Table of Content

25 October 2018, Volume 39 Issue 10

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Characteristics and related factors of coronary artery disease in premenopausal and postmenopausal women under 50 years of age

ZHANG Ran1,YAO Kang2*, WANG Ping3, LU Jianfei1,ZHENG Qingwen1

2018, 38(10):  1122-1126.  doi:10.3969/j.issn.10073205.2018.10.002

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［Abstract］ Objective〖HTSS〗〓To analyze the features of coronary artery disease and releated factors for postmenopausal and premenopausal women aged below 50  with coronary heart disease.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓One hundred and fiftyfour female patients who were aged below 50 and diagnosed with coronary heart disease by coronary arteriography were divided into postmenopausal group(46 women) and premenopausal group(108 women). The features of coronary artery disease and releated factors for 2 groups of patients were compared and analyzed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The age of the menopausal group was higher than that of the nonmenopausal group(P＜001). Premenopausal group had less diabetes than the menopausal group, more smoking and more family history of coronary heart disease. Triacylglycerol in the premenopausal group was lower than that in the menopausal group. The premenopausal group was dominated by singlevessel disease, while the menopausal group was dominated by multivessel disease, and the difference was statistically significant(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Coronary artery disease is not uncommon in premenopausal women with an increased incidence, but it is often underestimated in clinical practice and cannot be ignored in clinical work.


Effect of bilevel positive pressure ventilation on blood pressure in patients with refractory hypertension complicated with obstructive sleep apnea#br#

LU Xu1, YU Leilei2, CHEN Guanghui1

2018, 38(10):  1127-1133,1148.  doi:10.3969/j.issn.10073205.2018.10.003

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［Abstract］ Objective〖HTSS〗〓To study the effect of bilevel positive pressure ventilation on blood pressure in patients with refractory hypertension complicated with obstructive sleep apnea syndrome.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 114 patients with resistant hypertension combined with obstructive sleep apnea hypopnea syndrome were selected. The levels of renin, angiotensin Ⅱ, aldosterone, 24hour ambulatory blood pressure, multiple sleep monitoring, apnea hypopnea index, and minimum oxygen saturation were measured before the trial. Then each subject was given a bilevel positive pressure ventilation treatment for at least 6 hours every evening. Patients were followed up for 6 months. After the trial the levels of renin, angiotensin Ⅱ, aldosterone, 24 hour ambulatory blood pressure, multiple sleep monitoring, apnea hypopnea index, and minimum oxygen saturation were measured in the patients again . After followup for 6 months, the above indicators were compared with those before the trial.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓After 6 months bilevel positive pressure ventilation the apnea hypopnea index and oxygen saturation<90% were lower than before, and minimum oxygen saturation and mean oxygen saturation were uppered. The difference was statistically significant(P＜005). Systolic blood pressure and diastolic blood pressure in 24 h, systolic blood pressure and diastolic blood pressure in daytime, systolic blood pressure and diastolic blood pressure at night were compared with those before treatment, all were lowered, and the difference was statistically significant(P＜005). The blood pressure variability was reduced after the treatment, compared to that before the trial, the difference was statistically significant(P＜005). The levels of renin, angiotensin Ⅱ, aldosterone were also decreased compared with those before treatment. And the difference was statistically significant(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓In patients with resistant hypertension combined with obstructive sleep apnea hypopnea syndrome, a bilevel positive pressure ventilation treatment based on drug therapy for 6 months can effectively control the patients' blood pressure.


Effect of atorvastatin in a load capacity and high maintaining dose on the inflammatory cytokines and vascular endothelial function in ACS patients underwent PCI#br#

