Objective:To evaluate the preoperative and postoperative management in lung volume reduction surgery for patients with chronic obstructive pulmonary disease.Methods:All 7 patients were male.Age ranged from 65～76 years.Preoperative dyspnea index was grade 4 in 4 and grade 3 in 3.FEV1 were all less than 50%.We performed unilateral Lung volume reduction surgery on the lung that was estimated to have poorer lung function.The resected lung volume was 20%～30% of the operated.Results:2 tracheotomy were performed.Postoperative oxygen supply lasted 6～8d.The symptoms such as palpitaion,dyspnea were improved significantly.FEV1 and dyspnea index were respectively increased by 30%～45% and 1～2 grade.All patients recovered.Conclusions:Preoperative adjustment of the balance of water and electrolyte,proper respiratory exercises,resasonable postoperative oxygn supply and maintenance of unobstructed respiratory tract,all these are important.Moreover,tracheotomy shoulde be perfored promptly in acute cases.

Objective To investigate the role of bone marrow mesenchymal stem cells (MSCs) transplantation in repairing injured intestinal mucosa of acute pancreatitis.Methods MSCs were harvested and cultured from femurs of male SD rats.Twenty female SD rats were divided into three groups,and serve acute pancratitis (SAP) model was induced by intraperitoneal injection of L-arginine (2 g/kg) twice.Twelve hours after SAP model established,MSC transplantation group (n=8) were injected MSCs (5 × 106 cell/rat) through tail vein for three days,and SAP group (n=6) were injected the same volume of saline through tail vein as control.Control group (n=6) were only injected the same volume of saline without any treatment.All the rats were sacrificed at 72 hours after model established.The small intestinal tissues were taken for HE staining and pathological score,the TNF-α mRNA and IL-1β mRNA expression level in small intestine and pancreas were tested by RT-PCR.Y chromo-some (Sry) gene in pancreatic and intestinal tissue was examined by polymerase chain reaction (PCR).Results The relative expression quantity of TNF-a mRNA and IL-1β mRNA in pancreas was significant higher in SAP group and MSC transplantation group than in control group (7.22 ± 1.99,3.46± 1.75 vs 1.32 ± 1.04 ; 2.71 ± 0.56,1.92 ± 0.28 vs 0.61 ± 0.45 ),the difference was statistically significant (F=18.375,F=22.701; P＜0.05).Compared with SAP group,the expression quantity of TNF-α mRNA and IL-1β mRNA in pancreas was significantly decreased in MSC transplantation group,the difference was statistically significant (P＜0.05).The relative expression quantity of TNF-α mRNA and IL-1β mRNA in small intestine was significantly higher in SAP group and MSC transplantation group than in control group (3.93 ± 1.08,2.13 ± 0.53 vs 0.68 ± 0.42 ; 2.44 ± 1.54,1.02±0.44 vs 0.60±0.14),the difference was statistically significant (F=21.772,F=6.132; P＜0.05).The expression of TNF-αmRNA and IL-1β mRNA in MSC transplantation group was lower than that in SAP group,the difference was statistically significant (P＜0.05).Compared with SAP group,pathological score indicated that small intestine injure was slighter in MSC transplantation group (3.83±0.28 vs 2.83±0.56),the difference was statistically significant (F=12.013,P＜0.05).Sry gene could be detected in the pancreatic and intestinal tissue of MSC transplantation group.Conclusion Allogeneic MSC transplantation group can inhibit Pro-inflammatory cytokines expression in acute pancreatitis,relieve the intestinal mucosa injury and may involve in the intestinal tissue repair.

Purpose To compare the therapeutic effects of CO2 laser resection and traditional split laryngeal surgery on the early laryn-geal cancer, and to examine relationship between the expression of p27 and PTEN and clinical prognosis in early laryngeal squamous cell carcinoma. Methods 85 patients who underwent CO2 laser resection surgery and 46 patients who underwent split laryngeal surger-y were selected and the occurrence rates after surgery were observed. SP immunohistochemical method was uesd to detect the expression of p27 and PTEN in tumor resection marginal and their surgical margine tissues. Clinical data were collected and all patients were fol-lowed up. Results In the more than two-year follow-up study, 14 of 85 patients in CO2 laser treatment group ( recurrent group) pres-ented with local recurrence and the recurrence rate was 16. 5%, while 6 of 46 patients in split laryngeal surgery group presented with local recurrence and the recurrent rate was 13. 0%. There was no statistical significance in recurrence rate between the two groups ( P> 0. 05). 10 of all the none recurrent patients did not follow the doctor’s advice to quit smoking after the operation, while 12 in the recurrent patients did not, the difference between the two groups was statistically significant (P<0. 01). The positive rate of p27 and PTEN in laryngeal carcinoma tissues and the cancer adjacent tissues ( negative surgical margin tissues ) was 43. 5% ( 57/131 ) , 80. 2% (105/131) and 48. 9% (64/131), 83. 2% (109/131), respectively, with a significant difference (P<0. 01). The positive rate of p27 and PTEN in laryngeal carcinoma tissues of the recurrent group and non recurrent group was 20. 0% (4/20), 47. 7% (53/111) and 10. 0% (2/20), 55. 9% (62/111), respectively, with a significant difference (P<0. 05). While the positive rate of p27 and PTEN in tumor resection marginal tissues of the recurrence group and non recurrence group was 50. 0% ( 10/20 ) , 85. 6% ( 95/111) and 40. 0% (8/20), 91. 0% (101/111), the difference was also statistically significant (P<0. 01). Conclusions There was no statistically significant difference in tumor recurrence rate between CO2 laser surgery and traditional split laryngeal surgery. Postoper-ative recurrence is closely related to resume smoking. The recurrence rate of p27 and/or PTEN negative patients was higher than that of the opposite ones which should be followed up closely after treatment.

