Objective To explore the therapeutic efficacy of modified Taohong Siwu Decoctio n(TSD) combined with limited internal fixation and external fixation for the treatment of tibial plateau fracture of Schatzker type Ⅴand Ⅵ. M ethods A total of 31 cases of tibial plateau fractures of Schatzker type Ⅴ and Ⅵ treated with TSD orally combined with limited internal fixation and external fixation were enrolled into the study. Follow-up was carried out for the evaluation of therapeutic effect and postoperative complications. Results All of the cases received follow-up for 6 months to 3 years. According to Merchant scoring criteria, the therapeutic effect was excellent for 15 cases, good for 12 cases, acceptable for 3 cases and inferior for one case, with the excellent and good rate being 87.1%. One case had pin tract infection, and then was cured after symptomatic treatment. Conclusion For tibial plateau fracture of Schatzker typeⅤandⅥwith unsatisfactory skin state, we can perform limited internal fixation and external fixation to take the place of strong steel plate fixation with extensive exposure for surgical treatment, and then give postoperative oral use of TSD, which will be a safe and effective therapy for the fracture by promoting the relief of the clinical symptoms and signs of early fracture.

Objective To compare the efficacy and safety between local injection of triamcinolone and oral methylprednisolone in preventing esophageal stricture formation after endoscopic submucosal dissection (ESD) in patients with early esophageal cancer.Methods From January 2014 to January 2016,67 patients with early esophageal cancer were enrolled,all of them received ESD and were divided into triamcinolone injection group (22 cases),oral methylprednisolone group (22 cases) and control group (23 cases).Patients of triamcinolone group received injection of triamcinolone at injured mucosal under endoscope immediately after ESD.Patients of oral methylprednisolone group took methylprednisolone 30 mg per day since the third day after ESD,and then dosage reduced 5 mg every other week until drug withdrawal.Patients of control group only received ESD.After operation,gastroendoscopy examination was repeated to evaluate the extent of esophageal stricture.Patients with esophageal stricture were treated with an additional endoscopic balloon dilatation (EBD).The rate of esophageal stricture and the frequency of EBD treatment of the three groups were compared.Chi-square test,Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used for statistical analysis.Results The rates of esophageal stricture of triamcinolone injection group,oral methylprednisolone group and control group were 18.2％ (4/22),13.6％0 (3/22) and 73.9％ (17/23),respectively,and the difference was statistically significant (x2 =22.20,P＜0.01).There was no significant difference in the rates of esophageal stricture between triamcinolone injection group and oral methylprednisolone group (x2 =0.17,P=0.50),but the rate of esophageal stricture in triamcinolone injection group was lower than control group,and the difference was statistically significant (x2 =14.03,P＜0.01);the rate of esophageal stricture in oral rnethylprednisolone group was lower than control group,and the difference was also statistically significant (x2 =16.55,P＜0.01).The median frequency of EBD treatment of triamcinolone injection group,oral methylprednisolone group and control group were 2.1 (range 0 to 4.0),1.6 (range 0 to 3.0) and 6.0 (range 0 to 13.0) times,respectively,and the difference was statistically significant (H =17.80,P ＜ 0.01).There was nosignificant difference in the frequency of EBD treatment between triamcinolone injection group and oralmethylprednisolone group (Z=1.21,P=0.23);but the frequency of EBD treatment in triamcinolone injection group was less than control group,and the difference was statistically significant (Z=4.96,P＜ 0.01);the frequency of EBD treatment in oral methylprednisolone group was less than control group,and the difference was also statistically significant (Z=4.32,P＜0.01).There was no severe adverse effect in the three groups.Conclusions Local injections of triamcinolone and oral methylprednisolone both reduced the rate of esophageal stricture after ESD,and decreased frequency of EBD treatment in patients with esophageal stricture.The two regimens showed equal efficacy and good safety.

Objective To study the expressions of survivin and PTEN in ampullary carcinoma and their clinical significance.Methods The expressions of Survivin and PTEN proteins were tested by EnVision immunohistochemistry in 40 cases of ampullary carcinomas and 8 cases of normal ampulla of vater as control.Results The positive rate of Survivin in ampullary carcinomas was significantly higher than normal human controls (82.5％ vs 0％,P ＜ 0.01 ).The differences of the expression of Survivin in ampullaty carcinoma of duodenal invasion,pancreatic invasion,and lymph node metastasis were significant ( P ＜0.05 ).Significant differences were also observed in the expression rate of PTEN hetween the patients with ampullary carcinoma and the normal controls (50％ vs 100％,P ＜ 0.01 ).The differences of the expression of PTEN in ampullary carcinoma of duodenal invasion,pancreatic invasion,and lymph node metastasis were significant ( P ＜ 0.05 ).Significantly negative correlation was found between the expression of Survivin and PTEN by using spearman correlation analysis ( r =-0.57,P ＜ 0.01 ).Conclusions The abnormal expression of Survivin and PTEN gene may promote tumor genesis and progression of ampullary carcinomas and it may be used as the marker for prognosis.