JIA Huiyu, CHENG Guanghui

2018, 38(10):  1131-1134,1157.  doi:10.3969/j.issn.10073205.2018.10.004

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［Abstract］ Objective〖HTSS〗〓To explore the effect of atorvastatin in a load capacity and high maintaining dose on the inflammatory cytokines and vascular endothelial function in acute coronary syndrome(ACS) patients underwent percutaneous coronary intervention(PCI).
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓One hundred and fifty  patients with ACS who underwent PCI were randomly divided into observation group and control group with 75 cases each. Coronary angiography and PCI were performed in both groups, and conventional ACS drugs were given orally. The control group received oral atorvastatin 20 mg/time before going to bed every night. Observed group received oral atorvastatin 80 mg/time before bed every night before PCI, postoperatively reduced to 40 mg/time before going to bed every night, and changed to 20 mg every night before going to bed. Two groups of patients undergo comparative evaluation after 4 weeks, and maintain medication for a minimum of 2 years. Highsensitivity Creactive protein(hsCRP)， tumor necrosing factor alpha(TNFα)， interleukin6(IL6)， interleukin18(IL18)， nitric oxide(NO)， endothelin1(ET1)， von Willebrand factor(vWF)， PSelectin（CD62p）， GPⅡb/Ⅲa were measured before PCI, 1 day after surgery, and 4 weeks after operation in two groups of patients.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The hsCRP, TNFα, IL6 and IL18 levels in both groups were increased first and then decreased, but those in the observation group were decreased more significantly at 4 weeks postoperatively. The two groups had intergroup and time points. There was a statistically significant difference in the interaction between the two groups(P＜005). The NO in both groups were decreased first and then increased, but the increase was greater in the observation group. Both ET1 and vWF were increased first and then decreased, but those in the observation group were decreased more significantly. There was a statistically significant difference in the interactions among groups, time points, and between groups(P＜005). In both groups, CD62p and GPⅡb/Ⅲa were increased first and then decreased, but those in the observation group were decreased more significantly at 4 weeks postoperatively. The interactions among groups, time points, and between groups were similar between the two groups. The difference was statistically significant(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The loading and high maintenance atorvastatin can effectively inhibit the inflammatory response and platelet activation in patients with ACS and effectively improve the vascular endothelial function and cardiac function. It has high application value and is worthy of clinical promotion.


Study on the correlation between carotid artery stenosis and cerebral microbleeds in ischemic stroke

ZHANG Jun1, ZHAO Xian2*, CAO Xianguo1, SONG Zhe1, LIU Huiqin1, LI Xianjun1

2018, 38(10):  1135-1138.  doi:10.3969/j.issn.10073205.2018.10.005

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［Abstract］ Objective〖HTSS〗〓To discuss the correlation between carotid artery stenosis（CAS）and cerebral microbleeds（CMBs） in patients with ischemic stroke.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Two hundred and sixtyeight patients with ischemic stroke were divided into four groups according to the degree of CAS: the slight stenosis group（ninetysix cases, the degree of CAS was zero to fourtynine percent）, moderate stenosis group（eightyseven cases, the degree of CAS was fifth to sixtynine percent）, severe stenosis group （fiftythree cases,the degree of CAS was seventy to ninetynine percent） and total occlusion group （thirtytwo cases, carotid artery was completely blocked）. All patients were examined with susceptibility weighted imaging by 3.0T magnetic resonance imaging. New CMBs were counted after six months and twelve months.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓 In the cortex, subcortical area and basal ganglia, new CMBs were increased gradually with the increasing degree of CAS at the sixth month and the twelfth month. Especially in the cortex and the subcortical area at the twelfth month, the difference of total comparison was significantly statistical between the groups(P＜005), but there were no statistical differences between every two groups(P＞005). At the sixth month and the twelfth month，the new CMBs in all parts of each group showed a trend of gradual increasewith the increasing degree of CAS. At the sixth month, there were no significantdifferences between the groups(P＞005). At the twelfth month, there was statistical difference of total comparison between the groups(P＜005), but the differences were no statistical between every two groups(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The CMBs tends to increase gradually with the increasing degree of CAS in ischemic stroke and the probability of occurrence of CMBs is increased with the extension of time.


Investigation of risk factors for cerebral palsy#br#

LI Min1, MIAO Lixia2

2018, 38(10):  1139-1142.  doi:10.3969/j.issn.10073205.2018.10.006

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［Abstract］〓Objective〖HTSS〗〓To investigate the highly risk factors of cerebral palsy in order to avoid or reduce the occurrence of cerebral palsy.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓This was a retrospective investigation and analysis performed in a total of 795 children with cerebral palsy and further screened the highly risk factors of cerebral palsy.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The mother′s pregnant age in cerebral palsy group was higher than the control group, the gestational age was less than the control group, the group of children with cerebral palsy birth weight was lower than the control group. The incidence of multiplets, infection during pregnancy, birth asphyxia anoxia(suffocation time more than 5 min), preterm birth, neonatal convulsion, neonatal sepsis, postnatal jaundice in cerebral palsy were higher than the control group, and the difference was statistically significant(P＜005). Multiple factors Logistics regression analysis shows that the multiplets, history of infection during pregnancy, birth asphyxia anoxia, premature birth, low birth weight and neonatal convulsions, neonatal sepsis, jaundice after birth, and advanced age during pregnant were  risk factors for the onset of cerebral palsy.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The results showed that neonatal convulsion, asphyxia at birth, low body weight at birth, infection during birth and the advanced maternal age can increase the incidence of CP.


