This article is to report the result and experience of the clinical application of the extraluminal circumferential-suture ligation to close the bronchial stumps after pulmonary resections. This method was used for 469 times in 400 patients with various diseases including tuberculosis, lung cancer, and chronic suppurative disease with excellent results. After the use of this method, the incidence of the dreadful postoperative complication of broncho-pleural fistula was reduced to only 0.25%, and it never occurred when a main or a large bronchus was involved.It is pointed out that the advantage of this extraluminal circumferential-suture ligation method cannot be overemphasized and its success lies on two crucial steps as follows:1. The traditional open method to divide a bronchus is substituted with the new close method, which can avoid spraying the highly infectious bronchial contents into the pleural cavity to cause contamination. Thus the main source of infection is cut off.2. Every stitch of the circumferential suture is done extraluminally without penetrating the whole thickness of the bronchial wall or entering the infections bronchial lumen, which will further minimize the chance of infection.

ObjectiveTo investigate the impact of blood glucose,blood pressure and blood uric acid level on hematuria in patients with acute coronary syndrome (ACS).MethodsOne hundred and sixty-two ACS patients were selected and received standardized treatment after admission to hospital.Urine test was taken and patients were divided into no hematuria group(37 cases),microscopic hematuria group (56 cases) and gross hematuria group(69 cases) according to the results.Blood pressure,fasting and postprandial 2 hours blood glucose,glycated hemoglobin and blood uric acid level were measured and compared among three groups.ResultsMicroscopic hematuria group compared with no hematuria group,fasting and postprandial 2 hours blood glucose,glycated hemoglobin,systolic blood pressure and blood uric acid level raised 58.0％[(7.9 ±0.7) mmol/L vs. (5.0 ± 1.1) mmol/L],33.3％[(12.4 ±0.8) mmol/L vs.(9.3 ± 0.6 ) mmol/L ],48.2％ [ ( 8.3 ± 0.8 )％ vs.( 5.6 ± 0.5 )％ ],23.8％ [ ( 151.6 ± 7.0) mm Hg ( 1 mm Hg =0.133 kPa) vs.(122.5 ±9.9) mm Hg],29.2％ [(635.4 ±47.4) μmol/L vs.(491.8 ±83.4)μmol/L]respectively,there were significant differences (P ＜ 0.05 or ＜ 0.01 ).Gross hematuria group compared with microscopic hematuria group,the above mentioned indexes raised 16.5％[ (9.2 ± 1.1 ) mmol/L vs.(7.9 ± 0.7)mmol/L],30.6％[ ( 16.2 ± 1.8) mmol/L vs.( 12.4 ± 0.8) mmol/L],14.5％[ (9.5 ± 0.8)％ vs.(8.3 ± 0.8)％ ],18.8％[(180.1 ± 12.3) mm Hg vs.(151.6 ±7.0) mm Hg],34.6％[(855.5 ±74.5) μ mol/L vs.(635.4 ±47.4 ) μ mol/L ] respectively,there were significant differences ( P ＜ 0.05 or ＜ 0.01 ).Gross hematuria group compared with no hematuria group,the above mentioned indexes increased significantly(P＜ 0.01 ).The level of diastolic blood pressureamong three groups had no significant difference(P ＞ 0.05).The Logistic regression analysis showed that fasting and postprandial 2 hours blood glucose (r =3.175,P =0.001 ;r =0.906,P =0.001 ),glycated hemoglobin ( r =16.109,P =0.001 ),systolic blood pressure (r =0.429,P =0.003 ),blood uric acid level(r =1.317,P =0.004) were risk factors on hematuria after antiplatelet and anticoagulant therapy in ACS patients,the impact of glycated hemoglobin and fasting blood glucose on hematuria was stronger than that of blood uric acid level and systolic blood pressure.ConclusionWith the increase of blood glucose,systolic blood pressure,blood uric acid,the risk of hematuria increases in ACS patients.

Objective To investigate the relationship between the activity of nicotinamide adenosine dinucleotide phosphate(NADPH ) oxidase in peripheral blood mononuclear cell and left ventricular remodeling in patients with acute myocardial infarction (AMI).Methods Fifty-two patients with AMI hospitalized from December 2010 to June 2011 were selected as AMI group,and 25 patients with paroxysmal supraventricular tachycardia hospitalized in the same period were selected as control group.All patients were examined by Doppler echocardiography and left ventricular mass index (LVMI) was calculated.Fasting blood was drawn on the second day after hospitalization to measure the level of biochemical indexes,malondialdehyde(MDA ) and the activity of NADPH oxidase.The correlation of the level of MDA,the activity of NADPH oxidase and LVMI was analyzed.Results The level of MDA in AMI group was significantly higher than that in control group [(6.14 ±t 2.80) μ mol/L vs(2.95 ± 1.82) μmol/L,P ＜ 0.01 ].The levd of O2- in AMI group was also obviously higher than that in control group [(21.61 ± 10.66) RLU/mg protein vs.( 7.12 ± 4.48 ) RLU/mg protein,P ＜ 0.01 ],as well as the activity of NADPH oxidase [ ( 2.84 ± 1.05 ) RLU/mgprotein vs.( 1.97 ± 0.80) RLU/mg protein,P ＜ 0.01].Positive correlation was found between LVMI and the level of MDA(r =0.57,P ＜ 0.01 ),as well as between LVMI and the activity of NADPH oxidase(r =0.71,P＜0.01 ).Conclusions The activity of NADPH oxidase in peripheral blood mononuclear cell inereases in AMI patients and plays an important role in left ventricular remodeling after AMI.

