gross total or subtotal surgical removal, and had received no chemo- or radiotherapy postoperatively. Conclusion DNT is a benign lesion, and its characterization is better disclosed by MRI compared to CT scan.

Objective:To investigate the relationship between normal plasma fibrinogen(FIB)levels and disease duration in elderly patients with type 2 diabetes mellitus(T2DM).Methods:Clinical data and biochemical test results of 1 116 elderly subjects with T2DM admitted to the Department of Endocrinology of Shanghai Tianyou Hospital from January 2016 to October 2019 were retrospectively collected and analyzed.Subjects were classified into four groups based on the duration of DM: the Q1 group(n=276, < 2.0 years), the Q2 group(n=278, 2.0-7.9 years), the Q3 group(n=280, 8.0-13.9 years)and the Q4 group(n=282, ≥ 14.0 years). The correlation between FIB and the duration of DM was analyzed.Results:With the prolongation of DM duration, FIB levels increased significantly( P<0.05). Pearson correlation analysis showed that the duration of DM was positively correlated with FIB, age and serum creatinine( P<0.01). Multiple stepwise regression analysis showed that the duration of DM was an independent factor for FIB( β=0.104, P<0.01). Logistic multiple regression analysis showed that after adjusting for sex, age, body mass index, systolic pressure, diastolic pressure, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum creatinine, alanine aminotransferase, fasting plasma glucose, glycosylated hemoglobin, smoking and drinking, the risk of hyperfibrinogenemia was 2.436 and 2.104 times higher, respectively, in Group Q4 and Group Q3 than in Group Q1(95% CI: 1.317-4.507, P<0.01; 95% CI: 1.144-3.871, P<0.05). With the third-quartile FIB(3.70 g/L)as the cut-off value, the optimal cut-off point of the DM course was 9.5 years as calculated by receiver operating characteristic(ROC)curve analysis of DM duration and hyperfibrinogenemia. Conclusions:The FIB level is positively correlated with DM duration in elderly patients with T2DM.

Objective To evaluate the compositive methods of endovenous treatment with laser in the treatment of superficial varicosities in lower extremities individually.Methods Two hundred ninty-five limbs in 285 patients with chronic venons insufficiency were studied.According to the clinical manifestations,ultrasound and venography and using the clinical-etiology-anatomy-pathophysiology(CEAP) classification of chronic(venous) insufficiency,the patients were grouped A,B and C.Three surgical strategies were used.Group A:Simple endovenous laser therapy(129 limbs,43.72%).Group B: Endovenous laser therapy combined with punctate ligation(143 limbs,48.47%).Group C: Endovenous laser therapy combined with external banding valvuloplasty of superficial femoral vein and punctate ligation(23 limbs,7.8%).Results The cirsoid superficial vein disappeared in all the groups.The color of the skin became lighter,and swelling was reduced.The ulcers healed or shrunk in size.Conclusions Endovenous laser treatment(EVLT) is an(effective) minitraumatic operation for treatment of varicosities of lower extremities.The use of EVLT combined with other surgical procedures is effective treatment for primary deep venous valvalar insufficiency.

Objective To improve the diagnosis and treatment of neurenteric cyst. Methods The clinical manifestations, MRI characteristics and surgical results of 11 cases of intraspinal neurenteric cysts were analyzed. Results Positive pathological signs and paresis appeared in all cases, and radicular pain in 9 cases. The symptoms were episodic in 2 cases whose courses were more than 3 years. MRI could clearly demonstrate the exact extension of the cyst and the surrounding structures. These cysts showed as slightly long T 1, long T 2 homogeneous signal on MRI. Their neurological functions improved steadily after complete resection in 8 cases, subtotal resection in 3 cases. Conclusion Neurenteric cysts are rare congenital lesions, often associated with vertebral anomalies and occurred at subdural cervical location, anterior to the cord. MRI is a more effective and convenient method for neurenteric cyst image investigation. Total or subtotal resection of neurenteric cysts with subsequent recovery in neurological function is usually possible.

