Objective To investigate the effect of artifictal circadian rhythm of melatonin on the postoperative cellular immune function in patients undergoing gynecological operation Methods Eighteen ASA Ⅰ or Ⅱ patients,aged 25-50 yr,weighing 45-80 kg,scheduled for elective gynecological operation,were randomly divided into 3 groups (n =6 each):control group (group C),placebo control group (group P) and melatonin group (group M).In group M.melatonin 6 mg was given orally at 10 min before lights-out (21:00) on 1 day before operation,on the day of operation and on 1 day after operation,while placebo was given orally instead of melatonin in group P.The operation was performed under epidural anesthesia.Patient-controlled epidural analgesia with ropivacaine was used for postoperative analgesia.VAS score was maintained ＜ 5.Blood samples were collected from the peripheral vein at 1 day before operation (baseline),the end of operation and 1 day after operation to measure CD4+,CD8+ and CD3+ cell count by flow cytometry.The ratio of the number of CD4+ cells to the number of CD8+ cells was calculated.Results There were no significant differences in the number of CD4+,CD8+ and CD3 + cells and ratio of the number of CD4 + cells to the number of CD8 + cells between groups C,P and M (P ＞0.05).Conclusion Artificial circadian rhythm of melatonin exerts no influence on the postoperative cellular immune function in patients undergoing gynecological operation.

Objective To study the features of pulmonary cryptococcosis and the curative effect of thoracoscopic operation for it. Methods The authors retrospectively analyzed the clinical data of 11 patients with pulmonary cryptococcosis in this hospital between January 1996 and December 2002, consisting of 8 cases of thoracoscopic wedge resection, 2 cases of thoracoscopy-assisted modified posterolateral mini-lobectomy, and 1 case of pulmonary wedge resection. Results Ten patients were preoperatively misdiagnosed. Solitary lesions were found in 8 patients and multiple lesions in both lungs in 3 patients. Complete removal of lesions was achieved in 8 patients and pulmonary biopsy was conducted in 3 patients. Except for 3 cases of wound effusion, there were no other postoperative complications. Follow-up for (38.6?10.8) months (range, 12～72 months) found no pyothorax, bronchopleural fistula, or recurrence of cryptococcosis. Conclusions Pulmonary cryptococcosis usually makes its appearance as a solitary lesion without underlying diseases or symptoms, which is difficult to diagnose preoperatively. Video-assisted thoracoscopic surgery can remove the lesion completely, giving a minimal invasion and rapid recovery.

Objective To summarize the experience on diagnosis and treatment of ectopic ureters. Methods 52 patients with ectopic ureter were analysed retrospectively. Results Of the 52 patients,sonography,IVU,CT and retrograde ureterography were used in 37,45,8 and 18 patients respectively.49(94.0%) cases got the diagnosis preoperatively by these methods.28(53.8%) patients underwent ureteral reimplantation,12(23.0%)nephrectomy,9(17.3%) upper pole partial nephrectomy and 1(1.9%) with ureterocele incised endoscopically.The 42 patients have been followed up for 6 months to 10 years with an average of 3 years. Conclusions Most of the cases can be diagnosed preoperatively by utilizing the appropriate methods.Ureterovesicle reimplantation,upper pole partial nephrectomy and nephrectomy are the effective modalities in the treatment of ectopic ureters.

