Objective To explore the technical point of methylene blue staining for aponeurotic cyst′s resection in wrist for decrease the recurrence. Methods Fifty-six patients with aponeurotic cysts in wrist were divided into two groups, the control group: 33 patients accepted conventional aponeurotic cyst′s resection, the experimental group: 23 patients accepted the same operation along with methylene blue staining technique. Results In control group, 28 cases of aponeurotic cysts were ruptured in operation, rupture rate was 84.8%, recurrence was seen in 6 cases, recurrent rate was 18.2%. In experimental group, 17 cases of blue-stained aponeurotic cysts were ruptured in the operation, rupture rate was 73.9%. No recurrence was seen in this group. Recurrent rate in experimental group was significantly lower than that of control group (P0.05). Conclusions Methylene blue staining technique in the operation of aponeurotic cyst′s resection is helpful in confirming the base of cysts, completely removing cysts and reducing the recurrent rate.This method is both operable and feasible.

Objective To investigate the feasibility and effectiveness of laparoscopic extraperitoneal inguinal hernia repair with low-pressure pneumoperitoneum without using stapling devices.Methods A total of 38 patients with reducible inguinal hernia underwent laparoscopic extraperitoneal inguinal hernia repair in our hospital from January 2006 to February 2007.Three abdominal trocars were introduced into the extraperitoneal cavity.An 11-mm trocar was placed at the lower border of the umbilicus,and the other two sized 5.5 mm were at the upper and lower 1/3 of the line between the umbilicus and the pubic symphysis,respectively.Then,low-pressure(6-8 mm Hg) CO2 was insufflated into the extraperitoneal cavity.Non-traumatic forceps was used to create an operative space from the hilum to the pubic symphysis and the diseased inguinal area.The hernia sac and the fabrics around it were disconnected.For big hernia sacs,the sac was ligated,cut at the cervix,and then left at its original site.While for small hernia sacs,it was dissociated and put back into the abdominal cavity.Afterwards,a patch sized 12 cm ? 15 cm was placed into the cavity,stretched,and attached to the abdominal wall,covering the annulus inguinalis profundus,Hesselbach triangle,and the femoral ring,without using stapling devices.After the operation,the patients received sandbag compression at the operative area and were kept in bed with urethral catheter for 24 hours. Results The operation was successfully accomplished in all the 38 cases without conversion to open surgery.The operation time was 45-85 min(mean,56 min).The intraoperative blood loss was 5-10 ml.After the operation,seroma occurred in 4 cases,and perforation in 2.No subcutaneous emphysema,hypercapnia,intestinal injury,neuralgia,or hemorrhage was found.The patients were followed up for 6 to 19 months(mean,10.5 months),and no recurrence occurred.Conclusions It is feasible to use laparoscopic extraperitoneal inguinal hernia repair with low-pressure pneumoperitoneum without using stapling devices.The method is associated with few complications and confirmed efficacy.

Objective To study the feasibility,superiority and curative effect of percutaneous nephrolithotomy with fibrous sheath and Swiss LithoClast Master (EMS Ⅲ) through T-tube tract for retained choledocholithiasis. Methods This study involved 32 patients with hepatolithiasis who were treated in our hospital from August 2004 to August 2007. By combining percutaneous nephrolithotomy (with a fibrous sheath on) and Swiss LithoClast Master (EMS Ⅲ) through a T-tube tract,retained choledocholithiasis was removed. Results The 32 patients totally underwent 36 operations. The mean operation time was 43 minutes (ranged from 33 to 78 minutes). In 28 of the cases,the stones were extracted completely by one session; and 2 were cured by two operations. The final stone-free rate was 94% (30/32). Follow-up was carried out in all the patients for 26 to 48 months (mean,29 months),during which no patients developed abdominal pain,jaundice or fever,no recurrence was detected by B-ultrasonography. Two patients showed residual stones after the treatment,one of them received Roux-en-Y hepatocholangioenterostomy because of extensive multiple biliary stones in the liver,which could no be removed completely after three sessions of nephrolithotomy; another patient who was a 70-year old man refused the secondary operation and thus retained a few stones in the right inferior lobe of the liver. In this series of 32 cases,no bile duct tear,massive hemorrhage,biliary leakage,cholangitis or abdominal distension occurred. Conclusions It is a safe,convenient,and simple method to combine percutaneous nephrolithotomy with Swiss LithoClast Master via T-Tube tract for retained choledocholithiasis. The procedure results in less pain in patients,and reduced equipment spoilage,while the cost is low. As the surgery is easy to perform,it is worth being widely used.

