Objective To summarize the clinical diagnosis and treatment of diaphragm injuries.Methods 70 cases including traumatic ruptures of the diaphragm and diaphragmatic hernia,46 cases of open injury and 24 cases of close ones were retrospectively analyzed.50 patients were diagnosed before operationk,occupied 71%.20 cases were operated via thoracic incision,40 cases via abdominal incision and 10 cases were trans-thoracic-abdominal approach.Results 66 cases were cured,4 patients died,and the death rate was 5.7%.Conclusions Chest X-ray is the simplest and most reliable method to diagnose diaphragm injuries,early diagnosis and timely treatment are keys to increasing the effective rate and reducing the death rate.

Objective To approach the application of mesh plug hernia repair to recurring inguinal hernia.Methods 64 patients with recurring inguinal hernia were treated with tension-free mesh-plug repair by using polypropylene cone plug and patch.Results All the operations succeeded,the average time was 45 minutes,and the average hospital stay was 5 days.No cut infection,hematoma and scrotum hydrocele and recurrence occurred.Conclusion The mesh plug hernia repair is characterized by its safety,minimal wound,rapid recovery and low recurrent rate,its effect is satisfying.It is the perfect repair of inguinal hernia.

Objective To explore the changes of nitric oxide (NO) and nitric oxide synthase (NOS) of the aged rat brain, and the relationship between this change and neuronal apoptosis. Methods Five month old and 30 month old rats were used in the study. NO level and NOS activity were measured by Griess reaction and high presssure liquid chromatography. Neuronal NOS(nNOS) gene and bcl 2 gene were examined by in situ hybradization; nNOS protein level and free calcium level in synaptosome were determined by immunohistochemical method and Fura 2 fluorescence probe respectively. Apoptosis was observed using terminal transferase marking method. Results NO level and nNOS activity in the brain tissue of aged rats was (2 61?0 10) ?mol/L and (398 22?21 62) fmol?mg -1 ?min -1 , respectively,being significantly higher than that of the young rats(1 54?0 15) ?mol/L and (234 38?16 24)fmol?mg -1 ?min -1 respectively. Also both the nNOS gene transcription and protein expression increased in aged rats while bcl 2 gene expression reduced with aging. Free calcium level in synaptosome of aged and young rats was (485 26?28 48) nmol/L and (372 99?19 20) nmol/L respectively. Apoptosis in brain tissue was observed in aged rats, but not in young ones. Conclusions The increase of NO level in the aged rat brain is due to the increase of nNOS activity which is at least partially determined by the increased gene expression. Abnormal enhancement of NO in the aged rats may cause damage, even death of the brain. As an anti oxidant, bcl 2 gene expression reduced with aging and resulted in the brain tissue more vulnerable to oxidative stress and thus produced more lesions. Therefore, it is a promising method to screen and develop drugs that can be anti apoptotic and anti oxidative, and reduce the formation of pathologic NO to prevent and retard brain aging.

Objective To investigate the expressions of RUNX3 and CyclinDl in pancreatic carcinoma and their significance. Methods Expressions of RUNX3, CyclinD1 in 47 cases with pancreatic carcinoma, 18 cases with cystadenoma of pancreas and 12 normal pancreas cases were detected by immunohistochemistry, and the relationship between their expressions and clinicopathological parameters was analyzed. Results The positive expression rates of RUNX3 in pancreatic carcinoma, cystadenoma of pancreas, normal pancreas cases were 57.4％ (27/47), 94.4％ (17/18), 100％ (12/12); the positive expression rates of CyclinD1 in pancreatic carcinoma, cystadenoma of pancreas, normal pancreas cases were 72.3％ (34/47), 44.4％(8/18), 8.3％ (1/12). RUNX3 expression was not related to the age and sex, but it was negatively associated with clinical staging, lymph node metastasis, the differentiation degree (P ＜0.05 ). CyclinD1 expression was not related to the age and sex, but it was positively associated with clinical staging, lymph node metastasis, the differentiation degree (P ＜0.05 ). The expression of RUNX3 and CyclinD1 was negatively associated (r = - 0.375, P = 0.009). Conclusions The expression of RUNX3 is decreased in pancreatic carcinoma. The expression of CyclinD1 is increased in pancreatic carcinoma. They may play an important role in the carcinogenesis and progression of pancreatic carcinoma.

OBJECTIVETo assess the effect and safety of periodontal therapy in relieving the symptoms and clinical signs of rheumatoid arthritis (RA).

METHODSThe electronic search was conducted in Medline (OVID, 1950-2010 Sep), EMBASE (1984-2010 Sep), CENTRAL (2010, Issue 3), CBM (1978-2010 Sep) and the Chinese journals on stomatology were hand-searched. Clinical randomized controlled trials as well as clinical controlled trials were selected regarding the targeted issue. Two investigators evaluated the reporting quality and risk of bias of those included trials in accordance with CONSORT statement and Cochrane risk of bias assessment tools, and collected data of included studies in duplicate. Revman 5.0.23 was applied for Meta-analysis.