BACKGROUND:There are objections to the efficacy and safety of total hip arthroplasty and artificial femoral head arthroplasty in the treatment of femoral neck fracture.
OBJECTIVE:To assess the efficacy and safety of one-stage total hip arthroplasty and femoral head arthroplasty for > 60-year-old patients with femoral neck fractures.
METHODS:According to the search strategy of Cochrane colaboration network, we searched PubMed (1966 to December 2014), EMbase (1974 to December 2014), Cochrane Library (Issue 3, 2011), China Biology Medicine database(1978 to December 2014), China National Knowledge Infrastructure (1994 to December 2014), VIP database (1989 to December 2014), and Wanfang Database (1979 to December 2014). Twenty-one articles on total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures were included. Two reviewers independently evaluated the quality of the included studies and extracted the data. In case of disagreement, settlement was made by negotiation. Meta-analysis was performed by RevMan 5.0 software in the included studies.
RESULTS AND CONCLUSION:(1) Literature analysis: five randomized controled studies, three quasi-randomized controled studies, and thirteen retrospective cohort studies were included, containing 2 250 patients. (2) Meta-analysis: No significant differencein rate of dislocation, deep infection rate and mortality rate in 1 year after replacement was detected between total hip arthroplasty and hemiarthroplasty for elderly femoral neck fractures (dislocation rate:RR=1.38, 95%CI: 0.81-2.34; deep infection rate RR=1.12, 95%CI: 0.60-2.11; mortality rateRR=0.90, 95%CI: 0.69-1.18). Reoperation rate was higher in the hemiarthroplasty group than in the total hip arthroplasty group (RR=0.46, 95%CI: 0.32-0.66). Harris score on the affected side between1 and 4 years was significantly higher in the total hip arthroplasty group than in the hemiarthroplasty group (MD=5.64, 95%CI: 2.82-8.46). (3) Results suggested that if physical conditions permit, compared with hemiarthroplasty group, femoral neck fractures patients aged > 60 years old in the total hip arthroplasty group had better hip function, but no significant difference was found in dislocation, deep infection and mortality between both groups.

OBJECTIVE： To study the improvement effects of Atorvastatin calcium tablets on renal injury in nephrotic syndrome model rats， and to explore its possible mechanism. METHODS： Wistar rats were randomly divided into normal group， model group and Atorvastatin calcium tablets group， with 10 rats in each group. Model group and Atorvastatin calcium tablets group rats were given adriamycin 6 mg/kg intravenously for consecutive 21 d to induce nephrotic syndrome model. Since 22th day， Atorvastatin calcium tablets group was given drug 8 mg/kg intragastrically while normal group and model group rats were given equal amount of distilled water intragastrically， once a day， consecutive 6 days every week， for consecutive 10 weeks. At the second day after last medication， the plasma levels of albumin （ALB）， total protein （TP）， cholesterol （CH）， urine albumin excretion rate （UAE） were determined in each group. RP-PCR and Western blot assay were used to detect mRNA and protein expression of AMP-activated protein kinase （AMPK）， silent information regulator 1 （SIRT1） and nuclear factor κB （NF-κB） in liver tissue. RESULTS： Compared with normal group， the levels of ALB and TP， mRNA and protein expression of AMPK and SIRT1 were decreased significantly in model group （P＜0.01 or P＜0.001）， while the levels of CH and UAE， mRNA and protein expression of NF-κB were increased significantly （P＜0.05 or P＜0.01 or P＜0.001）. Compared with model group， the levels of ALB and TP， mRNA and protein expression of AMPK and SIRT1 were increased significantly in Atorvastatin calcium tablets group （P＜0.05 or P＜0.01 or P＜0.001）， while the levels of CH and UAE， mRNA and protein expression of NF-κB were decreased significantly （P＜0.05 or P＜0.01 or P＜0.001）. CONCLUSIONS： Atorvastatin calcium tablets has significant improvement effect on the renal injury of nephritic syndrome model rats， the mechanism of which may be associated with up-regulating the expression of AMPK and SIRT1 and down-regulating the expression of NF-κB.

Objective To investigate the diagnosis and therapy of the sclerosing hemangioma of the lung.Mothods The case history of 15 patients were analyzed retrospectively and summarized the diagnosis and therapy of the Sclerosing hemangioma of the lung.Results There were 2 males and 13 females(1:6.5).No patients were diagnosed this disease before operation for there were no specific imageology features.The tumor cell indicated pantomorphia and there were 3 cases were misdiagnosed during the operation frozen section pathology.The optimization therapy methods was to resect the tumor with the VATS.The prognosis of this disease was well and there were no cases recurrence in these 15 patients.Conclusion The sclerosing hemangioma of the lung was the benign tumor and there were no specific imageology features.The misdiagnosis was frequently before operation.To resect the tumor with the VATS was the optimal therapy method.

