To summarize the evolution of spleen surgery and prospects the future. The knowledge on the splenic function (anti-infection, cancer and certain blood effects)gradually promotes the reform of spleen surgery in clinical practical, resulting all kinds of spleen-preserving surgery when splenic injury. However,there is still controversy about spleen removal or reservation under the condition of portal hypertension in liver cirrhosis patients, because advantages and disadvantages between these different operations. Laparoscopic splenectomy is a major progress in recent years,the standard operation need to be further explored. Spleen transplantation in the treatment of hemophilia A is one of the characteristics of the spleen surgery in China, and this is the leading position in the world, now we will focus on how to prevent chronic spleen graft dysfunction. To keep the advanced international level, Chinese teams on spleen surgery are still required to deepen the related research and strengthen the academic communication in the future.

Objective To explore the cause and treatment strategy of chronic graft rejection characteristic of jaundice in patients with liver transplantation. MethodsPrimary disease, immunosuppressive protocol were reviewed in nine cases surviving more than 1 year after liver transplantation. The pathology examination, choledochoscopy and ultrasound examination were performed. The dosage of immunosuppressive agent was adjusted. Four cases underwent operation. Results Chronic rejection was well controlled in 6 out of the 9 cases with total bilirubin level decreased from 200 ?mol/L to less than 100 ?mol/L. Bile flocculus and bile slush became less obvious or disappeared after flushing and dilataltion of the common bile duct. Three cases died in spite of aggressive therapy. ConclusionsInsufficient immunosuppressive strength is one of the most important causes for chronic rejection. Immunological injury results in hepatocellular damage, bile slush, inflamed thick bile duct.

Objective To compare the recent clinical efficacy between ileal neobladder and orthotopic ileal neobladder.Methods The clinical data of 62 patients with bladder cancer who were performed with cystectomy plus urinary diversion were retrospectively analyzed.Among them,32 patients were performed with orthotopic ileal neobladder(orthotopic ileal neobladder group)and 30 patients were performed with ileal neobladder(ileal neobladder group).The operation time,intraoperative bleeding,intestinal function recovery time,hospital stay,early postoperative complications were compared between two groups.Results All the patients were successful,and there was no operative deaths occurred.There was no significant difference in the postoperative intestinal function recovery time between two groups(P ＞ 0.05).The operation time,intraoperative bleeding,hospital stay in orthotopic ileal neobladder group was higher than that in ileal neobladder group [(463.59 ± 50.24)min vs.(436.07 ± 44.91)min,(1081.16 ± 320.49)ml vs.(867.53 ± 224.61)ml,(46.88 ± 4.67)d vs.(20.37 ± 5.24)d],but the incidence of early postoperative complications in orthotopic ileal neobladder group was lower than that in ileal neobladder group [25.0％(8/32)vs.53.3％(16/30)],and there were significant differences between two groups(P ＜0.05).Conclusions Two kinds of urinary diversion surgical urinary diversion are clinically more mature manner,in clinical practice.Clinicians should be based on the patient's comprehensive situation,combined with the clinical experience to select the most appropriate surgical procedures.

Objective:To collect and summarize evidence for improvement of readiness for hospital discharge of patients after PCI.Methods:BMJ Best Practice, UpToDate, Joanna Briggs Institute (JBI) evidence-based health care center database, National Institutes of Health and Clinical Optimization Guidelines Network, Scotland Inter Hospital Guidelines Network, Ontario Registered Nurses Association, International Guidelines Collaboration Network, American Heart Association website, European Heart Association website, Cochrane The literatures about improving the discharge readiness of patients after PCI in library, PubMed, CINAHL, CNKI and Wanfang databases included guidelines, system reviews, best practice information books, evidence summary, expert consensus, and randomized controlled studies. The retrieval time limit was from the establishment of the database to October 2019. Four researchers evaluated the quality of the literature, and extracted evidence from the literature that met the quality standards.Results:A total of 5 articles were included, including 2 guidelines, 2 expert consensus, 1 systematic reviews,3 randomized controlled trials. The best evidence included evaluation of discharge readiness, education of knowledge and skills to patients and caregivers, improvement of self-efficacy of patients and caregivers in disease management, and assurance of social support and health resources for patients and caregivers after discharge.Conclusion:It is suggested that in clinical practice, medical personnel should use the discharge readiness assessment tool to comprehensively evaluate patients after PCI, carry out programmed health education, improve patients' self-efficacy in disease management, and ensure social and medical support for patients and caregivers after discharge as much as possible.

