An 70-year-old male come for swallowing pain 5 years, turning worse 10 months. Laryngoscopy showed a tumor with rough surface at the laryngeal surface of epiglottic. Outpatient pathology: poorly differentiated carcinoma of the larynx. CT: the root of epiglottic is slightly thickened. He accepted the partial laryngectomy, tracheotomy, bilateral functional neck dissection. Pathology: atypical carcinoid of larynx.
Aged ; Carcinoid Tumor ; pathology ; Epiglottis ; pathology ; Humans ; Laryngeal Neoplasms ; pathology ; Laryngectomy ; Laryngoscopy ; Larynx ; pathology ; Male ; Neck Dissection ; Tracheotomy

Objective To identify objective methods for medical service performance evaluation,and means to improve the efficiency of medical services.Methods By means of collection of medical records from 10 tertiary hospitals in Yunnan in 2012,and Diagnosis-related groups of Beijing version(BJDRGs)as a risk-adjustment tool,medical service performance was made to such hospitals.Results The capacity,efficiency and medical safety of hospital of the hospitals were subject to a comprehensive evaluation of their medical service capabilities.In terms of discharged inpatients and total weight,hospital A were found to be the highest(77 458 cases,104 227.5 respectively),and hospital I the lowest(25 450 cases,38 162.28)among these hospitals in 2012; compared with other hospitals,DRG groups of hospitals A,b and D were found higher,while the case mix index(CMI)of hospitals e and I were higher.The expenditure index of hospital C is the lowest(0.9359,0.8514); the mortality in cases of low risk of hospitals B,c and D were the lowest,while hospital F was the highest.Conclusion DRGs as a risk adjustment tool,can significantly improve the reliability,science and continuity of medical service performance evaluation,providing reliable basic data for hospitals accreditation in Yunnan.

Objective To evaluate the effects of ischemic preconditioning(IP) on liver function,complications and hospital stays after hepatectomy under hepatic vascular exclusion by a meta-analysis.Methods Randomized controlled trials(RCTs) were identified from PUBMED,EMBASE,the Cochrane Library,VIP,CNKI and Wanfang Data according to the inclusion and exclusion criteria.Literature screening,data extraction and quality assessment were made and the meta-analysis was processed by RevMan 4.2.2.Results Eight RCTs involving a total of 511 patients were included.The methodological quality was evaluated and all the trials were in graded B.The meta-analysis revealed that the postoperative ALT peak level(weighted mean difference=-176.37;95%CI:-320.67~-30.06;P=0.02)and postoperative complications incidence(odd ratio=0.64;95%CI: 0.41~0.98;P=0.04)were lower in IP group compared with control group,but there were no significant differences in blood loss,operating time,hepatic vascular exclusion time,postoperative AST and total bilirubin peak level,and hospital stays in both groups.Conclusions IP reduces the postoperative ALT peak level and complications incidence after hepatectomy under hepatic vascular exclusion,but there is no sufficient evidence to support that the IP can protect the liver from ischemia/reperfusion injury.

Objective To compare clinical outcomes of clavicular hook plate and coracoclavicu-lar screw fixation in treatment of acrmioclavicular dislocation (Tossy Ⅲ). Methods From August 2003 to January 2008,38 patients with acromioclavicular dislocation (Tossy Ⅲ) were randomly divided into two groups that were treated with coracoclavicular screw and clavicular hook plate fixation respective-ly. The range of shoulder movement was restricted after operation until the fixation was removed three months later. The shoulder function was evaluated by using Japanese Orthopedic Association (JOA) sco-ring system. The functional scores were compared before and after removal of the internal fixation in two groups. Results All patients were followed up, which showed no statistical difference upon final shoulder function of two groups. There was no loosening or migration of internal fixators. No redislocation occurred after removal of internal fixations. Seven patients complained shoulder pain and three had severe shoulder pain affecting sleep quality in coracoclavicular screw group. The pain was alleviated after remov-al of fixation. Conclusions Coraeeclavicular screw and clavicular hook plate fixation have similar clinical effect in treatment of acromioclavicular dislocation (Tossy Ⅲ), with satisfactory recovery of shoul-der function. Many complications of acromioclavicular fixations can be avoided by restriction of shoulder movement after operation and early functional exercise after removal of fixation.

The fragmentation pathways of five estrogens (estradiol, estrone, equilin sulfate, 17 a-dihydroequilin sulfate and equilenin sulfate) have been studied with high resolution and high mass accuracy using electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-Q-TOF/MS) in the negative ion mode. Molecular weights were obtained from [M-H](-) ions in the product ion spectra. The results indicate that the five structurally similar estrogens have similar fragmentation pathways. Using their stable isotope forms as internal reference compounds, the accurate mass and composition of the fragment ions were determined. During collision-induced dissociation (CID), cleavage is initiated by loss of oxygen atoms from carbon-17, after which D and C rings cleave sequentially and rearrange to finally form stable conjugate structures with highly abundant characteristic fragment ions at m/z 183 (accompanied by m/z 181), m/z 169 and m/z 145 (accompanied by m/z 143). Understanding these characteristic fragmentation pathways of estrogens will be helpful in identifying the structures of steroid hormones in general.

BJ-DRGs grouping process was cited as an example, to describe the factors affecting the grouping process, grouping results and assessment results, and the solutions in transferring homepages into WJT form 4-1 for inpatient medical record homepages (WJT form 4-1 for short).Authors analyzed how to better information acquisition quality of such homepages by unifying the data interface standard of WJT form 4-1, for the purposes of enhancing BJ-DRGs grouping efficiency, and expanding its functions as a tool for medical quality management and that for medical insurance payment management.