Objective To investigate the clinical characteristics of retinal degeneration (RD) with retinal holes and the therapeutic effect of argon laser therapy. Methods The data of argon laser therapy in 210 RD patients (224 eyes) with retinal holes who underwent the treatment in our department were retrospectively analyzed, which was compared with the data of argon laser therapy in 173 RD patients (198 eyes) without retinal holes. Results In RD patients with retinal holes, 89.7% of the patients were less than 60 years old (53.3% males and 46.7% females). Grid-like degeneration was found in 65.6% of the patients in whom 87.5% had the range of degeneration less than 1 quardrant. There were oval-shaped holes in 60.7% of the patients and accompanied with limited rhegmatogenous retinal detachment (LRRD) in 23.7%. Compared with RD patients without retinal holes, the ratio of patients with the age of≥35 years, cystic degeneration, retinal lengthways small plica, and subjective symptoms was higher in RD patients with retinal holes; while the therapeutic effect of argon laser therapy on patients with LRRD was obviously less than whom without retinal holes (P

This article is to report three cases of total anomalous pulmonary venous drainage(TAPVD). 2 out of the 3 cases were of the supracardiac form and they were corrected by anastomosis between the trunk of the pulmonary vein and the left atrium with excellent result. The third case was of the intracardiac form. The patient died in the late postoperative period of pulmonary venous obstruction due to the improper judgement during the operative procedure of compartmentalization. Meanwhile, the embryogensis, clinical manifestations, diagnosis, and operative proceduresfof TAPVD were reviewed and discussed.

OBJECTIVE To investigate the phenotypical and genotypical characteristics of the ?-lactamase in the 302 strains of Gram-negative bacilli,and assess the characteristics of the drug resistance.METHODS The phenotypes of ?-lactamase were detected in the Gram-negative bacilli by disc diffusion screen test,which were further ascertained by disc diffusion confirmatory test,a cefoxitin three dimensional test,and metallo ?-lactamases double-disc synergy test.The ?-lactamases were detected by multiple PCR amplification,then DNA product was sequenced.Antibiotics susceptibility was detected by K-B method.RESULTS Among the clinical Gram-negative isolates,a total of 26.49%(80/302)strains′ ?-lactamases phenotypes were positive,ESBLs,ESBLs combined with AmpC enzyme,ESBLs combined with AmpC enzyme and MBL,and AmpC enzyme producing strains were found in 16.56%,6.62%,1.66% and 0.66%,respectively.A total of 24.83% strains′?-lactamases phenotypes were positive,strains produced ESBLs,ESBLs combined with AmpC enzyme,ESBLs combined with AmpC enzyme and MBL,and AmpC enzyme producing strains were found in 17.55%,6.95%,0.33%,and 0.33%,respectively.Drug-sensitivity test showed multi-resistant Gram-negative isolates were more sensitive to amikacin(18.75%),and heavier resistant to ampicillin(97.50%).CONCLUSIONS ?-Lactamase producing Gram-negative bacilli are resistant to multi-antibiotics.

Objective To explore the evaluation value of dynamic monitoring of neutrophil/lymphocyte ratio(NLR)in severity of illness and prognosis of bacterial sepsis.Methods Clinical data and laboratory index of 72 cases of patients with bacterial sepsis in ICU of Yangpu Hospital Affiliated to Tongji University were retrospectively analyzed.According to the severity of illness,patients were divided into sepsis group(n=20),severe sepsis group(n=30)and septic shock group(n=22).According to the mortality within 28 d,patients were divided into survival group(n=47),death group(n=25).The 0 h NLR,48 h NLR and change rate of NLR between two groups were compared,and the influence factors of prognosis were analyzed.Results With the increase of severity of illness,the time of mechanical ventilation was shortened((8.8±1.9)d,(4.6±0.6)d,(3.9±0.4)d),and PLT((146.4±45.8)×109/L,(110.6±41.3)×109/L,(102.5±38.6)×109/L),NLR rate(0.61±0.26,0.26±0.11,0.22±0.09)were decreased significantly,APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were increased obviously((18.5±2.3)points,(20.4±3.6)points,(23.1±3.9)points;(72.6±10.4)mg/L,(78.2±11.6)mg/L,(85.2±12.5)mg/L;(1.5±0.4)μg/L,(2.3±0.6)μg/L,(2.7±0.9)μg/L;11.3±2.6,14.2±3.4,15.7±3.5;3.4±0.9,9.7±2.4,11.2±2.6),the differences were statistically significant(P＜0.05).Compared with death group,the time of mechanical ventilation in survival group was prolonged((4.1±0.3)d vs.(8.7±1.4)d),APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were decreased obviously((21.4±3.5)points vs.(18.3±2.6)points,(78.2±11.6)mg/L vs.(71.5±10.8)mg/L,(2.5±0.7)μg/L vs.(1.4±0.6)μg/L,(15.0±3.3)vs.(11.6±2.4),(10.5±2.8)vs.(3.2±0.8)),and PLT,NLR rate were increased significantly((106.5±41.5)×109/L vs.(148.4±50.8)×109/L,0.24±0.10 vs.0.65±0.24),the differences were statistically significant(t=16.18,4.26,2.44,6.99,5.01,16.73,3.54,8.15,P＜0.05).Multivariate logistic regression analysis showed that APEACHE Ⅱ score,0 h NLR were the independent risk factors of death in patients with bacterial sepsis(OR=3.99,3.01,95％CI:1.65-2.38,1.99-4.54,P＜0.05),and NLR rate was independent protection factor(OR=0.95,95％CI:0.91-0.97,P＜0.05).Conclusion Dynamic monitoring of peripheral blood NLR can help to judge the prognosis and severity of illness of patients with bacterial sepsis,and NLR before treatment and change rate of NLR are an independent predictors of death.

