Objective To study the features of pulmonary cryptococcosis and the curative effect of thoracoscopic operation for it. Methods The authors retrospectively analyzed the clinical data of 11 patients with pulmonary cryptococcosis in this hospital between January 1996 and December 2002, consisting of 8 cases of thoracoscopic wedge resection, 2 cases of thoracoscopy-assisted modified posterolateral mini-lobectomy, and 1 case of pulmonary wedge resection. Results Ten patients were preoperatively misdiagnosed. Solitary lesions were found in 8 patients and multiple lesions in both lungs in 3 patients. Complete removal of lesions was achieved in 8 patients and pulmonary biopsy was conducted in 3 patients. Except for 3 cases of wound effusion, there were no other postoperative complications. Follow-up for (38.6?10.8) months (range, 12～72 months) found no pyothorax, bronchopleural fistula, or recurrence of cryptococcosis. Conclusions Pulmonary cryptococcosis usually makes its appearance as a solitary lesion without underlying diseases or symptoms, which is difficult to diagnose preoperatively. Video-assisted thoracoscopic surgery can remove the lesion completely, giving a minimal invasion and rapid recovery.

Objective To summarize the experience on diagnosis and treatment of ectopic ureters. Methods 52 patients with ectopic ureter were analysed retrospectively. Results Of the 52 patients,sonography,IVU,CT and retrograde ureterography were used in 37,45,8 and 18 patients respectively.49(94.0%) cases got the diagnosis preoperatively by these methods.28(53.8%) patients underwent ureteral reimplantation,12(23.0%)nephrectomy,9(17.3%) upper pole partial nephrectomy and 1(1.9%) with ureterocele incised endoscopically.The 42 patients have been followed up for 6 months to 10 years with an average of 3 years. Conclusions Most of the cases can be diagnosed preoperatively by utilizing the appropriate methods.Ureterovesicle reimplantation,upper pole partial nephrectomy and nephrectomy are the effective modalities in the treatment of ectopic ureters.

Objective To investigate the effect of artifictal circadian rhythm of melatonin on the postoperative cellular immune function in patients undergoing gynecological operation Methods Eighteen ASA Ⅰ or Ⅱ patients,aged 25-50 yr,weighing 45-80 kg,scheduled for elective gynecological operation,were randomly divided into 3 groups (n =6 each):control group (group C),placebo control group (group P) and melatonin group (group M).In group M.melatonin 6 mg was given orally at 10 min before lights-out (21:00) on 1 day before operation,on the day of operation and on 1 day after operation,while placebo was given orally instead of melatonin in group P.The operation was performed under epidural anesthesia.Patient-controlled epidural analgesia with ropivacaine was used for postoperative analgesia.VAS score was maintained ＜ 5.Blood samples were collected from the peripheral vein at 1 day before operation (baseline),the end of operation and 1 day after operation to measure CD4+,CD8+ and CD3+ cell count by flow cytometry.The ratio of the number of CD4+ cells to the number of CD8+ cells was calculated.Results There were no significant differences in the number of CD4+,CD8+ and CD3 + cells and ratio of the number of CD4 + cells to the number of CD8 + cells between groups C,P and M (P ＞0.05).Conclusion Artificial circadian rhythm of melatonin exerts no influence on the postoperative cellular immune function in patients undergoing gynecological operation.

BACKGROUND:There are objections to the efficacy and safety of total hip arthroplasty and artificial femoral head arthroplasty in the treatment of femoral neck fracture.
OBJECTIVE:To assess the efficacy and safety of one-stage total hip arthroplasty and femoral head arthroplasty for > 60-year-old patients with femoral neck fractures.
METHODS:According to the search strategy of Cochrane colaboration network, we searched PubMed (1966 to December 2014), EMbase (1974 to December 2014), Cochrane Library (Issue 3, 2011), China Biology Medicine database(1978 to December 2014), China National Knowledge Infrastructure (1994 to December 2014), VIP database (1989 to December 2014), and Wanfang Database (1979 to December 2014). Twenty-one articles on total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures were included. Two reviewers independently evaluated the quality of the included studies and extracted the data. In case of disagreement, settlement was made by negotiation. Meta-analysis was performed by RevMan 5.0 software in the included studies.
RESULTS AND CONCLUSION:(1) Literature analysis: five randomized controled studies, three quasi-randomized controled studies, and thirteen retrospective cohort studies were included, containing 2 250 patients. (2) Meta-analysis: No significant differencein rate of dislocation, deep infection rate and mortality rate in 1 year after replacement was detected between total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures (dislocation rate:RR=1.38, 95%CI: 0.81-2.34; deep infection rate RR=1.12, 95%CI: 0.60-2.11; mortality rateRR=0.90, 95%CI: 0.69-1.18). Reoperation rate was higher in the hemiarthroplasty group than in the total hip arthroplasty group (RR=0.46, 95%CI: 0.32-0.66). Harris score on the affected side between1 and 4 years was significantly higher in the total hip arthroplasty group than in the hemiarthroplasty group (MD=5.64, 95%CI: 2.82-8.46). (3) Results suggested that if physical conditions permit, compared with hemiarthroplasty group, femoral neck fractures patients aged > 60 years old in the total hip arthroplasty group had better hip function, but no significant difference was found in dislocation, deep infection and mortality between both groups.

