Objective:To study the feasibility and efficacy of the modified posterolateral laparoscopic approach for resection of massive splenomegaly.Methods:The data of 48 patients who underwent laparoscopic splenectomy for massive splenomegaly at the Affiliated Hospital of Jiangnan University (Wuxi 4th People's Hospital) from January 2016 to July 2019 were retrospectively analyzed. There were 29 males and 19 females, with an average age of 55.8 years. These 48 patients were divided into two groups according to the operative approach, the study group ( n=26) using the modified posterolateral approach which treated the splenic pedicle as the last step; and the control group ( n=22) which used the posterior tunnel of splenic pedicle established by anterior approach to treat the splenic pedicle first. The operation time, gastrointestinal function, recovery time, intraoperative blood loss, rates of conversion to laparotomy and postoperative complications were compared between two groups. The follow-up data were also analyzed. Results:There were no significant differences in operation gastrointestinal function recovery and hospitalization time between the two groups (all P>0.05). The intraoperative blood loss, numbers of patients with convention to open surgery and intraoperative blood transfusion, were (50.2±15.1) ml vs (160.1±40.3) ml, 2 patients (7.7%) vs 7 patients (31.8%), and 1 patients (3.8%) vs 5 patients (22.7%), in study group and control group respectively. The differences between groups were significant (all P<0.05). The complications of the study group and control group were 9 patients (34.6%) vs 13 patients (59.1%), which were significantly in the two groups ( P<0.05). On follow-up which ranged from 1 to 15 months, the numbers of patients with thrombocytosis and portal vein thrombosis in the study group and the control group were 20 patients (76.9%) vs 17 patients (77.3%), and 7 patients (26.9%) vs 6 patients (27.3%), respectively. Conclusion:The modified posterolateral laparoscopic approach for resection of massive splenomegaly was safe and feasible. It should be promoted to treat massive splenomegaly.

BACKGROUND: It has been reported that chitosan can inhibit scar formation and promote wound healing. Medical invisible antimicrobial film is a new type of membrane materials which comprises chitosan as ground substance.OBJECTIVE: To determine the inhibitory effects of medical invisible antimicrobial film on the operative incision scar, and to observe its effects on wound healing.DESIGN, TIME AND SETTING: A controlled animal study was conducted at the IVC Experimental Animal Room, West China School of Pharmacy, Sichuan University from August to October 2007.MATERIALS: Medical invisible antimicrobial film stock solution was colorless transparent sticking solution, which formed colorless transparent film following spray painting (specification: 40 mL), provided by Chengdu Chaojl Technology Co., Ltd. (lot number 070501).METHODS: A total of 16 healthy Sprague Dawley rats aged 20 to 23 days were selected. Full linear skin incisions were operated in aseptic condition. After operation, the experimental group (right side) was sprayed medical invisible antimicrobial film 0.5 mL/time, once a day, for totally 3 days. The control group (left side) received an equal volume of 0.9% sodium chloride injection, with natural cure.MAIN OUTCOME MEASURES: At 3, 7 and 14 days following surgery, incision skin specimens were obtained, and subjected to hematoxylin-eosin staining and Masson staining was applied to observe wound healing and the formation of scar, then the scar area was analyzed.RESULTS: The scar relative mean area of control group was 154 069±51 356 and the experimental group was 98 200±34 719 on the postoperative 14~(th) day. The two groups were significantly different (P < 0.05). At 14 days following surgery, optical microscope showed that the experiment group had less collagen fibers and fibroblast accumulation. At 3 days, compared with the control group, the experimental group had less epithelization period, more granulation tissue and less inflammatory cell infiltration.CONCLUSION: The medical invisible antimicrobial film has inhibitory effect of the formation of operative incision scar, and no influence on wound healing of operative incision.

Objective To analyze the clinical and biological features of mixed acute leukemia(MAL).Methods Bone marrow specimens of 38 MAL patients were evaluated to prove the diagnosis and the classification by morphoiogic,immunologic examinations.These patients were treated with protocols suitable for both acute myeloid leukemia(AML)and acute lymphoblastic leukemia(ALL).Results All MAL patients had a leukemia syndrome.Morphologically,the subtypes of M1,M2 and M5 were predominant in AML,as L2 Was in ALL.Immunologically,coexpression of myeloid and B lineage associated antigens was predominant,about 68.4%;cytogenetically,Ph chromosome was observed in 33.3%(5/15)of MAL patients,and immunophenotype was B-M;1 Ph chromosome(+)MAL patient,fusion gene bcr-abl 190(+)and immunophenotype was B-M.In 38 cases,32 patients received chemotherapy.The complete remission rate was 28.1%(9/32).CR of.normal karyotype was significantly higher than that of abnormal ones.Conclusion Patients with MAL have unique biological features and the complete remission rate was low and the prognosis was poor.

Objective To study the correlation between ABO blood groups and leukemia and lymphoma, and the regional difference. Methods A case-control study had been conducted. The distribution of ABO blood groups was investigated in leukemia patients, lymphoma patients and controls, respectively. Also ABO blood group distribution of leukemia and lymphoma were compared in different areas. Results The distribution of ABO blood groups between patients with acute non-lymphocytic leukemia, acute lymphocytic leukemia, non-Hodgkin lymphoma and health person was significantly different (χ2 = 21.23, χ2 =8.36, χ2 = 9.39,P <0.05). There were regional differences in the ABO blood groups distribution of leukemia and lymphoma,especially ABO blood groups were significantly different in leukemia patients (χ2 = 50.65, P <0.05).Conclusion ABO blood groups might be a genetic susceptible factor of leukemia and lymphoma, but the geography might be a major influential factor.

