Objective To investigate the clinicopathological and prognostic characteristics of intestinal inflammatory myofibroblastic tumours(IMT)in middle-aged and elderly patients.Methods The clinical,pathologi-cal morphology,immunophenotype and follow-up results of 5 cases of intestinal IMT in middle-aged and elderly patients were retrospectively analyzed.Results 4 cases of IMT occurred in the right half colon and 1 in the ileum.Most patients(3/5)had a history of intestinal injury,starting the digestive tract symptoms and increased leukocytes.The tumor tissue was composed of fusiform myofibroblasts and fibroblasts arranged in storiform pattern,with an infiltrative growth pattern,accompanied by a large number of lymphocytes and plasma cells infiltration,collagen formation and myxedema.One case was atypically large and deformed.Immunophenotype:vimentin(5cases),SMA(5 cases),desmin(3 cases),ALK(3 cases),CK(2 cases)were positive.Caldesmon,CD34,β-catenin,MC,CD117,DOG1,S-100,BCL-2,CD99,CD68 were negative,and Ki-67 proliferation index was 1.28%to 10.01%.All the 5 cases underwent complete tumor resection and were followed up for 48.5 to 133 months.Among them,1 patient aged 83 was considered to have tumor recurrence 27 months after surgery.The other patient survived 122 months without tumor and died of other causes.All the others survived without tumor and were in good condition.Conclusion(1)Intestinal IMT in the middle-aged and elderly people in this group was more common in the right half colon,and most of them had a history of intestinal injury,first gastrointestinal symptoms and elevated white blood cells;(2)Vimentin and SMA were positive at the same time,and ALK was more positive;(3)4/5 patients had good surgical resection,and 1/5 patients could relapse 2～3 years after surgery;old age,ALK-positive,Ki67 up to 10%,atypia may be an important risk factor for intestinal IMT recurrence in the elderly,of which ALK-positive patients may have a recurrence risk of 1/3.

Objective: To observe the clinical effect of hyperbaric oxygen therapy on cervical spondylotic myelopathy (CSM) in the peri-operative period, and to explore its neural mechanism. Methods: Eighty patients who underwent surgical decompression for CSM were randomly divided into a hyperbaric oxygen group (n=40) and a control group (n=40). Both groups received cervical laminoplasty and systematic rehabilitation treatment after the surgery, while the hyperbaric oxygen group was additionally provided with hyperbaric oxygen therapy in the peri-operative period. The patients′ neurological status was evaluated using Japanese Orthopaedic Association (JOA) scores. Both groups received conventional MRI and diffusion tensor imaging (DTI) before and 6 months after the surgery. Results: After the surgery, both groups gained significant improvement in their average JOA score, with the improvement of the hyperbaric oxygen group significantly greater than in the control group. Pearson correlation analysis showed that the average pre-operative JOA score was significantly correlated with the anisotropic fraction (FA) and the apparent dispersion coefficient (ADC) of the compressed spinal cord. Six months after the surgery such correlation still persisted. During the six months, significant increase was observed in the average FA and significant decrease in the average ADC in both groups, with the average FA of the hyperbaric oxygen group (0.726±0.087) significantly higher at the end of the 6 months than that in the control group. The average ADC (1.148±0.079)×10^-3 mm²/s) was significantly lower. Conclusions DTI′s quantitative indicators can objectively show changes in the microstructure and pathological state of spinal cords. Exposure to hyperbaric oxygen may relieve ischemia and hypoxia of the spinal cord, promoting the repair of injured neurons and accelerating the regeneration of nerve fibers.

Objective: To explore the correlations relating functional MRI (fMRI) and diffusion tensor imaging (DTI) parameters with pre-operative neurological status and post-operative outcomes for patients with cervical spondylotic myelopathy (CSM). Methods: Eighty-seven CSM patients treated with surgical decompression and 38 healthy counterparts were enrolled as the CSM and control groups respectively. DTI and fMRI of the cervical spine were performed while the subjects performed a finger-tapping task with their right hands before the operation and 6 months later. The control group was evaluated only when they were enrolled. All of the patients were given systematic rehabilitation treatment after the surgery. The Japanese Orthopaedic Association (JOA) scoring system for CSM was used to evaluate neurological status, and a JOA recovery rate <50% was defined as a poor recovery. Results: Compared with the healthy controls, the pre-operative patients showed significantly higher volume of activation (VOA) in the left precentral gyrus (PrCG), but that had decreased significantly 6 months after the surgery. Before the surgery, the patients′ fractional isotropy (FA) was significantly less than that of the controls, but it had increased significantly 6 months after the operation. There was no difference in VOA in the left postcentral gyrus (PoCG) between the CSM patients and the controls before the surgery. The VOA ratio (PrCG/PoCG), VOA-PrCG, VOA-PoCG and FA were significantly correlated with both the JOA scores and recovery rates. Receiver operating characteristic (ROC) curve analyses were performed for the predictive ability with respect to surgical outcomes. The largest area under the ROC curve was observed for the VOA ratio (0.805), followed by FA (0.740), and the VOA-PrCG (0.715). The fMRI and DTI showed better potential for predicting functional outcomes than with standard MRI parameters. Multivariate logistic regression revealed that the VOA ratio and FA were independently associated with poor outcomes. Conclusions fMRI and DTI parameters may be more valuable than conventional MRI results for neurological assessment and prognosis with CSM patients. They can also provide references for making up rehabilitation plans.

