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1.
Background
Ovarian torsion in children is an uncommon cause of acute abdominal pain but mandates early surgical management to prevent further adnexal damage. The clinical presentation mimics other pathologies, such as appendicitis. We sought to more completely characterize ovarian torsion with respect to pain and ancillary studies, such as urinalysis.Methods
We performed a retrospective review of hospital charts of all patients aged 0–18 years with a diagnosis of ovarian torsion at the Children’s Hospital at London Health Sciences Centre, in London, Ont., from 1993 to 2008.Results
We analyzed 13 charts of patients aged 7 months to 18 years. Most patients presented with peripheral leukocytosis, vomiting and right lower quadrant pain that did not radiate or migrate. On urinalysis, about half the patients demonstrated pyuria without bacteruria. Pelvic ultrasound revealed an ovarian cyst on the same side of the pain in 11 of 13 patients. Most were found to have a hemorrhagic cyst or ovary and underwent salpingo-oophorectomy or cystectomy within 48 hours of presentation.Conclusion
Ovarian torsion should be considered in any female child with acute onset lower abdominal pain accompanied by vomiting. Pain can be characterized as constant or colicky, but unlike with appendicitis, does not typically migrate. Sterile pyuria is found in a substantial proportion of cases. Ultrasound is the most useful initial diagnostic modality, but the absence of flow on Doppler imaging is not always present. Conservative management with detorsion and oophoropexy is recommended. 相似文献2.
Perger L Muensterer OJ 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2011,15(4):565-567
Background:
Torsion of an otherwise normal appendix vermiformis is exceedingly rare and usually presents with symptoms consistent with acute appendicitis. We present the unusual case of an infant girl who was admitted with right lower quadrant pain and focal peritonitis who was found to have appendiceal torsion on laparoscopy.Case Report:
An 11-week-old girl was brought to the emergency department with a 48-hour history of abdominal pain, emesis, low-grade fever, and focal right lower quadrant tenderness. Sonography found a noncompressible distended appendix in the right lower quadrant. Upon laparoscopy, a torsed, necrotic appendix vermiformis was found. Appendectomy was performed, and the patient recovered uneventfully.Conclusion:
In an infant girl with lower abdominal pain, the differential diagnosis should include torsed appendix besides more common causes, such as torsed ovary, intussusception, or small bowel volvulus. Ultrasound is useful for planning the operative approach. 相似文献3.
Milan Thomas Narendra Nath Basu Manpreet Singh Gulati Tayo Oke Gabriel Constantinescu Midhat Siddiqui 《Annals of the Royal College of Surgeons of England》2009,91(4):340-343
INTRODUCTION
Isolated duodenal injury due to blunt abdominal trauma is extremely rare. We present a series of three such injuries due to go-karting accidents, which presented to our hospital over 5 months.CASE REPORTS
Between October 2007 and February 2008, three cases of D3/D4 duodenal rupture presented to our hospital after go-karting accidents. Trauma occurred as a result of the steering wheel impacting on the abdomen. All patients presented similarly with symptoms of epigastric and right upper quadrant pain. In all cases, computed tomography scanning was highly suggestive of duodenal injury and, in particular, demonstrated presence of retroperitoneal air centred around the duodenum. Treatment required laparotomy and operative repair in all cases.CONCLUSIONS
Duodenal injury presents insidiously due to its retroperitoneal position. A low threshold for investigating patients presenting with epigastric and right upper quadrant pain should be adopted along with active clinical vigilance to exclude serious and life-threatening trauma after go-karting accidents. 相似文献4.
