Objective To study the pathogenetic characteristics of tertiary hyperparathyroidism. Methods The diagnosis and treatment of a male patient with tertiary hyperparathyroidism were reviwed. Results The patient who had had chronic renal failure underwent excision of the adenoma of parathyroid gland 5 year ago.After that,the total parathyroidectomy and autografting were performed because of his recurrent hyperparathyroidism.The patient began hemodialysis therapy 3 years ago and then underwent allogeneic kidney transplantation 2 years ago.Two months after the operation,symptomatic hyperparathyroidism relapsed.The autonomic parathyroid grafts were removed three times (one part of the grafts resected each time) with relapse occurring three times.Later the hyperparathyroidism was cured by itself after the patient was mentally irritated. Conclusions Tertiary hyperparathyroidism may have already developed before kidney transplantation.

Objective To study the bladder function after internal iliac artery chemotherapy for bladder carcinoma. Methods Internal iliac artery chemotherapy was undertaken for 38 cases of bladder carcinoma comprehensively treated by TURBt,partial cystectomy or paliative TURBt.12 were T 1 carcinoma,14 T 2 and 12 T 3. Results The urinary bladder has been preserved in 33 patients.Of the 12 T 1 carcinoma,repeated recurrence occurred in 4.TURBt was undertaken on each occasion whereas total cystectomy was finally carried out in 2 of them.The bladder has been preserved in 10 of 14 and the 10 are still alive;of 14 T 2 (regional infiltrating carcinoma)patients,1 died of metastasis 2 years after surgery and another complicated by renal failure due to chemotherapy and has been on hemodialysis.The bladder has been preserved in 13 of the 14 and the 13 patients are still alive;of the 12 T 3 patients,8 were high risk patients,2 of them died of the cancer 2～3 years after the operation.Tumors vanished in 3 patients with negative multiple randomized biopsy.Tumors became smaller in 7 and partial cystectomy was performed for 3 of them.Of another 4 with shrunken tumors,hematuria has been controlled,the bladder capacity increased and the general condition of the patients improved.The bladder has been preserved in 10 of the 12.The mean survival time has been 58 months. Conclusions Internal iliac artery chemotherapy is effective and useful for some bladder cancer with the bladder function preserved.

Objective To study the diagnosis and treatment of ectopic testes. Methods 7 cases of ectopic testes were reviewed and studied. Results 5 cases of ectopic testes were diagnosed and located by physical examination and/or type B ultrasonography before operations whereas the ectopic testes was atrophic in the other two.All the ectopic testes were found successfully during surgical exploration.Orchidopexy was performed for 5 patients,and orchiectomy for the other 2 because of marked atrophy.Postoperative follow up has been 2 months to 8 years.All the patients have normal growth.In the 5 cases with reposited testes no displacement,atrophy or malignant change has been noted. Conclusions The diagnosis of ectopic testes should be mainly depended on physical examination and type B ultrasonography.Surgical exploration should be carried out through the inguinal canal and via the pathway of spermatic cord.

Clopidogrel is an essential drug for the treatment of ischemic stroke.It has been recommended by the multinational stroke treatment guidelines and has been widely used in clinical practice.Many patients with ischemic stroke may still have stroke recurrence after the standard treatment of clopidogrel; therefore,we must pay attention to the phenomenon of clopidogrel resistance.This article reviews the biochemical mechanisms,gene polymorphism,laboratory testing,and response measures of clopidogrel resistance.

