Objective To explore the effect of hippophae rhamnoides on the level of plasma appetite factors neuropeptide Y ,the gastric motility and on their body fat in children with functional dyspepsia .Methods A hundred and twenty children with functional dyspepsia were simple random sampled divided into the three groups :Group Ⅰ( treated with hippophae rhamnoides ) ,Group Ⅱ( treated with domperidone ) , and Group Ⅲ( treated with hippophae rhamnoides plus domperidone ) .The treatment lasted for eight weeks .The level of plasma neuropeptide Y ( NPY) were measured before and after treatment .All patients underwent a gastric emptying ( GE) test by ultrasound ( US) to measure the rate of postprandial gastric antrum residual ,at 30min,60min,90min and 120min.The average value of subcutaneous fat,body fat percentage,upper arm girth,weight and height were also measured .Results There were no statistical difference between the level of NPY in plasma of groupⅠ,ⅡandⅢbefore treatment,which were (107.52 ±24.12)ng/L, (114.63 ±17.95)ng/L and(114.56 ±25.10)ng/L(F=1.307,P>0.05).After treatment,there were statistical difference between the level of NPY in plasma of groupⅠ,ⅡandⅢ,which were (137.38 ±29.86) ng/L,(121.43 ± 13.78)ng/L and (149.27 ±31.9)ng/L.The level of NPY in plasma of groupⅠandⅢwere markedly increased after treatment(t=4.95,5.40,all P<0.05).The postprandial gastric antrum remains in Groups ⅠandⅢwere less than that in group Ⅱat 60 min,90 min and 120 min,respectively(F=4.93,6.40,4.61,all P<0.05).The thickness of skin fold(SF),body fat percentage and upper arm girth and weight in groupⅠand Ⅲ increased more than those in group Ⅱ(F=16.80,46.9,21.06,all P<0.05).The level of plasma appetite factors ,the rate of gastric antrum remaing and SF,body fat percentage,arm girth and weight was similar in groupⅠand group Ⅲ (P >0.05). Conclusion In children′s functional dyspepsia ,the hippophae rhamnoides increases the level of appetite factor neu-ropeptide Y,The child′s body fat increases markedly and physical growth also has obvious improvement .

Objective To look for an appropriate dietary pattern of early nutritional intervention, which does not only meet the need of catch-up growth but also avoids or reduces the incidence of insulin resistance (IR) in adulthood of rats born with intrauterine growth retardation (IUGR). Methods The model of IUGR in rats was established by maternal nutrition restriction. Sixty newborn female rats with IUGR were randomly divided into 5 groups: (1) IUGR control group fed with common diet. (2) IUGR high-carbohydrate diet group. (3) IUGR high-fat diet group. (4) IUGR high-protein diet group. (5) IUGR low-protein diet group. The IUGR newborn rats were breast-fed for 3 weeks, while the mother rats were fed with the above different diets with the same caloric amount. Twelve normal newborn female rats served as a normal control group and were fed with common diet. All newborn rats were fed routine diet starting from the 4th week of experiment. The body weight, perirenal fat weight and the serum leptin, blood glucose, insulin concentration were measured and the insulin sensitive index (ISI) were calculated at the 4th week and the 12th week of life. Results The IUGR rats fed with high-protein diet showed a catch-up growth without the increase of perirenal fat at the 4th week, a normal level of perirenal fat, leptin and ISI at the 12th week compared with the normal control group, and did not show IR. The groups fed with high carbohydrate diet and high fat diet also showed a catch-up growth, but did the same as the IUGR control group in other aspects, they all showed increased perirenal fat, higher levels of leptin, lower ISI and IR at adulthood. The group fed with low protein diet did not show IR, but kept a small body size with increased perirenal fats. The serum leptin level of rats was positively correlated to body weight at the 4th week of life and was positively correlated to the weight of perirenal fat and negatively correlated to ISI at the 12th week of life. Conclusion High protein diet is an appropriate early nutritional intervention for rats with IUGR. The serum leptin level at the 12th week of life seems to be an index of IR in adult rats with IUGR.

ObjectiveTo investigate the relationship between the imaging manifestations and postoperative efficacy scores through measuring postoperative ankle mortise morphometry of Rüedi-Allg(o)wer Ⅲ pilon fracture.MethodsForty-seven cases of Rüedi-Allg(o)wer Ⅲ pilon fracture patients,including 20 males and 27 females with a mean of 43 years (range,21-65 years) were treated and followed up.Indexes including the width,height,depth,coronal angle and sagittal angle of ankle mortise were measured at the last follow-up.According to the Mazur score at the last follow-up,operated ankle functions were evaluated and divide into three groups (excellent group,good group and poor group.By comparing the five indexes of 47 cases and 3 groups between injury ankle and healthy ankle,we analyzed the correlation of the ankle mortise change and the ankle function.ResultsAll patients were followed up 18-24 months(mean,21 months).The results showed there were significant differences about all the measuring indexes except the height of ankle mortise between the injury ankle and healthy ankle of 47 follow-up cases.About the difference between both sides in 3 groups,the results showed there was a negative correlation between all indexes except the height of ankle mortise and the Mazur score.No correlation was found between the height of ankle mortise and the Mazur score.Recovering the ankle mortise's width,depth,coronal angle as well as sagittal anglein the surgery of severe pilon fractures has a significant effect on ankle function.ConclusionRecovery of the ankle mortise's width,depth,coronal angle as welld as sagittal angle during the surgery of severe pilon fractures has a significant effect on ankle function,so the anatomy of the ankle mortise should be recovered as much as possible.

