Objective To discuss the clinical effect and safety of transurethral holmium laser resection of bladder tumors.Methods A total of 20 patients with bladder tumors(stage Ta～T2a)was treated by holmium laser resection transurethrally.There were 17 patients with primary tumor and 3 patients with recurrent tumor.The laser power was set at 15～40 W.Small lesions were vaporized directly,while large ones(more than 1.0 cm in diameter and with broad pedicels)were incised from the pedicel,with neighboring tissues 1～2 cm in extent vaporized and cauterized.Results The tumors were removed on one session in all the 20 patients.The operation time was 10～70 min(mean,30 min).No complications such as obturator nerve reflex,bladder perforation,or overhydration occurred.No blood transfusion was required.The postoperative catheterization time was 1～5 days(mean,3 days).No recurrence was found during follow-up examinations for 3 months in 16 patients and 6 months in 4 patients(mean,3.6 months).Conclusions Transurethral holmium laser resection of bladder tumors is a safe and effective procedure for the treatment of bladder tumors.

ObjectiveTo analysis the clinical efficacy of using lateral homodigital flaps based on digital artery perforator to repair the fingertip defects. MethodsFrom October 2008 to August 2010,nine patients with twelve fingertip defects,including 5 thumbs,2 index fingers,3 middle fingers,2 ring fingers,underwent repair with lateral homodigital flaps based on digital artery perforator.The size of the flaps ranged from 2.7 cm× 1.4 cm to 3.1 cm× 1.8 cm.The donor site were covered by skin graft. ResultsEleven flaps survived.One case met with partial necrosis.The follow-up time ranged from 3 to 6 months(average of 4.5 months).The finges had good appearance.Ten cases had gained full postoperative sensory recovery and the two-point discrimination was 4-Smm at 3 months after operation.ConclusionUsing the flaps pedicled with digital artery perforator is a feasible solution for treatment of fingertip defects.

Objective To select more rapid,sensitive and specific method in detection of respiratory syncytial virus(RSV)directly from clinical specimens.Methods RSV was detected by virus isolation in tissue culture,direct smears and detection by indirect immunofluorecence assay(IFA),rapid culture assay,sandwich enzyme linked immunosorbent assay(ELISA)as well as labbed streptavidin biotin method(LSAB)from 45 specimens(nasopharyngeal aspirates,NPAs) collected from infants and young children with acute lower respiratory tract infection.Results Of 45 NPAs,12 cases(26.7%) were positive by virus isolation,14 cases(31.1%) were positive for RSV by direct detection of RSV antigen by IFA,20 cases(44.4%) were positive with rapid culture assay,4 cases(8.9%)were positive by sandwich ELISA,4 cases(8.9%)were positive by LSAB.Conclusion Rapid culture assay and direct detection of RSV in NPAs direct smears by IFA are rapid,sensitive method in the diagnosis of RSV infections.

ObjectiveTo explore the diagnostic methods and surgery pattern at the first time of spontaneous perforation of congenital choledochal cyst.MethodsEleven cases(4 male,7 female) with spontaneous perforation of congenital choledochal cyst were 6 months to 5 years old,and their average course of disease were 4 days.Gustily abdominal distension,abdominal pain,crying and fever were present in all cases.Jaundice(7 cases) and emesis(5 cases) appeared.All cases were detected with physical sign of peritonitis by physical examination.Choledochal cysts were confirmed by CT or B ultrasound in 8 cases.All cases accepted abdominal paracentesis and biliary ascites was drawn.Three different operative procedures were performed:choledochocyst excision & Roux-Y choledocho-jejunostomy(2 cases),choledochotomy with T-tube drainage(3 cases),and cholecystostomy(6 cases).Nine children receiving external drainage operation accepted a second operation to rebuild biliary tract(choledochocyst excision & Roux-Y choledochoje-junostomy) after 3 to 6 months.ResultsAll cases had got satisfactory therapeutic efficacy without any grave complication such as fistula of anastomotic stoma,infection of biliary tract or obstruction of biliary tract.During operation,perforations were located in the juncture of choledochus and cystic duct in 5 children and were not found in the other 6 children.In the second operation,the cases receiving cholecystostomy had less peritoneal adhesion,anatomic structure changes,haemorrhage[(30-50) mL vs(100-200) mL] and operation time[(2.5-3.0) h vs(3.5-5.0) h] than those receiving choledochotomy with T-tube drainage,and did not appear inadequate drainage for cystic duct obstruction.ConclusionsFor children with more organ inflammatory edema and adherence and in a bad overall condition,the first-time operation of cholecystostomy is more reasonable.

