Abstract:Objective:To investigate the effects of telmisartan on transient outward potassium currents （Ito） and L-type calcium cur－rents （ICa-L） of atrial myocardium in two kidney one clip（2K1C） rats by measuring the alteration of mRNA and protein （Kv4.2 and Cav1.2） levels in encoding genes （Kcnd2 and Cacna1c）. Methods: Totally 39 male Sprague-Dawley rats were divided into control group，2K1C and Telmisartan 5 mg/（kg·d） group，2K1C and telmisartan[10 mg/（kg·d）] group and 2K1C group.After four weeks of treatment，mRNA and protein levels of Kcnd2 and Cacna1c were assessed by reverse transcriptase polymerase chain reaction and western blot. The data were analyzed by relative quantification. Results：The expression levels of mRNA and protein of Kcnd2 were decreased{（0.23?0.02） vs. （1.0?0.12）；（0.34?0.11） vs. （0.78?0.13），P<0.01}，but those of Cacna1c were increased{（1.54?0.17）vs. （1.0?0.13）；（1.58?0.09） vs. （0.92?0.05），P<0.01} in 2K1C group compared with those in control group.The expression levels of mRNA and protein of Kcnd2 were increased{（0.32?0.01），（0.53?0.11） vs. （0.23?0.02）；（0.54?0.07），（0.72?0.08） vs. （0.34?0.11），P<0.01}，but those of Cacna1c were decreased{（1.21?0.18），（1.02?0.14） vs. （1.54?0.17）；（1.21?0.06），（0.98?0.07） vs. （1.58?0.09），P<0.01} in 2K1C and Telmisartan 5 mg/（kg·d） group as well as 2K1C and telmisartan 10 mg/（kg·d） group compared with those in 2K1C group. Conclusion：Telmisartan exerts its antiarrhythmic effects by regulating mRNA and protein levels of Kcnd2 and Cacna1c.

Abstract:Objective:To investigate the expressions of maspin and EIF-5A2 in esophageal squamous cell carcinoma and the clinical significance. Methods：Immunohistochemical SP method was used to detecte the expressions of maspin and EIF-5A2 in 60 esophageal carcinoma tissues. Results：Maspin protein expression in esophageal squamous cell carcinoma tissues had a correlation with histologi－cal differentiation and lymph node metastasis（P<0.05），and EIF-5A2 expression in esophageal squamous cell carcinoma tissues had a correlation with invasion，lymph node metastasis and TNM staging（P<0.05）. Conclusion：The expressive intensity of maspin and EIF-5A2 in esophageal carcmoma tissue may be served as the molecular biological index of evaluating infilitration and metastasis. The combined examination of maspin and EIF-5A2 may be useful for the diagnosis of early esophageal squamous cell carcinoma and e－valuating prognosis in esophageal squamous cell carcinoma.

Abstract:Objective：To investigate the effect of all-trans retinoic acid （ＡＴＲＡ） in the differentiation of hepatic progenitor cell. Methods：The hepatic progenitor cell was isolated from E14.5 mouse liver and transfected with pALB-Luc，in which the ex－pression of luciferase was driven by （Albumin，ALB） promoter. The concentration of ATRA based on the expression of ALB was optimized. The change of differentiation markers of （Alpha fetal protein，AFP），（Delta like，DLK），（Cytokeratin19，CK19） and ALB in the hepatic progenitor cell treated with ATRA was evalu－ated by RT-PCR. The morphological change was observed by HE staining and PAS staining. Results：The expression of ALB was the highest when the cell was treated with ATRA a concentration of 1 μmol/L. Compared with control group，the expressions of early markers of DLK and CK19 more clearly decreased while AFP and ALB were increased in experimental group. The morphological changes were mainly enlargement of cellular size，decrease of karyoplasms ratio and increase of glycogenesis. Conclusion：ATRA can induce the differentiation of hepatic progenitor cell，especially at the concentration of 1 μmol/L.

