Objective To report the diagnosis and treatment of a case of renal inflammatory myofibroblastoma. Methods A 30-year-old man presented with space-occupying lesion of the kidney with no symptoms in physical examination.No abnormality was found in the laboratory tests.B-ultrasound showed a clear-edged,solid mass which was 4.5 cm?3.7 cm in size and had heterogeneous echo in the upper,middle part of the left kidney.CT showed a similar value of the mass to that of the normal tissue.Enhanced MRI showed heterogeneous intensification of the mass whose signal was slightly lower than that of the normal tissue.Preliminary diagnosis of renal cancer was made. Results Nephrectomy was performed.On pathological examination the tumor was mainly composed of spindle-shaped,fibrous cells, and positive staining for Vimentin,SMA and HHF35 were observed immunohistochemically.Inflammatory myofibroblastoma of the kidney was diagnosed.Follow-up of 54 months showed no recurrence and metastasis of the tumor. Conclusions Inflammatory myofibroblastoma is a kind of rare,benign or low-grade malignant tumor of the kidney, and the clinical diagnosis is often difficult.Definite diagnosis relies on pathology.For the sake of avoidance of resecting the kidney by mistake, pathological examination is the preferred choice during operation.

BACKGROUND: The rehabilitation outcome varies in stroke patients,and there are differences in the literatures about the influence of factors on the functional recovery in such patients.,OBJECTIVE: To evaluate the pre-rehabilitative and post-rehabilitative effects of stroke patients by functional independence measure (FIM) that is widely used, and analyze the influence of gender, age, motor and cognitive functions at admission, time interval from stroke onset to arrival at rehabilitative admission, comorbidity occurrence, laterality of lesion on the functional recovery of stroke patients.DESIGN: Before-after control observationSETTING: Center of Rehabilitation Medicine, Shandong Provincial Hospital; Faculty of Rehabilitation Medicine, Capital University of Medical SciencesPARTICIPANTS: From March 2000 to December 2002, 55 stroke patients were selected from Shandong Provincial Hospital. They were all first episode, and patients whose bilateral cerebral hemisphere were involved were excluded.METHODS: After the vital signs were steady, the stroke patients got through risk phase (31-75 days) and were treated with medicine improving microcirculation and providing neurotrophic factor for nerves. In addition, they accepted comprehensive rehabilitation training of Bobath technique, PNF technique and Rood method mainly, with 1-2 hours per day and five times per week.MAIN OUTCOME MEASURES: The patients were evaluated within 7days after admission and reassessed 3 days before discharge using FIM,including 18 items of motor and cognitive functions and 126 total scores (108-126 as elementarily or completely independent, 72-107 as mildly dependent, 54-71 as moderately dependent, 36-53 as severely dependent,18-35 as extremely or completely dependent). Multiple stepwise regression equation was applied to analyze the relation of above factors and functional recovery (increased value of FIM total score).RESULTS: Totally 55 patients were involved into the result analysis.①FIM total score of patients was significantly higher at discharge than at admission (93.8±12.0, 68.8±11.6, P ＜ 0.001), and motor function and cognitive function at discharge also increased compare with at admission (P ＜ 0.001).②Mean value of FIM motor score increased everyday was identical with that of total score (0.56±0.21, 0.59±0.21), and higher than mean value of cognitive score (0.03±0.03).Multiple stepwise regression analysis showed,scores of motor and cognitive status at admission, age, time interval from stroke onset to arrival at rehabilitative admission all affected the increased value of FIM total scores. No significant association between gender, comorbidity, laterality lesion of paralysis and functional recovery was observed (P ＞ 0.05). The most influential factors were orderly motor function,cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitation admission.CONCLUSION: Motor and cognitive function at admission, age and time interval from stroke onset to arrival at rehabilitative admission have a no table relationship with functional recovery of stroke patients, especially motor function at admission is positively related. Thus we should not neglect the influence of these factors when conducting rehabilitative treatment.

