Objective To conduct the clinical and pathological evaluation on the conservative surgery in tubal pregnancy . Methods 513 cases of tubal pregnancy in this hospital from January 2006 to December 2012 were divide into the conservative sur-gery group(A ,314 cases) ,samlpintectomy group(B ,43 cases) and the medication conservative treatment group (C ,156 cases) .The hospitalization days ,HCG negative-conversion time ,cure rate ,re-pregnancy outcome ,pregnancy during 1-year follow-up were com-pared between the group A and C .In group B ,43 cases of tubal pregnancy and accomplishing fertility were firstly performed the tubal linear incision in the pregnant site ,then the biopsy was conducted after stopping bleeding and finally the salpingectomy in af-fected side was performed .The tubal electric injury degree by the unipolar or bipolar electrocoagulation and the pathological changes under light microscope were observed .Results The hospitalization days ,symptom relief rate ,HCG negative-conversion time ,cure rate and re-pregnancy outcome had statistical differences between the group A and C (P<0 .05) .Conclusion The tubal conserva-tive surgery has short hospitalization time ,high symptom relief rate ,high cure rate and few complications .The pathological observa-tion shows the localized electrocoagulation injury .The pregnancy rate after surgery is high .

Objective To summarize experience of concomitant endovascular aneurysm aortic repair(EVAR) and coronary artery bypass grafting(CABG) for patients of severe coronary artery disease(CAD) complicated with infra-renal abdominal aortic aneurysm(AAA) or infra-renal abdominal penetrating aortic ulcer(PAU).Methods Between January 2013 and December 2016,13 patients with severe CAD and infra-renal AAA/PAU who underwent CABG and EVAR were enrolled in this study.12 patients (92.3 ％) were male and 1 patient was female (7.7 ％),the mean age of(63.7 ± 7.3) years.11 patients with CAD related symptoms,2 patients with AAA/PAU related symptoms,abdominal aortic lesions include:AAA in 3cases,PAU in 10 cases,2 patients combined with PAU of the thoracic aorta.CABG and EVAR manipulations were performed according to the routine protocol,patients who were combined with thoracic aorta PAU were treated with thoracic endovascular aortic repair (TEVAR) simultaneously.Results 7 patients received EVAR followed by CABG;6 patients received CABG followed by EVAR,TEVAR were performed in 2 patients.For all the patients,there were 11 cases of CABG were performed under the cardiopulmonary bypass(CPB) (ON-PUMP) and 2 others cases were performed without CPB(OFF-PUMP).On the average(2.5 ± 0.7)grafts were performed.The time of aortic clamp and CPB averaged were(50.7 ± 16.5)min and (58.0 ± 11.2)min respectively for the ON-PUMP CABG patients.Totally 30 thoracic aorta and abdominal aorta stent grafts were implanted in 13 patients.The duration of postoperative mechanical ventilation time was (17.8 ± 7.0) hours,Median intensive care stay was (2.7 ± 1.9) days,while hospital stay was(8.1 ± 2.4)days.All the patients was discharged.1 patient suffered wound unhealing 2 days after discharging,followed by sternal infection,he was re-admitted and received pectoralis major myocutaneous flap transfer operation,29 days after this operation,he suffered sudden cardiac arrest and eventually dead.The other 12 surviving patients was followed up for 1 ～ 36 months,The results showed that the patency of the grafts in all patients was good,no EVAR related secondary interventions were required.Conclusion For the patients with surgical indications,the procedure of one stage CABG and EVAR completed by one surgical team was safe and feasible.Comparing with the traditional one stage or staged surgical repair,this strategy showed less surgical trauma,shorter operation time,lower perioperative risks,more efficacy and more conducive to the overall management of patients.

Objective To investigate the esthetic effect of anterior ultra-thin veneers which were fabricated from heat pressed IPS e.max press ingots of high translucency.Methods The whole 62 anterior teeth of 12 patients,who wanted to receive aesthetic restorative treatment,were invloved in the study.Grooves with 0.5 mm depth were marked at the center of the labial face by the use of spherical diamond burs with 1 mm in diameter.At the cervix of the teeth,the design of 0.3 mm shallow concave shoulder was adopted.IPS e.max HT ingots of different color were chosen to be hotpressed; the straining technique was used on the marginal ridge and incisor ridge of the ultra thin veneers after they had been carefully trimmed.Subsequently,the restorations were bonded with Variolink Veneer resin cement.After a short-term follow-up for 3 years,a modified USPHS criterion was used to evaluate the esthetic effect.Results The thickness of the ultra-thin veneers fabricated by heat pressing was 0.3-0.5 mm,marginal integrity of the veneers was perfect and fitted well with the marginal finishing line of the abutment,and then the translucency of veneers was high.There was no edge discoloring after the veneers were used for 6 months to 3 years,and they might produce an excellent chameleon effect by mixing the color of adjacent teeth and gums,and appeared a surface morphology of natural enamel after carefully carved.In the short-term clinical observation,none of the 62 veneers fractured or fell off; there was no case of dentin hypersensitivity.Conclusions Ultra-thin veneers fabricated from IPS e.max Press ingots have the following advantages,a simple operating procedure,high mechanical strength,and satisfactory esthetic effect.