Objective To explore the diagnostic value of serum lipoprotein(a)[Lp(a)]in cerebral infarction by a model of Logistic regression and receiver operating characteristic(ROC)curve.Methods A total of 316 patients with cerebral thrombosis from Foshan Hospital Affiliated to Southern Medical University were col-lected.According to the diagnostic criteria,the patients were divided into cerebral thrombosis group(196 ca-ses)and non-cerebral thrombosis group(120 cases).All the subjects were tested for Lp(a)by immune turbi-dimetry.To evaluate the diagnostic value of Lp(a)by applying logistic regression model,drawing ROC curves and calculating the area under the curve(AUC).Results The P25,P50,P75of Lp(a)in cerebral thrombosis group and non-cerebral thrombosis group were 97.23,238.22,430.01 and 29.80,92.27,233.86,the average rank were 185.42 and 114.52,the differences in the two groups were significant(P<0.05).Logistic regres-sion showed that the correlation between Lp(a)level and cerebral thrombosis was positive,the partial regres-sion coefficient(B)was 0.005,Wald value was 31.295.It suggested that when the levels of Lp(a)was higher the risk of cerebral thrombosis increased.The most valuable diagnosis level was 305.80 mg/L.And the area under the ROC curve(AUC)was 0.724,which has moderate diagnostic efficacy.Diagnostic specificity was 91.7%,misdiagnosis rate was 8.3%,negative predictive value was 48.7%,sensitivity was 40.8%,omission rate was 59.2%,positive predictive value was 88.9%.Conclusion The level of serum Lp(a)has high diag-nostic specificity for the diagnosis of cerebral thrombosis.

Objective To investigate the application value of urine microalbumin (mALB) ,retinol binding protein(RBP) and cys-tatin C(CysC) and their combined detection in early diagnosis of type 2 diabetic nephropathy(DN) .Methods Ninety-two inpatients with DN (DN group) and 90 people undergoing the physical examination(control group) in our hospital from June 2014 to Decem-ber 2015 were collected .Urine mALB ,RBP and CysC were detected in all subjects and detection results were analyzed statistically . Results The levels of urine mALB ,RBP and CysC in the DN group were significantly higher than those in the control group ,the differences all had statistical significance (P< 0 .05) .Among 3 indicators ,the positive rate of urine mALB for detecting DN was highest (94 .57% ) ,while which of 3-index combined detection was 97 .83% ,and significantly higher than that of single detection , the difference was statistically significant(P<0 .05) .The sensitivity ,specificity ,positive predictive value ,negative predictive value and Youden index of 3-index combined detection were all higher than those of single index .The ROC curve showed that AUC of u-rine mALB for diagnosing DN was 0 .732 ,the diagnostic cut-off value was 43 .58 mg/L ,AUC of urine RBP was 0 .685 ,the diagnos-tic cut-off value was 1 .47 mg/mL ,AUC of urine CysC was 0 .701 ,the diagnostic cut-off value was 1 .42 mg/L ,while AUC of com-bined detection was 0 .928 .Conclusion Urine mALB ,RBP and CysC are better indexes reflecting renal injury .Their combined de-tection will increase the positive rate ,sensitivity and specificity for diagnosing DN .So monitoring the levels of urine mALB ,RBP and CysC has an important significance to diagnosing the occurrence and development of DN early renal injury and prevention ,treat-ment and delaying progress of DN .

