Thulium fiber laser is a novel laser of good potential in lithotripsy, which gained the attention of urology society in recent years. This article aimed to discuss Thulium fiber laser referring to lithotripsy mechanism, ablation efficiency, laser safety, clinical application and so on. Thulium fiber laser shares a similarity of lithotripsy mechanism with Holmium laser, whereas Thulium fiber laser has a higher ablation rate, thinner fragments, and smaller retropulsion compared to Holmium laser. Thulium laser may bring revolution in the field of laser lithotripsy.

OBJECTIVE To investigate the efficacy of coblation for early glottic cancer. METHODS Twenty-two patients with early glottic carcinoma (Tis-T2) without lymph node metastasis accepted resection of laryngeal cancer lesions using transoral endoscopic coblation,without pre-operative or post-operative radiotherapy and chemotherapy. All the patients were followed up for 30 to 70 months. RESULTS No severe complications such as dyspnea and bleeding occurred in these cases.Only mild postoperative pain happened to the patients.All patients could swallow and speak after operation. No recurrence occurred in 21 cases till now. One case, with poorly differentiated squarnous cell lesion in the anterior commissure invading subglottic area, recurred 4 months after operation. Salvage partial laryngectomy was performed and no recurrence was found after salvage operation. CONCLUSION The result suggests that transoral endoscopic coblation is a good method for early glottic cancer. It is worth popularizing.

Objective To e xplore the clinical value of adrenomedullin on children with acute heart failure treatment and progno-sis.Methods Selected 58 cases of AHF children,40 patients with pneumonia,40 cases of children with congenital heart disease and 50 healthy children as the object,radioimmunoassay was taken to detected plasma adrenomedullin and endothelin level,and analysed correlation between AMD,ET-1 and cardiac function.Results Pneumonia complicated with heart failure group,congenital heart disease complicated with heart failure group plasma AMD,ET-1 levels were significantly higher than those in the control group, congenital heart disease group and pneumonia group (P<0.05),congenital heart disease group and pneumonia group of plasma AMD,ET-1 levels were significantly higher than those in the control group (P<0.05).Heart failure stage plasma AMD,ET-1 lev-els were significantly higher than those of early stage and recovery period (P<0.05),heart failure early stage plasma AMD,ET-1 levels were significantly higher than those of early heart failure recovery period (P<0.05).There was a significantly negative cor-relation between with AMD,EF-1 levels and CI,LVEF in AHF children (r= -0.614,-0.793,-0.618,-0.547,P<0.05);AMD mutation rate was significantly higher than that of EF-1 (P<0.05).Conclusion Plasma levels of ADM are closely relate with heart function in AHF children,through the determination of plasma ADM level can assessment treatment and the prognosis of children with AHF,and worthy of clinical application.

Objective To investigate the risk factors of color-ectal cancer and to provide scientific basis for prevention of colorectai canc-er. Methods A 1:1 matched case-control study was carried out in Dalian including 200 cases with colorectal cancer and 200 controls. We analyzedthe data with the univariate analysis and mutivariate conditional logistic re-gressiou,theu calculated the Odds Ratio and the 95% confidence. Results Conditional logistic regression showed that history of constipation, family history of other tumor,intake much bloat food ten yeats ago and easily an-gry were the risk factors of colorectal cancer, and intake much fresh vegeta-bles ten years ago was the protective factors of colorectal cancer. One way analysis showed that following factors were the risk factors of coloroctal cancer:there were pollution factor around home 10 years ago, belly CT test,sleep over twelve o'clock at night,family history of coloroctal cancer, history of pries, appendicitis and the operation history of appendicitis, intake much fry and bake food,seashell and animal liver before ten years ago,of-ten feel strew, don't like to communicate with others,pessimism,don't harmonization with colleague. And iutaking much chicken meat, bean prod-ucts,garlic ten years ago,doing exercise and the frequency of exercise,high income were the protective factors of colorectal cancer. Conclusion Coloroctal cancer was the result of many factors. But the incidence of that in Dalian city was related to history of constipation, family history of other tumor, easily angry, intake less fresh vegetables and intake much bloat food ten years ago.

