Objective To evaluate the clinical significance of retroperitoneal laparoscopic adrenalectomy for benign adrenal tumors.Methods A total of 81 cases of retroperitoneal laparoscopic adrenalectomy from March 2002 to October 2005 was retrospectively analyzed,including 21 cases of Cushing's syndrome,57 cases of aldosterone-preducing adenoma,2 cases of adrenal pheochromocytoma,and 1 case of bilateral adrenocortical hyperplasia.Three trocars were introduced at the lumbar part and a retroperitoneal space was established by blunt dissection with the camera assembly.The tumor was removed by using a harmonic scalpel.Results The procedure was successfully completed in all the 81 cases,with an operation time of 20~140 min(mean,60 min) and an intraoperative blood loss of 20~100 ml(mean,45 ml).There was no need of blood transfusion intra-and post-operatively.Retroperitoneal hematoma occurred in 1 case post-operatively.Follow-up examinations in 37 cases for 3~18 months(mean,11 months) showed normal blood pressure,stature and laboratory findings.Conclusions Retroperitoneal laparoscopic adrenalectomy has advantages of minimal invasion,little blood loss,quick post-operative recovery,and low complication incidence.It should be considered as the first choice for treating benign adrenal tumors.

Objective To evaluate the clinical effects of Qufeng Jiedu Huoluo Decoction in treating the acute stage of periph-eral facial paralysis.Methods 60 cases of acute stage of peripheral facial paralysis were randomly divided into 2 groups,30 cases in each group.The two groups were treated by acupuncture.In addition the treatment group was added with oral Qufeng Jiedu Huoluo Decoction.Results The relief time of posterior auricular pain in the treatment group was shorter than that in the control group (P <0.05);the alleviation situation of the accompanying symptoms after 7 d and the neural function recovery situation after 14 d in the treatment group were superior to those in the control group (P < 0.05);the total effective rate in the treatment group was 93.3%,which was higher than 83.4% in the control group,the difference had statistical significance(P < 0.05).Conclusion Qufeng Jiedu Huoluo Decoction can effectively alleviate the clinical symptoms and signs of acute stage in peripheral facial paralysis.

Objective:To evaluate the effect of age and gender on the femoral morphology to guide prosthesis selection in operation and design.
Methods:A total of 500 females and males were collected from the departments of orthopedics and medical radiology, Second Xiangya Hospital, Central South University. Informed consent was obtained from all subjects. All patients underwent anteroposterior position scan of the left or right hip joint using Philips Digital Diagnost DR system. The shooting range included the hip joint and at least 2/3 of the proximal femur. The images were measured with Onis 2.3 software. We measured 13 parametersfromthepatients,includingtheexternalparamtersofthefemur,radius-lengthparameters of femoral medullary cavity, and morphological parameters of the femoral medullary cavity. Results:Compared with Westeners, the offset was smaller, while the neck shaft angle was signiifcantly larger in Chinese population (P<0.05). Most parameters of the proximal femoral medul ary cavity diameter were significantly smal er in Chinese population than those in Westerners (P<0.05). The canal lfare index in Chinese population was signiifcantly larger than that in the Westerners (P<0.01). According to the Noble classification, in Chinese population, the proportion of champagne lfute type was signiifcantly larger, while the proportion of standard type was significantly smaller than that in Westerners. There was significant difference in the proximal femur between Chinese population and Westerners. The largest difference of the proximal morphology was presented between males and females in the 31-50 years old people (P<0.05), while the smallest was in the over 70 years old population (P>0.05). The main differences between 31 and 70 years old were the diameter of femoral head, the offset of isthmus, the medullary cavity diameter and extracortical width at isthmus level and the medullary cavity diameter at the level of the lesser trochanter (P<0.05). The modullary transverse diameter at 20 mm below the lesser trochanter and isthmus and extracortical width of isthmus in the male and female group was positively correlated with age (P<0.01), while the parameters of the proximal femoral canal morphology in the female group were negatively correlated with age. The female canal parameters had a stronger correlation. Conclusion:Chinese proximal femoral parameters are signiifcantly different from Westerners. When people, especially females, get older, the medullary cavity diameter of the isthmus and proximal femur becomes wider and the morphology of the femur becomes straight. The difference in the femoral morphology between the male and female decline with the age. There is almost no difference for the over 70 years old. For the 31-70 years old, The male femoral cavity diameter is larger and the position of isthmus is lower than in the females.

