Objective To explore the diagnosis and treatment of adrenal black adenoma . Methods From June 2002 to July 2014, 7 patients with adrenal tumors were treated with retroperitoneal laparoscopic partial adrenalectomy in our hospital .During the operation all the patients were placed in healthy lateral decubitus position .Three trocars were introduced into the lumbar region:below the 12th rib along the anterior and posterior axillary lines , and 2 cm beyond superior iliac spine on the middle axillary line .The retroperitoneal space was established with homemade balloon-expanding devices .Afterwards , the tumors were removed by using a harmonic scalpel. Results All the tumors were resected completely .The average operation time was 60 min (range, 34-90 min) and the average blood loss in the operation was 70 ml (range, 20 -200 ml) without blood transfusion.The drainage tubes were removed on the 3rd or 4th postoperative day and the patients were discharged on the 6th or 7th postoperative day .They were pathologically diagnosed as adrenal black adenoma . Two patients manifested the Cushing ’ s syndrome and 3 patients showed hypertension , all of which were recovered to normal postoperatively .No recurrence or metastasis was noted during a follow-up for 12-24 months (mean, 18 months). Conclusions Adrenal black adenoma, without specific clinical features, is a rare kind of adrenocortical adenoma .The confirmative diagnosis depends on pathological results .Retroperitoneal laparoscopic surgery is a minimally invasive, safe and effective technique for adrenal black adenoma , which provides favorable prognosis .

Objective To observe the therapeutic effect of Argon laser photocoagulation on macular choroidal neovascularization. Methods 57 cases(58eyes)with macular choroidal neovascularization were treated with Argon laser photocoagulation,the visual acuity, the changing of macular choroidal neovascularization and macular hemorrhage before and after treatment were observed and compared with 34 cases(34eyes)with macular choroidal neovascularization who were treated with drugs.The average follow-up was 48(from2 to 84) months.Results The retinal hemorrhage decreased evidently in cases treated with laser coagulation.The hemorrhage absorb in therapeutic group is more evident than that in control group,There are statistically difference between the two groups(0.01＜P＜0.05).There are sig- nificantly difference between the two groups in increased visual acuity and choroidal neovascularization disappeared(P＜0.01).Couclu- sions Argon laser photocoagulation is effective on macular cloroidal neovasculurition.

Objective To study the effects of matrine in combination with 5-fluorouracil (5-FU) on inhibiting transplanted gastric cancer (cell line SGC-7901) in the nude mice and their myelotoxicity effects. Methods The two dosages of matrine (50 mg/kg and 100 mg/kg) combined respectively with 50 mg/kg of 5-fluorouracil (5-FU) were injected intra-abdominally, and 50 mg/kg or 100 mg/kg matrine or 5-FU injection alone groups served as controls. The relative tumor volume (RTV) and tumor inhibition rate (IR) were calculated. The nude mice bone marrow was taken, the number of the nucleated cells were calculated, and bone marrow colony was cultured. Results The tumor-inhibiting effect in the combined group of 100 mg/kg of matrine +50 mg/kg of 5-FU was significantly increased as compared with those in all the control group ( P

Objective To study the changes of corneal endothelium after silicone oil tamponade.Methods This trial involved 81 cases (81 eyes) who received vitrectomy with tamponade of silicone oil or vitrectomy and lensectomy with tamponade of silicone oil. The changes of corneal endothelium were observed before surgery and 1week, 1 month, 3 month, 6 month after surgery. Results The mean corneal endothelial cell densities was significantly decreased after surgery in all cases (P

Objective To analyze the restricted usage of TCRβ V/J subfamily and CDR3 repertoire in patients with peripheral T-cell lymphoma unspecified (U-PTL).Methods The total RNA was respectively extracted from lymph node of U-PTL and reverse transcriptase,then multi-PCR was used to amplify the complete DNA sequence(CDS) of TCR β-chain.The recombinant plasmids were sequenced and sequence was analyzed by using online TCR resources.Results There were 9 TCR β chain CDS obtained from four patients.TCRβ-chain presented specific repertoire skewing in patients with U-PTL.There were restricted usage of BV2,BV4S2,BV14,BV29S1 of BV subfamily and BJ1S4,BJ2S3,BJ2S5,BJ2S7 of BJ subfanily.The clonal proliferation T cells had different CDR3 amino acid sequences.Conclusions There are restricted usage of TCR β V/J subfamily in patients with U-PTL.The sequences of CDR3 in different TCR clone proliferation are mostly different.

