Objective To investigate the clinical and pathological features of pure type mitochondrial myopathy.Methods Clinical manifestations and pathological features of biopsied muscle specimens were summarized retrospectively in 9 cases of pure mitochondrial myopathy. 6 of them were followed up on the purpose of prognostic analysis.Results 9 cases of pure mitochondrial myopathy were clinical characterized by exclusive skeletal muscle involvement and fluctuating proximal muscle weakness. Extraocular muscles were spare. Most patients had moderately increased creatine phosphokinase level (539～2 913U/L). Electromyography examination showed myogenic changes in 6 cases and neurogenic in 3 cases. Pathologically, 8 cases had typical ragged red fibers (RRF) accounting for 5% to 60%. Mitochondrial intracristal inclusion bodies were observed by electron microscope in the patient with atypical RRF. Focal cytochrome C oxidase (COX) deficiency was seen in 4 cases and total deficiency in 2 cases. To a certain degree, the percentage of RRF was parallel to muscle weakness. Following-up data from 6 patients showed that symptoms had improved in 5 patients after treatment with vitamin B, vitamin E, CoQ 10 and inosine. One had a sudden death with unknown reason.Conclusion Pure mitochondrial myopathy may be a distinct subset of mitochondrial diseases that preferentially affects trunk and proximal muscles,Pathological charactoristic had typical RRF and COX deficiency,and RRF is related to patient's condition.It has relative chronic process and benign prognosis.

Objective To investigate the expression of MMP-2 and c-erbB-2 and evaluate the correlation of clinical pathological parameters in non-small cell lung cancer. Methods Forty-five paraffin-embedded specimens of radical postoperative non-small cell lung cancer was detective for MMP-2 and c-erbB-2 using immunohistochemical method. Results The positive rates of MMP-2 and c-erbB-2 are 57.8 %, 75.6 %, there is a significance between the expression of MMP-2 and lymph node metastases(P =0.006), the expression of c-erbB-2 is related to clinical stage and lymph node metastases (P =0.015, P =0.032), The expression of MMP-2 and c-erbB-2 are related to 5-year survival rate (P =0.002, P =0.003). Conclusion The expression of MMP-2 and c-erbB-2 is significantly related to some clinical parameters and 5-year survival rate.

Objective:To research the application of flurbiprofen compound small dose fentanyl with self-control vein analgesia after laparoscopic cholecystectomy and the influence on blood coagulation function.Methods:102 cases with laparoscopic cholecystectomy who were treated in our hospital from November 2015 to November 2016 were selected and divided into the control group and the research group,with 51 cases in each group.The patients in the control group were treated with postoperative intravenous analgesia with low-dose fentanyl,while the patients in the research group were treated with postoperative intravenous analgesia with flurbiprofen ester compound low-dose fentanyl.Then the fibrinogen (Fg),activated partial prothrombin time (APTT),prothrombin time (PT),platelet count (PLT),substance P,5-hydrocarbon serotonin (5-HT),interleukin 6,8 (IL-6,IL-8) and complications between two groups were observed and compared.Results:Before treatment,there was no statistically significant difference about the Fg,APTT,PT,PLT,substance P,5-HT,IL-6 and IL-8 between two groups (P＞0.05);After treatment,the Fg,APTT,PT,PLT,substance P,5-HT,IL-6 and IL-8 increased in the two groups,while the research group was lower than that of the control group,and the differences were statistically significant (P＜0.05).The postoperative complication rate of research group was lower than that of the control group (P＜0.05).Conclusion:Flurbiprofen ester compound small dose fentanyl with self-control vein analgesia can relieve coagulation function,and inhibit the levels of inflammatory factors.

