By using the transmission electron microscopy, the ultrastructure of the Clara cell of the normal adult guinea-pig and its change under the simulated elevation of 5 000m after 24 h, 28 h and 72 h are studied. Meanwhile the quantitative analysis of the SER and some organelles are carried out. Clara cell of the normal guinea-pig contains abundent SER and secretory granules with a prominent Golgi apparatus. The facts suggest that Clara cell has the secretory characteristics. After 24 h hypox ia, Clara cells appear the early states of response. After 48 h and 72 h the SER and Golgi apparatus appear highly exaggerated. Their volume density is increased and the numeral density of secretory granules also increased. The average volume of the secretory granules decreased apparently in 72 h groups. These results show that the hypoxia cause the ultrastructural changes and enhance the evidence that Clara cells may participate the formation of the surfactant.

Objective To improve the animal model of hypertrophic scars for studying their pathology. Methods Twenty nude mice were divided randomly into two groups of 10. In group one every mouse received a full thickness piece of human skin grafted into the subcutaneous tissue of their hack. After the graft had survived 14d after transplantation, a burn was caused on the graft with a heated copper cylinder. The mice in the second group received the transplant but no burn. The status of the grafts and scars was observed, and histological examinations of the grafts were performed. Results Nine mice in group one survived, of which eight developed obvious and persistent hyper-trophic scars after the burns. These were hard and rose above the surrounding skin. Eight nude mice survived in group two, of which only six developed hypertrophic sear analogues after transplantation. Histological examinations showed abundant collagen deposition and inflammatory infiltration in all sears. Conclusion The similarity, repeat-ability, certainty, and survival rate of this improved hypertrophic scar model are superior to those reported previously. This improved animal model can induce obvious and persistent scarring that can be used to observe the whole proce-dure of hypertrophic scarring, so it is a useful tool for studying hypertrophic scars.

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Objective To explore the safety and effectiveness of using low molecular weight heparin (LMWH) in place of warfarin for anticoagulation in patients with a previous cardiac valve replacement. Methods We reviewed 70 patients hospitalized from Jan 2002 to Apr 2009 undergoing abdominal surgery who have had a previous cardiac valve replacement and had been on warfarin anticoagulation therapy. LMWH began to replace warfarin for anticoagulation 3 clay before the surgery in 33 cases, while the other 37 patients simply ceased to use any anticoagulant since 3 days before the surgery. Postoperative bleeding and embolism risk were compared between these two groups. Results There were 2 patients suffering from postoperative bleeding in the operative field in LMWH group, while there was no postoperative bleeding in patients on anticoagulant suspension group (χ~2=0.641, P>0.05). There was no valve embolism occurred in these two groups. Conclusions It is a safe way to stop using warfarin with LMWH taking the task for perioperative anticoagulation in patients with a history of cardiac valve replacement 3 days before an elective abdominal surgery. This protocol decreases the risk rate of valve embolism not at the expense of increasing postoperative bleeding.

Objective To discuss the influential factors of postoperative pulmonary complications in elder patients accepted abdominal operation. Methods The clinical data of 95 cases accepted abdominal operation were analyzed retrospectively,and all the patients aged over 60. These patients were divided into two groups based on whether they had pulmonary complications or not. Seven relative factors including the age,sex,smoking history,surgery duration ,operation place,pulmonary function,anesthesia were analyzed and the relationship between these factors and the incidence of postoperative pulmonary complications were explored,too. Results Among the 95 patients,19 cases had pulmonary complications. The surgery duration in patients with pulmonary complications ((3.4 ± 1.1)h)were significantly higher than in those without pulmonary complications ((2. 6 ± 0. 9)h)(P ＜0.05). We also found significant differences in the comparison of FEV1%(59.2 ±9.5),FEV1/FVC(61.3 ±7.7)% ,MVV%(59.3 ±8.6)% in the group with pulmonary complications,with FEV1%(79.7 ± 11.5)%、FEV1/FVC(73.2 ±8. 3)% 、MVV%(74. 2 ±6. 4)% in the group without pulmonary complications. The epigastric operation and general anesthesia before operation were risk factors for post-operative pulmonary comphcations(P ＜0. 05). Conclusions Surgery duration,operation place,pulmonary dysfunction and anesthesia may be the risk factors of pulmonary complications after abdominal operation.

