Objective To summarize CT manifestation of atypical brain injuries . Methods The data of 14520 patients with brain injury who have examined by CT scan were collected from1996～2002. Thin slice and HRCT were performed in interested region.Of them,53 cases are diagnosed as delayed or atypical brain injuries. Results In 17 cases of brain contutions , high density punctate lesion(9 cases), and patchy low-dense areas(8 cases)were showed on CT. In 36 cases of delayed brain injuries, CT showed cerebral edema(9 cases),axonal injuries(7 cases), scattered micro-hematoma(5 cases), and delayed subdural hematoma (15 cases).Conclusion CT scan is of important value in dignosing brain injury. We should play much attention to the atypical CT manifestations of brain trauma , and reexamination has great sense to old age patients especially.

Objective To evaluate the outcomes of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods From December 2003 to June 2004,6 patients underwent laparoscopic live donor nephrectomy (younger brother to elder sister in 1 case,elder brother to younger brother in 1, younger sister to elder brother in 1,elder sister to younger brother in 1,father to son in 1,mother to son in 1).For tissue matching,1 case was mismatched of 0 locus,2,of 2 loci and 3,of 3 loci.The results of PRA and lymphocytotoxicity test were negative.The patient was placed in the lateral decubitus.With 3 trocars, the left kidney was dissected via retroperitoneal approach.The arteries and veins were cut off by endoscopic articulating linear cutter. The donor's left kidney was taken out through a 6-7 cm long incision between 2 trocars.Staplers on renal arteries and veins were cut off,and the donor kidney was perfused with liquid,and then was implanted at the right iliac fossa of the recipients.Triple immunosuppressant therapy was used to prevent rejection. Results Laparoscopic donor nephrectomy was successfully performed on all the 6 cases by retroperitoneal approach.The kidney transplantations using the donor live kidneys were also successful.Postoperatively,the mean urine volume was 5036 ml(range,3500-6500 ml) on the first day;the mean serum creatinine level was 598 ?mol/L on the first day and 129 ?mol/L at 1 month.Follow-up of 3-9 months showed that the renal function was normal and no rejection occurred. Conclusions Laparoscopic donor nephrectomy via retroperitoneal approach is safe,feasible,and less invasive to the donor; however,this technique needs skilled surgeons of laparoscopy and renal transplantation.

Objective To evaluate the technique and effect of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods Thirty-two donors (15 males and 17 females) underwent laparoscopic donor nephrectomy at our institution. Twenty-nine left and 3 right procedures were performed. Under general anesthesia, all donors were placed in lateral decubitus. Three transretroperitoneal trocars were used through different ports. The first 12 mm port was placed 2 cm inferior to the edge of rib and 1 cm lateral to the edge of sarcospinous muscle. The second 10 mm port was about 8 to 10 cm anterior to the first, or on the anterior axillary line and 2 cm inferior to the edge of rib. The third 5 mm port was also on the anterior axillary line but 2 cm superior to the iliac crest. The surgeon created the retroperitoneal working space with a constructed catheter balloon device, and made the donor kidney and ureter dissociated. Renal arteries and veins were cut with endoscopic articulating linear stapler for the first 6 patients and then with Hemo-Lok, a plastic clip with a lock, for the others. Finally, the dissected donor kidney and ureter were taken out through an incision extended from the first trocar port. Results All the 32 donor grafts were dissected successfully. The duration of procedure was ranged from 60 to 180 min, and the volume of blood loss was from 20 to 200 ml. The range of warm ischemia time was 3 to 8 min, and 25 to 50 min of cold ischemia time. Short renal veins were found in 3 cases, 1 cm, 1.5 cm and 2 cm respectively. And one case of renal endoarterial injury occurred. On the day after transplantation, the urine volume of recipients was from 2800 to 10 100 ml. There was no delayed graft function found in recipients. Conclusion Laparoscopic donor nephrectomy via retroperitoneal approach is available and safe to renal transplantation with minimal invasion to donors. It can help to obtain donor grafts with higher quality, though skillful laparoscopic technique is demanded.

