Objective To analyze and compare the effect of early surgical treatment and nonsurgical treatment for patients with severe acute pancreatitis.Methods Acccording to the including criteria,five randomized controlled trials of this topic were enrolled into the analysis.The detail about the trial design,characters of the subjects,results of the studies were reviewed and analysed by using Revman 4.2 software.Results Compared with nonsurgical treatment,early surgical treatment was associated with a significantly higher(incidence) of mortality(RR 3.42,95% CI 1.81～6.47,P=0.0002) and complications(RR 3.16,95% CI 2.15～4.64,P

Combined Modality Therapy ; Female ; Genital Neoplasms, Female ; radiotherapy ; surgery ; Gynecology ; education ; trends ; Humans ; Medical Oncology ; education ; trends

Adenocarcinoma, Clear Cell ; pathology ; Female ; Humans ; Middle Aged ; Ovarian Neoplasms ; pathology

BACKGROUND: There are disputes concerning limb salvage and reconstruction in treating pelvis malignant tumor.OBJECTIVE: To study the surgical treatment following resection of tumor at acetabular region in order to restore pelvic stability with less damage or recurrence.METHODS: Thirty-three patients diagnosed with pelvic tumor at Department of Orthopaedics, First Affiliated Hospital of Second Military Medical University from April 2002 to June 2008 were selected. All patients were received tumor resection and computer-aided prosthetic replacement, 18 patients (8 cases with chondrosarcoma, 2 cases with Ewing sarcoma, 2 cases with osteosarcoma, and 6 cases with malignant fibrous histiocytoma) were combined with antitumor drug treatment. Functional assessment of therapeutic efficacy was divided into 4 levels: excellent, good, moderate, and inferior.RESULTS AND CONCLUSION: Two patients died at months 4 and 6 after prosthetic replacement; 31 cases were followed-up for 8-32 months, mean 12.5 months. Seven cases were recurred chondrosarcoma, the recovery of other patients were as follow: 18 cases were excellent, 4 cases were good, 2 cases were moderate and no case was inferior. Most of limb function and pelvic stability was preserved. The results suggested that malignant fibrous histiocytoma and Ewing sarcoma can receive a high rate of limb preservation if treated by effective chemotherapy with low recurrence; the recurrence of chondrosarcoma was high. Tumor resection combined with computer-aided prosthetic replacement can maximatily reserve limb function and raise life quality.

Objective To explore the relationship between the levels of plasma coagulation factors (F) and acute myocardial infarction (AMI) in low age period (<60 years old) and their diagnostic value in diagnosing AMI in low age period.Methods One hundred and sixty inpatients with low age AMI in the cardiology department of the Heze Municipal Hospital were selected as the case group,and contemporaneous 160 cases of low age non-AMI served as the control group.F Ⅱ,FⅦ,FⅧ,fibrinogen (Fg) and von willebrand (vWF) were measured with enzyme-linked immunoabsorbent anti-sandwich assay.The relationship between coagulation factors and low age AMI was analyzed with univariate and multivariate analysis,and their value for diagnosing low age AMI was evaluated with diagnostic test and receiver operating characteristics (ROC) curve.Results The univariate analysis showed that FⅡ,FⅦ,FⅧ and Fg levels had significantly statistical difference between the case group and control group(P<0.05),and the vWF level had no statistically difference(P>0.05).The multivariate analysis indicated that the FⅡ level≥ 14.27 μg/L and FⅦ level ≥22.99 μg/L were the independent risk factors for low age AMI.The value of FⅡ for diagnosing low age AMI was lower,and the optimal cut off value of Fg for diagnosing low age AMI was 22.99 μg/L,its area under ROC curve was 0.709 with a moderate diagnostic value,and the sensitivity (91.88%) and negative predictive value (86.02%) were higher,the false negative rate (13.98%) was lower,and the accuracy (70.94%) was moderate.Conclusion The FⅡ level ≥14.27 μg/L and Fg level ≥22.99 μg/L are the independent risk factors for low age AMI,and detecting the Fg level could have hint significance in diagnosing low age AMI.

Objective To investigate the expression and clinicopathological significance of CXCR4 and HIF-1α protein in esophageal squamous cell carcinoma tissue and explore their correlation.Methods The expression of CXCR4 and HIF-1α protein were assessed by immunohistochemistry SP method in 56 cases with esophageal squamous cell carcinoma and in 20 cases with surrounded normal tissue.Results The expressions of CXCR4 and HIF-lα in esophageal squamous cell carcinoma were significantly higher than those in normal tissues[62.50 ％ (35/56) vs 10.00 ％ (2/20); 57.14 ％ (32/56) vs 0(0/20)](x2=16.259,19.740,P ＜0.01).The expression of CXCR4 and HIF-1α were both correlated with invasion depth (x2 =4.736,7.665,P ＜0.05) and lymph node metastasis ( x2 =7.207,6.389,P ＜0.05),and had no correlation with cancer cell differentiation.The expressions of CXCR4 and HIF-lα in esophageal squamous cell carcinoma were positively correlated (r =0.298,P ＜0.05).Conclusion CXCR4 and HIF-1α are highly expressed in esophageal squamous cell carcinoma.The two have a close relation to esophageal squamous cell carcinoma growth,invasion and metastasis.

