We should foster the students'service idea of human centered, make them to be skillful and have morals. Thus they could serve patients with enthusiasm, win the praise of patients by reasonable charge and smallest wound.

Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy combined with splenectomy. Methods Hand-assisted laparoscopic hepatectomy combined with splenectomy was performed in 3 patients. A midline epigastric or right subcostal incision was made for hand-assisted port. The attachments of the spleen were dissected with a harmonic scalpel and the pedicle of the spleen was severed with the Endo-GIA. The transection of the liver was conducted using the harmonic scalpel dissection and nonabsorbable polymer clipping. The cut surface of the liver was closed by interrupted sutures. Results The operation was successfully completed in all the 3 patients. The surgical time was 130 min, 115 min, and 145 min, and the blood loss was 350 ml, 50 ml, and 150 ml, respectively. No serious postoperative complications occurred. The postoperative hospital stay was 9, 7, and 11 days, respectively. Follow-up observations for 6, 23, and 5 months showed no recurrence. Conclusions Hand-assisted laparoscopic hepatectomy combined with splenectomy is feasible and safe in selected patients .

OBJECTIVE:To observe therapeutic efficacy of Compound Leonurus japonicus oral solution in the treatment of hemorrhage after artificial abortion and its effect and safety on normal menstruation recovery. METHODS:100 cases of artificial abortion selected and randomly divided into treatment group and control group,with 50 cases in each group. Control group re-ceived oxytocin intramuscularly after surgery,10 U/time,12 h/time,for 3 times;treatment group was additionally given Com-pound L. japonicus oral solution,2 piece/time,3 times/d,for 5 days,on the basis of control group. Metrorrhagia duration,hemor-rhage amount,normal menstruation recovery and duration of abdominal pain and ADR were all observed in 2 groups. RESULTS:The metrorrhagia duration [(5.38±0.95)d] of treatment group was significantly lower than that [(8.58±1.32)d] of control group, with statistical significance(P<0.05);hypomenorrhea cases(24 cases)of treatment group was higher than those(9 cases)of con-trol group;menorrhagia cases(8 cases)was lower than those(24 cases)of control group;with statistical significance(P<0.05). The normal menstruation recovery time [(27.34±3.87)d] of treatment group was significantly shorter than that [(40.13±2.58)d] of control group,with statistical significance(P<0.05);the duration of abdominal pain [(2.85±0.89)d] in treatment group was sig-nificantly shorter than [(5.02 ± 1.33)d] in control group,with statistical significance (P<0.05).Obvious ADR was not found in both groups. CONCLUSIONS:Compound L. japonicus oral solution is effective in the treatment of hemorrhage after artificial abor-tion,can significantl shorten metrorrhagia duration and hemorrhage amount,recover normal menstruation early,improve the symp-toms of abdominal pain after operation and is easy to take and good safety.

Objective To investigate the correlation of hypoxia-inducible factors (HIF),P53 level and liver cancer infiltration in the microenvironment of the liver cancer pathological.Methods Flow cytometry was used to determine the P53 expression.Immunohistochemical method was applied to detect the expression of HIF characteristics,the correlation between Liver function (alanine amiotransferase (ALT),albumin (ALB),alpha fetoprotein(AFP))and HIF,P53.Results HIP positive rate in patients with encapsulated with incomplete,tumor diameter ≤ 5 cm and＞ 5 cm,tumor stage Ⅰ+Ⅱ and Ⅲ were 50.0％ (14/28) and 33.3％ (14/42),43.6 ％ (17/39)and 22.6％ (7/31),29.7％ (11/37)and 18.2％ (6/33)respectively.The HIF positive rate decrease in patients with capsular damage,tumor diameter increases (＞ 5 cm),Ⅲ patients,and differences between groups were statistically significant (P =0.040,0.030,0.030,respectively).P53 positive expression rate were 42.9％ (12/28) vs.83.3％ (35/42),51.3％ (20/39) vs.93.5％ (29/31),35.1％ (13/37) vs.69.7％ (23/33).The P53 positive expression in patients with capsular damage,tumor diameter increases (＞ 5 cm),Ⅲ patients with were relatively higher,the difference between groups was statistically significant (P =0.030,0.030,0.040,respectively).HIP positive rate in patient with past suffering from chronic hepatitis,cirrhosis and chronic AFP ＞ 35 ng/L,ALT ＞ 80 U/L were 36.2％ (21/58),27.9％ (17/61),27.1％ (14/51),28.2％ (11/39),lower than that of 58.3％ (7/12) in non-chronic hepatitis,non-cirrhotic 55.0％ (5/9),AFP ＜35 ng/L 58.0％ (11/19),ALT ＜ 80 U/L 51.6％ (16/31) of patients,the differences were statistically significant (P =0.046,0.047,0.037,0.045,respectively).P53 positive rate in patient with past sufering from chronic cirrhosis,AFP ＞ 35 ng/L,ALT ＞ 80 U/L,albumin ＜ 35 g/L were 82.0％ (50/61),74.5％ (38/51),69.2％ (27/39),73.7％ (42/57),respectively,higher than that of patient without chronic cirrhosis 44.4％ (4/9),or with AFP ＜ 35 ng/L 31.6％ (6/19),ALT ＜ 80 U/L 22.6％ (7/31),albumin ＞ 35 g/L 46.2％ (6/13).Tthe differences were statistically significant (P =0.037,0.040,0.032,0.041,respectively).Conclusion HIF and P53 might be the important factor in monitoring the development of hepatocellular carcinoma invasion.