A 53-year-old male patient was admitted to the hospital on March 26, 2006. Ten years prior to the presentation, a small furuncle developed on the dorsum of his right hand, and subsided after 2-week treatment with erythromycin ointment; one month later, a broadbean-sized cutaneous ulcer developed on the dorsum of the same hand. After anti-infective treatment, the ulcer healed while the lesional skin thickened, and long-term topical treatment with compound dexamethasone acetate cream showed no obvious effect Dermatological examination revealed an irregular verrucous plaque measuring 2.5 cm × 4 cm with little exudation on the dorsum of the right hand. KOH preparation of the skin lesion revealed brown spores. Sabouraud's dextrose agar culture grew restricted, velvety and dark green colony, and microscopy revealed branched, globular conidiophores generated by cladospores. DNA sequencing showed that the isolate was different from Cladosporium sphaerospermum (AB100654) by 2 bases in the sequence of D1/D2 region of 26S rDNA, from Cladosporium sphaerospermum (AY625063) by 5 bases in the sequence of internal transcribed spacer 1 and 2 (ITS 1 and ITS 2), but fully consistent with Cladosporium sphaerospermum (AM 176719) in the sequence of ITS region. The isolate was identified as Cladosporium sphaerospermum. Hematoxylin-eosin stain of the lesional tissue revealed granulomatous changes,and PAS stain demonstrated brown spores. A diagnosis of phaeohyphomycosis was made. Antifungal susceptibility testing indicated that the isolate was highly sensitive to itraconazole. The lesion obviously subsided after treatment with oral itraconazole 0.2 g once daily for 8 weeks, but the patient was lost to follow up 2 months later.

Esophagus ; pathology ; Foreign Bodies ; Hoarseness ; diagnosis ; Humans

Bismuth quadruple therapy is recommended as a first-line therapeutic regimen for Helicobacter pylori (Hp) infection in China.However, the renal toxicity induced by bismuth resulted in limitation of its clinical use.Aims: To assess the efficacy and safety of hybrid therapy for initial eradication of Hp infection.Methods: One hundred and fifty-two patients proved to be positive for Hp infection and treatment-na(i)ve at the Fuzhou General Hospital of Nanjing Military Command of Chinese PLA from Jan.2014 to Dec.2015 were enrolled and randomized to receive either hybrid therapy (esomeprazole and amoxicillin for 7 days, followed by esomeprazole, amoxicillin, clarithromycin and metronidazole for 7 days) or bismuth quadruple therapy (esomeprazole, amoxicillin, clarithromycin and colloidal bismuth pectin for 14 days).Hp eradication was assessed by 14C/13C-urea breath test at a minimum of 4 weeks after the end of treatment.Results: No significant differences were found in general status between the two groups at baseline (P>0.05).A total of 149 patients completed the therapy.In hybrid therapy group the eradication rate was 97.4% (75/77) by ITT analysis and 98.7% (75/76) by PP analysis;while in bismuth quadruple therapy group the eradication rates by ITT and PP analyses were 89.3% (67/75) and 91.8% (67/73), respectively.Hybrid therapy was superior to bismuth quadruple therapy (P all <0.05).Although the incidence of adverse events was higher in hybrid therapy group than in bismuth quadruple therapy group (29.9% vs.16.0%, P<0.05), none of the patients discontinued the therapy because of severe adverse events.Conclusions: Hybrid therapy showed better efficacy than bismuth quadruple therapy for treatment of Hp infection, and the adverse events were well tolerated.Hybrid therapy might be used as first-line treatment for Hp infection.