Mobile service in libraries of domestic medical colleges and universities was investigated.The specific characteristics of specialized courses offered in medical colleges and universities, the special nature of medical sub-jects, and the unique features of medical library users were described with suggestions put forward for expanding the mobile service in libraries of domestic medical colleges and universities.

Objective To determine the impact of PEE with different ethanol concentration extract on the activity of tyrosinase in B16 melanoma and to explore the feasibility of PEE used as skin whitening agent make use of a model organism .Methods 30%, 50%, 70%, 95%, different concentration of ethanol reflux got four kinds of PEE alcohol extract, respectively.And selected the most active inhibition to mushroom tyrosinase ( PEE30、PEE50、PEE70、PEE95).The effect of extracts from the selected on B16 cell model was determined by MTS, NaOH splitting decomposition, L-DOPA oxidation progress.The change in protein expression level after ethanol extract of PEE was determined by Western bolt.Results The capacity of inhibition to mushroom tyrosinase in each concentration of PEE extraction, but PEE70 had the most active inhibition.When challenged with B16 cell model, PEE70 showed the capacity of decrease in tyrosinase activities and melanin synthesis (P<0.01) and had a does dependence ;it also decreased Tyrosinase and TRP-1 expression compared with control B16 cells.Conclusion These data support the idea that PEE can restrain melanogenesis, through its inhibitory effect on the activity of tyrosinase.

The functional framework of information management system for regional medical and health institutions was established according to the 5 application systems (public health, medical service, medical support, drug supply support and general management ) and the target to develop 2 databases ( a resident electronic health records data-base and a resident electronic medical records database ) and an operational network put forward in the overall framework of health information construction during The National Twelfth-5 Year Plan Period, based on the functional position of health institutions at different levels.The difficulties to realize the target of the national 3521 project and its prospects were pointed out.

Objective To evaluate the role of native ureter for the management of renal transplantation urological complications retrospectively.Method Twenty-six renal transplant recipients (18 males and 8 females) experienced the following urological complications:upper ureter injury,urinary leaks and moderate or severe ureteric obstructions secondary to ureterovesical anastomotic stricture.These complications have been managed with minimally invasive endourologic techniques or percutaneous nephrostomy as the first-line intervention.While endourologic treatment did not succeed,and the recipients have been treated with intraperitoneal open surgical correction.Urinary continuity was established by pyeloureterostomy or ureteroureterostomy using recipient native ureter.A pigtail ureteral stent was placed with the tip positioned in the pelvis of the graft and native bladder and removed after 4 to 6 weeks.Result The recipients were managed successfully during a follow-up period of 6 months to 6 years without occurrence of urological complications.One case underwent graft loss due to chronic rejection 5 years later postoperation,and the rest developed stable renal function with baseline serum creatinine.Conclusion Excellent outcomes have been achieved by the use of recipient native ureter for the management of urological transplant complications.This simple and efficient procedure should be considered as the superior choice for the recipients who experienced urological complications while less invasive endourologic techniques failed.

Social network analysis has been a study hot spot in academic circle in recent years and is applied in several fields.After a brief description of its basic theories and study methods, its application in domestic medical and health field were analyzed with its key study hot spots summarized and its problems pointed out, in order to provide the methods that can learned in domestic medical and health studies.

The key words, social network and author cooperation network in papers ( published in 2003-2014 ) on reform in domestic public hospitals were analyzed using Ucinet and CiteSpace visual softwares with CNKI as the data source.The current situation in reform in domestic public hospitals was revealed by mining its research hotspots, progress and author cooperation .Some suggestions were put forward for strengthening the reform in domestic public hospitals .