Objective To evaluate the effects of community-based rehabilitation therapy on activitv of daily living performance of the Chinese stroke patients. Methods In a single blinded,randomized,controlled multicenter trial,737 consecutive stroke patients were stratified by two groups of cerebral infarction and hemorrhage. All the patients were randomly divided into a rehabilitation group and a control group.The patients in the rehabilitation group received atandardized community-based rehabilitation therapy,while those in the control group did not.All the patients were followed up for 5 months for evaluation of their performance with activity of daily living by using Modified Barthel Index before intervention,after follow-up 2 and 5 months,respectively. Results Patients in the rehabilitation group performed better in ADL as reflected by the Modified Barthel Index score than those in the control group after 5 months of intervention(P＜0.05).Although both the rehabilitation group and control group improved over time,the rehabilitation group showed a greater improvement with the Modified Barthel Index scores when compared with the control group(P＜0.01).After 5 months follow-up,the total gain of Modified Barthel Index scores was 26.28 and 32.89 for those with cerebral infarction and hemorrhage,respectively,in the rehabilitation group. In comparison,the gain of Modified Barthel Index scores was 7.65 and 2 1.70 for those with cerebral infarction and those with hemorrhage,respectively in the control group.This implies a difference in improvement of 1 8.63 in cerebral infarction group and 1 1.19 in hemorrhage group,in favor of the rehabilitation group. Conclusion Standardized community-based rehabilitation therapy may help stroke patients to improve their performance in activity of daily living significantly.

Objective To observe the effects of enhanced exercise and combined vitamin D and calcium supplementation on muscular strength and fracture occurrence in postmenopausal women with a high risk of osteoporosis.Methods Totally 614 postmenopausal women at high risk factors of osteoporosis were enrolled in Dongcheng district of Beijing and randomized into four groups:group A(control group,n=173),group B(regular Tai Chi exercise,n=171),group C(calcium 600 mg/d+VitD800 U/d,n=139),and group D[calcium 600 mg/d+25 hydroxyl vitamin D(25OHD) 0.25 μg/d,n=131].Muscular strength was measured at baseline and one and two years after intervention.Bone turnover markers were measured at baseline and during the two-year follow-up.Falls and fractures were recorded.Results The incidence of 25OHD<50 nmol/L was approximately 92.6%.During the follow-up,the left grip strength decreased significantly two years after intervention(t=-3.252,P=0.001)in group A.Right grip strength decreased significantly in group B(t=2.460,P=0.015)while left grip strength improved significantly in group C(t=-2.051,P=0.043)one year after intervention.In group D,muscular strength in both 12-month and 24-month did not change compared with baseline(both P>0.05).Furthermore,serum procollagen type I N-terminal propeptide elevated significantly in group A(t=-2.962,P=0.004),group B(t=-2.888,P=0.005),and group C(t=-2.441,P=0.016),whereas β-C-terminal telopeptide of type I collagen decreased significantly in group B(t=2.285,P=0.024)and group D(t=2.596,P=0.011)two years after intervention.Conclusion Enhanced exercise and combined calcium vitamin D supplementation may help sustain muscle strength in postmenopausal women,while calcium and vitamin D supplementation may improve muscular strength within a short period of time.

Objective: To describe the distribution and drug resistance of pathogens at hematology department of Jiangsu Province from 2014 to 2015 to provide reference for empirical anti-infection treatment. Methods: Pathogens were from hematology department of 26 tertiary hospitals in Jiangsu Province from 2014 to 2015. Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or agar dilution method. Collection of drug susceptibility results and corresponding patient data were analyzed. Results: The separated pathogens amounted to 4 306. Gram-negative bacteria accounted for 64.26%, while the proportions of gram-positive bacteria and funguses were 26.99% and 8.75% respectively. Common gram-negative bacteria were Escherichia coli (20.48%) , Klebsiella pneumonia (15.40%) , Pseudomonas aeruginosa (8.50%) , Acinetobacter baumannii (5.04%) and Stenotropho-monas maltophilia (3.41%) respectively. CRE amounted to 123 (6.68%) . Common gram-positive bacteria were Staphylococcus aureus (4.92%) , Staphylococcus hominis (4.88%) and Staphylococcus epidermidis (4.71%) respectively. Candida albicans were the main fungus which accounted for 5.43%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were 3.5%-6.1% and 5.0%-6.3% respectively. The rates of Pseudomonas aeruginosa resistant to tobramycin and amikacin were 3.2% and 3.3% respectively. The resistant rates of Acinetobacter baumannii towards tobramycin and cefoperazone/sulbactam were both 19.2%. The rates of Stenotrophomonas maltophilia resistant to minocycline and sulfamethoxazole were 3.5% and 9.3% respectively. The rates of Staphylococcus aureus, Enterococcus faecium and Enterococcus faecalis resistant wards vancomycin were 0, 6.4% and 1.4% respectively; also, the rates of them resistant to linezolid were 1.2%, 0 and 1.6% respectively; in addition, the rates of them resistant to teicoplanin were 2.8%, 14.3% and 8.0% respectively. Furthermore, MRSA accounted for 39.15% (83/212) . Conclusions Pathogens were mainly gram-negative bacteria. CRE accounted for 6.68%. The rates of Escherichia coli and Klebsiella pneumonia resistant to carbapenems were lower compared with other antibacterial agents. The rates of gram-positive bacteria resistant to vancomycin, linezolid and teicoplanin were still low. MRSA accounted for 39.15%.