Table of Content

20 December 2017, Volume 17 Issue 06

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Clinical application of stem cells in the treatment of dilated cardiomyopathy

LIN Xifeng，ZOU Rongjun，TAO Jun，HUA Ping.

2017, 17(06):  631-644.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.001

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The pathogenesis of dilated cardiomyopathy（DCM）appears as progressive left ventricular or double ventricular fibrosis enlargement with ventricular systolic dysfunction. The dilated cardiomyopathy is a major cause of heart failure in patients and also a common indications of heart transplantation. New idea indicates that stem cell therapy for DCM has a significant curative effect and is expected to reverse the ventricular structure and improve heart function in patients with end- stage heart failure. Based on recent clinical studies，this paper will make a review from stem cell type，stem cell transplantation and its clinical curative effect，and focus on the clinical application of safety and efficacy of stem cell therapy for DCM，and further clarifies its clinical prospect.

Diagnosis and management of deltoid ligament injury in the supine-external rotation ankle joint fractures

DENG Dejun,LI Zhizhong.

2017, 17(06):  636-644.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.002

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Supination external rotation or Weber type B ankle fracture has both stable and unstable fractures. Unstable fractures always have fibula fractures and fractures of the medial malleolus or deltoid ligament tear at the same time. A consensus has reached that for unstable ankle fractures ，open reduction and internal fixation will achieve better clinical efficacy. There have been many studies on the diagnosis of medial ligament tears，but no consensus has yet been reached on the best method for assessing it. Since the number of patients with deltoid ligament tear due to external rotation is far greater than that we thought，possible information on ligament injury can be provided on the basis of the injury mechanism according to the Lauge-Hansen classification：based on X-ray，use the Lauge-Hansen classification system to evaluate if the deltoid ligament tear has important value，but its sensitivity and specificity remains to be studied. Physical examination，stress radiographs，MRI，arthroscopy，B- ultrasound have been used for a complete assessment of the medial collateral ligament in ankle fractures ，but none of these methods is cheap，simple and reliable. Now clinicians are accustomed to using the gravity stress test to make the assessment，and for suspected patients，it′ s quite worth their while doing arthroscopic exploration. The latest develpoment believes that the operation of open reduction and internal fixation for treating fibula fractures does no good to the repairment of the deltoid ligament tear in lateral malleolus fractures ，and there is no evidence shows that the exposure and repairment of the deltoid ligament has impact on the medial malleolus structure.

Causes and therapy of urethral stricture after transurethral resection of prostate

HUANG Chen， XU Yuyu，LIANG Jiang，SHENG Ming，XU Guibin，LI Xun.

2017, 17(06):  640-644.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.003

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Transurethral resection of the prostate is the preferred surgical procedure for the treatment of benign prostatic hyperplasia，but the complications such as urethral stricturebrings great pain to the elderly patients after transurethral resection of the prostate. This article will reviewthe causes of stricture of urinary tract due to transurethral resection，the measures of prevention and treatment. The main causes of urethral stricture are associated with cystoscope sheath ，operation violence，slowing operation，current reflux burn，urinary tract infection. Although there are still many controversies on the best way of treatment at present，the current surgical procedures include urethral dilatation（metal probe urethral dilatation，high pressure balloon urethral dilatation，etc.），endovascular stenosis incision（holmium laser ，cold knife urethral stricture ，etc.），urethroplasty（oral mucosa ，bladder mucosa ，penile flap ，tissue engineering graft）.

A validation analysis of prognostic model of metastatic breast cancer

KUANG Yuwen，PENG Haowei，ZHAO Jianli，LIN Xiao，JIANG Junrong，CHAI Jie，WANG Ying，YAO Herui

2017, 17(06):  645-648.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.004

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Objective  Tovalidate the ANZ model，a prognosticmodel of metastatic breast cancer among the patients of our breast cancer tumor center.Methods  The data of 104 patients starting first-line treatmentfor metastatic breast cancer from Jan. 2002 to Dec. 2012 were collectedas a validation dataset for ANZ model. Results   We validate the ANZ model in 104 metastatic breast cancer patientsof our breast tumor center，C-index is 0.61（，），the calibration plot suggested that the accuracy of the predicted OS using the nomogram is unsatisfied in the validation cohort. Conclusion  ANZ model showed an inferior prognosticpower in the metastatic breast cancer patientsof our tumor center. A more accurate prognostic model trained by Chinese metastatic breast cancer patients is needed.

Objective  To validate the ANZ model，a prognostic model of metastatic breast cancer among the patients of our breast cancer tumor center. Methods  The data of 104 patients starting first-line treatment for metastatic breast cancer from Jan. 2002 to Dec. 2012 were collected as a validation dataset for ANZ model. Results   We validate the ANZ model in 104 metastatic breast cancer patients of our breast tumor center，the C-index is 0.61（0.53，0.70），and the calibration plot suggested that the accuracy of the predicted OS using the nomogram is unsatisfied in the validation cohort. Conclusion  ANZ model showed an inferior prognostic power in the metastatic breast cancer patients of our tumor center. A more accurate prognostic model trained by Chinese metastatic breast cancer patients is needed.