Amid the progress of public hospitals reform,the paper probed into the influences and opportunities of the health reform on the development the hospital pharmacy.They discussed the roles of pharmacists in medical service,and recommended on building the pharmaceutical service system in view of the current caliber of the pharmacists.

AIM: To evaluate the efficacy of phacoemulsification and intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis.
●METHODS:Retrospective study. A total of 57 cases (57 eyes ) with complicated cataract with uveitis were involved in the study from Jan. 2015 to Dec. 2015. All cases underwent phacoemulsification and intraocular lens implantation surgery successfully. The postoperative reaction, effect, complications and so on were retrospectively analyzed after phacoemulsification and intraocular lens implantation surgery. The date of visual outcome was analyzed using Non - parametric Wilcoxon test.
●RESULTS: lris were bleed in 21 eyes ( 37%) , 4 eyes ( 7%) with posterior capsule rapture and posterior chamber intraocular lens was not implanted in 4 eyes ( 7%) . The uncorrected visual acuity ( UCVA ) was significantly increased after surgery. The UCVA of 8 eyes (14%) were 0. 1 or better before surgery, and the UCVA of 42 eyes (74%) were 0. 1 or better 3mo after surgery, the difference was statistically significant ( Z=23. 42, P<0. 001). The corneal edema (17 eyes, 30%), uveitis (2 eyes, 4%) and intraocular hypertension ( 1 eyes, 2%) were appeared in postoperative 1d. The corneal edema (3 eyes, 5%) was appeared in postoperative 1wk. The uveitis ( 1 eyes, 2%) was appeared in postoperative 1mo. The corneal edema (1 eyes, 2%), uveitis (2 eyes, 4%) , intraocular hypertension ( 1 eyes, 2%) and after-cataract ( 3 eyes, 5%) were appeared in postoperative 3mo.
● CONCLUSION: The phacoemulsification combined intraocular lens implantation surgical intervention of complicated cataract in patients with uveitis has good effect and fewer complications.

Objective:To explore the correlation among the expression of p53, p21, and PCNA in the negative surgical margin of early laryngeal cancer and its relationship with local recurrence of the cancer. Methods:Data of 92 patients with early laryngeal cancer admitted to the Tangshan Union Hospital from 2004 January to 2010 December were selected. Immunohistochemical method was used to detect the expression of p53, p21, and PCNA in the negative surgical margin tissues of cancer. All patients were followed up for two years to observe survival status and tumor recurrence. Results:The expression of P53, p21, and PCNA had no differences in the cancer tissues in terms of grade and stage. Two years after the surgery, 16 of the 92 patients with laryngeal cancer presented recurrence with a rate of 17.39%. The recurrence rates of expression of p53, p21 and PCNA protein in the positive cut edge were 50.00%, 34.21%and 33.33%, significantly higher than those of negative ones (8.33%, 5.56%and 9.68%). The positive rates of the three proteins were higher in the recurrence specimen than in the non-recurrence while there was a significant correlation between expression of PCNA and p21 (P<0.01). The expression of both p21 and p53 in laryngeal carcinoma was also significantly correlated with the negative margin. Con-clusion:The expression of p53, p21, and PCNA in the surgical margin of early laryngeal cancer are valuable biological markers for the prognosis of these patients. Thus, combined detection of p53, p21, and PCNA in laryngeal margin tissues can be used as a predictive in-dicator of the recurrence.

Objective:This article aimed to discusse the feasibility and effects of humanistic service using Kano model in outpatients .Methods:Using a self-designed Kano model outpatient humanistic service demand question-naire investigated clinic patients by using the Kano model analysis method , implementing humanistic service in the outpatient on the base of analyzing the starting point , and compare the satisfaction situation before and after the im-plementation .Results:There are service items including necessary quality , expected quality , attractive quality in Kano model analysis , 9, 8, 2 items respectively.After the implementation of humanistic service , patient's satisfac-tion increased significantly .Conclusion:The Kano model can be used in the outpatient services .The outpatient hu-manistic service could get the approvals from most outpatient patients .Outpatient humanistic service can improve the satisfaction of patients , so as to reduce medical disputes , alleviate conflicts between the doctors and patients , and improve the hospital popularity .