Objectives
To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000–2009 with the Medical Subject Headings (MeSH) and Emtree term ‘spinal cord diseases’ and determine changes in the number of articles over this period.Design
Literature searches and search filter development.Setting
Australia.Interventions
Titles and abstracts searched in MEDLINE and EMBASE (2000–2009) for articles involving humans using search terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ (concise search). Develop comprehensive search filter for ‘spinal cord damage not due to trauma’ and compare the results with the MeSH term ‘spinal cord diseases.’Outcome measures
Annual publications (2000–2009) identified in MEDLINE and EMBASE literature searches.Results
Concise search identified 35 articles published during 2000–2009. More publications were identified using the term ‘nontraumatic spinal cord injury’ (n = 20) than ‘non-traumatic spinal cord injury’ (n = 16). Publications increased for both terms ‘spinal cord diseases’ (2000 = 279; 2009 = 415) and ‘spinal cord damage not due to trauma’ identified by the comprehensive search filter (2000 = 1251; 2009 = 1921).Conclusions
Concise searches using terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for ‘spinal cord damage not due to trauma.’ 相似文献5.
INTRODUCTION
Small bowel injuries after blunt abdominal trauma represent both a diagnostic and a therapeutic challenge. Early diagnosis and prompt treatment are necessary in order to avoid a dangerous diagnostic delay. Laparoscopy can represent a diagnostic and therapeutic tool in patients with uncertain clinical symptoms.PRESENTATION OF THE CASE
We report the case of a 25-year-old man, haemodynamically stable, admitted for acute abdominal pain a few hours after a physical assault. Giving the persistence of the abdominal pain and the presence of free fluids at the computed tomography examination, an exploratory laparoscopy was performed.DISCUSSION
At the laparoscopic exploration, an isolated small bowel perforation was found, 60 cm distal from the ligament of Treitz. The injury was repaired by laparoscopic suturing and the patient was discharged home at postoperative day 3 after an uneventful postoperative course.CONCLUSIONS
Laparoscopy represents a valuable tool for patients with small bowel blunt injuries allowing a timely diagnosis and a prompt treatment. 相似文献6.
Mehmet Odabasi Cem Arslan Hasan Abuoglu Emre Gunay Mehmet Kamil Yildiz Cengiz Eris Erkan Ozkan Ali Aktekin M.A. Tolga Muftuoglu 《International journal of surgery case reports》2014,5(2):76-78
INTRODUCTION
Atypical presentations of appendix have been reported including backache, left lower quadrant pain and groin pain from a strangulated femoral hernia containing the appendix. We report a case presenting an epigastric pain that was diagnosed after computed tomography as a perforated appendicitis on intestinal malrotation.PRESENTATION OF CASE
A 27-year-old man was admitted with a three-day history of epigastric pain. Physical examination revealed tenderness and defense on palpation of epigastric region. There was a left subcostal incision with the history of diaphragmatic hernia repair when the patient was 3 days old. He had an intestinal malrotation with the cecum fixed at the epigastric region and the inflamed appendix extending beside the left lobe of liver.DISCUSSION
While appendicitis is the most common abdominal disease requiring surgical intervention seen in the emergency room setting, intestinal malrotation is relatively uncommon. When patients with asymptomatic undiagnosed gastrointestinal malrotation clinically present with abdominal pain, accurate diagnosis and definitive therapy may be delayed, possibly increasing the risk of morbidity and mortality.CONCLUSION
Atypical presentations of acute appendicitis should be kept in mind in patients with abdominal pain in emergency room especially in patients with previous childhood operation for diaphragmatic hernia. 相似文献7.
Richard M. Peterson Curtis Ollayos Deepak Merchant 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(3):392-395
Background:
The urachus is a vestigial structure between the dome of the bladder and the umbilicus. Tumors may develop from the remnants, most of which are well-differentiated, mucinous adenocarcinomas. Urachal adenocarcinoma is an exceedingly rare type of tumor.Methods:
We present a case of a 51-year-old female presenting to our institution with complaints of abdominal pain for 36 hours. The patient was taken to the operating room for an acute appendicitis. Laparoscopy was performed, and gross purulence and appendiceal perforation were noted as well as a mass on the anterior abdominal wall. Based on the location of the mass, we converted to an open midline laparotomy to treat both the perforated appendicitis and to remove the mass.Results:
Pathology confirmed the diagnosis of perforated appendicitis and a mucinous-producing urachal adeno-carcinoma.Discussion:
Data support both open and laparoscopic approaches for appendicitis. This case, although rare, highlights the importance of laparoscopy in a complete and thorough examination of the abdominal cavity. A standard right lower quadrant incision for an open technique would likely have resulted in omission of this lesion, and the patient would have presented at a more typical late stage of her cancer development with significantly more morbidity. 相似文献8.
