Objective To explore the indication,technique and complications of Snodgrass operation in hypospadias repairment.Methods From Sep.2005 to Nov.2006,22 boys from 2 to 18 years old with hypospadias were treated with Snodgrass modification.The procedure was performed in 16 patients as a primary repairment and in 6 patients as the 2-stage repairment.The entire length of the urethral plate was incised along the midline in primary repairment,and the skin flaps and residual urethral plate were incised in the 2-stage repairment.The length of neourethra was from 1 to 10 cm.The neourethra was tubularized over a F 6 or F 8 catheter.The urethral stent was removed in 10 to 14 days pos-toperatively.Results Of the 22 patients,18(81.8%) required no other surgery as the repairment provided a normal appearing penis(straight,terminal meatus, cosmetics) without complications.Fistul aoccurred in 4 patients(18.2%) and meatal stenosis in 1 patient.Conclusion Snodgrass operation creates a vertical slit-like neomeatus.The procedures restores good function and normal appearance to the penis.

Objective To analyze the clinical diagnosis and therapeutic effect of primary middle lobe lung cancer,in order to provide evidence for clinical diagnosis and treatment.Methods The clinical data of 45 cases of primary middle lobe lung cancer treated by surgery from January 2002 to January 2007 were ana- lyzed retrospectively.The operation style includes:simple middle lobectomy 12 cases(26.7 %),middle or up- per lobectomy 10 cases(22.2 %),right lung total resection 5 cases(11.1%).Chest exploration was done on 2 cases(4.44 %),palliative resection or vedged resection 2 cases(4.44 %).Results 1 case died from lung in- fection and respiratory failure(2.22 %).15 cases with arrhythmia (33.3 %), 1 case with chylothorax were cured after conservative treatment.The survival rate of 1,3,5 year were 82.1%,64.3 %,32.1% respectively. Conclusion The treatment of primary middle lobe lung cancer is dominated by regular lobectomy. It is difficult to perform middle lobectomy,so double or total lobectomy is done generally.Owing to the more postoperative complications, it should be cautious to perform sleeve resection.It should be avoided to do vedged resection for primary middle lobe lung cancer in order to lessen local recurrence.

Objective To study the potential of bFGF to promote human bone marrow derived MSCs to differentiate into cardiomyogenic cells, and its effect on proliferation of MSCs. Methods MSCs isolated from adult human bone marrow were cultured in four different systems. Group A: medium with 5-aza. Group B: medium with bFGF. Group C: medium with 5-aza+bFGF. Control group: medium alone. The morphological changes of MSCs were observed. Then immunocytochemistry staining against ?-actin,cTnT,and Connixin43 was performed. The expression of Nkx2.5, GATA-4 and cTnT was detected by semi-quantitative RT-PCR. The proliferation of MSCs in different groups was measured by MTT. Results The MSCs in both group A and C partially differentiated into myogenic cells and expressed proteins of ?-actin,cTnT,and connixin43. In group A and group C, the mRNA level of Nkx2.5,GATA-4 and cTnT was higher than that of control group. In group B, mRNA level of Nkx2.5 and GATA-4 was higher than that of control group. As compared with the control group, cell proliferation was faster in group B than in group A and C. And the proliferation was faster in group C than in group A. Conclusion bFGF can promote the proliferation of MSCs significantly. When combining with 5-aza, bFGF can promote MSCs to differentiate into cardiomyogenic cells more effectively.

Objective To explore the effect of surgical treatment of bronchioloalveolar carcinoma (BAC). Methods Data were collected from 94 patients with BAC (including 67 cases with pure bronchioloalveolar carcinoma, 16 cases with BAC by local infiltration and 11 cases with adenocarcinoma having BAC character). All patients were proved pathologically bronchioloalveolar carcinoma from January 1989 to December 2003. Clinical features, characteristics of radiology, methods of treatment and survival status were studied retrospectively. Surgical treatment and efficacy approaches according to different TNM stages and clinical patterns were also analyzed. Results Ninety-eight patients underwent complete resection and 4 underwent palliative operation and 2 underwent exploratory thoractomy. The 1-, 3-, 5-year survival rates were 75.5 %, 53.2 %, 41.5 %. According to international staging system of lung cancer, there were marked difference in stage Ⅰ group, stage Ⅱ group and stage Ⅲ group (P <0.01). According to pathological classification, there were marked difference in pure bronchioloalveolar carcinoma, BAC with local infiltration and adenocarcinoma having BAC character (P <0.01). Conclusion Bronchioalveoar carcinoma is a special form of lung cancer. It has its own characteristics on biology,radiology,clinic or pathology. Lobectomy is performed commonly in patients with bronchioloalveolar carcinoma. It may be concluded that the early diagnosis, early therapy are the key points for improving the survival rate of BAC.

