Acute appendicitis is the most common surgical or acute abdomen in childhood.Rapid and correct diagnosis is the premise of rational therapy,but there are still some problems in diagnosis and differential diagnosis.Sufficient comprehension about clinical features and differential diagnostic diseases,typical clinical symptoms,physical examination,laboratory examinations,ultrasonography or CT would make a definite diagnosis.Laparoscopy is also used to make a diagnosis if necessary.

Ohjective To know the proper wraping method for postoperative patients with neurosurgical intervention treatment. Methods Divided 94 patients with neurosurgical intervention treatment into the ban-dage group and the gauze group randomly, there were 47 cases in the each group. Bandage and gauze was used in the two groups for punctured wound respectively, and then compared the condition of complications and puncture location between the two groups. Results The incidence rate of puncture-associated comphcations in the bandage group was sinificant lower than that of in the gauze group. Conclusions Wraping by bandage for postoperative patients with neurosurgical intervention treatment is more effective than gauze method.

[Summary] This review summarized the evolution of surgical timing and procedure skills of postnatal repair in the treatment of congenital diaphragmatic hernia ( CDH ) .Minimally invasive repair of diaphragmatic hernia was highlighted.The current status, difficulties, and future trends of surgical intervention for CDH were analyzed.

OBJECTlVE To study the effect of ganoderma poIysaccharide( GLP)on zebrafish ( Danio rerio)survivaI,deveIopment and senescence. METHODS A p53-knockout zebrafish modeI was estabIished by injecting of morphoIino phosphorodiamidate(mO)into normaI zebrafish eggs in the singIe ceII deveIopment stage. Different concentrations of GLP 1,2 and 3 g·L-1 were used to treat both wiId type and p53-knockout zebrafish embryos 8 h post fertiIization(8 hpf)under 28℃ for 3 d. The survivaI and maIformation rates were caIcuIated after 72 hpf,and the effect of GLP on ceII senescence was evaI-uated by senescence associated β-gaIactosidase(SA-β-gaI)staining both in wiId type and p53-knockout zebrafish embryos. In addition,the differentiaI gene expression of cancer inhibitor gene(p53),teIomer-ase reverse transcriptase( TERT),murine doubIe minute2( mdm2)and p21 was examined by RT-PCR both in wiId type and p53-knockout zebrafish embryos after treatment with different concentrations of GLP. RESULTS GLP 1 and 2 g·L-1 had no effect on deveIopment of wiId type zebrafish embryos,but after GLP 3 g·L-1 treatment,most of zebrafish embryos dispIayed maIformation and the survivaI rate was onIy 48.6%. GLP 1,2 and 3 g·L-1 had no effect on survivaI and deveIopment of p53-knockout zebrafish embryos. After GLP 2 g·L-1 treatment for 3 d,the SA-β-gaI staining positive rate of wiId type zebrafish embryos was reduced compared with controI group(P﹤0.01),whiIe there was no significant change in p53-knockout zebrafish embryos. The resuIts of RT-PCR showed that GLP 2 g·L-1 treatment depressed p21 and p53 gene expression(P﹤0.05,P﹤0.01),and had no effect on mdm2 and TERTgene expres-sion of wiId type zebrafish embryos. For p53-knockout zebrafish embryos,the TERT,mdm2,p21 and p53 gene expression dispIayed no significant difference after GLP 2 g·L-1 treatment. CONCLUSlON GLP 2 g·L-1 may improve senescence of wiId type zebrafish embryo ceIIs. GLP ≥3 g·L-1 may Iead to death and abnormaI deveIopment of wiId type zebrafish embryos. The improvement of GLP on senescence of wiId type zebrafish embryo ceIIs might be mediated by its down-reguIation of p21 and p53 gene expression.