Objective To investigate the influence of tiotropium bromide on lung function index,quality of life and re-hospitalization risk of patients with bronchial dilation and pulmonary infection.Methods 100 patients with bronchiectasis and lung infection were chosen,and they were randomly divided into control group (50 patients) with BAL used alone and observation group(50 patients) with tiotropium bromide on the basis of control group.The short-term clinical effects,the levels of FVC,FEV1 and FEV1 ％,BODE index scores and QLI scores before and after treatment,and re-hospitalization rate of the two groups were compared.Results The short-term effective rate of the observation group was significantly higher than that of the control group(94.00％ vs.76.00％,x2 =7.81,P ＜ 0.05).The levels of FVC,FEV1 and FEV1％ after treatment of both two groups were significantly higherthan before treatment[(2.78 ±0.57)L vs.(2.15 ± 0.33) L,(3.60 ± 0.71) L vs.(2.20 ± 0.36) L;(2.15 ± 0.42)L vs.(1.23 ±0.32)L,(2.77±0.59)L vs.(1.17 ±0.29)L;(65.25 ±11.45)％ vs.(51.79 ±9.23)％,(77.46 ±15.80) ％ vs.(52.02 ± 9.36) ％,t =2.34,2.97;2.52,3.07;2.47,3.12,all P ＜ 0.05].After treatment,the levels of FVC,FEV1 and FEV1 ％ of the observation group were significantly higher than control group [(3.60 ± 0.71) L vs.(2.78 ±0.57)L;(2.77 ±0.59)L vs.(2.15 ±0.42)L;(77.46±15.80)％ vs.(65.25 ± 11.45)％,t =2.26,2.44,2.30,all P ＜0.05].The QLI score and BODE index scores after treatment of both two groups were significantly better than before treatment[(3.37 ± 0.54) points vs.(3.95 ± 0.65) points,(2.11 ± 0.40) points vs.(3.87 ±0.61)points,(7.28 ±1.18)points vs.(5.04 ± 0.95) points,(8.69 ± 1.54) points vs.(5.13 ±0.98) points,t =2.29,2.81;2.50,2.96,all P ＜ 0.05].After treatment,the QLI score and BODE index scores of the observation group were significantly better than the control group[(2.11 ±0.40) points vs.(3.37 ±0.54) points,(8.69 ± 1.54) points vs.(7.28 ± 1.18)points,t =2.21,2.44,all P ＜ 0.05].The re-hospitalization rate of the observation group was significantly lower than that of the control group (16.00％ vs.2.00％;28.00％ vs.6.00％;x2 =8.02,9.74,all P ＜ 0.05).Conclusion Selective cholinergic receptor blocker combined with BAL in the treatment of patients with bronchial dilation and pulmonary infection can efficiently relieve the respiratory symptoms,improve lung function,improve the quality of life and is helpful to avoid re-hospitalization occurrence.

Objective    To compare the in-hospital and midterm outcomes after simultaneous hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) in diabetic patients with multivessel coronary artery disease. Methods    One hundred thirty-two diabetic patients with multivessel coronary artery disease underwent one-stop HCR at Fuwai Hospital from January 2010 to January 2015. These patients were 1∶2 matched with those who underwent OPCAB using propensity score matching. Results    Simultaneous HCR had less chest tube drainage (618 (420, 811) ml vs. 969 (711, 1 213)ml, P<0.001), lower transfusion rate (19.7% vs. 34.1%, P=0.026), shorter mechanical ventilation time (11.6 (8.2, 14.8) h vs. 16.0 (12.1, 18.7) h, P<0.001), and shorter stay in intensive care unit (21.5 (18.8, 42.0)   h vs. 44.6 (23.7, 70.1) h, P<0.001) than OPCAB. During over median 40 months follow-up, simultaneous HCR offered similar major adverse cardiac or cerebrovascular events (MACCE) rate (6.8% vs 9.0%, P=0.826), but lower stroke rate (0%vs 3.0%, P=0.029), compared with OPCAB. Conclusion    For selected patients with diabetes, simultaneous HCR provides a safe and effective revascularization alternative. It decreases perioperative invasiveness and incurred similar and favorable midterm outcomes with OPCAB.

OBJECTIVE: To explore the appropriate treatment of malignant germ cell tumor (MGCT) in the female genital system, and to analyze the factors influencing both therapeutic response and survival outcome. METHODS: A cohort of 230-Chinese women diagnosed with MGCT of the genital system was retrospectively reviewed and prospectively followed. The demographic and pathological features, extent of disease and surgery, treatment efficiency, recurrence and survival were analyzed. RESULTS: MGCTs from different genital origins shared a similar therapeutic strategy and response, except that all eight vaginal cases were infantile yolk sac tumors. The patients' cure rate following the initial treatment, 5-year overall survival and disease-free survival (DFS) were 85.02%, 95.00%, and 86.00%, respectively. Although more extensive excision could enhance the remission rate; it did not improve the patients' survival. Instead, the level of the medical institution, extent of surgery and disease were independent prognostic factors for relapse (p<0.05). Approximately 20% of patients had recurrent or refractory disease, more than half of whom were in remission following secondary cytoreductive surgery with salvage chemotherapy. CONCLUSION: Fertility-sparing surgery with or without standardized PEB/PVB (cisplatin, etoposide/vincristine, and bleomycin) chemotherapy is applicable for female MGCTs of different origins. Comprehensive staging is not required; nor is excessive debulking suggested. Appropriate cytoreduction by surgery and antineoplastic medicine at an experienced medical institution can bring about an excellent prognosis for these patients.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Female ; Genital Neoplasms, Female/diagnosis/mortality/pathology/*therapy ; Humans ; Infant ; Middle Aged ; Neoplasms, Germ Cell and Embryonal/diagnosis/mortality/pathology/*therapy ; Prognosis ; Recurrence ; Survival Analysis ; Young Adult