Objective To improve the pancreaticoenterostomy technique and drainage in panereatieoduodenectomy, so as to prevent postoperative pancreatic leakage. Methods One hundred and thirty-eight panereaticoduodenectomy cases underwent parachute continuous running suture of pancreaticojejunostomy and extra drainage of the anastomotic stoma. Results The average time of the double-deck continuous invaginated pancreaticoenterostomy was 11 minutes, and there was no pancreaticoenterostomy leakage in all cases, lntraoperative blood loss was 353±61 ml, the average hospital stay was 19.2 days. Pulmonary infection developed in 6 cases, three cases suffered from postoperative upper gastrointestinal bleeding due to stress ulcer, two cases from functional delayed gastric emptying. All these complications were cured by conservative treatment, and there was no mortality in these series. Conclusions The parachute continuous running suture of pancreaticojejunostomy and extra drainage has the advantages of easy performance, saving time and less complications, and is an effective way in the prevention of panereatieojejunostomy leakage.

Objective To investigate antibiotic resistance of Pseudomonas aeruginosa isolated from the patients'specimens in the hospital ,the carrying rate of integronⅠ and insertion sequences common area(ISCR)and provide reference for clinical treatment . Methods 106 isolates of Pseudomonas aeruginosa were collected and their bacterial antibiotic resistance and clinical distribution were analyzed by using WHONET5 .6 software .PCR and electrophoresis were used to screen integronⅠ and ISCR carried by the target strains .Results Clinical isolates of Pseudomonas aeruginosa mainly collected from department of pulmonary disease which accounted for 48 .11% ,and sputum specimens were the major source of the 106 isolates ,which accounted for 73 .58% .The sensitiv‐ities of Pseudomonas aeruginosa to tobramycin ,amikacin ,gentamicin were about 85% ,while to imipenem only 65 .09% .The carry‐ing rate of integronⅠ and ISCR in Pseudomonas aeruginosa was 84 .91% and 76 .42% ,respectively .Conclusion Pseudomonas aeruginosa distribution of hospital departments mainly concentrate in pulmonary department and the major type of specimen is spu‐tum .The sensitivity of Pseudomonas aeruginosa to aminoglycoside antibiotic is relatively good .IntegronⅠand ISCR in Pseudomonas aeruginosa could be associated with antibiotic resistance .

Objective To understand the pathogenic distribution and drug resistance in the patients with blood infections in our hospital to provide reference for the empirical medication of blood infections .Methods The cases of blood infections in our hospital during the period 2012-2014 were performed the retrospective investigation .The BD Bactec blood culture system was adopted to conduct the blood culture .The bacterial strain identification and susceptibility test was conducted by using the Microscan Walkaway 40 and the data were analyzed by adopting the WHONET5 .6 software .Results The top four of department distribution in blood infections were the digestive system department ,lung diseases department ,orthopedic department and surgery department ,account‐ing for 25 .20% ,19 .60% ,14 .70% and 10 .50% respectively .The pathogens were mainly Gram negative bacteria ,and the top three were Escherichia coli ,Klebsiella pneumoniae and non fermenting bacteria ,accounting for 44 .10% ,13 .30% and 7 .69% respective‐ly .The top three of Gram positive bacteria were coagulase negative staphylococci ,Staphylococcus aureus and Enterococcus ,account‐ing for 12 .58% ,9 .09% and 7 .69% respectively .The positive rates of ESBL in Escherichia coli and Klebsiella pneumoniae were 45 .5% and 60 .8% respectively .The detection rate of methicillin resistant coagulase negative staphylococci (MRCNS) was 55 .5% , which of methicillin-resistant staphylococcus aureus (MRSA) was 58 .0% .Conclusion The cases of blood infections in our hospi‐tal come from different wards areas ,and the digestive system department is in the majority mostly .The pathogenic bacteria are dom‐inated by Gram negative bacteria ,and the treatment should rationally use the antibacterial drugs according to the bacteria drug re‐sistance situation .

