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Objective To assess the safety and effectiveness of laparoscopic implantation of three-dimensional (3D)-printed extravascular stent for treatment of nutcracker syndrome (NCS).Methods The clinical data of NCS in our hospital were prospectively collected from August 2015 to August 2016.Doppler ultrasound and CT examination were performed before the operation of all the patients who were in line with the diagnostic criteria of NCS.The 3D model of extravascular stents with especial device to prevent migration was designed and was made by 3D metal printer with titanium alloy.The left renal vein(LRV) was exposed completely up to the inferior vena cava,then the stent was placed around the compressed LRV.Results 10 patients were enrolled in the study,including 9 males and 1 females,age (21.5 ±4.6) years.Among these patients,there were 4 cases with severe hematuria,1 case with proteinuria,5 cases with left lumbago,and 5 cases with left severe varicocele.The preoperative doppler ultrasound examination showed the diameter of the the compressed LRV was (1.57 ± 0.25) mm,and flow velocity was (164.40 ± 55.27) cm/s;the diameter of the LRV at the renal hilum was (8.7 ± 1.59) mm,and flow velocity was (10.70 ± 2.21) cm/s.The average operation time was (75 ± 11) min,and the average hospital stay after operation was 7 d.All symptoms were relieved at 3-7 d after operation.All patients were asymptomatic and all stents were stable after follow-up.At 12 months after surgery,the diameter of the LRV at the renal hilum was (8.23 ± 1.90) mm on doppler ultrasound,and there was significant decrease (P ＜ 0.01);the flow velocity was (21.20 ±3.88) cm/s,and there was significant increase (P ＜ 0.01).Conclusions Laparoscopic three-dimensional printed extravascular stent placement is a safe,effective and minimally invasive technique for treatment of NCS.
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Objective To measure the costs of primary health services in the community for developing government compensation standard and prediction of budget in 201 5.Methods Literature review and panel discussions were used to build the index database.A two-round Delphi expert consultation determined the work to do and steps for community healthcare standards.60 community health centers were sampled by stratified random sampling for survey,and the work hours,workload and service volume of respective services in 2013 were measured according to the service standards of primary care.Results The community primary care consists of the categories of outpatient services,nursing care, laboratory tests and drug management,totaling 20 services and 88 working procedures.The total work hours of primary healthcare service at 60 community health centers were 2 557 187.9 hours,which is adjusted to 2 959 21 5.1 hours based on workload coefficients.Based on the income standards of employees at the community health centers investigated,and the human cost price which was recommended by the experts,the total costs of primary healthcare of the 60 centers were 245 million,248 million and 318 million respectively,and the average cost was 71.0 yuan,71.8 yuan and 92.1 yuan per visit respectively.By such standards,the government should subsidize 38.9 ~ 60.0 yuan per visit to the centers.The total expenditure of primary healthcare of all communities in Shenzhen in 201 5 was predicted to be 314 to 407 million,for which the government is expected to subsidize 1.68~2.58 billion.Conclusion The subsidies for community primary healthcare fall short as the cost per visit runs up in 2013 to 71.0 yuan per visit or more,far above the current subsidy of 32.1 yuan per person.The subsidy per visit should be made 50.0 yuan in 201 5.
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Objective To understand the clinical features and laboratory examination and diagnosis of Langerhas cell histio-cytosis (LCH) in newborns. Methods Retrospective analysis of the clinical data of a neonatal case of LCH was performed. Results A one-day-old girl was admitted with chief complaint of eating less, less crying and skin rash for one day. The unequal sized rash was on the head, limbs, trunk, toe and oral mucosa. The skin rashes were protruding from the skin and were partially broken and crusted. Biopsy of the skin tissue showed the expression of S-100 and CD1α, consistent with the diagnosis of LCH. Conclusions When new-borns have special rash after birth, LCH should be considered. To avoid misdiagnosis, skin biopsy should be performed.
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Overall enhancement of the public health system ranks a key task and goal for the ongoing health reform.This paper described the public health development in Shenzhen amid the ongoing health reform.Shenzhen has achieved the following objectives as required in the reform:better public service by public health institutions,availability of major and primary public health services as required by the state and city,overall elevation of public health service capabilities,and significant drop of disease morbidity and mortality.Challenges ahead include room of improvement in public health service network,incentive mechanism of public health service providers,and that of public health service delivery capability.