Objective To evaluate the effect of dexmedetomidine (DEX) on inflammatory responses in patients performed cardiac surgery with cardiopulmonary bypass (CPB) at perioperative period,and explore the influencing factors of postoperative cognitive dysfunction (POCD) in these patients.Methods Eighty patients scheduled for cardiac surgery with CPB at hospital from July 2013 to June 2014 were randomized into control group and DEX group (n=40).Before induction of anesthesia,DEX was administered to the patients from DEX group with a loading dose of 1 μg/kg followed by maintenance dose of 0.5 μg/ (kg·h),while the same dose of normal saline was administered to patients from control group.Before incision (T0),30 min after beginning of CBP (T1),30 min after end of CBP (T2),end of surgery (T3),24 h after end of surgery (T4) and 72 h after end of surgery (T5),venous blood samples from jugular bulb catheters were drawn,and serum concentrations of tumor necrosis factor α (TNF-αt),interleukin (IL)-6 and IL-10 were determined.One d before operation,3nd,7th,90th and 180th day after operation,the cognitive functions of patients were tested with mini-mental state examination (MMSE),digit span subtest (DSpan),digit symbol subtest (DSy) and trail making test (TMT).The DSpan contained digit span forward subtest (DSpan-F) and digit span reverse subtest (DSpan-R).Results The serum concentrations of TNF-α,IL-6 and IL-10 in two groups at T1,T2 and T3 were significantly higher than those at T0 (P＜0.05);the serum concentrations of TNF-α and IL-6 in DEX group were significantly lower than those in control group (P＜0.05),while that of IL-10 in DEX group was significantly higher than that in control group (P＜0.05).In the control group,all results excepted for TMT on the 3nd d after operation,MMSE and DSpan-R results on the 7th d after operation,and DSpan-R results on the 90th d after operation were significantly lower than those results one d before operation (P＜0.05);in the DEX group,MMSE and DSpan-R results on the 3nd d after operation were significantly lower than those results one d before operation (P＜0.05);MMSE and DSpan-R results on the 3nd and 7th d after operation,and DSpan-R results on the 90th d after operation in the DEX group were significantly higher than those in the control group (P＜0.05);TMT on the 3nd after operation in the DEX group was significantly lower than that in the control group (P＜0.05).The incidence rate of POCD in the DEX group on the 3nd and 7th d after operation (23.5％ and 14.7％) was significantly lower than that in the control group (46.9％ and 37.5％,P＜0.05).Conclusion DEX with a loading dose of 1 iμg/kg followed by maintenance dose of 0.5 μg/ (kg· h) can reduce the early incidence of POCD in cardiac surgery with cardiopulmonary bypass,but can not reduce the late incidence.

Objective To evaluate the effect of dexmedetomidine on brain injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes, aged 18-64 yr, with body surface area of 1.6-2.0 m2, with left ventricular ejection fraction＞30％, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ), scheduled for elective cardiac surgery with CPB, were equally and randomly divided into control group (group C) and dexmedetomidine group (group D) using a random number table.Before induction of anesthesia, dexmedetomidine was given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery in group D, and the equal volume of normal saline was given in group C.After induction and before skin incision (T0) , at 30 min after beginning of CBP (T1) , at 30 min after the end of CBP (T2) , at the end of surgery (T3) , and at 24 and 72 h after surgery (T4.5) , blood samples from jugular bulb were drawn for determination of serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-10, S-100β protein and neuron-specific enolase (NSE).Results Compared with group C, the serum concentrations of TNF-α and S100β at T1-3 and IL-6 and NSE at T1.4 were significantly decreased, and the serum concentrations of IL-10 at T1-4 were increased in group D (P＜0.05).Conclusion Dexmedetomidine given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery can reduce the brain injury in the patients undergoing cardiac surgery with CPB, and the mechanism is related to inhibited inflammatory responses.