Objective To investigate the position sense in chronic non-specific low back pain (CNLBP) patients, and the correlation to pain and endurance of psoas muscles. Methods From January, 2014 to May, 2015, 30 patients with CNLBP and other 30 healthy subjects were measured spine flexion and extension position sense absolute error (AE) and psoas endurance with Biodex System 3 synchronously, and the patients were self-assessed the pain in lumbar with Numerical Rating Scale (NRS). The Pearson correlation coefficient of AE to pso-as endurance and NRS was calculated. Results AE of flexion and extension was both more in the patients than in the healthy (t>1.862, P<0.05), and the psoas muscle endurance was less (t=2.307, P<0.05). AE of flexion (r=-0.71) and extension (r=-0.47) negatively correlated with the psoas muscle endurance in the patients, and positively correlated with NRS score (r=0.78 for flexion, and r=0.49 for extension). AE mildly negative correlated with the psoas muscle endurance (r=-0.38 for flexion, and r=-0.29 for extension). Conclusion Spine sensation has been impaired in CNLBP patients, and may associate with pain and psoas muscles endurance loss.

Objective To investigate the oxalate-degrading and growth abilities of lactic acid bacteria coming from yoghourt in vitro culture broth. Methods The species of lactic acid bacteria obtained from 6 brands of yoghourt were identified. Different brands of yoghourt were separately cultured in broth and incubated at 37 ℃,5% CO2 for 48 h, getting the concentration of lactic acid bacteria through slab counting method. The brand of yoghourt with the highest quantity of bacteria was chosen as the study subject. Three species of bacteria and the mixture bacteria obtained from the chosen brand of yoghourt were cultured separately for 72 h in MRS broth which contained three different concentrations of ammonium oxalate, and the broth without inoculating of bacterium was prepared as control. The amount of bacteria in culture was detected, the concentration of ammonium oxalate was detected through photometric determination of oxalic acid by its catalytic reaction of methyl red by potassium chromate. Results Three species of lactic acid bacteria (L.bulgaria, L.acidophilus and L.thermophilus) were detected in each brand of yoghourt. The quantity of bacteria in Weiquan yoghourt is the highest. After 72 h incubation, the concentrations of oxalate in all the broths containing bacteria were lower than those in the control. L.acidophilus showed the best degrading activity. The higher the concentration of oxalate was, the bigger the amount of oxalate degraded was, the smaller the percent of degrading was, and the less the growth ability of bacteria was. Conclusion All the species coming from yoghourt have the ability of oxalate degrading, which increases with the concentration of oxalate in culture.But the high concentration of oxalate restrains the growth of bacteria.

The fragmentation pathways of five estrogens (estradiol, estrone, equilin sulfate, 17 a-dihydroequilin sulfate and equilenin sulfate) have been studied with high resolution and high mass accuracy using electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-Q-TOF/MS) in the negative ion mode. Molecular weights were obtained from [M-H](-) ions in the product ion spectra. The results indicate that the five structurally similar estrogens have similar fragmentation pathways. Using their stable isotope forms as internal reference compounds, the accurate mass and composition of the fragment ions were determined. During collision-induced dissociation (CID), cleavage is initiated by loss of oxygen atoms from carbon-17, after which D and C rings cleave sequentially and rearrange to finally form stable conjugate structures with highly abundant characteristic fragment ions at m/z 183 (accompanied by m/z 181), m/z 169 and m/z 145 (accompanied by m/z 143). Understanding these characteristic fragmentation pathways of estrogens will be helpful in identifying the structures of steroid hormones in general.
Chemical Fractionation ; methods ; Equilenin ; chemistry ; Equilin ; analogs & derivatives ; chemistry ; Estradiol ; chemistry ; Estrogens ; chemistry ; Estrone ; chemistry ; Ions ; Spectrometry, Mass, Electrospray Ionization

Objective To investigate the immunomodulatory effects and the mechanism of interferon (IFN)-γ-pretreated adult autologous adipose tissue-derived mesenchymal stem cells (ADSCs) on peripheral blood lymphocytes. Methods ADSCs were obtained from adult subcutaneous adipose tissues. IFN-γ with and without pretreated ADSCs were used as IFN-γ-pretreated group and IFN-γ-unpretreated group, which were cultured with autologous peripheral blood mononuclear cells (PBMCs) at different concentrations of ADSCs-to-PBMCs ratios in presence of concomitant phytohemagglutinin (PHA)/interleukin (IL)-2 stimulation. After 5 days of culture, the proliferatory inhibitory rate of activated T cells, the percentage of CD4+CD25+ regulatory T cells (Treg), and the expression of indoleamine 2,3-dioxygenase (IDO) mRNA were assessed. Results ADSCs were isolated from autologous adipose tissue, which strongly expressed CD73, CD90, and CD105, as well as displayed adipogenic and osteogenic differentiation. The percentage of CD4+CD25+Treg was significantly higher in IFN-γ-pretreated group than that of IFN-γ-unpretreated group. The expression level of IDO mRNA in ADSCs was significantly increased in IFN-γ-pretreated group than that of IFN-γ-unpretreated group. The proliferation inhibition of activated T cells was significantly decreased in IDO-blocker group than that of IFN-γ-pretreated group (P < 0.01). Conclusion These results suggest that IFN-γ can promote immunosuppressive effects of ADSCs on activated T cells through increased expression of IDO.