Objective To analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods From December 1995 to January 2003, we operated on 33 patients aging from 8 to 16 years (average 12.2 years) with diagnosis of primary malignant bone tumor of the extremities with preserving the epiphysis in the limb salvage surgery. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing sarcomas, 2 chondrosarcomas, and 2 invasive osteoblastomas. The tumors were staged clinically, 2 cases inⅠA, 2 cases inⅠB, 17 cases in ⅡA, and 12 cases inⅡB. According to the relationship between the tumor and epiphyseal plate, the metaphyseal tumors in children were classified into 3 types: 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. Serious bone defects after tumor resections were repaired with massive allograft bone transplantation, followed by internal fixation by intramedullary nails and cancellous screws. Results Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clinical data. Postoperative follow-up was 12-72 months (average 37.6 months). Recurrences were seen in 3 cases, with one local recurrence in type Ⅲ case one year after tumor resection, other 2 recurrences around the femoral vessels in typeⅡcases 15 and 30 months after the tumor resection respectively. The recurrence rate accounted for 10.3%. Amputation was performed for the cases with recurrences. But pulmonary metastasis developed and the patients died. In this cohort, 9 cases died. Five-year survival rate was 57.9%. 4 cases reported 5 complications (17.2%). No patient reported skin necrosis, hematoma, infection, rejection to the allograft, and nonunion at the end of the follow-up. According to the functional evaluation criteria of Enneking, excellent were 11 cases, good 13 cases, fair 3 cases, and poor 2 cases. The excellent or good rate was 82.8%. Conclusion The limb salvage surgery with preservation of epiphysis for malignant bone tumors in children and adolescents guarantees the patient's satisfactory postoperative limb functional results. Preoperative effective adjuvant chemotherapy and prevention of postoperative complications deserve great attention.

Objective To investigate the effects of transcranial electrotherapy stimulation (TES)on patients with generalized anxiety disorder (GAD). MethodsA total of 62 patients with GAD were randomly divided into two groups,the study group (treated with TES and venlafaxine) and the control group (treated with venlafaxine only).TES was administered 1 time per day for 14 days,while venlafaxine was administered with oral intake of 75-150mg/d for 4 weeks.The clinical effects were assessed by using Hamilton anxiety scale (HAMA).ResultsThere was no difference between the two groups in average HAMA total scores,psychic and somatic factor scores before the treatments (P ＞ 0.05).The effective rate of study group was significantly higher ( P ＜ 0.05 ) at the end of the 1 st week after treatment than,but similar at the end of the 2nd and 4th week after treatment (P ＞ 0.05 ) to that,of control group,with regard to HAMA total score and psychic factor score.With regard to the HAMA somatic factor score,the effective rate of study group was not significantly different from that of control group at the end of the 1st,2nd and 4th week after treatment (P ＞ 0.05).ConclusionTranscranial electric stimulation in conjunction with venlafaxine may improve the symptoms of anxiety of patients.

Objective To assess the effectiveness of carotid endarterectomy(CEA) in the surgical treatment of stenosis of carotid artery.Methods From December 2003 to June 2006,28 patients of carotid arteriosclerotic stenosis received CEA and vascular repair or plasty(VP).Before and after operation,the hemodynamic parameters including inner diameter of internal carotid canal,blood flow rate,blood flow and blood flow rate of middle cerebral artery of 28 patients were measured by color Doppler flow imaging(CDFI) and transcranial Doppler(TCD).Results The inner diameter of internal carotid canal in all patients recovered to normal range.Blood flow rate and blood flow after operation were improved.No postoperative complications occurred,and no aneurysms formed.Conclusion CEA is one of the effective ways to manage carotid stenosis and angioplasty can improve the long-term efficiency.

