Objective To investigate the clinical characteristics and therapy of acute perforation of gastric carcinoma(APGC) to improve the diagnosis,treatment and prognosis of APGC. Methods Forty cases of APGC admitted to Gong liao hospital of Zhenping county.Of the forty patients,ten underwent repair of perforation,twenty-one cases underwent palliative gastrectomy (six of them underwent lymphadenectomy three weeks after previous gastrectomy );five subjected to radical gastrectomy. two underwent gastrostomy or jejunostomy for nutrition.One underwent drainage and peritoneal lavage only;1 received non-operative therapy.Results Four patients died in this series.The 1-,2-,3-years survival rate was 83.3%(30/36),52.8%(19/36),27.8%(10/36)respectively. Conclusions Early diagnosis and adopting resection of gastric cancer plus comperhensive treatment can improve the prognosis of patients with APGC.

Thyroid cancer is one of the most common malignant tumors in the human endocrine system . It is one of the common diseases in head and neck ,thyroid and breast surgery .Its incidence rate is increasing year by year .With the development of ultrasonography and fine needle aspiration biopsy ,as well as the auxiliary exami-nation of gene detection technology ,the detective rate of early diagnosis of papillary thyroid microcarcinoma ( PT-MC) is getting higher and higher .Compared with conventional surgery , highlighting the advantages of minimally invasive surgery , endoscopic and ultrasound guided percutaneous ablation and other new surgical methods are gradually applied in clinical treatment .Combined with the new guideline ,the present paper reviews the progress in the diagnosis and treatment of papillary thyroid microcarcinoma .

Background The study on influences of gender,age and axial length (AL) on lens thickness (LT) and anterior chamber depth (ACD) in normal population is still lack in China.Objective This study was to measure LT and ACD in normal subjects and discuss their changes with age,gender and AL.Methods AL,ACD and LT were measured on 866 eyes of 433 normal population with Lenstar LS900 in Tianjin Eye Hospital from March through December in 2013,including 390 eyes in 195 males and 476 eyes of 238 females.ACD/AL,LT/AL and (ACD+LT)/AL were calculated after measurement.The subjects were grouped to the 10-20 years group,21-30 years group,31-40 years group,41-50 years group,51-60 years group and ≥61 years group based on age,or the 22 mm≤AL＜24 mm group,24 mm≤AL＜26 mm group and AL≥26 mm based on AL,and the measured parameters were compared and analyzed among the groups.Oral informed consent was obtained from each subject or child contutor prior to any medical examination.Results AL,ACD and LT values were (24.41±1.37),(2.89±0.42) and (4.05±0.52) mm in the males,and those in the females were (23.83±1.31),(2.72±0.40) and (4.20±0.44) mm,showing significant differences between them (t=6.278,6.102,-4.595,all at P=0.000).No significant differences were found in ACD,LT,ACD/AL,LT/AL and (ACD+LT)/AL values between the right eyes and the left eyes (t=-0.713,0.186,-0.754,0.296,-0.168,all at P＞0.05).As the increase of the AL,ACD was remarkable deepened but LT was declined,with the considerable difference among the 22 mm ≤ AL＜24 mm group,24 mm ≤ AL＜ 26 mm group and AL ≥ 26 mm group (F =176.640,94.569,both at P =0.000).ACD value was higher,but LT value was lower in the 24 mm≤AL＜26 mm group or AL≥26.00 mm group than that in the 22 mm≤AL＜24 mm group (all at P＜0.05).ACD value was gradually reduced,while LT value was elevated with aging,with significant differences among the different age groups (F =104.531,373.225,all at P =0.000).Significant correlations were found between age and ACD,LT or (ACD + LT)/AL,with the regression equations of ACD (mm) =-0.015 × age + 3.434 (F =-22.979,P =0.000);LT (mm) =0.024 × age + 3.122 (F =44.856,P =0.000),LT/AL =0.001 × age + 0.122 (F=37.982,P=0.000),(ACD+LT)/AL=0.001×age+0.259 (F=22.451,P=0.000).Conclusions Compared with normal females,males have thinner LT and deeper ACD.In the normal eyes,longer AL is,thinner LT is and the deeper ACD is.LT thickens and ACD deepens with aging.

