Extramedullary infiltration is one of the reasons of relapse and death for leukemia patients.Reaearches increasingly show that extramedullary microenvironment plays a pivotal role on progress and relapse of leukemia.Extramedullary infiltration of leukemia is the result of interactions among many factors and many steps,involving liver,spleen,central nervous system,thymus and other tissues and organs.

Objective To evaluate the value of mediastinoscopy in the diagnosis of undifferentiated mediastinal diseases. Methods A total of 35 mediastinoscopies were performed for patients with undifferentiated mediastinal disease from November 1999 to February 2002 and suspicious tissues at peritracheal,retrosternal,subcarinal,or bilateral hilar areas were obtaiued for pathological examination. Results Thirty four of 35 patients with undetermined mediastinal diseases had definite pathologic diagnosis.The diagnosis accuracy was 97%(34/35).Of the 34 patients,18 were diagnosed as malignant accounting for 52.9%.Sixteen of the 34 were diagnosed as benign,accounting for 47.1%.The diagnostic consistency of preoperation and postoperation was 47.1%(16/34).The misdiagnosis of preoperation was 52.9%(18/34).In this series,the benigns were apt to lead to misdiagnosis.10 of 16 patients with benign disease were diagnoscd as initially malignancies,representing 62.5%.In the entire group one patient had complications (2.9%).Yet no perioperative death occurred. Conclusions Mediastinoscopy is a valuable procedure which helps mede a correct diagnosis of mediastinal diseases.Given its safety and usefulness It is suggested that mediastinoscopy should be used routinely in the diagnosis of undifferentiated mediastinal diseases.

1.0 cm) by radiographic examinations, video-mediastinoscopy showed positive results in 30 cases, and negative in 14 cases, in which the surgical exploration found no evidence of metastasis to mediastinal lymph nodes. No postoperative complications and mortality were observed. Conclusions Video-mediastinoscopy offers clear operation field, high resolution, convenient application, safety and reliability. We suggest that it be adopted as a routine method in the diagnosis of mediastinal tumor and the staging of lung cancer.

Objective: To compare the clinical value of video-mediastinoscopy (VM) and standard mediastinoscopy(SM) in diagnosis of thoracic diseases. Methods: The clinical data of 100 patients with mediastinoscopy were studied retrospectively. Of them, 54 patients underwent VM, and 46 patients underwent SM. The operative parameters including operating time, complications and post-operative hospital stay, the diagnosis accuracy of undifferentiated mediastinal diseases and the accuracy of perioperative staging of lung cancer were compared. Results: The average operating time in VM group was (53.9?17.2) mins, which was less than that in SM group (69.4?24.7)mins (t=2.05,P

Objective To evaluate the role of mediastinoscopy with biopsy on right trachea-bronchial lymph node (R4) in the diagnosis and pathologic staging of lung cancer. Methods From November 1999 to May 2004, sixty-six patients with lung cancer (47 right and 19 left) received mediastinoscopic biopsy on R4 lymph node. 17 patients were preoperative diagnosed and 49 suspected have lung cancer. The approach included cervical mediastinoscopy in 62 cases, parasternal mediastinoscopy in 1 and cervical combined with parasternal mediastinoscopy in 3. Results In total 66 patients, R4 lymph node positive was found in 49 cases, including 38 patients with right lung cancer and 11 with left lung cancer. The metastasis rate in small cell lung cancer, adenocarcinoma and squamous cell carcinoma were 100%, 82.2% and 52%, respectively. For 49 preoperatively suspected lung cancer patients, malignant tumor was confirmed by mediastinoscopy with biopsy in 40 and open thoracic surgery in 9. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusion R4 lymph node is one of the most common and important site for the tumor metastasis in lung cancer. Mediastinoscopy with biopsy on R4 lymph node has incomparable advantages in diagnosis and staging lung cancer over other examinations and biopsy on other sites of lymph nodes.