ObjectiveTo introduce the operative technique of pedicle evolution from isolated perforator to perforator-plus-adipofascial,and investigate its clinical results in venous drainage and safety in distallybased sural flaps.MethodsAfter identifying the proper viable perforators,the whole flap was designed in an eccentric propeller shape,with the perforating vessels corresponding to the pivot point.The proximal larger blade was a fasciocutaneous flap, while the distal smaller blade was a subdermal vascular plexus flap,preserving at least a quarter area of adipofascial tissue around the perforator.From January 2008 to December 2010,we performed distally perforator-adipofascial pedicled sural fasciocutaneous propeller flap in 12 patients,with 180 degrees rotation to cover foot and ankle defects.Postoperatively,flap swelling,survival and functional recovery were evaluated. Results There were 7 posterior tibial artery perforator flaps from the posteromedial and 5 peroneal artery perforator flaps from the posterolateral sural region. The proximal fasciocutaneous flap measured 4 cm × 8 cm-6 cm × 18cm, and the distal cutaneous flaps measured 2 cm × 2cm-4 cm × 4 cm.Flap swelling was noted under grade 2 in 9 cases,grade 3 in 2 cases,and grade 4 in 1case with some distal superficial skin necrosis,which occurred in the largest flap in our series.All flaps survived eventfully.After average 13 months follow up,the wound were cured successfully,and all patients recovered walking and shoe wearing function. ConclusionPedicle evolution by keeping some adipofascial tissue around the pivot perforator, can preserve more venous return routes and relieve flap swelling. This technique should be recommended in perforator pedicled propeller flaps,as it enhances flap safety,and without increasing the difficulty of 180 degrees rotation.

Objective To explore the clinical pathological data of the elderly patients with paroxysmal supraventricular tachycardia(PSVT) and the timing of the radiofrequency ablation treatment for PSVT and its clinical efficacy.Methods The clinical pathological data of 45 elderly patients with PSVT for radiofrequency ablation were retrospectivly analyzed,and the information of cardiovascular and cerebrovascular diseases,the duration of PSVT and frequency of attacks,the reason of patients had to accept radiofrequency catheter ablation,the treatment effective of electrophysiological study and radiofrequency ablation were recorded.Results The duration and frequency of attacks with PSVT were positively related with pathogenesis in the elderly patients.Elderly PSVT patients with severe cardiovascular disease accounted for 28.89％.The first radiofrequency ablation treatment success rate was 100％ in this research and the recurrence rate was 4.4％.Conclusion It is recommended that elderly PSVT patients early access to the radiofrequency ablation.

OBJECTIVE To survey the Escherichia coli infection in our hospital in the field of flora distribution,structure and status quo resistance in order to guide the rational use of antibiotics.METHODS From Nov 2005 to Dec 2006 247 E.coli strains were isolated from 2940 samples with conventional method identification,K-B method was used for bacterial susceptibility,and resistance test.RESULTS The top six susceptible antibiotics were cefoperazone/sulbactam(86.84%),nitrofurantoin(55.56%),chloramphenicol(43.25%),amikacin(40.43%),ceftriaxone(27.41%),and cefoperazone(27.16%).The top six resistant antibiotics were sulfamethoxazole/trimethoprim Co-trimoxazole(93.33%),ampicillin(93.18%),amoxicillin(92.00%),cefalotin(86.67%),cefradine(85.03%),and cefuroxime(81.25%).CONCLUSIONS Strengthening antibacterial drug sensitivity test,and conduct ing timely the effective treatment and corresponding measures could guide the clinician to provide a reasonable use of antibiotics.

