Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.

0. 05). Creatinine clearance improved significantly in group C from a mean value of (90?23)ml/min preoperatively to (139?46)ml/min during operation (P

Objective:To explore the relationship among cardioversion ,cerebral infarction (CI) and N terminal pro brain natriuretic peptide (NT‐proBNP) level in patients with heart failure (HF) complicated atrial fibrillation (AF) . Methods :A total of 150 HF + AF patients received intravenous drip of amiodarone for cardioversion therapy .Ac‐cording to cardioversion results ,they were divided into cardioversion group (n=100 ) and non‐cardioversion group (n=50) ,NT‐proBNP level change was observed in two groups before and after cardioversion .According to CI on‐set or not ,patients were divided into CI group (n=20) and non‐CI group (n= 130) ,NT‐proBNP level was com‐pared between two groups before and after onset .Results :Within 48h after administration ,a total of 100 patients (66.67% ) recovered to sinus rhythm .Compared with before cardioversion ,NT‐proBNP level significantly reduced [(967.04 ± 366.16) pg/ml vs .(496.21 ± 142.54) pg/ml] after cardioversion in cardioversion group ,and was signifi‐cantly lower than that of non‐cardioversion group (996.76 ± 351.28) pg/ml , P<0.01 all . In CI group ,compared with small size CI group ,there were significant rise in NT‐proBNP level [ (784.21 ± 231.26) pg/ml vs .(1983.24 ± 32.96) pg/ml ,(3562.19 ± 1468.32) pg/ml] in medium and large size CI group , P< 0.05 or <0.01 .Conclusion:NT‐proBNP level at hospitalization possesses predictive value for drug cardioversion effect in HF + AF patients . NT‐proBNP level is related with CI onset .After acute CI ,the higher NT‐proBNP level is ,the larger infarct size is , the poorer prognosis is .

Objective To analyze the mid- and long-term results after coronary artery bypass graft surgery (CABG), to evaluate the accuracy of multi-detector CT coronary angiography (MDCT) on the graft patency status and to compare the patency for different grafts. Methods One hundred and one cases underwent CABG from June 1992 to March 2008 were followed up by searching the database of MDCT (42 cases) and selective coronary angiography (SCA, 59 cases). The mean following up period was (66.79 ±44.27) months. Three hundreds and 10 grafts including 115 arterial and 195 venous were analyzed.A comparison of the patency rate between the arterial and venous grafts was also carried out. At the mean time, 2 groups were divided according to the paft lesions( patency of not). Uunivariate analysis and Logistic regression analysis were made for statistics. Results At the follow-up of (53.93 ± 36.80) months, the patent rate of LIMA, RA, SV and CV examined by MDCT was 94.7%, 92.0%, 85.9% and 60.0%, respectively. The patent rate for MDCT patients with angina was 83.5%, and 95.2% for angina-free group ( P = 0.046). At the follow-up of (75.95 ±47.09) months, the patent rate of LIMA, RA, SV and CV examined by SCA was 87.1%, 81.0%, 53.6% and 57. 1%, respectively. In SCA patients the patent rate was 62.0% for angina group and 100% for angina-free group ( P = 0.025 ). According to logistic regression analysis, only the postoperative period was statistically related to the graft lesion. Conclusion MDCT could find out the occlusions and obvious stenoses of the grafts after CABG. It might be served as a noninvasive method to evaluate the grafts patency postoperatively. The mid- and long-term patency of arterial grafts is better than venous grafts. Graft lesion is an important factor leading to postoperative recurrent angina pectoris. The severity of the graft lesion has a close relation to the lenth of postoperative period.

Objective: To observe influence of enalapril maleate and folic acid tablet (EFA) on blood pressure and blood glucose levels in patients with H-type hypertension (HTH) complicated diabetes mellitus (DM).Methods: According to random number table, a total of 300 HTH + DM patients were equally divided into enalapril group, amlodipine group and EFA group.Levels of blood pressure, plasma homocysteine (Hcy), carotid intima-media thickness (CIMT), fasting plasma glucose (FPG), 2h postprandial glucose (2hPG), fasting insulin (FINS), 2h postprandial insulin (2hPINS) were measured and compared among three groups before, and one, 12 and 24 months after treatment.All patients were followed up for two years, incidence rates of cardiovascular and cerebrovascular events were compared among three groups.Results: Compared with enalapril group and amlodipine group on 24 months after treatment, there were significant reductions in levels of SBP[(134.65±7.25) mmHg, (136.00±8.62) mmHg vs.(128.62±5.00) mmHg], DBP[(84.79±4.26) mmHg, (88.47±7.25) mmHg vs.(74.29±5.06) mmHg], plasma Hcy[(11.18±5.21)μmol/L , (30.29±5.62)μmol/L vs.(9.72±2.47)μmol/L], CIMT[(1.30±0.19) mm, (1.46±0.37) mm vs.(0.95±0.38) mm], 2hPG[(12.50±1.70)mmol/L, (12.90±1.90)mmol/L vs.(9.50±1.00)mmol/L]and 2hPINS[(71.38±17.63)μU/ml, (78.42±21.49)μU/ml vs.(61.28±18.14)μU/ml], P<0.05 or <0.01.After two-year follow-up, compared with enalapril group and amlodipine group on 24 months after treatment, there was significant reductions in incidence rates of cerebrovascular events (11%, 23% vs.0) and cardiovascular events (2%, 11% vs.0) in EFA group, P<0.01 all.Conclusion: EFA tablets can significantly reduce blood pressure, blood glucose and Hcy level and effectively delay atherosclerosis progression in HTH+DM patients,its safety is good, which is worth extending.

