Objective To investigate the technique and feasibility of video-assisted thoracoscopic surgery (VATS) in the treatment of esophageal carcinoma. Methods Sixteen patients with esophageal carcinoma underwent esophagectomy by VATS between October 2002 and October 2003. The tumors were found in mid-segment in 13 patients and lower segment in 3 patients. Their TNM staging was: stage T 1 2 patients, stage T 2 5 patients and stage T 3 9 patients; stage Ⅰ 2 patients, stage Ⅱ 8 patients and stage Ⅲ 6 patients. Results No conversion to open surgery was required. The operation time of VATS was 90～150 min (mean, 110 min). The number of removed mediastinal lymph nodes was 6～14 (mean, 7.3). Drainage tube was taken out 2～3 days after operation and the drainage volume was 300～600 ml. No complications were seen. Conclusions VATS for esophageal carcinoma is feasible. Indications for VATS should be stage Ⅰ～Ⅱ and in addition no outward infiltration (≤stage T 3).

The paper discusses the basic contents, characteristics, and development trend of training programs abroad for high level hospital administrators as represented by MHA (Master of Hospital Administration) programs. Those programs establish curricula and training modes in light of the primary tasks and responsibilities of high level hospital administrators. They attach importance to the cultivation of concepts of macro health and ideas of modern management, provide training in methodologies of public health as represented by bio statistics and epidemiology, emphasize practical matters of operation and management such as hospital planning, quality control and financial accounting, and make wide use of case studies so as to enhance the abilities to solve practical problems. Hospital reform and development make it imperative to improve the training of high level hospital administrators, which must be properly oriented, and to develop domestic MHA programs with Chinese characteristics by utilizing existing resources of health administration education and integrate relevant courses.

The effects of low-level radiation on cAMP in peasma, adrenal and testis and cGMP in adrenal of rats were studied. Adult male rats were given whole-body irradiation with x-rays at a dose rate of 15 mGy/min. They were irradiated with 50 and 100 mGy daffy for 30 days within 5 weeks with cumulative doses of 1.5 and 3.0 Gy respectively. One, two and four weeks after termination of irradiation, the levels of cAMP in plasma, the adrenal gland and testis, the level of cGMP in the adrenal gland and the weights of the body, testes and pitutary were examined. The weights of testes decreased within 4 weeks after irradiation as compared with the control and the level of cAMP in the testis was significantly increased at weeks 1 and 2 in the 3.0 Gy group. At week 4, it returned to near normal. In another experiment, animals were irradiated with ~(60)Co ?-ray at a dose rate of 45.3?Gy/min, 16.3 mGy/6h/day and 6 days per week. At 6, 10, 14, 18 and 22 weeks, with cumalative doses of 0.59, 0.98, 1.37, 1.76 and 2.15 Gy respectively, the levels of cAMP in the pitutary and testis and testicular weight were quantified. No significant changes were found. These results suggest that dose rate is an important factor In the determination of the degree of damage of the testis following low-level irradiation.

Diabetic retinopathy (DR) is a common disease of ophthalmology,often causes irreversible decline of patients' vision,which has two features including macular oedema,diabetic retinal neovascularization.Diabetic retinal neovascularization is one of the most important reasons leading to blindness.Endostatin (ES) is one of the most effective agents inhibiting angiogenesis,whose biological function has a close relationship with its chemical construction.However,its mechanisms of treating diabetic retinal neovascularization are very complicated and remain unclear.Therefore,in this review we summarized several possible mechanisms,including regulating the expression of extracellular matrix,inhibiting the expression of pro-angiogenic factors,and regulating the signaling pathways,by which ES may inhibiting diabetic retinal neovascularization.

Objective:To investigate the relationship of micro-inflammation,cellular and humoral immune function and kidney disease of patients with diabetic nephropathy. Methods:124 cases of DN were randomly divided into normal albuminuria group ( NA, n=35),microalbuminuria group (MA,n=45) and clinical albuminuria groups(CP,n=44) based on 24 h urinary albumin excretion rate ( UAER) and the healthy subjects were selected as the control group ( n=35 ) . The levels of C-reactive protein ( CRP ) were measured with radioimmunoassay,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α) and humoral immunity(IgG enzyme-linked immunosorbent assay,IgA,IgM) were measured with ELISA. The levels of immune response ( CD4+Th17,Th17/Treg, CD4+ CD25+ Treg) were measured with flow cytometry cellular. The levels of creatinine ( Scr) ,cystatin C ( CYSC) and UAER of each groups were analyzed with fully automated biochemistry. Results:The levels of CRP,IL-6,TNF-α,Scr,CYSC,UAER of NA group,MA group,CP groups were higher than control groups(P<0. 05),the levels of CRP,IL-6,TNF-α,Scr,CYSC,UAER of CP groups were higher than NA,MA group (P<0. 05). The levels of CD4+CD25+ Treg,IgG were lower than the control group (P<0. 05),while the levels of CD4+ CD25+ Treg,IgG of CP groups were higher than NA group,MA group (P<0. 05). The levels of IgA,IgM,Th17/Treg, CD4+ Th17 of NA group,MA group,CP groups were higher than control groups(P<0. 05). The levels of CRP,IL-6,TNF-α were positively correlated with Scr, CYSC, UAER ( P<0. 05 ) and were negatively correlated with Th17/Treg, CD4+CD25+ Treg, IgG ( P<0. 05). Conclusion:DN patients with micro inflammatory status and immune function disorder,through the control or elimination of pro-inflammatory factors,improve the immune function of DN patients to delay the occurrence and progress of DN patients has important significance.