Abstract:Objective：To study the expressions of matrix metalloproteinase-7（MMP-7），vascular endothelial growth factor-D （VEGF-D） and （Vascular endothelial growth factor receptor-3）（VEGFR-3） in colorectal carcinomas and relationship between MMP-7 ex－pression and lymphangiogenesis. Methods：124 primary tumors with colorectal carcinoma were studied，together with 70 normal col－orectal tissues by immunohistochemistry. Results：The expressions of MMP-7，VEGF-D and VEGFR-3 were higher in the primary tu－mors than those in mucosa. MMP-7 expression was associated with tumor volume，Dukes stage，invasive depth and lymph node metastasis. VEGF-D and VEGFR-3 expressions were associated with tumor volume and lymph node metastasis. There was positive correlation between MMP-7，VEGF-D and VEGFR-3 in primary tumors. The higher expressions of MMP-7，VEGF-D and VEGFR-3 indicated worse prognosis in colorectal carcinoma. Conclusion：MMP-7 overexpression was closely related to the expressions of VEGF-D and VEGFR-3 that might be involved in the lymphangiogenesis. MMP-7，VEGF-D and VEGFR-3 might be helpful to predict the prognosis of colorectal carcinoma.

Abstract:Objective：To establish the chronic intermittent hypoxia （CIH） rat animal model Dv simulation of obstructive sleep ap－nea-hypopnea syndrome（OSAHS），and to observe the effect of CIH on oxidative stress in rat myocardial injury and reoxygenation.Methods：Chronic intermittent hypoxia rat model with 16 rats were established，in which eight rats were reoxygenated after hypoxia. Glutathione（GSH） and protein carbonylation of heart muscles were determined with the method of Western blot，and then were com－pared with those of eight normal rats. Results：The glutathione of myocardial muscles were significantly decreased in chronic inter－mittent hypoxia group compared with that in control group（P<0.05）. However，the protein carbonylation levels were significantly high－er （P<0.05）. Compared with those in the control group，the glutathione and protein carbonylation levels of the reoxygenation group had no significant difference（P>0.05）. Conclusion：Oxidative stress level increase and modification of proteins takes place in myocar－dial muscle of rats with chronic intermittent hypoxia. After reoxygenation，the oxidative stress level returns to normal.

Abstract:Objective:To investigate the correlation between BMI and lung injury degree in acute lung injury of rats. Methods：A total of 60 male sprague-dawley （SD ）rats were randomly divided into control group（C），Oleic acid-treated group（OA），control-hperlipi－demia（C-H） group，and Oleic acid-hperlipidemia（O-A） group. Acute lung injury was induced by injection of OA，O-A（does，0.15 ml/kg） via intravenous vein. Rats were killed at scheduled time-points and the Lung tissues were removed for lung pathology and determination of wet/dry weight ratio（W/D），nuclear factor-kb（NF-κB） expression，inflammatory cytokines interleukin-1β（IL-1β），and tumor necrosis factor α（TNF-α）. Results：In O-H group，the pathology of lung injury score，IL-1β and TNF-α were significant－ly increased，as compared with the OA group （P＜0.05）. The above lung tissue expression of NF-κB mRNA in O-H group were also significantly increased than OA group. Conclusion:Under the same dose of oleic acid induction，the mRNA and the level of inflam－matory cytokines suggest that BMI levels and lung injury were positively correlated with each other.

