Objective： This study was designed to evaluate the clinical, endoscopic, and pathologic characteristics of primary gastric malignant lymphoma(PGML). Methods： Thirty patients with PGML were retrospectively reviewed and analyzed in the aspects of elinical, roentgenography, and endoscopic status. Results： The clinical presentations including abdominal pain, loss of weight, fever, and upper gastrointestinal hemorrhage were invariably found. Most lesions were in the body of stomach(73.3％ ). All patients were examined by endoscopy with protruding, infiltrative, and ulcerative lesions accounting for 46.7％ (14/30), 40.0％ (12/30), and 13.3％ (4/30) ,respectively. The pathological coincidence rate of endoscopic biopsy with resected operation was 80.0％ . The tumor might originate from the following organisms： B cell of 90.0％ (27/30)(19 of them are mucosa-associated lymphoid tissue lymphoma) and T cell of 10.0％ (4/30). The operative resectability of these PGML remained higher and these PGML were sensitive to chemotherapy and radiotherapy. Conclusion： PGML is very likely to be misdiagnosed or neglected due to its rarity and specificity. Gastroscopy remains to be valuable to correct diagnosis of PGML. Better prognosis is often expected if followed by operative resection, chemotherapy and/or radiotherapy.

Objective To study the correlation between level of nitric oxide/ nitricoxide synthase(NO/NOS) on placenta homogenate and ultra-structure changes of placenta in pregnancy lead exposure in rats.Methods Seventeen normal pregnant rats and 46 rats of exposured in lead which were divided into A,B,C groups were studied.The level of NO/NOS of placenta were measured by nitrate reductase and NOS kit.Placentas were randomly selected from each group to detect ultra-structure by electron-microscope.Results There were significant difference among A,B and control groups on level of NO/NOS(all P0.05).Compensation hyperplasy or minor injury were observed in lead exposure of stage groups.Lead exposure during whole gestation period,the lead level was maxmum,and decompensation were observed on placental construction.Conclusions There is a close correlations between level of lead,NO/NOS and pathological change of placental tissue,and both of them may play an important role in the pathogenesis of peripartum lead exposure.

OBJECTIVETo summarize the experience and short-term clinical outcomes of hand-assisted laparoscopic surgery (HALS) in sphincter-preserving surgery for low and ultralow rectal cancer.

METHODSData of 49 patients with rectal cancer who underwent HALS for low or ultralow anterior resection between January 2010 and January 2011 were analyzed retrospectively.

RESULTSThe proximal resection margin was (14.3±6.9) cm and the distal margin was(4.3±1.9) cm. The mean operative time was(128.3±70.9) min. On postoperative macroscopic evaluation, the mesorectum was intact in 42 cases, nearly intact in 7 cases. The circumferential resection margin was more than 2 mm in 42 cases, and less than 2 mm in 7 cases. Forty-six patients underwent R0 resection, and 3 cases underwent R1 resection. The median retrieved lymph node (LN) was 16.20±9.23, and the median positive LN was 1.12±2.19. Postoperative pathological examination showed TNM stage was I( in 12 patients, II(A in 18, II(B in 1, III(A in 2, III(B in 8, III(C in 5, IIII( in 3. The median postoperative hospital stay was (6.25±3.87) d. There were no anastomotic leakage, ileus, intra-abdominal or anastomotic bleeding. There were two wound infections.

CONCLUSIONLow and ultralow anterior resection for rectal cancer using HALS approach is safe and feasible with favorable short-term outcome.

Adult ; Aged ; Aged, 80 and over ; Anal Canal ; surgery ; Female ; Hand-Assisted Laparoscopy ; methods ; Humans ; Male ; Middle Aged ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome

BACKGROUNDDifficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.

METHODSThirty adult patients referred for elective surgery under general anesthesia, aged 18 - C60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg), propofol (2 mg×kg(-1)×h(-1)) and remifentanil (0.05 µg×kg(-1)×min(-1)). Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation.

RESULTSAll patients were intubated at the first attempt, the average intubation condition score was 7.0 ± 1.1, from 6 to 10, satisfied intubation condition. MAP and HR increased significantly but mildly immediately after the tracheal intubation (P < 0.05), and decreased to the pre-intubation level soon after intubation. There were no related complications and patients had no recall of the intubation procedures.

CONCLUSIONSTopical anesthesia with pressure driven 2% lidocaine spray, where pressure is achieved by 10 L/min oxygen flow, can offer satisfactory intubation conditions for conscious sedation intubation.