Objective To screen the indicator system of sub-health.Methods Three rounds delphi consultations were conducted for selected indicators of sub-health.30 experts were selected for the three rounds' consultations.Results The experts who had been invited are from about 10 different majors and have been engaged in their current profession for 21.75 years on average.The enthusiasm coefficient of specialists in pretest and two rounds' formal consultations were 90.00%, 93.33% and 89.29% respectively.The coordination coefficients Kendall' W of the experts' opinion were 0.327,0.185 and 0.249 respectively.The weight of the first grade indexes of the sub-health namely physical, mental and social sub-health indicator dimension were 40.61%, 33.34%and 26.05% respectively.After two rounds' formal consultation,64 assessing indicators were remained in the final.Conclusion It is practical,efficient and successful to use Delphi method in screening indicator system of assessing sub-health.

OBJECTIVETo investigate the clinicopathological and immunohistochemical features of primary malignant tumor of the appendix.

METHODSThe clinical data were reviewed; and histopathological and immunohistochemical features were analyzed in 22 cases with primary malignant tumor of the appendix.

RESULTIn 22 cases of primary malignant tumor of the appendix, 19 cases were carcinoid and 3 were adenocarcinoma. Immunohistochemistry showed that the carcinoid was positively reacted to the neuroendocrine markers, and the adenocarcinoma was negatively reacted to the neuroendocrine markers.

CONCLUSIONImmunohistochemistry is useful in diagnosis of primary malignant tumor of the appendix, a rare type of cancer.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Appendiceal Neoplasms ; diagnosis ; pathology ; surgery ; Carcinoid Tumor ; diagnosis ; pathology ; surgery ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Young Adult

Background and purpose:Whether axillary sentinel lymph node biopsy (ASLNB) could replace axillary lymph node dissection (ALND) in patients who converted after neoadjuvant chemotherapy (NAC) from cN+ to ycN0 is still contentious, and the previous study only evaluated the pathological status of ALN without internal mammary lymph node (IMLN) condition. This study is to evaluate roles of ASLNB and internal mammary sentinel lymph node biopsy (IM-SLNB) in breast cancer patients after NAC.Methods:From Jan. 2012 to Dec. 2014, 60 breast cancer cT1-4N0-3M0patients who were scheduled for neoadjuvant chemotherapy (NAC) and agreed to accept surgery after NAC from our department were enrolled into the retrospective study. Patients with cN0 before NAC and ycN0 after NAC underwent ASLNB (group A). Patients with cN+ received NAC and ycN0 after NAC (group B) were treated with ASLNB and ALND. Only patients whose clinical nodal status remained positive (ycN+) after NAC underwent ALND without ASLNB (group C). All the patients received radiotracer injection and patients in group A and group B received blue dye injection additionally. Meanwhile, IM-SLNB would be performed for all patients with IM-SLN visualization.Results:The number of patients enrolled in group A, group B and group C was 6, 45 and 9 cases respectively. The accuracy rate of ASLNB in group A was 100% (6/6). Only one patient was axillary sentinel lymph node (ASLN) positive performed ALND. With combination of blue dye and radiolabeled colloid, the accuracy rate of ASLNB in group B was 100% (48/48) and the false negative rate (FNR) was 17.9% (5/28). The FNR in patients with 1, 2 and>2 SLNs examined was 27.3% (3/11), 20.0% (2/10) and 0% (0/7). All of the ALNs were positive in group C. The visualization rate of IM-SLN was 63.3% (38/60). The detection rate of IM-SLNB was 97.4% (37/38) and the metastasis rate was 8.1% (3/37). The incidence of complications was 5.3% (2/38).Conclusion:ASLNB can be performed either before or after preoperative chemotherapy for patients with cN0 disease. Among women with cN+ converted to ycN0 who had 3 or more SLNs examined, the FNR could return to be less than 10%. Those patients whose nodes are still ycN+ should perform ALND. IM-SLNB should be performed routinely in all breast cancer patients after NAC, for it might help to make clear of the nodal staging and the pathological status of IM-SLN and provide the accurate indication of radiation to the internal mammary area in case of under-stage and under-/over-treatment, expecting to develop the deifnition of pathological complete response (pCR).