Objective To investigate the results and effects of freezing phrenic nerves for the patients of pulmonary lobectomy.To optimize the best freezing time by studying the effects of different time at-65 ℃.Methods 50 patients of pulmonary lobectomy were randomly entered into 5 groups,including control group,30 seconds group,60 seconds group,90 seconds group,120 seconds group.After operation,the patients' cardiotach,blood pressure,SaO2,breath rate,time period of pulling out drainage tube and VAS about referred pain of scapular region were noted.After pulling out the intrathoracic drain tube,the routine chest normal X ray film and chest ultrasonic inspection were processed and the post-operation remnant cavity were observed.The chest normal fluoroscopy was inspected in 90 days after operation in order to observe the motion information of trouble side diaphragmatic muscle.Results The chest fluid [first day (329±178) ml,(345±150)ml,(268±51) ml,(227±36) ml,second day (251±131) ml,(269±112) ml,(208±61) ml,(158±110) ml,time of pulling out intrathoracic drain tube (5.8±1.75) days,(4.6±1.77) days,(3.9±0.74) days,(3.6±1.07) days] and VAS [(3.6±2.9) scores,(2.2±2.4) scores,(1.0±1.3) scores,(0.7±1.2) scores] about referred pain of scapular region of freezing groups were obviously lower than those in the control group [(375±136) ml,(309±132) ml,(5.7±2.36) days,(4.0±3.3) scores].90 s and 120 s freezing groups were lower than that of 30 s and 60 s groups,andthe 90 s freezing group did not significantly different from the 120 s group.The heart rate,blood pressure,saturation of blood oxygen and breathing rate of each group also had no difference.The remnant cavity sizes were larger in the control group (＞200 ml),they also had more fluidity (＞200 ml),and one case had been taken punctuation.The remnant cavity sizes of freezing groups were small and didn' t need special treatment.The diaphragmatic muscle' s movement of each group were fine after 3 months of operation.Conclusion The freezing phrenic nerves can effectively reduce the chest fluid,the post-operation remnant cavity and the time of pulling out intrathoracic drain tube.The freezing phrenic nerves can reduce the pain of referred pain of scapular region.The best freezing time should be 90 s.The freezing phrenic nerves do not influence the respiration function,and should be advantages of for the clinic researches and applications.

Objective To evaluate clinical treatment method and efficacy of newly diagnosed acute promyelocytic leukemia (APL),and analyze the relevant factors about the long-term survival.Methods The clinical data of 48 patients with newly diagnosed APL were analyzed retrospectively.All of them used alltrans retinoic acid (ATRA) combined with anthracycline as induction remission therapy.After induction remission,ATRA combined with chemotherapy was used as consolidation therapy,and ATRA,arsenic trioxide and conventional chemotherapy alternated as maintenance therapy.Short-term efficacy was analyzed.Patients were followed up,and the rates of overall survival (OS) and disease-free survival (DFS) were analyzed.Long-term efficacy was analyzed by COX proportional hazards regression models univariate analysis.Results The complete remission (CR) rate was 87.5％(42/48) in all 48 patients with APL.The time from treatment beginning to CR was (30.7 ± 4.6) d.Age was the only factor affecting the rate of CR.The rates of 1-year,3-year and 5-year OS were (87.5 ± 4.8)％,(85.4 ± 5.1)％ and (78.3 ± 6.7)％ in 48 patients with APL.The rates of 1-year,3-year and 5-year DFS were (97.6 ±2.4)％,(93.9 ±4.2)％ and (89.5 ± 5.9)％ in 42 patients with CR.COX proportional hazards regression model univariate analysis result showed that the patient' s age,gender,lactate dehydrogenase,diffuse intravascular clotting,risk stratification and bone marrow abnormalities promyelocyte ratio had no correlation with the rate of DFS (P ＞0.05).Conclusions ATRA combined with anthracycline as induction remission therapy,after induction remission ATRA combined with chemotherapy as consolidation therapy,and ATRA,arsenic trioxide and conventional chemotherapy alternated as maintenance therapy can get a higher rate of CR and long-term survival in patients with newly diagnosed APL.It is worthy of clinical application.