Aim To explore the effects of anti-HER-2 chimeric antibody chA 21 on proliferation and apoptosis of SKBR3 cells.Methods MTT colorometric assay,HE staining,transmission electron microscopy,flow cytometry,and TUNEL were used to study the proliferation inhibition and apoptosis induction of SKBR3 cells by chA 21 in vitro.Results Proliferative inhibition rates and apoptotic index of SKBR3 cells were increased in a dose and time dependent manner after exposure to chA21(0.2～5.4 mg?L~(-1)).Conclusion chA 21 could remarkably inhibit proliferation of SKBR3 cells in vitro and apoptosis induction may be one of its main mechanisms.

Objective To investigate the numbers, sizes and types distribution of diatoms in drowned and postmortem immersed rabbits’ lungs. Methods Sixty-two rabbits were randomly divided into drowning group (n=30), postmortem immersion group (n=30) and land death group (n=2), and the diatoms in each lung lobe were analyzed quantitatively and qualitatively by microwave digestion and scanning electron microscopy. Results In the drowning group, the diatoms were detected in each lung lobe with Cyclotella and Melosira in the majority. In the postmortem immersion group, Cyclotella was in the majority. And the diatoms weren’t detected in some lung lobes in postmortem immersion. There were significant dif-ferences in the detection rates of upper lobe of left lung, middle lobe and cardiac lobe of right lung in two groups (P<0.05). Conclusion Based on the microwave digestion and scanning electron microscopy, the numbers, sizes and types distribution of diatoms in drowned and postmortem immersed rabbits ’ lungs can be analyzed and used as references for testing theory.

Objective To investigate the therapeutic effect of single stage cavernostomy and myoplasty on the aspergillus thoracic empyema. Method Four patients suffering from aspergillus thoracic empyema were treated with single stage cavernostomy and myoplasty. They got the inflammation of aspergillus after the operation for tuberculosis in 2, bronchiectasis in 1 and lung cyst in 1. They were performed rib resection, cavernostomy, closure of the bronchial openings and total/partial obliteration of the cavity with a muscle flap as a single stage technique. Pectoralis major muscle was used for the myoplasty in 1, latissimus dorsi in 1 and intercostal muscle in 2. All patients were given the therapy of nutritional support, local pressure dressing and oral anti-fungus drugs. Result Two patients got the primary healing, the chest tube were pulled out 2 days later and they were discharged 12 days after the operation. One patient′s cavity became little and there was pus drained from the chest tube, he cured after prolonged draining and washed with the anti-fungus drugs. One patient dead for pneumonia 67 days after the operation. Conclusion Cavernostomy and myoplasty as a single stage technique is safe and reliable in the management of patients with aspergillus thoracic empyema.

Objective To analyze and compare the capacity and efficiency of county-level hospitals′medical service by using the diagnosis related groups ( DRGs ) method. Methods The homepage data of discharged inpatients from seven county-level hospitals in Wenzhou region in 2013 - 2015 period were analyzed, for measurement of the medical service capacity changes of such hospitals using the number of DRGs, total multiplicity of weight, and CMI value, and that of their medical service efficiency changes using expense consumption index and time consumption index. Results The study found in the seven hospitals 8. 49% increase of the total number of DRGs, 17. 34% increase of total multiplicity of weight, and 5. 06%increase of CMI value, with unchanged expense consumption index and 9. 82% decrease of the time consumption index. These facts evidenced enhancements of these hospitals in both service capacity and service efficiency in general. Conclusions DRGs as tools prove useful objectively and scientifically. Policies of Two emphases at primary ends and two enhancements have been implemented desirably.