Video assisted thoracic surgery(VATS) was rapidly developed in recent years.It's been widely accepted because it was minimally invasive and the patients were fast recovery with a survival rate similar to routine thoracotomy patients.However,more and more attention was paid to the side effect of general anesthesia with double cavity intubation during the surgery.Nonintubated thoracoscopic surgery for lung cancer was progressively developed.This surgery method decreases the side effect compared to general anesthesia with double cavity intubation.However,more surgical difficulty,additional surgical risk and prolonged surgery time were all inevitable become disadvantages of this new method.The less side effect of general anesthesia for patients and the more challenge for thoracic surgeon was brought simultaneous by this new method.More clinic trial should be implemented in validating the advantages and disadvantages.

OBJECTIVE:To discuss how to carry out clinical pharmacy in second-class medical institution.METHODS:The contents,methods and experience of implementing clinical pharmacy in our hospital in recent 6 years were summarized.RESULTS:The practice such as reorganizing departments,training professionals,pharmacists' ward round,providing information services and supervising of ADR etc facilitated the combination of medicine and pharmacy,enhanced the quality of medical treatment and shed insights into the exploring of a suitable clinical pharmacy mode.CONCLUSION:The support of policy and the training of clinical pharmacists are essential factors for the successful clinical pharmacy.

Objective To understand the clinical value on the detection of carcinoembryonic antigen mRNA (CEA mRNA), cytokeratin 19 mRNA (CK19 mRNA) and telomerase in blood for the monitoring of blood metastasis of lung cancer. Methods CEA mRNA and CK19 mRNA were detected by reverse transcriptase-nested primers-polymerase chain reaction, telomerase was detected by telomeric repeat amplification protocol-hybridism-enzyme-linked immunosorbent assay in peripheral blood. Results The positive rates of the three tumor markers in lung cancer group were much higher than the non-tumor group and the health group (P<0.001). The sensibility of CEA mRNA and telomerase were much higher than CK19 mRNA (P<0.01). The positive rates of the markers in TNM stages Ⅲ and Ⅳ were much higher than in stages Ⅰ (P<0.05 to P<0.01). Conclusion It had high value that detecting CEA mRNA, CK19 mRNA and telomerase in peripheral blood on the discovery of blood metastasis of lung cancer. Among them, the clinical value of CEA mRNA and telomerase are higher than CK19 mRNA, and combined assay of the markers can improve the sensibility.

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage,and to observe the outcome and summarize the possible complications.Methods A 6-7 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes.A lancet shaped piece was used for dorsal augmentation,several cartilage bars for collumellar elevation and nasal tip elongation.Comprehensive structural rhinoplasty was then done with open rhinoplasty incision.Results 52 patients were treated with this method and satisfying aesthetic contouring of the nasal tip and dorsum was achieved.Among these patients,no such complications as implant extrution or dislocation,cartilage distortion,pneumothorax,hemothorax,infection or hemotoma were observed.The scar on the donor site was not obvius.Conclusions Costal cartilage can meet the demands of patients who consider prosthesis as an unacceptable option.For secondary revision rhinoplasties,costal cartilage provides sufficient materials to ensure a promising outcome with lower risk of infection and other complications.

Objectives To explore the changes of T helper (Th) lymphocyte and its related factors in children with syste-mic-onset juvenile idiopathic arthritis (SoJIA). Methods A total of 36 SoJIA inpatients, hospitalized from January 2012 to June 2013, were divided into active phase group and remission group. In addition, 20 healthy children were selected as normal con-trols. Th1, Th2 and Th17 cell ratios in peripheral blood mononuclear cells were detected and compared between each group by flow cytometry. Serum interferon-γ(INF-γ), interleukin-4 (IL-4), interleukin-17 (IL-17) levels were measured by enzyme-linked immunosorbent assay. Results The proportions of Th17 cells over CD3+CD8-cell were (3.30±2.15)%, (1.78±1.14)%and (1.22± 1.14)%in active phase group, remission group and control group. The difference among three groups was significant (H=14.437, P=0.001), and the active phase group had higher proportion of Th17 than the other two groups (P<0.05). The ratio of Th1 and Th2 over CD3+CD8-cell between each group was not significantly different (P>0.05). The serum IL-17 levels were (125.82 ± 45.87) pg/ml, (57.79±25.84)pg/ml and(50.02±18.37)pg/ml in active phase group, remission group and control group with signifi-cant difference among three groups (F=31.82, P=0.000), and the active phase group had higher level of IL-17 than the other two groups (P<0.05). But serum INF-γ and IL-4 were not significantly different between each group (P>0.05). Conclusions Acquired cellular immunity is involved in pathogenesis of SoJIA, the increased proportion of Th1 and Th17 cell and the changes of related cytokines seem to correlate with active phage of SoJIA.

