Objective To evaluate the value of laparoscopy in the treatment of intramural myoma.Methods Totally 120 cases of intramural myoma were randomly divided into laparoscopy(n=52)and open groups(n=68).Clinical data,including operation time,intraoperative blood loss,rates of postoperative pyrexia and postoperative complications,length of hospital stay and follow-up,were compared between the two groups.Results Compared to the open group,the laparoscopy group had significantly longer operation time (106.3?54.9)min vs(66.5?7.3)min,t=5.918,P=0.000],less blood loss 10-300 ml(median,50 ml)vs 20-200 ml(median,50 ml),Z=-1.998,P=0.046],lower rate of postoperative pyrexia 7.7%(4/52)vs 30.9%(21/68),?2=9.608,P=0.002],similar rate of postoperative complications 3.8%(2/52)vs 8.3%(3/36),?2=0.000,P=1.000],shorter hospital stay (7.5?1.4)d vs(10.4?1.2)d,t=-12.201,P=0.000],and similar length of follow-up (9.7?2.3)months vs(9.6?1.8)months,t=0.267,P=0.790] and rate of normal menses 94.4%(17/18)vs 90.5%(19/21),?2=0.000,P=1.000].Conclusions Laparoscopy is as effective as open surgery for intramural myoma.While the laparoscopy leads to better postoperative recovery than the open surgery.

Objective To evaluate the clinical significance of laparoscopic operations in the treatment of ovarian endometriosis cysts. Methods We compared clinical data between 52 cases of laparoscopic operation for ovarian endometriosis cysts (Laparoscopy Group) and 75 cases of open operation for ovarian endometriosis cysts (Open Group) in the same period. Results The operation time was significantly shorter in the Laparoscopy Group (61 4?9 3) than in the Open Group (72 6?7 1) ( t =7 692, P =0 000). The time to first flatus was significantly earlier in the Laparoscopy Group (25 3?4 1 h) than in the Open Group (49 8?6 9 h) ( t =22 935, P =0 000). The postoperative pyrexia rate in the Laparoscopy Group (9/52) was significantly lower than that in the Open Group (31/75) ( ? 2 =8 216, P =0 004). There were no significant differences on the remission rate of dysmenorrhea between the Laparoscopy Group (26/37) and the Open Group (34/51) ( ? 2=0 128,P =0 818) and on the postoperative pregnancy rate between the Laparoscopy Group (5/22) and the Open Group (7/25) ( ? 2 =0 171, P =0 747). Conclusions Laparoscopic operation for ovarian endometriosis cysts is as effective as open operation, being an ideal alternative.

OBJECTIVE:To evaluate the economic effectiveness in different chemotherapeutic schemes for acute mononu?clear leukemia(M 5 ).METHODS:Using pharmacoeconomic cost-effectiveness analysis,three chemotherapy schemes for M 5 we_ re compared.RESULTS:Among three schemes,DAE scheme was the best one.CONCLUSION:The results show that phar?macoeconomics plays an important role in optimizing therapeutic scheme,in helping the physician to choose the best therapeutic plan in making clinical decision.

Objective To characterize clinical features,antimicrobial susceptibility and the outcome of nosocomial Acinetobacter baumannii meningitis.Methods All patients with nosocomial meningitis due to Acinetobacter baumannii in 2nd Affiliated Hospital Medical School of Zhejiang University between January 2010 and October 2011 were retrospectively reviewed.Results During the study period,40 patients of this nosocomial infection were identified,who came from neurosurgery ward (19 cases,47.5％),neurosurgieal intensive care unit (18 cases,45.0％),emergency intensive care unit (2 cases,5.0％) or intensive care unit (1 case,2.5％).All the patients had a history of recent neurosurgical procedures. Fever and disturbance of consciousness were the major manifestations,and cerebrospinal fluid examination showed elevated white blood ceil count and protein,and reduced glucose.All isolated pathogens were resistant to the first line antibiotics.The fatality rate was high. Conclusions The most common risk factor for nosocomial Acinetobacter baumannii meningitis is neurosurgery. Resistance to the first line antibiotics is common among all pathogens isolated.The prognosis of the meningitis is poor.