The etiology analysis of nonHIV immunosuppressed patients with severe pneumonia#br#

GU Ying, PAN Wensen*, YU Jing, XIAO Ranran, LI Yan, YUAN Yadong

2018, 38(10):  1143-1148.  doi:10.3969/j.issn.10073205.2018.10.007

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［Abstract］〓Objective〖HTSS〗〓The purpose of this study is to analyze the etiology characteristics of severe pneumonia in nonHIV immunosuppressed patients.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 101 cases of nonHIV immunosuppressed patients with severe pneumonia in the intensive care unit. The etiology data(including sputum, lower respiratory tract secretion and alveolar lavage fluid, pathogens antibody examination, G test, blood culture and drug susceptibility test results) of these patients were retrospectively analyzed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The 251 strains of pathogen were isolated from these patients. Thegramnegative bacilli were 184 strains(73.31%), including acinetobacter baumannii, pseudomonas aeruginosa, klebsiella pneumoniae and e. coli etc. The gram positive coccus were 5 strains(1.99%). Funguses were 62 strains(24.70%), including Candida albicansand Aspergillus. Pneumocystis was 8 cases(3.19%). Serological G test were positive in 54 cases(53.47%). Virus serological examination revealed cytomegalovirus(CMV) DNA copy were positive in 31 cases, CMV IgG antibody were positive in 3 cases. Epsteinbarr virus(EBV) DNA copy was increased in 23 cases, EBV IgG antibody were positive in1 cases. Herpes simplex virus type 1 IgG was positive in 3 cases, Herpes simplex virus type 2 IgG was positive in 2 cases, Rubella virus IgG was positive in 3 cases, respiratory syncytial virus IgM antibody was positive in 2 cases. Serum Mycobacterium tuberculosis antibody was positive in 9 cases. The 38 kDa protein antibody was positive in 7 cases, 16 kDa protein antibody was positive in 1 case, LAM antibody was positive in 8 cases. Blood culture of bacteria was positive in 11 cases, a total of 17 strains pathogens were isolated, mainly were aureus, including staphylococcus 7 cases, staphylococcus epidermidis 2 cases and staphylococcus haemolyticus 2 cases, and staphylococcus aureus, staphylococcus capitis, enterococcus faecium, acinetobacter baumannii were all 1 case separately. Drug sensitive test showed high multiple drug resistance in gram negative bacilli including acinetobacter baumannii, pseudomonas aeruginosa, and klebsiella pneumonia. But no grampositive cocci were founded to be resistant to vancomycin or linezolid.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Multiple drugresistant bacteria infection, fungi and viruses infection ratio were high in nonHIV immunosuppressed patients with severe pneumonia. And pneumocystis pneumoni should be vigilant also.


Study on the relationship between 25hydroxy vitamin D3， hsCRP and type 2 diabetic retinopathy

 

WANG Linxia, SU Na, ZHANG Yunna, GUO Ningning, WANG Guangya

2018, 38(10):  1149-1152,1184.  doi:10.3969/j.issn.10073205.2018.10.008

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［Abstract］ Objective〖HTSS〗〓To test the level of serum 25hydroxy vitamin D3 and highsensitivity Creactive protein(hsCRP ) in type 2 diabetic patients with retinopathy, and to investigate the relationship between 25hydroxy vitamin D3, hsCRP and type 2 diabetic retinopathy.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 560 cases with type 2 diabetes were selected, including type 2 diabetes mellitus without retinopathy(NDR, n=230), type 2 diabetes with background retinopathy(BDR, n=190), type 2 diabetes with proliferative retinopathy(PDR, n=140), 140 healthy subjects were selected as control group at the same time. All clinical data were collected, serum levels of 25hydroxy vitamin D3 and hsCRP were determined.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no significant difference in age, body mass index(BMI), total cholesterol(TC), triglyceride(TG), lowdensity lipoproteincholesterol(LDLC) and highdensity lipoproteincholesterol(HDLC) in the four groups(P＞005). The duration of disease, fasting blood glucose(FBG), hemoglobin A1c(HbA1c), hsCRP and 25 hydroxy vitamin D3 in the group of NDR, BDR and PDR were significantly different from those of the control group(P＜005). The duration of disease, FBG, HbA1c, hsCRP, 25hydroxy vitamin D3 of the group BDR and PDR had significant difference compared to the group NDR(P＜005). The duration of disease, FBG, HbA1c, hsCRP, 25hydroxy vitamin D3 in the group BDR were significantly different from those in the group PDR(P＜005). After pearson correlation analysis, the duration of disease, FBG, HbA1c, and hsCRP were positively correlated with DR(P＜005), and 25hydroxy vitamin D3 was negatively correlated with DR(P＜001). After logistic regression analysis, the duration of disease, FBG, HbA1c, and hsCRP were independent risk factors of DR, and 25hydroxy vitamin D3 was the protective factor of DR(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The serum 25hydroxy vitamin D3 levels in patients with type 2 diabetic retinopathy were significantly decreased, hsCRP was significantly increased. They were associated with the severity of retinopathy. Vitamin D deficiency may lead to the development of diabetic retinopathy through hsCRP.


