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 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 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.

Objective To preliminarily investigate the feasibility of MRI-T2* map in evaluating myocardial iron load of myocardial iron overload rabbit models.Methods Eleven rabbits were included in this study and divided into two groups,myocardial iron overload group (n =10) and the control group (n =1).Iron dextrin (dose of 50 mg/kg) was injected in muscles of thigh once a week,totally 12 weeks.Serum iron test and MRI examination were performed before iron injection,and 1 week to 12 weeks after iron injection.MRI scan protocol included short axial T2* map of the left ventricle and cross-section T2* map of the liver.T2* and R2* of the heart and the liver were measured.One rabbit was killed after MRI examination at pre-iron injection,1 week to 8 weeks,11 weeks and 12 weeks after iron injection,respectively.Heart and liver were avulsed to undergo in vitro MRI scan and then paraffin embedded for pathological slices.MRI scan protocol and measurements of the heart and the liver samples were the same to that of in vivo ones.Pearson correlation was used to calculate the relationships between the parameters.Results Myocardial T2* [(32.5 ± 8.3 ms)] and R2* values [(38.4 ± 7.9) Hz] had significant correlation with injecting iron content(1 033.2 ± 673.4 mg),the Pearson coefficients were-0.799 (P =0.001) and 0.770 (P =0.002),respectively.Myocardial T2 had no significant correlation with liver T2* values (r =0.556,P =0.070).T2* values of heart and liver in vivo [(32.5 ± 8.3) ms and (8.8 ± 5.4) ms],respectively had strong correlation with those in vitro [(19.4 ± 6.5) ms and (9.8 ± 5.0) ms],respectively (r =0.757,P =0.007 and r=0.861,P=0.001).T2* and R2* values of the heart and the liver in vivo and in vitro had no significant correlations with serum iron (P ＞ 0.05).On Prussian blue staining slices,blue particles of myocardium,sinus hepaticus and hepatocyte increased with injecting iron content.Conclusions It is feasible for MRI-T2* map to evaluate the myocardial iron load noninvasively.It may provide reliable information for detecting myocardial iron overload in patients with iron overload at an early stage.

Objective To study the expression and significance of miR-26a in intrahepatic cholangiocarcinoma.Methods The expression of miR-26a in 46 intrahepatic cholangiocarcinoma(ICC) tissues and peritumoral tissues was detected by quantitative real time polymerase chain reaction (qRT PCR).The intrahepatic eholangiocarcinoma cell line HCCC-9810 and RBE were transfected with miR 26a mimics and miR 26a inhibitors,respectively,by lipofectamine 2000.The growth curves were constructed by the CCK 8 method.The migration and invasion ability was demonstrated by wound healing and transwell assay.The cell cycle was analyzed by flow cytometry.The potential mechanism was illustrated by Western blotting.Results For the 46 ICC tissues and peritumoral tissues,miR 26a levels were significantly higher in the tumor tissues than in the peritumoral tissues (P＜0.05).Vascular invasion,TNM Ⅲ～Ⅳ stage and lymph node metastasis were significantly associated with high miR 26a expression levels (P＜0.05),but gender,age,tumor amounts,tumor encapsulation,tumor diameter and tumor differentiation showed no significant association (P＞0.05).Enhanced cell proliferation,migration and invasion ability,accelerated G0/G1 phase to S phase transition,activated AKT by PTEN suppression were observed in HCCC-9810 cells with up regulation of miR-26a.Conversely,cell proliferation,migration and invasion ability was inhibited,G0/G1 phase was blocked and AKT was restrained by PTEN increase wkh down regulation of miR-26a in RBE cells.PTEN mRNA in versely correlated with the miR-26a level (r=-0.8272,P＜0.01).Patients with a high miR-26a expression had significantly poorer overall survival (P＜0.05).A high miR 26a exprcssion,multiple tumors and lymph node metastasis were independent prognostic factors of overall survival (P＜0.01).Conclusion Overexpression of miR-26a in intrahepatic cholangiocarcinoma correlated with clinicopath ological features and overall survival,and it potentially promoted tumor proliferation and metastasis through the PTEN/AKT pathway.