Objective:To establish the methods and standard for the evaluation of rational application of parenteral nutrition ( PN) in primary hospitals. Methods:Medical records with the use of fat emulsion, amino acids (17) and glucose (11%) injection were col-lected. The integrity of the medical records was analyzed, the compatibility of supplementary drugs was evaluated, and basal metabo-lism rate(BMR) was calculated for the relevant assessment. Results:Totally 66. 7% of the patients had incomplete basic parameters of nutritional risk assessment, the cases had different course of treatment but showed no significant difference in total usage of fat emul-sion, amino acids (17) and glucose (11%) injection,and the non-protein calories of fat emulsion, amino acids (17) and glucose (11%) injection accounted for 72. 1% of basal metabolism rate of an individual on average (S=8. 9). Supplementary usage of KCl accounted for 63. 0% of the cases, of which 70. 6% were overdosed;62. 9% of the cases used supplementary alanyl-glutamine with overdosage. Conclusion:In the PN application in our hospital, nutritional risk assessment is basically missed, and there is a great gap between the level of developing reasonable individual program and the requirements in guidelines. Clinical pharmacists should enhance the related monitoring and evaluation in PN application.

Objective To investigate the radiosensitization effect of the simultaneous silence of bcl-2 and XIAP on human head and neck cancer cell line in vitro.Methods Four groups of UMSCC12 cells were transfected with siRNA-bcl-2,siRNA-XIAP,siRNA-bcl-2 plus siRNA XIAP,and siRNA control,respectively.The silence efficiency was tested by Western blot assay. Apoptosis was evaluated with the activities of caspase-3 and caspase-9,and radiosensitization effect was evaluated with clonogenic assay.Results Bcl-2 and XIAP protein expressions were effectively eliminated in the cells simultaneously transfected with siRNA-bcl-2 and siRNA-XIAP.Transfection of cells with bcl-2 siRNA increased radiationinduced apoptosis ( t =5.32,6.27 ; P ＜ 0.05 ),but transfection with XIAP siRNA did not impact cell apoptosis.Since the simultaneous transfection of the above two siRNAs,the activities of caspase-3 and caspase-9 were increased by 1.36 and 1.34 times ( t =11.47,6.22 ; P ＜ 0.05 ) in nonirradiated cells and increased by 1.72 and 1.98 times ( t =12.02,20.14; P ＜ 0.05 ) in irradiated cells,respectively.The colonic assay showed that the SERs were 1.06,1.15 and 1.41 for the cells transfected with XIAP siRNA,bcl-2 siRNA and both siRNAs,respectively.Conclusions Compared to single silence of XIAP or bcl-2,simultaneous silence of XIAP and bcl-2 offers a potential approach to improving the radiosensitivity of the head and neck cancer cells,and apoptosis might contribute to the enhancement of radiosensitization.

This study is based on the requirements of the construction of applied undergraduate colleges and development of excellent doctor education training pilot project of the ministry of education. The situation of higher medical education and the requirement of health career development are analyzed. The medical talents training mode of three oriented which is taking the post competency of medical students as the frame is constructed. This paper expounds the background proposed by training mode from the internal drive, external drive and project boosting. With the national education policy as the basis, the theoretical basis of the international advanced education teaching idea, theory and standard is explained. The connotation of the training mode is revealed by the humanistic quality education, professional quality training and physical and psychological quality cultivating. The evaluation strategy of clinical medical per-sonnel training standards, index system, the implementation approach and evaluation methods which have certain feasibility and timeliness is established.

Objective To develop a rapid method with high sensitivity and specificity to detect Mycobacterium avium.Methods A polymerase chain reaction(PCR)was developed.Its sensitivity and specificity were verified by sequential dilution of DNA of M.avium and other17Mycobacterium spp.,respectively.Simulation of clinical infection was established by mixing normal skin tissue with M.avium.The treatment of the tissue specimens was optimized in order to improve the sensitivity of the PCR assay.Results A fragment of427bp was amplified by the PCR assay with the strains of M.avium at the sensitivity of1?10 2 cells/mL.The other17Mycobacterium spp.were all negative.The sensitivity of the PCR assay decreased to1?10 4 cells/mL when M.avium was mixed with the homogenized skin tissue.The sensitivity recovered to1?10 2 cell/mL when the skin tissue was diluted to≥1∶4.Conclusion It is suggested that PCR be a rapid and reliable method for detection of M.avium.

