There is significant evidence to show that many neurosurgical patients with hyponatremia, who were previously diagnosed with syndrome of inappropriate antidiuretic hormone secretion(SIADH), actually have cerebral salt wasting syndrome(CSWS). The critical difference between SIADH and CSWS is that CSWS involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. The primary treatment for CSWS is water and salt replacement. The mechanisms underlying CSWS are not understood but may involve ANP or other natriuretic factors and direct neural influence on renal function.

Based on the pathogenic mechanisms of age-related macular degeneration (AMD),tremendous preclinical and clinical trials have demonstrated that cell transplantation which aim to replace impaired retinal pigment epithelium (RPE) with healthy RPE cells is a promising approach to treat AMD.So far,choices of cell sources mainly are autologous RPE,iris pigment epithelium,fetal RPE,human embryonic stem cell-derived RPE and human induced pluripotent stem cell-derived RPE,and some of them are undergoing clinical researches.Grafting manners in cell-based therapies are various including RPE sheet or RPE-choroid complex transplantation,RPE cell suspension injection,and RPE sheet transplantation with scaffolds.This review is limited to cell-based therapies for RPE that damaged first in the progress of AMD and focus on recent advances in cell sources,transplantation methods,preclinical and clinical trials,and the obstacles that must be overcome.

To examine the actual clinical diagnosis capability,the import of computer-based case simulations ( CCS ) technology in medical education is very important.The CCS examination system that integrated the ASP.NET and CCS technology can simulate doctor's clinical course more realistically and realize the students' practical skills evaluation.The system has a good prospect in medical education and clinical skills training.

To evaluate the efficacy of Tuina and Chinese patent drug Shuxuetong injection in preventing patients undergoing total knee arthroplasty from deep venous thrombosis and in functional rehabilitation.

Objective To explore the method of pre expanded deltopectoral flap for repairing post burn faciocervical scars.Methods Anterior axillary incisions were made and appropriate expanders were implanted above anterior chest wall at the first stage.After a 4 6 months' expanding,the flaps based on perforating branches of the internal mammary artery,branches from the thoracoacromi al area,or perforating branches from deltoid muscle,were designed and raised according to scars and dominant vessels.The donor sites were closed at same time without skin graft.Results 43 patients with 51 flaps were operated for reconstruction of post burn faciocervical scars.All flaps and donor sites survived well.Conclusions Pre expanded deltopectoral flap is an ideal donor site for repairing post-burn faciocervical scars.

Objective To understand environmental quality status of clean operating rooms in municipal hospitals of Xi’an,and provide reference for ensuring the clean quality of operating rooms.Methods On-site specimen collec-tion and detection were conducted to detect and analyze the cleanlinss of air in clean operating rooms in 15 hospital of Xi’an.Results A total of 51 operating rooms were monitored,secondary and tertiary hospitals had 24 and 27 operating rooms respectively;26 were grade-I and 25 were grade-Ⅲ operating rooms.The qualified rates of dust particle≥0.5μm/particle size in grade-I and grade-Ⅲ clean operating rooms were 76.92% and 80.00% respective-ly,≥5μm/ particle size were 73.08% and 88.00% respectively.The qualified rates of dust particle counts in grade-I and grade-Ⅲ clean operating rooms were 61 .54% and 80.00% respectively,difference was not significant(χ2=2.092,P >0.05 ).The qualified rate of dust particle counts in clean operating rooms in tertiary hospitals was significantly higher than secondary hospitals(85.19% vs 58.33%,χ2 =4.600,P <0.05 ).The qualified rates of airborne microbes in operating zone of secondary and tertiary hospitals were 87.50% and 92.59% respectively(P >0.05),in surrounding zone were 95.83% and 92.59% respectively (both P >0.05).Conclusion Dust particle and airborne microbes in some clean operating rooms in municipal hospitals of Xi’an are beyond the standard,supervi-sion and management should be strengthened.

Objective To study the relationship between the type of histopathology and prognosis of contained mucous adenocarcinoma(CMAC) of stomach and its clinical significance. Methods Eighty-seven cases of CMAC of stomach were observed by means of pathomorphology, histochemistry, immunohistochemistry and follow up etc. Results The malignant behavior of the cancer was significant difference according to the nature and quantity of the CAMC and the primary pathological type of the cancer.The clinical type in simple mucous carcinoma was mainly Borrmann type I;in tubular papilla mucous adenocarcinoma was mainly Borrmman type II; in signet-ring cell mucous carcinoma was mainly Borrmman type IV,and in mixed cell mucous carcinoma was mainly Borrmman type III. There was significant difference in the lymphatic metastasis and survival rate between the 4 groups. Conclusions Correct differentiation of the pathological type of contained mucous adenocarcinoma of stomach is important for guading the treatment and predicting the prognosis.Cathepsin D expression can help for understanding the biological behavior of CMAC of the stomach.