OBJECTIVE:To provide reference for perioperative rational application of antibiotics in gynecologicalⅡandⅢinci-sion surgery. METHODS:The perioperative patients of typeⅡandⅢincision surgery were collected from our hospital during Jul.-Dec. 2013-Jul.-Dec.2014,and then divided into pre-rectification group and post-rectification group. The prophylactic application of antibiotics in 2 groups were analyzed statistically. RESULTS:After rectification,rational rate of prophylactic medication in-creased from 5.38% to 89.69%(P<0.01);rational rate of prophylactic medication time increased from 11.83% to 91.75%(P<0.01);prophylactic medication duration decreased from (12 ± 2.1)d to(5.5 ± 1.9)d(P<0.01);after rectification,both total drug cost and drug cost per capita decreased significantly (P<0.01);postoperative infection rate showed no significant change before and after rectification (P>0.05). After rectification,usage and dosage of β-lactam antibiotics were in line with pharmacokinetics, Intravenous drip was adjusted from once a day to twice a day,and its rational rate increased significantly compared to before rectifi-cation(P<0.05). CONCLUSIONS:The antibiotics special rectification activities significantly promote the rationality of periopera-tive prophylactic application of antibiotics in gynaecologyⅡandⅢincision surgery of our hospital,reduce adverse drug reactions and resistant strains due to irrational use of drugs,and decrease the drug cost.

Objective To compare safety,completeness and long-term results between lobectomy by video-assisted thoracoscopic surgery(VATS) and thoracotomy for clinical stage Ⅰ / Ⅱ non-small cell lung cancer(NSCLC).Methods Between July 2010 and December 2011,673 patients with clinical stage Ⅰ / Ⅱ NSCLC from 11 hospitals underwent pulmonary lobectomy(425 VATS,248 thoracotomy).Patients were matched by propensity score matoh method to create two comparable groups,402 patients remained eligible for analysis,with 201 patients in each group.Perioperative variables and follow-up results were compared between the two groups.Results Patients characteristics were comparable between the two groups,except for a slight lower preoperative FEV1,FEV1％ and FEV1/FVC in the VATS group (P ＜ 0.05).There was one postoperative death in each group.There was no significant difference in operative time,mediastinal lymph nodes stations/numbers dissected and postoperative drainage time between the two groups.The operative blood loss was lower in the VATS group(P ＜ 0.001),the mean hospital stay was shorter in the VATS group(P ＜ 0.001).Postoperative pneumonia/pulmonary atelectasis rate was lower in the VATS group than in the thoracotomy group (5.1％ vs.10.4％,P ＜ 0.05).Median follow-up time was 20 months in both groups.One-year and two-year recurrence-free survival was 90％ vs.88％ and 80％ vs.70％,respectively(P =0.163).One-year and two-year overall survival were 96％ vs.95％ and 88％ vs.85％,respectively(P =0.226).Conclusion For clinical stage Ⅰ / Ⅱ NSCLC,VATS lobectomy is a feasible procedure with shorter hospital stay and less complications,while its surgical and oncologic outcome is comparable to that of thoracotomy lobectomy.

Objective: To observe the effects of erigeron injection on the biochemical indicators of hepatotoxicity caused by ischemia and reperfusion of the mice intestine.　Methods:A experimental model of liver lesion induced by ischemia－reperfusion of the mice intestine was set up. Serum was obtained after 20 minutes of ischemia followed by 1 hour of reperfusion. Contents of SOD and MDA in liver were measured.　Results: The serum ALT significantly increased following ischemia and reperfusion, which was attenuated by the erigeron injection (P＜0.01). Erigeron injection can also increase the contents of SOD and MDA in the mice liver (p＜0.05 and 0.01, respectively).　Conclusion: Erigeron injection can improve the biochemical indicators of liver lesion induced by ischemia and reperfusion of the mice intestine. It is indicated that the protective effects of erigeron injection was related to anti－oxidation mechanisms.

With the development of organ transplantation for nearly half a century, currently the hot issues in clinical renal transplantation have already shifted to the application of low toxicity immunosuppressive drugs and their projects, as well as the research of technique which induces low or no immunity response to the specific donor. At present the main effective strategies of inducing immune tolerance are donor specific blood transfusion and donor specific bone marrow transplantation. This article summarizes the background, mechanism and clinical application of these two strategies.

Objective To study the changes of the urinary ?-1 microglobulin and urinary immunoglobulin G(IgG) and to investigate the relationship between these two proteins and the allograft function after renal transplantation.Methods Twenty-nine renal transplant recipients were included in the study.Urinary ?-1 microglobulin and urinary IgG were analyzed at d 1,7,14,21,28 after renal transplantation.The allograft function was evaluated based on the clinical manifestations,laboratory and imaging examinations,and the relationship between urinary ?-1 microglobulin,IgG and serum cretinine(SCr) were analysed. Results Urinary ?-1 microglobulin and urinary IgG correlated with SCr after renal transplantation in one month.Of all the 29 cases,14 experienced allograft function recovery(group A),and 15 failed(group B).Urinary ?-1 microglobulin decreased significantly in group A(P