0.05; the holding vs neutral position, the disaster side and the healthy side all had significant difference,P0.05.This showed that the capability of stability of a-c joint were good. The Roentgenograms of shoulder elevation position raise showed that there was no impact in the a-c joint.[Conclusion]The results of small incision Dewar's operation is good in treating instability distal clavicular fracture.It has the advantages of minimally invasive,easy operation and fixation.

Objective To explore the clinical efficacy of small-incision Dewar's operation for acute acromioclavicular dislocation.Methods Without exposing the a-c joint,the coracoid tip with tendon were transferred to the clavicle to reconstruct the coracoclavicular ligaments.And then the a-c joint was statically fixed and dynamically replaced.Results A 1-to 9-year follow-up(mean,4.9 years)was available in 52 patients.According to the Lazzcano Criteria,44 cases had excellent and 7 cases had good results,only one was failed because of bolt prematurity at 2 month after the operation.Roentgenogram,CT,and MRI showed that the surface of the acromioclavicular joint was smooth,no arthritic sign of cirrhosis,hyperplasia,or theca.The signal of the a-c joint was uniform.The Roentgenograms showed that,at the neutrality position,the distal end of the clavicle of the injured side was higher than that of the healthy side.The D/W of the healthy side was 0.432?0.101,which was significantly higher than that in the injured side(0.523?0.083,t=2.188,P=0.042).The difference between the neutrality and hold of the healthy side was 0.116?0.025,while that of the injured side was 0.087?0.016(t=1.114,P=0.280).The Roentgenograms of the raise position showed no impact in the a-c joint.Conclusions Small incision Dewar's operation is an effective,safe,and minimally invasive method for the treatment of acute acromioclavicular dislocation.

OBJECTIVE: To study the influence of cyclosporine and tacrolimus on self-rated health in kidney transplantation patients with or without post-transplantation diabetes mellitus (PTDM). METHODS: Outpatients with kidney transplantation were divided into group with PTDM, group without PTDM, cyclosporine group and tacrolimus group according to mainly used immunosuppressant and patients with or without PTDM. Self-rated Health Measurement Scale (SRHMS) was applied for investigation. RESULTS: The level of physical health, psychological health and social health of kidney transplantation patients with PTDM were markedly lower than patients without PTDM (P

Objective To investigate the risk factors of postoperative complications of delayed hemorrhage,perforation and digestive tract stenosis after endoscopic submucosal dissection (ESD).Methods The complete data of 793 patients with digestive tract disease who underwent the endoscopic submucosal dissection in the Department of Digestive Surgery in our hospital from January 2011 to December 2014 were retrospectively analyzed.All of the patients were divided into delayed hemorrhage group (n =67) and nonbleeding group (n =726);perforation group (n =47) and non-perforation group (n =746);and digestive tract stenosis group (n =38) and non-stenosis group (n =755).The clinical basic data,lesion related data,and operation related data were independent risk factor and analyzed by single factor analysis and Logistic multiple factor regression analysis.Results The incidence of delayed bleeding,perforation and stenosis in patients with ESD were 8.45％,5.93％,and 4.79％,respectively.The results of single factor analysis:the risk factors for delayed bleeding were long-term use of anticoagulant drugs,gastric sinus disease,lesion diameter,and lesion excision (P ＜ 0.05).The risk factors for postoperative perforation were the diameter of the lesion and the time of operation (P ＜ 0.05).The risk factors of digestive tract stenosis were the esophageal lesions,the diameter of the lesion,and the depth of the lesion to the intrinsic muscle layer (P ＜ 0.05).The results of multi factor Logistic regression analysis:the risk ranking of risk factors for delayed bleeding was gastric antrum occurrence lesion ＞ lesions graded resection ＞ long-term use of anticoagulants ＞ lesion diameter (≥5 mm).The risk ranking of risk factors for perforation was operation time (≥90 mm) ＞ lesion diameter (≥5 mm).The risk ranking of risk factors for digestive tract stenosis was esophageal lesion ＞ lesion diameter (≥ 5 mm) ＞ lesions depth to the muscularis propria.Conclusions For long-term anticoagulation,gastric antrum and fractional resection lesions of patients should pay attention to delayed bleeding.Patients with long operation time are easy to cause postoperative perforation.For long-term anticoagulation,gastric antrum and fractional resection lesions of patients should pay attention to delayed bleeding.

