Objective To analyze the clinical features and diagnostic experiences of retroperitoneal neuroendocrine carcinoma (NEC).Methods Clinical data of primary retroperitoneal NEC from January 2000 to January 2012 were retrospectively collected and analyzed.Results Five candidates were included 4 male and 1 female.The median age was 53 years old.3 cases initially suffered from abdominal pain and radiative back pain,2 cases were confirmed by normal physical check.The CT scan and B type ultrasound were performed among all patients,1 case was diagnosed as pancreas head neoplasm,1 case pancreas insulinoma,which was closely associated with other tissues and the intervational therapy was performed twice preoperatively.All 5 cases were selected surgery as the main treatment,2 cases performed radical tumor resection,3 cases received bypass operation.2 cases were 3 years survival.Conclusion Retroperitoneal NEC is a rare carcinoma,characterized by seriously invasion and high malignant degree.Surgery still remains the mainstay of selections,early diagnosis can significantly improve NEC patients’ overall survival rate.But the early diagnosis rate of this rare kind of patients still need to be improved.

Objective To observe the activation patterns in surface electromyographs (sEMGs) of the lumbar dorsal and ventral muscles and the gluteus medius during asymmetrical trunk postures and while carrying loads with the trunk rotated.Methods sEMGs were recorded from ten healthy men as they stood with their feet in 5 positions-rotated clockwise 0°,45°,90°,135° and 180° with respect to the initial plane of the torso.With each foot position they stood in 3 postures:upright,in lateral flexion and in lateral extension.Each posture was recorded with and without carrying a load of 20 kg by the right hand.The EMG activities of the rectus abdominis (RA),obliquus externus abdominis (EO),erector spinae (ES),multifidus (LM) and gluteus medius (GM) on both sides were recorded.Trunk displacement was monitored by 8 cameras.The EMG data of each muscle were normalized with readings from a maximal voluntary contraction (MVC) of the muscle.Results With the feet at 0° and no load the muscle activities on both sides were 1％-2％ of the MVC readings.With a 20 kg load the percentage was 3％-13％.With the feet at 45° and no load the activities were greater,except in the RA on the contralateral side.With no load at 90°,135° and 180° the muscle activities were greater,but a few muscles in the two extreme trunk postures showed greater activity only on one side,especially the ES and LM.With a load and rotational torque in the spine,the ventral muscles were less active but the dorsal muscles were significantly more active on both sides.Conclusion Standing with rotation of the spine,the activity of some trunk muscles shows great asymmetry,particularly with asymmetric loading of the arms.This might create a phenomenon of lumbar flashing and it could possibly be one of the pathological bases of acute lumbar sprain.

Perioperative pain management play a critical role in rapid recovery and long term outcome in patient undergoing total knee arthroplasty.With the advancement of peripheral nerve block, technique such as femoral nerve block, sciatic nerve block, abductor canal block have play an important role in perioperative pain management.Local infiltration analgesia have also gained popularity.The ultimate goal of perioperative pain management is to ensure analgesia effect and maintain good motor function of lower extremity.We are still in searching of a safe, effective, analgesia without motor block.Currently multimodal analgesia seems to be the most favorable choice.

Objective To determine the relationship between the residue amniotic fluid volume after preterm premature rupture of membranes(PPROM)and maternal-fetal prognosis.Methods One hundred and forty-five pregnant women with PPROM during 28-34 gestational weeks were studied,hospitalized in department of Obstetrics and Gynecology,The First Affiliated Hospital of Chongqing Medical University from Jan.2002 to Feb.2009,and Chongqing Health Center For Women And Children from Jan.2005 to Feb.2009.All patients are willing to take part in these experiments.According to Amniotic fluid index(AFI)by ultrasound,patients were derided into three groups:(1)Group of oligohydramnios:AFI＜50 mm;(2)Group of berderline oligohydramnios:50 mm≤AFI＜80 mm;(3)Group of normal amniotic fluid:80 mm≤AFI＜180 mm.All the groups weFe similar with patient's age.gravidity and parity,white blood cell count (WBC),gestational age at rupture of membrane,rates of placental abruption,neonatal jaundice,neonatal hypoglycemia,neonatal respiratory distress syndrome(NRDS),neonatal hypoxic ischemic encephalopathy (HIE)and neonatal respiratory failure(RF;P＞0.05).Resalts (1)Group of oligohydramnios had a shorter latent period(P＜0.05)compared with other two groups;(2)Group of oligohydramnios had a hish rates of cesarean section(69%),Intra-amniotic infection(IAI,36%),fetal distress(19%),neonatal asphyxia(28%).early-onset neonatal sepsis(28%)and hypoxic-ischemic myocardial injury(56%)than those in Group of normal amniotic fluid(39%,9%,3%,8%,9%,13%;P＜0.01);(3)Logistic regression analysis showed that group of oligohydramnios wag an independent risk factor of IAI and earlyonset neonatal sepsis(P＜0.05).Conclusions Oligohydramnios after pprom is associated with the shorter latent period,as well as the increasing risks of pregnancy complications of cesarean Section,IAI,fetal distress,neonatal asphyxia,early-onset neonatal sepsis and neonatal hypoxic-ischemic myocardial injury.So,the amniotic fluid volume might be an important prognostic indicator to assess the outcomes of maternal and neonatal when PPROM happened.