BACKGROUND: Embryonic stem cells (ESCs), the seed cells of all mature cells in vivo, are useful tools for nerve transplantation and developmental gene function research. Notch1 signaling pathway is the key pathway to control the ordered neural development and differentiation of many kinds of neural cells, however, there is no report on the dynamic expression of Notch1 signal during the ESC differentiation to date. OBJECTIVE: To investigate the expression of Notch1 protein, transmembrane signal transduction molecule, during directional differentiation of embryonic stem cells into neural cells. DESIGN, TIME AND SETTING: Cell research was carried out between October 2003 and October 2004 at Zhongshan Ophthalmic Center, SUN Yat-sen University, Guangzhou, Guangdong Province, China. MATERIALS: BALB/C mouse embryonic stem cell line Ⅵ (passage 11)was obtained from experimental animal center of SUN Yat-sen University, provided by professor Huang Bing. ESC culture medium was high-glucose DMEM medium with 20% bovine serum and 106 IU/L mouse leukemia inhibitory factor. Induced differentiation medium was high-glucose DMEM medium with 20% fetal bovine.serum and 5×107 mol/L retinoid acid(RA). METHODS: Passage 11 ESCs were resuscitated and incubated by ESC culture medium in incubator at 37℃ with 5% CO2. Passage 11 ESCs were subcultured after 2 or 3 days and RA was added into medium to induce differentiation. Three time points for observation were established: induced for 1, 5 and 9 days. MAIN OUTCOME MEASURES: Morphological changes were observed under inverted phase contrast microscope, MAP-2 antigen expressed in differentiated cells was detected by immunofluorescence method. Immunocytochemistry, Western Blot, flow cytometry assay were used to investigate the Notch1 protein expression. RESULTS: ESCs presented clone-like growth. After induced by RA for 9 days, single neural network was achieved around most of the cell clusters. With the prolongation of induction, MAP-2 positive neural cells increased gradually. Almost all ESC clones expressed Notch1 protein strongly or positively, but Notehl protein expression decreased gradually after induced differentiation (P < 0.01). CONCLUSION: Notch1 signal shuts off progressively during induction of ESCs into neural cells, which suggests Notch1 may play an important role in the differentiation of ESCs into neural cells.

Objective To discuss the value of applying psychological therapy for patients with cerebral apoplexy in recovery.Methods In recent years,65 patients with cerebral apoplexy admitted in our hospital were randomly selected and divided into observation group and control group.Patients in the control group only received the conventional treatment and those in the observation group received psychological treatment on the basis of the traditional therapy.Psychological characteristics,activity of daily living and the improvement of nerve function were compared between two groups before and after treatment.Results After treatment,mental improvement,FMA,MBI in the observation group were significantly better than those of control group (P＜0.05).Conclusion To improve the prognosis of patients with cerebral apoplexy effect,physical and mental development should be equally emphasized.Psychological intervention has become a key for stroke rehabilitation treatment,which significantly improves the treatment compliance,rehabilitation and the quality of life in patients.

Objective To observe the effects of hypnosis therapy on rehabilitation of patients with spinal cord injury.Methods The data were randomly selected from 66 cases of patients with spinal cord injury treated in our hospital from November 2011-November 2012.According to the treatment,the patients were divided into research group and control group.Control patients were given routine therapy,and patients in the research group were given hypnosis therapy,we observed and compared the recovery of two groups of patients after treatment.Results After treatment,the spinal cord function score (SCIM) of patients in the research group was better than control group,the difference was statistically significant (P ＜ 0.05) After treatment,the depression and anxiety scale (HAMD,HAMA) of patients in the research group was better than control group,the difference had statistical significance (P ＜ 0.05) The quality of life after treatment of research group patients (WHOQOL BREF) was better than control group,the difference had statistical significance (P ＜ 0.05).Conclusion Hypnosis therapy helps to improve depression and anxiety in patients with spinal cord injury,improve patients with spinal cord function independently,should be widely used in clinical treatment and promotion.

Objective To analyze the therapeutic effect of acute stroke dysphagia using rehabilitation therapy.Methods A total of 94 cases diagnosed with dysphagia after acute stroke were randomly selected from January 2012 to May 2013 in our hospital.The patients were equally divided into control group and research group.The control group received the conventional support treatment and the research group received comprehensive rehabilitation treatment.The results of swallowing dysfunction recovery of two groups were compared.Results After the treatment for 3 weeks,swallowing disorder degree score and swallowing function ratings were improved in both groups and the research group's scores were significantly higher than those of the control group (P ＜0.05) Conclusion Application of comprehensive rehabilitation treatment for dysphagia in patients with acute stroke has significant curative effect and is worth promoting.

Phosphate-dissolving microorganisms are widely distributed in soil, rhizosphere and other ecological environment. Understanding the characteristics of these microorganisms in solubilizing phosphates is helpful to apply them in improving P use efficiency. The obtained results indicated that the fungi had much higher capacity to dissolve the rock than the bacteria. Existence of Fe, Al, Mg and Na in the culture media reduced the rock solubilization by the bacteria, but increased the solubilization of the fungi. The higher content of the rock in the media, the lower capacity of the rock phosphate solubilization was found. The capacity was also significantly reduced if the concentration of C material in the media was higher than 3%. It was also found that the microorganisms destroyed the rock structure. The P was more easily released from the rock at further incubation. In conclusion, there is some potential to utilize the microorganisms to activate the rock phosphate.

Objective To research the method and effect about the bronchoscopic lung volume reduction by ?-cyanoac- rylate in the therapy of chronic obstructive pulmonary disease (COPD).Methods The 14 patients had been examined bosoms by CT before the operation and determined the type of emphysema and the distributing of pneumatocele,had blood gas analyzed and pulmonary function checked.The operation was carried through trachea cannula and intravenous anesthe- sia.When the bronchoscope came to the goal bronchia,we infused the meglumine diatrizoate through the biopsy orifice and approved the location of pneumatocele forward。Then,we infused erythromycin and ?-cyanoacrylate in turn through the biopsy orifice by silica del tube.Results The 3 pneumothorax patients had been removed the drainage tube in 3 days af- ter the operation.8 cases had been counterchecked sternite in one week and the pneumatocele was just like before,among which,1 case developed exudation.1 case had shown pleural thickening in the right-up lung counterchecked sternite 9 months later.1 case been checked the pulmonary function,the FEV_1 enhanced from 24.7% pred before operation to 32. 9% pred after operation one week.3 cases felt polypnea improved greatly and 7 cases felt polypnea improved a little.Con- clusion The bronchoscopic lung volume reduction by ?-cyanoacrylate is a safe,effective and economical method in the therapy of COPD.