Objective To evaluate the safety and efficacy of interventional procedure for treating the renal artery aneurysm (RAA).Methods From Jan 2009 to Apr 2014,17 patients,who were diagnosed as RAA and accepted the interventional therapy,were reviewed in our hospital.The mean age in those patients,including 7 males and 10 females,was (46.4±10.3) years old (range from 20 to 67 years old).The related symptoms included backache in 4 cases,abdominal pain in 4 cases,intermittent hematuria in 2 cases,chyluria in one case,oligouria in one case.9 cases were diagnosed as multiple RAA and 8 cases were confirmed as signle cases.In 17 cases,31 aneurysms were found,including 26 true aneurysms,5 pseudoaneurysums,17 sacculated aneurysms,4 spindle-like aneurysms,4 irregular shape aneurysms,4 parenchyma aneurysm and 2 dissecting aneurysm.8 aneurysms located in the main renal artery,19 aneurysms located in the branch of renal artery,4 aneurysums located in the renal parenchyma.Intracavitary coil embolization was used in 4 patients.We carried out parent artery embolization in 3 patients.A combination of the former techniques was performed in 6 cases.Covered stent placement was operated in one case.Combination of the intracavitary coil embolization and nude stent placement were performed in 2 patients.We used two techniques in one patient with multiple artery aneurysms in both sides.Results The interventional treatment of RAAs succeed at the first operation in 16 of 17 patients.17 cases were followed-up from 3 to 53 months (mean 23 months).No severe complications or death cases occurred in this study.Urine occult blood in 3 patients turned to negative after one week.Primary symptoms such as gross hematuria,abdominal pain,lumbodorsalgia,fever vanished or obviously eased after a month.Laboratory tests showed that normal level in SCr,BUN,routine urinalysis 3 months,6 months and 1 year later.No tendency of stent and coil stent shifting was found in 16 patients and the parent arteries were patent in 8 cases,with reexamination bv ultrasonic or computed tomography angiography (CTA).Conclusions Interventional techniques are minimally-invasive,safe and effective methods for treating the RAAs.

Objective To evaluate tumor angiogenesis and clinical significance by contrast-enhanced CT in case of non-small cell lung cancer (NSCLC). Methods 30 patients with NSCLC underwent dynamic thoracic CT, and histopathological slides were carefully prepared for VEGF immunohistochemical staining. Maxium attenuations of dynamic CT were compared with VEGF expression levels and lymph-node metastases. Results The mean peak attentation was (36.28?6.41)HU, VEGF positive expressions were in 21 patients, and negative expressions were in 9 patients. VEGF expression levels in patients with NSCLC stage II and III were higher than those in stage I , and in lymph node metastases group, the expression levels of VEGF were also higher than those in non-metastatic nodes. CT enhancement of NSCLC was positively related to VEGF expression,neoplasm stage and lymph-node metastases. Conclusion CT enhancement of NSCLC can reflect tumor angiogenesis and correlate to lymph-node metastases closely, help lung cancer diagnoses,neoplasm stage, and serve as a supplement to the present staging system for lung cancer in biological behavior.

ood long-term efficacy for cirrhosis patients with portal hypertension was a useful treatment for these patients.

Objective To investigate the precision and trueness of results from six imported commercial systems for measurement of gamma-glutamyltransferase (GGT) in serum in order to provide reference for the clinical laboratories to verify the target accuracy. Methods Five fresh frozen human serum samples that differed in catalytic concentration were analyzed in two candidate domestic reference laboratories and the target values for GGT were assigned using IFCC reference measurement procedure. The same samples were tested by six commercial systems which were calibrated using the matched calibrator. Each system consisted of five instruments in five laboratories, which had been well maintained before measurement. The data was collected. Precision from the same manufacturer and different manufacturers and biases between target values and mean values from each system were calculated. Results The differences of the mean values for five levels of commercial systems varied from 16. 1% to 35.4%. For the five levels, the coefficients of variation (CVs) of the results from all measurement system were from 5.3% to 8. 8% , and CVs from each level were A 2. 17%- 5.07%, B 4. 21%-10. 98%, C 0. 52%-2. 38%, D 1.35%-2. 59%, E 0. 23%-1..54%-), F 1.83%-2. 38%. Biases between the mean values of each commercial systems and the target values were A 0. 43% -8.41% ), B -1.49% - -13.04% ), C 11.20% -17.73% ), D 0. 19% -4. 62% ), E -0. 30% - -2. 63% ), F 4). 46%-7.90%, respectively. The investigation showed that biases of two manufacturers were less than a quarter of the total allowable error (TAE) of The Clinical Laboratory Improvement Amendments of 1988 (CLIA'88) in the whole range of investigated concentrations and the other two manufacturers' biases could meet a quarter of TAE in a relative limited range. The biases of two manufacturers were near or more than half of TAE in most levels. It also revealed that the biases of more than half of manufacturers were more than a quarter of TAE in the low or high level of investigated concentrations. Conclusions The mean values of each manufacturer were significantly different. The variances of commercial systems from different manufacturers were much higher than those from the same manufacturer. Some imported commercial systems for measurement GGT should be better calibrated with the reference method, especially in the whole measurement linearity.