Improvement and curative effect analysis of method of dural suturing in microvaseular decompression

SHI Hailiang, WANG Yinzhan, ZHANG Kuo,GUO Wenchang, SHI Haowei, QIAN Tao

2018, 38(10):  1153-1157.  doi:10.3969/j.issn.10073205.2018.10.009

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［Abstract］ Objective〖HTSS〗〓To investigate the effect of improved microvascular decompression(MVD) on the incidence of postoperative complications.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The clinical data of 235 patients undergoing MVD were analyzed retrospectively. Among them, traditional method of skull closing was used in 115 patients and 120 patients received modified method of skull closing. The modifications involved aspects including forming bone window, duradic cutting method，suturing of dual matter, skull reconstruction and suturing of skin. To study the effect, the operation time(craniotomy time, intracranial operation time, closed cranial time) and other complications were compared between the traditional and modified groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓 The craniotomy time and intracranial operation time of modified group were shorter than those of traditional group, while the craniotomy time was longer than that of traditional group, and the difference was statistically significant(P＜005).The incidence of postoperative complications in traditional group was 20.9%, which included 4 cases of cerebrospinal fluid leakage, 10 cases of hearing loss, 8 cases of tinnitusand 2 cases of facial paralysis. The incidence of postoperative complications in modified group was 8.3%, which included 5 cases of hearing loss，4 cases of tinnitus and1 cases of facial paralysis. There was significant difference in incidence of postoperative complications between two groups(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The improvement of microvascular decompression for hemifacial spasm can reveal the surgical perspective, reduce the operation time and the postoperative complications.


Effects of minimally invasive puncture drainage combined with postoperative urokinase dissolution on patients with hypertensive cerebral hemorrhage

LIU Hongzhi

2018, 38(10):  1158-1160,1165.  doi:10.3969/j.issn.10073205.2018.10.010

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［Abstract］〓Objective〖HTSS〗〓To analyze the effect of minimally invasive operation combined with postoperative urokinase treatment on hypertensive intracerebral hemorrhage and its influences on patients′ complications and prognosis.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 118 cases of patients with hypertensive intracerebral hemorrhage were randomly divided into the observation group and control group. The control group was treated with traditional craniotomy surgery. The observation group was administrated minimally invasive puncture drainage combined with postoperative urokinase dissolution. Then the treatment effect, recent survival rate, complication rate, and quality of life scores before and after treatment were compared between the two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The treatment effect and recent survival rate of the observation group were significantly higher than those of the control group, while the incidence of complications in the observation group was significantly lower than that of the control group(P＜005). After treatment, the scores of somatic function, psychological function and social function in the two groups were significantly higher than before treatment. The scores of physical function, psychological function and social function in the observation group were significantly higher than those of the control group(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Minimally invasive puncture drainage combined with the treatment of postoperative urokinase dissolution has achieved a good therapeutic effect in the treatment of  hypertensive cerebral hemorrhage with lower rate of complications. It  not only can improve the  clinical symptoms and the quality of life after treatment, but also has a positive impact on the recovery of patients′ health. It should be widely applied and promoted in clinical practices.


Efficacy of anatomical locking plate combined with anchors on distal clavicle fracture type Neer Ⅱ#br#

SUN Ping， GAO Tiantian， ZHANG Wei， FU Shiping

2018, 38(10):  1161-1165.  doi:10.3969/j.issn.10073205.2018.10.011

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［Abstract］〓Objective〖HTSS〗〓To observe the efficacy of anatomical locking plate combined with anchors and clavicular hook plate in the treatment of distal clavicle fracture type Neer Ⅱ and their impact on shoulder function. 
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Eighty patients with distal clavicular fracture type Neer Ⅱwere divided into observation group and control group according to random number method. Each group had 40 cases. The observation group was treated with anatomical locking plate combined with anchors, control group was treated with clavicular hook plate. The efficacy, operation time, intraoperative blood loss, fracture healing time, postoperative hospital stay, shoulder function score and incidence of complication were observed in two groups.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The clinical efficacy in the observation group was better than that in the control group, and the excellent and good rate was significantly higher than that in the control group, the difference was statistically significant(P＜005). The fracture healing time in the observation group was significantly shorter than that in the control group, the difference was statistically significant(P＜005), there was no significant difference in the operation time, intraoperative blood loss and postoperative hospital stay between the two groups(P＞005). The pain, activity, flexion, internal rotation, muscle strength and total score in the observation group were significantly higher than those in the control group(P＜005). There was no statistical difference in the abduction and external rotation score between the two groups(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Efficacy of anatomical locking plate combined with anchor for the treatment of distal clavicle fracture type Neer Ⅱis obvious, with minimally invasive, small injury, quick healing of fracture and less complication, it is helpful to recovery shoulder function.

