Objective To study the clinical features,pathological characteristics and prognosis of renal cell carcinoma(RCC)in young adults,and to improve the recognition of RCC in young population. Methods The data of 35 young patients with RCC under the age of 35 years from August 1983 to June 2005 were analyzed retrospectively.There were 22 males and 13 females with a mean age of 31 years(age range, 19-35 years).The clinical presentations were as follows:painless hematuria in 12 cases(34%),low back pain in 12(34%),abdominal mass in 2(6%),fever in 3 and Stauffer syndrome in 1.The tumor size was 1.2-13.8 cm in diameter(mean,6.0cm).AJCC staging showed stage I tumor in 8 cases,stageⅡin 4, stageⅢin 18 and stageⅣin 5.Of the 35 cases,28 underwent radical nephrectomy(including simultaneous extraction of the vena cava emboli in 3 cases and extraction with pulmonary lobectomy in 1);5 cases under- went partial nephrectomy;and 2 cases lost the chance of operation(1 of them had biopsy).Results The operations were successful.The postoperative pathologic diagnoses consisted of clear cell carcinoma in 23 ca- ses,mixed cell carcinoma in 5,papillary cell carcinoma in 2,and chromophobe cell carcinoma in 2,low-dif- ferentiated and undifferentiated cell carcinoma each in 1.Of them,26 cases were followed for 12-148 months(mean,56 months).Postoperative 3-and 5-year survival rates were 65% and 50%,respectively. Conclnsions In young population,RCC is difficult to diagnose because of occult symptoms at early stage and lack of tumor specificity,which leads to relatively late clinical staging at diagnosis.RCC is characterized by higher malignancy,easy invasion to surrounding tissues and metastasis,and thus poor prognosis.

Objective To analyze the clinical characteristic,treatment and prognosis of traumatic macular holes resulted from ocular contusion.Methods The clinical data of 47 cases with traumatic macular hole was retrospectively reviewed.The general condition of the patients was summarized,optical coherence tomography and multifocal electroretinogram (mfERG) were used to evaluate anatomic and functional outcomes.The patients were divided into observation group and surgery group by the treatment they received,and the prognosis was evaluated.Results Traumatic macular hole occurs mainly in male.In the observation group,the mean diameter of macular hole was(490.0±86.9) μm.During the 12 month follow up,the holes in 7 cases (33.3％) were closed spontaneously,Vision and diameters of 14 cases (57.1％) maintained stable for a long time,the vision of 1 case (3.3 ％) declined mildly and the diameter of 1 case (3.3％) enlarged slightly.Visual acuity was improved significantly at last follow up (Z=-2.40,P＜ 0.05).The amplitudes of N1 wave of mfERG increased both in central fovea and macular area(t=13.30,5.06;P＜0.05).These data suggests that the macular function was recovered well.In the surgery group,the mean diameter of macular hole was (643.3 ± 125.0) μm and statistically larger than that of the observation group (t=-4.76,P＜0.05).At the last follow-up,visual acuity were not improved significantly (Z=-1.79,P＞0.05).The amplitudes of N1 wave in 6 cases (23.1 ％) improved merely and the difference was not statistically significant (t =1.98,P ＞ 0.05).These data suggests that the macular function was recovered slightly only in a few patients.Conclusions A part of the patients with smaller diameters of macular holes may close spontaneously,and they may get better visual acuity.Vitrectomy may help to close the macular holes in some severe cases,but the improvement of functional outcomes is not significant.