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Objective To explore the clinical value of the level of granzyme B and perforin mRNA in urine for the diagnosis of renal transplantation patients with delayed graft function (DGF). Methods Twenty-four cases of renal transplantation patients with DGF were included in this study. Seventy-three u-rine specimens were obtained from these patients who received graft biopsies. Among the 24 cases, ureteral obstruction occurred in 2 cases, vascular thrombosis in 1 case, acute CsA intoxication in 3 cases, acute tubu-lar necrosis (ATN) in 7 cases, ATN complicating borderline change in 2 cases, ATN complicating acute re-jection (AR) in 3 cases, AR in 6 cases. Total RNA was isolated from the urinary cells. Messenger RNA (mRNA) encoding the cytotoxic proteins perforin and granzyme B gene were measured with the quantitative polymerase-chain-reaction assay-(RT-PCR). SPSS13.0 software was used for data analysis. Levels of mRNA were log-transformed before analysis. Results The levels of perforin and granzyme B mRNA in u-rine among the ureteral obstruction group, vascular thrombosis group, acute CsA intoxication group and ATN group were very low. There was no significant difference among these groups (P>0.05). However,among the ATN complicating borderline change group 1.22, 0. 97 fg/μg, ATN complicating AR group (1.20±0.39), (1.07±0.30)fg/μg, and AR group(11.13±0. 33), (1.01±0.19)fg/μg, the levels were increased significantly(P<0.001). Conclusion Measurement of mRNA encoding the cytotoxic proteins perforin and granzyme B gene in urinary cells in renal transplantation patients with DGF could be helpful to etiological diagnosis of DGF, and might be used as an index for the appropriate management of the borderline change.
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Objective To study the expression of high molecular weight cytokeratin (CK34βE12) in breast carcinoma and the relationship between the high molecular weight cytokeratin expression and patient's prognosis. Methods We detected the high molecular weight cytokeratin expression in 100 patient's of breast cancer tissues and paracancerous breast tissue in 30 cases immunohistochemically. The relationship between the expression of high molecular weight cytokeratin in breast cancer tissues and age, menstrual status, estrogen receptor expression, progesterone receptor expression, histology grading, TNM staging, pathology type, and patient survival was analyzed. Results (1) There was no significant correlation between high molecular weight cytokeratin expression of breast -cancer tissues and age, menstrual status, estrogen receptor expression, progesterone receptor expression (all P>0.05). But the correlation was statistically significant between that expression and histology grading, TNM staging, pathology category (all P<0.05). (2) By univariate analysis, the 5-year disease-free survival rate in patients with negative expression was lower than those with positive expression(P<0.05). By multivariate analysis, the expression of high molecular weight cytokeratin was unfavorably related with tumor free survival. Conclusion The expression of high molecular weight cytokeratin in breast carcinoma tissues was correlated with biologic malignancies of breast cancer, the negative high molecular weight cytokeratin expression of breast cancer tissues predicts poor prognosis.
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Objective To observe the expression of cell proliferation and apoptosis in congenital pulmonary cyst and to investigate their effect in the development of aspergillus.Methods Immunohistochemical method was used to detect the expression of KI-67、BCL-2 and BAX in normal lung tissue from 10 adult(control group 1,CG1),relative normal lung tissue around the aspergillus from 20 aspergillus cases(control group 2,CG2)and abnormal lung tissue from 20 aspergillus cases.Results The expressions of KI-67,BAX and the ratio of BAX/BCL-2 in the bronchial epithelium of aspergillus were significantly higher than those in two control groups(P
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Objective To explore the expression of COX-2,PD-ECGF and VEGF in gastric carcinoma tissue,and analyze and identify the relationship between the expression and tumor angiogenesis together with biological behaviour in gastric carcinoma.Methods ElivisionTM immunohistochemical method was performed to detect the expression of COX-2,PD-ECGF,VEGF and CD34,and evaluate the value of MVD in surgically resected gastric carcinoma specimens and biopsy tissues under gastroscope,including normal gastric mucosa tissues, metaplasia tissues and gastric mucosal atypical hyperplasia tissues. Clinicopathologic data of patients were analyzed retrospectively. Results The positive expression of COX-2, PD-ECGF,VEGF and MVD in gastric carcinoma were significantly higher than those in normal gastric mucosa, metaplasia or gastric mucosal atypical hyperplasia,and also their expression and MVD were closely related to lymph node metastasis and depth of invasion. The MVD in the groups of COX-2,PD-ECGF,VEGF positive-expression were significantly higher than those in negative-expression groups respectively. There were positive correlations among the expression of COX-2,PD-ECGF and VEGF in gastric carcinoma. MVD increased significantly when COX-2, PD-ECGF and VEGF coexpressed. Conclusion The expression of COX-2,PD-ECGF,VEGF and tumor angiogenesis participated in the genesis,invasion and metastasis of human gastric carcinoma.COX-2,PD-ECGF and VEGF participated in the tumor angiogenesis of gastric carcinoma. In the process of tumor angiogenesis and expression in gastric carcinoma, COX-2, PD-ECGF and VEGF could strengthen the effectiveness each other.They could strengthen the effective ness of tumor angiogenesis when they coexpressed. They could be selected as targets for tumor anti-angiogenesis treatment.