Objective To explore the feasibility and application value of combined C2 laminar screw fixation technique in treatment of cervical vertebral injury. Methods Dense axial CT scanning was done on C2 laminar of 32 specimens of cervical vertebra to measure the length and height of the axis, the thickness of upper, middle and lower parts of the axis as well as the angle between the axial ray and the sagittal plane. There were eight patients with cervical vertebral injury including two with type Ⅱ odon-told process fractures combined with backward dislocation of atlanto-axial joint, one with forward disloca-tion of atlanto-axial joint, one with nonunion of odontoid process fractures, two with type Ⅲ odontoid process fractures combined with atlanto-axial joint instability and transverse ligament rupture, one with type Ⅱ Hangman fracture combined with instability of C2～3 and one with forward dislocation of atlanto-axial joint combined with transverse ligament rupture. With accomplishment of traction reduction, combined fixation with axis laminar screws and posterior autogenous lilac graft fusion were done based on injury se-verity of the patients. Results The length and height of axis laminar was (26.2±1.2) mm and (12.8±1.6) mm, respectively. The thickness of upper, middle and lower parts of the C2 laminar was (3.0±1.4) mm, (6.0±1.6) mm and (5.6±1.2) mm, respectively. The mean angle between the axial ray and sagittal plane was 43.5°. All patients were followed up for 6-14 months ( mean 6 months), which showed that all patients obtained favourable bone union and all screws remained at sound position, without deflexion of the screws or any perioperative or postoperative complications. No screw loosening or breakage occurred. Conclusions C2 laminar screw fixation technique can prevent the risk of vertebral artery injury during screw insertion. In the meantime, such technique is simple to operate and free from limitation of the vertebral artery in the cervical foramen. Whole course of visualization during C2 laminar screw insertion may facilitate it as a supplementary method for conventional posterior C2 screw fixation.

Objective To investigate the clinical significance of I-FISH for detection of genomic abnormalities in MM. Methods Twenty newly diagnosed MM patients(seven cases at stage Ⅰ , five cases at stage Ⅱ and eight cases at stage Ⅲ according to Bataille staging) were analyzed by combining the technique of CC (R-binding stain) and I-FISH [ including GLP13q14 (RBI gene), GLP17p13. 1 (P53 gene),GLP13q14. 3(D13S319) ,GLP1q21 ,GLP14q32(IgH gene) DNA sequence probes]. These two methods were compared for the detection rates of chromosomal and genomic abnormalities in MM and the association between genomic abnormalities and Bataille stages was also analyzed. Results CC examination showed only 1 case [5% (1/20) ] was found complex chromosomal abnormalities--46,XX,-2,del(3) (p21) ,add(6)(q26) ,der(10)(q26),der(14)(q32), + mar, inc[6]. While I-FISH assay showed that 12 cases [60%(12/20) ] were found genomic abnormalities. The frequencies of RB1, D13S319 and P53 were all 30%(6/20), and the frequencies of IgH gene and 1q21 were both 20% (4/20). The detection rate of the I-FISH was much higher than CC (χ2 = 9. 09, P = 0. 001) according to paired χ2 test. Of 20 patients,6 cases had RB1 gene abnormality, 1 case at stage Ⅰ , 2 cases at stage Ⅱ and 4 cases at stage Ⅲ. Of 20 patients, 6 cases had D13S319 gene abnormality, 2 cases at stage Ⅰ , 1 case at stage Ⅱ and 3 cases at stage Ⅲ. Of 20 patients, 6 cases in 20 had P53 gene abnormality, 2 cases at stage Ⅰ and 4 cases at stage Ⅲ. Of 20 patients, 4 cases had 1q21 gene abnormality, 2 cases at stage Ⅰ and 2 cases at stage Ⅲ. Of 20 patients, 4 cases had IGH gene abnormality, 1 case at stage Ⅰ and 3 cases at stage Ⅲ. Conclusion Ⅰ-FISH has higher detection rate for the genomic abnormalities in MM and can be used in detection of MM patients in different Bataille stages.