Objective To explore the techniques and efficacy of retroperitoneal laparoscopic operations in the treatment of renal cyst. Methods A total of 35 patients were operated on under general anesthesia. A water-filled balloon was used to dilate the retroperitoneal cavity. The renal cyst was exposed by identifying the psoas major muscle, peritoneal reflection, pillar of diaphragm and so on. All cyst walls were unroofed with ultrasonic scalpel 3～5 mm from the edge of renal parenchyma. Results With renal cysts removed, the operations were successfully accomplished in all the 35 patients. The operation time was 15～60 min (mean, 32 min). The intraoperative blood loss was 5～60 ml (mean, 35 ml). The postoperative hospital stay was 3～6 days. Pathological examinations reported benign lesions in 34 patients and suspected cystadenocarcinoma in 1 patient. All the 35 patients were followed for 1～22 months. No recurrence was found with exception of 1 case of remaining renal cyst 1.5 cm in diameter under B-ultrasonography at the first postoperative month. The patient with suspected adenocarcinoma had been followed for 1 year and no evidences of neoplasm or metastasis were detected on the chest roentgenogram and B-ultrasonography of the liver and the kidneys. Conclusions Retroperitoneal laparoscopic unroofing is a safe and effective procedure for renal cyst.

Objective To evaluate the feasibility and curative effects of retroperitoneal laparoscopic surgery for adrenal pheochromocytoma. Methods Clinical records of 9 cases of retroperitoneal laparoscopic adrenalectomy of pheochromocytoma from October 2002 to November 2004 were reviewed. Results The operations were successfully completed in all 9 cases without severe complications. A sudden rise of blood pressure with an amplitude over 30 mmHg appeared in 3 cases during the operation, which took a favorable turn after adjusting the surgical performance and blocking the central vein. The operation time was 90~210 min (mean, 150 min). The intraoperative blood loss was 30~150 ml (mean, 50 ml). Blood transfusion was required in no cases. The postoperative length of hospitalization was 4~9 days (mean, 5 days). Pathological examination revealed benign adrenal pheochromocytoma in all cases. Follow-up for 3~24 months (mean,11 months)in the 9 cases found symptom free and no recurrence by B-ultrasonography or CT scans. Conclusions Retroperitoneal laparoscopic surgery for adrenal pheochromocytoma is a feasible procedure which offers advantages of minimal invasion, short operation time, less blood loss, quick postoperative recovery, fewer complications and good curative effects, having a promising future.

Objective This paper investigated and analyzed medical service of clinical pathway which carries out during five tertiary hospitals from August 2010 to August 2011 in order to understand the weight of high quality nursing care in the clinical pathway and satisfaction for hospitalized patients.Methods 959 hospitalized patients were investigated by way of questionnaire survey,561 in CP wards and 398 in non-CP wards.Some influential data were statistically analyzed using SPSS17.0 statistical software.Results High quality nursing care in clinical pathway possessed a higher proportion of the actual weight.It had positive func-tion for improvement of the satisfaction degree of hospitalized patients.Conclusions It is an impor-tant way for continuous improvement of medical service by carrying out the clinical pathway combined with high quality nursing demonstration project.

BACKGROUND: Improper practice during military training is likely to cause various training wounds, among which patellar tendinosis is the common one.OBJECTIVE: To explore the onset characteristics of patellar tendinosis caused by military training and incidence changes after the implementation of interventions.DESIGN:Sampling investigation.SETTING: Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Area Command of Chinese PLA; Department of Surgery, Hospital of Chinese PLA Garrison in Hong Kong PARTICIPANTS: Male army soldiers aged 18-24 years were recruited from a full-time training army in August 2000 (non-intervention group) and August 2001 (intervention group). The same training program was carried out among the 2,783 soldiers in non-intervention group and 5,824 soldiers in the intervention group.METHODS: The investigation group was composed of medical workers with senior and intermediate professional titles. Uniform diagnostic standard was made before the investigation, and questionnaire survey wascombined with on-the-spot inspection on soldiers who complained about knee joint pain following training. Those who conformed to the diagnosis were inquired of their training state in detail and possible causes; meanwhile knee X-ray examination was also conducted. Soldiers in the non- intervention group were subjected to the investigation of the incidence and cause of patellar tendinosis due to fulltime training without given any preventive intervention. By contrast, soldiers in the intervention group were given preventive and therapeutic interventions and then subjected to the investigation into the interventional outcomes one year later.MAIN OUTCOME MEASURES: The incidence of patellar tendinosis in soldiers of the two groups.RESULTS: The first and second investigations were conducted on the 2 783 soldiers and 5 824 soldiers, respectively. All of them entered the rediers of the non-intervention group (the incidence of 0.61%) as compared to 15 soldiers in the intervention group (the incidence of 0.26%) (P＜0.01).tenderness. Patel1ar bone X-ray inspection on 12 of them displayed patellar ciated with run-jump training projects; 23 cases were caused by 400 mbarrier training and 7 cases by 5 km cross-country training.CONCLUSION: Patellar tendinosis during military training is mostly caused by run-jump training and can be remarkably prevented by preventive interventions.