Background and purpose:Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN0) papillary thyroid carcinoma (PTC). The aim of this study was to investigate the risk factors of LNM, especially of high volume LNM (more than 5 metastatic lymph nodes) and contralateral central compartment LNM, in cN0 PTC.Methods:Medical records of 350 PTC patients (265 female, 85 male, 212 patients with solitary lesion in unilateral lobe) were reviewed. All operations of these patients were performed by one surgical team. The clinical pathological data were collected, and univariate and multivariate analysis was performed.Results:LNM was conifrmed in 138 patients (39.4%) and 20 patients had high volume LNM. In 169 patients with solitary lesion in unilateral lobe with total thyroidectomy and bilateral central neck dissection, 24 patients had contralateral metastasis (14.2%). In univariate analysis, tumor size (58.5% in >1 cmvs 33.6% in≤1 cm) and tumor with calcification in preoperational ultrasonography (43.7% withvs 31.7% without) showed signiifcant difference in prevelance of LNM. In multivariate analysis, tumor size >1 cm (OR=2.792) was the independent risk factor of LNM. Gender (3.8% in male vs 11.8% in female), age (10.7% <40 yearsvs 3.4%≥40 years ), tumor size(13.4% in >1 cmvs 3.4% in≤1 cm) and tumor with low echo in preoperational ultrasonography (13.9% withvs 4.8% without) showed signiifcant difference in univariate analysis of high volume LNM. Male (OR=5.152), tumor size >1 cm (OR=5.712) and age <40 years (OR=3.959) were conifrmed as independent risk factors of high volume LNM. Male (OR=3.105) and tumor size >1 cm (OR=3.863) were also demonstrated as independent risk factors of contralateral LNM in patients with solitary lesion in unilateral lobe, the prevalence of LNM were 26.5% in male and 26.1% in tumor size >1 cm, respectively.Conclusion:LNM was not “rare” in cN0 PTC patients. Prophylactic central neck dissection should be performed in cN0 patients with tumor size >1 cm. For cN0 microcarcinoma, more active surgical treatment may be considered in male and young patients.

Objective To compare the safety , surgery effects , pain scores of the close-distance-two-port video-assisted lobectomy and systematic dissection of the mediastinal nodes , and single-port video-assisted thora-coscopic surgery (VATS). Methods Between October 2012 and January 2015 in Peking University First Hospi-tal and Beijing Hospital , 269 patients who were going to be performed lobectomy and systematic lymph node dissection, were gathered and 205 patients were included in this study finally. Of the total, 122 patients were performed close-distance-two-port VATS , and 83 patients underwent single-port VATS. The clinical data were gathered, and statistically analyzed. Result In both groups, no severe postoperative complications or death oc-curred. No significant differences existed between the two groups in terms of intraoperative blood loss , duration and volume of chest tube drainage , postoperative pain score , hospital stay after surgery and hospitalization ex-penses (P > 0.05) but the data about operating time, number of dissected lymph nodes, complications(subcuta-neous emphysema , air-leak from the port of drainage tube and poor wound healing ) were significantly different (P < 0.05). Conclusions Compared with the single-port VATS, the method of close-distance-two-port video-as-sistant lobectomy and systematic dissection of the mediastinal nodes is safe and practicable with definite thera-peutic effect, less operation difficulty and complications.

Objective To investigate the biological effect of anti-leukemic cells induced by eosinophilic granulocyte (EOS) in bone marrow of patients with chronic myelogenous leukemia (CML).Methods The BCR-ABL fusion gene as well as the expression of IL-12 and IL-17 mRNA were performed by RT-PCR.The serum concentrations of cytokine IL-12 and IL-17 were determined by enzyme-linked immuno sorbent assay (ELISA).Immunochemistry staining and cytochemistry staining were used to observe the peroxydase (POX) and human Leukocyte antigen (HLA)-DR expression of EOS in bone marrow.Immunofluorescence staining was used to observe mannose receptor (MR),IL-12,IL-17A and IL-17receptor A (IL-17RA) expression of EOS.The results between the CML patients and the healthy controls were compared.Results Serum levels of IL-12 and IL-17 were higher in the 60 CML patients [(196.33 ±21.79) ng/L and (36.55-±3.01) ng/L] than those in the controls [(96.60 ±4.92) ng/L and (23.74 ±1.36) ng/L].In the 32 patients with activated EOS,the levels of IL-12 and IL-17 were (273.12 ± 17.16)ng/L and (40.11 ± 6.13) ng/L,which were significantly higher than those in the non-activated EOS [(126.16 ± 14.27) ng/L and (28.14 ±5.29) ng/L] (P values ＜0.01).IL-12 and IL-17 mRNA were expressed in activated EOS,while BCR-ABL fusion gene was not found.The amounts of EOS were increased abnormally in the bone marrow and peripheral blood of the CML patients with POX positive staining in the cytoplasm and weakly positive HLA-DR staining.It was observed easily by a microscope that EOS could attack leukemic cells in bone marrow through adhesion,capture and phagocytosis.Activated EOS could express IL-12,IL-17A and MR,which was related with the serum levels of these cytokines.Conclusions Activated EOS in bone marrow of CML patients could express IL-12 and IL-17.Activated EOS could induce coup injury to leukemic cell by releasing POX and expressing IL-12 and IL-17.It can also capture or swallow target cells via the expression of MR on the membrane.EOS may play an important role in the anti-tumor immunologic function in bone marrow of CML patients.