County -level public hospitals reform is an important measure of deepening reform of the medical and health system.Medicare payments system reform is therefore an important part of public hospitals reform.By abolishing drugs addition,registration fee,treating fee and setting up medical service fee instead,our hospital carried on a diversified management style in the aspect of medical insurance total prepaid system.The implementation of the reform measures turns out a good result:reasonably keeping a control on the medicare spending and really embodying the transformed of interests patterns.On the premise of ensuring patients interests,medical personnel′s interests are improved to a new level and medical insurance fund are also brought under a reasonable control.The medicare payments system reform puts equity in access and people benefit as the starting point and footing of county -level public hospitals reform,thus lays a foundation of further development of public hospitals reform.

Objective To compare the perioperative safety and curative effects oflaparoscopic adrenal sparing surgery (ASS) with laparoscopic total adrenalectomy (TA) for aldosterone producing adenoma (APA).Methods An online systematical retrieval was performed with Pubmed,ScienceDirect,Springerlink,the Cochrane library,CNKI and China Biology Medicine disc for clinical comparative studies published before May 2016,these studies reported the treatment of ASS/partial adrenalectomy (PA) versus TA for APA.The selected studies were applied to Revman 5.3 software for meta-analysis.The main contents were perioperative outcomes (operative time,intra-operative blood loss,and length of hospital stay) and postoperative efficacy (cure rate,partial response rate,inefficiency rate).Results A total of 9 clinical studies (3 English documents and 6 Chinese documents) with 1036 patients were included into the final analysis,among which 544 patients were assigned to ASS group and 492 in TA group.The analyzed results demonstrated no statistical significance between ASS group and TA group on operative time (WMD:-2.09min,95％CI:-9.86-5.67,P=0.60),length of hospital stay (WMD:-0.10d,95％CI:-0.32-0.12,P=0.36),intra-operative blood loss (WMD:1.13ml,95％CI:-8.86-11.12,P=0.82),cure rate (OR=l.07,95％CI:0.73-1.58,P=0.72),partial response rate (OR=0.85,95％CI:0.57-1.27,P=0.43) and inefficiency rate (OR=2.15,95％CI:0.32-14.34,P=0.43).Conclusion For surgical treatment of APA,ASS is technically safe,can achieve reliable postoperative efficacy and a similar therapeutic effect compared with TA,so deserves further application in clinical practice.

Objective To analyze the clonal gene rearrangement and complementarity determining region 3 (CDR3) repertoire of TCR β-chain in fine needle aspiration biopsy (FNAB) specimens of lymph node metastasis in patients with breast cancer. Methods The TCR CDR3 region genes of 24 TCR Vβ subfamilies were amplified by utilizing RT-PCR technology, and the CDR3 lengths of TCR β-chain were analyzed with gene scan technology for 2 cases with lymph node reactive hyperplasia and 3 patients with lymph node metastasis of breast cancer. The clonality of T cells presumed by spectra typing was further confirmed by CDR3 sequencing. Results TCR β-chain presented specific repertoire skewing in metastatic lymph node,and only 3-5 TCR Vβ subfamily of T cells were identified, respectively. Clonal expanded T cells, including oligoclonal, polyclonal patterns, in one or more Vβ subfamilies were found in all cases. The oligoclonal expanded T cells had different CDR3 amino acid sequences. Conclusion There are characteristic T cells cloning proliferation and selected usage of TCR Vβ subfamily T cells could be found in metastatic lymph node.The sequences of CDR3 in different TCR clone proliferation are mostly different.