RESULTSFour trials met the inclusion criteria and a total of 150 patients were enrolled in the trials, one had low risk of bias and others had moderate risk of bias. Meta-analysis showed that pure periodontal therapy could not decrease disease activity score in 28 joints (DAS28) (P=0.06), and there was no statistically significant difference between periodontal therapy with anti-tumor necrosis factor-alpha (TNF-alpha) medication and pure anti-TNF-alpha medication (P=0.24). But the subgroup analysis showed that a significantly decreased DAS28 was achieved by periodontal therapy (P=0.03), and the interventions provided a remarkable effect on alleviating clinical signs and erythrocyte sedimentation rate of RA (P<0.05). Results of the symptoms relief differed from the studies. No adverse events were reported.

CONCLUSIONThe evidence available currently indicates that periodontal therapy may play a positive role in remitting the clinical signs and periodontal status of RA except the relief of the symptoms.

Objective:To investigate the clinicopathological features of fumarate hydratase (FH) deficiency uterine leiomyoma.Methods:The data of 38 patients with FH deficiency uterine leiomyoma were screened and analyzed. The expressions of FH, S-(2-succino)-cysteine (2SC), desmin, p16, p53, CD 10 and cell proliferation associated nuclear antigen (Ki-67) proteins were detected by immunohistochemistry, and their clinicopathological features were analyzed retrospectively. Results:(1) Clinical features: the median age of the patients was (42.5±7.4) years old. Twenty-one cases (55%) of them were myomas found in physical examination, and the median maximum diameter of the tumor was 6.0 cm (range: 5.0-7.5 cm); myomectomy was performed in 23 cases (61%), total hysterectomy with or without bilateral appendages in 15 cases (39%); laparoscopic surgery in 27 cases (71%), open surgery in 11 cases (29%); none of the patients had renal cell carcinoma. (2) Histological features: atypical nuclear cells were distributed locally or diffusely, eosinophilic nucleoli and intranuclear inclusion bodies could be seen, glass like globules could be seen in the cytoplasm, nuclear division was 0-4/10 high power field (HPF), and antler like blood vessels and pulmonary edema-like changes could be seen in the stroma. Among 38 patients with FH deficiency uterine leiomyoma, FH was negative in 37 cases (97%), and positive in 1 case (3%); 2SC, desmin, p16, p53, CD 10 and Ki-67 showed focal positive expression in 38 cases (100%), including 35 cases (92%) with Ki-67 index<10% and 3 cases (8%) with Ki-67 index ≥10%. (3) Follow-up: 4 cases (11%) recurred, and there was no death. There were significant differences in age, family history, distribution of atypical nuclei and mitosis number between recurrent group and non-recurrent group (all P<0.05). Conclusions:FH deficiency uterine leiomyoma is a rare tumor, which needs pathological examination,immunohistochemical examination and clinical history. Patients younger than 43 years old, with family history, histologically atypical diffuse nuclear distribution and mitotic number ≥3/10 HPF should be alert to the risk of recurrence.

Objective:To help clinicians simplify the post-processing operations of structures by developing rapid processing software for target area and organs at risk structures based on ESAPI.Methods:SmartStructure script software was developed based on ESAPI, verified and evaluated in clinical work. 10 cases of rectal cancer receiving neoadjuvant radiotherapy, 10 breast cancer treated with postoperative radiotherapy, 10 cervical cancer receiving postoperative radiotherapy, 10 nasopharyngeal carcinoma receiving radical radiotherapy and 10 lung stereotactic body radiotherapy (SBRT) were selected, and different types of tumors had different post-processing operations of structures. In each case, three methods were used for post-processing of structures. In the control group (manual group), normal manual processing was employed. In the experimental group 1(SmaStru-N group), scripts without templates were utilized. In the experimental group 2(SmaStru-P group). scripts combined with templates were adopted. The processing time of the three methods was compared. Clinicians scored the scripting software from multiple aspects and compared the feeling scores of scripting software and manual operation.Results:All three methods can be normally applied in clinical settings. The error rate in the manual group was 7.0%, 3.0% in the SmaStru-N group 0% in the SmaStru-P group, respectively. Compared with the manual method, SmaStru-N shortened the processing time of target area and organs at risk by 60.9% and 93.3% for SmaStru-P. In addition, SmartStructure was superior to manual method in terms of using feeling scores. Clinicians gave lower score for the" applicability" and" simplicity" , and higher score on the" accuracy" and" efficiency" .Conclusions:Compared with conventional manual structure processing method, SmartStructure software can rapidly and accurately process all structures of the target area and organs at risk, and its advantages become more obvious with the increasing number of structures that need to be processed. SmartStructure software can meet clinical requirements, reduce the error rate, elevate processing speed, improve the working efficiency of clinicians, providing basis for the development of adaptive radiotherapy.