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.

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 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.

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 evaluate the effect of melatonin on postoperative apoptosis in hippocampal cells of aged rats undergoing surgery under isoflurane anesthesia.Methods Sixty healthy male Sprague-Dawley rats, aged 18 months, weighing 550-610 g, were randomized into 5 groups (n=12 each) using a random number table: control group (group C), 2％ isofiurane anesthesia group (group I), 2％ isoflurane + melatonin group (group IM), surgery group (group S), and surgery + melatonin group (group SM).Group IM inhaled 2％ isoflurane for 4 h.Group S inhaled 2％ isoflurane for 4 h, and then back surgery was performed.In IM and SM groups, melatonin 10 mg/kg was injected intraperitoneally everyday for 7 consecutive days before anesthesia, while the equal volume of normal saline was given in C, I and S groups.The cognitive function was assessed using the Morris water maze test on 2nd after anesthesia.The escape latency, space exploration time spent at the original platform quadrant, and frequency of crossing the original platform were recorded.After the end of the Morris water maze test, the rats were sacrificed on that day, and the hippocampi were isolated for detection of the expression of Bcl-2, Bax and caspase-3 by Western blot.Bcl-2/Bax ratio was calculated.Results Compared with group C, the escape latency was significantly prolonged on days 1-3 after anesthesia in group I, the escape latency was significantly prolonged, the space exploration time spent at the original platform quadrant was shortened,and the frequency of crossing the original platform was decreased on days 1-3 after operation in group S,and the expression of caspase-3 and Bax was significantly up-regulated, the expression of Bcl-2 was downregulated, and Bcl-2/Bax ratio was decreased in I and S groups (P＜0.05).Compared with group I, theescape latency was significantly shortened on days 1-3 after anesthesia (P ＜ 0.05) , and no significant change was found in the expression of caspase-3, Bcl-2 and Bax, and Bcl-2/Bax ratio in group IM (P＞ 0.05).Compared with group S, the escape latency was significantly shortened, the space exploration time spent at the original platform quadrant was prolonged, and the frequency of crossing the original platform was increased on days 3-5 after operation, the expression of caspase-3 and Bax was significantly downregulated, the expression of Bcl-2 was up-regulated, and Bcl-2/Bax ratio was increased in group SM (P＜0.05).Conclusion Melatonin can inhibit apoptosis in hippocampal cells and improve postoperative cognitive dysfunction in aged rats undergoing isoflurane anesthesia.

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.

Objective:To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach.Methods:In the study,27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively.The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine.The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles.Once the space between the muscles was achieved,20 mL of 0.5％ (mass fraction) ropivacaine was injected and a catheter was inserted.Whether the tip of catheter was in right place was evaluated by ultrasound image.The block dermatomes of cold sensation were recorded 10,20 and 30 min after the bolus drug was given.Then 0.2％ ropivacaine was infused with 6 mL/h via the catheter by an analgesia pump postoperatively.The block dermatomes of cold sensation and pain score were recorded 1,6,24 and 48 h postoperatively.Results:The first attempt success rate of catheteration was 81.48 ％ (22/27);the tips of catheter were proved in right places after the second or third attempt in 5 patients.The median numbers of the block dermatomes 10,20 and 30 min after the bolus drug was given were 2,3,4;the median numbers of block dermatomes were 5,5,5,4,and of pain score were 1,1,2,2 at 1,6,24,48 h postoperatively;no case of bilateral block,pneumothorax or vessel puncture occurred.Conclusion:Thoracic paravertebral block using laterally intercostal approach is feasible,which has high success rate of block and low rate of complications.

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 investigate CT characteristics of ganglioneuroma.Methods CT findings in 12 patients with ganglioneuroma proved histopathologically were retrospectively analyzed.Results The lesions localized in the adrenal gland in 8,the retroperitoneum in 3,the posterior mediastinum in 1.eleven lesions appeared as homogeneous hypo-or isodense oval masses with well delineated margins and 1 was cysto-solid on plain CT scans.The calcifications were seen inside one tumor.On enhanced CT scans,the lesions were mild enhancement in 4,moderate enhancement in 3,significant enhancement in 3 and no enhancement in 2.Mild delayed enhancement in 5 cases,moderate delayed enhancement in 4 cases and no delayed enhancement in 3 cases were showed.Conclusion Typical ganglioneuroma shows low intensity,mild or moderate enhancement and delayed enhancement.