Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) with scissors knife in difficult cases.Methods A total of 36 sessions of ESD in 34 patients were performed from May 2010 to May 2012 with application of new scissors knife.The complications and followup outcomes were recorded.Results All lesions were removed successfully with an en bloc resection rate at 91.7％.Delayed bleeding occurred in 2 patients (5.6％),and both of them were cured sucessfully with endoscopy.No perforation happened and the average hospitalization time was 5 days.Follow-up endoscopy performed 6 or 12 months after ESD in 6 patients revealed no recurrence or residual lesions.Other patients are under follow-up now.Conclusion The scissors knife is easy to manipulate,which can ensure the safety and efficiency of ESD.

An introduction to the telemedicine service of the hospital in its web-based hospitalprogram which covers theweb-based healthcare center,and thehealthcare cabin to interact with the center remotely.The center operates on the telehealth management platform based on cloud computing, offering remote monitoring,health assessment,health management,follow-up,online consultation,pre-registration and mobile payment.Theweb-based hospitalcan simplify the medical service flow,alleviate the complaints incurred by concentrated quality medical resources,influx of patients and limited physical space of tertiary hospitals,and the tense doctor-patient relationship as well.

An organic solvent tolerant isolate A213 originating from soil samples were successfully isolated via direct plating method using 10g/L of toluene as the sole carbon source and transparent cycle plate assay method.It was identified as Yarrowia based on its characteris- tics.The results in shake flask cultivation showed that the suitable tipase producing media were(g/L):yeast extract 40,vegetable oil 10, MgSO_4?7H_2O1,KH_2PO_4 5.Under optimal culture conditions (27℃and pH 6.5 ),the maximal lipase activity could reach 67.8 IU/ mL The optimal pH and temperature for the hydrolysis of p-nitrophenyl acetate by crude lipase were pH6.5 and 40℃The enzyme was sta- ble under 70℃and pH 5.5～8.5.Then isolate A213 was found to produce the lipase which can synthesize L-ascorbyl palmitate in tert-amyl alcohol validated by the thin-layer chromatography.

OBJECTIVETo observe the clinical effects of two different circumcision procedures with the Shang Ring and compare their advantages and disadvantages.

METHODSA total of 527 adult males with phimosis or redundant prepuce underwent Shang Ring circumcision by conventional outward replacement (n = 254) and inward placement (n = 273), respectively. We observed the in-ring nocturnal pain, complications, ring-removal pain, degree of edema, recovery time, and patients' satisfaction after surgery, and compared them between the two groups.

RESULTSCompared with the conventional outward placement (5.9%) of the Shang Ring, the inward placement method showed the advantages of mild in-ring nocturnal pain, a low complication rate, significantly reduced ring-removal pain, and mild edema, but exhibited longer healing time.

CONCLUSIONIn Shang Ring circumcision for phimosis and redundant prepuce in adult males, each of the outward and inward placement methods has advantages and disadvantages of its own, but the latter is more advantageous and feasible.

Adult ; Circumcision, Male ; adverse effects ; instrumentation ; Edema ; etiology ; Foreskin ; abnormalities ; surgery ; Humans ; Male ; Pain, Postoperative ; Patient Satisfaction ; Penile Diseases ; etiology ; Penis ; abnormalities ; surgery ; Phimosis ; surgery ; Prostheses and Implants ; Wound Healing

Humans ; Hyperplasia ; pathology ; Male ; Melanoma ; pathology ; Middle Aged ; Neoplasm Metastasis ; Palatine Tonsil ; pathology ; Skin Neoplasms ; pathology

Objective To evaluate the effects of mild hypothermia therapy on cerebral function and edema as assessed by magnetic resonance imaging (MRI ) during the first 72 hours after restoration of spontaneous circulation (ROSC)in a porcine model.Methods Ventricular fibrillation was induced in 33 Inbred Wuzhishan miniature swine.After ventricular fibrillation untreated for 8 min,standard CPR was initiated and 30 animals got ROSC.The ROSC animals were randomly (random number)assigned to normothermia group (n=15 ) and hypothermia group (n =15 ).The hypothermia group immediately received endovascular cooling to regulate temperature to 33 ℃,which was maintained for 12 h,followed by passive rewarming at 0.5 ℃/h to 37 ℃.The two groups were scanned to get Diffusion-weighted imaging (DWI)at baseline (before experiment),6 h,12 h,24 h,and 72 h after ROSC.The statistical analysis was carried out with Student t test,One-way repeated-measures and Kaplan-Meier survival analysis.Results Compared with the normothermia group,the hypothermia group exhibited a higher 72-h survival rate (73.3% vs.40%,P<0.05),lower neurological deficit scores (43.81 vs.119.50;P<0.01),a lesser decrease in the apparent diffusion coefficient during DWI and milder cerebral edema on DWI image. Conclusions Cerebral edema occurred at early stage after ROSC.Cerebral edema was worst at 6 hours after ROSC and then subsided gradually.Hypothermia therapy could reduce cerebral edema and produce a protective effect on neurological function.MRI could effectively reflect the underlying trend of cerebral injury of swine within the first 72 h after ROSC,and demonstrated that hypothermia could reduce brain edema, increase cerebral blood flow,and reduce the production of toxic metabolites.DWI could monitor brain injury after resuscitation and could be used to evaluate the efficacy of hypothermia intervention dynamically.