Objective Severe preeclampsia (sPE), which is usually complicated by small-for-gestational-age (SGA) and immature labor , remains a leading cause of maternal and neonatal mortality and morbidity. This study was to investigate the risk factors of SGA in sPE. Methods We retrospectively analyzed 100 cases of sPE, 35 with SGA (the case group) and the other 65 without it ( the control group ) .We conducted single-factor analysis on the general characteristics and potential impact factors of the patients , i-dentified the independent risk factors of SGA using the un-conditional stepwise logistic model , and assessed the value of umbilical arter-y S/D ratio and proteinuria ration in the diagnosis of sPE with SGA with the ROC curve . Results Compared with the control group , the case group had more cases of early-onset sPE ( P =0.010 ), earlier gestational and delivery weeks (P<0.001), lower neonatal weight at birth ( P<0 .001 ) , higher rate of admission to and longer stay in the neonatal ICU (P<0.001), and higher incidence of neo-natal complications (P<0.05).The case group also showed signifi-cant increases in comparison with the control in the umbilical artery S/D ratio (2.95 ±0.75 vs 2.31 ±0.47, P<0.05), frequency of S/D ratio ≥95th percentile (22.86% vs 6.15%, P<0.01), and rate of proteinuria ≥5 g/24 h (42.86% vs 20.00%, P<0.05).The S/D ratio ≥95th percentile (OR=6.02, 95%CI:2.32-16.78) and proteinuria≥5 g/24 h (OR=1.65, 95%CI:1.56-3.01) were found to be the risk factors of sPE with SGA.The area under the curve was 0.852 for the combination of S/D ra-tio and proteinuria ration in the diagnosis of sPE with SGA (P<0.05). Conclusion Umbilical artery S/D ratio≥95th percentile and proteinuria ≥5 g/24 h contribute to the early prediction, prevention, and prognosis of sPE, and is valuable for the diagnosis of sPE with SGA.

Objective To analyze the clinical and pathological factors that affect the prognosis of gastric cancer patients after radical resection,and study the relationship between biological behavior of gastric cancer and clinical so as to provide clues to the basis for clinical diagnosis and treatment.Methods The clinical and pathological data of the gastric cancer patients who underwent radical resection from January 1999 to December 2009 were retrospectively analyzed.Of the 581 eligible patients were followed up in 179 cases.A database was established for SPSS 13.0 software analysis.Results Single factor analysis showed that the prognosis influencing factors in gastric cancer patients after radical resection were age,tumor location,tumor size,gross type,histological type,depth of invasion,TNM stage,surgical procedure,the cancerous remains of specimen surgical margin and the number of lymph node metastasis (P ＜ 0.05 or ＜ 0.01),no correlation was found between gender and prognosis (P ＞ 0.05).Multiple Cox regression analysis showed that TNM stage and number of lymph node metastasis were independent gastric cancer prognostic influencing factors,and the number of lymph node metastasis was found to be the more significant factor.Conclusions TNM stage and the number of lymph node metastasis are independent prognostic influencing factors in gastric cancer,and the number of lymph node metastasis is the more important factor in gastric cancer prognosis.Therefore,Union for International Cancer Control lymph node staging of gastric cancer is a better indicator for gastric cancer prognosis.

BACKGROUND:Elderly patients have more loose bone. After fractures, bones are mostly crushed. Simultaneously, many elderly patients experience many internal diseases. Various organs have dysfunction. Surgery tolerance is poor, which also brings difficulty in treatment with internal fixator, and increases the risk of therapy. Thus, the choice of internal fixation method is not uniform. OBJECTIVE: To compare and analyze the repair effects of proximal femoral nail anti-rotation blade and anatomic proximal femoral locking plate in treatment of unstable intertrochanteric fractures in the elderly. METHODS:A total of 100 elderly patients with unstable intertrochanteric fractures were selected from the Youyi Branch, Kunshan First People’s Hospital from April 2011 to June 2013. They were randomly assigned to two groups. Patients in the experimental group received internal fixation with proximal femoral nail anti-rotation blade. Patients in the control group received anatomic proximal femoral locking plate. After treatment, folow-up was conducted. Operative indexes, postoperative Harris score for hip function and incidence of complications were compared and analyzed in both groups. RESULTS AND CONCLUSION: No significant difference in various indexes was detected in both groups (P > 0.05). Harris scores were significantly better in the experimental group than in the control group (P < 0.05). Postoperative complications were significantly less in the experimental group than in the control group (P < 0.05). These results indicated that internal fixation of proximal femoral nail anti-rotation blade for unstable intertrochanteric fractures in the elderly achieved satisfactory results in the recovery of joint function and had the advantage of few complications.

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.