The clinical analysis about the erythrocyte sedimentation rate and prognosis in the patients with osteoarticular tuberculosis#br#

GAO Jianguo1, LI Shuo1， ZHANG Helong1*, BAI Hongzhong2, LU Wei1, LI Lingdi1

2018, 38(10):  1166-1168,1178.  doi:10.3969/j.issn.10073205.2018.10.012

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［Abstract］ Objective〖HTSS〗〓To investigate influence of the erythrocyte sedimentation rate（ESR） of postoperative of bone joint tuberculosis and to determine the factors correlating with the prognosis.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Total 403 cases accepting surgical treatment for bone tuberculosis  were selected in our department, among them, 178 cases of spinal tuberculosis, knee joint tuberculosis, 83 patients, 79 cases of hip joint tuberculosis and 14 cases with elbow joint  tuberculosis, 11 cases with ankle tuberculosis, wrist joint tuberculosis in 38 cases. The ESR was controlled properly in Spine, hip joint tuberculosis patients, and if ESR>85 mm/1 h, the patients were treated in knee, ankle, elbow, wrist joint tuberculosis  with the chemotherapy drug. Other patients before operation didn′t give the chemotherapy drugs for a long time. The patients were divided into three groups according to the preoperative ESR(Group A  ESR<40 mm/1 h, Group B ESR 40 mm/1 h-85 mm/1 h, and Group C ESR>85 mm/1 h) . All the patients underwent debridement surgery according to the size of the lesions or abscess. The VAS score, primary healing rate, recurrence rate  of three groups were compared.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The pathological results of 31 patients were reported as acute and chronic inflammation, and the rest were confirmed as tuberculosis by postoperative pathology or tuberculous culture. There were no statistically significant differences in VAS scores before and after operation in the 3 groups(P＞005), and the clinical efficacy differences of 3 groups were not statistically significant(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Surgical treatment is an important method in the treatment of bone and joint tuberculosis. ESR had no obvious effect on the longterm recurrence rate and functional recovery. Surgical indications can  be consider comprehensive, and high ESR is no longer as a single absolute contraindications.


Analysis of pathological feature and treatment of the pancreatic neuroendocrine tumors#br#

LI Shengchao， PENG Li

2018, 38(10):  1169-1173.  doi:10.3969/j.issn.10073205.2018.10.013

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［Abstract］ Objective〖HTSS〗〓To analyze the clinicopatholocal features of pancreatic neuroendocrine neoplasms(PNENs) and investigate the treatment and prognosis in patients with pancreatic neuroendocrine tumor.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓According to the results of immunohistochemical examination, 47 cases of pancreatic neuroendocrine tumors were divided into functional group(11 cases) and nonfunctional group(36 cases). According to the nuclear fission image count and the Ki67 index, 40 cases were divided into the nuroendocrine tumor(NET) group and 7 cases were divided into the nuroendocrine carcinoma(NEC) group. The patients were followed up, and the case data, pathological data, treatment process and prognosis of the patients were analyzed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There were no statistically significant differences in gender, clinical stage and tumor grade between functional groups and nonfunctional groups(P＞005). NET groups were all in Ⅰperiod and Ⅱ period, NEC group are distributed in each period. The difference between the 2 groups was statistically significant.(P＜005). There were no statistically significant differences in gender, CgA and Syn expression between the NET group and the NEC group(P＞005). Thirty patients were followed up, with a followup period of 4-68 months. One patient had liver metastasis and underwent microwave ablation until the end of the followup.  The survival condition was still good. The remaining 29 patients had no metastasis or recurrence and had a good survival.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Pancreatic neuroendocrine tumors can occur in all parts of the pancreas. CT or MRI is the main examination method, and the diagnosis depends on pathological diagnosis, and the treatment is mainly surgery, combined with targeted therapy, radiofrequency ablation, chemotherapy and other methods. The overall prognosis of pancreatic neuroendocrine neoplasms is good.