Infection hampers wound healing by regulating the activation phenotype of macrophages

ZENG Zhiqing，LAO Liyan，CHEN Jianing

2017, 17(06):  649-653.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.005

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Objective To investigate how the infection factors affect the activation and biologic function of dermal fibroblasts by regulating the activation phenotype of macrophages. Methods The activation phenotype of macrophages was assessed by flow cytometry ；the interaction between macrophages and fibroblasts was established by a transwell co- culture system ；the proliferation of dermal fibroblasts was determined by MTT assay；the expression of α-SMA in fibroblasts was detected by cell immunofluorescence；the secretion of type Ⅰ and type Ⅲ collagen was detected by ELISA；the mRNA expression of MMP9 and MM913 was detected by q-PCR. Results The M2 macrophages activated by IL-4 could significantly induced the expression of α-SMA，promoted the proliferation and secretion of type Ⅰ and type Ⅲ collagen of dermal fibroblasts. However，LPS could significantly induce macrophages activating to M1 phenotype and macrophages activated by LPS could dramatically inhibit the secretion of type Ⅰ and type Ⅲ collagen of dermal fibroblasts and promote the expression of MMP9 and MMP13. Conclusion Infection factors could affect the activation and biological function of dermal fibroblasts by regulating the activation phenotype of macrophages. We expected that people could improve wound healing by regulating the activated phenotype of macrophages in the wound area in the future.

Study on the function and mechanism of circular RNA- circ- VCAN in glioma

HUANG Zuoyu， XIE Lin，OUYNAG Leping，HE Mingliang，LIU Jiahao，LIU Anmin.

2017, 17(06):  654-664.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.006

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Objective To explore the function and mechanism of circular RNA circ-VCAN in glioma. Methods The expression of circular RNA circ-VCAN in normal glial cells and glioma cells was confirmed by fluorescence quantitative PCR. Nucleocytoplasmic separationexperiments verified the distribution of circ- VCAN in the nuclear or cytoplasmic. RNaseR linear RNA digestion experiment was used to examine the circ- VCAN resistance to digestion of RNaseR. Circ- VCAN knockdown transfected cell lines were constructed. CCK8 was used to detect the cell proliferation ability after knockdown the circ- VCAN.Western blot was used to detect the expression levels of the NF- κB pathway proteins. Results When compared to the normal glial cells（HA1800）Circular RNA circ- VCAN was highly expressed in glioma cells，the differences were statistically significant（P<0.05）. Nucleocytoplasmic separation experiments demonstrated that circ-VCAN mainly existed in the cytoplasm. Circ-VCAN could resist digestion of RNaseR. Knock down circ- VCAN could inhibit the proliferation of U373 and T98G cells（P<0.05）. Western blot analysis showed that knockdown of circ-VCAN in U373 and T98G cells decreased expression of NF- κB pathway protein P- P65. Conclusion Knockdown circ- VCAN in the glioma cells can slow down the growth of glioma cells，suggesting that circ-VCAN may become a new therapeutic target.

Study on correlation between percent alpha variability and clinical prognosis in patients with severe actue cerebral infarction

LIU Jinyi，LEI Weijian，OUYANG Chan，YU Binjian.

2017, 17(06):  658-664.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.007

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Objective To analyze the correlation between percent alpha variability and clinical prognosis in patients with severe actue cerebral infarction after 90 days，and evaluate its clinical practical value of the clinical prognosis. Methods Thirty- one patients with severe actue cerebral infarction were accepted continuous brain function monitoring and clinical diagnosis and treatment. All patients in group were accepted the continuous 72 hours of continuous brain function monitor，and were recorded the average of Percent Alpha Variability which admitted to hospital 24 h ，48 h ，72 h. And scored the NIHSS，GCS，CNFD when admitted to hospital ，and 90 days after onset. According to the clinical prognosis ，the patients were divided into good and poor prognosis groups，and the correlation between Percent Alpha Variability and clinical prognosis were analyzed in patients with severe actue cerebral infarction after 90 Days. Results The Percent Alpha Variability was associated with the affected hemisphere. The Percent Alpha Variability of affected hemisphere is lower than the no- affected hemisphere. Between good prognosis and poor prognosis groups，there were significant differences of the score of the percent alpha variability in the hospital within 0-24 h，24-48 h，48-72 h. Spearman analysis indicated the percent alpha variability in the hospital within 0-24 h，24-48 h，48-72 h were positive correlated with good prognosis. The percent alpha variability in the hospital within 0-24 h，24-48 h，48-72 h predicted good prognosis. The sensitivity and specificity of good prognosis would be high when the percent alpha variability≥20%. The sensitivity of the percent alpha variability in the hospital within 0-24 h，24-48 h，48~72 h was 68.4% ，63.25，63.2% ，and the specificity was 66.7% ，75.0% ，91.7% . Conclusion The percent alpha variability of affected hemisphere in the hospital within 72 h was positively correlated with good prognosis in severe acute cerebral infarction. To some extent ，the percent alpha variability could predict the clinical prognosis of severe acute cerebral infarction.

Expression of Lnc-DQ in hepatocellular carcinoma and its role in regulating of the stemness characteristics of SMMC7721 cells

LIN Zewei，ZENG Bing，YE Huilin，CHENG Di，LIU Jikui

2017, 17(06):  665-668.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.008

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Objective To investigate the expression of Lnc- DQ in hepatocellular carcinoma （HCC） and its role in regulating of the stemness characteristics of SMMC7721 cells. Methods The expression of Lnc- DQ was determined by real- time quantitative reverse transcriptase polymerase chain reaction（RT-qPCR）in HCC samples and cell lines. Cells were infected with negative control short hairpin RNAs（sh- NC）or specific shRNAs targeting Lnc- DQ （sh- Lnc- DQ）to generate stable Lnc- DQ knockdown cell lines. Colon formation ，anchorage- independent sphere formation and flow cytometry assays were used to analyze the effects of Lnc- DQ knockdown on the cancer stem- like phenotype of SMMC7721 cells. Results LncDQ was up-regulated in both HCC tissue samples and cell lines. shRNA transfection could significantly reduced the expression of Lnc-DQ in HCC cells. For colon formation assay，the colony number was 43.62±5.35 in sh-Lnc-DQ group，and was significantly lower than 94.31±5.07 in sh- NC group（P<0.05）. The mammosphere number in sh- Lnc- DQ group was small and lower than in sh- NC group（P<0.05）. The proportion of CD133 positive was 2.32% ± 0.25% in sh- Lnc- DQ group and 9.24% ± 0.69% in sh- NC group（P<0.05）. Conclusion LncDQ was up- regulated in HCC and play an important role in the regulating of the stemness related characteristics of SMMC7721 cells.