Objective To investigate the management of research instruments.Methods Scientific and effectual device management and technical training were established.Results The instruments availability and intact conditions including economic efficacy were greatly improved via scientific and effectual management in our neurosurgical institute.Conclusion Scientific standard and systematic management can not only ensure the optimal working conditions of research instruments for research work,but promote the equipment efficacy and increase economic returns.

Objective To analyze the distribution and antimicrobial resistance of bloodstream pathogens in surgical intensive care unit (SICU) and medical intensive care unit (MICU) of Fujian Provincial Hospital in the past four and half years for better use of antimicrobial drugs.Methods A retrospective analysis was carried out for the bloodstream pathogens isolated from SICU and MICU patients from January 2012 to June 2016.The clinical data and outcomes of patients were also reviewed.Results A total of 329 strains of isolates were recovered from blood samples in SICU,including gram-negative bacteria (53.5％),gram-positive bacteria (39.2％),and fungi (7.3％);258 strains were collected from MICU,including gram-negative bacteria (57.8％),gram-positive bacteria (36.0％),and fungi (6.2％).A.baumannii,K.pneumonia and E.coli were the top three gram-negative species in both SICU and MICU.The main gram-positive species were coagulase-negative Staphylococcus and Enterococcusfaecium.Overall,386 cases of bloodstream infections were diagnosed,including 226 cases in SICU (202 cases of single bacterial infection and 24 cases of multiple bacterial infection),and 160 cases in MICU (138 cases of single bacterial infection and 22 cases of multiple bacterial infection).A.baumannii isolates showed significantly higher rate of resistance to antibiotics in SICU than in MICU,while the K.pneumoniae and E.coli isolates in MICU showed higher resistance rates to cephalosporins,quinolones,penicillins and carbapenems than the corresponding isolates in SICU.The coagulase negative Staphylococcus and E.faecium isolates in MICU were associated with significantly higher resistance rates to quinolones and tigecycline than those strain in SICU.The bloodstream infections due to K.pneumoniae,E.coli and E.faecium were associated with higher mortality in MICU than in SICU,while the bloodstream infections due to A.baumannii were associated with higher mortality in SICU than in MICU.The total mortality rate of bloodstream infections was higher in MICU than in SICU.Conclusions SICU and MICU share similar profile of main bloodstream pathogens even though the disease spectrum was different between SICU and MICU.All the bloodstream pathogens isolated from MICU patients except A.baumannii showed significantly higher antimicrobial resistance rates than the isolates from SICU.The mortality rate associated with bloodstream infection was also higher in MICU patients than in SICU.

Objective To evaluate impacts of acute hypervolemic hemodilution (AHH) and intra-operative cell salvage (ICS) with 6％ volume fraction of hydroxyethyl starch (HES) on hemodynamics,blood saving efficiency and renal function of orthopedic surgery patients.Methods A total of 58 patients from orthopedic surgery were involved and randomly divided into AHH + ICS group (30 cases) and control group (28 cases).Changes of hemodynamic indices (HR,MAP and CVP) and renal function indices (BUN,BCr,UCr and ALB) in both groups were compared before operation (T0),immediately after operation (T1) and at postoperative 4 hours (T2),1 day (T3) and 2 days (T4).CCr was counted and intraoperative blood conservation was observed at each time point as well.Results HR,MAP and CVP of the two groups had no significant differences.Both groups showed some drop of HR (P ＜ 0.05),but an increase of MAP and CVP at T1-T4 (P ＜ 0.05),in contrast with levels at TO.BUN,BCr and ALB also showed insignificant differences between groups or within group at each time point.CCr in the control group showed no significant difference at each time point.On the contrary,CCr in the AHH + ICS group had a fall at T1-T4 and was declined to the lowest level at T2.CCr in the AHH + ICS group showed a recovery at T3-T4 and its level at T4 was still lower than that at TO,with no significant difference.CCr in the two groups showed insignificant difference at TO,but its level in the AHH + ICS group was lower than that in the control group at T1-T4,at T2 in particular (P ＜0.01).Moreover,CCr in the two groups was still significantly different at T4 (P ＜ 0.05).Renal function indices of the two groups were all within normal range at each time point.Intraoperative blood loss and unrine volume of the two groups had no significant differences,but intraoperative fluid requirement,allogenic blood transfusion volume and transfusion rate of AHH + ICS group were notably lower than those of control group (P ＜ 0.05 or P ＜0.01).Conclusions AHH plus ICS using HES are safe,effective and promising integrated blood conservation measures,which significantly reduces intraoperative allogenic blood transfusion volume and transfusion rate and has few impacts on fundamental vital signs and renal function.However,prolonged use of large dose of HES may do harm to renal function and therefore should be carefully considered in treatment of patients with severe renal dysfunction.

