ObjectiveTo investigate the cause, treatment and prevention of splenic injury in radical nephrectomy for left renal cell carcinoma.MethodsThe clinical data of 27 cases of splenic injury in 458 cases of radical nephrectomy for renal cell carcinoma were retrospectively analyzed.ResultsThe injured spleen was saved in 21 cases (18 gradeⅠ injury,3 grade Ⅱ).The injured spleen was sewed up and pressed with hemostatic ganze in 7,pressed with medical sponge laid with spurting argon on biological glue in 11 and the same was carried out in 3 grade Ⅱ injury.Spleenectomy was conducted in the other 6 cases (4 grade Ⅱ injury,2 grade Ⅲ).The patients have been followed up for 6 months to 5 years.The outcome has been good in all except 1 patient died of tumor recurrence 1 month after operation.No late bleeding or adverse side effects has been noted.Conclusionssplenic injury may occur in radical nephrectomy for renal cell carcinoma especially the tumor is lasge or adhered to spleen in the upper past of left kidney.The occurrence of splenic injury is also related to the tumor stage.Attention should be called to the mentioned surgical complication.

Objective To investigate perinatal outcomes of twin pregnancy.Methods Perinatal outcomes of 658 pregnancies with twins hospitalized and born at Beijing Obstetrics and Gynecology Hospital during 2002 to 2005 were retrospective analyzed to compare the influence of type of twin,delivery mode, gestational week,birth time interval between twins,as well as specific complications of twin pregnancies on their outcomes.Results Pefinatal fatality of monzygous twins was 53.69 per thousand(16/298),higher than that of dizygous twins(27.11 per thousand,9/332),with U=2.35,P0.05.Perinatal fatality was higher in twins with different development (birth weight).Perinatal fatality in dizygous twins(12.5 percent,2/16)was lower than that in monozygous ones(14.3 percent,6/42),and that in twins with different development(birth weight)(0.6 percent, 2/316)was lower than that with same development(1.2 percent,3/256),with ?~2=16.944,P

ObjectiveTo study the alteration mechanism of T follicular helper (Tfh) cells in patients with Kawasaki disease (KD).MethodsTwenty children with KD and the same number of agematched healthy subjects were studied.The proportion of CD4+CXCRS+ICOS+ T in peripheral blood was analyzed by flow cytometry.Real-time PCR was performed to detect the level of Tfh transcriptional factor( Bcl6) and its inhibitor( Blimp-1 ).The plasma concentration of IL-4 and IL-21 were determined by ELISA.ResultsThe proportion of CD4+CXCR5+ICOS+ T in patients with KD was significantly higher than healthy controls [ (2.6±0.6) ％ vs ( 1.8±0.7 ) ％,P＜0.05 ].Transcription levels of Bcl-6 were significantly elevated in patients with KD( P＜0.05),its inhibitor Blimp-1 were found to be down-regulated during acute phase of KD compared with healthy controls (P ＜ 0.05 ).The significant increase of IL-4 and IL-21 plasma concentrations were detected in patients with KD(P＜0.05),in comparison with healthy controls.ConclusionThe over activity of Tfh might be correlated with immune dysregulation in Kawasaki disease.Dysregulation of Bcl-6/Blimp-1,altered microenvironment of IL-4 and IL-21 might be correlated with the abnormal activity of Tfh cells.

Objective To retrospectively investigate the impact of postoperative radiotherapy ( RT) on the relationship between molecular subtype and survival in patients with breast cancer ( BC ) . Methods A total of 716 women who were admitted to our hospital in 2008 and newly received unilateral mastectomy were divided into Luminal A ( LA ) , Luminal B?HER?2?negative ( LB1 ) , Luminal B?HER?2?positive ( LB2) , HER?2 overexpression ( HER?2+) , triple?negative ( TN) , and unassigned subtypes according to the 2011 St. Gallen Consensus. The Cox model was used to analyze the differences in overall survival ( OS) and disease?free survival ( DFS ) rates between subtypes in all patients, RT group, or non?RT group. The Kaplan?Meier method was used to calculate OS and DFS rates. The Cox model was used to perform the factor analysis. Results In all patients, the median follow?up time was 71?4 months;the overall mortality rate was 10?5%;the incidence of treatment failure ( death+relapse+metastasis) was 14?9%;217 patients ( 30?3%) received RT. The multivariate analysis showed that there was no significant difference in OS between subtypes in any group ( all P>0?05 ) . In all patients, patients with LB1 subtype or unassigned subtype had significantly poorer DFS rates than those with LA subtype ( HR= 1?881, P= 0?035;HR= 1?907, P=0?049) . In the non?RT group, patients with LB1 subtype had significantly poorer DFS rates than those with LA subtype (HR=3?324, P=0?01). In the RT group, there was no significant difference in DFS rate between subtypes ( all P>0?05) . The two?dimensional cross analyses of RT and subtype demonstrated that patients with LB1 subtype in the non?RT group had lower OS and DFS rates than patients with LA subtype in the RT group ( P=0?09,0?06) . Conclusions Patients with LB1 subtype have lower OS and DFS rates than patients with LA subtype, especially in the non?RT patients. RT has no impact on the relationship between subtype and prognosis.