Objective To investigate the general information and death causes in the emergency department ( ED) with an epidemiological study in the death cases.Methods The clinical records of 1007 death cases in the ED admitted in three years from 2011 to 2013 were collected and statistically analyzed.Methods The clinical records of 1 007 death cases in the ED admitted in three years from 2011 to 2013 were collected and statistically analyzed.Results The mean age of the 1 007 deaths was ( 75.95 ±13.89 ) ears, and the mean score of APACHEⅡ at admission was ( 27.19 ±6.44 ) .Malignant neoplasm, pulmonary infection, chronic obstructive pulmonary disease, coronary heart disease, stroke, sepsis, acute coronary syndromes were main underlying causes of death, while respiratory failure, circulatory collapse, generalized debility, multiple organ dysfunction syndrome, emaciation from malignant neoplasm, septic shock, severe pulmonary infection were main direct lethal causes of death.Most patients were vulnerable to be dead in the spring season, January and around midnight from 23: 00 to 1: 00 (zi time).It is noteworthy that pulmonary infection accounted for 74.75%(151/202 ) of the nosocomial infection. Hyperlactacidemia and low oxygenation index indicated a poor prognosis.Conclusions The deaths were predominant in old age, and the order of incidence of the underlying death causes from high to low arranged was consistent with the sequence of death causes of the cities in China in 2010.To identify carefully the risk factors of death and concern about the early symptoms of exacerbation of underlying diseases can make a big difference in enhancing the success rate of rescuing the critical emergency patients.Besides, it's worth pondering over that the medical care of patients with malignant neoplasm spent abundant emergency resources.

Objective To determine the effect of nanochemotherapy drug on Survivin and p53 ex-pressed by human biliary traet carcinoma cell line QBC939.Methods Culturing the human biliary tract carcinoma cell line QBC939 in vitro and it was divided into five groups including saline,nanochemotherapy drug,nanopartiele withoul nanochemotherapy drug,5-FU and gemcitabine.Using the methods of MTT and flow cytometry to observe the growth of QBC939 which was dealt with different drugs.In addition,RT-PCR and Western blot were used to delect the expression of mRNA and protein by Survivin or p53.Results The expression of mRNA and protein by Survivin decreased in the following set:saline,nanoparlicle withoul nanochemotherapy drug,5-FU,gemcitabine and nanochemotherapy drug,respeclively.However,the ex-pression of mRNA and protein by p53 were in reverse order.The inhibiting action to QBC939 was obvious in nanochenmtherapy drng and the apoplotic rate was higher than others except for gemcitabine(P＜0.05). Conclusion Nanochemotherapy drug has significant effect on treatment cholangiocarcinoma in vilro,which may attribute to the down regulation of Survivin and up regulation of p53.

Objective To present our experience with management of craniopharyngiomas by endoscopic endonasal approach Methods A retrospective review of clinical data of 65 patients who were treated for craniopharyngiomas by endoscopic endonasal approach from February 2012 to May 2016. All patients were analyzed by treatment effect, complications, and follow-up result. Results Total removal of the tumors were completed in 52 cases (80.0%), subtotal removal in 11 cases (16.9%), and partial resection in 2 cases (3.1%). The pituitary stalks were identified in 57 cases when surgery, and severed in 41 cases (71.9%). Postoperative visual acuity was improved in 31 cases (47.7%), and 6 cases remained in the preoperative level, whereas worsening occurred in 1 case. Worsening of the anterior pituitary function was reported in 21 cases (32.3%). Transient diabetes insipidus after operation was occurred in 45 patients (69.2%), and long-term diabetes insipidus was occurred in 9 cases (13.8%). Postoperative cerebrospinal fluid (CSF) leak was occurred in 4 cases (6.2%), accompanied with intracranial infection, and all these cases were repaired under endoscope again, 3 cases were saved, but 1 case was dead. Perioperative mortality rate was 4.6%. 52 patients were followed up for 4.0 ~ 45.0 (mean, 20.8) months, and 44 patients (84.6%) returned life to normal. Obesity developed in 8 patients (15.4%), with 2 recurrent cases and no deaths during follow-up period. Conclusion The endoscopic endonasal approach is a safe and effective minimally invasive surgery approach for treating craniopharyngiomas, and has its own unique advantage.

Objective To investigate the suppressive effects of collagen from Cyanea nozakii on adjuvant induced arthritis inrat.Methods Rats with adjuvant arthritis received different do- ses of Cyanea nozakii collagen by intragastric administration for two weeks.Incidence and severity of arthritis were assessed by calculation of mean arthritis index,the concentrations of NO,MDA and activity of SOD in the serum were examined.Results Cyanea nozakii colla- gen at different doses could ameliorate the adjuvant induced arthritis,suppress the concen- trations of NO,MDA and increase the activity of SOD in the serum.Conclusion Cyanea noza- kii collagen has therapeutic efficacy in treatment of adjuvant arthritis rats,and the mecha- nism of Cyanea nozakii collagen is probably related to the antioxidation.