Objective To study the clinical outcome of patients with fns-like tyrosine kinase-3internal tandem duplication (FLT3-ITD) positive acute myeloid leukemia (AML) treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT) and to explore the potential prognostic factors to patients' survival including transplant types or disease status.Methods A total of 314 AML patients in our center from October 2006 to October 2012 were retrospectively analyzed,among whom,54 patients were defined with FLT3-ITD positive.Survival rates and treatment-related mortality were further analyzed.Results For all 54 FLT3-ITD positive patients,the 3-year overall survival (3-OS) rate was 56％ and 3-year leukemia-free survival (3-LFS) rate was 47％.The outcome of haplo-identical HSCT was similar as that of sibling donors(3-OS rate:60％ vs 54％ ; 3-LFS rate:54％ vs 45％,respectively).There were 47 patients who received transplantation in first complete remission(CR1).The other 7 patients were of disease relapse or in CR2 before transplantation.Not surprisingly,patients in CR1 had better prognosis than those in nonCR1.Conclusions Allo-HSCT is an effective treatment for AML patients with FLT3-ITD positive mutation.The survival outcome of haplo-identical HSCT was comparable with that of sibling donors.Relapse of AML was the dominant factor related to the mortality of FLT3-ITD positive AML patients after allo-HSCT.

BACKGROUND:Calcaneus is a kind of irregular bone, with complicated three-dimensional structure. Calcaneus is often measured with X-ray plain film, while spiral CT three-dimensional imaging is a potent technology for anatomic measurement and has good application prospect. However, little is known about it. OBJECTIVE:To measure calcaneal anatomic data in Chinese peoples with spiral CT three-dimensional reconstruction and to explore its clinical significance.
METHODS:Calcaneal spiral CT three-dimensional reconstruction in 100 Chinese adults (including 50 males and 50 females) were performed. The length, width, height of calcaneus, and Bohler’s and Gissane’s angles were measured after reconstruction, and compared with the data of westerners.
RESULTS AND CONCLUSION:The mean length, width and height of the Chinese calcaneus were respectively (74.60±5.06) mm, (29.71±2.93) mm and (45.23±4.46) mm in male group, and (71.48±5.36) mm, (26.65±3.01) mm and (42.23±4.49) mm in female group. There were no significant differences between male group and female group in al the above parameters (P>0.05). There was no significant difference in the Gissane’s angle between the two groups (123.3±8.5° versus 122.7±8.9°;P>0.05). The Bohler’s angle in male group (35.98±4.34)° was significantly lower than that in female group (38.81±4.43)° (P<0.05). The length, width and height of Chinese calcaneus were significantly lower than those of westerners (P<0.05). The Bohler’s angle and Gissane’s angle in Chinese adults showed no statistical significance compared with the westerners (P>0.05). Experimental findings indicate that, the length, width and height of Chinese calcaneus in female were lower than that in male, but Bohler’s angle is significantly higher than that in male, there was no significant difference in Gissane’s angle between males and females. Compared with the data of westerners, the length, width and height of Chinese adult calcaneus are significantly decreased, and no difference is found in Bohler’s angle and Gissane’s angle.

Objective To investigate the learning curve of laparoscopy-assisted anorectoplasty in the treatment of high imperforate anus.Methods Sixty patients with high congenital anal atresia who were treated with laparoscopy-assisted anorectoplasty in the Capital Institute of Pediatrics from December 2008 to October 2015 by one experience surgeon were selected as observation group.Based on the criteria,the patients were divided into 4 groups(15 cases in each group) according to the sequence of the operation and every 15 cases served as a learning phase.The operating time,frequency of operation,complication rate,conversion rate to open surgery,blood loss,the rates of blood transfusion and hospital stay were compared among the 4 phases.Results The mean operation duration was (176.3 ±41.6) min,(128.8 ± 36.1) min,(127.3 ± 35.2) min,(124.0 ± 30.1) min in group A,B,C and D,respectively.The operation duration of 4 groups showed a declining trend.Group A has longer operation time than group B,C and D,the difference were statistically significant (P ＜ 0.05).In detail,the comparison of operation time between group A and group B was statistically significant (P ＜ 0.05).Furthermore,group A had significantly more median blood loss than group B,C and D,the differences were statistically significant [the 4 groups of data,respectively,group A:(17.5 ±6.5) mL,group B:(15.0±5.0) mL,group C:(14.5 ±5.5) mL,group D:(8.5 ±6.5) mL,P＜0.05].The mean capacity of blood loss was 12.7 mL.No significant difference was found in surgical complications,the rates of blood transfusion,total hospital stay,and postoperative hospital stay among the 4 groups(P ＞ 0.05).But the postoperative hospital stay decreased from 9.8 d (group A) to 7.4 d (group D).Conclusions For a well-trained surgeon in imperforate anus surgery.The learning curve of laparoscopy-assisted anorectoplasty in the treatment of high imperforate anus on about 15 cases helps to make a skillful surgeon.