Objective To compare the effectiveness of the three operation mode in treatment of ovarian cyst. Methods According to the digital table,138 patients with ovarian cyst were divided into three groups,the group A (n=46 cases)were operated through open operation,group B (n =46 cases)were operated through transvaginal operation,group C(n=46 cases)were operated through laparoscopic operation.The three groups were observed the situation of operation (operation time,bleeding volume,the first exhaust time,hospitalizationtime ),complications (infection,hemorrhage,perimenopausal changes ),postoperative follow -up for 1 years.The recurrence rate was observed.Results Group A of 46 patients were successfully completed surgery,B,C groups of 1 patients was con-versed to laparotomy due to severe adhesion.B,C groups in the operation time,amount of bleeding during the opera-tion,the time of hospitalization were significantly less than that of group A (t=4.306,5.172,3.012,3.926,3.776, 2.168,P<0.05,P<0.01).B group was significantly less than those of A,C group in the first exhaust time (t=3.014,2.446,all P<0.05).In the operation time of group B was obviously less than that of group C (t=2.748,P<0.05).A,B,C three groups of postoperative complication rates were 39.1%,11.1%,15.6% respectively;the incidence of complications of B,C groups was lower than that in A group (χ2 =9.82,8.64,all P<0.01 ).After 1years follow-up,the recurrence rate in group B was significantly higher than that of A and C groups (χ2 =6.72, 6.72,all P<0.01).Conclusion Treatment of ovarian cyst vaginal surgery and laparoscopic surgery wound is small, but the person that weigh should be performed open adhesion treatment,individualized treatment.

Objective To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. Methods A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled. They were randomly divided into two groups. The patients in APRV group were given APRV pattern, while those in control group were given lung protection ventilation, synchronized intermittent mandatory ventilation with positive end-expiratory pressure (SIMV+PEEP). All patients were treated with AVEA ventilator. The parameters such as airway peak pressure (Ppeak), mean airway pressure (Pmean), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial blood gas, urine output (UO), the usage of sedation and muscle relaxation drugs were recorded. AVEA ventilator turning point (Pflex) operation was used to describe the quasi-static pressure volume curve (P-V curve). High and low inflection point (UIP, LIP) and triangular Pflex volume (Vdelta) were automatically measured and calculated. The ventilation parameters were set, and the 24-hour P-V curve was recorded again in order to be compared with subsequent results. Venous blood was collected before treatment, 24 hours and 48 hours after ventilation to measure lung surfactant protein D (SP-D) and large molecular mucus in saliva (KL-6) by enzyme linked immunosorbent assay (ELISA), and the correlation between the above two parameters and prognosis on 28 days was analyzed by multinomial logistic regression. Results Twenty-six patients with ALI/ARDS were enrolled, and 22 of them completed the test with 10 in APRV group and 12 in control group. The basic parameters and P-V curves between two groups were similar before the test. After 24 hours and 48 hours, mechanical ventilation was given in both groups. The patients' oxygenation was improved significantly, though there were no significant changes in hemodynamic parameters. The Pmean (cmH2O, 1 cmH2O = 0.098 kPa) in APRV group was significantly higher than that in control group (24 hours: 24.20±4.59 vs. 17.50±3.48, P < 0.01; 48 hours: 18.10±4.30 vs. 15.00±2.59, P < 0.05). After ventilation for 24 hours, the ratio of patients with increased Vdelta in APRV group was higher than that in control group (90% vs. 75%), but without statistical difference (P > 0.05). The SP-D level (μg/L) in serum in APRV group showed a tendency of increase (increased from 19.70±7.34 to 27.61±10.21, P < 0.05), in contrast there was a tendency of decrease in control group (decreased from 21.83±7.31 to 16.58±2.90, P > 0.05), the difference between the two groups was statistically significant (P < 0.05). After 48-hour ventilation, SP-D in APRV group was decreased, but no change was found in control group, and no significant difference was found as compared with that of the control group (16.45±8.17 vs. 17.20±4.59, P > 0.05). There was no significant difference in serum KL-6 between the two groups before and after ventilation. The SP-D and KL-6 levels in serum were unrelated with 28-day survival rate of the patients. The odds ratio (OR) of SP-D were 0.900 [95% confidence interval (95%CI) = 0.719-1.125], 1.054 (95%CI = 0.878-1.266), 1.143 (95%CI = 0.957-1.365), and the OR of KL-6 were 1.356 (95%CI = 0.668-2.754), 0.658 (95%CI = 0.161-2.685), 0.915 (95%CI = 0.350-2.394) before the test, 24 hours and 48 hours after ventilation (all P > 0.05). Conclusions APRV was similar to lung protective ventilation strategy in oxygenation and improvements in the lung mechanics parameters. APRV with a higher Pmean can recruit alveolar more effectively, and it had no impact on hemo-dynamics, but might exacerbate VILI.

