A service system was created that the tertiary hospitals as the leader, the secondary hospitals as the core and the basic hospi-tals as the foundation, formed the one-stop three level medical rehabilitation service system. It made the referral process more convenient with the operation of the one-stop service, along with the integrated management, the homogenization treatment and the one-stop three level medical institutions;and also solved the problems of the inadequate of rehabilitation medical institutions, the lackage of rehabilitation profes-sionals and the uneven professional and technical condition, that realized hierarchical rehabilitation and two-way referral to meet the rehabil-itation needs of patients.

Objective To evaluate the clinical efficacy and safety of low-volume TURP on patients with BPH. Methods A total of 76 high-risk patients with BPH were treated with either standard TURP (Group 1,n=39) or low-volume TURP(Group 2,n=37).The operative duration,blood loss,postoperative irrigation time,IPSS,Qmax,postvoid urine residual volume (PURV) were comparatively evaluated. Results In Groups 1 and 2,the operation durations were (67.5?18.2)min and (16.4?3.5)min (P= 0.011);blood loss,(158.4?47.3)ml and (54.7?25.2)ml (P=0.013);postoperative irrigation time (4.9?1.8)d and (1.3?0.5)d (P=0.029);IPSS change (19.3?7.6) and (15.3?9.7)(P=0.46);Qmax (13.4?8.8)ml/s and (11.7?9.1)ml/s (P=0.79);PURV (134.9?68.6)ml and (163.8? 94.5)ml (P=0.17) respectively.31 cases in Group 2 (low-volume TURP) were followed up for 2 to 18 months (mean,10 months) with satisfactory results. Conclusions The low-volume TURP is effective and characterized by shorter operative duration,minimal-invasion and better tolerance for the high-risk patients with BPH.

Objective To explore how to treat open neck trauma in time and with reason in the primary hospital.Methods 57 cases of neck open injury were hospitalized from Aug.1997 to Jan.2()07,and injury cause,mechanism,diagnosis and treatment of them are analyzed retrospectively.Results There were 29 incisal wounds and 23 penetrating wounds and 5 contusing wounds.Among 57 patients there were 12 significant injuries and 55 minor injuries cases.53 patients had been treated with operative exploration and 10 patients had therapeutic exploration.The result of treatment showed that 50 patients were cured,and 4 patients died of head injury,cervical spinal injury and respiratory failure,anoxic encephalopathy from airway obstruction and hemorrhagic shock from combined injuries of common carotid artery and internal jugular vein.Conclusion The mainstay of choice of treatment is the injury mechanism and clinical signs and symptoms of patient.

Objective To explore applied characteristics of the prolene hernia system(PHS) in inguinal hernioplasty, and management during and after operation, and long-term effect of this kind of hemioplasty in aged patients. Methods 69 aged patients using PHS were followed and analyzed retrospectively. Results Tension-free inguinal hernioplasty with the PHS were performed in 69 aged patients of groin hernia. Operative time ranged from 45min to 160min. Post-operatively, 3 patients developed gentle scrotal swelling, and 20 patients had been adminis- tered anodyne for pain of incision, and 12 cases experienced retention of urine, 1 case developed pneumonia, and 2 cases oeeurred incisional infection and gore. 68 cases of them recovered daily life about 2 to 3 weeks after operation. During follow-up period from 6 months to 77 months,there was no recurrence of inguinal hernia and no pain in in-guinal region, but 2 patients feel discomfort sporadically. Conclusion The PHS strengthens the myopectineal orifice and seals up-area of it,so the system is especially preferred in treating aged patients of groin hernias who have some defectsof anatomic structure in inguinal region. The local anaesthesia is also suitable for this kind of hernioplasty in aged patients.