Objective To evaluate the value of serum procalcitonin(PCT ) and C-reactive protein(CRP) analysis in the differenti-ation of the cause of fever in cancer patients .Methods 218 cases with fever enrolled were divided into three groups ,including bacte-rial infection group ,viral infection group and tumor related fever group .The positive rates of white blood cell(WBC) count ,percent-age of neutrophil ,PCT and CRP were determined and there correlations were analyzed .Results The positive rates of WBC count , percentage of neutrophil ,PCT and CRP in bacterial infection group were significantly increased compared to viral infection group and tumor related fever group(P<0 .05) .The positive rate of PCT in tumor related fever group was also statistically significant difference compared to viral and bacterial infection group(P<0 .05) .The sensitivity of PCT was 97 .83% and the specificity of PCT was 83 .33% .Conclusion PCT and CRP can help identify causes of fever in cancer patients .PCT has better sensitivity and specific-ity ,it can help anti-infective and provide experimental evidence for tumor treatment ,and also help determine the disease outcome and clinical deterioration .

Objective To explore influencing factors of postoperation fast-track recovery in patients with thoracoscopic lobectomy and provide support for the concept of fast track surgery in clinically application. Methods A total of 129 patients who underwent thoracoscopic lobectomy were selected and questionnaire were adopted for survey between January 2015 and September 2015. Univariate analysis and multivariable logistic regression analysis were used to screen influencing factors of postoperation fast-track recovery. Results Univariate analysis showed that the influnecing factors of postoperation fast-track recovery in patients with thoracoscopic lobectomy were closely related to the age, combined basic disease or not,smoking index,preoperative smoking cessation time,preoperative pulmonary function training or not,systematic health education or not,postoperative wound pain,early postoperative ambulation or not,postoperative chest exercises in time or not (t=2.880,χ2=0.219-33.224, P<0.01 or 0.05). Multivariable logistic regression analysis showed that systematic health education or not, postoperative wound pain,preoperative pulmonary function training or not,postoperative chest exercises in time or not,combined basic disease or not,smoking index,and quit smoking more than two weeks or not were the independent risk factors. Conclusions For the patients with thoracoscopic lobectomy, preoperative condition and postoperative condition in the early should be assessed in time. Controlling the pain effectively,giving reasonable guidance of preoperative pulmonary function exercise,strengthening the respiratory tract management,systematic health education,improving the ward environment,high quality of social support and other diversified services could accelerate the recovery of the postoperative patients.

OBJECTIVE:To observe clinical efficacy and safety of Modified xiaohuang paste in the treatment of paralytic ileus after thoraeolumbar fractures.METHODS:One hundred and thirty-eight patients with paralytic ileus after thoracolumbar fractures were divided into control group (group A,43 cases),Xiaohuang paste group (group B,47 cases) and Modified xiaohuang paste group (group C,48 cases).Group A was given routine treatment as fasting,gastrointestinal decompression,fluid replacement,nutritional support;group B was additionally given Xiaohuang paste on the basis of group A;group C was additionally given Modified xiaohuang paste on the basis of group A.Group B and C were given relevant paste every 12 h until intestinal peristalsis was recovered and gas exhausted from anus,at the most for 5 days.The improvement time of clinical symptom improvement,VAS score and CRP level were compared among 3 groups as well as the occurrence of ADR.RESULTS:After treatment,the time of gastrointestinal decompression,bowel sound recovery and passage of gas by anus in group B and C were significantly shorter than group A,and group C was significantly shorter than group B,with statistical significance (P＜0.05).Before treatment,there was no statistical significance in VAS score and CRP level among 3 groups (P＞0.05).After treatment,VAS score of abdominal pain and distension,CRP level of 3 groups were decreased significantly compared to before treatment;those of group C were significantly lower than group A and B,and CRP level of group B was significantly lower than that of group A,with statistical significance (P＜0.05).There was no statistical significance in VAS score between group A and B (P＞0.05).No significant ADR was found in 3 groups.CONCLUSIONS:For paralytic ileus after thoracolumbar fracture,Modified xiaohuang paste can significantly shorten treatment duration,relieve abdominal distension and pain,inflammation with good safety.

