Fast track surgery(Frs) is an idea and theory which has been highlighted by more and more clinic doctors and scholars, and widely used in the surgical operations recently. ~TS has greatly changed the mode of clinic therapy, ameliorated the velocity of the rehabilitation and prognosis after operation, and improved the quali- ty of life and the therapeutic effect. We reviewed the application of FTS in the surgery in this article.

Objective To explore the clinical effect of the improved operation of endoscopic thoracic sympathectomy(ETS)for treatment of palmar hyperhidrosis.Methods The improved operation of ETS was used to 105 patients with palmar hyperhidrosis.T3 sympathetic was blocked in 105 cases with palmar hyperhidrosis.Results Hand sweating disappeared and axillary sweating discreased significantly in all patients.No one had any serious complications such as bleeding and Horner Syndrome except for five patients with pneumothoraces.Compensatory sweating was found in 15 patients following up from 1~12 months after operation.Conclusion The improved operation of ETS is a simple,safe,effective and less complications procedures.

Purpose　The aim is to investigate the effects of BSP on immunological function in normal and immunosuppressed mices.Methods　Thymus and spleen indexes, peripheral blood WBC number,the lymphocyte proliferation response, IL-2 production and serum and splenocyte hemolysin contents were measured after intraperitoneal injection of BSP in normal and immunosuppressed mices.Results　(1)BSP 100 mg/（kg*d）×10d significantly increased the thymus and spleen indexes and peripheral blood WBC number in immunosuppressed mice.The thymus and spleen indexes in normal mice was also increased. In addition,BSP markedly improved T,B lymphocyte proliferation responses and IL-2 production in normal and immunosupressed mices.(2) BSP improved the serum and splenocyte hemolysin contents in normal and immunosuppressed mice. Conclusion　It was suggested that BSP was a kind of immunomodulator, and could improve the immunological function of normal and immunosuppressed mices.

Objective To observe the effect of Jianpi Buxue Decoction on the protein expression of neurokinin 1 receptor (NK1R) and CD34 in C57BL/6 mice of lung cancer after chemotherapy, and to explore the improvement of chemotherapy-induced nausea and vomiting and myelosuppression treated with Jianpi Buxue Decoction. Methods Forty C57BL/6 mice were transplanted with Lewis lung cancer cells in the armpit of left anterior limb after being fed for 7 days, and then were randomly divided into lung cancer group, model group, and high-, middle- and low-dose Chinese medicine groups. Model group and Chinese medicine groups were injected intraperitoneally with cyclophosphamide (80 mg/kg) for one day. Lung cancer group and model group were given normal saline. Chinese medicine groups were administered with high-, middle- and low-dose of Jianpi Buxue Decoction (25, 12.6, 6.25 g/kg respectively) for 14 days. After the modeling, all of the mice were sacrificed, and then the brains and spleens were sampled. Western blotting method was used to detect the protein expression of NK1R and CD34. Results Compared with lung cancer group, the protein expression of cerebral NK1R and splenic CD34 in the model group was increased significantly ( P<0.01) . Compared with the model group, the protein expression of NK1R in mice brain tissues of high-, middle- and low- dose Jianpi Buxue Decoction groups was decreased significantly (P<0.01) , while the protein expression of CD34 in spleen tissues of middle-and low-dose Jiangpi Buxue Decoction groups was increased obviously ( P<0.05) . Conclusion Jianpi Buxue Decoction has an effect on down-regulating the protein expression of NK1R in brain tissues and on up-regulating the protein expression of CD34 in spleen tissues of C57BL/6 mice with lung cancer after chemotherapy, indicating that Jianpi Buxue Decoction probably can relieve chemotherapy-induced nausea and vomiting, and can improve the myelosuppression after chemotherapy.

Objective: To investigate the effects of BSP on lymphocyte function and cytokines production in normal and immunosuppressed mice.Methods: The lymphocyte proliferation response, T lymphocyte subpopulations and IL 2 production were measured after intraperitoneal injection of BSP in normal and immunosuppressed mice, and the activity of IL 1 and TNF secreted by mouse peritoneal macrophages were detected after BSP supplementation in vitro.Results: (1)BSP〔(100 mg/(kg?d)?10 d)〕markedly improved T,B lymphocyte proliferation responses and IL 2 production in normal and immunosuppressed mice, and significantly increased the number of L 3T + 4 cells in thymus and spleen of immunosuppressed mice, and the ratio of L 3T + 4/Lyt 2 + cells was also increased.(2)BSP distinctly enhanced the activity of IL 1 and TNF production by mouse peritoneal macrophages in vitro.Conclusion: BSP can improve the immunological function of normal and immunosuppressed mice.

Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.

Objective To explore the effectiveness and safety of vaginal paravaginal repair(VPVR) plus vaginal bridge repair in the treatment of female pelvic organ prolapse (POP). Methods Sixty-five patients with different defects of pelvic floor underwent VPVR or plus vaginal bridge repair for posterior vaginal wall. Patients were followed up after operation. The cure rate was estimated subjectively and objectively. The patients' quality of life was evaluated by the pelvic floor distress inventory short form 20 (PFDI-20). Results All 65 cases were treated by vaginal hysterectomy and anterior vaginal repair, in which there were 33 cases underwent VPVR while 32 cases underwent VPVR plus middle area repair. Forty concomitant procedures for vaginal bridge repair were also performed. The average operative time was (110.00±20.12) min and blood loss was (119.52±45.33) ml. The symptom of stress urinary incontinence of 25 cases significantly released after operation. Four incision recovery delayed and there were no other complicatious occurred. Patients were followed up for 6-29 months,the objective cure rate was 100.00% (65/65) and subjective cure rate was 92.31%(60/65), and 58 cases (89.23%)improved significantly with the quality of life comparing with that of pre-operation by completing PFDI-20 (P<0.01). Conclusions It is an effective and safe procedure for VPVR plus vaginal bridge repair to correct median to severe anterior vaginal prolapse and posterior vaginal wall prolapse. More clinical trials are needed to evaluate their long-term outcome.