Objective To compare the clinical effect of two-person operations of disposable circumcision stitching instrument and one-man operations of disposable circumcision stitching instrument.Methods Clinical data of 340 patients with redundant prepuce or phimosis from March 2015 to August 2017 were randomly divided into control group which patients with two-person operation of disposable circumcision stitching instrument and study group which patients with one-man operation of disposable circumcision stitching instrument were reviewed prospectively.There were 188 patients in the study group,including 22 patients with phimosis and 166 patients with redundant prepuce;Among the 152 patients in the control group,there were 17 cases with phimosis and 135 cases with redundant prepuce.Two groups with operation time,intraoperative blood loss,postoperative skin staple missing,2 hours postoperative pain,postoperative edema,the swelling subsided time,postoperative complications,postoperative patient satisfaction,and so on.Measurement data were represented as (x) ± s,and comparison between groups was analyzed using t test;count data were represented as percentage and comparison between groups was analyzed chi-square.Results All operations were finished successfully for the patients by two-person or one-man of operations of disposable circumcision stitching instrument.In terms of operation,the operation time of the observation group and the control group was (7.76 ±0.45) minutes and (7.86 ±0.91) minutes respectively,and the difference was not statistically significant(P ＞ 0.05).Intraoperative hemorrhage of observation group and control group were (1.77 ± 0.22) ml and (1.72 ± 0.26) ml,and the difference was not statistically significant (P ＞ 0.05).There was no statistically significant difference between the observation group and the control group (P ＞ 0.05) in the postoperative 2 hours pain score and skin staple missing.In the postoperative complications,the deviation rate of the prepuce was 1.11％,significantly lower than the control group 5.92％,and the difference was statistically significant (P ＜ 0.05).There was no statistically significant difference between the observation group and the control group in terms of edema on the third postoperative day,short postoperative anastomosis,patient satisfaction,and postoperative infection.Conclusion The way of one-man operation of disposable circumcision stitching instrumente not only saves labor costs,but also has a good postoperative clinical effect,meanwhile,it has high efficiency and strong operability,and is worthy of promotion for clinical first-line urologists.

Objective: To investigate the clinical value of gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery on patients with cholecystolithiasis. Methods: A retrospective study was performed on data of 15 patients with cholecystolithiasis, who underwent gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery from April 2018 to July 2018. The operative data, including situation of operation, operative time, intraoperative hemorrhage, and postoperative complications were recorded. Results: The procedure was performed successfully in all patients with a mean operative time of 108±12 min (ranged from 92-129 min). The intraoperative hemorrhage was 10-30 mL. Eight patients suffered from slight right upper abdominal pain, and 7 patients felt slight pain in umbilical a week after surgery. No fever, incision infection, umbilical hemia, peritonitis, and ascites were reported. The clear-liquid diet was recommended for one day after operation, and postoperative activity was allowed since the second day after operation. All patients were discharged on the fourth or fifth day, and all recovered to their normal life at one week after discharge. Follow-up showed that the scar was small and hidden in umbilical without visible incision after one month. Ultrasonic examination results showed that gallbladder contractile function worked perfectly in four patients and no gallbladder stone was found after three months. Conclusion Gallbladder-preserving cholelithotomy by natural orifice transumbilical endoscopic surgery is a safe and effective option for patients with cholecystolithiasis, provides excellent cosmetic outcomes, and can be appropriately carried out under the strict control of surgical indications.

Objective To discuss effects of different injection methods of nanocarbon tracer on gastrectomy for patients with gastric cancer. Methods Patients, who underwent D2 gastrectomy in Fuzhou General Hospital from January 2014 to December 2015, were randomly divided into group A and group B. The patients in group A were injected with nanocarbon into gastric submucosa of peripheral area of tumor under gastroscope 24 hours before operation. The patients in group B were injected with normal saline firstly, and then injected with nanocarbon. The operations were performed by 5 high qualification physicians and 3 low qualification physicians. The detection of lymph nodes and black stain nodes,detection time,and lymph node metastatic rate were compared between the two groups.Results A total of 248 patients were enrolled in this study,and each group had 124 cases. There was no statistical difference on basic characteristics between the two groups(P>0.05). A total of 2 975 and 3 855 lymph nodes were detected in group A and group B, respectively. The mean number of detected lymph nodes in group A was significantly lower than that of group B(23.9±7.9 VS 31.1±3.6, P=0.00). The rate of black stain nodes in group A was significantly lower than that of group B[71.3%(2 121/2 975)VS 78.1%(3 011/3 855), P= 0.00].There were no statistical differences on lymph node detection time(24.3±5.7 min VS 23.5±6.2 min), tiny lymph node detection rate(33.1% VS 34.9%),and lymph node metastatic rate(27.3% VS 25.8%)between the two groups(P>0.05).In subgroup of low qualification physicians, the number of lymph nodes(16.9± 4.0 VS 30.1±3.7)and the rate of black stain nodes(61.3% VS 77.2%)in group A were significantly lower than those of group B(P<0.05). The corresponding indicators(31.1±3.3 VS 31.5±3.5,76.8% VS 79.0%) had no statistical differences in the subgroup of high qualification physicians(P>0.05). Conclusion For low qualification physicians, injection of normal saline then of nanocarbon into gastric submucosa under gastroscope could improve lymph node and black stain nodes detection rate for patients with gastric cancer on gastrectomy.