ObjectiveTo study preoperative diagnosis and operative route of traumatic diaphragmatic rupture in order to improve postoperative quality of patients' life.MethodsA retrospective analysis was carried out in 63 patients with traumatic diaphragmatic rupture,all that were identified through operation from January 1990 to March 2009.All cases were associated with pneumothorax and/or hemopneumothorax at various degrees.Forty-nine cases complicated with acute peritonitis and 41 cases complicated with hemorrhagic shock.Thirty-seven cases were diagnosed definitely preoperatively,22 cases were found in operations research,4 cases with inefficacious conservation converted to operation.Thoracotomy was performedin 24 cases,laparotomy in 14 cases,combined thoracolaparotomy in 8 cases and thoracotomy plus laparotomy in 17 cases.ResultsFifty-seven cases recovered,6 cases died of hemorrhagic shock (2 cases),pericardial tamponade ( 1 case),acute respiratory failure ( 1 case) and acute renal failure at postoperative 1 week (2 cases).ConclusionDefinite and timely preoperative diagnosis and correct operative approach are striving the rescue time and success and avoiding complication.

ObjectiveTo detect the mRNA and protein expressions of Bmi-1 in hepatocellular carcinoma (HCC) tissue,pericarcinomatous tissue,portal vein tumor thrombus and normal liver tissue,and to investiage the significance of Bmi-1 in the genesis and progression of HCC.MethodsForty tissues of HCC were collected from the Tongji Hospital of Huazhong University of Science and Technology from January 2005 to December 2009.The mRNA and protein expressions of Bmi-1 in the HCC tissues (40 cases),pericarcinomatous tissues (40 cases),portal vein tumor thrombus ( 11 cases) and normal liver tissues ( 10 cases) were detected by immunohistochemistry,Western blot and real-time polymerase chain reaction.The relationship between the expressions of Bmi-1 and the clinicopathological factors was analyzed.Differences in each group were compared by using the Nemenyi test or Dunnet t test,and the relationship between the clinicopathological factors and the protein expression in the HCC tissues was analyzed by the chi-square test or Fisher exact probability.The survival curve was drawn by the Kaplan-Meier method,and the survival rate was analyzed by the Log-rank test.Results The median relative mRNA expressions of Bmi-1 in the normal liver tissues,pericarcinomatous tissues,HCC tissues and portal vein tumor thrombus were 0.96,2.60,7.51 and 29.95,respectively.The results of immunohistochemistry showed that the high protein expression rates of Bmi-1 in the normal liver tissues,pericarcinomatous tissues,HCC tissues and portal vein tumor thrombus were 10.0％,20.0％,67.5％ and 100.0％,respectively.The high protein expression rates of Bmi-1 in the HCC tissues and portal vein tumor thrombus were significantly higher than those in the normal liver tissues and pericarcinomatous tissues (x2 =17.25,22.77;22.04,23.95,P ＜ 0.05 ). High protein expression of Bmi-1 was also detected in 11 cases of HCC tissues with portal vein tumor thrombus.The results of western blot were consistent with those of the immunohistochemistry.The mRNA and protein expressions of Bmi-1 were correlated with Edmondson grade and portal vein metastasis ( x2 =5.572,P ＜ 0.05 ),whereas they were irrelevant to the tumor size,serum levels of α-fetoprotein and hepatitis B surface antigen ( x2 =0.000,0.019,0.663,P ＞0.05).Patients with high expression of Bmi-1 had poor prognosis.ConclusionsBmi-1 is correlated with the genesis and progression of HCC as well as the formation of portal vein tumor thrombosis.Patients with high Bmi-1 expression have poorer prognosis when compared with those with low Bmi-1 expression.

Objective To investigate the correlative factors affecting the plasma D-dimer level in elderly patients. Methods Five hundred and seventy-eight hospitalized elderly patients were included in this study. All participants were di-vided into normal group (＜0.4 mg/L) and elevated group (≥0.4 mg/L) according to the plasma D-dimer value,which was mea-sured by automated quantitative turbidimetric latex agglutination test. The differences in clinical indicators were compared be-tween two groups. The factors leading to the increased plasma levels of D-dimer in elderly patients were also analyzed. Results It was found that the patient age, C-reactive protein, prothrombin time, proportions of type 2 diabetes mellitus, ma-lignant tumor, bacterial pneumonia and (or) acute exacerbation of chronic bronchitis were significant higher in elevated group than those of normal group (P＜0.05), but the levels of total cholesterol and low density lipoprotein cholesterol were lower in elevated group than those of normal group (P＜0.05). There was a positive correlation between serum level of D-dimer and age, C-reactive protein (r=0.254 and 0.265, P ＜ 0.05). Binary logistic regression analysis showed that the factors affecting plasma D-dimer level of elderly patients were aging, elevated C-reactive protein level, existing of malignant tumor, type 2 dia-betes mellitus, and bacterial pneumonia and (or) acute exacerbation of chronic bronchitis. Conclusion Aging, existing of type 2 diabetes mellitus, malignant tumor, or acute inflammatory state were the important factors leading elevated plasma D-dimer levels in elderly patients.