BACKGROUND:Porcelain jacket crowns have achieved good results in the repair of porcelain ceramic crown and bridge colapse.
OBJECTIVE:To test the bond strength of single porcelain jacket crown, thus determining the feasibility of clinical application of repairing colapsed crown and fixed bridge by porcelain jacket crown, and meanwhile to discuss the influence between blastsanding and silane coupling agent treatment on the metal bonding strength in the repair of porcelain fracture.
METHODS: The porcelain jacket crown was cast in the same shape from disk-shaped waxpatterns. Twenty specimens were chosen without blowholes and casting defects and they were al routinely burnished and cleaned in an ultrasonic bath and dried using an oil-free air stream stand-by. Then we randomly divided the specimens into four groups: specimens were treated with nothing (control), sandblast, silane coupling agent and sandblast+silane coupling agent, respectively. Each of the specimen was bonded with Poly-F Plus. AG-10TA universal testing machine was used to test the tensile strength.
RESULTS AND CONCLUSION:The tensile bond strength of control, sandblast, silane coupling agent and sandblast+silane coupling agent groups respectively were (0.68 0.04), (1.00 0.02), (1.31 0.08), and (1.09 0.04) kN. There were significant differences between groups (P < 0.01). In the control group, the metal surface was smooth, showing some irregular smal superficial veins. In the sandblast group, the metal surface showed irregular scaly protrusions conducive penetrate adhesives. In the silane coupling group, the metal surface manifested a honeycomb structure in favor of chimeric adhesives. The sandblast+silane coupling agent group showed some metal projections ranging in size, on the rough metal surface, which was conducive to bond. Porcelain jacket crown applied to repair colapsed crown and fixed bridge is feasible. Sandblasting and silane coupling agent can improve bond strength of porcelain jacket crown. The bond strength of metal specimens treated with silane coupling agent is the best folowed by the sandblasting+silane coupling agent.

objective To explore the indication of mechanical ventilation and evaluate the effects of mechanical ventilation with the least delay on the Severe cases of hand-foot-mouth disease(HFMD).Methods Retrospective cohort study was conducted among the severe HFMD cases(n=66)admitted to pediatric intensive care unit(PICU)between July 2008 and september 2009.Sixty-six cases were divided into two groups:42 cases(group A,July 5 to October 31,2008)were ventilated with the common mechanical ventilation,24 cases(group B,April 21 to september 30,2009)were ventilated at least delay when the symptoms of neurogenic pulmonary edema appeared.Then the diffcrences on the survival rate and the mortality in the group A and group B were investigated.Results Twenty out of 42 patients died(47.6%),eighteen were cured(42.6%) and four showed improved signs(9.5%)in group A.Twenty-two out of 24 patients were cured(91.7%),two showed improved signs(8.3%)and no death in group B.The clinical effect of group B was much better tllan group A(P<0.001).Conclusion Early mechanical ventilation would improve the survival rate and decrease the mortality of severe hand-foot-mouth disease.

Objective To investigate the effect of early low-glucocorticoid on hemodynamics and prognosis in the patients with septic shock.Methods Sixty patients with septic shock failing in active fluid resuscitation and vasoactive drugs in our hospital from June 2013 to August 2015 were selected and divided into the control group,early-hormone group and late-hormone group.MAP,HR,PO2/FIO2 and serum lactic acid levels were monitored in all selected patients before treatment and at 12,24,48 h after treatment.Apache Ⅱ,SOFA scores were assessed before treatment and on 1,3,7 d after treatment.The ventilation time,ICU stay time,hospital stay time and intravenous use time of vasoactive agents(VDNT) were recorded.Results The Apache Ⅱ scores and SOFA scores on 3,7 d after treatment in the early-hormone group were significantly decreased compared with the late-hormone group and control group (P＜0.05).MAP and HR at 24,48 h after treatment in the early-hormone group were significantly improved compared with the late-hormone group and control group (P＜0.05).The level of serum lactic acid at 12,24 h after treatment in the early-hormone group and late-hormone group were obviously lower than that in the control group,the levels of serum lactic acid at 12,24 h after treatment in the early-hormone group were obviously lower than those in the late-hormone group (P＜ 0.05).PO2/FIO2 at 12 h after treatment in the early-hormone group and late-hormone group were obviously better than that in the control group,and PO2/FIO2 at 12 h after treatment in the early-hormone group was obviously better than that in the late-hormone group(P＜0.05).The ventilation time,ICU stay time,hospital stay time and VDUT in the early-hormone group were significantly shortened compared with the late-hormone group and control group.The ventilation times,ICU stay time and VDUT in the latehormone group were significantly shortened compared with the control group (P＜0.05).Conclusion Early using low-dose glucocorticoid may restore hemodynamics more quickly,protects the organ function and improves the prognosis in the patients with septic shock.