The manifestation of clinical symptoms of cerebral small-vessel disease (SVD) is cognitive disorders. Its pathological changes are manifested as leukoaraiosis and/or lacunar infarction. However, it is not clear whether cognitive disorders caused by SVD is correlated with the severity of white matter damage. Magnetic resonance spectroscopy analysis can noninvasively detect metabolite concentrations of brain tissue in vivo and directly reflect cerebral metabolism; Diffusion-tensor imaging is a novel noninvasive technique for specific observation of white matter through different parameters such as mean diffusivity and anisotropy for quantitative evaluation of the abnormalities of fine structure of white matter. The combination of magnetic resonance spectroscopy analysis and diffusion-tensor imaging may more sensitively reveal the severity of white matter damage, and provide a research tool for cognitive disorders caused by SVD.resonance imaging

AIM:Researches have shown that musculocutaneous flap or fascial flap could well treat refractory bedsore in a long term. This study observed the clinical experience in the treatment of sacrococcygeal ulcers. METHODS:From January 2000 to January 2006,19 patients with sacrococcygeal ulcers,who received myocutaneous flap transposition in Department of Burns and Plastic Surgery,West China Hospital of Sichuan University,were selected. The informed consent was obtained from all patients. The surgery included two stages. At the first stage,debridement and eschar excision were performed. At the second stage,the surgery was undergone after selecting the myocutaneous flap type according to the patients' age,ulcer position,and ulcer extent. Twenty-one wounds were repaired by gluteus maximus myocutaneous flaps,and the flap size was 13 cm ?11 cm-17 cm?14 cm;8 by long-head of biceps femoris flaps of 10 cm?6 cm-13 cm?6 cm. After operation,the patients were placed on turn-over bed for 14 days and followed regularly. RESULTS:All flaps survived and the wounds in 18 cases healed at the first stage. Hematocele underlying flap occurred in one patient with urinemia,and healed by dressing exchange. After a follow-up of 5 months to 3 years,no patient had a recurrence;the color and texture of the flaps were good,and he appearance was satisfactory. CONCLUSION:The technique of two period operation treatment of myocutaneous flap transposition can accelerate the healing of sacrococcygeal ulcers and improves the success rate of operation.

Objective:To survey the status quo of job burnout among rural general practitioners and to analyze its influencing factors.Methods:A total of 2 805 rural general practitioners in three counties in southwest Shandong province were enrolled in the study. The survey was conducted with a basic information questionnaire and the Maslach Burnout Inventory-Human Service Survey (MBI-HSS). The influencing factors of job burnout were analyzed by Pearson chi-square test (χ2) and binary logistic regression model.Results:A total of 2 272 rural general practitioners completed the survey with a completion rate of 81.0%. The rates of middle or high job burnout in the dimensions of emotional exhaustion, depersonalization and reduced personal sense of achievement were 55.1%(1 251/2 272), 34.0%(772/2 272) and 91.3%(2 075/2 272), respectively. Binary logistic regression model showed that working hours/week ≥ 60 h ( OR=1.341, 95 %CI:1.057-1.702, P<0.05), monthly shift times ≥20 ( OR=1.434, 95 %CI:1.182-1.739, P<0.05), daily consultation time≥13 h ( OR=1.294, 95 %CI:1.055-1.589, P<0.05), daily consultation of 11-20 patients ( OR=1.317, 95 %CI:1.075-1.614, P<0.05), no part-time job ( OR=1.583, 95 %CI:1.201-2.087, P<0.05), insomnia ( OR=2.638, 95 %CI:2.225-3.128, P<0.05), feeling depressed at work ( OR=3.170, 95 %CI:2.661-3.776, P<0.05) were risk factors for emotional exhaustion; participation in public health services ( OR=1.485, 95 %CI:1.155-1.910, P<0.05), being married ( OR=2.273, 95 %CI:1.198-4.313), no part-time jobs ( OR=1.677, 95 %CI:1.276-2.203, P<0.05), insomnia ( OR=1.487, 95 %CI:1.211-1.827, P<0.05), and feeling depressed at work ( OR=1.642, 95 %CI:1.339-2.015, P<0.05) were risk factors for depersonalization; working hours/week ≥ 60 h ( OR=2.089, 95 %CI:1.454-3.002, P<0.05), daily consultation time ≥ 9 h ( OR=2.495, 95 %CI:1.748-3.561, P<0.05), insomnia ( OR=2.061, 95 %CI:1.519-2.796, P<0.05), and feeling depressed at work ( OR=1.894, 95 %CI:1.383-2.593, P<0.05) were risk factors for reduced personal achievement. Protective factors included monthly income ≥3 000 Yuan ( OR=0.589, 95 %CI: 0.353-0.982, P<0.05) and monthly shift of 10-19 times ( OR=0.581, 95 %CI:0.411-0.820, P<0.05). Conclusion:The overall job burnout among rural general practitioners in southwest Shandong province is serious, especially the depersonalization and the reduction of personal sense of achievement. It is suggested to improve the salary, reduce the working intensity, optimize the working hours, and pay attention to their physical and mental health for rural general practitioners to alleviate the current situation of their occupational burnout.