Objective To study the probability safety assessment to analyze and evaluate radiation error risk in the external beam radiotherapy,so as to establish and strengthen the control and management of the radiotherapy process,continuous improvement of quality control and quality management.Methods To build the whole of radiotherapy flow chart and process tree,using the decision tree model to determine critical control points in the whole process,making risk assessment chart and analyzing 4 patients with potential safety hazards error.Results The whole process is divided into 22 missions in 3 functional areas,the entire cover 15 branches and 59 key and 11 key control point.The enumeration of error as risks and critical control points has certain correlation.Conclusions Probabilistic safety assessment method have strengthened manage,analyze and control to risk,and all these provide the basis for developing and improving radiotherapy process control management.Radiotherapy quality management for future multidisciplinary and high-level management personnel who take up provides a prospective study.

Objective To study the expression of macrophage inflammatory protein-1α(MIP-1α),inter-feron gamma inducible protein 10(IP -10)and angiopoietin -1 (Ang -1)in primary acute myelogenous leukemia (AML),and clarify their clinical significance.Methods ELISA was used to detect the expressions of MIP -1α,IP-10 and Ang -1 in serum samples from 54 AML patients(observation group),and twenty volunteers(normal control group).Results The expression levels of MIP -1α,IP -10 and Ang -1 in the observation group[(198.813 ± 53.923)pg/mL,(2.332 ±0.745)ng/mL,(1.593 ±0.447)ng/mL]were significantly higher than the normal control group[(153.309 ±44.475)pg/mL,(1.569 ±0.485)ng/mL,(0.838 ±0.333)ng/mL](t =3.369,5.133,6.856, all P <0.05).Subgroup analysis,during the groups of better -risk,intermediate -risk and poor -risk,the contents of MIP -1αwere (141.524 ±27.510)pg/mL,(196.370 ±31.966)pg/mL,(269.892 ±54.795)pg/mL;the contents of IP -10 were (2.085 ±0.332)ng/mL,(2.307 ±0.696)ng/mL,(2.685 ±0.348)ng/mL;the contents of Ang -1 were (1.248 ±0.454)ng/mL,(1.599 ±0.386)ng/mL,(1.951 ±0.359)ng/mL.The levels of MIP -1αand Ang -1 in the better -risk group were significantly lower than those in the intermediate -risk group and poor -risk group (q =6.100,11.438,3.603,5.742,all P <0.05).While the levels of IP -10 had no closely correlation with NCCN risk status(q =1.225,2.643,2.016,all P >0.05).There were remarkable correlation between the serum expression levels of MIP -1αand Ang -1 (r =0.324,P <0.05).Conclusion There are differences of serum MIP -1α, IP -10 and Ang -1 in the different NCCN prognosis groups,which reflect they may have certain guiding significance in the choice of clinical treatment and the prognosis for newly diagnosed AML.

Background and purpose:Now 3-dimensional conformal radiotherapy(3DCRT)and intensitymodulated radiotherapy(IMRT)are widely used in the treatment of head and neck tumor.For the parotid,this target area is located on the side of the head and the tumor has a concave shape.What kind of radiation method can be used more eriectively to achieve dose uniformity and protection organs at risk is the topic of much discussion.The postoperative irradiation of parotid tumor is varied in the techniques used.In this study,3-dimensional conformal radiotherapy (3DCRT),intensity-modulated radiotherapy(IMRT)and simplified forward planned multi-segment radiotherapy (MSRT)were compared to conventional planning techniques in order to investigate the potential advantages of these new treatments.Methods:The conventional planning included the large opposed lateral fields with 2 or 3 weight ratio at the target lateral(2F-2D)and the unilateral field with mixture of 6 MV photon and electron beams(X+E).The 3D techniques included 3DCRT,MSRT and IMRT.Their dose distributions were calculated and compared for 8 patients treated in our center.Different beam arrangements were used for 3D techniques.In each case.the dose of PTV was prescribed to 60 Gy.All plans were compared using dose-volume histogram data.The conformity index(CI)and heterogeneity index(HI)of dose were used to evaluate the dose coverage of the target volume.Dose sparing of brain stem.spinal cord and the contra lateral parotid was also compared.To compare IMRT and MS RT,the timing ofplanning and radiation delivery was recorded.Results:Compared to conventional planning,the 3DCRT,MSRT and IMRT plans produced adequate target coverage,and the CI showed 3DCRT plans(0.78)produced poorer target coverage than MSRT(0.81)and IMRT(0.85).MRST and IMRT plans showed a significant reduction in maximum dose to the spinal cord,brainstem and the contra lateral parotid,compared to the conventional plans,while the 3DCRT plan did not show significant sparing of these structures.MSRT and IMRT plans produced better dose coverage among all the techniques.The efficacy of beam delivery comparing between two modulated planning showed MSRT was better.Conclusion:For postoperative irradiation of parotid cancer,3D planning techniques generated better target dose-coverage,without compromising the dose-sparing advantages of important structures.A satisfactory dose distribution can be obtained using MSRT and such a simple technique may be suitable for replacing IMRT.