AIM: To study the expression and its kinetics of rice phenylalanine ammonia-lyase gene encoding into E. coli as the basis of treatment for phenylketouria. METHODS: The phenylalanine ammonia-lyase-1-cDNA(rPAL-1-cDNA) from rice was recombined into E. coli high expression vector pET-28c and transformed into E. coli host strain BL21DE3. Engineering bacteria was then inducted by isopropyl-?-D-thiogalactoside (IPTG) for 1, 3, 5, 7 hours, in order to obtain high level expression. RESULTS: After induction, the expression level of fusion protein was 21.40%, 30.60%, 35.40%, 35.43% respectively. The fusion protein exhibited a band of 78 6 kD on SDS-PAGE analysis,but was not found in controls.The target protein was mainly existed in the form of inclusion body. CONCLUSION:Rice PAL gene expressing E. coli was established by gentic engineering technique.

AIM: To evaluate the ability of spectral domain optic coherence tomography ( SD-OCT ) parameters to detect progressive structural damage in primary open angle glaucoma ( POAG) by contrasting with visual field. ·METHODS: Retrospectively we evaluated 48 subjects (48 eyes ) of POAG, followed up 14 to 62mo. The parameters of SD-OCT and visual field were obtained. The correlation between the change of visual field measurements and OCT measurements were analyzed. Visual field progression was defined as reproducible drop of at least 2dB of mean deviation (MD) from the baseline visit. ROC curve was made to evaluated the ability of OCT parameters in detect progression of POAG. ·RESULTS: The 25 eyes were classified in progression group and 23 eyes were in non-progression group. No significant correlation was seen between OCT parameters and visual field in non-progression group. In progression group, OCT parameters which were significantly correlated with MD reduce were rim volume ( r=-0. 5997, P=0. 0007), C/D vertical ratio (r=-0. 6309, P=0. 0003), RNFL(r= 0. 4201, P= 0. 0260), and GCC(r= 0. 7080,P<0. 01). ROC curves showed the GCC reflected the reduce of MD accurately (P=0. 013). ·CONCLUSION: Part parameters of SD-OCT can reflect the progression of POAG accurately and provided a new method to detect the damage of visual function of POAG.

Objective:To discuss the characteristics of auditory brainstem response in preterm very low birth weight (VLBW) babies and to investigate the correlations between the ABR and clinical characteristics. Method: Fifty-nine VLBW babies (118 ears) were enrolled in the study and 30 term normal babies as the control group. Tympanometry, acoustic reflex, DPOAE, ABR were obtained in all the babies. Result:The prevalence of hearing loss in VLBW babies was higher than normal term babies and babies with perinatal complications higher than those without perinatal complications. There was no correlations between ABR threshold and gestational age, birth weight, postconceptional age, negative correlations between wave Ⅰ,Ⅲ and Ⅴ latencies Ⅰ-Ⅲ ,Ⅲ-Ⅴ and Ⅰ-Ⅴ intervals and postconceptional age. Wave Ⅰ and Ⅴ latencies, Ⅰ-Ⅲ and Ⅲ-Ⅴ intervals differed significantly between the two groups. Conclusion:The perinatal complications were the most important causes of the hearing loss in preterm VLBW babies than the gestational age and birth weight. There was a high prevalence of peripheral hearing loss in the preterm VLBW babies. Combining OAE and automated ABR should be applied for hearing screening. Regular follow-up was very important in all the preterm VLBW neonatal.

Objective To investigate the influence of service-learning model on medical graduates' ethical behavioral tendency. Methods A self-designed questionnaire was conducted among 302 medical students who have graduated in the last five years including the basic information, ethical behavioral tendency and participation of service-learning. The acquired data was analyzed and com-pared using chi-square test and unconditional logistic multiple regression. Results 68.2%(206/302) undergraduates participated in service-learning. Undergraduates participated in service-learning be-haved more ethical than those did not participated when facing the situation of patient' vomits (P=0.037). There were statistical differences in taking bribes from patients between those participated in service-learning and those did not (P=0.031). According to the results of unconditional logistic multiple regression analysis, whether participating in the service-learning is one of significant factors influenc-ing undergraduates' attitude towards bride-taking. Conclusions Medical students educated by service-learning model will exhibited more ethically accepted medical behaviors after becoming doctors. Ser-vice-learning model, a new medical education model, is worth promoting.