Objective To evaluate the feasibility of retroperitoneal laparoscopic adrenalectomy for large (≥6 cm in diameter) adrenal tumors. Methods Between June 2002 and June 2008,30 patients with large adrenal tumors underwent retroperitoneal laparoscopic adrenalectomy in our hospital. With the patients being placed in the lateral position at the uninjured side,a self-made balloon was used to dilate the retroperitoneal space. Afterwards,3 trocars were inserted via the costal margin at the posterior axillary line and the anterior axillary line,and 2 cm above the anterior superior iliac spine at the middle axillary line to remove the tumors. After resection of the tumor,an drainage tube was indwelled. Results Retroperitoneal laparoscopic surgery was performed successfully in the 30 cases without conversion to open surgery. The mean operation time was 100 min (range,65 to 185 min),and the mean blood loss was 80 ml (range,50 to 250 ml). Over a mean of 18.5-month follow-up (range,3 to 36 months) was achieved in the cases,during which no one had local recurrence. Conclusions Retroperitoneal laparoscopic adrenalectomy is feasible and safe for patients with large adrenal tumors as long as no contraindication of the surgery is found. The diameter of the tumor does not play a role when determining the surgery.

ObjectiveTo investigate the protective effect of combination of triptolide and irbesartan on the podocytes in a type 2 diabetic(T2DM) rat model,and evaluate its mechanism.Methods T2DM rats were induced by fed with high-sucrose-high-fat diet combined with a low dose of streptozocin.The rats were randomly divided into 5 groups:normal control group ( NC,n =10),diabetes group ( DM,n =11),triptolide treatment group (DT,n =12),irbesartan treatment group (DI,n =12) and triptolide combined with irbesartan treatment group (DTI,n =13). Ultrastructure of podocytes was observed by electronic microscopy and urinary albumin (UAL) excretion by ELISA was determined after 8 weeks.The expression of nephrin and bone morphogenetic protein-7(BMP-7), connective tissue growth factor (CTGF),transforming growth factor (TGF)β1 mRNA and proteins were detected by immunohistochemistry,real-time PCR and Western blot. Results Increased UAL was significantly attenuated in all treatment groups.Compared to NC group,UAL in DM group was increased significantly (0.45 ± 0.09 vs 6.36 ± 0.87,P ＜ 0.01 ),while decreased in triptolide or irbesartan alone treatment group (2.48 ± 0.37 and 2.68 ±0.42,both P ＜ 0.01 ).Compared with those in control groups,kidney expression of nephrin,BMP-7 mRNA and proteins were downregulated while CTGF, TGFβ1 mRNA and proteins were significantly upregulated in T2DM rats. Triptolide or irbesartan each alone moderately ameliorated albuminuria and podocyte damage.However,their combined usage showed a dramatic therapeutic synergism,manifested by prevention of progressive albuminuria,restoration of the glomerular filtration barrier,reversal of the decline in slit diaphragm proteins,reduction expression of CTGF,TGFβ1,and upregulation of BMP-7.Conclusion Our findings show that triptolide can increase the efficacy of irbesartan,leading to a more effective prevention of kidney disease in T2DM rat model,which may through upregulation of BMP-7 and inhibition the overexpression of CTGF and TGFβ1.