Objective To detect serum ubiquitin-like with PHD and ring finger domains 1 (UHRF1) levels in the patients with esophageal squamous cell carcinoma (ESCC),and analyze their differences among different clinicopathological features subgroups and changes during the perioperative period.Methods Serum samples from 130 preoperative ESCC patients,62 patients 1 week after operation,14 patients 1 week and 2 weeks after operation and 67 healthy controls,and clinicopathological data from ESCC patients were collected.Serum UHRF1 levels were detected by ELISA,and the differences among different groups were analyzed with independent t test,paired t test or one-way ANOVA.Results Serum UHRF1 levels in 130 preoperative ESCC patients were significantly higher than that in healthy controls (t =7.680,P ＜ 0.01),and they were related to the ESCC patients' tumor size,differentiation degree,tumor invasion,lymph nodes metastasis and pTNM stage (P ＜ 0.05),but unrelated to the patients' age,gender,tumor location and types (P ＞ 0.05).Serum UHRF1 levels in 62 postoperative patients were significantly lower than that before operation (t =5.530,P ＜ 0.01),but similar to that in healthy controls (t =1.622,P ＞ 0.05).The serum UHRF1 levels before operation,1 week after operation and 2 weeks after operation in 14 ESCC patients decreased gradually (F =7.595,P ＜ 0.01).Conclusion Serum UHRF1 levels may be a potential biomarker for dynamically monitoring perioperative ESCC patients.

OBJECTIVE In order to take further study of principles and risk factors of infection breakouts at hospitals to reduce infection rates,and provide all levels of management with infectious information.METHODS After collecting the data of hospital infections and analyzing the datum structure of the hospital information system,we developed the software of nosocomial infection information management system using word `segmentation.RESULTS The subsystem could monitor infection of all inpatients,collect and analyze the data of infection examination,patients infected,usage of antibiotics and intervening operations,therefore,relieve information administers from collection works and make them focus on analysis,guidance and problem solutions.CONCLUSIONS As a part of the hospital information system,nosocomial infection information management system can improve the affectivity and efficiency of hospital infection administers due to its accuracy,timeliness and wide coverage.

OBJECTIVE:To improve information management of hospital infections.METHODS:The hospital infection monitoring and management software developed by the hospital where the authors work was applied to monitor the risk factors of hospital infections at real time and selectively.RESULTS:The software could be applied to investigate the situation of antibacterial use in hospital,evaluate the rationality of drug action,monitor the incidence of hospital infections,and analyze the risk factors of hospital infections.CONCLUSIONS:The hospital infection monitoring and management software is con-venient and easy to operate,which can enhance the efficiency and effect of the management of hospital infection.

Objective To study the effects of using jaw tracking technique with Smart LMC algorithm on the absorbing dose of planning target volume (PTV) and organs at risk (OARs) in dynamic intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC).Methods Field fluencies of 10 cases of NPC patients were optimized using DVO algorithm on Eclipse TPS (11.0),and according to the same optimal fluence,MLC operation files were calculated using jaw tracking technique and jaw fixing technique respectively,dose distribution was calculated with AAA algorithm and jaw tracking IMRT plan (JT-IMRT) and jaw fixing IMRT plan (JF-IMRT) were generated respectively.Collimators' position at the plan implementation was observed,and the total number of plans' monitor units (MU),the dose of PTV,the absorb dose of OARs,and the actual fluence verification pass rate were compared.Results The collimators' opening gap distances in 166 control points of the JT-IMRT reduced in both X and Y directions in the field,compared to that of the JF-IMRT.Total number of the JT-IMRT's MU increased by 3.59％-11.63％.There was no statistical significant difference between the doses of the PTV.Statistical significance was found in the differences between maximum dose (Dmax) of brainstem,spinal cord,crystal,optic nerve,the mean dose (Dmean) and D50％ of parotid and their decreased values after therapy (t=5.70-8.66,P＜0.05).The actual fluence verification pass rate of the JT-IMRT was higher than that of the JF-IMRT.There was a significant difference between the results (t=5.18,P＜0.05).Conclusions The JT-IMRT plan of the smart LMC algorithm is more tolerant to the radiation leakage between inter-and intra-leaf.The dose of OARs is lower,while the dose calculation precision and the verification pass rate are higher,the actual radiation dose is more accurate and reliable.Therefore it is more suitable for clinical applications.