Objective To investigate the efficacy of ventral bladder mucosa onlay graft urethroplasty for the management of panurethral stricture.Methods From August of 2005 to July of 2013,11 cases of panurethral stricture were treated by ventral bladder mucosa onlay graft urethroplasty.The median age of the patients was 53 years (22-72 year),The median stricture length was 15 cm (12-18 cm).The patient was placed in the lithotomy position,Penile urethra was exposed by circumcoronal incision and degloving of skin,Bulbar urethra was exposed by inverted Y-shaped perineal incision.The strictured urethral segment was then opened ventrally in the midline up to at least 1 cm proximally into the healthy urethra.An appropriate size bladder mucosa graft was harvested,and was quilted to the splited urethra edge,the graft width was 1.5-2.0 cm.Two F10 fenestrated silicone catheters were left as urethral stents,a suprapupic cystostomy tube was left.The urethral stent was removed 4 weeks postoperatively.Follow-up was performed every 3 months for the first year,and annually thereafter.Success was defined as normal voiding with a maximum flow rates ≥ 15 ml/s,and the patients required no further instrumentation,including dilation or urethrotomy.Results The mean follow-up was 18 months (range,9-36 months),the overall success rate was 10/11.One patient developed urethral meatus stenosis 3 months postoperatively,and was managed by meatal dilatation.Conclusion Ventral bladder mucosa onlay graft urethroplasty can be used for the management of panurethral stricture,Bladder mucosa is an alternative substitution for complex urethral reconstruction.

Objective To investigate the medical assistance to inpatients from low-income families for solving their difficulties in seeing doctors and affordability.Methods Random sampling was made to five ongoing medical assistance projects in the hospital for statistics and analysis of the data so collected.Results Medical expenses of such inpatients are beyond their affordability.Despite the coverage of their basic medical insurance,the reimbursement rate is too low to alleviate their financial burden.Conclusion A“4-party payment”model is recommended,combining the government support for basic medical insurance,social welfare assistance,philanthropic assistance and that paid by the inpatients.This model is expected to effectively alleviate the financial burden of such inpatients.

Objective To compare the rates of successful intubation between light-stylet and adjustable McCoy laryngoscope for the management of difficult airway with active oral bleeding. Method Thirty casualties traumatized with active oral bleeding were enrolled after failure of endotracheal intubation tried twice by an attending doctor with Macintosh laryngoscope. The patients were randomly( random number) divided into light-stylet (LS)group and McCoy laryngoscope(MC) group ( n = 15 in each group). The rate of successful intubation and the time consumed for intubation were recorded. Results The rate of successful intubation at the first attempt and the total rate of successful intubation in LS group were higher than those in MC group (14/15 vs. 6/15, P =0.005, 15/15 vs. 9/15, P =0.017, respectively). The time consumed for intubation was less in LS group than that in MC group (24 seconds in average,ranged from 23 ～ 34 seconds vs 48 seconds in average, ranged from 31 ～ 119 seconds, P =0.011). Conclusions The light-stylet is a novel tool for intubation in casualties with difficult airway and active oral bleeding with high success rate.

Objective To study the effects of different doses of dexemedetomidine on perioperative stress response in elderly patients undergoing laparoscopic gastrointestinal surgery.Methods Eighty ASA grade Ⅰ or Ⅱ elderly patients,aged≥65 years,falling into ASA Ⅰ or Ⅱ,undergoing laparoscopic gastrointestinal surgery,were randomly divided into four groups:group D1,D2,D3 and C,twenty cases in each.Dexmedetomidine was administrated with a loading dose of 0.5 μg/kg which was infused intravenously over 10 minutes before induction,and was infused intrave nously with a continuous dose of 0.2μg·kg-1 ·h-1,0.5μg·kg-1 ·h-1 and 0.8μg· kg-1 ·h-1 during operation respectively in group D1,D2,D3.In group C,patients were given 7 ml saline which was infused intravenously over 10 minutes before induction,and was infused with a continuous dose of 10 ml/h saline during operation.HR,SBP and DBP were recorded at before infusion (T0),immediately after intubation (T1),5 minutes after pneumoperitoneum (T2),1 hour after pneumoperitoneum (T3),immediately after extubation (T4),10 minutes after extubation (T5).The time of operation and the time of extubation were also recorded.Concentrations of Glu,Cor,E and NE were measured at T0,T1,T3,T5.Results The dosage of remifentanil in group D1,group D2 and group D3 was significantly lower than that in group C,and in group D2 and D3 was significantly lower than that in group D1 (P＜0.05).During T2-T5,HR of group D2 and group D3 was significantly slower than that of group C and group D1 (P＜0.05),and SBP of group D2 and group D3 was obviously lower than that of group C (P＜0.05),respectively.Compared with T0,HR of group C was significantly faster than that at T1-T5 (P＜0.05).Compared with group C,the concentrations of Glu,Cor,E and NE in group D2 and group D3 were extremely decreased (P＜0.05) at T3 and T5,and the concentrations of Cor and NE were obviously lower at T1 (P＜0.05).The concentrations of Cor and NE in group D2 and group D3 were remarkably lower than those in group D1 at T3 and T5 (P＜0.05).The extubation time of group D3 was apparently longer than that of group C (P ＜ 0.05).Conclusion Compared with continuous dose of 0.2 μg·kg-1 ·h-1 and 0.8 μg·kg-1 ·h-1 dexmedetomidine,dexmedetomidine infused intravenously at 0.5 μg· kg-1 · h-1 can more effectively inhibit perioperative stress responses of elderly patients undergoing laparoscopic gastrointestinal surgery,and maintain hemodynamic stability.