Objective To compare the result differences of different dynamic nerves transferring to different segments of the radial nerve. Methods From 1997 to 2000, different ways of intercostal nerves or contralataral C 7 transfering to different segments of the radial nerves were carried out in 36 cases with total avulsed brachial plexus injuries that were followed up for average 42.39 months. Four-fold table was selected to statistically calculate the effective rate of muscle strength recovery. Results The total effective rate was 56% (20/36). The effective rate of the functional rehabilitation of elbow extension was 5/8 in the group with neurotization to radial nerve trunk and 4/4 in the group with neurotization to branches innervating the triceps brachii muscle of radial nerve. The highest effective rate up to 75% (9/12) of the functional rehabilitation of wrist and digit extension belonged to the group with contralateral C 7 transferring to the radial nerve segment in the humeral spiral groove where branches innervating the triceps brachii muscle had already diverged. Conclusions The way of neurotization to radial nerve trunk and to branches innervating the triceps brachii muscle of the radial nerve can win good functional rehabilitation of elbow extension. Contralataral C 7 transfering to the radial nerve segment in the humeral spiral groove ranks the best way for function recovery of the wrist extension. Age below 30 years and operation interval less than 12 months are helpful for functional rehabilitation of the radial nerve.

Objective To evaluate the efficacy of PAD regimen (bortezomib, doxorubicin, dexamethasone) and VAD-like T regimen (vincristine, doxorubicin/doxorubicin derivatives, dexamethasone combined with thalidomide) in the treatment of patients with newly diagnosed multiple myeloma (MM). Methods The efficacy of 54 patients with MM who received VAD like-T regimen and 72 patients with MM who were treated with PAD regimen, including complete remission (CR) rate, very good partial remission (VGPR) rate, overall response rate (ORR), overall survival (OS), progression-free survival (PFS) and adverse events, were retrospectively analyzed. Results The CR rate of PAD group was higher than that of VAD-like T group [31.5 % (23/72) vs. 9.3 % (5/54), χ2=0.30, P=0.002]. The VGPR rate and ORR of PAD group were not statistically higher than those of VAD-like T group [16.7 % (12/72) vs. 16.6 % (9/54), P=0.180; 82.2 %(65/72) vs. 81.5 % (44/54), P=0.190, respectively]. Median PFS of PAD group was significant longer than that of VAD-like T group [(38.2±2.2) months vs. (28.0±7.6) months, P=0.017]. The 3- and 5-year OS rates of PAD group were higher than those of VAD-like T group, but there were no significant differences between two groups (P>0.05). In terms of the adverse events, the incidence of peripheral neuropathy in PAD group was significantly higher than that of VAD-like T group [31.5 % (23/72) vs. 14.5 % (8/54), P=0.03]. Conclusions Compared with PAD protocol, the CR and median PFS of VAD-like T regimen are poor, however, VGPR,ORR, PFS and 5-year OS are similar between the two groups, and VAD-like T regimen is safer with low incidence of peripheral neuropathy. VAD-like T regimen as the first-line treatment is effective and well-tolerated, especially for newly diagnosed MM patients not suitable for transplantation and bortezomib.

Objective To study the relationship between the reexpression of nestin protein and the expression of basic fibroblast growth factor (bFGF) protein in cerebral ischemia. Methods By using rat permanent cerebral ischemia as a model, immunohistochemical staining was used to observe the expression of nestin protein and the bFGF protein 1,3,7,14 and 28 days after cerebral ischemia. Results The number of nestin cells around the ischemic area increased 1 to 3 days after cerebral ischemia,but it decreased 7 days after cerebral ischemia. However, the number of bFGF cells around the ischemic area increased obviously 14 days after cerebral ischemia, but it decreased 28 days after cerebral ischemia. Conclusion Reexpression of nestin protein around ischemic cerebral tissues does not need the nourishment and susteinance of bFGF protein; nestin cells around ischemic foci are originated from astrocytes which replay the course of fetation.