Effects of laparoscopic surgery on systemic stress response and recent clinical outcomes for the acute perforation of colorectum patients

WANG Xi，YUAN Lesheng，LIU Xihong，LI Wenyu， XIAO Linghui，ZENG Huiming，WANG Hua，XIE Wei

2017, 17(06):  669-673.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.009

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Objective To evaluate the effect of laparoscopy operation on systemic stress response and recent clinical outcomes for the patients with acute colorectal perforation. Methods Seventy- eight patients received surgery for the acute colorectal perforation. Based on whether accomplished by laparoscopy，the patients were divided into two groups：laparoscopy group（n=43）and laparotomy group（n=35）. C-reactive protein（CRP），insulin resistance（IR）in 78 patients were assayed preoperatively and postoperatively on the first day，third day and seventh day. The average length of postoperative hospital stays，the postoperative complications，the time of first flatus were recorded respectively. Results All surgical procedures were completed smoothly，and no case died. The levels of CRP & IR on 3rd，7th day postoperative in patients of laparoscopy group were significantly decreased than in laparotomy group（P<0.05）. The infectious complications and the occurrence of deep venous thrombosis in patients of laparoscopy group were significantly lower than in laparotomy group（P<0.05）. The time to first flatus and the length of postoperative hospital stay in patients of laparoscopy group were significantly shorter than those in the laparotomy group （all P values <0.05）. Conclusion Laparoscopy for the patients with acute colorectal perforation was safe and reliable. Laparoscopic surgery could significantly accelerate recovery of postoperative systemic stress response，release the incidence of postoperative complications and shorten the length of postoperative hospital stay.

Treatment of acute cholecystitis in 41 high- risk patients by percutaneous transhepatic gallbladder drainage guided by ultrasound

KUANG Naile，WU Junhua，XU Jiena，ZUO Chaohai，YU Jiexiong.

2017, 17(06):  674-677.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.010

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Objective To evaluation of percutaneous transhepatic gallbladder drainage（PTGBD）guided by color doppler ultrasound for the treatment of high- risk groups for acute cholecystitis. Methods The clinical data of 41 high-risk patients with acute cholecystitis were analyzed retrospectively from March 2014 to April 2017. Results All patients were successfully completed the PTGBD. There were two cases of biliary hemorrhage，and cured after conservative treatment. No gall leakage，perforation and other complications occurred. Three patients had catheter dislocation ，who did not agree to the operation without further treatment due to the improvement of the symptoms. Three patients were unable to tolerate surgery due to cardiopulmonary function，and six cases patients did not agree with the surgical and removed drainage tube. The above cases were followed up for six to 24 months without acute cholecystitis. Twenty-nine cases were successfully underwent by LC，and no case was underwent laparotomy. LC came two weeks to three months after PTGBD. The operation time was 74.9±67.3 min，the intraoperative hemorrhage was 7.2 ± 9.2 ml，and the postoperative hospitalization time was 2.6 ±2.1 days. One cases of abdominal bleeding was found and cured after conservative treatment. The thickness of gallbladder wall was positively correlated with LC time ，and the correlation coefficient was 0.455. Conclusion Our Results confirmed that PTGBD should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis.

An analysis between laparoscopic and open pancreaticoduodenectomy

WU Zuguang，DENG Guoming，ZHANG Yaoming，LIU Hongtao，LI Zhiwang.

2017, 17(06):  678-680.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.011

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Objective To evaluate the curative effects of laparoscopic pancreaticoduodenectomy（LPD），and discuss the safety and feasibility of LPD. Methods Retrospective analysis was conducted in clinical data of pancreaticoduodenectomy from January 2012 to December 2016，including 22 cases of laparoscopic pancreaticoduodenectomy and 21 cases of open pancreaticoduodenectomy（OPD）. The related outcomes of the two groups were compared ，which included operation time ，intraoperative blood loss ， intraoperative blood transfusion rate，postoperative anal exhaust time，postoperative hospital stay and postoperative complication. Results The laparoscopic group had significantly longer operation time（414.0±31.0 min vs. 263.8±34.4 min，t=11.634，P<0.001），however，shorter intraoperative blood loss（176.0±50.4 mL vs. 290.8±41.9 mL，t= -6.613，P=0.01），postoperative anal exhaust time（4.9±0.7 d vs. 6.7±0.8 d，t=-5.724，P=0.025）and postoperative hospital stay（17.3±2.0 d vs. 21.3±3.2 d，t=-3.514，P=0.002）than those in the open group（all P values were less than 0.05）. Conclusion Compared with OPD，LPD follows the principle of tumor occurring，which is safe and feasible.