Objective To verify the accuracy of the modified technique for internal mammary sentinel lymph node biopsy ( IM-SLNB) in breast cancer .Methods In the validation study , the radiotracer was injected with the modified technique , and fluorescence tracer was injected into the peritumoral breast tissue .The radioac-tive IM-SLN was identified by preoperative lymphoscintigraphy and γprobe.The radioactive IM-SLN received bi-opsy during operation .The status of the fluorescence tracer was identified by the fluorescence imaging system . Results A total of 162 patients were enrolled from Sep .2013 to Dec.2014.IM-SLNB was performed in 110 pa-tients.The radiotracer and the fluorescence tracer were identified in the same IM-SLN in 94 cases, and the con-cordance rate was 85.5%(Case-base, Spearman coefficient correlation 0.823, P<0.001).Conclusion Dif-ferent tracers injected into the different sites of the intra-parenchyma can reach the same IM-SLN, proving the ac-curacy of the modified technique and the hypothesis of IM-SLN lymphatic drainage pattern ( IM-SLN receives not only the lymphatic drainage from the primary tumor area but the entire breast parenchyma ) .

"5+3" integrated training program is a new training model to cultivate doctors under the background of preclinical teaching and clinical training integration. Based on practice in Shantou University Medical College, the program design current progress and solution to the problem were elaborated. It adheres to principles of overall optimization and orienting to clinic, and to ensure the smooth implementation of the training model. Which will provide important reference for the reform of long-term medical training program in higher medical colleges and universities.

Objective To evaluate clinical outcomes of the Kocher-Langenbeck (K-L) approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area.Methods From January 2012 to January 2017,20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome.They were 13 males and 7 females,with an average age of 40.7 years (range,from 22 to 67 years).According to the Letournel-Judet classification,there were 8 posterior wall fractures,one transverse fracture,one T-shaped fracture,one transverse and posterior wall fracture,3 posterior column and posterior wall fractures,and 6 double-column fractures.All patients received open reduction and internal fixation with plates and screws.The outcomes of reduction were evaluated at follow-ups according to the Matta criteria.The hip function was evaluated according to the modified Merle d'Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups.Results All the 20 patients were followed up for an average of 8.2 months (range,from 7 to 21 months).They all obtained bony union after 10 to 18 weeks (average,11.4 weeks).No fracture displacement,internal fixation loosening or deep infection occurred.According to the Matta criteria,anatomic reduction was achieved in 13 cases,satisfactory reduction in 6 cases,and unsatisfactory in one (a satisfactory rate of 95％).The modified Merle d'Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases,7 good cases,3 fair cases and one poor case (an excellent to good rate of 80％).Ectopic ossification of Brooker grade Ⅰ occurred in one case.The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17.Conclusions In the treatment of acetabular fractures involving the acetabular dome,the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area,enhance the anatomic matching of femoral head and acetabular roof,and reduce the difficulties in reduction and fixation.

Objective:To investigate the role of follicular helper T(Tfh) cells and galactose deficiency IgA 1(Gd-IgA 1) in the children that were suffering from Henoch-Sch?nlein purpura(HSP) and Henoch-Sch?nlein purpura nephritis(HSPN)and the correlation between them. Methods:According to the presence or absence of renal injury, 62 children with HSP were divided into HSP group with 32 children and HSPN group with 30 children.Twenty children who underwent physical examination at outpatients were known as the healthy control group.Flow cytometry was used to measure the proportion of Tfh(CD4 + CXCR5 + PD-1 + ) in peripheral blood.Immunoturbidimetry and ELISA were used to measure the serum levels of IgA 1 and Gd-IgA 1 respectively. Results:(1) The proportion of Tfh cells in peripheral blood and the serum levels of Gd-IgA 1 in both HSP group and HSPN group had significantly increased than those in healthy control group( P<0.01). Compared result of the HSPN group with HSP group, the proportion of Tfh cells in peripheral blood and the serum levels of Gd-IgA 1 in HSPN group were higher than that in HSP group( P<0.05). (2) In the HSPN group, the proportion of peripheral blood Tfh cells and the serum levels of Gd-IgA 1 in group of renal pathology ≥ grade Ⅲ and heavy proteinuria were significantly elevated compared with group of renal pathology < grade Ⅲ and non-heavy proteinuria(<0.01). (3) In the healthy control group, the serum levels of Gd-IgA 1 was positively correlated with the proportion of Tfh cells in peripheral blood and the serum levels of Gd-IgA 1( P<0.05). Conversely, a non-positive correlation was shown in HSP and HSPN groups( P>0.05). Conclusion:The excessive activation of Tfh cells and the serum levels of Gd-IgA 1 may be one of the pathogenesis of HSP/HSPN, the degree of increment of the two factors may be related to the activity and severity of the disease.The mechanism of Tfh cells potentially leading to an increase of Gd-IgA 1 production requires further study.