Objective To obtain Chinese hamster ovary (CHO) cell lines that stably express a targeting complement inhibitor CR2-CD59.Methods The recombinant plasmid PEE14.1-CR2-CD59 was constru-cted by cloning the DNA fragment CR2-CD59 into plasmid PEE14.1,and the obtained plasmid was transfected into CHO cells by FuGENE 6.The clones with stable high expression of target fragment were selected by methionine sulfoximine (MSX),the expression of CR2-CD59 was analyzed by ELISA,SDS-PAGE and Western blotting analysis.Results Several stable expression clones were obtained,and CR2-CD59 was highly expressed in the secret form in CHO cells.SDS-PAGE analysis showed that the molecular weight of the recombined protein CR2-CD59 was consistent with the predicted one.ELISA and Western blotting results revealed that the CR2-CD59 could react with both anti-human CR2 and anti-human CD59 polyclonal antibodies.Compared with serum-containing medium,the protein was highly expressed in serum-free medium (P

OBJECTIVETo investigate the blood supply patterns of the anteriorlateral thigh adipofascial flap for clinical applications.

METHODSTo investigate the blood supply patterns of the anteriorlateral thigh (ALT) adipofascial flap, 16 fresh cadavers were anatomically examined by intraarterial injection of colored latex. Three-dimensional analysis of the vasculature of the subcutaneous adipofascial tissue was performed. Sixteen patients underwent microsurgical correction with the ALT adipofascial flap. Among them, there were fifteen with hemifacial atrophy, one with micromastia.

RESULTSThe three-dimensional arterial structures of the ALT adipofascial flap were the same in all the cadaver specimens. Each layer of the adipofascial tissue was supplied by several blood vessels of the axial pattern, especially in the deep layer. Sixteen patients were successfully treated with this flap. The postoperative follow-up ranged from six months to eleven years. There was not postoperative flap necrosis or absorption of the fatty tissue. Stable restoration of the facial contour or the breast was achieved. The donor-site morbidity was minimal.

CONCLUSIONThe blood supply of the ALT adipofascial flap is reliable. A considerable amount of the fatty layer of the flap can be removed primarily. It is a preferable procedure for reconstructing soft tissue defects.

Adipose Tissue ; Adolescent ; Adult ; Breast ; surgery ; Female ; Humans ; Male ; Mammaplasty ; methods ; Surgical Flaps ; blood supply ; Thigh

Objective: To explore the effects of surgical technique of single one-stage posterior C_1-2 screw rod fixation of Chiari malformation (CM) associated with occipitalization and without atlantoaxial dislocation. Methods: A total of 23 patients with CM treated between January 2014 and October 2015 in Department of Neurosurgery of Chinese People′s Liberation Army General Hospital were retrospective reviewed. All of them were diagnosis with CM associated with occipitalization and without atlantoaxial dislocation, including 8 males and 15 females, aging from 11 to 57 years (mean (35.5±10.52) years). Single one-stage posterior C_1-2 screw rod fixation with bone grafting fusion was performed. Operation time and intraoperative blood loss were recorded. Japanese Orthopaedic Association (JOA) scores and Odom rating were used to evaluate the clinical effects at pre- and post-operative. Regression of the cerebellar tonsillar was measured by MRI. The results were analyzed by paired samples t test. Results: Twenty-three patients were implanted screws successfully, the vertebral artery injury and cerebrospinal fluid leakage were not found. The mean operation time was (172.7±19.9) minutes, the intraoperative blood loss was (153.9±49.3) ml. Compared to preoperative, the JOA score increased (13.7±1.6 vs. 11.5±1.4) and the tonsillar herniation decreased ((0.8±0.6)cm vs. (1.9±0.6) cm) in the last follow-up, there were statistical difference (t=13.386, P<0.01; t=17.995, P<0.01). The results of the postoperative Odom grading were as follows: 6 cases were perfect (26.1%), 13 cases were good (56.5%), 4 cases were moderate (17.4%) and no case was poor.No signs of instrument loosen or screw broken was noticed. 100% bony fusion rate was achieved. The follow-up time was 6 to 23 months (mean (10.5±3.2) months). One case developed internal fixator related discomfort, the symptom was relieved by internal fixator removal surgery performed 4 months after the operation when osseous fusion had already been achieved. No new neurologic symptoms were observed in other 22 patients. Conclusions The results of the study substantiates the effectiveness of single one-stage posterior fixation strategy for CM, which is associated with occipitalization and without atlantoaxial dislocation. This technique could be an alternative choice for this type of CM.