Endoscopic- guided biliary drainage：stenting selection for malignant common bile duct obstruction

LIU Hui，CHU Chunxiang，WU Qingsong，ZHAO Jiafeng，CHEN Xiaofei.

2017, 17(06):  681-687.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.012

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Objective To observe the effect，postoperative complications and treatment costs of different bile duct stent selection on malignant common bile duct obstruction and investigate the optimal treatment. Methods Forty- seven consecutive patients with malignant bile duct obstruction underwent endoscopic biliary stenting by ERCP surgery in the Hepatobiliary Surgery of our hospital from July 2010 to December 2015. Of all patients，16 were treated by metal stent（group A），17 had single plastic stent（group B）and 14 had multiple plastic stent（group C）. The patency duration，complications and operation cost were recorded and compared between three groups. Results For the patients with pancreatic cancer，the mean stenting patency durations of group A and group C were significantly longer than of group B，but there was no significant difference between group A and group C. For cholangiocarcinoma and periampullary carcinoma patients，the mean stenting patency durations of group A and group C were significantly longer than of group B，and group C was slightly better than the group A but the difference was not statistically significant. Conclusion As regard to the patients with malignant common bile duct obstruction，endoscopic biliary stenting should follow the individualized treatment option program for the purpose of improving treatment effect，reducing complications and costs.

Clinical practice of rapid rehabilitation surgery in thyroid surgery

YAN Weihua，TAN Xingying， WU Zhihui

2017, 17(06):  684-687.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.013

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Objective To explore the feasibility of rapid rehabilitation surgery in thyroid surgery. Methods This was a prospective study. 120 cases of patients with thyroid surgery in our hospital from September 2016 to September 2017 were divided into observation group（n=60）and control group （n=60）. The control group received traditional rapid rehabilitation surgery clinical pathway the intervention，and the observation group rapid rehabilitation surgery intervention. Results The average operation time，anesthesia onset time，postoperative recovery time，exhaust time，length of hospital stay of observation group were lower than those of control group（all P values <0.05）. The intraoperative blood loss and total hospitalization expenses of two groups had no significant difference（P>0.05）. The STAI score of observation group were lower than those of control group （P<0.05）. The satisfaction of observation group and control group were（3.31±1.02）and（5.25±2.57），and the difference was statistically significant （P<0.05）. The total complication rate of observation group and control group were8.33% and 11.67% . And there was no significant difference between the two groups （P>0.05）. Conclusion The clinical pathway of rapid rehabilitation surgery reduce patient's pain and adverse reaction ，shortened the average surgery time and hospitalization time，and improve satisfaction.

Comparative study of laparoscopic and open ISR

KONG Lianguang,CAO Jiezhi.

2017, 17(06):  688-691.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.014

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Objective To support the clinical dada in comparison between laparoscopic and traditional open abdominal intersphincteric resection（ISR）. Methods In this retrospective case-controlled study，90 colorectal cancer cases with anal sphincter preservation surgery were recruited from January 2013 to August 2015 in our hospital for treatment，in which 45 cases received open ISR （control group），and other 45 cases underwent laparoscopic transabdominal ISR（observation group）. The operative time，blood loss，regular mealtimes，flatus，complications，and length of stay，number of lymph node dissection，far margin length，positive circumferential resection margin and local recurrence rate ， mortality and anal functions between the two groups were compared. Results The operation time，flatus time，normal diet time，postoperative hospital stay（185.26 ± 15.89 min，2.61 ± 0.21 d，6.15 ± 1.14 d，7.59 ± 1.15 d） in the observation group were significantly shorter than those in the control group （223.02 ± 21.35min，3.26±0.411 d，7.58±0.98 d，9.58±0.64 d）（all P values <0.05）. Blood loss and the postoperative complications were significantly lower in the observation group （157.26 ± 12.54 mL， 4.44%）than in the control group（214.58±30.15 mL，20.00%），（P<0.05 for all）. No difference of the number of lymph node dissection and far margin length were found between the two groups （P>0.05）. The circumferential positive margin rate，the rate of local recurrence，distant metastasis and mortality were significantly lower in the observation group （4.44% ，2.22% ，0.00% ，2.22%） than that in the control group（20.00% ，15.56% ，11.11% ，22.22%），（P<0.05 for all）；The defecation urgency，stool frequency and bowel problems were lower significantly in the observation group than in the control group patients （P<0.05）. No significant difference of Wexner were found between the two groups （P>0.05）. Conclusion Laparoscopic abdominal ISR surgery in ultralow colorectal cancer has better clinical efficacy and safety.

Survival analysis of laparoscopic radical gastrectomy for gastric cancer patients with different age and occupation

LIANG Yongsheng，HUANG Shaozhuo，DIAO Dechang

2017, 17(06):  692-698.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.015

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Objective To explore the effects of different age，occupation and operative methodon survival rate in patients with radical gastrectomy in Yangjiang district ，a city locates in the west of Guangdong. Methods One hundred and sixty eighty patients with radical gastrectomy were performed five-year follow-up as research object. and analyzed. The survival condition in different risk factors was analyzed Using Kaplan Meier method. Results A total of 101 cases of patients died，survival interval ranged from 2 months to 70 month，and 5 years survival rate was 34.6% . Kaplan and Meier analysis showed there were no statistical differences in gender on survival time（P>0.05）. Survival time in young and middle- aged patients was shorter than old and middle- aged patients （P<0.05）. Survival time in mental labor patients was shorter than in manual labor patients（P<0.05）. Survival time in laparoscopic gastrectomy patients was longer than in open gastrectomy patients （P<0.05）. Conclusion The Results above showed agedness，laparotomy，and mental work were risk factors for the post- operation patients with gastric cancer in Yangjiang City.