Objective To investigate the expression of phospho-histone H3 (PHH3) protein in pancreatic neuroendocrine neoplasms (PNENs) and explore its potential value for pathological grading of PNENs.Methods Clinical and pathological data of 283 patients with PNENs treated in Changhai Hospital from December 2000 to May 2016 were retrospectively analyzed.PNENs tissue chip was prepared,and immunohistochemistry was used to examine the expression of PHH3 and Ki67.The receiver operating characteristic curve for PHH3 was drawn and the area under the curve(AUC) was calculated to determine the cutoff value for PNENs grading.Ki67 was used for PNENs grading according to domestic and intemational criteria for PNENs classification.The relationship of PHH3 and Ki67 classification with clinical pathological features and prognosis of PNENs as well as the correlation between the two classification methods were analyzed.Results Of 283 patients,132 were male and 151 were female,aged from 16 to 78 years old.The average age was (50 ± 1) years old.There were 44 cases with functional PNENs and 239 with non-functional PNENs.The diameter of tumors ranged from 1.1 cm to 17 cm and the average diameter was (4.1 ± 1.2)cm.According to the Ki67 standard,there were 127,116,33 and 7 cases of Grade G1,G2,pancreatic neuroendocrine tumor(PNET) G3 and pancreatic neuroendocrine cancer(PNEC) G3.According to the PHH3 standard,there were 118,119,3 8 and 8 cases of Grade G1,G2,PNET G3 and PNEC G3.There was a positive correlation between the two grading criteria (r =0.941,P ＜0.001).PHH3 expression and PNENs grading were not correlated with age,gender,tumor functional or not and tumor locations (all P ＞ 0.05),but were both positively correlated with tumor size,histological grade,lymph node metastasis,TNM stage and prognosis (all P ＜0.05).The average time of observing PHH3 and Ki67 staining per case in the immunohistochemistry of tissue chip was 9 min and 45 min,respectively.Conclusions Detection of PHH3 expression in PNENs can be used for the pathological diagnosis,grading and prognostic evaluation,which was more accurate and convenient than Ki67 criteria.

Alveolar soft part sarcoma (ASPS) is a rare soft tissue sarcomas, this sarcoma occurs rarely in the larynx. Herein, we describe an unusual case of ASPS occurring in the larynx. The patient was a 46-year-old woman who presented with a more than 2-year history of right pyriform fossa mass and progressive hoarseness for three months. The endoscopic examination of the larynx revealed a mass in the right pyriform fossa with smooth surface and well-defined margin. Computed tomography demonstrated a heterogeneous tumor in the right pyriform fossa, and involving the paralaryngeal space, measuring approximately 2.1 cm x 1.7 cm x 2.6 cm, which was resected via lateral neck approach. Histopathology and immunohistochemistry revealed an ASPS. To ours knowledge, this is the first reported case of ASPS arising in pyriform fossa.
Female ; Hoarseness ; Humans ; Immunohistochemistry ; Larynx ; pathology ; Middle Aged ; Sarcoma, Alveolar Soft Part ; pathology ; Tomography, X-Ray Computed