Objective:To study the effect of immunological molecules expressive state upon the telomerase activation ( TA) of bone marrow mononuclear cells ( BMMNC ) in the hemopoietic microenvironment of patients with immune related hematocytopenia ( IRHS) ,and to explore the immunologic mechanism as well as the clinical significance of hematoclasis in marrow of IRHS patients .Methods:①TRAP-PCR-ELISA method was performed to detect the TA of BMMNC in marrow of 366 IRHS patients before and after therapy.②The molecules HLA-DR,anti-hunman IgG,FcγⅡR,mannose receptor ( MR),IL-17A and its receptor ( IL-17AR) were analysed by immunochemistry and immunofluorescence staining .③The flow cytometric ( FCM) was used to analyse the proportion of CD3+CD4+T cells as well as CD3+CD8+T cells ,CD3-CD19+B cells and CD3-CD16/56+NK cells in peripheral blood lymphocyte.60 cases of health examination were selected as the control group , and 30 cases hypoferric anemia patients were selected as disease control.The differences between patient group and control group were analysed with statistic method .Immunochemistry and immunofluo-rescence staining were performed to in situ analyze the activation-characteristics of immunocyte in bone marrow slides of IRHS ,and the dependablity of cellular immunologic injury was also checked.Results: ①The levels of TA was 0.261 7 ±0.021 6 before treatment , higher than the disease control group (0.061 6±0.031 3 ,P<0.01).Among of them HLA-B27+patients were higher than HLA-B27-patients (0.301 3±0.020 6 vs.0.192 3±0.012 9,P<0.05).Serious IRP patients with HLA-B27+IgG+were obviously higher than HLA-B27-IgG+patients (0.401 6±0.017 2 vs.0.221 1±0.011 0,P<0.01).②In marrow of HLA-B27+IgG+patients,both cell immunity and humoral immunity were in disorder in the hemopoietic microenvironment ,and immonocyte in marrow expressed HLA-DR, FcγⅡR,IL-17A,IL-17RA and MR,and Th,Ts,B cell and NK cell in peripheral blood increased in different degree ,inducing the in-flammation of haemocyte and lead to destruction.③Humoral immunity was in the dominant level in morrow;humoral immunity of HLA-B27-IgG+patients,immonocyte expressed FcγⅡR in high level,but IL-17A was seldom expressed,only CD19+B cell was increased slightly ,the antibody dependent cellular cytotoxicity ( ADCC) was the main mode of destruction.After therapy glucocorticoids associated with ciclosporin A ,the TA level of BMMNC decreased to 0 with devitalization.Conclusion: The telomerase activation of bone marrow mononuclear cells in IRHS is related with the immune state of hemopoietic microenvironment and the pathologic lesion degree of hema -topoietic cell in marrow.It is viral infection and immunological activation as well as a variety of inflammatory factors play a part in the immunologic injury that might be an important factor of the enhancement in TA.

Objective: To explore the effect of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood on the survival of patients with multiple myeloma (MM). Methods: The clinical data of 195 patients with MM who were diagnosed in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2007 to December 2015 were retrospectively analyzed. According to NLR, the patients were divided into the low NLR group (NLR<3) or high NLR group (NLR≥3). The relationship between NLR and the parameters including clinical indicators, treatment response and overall survival of the patients was detected. Results: There were 61 cases in the high NLR group and 134 cases in the low NLR group. Compared with the low NLR group, creatinine and serum calcium in the high NLR group were higher (all P < 0.05). Complete remission rate after initial induction therapy in the low NLR group (32.1%, 43/134) was higher than that in the high NLR group (16.4%, 10/61), and there was a statistically significant difference (χ²=5.218, P=0.022). Median survival time in the low NLR group (38 months) was longer than that in the high NLR group (27 months), with a statistically significant difference (P=0.022). Cox univariate and multivariate analysis showed NLR≥3 was a risk factor (P=0.024), but not an independent risk factor (P=0.064). Conclusion NLR is associated with creatinine and serum Ca, which can be used to evaluate the overall survival time and inductive treatment response in patients with MM.