Basili G Romano N Bimbi M Lorenzetti L Pietrasanta D Goletti O 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2011,15(2):268-271
Background:
Ovarian vein thrombosis (OVT) is a rare but potentially serious postpartum complication, which occurs in 0.05% to 0.18% of pregnancies and is diagnosed on the right side in 80% to 90% of the cases.Case Report:
A 32-year-old woman presented at 15 days postpartum to our emergency department with severe abdominal pain, fever, and abdominal distension. Abdominal examination revealed right lower quadrant pain with rebound tenderness. The plain abdominal radiography evidenced a diffuse fecal stasis; abdominal ultrasound showed the presence of free fluid in the Douglas’ pouch and between small bowel loops. Diagnosis of acute appendicitis was made. The patient immediately underwent explorative laparoscopy; at surgery, a woody tumoration consistent with right ovarian vein thrombosis was found. Laparoscopic ultrasound confirmed the diagnosis. Anticoagulation therapy and antibiotics were instituted. CT-scan confirmed the presence of thrombosis up to the vena cava. The patient was discharged on postoperative day 4. At 1-month follow-up, she remained stable and symptom free.Discussion:
Even though postpartum ovarian vein thrombosis is rare, recognition and treatment is needed to institute adequate therapy and avoid potential serious sequelae. The diagnosis can be established by ultrasound, CT scan, and MRI examinations, although, as in the case described, the limitation of ultrasound includes obscuration of the gonadic vein by overlying bowel gas.Conclusion:
OVT should be considered in any woman in the postpartum period with lower abdominal pain, fever, and leucocytosis. 相似文献9.
Anshuman Sengupta George Bax Simon Paterson-Brown 《Annals of the Royal College of Surgeons of England》2009,91(2):113-115
INTRODUCTION
Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain.PATIENTS AND METHODS
WCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient''s outcome.RESULTS
No patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications.CONCLUSIONS
This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home. 相似文献10.
Becerra P Becerra V Aguilar C Modragon I Cooper DK 《International journal of surgery case reports》2011,2(7):228-229
Introduction
There is a high incidence of gallstones in the Chilean population.Presentation of case
We report on a 57-year-old man who complained of abdominal pain in the right upper quadrant. Abdominal ultrasound indicated acute cholecystitis and a single, extremely large pear-shaped gallstone (16.8 cm long, and 7.8 cm at its widest point and 4.1 cm at its narrowest point). Its fresh weight (at operation) was 278.0 g and, after 4 years, its dry weight was 259.5 g. Emergency classical cholecystectomy was carried out successfully.Discussion and Conclusion
We have been unable to find a report of a larger gallstone in the English or Spanish language medical literature. 相似文献11.
Gregorio Zubieta-O’Farrill José Raúl Guerra-Mora Andrés Gudi?o-Chávez Carlos Gonzalez-Alvarado Gilberto Bernabe Cornejo-López Eduardo Villanueva-Sáenz 《International journal of surgery case reports》2014,5(12):961-963
INTRODUCTION
Appendiceal diverticulosis is a rare entity, with a global incidence between 0.004% and 2.1% of all appendectomies. It has been related with an elevated risk of perforation in comparison to acute appendicitis, as well as an increased risk for synchronic appendicular cancer in 48% of the cases, and colonic cancer in 43%. The incidence of chronic appendicitis has been reported in 1.5% of all appendicitis cases.PRESENTATION OF CASE
We present a 73-year-old female, with no relevant familial history, who presented due to a four-month-long oppressive, moderate pain in the lower right abdominal quadrant without irradiation or any other accompanying symptoms.DISCUSSION
The documented incidence of appendiceal diverticula and chronic appendicitis by themselves is low; therefore the presence of both entities at the same time is extremely rare.CONCLUSION
We present a case in which both diagnoses concurred in the same patient. The relevance of this case relies on the importance of the adequate knowledge of these pathologies, so we can approach them correctly. Although it does not represent an absolute surgical emergency, appendectomy represents the first therapeutic option. 相似文献12.