Objective To investigate the expression and the role of Tim-3 and Th-17 in ITP patients and to research their clinical application. Methods Total 42 active ITP patients and 39 healthy donors were recruited in this research. The expressions of Th17 and CD4+ CD25+ Treg were measured with flow cytometer. IL-17, IFN-γ levels as well as IL-4 plasma levels were determined by ELISA. The mRNA expression of Tim-3, IFN-γ, IL-4 and T-bet were measured using RT-PCR in all samples. Results The expression of Th17 cells in ITP patients was (2.41 ± 1.43 )%, which was significantly higher than control group ( 1.08 ± 0.59)% ( t = 5.35, P < 0.05 ). But the percentage of Treg in ITP patients was ( 1.64 ±0.74)%, which was lower than control group (3.12 ±0.52)% (t = 10.33, P <0.05). The levels of IL-17 in plasma of ITP and controls were ( 14.42 ±6.37) ng/L and ( 13.91 ±4.47) ng/L respectively (t =0.42, P > 0.05). The level of IFN-γin plasma of ITP was (55.74 ± 15.25 ) ng/L, which was higher than control group (31.33 ± 12.99) ng/L (t = 7.72, P < 0.05 ). The level of IL-4 in the plasma of ITP was (7.42 ± 1.50) ng/L, which was lower than controls ( 18.17 ± 5.19) ng/L ( t = 12.87, P ＜ 0.05 ). Both IFN-γand T-bet mRNA levels were up-regulated in active ITP patients by the factor ( 8.57 ± 3.44 ) -fold and (3.34 ± 1.32)-fold than control group (t = 13.21,6.41 ,P <0.05). The decreases observed in IL-4 and Tim-3 were (0.25 ±0.15 )-fold and (0.29 ±0.15)-fold respectively in ITP patients compared with control group (t=10.02,9.61,P＜0.05 ). Conclusion The imbalance of Th17/Treg and the decrease of Tim-3 might be important determinants in the evolution of ITP.

Objective To compare the degree of pain in patients after radical gastrectomy under different anesthetic regimens.Methods One hundred and two ASA Ⅰ or Ⅱ patients of both sexes,aged 50-75 yr,weighing 45-70 kg,undergoing elective radical gastrectomy,were randomly divided into 3 groups ( n =34 each):general anesthesia (GA) group,combined general-subcostal transversus abdominis plane block (CGTA) group and combined general-epidural anesthesia (CGEA) group.The patients were sent to the postanesthesia care unit (PACU) after tracheal extubation,and the VAS score on arrival in the PACU was recorded.The degree of pain was evaluated by VAS score,and when VAS scores ＞ 3,the patients received intravenous morphine titration.When VAS scores ≤ 3,morphine titration was stopped and all the patients were connected to patient-controlled intravenous analgesia and/or epidural analgesia pump.The total amount of morphine consumed was recorded at the end of titration,and the occurrence of adverse reactions was also observed.Results Compared with groups GA and CGTA,the incidence of moderate to severe postoperative pain was significantly decreased in group CGEA (P ＜0.01).The incidence of severe postoperative pain,the VAS score on arrival in the PACU and the total amount of morphine consumed were decreased gradually in groups GA,CGTA and CGEA ( P ＜ 0.01 ).The incidence of sedation was significantly lower in group CGEA than in group GA (P ＜ 0.01 ).There were no significant differences in the other adverse reactions among the three groups ( P ＞ 0.05 ).Conclusion The degree of pain is reduced gradually in patients after radical gastrectomy under GA,CGTA and CGEA.