Objective To determine the optimal cut-off value of critical-care pain observation tool (CPOT) in assessing degree of pain in patients undergone craniotomy, and to determine the sensitivity and specificity of CPOT with this cut-off value. Methods A prospective observational study was conducted in Beijing Tiantan Hospital. A total of 118 patients admitted to intensive care unit (ICU) after craniotomy was consecutively enrolled during August 2014 to August 2015. CPOT and visual analogue scale (VAS) were used to assess the pain before, during and 20 minutes after the removal of central venous catheters, and the difference was compared between two scores at three time points. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for evaluation of the sensitivity and specificity of CPOT. Patients' complaint of pain was considered the gold-standard. Results CPOT values (inter-quartile range) before, during and after the procedure were 0 (0-3), 0 (0-6) and 0 (0-2), respectively; while VAS values were 4 (1, 6), 3 (1, 6) and 4 (1, 6), respectively. CPOT value during the procedure was significantly higher than CPOT values before and after the procedure (both P < 0.01). When the optimal cut-off value of CPOT was 1, CPOT showed the highest Youden index before, during and after the procedure (1.183, 1.515, and 1.438, respectively), and showed high specificity (all 100%) and low sensitivity (18.3% and 43.8%, respectively) when assessing the pain before and after the removal of the catheter. The sensitivity and the specificity were high when assessing the pain during the procedure, the sensitivity was 69.4%, and the specificity was 82.1%. When the optimal cut-off value of VAS was 2 before and during the procedure, and was 4 after the procedure, VAS showed the highest Youden index, 1.568, 1.452, and 1.509, respectively. VAS demonstrated high sensitivity and specificity before, during and after the procedure (sensitivity was 97.2%, 95.2% and 75.0%, respectively; specificity was 59.6%, 50.0% and 75.9%, respectively). The area under ROC curve (AUC) of CPOT before, during and after the procedure were 0.592 [95% confidence interval (95%CI) = 0.490-0.693], 0.778 (95%CI= 0.693-0.863) and 0.719 (95%CI = 0.627-0.811), respectively; the AUC of VAS before, during and after the procedure were 0.846 (95%CI = 0.771-0.920), 0.767 (95%CI = 0.681-0.854) and 0.838 (95%CI = 0.767-0.909), respectively. The AUC of VAS before and after the procedure was significantly higher than the AUC of CPOT (P < 0.001 and P = 0.006), while there was no significant difference between the AUC of VAS and CPOT during the procedure (P = 0.826). Conclusion CPOT can be used to assess the pain during painful procedure, and it shows high accuracy, but with poor evaluation effect on pain in rest.

Objective To study the effect of Mycoplasma pneumoniae infection on the coagulation system in children and to clarify its mechanism in order to guide the therapeutic strategy for Mycoplasma pneumoniae infection in clinical practice.Methods A prospective and case control study was carried out in 36 children with Mycoplasma pneumoniae infection in Weifang People ' s Hospital from January through December in 2011.The 36 patients were divided into two groups according to the MP-IgM plasma titers,namely low-titer group with MP-IgM 1 ∶ 80-1 ∶ 160 (n =17) and high-titer group with MP-IgM 1 ∶ 320-1 ∶1280 (n =19).The subjects of control group (n =20) were recruited from healthy children as they took routine physical examination during the same period.Six indexes related to the coagulation function as well as D-dimer in plasma were determined.All data were analyzed by using SPSS 15.0 software.Results The levels of fibrinogen (FIB) and D-dimer in the low-titer group and high-titer group were significantly higher than those in the control group (P ＜ 0.05).The prothrombin (PT) and activated partial thromboplastin time (APTT) in the high-titer group were significantly shorter than those in the control group respectively (P ＜ 0.05).Conclusions Mycoplasma pneumoniae infection in children gives rise to the potential for activating the extrinsic and intrinsic coagulation system,promoting thrombosis and in turn inducing ischemic stroke in serious cases.