To assess the impact of the operational simulation training system on the cultivation of ophthalmic students.
●METHODS: Four hundred and eighty ophthalmic students in China Medical University from 2009 to 2011 were chosen as objects and divided into two groups at random. The students in the experimental group used operation simulation training system combined with traditional teaching methods, while the students in the control group only used traditional teaching methods. We examined the operation skills and the confidence of all the students half a year later.
●RESULTS: The improvement of the operation skills during the suture technique examination, and the confidence for operation technology were significantly different in two groups. The basic skills of the students in the examination groups improved apparently during the operational simulation training and they were full of confidence to their operational technique.
●CONCLUSlON: The operational simulation training is useful for promoting the clinical ability for ophthalmic students and should be widely popularized.

Objective　To explore the effects of hypoxia on the syntheses and secretion of adrenomedullin (AM), calcitonin gene related peptide (CGRP) and c-type natriuretic peptide (CNP) and the relationship between these peptides. Methods　Rat models were established with hypoxia for 10, 20 and 30 d respectively and rats under normal altitude were served as control. Pulmonary artery pressure and the maximum increasing speed of right ventricle (RVdp/dtmax) were measured in every group. The dynamic changes of AM, CGRP and CNP concentrations in plasma were studied with radioimmunoassay. Results　During hypoxia, pulmonary artery pressure and RVdp/dtmax were enhanced. Plasma AM and CNP concentrations were increased while CGRP was decreased significantly. The plasma level of AM had positive correlation with that of CNP, but negatively correlated with that of CGRP. Conclusion　Results indicate that hypoxia may cause pulmonary artery pressure change and right ventricle has compensatory reaction to hypoxic pulmonary hypertension. Dynamic changes of plasma AM, CGRP and CNP concentrations can be regarded as indexes for condition of illness.

Child ; Graft Survival ; HLA Antigens ; genetics ; immunology ; Hematopoietic Stem Cell Transplantation ; Humans ; Polymerase Chain Reaction ; Tissue Donors ; Transplantation Chimera ; genetics ; Transplantation Conditioning ; methods ; Transplantation, Homologous ; immunology

Objective To investigate effect of dexmedetomidine on postoperative analgesia pump dose and effect.Methods 50 cases of patients with abdominal surgery under general anesthesia were selected.According to the postoperative analgesic drugs were divided into control group and experimental group, 25 cases in each group were given corresponding drug treatment.After treatment, the visual analogue scale, comfort score, adverse reaction rate and dosage of analgesic drugs were detected and compared.Results Compared with the control group,the VAS score were lower(P <0.05),the BCS score were higher(P<0.05),the adverse reaction rate were lower(P<0.05),the dosage of analgesic pump were lower(P<0.05). Conclusion Dexmedetomidine can significantly reduce postoperative pain degree of patients, reduce the incidence of adverse reaction, reduce analgesic dosage of the drug pump.

Objective To study the prevalence and characteristics of gastroesophageal reflux disease (GERD) in patients with idiopathic pulmonary fibrosis(IPF).Methods A total of 48 patients with diffuse parenchymal lung disease(DPLD) including 25 IPF and 23 other DPLD were enrolled from Department of Respiratory Disease in the First Affiliated Hospital of China Medical University.All patients were subjected to 24-hour esophageal pH monitoring.Pulmonary function test and HRCT of lung were performed at the same time.Results The prevalence of GERD in IPF patients was 64.0％,which was significantly higher than that in other DPLD patients.DeMeester scores were significantly higher in IPF patients than those in non-IPF group[(22.8 ± 21.5) score vs (15.7 ± 14.0) score respectively P ＜ 0.05].Numbers of reflux longer than 5 minutes [(3.8 ± 4.1) time vs (2.1 ± 2.1) time respectively) and reflux index (1.8 ± 1.7 vs 1.3 ± 1.2) in IPF group were higher than those in non-IPF group,yet without statistical significance.Patients with IPF had significantly higher values of following parameters than those in non-IPF patients including percentage of total reflux time(pH ＜ 4.0) (9.2 ± 5.1) ％,percentage of upright reflux time (8.5 ± 5.2) ％,percentage of supine reflux time (10.8 ± 10.7) ％,numbers of reflux (54.2 ± 22.7) time,numbers of regurgitation longer than 5 minutes (6.3 ± 4.2) time,thelongest reflux time (14.5 ± 15.3) min,reflux index 2.5 ± 1.7 and DeMeester scores (34.9 ± 20.3) time (P ＜ 0.05).DeMeester score was positively correlated with gastroesophageal reflux diseases questionnaire (GerdQ) score (r =0.667,P ＜ 0.01).The prevalence of typical GERD sympotoms in the IPF-GERD patients was higher (heartburn 7/16,regurgitation 6/16) than that in IPF patients without GERD (heartburn 2/9,regurgitation 1/9).Conclusion Patients with IPF have a high prevalence of GERD,but usually without typical GERD symptoms.In the hospitals 24-hour esophageal pH monitoring not available,GerdQ can be used to identify GERD in IPF patients.

Objective To summerize the experiences of using random flaps to reconstruct soft tissue defects of the periorbital region.Methods Periorbital soft tissue defects in 65 patients underwent reconstruction surgery by random flaps with pedicle 1.0～2.5 cm in width.The length of the flap ranged from 1.0 cm to 3.5 cm,with the rate of length to width less than 2.5:1.Detail plans on flap and incision design were made based on the aesthetic and functional problems.Results Phenomena of blister and purplish red in the edge or the distal area of the flaps were observed in 3 cases,and were disappeared after corresponding treatment.The other flaps survived and the wound healed primarily after operation.The color and the texture of the flaps matched well to the adjacent tissues with satisfied function and aesthetic Results .Conclusion Random flap is an ideal substitute to repair periorbital soft tissue defects.