427 cases of pediatric inguinal hernia treating with laparoscopic high ligation of hernia sac with straight threaded needle via single tunnel

MAO Jianxiong，XIAO Dong，XU Haozhong，CUI Xiong jian，ZHANG Chi，CHU Dongdong，WANG Xiuliang.

2017, 17(06):  696-698.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.016

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Objective To investigate the value of laparoscopic high ligation of hernia sac withstraight threaded needle via single tunnel in treating pediatric inguinal hernia. Methods Set up a 3 mm supraumbilical incision and a 5 mm subumbilical incision ，place 5 mm and 3 mm Trocars were placed after the artificial pneumoperitoneum. Set up a 1 mm in surface projection of the hernia sac，then the threaded needle was pierced through this incision，and make the needle stealthed along the backside of hernia sec extraperitoneally. After crossing the spermatic vessels tip ，the hernia needle pierced peritoneum into the abdominal cavity. Pull the thread into the abdominal cavity from the needle with laparoscopic clamp till it was long enough. Pull the needle back along the tunnel slowly till it reach the original vertical extraperitoneal entrance，then let the needle stealth along the outside of hernia sec extraperitoneally and pierce into abdominal cavity at the place of previous piercing into abdominal cavity. Put the thread in abdominal cavity into the gap between the thread on needle and the hernia needle ，and pulled the thread and the needle from extraperitone gently. The thread in abdominal cavity was taken outside ， then cut and knot it. So the hernial sac were ligated twice. Results There were 218 contralateral vestigium proceseus vaginalis cases out of 427 cases，accounting for 51.2% of the patients with unilateral inguinal hernia. The average time of one side operation was about 8.5 minutes. There were 5 cases of umbilical hemorrhage，and no scrotum，groin hematoma or other complications occurred after operation. The average hospital stay was 3.1 days. 312 cases were followed up from 3 months to 24 months after operation. No recurrence or surgical knots reaction were found. Conclusion Laparoscopic high ligation of hernia sac with straight threaded needle via single tunnel is satisfactory and worthy of promotion.

Diagnosis and treatment of 5 cases of insulinoma

WU Gang，LI Li

2017, 17(06):  699-700.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.017

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Objective To summarize the clinical characteristics and therapeutic Methods ofinsulinomain our Department in order that we couldoptimize its treatmentincorporate with the advancement in associated medical areas. Methods Five cases of insulinomain our Department during the past 10 years were followed-up and analyzed retrospectively. Results The incidence rate of insulinoma was very low，misdiagnosis may found in out-patient clinic without the laboratory and imaging examination. Radical resection under the guide of ultrasound provided a better prognosis and treatment with insulinomapatients. Conclusion Insulinoma is worth of consideration of clinicians though its incidence rate is low. The individualizedsurgical treatment is the first choice forinsulinoma.

Relationship between Ki- 67 and clinical，pathological and molybdenum target BI- RADS grading of breast cancer

TU Yingbing.

2017, 17(06):  701-704.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.018

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Objective To investigate the relationship between Ki-67 and clinical，pathological and molybdenum target BI- RADS grading of breast cancer. Methods Clinical data of 199 female patients with breast cancer treated in Xiaogan Central Hospital from January 2015 to December 2016 were retrospectively analyzed，including clinical，pathological and molybdenum target BI-RADS classification. Results Ki- 67 labeling index was correlated with tumor diameter ，lymph node metastasis status，molybdenum target BI- RADS grading，ER，PR，HER- 2 and WHO grading of invasive ductal carcinoma （all P values <0.05），uncorrelated with age （P>0.05）. The average Ki- 67 labeling index value of medullary carcinoma（61.47%）was greater than that of the invasive ductal carcinoma（36.26%）， mucinous carcinoma（15.10%），invasive lobular carcinoma（20.62%）and ductal carcinoma（12.53%）（all P values <0.05）；The average Ki-67 index value of invasive ductal carcinoma was higher than that of mucinous carcinoma and ductal carcinoma（all P values <0.05）. The average Ki-67 index value of luminal A subtype（7.23%）was significantly lower than that of luminal B（35.43%），HER- 2 overexpression （39.58%）and triple negative（57.26%）subtypes（P<0.05 for all）. The average value of Ki-67 index in luminal B subtype was less than that in HER-2 overexpression subtype（P<0.05）. The mean value of Ki-67 index of triple-negative subtype were higher than those of non-triple-negative subtype（30.20%）（P<0.05）. Conclusion Ki- 67 level was related to the clinical，pathological and molybdenum target BI-RADS grading of breast cancer patients，and it has some guidling significance for the treatment and prognosis of breast cancer.

Application and experience of transparent cap-assisted removal of sharp foreign bodies impacted in the esophagus during endoscopy

ZUO Haijun，JIANG Di，YU Xiaoqun，SU Jiandong，SUN Xianjiu，LIAO Suhuan. Gastroenterology

2017, 17(06):  706-708.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.019

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Objective To explore the efficacy and safety of transparent cap in sharp foreign body removal and summarize experience. Methods 124 cases of esophageal sharp foreign body were retrospectively analyzed in Endoscopic Center of our hospital from January 2015 to January 2017. Of 124 cases，76 were males and 48 females，aged 16- 82 years. All patients wereimplemented endoscopic removal of sharp foreign bodies impacted in the esophagus，in which 70 cases were performed operation by transparent cap- assisted procedure（transparent cap group），54 cases were under non- transparent cap assisted group. The visual field clarity，time of foreign body removal，success rate，mucosal injury rate， complications of bleeding and perforation were recorded and analyzed. Results The mean time of transparent cap group was 234.14 ± 67.38 s，and 337.11 ± 116.61 s of the non- transparent group（P<0.05）. The success rate and visual field clarity rate of the transparent cap group were better than those of the non-transparent cap group，and the difference was statistically significant（P<0.05）. The rate of mucosal injury and the incidence of complications in transparent cap assisted group were significantly lower than those in the non-transparent caps group，with statistical difference（P<0.05）. Conclusion The procedure of transparent cap-assisted endoscopy for removal of esophageal sharp foreign bodies showed shorten the operation time，had higher success rate and visual field clarity，reduce the mucosal damage and complications.

