Objective To investigate the therapeutic effects of pedicled greater omentum displacement for the repair of complex vesicovaginal fistulas. Methods This series included 67 cases of complex vesicovaginal fistulas.Their mean age was 24 years (range,19-38 years). The disease course ranged from 6 months to 11 years (mean, 3.5 years).All the fistulas resulted from dystocia.The fistula outlet was 2.5-4.5 cm in greatest dimension with a mean of 3.0 cm.The complications included ureter vesicovaginal fistulas in 15 cases (left side in 5,right in 7 and both in 3),ureter orifice stricture in 4 cases (left side in 2,right in 1 and both in 1),hydronephrosis in 17 cases (left side in 7, right in 9 and both in 1),bladder calculi in 9 cases.The pedicled greater omentum displacement was performed to form a kind of protective "tightening screen", which covered the wound repaired between bladder and vesicovaginal fistula. Results The procedure was successfully completed at a single session of repair in 63 patients with a success rate of 94%.Two patients underwent further prolonged indwelling catheterization because of tiny vesicovaginal fistulas of 0.2-0.4 cm after initial operation.The procedure failed in 4 cases (6%).Among the 67 patients,ureterovesicoplasty was performed in 21 cases.After operation,29 patients (46%) had mild incontinence; of them 21 got successful further treatment.The follow-up was 3 months in the 63 cases with successful results.No vesicovaginal fistula occurred. However,8 cases had mild incontinence,and B-ultrasound and IVU showed mild hydronephrosis in 3 cases. Conclusions The operation by “tightening screen” to repair vesicovaginal fistulas through pedicled greater omentum displacement can improve the success rate of operation and allow the appropriate treatment of complications such as ureter orifice stenosis and fistulas.

Objective To compare and study the value of multiple antigens dot immunogold filtration assay (DIGFA ) and ima-ging diagnosis for rapid diagnosis of two kinds of echinococcosises .Methods 167 cases of hydatid patients diagnosied by pathologi-cal examination were divided into the DIGFA group for diagnosis of DIGFA and the control group for imaging diagnosis .Results The diagnosis rate of cystic echinococcosis (CE) in the DIGFA group was 74 .60% and control group was 90 .48% (P<0 .01);the diagnosis of alveolar echinococcosis(AE) in the DIGFA group was 92 .68% and the control group was 73 .17% (P<0 .05);when the cystica<5 cm ,the diagnosis rate of AE and CE in the DIGFA group was 91 .67% and 61 .11% (P<0 .05) ,when the cystica 5- <10 cm ,the detection rate of AE and CE in the DIGFA group was 94 .12% and 71 .43% (P<0 .05) .When the cystica≥10 cm ,<5 cm or between 5 - < 10 cm ,the detection rate of CE in DIGFA group was 94 .12% ,61 .11% ,71 .43 ,respectively (P<0 .05);The totle detection rates of the AE and CE in DIGFA group were 92 .68% and 74 .60% (P<0 .05) .Conclusion Imaging di-agnosis for the CE was higher and the DIGFA diagnosis for the AE was higher and the DIGFA also had clinical significance espe-cially applicated to the early diagnosis of AE .With the help of the imaging diagnosis ,the DIGFA could diagnose two kinds of echi-nococcosises correctly and it provided the benefits of specificity and sensitivity and performed easily .

Objective To explore the value of minute ventilation recovery time (VERT) as a weaning predictor in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD).Methods A prospective study was performed from March 2008 to July 2012.Fifty-two COPD patients under mechanical ventilation for more than 48 hours in our RICU tolerated a spontaneous breathing trial (SBT) and were ready for planned extubation.After SBT,these patients were placed back on their pre-SBT ventilator settings for up to 25 minutes,during which VERT was obtained.VERT was defined as the time for minute ventilation to return to baseline measured before SBT.Respiratory rate,tidal volume,minute ventilation and respiratory rate/tidal volume ratio were also obtained before SBT and just after SBT.Arterial blood gas data were measured and recorded before weaning.According to the weaning outcome,the patients were classified as successful group (40 cases) or failed group (12 cases).VERT and other quantitative variables were compared using t test.A multiple logistic regression was performed to explore possible factors associated with the weaning outcome.The sensitivity and specificity of VERT for predictive capacity in weaning were assessed using ROC cure.Results VERT and respiratory rate after SBT were significantly different between two groups.Multiple logistic regression revealed that VERT was the only predictor associated with weaning outcome (b =0.282,P ＜0.001).The area under ROC curve for VERT was 0.957 (95％ CI:O.907-1.008).With a cut-off value of 10.5 minutes,the sensitivity and specificity of VERT for predicting weaning failure were 1.0 and 0.85,respectively.Conclusions VERT may be a new predictor for extubation and determination of mechanical ventilation weaning in patients with COPD.VERT is a variable to be easily measured thereby being conveniently used in clinical practice.

Objective To investigate the expression of osteopontin (OPN)and matrix metalloproteinase-2(MMP-2)in hepatic alveolar echinococcosis(HAE) ,and explore the role of OPN and MMP-2 in the invasion and metastasis of HAE infection .Methods Expression of OPN and MMP-2 in HAE tissues from 69 patients within12 nomral liver tissues .HAE were detected using SP im-munohistochemical technique ,the correlation between OPN and MMP-2 expression and clinieopahtologic features was analyzed .Re-sults OPN and MMP-2 mainly distributed in the cyst wall about granuloma inflammatory cells of HAE and and the peripheral por-tion of stromal cell and liver cells ,the positive expression rate in HAE focus and normal liver tissue at the juncti-on of the invasive margin the most obvious .The results showed that the positive rates of OPN and MMP-2 in HAE tissue were 72 .5% (50/69)and 59 .4% (41/69) ,respectively ,and in normal liver tissue were 16 .7% (2/12) and 8 .3% (1/12) ,respectively .The positive rates of OPN and MMP-2 in HAE were significantly higher than those in normal liver tissue(P<0 .01) .The positive rates of OPN and P21 in HAE tissues with metastasis were 86 .8% (33/38)and 76 .3% (29/38) ,respectively ,which were significantly higher than those without metastasis of OPN and MMP-2 positive expression rate of 54 .8% (17/31) and 38 .7% (12/31) ,(P<0 .01) .The positive expression of OPN and MMP-2 were not related to the size of tumor bulk ,HBsAg ,gender ,age and nation of tumor .Rank correlated analysis showed that OPN and MMP-2 were positive correlated(r=0 .36 ,P<0 .01) .Conclusion OPN and MMP-2 mainly distrib-utes in the cyst wall about granuloma inflammatory cells of HAE and and the peripheral portion of liver cells ,the positive expres-sion rate in HAE and normal liver tissue at the junction of the invasive margin the most obvious ,which might be invasion and me-tastasis of HAE .