Objective To explore the standardized procedures of laparoscopic sleeve gastrectomy (LSG).Methods The clinical data of 153 patients with obesity who underwent LSG at the First Affiliated Hospital of Nanjing Medical University from December 2010 to December 2014 were retrospectively analyzed.All the 153 patients were divided into 3 groups:22 patients in the first stage group were admitted to the hospital from December 2010 to September 2011,57 patients in the second stage group were admitted to the hospital from October 2011 to December 2013 and 74 patients in the third stage group were admitted to the hospital from January 2014 to December 2014.In the first stage group,1.1 cm gastroscope in diameter was introduced into the pylorus as a support,great curve of stomach with 5 cm distances from the pylorus was cut using a green cartridge,and then blue cartridges were used at the body and fundus of stomach.The 3-0 vicryl continuous and whole-layer suture was performed.The routine abdominal drainage was ended at postoperative hour 24 without the gastric tube placement.In the second stage group,36 Fr bougie tube was placed at the gastric antrum,cutting at the proximal 5 cm from pylorus was performed using a green cartridge,and then blue cartridges were used.The 3-0 Vicryl interrupted and wholelayer suture was performed at the reinforcement of staple lines,and no drainage tube was placed.In the third stage group,36 Fr bougie tube was placed at the gastric antrum,cutting at the proximal 3 cm from pylorus was performed using two green cartridges,and then blue cartridges were used.The 3-0 vicryl continuous and whole-layer suture was performed at the reinforcement of staple lines,and no drainage tube was placed.Other common perioperative management included as follows:free greater omentum was done by the supersonic knife.Patients had outof-bed activity after waking up and intake of water and fluid diet at postoperative hour 6-8,including oral liquid diet of 300-500 mL at postoperative hour 24 and 500-1 000 mL at postoperative hour 48.Patients were followed up till May 2015,and return visit at postoperative month 1,3,6,9 and 12 within 1 year and once every 6 months after postoperative year 2.The operation time,volume of intraoperative blood loss,duration of hospital stay and excess weight loss (EWL) percentage were analyzed.Comparison of count data was analyzed by the chi-square test.Measurement data with normal distribution were presented as-x± s.Comparisons among groups were evaluated with the one-way ANOVA and chi-square test.Results All the patients received successfully LSG without conversion to open surgery,perioperative reoperation and death.Four patients were complicated with intraoperative injury,including 3 patients with liver injury and 1 patient with hepatic round ligament injury.No intraoperative and postoperative hemorrhea,postoperative gastric leakage and obstruction were detected.The operation time,volume of intraoperative blood loss,duration of hospital stay and 1-year EWL were (91 ± 31) minutes,(51 ± 33) mL,(4.1 ± 3.4) days,67％ ± 12％ in the first stage group,(56 ± 27) minutes,(24 ± 20) mL,(3.1 ± 2.7) days,65 ％ ± 14％ in the second stage group and (54 ± 18) minutes,(21 ± 20) mL,(3.0 ± 2.1) days,68％ ± 24％ in the third stage group,respectively.There were significant differences in the operation time and intraoperative volume of blood loss among the 3 groups (F =7.471,6.037,P ＜0.05).There was no significant difference in the duration of hospital stay and 1-year EWL among the 3 groups (F =1.439,2.296,P ＞ 0.05).All the patients were followed up.Nineteen patients with sleep apnea had complete remission of symptoms at postoperative month 3.Twenty-one patients with polycystic ovary syndrome had remission of symptoms after operations.Of 27 patients with type 2 diabetes mellitus,25 patients had remission of symptoms at postoperative year 1 and 2 patients had improvement of symptoms.Fifty-seven of 79 patients with lipid metabolism disorders returned to normal at postopera tive year 1.One hundred and twelve patients with fatty liver were improved after operation.Conclusions LSG is safe and feasible with a standardized operative procedure.Whole-layer suture may be prevent the leakage and no placement of gastric tube and drainage tube after operation can reduce the incidence of complications.