Application of enhanced recovery after surgery tactics in perioperative of laparoscopy combined edoscopic naso biliary drainage

 

LIU Jinheng, WANG Yanting, CHEN Anping, SUO Yunsheng, WANG Anqi

2018, 38(10):  1174-1178.  doi:10.3969/j.issn.10073205.2018.10.014

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［Abstract］ Objective〖HTSS〗〓To investigate the perioperative practicality of enhanced recovery after surgery(ERAS) tactics in laparoscopy combined endoscopic naso biliary drainage.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Eightyfour patients with cholecystolithiasis combined with choledocholithiasis were divided into the enhanced recovery after surgery group(n=42) and the traditional group(n=42), All patients in two group were treated by laparoscopic combined intraoperative endoscopic surgery,and 42 patients with ERAS method,42 patients with traditional method. The first ambulation time after operation, recovery time of intestinal function, postoperative removal time of nasal bile duct, removal time of abdominal drainage tube, postoperative infusion stop time, hospitalization time, postoperative pain, postoperative complications, postoperative white blood cells, serum amylase, alanine aminotransferase and total bilirubin of two groups were compared.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓The first ambulation time, the recovery time of intestinal function, the removal time of nasal biliary duct and laparoscopic drainage tube, the time of stopping infusion and the time of hospitalization in ERAS were shortened. The pain rate was lower than that in the traditional group. Recovery of the liver function and total bilirubin in the patients was lower than that in the conventional group（P＜005）. 
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓ERAS tactics has highly practicability for patients in laparoscopic surgery combined with endoscopy and can be further explored.


Effects of ATIP3aHMGA2ERK signaling pathway on cisplatin resistance in epithelial ovarian cancer

HUANG Ping, LI Yanying, LI Lingling, QI Bingli, SU Mengya, ZHANG Jiyan

2018, 38(10):  1179-1184.  doi:10.3969/j.issn.10073205.2018.10.015

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［Abstract］ Objective〖HTSS〗〓To explore the effects of ATIP3aHMGA2ERK signaling pathway on cisplatin resistance in epithelial ovarian cancer.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓DDPresistant ovarian cancer cell lines SKOV3/DDP and A2780/DDP were cultured to exponential phase and assigned to control group(C1and C2 Group), ATIP3a group(A1 and A2 Group), siRNAATIP3a group(S1and S2 Group) and siRNAvector group(VC1 and VC2 Group)(n=3), respectively. The cells in A1 and A2 groups were treated with ATIP3a polypeptides(1 nmol/L). The cells in S1 and S2 groups were treated with siRNAATIP3a, but VC1 and VC2 were treated with siRNAvector as control. Then all the cells were treated with DDP for 72 h. The effects of cell proliferation and invasion were assessed by lactate dehydrogenase and transwell assays. The expression in HMGA2 was measured by Realtime PCR and westernblot. Phosphorylation of ERK was also assessed by Westernblot.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Compared with C1, ATIP3a polypeptides treatment decreased cell proliferation,invasion, mRNA and protein expression of HMGA2, and phosphorylation of ERK in A1 group. Compared with C1 and A1 groups, siRNAATIP3a increased cell proliferation, invasion, mRNA and protein expression of HMGA2, and phosphorylation of ERK in S1 group. The cell proliferation, invasion, mRNA and protein expression of HMGA2, and phosphorylation of ERK in VC1 group were increased compared with A1, but decreased compared with S1. Compared with C2, ATIP3a polypeptides treatment decreased cell proliferation, invasion, mRNA and protein expression of HMGA2, and phosphorylation of ERK in A1 group. Compared with C2 and A2 groups, siRNAATIP3a increased cell proliferation, invasion, mRNA and protein expression of HMGA2, and phosphorylation of ERK in S2 group.The cell proliferation, invasion, HMGA2 expression of mRNA and protein, and phosphorylation of ERK in VC2 group were increased compared with A2, but decreased compared with S2.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The DDPresistant of human epithelial ovarian cancer might be associated with ATIP3aHMGA2ERK signal pathway.


Influence of endocrine status on the success rate of intrauterine insemination in patients with polycystic ovary syndrome #br#