ObjectiveTo explore the inflammatory factors C-reactive protein (CRP),interleukin (IL)-6,tumor necrosis factor (TNF)-α and white blood cell (WBC) count differences between acute myocardial infarction(AMI ) thrombolysis treatment and unthormbolysis treatment,and find out the relevance between the inflammatory factors and the prognosis.MethodsAccording to the condition of accepting AMI thrombolysis treatment,the 229 patients of AMI were divided into the thrombolysis group( 131 cases) and the unthrombolysis group(98 cases).The levels of myocardial troponin I (cTnI),creatine kinase(CK),creatine kinase isoenzyme-MB (CK-MB) were detected at the time of patients sent into the hospital for the immediate,6-hour later and 24-hour later.After 6-month's follow-up,prognosis was compared between two groups.ResultsTwenty-seven cases lost in the thrombolysis group.One case died within 6 months and the mortality was 1.0％(1/104) in the thrombolysis group,and 6 cases died within 6 months and the mortality was 6.1％(6/98 ) in the unthrombolysis group.There was significant difference between two groups (P ＜ 0.05 ).The levels of CK,CK-MB in the thrombolysis group advanced,and compared with that in the unthrombolysis group,there were significant differences (P ＜ 0.05 ).The levels of TNF-α,IL-6 in the thrombolysis group were significantly higher than those in the unthrombolysis group (P＜ 0.05),and CRP and WBC count had no significant differences between two groups (P ＞ 0.05).The repatency rate was 79.4％( 104/131 ) in the thrombolysis group,the levels of TNF- α,IL-6 in repatency patients were higher than those in non-repatency patients.There were significant differences(P ＜ 0.05 ).ConclusionsThe thrombolysis is an effective way to cure AMI.The increase of TNF- α,IL-6 after the thrombolysis is considered to be related to reperfusion injury,and CRP,IL-6,TNF-α and WBC count can forecast the inflammation of myocardial necrosis and take an impotant role in predicting the prognosis of the AMI.The antiinflammatory and antioxidation treatment is significant to improve the prognosis of the AMI.

Objective: To explore the related influencing factors of carotid atherosclerosis (AS) plaque formation and stability in the patients with type 2 diabetes mellitus (T2DM), and to provide scientific evidence for early prevention and treatment. Methods: A total of 249 cases of simple T2DM patients were selected. According to the results of carotid artery color Doppler ultrasound, they were divided into AS group, stable plaque group and unstable plaque group. The differences in physicochemical indexes and life style of the patients were compared between three groups; univariate analysis and Logistic regression analysis were used to screen the related influencing factors of carotid AS plaque formation and stability of the T2DM patients. Results: The univariate analysis showed that age, fasting blood glucose (FBG), glycosylated hemoglobin (HbAlc), non-high density lipoprotein cholesterol (NHDL-C), monocyte/high density lipoprotein ratio (MHR), smoking ratio (Smoking%), T2DM disease course, high density lipoprotein protein cholesterol (HDL-C) had significant differences between AS group and plague group (P<0.05). There were significant differences in the values of postprandial blood glucose (PBG), systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-C), HbAlc, MHR, Smoking% and HDL-C of the patients in stable plaque group and unstable plaque group (P<0.05). The Logistic regression analysis showed that high age, HbAlc, NHDL-C, MHR and smoking were the risk factors of the plaque formation and high HDL-C was a protective factor of plaque formation (Age: OR=l. 62, P=0. Oil; HbAlc: OR=l. 25, P=0.027; HDL-C: OR=0.65, P = 0.009; MHR: OR= 3.50, P= 0.000; Smoking: OR=2.28, P = 0.009; NHDL-C: OR=l. 39, P = 0.028). High SBP, LDL-C, MHR and smoking were the risk factors of unstable plaque formation, and high HDL-C was a protective factor of unstable plaque formation (SBP: OR=l. 57, P = 0.003; LDL-C: OR=l. 99, P = 0.000; MHR: OR=3.88, P = 0.000; Smoking: OR = 2.01, P = 0.001; HDL-C: OR=0.53, P=0.001). Conclusion: For the patients with simple T2DM and carotid AS plaque, blood lipid, blood pressure and smoking cessation should be emphasized and HDL-C level should be increased, which can effectively prevent the formation of AS plaque and stabilize the plaque.