OBJECTIVESTo investigate the value of colonoscopy for the diagnosis and preoperative staging of colorectal cancer, and evaluate the significance of correct preoperative staging in guiding treatment.

METHODS28 patients with colorectal cancer were examined by general colonoscopy, magnifying endoscopy and endoscopic ultrasonography before operation. Preoperative staging, and proper treatment protocols were made.

RESULTSEndoscopy revealed that 15 of the 28 patients had early colorectal cancer and 13 advanced colorectal cancer. The correct diagnosis rate for preoperative staging was 100%; the accuracy of penetrating depth was 89% (25/28). In the early cases, tumour invasion was confined to mucosal layer in 11 patients and submucosal layer in 4. Six patients with early cancers 6 cm from the anus were treated by endoscopic mucosa resection (EMR) or EMR combined with open surgery. No postoperative recurrence was found by endoscopy during the period of follow-up for 12 - 40 months.

CONCLUSIONCorrect preoperative staging for colorectal cancer is of important significance in guiding treatment, especially in early staging cases. In order to improve the quality of life for colorectal cancer patients, we should treat them with individualized operation based on curative resection.

Adult ; Aged ; Colonoscopy ; Colorectal Neoplasms ; pathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging

Objective: To study the cytomorphologic features and determine whether pancreatic neuroendocrine tumors (PanNET) sampled by fine-needle aspiration (FNA) can be accurately graded based on the Ki-67 index when compared to surgical samples. Methods: Corresponding intraoperative (19 cases) or endoscopic ultrasound-guided (3 cases) FNA cytology and surgical tissue specimens were obtained from 22 tumors, which were reviewed and stained for Ki-67 proliferation marker. The cytological samples included more than 200 tumor cells. Samples were graded by scoring the Ki-67 positive index in accordance with the 2010 WHO criteria. The grading scores assigned to the FNA cytology samples were compared with the scores assigned to the corresponding histological samples. Concordance was achieved by using 5% (instead of 2%) as a cut-off value for defining G2 tumors. One cytological sample included less than 500 tumor cells was excluded in the concordance calculation. Results: The cytological smears consisted of uniform, monotonous and isolated cells, loose cellular aggregates and rosette-like formations. Some tumor cells clustered around segments of capillaries. The cells demonstrated distinct cytoplasmic and nuclear features. Mitoses and necrosis were rarely seen. When traditional 2% Ki-67 index cut-off value were used to classify G2 tumors, the majority (86.4%, κ=0.812, P<0.01) of FNA cytology samples and corresponding surgical tissue specimens demonstrated concordance. When a 5% cut-off value was adopted, the concordance rate was 95.5% (21/22, κ=1.000, P<0.01). Similar concordance rates between the cytological and histological grades were achieved with threshold value of cytological assessment material set at more than 500 or 200 cells. Conclusions The cytological Ki-67 index in adequate material (>200 tumor cells) is useful in grading pancreatic neuroendocrine tumors, and a cut-off value of 5% showed better predictive value compared with that of 2%. Accurate grading of PanNET is critical for predicting tumor biology, patient prognosis, and making informed decisions regarding patient management and treatment.