Objective To analyze and summarize the characteristics of thyroid diseases on the MR diffusion-weighted imaging.Methods Forty-two patients with thyroid lesions,including 10 males and 32 females [age range 20-72 years,mean age (42 + 13) years] underwent MR DWI before surgery and biopsy.The diagnoses of thyroid lesions were confirmed by pathological results.ADC values of benign and malignant nodules,with different b values (b values was 300,500 and 800 s/mm2),were generated by using post-processing software Functool of GE company(USA).The independent-samples t test was used and ROC curve was made to evaluate the diagnostic efficiency of the ADC values by using statistical software SPSS 12.0.Results Histologically,there were 28 benign lesions and 14 malignant lesions.Benign lesions included 20 cases of thyroid adenoma,6 cases of nodular goiter and 2 cases of Hashimoto's thyroiditis respectively.Malignant lesions consisted of 11cases of thyroid papillary carcinoma,2 cases of follicular thyroid cancer,and 1case of dysplasia.mean ADC value of benign thyroid lesions was (2.39 ±0.38) ×10 -3 mm2/s and mean ADC value of malignant thyroid lesions was ( 1.60 ± 0.56) × 10 -3 mm2/s with b value of 300 s/mm2.The statistical difference was significant between them( t =5.35,P ＜ 0.05 ).The statistical difference of mean A DC values,between benign and malignant nodules with b value of 500 s/mm2 [ (1.85 +0.33 ) × 10 -3 mm2/s and ( 1.65 ± 0.42 ) × 10 -3 mm2/s ],was insignificant ( t =1.70,P ＞ 0.05 ).The statistical difference of mean ADC values,between benign and malignant nodules with b value of 800 s/mm2 [ ( 1.61± 0.30) × 10 -3mm2/s and( 1.44 +0.29) × 10 -3mm2/s],was insignificant (t =1.76,P ＞0.05 ).ROC curve indicated that the ADC value of 1.98 × 10-3 mm2/s or higher was the cut-off value for differentiating benign from malignant cold thyroid nodules,with a sensitivity of 85.7％,and a specificity of 78.6％.Conclusions The image quality is best with b value of 300 s/mm2.Mean ADC value of benign lesions was significantly higher than mean ADC value of malignant lesions with b value of 300 s/mm2.

Clinical trials are important means to push forward the development of human health. Every new drug needs to under-take clinical trials eventually to determine the efficacy and safety. In the paper, through our clinical trial experiences and extensive lit-erature retrieval, some problems of the communication management in clinical trials were analyzed and relevant countermeasures were suggested to improve the communication management in clinical trials in order to help the development of clinical trials.

[Objective] To explore the surgery protocol of the serious dislocation of acromio-clavieular joint,and compare the outcome of ORIF with AO/ASIF clavicle hook plate only to ORIF with eoraco-clavieular ligament reconstruction.[Method]Fity-two cases of the dislocation of acromio-clavicular joint were reviewed,Group A was ORIF only including 29 cases(male 20,female 9,mean age 45),according to the system of Rockwood,as TypeⅢ in 12 patients,TypeⅣ in 15 patients and TypeⅤ in 2 patients,the other 23 cases ORIF with eoraeo-clavieular l ligament reconstruction was Group B(male 15,female 8,mean age 50.6),according to the system of Rockwood,as TypeⅢ in 9 patients,TypeⅣ in 13 patients and TypeⅤ in 1 patients,AO/ASIF claviadar hook plates were used for all of the ORIF,and modified Weaver's method was used to reconstruct eoraco-clavieular ligament.Outcome was evaluated by Lazzcano scale after 8~12 months,and data was analyzed by SPSS 10.0.[Result]Good outcome was achieved in all of the patients,there was no significanty statistical difference between the two groups.[Conclusion]Clavicle hook plate is a kind of perfect internal fixation.Reconstruction of eoraco-clavleular ligament is not necessary if the AO/ASIF plate is used,unless serious avulsion of deltoid and trapezius muscle involved.