Objective To investigate the diagnostic values of direct lymphangiography for the thoracic duct outlet obstruction.Methods The image data of direct lymphangiography were retrospectively analyzed in 124 patients with lymphedema,Chylothorax,chylous ascites,chyluria and intestinal lymphangiectasis,and compared with the results of neck thoracic duct surgical exploration,2 radiologists reviewed DLG DSA images in a double blind manner.The number of neck stem,subclavian stem,bronchialmediastinal stem and TD terminal into blood obstruction on the operation side showed by DLG were assessed using Kappa analysis.Results Of 124 patients,80 patients had the left cervical lymphatic stem reflux on DLG,75 patients with the left subclavian lymphatic stem reflux,30 patients with the left bronchial-mediastinal lymphatie stem reflux,118 patients showed the thoracic duct outlet barrier into the blood.The consistency rate of DLG were 89.9％ (80/89),92.6％ (75/81),90.9％ (30/33) and 95.2％ (118/124) compared with the neck thoracic duct surgical exploration.Tow radiologists had a high degree of diagnostic consistency (K =0.82,P ＜ 0.05).In addition,114 patients (91.9％) had tortuous,dilated waist lymphatic stem,only 10 patients (8.1％) were normal.The cisterna chyli reflux were found in 92 patients (74.2％),intestinal stem reflux in 16 patients (12.9％),reflux to the kidney area in 11 patients (8.9％),to the pericardium reflux in 5 patients (4.0％),vaginal lymphatic leakage in 7 patients (5.6％),retroperitoneal lymph leakage in 2 patients (1.6％),pleural lymphatic leakage in 3 patients (2.4％),tracheal lymph leakage in 1 patient (0.8％).Conclusion Direct lymphangiography has a high consistency with the cervical thoracic duct surgical exploration in displaying thoracic duct outlet obstruction.

Objective To investigate and analyze the current situation of reference intervals and decision limits of reticulocyte count in China.Methods The information related to upper/lower limits,decision limits,data resources,method principles, instruments and reagents of reticulocyte count in 2014 was collected via the external quality assessment software system based on website.The participants were divided according to their methods and instruments.The SPSS 1 9.0 was used for conducting the data analysis and statistics of results for each group.Results There were 276 laboratories submitting the val-id results.The major resources for reference intervals came from national guide to clinical laboratory procedures (53.99%), instructions of instrument manufacturers (16.30%),textbook (9.78%),instructions of reagents manufacturers (9.06%) and others.The major resources for decision limits were national guide to clinical laboratory procedures (56.06%),instruc-tions of instrument manufacturers (16.67%),textbook (7.58),instructions of reagents manufacturers (7.58%)and others. The medians and averages of upper/lower limits and decision limits among subgroups were close,whereas the P2.5 and P97.5 were significant discrepancies.Only 45.65% and 48.48% of participant laboratories had verified reference intervals and deci-sion limits before clinic use.The lower limits and decision limits among subgroups had nostatistical difference (P>0.05), where as the upper limits of different instrument groups had significant differences (P<0.001).Conclusion The current situation of reference intervals and decision limits of reticulocyte count is unsatisfactory.It is certain to establish a uniformed reference interval and decision limits for reticulocyte count,which provides a reference for the standardization of reticulocyte count testing.

Objective Discussthe reference intervals and their sources of lymphocyte subsets by flow cytometry tests by all Chinese clinical laboratories at 2014 with a comparison of difference between different test systems.Methods Questionnaires about reference intervals were distributed to 212 clinical laboratories participating in October 2014 national external quality assessment scheme of lymphocyte subsets by flow cytometry tests of National Center for Clinical Laboratory.Relevant information about reference intervals of 5 relative counting items CD3 + (％),CD3 + CD4 + (％),CD3 + CD8 + (％),CD3-CD16 + CD56 + (％) and CD3-CD19 + (％) was collected by a internet-based external quality assessment software systems.Microsoft Excel 2010 and SPSS 19.0 were used to sort out raw data,eliminate unreasonable or incorrect data,and only analyze source distribution,arithmetic average,median,minimum value,maximum value and percentiles (P2.5 and P97.5) of upper and lower limits about healthy adults' reference intervals.Laboratories derived from the highest percentage of source distribution whose reagent and instrument were matching with each other were grouped according to the test systems used and the differences of reference intervals between different systems were compared with Mann-Whitney test.Results For five items collected,in the clinical laboratories who accepted statistical analysis,respectively 39.32％ (81/ 206),37.44％ (79/211),37.68％ (78/207),37.11％ (72/194),36.98％ (71/192) of them had verified the reference intervals they used.The top three sources of reference intervals were instructions of reagent and instrument manufactures (49.70％-52.54％),calculations by laboratories themselves (18.64％-20.00％),and calculations by other laboratories (14.12％-15.43％).The arithmetic averages and medians of upper and lower limits about every item were relatively close.But the minimum and maximum values of upper and lower limits of certain items had moderate differences.As Mann-Whitney test later showed,all items with the P values of upper and lower limits between different test systems,except for the lower limit of CD3 + CD4 + (％) (P value is 0.052) and the upper limit of CD3-CD19 + (％) (P value is 0.117),were lower than 0.05 which meant an existing statistical difference.Conclusions The sources of lymphocyte subsets by flow cytometry tests in all Chinese clinical laboratories were different and the instructions of reagent and instrument had the highest percentage,but the reference intervals among differenttest systems had statistically significance.

