Objective To evaluate the effect of local resection for the tumor of Vater ampulla. Methods seventeen cases of Vater ampullary tumor were subjected to tumor local resection from November 1987 to December 1998, including 3 adenomas and 14 adenocarcinomas confirmed by pathology. Two methods of excision for the tumor were performed, including through duodenum to perform the tumor local resection in 16 cases, and through common bile duct in 1 case. Results Bile duct infection occurred in 3 cases. There was no death in this series. 12 of the 17 cases (70.6%) had been followed up for 4～61 months, median survival time was twelve months. In three benign cases ,one died with another disease 17 months postoperatively, two still alive well 38 and 7 months after operation respectively. In 14 malignancy, 9 cases (64.3%) had been followed up. Of the 9 cases, 6(66.7%) alived ≥ 12 months, 4 (44.4%) 24 months, two(22.2%) 60 months. Conclusions Local resection of the Vater ampulla tumor has advantages, such as small damage ,less bloodlass, quick recovery and less interference of the body, but it must be performed by rich experienced surgeons. It is suitable for patients with a small benign tumor, or in the high risk patients whose carcinoma showed no invasion or metastasis, and it also can be performed in patients such as those with atypical hyperplasia and suspious malignant tumor.

OBJECTIVE: To explore the value of computer-aided design/computeraided manufacturing (CAD/CAM) technology for individual reconstruction of the thyroid cartilage defects. METHOD: Select the 20 New Zealand white rabbits (male or female). Randomly divided into two groups. Group A in the pre-operative CT scan of the throat, three-dimensional reconstruction of the thyroid cartilage imaging, surgical removal of either side of the thyroid cartilage, defect implanted in the use of CAD/CAM technology and mirror technology to produce personalized restorative materials; Group B surgical resection either side of the thyroid cartilage, defect implanted production of non-personalized probably according to the experimental animals unilateral thyroid cartilage repair materials. After surgery by gross observation, electronic laryngoscopy observed experimental animals throat. RESULT: General check and electronic laryngoscopy show: the use of CAD/CAM technology to prepare the individual repair materials throat plays better supporting role than the non personalized materials. CONCLUSION CAD/CAM technology before surgery designed to provide a personalized solid model to improve the accuracy of the surgery, time saving surgery to reduce surgical complications.
Animals ; Computer-Aided Design ; Female ; Image Processing, Computer-Assisted ; Male ; Prostheses and Implants ; Rabbits ; Reconstructive Surgical Procedures ; Thyroid Cartilage ; surgery ; Tomography, X-Ray Computed

Objective To investigate choroid thickness at horizontal meridian with optical coherence tomography (OCT) and compare the choroid thickness difference between first visit myopia children with those children who wear orthokeratology lens for more than 1 year.Methods This retrospective study enrolled 68 myopia children with low to moderate myopia (-1.00--6.00 D) who visited our hospital and took choroid images by OCT.The total subjects were divided into 2 groups.The subjects of 34 children in group 1 visited for myopia initially and wear spectacles.The other one group wear orthokeratology lens more than 1 year.Only the data of right eye were analyzed.Scans through the fovea at horizontal meridian were acquired with OCT.Choroid images were detected by custom software with 500 μm intervals up to 3.5 mm around fovea.Choroid thickness (CT) was calc~ated based on the average of the 7 zones.Statistical analysis was performed to evaluate choroid thickness at each zone.ANOVA was used to compare choroid thickness differences between various zones in each group.Paired t test was used to compare choroid thickness difference at the same zone between two groups.Results The mean age of OK lens group was (12.3 ± 1.8) years old,and the spectacles group was (11.8 ± 1.4) years old,there was no statistical difference.From temple to nasal choroid,the mean CT of the orthokeratology lens group were (296.7 ± 61.8) μm (T3),(290.7 ± 58.9) μm (T2),(285.7 ± 57.4) μm (T1),(278.5 ±57.7) μm (M),(262.2 ±57.9) μm (N1),(239.8 ±59.7) μm (N2),(214.7 ±59.0) μm (N3);And the mean CT of the spectacles group were (294.2 ± 45.4) μm (T3),(292.0±44.0) μm (T2),(283.6 ±45.5) μm (T1),(272.0 ±51.6) μm (M),(255.2 ± 56.3) μm (N1),(236.5 ±58.1)μm (N2),(212.8 ±57.7) μm (N3),respectively.The thicknesses were significantly thicker in temple zones than that in nasal zones in each group (all P ＜ 0.05),but the CT was not significantly different between the two groups in each zone (all P ＞ 0.05).Conclusion The choroid thickness has regional deference in myopia children,the thickest is in the temple and the thinnest in the nasal region.There is no significant difference between the children who initially corrected by spectacles and those who wear OK lens more than 1 year.