Objective To compare the differences and similarities between the diagnostic criteria of obstetrics and internal medicine in China with that of Hibbard for peripartum cardiomyopathy (PPCM).Methods From March 1995 to September 2009, a total of 49 patients were diagnosed as PPCM at the Peking University People's Hospital and the Fu Wai Hospital in Beijing, China. Obstetric diagnostic criteria was:PPCM was one of dilated cardiomyopathy,occurred during the third trimester of pregnancy through the 6th month postpartum,and without cardiovascular diseases before. Internal medicine diagnostic criteria was:PPCM was unexplained cardiomegaly and heart failure, occurred during the last month of pregnancy through the 5th month postpartum, and meet the echocardiographic criteria of dialated cardiomyopathy as follows:left ventricular end-diastolic dimension (LVEDd) greater than 5.0 cm; left ventricular ejection fraction (LVEF)less than 45% , and(or) left ventricular fractional shortening (LVFS) less than 30% ; or LVEDd greater than 2. 7 cm/body surface area (m2) ; or LVEDd > 117% of age and body surface area predictive value. Hibbard diagnostic criteria was: All four of the following: (1) heart failure within last month of pregnancy and 5 months postpartum; (2) absence of prior heart disease; (3) no determinable cause; (4) strict echocardiographic indication of left ventricular dysfunction; LVEF less than 45% , and/or LVFS less than 30% , and LVEDd greater than 2. 7 cm/m2. The compliance between obstetric and internal criteria with Hibbard criteria, and the reasons of incompliance between Chinese and international criteria were analyzed. Results Eight patients were diagnosed of PPCM by obstetricians according to Chinese obstetric criteria. Among them, 6 patients (6/8) did not meet Hibbard criteria. 2 of the six did not reach the time regulated in the criteria. All of the six had other determinable causes for heart failure, and their echocardiographic results did not meet the diagnostic standard either. The other 41 patients were diagnosed of PPCM by physicians according to Chinese internal medicine criteria. Among them, 7 patients (17%) did not meet Hibbard criteria, 3 of the seven did not reach the time regulated in the criteria, and had other determinable causes for heart failure either. 4 of the seven did not meet the echocardiographic standard part in the criteria. The Chinese internal medicine diagnostic criteria has a significant higher coincidence rate with Hibbard criteria, compared to Chinese obstetric criteria (83% vs. 25% ; P <0. 01). Among all 13 patients whose PPCM diagnosis did not meet Hibbard criteria, 5 cases did not reach the time regulated in the criteria, 9 cases had other determinable causes for heart failure, and 10 cases did not meet the echocardiographic standard part in the criteria. Preeclampsia was the most common determinable causes for heart failure, accounted for 7 cases. Conclusion There is obvious difference between Chinese and Hibbard diagnostic criteria for PPCM, especially Chinese obstetric criteria.

Objective To study the sonographic features of mammary sclerosing adenosis (SA) and evaluate the diagnositic value of ultrasound. Methods Thirty-ifve patients with pathologically conifrmed SA in Ruijin Hospital from May 2009 to August 2013 were retrospectively analyzed. The Breast Imaging Reporting and Data System (BI-RADS) lexicon was introduced to describe the lesions. The diagnostic sensitivity was analyzed. Results The main sonographic ifndings of SA could be characterized into three types:(1) malignancy-looking nodule type (typeⅠ) (34%, 12/35). (2) benignity-looking nodule type (typeⅡ) (43%, 5/35). (3) architectural disorder type (typeⅢ) (23%, 8/35). Lack of blood supply has the greatest value in differential diagnosis among all sonographic features. The diagnositic sensitivity in typeⅠ, typeⅡ, typeⅢwere 0 (0/12), 93%(14/15), and 75%(6/8) respectively. The general sensitivity was only 57%(20/35). Conclusions There are no typical sonographic features in mammary sclerosing adenosis. Ultrasound doctors should improve their knowledge about this disease.

Objective To explore CT manifestion of multiple primary lung cancer (MPLC)and to improve the recognization of MPLC.Methods The CT manifestions of 12 cases with MPLC proved by pathology were retrospectively reviewed.Results All the 12 cases were double primary lung cancer.There were 24 lesions with 21 peripheral and 3 central,the average diameter was (2.2 ± 0.6)cm.Lesions located in contralateral lobes were in 2 patients,and located in ipsilateral lobes were in 10 patients,with 3 located in the same lobe and 7 in the different lobes.There were 7 cases of adenocarcinoma-adenocarcinoma,3 cases of squamous cell carci-noma-adenocarcinoma,1 case of squamous cell carcinoma-squamous cell carcinoma and 1 case of squamous cell carcinoma-carcinoid. 1 1 cases were metachronous and 1 case was synchronous.3 lesions were lump located at hilus of the lung,21 lesions were intrapul-monary nodules,showing masses with lobulated shape,spicules of margin,vascular convergence,vacuole and pleural indentation sign.Most foci displayed moderate intensity enhancement and homogeneous density in triphase enhanced scans,the CT value of le-sions on enhanced images ranged from 20-60 HU.Conclusion MPLC are synchronous and peripheral adenocarcinoma type,all of the lesions have typical CT features of primary lung cancer.