Objective To explore the effect of the antero-posterior translation of the femur on the maximum knee flexion and the relative movement of the femur for the three different kinds of prosthesis after total knee arthroplasty(TKA), such as posterior-stabilizing, fixed-bearing and mobile-bearing with the PCL retention. Methods 25 patients were selected for each kind of the prosthesis, and the inclusion criterion was based as the knee OA, good-excellent outcome after TKA, the flexion of the knee beyond 90?, and more than one year follow-up. The average age of these patients was 68 years with a range of 63 to 77 years, which involved 32 males and 43 females. The average preoperative knee flexion in the three groups were 77.8??15.1?, 80.1??12.9? and 76.4??12.7? respectively. The roentgenograms were taken both at the knee extension and maximum flexion, then the femur translation and the knee flexion were measured. Results The difference of the knee flexion among three groups preoperatively was of no significance. The maximum postoperative knee flexion in the posterior stabilizing, fixed-bearing and mobile-bearing was 118.0??7.1?,108.7??7.9? and 100.2??8.3? respectively. The analysis of variance showed the difference was of significance (F=32.86, P=0.0001). The relative movement about the femoral prosthesis in the three groups were (6.3?2.5) mm, (1.2?4.6) mm and ( 4.7?3.7) mm respectively (the posterior movement was positive, and the anterior was negative). The difference was of significance(F=57.71, P=0.0001). The femoral antero-posterior translation was proved to have correlation with the maximum knee flexion. Conclusion The femoral translation among three groups are different in manner, accordingly, the maximum knee flexion was different too.

Objective To observe the clinical effect of Shiwei Wendan Decoction on coronary heart disease stable angina pectoris of qi deficiency and stasis-phlegm type. Methods Sixty patients of stable angina pectoris which belonged to the type of qi deficiency and stasis-phlegm were divided randomly into the treatment group and the control group,and each group has 30 cases. The treatment group was given Shiwei Wendan Decoction and the control group was given Tongxinluo Capsule for 4 week,one course. The changes of symptoms integral,ECG,clinical efficacy,blood-fat and CRP of the two groups were observed after the treatment. Results The total effective power of the treatment group was higher than that of the control group (P

Objective To investigate the best models of esophageal cancer surgical approaches,lymphadenectomy ranges and postoperative comprehensive treatment.Methods From January 1998 to December 2007 in 10 years,1 162 cases of different parts with esophageal cancer were analysized which were treated with surgically adopting sequential abdomen,chest,neck three-incision approaches.Taking three-step screening way of preoperative imaging,preoperative ultrasound localigation fineneedle aspiration biopsy cytology and intraoperative rapid fieezing pathological examination were applied to make the selectivity of the first-times cervico-thoraco-abdominal three-field lymph node dissection (3FLND),first-times standard thoracoabdominal two-field lymph node dissection (2FLND) and second-times third-field cervical lymphadenectomy.Meanwhile,we implemented actively postoperative comprehensive treatment and observed the overall clinical efficacy and long-term survival.Results In the group of 1 162 cases with esophageal cancer surgery.The operating resection rate was 100 ％,Radical resection of 97.6 ％ (1 134/1 162).Perioperative overall complication rate was 16.4 ％ (191/1 162).Anastigmatic fistula was 0.6 ％ (7/1 162).Five cases dead in 30 days after surgery.The whole group of lymph node metastasis rate was 52.6 ％ (611/1 162),lymph node metastasis degree in 12.1％ (3 092/25 564).Full group of the first-times 3FLND was 348 cases.The positive rate was 94.8 ％ (330/348),Implementing the first-times 2FLND was in 814 cases and the second-times thirdfield cervical lymph node dissection was performed in 89 cases.The postoperative complications of the 3FLND was significantly higher than that of 2FLND (23.6 ％ vs 13.4 ％).The difference was statistically significant (x2 =18.37,P ＜ 0.001).However,The difference was not statistically significant between 3FLND and 2FLND (P ＞ 0.05).There is no significant difference between the first-times 3FLND with the second-times 3FLND accumulating survival (P ＞ 0.05).But different degree of lymph node metastasis determined prognosis.The difference was significant (x2 =35.57,P ＜ 0.001).In our group the postoperative comprehensive treatment application rate was 87.2 ％.Surgery combined with comprehensive treatment overall 1,3,5 years survival rates were 92.1％,69.2 ％,49.6 ％ respectively.Conclusions The sequential three-incision approaches and selectivity of lymph node dissection have the radical nature thoroughly,fewer complications,high quality of life and the long-term survival advantages.It should be a widely used method in the clinical surgery of the esophageal cancer.Implementing the three-step screening way to selecting the first-times 3FLND,the firsttimes 2FLND and the second-times third-field cervical lymphadenectomy that have targeted strongly and high accuracy,a definite object in view and avoiding patient excessive trauma.Applying the comprehensive treatment after surgery and the re-treated of patients with recurrence that can further more improve the longterm survival of patients.The comprehensive treatment should be the target direction of the future development of esophageal cancer.