OBJECTIVE： To study the improvement effects of Atorvastatin calcium tablets on renal injury in nephrotic syndrome model rats， and to explore its possible mechanism. METHODS： Wistar rats were randomly divided into normal group， model group and Atorvastatin calcium tablets group， with 10 rats in each group. Model group and Atorvastatin calcium tablets group rats were given adriamycin 6 mg/kg intravenously for consecutive 21 d to induce nephrotic syndrome model. Since 22th day， Atorvastatin calcium tablets group was given drug 8 mg/kg intragastrically while normal group and model group rats were given equal amount of distilled water intragastrically， once a day， consecutive 6 days every week， for consecutive 10 weeks. At the second day after last medication， the plasma levels of albumin （ALB）， total protein （TP）， cholesterol （CH）， urine albumin excretion rate （UAE） were determined in each group. RP-PCR and Western blot assay were used to detect mRNA and protein expression of AMP-activated protein kinase （AMPK）， silent information regulator 1 （SIRT1） and nuclear factor κB （NF-κB） in liver tissue. RESULTS： Compared with normal group， the levels of ALB and TP， mRNA and protein expression of AMPK and SIRT1 were decreased significantly in model group （P＜0.01 or P＜0.001）， while the levels of CH and UAE， mRNA and protein expression of NF-κB were increased significantly （P＜0.05 or P＜0.01 or P＜0.001）. Compared with model group， the levels of ALB and TP， mRNA and protein expression of AMPK and SIRT1 were increased significantly in Atorvastatin calcium tablets group （P＜0.05 or P＜0.01 or P＜0.001）， while the levels of CH and UAE， mRNA and protein expression of NF-κB were decreased significantly （P＜0.05 or P＜0.01 or P＜0.001）. CONCLUSIONS： Atorvastatin calcium tablets has significant improvement effect on the renal injury of nephritic syndrome model rats， the mechanism of which may be associated with up-regulating the expression of AMPK and SIRT1 and down-regulating the expression of NF-κB.

Objective To analyze and compare the capacity and efficiency of county-level hospitals′medical service by using the diagnosis related groups ( DRGs ) method. Methods The homepage data of discharged inpatients from seven county-level hospitals in Wenzhou region in 2013 - 2015 period were analyzed, for measurement of the medical service capacity changes of such hospitals using the number of DRGs, total multiplicity of weight, and CMI value, and that of their medical service efficiency changes using expense consumption index and time consumption index. Results The study found in the seven hospitals 8. 49% increase of the total number of DRGs, 17. 34% increase of total multiplicity of weight, and 5. 06%increase of CMI value, with unchanged expense consumption index and 9. 82% decrease of the time consumption index. These facts evidenced enhancements of these hospitals in both service capacity and service efficiency in general. Conclusions DRGs as tools prove useful objectively and scientifically. Policies of Two emphases at primary ends and two enhancements have been implemented desirably.

Objective To investigate the diagnosis and therapy of the sclerosing hemangioma of the lung.Mothods The case history of 15 patients were analyzed retrospectively and summarized the diagnosis and therapy of the Sclerosing hemangioma of the lung.Results There were 2 males and 13 females(1:6.5).No patients were diagnosed this disease before operation for there were no specific imageology features.The tumor cell indicated pantomorphia and there were 3 cases were misdiagnosed during the operation frozen section pathology.The optimization therapy methods was to resect the tumor with the VATS.The prognosis of this disease was well and there were no cases recurrence in these 15 patients.Conclusion The sclerosing hemangioma of the lung was the benign tumor and there were no specific imageology features.The misdiagnosis was frequently before operation.To resect the tumor with the VATS was the optimal therapy method.

Objective To investigate the effects of melatonin on choline acetyltransferase (ChAT) in the hippocampus of rats after isoflurane anesthesia.Methods Sixty male SD rats weighing 390-440 g were randomized into five groups (n =12 each):control group (group C),1％ isoflurane group (group Ⅰ),1％ isoflurane + melatonin group (group IM),2％ isoflurane group (group J) and 2％ isoflurane + melatonin group (group JM).Rats in groups IM and JM received intraperitoneal injection of melatonin (10 mg/kg) for 7 days,and rats in other groups received normal saline.On the 7th day of injection,rats in groups Ⅰ and IM inhaled 1％ isoflurane for 4 hours,and rats in groups J and JM inhaled 2％ isoflurane for 4 hours.One day after anesthesia,all the rats began Morris water maze to assess the learning and memory ability,which was made for continuous 5 days.At the end of probe test,6 rats in each group were randomly selected,blood samples were collected to detect plasma melatonin level,and the hippocampi were removed to evaluate the expression and activity of ChAT.The other rats were sacrificed to perform immunofluorescence to detect ChAT in hippocampal CA1 region and dentate gyrus.Results The plasma melatonin level,and the expression and activity of ChAT were significantly lower in group Ⅰ than in group C (P ＜ 0.01).The escape latency was significantly longer,the probe time was significantly shorter,and the plasma melatonin level and the expression and activity of ChAT were significantly lower in group J than in group C (P ＜ 0.05 or 0.01).The escape latency was significantly shorter,the probe time was significantly longer,and the plasma melatonin level and the expression and activity of ChAT were significantly higher in group IM than in group Ⅰ (P ＜ 0.05 or 0.01).The escape latency was significantly shorter,and the plasma melatonin level and the ChAT activity were significantly higher in group JM than in group J (P＜ 0.05 or 0.01).Conclusion Melatonin can attenuate isoflurane-induced ChAT inhibition and thus improve the cognitive function of rats after isoflurane anesthesia.