Huseyin Aksoy Sezin Ozyurt Ulku Aksoy Gokhan Acmaz Ozge Idem Karadag Mert Ali Karadag 《International journal of surgery case reports》2014,5(12):1074-1076
INTRODUCTION
Ovarian torsion (OT) is a rare cause of acute abdominal pain that requires prompt recognition and treatment during puerperium. Diagnosis of OT can be challenging due to nonspecific clinical features and uncommon objective findings. The management of OT is often delayed because of diagnostic uncertainty. Early and timely recognition and prompt intervention are crucial to preserve ovarian function and to minimize morbidity.PRESENTATION OF CASE
We report a 29-year-old postpartum woman who presented to the emergency department (ED) with severe right flank pain, nausea and anorexia initially considered as renal colic. After further investigation, OT caused by large mucinous cyst was diagnosed. Right-sided salpingo-oophorectomy was performed due to hemorrhagic ovary and huge cystic mass causing ischemic OT.DISCUSSION
OT is often diagnosed based on the clinical presentation, including severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness with a palpable laterouterine pelvic mass and nausea/vomiting. Emergency surgical intervention should be performed if OT is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage.CONCLUSION
In conclusion, emergency physicians should be aware of the possibility of OT in postpartum women. Therefore, early and timely surgical intervention should be undertaken. 相似文献13.
TC Hall AR Dennison DK Bilku MS Metcalfe G Garcea 《Annals of the Royal College of Surgeons of England》2012,94(5):318-326
INTRODUCTION
The terms ‘enhanced recovery after surgery’, ‘enhanced recovery programme’ (ERP) and ‘fast track surgery’ refer to multimodal strategies aiming to streamline peri-operative care pathways, to maximise effectiveness and minimise costs. While the results of ERP in colorectal surgery are well reported, there have been no reviews examining if these concepts could be applied safely to hepatopancreatobiliary (HPB) surgery. The aim of this systematic review was to appraise the current evidence for ERP in HPB surgery.METHODS
A MEDLINE® literature search was undertaken using the keywords ‘enhanced recovery’, ‘fast-track’, ‘peri-operative’, ‘surgery’, ‘pancreas’ and ‘liver’ and their derivatives such as ‘pancreatic’ or ‘hepatic’. The primary endpoint was length of post-operative hospital stay. Secondary endpoints were morbidity, mortality and readmission rate.RESULTS
Ten articles were retrieved describing an ERP. ERP protocols varied slightly between studies. A reduction in length of stay was a consistent finding following the incorporation of ERP when compared with historical controls. This was not at the expense of increased rates of readmission, morbidity or mortality in any study.CONCLUSIONS
The introduction of an ERP in HPB surgery appears safe and feasible. Currently, many of the principles of the multimodal pathway are derived from the colorectal ERP and distinct differences exist, which may impede its implementation in HPB surgery. 相似文献14.
SS Sarmah S Patel G Reading M El-Husseiny S Douglas FS Haddad 《Annals of the Royal College of Surgeons of England》2012,94(5):302-307
INTRODUCTION
The number of total knee arthroplasties performed continues to rise annually and it would be expected that complications, which include periprosthetic fractures, will also therefore become more commonplace. This article reviews the current literature regarding this injury and identifies the treatment principles that enable patients to regain optimal function.METHODS
A comprehensive search of the Pubmed and Embase™ databases was performed to identify relevant articles. Keywords and MeSH (Medical Subject Headings) terms included in the search strategy were ‘periprosthetic fracture(s)’, ‘femur’, ‘tibia’, ‘patella(r)’, ‘complication(s)’, ‘failure(s)’, ‘risk(s)’, ‘prevalence’, ‘incidence’, ‘epidemiology’ and ‘classification(s)’. The search was limited to all articles published in English and reference lists from the original articles were reviewed to identify pertinent articles to include in this review. A total number of 43 studies were identified.RESULTS
Common treatment aims have been identified when managing patients with a periprosthetic fracture around total knee arthoplasty. The main criterion that determines which option to choose is the degree of remaining bone stock and the amount of fracture displacement.CONCLUSIONS
Treatment of a periprosthetic fracture around total knee arthroplasty will either be non-operative, osteosynthesis or revision arthroplasty. It is imperative that a suitable option is chosen and based on the published literature, pathways are outlined to aid the surgeon. 相似文献15.