Objective To study the effect of continous subcutaneous insulin infusion (CSII) and mutiple subcutaneous insulin infusion (MSII) on type 2 diabetes mellitus during perioperation. Methods One hundred and eighty surgical patients complicated with Type 2 diabetes were randomly divided into two groups,98 cases in the CSII group (treated with CSII of novolin R) and 82 cases in the MSII group (treated with MSII of novolin R and no-volin N). Blood glucose level,the time to reach normal blood glucose level, the average dosage of insulin, the inci-dence of hypoglycemic,infection rate of incisions and inpatient days were measured in two groups before and after treatment. Results The level of fasting blood glucose after treatment in the CSII group (4.8 mmol/L (SD: 1.6)) was significantly lower than that of the MSII group (6.4 mmol/L(SD :2.1)) (t = 7.74,P < 0.05), and 2-h glucose in the CSII group (7.6 mmol/L(SD :2.3)) was significantly lower than that of the MSII group (9.3 mmol/L(SD: 2.4)) (t = 7.72, P < 0.05). The time to reach normal blood glucose level in the CSII group (4.1 days (SD: 2.9)) was shorter than that of MSII group (6.9 days (SD :2.0)) (t=2.81, P < 0.05). The average dosage of insulin in the CSII group (40.7 U(SD: 10.3)) was lower than that of the MSII group (63.2 U (SD: 17.0)) (t=3.57, P <0.05). The incidence of hypoglycemic in the CSII group (3.05%) was lower than that of the MSII group (9.20%) (χ~2 = 4.92,P < 0.05). The infection rate of incisions in the CSII group (0.0%) was lower than that of the MSII group (10.9%) (χ~2 =4.18, P < 0.05). The inpatient days in the CSII group (15.3 days (SD :7.2)) was shorter than that of the MSII group (22.5 days (SD :9.7)) (t = 3.12, P < 0.05). Conclusions Compared to multiple sub-cutaneous insulin infusion, continuous subcutaneous insulin infusion is more effective in controlling blood glucose, hypoglycemic and incision infection, thus is recommend to perioperative patients complicated with type 2 diabetes mellitus.

Objective To investigate and analyze the efficacy of Cervus and Cucumis Polypeptide for Injection in the treatment of osteoarthritis of the knee. Methods 100 patients with osteoarthritis of knee joint treated in Xinchang people's hospital from February 2015 to May 2017 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The control group were treated with oral glucosamine capsules in the treatment of the experimental group, Cervus and Cucumis Polypeptide for Injection palliative treatment, 250 mL saline plus 25g guguatiquwu, oral Nimeilishu capsule. The treatment time of the 2 groups was one month. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results After the corresponding treatment, 4 patients in the experimental group were invalid, 20 cases were effective, and 26 cases were effective. In the control group, 13 patients were ineffective. The effective rate of the experimental group was 92％, which was significantly higher than that of the control group (P<0.05). The IL-1 of the knee joint fluid in the experimental group was (8.01±1.72), and the IL-1 of the knee fluid in the control group was (7.08±0.97). The level of IL-1 in the knee joint fluid of the experimental group was significantly higher than that of the control group, with statistical difference (P<0.05). Conclusion Cervus and Cucumis Polypeptide for Injection is effective in the treatment of osteoarthritis of the knee, and can significantly improve the efficiency of treatment,.

ObjectiveTo explore the effect of doctor-nurse integration mode in treating patients with liver cirrhosis treated with endoscopic variceal ligation (EVL).Methods According to the random number table,74 patients were randomly divided into control group and experiment group with 37 in each group.The control group was given routine nursing,while the experiment group was managed by doctor-nurse integration nursing mode.The two groups were compared in respect of early re-bleeding after EVL and mastery of health knowledge.Result The mastery of health-related knowledge in the experiment group was better than the control one and the rate of re-bleeding was significantly lower (P<0.05).Conclusion The doctor-nurse integration care mode can reduce the early postoperative re-bleeding after EVL in patients with liver cirrhosis and enhance the health education awareness.

BACKGROUND: High-concentration glucose can induce the formation of biofilms in Staphylococcus epidermidis.OBJECTIVE: To investigate the effect of high-concentration glucose on eliminating ability and adhesion of Staphylococcus epidermidis in Tupaia belangeri.METHODS: Tupaia belangeri models of hyperglycaemia (≥11.1 mmoL/L) were induced by intraperitoneal injection of Streptozocin. PVC catheters were inserted into the left femoral vein, and Staphylococcus epidermidis with or without formation of biofilms was inoculated into the catheters.RESULTS AND CONCLUSION: Following transfection of Staphylococcus epidermidis with formation of biofilms, there were higher rates of bacterial infection as well as higher bacterium colony number in the serum, heart, liver, kidney and pancreas of Tupai belangeri in hyperglycemia group (≥11.1 mmoL/L) as compared with the control group (P < 0.05). Detected by scanning electronic microscope, biofilm formation was remarkable in hyperglycemia group (≥11.1 mmoL/L) (P < 0.05). However, there was no formation of biofilms in hyperglycemia or control groups following transfection of Staphylococcus epidermidis without formation of biofilms. Hyperglycemia can induce the decreasing ability of eliminating bacteria and the increasing formation of biofilms on the surface of biomaterials transfected with Staphylococcus epidermidis.

