Objective To study the influence of splenectomy on the surgical efficacy in the patients with gastric cancer in the up-per and middle portion and entire stomach .Methods 86 patients with gastric cancer in the upper and middle portion and entire stomach receiving the gastric cancer D 2 radical operation in the two hospitals from April 2003 to January 2008 were selected and di-vided into the observation group(47 cases) and the control group(39 cases) .The observation group accepted the modified lymph-adenectomy with spleen-preserving ,while the control group accepted the D2 total radical gastrectomy with splenectomy .The long-term effects were compared between the two groups .Results The total hospitalization time and the occurrence rate of postoperative complications were(20 .62 ± 7 .93)d and 10 .64% in the observation group ,which were less than (27 .51 ± 12 .44)d and 30 .77% in the control group ,and the differences between the two groups showed the statistical significance (t=3 .128 ,χ2 =5 .446 ,P=0 .000) . The 5-year survival rate in different TNM stages had no statistical difference between the two groups (P>0 .05) .Conclusion For the patients with gastric cancer in the upper and middle portion and entire stomach without spleen or splenogastric ligament metas-tasis ,the modified spleen-preserving lymphadenectomy could make the patients to get the same prognosis as the gastrectomy com-bined with splenectomy ,which reduces the occurrence rate of complications and is worth promoting clinically.

To correlate the ultrasound and MR imaging of carotid atherosclerotic plaque with its histologic compositions,20 patients(22 lesions) scheduled for carotid endarterectomy were examined by B mode ultrasound and MRI preoperatively. The specimens were also examined postoperatively and the images of carotid plaque were recorded. The transverse pathological sections of plaques were made and matched with images of ultrasound and MRI. 256 gray scale ultrasound densitometric analysis of carotid plaque compositions was performed. Ultrasonic density of calcium, fibrous tissue, hemorrage/thrombus and lipid deposits was (89?12), (53?8), (37?6) and (39?3) respectively in vivo , and was (168?11), (136?12), (85?12) and (89?10) respectively in vitro . In vivo relative signal intensities of calcium, fibrous tissue, old hemorrhage/thrombus and lipid deposits were low, equal, equal and very high respectively on T 1 W MR image, and very low, equal, high and high respectively on PDW MR image, and low, equal or slightly high, high and high respectively on T 2 W MR image. Signal intensities of plaque contents ex vivo were correlated to signal intensities in vivo. Densitometric analysis of ultrasound images of carotid plaques can quantify possible components of plaque, and MRI has the feasibility to identify the components of plaque.

To study the distribution of two different phenotype mast cells in atherosclerotic lesions of human carotid arteries, 32 samples of endarterectomy and 10 autopsies of normal carotid specimens were fixed and embeded in paraffin, sections were stained with hematoxylin-eosin, toluidine blue,monoclonal antibodies against the two major proteases of mast cells(tryptase and chymase) and monoclonal antibodies against CD-3 of T lymphocytes and CD-68 of macrophages. The quantity,distribution and degranule of two different phenotype mast cells in atherosclerotic lesions of human carotid arteries were investigated,and the ratio of mast cells to T lymphocytes and macrophages in atherosclerotic lesions was calculated. The density(cells/mm 2 ) of mast cells in shoulder region of plaque(6 3?4 0) was much higher than that in normal intima,cap and core region(1 3?2 3,2 3?2 6,2 2?3 7) .The proportion of chymase-containing mast cells to tryptase-containing mast cells was 0 36,0 51,0 47 and 0 39 respectively in normal intima,cap,core and shoulder region of plaque.The propotion of degranulated mast cells was the highest in shoulder region of plaque(65%).The ratios of mast cells to T lymphocytes and to macrophages were 0 25 and 0 14 respectively in shoulder region of plaques.Light microscopic studies of mast cells revealed that mast cells were more commonly observed in thrombus and around calcification and blood vessels of plaque.Mast cells play a role in the formation of plaque,and participate in the destabilization of plaque.

