Objective To increase curative rate of nonoperation treatment for adult blunt splenic trauma.Methods Data of 141 patients with blunt splenic trauma treated in our hospital from March 2010 to October 2014 were retrospectively analyzed in accordance with the spleen injury degree classification issued by the Spleen Surgery Group of Chinese Society of Surgery in 2000.According to the treatment within 6 hours of injury,these patients were divided into operative and nonoperative management groups.Results The proportion of non operation was 69.5％ (98/141) and the success rate was 89.8％ (88/98).43 cases were in operation group:34 cases in grade Ⅲ,9 cases with grade Ⅳ,3 cases died; 98 cases were in non operation group:including 32 cases of grade Ⅰ,50 cases of grade Ⅱ,15 cases of grade llⅢ,1 case with grade Ⅳ.10 cases failed non operation treatment including 1 case with grade Ⅰ complicated by pancreatic and intestinal injury causing peritonitis during the period of observation,1 case of grade Ⅱ complicated by contusion of the liver and secondary bleeding on day 3 after the trauma,7 cases of grade Ⅲ,were converted to surgery because of multiple organ injury and rebleeding secondary to pulmonary complications,and 1 case of grade Ⅳ with multiple organ injury and shock being immediately converted to surgery.In overall there were 2 deaths in nonsurgery group,1 case with grade Ⅲ and 1 case with grade Ⅳ.Condusions Nonoperative treatment of blunt splenic trauma is safe and feasible in grade up to]Ⅱ blund splenic trauma patients.

Objective:To establish a method for determining three residual organic solvents in nimodipine liposomes. Methods:The samples were injected into a DB-624 capillary column (30 m × 0. 32 nm,1. 8 μm) by a headspace sampler and analyzed with an FID detector, the carrier gas was nitrogen, the injector temperature was 250℃, and the detector temperature was 250℃. The column temperature was programmed raised. Results:Three residual solvents, namely ethanol, acetone and acetic ether were completely sepa-rated. There was a good linearity within the experimental concentration range. The average recovery was 98. 9%,98. 5% and 99. 4%(RSD=0. 32%,1. 12%,0. 76%,n=9), respectively. The detection limits was 0. 20, 0. 18 and 0. 22μg·ml-1, respectively . Con-clusion:The method is rapid, sensitive and accurate. It can be used in the determination of residual organic solvents in nimodipine li-posomes.

Objective:To examine the effects of different endodontic irrigation methods on root canal morphology.Methods:We collected 20 extracted single-root premolars from elderly patients(≥60 years)with periodontitis and randomly divided them into 5 groups.Group A: syringe irrigation; Group B: P5 ultrasonic irrigation, Group C: 0.20 W Er: yttrium aluminum garnet(YAG)laser irrigation; Group D: 0.30 W Er: YAG laser irrigation; and Group E; 0.35 W Er: YAG laser irrigation.Changes in the smear layer in the root canal and the hardness of the root canal were assessed.Results:After treatment with different root canal cleaning methods, the scores of smear layer removal for Groups A, B, C, D and E were(4.67±0.27), (3.08±0.57), (2.83±0.43), (1.17±0.19)and(2.87±0.50), respectively.There were statistically significant differences between them( F=35.946, P<0.01). Among them, Group B, C, D and E had better smear layer removal than Group A, and the differences were statistically significant(all P<0.01). Group D had better removal of the smear layer than Groups B, C and E, and the differences were statistically significant( P<0.01); Values for dentin microhardness of Groups A, B, C, D and E were(58.98±5.54), (55.19±5.71), (56.04±3.96), (66.65±3.23)and(45.68±7.58), respectively, with statistically significant differences( F=5.83, P<0.05), and for laser-based irrigation, the value for dentin microhardness of Group D was higher than those of groups C and B(all P<0.05). Conclusions:Laser-based root canal irrigation is better than traditional irrigation methods, with 0.30 W Er: YAG laser achieving maximal removal of the smear layer and at the same time having the least impact on root canal hardness.