Objective To evaluate the diagnostic performance of plasma miR-499 in acute myocardial infarction (AMI) diagnosis.Methods Diagnostic accuracy test.The suspected AMI patients,who with chest pain for more than half an hour and been admitted in the Second People's Hospital of Wuxi and First People's Hospital of chuzhou during October 2010 and July 2011,were consecutively and prospectively enrolled in the present study.Sixty apparently healthy individuals were designed as healthy control.The plasma samples of the suspected AMI patients were collected within two hours after admission.The plasma miR-499 was determined by real time polymerase chain reaction (RT-PCR).The diagnostic performance of plasma miR-499 for AMI was estimated by receiver operating characteristic (ROC) curve analysis.The association between plasma miR-499 and AMI was analyzed by multivariable logistic model.The plasma miR-499 was determined and explained in blind fashion.Results Two hundred and nine suspected AMI patients,including 131 confirmed AMI patients (46 STEMI and 85 NSTEMI) and 78 AMI free patients were enrolled in the present study.The delta cycle threshold (ΔCT) was 1.01 ± 3.34 for AMI patients,-2.76 ± 2.90 for non-AMI patients and-3.79 ± 2.21 for healthy controls.The differences had statistical significance (x2 =96.77,P ＜ 0.01).The area under curve (AUC) of plasma miR-499 was 0.80 (95％ C I:0.74-0.86),lower than that of cardiac troponin Ⅰ (AUC =0.90,95％ CI:0.86-0.94) on admission (P ＜0.01).At the optimal cut-off of 0.18,the diagnostic sensitivity and specificity were 0.69 (95％ CI:0.61-0.77) and 0.77 (95％ CI:0.66-0.86),respectively.The coefficient of correlation between plasma miR-499 and cTnI was 0.72 (P ＜0.01).The odds ratio (OR) of plasma miR-499 ＞0.18 for AMI was 2.59 (95％ CI:1.10-6.07),after adjusted cTnI.Conclusions Plasma miR-499 is a useful biomarker for AMI diagnosis.It can provide additional diagnostic information beyond cTnI.Combination utility of plasma miR-499 and cTnI may improve the diagnostic accuracy for AMI.