Objective To study comparatively reduction and prevention of surgery-induced peritoneal adhesion by methylene blue and hyaluronate sodium. Methods 46 patients with acute diffuse peritonitis or adhesion intestinal ileus were divided at random into 3 groups: methylene blue ( MB) group, hyaluronate sodium (HS) group and control ( C ) group. The alteration of postoperation recovery,serum MDA, TNF? and erythrocytes SOD in patients were investigated. Results The recuperation in group MB was better than in group C (P

Objective:To create hospital data fusion centers to solve the problems involving data incompatibility between business system and administration system and incomplete data-sharing service.Methods:The needs for hospital data fusion center were analyzed, and the protocol design for creating hospital data fusion center was put forward according to the needs.Results:The protocol design for creating hospital data fusion center facilitates the specific methods of promoting hospital data fusion.Conclusion: The protocol design for creating hospital data fusion center may promote in-and out-hospital data-sharing service and comprehensive data utilization, so as to improve hospital information utilization.

Objective To discuss the clinical application value of 256-slice helical CT 3D-imaging in guiding interventional occlusion therapy for patent ductus arteriosus (PDA).Methods A total of 40 patients with sonography-proved PDA were randomly divided into group A (angiography group) and group B (CT-guided group) with 20 patients in each group.For the patients of group A,occlusion of PDA was performed based on the intraoperative angiography findings;and for the patients of group B,occlusion of PDA was carried out according to CT examination results.Intraoperative cardiac ultrasound monitoring was adopted and the curative effect was evaluated.Results The morphology of PDA demonstrated on CT 3Dimaging in group B was highly consistent with the configuration of PDA displayed on intraoperative angiography in group A.The most narrow diameters of PDA in group B and group A were (3.88±1.59) mm and (3.63±1.41) mm respectively,and the lengths of PDA in group B and group A were (6.1±1.06) mm and (6.82±0.74) mm respectively;the differences between the two groups were not statistically significant (P＞0.05).The time spent for surgery in group B and group A was (34.3±9.11) min and (17.33±5.81) min respectively,and the intraoperative X-ray radiation doses in group B and group A were (33.93±11.0) mGy and (66.48±9.77) mGy respectively;the differences between the two groups were statistically significant (P＜0.001).In group B,the preoperative X-ray radiation dose from CT examination was (119.79±29.45) mGy,when it was added to the intraoperative X-ray radiation dose the total cumulative radiation dose of group B was strikingly higher than that of group A.Conclusion Contrast-enhanced 256-slice helical CT scan and 3D-imaging technique can replace intraoperative angiography to get accurate anatomical imaging information of PDA,which are very helpful for the performance of interventional occlusion of PDA,meanwhile,it can effectively reduce the damage to the punctured artery and shorten the operation time.However,the radiation dose is a factor that should be taken into consideration.(J Intervent Radiol,2017,26:206-209)

Objective To investigate the risk factors of postoperative complications in spinal tuberculosis surgery,and try to find a way to improve the results of perioperative management and reduce or avoid the postoperative complications.Methods All of 172 cases of spinal tuberculosis who were treated by surgery from February 2005 to January 2013 in orthopedic department of Zhongshan hospital,Fudan University were retrospectively analyzed.There were 88 males and 84 females,whose average age was 50.9± 18.7y (18-84y).Among them 98 cases got cold abscess,and 56 cases had tuberculosis poisoning symptoms.The lesions located mostly in thoracic spine (112/172,65.1％) and lumbar spine (40/172,23.3％),while rarely in cervical or sacral spine.2 intervertebral spaces were involved in 116 cases (67.4％),more than 2 intervertebral spaces were involved in 32 cases (18.6％),and single intervertebral space were involved in the rest cases (14.0％).38 cases were treated through single anterior approach,54 cases were treated by anterior-posterior surgical approach,and single posterior approach was performed in 80 cases.58 cases were suffered from neurological dysfunction.All the postoperative complications and related clinical parameters during hospitalization period were collected and analyzed with SPSS software.Each clinical parameter was analyzed with univariate analysis to find the factors related to postoperative complications,and then the related factors were analyzed by multivariate regression analysis.Results All of 172 patients were included and 41.9％ (72/172) of the patients suffered from postoperative complications.System complications were the most common (33.7％,58/172).The rates of local complications were 10.5％ (18/172).Univariate analysis showed that the lesion site,value of hemoglobin,electrolyte disturbances,postoperative ASIA score and blood loss were related with postoperative complications.Posterior approach related with local complications.Multivariate regression analysis showed that preoperative hemoglobin ＜100 g/L,poor postoperative ASIA scores and long period of preoperative anti-TB treatment (＞28 days) were related with the system or local postoperative complications.Conclusion Patients with anemia (hemoglobin ＜ 100g/L),poor postoperative neurological function and long period of preoperative anti-TB treatment could take more risks of the postoperative complications.