LIU Pan， GUO LIna， ZHAO Minying

2018, 38(10):  1185-1188,1192.  doi:10.3969/j.issn.10073205.2018.10.016

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［Abstract］ Objective〖HTSS〗〓To evaluate the effect of endocrine status on success rate of intrauterine insemination (IUI)in patients with polycystic ovary syndrome(PCOS).
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The clinical data of polycystic ovary syndrome patients who was implemented intrauterine insemination by husband in reproductive medicine department were collected, with 180 cycles. It was divided into three groups according to the antimullerian hormone (AMH) value. In group 1,AMH values were equeal to or less than 16.32 pmol/L(25 th percentile). In group 2, AMH values were more than 16.32 pmol/L，but equeal to or less than 29.35 pmol/L. In group 3,AMH values were more than 29.35 pmol/L(75 th percentile). The value of luteinizing hormone (LH), luteinizing hormone/folliclestimulating hormone(LH/FSH) and testosterone(T) and pregnancy rate were compared in each group. 
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no significant difference in age, body mass index (BMI) and infertility among the three groups(P＞005).The values of LH, LH/FSH and T in group 2 and 3 were higher than those in group 1, and the values of LH, LH/FSH and T in group 3 were higher than those in group 2, the difference were all statistically significant(P＜005). The AMH value of PCOS patients was positively correlated with the value of LH, LH/FSH and T. The pregnancy rate of group 1 was 24.4%. The pregnancy rate of group 2 was 14.4%. The pregnancy rate of group 3 was 8.9%.There was no significant difference in the pregnancy rate among the three groups(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓High AMH levels of PCOS patients also have high LH, T and LH/FSH. The level of AMH is limited in predicting the pregnancy outcome of PCOS patients treated with IUI, but its high level will reduce the pregnancy rate.


The value of DWI in differential diagnosis of benign and malignant gastric stromal tumors

SONG Min, LIAO Feng, SHEN Xudong

2018, 38(10):  1189-1192.  doi:10.3969/j.issn.10073205.2018.10.017

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［Abstract］ Objective〖HTSS〗〓To evaluate the correlation between the apparent diffusion coefficient(ADC) of gastric stromal tumors and the benign and malignant lesions, and to evaluate the diagnostic value of diffusion weighted imaging(DWI) in gastric stromal tumors.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The DWI data and pathological features of 21 patients with gastric stromal tumor proved by immunohistochemistry after operation were retrospectively analyzed. The ADC values of the tumors were measured and the correlation between the ADC values of the tumors and their pathologic results were statistically analyzed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Twentyone cases of gastric stromal tumors showed different degrees of high signal on DWI images. The ADC values of gastric stromal tumors and normal gastric wall tissues were statistically significant(P＜005). Pathological results of 21 patients with gastric stromal tumors showed that 6 of them were benign, 5 were potentially malignant, and 10 were malignant. The ADC values of gastric stromal tumors in the three degrees of differentiation were statistically significant(P＜005), the ADC values were lower in the potentially malignant and malignant groups than in the benign group, and were lower in the malignant group than in the potentially malignant group.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓As a noninvasive imaging technique, DWI helps to distinguish between normal gastric and gastric stromal tumors, and helps to assess benign and malignant gastric stromal tumors and assist in clinical diagnosis.


The effect of different ways of delivery on the structure and function of pelvic floor evaluated byultrasoundand the effect of rehabilitation treatment

LIU Wencong1, ZHANG Peng2*, LI Haiyan3, LIU Yunqing4, MA Xiaowen1, LIU Wenxuan5

2018, 38(10):  1193-1196,1200.  doi:10.3969/j.issn.10073205.2018.10.018

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［Abstract］ Objective〖HTSS〗〓To explore the effects of different ways of delivery on the structure and function of the pelvic floor by ultrasound, and toevaluate the therapeutic effect of pelvic floor rehabilitation treatment on the patients of stress urinary incontinence(SUI), so as to provide imaging basis for assessing pelvic floor function after production, as well as toprovide theoretical basis for the treatment of SUI.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓All individuals were divided into three groups: transvaginal natural delivery group(129 cases), selective cesarean section delivery group(126 cases), and childless women were served as the control group(105 cases). The thickness of bladder detrusor, the angle after bladder, the displacement of bladder neck, the area and perimeter of levator hiatal of them by the perineum pelvic floor ultrasound were measured. Oneway AVONA was used to compare the above indexes among three groups. Meanwhile, 75 cases of SUI patients induced by delivery were treated with pelvic floor rehabilitation therapy. Above indexes were measured before and after treatment, and compared by paired samples t test. 
〖HTH〗〖WTHZ〗Results〖HTSS〗〓There were significance differences in the thickness of bladder detrusor, in the angle after bladder, in the displacement of bladder neck, as well as in the area and perimeter of levator hiatal among three groups(P＜005). The following Post Hoc multiple comparisons revealed that the above indexes of the transvaginal natural delivery group were higher than those of selective cesarean section delivery group, which were all higher than those of the control group.After pelvic floor rehabilitation treatment for six months, all above indexes of SUI patients were reduced, there were significance differences in each indexes between before and after treatment(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Pregnancy and production can induce damage on the structure and function of female pelvic floor. Transvaginal natural delivery impacts more serious damage on the structure and function of pelvic floor to the primipara. Pelvic floor rehabilitation therapy is effective to the postpartum stress urinary incontinence.