Objective To investigate the detection rate and diagnostic value of multi-slice spiral CT scan in detecting fish bone impaction in the esophagus.Methods Experimental group: 30 fresh water fish bones from three variety classes were divided into three groups with length of(23.36±0.15), (28.51±0.07) and (30.89±0.10) mm, and diameter of (4.49±0.31), (1.78±0.09) and (0.49±0.07) mm.The fish bones were put into esophagus models in three different types including parallel, perpendicular and oblique.MSCT with axial scan combined with three dimensional reconstruction technique and plain X-ray film (CR and DR) were used to examine the model.The relations of the number and rate of fish bones were compared between MSCT and X-ray film.Clinical group: MSCT imaging were performed in 20 cases proved by esophageal endoscope or clinical operation, among which 11 cases received plain X-ray film (CR and DR), 15 cases received Barium-soaked cotton and 17 cases received endoscope.Paired Chi-square test was used to compare the differences of detection of fishbone by the different ways.Results In experimental group: All the 90 cases(100%) fish bones of three different species were clearly revealed on MSCT image; only 60 cases(66.7%) fish bones were revealed by plain X-ray film(CR and DR).The number and rate of fish bones detected by MSCT was higher than that of plain X-ray film (CR and DR) (X2=28.03, P < 0.01).In clinical group: 20 cases were made right diagnosis by MSCT, and the location and size of fish bone in the esophagus, the surrounding and complications of esophagus could be clearly demonstrated on MSCT image.Two cases detected by plain X-ray film(CR and DR) ;9 cases detected by Barium-soaked cotton;14 cases detected by endoscopy.The number and rate of fish bones detected by MSCT was higher than that of plain Xray film (CR and DR) (X2=7.11, P < 0.05) and Barium-soaked cotton (X2=4.17, P < 0.05).Conclusions The sensitivity and detection rate of fish bone with MSCT was high and could evaluate the surrounding and complications of the esophagus.MSCT could be used as the first examination of impacted fish bones in the esophagus.

Objective: To explore the regulative role of extracellular regulated protein kinase-5 (ERK5)/Bcl-2 interacting mediator of cell death (Bim) pathway in hypothermal stimulation induced neonatal rat’s cardiomyocytes (CMs) damage and apoptosis.
Methods: CMs were cultured for hypothermal stimulation and the speciifc siRNA was used to down-regulate the ERK5 or Bim in CMs. The cell apoptosis was detected by lfow cytometry, protein expression was examined by Western blot analysis, the intracellular Ca2+, reactive oxygen species (ROS) and mitochondrial membrane potential (ΔΨm) were evaluated by lfuorescent labeling and lfow cytometry.
Results: In hypothermal stimulated CMs, ERK5 siRNA could promote Bim protein expression, but Bim siRNA could not inlfuence ERK5, while attenuated p-ERK5 expression. ERK5 siRNA induced higher apoptosis rate, while Bim siRNA could decrease such effect. ERK5 siRNA increased the intracellular Ca2+overloading, ROS activation andΔΨm damage, while Bim siRNA played the role to against those effects in hypothermal stimulated CMs.
Conclusion: Our study revealed that ERK5/Bim pathway played the important regulative roll in hypothermal stimulation induced neonatal rat’s CMs damage and apoptosis.

Objective to investigate a new synthesis for the preparation of fosfomycin tromethamine and to seek for the opti‐mized process and crystallization conditions .Methods An inorganic method ,utilizing in situ generated tromethamine bisulfate to re‐act with fosfomycin sodium was used to gain fosfomycin tromethamine .Results After the optimization of reaction and crystalliza‐tion condition ,it can produce fosfomycin tromethamine .Conclusion Inorganic acid salt synthesis technology is feasible with high yield .

OBJECTIVE:To provide reference for clinical rational drug use in advanced breast cancer patients with grade Ⅳmyelosupression induced by chemotherapy. METHODS:108 advanced breast cancer patients with grade Ⅳ myelosupression in-duced by chemotherapy in our hospital from July 2014 to June 2015 were retrospectively analyzed on the characteristics of myelosu-pression and the reasonability of chemotherapy reguneb and adjuvant drug for myelosupression. RESULTS:The incidence of gradeⅣ myelosupression induced by chemotherapy in advanced breast cancer patients was 8.3%,chiefly manifesting as grade Ⅳ neutro-penia(94.4%). The chemotherapy regimens which induced grade Ⅳ myelosupression were mainly docetaxel+epirubicin,docetaxel, vinorelbine+lobaplatin;irrational chemotherapy plan mainly shows irrational pretreatment of chemotherapy drug (32 cases, 91.4%);irrational therapy of myelosupression mainly manifested as rophylactic use of antimicrobials without indication,unsuitable choice of antibiotics(29 cases for each,36.2% for each). CONCLUSIONS:The use of drugs used in advanced breast cancer pa-tients with grade Ⅳ myelosupression induced by chemotherapy is basically rational,yet it is far from perfect in pretreatment of che-motherapy drug and therapy for gradeⅣmyelosupression,which should be further improved.