Objective To explore the clinical effects of metabolic surgery on obese adolescents.Methods The clinical data of 28 obese adolescents who were admitted to the First Affiliated Hospital of Nanjing Medical University from June 2010 to January 2014 were retrospectively analyzed.Patients underwent gastric bypass and sleeve gastrectomy according to their own intention and were followed up regularly at 1,3,6,9 months after surgery till October 2014.The perioperative conditions and postoperative effecacies of patients were observed.The measurement data with normal distribution were presented as-x ± s,the comparisons of weight-loss trends among different surgeries were analyzed by the repeated measures ANOVA.Results All surgeries were performed under laparoscope without severe complications or deaths,including 16 cases of gastric bypass and 12 cases of sleeve gastrectomy.The median operation time and duration of postoperative stay were 136.5 minutes (range,60.0-320.0 minutes) and 4 days (range,2-8 days),respectively.Three patients had perioperative complications.All patients received postoperative follow-ups.The median body mass index(BMI) at postoperative month 1,3,6,9 were 36.1 kg/m2,33.2 kg/m2,30.2 kg/m2 and 28.4 kg/m2,and mean excess weight loss (EWL) rate were 24.6％,40.4％,55.1％ and 63.9％.The BMIs before operation and at postoperative month 1,3,6,9 were (43 ± 6) kg/m2,(37 ± 5) kg/m2,(34 ± 4) kg/m2,(30 ± 4) kg/m2 and (29 ± 4) kg/m2 in patients undergoing gastric bypass,and (39±4)kg/m2,(35±4)kg/m2,(32 ±5)kg/m2,(31 ±4)kg/m2 and (28 ±4)kg/m2 in patients undergoing sleeve gastrectomy,respectively.The EWL at postoperative month 1,3,6,9 were 24％ ± 9％,40％±9％,59％ ± 12％ and 65％ ± 12％ in patients undergoing gastric bypass,and 25％ ±9％,41％ ± 15％,49％ ± 16％ and 63％ ± 17％ in patients undergoing sleeve gastrectomy,respectively.There was no difference in the change of BMI and EWL between gastric bypass and sleeve gastrectomy (F =0.777,0.332,P ＞ 0.05).Four patients undergoing gastric bypass were found to have nutritional complications in follow-up and recovered after symptomatic treatment.Concltsion Bariatric surgery is safe and feasible for obese adolescents with a significant weight loss.However relevant nutrition complications may occur,it is significant to sustain a long-term followup and nutrition intervention,and the choice of surgical procedures should follow the principle of individuation.

BACKGROUND:In treatment of lumbar diseases, lumbar fusion therapy fails in 20%of cases and may lead to a series of complications such as pain, intervertebral space col apse, and delayed kyphosis deformity.
OBJECTIVE:To observe the effect of nucleus pulposus on interbody fusion after removing the anterior column disc of rabbit lumbar vertebra.
METHODS:A total of 36 healthy Japanese white rabbits were randomly and equal y divided into three groups, with 12 rabbits in each group. (1) Group of anterior longitudinal ligament+bone grafting:The L3 intercalated disc were wel exposed and anterior longitudinal ligament was stripped, obtaining a space to L3 intercalated disc, then the iliac bone was implanted. (2) Group of excising anterior 1/3 disc+bone grafting:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and sutured as Group of anterior longitudinal ligament+bone grafting. (3) Group of excising anterior 1/3 disc+fixation:After the anterior 1/3 disc tissue was excised, the iliac bone was implanted and the anterior column fixation was performed.
RESULTS AND CONCLUSION:Biomechanical testing showed that, at 12 weeks, the verticality tensile force in the group of anterior longitudinal ligament+bone grafting was obviously higher than other two groups, and have better fusion rate and could bear stronger force. Lateral position lumbar radiography showed that, the bone graft was absorbed and no new bone grew into the intervertebral space in the group of excising anterior 1/3 disc+bone grafting at 12 weeks;the formation of osseous bridge was found in the group of excising anterior 1/3 disc+fixation;complete bony fusion was found in the group of anterior longitudinal ligament+bone grafting. Histological examinations showed that, at 12 weeks, no bone tissue formed in the group of excising anterior 1/3 disc+bone grafting;a smal amount of bone trabecula and osteocytes were observed in the group of excising anterior 1/3 disc+fixation;a great quantity of newborn bone trabecula and osteocytes, remodeling lamel ar bone and canalis haversi structure were observed in the group of anterior longitudinal ligament+bone grafting. The stability of anterior column has notable effect on interbody fusion, after the anterior column disc is destroyed, the free nucleus pulposus may affect spinal fusion, so restoring the stability of the anterior column may promote interbody fusion, but stil cannot get solid spinal fusion.

In the present study, the efficacy of Naoxintong capsule (NXT), a compound Chinese herbal medicine, combined with dual antiplatelet therapy (DA) in a rat model of coronary microembolization (CME) was evaluated.

Risk Factors ; Tars ; toxicity ; Tobacco Products ; standards ; toxicity ; Tobacco Use Disorder ; etiology ; prevention & control