Abstract:Objective：To explore the expressions of CD44v6 and receptor of HA mediated motility（RHAMM） in tissues of gastric carcinoma and their relationship with the clinicopathological features and patients’ prognosis. Methods：The expression levels of CD44v6 and RHAMM in 78 cases of resected gastric carcinoma tissues and 25 cases of normal gastric mucosal tissues were detected by immunohistochemistry method. Results：Both CD44v6 and RHAMM were expressed as brown granules. The positive rate of CD44v6 expression in gastric carcinoma tissues was 64.1%（50/78），which was significantly higher than that of 0% in normal tissues（P<0.05）.The positive rate of RHAMM expression in gastric carcinoma tissues was 66.7%（52/78），significantly higher than that of 12%（3/25） in normal tissues （P<0.05）. There was no correlation between CD44v6 and RHAMM expressions and the sex，age，tumor size and tu－mor differentiation （P>0.05）. However，the expressions of CD44v6 and RHAMM were closely related with the invasion depth and the extent of lymph node metastasis （P<0.05）. Conclusion：Both CD44v6 and RHAMM are highly expressed in gastric carcinoma，which may promote the metastasis of gastric carcinoma cells. The expressions of CD44v6 and RHAMM play an important role in the invasion and metastasis of gastric carcinoma.

Abstract:Objective：To study the polymorphism of E6 gene of HPV 52 in Chaozhou. Methods：The DNA was extracted from the cervical exfoliated cells of 101 cases of simple infection of HPV 52. 83 cases of E6 gene complete sequence was amplified success－fully and sequenced. The BLAST 2.0 software online was used for polymorphism study. Results：Totally，76 complete E6 genes were successfully amplified. The similarity was 99% compared with reference strain（GQ472848）. 11 kinds of polymorphism were found，of which 9 kinds were nonsense mutation and the other 2 kinds were sense mutation，which would cause amino acid alteration. All of the 76 cases were divided into Asian cluster and American-European cluster according to the polymorphism of E6 gene. Asian cluster had seven groups. The most common polymorphism was completely matched with the sequence reported in Guangzhou （EU924143） and Hongkong（DQ057293），and this group was named the predominant sequence in Chaozhou area；the variant of the second group was completely matched with the sequence reported in Guangzhou（EU924144）；the variant of the third group was completely matched with the one reported in Zhejiang University reported（HM004117）；while the other 4 groups had never been reported worldwide so far. American-European cluster had three groups. The most common polymorphism was found in 5 different cases，which was com－pletely matched with the sequence reported in America （HQ537745）. The second group polymorphism were found in 2 samples，it was completely matched with sequence reported from America （DQ057291） and Germany （X74481）. The third group was found in one case，which had not been reported before. Conclusion：There is a complicated polymorphism of HPV52 E6 genes in Chaozhou area. The common polymorphism is similar with that reported in the South-east in China or the South-east Asia. The rare sequence matches with American and European reports. This study provides molecular evidence for gene vaccine exploration in Chaozhou.

Abstract:Objective：To optimize the synthetic technological conditions of 1-aminomethyl-1，2，3，4-tetrahydroisoquinoline hy－drochloride as important intermediate for drugs by orthogonal experimental method. Methods：The target product was synthesized from β-phenethylamine by phthalimide N-hydrocarbylation reaction，Bischler-Napieralski reaction，cyclization with Bischler-Napieralski method，hydrazinolysis reaction，reduction and salification. The key factors on each reaction were discussed separately and optimized by orthogonal experiment. Results：The overall yield was 65%，2.5 times as much as that of the reported. Conclusion: The optimized synthetic route has promise in industrial production for its cheap and readily available raw materials，easy and environmentally-friend processes，high yield and good quality of products.