Objective To understand the current situation of pressure steam sterilization in medical institutions in Xi'an city,and provide reference for the monitoring and quality control of pressure steam sterilization.Methods Central sterile supply departments(CSSDs) in medical institutions in Xi'an in 2012-2014 were investigated.Physical,chemical,and biological monitoring methods were used to evaluate the pressure steam sterilizers.Results A total of 135 medical institutions in Xi' an were monitored,including 40 tertiary medical institutions and 95 secondary and below medical institutions.A total of 540 specimens were collected,454 were qualified,overall qualified rate was 84.07 ％.Qualified rate of monitoring result of pressure steam sterilization of tertiary medical institutions was higher than secondary and below medical institutions(93.13 ％ vs 80.26 ％,x2 =13.91,P＜0.01).Qualified rates of chemical PCD and biological test pack of tertiary as well as secondary and below medical institutions were 100％ and ＞90％ respectively.The qualified rate of recoded temperature in secondary and below medical institutions was 88.42 ％,but actually measured temperature was 38.95 ％,which was significantly lower than 72.50 ％ of tertiary medical institutions(x2 =12.68,P＜0.01).The rates of the measured temperature＞ 134℃ of pressure steam sterilizer in each year were all low,but measured temperature＜132℃ was about 50.00 ％,difference between actually measured temperature and recorded temperature was-4℃-1 ℃,difference between-2.5 ℃-0.5℃ accounted for 80.00％,the main unqualified temperature was 130℃-131 ℃,accounting for 82.61 ％.Conclusion Efficacy of pressure steam sterilization is different in different levels of medical institutions in Xi'an,physical monitoring measures are not standardized,the supervision of physical parameters in key sectors should be strengthened to ensure the sterilization quality of medical institutions and reduce the occurrence of iatrogenic infection.

Objective To evaluate the outcome of primary total knee arthroplasty (TKA) in treatment of stiff knee, and discuss the key points of operative technique and rehabilitation. Methods From February 2005 to April 2009, 23 patients with 34 stiff knees were treated with primary TKA. The study included 3 males (4 knees) and 20 females (30 knees), with the mean age of 56.9 years. Primary disease of the patients included rheumatoid arthritis (26 knees in 15 cases) and osteoarthritis (8 knees in 8 cases). Varus deformity was found in 10 knees (5°-15°), and valgus was found in 5 knees (5°-10°). Evaluations included preoperative and postoperative range of motion (ROM) measurement, hospital for special surgery knee score (HSS), blood loss, operative time and assessment of postoperative complications. Results All patients were followed up. The mean follow-up time was 32.2 (range, 24 to 40) months. At the final follow-up visit, the HSS score increased from 42.9±5.2 preoperatively to 85.7±4.3, the range of motion increased from 42.6°±5.7° preoperatively to 89.2°±10.5°. Sixteen knees in 12 cases underwent manipulation at 3 to 8 weeks postoperatively for unsatisfied ROM, but ROM was still less than 90° in 8 knees at the last follow-up. The average blood loss were (632.4±180.2) ml in first 24 hours (450-850 ml) and the operative time were (98.1±18.6) min (80-150 min). Deep venous thrombosis was found in 3 patients. All the symptoms relieved after anticoagulant therapy. Postoperative varus deformity was seen in one patient, but the function of knee was good. No revision was needed. Conclusion Primary total knee arthroplasty is reliable method in treatment of stiff knees. Sufficient soft tissue release during the operation, postoperative muscle strength exercise and essential manipulation are key points for satisfactory outcomes.

Objective To investigate the current status of hand hygiene(HH) among health care workers(HCWs) in clinical laboratories in medical institutions in Xi'an City.Methods HH status of HCWs in clinical laboratories in medical institutions in Xi'an was performed random on-the-spot sampling and monitoring.Results A total of 240 HH specimens of HCWs in clinical laboratories in 80 medical institutions in Xi'an City were collected, 127 detected results were qualified, the total qualified rate was 52.92%.The qualified rates of medical institutions were as follows: municipal hospitals 62.67%,workers' hospitals 55.95%,private hospitals 40.74%;comprehensive medical institutions 67.68%,specialized medical institutions 42.55%;tertiary medical institutions 79.63%(n=43),secondary and below medical institutions 45.16%(n=84),there were significant differences in HH qualified rate among HCWs in different types of medical institutions(all P<0.01).Of different HH detection items, detection rates of Escherichia coli and Staphylococcus aureus were 0.83% and 8.33% respectively.There were significant differences in HH compliance rates among HCWs of all age groups(χ2=9.103,P<0.05), HCWs aged≥50 years had the highest qualified rate of HH(71.43%), followed by those aged<30 years (67.82%),HCWs in 40~ year age group had the lowest HH qualified rate (39.66%).Conclusion The qualified rate of HH of HCWs in clinical laboratory of medical institutions in Xi'an City is low, it is necessary to enhance the procaution awareness of HCWs in clinical laboratories, strengthen quality control of HH, strictly implement standard hand-washing procedures to reduce occurrence of HAI.