OBJECTIVE:To observe the effects of remifentanil-induced controlled hypotension (CH) on postoperative cogni-tive dysfunction (POCD) and serum S100β protein in elderly patients underwent spinal surgery,and to investigate their relation-ship. METHODS:Sixty elderly patients undergoing selective laminectomy decompression internal fixation of lumbar or thoracic fractures under general anesthesia were selected prospectively from orthopedics department of our hospital during Jan. 2014-Dec. 2015,and then divided into CH group and non-CH group in accordance with random number table,with 30 cases in each group. Both groups received general anesthesia of injection and inhalation via endotracheal intubation. Mean arterial pressure (MAP) of CH group were reduced to 70%-80%of the basic values by adjusting remifentanil infusion rate;those of non-CH group were main-tained at basic level. Surgery duration,anesthesia duration,intraoperative blood loss,the incidence of POCD and serum concentra-tion of S100β protein were observed in 2 groups. The relationship of serum concentration of S100β protein with POCD was ana-lyzed,and the occurrence of ADR was recorded. RESULTS:The intraoperative blood loss of CH group was significantly less than that of non-CH group,with statistical significance (P<0.05). There was no statistical significance in the incidence of POCD be-tween 2 groups on the 1st and 7th day after surgery(P>0.05). The incidence of POCD and serum concentration of S100β protein in CH group were significantly higher than in non-CH group on the 2nd and 3rd day after surgery,with statistical significance(P<0.05). The serum concentration of S100β protein may be related to the incidence of POCD (r=0.992 7,P=0.001 3). CONCLU-SIONS:Remifentanil CH used in elderly patients underwent spinal surgery can reduce intraoperative blood loss,but increase the se-rum concentration of S100βprotein and the incidence of POCD at early stage.

Objective To study the effect of parecoxib sodium preemptive analgesia on the postoperative cognition and inflammatory cytokines in elderly patients.Methods Sixty elderly male patients undergoing replace-ment of total hip were randomly divided into two groups:the control group(group C,30 cases) and the parecoxib sodi-um group(group P,30 cases).In group C,physiological saline 5 ml was injected after induction of anesthesia.Pare-coxib sodium 40 mg was injected after induction of anesthesia in group P.Peripheral venous blood was collected at the following time points:2h before operation(T0 ),and 4h(T1 ),24h(T2 ) and 48h(T3 ) after operation.And the serum concentrations of IL -1β,IL -6,tumor necrosis factor α(TNF -α) were measured by enzyme linked immunosorbent assay(ELISA).Cognitive function was assessed by mini -mental state examination(MMSE) at the time of T0 -T3 . Results The MMSE scores in group P[(25.4 ±0.6) points,(27.2 ±0.1)points] were significantly higher than those in group C at T1 and T2 .The concentrations of IL -1β,IL -6 and TNF -αin group P[T1:(18.43 ±4.45)pg/mL, (165.34 ±9.57)pg/mL,(34.43 ±3.83)pg/mL;T2:(14.59 ±2.59)pg/mL,(98.99 ±7.28)pg/mL,(22.32 ± 3.81)pg/mL]were lower than those in group C[T1:(23.97 ±3.85)pg/mL,(204.19 ±12.44)pg/mL,(37.77 ± 4.81)pg/mL;T2:(19.33 ±3.18)pg/mL,(121.35 ±9.67)pg/mL,(29.01 ±3.39)pg/mL]at T1 ,T2 .The concen-trations of IL -1β,IL -6 and TNF -αand the MMSE scores had no differences in group P and group C at T3 .The concentrations of IL -1β,IL -6 and TNF -αin group P at T1 and T2 [(9.57 ±2.24)pg/mL,(46.15 ±6.18)pg/mL, (14.48 ±3.14)pg/mL] were lower than those at T0,and had no difference at T3 .Conclusion Parecoxib sodium preemptive can reduce the incidence of POCD in elderly patients by inhibiting the release of early postoperative pro -inflammatory cytokines.

Objective To explore the feasibility of coelocentesis in prenatal diagnosis.Methods Coelocentesis were applied on 58 women scheduled for at 6～12 weeks of gestation,and fetal heart rate before the procedure and 1,5,30 minutes afterwards and hemorrhage of amnionic cyst was observed.Y gene of sex-determining region was detected by polymerase chain reaction,and compared with chorionic villi sample.Results The total achievement ratio of coelocentesis was 96.6% of all cases in five minutes.The coelomic fluid was successfully aspirated at first attempt in 93.2% at 7～10 week's gestation,25.0% at 6～7weeks and 50.0% at 10 ~ 12 weeks.There was no significant difference in FHR between before coelocentesis and afterwards (P＞0.05).The detection accurate rate of SRY was 91.1%,all female fetus were matched with those observation by chorionic villi sampling,and only 5 male fetus were not matched,the accurate rate was 80.8%.Conclusion Coclocentesis has the advantage of simple procedure,safe and high feasibility.The optimal time of coclocentesis is in the 7th to 10th week of gestation.