To evaluate the clinical efficacy of corneal lamellar debridement combined with sutureless amniotic membrane transplantation for the treatment of superficial fungal keratitis.
●METHODS:Totally 22 cases (22 eyes) with superficial fungal keratitis were referred to our hospital from April 2012 to October 2013. The patients with persistent cornea ulcer after treatment of local and systemic antifungal drugs underwent corneal lamellar debridement combined with sutureless amniotic membrane transplantation, and the recipient bed was covered with an amniotic membrane using fibrin sealant during the operation. All patients were still given topical antifungal therapy for 1 -2mo after operation. The followed- up time was 3mo or above. We observed the corneal healing and amniotic membrane adhesion by split lamp microscope, and investigated the transformation of amniotic membrane and fungal infection recurrence with confocal microscope.
●RESULTS: Corneal edema and anterior chamber reaction of 21 patients disappeared gradually, and no amniotic membrane graft dissolved and shed off within 1-2wk postoperatively. Two weeks after operation, the graft integrated into the corneal and the corneal wounds' thickness increased gradually, the corneal epithelium reconstructed and corneas became clear. Four weeks after operation, the corneal scarring developed gradually and fluorescence staining was negative. Nineteen cases' amniotic membranes that adhered with the cornea dissolved 4wk after operation. There were different degrees of corneal nebula or macula remained 3mo postoperatively. All patients' vision improved in varying degrees, except in 1 case with fungal keratitis who had been cured by lamellar keratoplasty.
●CONCLUSlON:Corneal lamellar debridement combined with sutureless amniotic membrane transplantation can effectively remove the foci of inflammation, improve the local efficacy, shorten the operation time, relieve the postoperative reaction, and promote cornea union, which is an effective way to treat superficial fungal keratitis.

Objective To explore the social economic factors related to depressive in patients with long-term hemodialysis.Methods A total of 122 patients with hemodialysis for more than 3 months from December 1st 2008 to February 1st 2009 in Dongfang Hospital and Wangjin Hospital,were divided into a depression group (41 cases) and a non-depressed group (81 cases).Informations such as economic status,social interaction,education,hobbies,etc were collected by questionnaire and the relationship between these factors and depression was analyzed.Results There was significant difference between the two groups in the factors of economic status,social interaction,education,and hobbies (x2 values were 14.671 、6.256、6.744、6.390,P＜0.05).There was no significant difference in the factors of gender,drinking,relationship of family,profession,the condition of housing,social status,seasons of born,and careers,etc (x2 values were 3.651、0.765、2.034、3.093、0.772、5.956、2.687、5.138,P＞0.05).Conclusion Thepatientswithpooreconomic,lower education,less social communication,fewer hobbies,and no smoking habits are easy to be depressive.

BACKGROUND:Number of experimental and clinical studies have shown that stem celltransplantation can establish new blood vessels and improve heart function instead of necrotic myocardium, to significantly improved clinical symptoms and prognosis of cardiovascular disease patients.
OBJECTIVE:To observe the safety of human umbilical cord blood mononuclear cells transplantation in patients with coronary heart disease and heart failure.
METHODS:A total of 12 patients with coronary heart disease and heart failure (acute myocardial infarction and heart failure in six cases, old myocardial infarction and heart failure in six cases) were enrol ed in this study. Patients were treated on the basis of standard medication and percutaneous coronary intervention. The coronary pathway was established via a percutaneous catheter, and suspension of cord blood mononuclear cells was injected through microcatheter into the distal artery. Routine blood test was carried out at 1 week after celltransplantation, blood routine, liver function, kidney function, C-reactive protein, IgA, IgG were compared preoperatively and postoperatively.
RESULTS AND CONCLUSION:The incidence of adverse reactions in cord blood stem celltransplantation was 8.3%, including one case of fever. No micro-embolism occurred. During 1-week fol ow-up, no graft-versus-host disease appeared. After celltransplantation, there were no significant changes in blood routine, liver function, kidney function, C-reactive protein, IgA, IgG. These findings indicate umbilical cord blood monomuclear cells transplantation is safe in a short term for patients with coronary heart disease and heart failure.

BACKGROUND:Myocardial infarction patients commonly appear to have left ventricular remodeling and heart failure. Because of physical characteristics, these two complications are more likely to occur in elderly patients with myocardial infarction. In recent years, stem celltransplantation in the treatment of acute myocardial infarction and heart failure has become a hot topic, and the feasibility and safety has been confirmed, but its long-term outcomes in elderly patients are stil unclear.
OBJECTIVE:To assess the long-term effect of transplantation of autologous peripheral blood stem cells on the left ventricular remodeling and heart function in the old patients with myocardial infarction.
METHODS:Thirty old patients (age ≥ 60 years) with myocardial infarction were randomly assigned to receive intracoronary transplantation of peripheral blood stem cells fol owing bone marrow cells mobilization by granulocyte colony-stimulating factor ( 300-600μg per day) subcutaneously for 5 days in addition to conventional therapy (standard drug therapy and percutaneous coronary intervention;transplantation group, n=15) or standard therapy (standard drug therapy and percutaneous coronary intervention;control group, n=15) . Complications during intervention, left ventricular function and left ventricular remodeling at baseline and 6, 12, 24, 60 months after treatment were monitored.
RESULTS AND CONCLUSION:Left ventricular function, left ventricular end diastolic volume, and left ventricular end-systolic volume were significantly improved 6,12, 24, 60 months after autologous peripheral blood stem celltransplantation compared to baseline, while these parameters remained unchanged in the control group. These parameters had statistical difference between the two groups after treatment. During the fol ow-up, no severe side effects were observed. These findings indicate that autologous peripheral blood stem celltransplantation leads to significant and longstanding improvements in left ventricular performance of old patients with myocardial infarction, and shows good safety.