Background p21 is a cyclin-dependent kinase inhibitor,and it can prevent cells from going through the G1/S phase checkpoint and inhibit cell proliferation.Stuies determined that the expression level of p21 WAF1/CIP1 is associated with proliferative diseases.Traumatic proliferative vitreoretinopathy (PVR) is a proliferative response of eye.Understaining the relationship of dynamic expression levels of p21 WAF1/CIP1 in PVR is of significance for the prevention and management of PVR.Objective This study was to investigate the expression of p21 WAF1/CIP1 during the course of experimental traumatic PVR in rabbits.Methods Fifty-four pigmented rabbits were randomized into the normal control group and different experimerital groups,and one lateral eye of each rabbit served as experimental eye.PVR models were established by intravitreal injection of human platelet-rich plasma (PRP) (0.4 ml)combined with cryotherapy for 5 seconds,and vitreous and retinas were examined with B type sonography.The rabbits were sacrificed in 7,14,21 and 28 days after operation,and histopathological examination of the retinas was performed by haematoxylin and eosin stain.The expression levels of p21WAF1/CIP1 protein and gene were detected by immunohistochemistry,Western blot and reverse transcription-PCR (RT-PCR).The use and care of the rabbits complied with Statement of ARVO.Results B type sonography showed that the retinal morphology was normal in the normal control group.However,the proliferative membrane was gradually thickened 1 to 7 days after operation.Retinal folds of rabbits were seen in 7 days,and tractional retinal detachment was found in 14 days and 28 days after operation.The histopathological examination of the retinas showed epiretinal membrane and infiltration of inflammatory cells 7 days and fixed ruffle 28 days after operation.The p21WAF1/CIP1 was strongly expressed in the cell nucleus of retinal ganglion cell layer (GCL) and inner nuclear layer (INL) in the normal control group,and the expression was gradually weakened after modeling,with the weakest expression in the retinas in 14 days after modeling.The relative expression levels of p21 WAF1/CIP1 protein was 0.74±0.08,0.60±0.05,0.56±0.03,0.74±0.02 and 0.65 ±0.04 in the normal control group,postoperative 7-day group,postoperative 14-day group,postoperative 21-day group and postoperative 28-day group,respectively,showing a significant difference among the groups (F =20.55,P =0.00),and the expression levels of p21WAF1/CIP1 protein were significantly lower in the postoperative 7-day group and postoperative 14-day group than those of the normal control group,postoperative 21-day group and postoperative 28-day group (all at P＜0.05).The relative expression levels of p21 WAF1/CIP1 mRNA was 0.65 ± 0.09,0.57 ± 0.05,0.45 ±0.04,0.46±0.02 and 0.47±0.04 in the normal control group,postoperative 7-day group,postoperative 14-day group,postoperative 21-day group and postoperative 28-day group,respectively,with a significant difference among the groups (F =18.06,P =0.00),and the expression levels were significantly lower in the postoperative 14-day group,postoperative 21-day group and postoperative 28-day group than those of the normal control group and postoperative 7-day group (all at P＜0.05).Conclusions The dynamic expression of p21WAF1/CIP1 in the retinas is consistant with the prograssion of traumatic PVR,and the reduce tendency of p21 WAF1/CIP1expression is similar to cell prolieration change,indicating that reduce of p21WAF1/CIP1 expression in the retinas may promote the development of traumatic PVR.

Objective To study the clinical characteristics and outcome of cytomegalovirus(CMV) infection in infants.Methods All data including time of infection,clinical characteristics,laboratory tests and outcome of CMV infections in hospitalized infants were collec-(ted) and analyzed from January,1994 to July,2004.Results In 87 infected infants,congenitally infected newborns,perinatal infection in infants and postnatal infection in infants accounted for 27.6%,62.0%,16.6%,respectively.CMV hepatitis was the most frequent type of disease with the incidence of 41.3%,in which the incidence of splenomegaly was 10.3%.Most of CMV hepatitis infants had a good prognosis with the improved rate 80.5%.Central nervous system abnormality(including abnormal intension of muscle,convulsion,ocular and hearing abnormalities) occurred only in congenital and perinatal infection with the incidence of 20.4%.Generalized infection,the incidence of congenital infection and perinatal infection was 16.7%,1.8%,respectively.It did not occur in postnatal infection.The mortality rate of congenital infection and perinatal infection were 12.5% and 1.85%,respectively.Conclusions CMV infection is the main cause of infant hepatitis and it can also cause neurologic sequelae.The outcome of generalized infection in congenital infection is bad and the mortality rate is high.

Objective When cumulus-enclosed oocytes are isolated from ovarian follicles and cultured in vitro,they undergo germinal vesicle breakdown(GVBD) and extrude the first polar body,then remain in meiotic arrest.In this study,we examined the timing of progression of human oocytes through meiosis using in vitro maturation conditions.Measurements made include nuclear changes,oocyte diameter and the perivitelline space(PVS).Methods Oocytes were collected from polycystic ovary patients by transvaginal immature follicle puncture(TV-IMFP) and matured in vitro.At 4,8,12,16,20,24,and 28?h from the onset of culture,oocytes were put into culture droplets and analyzed under light microscope to measure their diameter and the PVS width,then fixed and stained to evaluate the chromosomal status.Results About 50% of the oocytes underwent GVBD before 10?h culture,maximum chromatin condensation peaked at 8?h to 12?h,the majority of oocytes reached metaphase Ⅰ at 20?h,and soon anaphase and telophase Ⅰ progression occurred from 20?h to 24?h.Finally about 70% of oocytes extruded the first polar body by 28?h.With the maturation progressing,oocyte diameter did not change significantly;however,the perivitelline space width enlarged from 5.27+/-0.88??m to 17.18+/-1.26??m during this time.Conclusion The results presented here delineate the timing of nuclear events in the human oocyte during maturation in vitro with this culture system. The size of PVS is related to human oocyte meiotic progression.Thus,the size of the perivitelline may be a useful indication of the maturation state of the ooeyte.

