Objective To assess clinical efficacy of the combined laparoscopic technique for superficial bladder neoplasms involved uretetic orifice. Methods A totsl of 12 patients with bladder neoplasms involved ureteric orifice were treated and reviewed.The clinieal tumor stage was Tis in 6,T1 in 6.During the procedure,the transurethral resection of bladder neoplasms was performed firstlythe extent including 0.5-1.0 cm formal bladder tissue around ureteric orifice,deep to superficial muscle of bladder,then ureteroneocystostomy was done with transperitoneal laparoscopic technique.Results The operations were successfully in all 12 cases.The average procedure time was 2.2 h.The average volume of hemorrhage was 25 ml.The double J stents were removed 3 months postoperatively.Six months after surgery intravenous pyelography(IVU)and cystography showed no ureter obstruction in all cases,Ⅰ-Ⅱ degree vesicle-ureteral reflux in 2 cases.One year after surgery custography showed Ⅰ-Ⅱdegree vesicle-ureteral reflux in 4 cases,Ⅱdegree relux in 3 cases.During 324 months' follow-up,B type ultrasound and IVU showed moderate hydronephrosis in 1 case,mild in 5. Conclusion The treatment of combining laparoscopic technique for superficial bladder neoplasms involved ureterie orifice might be an effective and safe method.

Introduction to the specific practice and policies of the hospital for academic promotions. The emphasis is placed on "quality priority" and "work performance", making an overall assessment of the applicants on their professional virtue, academic skills, research outcome and social services. Among all these indicators, appraisal of the clinical skills and teaching skills is prioritized,encouraging the creativity and incentives of clinicians for clinical and teaching work.

We establish the new capacity-based teaching mode in clinical teaching of nursing obstetrics and gynecology.We have obtained more satisfied teaching quality.

0.25. Conclusions Modified Stamey bladder neck suspension is an effective treatment for type Ⅰ female stsees urinary incontinence.

Objective To explore the short-term clinical outcome of percutaneous posterior lumbar interbody fusion using B-twin stand-alone expandable spinal spacer in the degenerative lumbar diseases.Methods From January 2006 to March 2009,41 consecutive patients with lumbar degenerative disc diseases were enrolled and 44 intervertebral spaces were observed in this study.There were 20 males and 21 females,with an average age of 57.51(ranging from 31 to 77 years old).Indications for treatment included degenerative lumbar disc herniation(LDH) with intervertebral instability or Ⅰ? spondylolisthesis(25 cases),LDH with intervertebral space collapse(15 cases) and lumbar discogenic pain(1 case).Fusion segments included 3 cases of L3,L4 and L5,3 cases of L3 and L4,27 cases of L4 and L5,and 8 cases of L5 and S1.After percutaneous discectomy and endplate,curettage were meticulously carried out.A B-twin expandable spinal spacer was introduced into the intervertebral space and then expanded and an allograft cancellous bone of 4 to 5 g was implanted around the B-twin in the intervertebral space.The whole operation was monitored by C-arm fluoroscopy.The clinical outcome was evaluated by JOA scale and X-rays and CT examination before the operation,and 1 week,3 and 12 months after the operation.Results After follow-up of 3 to 38 months(mean 16 months),all the patients were evaluated,and excellent was obtained in 13 cases,good in 21 cases,fair in 5 cases,and poor in 2 cases.The excellent and good rate was 82.93% according to the JOA scale.X-rays and CT showed that the subsidence of the B-twin was found in 3 cases,and 1 case was significantly subsided by more than 20%.Cage shift was seen in 1 case.Conclusion Percutaneou posterior lumbar interbody fusion with B-twin is efficient with minimal surgical trauma,blood loss,better rehabilitation and reliable short-term outcome.Strict indications and pinpoint skills for surgery are the precondition to obtain satisfactory outcome in the treatment of degenerative disc disease.

We establish the new student-centered teaching mode and reform the evaluation system in clinical teaching of nursing obstetrics and gynecology. We have got more satisfied teaching quality.

AIM: To observe the effects of norepinephrine (NE) on the cardiopulmonary and lung injury in goats with acute respiratory distress syndrome (ARDS) induced by endotoxin. METHODS: A model of septic ARDS was induced by intravenous infusion of low dose endotoxin in six goats. Then 40?10~ -6 NO inhalation was applied to the animals. After 30 min, combined intravenous infusion of NE at concentration of 0.5 mg?kg~ -1 ?min~ -1 was conducted. The dynamic changes in gas exchange and hemodynamics were measured with the aid of Swan-Ganz catheter. Arterial blood gas analysis before and after the onset of ARDS, 30 min after NO inhalation and combined NE was detected. Histology of the lung was also observed. RESULTS: Inhalation of NO rapidly reduced mean pulmonary arterial pressure (MPAP), increased PaO_2, decreased P_ (A-a) O_2 and Qs/Qt in septic ARDS goats. These decrease and increase were more significant than those in NO inhaled alone when animals received NE. The combination of NO inhalation and NE injection resulted in increase in mean arterial pressure. NO inhalation did not ameliorate lung injury and combined NE intravenous injection ameliorated lung injury. CONCLUSION: Injection of low dose norepinephrine improves the beneficial effects of inhaled nitric oxide on lung gas exchange and ameliorates lung injury in goats with acute respiratory distress syndrome induced by endotoxin.