OBJECTIVE: To explore the clinical effects of using custom-made tumor prosthesis replacement to treat malignant tumor located in the distal femur or proximal tibia. METHODS: A retrospective study of 29 cases malignant tumors around knee treated surgically from June 2001 to October 2008. In the study there were 19 males and 10 females, aging from 17 to 65 years, with an average of 38.5 years. The location of tumors was at distal femur in 22 cases and 7 cases at proximal tibia. After the tumor was extensively resected or radically resected, custom-made tumor prosthesis replacement was performed for reconstruction, simultaneously, neoadjuvant chemotherapy and radioactive-therapy were used in treating the tumor according the pathology. RESULTS: All patients were followed-up for 18-84 months, with average follow-up period of 54.2 months. The 3 year survival rate was 79.8%, and the 5 year survival rate was 63%. As for the complications, prosthesis breakage occurred in 2 patients, aseptic loosening in 1 patients, 2 had a recurrence of the soft tissue tumor for which the diseased limb amputation was performed. The mean MSTS score showed excellent limb function in 15 patients, good in 8 patients, fair in 5 patients and poor in 1 patient. The overall excellent and good function was obtained in 79% of the patients. No superficial or deep infection occurred. Two patients suffered common peroneal nerve injury, but were cured by symptomatic treatments. CONCLUSION: Application of tumor prosthesis can give a satisfactory functional outcome, which is an effect method in limb salvage treatment of malignant tumor around the knee.

BACKGROUND: Evidence exists that inhibition of matrix metanoproteinase-2(MMP-2) secretion in the proliferating hernangioma tissue by transfection of adenovirus-active MMP-2(Ad-aMMP-2) cDNA would become an important means for treatment of proliferating hemangioma.OBJECTIVE: To investigate the influences of Ad-aMMP-2 cDNA transfection on human proliferating hemangioma growth in nude mice.DESIGN, TIME AND SETTING: A randomized, grouping, and controlled observation was performed in West China Hospital of Sichuan University between August 2003 and September 2004.MATERIALS: Eighteen BALB/c-nu/nu nude mice, weighing approximately 20 g, were included. Cavernous hemangioma specimen pathologically confirmed as proliferating hemangioma was resected from one 52-day-old female child patient.METHODS: The freshly reseoted human proliferating hemangioma specimen was sliced into small pieces with a size of 5 mm×4 mm×3 mm and subcutaneously implanted into the back of 18 nude mice within 1 hour to develop mouse models of hemangioma.Forty-five days after hemangioma implantation, 15 successful hemangioma nude mice were treated by intratumoral administration of adenovirus green fluorescent protein (Ad-GFP1 n = 51 Ad-GFP group), adenovirus-active MMP-2 (n = 5, Ad-aMMP-2 group), or the same amount of phosphate buffered saline (PBS1 n = 51 control group). Intratumoral administration was performed once every other day, for a total of 4 times.MAIN OUTCOME MEASURES: Observation of tumor volume and compadson of tumor necrosis area among 3 groups; detection of GFP expression in nude mouse; gross, hematoxylin-eosin staining, and transmission etectron microscope observation of tumor tissue morphology; determination of MMP-2 cDNA expression and microvascular density by immunohistochemistry; and detection of growth cycle and apoptosis of tumor cells by flow cytometry.RESULTS:①Ad-aMMP-2 could inhibit hemangioma growth in vivo, without marked adverse reactions. Tumor necrosis of different degrees was found in each group, and tumor necrosis area was significantly greater in the Ad-aMMP-2 group than in the control and Ad-GFP groups (P < 0.01). ②Histological sections displayed GFP gene expression in the Ad-GFP group. ③Gross observation results revealed relatively large tumor tissue in the control and Ad-GFP groups and relatively small tumor tissue in the Ad-aMMP-2 group. Hernatoxylin-eosin staining results showed that in the control and Ad-GFP groups, endothelial cells aggregated together in strip-shaped or lump-shaped appearance, and in the Ad-aMMP-2 group, there were many necrotic loci arranging in lamellar-shape appearance. Transmission electron microscope results revealed vascular endothelial cells with normal morphology in the control group and tumor cells with apparent nucleoli in the Ad-GFP group, while in the Ad-aMMP-2 group, some vascular endothelial cells exhibited chromatin pycnosis in the nucleus, forming apoptotic bodies.④ MMP-2 expression and microvascular density were significantly reduced in the Ad-aMMP-2 group than in the Ad-GFP and control groups (P < 0.05). ⑤The percentage of tumor cells in G0/G1 phase was significantly higher (P < 0.05), while the proliferating index was significantly decreased, in the Ad-aMMP-2 group than in the Ad-GFP and control groups. The Ad-aMMP-2 group exhibited higher apoptosis rate of tumor cells (P < 0.05), as well as more markedly increasing apoptosis index, than the control and Ad-GFP groups.CONCLUSION: It is feasible to block human proliferating hemangioma growth by transfeotion of Ad-aMMP-2 cDNA. The included mechanisms are to inhibit vascular endothelial cells to secrete MMP-21 thereby leading to local ischemia.

