Objective To compare the clinical effect before and after the implementation of extended pelvic lymph node excision on patients with radical cystectomy.Methods The patients underwent radical cystectomy and extended pelvic lymph node excision for bladder cancer patients were divided into two groups by random digits table method,preoperative excision group (52 cases) used in radical cystectomy after the implementation of extended pelvic lymph node excision,postoperative excision group (54 cases) used in radical cystectomy before the implementation of extended pelvic lymph node excision.Results The operation time of radical cystectomy in preoperative excision group was significantly shorter than that in postoperative excision group [(78.6 ± 24.5) min vs.(115.1 ± 29.7) min],the number of iliac and anterior iliac lymph node excision was significantly lower than that in postoperative excision group [(5.4 ± 2.3) pieces vs.(7.3 ± 3.1) pieces and (1.4 ± 1.0) pieces vs.(2.4 ± 1.5) pieces],the number of total pelvic lymph node excision was significantly lower than that in postoperative excision group [(25.6 ± 8.3) pieces vs.(29.1 ± 8.5) pieces],there were statistical differences (P ＜ 0.05).There were no statistical differences in vein injury,lymphatic fistula delayed removal of drainage tube and other complications occurred in 2 groups (P ＞ 0.05).Conclusion Before radical cystectomy,the first implementation of the expansion pelvic lymph node excision is a safe and effective way in patients.

T follicular helper cells(Tfh)possess the function to induce efficient B cell maturation in germinal center (GC).However,HIV infection can destroy the structure of lymphoid follicles,and disturb the quantity and function of Tfh,resulting in the dysfunction of B cells.Meanwhile,HIV may remain dormant in the Tfh after invading host and escape the elimination of immunologic system.Consequently,the Tfh turns into the sanctuary of HIV.By the above mentioned mechanism,HIV infection leads to the progressive damage of CD4 + T lymphocytes, hypergammaglobulinemia and the loss of memory B lymphocytes.

Objective To evaluate the efficacy of catheterization of left atrium for postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.Methods Sixty ASA Ⅲ or Ⅳ pediatric patients of both sexes,aged 9 months-14 yr,scheduled for elective congenital heart disease complicated with moderate-to-severe pulmonary hypertension under cardiopulmonary bypass,were randomly divided into 2 groups (n =30 each):central venous catheterzation group (C group)and catheterization of left atrium group (L group).After induction of anesthesia,triple-lumen central venous catheters were inserted in both groups.In group L,the right internal jugular vein was cannulated with a single lumen venous catheter passed through the left atrium for monitoring postoperative left atrial pressure (LAP) and administration of vasoactive drug and LAP was maintained at 8-12 mm Hg after operation.Duration of mechanical ventilation and duration of stay in intensive care unit were recorded.The amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed within 48 h after operation was also recorded.Results Compared with C group,the amount of dopamine,dobutamine,nitroprusside,milrinone,and alprostadil consumed was significantly reduced and duration of mechanical ventilation and duration of stay in intensive care unit were significantly shortened in group L.Conclusion Catheterization of left atrium is used for monitoring postoperative LAP,which can provide a basis for reasonable clinical prescription and optimize the efficacy of postoperative management in pediatric patients undergoing congenital heart disease complicated with moderate to severe pulmonary hypertension.

Objective To explore the highly effective teaching and training approaches to electrocardiogram (ECG) monitoring. Methods Using computer simulation and digital programming, ECG data-gathering platform was set up. Results Not only ECG data were gathered and stored automatically in real time, but its dynamic databases including examination database were established as well. Therefore the teaching and training approaches to ECG monitoring achieved digitization with network and multimedia. Conclusion On the basis of new computer techniques, the application study on teaching and training approaches to ECG monitoring helps to the organic integration of teaching, scientific research and clinical practice, and also helps to the improvement in the training level or quality.