Objective To investigate safety and efficiency of anti-coagulation therapy in patients with high-risk of bleeding and multiple organ dysfunction syndrome (MODS) during continuous veno-venous hemofiltration (CVVH). Meth-ods Forty patients with high-risk bleeding MODS during CVVH in our hospital were divided into heparin-free group (A group) and low-dose heparin group (B group). Blood coagulation function, platelets counts, blood urea nitrogen, serum creati-nine, PaO2/FIO2 and Apache Ⅱ scores in two groups were tracked before treatment and 24 h, 48 h after treatment. Filter lifespan, median ventilation time, ICU admission time and bleeding complications were observed. Results (1)There was significant difference in levels of blood urea nitrogen, serum creatinine, PaO2/FIO2 and ApacheⅡscores at 24 h, 48 h after treatment between in low-dose heparin group and those in heparin-free group (P＜0.05). (2)Levels of activated partial thromboplastin time(APTT), thrombin time (TT) were prolonged. Platelets count were significantly lower at 24 h after treat-ment than that before treatment in low-dose heparin group. Levels of APTT, TT and platelets count had no changes with pro-longed time of CVVH therapy.(3)Average ventilation time, ICU admission time were obviously shorter in low-dose heparin group than that in heparin-free group. Filter lifespan was significant longer in low-dose heparin group than that in heparin-free group, (P＜0.05).(4)Bleeding in skin and mucosa was observed in 1 case in low-dose heparin group without other se-vere bleeding complications. Conclusion The results of monocentric study show that low dose of heparin ensure smooth op-eration of CVVH in patients with MODS and high-risk bleeding. The clinical application is safe and efficient.

Objective To explore the interleukin (IL)-6,IL-10 and T cell subsets levels in bronchoalveolar lavage fluid(BALF) of children with refractory mycoplasma pneumonia.Methods A total of 53 children with refractory mycoplasma pneumonia were selected as the observation group,30 children with bronchial foreign body in our hospital were chosen as controls during the same period.ABC-double antibody sandwich ELISA method was used to detect IL-6,IL-10 levels and the CD3 +,CD4 + and CD8 + T levels were measured by means of flow cytometry in BALF.Results The IL-6 and IL-10 levels in BALF of children in the observation group were (63.25 ± 18.61) ng/ml,(31.83 ± 8.33) ng/ml respectively,and they were significantly higher than those of the controls[(30.51 ± 1.34) ng/ml,(11.01 ± 2.91) ng/ml] (P ＜ 0.05,respectively).The percentage of CD3 +,CD4 +,CD8 + T cells and the ratio of CD4 +/CD8 + T cells in BALF of the observation group were (48.47 ± 2.88)％,(21.16 ± 6.29)％,(23.04 ± 4.63)％,0.94 ± 0.33,respectively,and they were significantly lower than those of the controls [(64.24 ± 3.06) ％,(34.34 ± 7.59) ％,(26.71 ±5.29)％,1.56-±0.67] (P＜0.05,respectively).Conclusion The IL-6,IL-10 levels in BALF of children with refractory mycoplasma pneumonia significantly increased,suggesting that cell-mediated immunity play an important role in the pathogenesis of refractory mycoplasma pneumonia.

Objective:To explore the application of real-time transrectal ultrasound (TRUS) during seminal vesiculoscopy in infertile men with azoospermia or oligoasthenospermia.Methods:We retrospectively analyzed the clinical data of 25 cases of azoospermia or oligoasthenospermia due to ejaculate ducts obstruction who were treated with real-time transrectal ultrasound-guided seminal vesiculoscopy between September 2011 and December 2015. Patients’ age was(29.4±4.5) years. All patients accepted semen analysis, serum sex hormone, MRI, TRUS and then diagnosed as obstructive azoospermia, and 13 cases had intractable obstructive azoospermia or oligoasthenospermia after the failure of simple seminal vesiculoscopy(the path to the ejaculatory duct and seminal vesicle couldn’t be found). All patients were treated with seminal vesiculoscopy under real-time guidance with TRUS. We assessed the success rate of surgery, surgical time and complications.Results:The scope was successfully inserted into the seminal vesicle in 21 of the 25 cases (success rate, 84%). The median operative time was 75(31, 148) min. None of the patients developed severe complications. Among 4 failure cases (4/25, 16%), 1 was due to abnormal congenital development. In 2 cases, a clear outlet of the dual ejaculatory duct could not be found after it was inserted into the prostatic utricle. One case was considered as a Müllerian tubular cyst, and the seminal vesicle scope was used to assess the cystic side wall. The 21 patients were followed up for 3 to 6 months, semen volume 2.0(0-5.2)ml, total sperm 28(0-832) ×10 6/ejaculate, sperm density 5.6(0-110.3)×10 6/ml, mobility rate of sperm 5.4%(0-63.6%), and the differences were significant as compared to that before the surgery [semen volume 0.4(0-2.8)ml, total sperm 0(0-342)×10 6/ejaculate, sperm density 0(0-90.7)×10 6/ml, mobility rate of sperm 0(0-24.1%), all P<0.05]. Among the 17 patients who underwent follow-up of 5 to 9 years, 3 patients was conceived naturally and 9 patients’ postoperative sperm quality has improved and pregnancy in vitro fertilization by extracting sperm from semen. Conclusions:Intraoperative real-time transrectal ultrasound guidance can improved the success rate of seminal vesiculoscopy and promoted operative safety.