Objective To investigate the surgical method and clinical curative results of acetabulum top compression fractures with sea gull sign. Methods Data of 14 patients who had acetabulum top compression fractures with sea gull sign were retrospectively analyzed and were accepted surgical therapy and followed up. There were 5 females and 9 males, aged from 28 to 71 years (average, 49.9 years). The pre-operative time was from 4 to 14 days (average, 9 days). Letournel-Judet fracture classifica-tion:eight cases for the anterior column+posterior semi-transverse, six cases for a simple anterior column. Three patients with lum-bar compression fracture, two patients with tibial plateau fracture, one patient with multiple rib fractures. All patients were accept-ed open reduction and bone graft and internal fixation through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach. The quality of fracture reduction was assessed according to the Matta reduction criterion after operation. The hip func-tion was evaluated according to Matta. Results 14 patients were followed up from 6 to 60 months (average, 36 months). All pa-tients reached bone healing;healing time was from 3 months to 4 months (average, 3.4 months). According to the Matta reset stan-dard after operation, there were 6 excellent cases, 5 good cases, 2 fair cases, 1 poor case, the excellent and good rate was 78.5%(11/14). The Matta was from 10 to 18 scores (average, 16.4 scores), 5 excellent cases, 5 good cases, 3 fair cases, 1 poor case, the ex-cellent and good rate was 71.4%(10/14). Traumatic arthritis occurred in 3 patients. Pain was serious in two patients and disap-peared after total hip joint replacement. Pain was mild for one patient and disappeared after accepted non steroidal painkiller. One patient had heterotopic ossification after operation, which was not treatmented because of no obvious symptom. Conclusion The appropriate operation time of acetabular roof compression fracture with sea gull sign was from 5 to 10 days after fracture, which was no more than two weeks had best. Through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach, the articular surface could be reduced excellent and got sufficient bone graft. The clinical efficacy was satisfactory after operation.

Objective To carry out the current status of internal quality control by statistical analysis of the Internal Quality Control (IQC)data of homocysteine in 2014 March.Methods Web-based External Quality Assessment (EQA)system was used to collect IQC data of homocysteine from 292 EQA participant laboratories nationwide.The data include thecoefficient of variation (CV)of IQC data under control in March 2014 and long-term cumulative data.Acceptable rates of CVs of two-lot internal quality controls in homocysteine were calculated according to 5 criteria,that were 1/3TEa,1/4TEa and the speci-fications based on biological variation including the minimal,appropriate and optimal allowable imprecision.The instrument the participant laboratories used were sorted into 6 groups and the passing rate of each group were calculated by the 5 crite-ria.Results 292 laboratories reported the data of level 1 IQC for homocysteine,106 of which reported the data of level 2 IQC.The passing rate was different according to different criteria.The passing rate had few difference by the criteria of 1/3TEa and the minimal allowable imprecision based on biological variation,which were from 63.36% to 76.42%.It was also true for 1/4TEa and the appropriate allowable imprecision based on biological variation,which were from 34.25% to 57.55. The passing rate was only 10.62%~16.98% by the criteria of appropriate allowable imprecision based on biological varia-tion.Statistical results showed that instruments the participant mainly used were HITACHI (77/292),Olympus (61/292), Roche (19/292),Beckman (14/292),Abbott (10/292)and Simens (10/292).The passing rates of all the instrument group had few difference except Simens group.Conclusion Most of the laboratories could meet the criteria of 1/3TEa and the min-imal allowable imprecision based on biological variation.But less than half of the laboratories could meet the criteria of 1/4TEa and the appropriate and optimal allowable imprecision based on biological variation.The precision performance of ho-mocysteine among laboratories needs further improvement.

Human proximal tubule epithelial cell line,HK-2 cells,were cultured with various concentrations of insulin for 48 h.Human urate transporter (hUAT) mRNA was detected by realtime quantitative PCR.hUAT mRNA levels were down-regulated by insulin (5,25,125,500 μIU/ml)in a dose-dependent manner (relative expression median were 0.95,0.40,0.24,and 0.23).In vitro,the expression of hUAT mRNA in HK-2 cells is associated with the concentration of insulin.