BACKGROUND: Hip arthroplasty is most effective method to treat hip diseases such as femoral head necrosis, osteoarthritis, hip dysplasia and femoral neck fracture in the elderly. Therefore, it is necessary to study the biomechanical behaviors of hip arthroplasty. OBJECTIVE: To simulate the contact stress and Von Mise stress values and distributions of trabecular acetabular cup and solid acetabular cup by finite element analysis method, and to predict its effects on prosthesis and hip joint. METHODS: Two hip joint component models with different structures, trabecular acetabular cup and solid acetabular cup were designed in 3-Matic Research 11.0 software. The well-designed models were imported to Hypermesh 14.0 software to divide meshes and assign material properties. Finite element analysis software Abaqus 6.13 was used to simulate the stress values and distributions of both models. RESULTS AND CONCLUSION: The results of this study showed that the stress of the trabecular acetabular cup was scattered and distributed widely. The solid acetabular cup is prone to stress concentration, and the stress distribution is concentrated near the point of stress. Compared with the solid acetabular cup and the trabecular acetabular cup, the latter has larger contact area of stress distribution and more uniform stress distribution, which can reduce the wear between hip prostheses and the risk of aseptic loosening of hip prostheses.

Objective To explore the clinical utilization value of regional blood flow fluorescence visualization in selective arterial clamping robotic partial nephrectomy.Methods 12 cases of robotic partial nephrectomy with indocyanine green-based regional blood flow fluorescence visualization selective arterial clamping between October 2016 and June 2017 by our team were retrospectively analyzed.There were 9 males and 3 females with age between 36-78 years,mean age(51.2 ± 11.0) years,BMI 20.1-36.2 kg/m2,mean of (25.6 ± 4.8) kg/m2,tumor diameter 2.0-5.1 cm,mean of(3.3 ± 0.9) cm,and R.E.N.A.L.score 4-10,mean(7.3 ± 2.0).Preoperative renal function status of eGFR (estimated glomerular filtration rate) was 82-133 ml/(min · 1.73 m2),mean (101.9 ± 13.7)ml/(min · 1.73 m2) and split ECT-GFR of 44.5-70.6 ml/min,mean of(53.8 ± 8.5) ml/min in operated kidney;48.2-71.1 ml/min,mean of(56.8 ±6.8) ml/min in contralateral kidney;in total,92.7-139.1 ml/min,mean of(109.8 ± 14.6)ml/min.Perioperative information including operative time,blood loss,warm ischemia time,surgical complications,pathologic outcomes and follow-up data of included patients were analyzed.Results All procedures were done smoothly without open or radical conversion,with operative time of 95-203 min,mean of (170.6 ±38.6)min,and estimated blood loss of 60-1 000 ml,mean of(178.3 ± 206.9)ml.According to the visualize uptake of fluorescence imaging perfusion area visualization after selective arterial clamping,1 case underwent unclamping robotic partial nephrectomy,1 case converted to main renal artery clamping with warm ischemia time of 18 min,10 cases performed via renal arterial branch clamping with an average ischemia time of (25.5 ± 10.5) (range 17-46)min,1 of which due to parenchymal bleeding obscuring visualization necessitated clamping of the main renal artery with 1000 ml blood loss,46 min of arterial branch occlusion and 16 min of main artery clamping.The average postoperative hospital stay was (5.8 ± 0.9) (range 5-8)days,and the duration of drainage was (3.5 ± 0.5) (range 3-4) days.No postoperative complications occurred.Postoperative pathology:all margins were all negative,11 cases of clear cell carcinoma,eosinophilic adenoma in 1 case.The average eGFR of 9 cases of renal arterial branch clamping was (94.5 ±22.5)(range 56-140)ml/(min · 1.73 m2) at discharge with a 5％ percentage decrease versus preoperative level.Among them,4 cases obtained with ECT-GFR data 1 month postoperatively had a mean of(37.6 ±13.2)(range 20.8-55.8) ml/min with 29％ percentage decrease on the surgical side,an average of (58.5 ± 6.9) (range 51.2-68.4) ml/min with 2％ compensatory increase of the contralateral side,and (98.7 ± 16.2) (range 79.3-124.3) ml/min in total with a 10.4％ overall decrease.Conclusions The visualization of blood flow imaging based on indocyanine green fluorescence can clearly and intuitively show the effect of branching arterial occlusion in robotic partial nephrectomy,guide the optimization of surgical resection strategy,and improve safety and clinical outcome.