Expression and clinical significance of branched- chain amino acid transferase- 1 （BCAT1） in breast cancer

GUO Xiongtu，YUAN Nangui，LUO Weimin，YAN Xuejing，HU Yuping

2017, 17(06):  709-713.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.020

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Objective To investigate the expression level and prognostic value of branched- chain amino acid transferase- 1（BCAT1）in breast cancer. Methods We retrospectively analyzed the specimens of 74 patients with breast cancer who underwent radical mastectomy from 2009 to 2010 in our Department. Immunohistochemistry assay was carried out to assess the protein expression levels of BCAT1 in breast cancer and the adjacent normal tissue. The relationship between BCAT1 expression and clinical parameters and survival outcome were also studied. Result According to theimmunohistochemistry assay，the expression of BCAT1 protein in breast cancer was significantly higher than that in adjacent normal breast tissues（68.9% vs 35.0% ，P<0.05）. Moreover，the high BCAT1 group had higher percentages of advanced T stage，lymph node metastasis，advanced TNM stage and larger tumor size compared with the ones in the low BCAT1 group （χ2=6.228，6.894，7.415，6.210 respectively，all P values <0.05）. The overall 5-year survival rate in the high and low BCAT1 group was 56.9% and 82.6% and thelog-rank test revealed that the survival outcome in the low BCAT1 group was significantly better than the one in the high BCAT1 group（χ2=5.209，P<0.05）. Conclusion BCAT1 protein expression was elevated in breast cancer. Moreover，the high expression of BCAT1 expression was positively associated with tumor size，lymph node metastasis and survival outcome. BCAT1 may be a potential target of breast cancer.

An ultrasonic screening on developmental dysplasia of the hip in neonates and infants less than six months old in Guangzhou city

WU Baojie，YU Shenghua，CHEN Huirun，HU Hansheng，LIANG Shaozhen，ZHU Junlin

2017, 17(06):  714-717.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.021

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Objective To invastigate the prevalence rate of developmental dysplasia of the hip in neonates and infants less than six months old in Guangzhou city. Methods From August 2015 to August 2017，the survey of developmental dysplasia of the hip with Graf ultrasound was taken in 9766 cases of neonates and infants less than six months old（19532 hips）in Guangzhou. Results Eighteen （0.09%）cases with DDH were detected，with 13 cases（0.13%）of male and 5 cases（0.05%）of female. The prevalence rate of female was significantly higher than that of male（P<0.05）. The detection rate of DDH of infants with breech presentation（0.35%）was higher than those with other position（0.08%）（P<0.05）. The detection rate of DDH of infants with family history（0.22%）was higher than those with no family history（0.07%）（P<0.05）. The detection rate of DDH of infants with abnormal examination was higher than those with normal examination. Conclusion The prevalence rate of developmental dysplasia of the hip in neonates and infants less than six months old in Guangzhou district is 0.09% . Female ， family history，breech presentation，abnormal ones in examination，has higher prevalence rate than male，those with no family history，non-breech presentation，normal ones in examination individually， which suggests special monitoring.

Pavlik harness treatment for developmental dysplasia of the hip in neonates and infants within 6 months

HU Hansheng，YU Shenghua，WUBaojie，CHEN Huirun，LIANG Shaozhen，ZHU Junlin.

2017, 17(06):  718-723.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.022

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Objective To investigate the treatment effect of the Pavlik harness for developmental dysplasia of the hip（DDH）in neonates and infants less than six months old. Methods From August 2015 to August 2017，18 cases with DDH of hips were detected and confirmed，with 13 cases of female and 5 cases of male. According to Graf ultrasound hip type，9 patients with type IIb，6 patients with type IIc，2 patients with type III，one patients with type IV. All of the DDH hips were treated with Pavlik harness. The ultrasound was used to monitor the hip development one time in two weeks. The treatment time was 6 to 20 weeks；the follow-up time was 3 to 18 months，an average of 8 months. Results Of them，17 cases of type II hips were cured by Pavlik harness，one case got better by ultrasound examination which alpha angle of which was 59°. All patients had no complications such as avascular necrosis of the femoral head. Conclusion Pavlik harness had high cure rate for affected children. Early ultrasound provides the possibility to use Pavlik harness treatment.

Efficacy of oral atorvastatin calcium combined with drilling drainage in the treatment of chronic subdural hematoma

XIE Lin，LI Kaishu，TIAN Limei，YU Yuyin，XU Shunpeng，CHENG Yan.