Diagnostic Errors ; Humans ; Inflammation ; diagnosis ; etiology ; Laryngeal Neoplasms ; surgery ; Male ; Middle Aged ; Papilloma ; surgery ; Pneumonia ; diagnosis ; Postoperative Complications ; diagnosis

We investigated the Toxop lasma infection prevalence among planned pregnant women in Chongqing ,and to pro‐vide reference for the first level intervention of birth defects in the region .A total of 11 953 planned pregnant women were se‐lected by proportionally stratified multi‐stage random sampling method .Questionnaire survey was given to the women ,and blood samples were collected .Specific IgM and IgG antibodies against Toxoplasma were detected with ELISA .Results showed that among the 11 953 cases surveyed ,Toxoplasma IgM was positive in 71 cases ,with the positive rate of 0 .59% ;IgG was positive in 771 cases ,with the positive rate of 6 .54% .The positive rate of IgM and IgG antibodies in the metropolitan core re‐gion of the city was higher than that in the suburb areas (χ2 =35 .28 ,P<0 .000 1 ;χ2 =82 .65 ,P<0 .000 1) .The positive rate of IgM antibody increased with the educational level (χ2trend=3 .25 ,P=0 .001 1) .The positive rates of IgM and IgG varied in occupations among women (χ2 =13 .93 , P= 0 .016 0;χ2 = 15 .58 ,χ2 =0 .008 1) ,with the highest rate of public officials . Planned pregnant women with the history of abnormal pregnancy outcomes had higher positive rate of T .gondii IgM and IgG antibodies than those in the control (χ2 =6 .85 ,P=0 .008 9;χ2 =59 .25 ,P<0 .000 1) .There was no significant difference of IgM positive rate between the planned pregnancy women who had closed contact to cats and the control group (χ2 =0 .23 ,P=0 .628 6) ,while the positive rate of IgG was higher than that of the control group (χ2 =9 .95 ,P=0 .001 6) .T .gondii infec‐tion rate was on the low level of planned pregnant women in Chongqing .Adverse pregnancy outcomes are related to Toxoplas‐ma infection .

Objective To investigate the prevalence of hepatitis B virus infection and its epidemiological characteristics among planned pregnancy couples in Chongqing.Methods A total of 10 712 planned pregnancy couples were selected by proportionally stratified multi-stage random sampling method during April and December 2013.A questionnaire survey was performed, and enzyme linked immunosorbent assay ( ELISA) was used for hepatitis B virus surface antigen ( HBsAg ) and hepatitis B surface antibody ( anti-HBs) detection.SAS 8.2 was adopted for data process.Chi-square test and test for linear trend were performed to compare the rates of HBsAg and anti-HBs among different populations.Results Among 21 424 individuals, 1 718 (8.02%) were HBsAg positive.The positive rate of HBsAg in husbands was 9.48%, which was significantly higher than that in wives (6.55%,χ2 =63.39, P<0.01).Anti-HBs was positive in 8 967 (41.85%) individuals, and the positive rates in husbands and wives were 42.39% and 41.32%respectively (χ2 =2.54, P>0.05).The positive rates of HBsAg and anti-HBs increased with the age (χ2 =2.98 and 9.83,P<0.01).The highest HBsAg positive rate and lowest anti-HBs positive rate were observed among individuals of southeast of Chongqing.The positive rates of HBsAg and anti-HBs varied in people with different occupation.The highest HBsAg and anti-HBs positive rates were found in private business owners (9.18%) and public employees (49.69%) , respectively;and the lowest HBsAg and anti-HBs positive rates were found in public employees (6.79%) and farmers (39.08%), respectively.As the education level increased, HBsAg positive rate was decreasing (χ2 =-3.33, P<0.01), and anti-HBs positive rate was increasing (χ2 =9.73, P<0.01).Conclusions The prevalence of HBV infection is still high among planned pregnancy couples in Chongqing in the year of 2013.Vaccination and the related treatments should be enforced in population with high risk of HIV infection.

Objective To investigate the influence of Cordyceps polysaceharide (Cp) on epithelial-to-mesenchymal transition (EMT) induced by transforming growth factor-β1 (TGF-β1)in proximal tubular epithelial cells (PTEC). Methods HK-2 cell proliferation was determined by MTT assay. After incubation of HK2 cells with increasing concentrations of TGF-β1 (0, 0.1, 0.5, 1, 5, 10 μg/L) at 48 h and with TGF-β1 (5 μ/L) at different time points, E-cadherin, α-SMA, FN expression at transcriptional and protein levels were detected by real-time PCR and Western blotting respectively. The cells were pretreated with 1,5, 10 g/L Cp respectively for 24 h before adding TGF-β1 (5μg/L), then the cells were incubated for additional 48 h, mRNA and proteinexpression of above 3 cytokines was examined by real-time PCR and Western blotting as well. Results CP alone (0.01, 0.1, 1,5, 10 g/L) induced HK-2 cell proliferation in a dose-dependent manner. TGF-β1 enhanced α-SMA, FN expression while inhibited E-cedherin expression at both transcriptional and" protein level in HK-2 cell. At transcriptional level, compared to single TGF-β1 (5 μg/L) stimulating group, after Cp (1,5, 10 g/L) pretreatment for 24 h, the inhibition rate of a-SMA mRNA was 37.98%, 68.08% and 84.36%, respectively; FN mRNA was 46.97%, 63.82% and 81.85%, respectively; E-cadherin was up-regulated by 0.67 fold, 2.69 folds and 5.43 folds, respectively (P＜0.05). At protein level, the inhibition rate of α-SMA was 33.40%, 47.75% and 68.50%, respectively; FN was 16.26%, 65.92% and 80.30%, respectively; E-cadherin was up-regulated by 1.33 folds, 3.19 folds and 4.29 folds, respectively (all P＜0.05). Under Light microscopy, the Cp reversed cell shape from spindle-shape induced by TGF-β1 to nearly normal shape. Conclusion Cp may exert its inhibitive effects on TGF-β1-induced EMT.