AIM:To explore the changes of L-selectin expression and F-actin distribution of leukocytes from pancreatic circulation in the experimental acute necrotizing pancreatitis (ANP) rats and impact of Chinese herbs west China pancreatitis yi hao (WPY) on them in vivo. METHODS:Forty-four Wistar rats were randomized into control group,ANP group and ANP WPY treated group. The leukocytes from blood of splenic vein were incubated with PE-anti-CD62L for L-selectin and TRTIC-Phalloidin for F-actin,then the ratio of CD62L positive granulocytes was measured by flow cytometry and leukocytes were taken images with confocal laser scanning microscope. The distribution of F-actin at the border or central part of leukocyte was analyzed by using Mias system. RESULTS:The ratio of CD62L positive granulocytes increased in ANP rats,but those increases at 6 h (31.78%?12.37%) and 12 h (29.83%?13.73%) were significant [vs control group(11.96%?5.32%),P

Objective To evaluate endovascular treatment of Budd-Chiari syndrome(BCS)with occlusion of hepatic veins.Methods Retrospective analysis on the clinical materials of 32 BCS cases with occlusion of hepatic veins was made.Four cases received inferior vena cava(IVC)angioplasty or stent implant and splenorenal shunt;Transfemoral vein or transjugular hepatic vein angioplasty was performed in 10 cases,and percutaneous transhepatic recanalization combined with transjugular and/or transfemoral vein angioplasty of hepatic veins was performed in 16 cases,respectively.Two cases failed therapy attempt.Results A failure to find the main hepatic vein in percutaneous transhepatic venography lead to the abandent of therapy in 2 cases.Hepatic vein angioplasty and IVC angioplasty was successful in the other 30 cases.The pressure of hepatic vein decreased from(43±8)cm H_2O to(16±4)cm H_2O(t=21.23,P<0.01).The symptoms were obviously relieved,ascites disappeared,abdominal distension palliated,chest and abdominal wall varicose veins collapsed one week after endovascular treatment.During perioperative procedure,2 cases with liver puncture bleeding were cured by laparotomy.The follow-up duration was 5 months to 65 months and mean(26.0±2.0)months.There was no stent migration and hepatic vein restenosis and occlusion.Chest and abdominal wall varicose veins disappeared and esophagus phlebeurysma were ameliorated as shown by esophageal barium series.There were no pulmonary embolism and death.Conclusions The procedure of endovascular treatment of BCS with occlusion of hepatic veins is simple,mini-traumatic and effective.

Objective To investigate whether initial intervention based on WBC measured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL.Methods From May,2015 to July 2015,24 female New Zealand rabbits,weighing 2.0-2.5 kg,born 2-3 months,used as uroseptic shock model.Their ureters were ligated and followed by injection of Escherichia coli solution into the renal pelvis.Then,those animals were randomly assigned into control group(the first group)and experimental groups (the second group,the third group).Each group had 8 rabbits initially.The first group did not receive sensitive antibiotic or fluid resuscitation.The second group received imipenem and cilastatin sodium 15mg/kg and normal saline 5 ml/kg 2 hours postoperatively.The third group received sensitive antibiotic and fluid resuscitation the same dosage as the second group 6 hours postoperatively.Mean arterial pressure(MAP) was recorded for 10 hours and survival rate of all groups for 72h postoperatively was recorded..The clinical data of 46 patients whose WBC count less than 2.85 × 109/L within two hours after UUTEL were analyzed retrospectively.These patients were divided into two groups based on the time of intervention.Group A including 19 patients received routine antibiotic,fluid therapy,low-dose corticosteroids when there was symptom of shock.Group B including 27 patients immediately received resuscitation bundle protocol when there was a drastic decrease in WBC.The incidence of septic shock,the rate of intubation,length of stay in ICU,length of stay in hospital postoperatively,hospitalization cost and survival rate of these two groups were compared.Results All 8 rabbits of the first group died within 72 h,postoperatively and the median time of survival was 11 h.None of the second group rabbits developed shock and all rabbits survived 72 h after operation.6/8 rabbits of the third group survived 72 h after operation.15 patients in Group A and 3 patients in Group B experienced acute uroseptic shock (P ＜ 0.05).11 patients in Group A and one patients in Group B underwent tracheal intubation (P ＜ 0.05).18 patients in Group A and 6 patients in Group B were transferred to ICU(P ＜ 0.05),and their length of stay in ICU was (10.8 ± 5.4) d and (7.5 ± 2.8) d,respectively(P ＞ 0.05).The length of stay in hospital and hospitalization cost of Group A and B were (19 ± 9.8)d vs.(7 ±4.7)d(P ＜0.05),(94 583 ±51 623) RMB vs.(35 389 ± 16 342) RMB respectively (P ＜ 0.05).One patient in Group A died due to acute uroseptic shock and none of Group B died.Conclusions Our animal model and clinical cohort study showed that initial intervention based on WBC mneasured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL and improve the prognosis.