Mild hypothermia significantly increases perioperative complications,such as adverse myocardial outcomes,coagulopathy,infection and delayed recovery.So it is important to maintain the core temperature above 36 ℃.Redistribution is the major cause of hypothermia during the first hour of intravertebral or general anesthesia.There are many methods to protect patients from hypothermia including passive insulation and active warming.Forced-air and electric heating pad are currently the most effective noninvasive choices.The contribution of intravenous fluids heating to patients' temperature is limited but it should be performed when large volume is required.

Objective To explore the clinical efficacy of anti-helicobacter pylori (HP) treatment on patients with type 2 diabetes mellitus and HP infection.Methods A total of 112 type 2 Diabetes patients were diagnosed with HP infection in Combine Traditional Chinese and Western Medicine Hospital of Taizhou from April 2012 to June 2016.These patients were divided into control and treatment group based on the preprandial blood glucose averages from lower to higher hierarchy.Thus,there were 56 patients in each of the two groups.The control group was given Motilium and Talcid for gastric symptoms in addition to anti-diabetes treatment,while the treatment was administered the same treatments as well as the quadruple anti-HP therapy (omeprazole,amoxicillin,clarithromycin and colloidal-bismuth-subcitrate,with Talcid stopped while colloidal-bismuth-subcitrate was administered).The anti-HP lasted for 14 days.The two groups were compared the gastric symptoms,the blood glucose levels,and the HbA1c one month after treatment.Half a year and one year post treatment,the two groups were compared the gastric mucus signs under gastroscopy.Results The improvement rates after treatment with the treatment group in abdominal pain,bloating,regurgitation,belching and diarrhea/constipation were 88.5％ (23/26),83.3％ (25/30),74.1％ (20/27),83.9％ (26/31),82.6％ (19/23),respectively,and with the control group being 29.2％(7/24),32.1％(9/28),28％(7/25),30.3％(10/33),18.2％ (4/22),respectively.The differences between the two groups were significant (x2=8.06,6.62,3.92,7.65,6.66,P＜0.05 or P＜0.01).The control group did not show significant changes in preprandial glucose levels,the glucose levels two hours post meals and the HbA1c(P＞0.05) while the treatment group showed statistically significant changes(P＜0.05 or P＜0.01).The differences in the three indicators after treatment between the two groups were significant (t =4.07,7.85,4.16,P＜ 0.05).The Gastric mucus signs under gastroscopy showed improvements in both groups after treatment.The improvement rates with the treatment group were 86.2％(25/29),86.7％ (13/15),77.8％ (14/18),72.7％ (8/11) respectively,with the control group being 36％ (9/16),27.3％ (3/11),13.3％ (2/15),14.3％ (1/7),respectively.The differences between the two groups were significant (x2 =6.71,4.12,4.38,3.85,P ＜ 0.05 or P＜ 0.01).The effectiveness rate,which was based on combined improvements in gastric symptoms,glucose levels and gastric mucus signs,was 76.8％ with the treatment group and 32.1％ with the control group.The difference was statistically significant (x2 =6.78,P＜0.01).Conclusion Anti-HP treatment can relieve the gastric symptoms,stabilize the glucose levels,and help to reverse the changed gastric mucus.All these can reduce the complications of the diabetes and improve the prognosis of the patients.