2017, 17(06):  721-724.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.023

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Objective To compare the efficacy of oral atorvastatin calcium combined with drilling and drainage with simple drilling drainage in the treatment of chronic subdural hematoma（CSDH）. Methods The data of patients with chronic subdural hematoma treated by drilling and drainage were collected from Sun Yat-sen Memorial Hospital of Sun Yat- sen University and Guangdong Tongjiang Hospital from January 2016 to July 2017. Patients were divided into observation group（36 cases）and control group （32 cases） according to whether they aided oral administration of atorvastatin calcium tablets.In the observation group，the patients were treated with oral atorvastatin calcium for more than 8 weeks after drilling and drainage ，while the control group received drilling and drainage only. The treatment effect and Karnofsky（KPS）functional score were compared between the two groups. Results The total effective rate（97.22%）in the observation group was not significantly different from that in the control group （84.38%）（χ 2=2.062 ，P=0.151）. However ，the therapeutic efficacy of observation group was better than that of the control group（Z=- 2.413，P=0.016）. The recurrence rate in the observation group（0%）was lower than that in the observation group（12.5%）（χ2=4.711，P=0.03）. The KPS score at the 8th week after surgery was significantly higher in the observation group（92.78±9.74）than in the control group（87.19±12.50），with a significant difference（Z=-2.093，P=0.036）. Conclusion Atorvastatin combined with drilling and drainage shows better therapeutic efficacy and lower recurrence rate ， also helps patients in neurological recovery.

Effect of different blood transfusion Methods on coagulation function and D-two dimer in patients with moderate blood loss after total hip arthroplasty

HE Yingyi，LUO Cheng，CHENG Pingrui

2017, 17(06):  725-728.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.024

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Objective To investigate the effect of different blood transfusion Methods on the coagulation function and the time effectiveness of D- dimer in patients undergoing total hip arthroplasty （THA）with moderate blood loss. Methods Using prospective caes control method ，according to the intraoperative blood loss +6 hours of drainage after surgery，the flow volume loss between the total 10%-20% screening condition，the first THA patients were selected and divided into two groups：autologous blood transfusion group （ABT group） and allogeneic blood transfusion group （group AT）. They were recorded before operation（T0），first days after operation（T1），3 days（T2），7 days（T3），14 days（T4） of the platelet count（PLT），prothrombin time（PT），prothrombin international ratio（INR），activated partial thromboplastin time（APTT），fibrinogen（FIB）and D-dimer（DD）. Results In group comparison，the effects of FIB and DD content at different time points were statistically significant （P<0.05）. Comparison between groups：through the interaction of treatment Methods ，the changes of PLT，PT， INR，APTT，FIB in the time points were not statistically significant （P>0.05）；DD content in T1 ，T2 time points were not statistically significant difference（P<0.05）. Conclusion Compared with allogeneic blood，intraoperative blood transfusion has the same influence on blood coagulation and thrombosis. The FIB and DD of the two groups showed regular changes after operation.

Treatment strategy of hemilaminectomy or laminectomy microsurgery for intraspinal tumor of thoracic spine

ZENG Haiyong，LI Baisheng，LUO Honghai.

2017, 17(06):  729-732.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.025

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Objective To analyze and compare the clinical effect of intraspinal tumor of thoracic spine between hemilaminectomy approach and complete laminectomy approach. Methods The clinical database was reviewed for patients with intraspinal tumor of thoracic spine who underwent surgical procedure by hemilaminectomy approach or total laminectomy between January 2010 and June 2016. Of 60 cases received surgery，32 underwent hemilaminectomy approach（observation group）and 28 complete laminectomy（control group）. The perioperative indicators，curative effect，the spinal stability and complications were compare between two groups. Results After surgery，the preoperative symptoms improved in all patients. Compared with complete laminectomy approach ，hemilaminectomy microsurgery showed better clinical effect. There were significant differences between the two groups in the operation time （t=8.473 ，P<0.001），the amount of intraoperative bleeding （t=17.612 ，P<0.001），the time of hospitalization（t=16.655，P<0.001），the time to go out of bed（t=54.138，P<0.001），spinal stability （χ2=6.184，P=0.013）. There was no statistically significant difference in the incidence of complications between two groups. Conclusion The clinical efficacy of hemilaminectomy approach for treatment of intraspinal tumor of thoracic spine is better than that of the laminectomy .

Combination of radiofrequency ablation and ozone technology as treatment on lumbar disc herniation LIU

Xuchen，CHEN Jianping

2017, 17(06):  733-736.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.026

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Objective To explore the clinical effects of plasma radiofrequency ablation combined with ozone technology to treat lumbar disc herniation. Methods Sixty two patients with Lumbar disc herniation were selected and underwent surgical treatment in our hospital from June 2016 to June 2016，in which 31 cases received the management of combination of radiofrequencyablation and ozone technology （observation group） and other 31 were treated with radiofrequencyablation along （control group）. VAS score，Macnab criteria were recorded. F wave and electromyography on posterior tibial nerve and sural total neuromuscular electrical figure were recorded and analyzed. Results In the first， third and sixth months after treatment，the VAS score of both groups decreased significantly（P<0.05）， and the observation group was significantly lower than the control group（P<0.05）. By Macnab criteria， the patients of observation group in the first，third month after treatment had the better clinical effects than that of control group（P<0.05），while in sixth month after treatment there was no statistical difference（P>0.05）. After 6 months of treatment，the velocity of F?wave was significantly higher than that in the control group（P<0.05）. Conclusion The treatment of lumbar intervertebral disc herniation by radiofrequency ablation combined with ozone ablation can significantly reduce postoperative pain and improve the nerve transmission of lumbar spine and lower limb。

Roles of combined no- spa with Shubitong on reducing the frequency of renal colic attack and promoting excretion of stone in patients with upper ureteral stones after the ESWL

PENG Jicai， LUO Zitong，YU Menglei，CAO Yi，ZHU Jie，HUANG Duping，YANG Tao.