The pathogenesis of diabetes is complicated by several factors including autoimmunity, environment, heredi?ty, and etc. Autophagy is a kind of intracellular biodegradation processes, which plays an important role in intracellular ho?meostasis of islet cells. In diabetes, autophagy is involved in the endoplasmic reticulum stress, mitochondrial dysfunction and inflammatory, and it affects the development of the disease. In this paper, we reviewed the interactions of autophagy with endoplasmic reticulum stress and mitochondrial dysfunction with inflammation in diabetes in order to investigate the patho?genesis of diabetes, to find new strategies for prevention or treatment of diabetes.

Objective To summarize the clinical features,treatment and prognosis of infantile hepatic hemangioendothelioma(IHHE) combined with congestive heart failure(CHF) in children.Methods A retrospective analysis was made with the clinical data from 4 children with IHHE combined with CHF in Department of Pediatric Cardiology,Affiliated Guangzhou Women and Children's Medical Center of Guangzhou Medical University from May 2013 to December 2015.Results Among 4 infants,there were 3 male and 1 female,mean aged of 109 days (21-219 days),the average weight of 4 350 g (2 750-6 500 g),and 1 case was admitted because of abdominal swelling and respiratory distress,1 case of abdominal swelling,jaundice,shortness of breath admission,1 case of fever and shortness of breath admission,and 1 case of cyanosis and shortness of breath admission.Two patients were associated with hemangioma and Kasabach-Merritt syndrome.Three cases had multiple liver hemangioma scattered in the left lobe and right lobe of the liver,and 1 case had solitary liver hemangioma scattered in the right lobe.Tumor size diameters were ranged from 2-10 mm.Four children had been used Prednisone [1-2 mg/(kg · d)] and Digoxin,Dopamine,Furosemide,Spironolactone.Two cases responsed well to the therapy and were followed up for 2 years or 1 year and 6 months respectively,whose heart size,heart function and pulmonary hypertension became normal.One case with Kasabach-Merritt syndrome responsed poorly to the therapy.Two cases experienced transcatheter hepatic arteriovenous fistula embolization by using coil occlusion of hepatic artery-venous fistula.The postoperative hepatic tumor volume was significantly decreased,and the heart function was improved.One patient was followed up for 1 year and 6 months,and the heart size,pulmonary hypertension and heart function returned to normal.One case was still under follow-up.One case with Kasabach-Merritt syndrome died from heart failure and severe infection before surgery.The mortality rate was 25％ (1/4 cases).Conclusions IHHE is a rare cause of CHF in children.If heart failure is found unexplained in children,abdominal ultrasound or CT examination should be done immediatey in order to confirm the presence or absence of IHHE.The mortality rate in IHHE associated with CHF is very high.Early identification,early intervention,especially Prednisone combined with transcatheter hepatic arteriovenous fistula embolization can significantly improve heart function,reduce the mortality and improve the prognosis of IHHE associated with CHF in children.

Objective To identify and analyze the plasmid (pR_ ST98 ) encoding multi-resistance to anti-microbial agents in S.typhi presenting the Salmonella plasmid virulence gene (spv).Methods Plasmid pR_ ST98 ,which could mediate virulence to its host bacteria, was used as the templete. The spv-specific PCR and Southern blot were employed to identify the spv virulence gene on this plasmid. The amplified spv fragments (spvR and spvB) were cloned into pGEM-T EASY.Then the DNA sequences were analysed. Results The date of PCR and Southern blot showed that spv,which had been found in other pathogenetic Salmonella spp. except S. typhi was also presented on pR_ ST98 . The ORF of spvR and spvB of pR_ ST98 were 894bp and 1 776bp respectively. They had more than 99% homologus with that of spvR and spvB on virulence plasmid in S.typhmurium.Conclusion From the results of PCR,Southern blot and nuclei acid sequencing, we concluded that this is the first report of revealing a mosaic-like plasmid carrying genes encoding not only drug resistance but also virulence in S.typhi.