OBJECTIVETo select the premium alert threshold for major communicable disease by using the control graph alert technique based on the local disease information.

METHOD8 major communicable diseases in Songjiang district were ascertained by analysis of the national early warning detection information system which include the other diarrhea, mumps, chickenpox, scarlet fever, rubella, hand foot mouth disease, influenza and dysentery; weekly reported cases from 2008 to 2011 were used to establish the early detection model (PERCENTILE (array, x), array (4×5), x = 0.05, 0.10…0.95) by moving percentile method, next applying the established early detection model and the golden standard (AKX(-)D ± 2s) to predict the expected weekly cases in 2012 respectively, and then ascertain the predict results by comparison with the actual weekly cases in 2012 respectively, finally the premium threshold was selected by comparison of the model predicted results with the golden standard predicted results after comprehensive consideration of the sensitivity, specificity, positive predictive value and negative predictive value and receiver operating characteristic (ROC) curve.

RESULTSThe premium alert threshold for mumps, other diarrhea and rubella was P90, dysentery was P75, scarlet fever and chickenpox was P80, and the premium threshold for hand-foot-mouth disease (HFMD) and influenza was P95, the sensitivity of 8 major communicable diseases were 100%, 100%, 86%, 100%, 100%, 100%, 94%, 100%, respectively; the specificities were 92%, 73%, 72%, 77%, 73%, 92%, 66%, 80%, respectively; the positive predictive values were 43%, 40%, 32%, 8%, 24%, 20%, 59%, 47%, respectively; and the negative predictive values were 100%, 100%, 97%, 100%, 100%, 100%, 96%, 100%, respectively. The national recommended alert thresholds for the 8 major communicable diseases were P80, except for chickenpox (P50) and HFMD (CUSUM).

CONCLUSION6 out of 8 major communicable diseases' early detection thresholds in Songjiang district should be adjusted according to the analysis results. Premium alert threshold selection need to consider the local disease report and the characteristics of infectious diseases to upgrade the early detection capability.

China ; epidemiology ; Communicable Disease Control ; methods ; Communicable Diseases ; epidemiology ; Disease Notification ; Disease Outbreaks ; prevention & control ; Humans ; Models, Theoretical ; Population Surveillance ; methods

OBJECTIVETo investigate general and clinicopathological characteristics of male breast cancer and analyzed the factors affecting the outcomes of the patients based on the data from a single institution.

METHODSTwenty-five male breast cancer patients treated at Sun Yet-sen University Cancer Center between January 1, 2000 and April 30, 2011 were included into the study. The patients were followed up for 1 to 90 months with a median follow-up of 51 months. The general and clinicopathological characteristics including family history, age, smoking, alcohol drinking, site of tumor, location of tumor, histological type, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), Ki-67, vascular endothelial growth factor (VEGF), P53 expression, neoadjuvant chemotherapy, surgery, adjuvant chemotherapy, adjuvant radiotherapy, adjuvant endocrine therapy, tumor size, lymph node status, distant metastasis and TNM stage were investigated by univariate analysis to evaluate the impact of these factors on patient survival.

RESULTSThe 5-year survival rate was 66.5% in these patients. Neoadjuvant chemotherapy, tumor size, lymph node status, distant metastasis and TNM stage were significant predictors for the overall survival. Patients receiving adjuvant endocrine therapy tended to have a better overall survival, though this was not supported statistically (P=0.086). However, patients with neoadjuvant chemotherapy had a poorer overall survival than those without it (P=0.000). Patients in stages I and II had better overall survival than those in stages III and IV (P=0.000).

CONCLUSIONThe 5-year survival rate was 66.5% in these male breast cancer patients. Neoadjuvant chemotherapy, tumor size, lymph node status, distant metastasis and TNM stage are significant predictors of the overall patient survival.