Objective The aim of this study is to investigate the protective effect of inhibiting the open of mitochondrial permeability transition pore on neural stem cells. Methods In present study, four groups were set up, such as control, conditioned medium control group, Aβ1-42 group and CsA group. The levels of inflammatory mediators were detected by LiquiChip technique. The apoptotic rate of neural stem cells was detected by flow cytometry and the expression of caspase-3 was confirmed by western blotting. Results The levels of IL-6 and TNF-αwere 7.92 and 1.22 times higher than those in control group after Aβ1-42 acting on microglia for 96 h. After being exposed to inflammatory media, the apoptotic rate of neural stem cells reached 41.17%, these was significant increase compared to control (P<0.001);while the apoptotic rate were decrease significantly if the open of the mitochondrial permeability transition pore was inhibited. In the meantime, the activation of caspase-3 was reduced obviously. Conclution Inhibiting the open of mitochondrial permeability transition pore can markedly reduced the apoptotic rate of neural stem cells , and dramatically impaired the effect of inflammatory on the apoptosis of neural stem cells , suggesting that inhibiting the opening of the mitochondrial permeability transition pore have protective effect on neural stem cells.

Objective To evaluate the efficacy and safety of endoscopic submucosal excavation in the treatment of suhmucosal tumor.Methods From 2010 to 2013,a total of 108 cases of suhmucosal tumor detected by endoscopic,endoscopic ultrasonography and computed tomography (CT) scan,most of which grew toward the lumen,were treated by endoscopic suhmucosal excavation.After the lesions were completely excavated,pathological examination were performed.All the cases were followed up with endoscopic examination at one,three,six,12 and 24 months after operation.Results Among 108 cases of lesions,27 cases were located in esophagus,eight in cardia,59 in stomach,two in duodenum and 12 cases in rectum.The diameters of the lesions ranged from 0.5 to 5.5 cm (median 2.1 cm).Operation time was between 18 and 240 minutes (median 105 minutes).The endoscopic treatment was converted to laparoscopic operation in three cases because the submucosal tumors of gastric body growing towards outside the lumen,or adhesive to muscular layer tightly and or perforation too big to be sutured.Three cases of submucosal tumor of fundus were failed to excavate,the other 102 cases (94.44％) of lesions were completely removed.Perforation occurred in 19 cases (17.59％).The procedure was converted to laparoscopic operation in one case.Effective endoscopic suture was complered in 18 cases.The volume of haemorrhage during operation was about 0 to 50 mL and no post-operational bleeding was found.Eight cases had cervical subcutaneous emphysema.Nine cases had pneumoperitoneum.Left parotid gland swollen was found in one case.Nine cases were lost to follow up.The left 99 cases were followed up for one to 24 months and no recurrence.Conclusion ndoscopic submucosal excavation safety and effectively achieve once complete removed of the big submucosal tumor which grows towards inside the lumen,and provide complete pathologic data.

Objective To evaluate surgical approach,safety and efficacy of endoscopic submucosal excavation (ESE) for the treatment of gastric submucosal tumors originated from the muscularis propria layer.Methods Fifty-three patients with submucosal tumors of the stomach diagnosed by gastroscope,were examined using endoscopic ultrasonography (EUS) from February 2012 to April 2013.The patients were completed ESE at general anesthesia.Results The diameter of the tumor was from 5 to 35 mm (median 13.2 mm).The tumors of 48 patients were complete resection,the complete resection rate was 90.6％(48/53).The operation time was from 30 to 150 min (median 45 min).Three patients (5.7％,3/53) had impulsivity hemorrhage during ESE,no patients had unmanageable hemorrhea under the gastroscope.Perforation occurred in 6 patients during ESE,perforation rate was 11.3％ (6/53),the perforation was closed by endoclip in 5 patients.Five patients with inability resection and 1 patient with perforation inability closed were treated with surgical operation.None was developed perforation postoperative and hemorrhea.Conclusion ESE is a safety and efficacy method for treating gastric submucosal tumors originating from the muscularis propria layer.