Adolescent ; Adult ; Anesthesia, Local ; methods ; Conscious Sedation ; methods ; Female ; Humans ; Intubation, Intratracheal ; methods ; Lidocaine ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Young Adult

【Objective】 To explore the differences of clinical medicine ，magnetic resonance imaging（MRI）and pathology in multifocal and multicentric breast cancer（MMBC）and unifocal breast cancer（UBC）. 【Methods】 In this retrospective analysis，55 MMBC and 68 UBC patients with pathology confirmed from April 2016 to February 2018 were enrolled，and the characteristics and difference of routine pathological types，molecular subtypes and MR enhancement types were compared. The relationships between MMBC ，UBC and the methods of clinical treatment were studied by correspondence analysis（CA）.【Results】Significant difference was observed between routine pathological types of MMBC and UBC（P < 0.001）. The high grade invasive ductal carcinoma was more frequent in maximal lesions of MMBC than in UBC lesions，whereas there was no statistical correlation between molecular subtypes，molecular subtypes and MR enhancement types（P = 0.265，P = 0.152）. However，there was statistical difference in masses enhancement（P = 0.013）. CA showed that the molecular subtypes of MMBC and UBC were the key factors for clinical treatment. In addition ，HER- 2（+）and Luminal B type breast cancer showed high correlation with treatment method，while triple-negative showed low correlation with treatment method.【Conclusions】The pathology types of the maximal lesions of MMBC were less aggressive than UBC lesions. There was significant correlation between clinical treatment and molecular subtypes of MMBC and UBC. Therefore，individualized treatments are recommended on the basis of biological characteristics in both MMBC and UBC.

OBJECTIVEThe presence of liver fibrosis in patients with beta-thalassemia major has been demonstrated to be an important negative prognostic factor. Identification of liver fibrosis in early stage would be of great value. Hyaluronic acid (HA), type III pre-collagen (PC III), collagen IV (C IV) and laminin (LN) as serum markers were widely used in the diagnosis of liver fibrosis in patients with chronic viral infections or alcoholic liver diseases. However, their values in thalassemic liver fibrosis have not been studied. This work was to determine the serum HA, PC III, C IV and LN levels in children with beta-thalassemia major and evaluate the diagnostic utility.

METHODSerum HA, PC III, C IV and LN in 49 hospitalized children with beta-thalassemia major (aged 1 - 15 years with the media age of 6.27 years) and 41 healthy children served as controls (aged 1 - 13 years with media age of 6.40 years) were detected by radioimmunoassay (RIA). Forty-five of 49 cases were performed percutaneous liver biopsies, and the histopathological fibrosis was compared with the four serum markers. The correlation and discriminate analysis were used.

RESULTSAll the serum levels of HA, PC III, C IV and LN in beta-thalassemia were significantly higher than those in controls (P < 0.01). In 36 of 45 cases, the histopathology showed liver fibrosis including stage I and stage II by biopsies with a positive rate of 80%. The serum levels of four markers increased successively with the aggravation of liver fibrosis from stage 0 to stage II, and significant correlation was observed between the level of HA or PC III and the stage of fibrosis (HA, r = 0.379, P = 0.017; PC III, r = 0.455, P = 0.04). While there was no difference between the level of C IV or LN and fibrosis (C IV, r = 0.312, P = 0.053; LN, r = 0.310, P = 0.055). Using discriminate analysis, the discriminate function of co-detection of the four markers for the diagnosis of fibrosis was 0.002 HA + 0.003 PC III + 0.002 C IV + 0.006 LN-1.859, which had a sensitivity of 93.88%, specificity of 68.29%, predictive value of positive test and negative test of 77.97% and 90.32%, respectively. Moreover, there was a significant correlation between the serum level of HA or PC III and the liver iron concentration (HA, r = 0.318, P = 0.035; PC III, r = 0.305, P = 0.044).

CONCLUSIONThe results suggest that, in beta-thalassemia major with chronic liver disease, HA and PC III showed more practical value in diagnosing liver fibrosis than the levels of C IV and LN. The combination of the four serum markers could improve the accuracy and reliability of the diagnosis. A validation study is necessary before introducing into the prediction function during the clinical practice.