The incidence and proportion of right colon cancer is increasingly high in recent years with a relatively poor prognosis. Right hemicolectomy is the standard procedure for the treatment of right colon cancer. Recently, infrapyloric lymph node (No.206 nodes) dissection has become one of the hot topics of surgical treatment for right colon cancer. The incidence of infrapyloric lymph node metastasis is still unclear, and whether it belongs to the regional lymph node of the right colon cancer is controversial. There are few methods to judge and predict infrapyloric lymph node metastasis, and the accuracy of diagnosis is low. What's more, dissection of infrapyloric lymph node might increase the risk of complications and perioperative mortality, as well as lead to overtreatment. As a result, this series of problems and controversies result in the obscure of the clinical value of infrapyloric lymph node dissection. Therefore, there is urgent need to design more high-quality, multicenter and large-sample prospective randomized controlled trials to explore the standard of routine dissection of infrapyloric lymph node for right colon cancer. Based on research advances at home and abroad, the authors review the incidence of infrapyloric lymph node metastasis, methods for judgement of infrapyloric lymph node metastasis, inluencing factors for lymph node metastasis, value of lymph node dissection, and research of direction in the future.

Objective To study the cytogenetic changes in HPV-immortalized cells(SHEE)for further investigating the esophageal carcinogenesis. Methods Giemsa staining was used to show the modal number of chromosomes.G-banding was done to observe the chromosomal aberrations.Fluorescence in situ hybridization(FISH)of the interphase nuclei with the centromere probes of chromosome 1,7 and 8 were performed to determine the numerical abnormalities. Results The modal numbers at passage 10 and 20 were 58-63 and 57-64, respectively.Passage 61 had a bimodal distribution 58-61 and 63-65.The structural aberrations could almost be found in all of karyotypes.The following structural aberrations were identified:1.del(1)(q12);2.del(1)(p32);3.der(4),t(4;?)(q31;?);4.der(5),t(5:?)(q31;?).FISH results showed that trisomy 1 and tetrasomy 7 markedly increased with the increase of passages and disomy 8 kept in faint change in all passages.Conclusion The modal number moved right slowly in the graph of the modal distribution and the increases of chromosomal numbers were in imbalance with increases of passages of SHEE.The structural aberrations of chromosome were found in most of karyotypes.Our results suggest that the cell immortalization is a multistep process involved in the multiple chromosomes.;

Objective To evaluate the feasibility of using a microsensor motion capture unit (MCU) to assess the reaching characteristics of hemiplegic stroke patients. Methods Twenty-three hemiplegic stroke patients with an average age of (61 ± 11) years and ten normal subjects of matching age were asked to sit on a chair and use the affected arm (for the patients) or the right arm (for the normal subjects) to reach for a cup on a table just in front of the shoulder at arm's length away.Four small sensor boxes which could detect movement and its speed and smoothness in three dimensions were fixed to the subject's spine,upper arm,forearm and hand.The test was repeated four times after two trial runs.The average velocity,peak velocity,degree of joint dispersion,entropy of acceleration,joint coordination and active range of motion ( AROM ) of the shoulder were analyzed.The patients and normal subjects were statistically compared.The results were correlated with Fugl-Meyer upper extremity scores using Spearman correlation analysis. Results All of the measured variables showed significant differences between the patients and normal subjects.In the correlation study,the average velocity,peak velocity,AROM of the shoulder and joint coordination showed significant correlation with the Fugl-Meyer scores.There was,however,no significant correlation between degree of dispersion of the shoulder or elbow joints or the entropy of acceleration ( which represented the quality of movement) and Fugl-Meyer upper extremity scores. Conclusions The results suggest that microsensor MCUs can quantitatively assess the kinematics of reaching among hemiplegic stroke patients.They can provide valuable and objective data about the functional quality of multiple joint movements in three dimensions.

Objective To study the clinical features of gallbladder small cell carcinoma (GSCC),to improve the diagnosis and treatment of GSCC.Methods We retrospectively analyzed the clinical data of GSCC patients at our hospital from January 2000 to January 2012,and made a collective review of the literature.Results In this series,there were four female cases,one male case,the age at the first diagnosis was between 42-67,with the median age of 57.The main complain was pain and dis-comfort on the up and right abdomen.Tumor located in the bottom of gallbladder in 3 cases,and in the body in 2.Cholelithiasis was complicated in 4 cases.2 patients received radical resection of GSCC,followed by adjuvant chemotherapy of VP-16 and cisplatin,radioactive therapy in one.Postoperatively,these two were followed up for 45 and 32 mons with tumor free survival.3 cases received palliative resection,followed by adjuvant chemoradioactive therapy or intervention treatment,these three were followed up to 8,11,30 months respectively to their death for tumor recurrence.Conclusions GSCC is a rare disease,the initial symptoms are not often specific and easily misdiagnosed.The prognosis of GSCC is poor.