Objective To investigate the effect of exogenous stromal cell-derived factor-1 α (SDF-1 α) on angiogenesis peri-infarct region in cerebral cortex in adult rats and its possible mechanisms.Methods Twenty-four adult male Sprague-Dawley rats were randomly divided into four groups:sham operation,solvent control,SDF-1α treatment,and SDF-1α + CXCR4 antagonist (n =6 in each group).A model of focal infarct in the cerebral cortex was induced by permanent ligation of the cortical branch of the right middle cerebral artery with temporary clip occlusion of both common carotid arteries.At 1 h after cortical branch occlusion of the right middle cerebral artery,SDF-1 α (1 μg/d) or equal volume of normal saline were injected via the lateral ventricle in the SDF-1α treatment group and solvent control group,and continued for 6 days.CXCR4 antagonist AMD3100 (1 mg/d) was injected subcutaneously before injecting SDF-1 α in the SDF-1 α + CXCR4 antagonists group,and continued for 6 days.Before all the rats were sacrificed,5-bromo-2-deoxyuridine (BrdU) was injected intraperitoneally and their newly proliferated cells were labeled.At day 7 after modeling,the rats were sacrificed after neurological scores.Immunofluorescence staining was used to detect the vascular density,the numbers of neovasculature endothelial cells and the CXCR4 + cells in the peri-infarct regions or sham operation regions.Results At 7 d after modeling,the neurological function of the SDF-1α treatment group was improved significantly compared with those of the solvent control group and the SDF-1α + CXCR4 antagonist group (all P＜ 0.01).The vascular densities in the peri-infarct or sham operation regions in the groups of sham operation,solvent control,SDF-1α treatment,and SDF-1α+ CXCR4 antagonist were 2.1±0.3％,7.0±0.3％,10.0 ±0.9％ and 7.1 ±0.3％,respectively (F=232.469,P＜0.001),and that in the sham operation was significantly lower than that in the SDF-1α group (P ＜0.001),SDF-1 α group significantly higher than both groups of solvent control (P =0.002) and SDF-1oα + CXCR4 antagonist (P =0.001).The numbers of BrdU+/laminin+ cells in the peri-infarct regions in the groups of sham operation,solvent control,SDF-1α treatment,and SDF-1α + CXCR4 antagonist were 21.7 ± 3.1,79.7 ± 6.0,176.0 ± 12.5 and 90.3 ± 6.9,respectively (F=391.550,P＜0.001),and that in the sham operation was significantly less than that in the SDF-1 α group (P ＜ 0.001),SDF-1 α group was significantly more than both groups of solvent control and SDF-1 oα + CXCR4 antagonist (all P ＜0.001).The numbers of CXCR4 + cells in the peri-infarct regions in the groups of solvent control,SDF-1α treatment,and SDF-1α+ CXCR4 antagonist were 59.3± 4.5,120.3 ± 13.9 and 62.9 ± 5.9,respectively (F =85.052,P ＜ 0.001),and that in SDF-1α group was significantly more than those in the both groups of solvent control and SDF-1 α + CXCR4 antagonist (all P ＜ 0.001).Conclusions SDF-1α treatment may improve the neurological function after focal infarction in the cerebral cortex in adult rats and promote angiogenesis in peri-infarct region.The SDF-1/CXCR4 signal pathway may play an important regulatory role in the process of angiogenesis after cerebral infarction.

Objective To investigate the value of two-dimensional echocardiography (2DE) in detecting left ventricular regional wall motion abnormality (RWMA) in non-ST-elevation myocardial infarction (NSTEMI) by contrast with coronary angiography (CAG).Methods Totally 68 cases of NSTEMI patients (NSTEMI group)and 50 cases of normal peoples (normal group)were collected.2DE dynamic image and CAG results were comparatively analyzed in two groups.Left ventricular RWMA of all patients were observed through multi-section dynamic images by 2 experienced echocardiographic physicians.Left ventricular wall motion abnormalities were determined according to the 16 segment method of the American Society of echocardiography (ASE).2DE-RWMA was positive if there were one or more segments of motion abnormalities.All NSTEMI patients underwent CAG 2 days after 2DE examination,CAG was positive if the degree of coronary artery stenosis was more than 50％.Results In 68 NSTEMI patients,66 cases were CAG positive and 2 cases were negative,35 cases were 2DE-RWMA positive and 33 cases were negative.Taking CAG as a gold standard,the sensitivity,specificity and accuracy,positive predictive value and negative predictive values of 2DE-RWMA in diagnosis of NSTEMI were 51.52％ (34/66),50.00 ％ (1/2),51.47％ (35/68),97.14％ (34/35),3.03 ％ (1/33).Compared with the 2DE-RWMA negative patients,the rate of three branches of coronary artery stenosis in 2DE-RWMA positive patients was higher (62.85％ vs 39.39％,P＜0.05),the degree of coronary artery stenosis that reached 90％-99％ was higher (68.57％ vs 48.48％,P＜0.05).Conclusion The sensitivity of 2DE is low of NSTEMI in detecting the left ventricle RWMA.The degree of coronary artery stenosis is probably serious if 2DE-RWMA is positive,which is helpful for preliminary clinical judgment.