Adolescent ; Biomarkers ; blood ; Child ; Child, Preschool ; Collagen Type III ; blood ; Collagen Type IV ; blood ; Female ; Humans ; Hyaluronic Acid ; blood ; Infant ; Laminin ; blood ; Liver Cirrhosis ; blood ; complications ; diagnosis ; Male ; Prognosis ; beta-Thalassemia ; blood ; complications ; pathology

OBJECTIVEThe purpose of this study was to investigate the clinical significance of THY1 protein expression in epithelial ovarian cancer.

METHODSImmunohistochemistry (IHC) and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining were used to detect the protein expression of THY1, Ki67 and cell apoptosis in 76 epithelial ovarian cancers by tissue microarray. The correlation between THY1 expression and patients' clinical features was analyzed.

RESULTSOf the 76 epithelial ovarian cancer samples, 64 were informative for IHC and TUNEL assays and 42 (65.6%) among them showed down-regulated/loss expression of THY1 protein. A significant positive correlation of THY1 protein expression with clinical stage and distant metastasis was observed in this ovarian cancer cohort (P < 0.05). The more advanced the tumor stage, the more frequency of loss expression of THY1 protein. In addition, the mean positive rate of Ki67 staining in tumors with down-regulated/loss expression of THY1 was 33.7% +/- 3.5%, significantly higher than that in the tumors with normal expression of THY1 (17.3% +/- 6.1%, P = 0.0027). However, no significant correlation was observed between THY1 protein expression and tumor cell apoptosis as well as patients' survival in this series (P > 0.05).

CONCLUSIONDown-regulated/loss expression of THY1 protein in epithelial ovarian cancer is significantly correlated with cancer cell proliferation and metastasis in the epithelial ovarian cancer, and it may be used as one of the new molecular biomarkers to predict the disease progression in patients.

Adult ; Aged ; Apoptosis ; Cystadenocarcinoma, Mucinous ; metabolism ; pathology ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Down-Regulation ; Female ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic ; Humans ; Ki-67 Antigen ; metabolism ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Ovarian Neoplasms ; metabolism ; pathology ; Survival Rate ; Thy-1 Antigens ; metabolism

OBJECTIVETo explore the application value of the high-frequency ultrasound examination of the normal adult sciatic nerve.

METHODSThe high frequency ultrasound was used to examine 60 cases ,a total of 120 normal adult sciatic nerve (28 males and 32 females ranging in age from 19 to 38 years old, averaged 23.8 years old). The age between men and women, height and weight showed no significant difference. The cross-sectional scanning and longitudinal scanning, if necessary, Panoramic Imaging were conducted. The cross section area of sciatic nerve was measured at the hip line, the middle of the thigh, the edge of the popliteal fossa, and the relationship betwen the sciatic nerve and surrounding muscle group was observed in each cross-section. Probe was rotated 90 degree to display the long axis of sciatic nerve, to get the longitudinal section along the long axis from top to bottom. So the sciatic nerve in the vertical axis and the surrouunding muscles was displayed by above method combined with panoramic imaging. The data of coss-sectional area of sciatic nerve were obtained at the central of hip line, the middle of the thigh, the edge of the popliteal fossa, and then were divided into different groups by gender and sides to do statistical analysis.

RESULTSThe applicatic nerve in thigh can be clearly displayed by high-frequency ultrasound in this group of 60 people with 120 nerves, but low display rate of sciatic nerve in hip, approximatley 31.4% (21/66). The longitudinal section of the sciatic nerve displayed as the banded isoechoic or slightly hyperechoic, parallel partial hyperechoic line could be seen in it; in the cross-section, it showed a clear edge of the sieve-like isoechoic or slightly hyperechnie, which could be oval ,trapezoidal, triangular and irregular in shape; the sciatic nerve bad visible passive movement and shape change when muscle contracted. There were statistically significant differences of cross-sectional area of sciatic nerves at the hip line ,the middle of thigh and edge of the popliteal fossa between 56 sciatic nerves in 28 males and 64 sciatic nerves in 32 females (P< 0.05); but there were no significant differences between left and right sides (P>0.05).

CONCLUSIONHigh frequency ultrasound can be used as the first choice of the sciatic nerve when an imaging method preferred.

Adult ; Female ; Humans ; Male ; Sciatic Nerve ; diagnostic imaging ; Ultrasonography

OBJECTIVETo investigate the effects of lead exposure to rat placenta and pups during different gestation periods.

METHODSAll 108 Wistar rats (72 females, 36 males) were randomly divided into four groups. All rats were orally fed with 0.025% lead acetate during different gestation periods. Blood was obtained from the abdominal vena cava and the lead level in maternal blood was measured by means of atomic absorption spectrometry at the end of the pregnancy. The number of pups, their body weight, body length and tail length were measured. The effects of lead to rat placenta were observed by level of microscopy, optical microscopy and electronic microscopy.