Objectives To explore a comprehensive approach for the functional and aesthetic correction of septal deviation. Methods From Jan. 2007 to Dec. 2009, 48 patients with deviation of the frontier and ceiling border of the septal cartilage, 6 males, 42 females, average age of 26.5 years, were surgically treated with a comprehensive use of several techniques, such as septoplasty, reconstruction of septal support, precise osteotomies and nasal tip plasty. Results Functional improvement achieved in all the patients, contour satisfaction achieved in 91.7 % patients; 30 patients were very satisfied, and 14 satisfied with the outcome. Conclusions With the thorough understanding of surgical anatomy of the nose and the use of comprehensive surgical approach, satisfactory outcomes can be achieved both functionally and aesthetically in patients with septal deviation.

Objective To employ autologous septal cartilage grafting as a new method of elongating the nose and adjusting the nasolabial angle in order to correct the deformities of short nose and bulbous tip.Methods A set of techniques,including,yet not limited to,releasing and sculpturing of the alar cartilages,harvesting of septal cartilages and carving them into L shape and cap-like shape for transplant,moulding the soft tissue envelop with buried through and through sutures etc.were used to lengthen the nose and modify the tip.Results From 2004 to now,the new technique had been applied to 345 patients with short nose and bulbous tip.Follow-up ranged from 6- 48 months,satisfactory outcomes were obtained.Conclusions The new technique adopted by the author in which autologous septal cartilages are settled to the anterior angle of the nasal septum and between the domes of alar cartilages has been proved to be a viable and reliable way to lengthen the nose.Further advantages of this technique include the easiness of harvesting grafts,minimal injury,rare complications of infection and rejection etc.

Objective To explore the comprehensive approach of rhinoplasty using autologous costal cartilage and e-PTFE,and to observe the outcome and possible complications.Methods A 3-4 cm long costal cartilage was taken out mostly from the 6th or 7th rib and then divided into several parts and shapes.Structural reconstruction of the nasal tip was then done with these costal cartilage parts.Radix augmentation was conducted with e-PTFE.Results From Jan.2013 to Sept.2014,48 patients were treated with this method,all females,aged 22-35 years.36 of them had received rhinoplasty before,12 of them received none.Satisfying aesthetic contouring of the nasal tip and dorsum had been achieved in 45 patients.Deviation of the collumella and nostril asymmetry were found in 3 patients.Among all patients,no such complications as pneumothorax,hemothorax,infection,or hemotoma were observed.The scar on the donor site was not obvious.Conclusions Costal cartilage is sufficient,supportive and easily shapable,when applied to the structural reconstruction of the nasal tip,which can meet the demands of patients who prefer more outstanding and delicate nasal tip contouring.

Objective:To observe the therapeutic effects of lung protective ventilation on acute lung injury caused by chest trauma and seawater.Methods: Acute lung injury was induced in 18 healthy dogs by open pneumothorax and seawater and the dogs were then randomly divided into 3 groups: non-treatment group(received no treatment),common treatment group(nasal ventilation,thoracic drianage and intravenous 5% glucose solution) and lung protective ventilation group(mechanical ventilation,thoracic drianage and intravenous 5% glucose solution).Blood samples were taken at different time points to observe the changes of blood gas(PaO_(2),PaCO_(2)and PaO_(2)/FiO_(2)),hemodynamic parameters(heart rate,mean blood pressure,cardiac output) and cytokines(TNF-?,IL-4 and IL-8).Results: After injury,PaO_(2) declined significantly in the dogs,PaO_(2)/FiO_(2) was lower than 300 and the levels of TNF-?,IL-6 and IL-8 were increased obviously.PaO_(2),PaO_(2)/FiO_(2) and TNF-? level were significantly higher in lung protective ventilation group than those in common treatment group(P

0. 05) . Conclusion Despite immersing in seawater and in freshwater worsen the ALI after open chest trauma,the ALI induced by seawater-immersion is severer than that caused by freshwater-immersion. It is attributed to higher plasma osmotic pressure and abundance of salts after seawater immersion,which increasing the pulmonary penetration index and aggravating the inflammatory response.