Kordzadeh A 《International journal of surgery case reports》2011,2(8):264-266
Introduction
Vanek''s tumour or Inflammatory Fibroid Polyp (IFP) are rare, benign localised lesions originating from the sub-mucosa of the gastrointestinal tract (GI) tract.1 They have been widely reported as occurring within the stomach, Duodenum, Jejunum and Ileum, more rarely (<1%) in the caecum or appendix.Presentation of case
We present a case of a 28-year-old lady who presented with a 2-day history of right iliac fossa pain, nausea and low-grade fever. Subsequent, ultrasonography (USS) of the abdomen demonstrated an inflamed tubular structure originating from caecum with fluid in the pelvis mimicking an acute appendicitis. Next to normal appendix an inflammatory polypoid mass was identified and on histological examination confirmed to be an IFP (Vanek''s tumour).Discussion
Right Iliac Fossa (RIF) pain with suspected appendicitis is one of the most common presentations in any acute surgical unit. In young women of childbearing age, the differential diagnosis can be varied and vast. The surgical management of IFP (Vanek''s tumour) in such cases ranges from limited resection and caecectomy to limited right hemicolectomy.Conclusion
To date, the exact histiogenesis of these tumours remains unclear and requires a high level of intra-operative suspicion. According to our search such presentation is not reported. 相似文献16.
Introduction
Very few cases of superior mesenteric vein thrombosis have been reported as a complication of appendicitis. In these handful of cases, the thrombosis was identified early with computerised tomography scan and patients have been managed conservatively with antibiotics and anticoagulation.Presentation of case
A 45-year-old gentleman presented to the emergency department with a 13-day history of right lower quadrant abdominal pain and rigors. CT scan of the abdomen revealed an appendicular mass and superior mesenteric vein thrombosis. The patient was initially managed by anticoagulation and antibiotics for two weeks and was discharged after satisfactory clinical improvement. He represented after discharge for increased severity of his abdominal pain and abnormal inflammatory markers. Emergency open appendicectomy for complicated appendicitis was performed and his postoperative course was unremarkable. He was discharged on the 7th postoperative day with anticoagulation. Outpatient review at two months was unremarkable.Discussion
Acute appendicitis is a common surgical presentation where history and examination is key in clinching the diagnosis. Inflammatory markers and imaging modalities such as a CT scan can be helpful. Although surgical intervention is the mainstay of treatment, conservative management with antibiotics is an option if the diagnosis of appendicitis is equivocal. Recent evidence has revealed that elective appendicectomy is not necessary upon successful conservative management. Acute appendicitis can lead to local perforations and abscesses. Complications such as thrombosis in the superior mesenteric vein are rare and can be managed successfully with anticoagulants.Conclusion
Although this is a rare complication of appendicitis, the case was managed successfully with a conservative approach. This is inline with the general consensus which is to treat superior mesenteric vein thrombosis secondary to appendicitis conservatively unless the patient deteriorates. 相似文献17.