Background:Irritable bowel syndrome( IBS)patients are often accompanied by anxiety,depression and other psychological abnormalities,but the effects of psychological abnormalities on daily life have not yet been fully clarified. Aims:To investigate the effects of psychological abnormalities on life quality,sleep quality and symptom severity in IBS patients. Methods:A total of 101 IBS patients admitted from Nov. 2014 to May 2015 at Anhui Provincial Hospital Affiliated to Anhui Medical University were enrolled in this study. Zung self-rating anxiety scale(SAS)and Zung self-rating depression scale(SDS)were used to evaluate the mental state;IBS-quality of life(IBS-QOL)was used to evaluate the life quality;Pittsburgh sleep quality index(PSQI)was used to evaluate the sleep quality;IBS symptom severity score (IBS-SSS)was used to evaluate the symptom severity. Correlations between psychological factors,life quality,sleep quality and symptom severity were analyzed. Results:57. 4%(58 / 101)of IBS patients were accompanied by varying degrees of anxiety and/ or depression. The IBS-QOL score of 101 patients was 73. 28 ± 12. 79,in which anxiety,loss of appetite and health concerns were the most severely affected. 73. 3%(74 / 101)of IBS patients were accompanied by varying degrees of sleep disorders,in which daytime dysfunction,sleep quality and sleep efficiency were the most severely affected. Of the 101 IBS patients,the symptom of 13 cases was mild,63 cases was moderate and 25 cases was severe. IBS-SSS score was 253. 00 ± 72. 58. Correlation analysis showed that anxiety,depression were negatively correlated with life quality(r = - 0. 426,P < 0. 001;r = - 0. 501,P < 0. 001)and positively correlated with sleep quality(r = 0. 556, P = 0. 000;r = 0. 513,P = 0. 000)and symptom severity(r = 0. 231,P = 0. 020;r = 0. 357,P < 0. 001). Life quality was negatively correlated with symptom severity(r = - 0. 417,P < 0. 001). Conclusions:IBS patients have psychological abnormalities and their life and sleep qualities are decreased,the more serious the psychological abnormalities,the more damage on life and sleep qualities and the more severe the IBS symptoms.

Objective To evaluate the clnical value of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complicated renal calculi.Methods Data of 53 cases of complex renal calculi treated with single channel percutaneous nephrolithotomy combined with flexible cystoscope from July 2011 to September 2013 were analyzed retrospectively.There were 31 males and 22 females.Their age ranged from 26 to 74 years with a mean age of 49 years.Thirty-two cases were located on the left side,19 cases right,2 cases bilateral,21 cases of staghorn calculi and 32 cases of multiple stones.All the stones were filled in 2 or more calyces,with 7 cases in upper ureteral stones at the same time and 2 cases in solitary kidney.The longest diameter of stones was between 2.5 cm to 4.6 cm,with an average of 3.7 cm.There were 39 cases with hydronephrosis and the separation of the collection system was 2.0-5.1 cm with an average of 3.8cm.The period which patients suffered from stones was from 1 month to 6 years.Fourteen cases underwent ESWL and 6 cases underwent open operation before percutaneous nephrolithotomy.All patients underwent single channel percutaneous nephrolithotomy under the guidance of color Doppler ultrasound,and the channel of puncture was expanded to 24 F.Results Fifty-three cases (55 sides) were performed successfully in one-stage sugery and the operation time was between 85 to 170 min,with an average of 119 min.Thestone clearance rate was 89％ (49/55) and postoperative hemoglobin decreased 3.9-9.2 g/L with an average of 6.1 g/L.The hospitalization time was 8 to 12 days with an average of 9.2 days.Two cases had hemorrhage of about 500 ml after surgery and the renal hemorrhage stopped after clamping of renal fistula without blood transfusion.Two patients suffered from fever on surgery day and 1 patient on one day after surgery,and the body temperature returned to normal level after anti-infection treatment for 2 or 3 days.No renal perforation,fluid pneumothorax or damaged surrounding organs occurred.6 patients had residual stones,among which 2 were treated by two-stage operation and 4 were treated with extracorporeal shock wave lithotripsy.Conclusion Percutaneous nephrolithotomy combined with flexible cystoscope has little trauma and high stone clearance rate in the treatment of complex renal calculi with high clinical value.