OBJECTIVE:To explore the clinical efficacy and safety of nalmefene combined with monosialotetrahexosylganglio-side sodium in the treatment of patients in brain tumor operation. METHODS:64 patients in brain tumor operation were randomly divided into observation group and control group,32 cases in each group. Control group received brain cell protection,reducing in-tracranial pressure,anti-infective,vasodilator and other conventional treatment;observation group additionally received 0.7μg/(kg· h) nalmefene combined with 100 mg/d monosialotetrahexosylganglioside sodium from the first day of operation,for continuous 7 d. The plasma cortisol,adrenocorticotropic hormone (ACTH) before and 3,7 d after treatment,changes of serum IL-6,TNF-αand Barthel index (BI) in 2 groups were observed,improvement of neurological function and ADR were observed;Karnofsky (KPS)score was determined after 90 d follow-up used to assess the patient’s ability to take care of themselves. RESULTS:After treatment,plasma cortisol and ACTH content,serum TNF-αand IL-6 levels in 2 groups significantly decreased than before,the dif-ference was statistically significant(P<0.05);cortisol,ACTH and TNF-α levels 3,7 d after treatment,IL-6 level 7 d after treat-ment in observation group decreased more significantly than control group,the differences were statistically significant(P<0.05). After treatment,BI score in 2 groups significantly increased,and observation group increased more significantly than control group,the differences were statistically significant (P<0.05). 7 d after treatment,improvement rate of neurological function was 50.00%,which was significantly higher than that of the control group(18.75%),the difference was statistically significant(P<0.05). There was no significant ADR occurred of 2 groups in the study. Following-up for 90 d,the KPS score in observation group with not less than 70 points accounted for 71.88%,which was significantly higher than the control group(46.87%),the difference was statistically significant (P<0.05). CONCLUSIONS:Nalmefene combined with monosialotetrahexosylganglioside sodium can promote the recovery of patients in brain tumor operation,reduce cortisol,ACTH,IL-6 and TNF-α levels and improve prognosis of patients.

Objective To investigate the effect and implying mechanism of continuous veno-venous hemofiltration(CVVH) on endoplasmic reticulum stress(ERS) and apoptosis of HUVEC cells which induced by serum of patients with multiple organ dysfunction syndrome(MODS).Methods Ten patients with MODS who received CVVH and 10 healthy volunteers were involved in this study.This experiment was divided into 4 groups: healthy control,group of pre-CVVH,group of 6-hour-CVVH and group of 20-hour-CVVH.Serum of healthy volunteers and the sera of patients with MODS at pre-CVVH,6-hour-CVVH and 20-hour-CVVH were used to induced HUVEC cells respectively in vitro for 24 h.The cell apoptosis was examined by TUNEL assay,the intracellular GRP78 protein was observed by immunocytochemistry,and the mRNA expressions of GRP78,CHOP,TNF-?,and IL-6 in the cells were measured by RT-PCR.The levels of serum SOD and MDA were detected by colorimetric method,and those of of TNF-? and IL-6 of by ELISA.Results Compared with healthy control,the group of pre-CVVH showed higher cellular apoptosis rate(P

Objective To examine the pathological changes in the liver of an AIDS patient with complicated infection of Pneumocystis carinii(PC). \ Methods\ A liver biopsy was made. The tissue was stained with HE, PAS, Giemsa, GMS, and acid\|fast staining, and examined under light microscope and transmission electron microscope. \ Results\ Granulomas (acid\|fast negative) in the tissue and numerous pathogens (PAS positive) in hepatic sinusoids were detected. Giemsa and GMS staining and electron microscopy all confirmed that the pathogen was Pneumocystis carinii. \ Conclusion\ The pathological findings revealed a diffuse extrapulmonary infection of Pneumocystis carinii in the patient of AIDS.