Objective To set up an information platform applicable to medical non-commissioned officers (NCOs) so as to integrate,multiply and share teaching resources,and optimize and improve training abilities.Methods The downstage application and backstage management were realized by ASP and WEB database program,as well as by dynamic renewal of web pages via backstage adjustment.Results Based on local area network,an information platform applicable to medical NCOs' education was set up,on which the goals,including digitization of textbooks,integration of courseware,standardization of picture and word materials,automatic formation of teaching plans,and upload,download and broadcast of courses,were reached.Conclusion The educative digitization can be realized for medical NCOs by means of computerized network,database and multimedia techniques,which helps to push forward the innovation of educative modes and approaches.

Objective:To explore mental problems of middle school students using benzodiazepine(BZD) .Method:A cross-sectional survey was done in 28 middle schools of 7 urban areas of Wuhan.12345 subjects from 258 classes completed the survey(98.2%).Results:The rate of BZD use was 4.0%,that of drug dependence was 0.41%.More boys than girls had used BZD(4.9%vs.3.2%,?2=24.34,P

OBJECTIVE　To evaluate the availability and safety of a new carbapenem meropenem.METHODS　The randomized study was conducted in 60 patients with respiratory tract infections.They were divided into two groups:meropenem or imipenem/cilastatin.RESULTS　The cure rate,effective rate and bacterial clearance rate for meropenem were 80.0%,93.3%,92.3%,respectively and for those of imipenem/cilastatin were 76.7%,90.0% and 91.3%,respectively.The rate of adverse reactions for both meropenem/cilastatin was 3.3%.CONCLUSION　Meropenem appeared to be a highly effective and safe agent in treatment of respiratory tract infections.Its efficacy and safety are similar to that of imipenem/cilastatin.

Pancreaticojejunostomy is a difficult procedure in laparoscopic pancreaticoduodenectomy.How to improve the method of laparoscopic pancreaticojejunostomy and decrease the incidence of pancreatic leakage is a never-ending issue for clinicians.From November 2002 to March 2012,the digestive tract of 34 patients who received laparoscopic pancreaticoduodenectomy at the First Affiliated Hospital of Guangxi Medical University was constructed by wrapping pancreatic duct-jejunum anastomosis,and satisfactory outcomes were observed except for 2 patients with slight pancreatic leakage.The results of the study showed that wrapping pancreatic duct-jejunum anastomosis is a fast,safe and effective method for pancreaticojejunostomy.

Objective To compare the incidence of C5 nerve root palsy after laminoplasty and laminectomy with internal fixation for treating multilevel cervical spondylotic myelopathy (MCSM).Methods From January 2008 to August 2012,98 patients with MCSM were treated with laminoplasty (47 patients,group A) or laminectomy (51 patients,group B) with internal fixation.All the patients were followed up for 13-56(26.5 ± 7.9) months.In both groups,Cobb's method was applied to measure cervical lordotic angle,and Ishihara's method was conducted to measure cervical curvature index (CCI) before and after operation.The incidence of C5 nerveroot palsy was recorded and compared.Results The incidence of C5 nerve root palsy in group A was 2.1％ (1/47),while 21.6 ％ (11/51) in group B (x2 =5.430,P ＜ 0.05).The JOA scores in group A and group B before and after operation and improvement rate of JOA scores had no significant difference (P＞ 0.05).The cervical lordotic angle and CCI in group A and group B before and after operation had no significant difference (P ＞ 0.05).The improvement rate of CCI between two groups had no significant difference (P ＞ 0.05).All of 11 patients with C5 nerve root palsy were group B 1,and other 40 patients were group B2.The improvement rate of CCI in group B1 was significantly higher than that in group B2 [(38.7 ± 18.3)％ vs.(22.1 ± 12.1)％](t =1.772,P＜ 0.05).Conclusions Compared with laminoplasty,laminectomy with internal fixation has a higher incidence of C5 nerve root palsy.The C5 nerve root palsy may be associated with postoperative increase of cervical lordosis angle.Moreover,tethering of the C5 root may he one of its important pathomechanisms.

Ubiquitin-proteasome pathway is an important mechanism regulating many processes of cellular biology,and also a potential target for abnormal regulation associated with malignancy. This pathway may up-regulate or down-regulate the expression of some tumor-inhibitory genes, transcriptional factors and cyclins,and alter the generation of MHC-I-restricting antigen peptides through the activity of specific proteasome, and consequently,participates in the genesis and progression of malignancy.