OBJECTIVE To discuss the feasibility of the establishment of the ventilator management center.METHODS Through the investigation on the circumstances of the use of ventilator in 2005 to find out the risk factors of ventilator associated pneumonia(VAP).RESULTS In whole hospital-acquired infections cases,VAP occupied 54.3% in lower respiratory tract infections.CONCLUSIONS Ventilator management is an important and complex work and the establishment of a ventilator management center is a favorable measure to prevent nosocomial infections.It is not only grant the use of ventilator in emergency,but also reduces the incidence of nosocomial infections.It can raise the intact rate of ventilator use,reduce energy and human resources consumption greatly and create a good economic and social benefits.

Objective To study the surgical techniques and effects of laparoscopy-assisted sigmoid colon vaginoplasty.MethodsClinical data of 27 patients,who underwent laparoscopy-assisted sigmoid colon vaginoplasty at Beijing Anzhen Hospital between June 2006 and June 2007,were retrospectively analyzed.A 15-cm segment of pedicled sigmoid colon was isolated using an ultrasound knife.The distal end of the segment was pulled into the vaginal space in the cul-de-sac of Douglas under a laparoscopic vision as the neovagina.The continuity of the intestinal tract(end-to-end bowel anastomosis) was restored using a circular mechanical suture through the rectum.ResultsThe surgery was successfully completed in all the cases,no intra-operative complication occurred.The mean blood loss and operation time was 82 ml(50-180 ml) and 168 min(120-246 ml) respectively.One patient developed incomplete intestinal obstruction 16 days after the operation,and was cured by conservative treatment.Follow-up was available in 21 patients for 14-20 months.Five patients had no sexual partner during the follow-up,while the other 16 patients were satisfied with their sexual lives after the surgeries.ConclusionLaparoscopic vaginal reconstruction using a sigmoid colon segment is satisfying for cosmetic,functional,and anatomic results.

Objective To report our experience on laparoscopic cholecystectomy(LC) for elderly patients with cholecystitis and cardiopulmonary diseases.Methods Totally 225 elderly patients,who had undergone laparoscopic cholecystectomy in our hospital between January 2000 and June 2008,were retrospectively analyzed. Results Among the cases,LC were completed in 222 patients,the other 3 were converted to open surgery.No bile duct injury or biliary leakage occurred.After the operation,7 cases developed pulmonary infection,and 3 cases showed urinary infection,all of them were cured by antibiotics.Three cases suffered from cardiac ischemia without further damage.Conclusions With strict enrollment criteria,careful preoperative preparation,skillful operation,and intensive intra-and postoperative monitor,the LC is safe for elderly patients as a minimally invasive surgery.

Objective To investigate the characteristics of laparoscopic cholecystectomy(LC) in the elderly. Methods A retrospective analysis was made on clinical data of 118 elderly patients treated with LC in this hospital between January 2000 and January 2005. Results The LC was successfully completed in 116 patients,while conversions to open surgery were required in 2 patients due to low level of insertion of the cystic duct(1 patient) and common bile duct injury(1 patient).The operation time was(30~120 min)(mean,50 min).The postoperative recovery was uneventful in all the patients.The length of hospital stay after operation was 3~7 d(mean,4.5 d).The patient with common bile duct injury was followed for 2 years and 6 months.Transient onsets of abdominal pain and fever were noted and cured with antibiotics for 2~5 days.No biliary tract stenosis or bile duct calculus was seen.Follow-up observations in the remaining 117 patients for 6~12 months(mean,10.5 months) revealed no abdominal pain,fever,or jaundice. Conclusions Laparoscopic cholecystectomy is acceptable and safe for elderly patients.Proper peri-operative management and careful surgical performance are essential to the success of surgery.

Objective To study surgical techniques and curative effects of laparoscopic vaginoplasty with transferring vascularized ileal flap.Methods Clinical data of 62 cases of laparoscopic vaginoplasty using vascularized ileal flap from March 2004 to March 2006 in this hospital were retrospectively analyzed.There were 16 cases of total laparoscopic surgery and 46 cases of laparoscope assisted surgery.Results The operation was successfully completed in all the 62 cases.The intraoperative blood loss was 30~50 ml(40.0?0.6 ml) and the operating time was 90~313 min(165.0?5.6 min).Intestinal obstruction occurred 1 month after total laparoscopic surgery in 1 case,requiring a re-operation of ileectomy with end-to-end anastomosis.Vaginal stenosis occurred in 3 cases because of incorrect use of the vaginal mold.The remaining 58 cases had satisfactory vaginal dilatation outcomes. Conclusions Laparoscopic vaginoplasty with vascularized ileal flap is micro-invasive and accordant to normal physiological conditions,being an ideal method for vaginoplasty.