Objective To evaluate the efficacy of endoscopic ultrasonography(EUS)guided implantation of 5-FU seeds for progressive gastric cancer.Methods A total of 23 patients with progressive gastric cancer and outflow obstruction were enrolled into the study.During the endoscopy procedure, 45-60 5-FU seeds were implanted into the tumors with guidance of EUS, with an average dose of 100 mg.Volumes of tumor were examined with 3D-EUS before and after the treatment.Results A total of 33 procedures of 5-FU implantation were performed.By measurements of 3D-EUS, the numbers of patients with complete respons, partial response, no change, progressive disease were 1, 15, 6 and 1, respectively.In terms of outflow obstruction improvement, significant effect, obvious effect and average effect were achieved in 6, 7 and 9 patients, respectively, with an overall response rate at 91.4%.Conclusion EUS-guided 5-FU seed implantation in progressive gastric cancer is safe,reliable and effective with few complications.3D-EUS may be a new method to evaluate curative effect.

Purpose To explore the clinical pathological features and differential diagnoses and therapeutics of hyalinizing trabecular tumours ( HTT) of thyroid. Methods The clinical manifestations, high-frequency color doppler ultrasonography, histopathological and immunohistochemical features were analysed in six cases of HTT of thyroid. Related literatures were reviewed. Results On his-topathological examination, polygonal and elongated cells arranged in pattern of trabecular and organoid, with a clear perinucleolus ha-lo. Basement membrane-like material deposited intertrabeculae widespreadly. The tumour cells are completely filled with eosinophilic and granular material in their cytoplasm, nuclei with prominent grooves and pseudoinclusions. Immunohistochemically, the tumour cells were positive for TG, TTF-1 and CD56, CK19 and Galectin-3 interspersed expression. And all of them were negative for Calcito-nin, MC, CEA, Syn, CgA, Ki-67, p53 were lower expression. The differential diagnosis included solid variant of papillary carcinoma, medullary thyroid carcinoma and paraganglioma and so on. Conclusion HTT is an uncommon thyroid tumor, the majority of them be-have as benign neiplasms and that, correct pathologic diagnosis may play an important role in standard treatment and prognostic evalua-tion of HTT.

Objective: To explore effectiveness of exercise intervention and group cognitive therapy on mobile phone dependence in college students. Methods: A total of 762 college students from a university in Wuhan were selected through random cluster sampling method in Oct. 2019. Among them, 126 students with higher risk for mobile phone dependence were selected as experimental group which were assigned to four groups:open exercise group(basketball,31),close exercise group(baduanjin,31), group cognitive group(30) and control group(34). The exercise group attended 60 min intervention twice a week for 10 weeks. The effectiveness was evaluated through the changes in the Mobile Phone Addiction Index (MPAI). Results: The 10week exercise and group based cognitive therapy intervention can improve mobile phone dependence behavior among college students ( F group= 4.54, F time = 3.67, P <0.05). Among them, the open exercise group and the group cognitive therapy group showed slightly better effects( t= 0.06, P >0.05). In the follow up visit two months after intervention, no significant difference between the closed exercise group and the post test results( t=1.23, P >0.05). In the dimensions of out of control and withdrawal, the open exercise was more effective than the closed exercise intervention( t=2.58, 2.67, P <0.05). Conclusion Open exercise group has similar effect on improvement in mobile phone dependence with group cognitive therapy among college students, while closed exercise intervention shows better long term effect.

Objective To explore the optimal timing of operation for experimental obstructive jaundice in a dog model. Method A dog model of bile duct stricture (BDS) was established. Dogs were divided into (n = 12 in each group) 6 groups, ie control, BDS days 5, 10, 15, 20, and 30. In each dog,the morphology and local histopathology of the bile duct, and the liver function in different periods were observed. At the time of surgery biopsy was taken and Roux-en-Y hepaticojejunostomy performed. Surgical complications and survival were evaluated. Result After bile duct obstruction, the proximal bile duct dilated continuously. The diameter of bile duct was 15.6 ± 1.7 mm at the 10th day. The injury bile ductshowed the acute inflammation change. In the early time (in 10 days), inflammatory cells increased in the tissues, mucous edema aggravated, the wall was edematous thickening, it was most severe ( WBC counting 54 ±6) in the 5th day. In the later period (10 -30 days), inflammatory cells reduced, bile duct wall became fibrosis, which was most obvious in the 15th day (42 ± 7 vs 54 ± 6, P ＜ 0.05 ). During the development of jaundice, serum bilirubin reached the highest level in the early period ( BDS days 5 group),then presented a platform time, and then rised extremely at the last stage of the experiment ( BDS day 30 group) . Changes of ALT and AST paralleled that of bilirubin before the 20th day of obstruction and then plummeted. BDS was repaired successfully in 57 dogs. Ten dogs died postoperatively due to bile leakage within 10 days, 3 dogs in BDS days 5 group (3/11), 4 in BDS days 10 group (4/12), one each in other groups. Postoperatively 13 BDS dogs died of malnutrition and organ failure within 3 months, including one each in days 5 and days 10 group, two each in days 15 and days 20 group, and 7 in days 30 group (P＜0. 05). Conclusion Considering the changes of morphology, physical function and result of follow up.The period between 10 and 20 days after acute bile duct injury is optimal for surgical repair.