Objective To study the effect of mechanical tension on collagen arrangement and illustrate the relationship between tissue architecture and tension properties. Methods Cell morphologies, orientation and collagen arrangement of fibroblasts cultured in three different types of collagen gels with variation of mechanical tension were observed by phase contrast photomicrographs, light microscopy and transmission electron microscopy. Expression and distribution of a-smooth muscle actin (α-SMA) were investigated by immunohistochemistry. Results Phase contrast photomicrographs, light microscopy and transmission electron microscopy showed high level of tension distributed anisotropically in the monolayer gels and the anchored collagen gels, with bipolar shape of the fibroblasts, obvious polarity, arrangement of exogenous collagen fibres parallel to the long axis of the fibroblasts, especially prominent in monolayer gels. Low level of tension distributed isotropically was observed in floating collagen gels, with stellate morphology and arrangement of exogenous collagen fibres in a reticular array. Immunofluorescence showed that fibroblasts expressed high level of α-SMA protein distributed along the long axis of fibroblasts in the monolayer gels and the anchored collagen gels, especially in former ones. In contrast, few expression of α-SMA protein was found in floating collagen gels. Cell morphologies and orientation, expression and distribution of α-SMA as well as collagen arrangement of fibroblasts in the monolayer gels and the anchored collagen gels were similar to those in granulation tissue, whereas floating collagen gels resembled normal dermis or remodelled tissues. Conclusions Tissue architecture or morphology of the dermis are corresponding to tension proporties. Different tissue architectures are closely correlated with particular tension proporties.

Objective To analyze preoperative risk factors of perioperative pulmonary hypertension crisis (PHC) for pregnant woman with severe pulmonary artery hypertension (PAH), and approach its clinical value. Methods A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not. Through the case management system, age, height, weight, gestational age, pregnancy time, type of PAH, emergency or selective surgery, New York Heart Association (NYHA) cardiac function classification, and preoperative ultrasound left ventricular ejection fraction (LVEF), left ventricular diastolic final diameter (LVEDD), the pulmonary artery systolic pressure (sPAP) estimated by ultrasonic TI method, radial artery systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2) without oxygen, oral sildenafil ingestion, having Swan-Ganz catheter placement or not, and whether used norepinephrine or not, as well as the occurrence of perioperative PHC and clinical outcomes were collected. Possible preoperative risk factors were compared between the two groups by single factor and multiple factors logistic regression analysis. The receiver-operating characteristic curve (ROC) was plotted to assess the diagnostic value of various risk factors.Results A total of 152 patients were screened. Ten patients got heart surgery under general anesthesia at the same time, and 4 patients experiencing cesarean section with general anesthesia were excluded. 138 patients were enrolled finally, 27 patients underwent perioperative PHC (19.57%), and 17 patients died with a mortality of 62.96%. Compared with non-PHC group, the patients in PHC group were older (years: 25.07±3.55 vs. 27.64±4.82), had a poor cardiac function (NYHA cardiac function classification: 3.22±0.64 vs. 2.85±0.53), a smaller LVEDD (mm: 38.78±4.76 vs. 43.91±9.67), lower SpO2 without oxygen (0.83±0.12 vs. 0.92±0.06) and oral sildenafil ingestion rate (29.63% vs. 56.76%), and higher sPAP estimated by ultrasonic TI method [mmHg (1 mmHg = 0.133 kPa): 113.41±24.73 vs. 99.35±21.10] and DBP (mmHg: 79.63±13.23 vs. 75.23±12.14), more having Swan-Ganz catheter placement (85.19% vs. 57.66%), more Eisenmenger syndrome (70.37% vs. 37.84%), and more emergency operation (48.15% vs. 23.42%, allP ≤ 0.1). The variables with statistically significant differences showed by single factor analysis were collected, and it was shown by multiple factors logistic regression analysis that LVEDD [odds ratio (OR) = 0.878, 95% confidence interval (95%CI) = 0.796-0.968,P = 0.009], whether oral taken sildenafil (OR = 0.161, 95%CI = 0.051-0.515,P = 0.002) or not, SpO2 at room air (OR = 0.882, 95%CI = 0.829-0.938,P = 0.000), Swan-Ganz catheter placement or not (OR = 6.186, 95%CI = 1.533-24.964,P = 0.010) were independent risk factors of perioperative PHC in pregnant women with severe PAH. It was shown by ROC curve analysis that the area under the ROC curve (AUC) of four factors mentioned above combined diagnosis for PHC was 0.878 (P = 0.000) with the sensitivity of 88.89% and specificity of 76.58%.Conclusions PHC is very dangerous for gravida with severe PAH, and the mortality rate is very high. LVEDD, oral sildenafil, SpO2 at room air, Swan-Ganz catheter placement or not were independent risk factors of perioperative PHC for severe PAH maternal. Four preoperative factors of perioperative PHC joint diagnosis accuracy were higher.