Objective To investigate the curative effect of Quadrant channel transforaminal lumbar interbody fusion(TLIF) in the treatment of recurrent lumbar disc herniation(RLDH).Methods Seventy-six cases patients with RLDH were divided into traditional TLIF group(36 cases) and Quadrant group(40 cases) by the different operation modes.The operation,VAS scores and ODI scores were compared between the two groups.Results Operation time((98.2±18.1) min vs.(118.5±27.2) min,t=3.79,P<0.05),incision length((2.7±0.6) cm vs.(5.5±1.0) cm,t=14.97,P<0.05),intraoperative blood loss((90.7±20.1) ml vs.(170.3±33.5) ml,t=12.71,P<0.05) and intraoperative drainage((43.8±12.4) ml vs.(117.1±28.9) ml,t=14.62,P<0.05) in Quadrant group were less than that in traditional TLIF group.The ambulation time((2.8±0.6) d vs.(6.8±1.1) d,t=19.95.P<0.05) and hospitalization time((7.1±2.0) d vs.(14.2±2.7) d,t=13.11,P<0.05) of Quadrant group were shorter than those of TLIF group.VAS scores in both groups were significantly decreased.VAS in Quadrant group was significantly lower than that in traditional TLIF group from 3 d to 6 months after operation((4.4±1.0,3.9±1.2,3.4±0.8,1.9±0.6,1.3±0.4) points vs.(5.0±1.4,4.5±1.1,4.1±0.9,3.6±0.7,2.5±0.6) points,P<0.05).ODI scores in both groups were significantly decreased.ODI in Quadrant group was significantly lower than that in traditional TLIF group from 1 d to 6 months after operation((36.7±7.1,33.4±6.2,30.7±4.1,27.8±5.3,24.5±5.4,18.4±4.7) points vs.(39.8±6.0,36.8±5.8,33.5±6.6,31.3±5.1,28.9±6.6,22.3±5.2) points,P<0.05).Conclusion The treatment of RLDH by Quadrant channel TLIF has obvious curative effect,short operation time,less trauma,faster recovery and shorter hospital stay.

AIM: To investigate the pathological changes of motoneuron's function and morphology after root avulsion in order to study the neurobiology mechanism of motoneuron death. METHODS: Twenty female adult Sprague-Dawley rats, 200-300 g were used. The C 5-C 8, T 1 roots of the right brachial plexus were avulsed. All rats were killed 3 d, 5 d or 1 week after avulsion. One group of the C 5-C 8 spinal cords freeze sections (40 ?m thick) were collected for the NADPH-d histochemistry with neural red counterstained. Another group of the C 5-C 8 spinal cords freeze sections (40 ?m thick) were collected for the c-Jun immunocytochemistry stain. The paraffin sections (5 ?m thick) were collected for HE stain. The amount of NOS-positive and survival motoneurons was counted. The percentage of NOS expression and motoneuron survive were quantitatively analyzed considering the amount of contra lateral motoneurons as one hundred percent. RESULTS: The NOS expression rate was 0.74%?0.59% (3 d), 24.84%?6.73%(5 d), or 51.16%?8.67% (1 week), respectively. The survive rate was 93.00%?4.32% (3 d), 93.67%?5.27% (5 d), or 89.83%?2.65% (1 week), respectively. The motoneuron expressed c-Jun as early as 3 days after avulsion. The expression declined afterward until one week after avulsion. There was no significant change on the size of motoneuron. The nuclear membrane was still clear but some nuclei were not located in the middle of the cell body. There were some nucleoli with the chromatin condensation. CONCLUSION: The motoneuron NOS expression and cell death were increased within one week after spinal root avulsion. meanwhile, the c-jun expression was decreased. The NO/NOS may induce the motoneuron death by inhibiting the regenerating reactions of motoneuron after root avulsion injury.