Objective:To investigate the association between early central venous pressure (CVP) measurement and mortality in patients with sepsis.Methods:The adult patients with sepsis were identified from the health data of Medical Information Mart for Intensive Care-Ⅲ v1.4 (MIMIC-Ⅲ v1.4). Data of all adult patients with sepsis were collected, including gender, age, comorbidities, length of survival, total length of hospital stay and intensive care unit (ICU) stay, sequential organ failure assessment (SOFA) score, vital signs, laboratory test results on the first day, vasoactive agents usage, fluid input, urine output and fluid balance on the first day, need for renal replacement therapy and mechanical ventilation, diagnosis of sepsis, and the time and value of the first CVP measurement in the ICU. Patients were divided into early measurement and control groups based on whether or not they had a CVP measurement within the first 6 hours of ICU stay. According to the time of the first CVP measurement, the patients were subdivided into four subgroups: ≤ 3 hours, 4-6 hours, 7-12 hours and no measurement within 12 hours. The primary endpoint was 28-day mortality. The relationship between initial CVP and mortality was analyzed by Lowess smoothing method. Kaplan-Meier survival analysis and Log-Rank test were performed for univariate analysis. Cox regression analysis was performed for multivariate analysis to estimate the relationship between timeliness of CVP measurement and mortality.Results:A total of 4 733 sepsis patients were enrolled, 1 673 of whom had CVP measured within 6 hours of admission to the ICU, and the other 3 060 patients served as the control group. There were no differences in demographic characteristics and underlying diseases between the two groups, except that the early CVP measurement group had less underlying renal failure compared with control group. The early CVP measurement group had higher lactic acid (Lac) levels and SOFA scores, indicating worse severity of disease as compared with control group. The 28-day mortality in the early CVP measurement group was significantly lower than that in the control group (34.2% vs. 40.7%, P < 0.01). The early CVP measurement group had shorter length of total hospitalization and longer length of ICU stay, higher rate of mechanical ventilation and vasoactive agents dependent, and more fluid input and fluid balanced in the first day of ICU stay compared with control group. Lowess smoothing analysis showed that a "U"-shaped relationship between initial CVP and mortality was identified, suggesting that too high or too low initial CVP was associated with worse survival. Kaplan-Meier survival analysis showed that compared with the patients without early CVP measurement within 12 hours, the cumulative survival rate of patients with CVP measured within 3 hours was significantly higher (66.7% vs. 59.1%; Log-Rank test: χ2 = 15.810, adjusted P < 0.001); while no significant difference was found in patients with CVP measured between 4 hours and 6 hours and between 7 hours and 12 hours compared with the patients without early CVP measurement within 12 hours (64.4%, 60.3% vs. 59.1%; Log-Rank test: χ2 values were 5.630 and 0.100, and adjusted P values were 0.053 and > 0.999, respectively). Cox multivariate analysis showed that the Cox proportional risk model was established by taking patients without CVP measurement within 12 hours as reference, timely CVP measurement after ICU admission was associated with reduced 28-day mortality of patients with sepsis [≤3 hours: hazard ratio ( HR) = 0.65, 95% confidence interval (95% CI) was 0.55-0.77, P < 0.001; 4-6 hours: HR = 0.72, 95% CI was 0.60-0.87, P = 0.001; 7-12 hours: HR = 0.80, 95% CI was 0.66-0.98, P = 0.032] after the confounding variables (gender, age, SOFA score, initial Lac, renal failure, maximal blood glucose and white blood cell count, and minimal platelet count within 24 hours) were adjusted. Conclusions:Early CVP measurement is associated with decreased 28-day mortality in patients with sepsis. CVP should be considered as a valuable and easily accessible safety parameter during early fluid resuscitation.