10.3969/j.issn.2095-4344.2013.24.015

Objective: To evaluate the effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection. Methods: The perioperative data and short-term quality of life of 120 patients received uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection were analyzed from September to November 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China. There were 64 male and 56 female patients aging of (62±10) years (ranging from 28 to 82 years). There were 60 cases received uniportal (uniportal group) and 60 cases received three portal video-assisted thoracic surgery (three-portal group). Quality of life by measurement of functional and symptom scales was assessed before surgery at baseline, and 1, 2, 4, and 8 weeks after the operation. The t test, χ² test, Fisher exact test and Wilcoxon rank-sum test were used to compare the date between the 2 groups. Repeated measurement variance was used for comparison of the quality of life at different time points. Results: There were no statistically significant differences in the clinicopathological features of the two groups (P>0.05). Intraoperative bleeding volume ((92±85) ml vs. (131±91) ml, t=2.387, P=0.019), postoperative catheter time ((4.4±3.1) days vs. (6.0±3.9) days, t=2.401, P=0.018), and postoperative hospitalization time ((6.2±4.0) days vs. (8.3±4.6) days, t=2.626, P=0.010) in the patients with uniportal group were less than that in three-portal group. Preoperative functional areas, symptom areas and overall health scores were similar in the two group. The functional areas such as physical function, role function, emotional function and social function and overall health status of uniportal group were significantly higher than those of three-portal group in postoperative time, while the fatigue and pain of uniportal group were significantly lower than that of three-portal group. Conclusions Uniportal video-assisted thoracic surgery can achieve the same safety and radical of three-portal video-assisted thoracic surgery. It has advantages in intraoperative bleeding volume, postoperative time after operation, hospitalization time and postoperative life quality.

OBJECTIVETo investigate the promoter methylation of p16, FHIT and RASSF1A gene and telomere damage in the workers exposed to coal tar pitch, and to explore the effective biomarker of occupational exposure to coal tar pitch.

METHODS180 cases of workers exposed to coal tar pitch in a certain carbon plant named as exposure group, and 145 healthy cases with a medical examination in the first affiliated hospital of Zhengzhou University were selected as control group. Relative telomere length in peripheral blood DNA was detected using real-time quantitative PCR, and the promoter methylation rate of p16, RASSF1A and FHIT gene in peripheral blood DNA were determined by real-time quantitative methylation specific PCR. The relative telomere length and gene promoter methylation in two groups were compared, and influencing factors were analyzed.

RESULTSRelative telomere length in exposed group was lower than that in the control group, and the difference was statistically significant (Z = -5.395, P < 0.001). There was no significant difference in the promoter methylation rate of p16, FHIT and RASSF1A gene between the two groups (P > 0.05). Stratification analysis by gender, age, and smoking, we found that when the age was less than or equal to 40, the promoter methylation rate of p16 in exposed group was more than that in control group, and the difference was statistically significant (Z = -1.914, P = 0.011).

CONCLUSIONOccupational exposure to coal tar pitch may induce leukocyte DNA telomere length of human peripheral blood shortened, and may not change the promoter methylation rates of p16, FHIT and RASSF1A gene.

Acid Anhydride Hydrolases ; genetics ; Coal Tar ; adverse effects ; Cyclin-Dependent Kinase Inhibitor p16 ; genetics ; DNA Methylation ; Humans ; Leukocytes ; drug effects ; Neoplasm Proteins ; genetics ; Occupational Exposure ; adverse effects ; Promoter Regions, Genetic ; Telomere ; drug effects ; ultrastructure ; Tumor Suppressor Proteins ; genetics