RESULTSExperimental groups the blood lead level at the end of gestation were above 0.483 micromol/L. There were significant differences among, of pups, during different groups (P < 0.01). Among them the drinking lead group of whole distant was the lowest in placenta weight [(0.31 +/- 0.13) g] body weight of pups [(2.08 +/- 0.88) g] length and tail length of pups [(2.37 +/- 0.32) cm, (0.98 +/- 0.09) cm]. There were significantly differences between the experimental groups and controls. Maternal blood lead level was negatively related to placenta weight (r = 0.652, P < 0.01), and had no relation with the body weight of pups (r = -0.107, P = 0.46). In the experimental groups of lead poisoned rats, the placenta showed focus necrosis in the deciduas, and increased the trophoblastic giant cells and light staining cells in the trophospongium. Trophoblast in the labyrinth and trophospongium showed degeneration; fibrin deposition around the villi was increased. Microvilli around the trophoblast were shorter and less, mitochondrion was swollen and decreased in number, rough endoplasmic reticulum was distended and ribosomal number on membrane decreased.

CONCLUSIONLead exposure during different gestation periods should have a traumatic effect on the trophoblast, leading to interference of nutrition and oxygen exchange. Furthermore, the blood supply to the placenta and nutrition and oxygen exchange between mother and pups were also interfered, leading to reduction of placenta weight and retardation of development of pups.

Animals ; Environmental Exposure ; adverse effects ; Female ; Lead ; toxicity ; Male ; Organ Size ; drug effects ; Placenta ; drug effects ; Pregnancy ; Rats ; Rats, Wistar

BACKGROUNDThe diagnosis of Parkinson's disease is presently based on non-specific symptoms. However, radionuclide dopamine transporters imaging can provide specific diagnostic tool for Parkinson's disease. This study was designed to investigate the effects of imaging of dopamine transporters with 99mTc-TRODAT-1 in early diagnosis or differential diagnosis of Parkinson's disease.

METHODSNine normal monkeys were used to establish N-methyl-4-phenyl-1, 2, 3, 6-tetra-hydropyridine (MPTP) hemi-Parkinsonian animal models, and they were subjected to imaging. Twenty-nine patients with Parkinson's disease, 12 age-matched healthy volunteers, and 18 age-matched patients with Parkinson's syndrome were investigated. Single photon emission computer tomography (SPECT) was performed 3 hours after intravenous injection of 740 MBq 99mTc-TRODAT-1. Striatum specific uptake of 99mTc-TRODAT-1 was calculated according to the ratio of striatum (ST) to cerebellum (CB) in dopamine transporters uptake.

RESULTSIn normal monkeys, bilateral ratio of ST/CB was 2.34 +/- 0.41. After the injection of MPTP, uptake rate of 99mTc-TRODAT-1 at damaged region was much lower than that at the contralateral region, resulting in a significant difference in the ratio of ST/CB (right: ST/CB = 1.73 +/- 0.35; left: ST/CB = 1.90 +/- 0.30), especially in hemi-Parkinsonian model monkeys (right: ST/CB = 1.29 +/- 0.17; left: ST/CB = 1.80 +/- 0.33). The ratios of ST/CB were 1.57 +/- 0.17 and 1.61 +/- 0.14 for the right and left respectively in the healthy volunteers, 1.04 +/- 0.29 and 1.06 +/- 0.30 in the age-matched patients with Parkinson's disease, and 1.56 +/- 0.17 and 1.59 +/- 0.18 in the age-matched patients with Parkinson's disease syndrome. A significant difference was noted between group of Parkinson's disease, normal controls and Parkinson's disease syndrome.

CONCLUSIONThe results suggest that 99mTc-TRODAT-1 dopamine transporters SPECT has clinical application value in early diagnosis or differential diagnosis of Parkinson's disease.

Adult ; Aged ; Animals ; Dopamine Plasma Membrane Transport Proteins ; Female ; Haplorhini ; Humans ; Male ; Membrane Glycoproteins ; analysis ; Membrane Transport Proteins ; analysis ; Middle Aged ; Nerve Tissue Proteins ; analysis ; Organotechnetium Compounds ; Parkinson Disease ; diagnosis ; Radiopharmaceuticals ; Tomography, Emission-Computed, Single-Photon ; Tropanes