Objective To investigate the correlation between white matter hyperintensities (WMH)and hyperintense vessel sign (HVS) on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging(MRI)in old adults and to explore the risk factors and pathogeneses of WMH.Methods We retrospectively collected imaging and clinical data of patients who had received both head and neck CTA and brain MRI within one month at our hospital from 2013 to 2016.The Fazekas visual scale was used to evaluate periventricular white matter hyperintensity(PWMH)and deep white matter hyperintensity(DWMH)in each brain hemisphere.According to the presence or absence of HVS in a cerebra[hemisphere,patients were assigned into an HVS-positive group or an HVS-negative group.Clinical data,PWMH,and DWMH differences were compared between the two groups.Results A total of 271 patients(542 cerebral hemispheres)were included in this study.HVS-positive imaging occurred in 79(14.6％)cerebral hemispheres and negative imaging was observed in 463 (85.4％) cerebral hemispheres.There was a significant difference between the HVS-positive and negative groups in the ipsilateral CIA stenosis(x2 =126.840,P＜0.01).The incidence of ipsilateral severe carotid artery stenosis in the HVS-positive group was 62.0％ (49/79),which was significantly higher than 9.9％ (46/463)in the HVS-negative group.The incidence of moderate-severe DWMH was 65.8％(52/79) in the HVS-positive group,which was higher than 34.8％ (161/463)in the negative group(x2 =34.962,P ＜20.01).Nevertheless,the incidences of moderate-severe PWMH in the two groups were 65.8％ (52/79) and 55.5％ (257/463),respectively,without a significant difference between them (x2 =6.944,P =0.074).After adjusting for age,gender,ipsilateral ICA stenosis,hypertension,diabetes,etc.multivariate analysis suggested that HVS-positive imaging was still an independent risk factor for DWMH(OR =2.653,95％CI:1.489-4.726,P =0.001).Conclusions HVS-positive imaging is an independent risk factor for DWMH in the elderly,but no clear correlation with PWMH is found.It suggests that hypoperfusion is a possible mechanism for the development of DWMH in the elderly.

Objective To evaluate the effect of melatonin on postoperative apoptosis in hippocampal cells of aged rats undergoing surgery under isoflurane anesthesia.Methods Sixty healthy male Sprague-Dawley rats, aged 18 months, weighing 550-610 g, were randomized into 5 groups (n=12 each) using a random number table: control group (group C), 2％ isofiurane anesthesia group (group I), 2％ isoflurane + melatonin group (group IM), surgery group (group S), and surgery + melatonin group (group SM).Group IM inhaled 2％ isoflurane for 4 h.Group S inhaled 2％ isoflurane for 4 h, and then back surgery was performed.In IM and SM groups, melatonin 10 mg/kg was injected intraperitoneally everyday for 7 consecutive days before anesthesia, while the equal volume of normal saline was given in C, I and S groups.The cognitive function was assessed using the Morris water maze test on 2nd after anesthesia.The escape latency, space exploration time spent at the original platform quadrant, and frequency of crossing the original platform were recorded.After the end of the Morris water maze test, the rats were sacrificed on that day, and the hippocampi were isolated for detection of the expression of Bcl-2, Bax and caspase-3 by Western blot.Bcl-2/Bax ratio was calculated.Results Compared with group C, the escape latency was significantly prolonged on days 1-3 after anesthesia in group I, the escape latency was significantly prolonged, the space exploration time spent at the original platform quadrant was shortened,and the frequency of crossing the original platform was decreased on days 1-3 after operation in group S,and the expression of caspase-3 and Bax was significantly up-regulated, the expression of Bcl-2 was downregulated, and Bcl-2/Bax ratio was decreased in I and S groups (P＜0.05).Compared with group I, theescape latency was significantly shortened on days 1-3 after anesthesia (P ＜ 0.05) , and no significant change was found in the expression of caspase-3, Bcl-2 and Bax, and Bcl-2/Bax ratio in group IM (P＞ 0.05).Compared with group S, the escape latency was significantly shortened, the space exploration time spent at the original platform quadrant was prolonged, and the frequency of crossing the original platform was increased on days 3-5 after operation, the expression of caspase-3 and Bax was significantly downregulated, the expression of Bcl-2 was up-regulated, and Bcl-2/Bax ratio was increased in group SM (P＜0.05).Conclusion Melatonin can inhibit apoptosis in hippocampal cells and improve postoperative cognitive dysfunction in aged rats undergoing isoflurane anesthesia.