OBJECTIVETo evaluate effectiveness therapeutic regimens for obstructive sleep apnea hypopnea syndrome (OSAHS) children at an acceptable cost.

METHODThis study was performed at Yuying Children's Hospital of Wenzhou Medical University from Mar. 2008 to Dec. 2010. Prospective random number table method was used for the analysis; 60 children with mild OSAHS were divided into Mild OSAHS Montelukast Treatment (MM) group and Mild OSAHS Adenotonsillectomy Treatment (MAT) group. 32 children in MM group were treated with leukotriene receptor antagonists (LTRAs), while 28 children in MAT group were treated with adenotonsillectomy. Also, 58 children with moderate and severe OSAHS were divided into severe OSAHS Montelukast Treatment (SM) group and severe OSAHS Adenotonsillectomy Treatmen (SAT) group. Twenty-two children in SM group were treated with LTRAs, while 36 children in SAT group were treated with adenotonsillectomy. All selected children were evaluated by polysomnography (PSG) and Obstructive Sleep Apnea-18 (OSA-18) items before and after a six-month treatment. Both records were taken and analyzed, surgical complications and the reason for non-remission after operation were also analyzed. Two therapies were compared based on economic consideration and therapeutic effect. Result (1) PSG: A significant change of a significant change of Apnea Hypopnea Index (AHI) was observed in MM group after the treatment (before receiving the treatment 4.56 ± 1. 26, and after receiving the treatment 3. 48 ± 1. 52, t =3. 50, P <0. 05). But for oxygen desaturation Index (ODI) (MM group 2. 18 ± 2. 19, and MAT group 1. 80 ± 2. 34) and Lowest Oxygen satuation (LSaO2) (MM group 91. 66 ± 2. 34, and MAT group 92. 79 ± 2. 18), there was no significant difference in MM group and MAT group after the treatment (ODI, t =0. 65, and LSaO2 t = - 1. 93, P >0. 05). (2) OSA-18 scores: Significant differences were found in sleeping disorder (before 14. 81 ± 6. 28, and after 10. 56 ± 3. 57), the degree of familial stress (before 13. 56 ± 3. 54, and after 8. 97 ± 2. 96), and OSA-18 total scores (before 52. 66 ± 1. 11, and after 42. 56 6. 48) in MM group after the treatment (sleeping disorder Z - 3. 14, the degree of familial stress Z = -4. 50, and OSA-18 total scores Z= -4. 01, P <0. 05). (3) In addition to the cost of drugs, groups with surgical treatment had a larger economic burden than those with LTRAs treatment. (4) Treatment was totally effective for 28 children (88%) in MM group, and 28 children (100%) in MAT group. Meanwhile, treatment also achieved an obvious effect on 2 children (9%) in SM group, and in 35 children (97%) in SAT group. In MAT group, 3 children improved (11%). And in SAT group, 7 children improved (19%), but treatment was found to be ineffective in 1 case (3%). Among those effective and ineffective cases in groups with surgical treatment, there were 9 children with nasal diseases.

CONCLUSION(1) Surgical treatment is recommended as the first choice for children with moderate and severe OSAHS. And for those who also suffer from nasal diseases, treatment combining drugs with surgery is necessary. (2) LTRAs therapy has a good effect for mild OSAHS. Surgery is also recommended when drugs could not achieve any obvious improvement in clinical symptoms of children with mild OSAHS.

Adenoidectomy ; Blood Gas Analysis ; Child ; Cost of Illness ; Humans ; Oxygen ; Polysomnography ; Prospective Studies ; Sleep Apnea, Obstructive ; surgery ; Sleep Wake Disorders ; Tonsillectomy ; Treatment Outcome

Objective: To summarize the methods of preventing and managing the complications in thoracoscopic lobectomy. Methods:The participants of this study included 317 patients undergoing lobectomy with video-assisted thoracoscopic surgery in the Department of Thoracic Surgery between January 2007 and December 2012. Intra-operative complications were observed, and countermeasures were summarized. Results: Complications occurred 28 times (8.8%), including bleeding in 16 cases because of accidental vascular injury (5.0%), accidental injury/break of bronchus in two cases (0.6%), vascular stump errhysis from cutting stapler in four cases (1.3%), lung stump air leakage in three cases (0.9%), lung injury in two cases (0.6%), and diaphragmatic injury in one case (0.3%). Conversion to thoracotomy was conducted in 17 cases, with a conversion rate of 5.4%. Thoracoscopic repair operation was performed in 14 cases that exhibited bleeding, with a success rate of 70% (14/20). No mortality was reported during the operation. Conclusion:Thoracoscopic lobectomy is a highly difficult method in thoracic surgeries. The procedure requires substantial attention on the timely prevention and correct management of intra-operative complications, particularly the injury and bleeding of major vessels, to reduce the rate of conversion to thoracotomy and the incidence of post-operative complications, as well as to promote the surgery in clinics.