Breast Neoplasms, Male ; diagnosis ; drug therapy ; pathology ; Follow-Up Studies ; Humans ; Male ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Survival Rate

Objective To investigate the effect of recombinant botulinum neurotoxin serotype A heavy chain (BoNT/A heavy chain)on local proteins which are related to nerve growth after spinal cord injury in rats,and to get some experimental evidence to explain the mechanism of BoNT/A heavy chain in stimulating neuritogenesis. Methods Recombinant botulinum neurotoxin serotype A heavy chain was applied locally or intrathecally to rats with ipsilateral semi-dissociated lumbar spinal injury. Local spinal tissue was extracted for general protein expression by two dimension electrophoresis plus nitrate silver staining after different time period of injury. Based on the results of 2-D gel electrophoresis,growth-associated protein 43(GAP-43)and of superior cervical ganglion 10(SCG 10)were selected to examine the changes of their expression and distribution features under BoNT/A heavy chain administration using SDS-PAGE,western blot and immunofluorescence. Results (1)The model of spinal cord injury(SCI)in this study was an ipsilateral semi-dissociated lumbar SCI in rat. The rats showed obvious motor and sensory dysfunction in the ipsilateral hind limb.(2)The results from 2-D gel electrophoresis plus nitrate silver staining showed that the administration of BoNT/A heavy chain based on SCI altered the local protein expression pattern. The decrease or increase in the expression of some protein dots /dots group was clearly seen after single SCI. However, these changes were transformed by BoNT/A heavy chain treatment,which appeared as a reversed pattern turning toward that in control group or further increased expression upon SCI,such as the dots located respectively at 35-45 kDa and 18-25 kDa level,pI between 5-7. In addition,the expression of the two dots located at the level as above increased after SCI only, and showed further increase in their expression with BoNT/A heavy chain intervention.(3)The changes of selective GAP-43 and SCG 10 expression and distribution by western blot and immunofluorescence indicated that the administration of BONT/A heavy chain based on SCI amplified the expression of GAP-43 and SCG 10(P < 0.05). Meanwhile,the positive immuonfluorescent staining for both GAP-43 and SCG 10 mainly distributed nearby the proximal area of injury, both cytoplasm and neuronal processes were positively stained. Conclusions Intrathecal delivery of BoNT/A heavy chain increases the expression of growth-associated proteins GAP 43 and SCG 10 after SCI in rats.

Objective To investigate the effect and molecular mechanism of botulinum neurotoxin serotype A (BoNT/A) heavy chain on neuron regeneration. Methods Cell culture, rats, immunofluorescence, SDS-PAGE and western blot, etc. were adopted in this study to explore the alterations of histone-3 acetylation (acetyl-H3 ) by local treatment of BoNT/A heavy chain to spinal cord injury (SCI) in rats (in vivo) or by adding it into cell culture (in vitro). Meanwhile, the relevance of acetyl-H3 to neurite out-growth based on SCI and cell culture with BoNT/A heavy chain application was approached as well. Results The application of BoNT/A heavy chain to cultured Neuro-2a cells increased the level of H3 acetylation. The increase of H3 acetylation was paralleled with the growth of neuritogenesis. Also, the neuronal treatment of BoNT/A heavy chain to SCI promoted the re-growth of neuronal processes surrounding the lesions. The growth of neuronal processes was positively correlated to the level of H3 acetylation. During the periods of BoNT/A heavy chain treatment in vivo or in vitro, the increase of H3 acetylation showed two peaks. Conclusions BoNT/A heavy chain increased the H3 acetylation, which might be one of its neuritogenic mechanisms.