Bagley CH Hunter AR Bacarese-Hamilton IA 《Annals of the Royal College of Surgeons of England》2011,93(5):401-404
INTRODUCTION
Patients'' understanding of their medical problems is essential to allow them to make competent decisions, comply with treatment and enable recovery. We investigated Patients'' understanding of orthopaedic terms to identify those words surgeons should make the most effort to explain.METHODS
This questionnaire-based study recruited patients attending the orthopaedic clinics. Qualitative and quantitative data were collected using free text boxes for the Patients'' written definitions and multiple choice questions (MCQs).RESULTS
A total of 133 patients took part. Of these, 74% identified English as their first language. ‘Broken bone’ was correctly defined by 71% of respondents whereas ‘fractured bone’ was only correctly defined by 33%. ‘Sprain’ was correctly defined by 17% of respondents, with 29% being almost correct, 25% wrong and 29% unsure. In the MCQs, 51% of respondents answered correctly for ‘fracture’, 55% for ‘arthroscopy’, 46% for ‘meniscus’, 35% for ‘tendon’ and 23% for ‘ligament’. ‘Sprained’ caused confusion, with only 11% of patients answering correctly. Speaking English as a second language was a significant predictive factor for patients who had difficulty with definitions. There was no significant variation among different age groups.CONCLUSIONS
Care should be taken by surgeons when using basic and common orthopaedic terminology in order to avoid misunderstanding. Educating patients in clinic is a routine part of practice. 相似文献18.
Young A Ismail M Papatsoris AG Barua JM Calleary JG Masood J 《Annals of the Royal College of Surgeons of England》2012,94(1):8-11
INTRODUCTION
Entonox® (50% nitrous oxide and 50% oxygen; BOC Healthcare, Manchester, UK) is an analgesic and anxiolytic agent that is used to successfully reduce pain and anxiety during dental, paediatric and emergency department procedures. In this article we review the application and efficacy of Entonox® in painful local anaesthesia urological procedures by performing a systematic review of the literature.METHODS
A MEDLINE® search was performed using the terms ‘nitrous oxide’, ‘Entonox’, ‘prostate biopsy’, ‘flexible cystoscopy’ and ‘extracorporeal shock wave lithotripsy’. English language publications of randomised studies were identified and reviewed.RESULTS
The search yielded five randomised studies that investigated the clinical efficacy of Entonox® as an analgesic for day case urological procedures. Three randomised controlled trials (RCTs) investigated Entonox® in transrectal ultrasonography guided prostate biopsy. All three reported significant reductions in pain score in the Entonox® versus control groups. One RCT reported significant reduction in pain during male flexible cystoscopy in the Entonox® group compared with the control group. One RCT, which examined the use of Entonox® during extracorporeal shock wave lithotripsy, found its use significantly decreased the pain score compared with the control group and this was comparable to intravenous pethidine.CONCLUSIONS
Evidence from varied adult and paediatric procedures has shown Entonox® to be an effective, safe and patient acceptable form of analgesia. All published studies of its use in urological day case procedures have found it to significantly reduce procedural pain. There is huge potential to use this cheap, safe, effective analgesic in our current practice. 相似文献19.
Gerrand C McNulty G Brewster N Holland J McCaskie A 《Annals of the Royal College of Surgeons of England》2007,89(7):685-688
INTRODUCTION
The introduction of minimally invasive techniques for hip replacement into clinical practice has been driven by the perceived benefits of smaller incisions, shorter in-patient stays and faster rehabilitation. This may be at the cost of higher complication rates. The purpose of this study was to explore the opinions and priorities of patients in relation to these techniques.PATIENTS AND METHODS
A cross-sectional survey was performed in an elective out-patient setting.RESULTS
Of 44 patients approached, 36 agreed to participate. From most important to least important, patients rated the following items in order: ‘rate of complications’; ‘implant survival’; ‘length of rehabilitation’; ‘time in hospital’ and ‘length of scar’. Despite this, 21 of 35 (60%) responders stated they would accept the offer of minimally invasive techniques if made.CONCLUSIONS
Patients appear to prioritise long-term outcomes and low complication rates over the shorter scars, reduced in-patient stay and reduced rehabilitation times potentially offered by minimally invasive hip arthroplasty. Despite this, the technique remains popular among patients. 相似文献20.
David H. Ballard Nadine M. Kaskas Alireza Hamidian Jahromi Justin Skweres Asser M. Youssef 《International journal of surgery case reports》2014,5(12):1238-1241