2017, 17(06):  737-741.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.027

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Objective To investigate the effects of no- spa and Shubitong capsules for thetreatment of patients with upper ureteral stones after extracorporeal shock wave lithotripsy （ESWL）. Methods A total of 80 patients with stones with the upper ureter were divided into two groups（40 cases in each group）. The patients of observation group were received the management of combined no- spa with Shubitong capsules after ESWL，and the control group underwent ESWL alone without medication. All patients were observe for 14 days. Results In the observation group，the stone removal rate was higher than the control group，the incidence of renal colic pain and the utilization rate of analgesics were lower than those in the control group，and the difference was statistically significance Conclusion The effect of the combined application of no-spa and Shubitong capsules was safe and well after the ESWL of the upper ureteral calculi.

Comparative study of effect of microsurgical and laparoscopic varicocelectomy in treatment of varicocele

LI Yi，LIN Chengchu，WANG Zhiwei.

2017, 17(06):  739-741.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.028

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Objective To evaluate the clinic effect of microsurgical and laparoscopic varicocelectomy in treatment of varicocele. Methods 129 patients with varicocele and infertility are included assign to two group，Group A（n=65）and Group B（n=64）. The patients in Group A received microsurgical varicocelectomy and those in Group B underwent laparoscopic varicocelectomy. The clinical effects were compared between two groups. Results The operation was completed normally in both groups without postoperative complications. The operation time of bilateral varicocelectomy in Group A was longer than that of Group B（P<0.05）. 129 patients were followed up 3 months after operation：Improvement of sperm motility in 84 cases （increase over 20%） including 45 case（45/65） in Group A and 39 case （39/63）in Group B（P>0.05）. 107 cases got 6 months follow-up：Improvement of sperm motility in 21 cases （comparison with the last result is increased by more than 20%） including 17 case（17/52） in Group A and 5（5/55）in Group B（P<0.05）. The data of 12-months follow-up after the operation were close to that of June. Conclusion In this article，microsurgical varicocelectomy approach was superior to laparoscopy varicocelectomy in postoperative curative effect.

Analysis of meningioma recurrence rates following treatment

ZHUO Shaowei，HUANG Liujun， GUO Shaolei，LIN Xioayi，ZHANG Zhunyi，SHI Shaochun，CAI Shujia.

2017, 17(06):  742-750.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.29

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Objective To predict recurrence rate by analysis of the literature to determine the recurrence rate ranges of meningiomas following surgery or radiation. Methods This search collected 13 studies that met all criteria for inclusion and a total of 2048 patients included in the assessment. Results Recurrence rates of meningiomas ranged from 0.00 to 2.36 per 100- person- years for WHO grade Ⅰ meningiomas；and from 7.35 to 11.46 per 100- person- years for WHO grade II meningiomas. From the literature of 14 studies，it was suggested that reported recurrence rates were variable and complicated by the heterogeneity of study populations. WHO grade Ⅱ meningiomas generally had a higher recurrence rate than WHO grade Ⅰ ，when controlling for time of diagnosis. Conclusion Our findings suggest that he recurrence rate of meningioma is difficult to predict accurately.There was a need for more rigorous reporting of recurrence rates，WHO grade，and Simpson grading for individual patients to determine a robust mean of recurrence across WHO grades.

Multimodal treatment of hepatocellular carcinoma

LU Jie，REN Huiqin.

2017, 17(06):  747-750.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.030

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Hepatocellular carcinoma（HCC）represents the most common liver cancer with an increasing incidence and it accounts for the third most common cause of cancer-related death worldwide. Even though the clinical diagnosis and management of HCC improved significantly in the last decades ， this malignant disease is still associated with a poor prognosis. Based on Barcelona- Clinic Liver Cancer （BCLC）staging system different surgical，interventional radiological/sonographical and non-interventional procedures have been established for the multimodal treatment of HCC. The BCLC classification system represents a decision guidance；however because of its limitations in selected patients treatment allocation should be determined on an individualized rather than a guideline-based medicine by a multidisciplinary board in order to offer the best treatment option for each patient. This review summarizes the current management of HCC.

The investigation of hepatitis B patients with stigma and its influence

LIU Lingyun，WANG Ruomei，BAIMA Quci.

2017, 17(06):  751.  DOI: doi：10.3969/j.issn.1009?976X.2017.06.031

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Objective To describe the status of stigma in patients with chronic hepatitis B， and discuss the influencing factors of stigma in patients with chronic hepatitis B. Methods By a descriptive research design，convenient sampling，stigma questionnaire survey were performed in 34 patients with chronic hepatitis B in a three- level hospital of Guangzhou. Results The four dimensions of the highest average score were intrinsic shame and the lowest was social isolation ，followed by the rest of social rejection and economic discrimination. The differences between marital status ，education level and family average monthly income levels in chronic hepatitis B patients with the stigma of were statistically significant. The stigma in single patients（including unmarried/widowed/divorced）were higherscores than in the married，the lower level of education and lower monthly income of family were more obvious. The differences between gender，age，nationality，religion and occupation hadnot statistical significance. Conclusion In the present study，stigma of patients with chronic hepatitis B in a higher level，and within the shame feeling was the most prominent. The single（containing unmarried，divorced and widowed） in patients with chronic hepatitis B，the stigma was significantly higher than that of the married；patients with education level was low，the higher the stigma；average monthly income is low，the stigma higher.