Objective To investigate the causes and prevention of postoperative pain of laparoscopic transabdominal preperitoneal (TAPP) and Lichtensteinrepair in the treatment of adult recurrent inguinal hernia.Methods Sixty adult recurrent inguinal hernia patients were enrolled in this study.They were divided into TAPP group and Lichtenstein group by random digits table,with 30 cases in each group.At 6 h Mter operation,the pain degree was evaluated by visual analogue scale (VAS) and compared between two groups.The level of VAS in TAPP group was (3.76 ± 1.47) scores,in Lichtenstein group was (6.36 ± 1.54) scores,and there was significant difference (t =-5.978,P =0.000).In TAPP group,pain was mainly moderate (17 cases,56.67％) and mild (11 cases,36.67％).In Lichtenstein group,pain was mainly moderate (14 cases,46.66％) and severe (13 cases,43.33％).Postoperative follow-up ranged from 6 to 48 months.No chronic pain appeared in TAPP group.There were 4 cases with chronic pain in Lichtenstein group,and the incidence rate of chronic pain was 13.3％.Conclusions The operation of TAPP in the treatment of recurrent inguinal hernia in adult patients has the advantage of shorter operation time,less postoperative pain,faster postoperative recovery,and can effectively reduce the incidence of postoperative pain.

Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP)and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults,and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia.Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time,intraoperative bleeding volume,postoperative hospitalization time,cost of hospitalization,postoperative complications,early postoperative pain and the recurrence of hernia were compared between the two groups.Results All patients were successfully completed surgery.The operation time of TAPP group (47.2 ±9.4)min was significantly shorter than (73.1 ±10.4)min of Lichtenstein group (t=-2.503,P=0.034).The median amount of bleeding during operation of TAPP group was 40(15 -110)ml,which was significantly less than 73(11 -130)ml in Lichtenstein group (t=-6.018,P=0.000). Postoperative hospital stay of TAPP group[(6.5 ±1.4)d]was shorter than (8.2 ±1.6)d of the Lichtenstein group (t=-2.613,P=0.028).Early postoperative pain score of TAPP group[(1.8 ±1.2)points]was better than (2.9 ± 1.4)points in Lichtenstein group (t=-7.006,P=0.000),the difference was statistically significant.However,the hospitalization cost of TAPP group[(8 842.8 ±415.2)yuan]was higher than (6 676.9 ±327.6)yuan of the Lichtenstein group,the difference was statistically significant(t=6.782,P<0.05).In TAPP group,2 cases had complications after operation,which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months,1 case of recurrence in Lichtenstein group,the recurrence rate was 3.8%.There was no recurrence in the TAPP group.Conclusion TAPP has the advantages of short operation time,less bleeding,rapid postoperative recovery,less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults.

Practical ability training is one of the core tasks during the education for master of public health (MPH).We got a deeper understanding of practical ability cultivation situation for MPH in our school and got a more accurate recognition of the existed problems through conducting questionnaire for three grades MPH of professional degree and related tutors.We analyzed the advantages and disadvantages of the existing mode and reflected on curriculum design,teaching method reform and practical ability training reform,etc based on the results of the questionnaire and years of experiences.

Objective To investigate clinicopathological and neuroimaging features of meninheal malignant melanosis.Methods The cytologic study of cerebrospinal fluid(CSF)and neuroimaging examination and meningeal histochemistry were performed in 3 cases of meningeal malignant melanosis. Results Three patients were found to have initial onsets of headache.followed by meningeal irritation.One case had huge malignant melanoma on skin.The second patient had diabrotic malignant melanoma on her face,which did not healed for a long time.The third patient had no malignant melanoma on skin and viscera.The MRI enhanced scanning of all 3 cases showed abnormal enhancement of meninge.There were a large number of abnormal shape cells in CSF.The meninxes were blackbrown or brown.The tumor cells were in various shapes with big and round irregular nucleus and rich cytoplasm.There were a great quantitv of melanosomes.The tumor cells were disarranged. Immunohistochemistry analyses found S-100 protein and Vim and HMB-45 were positive reaction. Conclusions The patients with meningeal malignant melanosis have an initial onset of headache,followed by meningeal irritation,and MRI enhanced scanning plays a valueble role in the diagnosis.A lage number of tumor cells in abnormal shape have been found in CSF.Thetumour cells of meninx presents different shapes with big and round or irregular nucleus.There are a great quantity of mellanosomes,and the tumour cells are arranged in a state of chaos.