Cultivating Clinical thinking ability is an important tache of clinical medical education. Teachers'guidance, the charateristics that suit teaching, the organic combination of the active methods which can mobilize clinical medical interns' learning enthusiasm, such as problem-based learning, and humanity education are effective approaches to enhancing interns' clinical thinking ability.

BACKGROUND: Permanent or transient implantation of biomaterials can result in biomaterials-centered infections (BCI) in lung cancer patients.OBJECTIVE: To investigate the relationship between BCI and peripheral blood transforming growth factor β1 (TGF-β1) in patients with lung cancer.METHODS: A total of 248 lung cancer patients undergoing in vivo intravascular catheter indwelling > 7 days were included.Quantitative method was used for intubation, bacteriological culture and paired blood culture, and API Staph strips were adopted for positive patients. While enzyme-linked immunosorbent assay was used to detect TGF-β1 levels in the peripheral blood of patients with lung cancer and 75 healthy volunteers as normal controls.RESULTS AND CONCLUSION: Among the 248 patients, there were 82 BCI-positive cases, and 166 BCI-negative cases.Thirteen patients were confirmed to have catheter-related bloodstream infection. There were 48 Gram-positive bacteria, 24Gram-negative bacilli, and 10 fungal. The levels of TGF-β1 were higher in BCI-positive patients than BCI-negative patients (P < 0.05); the levels of TGF-β1 in the BCI-negative group were higher than those in the normal control group (P < 0.05). For lung cancer patients with nosocomial infection induced BCI, there are various species of pathogenic bacteria, and Gram-positive bacteria are more common. To detect TGF-β1 levels in patients with lung cancer is of significance for early prevention of BCI.

Background and purpose: Primary signet ring cell carcinoma(SRCC) of the bladder is rarely diagnosed in the clinic. Few cases have been reported in the literature, so there was lack of understanding of the primary bladder SRCC in terms of diagnosis and treatment. Our study was to investigate the clinical features and treatment strategy for primary SRCC of the bladder and review the status of the disease along with the literature. Methods: 3 cases of primary bladder SRCC were studied, including clinical features, treatment, follow-up and their prognosis.The literature was reviewed. Results: All cases received ultrasound, computerized tomography, cystoscopy, biopsy and other related lab tests for diagnosis and differential diagnosis. Laparoscopic radical cystectomy and orthotopic ileal neobladders were performed in 2 cases, while the other case received laparoscopic radical cystectomy and ileal conduit diversion, Chemotherapy (cisplatin and 5-fluorouracil) was delivered in one case after surgery. One patient died at 6 months postoperatively because of multiple metastasis. The other 2 cases have been followed-up only for 8 and 12 months postoperatively, and no recurrence or metastasis have been observed. Conclusion: Primary SRCC of the bladder lacks distinctive clinical and imaging manifestations. The tumor grows very invasively. Radical cystcctomy is one of the optimal approaches for treatment of SRCC of bladder.

Background and purpose: The prognostic factors on survival for the patients with prostate carcinoma are still underdeterrnined. This study was to analyze the survival of three common treatment methods for prostate carcinoma and the prognostic factors on survival. Methods: 494 male patients who were diagnosed as prostate cancer were enrolled into the retrospective study. All of the data like age, stage, grade, PSA level, ALP, Hb and treatments were collected. Overall survival and disease specific survival rates for patients were analyzed by Kaplan-Meier method. Prognostic factors on disease specific survival were also analyzed by Log-rank test and Cox proportional hazards model. Results: Disease specific survival rates at 1, 3 and 5 year were 96.0%, 89.0% and 80.0% for all 494 patients, respectively. Disease specific survival rate at 3-year was 92.4% for brachytherapy, 100.0% for radical prostatectomy and 80.6% for hormonal therapy (P=0.008). Multivariate analysis by Cox model showed that stage, PSA level and age significantly impacted on disease specific survival. Conclusion: Brachytherapy and radical prostatectomy provides longer survival time than hormonal therapy for patients with prostate cancer. Clinical stage and PSA level and age of prostate cancer are independent factors impacting on survival significantly.