Clinical value of liver volume measurement by CT combined CTP grading in evaluating the liver reserve function in patients with primary hepatic carcinoma combined liver fibrosis#br#

PANG Yuhua1, MA Xiaoming2, WANG Jinhuan1, DING Ruihua1

2018, 38(10):  1197-1200.  doi:10.3969/j.issn.10073205.2018.10.019

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［Abstract］ Objective〖HTSS〗〓To investigate the clinical value of liver volume measurement by CT combined CTP grading in evaluating the liver reserve function in patients with primary hepatic carcinoma combined liver fibrosis.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Thirtyeight cases of hepatic carcinoma with hepatic fibrosis in our hospital were selected as experimental group, 38 healthy volunteers with normal abdominal CT findings in the same period were selected as control group. In the experimental group, the CTP grading was used and CT liver volume measurement was conducted in the two groups. Liver volume changes between two groups of patients and experimental group was compared, and the correlation between the measured liver volume and CTP grading was analyzed.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓Compared with the control group, the volume of right lobe and caudate lobe were decreased(P＜005), the volume of quadrate lobe and the total liver volume were decreased(P＜005). The volume of right lobe and the total liver volume in patients with primary liver cancer were decreased(P＜005). The CTP grading was negatively correlated with the volume of right lobe and liver volume(P＜005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The CT liver volume measurement combined with the CTP grading can accurately evaluate the liver lobe size, effectively assess the patient′s liver reserve function, and has guiding significance for the development of treatment scheme for patients with primary liver cancer and  hepatic fibrosis, which is worthy of popularizing.

Comparison of two methods for modeling proliferative vitreoretinopathy

LIU Liya, MA Jingxue*, AN Jianbin, MA Yuelei

2018, 38(10):  1201-1204,1209.  doi:10.3969/j.issn.10073205.2018.10.020

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［Abstract］ Objective〖HTSS〗〓To compare the time and effect of the 2 methods by using 2 methods to establish proliferative vitreoretinopathy(PVR) model in rabbit eye.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The experimental group was given intravitreal injection of a mixture of retinal pigment epithelium (RPE) cells and interleukin1(IL1) beta or simple RPE cells respectively. The control group was given intravitreal injection of normal saline, and vitreous, fundus and B ultrasonic examination were performed after operation. The degree of vitreous opacity and the degree of PVR were graded, and the incidence of retinal detachment was calculated.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓After 7 days of vitreous injection, occurrences of PVR were 100% in both of the two groups. PVR happened more earlier and faster in Group Ⅰ than Group Ⅱ. Group Ⅰ also had the higher incidence of retinal detachment.
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Injective vitreous of RPE cells combined with IL1β in rabbit eyes is the best method to establish of PVR model, and is more in line with the pathological process of PVR.


The application of whole slide images in clinicopathologic diagnosis

TANG Zhongping1, CUI Quanzhe2, YANG Libo3, BAO Ji3, ZHAO Chun1*

2018, 38(10):  1205-1209.  doi:10.3969/j.issn.10073205.2018.10.021

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［Abstract］〓Objective〖HTSS〗〓To explore the practical value and effect of whole slide images(WSI) in daily clinicopathological diagnosis.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 300 consecutive cases were chosen as the research object and applied digital scanning to all the histological slices by using WSI. Then, we reviewed digital slices on the computer screen and made pathological diagnosis. Finally, we compared the pathological diagnosis between traditional hematoxylineosin(HE) slices under the microscope and digital slices on the computer screen, analyzed the practical value and effect of WSI in daily clinicopathological diagnosis.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓In terms of the nature of disease in 300 cases of HE staining slices, the overall coincidence rate between microscope diagnosis and computer screen diagnosis was 98.67%(296/300). In terms of the specific disease types in 300 cases of HE staining slices, the respective rate of complete coincidence, partial coincidence and inconformity between microscope diagnosis and computer screen diagnosis was 90.67%(272/300), 3.00%(9/300) and 6.33%(19/300). When compared with the standard answers made by the senior pathologist, there was no significantly statistical difference in the coincidence rate between microscope diagnosis and computer screen diagnosis in HE staining, methylene blue staining and immunohistochemistry(P＞005). 
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓In daily work, the coincidence rate between microscope diagnosis and computer screen diagnosis made by the same pathologist is high. With the development of medical information digitization, the advantages of digital pathology in teaching, diagnosis, scientific research and data storage will be more and more obvious. Moreover, the role of digital pathology in daily clinicopathological diagnosis will become more and more important in the future.