Objective: o study the effect of cleaning treatment with hydrofluoric acid (HF) on the surface and bonding strength of IPS e.max and Vita Mark II ceramic inlays. Methods: Fifty pieces of IPS e.max and Vita Mark II ceramic inlay specimens were made separately using CAD/CAM. After uniformly bonding surfaces using 9% HF etching, they were randomly divided into an untreated control group (group A) and the following experimental groups: neutralizing powder (B group), 37% phosphoric acid (group C), ultrasonic cleaning (group D) and neutralizing powder + 37% phosphoric acid + ultrasonic cleaning (group E). Each set of 8 specimens was bonded to Variolink N resin adhesive under standard conditions. The shear adhesive strength was measured after exposure to a constant-temperature water bath at 37 ℃ for 24 h. The location of the fracture and the type of adhesion failure were recorded. The shear adhesion and the average strength of the connection were analyzed. The remaining 2 specimens were used for scanning electron microscopy (SEM) to observe the surface morphology, including the crystal structure, pore pattern, and residue. Results : The results were similar for the IPS e.max and Vita Mark II inlays. The maximum bond strength was observed in the IPS e.max ceramic inlays in group E, with an average bond strength 11.96 MPa higher than that in group A. Among the Vita Mark II porcelain inlays, the maximum bond strength was observed in group E. The average bond strength was 9.74 MPa higher than that in group A. The results of the statistical analysis were similar for the IPS e.max and Vita Mark II porcelain inlays, with significant differences in the bond strengths between groups C, D, and E and the control group (P < 0.05). There was no significant difference in the adhesive strength between groups B and A. At the same time, there was no significant difference in the bond strength between the treatment groups B, C, D, and E (P > 0.05). SEM revealed that the pores on the surface of ceramics subjected to the acid etching treatment were broadened and uniform, with less residue than observed in the control group. The effects of treatments D and E were the best. Conclusion The HF etching treatment can enhance the bonding strength of IPS e.max and Vita Mark Ⅱ ceramic inlays while leaving little residue, and the joint strength is highest when the joints are treated together.

Objective: To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease. Methods: The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed. The patients were all female, aged 19 to 70 years. Among them, 2 patients presented with lumbago on the right side, and the other one was diagnosed by physical examination. The body mass index ranged from 18.4 to 24.6 kg/m^2, with a median value of 20.4 kg/m². According to the American Society of Anesthesiologists (ASA), they were classified as grade Ⅱ. Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients, all of which showed hyperechoic solid mass in the right kidney. Color doppler ultrasound of IVC showed hyperechoic band in the IVC, indicating blood flow signals and the tumor thrombus. All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT. Two of them received MRI examination of IVC, which showed irregular lesions in the right kidney, short T1 and long T2 signals, low lipids, and no definite limited diffusion on DWI. Irregular fat signal were seen in the right renal vein and inferior vena cava. All 3 patients were diagnosed with right renal mass with IVC tumor thrombus, with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo gradeⅡtumor thrombus. One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy, another one underwent open right partial nephrectomy and tumor thrombectomy, and the third one suffered preoperative AML rupture, undergoing open radical nephrectomy and tumor thrombectomy. Results: The operation time was 168 to 659 min, with median of 220 min. Intraoperative blood loss ranged from 50 to 300 ml, with the median of 50 ml. Postoperative indwelling time of drainage tube was 5 to 11 days, with the median of 6 days. Postoperative hospital stay ranged from 7 to 14 days, with a median of 8 days. Postoperative follow-up ranged from 12 to 16 months, with a median follow-up of 13 months. All the three patients underwent operation without postoperative complications. Postoperative pathology proved to be right renal angiomyolipoma. After 3 months of follow-up, the patients showed no tumor recurrence or metastasis. Conclusions Renal AML is a benign lesion, which is rarely concurrent with inferior vena cava cancer thrombus. Enhanced CT examination is the main diagnostic method, surgical resection of the lesion is the preferred treatment, partial nephrectomy combined with thrombectomy can be performed in patients with AML, if permitted, and postoperative prognosis turns out to be propitious.