Objective To explore the image quality and diagnostic efficiency of coronary CTA (CCTA) in patients without heart rate (HR) control by optimizing acquisition phase with auto-ECG-gating technology using 256-row wide-volume detector.Methods Totally 200 patients with suspected coronary artery disease (CAD) were selected and underwent CCTA with auto-ECG-gating on a 256 row wide detector CT (Revolution CT).Patients were divided into 4 groups according to the real-time HR,group A (n=50):HR≤69 bpm;group B (n=50):HR 70-80 bpm;group C (n=50):HR 81-90 bpm;group D:HR≥91 bpm (n=50).CCTA images quality and diagnostic rate were assessed by two experienced radiologists blindly,and effective radiation dose were compared among 4 groups.Results There were no significant differences of age,sex,and body mass index among 4 groups (all P＞0.05),and there was significant difference of image quality score among 4 groups (P＜0.05).Totally,800 coronary arteries and 2 575 segments in 200 patients were assessed.There had no significant difference of diagnostic rate among four groups derived from the segment,coronary artery and patients (all P＞0.05).The effective radiation dose in A D groups were (1.05t0.48)mSv,(2.41± 1.20)mSv,(1.27±0.55) mSv,(2.66±1.12)mSv,and the difference was significant (F=29.22,P＜0.001).Conclusion It is feasible to perform CCTA in single cardiac cycle in patients with arbitrary heart rate by auto-ECG-gating using Revolution CT equipped widevolume detector.And it can improve image quality and success ratio in patients with moderate and high heart rate.

Objective To investigate the effects of heat-inactivated Cryptococcus neoformans(H-CN)on an experimental murine model of meningoencephalitis and on IL-1?,IFN-?and TNF-?gene ex-pression on the brain and spleen.Methods An experimental murine model of intracerebral infection with C.neoformans was established.Mice were divided into H-CN-treated group and control group.The brain and spleen of two groups were collected to obtain total RNA,and IL-1?,IFN-?and TNF-?were detected by RT-PCR method.After intracerebral challenging with lethal doses of C.neoformans,the survival time and colony forming units(cfu)of C.neoformans in the brain of two group were observed.Results The survival time was prolonged,and cfu of C.neoformans were decreased in the brain of H-CN-treated group in com-parison with those of control group.Expression of IL-1?was positive,and IFN-?and TNF-?negative in the brain tissue of H-CN-treated mice;while expression of IL-1?,IFN-?and TNF-?was all negative in the control mice,as indicated by RT-PCR.Expression of3cytokines,IL-1?,IFN-?and TNF-?was all positive in the spleen tissue of both groups,suggesting that there was no significant difference in the levels of cytokine gene transcripts in both groups.Conclusion These findings suggest that murine resistance to central nervous system infection of C.neoformans be enhanced by intracerebral administration of H-CN,and anti-cryptococcal mechanism probably involves a local cytokine IL-1?elicitated by H-CN in central nerve system.

Objective To evaluate the long-term effect of surgical procedures for congenital choledochal cyst (CCC).Methods From 1986 to 2000, 120 cases of CCC were admitted and 73 of them underwent the primary operations in General Hospital of PLA. Three types procedures were performed,type I: external drainage of CCC in 7 cases; type II:cystojejunal Roux-en-Y anastomosis in 5 cases; type III: cyst excision with cystojejunal Roux-en-Y anastomosis or cystoduodenostomy in 57cases,and other procedures in 4 cases.Results 68 cases were followed-up for 6 months to 5 years (median 2.7 years). Three cases undergoing type I operations accepted reoperations;two cases undergoing type II operations accepted reoperations due to severe complications as cholongitis and hepatolithiasis; 57 cases treated by type III operation with the good results 88.7% and none reoperation.Conclusions External drainage is only a first-aid management on emergency basis. Internal drainage should never be done,because the effect is temporary,and severe complications result in reoperations. Cyst excision with biliary tract reconstruction is recommended as the optimal treatment of CCC.

Objectives To evaluate the results and efficacy of gas-insufflated retroperitoneoscopic necrosectomy (GIRN) for proven infected necrotizing pancreatitis (INP).Methods 24 patients presenting proven infected pancreatic necrosis during course of acute pancreatitis were prospectively offered minimally invasive necrosectomy.A descriptive explanation of the GIRN was given together with the results of a retrospective analysis of all patients.Results All 24 patients who underwent retroperitoneoscopic necrosectomies survived.Postoperative hospitai stay ranged from 7 to 105 d (median,29 d).In 14 patients,GIRN yielded excellent results and avoided complementary treatment after a single session.7 patients underwent only one repeated session and the other 3 patients underwent 3 times.3 patients finally underwent laparotomy and necrosectomy due to remaining infected necroses in the peritoneal cavity.Conclusion GIRN has been found safe and is associated with a high success rate in our limited number of patients,and it should be regarded as a first-choice surgical option for INP.