Objective To analyze the changes of the frequency of staphylococcus aureus (SAU) and methicillin resistant staphylococcus aureus (MRSA) isolated from hospitalized children from 2003 to 2006,and investigate the 21 antimicrobial susceptibility against SAU strains for providing reference for clinical rational use of drug.Methods The SAU strains were isolated from 207 children who were hospitalized in department of pediatrics of the sixth people′s hospital affiliated to Shanghai jiaotong university from Jan.2003 to Dec.2006 during the first 48 h of hospital stay.Strains were isolated from cotton-tipped swab of throat culture 75 strains,sputum culture 57 strains,secretion of bellybutton culture 25 strains,liquor puris culture 23 strains,hemoculture 20 strains,tube thoracostomy culture 3 strains,middle piece urnary culture 3 strains,cerebrospinal fluid culture 1 strain.The strains were identified by latex agglutination test,the in vitro activities of the 21 antimicrobial agents against 207 SAU isolates was tested by disc diffusion test (K-B method) according to the guidelines of the clinical and laboratory standards institute.MRSA was screened by oxacillin disc diffusion test.The data were analyzed by WHONET 5 software,Cochran-Mantel-Haenszel was used to analyze the tendency of SAU isolating rate and MRSA detectable rate.Results Of these SAU,30 strains(14.5 %) isolates were MRSA and 177 strains(85.5 %) were methicillin sensitive staphylococcus aureus.The sensitive rates of SAU to Penicilin,Oxacillin,Cefuroxime Sodium,Cefotaxime,Ceftriaxone,Erythromycin,Clindamycin,Trimethoprim/Sulfamethoxazole,Ciprofloxacin,Fosfomycin and Rifampin were 4.8%,85.5%,84.9%,90.0%,88.3%,37.5%,46.3%,92.7%,74.2%,97.2%,94.0%,respectively.All the strains were sensitive to peptide antibiotic(for instance,vacomycin and teicoplanin) and Levofloxacin.The SAU isolated rate and MRSA detectable rate were 9.6%,19.8%,25.0%,39.5% and 5.0%,5.9%,12.7%,24.7% in 2003-2006,respectively.Conclusions SAU has strong resis-tance to Penicilin and Erythromycin,but relative sensitive to Oxacillin and Cephalosporin.The SAU isolatating rate and MRSA resistant rate is increased in our area,pediatrics should to strengthen the monitoring of SAU is important in pediatrics.

Objective To investigate the effects of family allergic history and dermatophagoides farina on the expressions of Th1/Th2 cytokine of cord blood and allergic disorders in infancy.Methods Ten mil cord blood were obtained from 34 neonates which 17 cases had family allergic history and 17 cases didn′t have.Cord blood mononuclear cells(CBMC) were isolated by gradient centrifugation with Ficoll and were cultured with phytohemagglutinin(PHA) or dermatophagoides farina for 48 hours in vitro.The expressions of interleukin(IL-4) and interferon(IFN-?) of the culture supernatant were detected by enzyme-linked immunosorbent assay(ELISA).Two groups were visited with telephone or clinical service every 1 or 2 months in 1 year follow-up survey.Results In no stimulation,the expressions of IL-4 of family allergic history and no family allergic history were(11.35?1.80) ng/L and(11.0?1.50) ng/L,respectively,there was no significant difference.The expressions of IFN-? were(9.55?1.47) ng/L and(10.19?1.37) ng/L,respectively,there was no significant difference also.In PHA stimulation,the expressions of IL-4 were(43.45?4.57) ng/L and(37.58?3.41) ng/L,respectively,there was significant difference.The expressions of IFN-? were(72.61?25.40) ng/L and(65.84?29.96) ng/L,respectively,there was no significant diffe-rence.In low density dermatophagoides farina stimulation,the expressions of IL-4 were(40.54?3.64) ng/L and(37.17?2.60) ng/L,respectively,which had significant difference.The expressions of IFN-? were(35.30?2.73) ng/L and(40.55?1.85) ng/L,respectively,which had significant difference.In high density dermatophagoides farina stimulation,the expressions of IL-4 were(43.50?3.19) ng/L and(39.55?4.13) ng/L,respectively,which had significant difference.The expressions of IFN-? were(39.40 ?5.21) ng/L and(40.94?2.96) ng/L respectively,which had no significant difference.Allergic diseases were happened in 7 cases of 13 cases with family allergic history and in 2 cases of 15 cases without family allergic history in 1 year follow-up except lost follow-up cases.There were significant difference in 2 groups.Conclusions Th2 cells of cord blood are relative dominant in neonates having family allergic history.Th2 cells relative dominant are more obvious in dermatophagoides farina stimulation.The neonates having family allergic history have a tendency to get allergic diseases in childhood.