This study was aimed to observe renoprotective effect and possible mechanism on Y i-Shui Sheng-Xin Yin in spontaneously hypertensive rats. Sixty 12-week male SHR rats were randomly divided into six groups , which were the Y i-Shui She ng-X in Y in low-dose group , middle-dose group , high-dose group , Benazepril group , model group and blank control group , and ten rats for each group . The SHR rats were sacrificed after eight weeks . The urine microalbumin , blood urea nitrogen and cystatin were tested in each rat . The HE and Masson staining method were used to observe changes of renal pathology . Changes of expression of transforming growth factor-β1 ( TGF-β1 ) , connective tissue growth factor ( CTGF ) , FN were detected by immunohistochemistry . The results showed that compared with the blank control group , blood pressure in model group was associated with a significant rise after 8 weeks. Compared with the model group, blood pressure in the Yi-Shui Sheng-Xin Yin middle-dose group, high-dose group and Benazepril group significantly decreased. Compared with the blank control group , urine microalbumin , blood urea nitrogen and cystatin in model group were associated with a significant rise . Compared with the model group , urine microalbumin , blood urea nitrogen and cystatin in the Y i-Shui She ng-X in Y in middle-dose group , high-dose group and Benazepril group significantly decreased . Pathological examinations showed that pathological changes in model group were faster than all drug-groups , appeared pathological changes of glomerular hypertrophy , glomerular basement membrane thickening of heterogeneity and extensive vacuoles degeneration . Immunohistochemical staining showed that compared with the blank control group , expressions of TGF-β1 , CTGF and FN of rat kidney tissue in model group were obviously up-regulated ( P < 0 . 05 ) . Compared with the model group , expressions of TGF-β1 , CTGF and FN in the Y i-Shui She ng-X in Y in , middle-dose group , high-dose group and Benazepril group were down-regulated ( P < 0 . 05 ) . It was concluded that Y i-Shui She ng-X in Y in can reduce SHR rats' early renal glomerulosclerosis and renal interstitial fibrosis , which play roles of delaying the progress of hypertension and protecting kidney . Its mechanism of action may be related to TGF-β1 , CTGF , FN signal pathways .