An introduction to the practice of introducing the“ surgeon qualification admittance system”in the hospital and a description of its management framework,basic principles,rules of classification for surgical operations,application and approval procedure,and supportive management regulations.The authors hold that this system has normalized behavior of medical activities,clarified operation authorities of medical doctors at various levels,and intensified the awareness of risk exposure.Therefore this system can safeguard the quality and safety of surgical operations and its efficiency to a great extent,in addition to better building the team and backup forces.

Objective To observe the protective effect of ghrelin on hippocampal injury induced by global cerebral ischemia/reperfusion (I/R) and explore its effect mechanisms.Methods The male Sprague-Dawley (SD) rats were randomly divided into four groups,namely sham group,I/R group,normal saline (NS)+I/R group and Ghrelin+I/R group,with 42 rats in each group.The model of I/R was reproduced by clipping bilateral carotid artery of rats 15 minutes and then releasing them for 60 minutes.There were no challenges for rats in sham group,just exposed their carotid artery.Ghrelin+I/R group and NS+I/R group were challenged by injecting 1 μ.L ghrelin or NS into lateral ventricle before I/R.Some of brain tissue in the rats was harvested after experiment to determine the levels of malonaldehyele (MDA),myeloperoxidase (MPO) and glutathione (GSH) in hippocampus by using chemical colorimetry and observe infarct sizes and histopathology.Single extracellular neuron discharge in other rats was recorded to observe the activity of glutamic sensitive neurons (Glu-N) and γ-aminobutyric acid (GABA) sensitive neurons (GABA-N) in hippocampus CA1 region of rats suffered I/R.Results Compared with sham group,the levels of MDA and MPO in hippocampus of rats in the I/R group were raised markedly,the level of GSH was decreased significantly,the infarct sizes was increased significantly and pycnosis neurons were increased markedly.All sorts of indexes between NS+I/R group and I/R group showed no significantly statistical significance.Compared with NS+I/R group,the levels of MDA and MPO in hippocampus of rats in the Ghrelin+I/R group were decreased significantly [MDA (nmol/g):16.4 ± 4.2 vs.24.5 ± 6.7,MPO (nmol/g):6.4 ± 1.8 vs.10.2 ± 2.9,both P ＜ 0.05],the activity of GSH was risen remarkably (μmol/g:2.65 ± 0.72 vs.1.66 ± 0.50,P ＜ 0.05),the infarct sizes of hippocampus were reduced markedly [(43.9 ± 9.5)％ vs.(77.0 ± 12.7)％,P ＜ 0.01],the number of pycnosis neuron was reduced markedly (cells:36.2±4.5 vs.47.1 ±6.1,P ＜ 0.01).The results of electrophysiology showed that the discharge frequency of Glu-N and GABA-N in hippocampus CA1 region of rats in I/R group increased markedly as compared with sham group,and no significant difference in the discharge frequency of Glu-N and GABA-N between NS+I/R group and I/R group.Compared with NS+I/R group,injected ghrelin could make the discharge frequency of Glu-N in hippocampus CA1 region of rats decreased markedly (Hz:3.81 ±0.67 vs.4.98±0.33 at ischemia,3.01 ±0.37 vs.3.77 ± 0.41 at reperfusion,both P ＜ 0.05),and the discharge frequency of GABA-N increased markedly (Hz:5.62 ± 0.54 vs.3.62±0.39 at ischemia,4.81±0.48 vs.3.71±0.21 at reperfusion,both P ＜ 0.05).Conclusion Ghrelin might protect hippocampal neuron after I/R iniury,and neuron excitability decrease might be related.

Objective To study the effects of electrical stimulation of efferent vagus nerve on the endotoxic shock in rabbits. Method Sixteen Newzealand rabbits were randomly divided into 2 groups, namely group S as the stimulation group and group C as the control group). Rabbits were subjected to bilateral cervical vagotomy and had challenge with intravenous injection of lipopolysaccharide (LPS) (E. COLI O111: B4 , DIFCO, USA) in a dose of 600 μg/kg. The distal end of the left vagus nerve trunk was connected to an electric stimulator with bipolar electrode and controlled by an acquisition system. Stimuli with stable voltage (10 V,5 Hz,5 ms) were applied twice to the nerve for 10 minutes just before and after the administration of LPS in group S. At the time before and after the infusion of LPS 30 min,60 min, 120 min, 180 min,240 min and 300 min respectively, the heart rate(HR)and the mean arterial blood pressure (MABP) in each animal were recorded, and blood samples were taken for measuring serum tumor necrosis factor-αa(TNF-α) and interleukin-10 (IL-10). Results Compared with group C,the electrical stimulation of efferent vagus nerve could significantly attenuated the LPS-induced hypotension and de-creased the contents of TNF-α[(38.12±7.85) pg/mL vs. (55.12±7.89) pg/mL, P <0.01], but increased the contents of IL-10[(55.12±9.37)pg/mL vs. (40.15±5.44) pg/mL, P <0.01]afar LPS challenge. Conclusions The stimulation of the efferent vagus nerve can down-regulate systemic TNF-α, production and attenu-ate the development of shock after LPS challenge.