Objective:To investigate the application value of dynamic scintigraphy single-photonemission computed tomography (SPECT) 99m-technetium-galactosyl human serum albumin diethy-lenetriamine pentaacetic ( 99Tc m-GSA) scintigraphy in assessing liver function of perihilar cholangio-carcinoma after portal vein embolization (PVE). Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 16 patients with perihilar cholangiocarcinoma who underwent 99Tc m-GSA scintigraphy after PVE in Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from October 2019 to January 2021 were collected. There were 8 males and 8 females, aged from 46 to 78 years, with a median age of 64 years. Observation indicators: (1) liver volume after PVE; (2) liver function after PVE; (3) typical case analysis. Measurement data with normal distribution were represented as Mean± SD. Count data were represented as absolute numbers or percentages. Comparison of data of the same patient was analyzed using the paired t test. Results:(1) Liver volume after PVE:the morphological liver volume and functional liver volume for the 16 patients were (1 420±211)mL and (389±112)mL. The morphological liver volume and functional liver volume were (636±143)mL and (234±106)mL of planning reserved lobe, (784±210)mL and (151±106)mL of planning resection lobe, respectively. The functional liver density (FLD) of planning reserved lobe and planning resection lobe were 0.36±0.12 and 0.19±0.11, showing a significant difference between them ( t=3.794, P<0.05). The planning resection rate of morpholo-gical liver volume and functional liver volume were 37.8%±0.6% and 54.8%±0.2%, showing a significant difference between them ( t=?3.720, P<0.05). (2) Liver function after PVE: 13 of 16 patients completed the indocyanine green (ICG) test, and 3 patients didn't complete the ICG test due to intolerance. For the 13 patients undergoing ICG test, the total ICG-K value was (0.15±0.03)/minutes, and the ICG-K value of planning reserved lobe was (0.07±0.02)/minutes. The total GSA-K value of 16 patients was (0.14±0.10)/minutes, and the GSA-K value of planning reserved lobe was (0.08±0.06)/minutes. (3) Typical case analysis: a 46-year-old male patient with type Bismuth Ⅲa perihilar cholangiocarcinoma was planned to perform perihilar hepatectomy combined with right hepatectomy. The imaging evaluation showed that the volume of reserved liver lobe accounted for 27% of the total liver volume. The serum total bilirubin was 256 μmol/L when admitted and decreased to 118 μmol/L on the day 5 after percutaneous transhepatic biliary drainage. The right anterior and right posterior branches of PVE was performed. SPECT 99Tc m-GSA examination was performed on the day 37 after PVE. The morphological liver volume was 559 mL of planned reserved lobe and 1 461 mL of the whole liver. The planned morphological liver volume resection rate was 61.7%. ICG-K was 0.12/minutes of the whole liver, and 0.04/minutes of planned reserved lobe. The functional liver volume was 134 mL of planned reserved lobe and 309 mL of the whole liver. The planned resection rate of functional liver volume was 56.6%. The GSA-K was 0.20/minutes of the whole liver and 0.09/minutes of planned reserved lobe. R 0 resection was achieved in perihilar hepatectomy combined with right hepatectomy and no liver failure occurred. The survival time of patients was 11 months. Conclusion:Dynamic SPECT 99Tc m-GSA scintigraphy can effectively evaluate the regional function of the reserved liver lobe in patients with perihilar cholangiocarcinoma after PVE.

Er: YAG laser bleaching is a new tooth bleaching method compared with traditional bleaching technology. The Er: YAG laser significantly improves the bleaching efficiency, has the advantages of high safety, short treatment time and excellent bleaching effect and is widely used in clinical operations. This paper summarizes the working principle and bleaching characteristics of Er: YAG laser bleaching technology and its effect on tooth structure. The existing literature suggests that the high absorption of water and hydroxyapatite by the Er: YAG laser makes it work well on water-bearing tissues and dental tissues. When it is absorbed by the bleaching agent on the tooth surface, it accelerates the catalytic oxidation-reduction reaction and selectively acts on the pigment particles deposited on the tooth, thereby achieving the effect of tooth bleaching. Er: YAG laser bleaching can be applied to most discolored teeth. The bleaching process is rapid and effective. During the bleaching process, for the dental pulp tissue, the temperature of the pulp cavity is lower than the critical value of 5.6 ℃, causing no pathological damage to the dental pulp tissue. For the hard tissues of the teeth, laser irradiation will cause changes in the chemical composition of calcium and phosphorus. The enamel presents a unique lava-like shape, and the bonding strength of the tooth increases after bleaching. Compared with other lasers, the Er: YAG laser has a wavelength close to the peak of water, and adding other ingredients to the bleaching agent is not required. Almost all the energy is used for the bleaching agent, with no damage to the surrounding tissues.