Objective To evaluate the expression of transient receptor potential melastatin 7(TRPM7)in cholangiocarcinoma and its correlation with prognosis.Methods The expressions of TRPM7 were detected by SP immunohistochemical in 49 cases of cholangiocarcinoma,7 cases of benign bile duct lesions and 36 cases of adjacent histologically noncancerous bile duct tissues,and to analysis its relationship with the clinical pathological characteristics of cholangiocarcinoma.Results The positive expression rate of TRPM7 in cholangiocarcinoma was 77.6%(38/49),which was higher than that in benign bile duct lesions(0,0/7)and adjacent his-tologically noncancerous bile duct tissues(2.8%,1/36),the difference was statistically significant(P <0.05).The positive expres-sion of TRPM7 in cholangiocarcinoma was correlated with the TNM stage of tumor,lymph node metastasis and organ metastasis (P <0.05),but not related to patients′age,gender,site,differentiation and hepatitis(P >0.05).Kaplan-Meier analysis showed that increased expression of TRPM7 was associated with shorted overall survival (P <0.05).Cox regression analysis showed that the expression level of TRPM7 was significantly associated with prognosis and an independent risk factor for prognosis(P <0.05 ). Conclusion TRPM7 plays an important role in the tumorigenesis progression,invasion,and metastasis of cholangiocarcinoma,and is an important factor for prognosis in patients with cholangiocarcinoma.

ObjectiveTo explore the histopathological changes of bile duct,liver and local tissue for injurious biliary stricture(IBS). MethodTo observe the morphological and pathological changes of bile duct, local tissue and liver in different periods with dogs as the established animal model for IBS. ResultBile duct obstruction due to injury can expand the proximal bile duct up to 18.91 ±1.85 mm as the pressure goes up. Damage to local tissue triggers acute inflammation. In early injury phase (within 10 d), inflammatory cell infiltration and proliferation appears on the wall of the duct with increased mucosal edema as well as thickening of the biliary ductile wall. In the late injury phase (15 d), the degree of infiltration of inflammatory cells, edema and mucosal thickness were reduced whereas fibroblast and collagen tissue were proliferated extensively. The wall of biliary duct also becomes fibrotic and thickens. Quantitative analysis of the inflammatory edema shows the most severe outcome on the 5th day (HE staining WBC count of 54.2±5.8 unit) and its severity progressively subsides on the 15th day. (HE staining WBC count of 41.7±7.2 vs 54.2±5.8 a, P＜0.0,5). In the early obstruction (5 d and 10 d), the liver cells showed mild to moderate swelling and its degeneration is often associated with steatosis and sinusoidal expansion and congestion. As the obstruction time increases in the 20 d and 30 d group, liver cells starts to show extensive vacuolation and sinusoidal occlusion. ConclusionsEarly phase (5 days) of acute bile duct obstruction due to injury shows rapid expansion of the bile duct, edema in the bile duct itself as well as its surrounding tissue and liver damage. After 15 days, the local inflammatory edema is greatly reduced and is replaced by hyperplasia of fibers and collagen. Liver damage appears to be irreversible after 20 days. Considering local environmental and systemic conditions, the optimal time frame to repair obstruction of bile duct surgically is between 10-20 days.

Osteoarthritis (OA) is a common degenerative disease. Its most significant pathological change is destruction of articular cartilage and the main clinical symptoms are pain and dysfunction of joints. Recent studies have shown that the expression of non-coding RNA (ncRNA) in chondrocytes can abnormally up-regulate or down-regulate and alter the activities of chondrocytes like their proliferation, migration and apoptosis, thus leading to the occurrence and development of osteoarthritis. Exosomes are extracellular vesicles with a diameter of 40-100 nm, which are secreted in intercellular fluid, act as medium of intercellular communication. They protect ncRNA, protein, lipid and other bioactive materials from enzymatic degradation by encapsulating them and transferring to sibling chondrocytes, due to their good tissue permeability. They can also improve communication between cells and regulate the activities of chondrocytes. Thus, exosomes behave like gene carriers. The ncRNA carried by exosomes can supplement or adsorb the abnormal ncRNA in chondrocytes, so as to regulate the activity of chondrocytes, and is therefore considered as a possible candidate with capabilities to repair cartilages. In this study we reviewed existing literatures related to the roles and effects of exosome miRNA, lncRNA and circRNA on osteoarthritis. We also reviewed the pathogenesis of exosome ncRNA in osteoarthritis.