Abstract:Objective：To explore the formulation and storage methods for bacillus fastidious uricase as a diagnosis enzyme. Methods： Lyophilized powders of this uricase containing protective additives，and solutions of this uricase containing preservatives，were stored at -18℃ or 4℃. Enzyme activity was monitored at proper intervals. Homotetramers and homodimers of this uricase were resolved by polyacrylamide gel electrophoresis（PAGE），and were stained separately for both proteins and enzyme activities. Results：The lyophilized powders and solution preparations of this uricase yielded the corresponding residual enzyme activities of 12% and 100%，respectively，after storage at 4℃ for 28 days，and the residual enzyme activities of 24% and 92%，respectively，after storage at -18℃ for 28 days.The use of trehalose，sucrose and mannitol as the protective additives in lyophilized powders gave the residual enzyme activities of 100%，76% and 43%，respectively，after storage for 56 days at -18℃. The use of NaN3 and benzoic acid as the preservative in the solutions gave the residual enzyme activities of 99% and 82%，respectively，after storage for 56 days at 4℃. By PAGE analyses of lyophilized powders of low activity，less active homotetramers but more inactive homodimers were observed. Conclusion：This uricase as a diagnosis reagent can be prepared in solutions containing NaN3 for storage at 4℃.

Abstract:Objective：To construct the expression vector of human staphylokinase （SAK） gene，express SAK protein in E.coli，purify recombinant SAK protein and to verify its bioactivity. Methods：On the basis of bioinformatics，gene sequence was analyzed and op－timized，SAK plasmid was constructed by gene synthesize methods and the protein was expressed by B834 strain. The recombinant protein was purified by ion exchange coloum （DEAE） and size exclusion chromatography（Superdex 75）. Soluble fibrin plate method was used to characterize its fibrinolytic activity. Results：The recombinant SAK was highly expressed in soluble supernatant by E coli system. The recombinant protein with 95% purity was obtained by using of DEAE and Superdex 75.Experiments in vitro revealed that the fibrinolytic activity of SAK was approximately equal to that of urokinase. Conclusion:The recombinant SAK with high fibrinolytic activity can be highly expressed in E coli system by utilizing sequence optimizing and gene synthesize.

Abstract:Objective：To explore the mental health status of the seven-year program medicine students and its relevant influencing factors in an aim to provide references for formulating intervention measures． Methods:Anonymous questionnaire adopting the scale of symptom checklist 90（SCL-90） was provided for 203 seven-year program medicine students in Chongqing medical university. Results：The detection rate of positive symptoms is 36.5% and the top three influencing factors were compelling factor，depression factor and anxiety factor. The detection rate for moderate or serious mental problems was 6.9% and the top three influencing factors were compelling factor，depression factor and anxiety factor. There was no significant difference in scores of SCL-90 factors between male and female（P＞0.05）. The total score and scores of factors of compelling，interpersonal relationship sensitivity，depression，horror，stubborn，anxiety and mental disorder in SCL-90 among country students were higher than those among city students（P＜0.05）. Family education，sleeping condition，interpersonal relationship and study pressure were the main influencing factors of the seven-year program medical students. Conclusion：The mental health condition of the seven-year program medical students is poor and mental health education should be enhanced.

Abstract:Objective：To explore a new screening way for early breast cancer，for the early discovery，early diagnosis and treatment of the disease. Methods：Retrospective analysis was made on the mammography screening of 3 107 women by our hospital from March 2010 to May 2011. Results：6 cases of breast cancer were detected by screening，with the detection rate of 193.11/100 000，all ranging from 40 to 60，including stage 0 DCIS in 1 case，stage Ⅰ in 4 cases，and stage Ⅱ in 1 case. Primary malignant lymphoma of the breast was in 1 case.Precancerous lesions was in 17 cases，including papillomatosis in 5 cases，ductal epithelial hyperplasia in 1 case，atypi－cal hyperplasia in 11 cases；the age of the screening targets was mainly between 40 and 49，which occupied 88%. Axillary accessory breast was in 629 cases，with the detection rate of 20.24%，and the incidence of accessory breast increased with the breast density． Conclusion：The detection rate of this screening for breast cancer is high. Mammography in breast cancer screening is extremely im－portant so that treating all objects with mammography may improve breast cancer detection rate；color ultrasonography and clinical breast examination （CBE） can be taken as the joint inspection measures of mammography screening.

Abstract:Objective：To investigate the prevalence of depression and influential factors in drug users receiving methadone mainte－nance treatment in Nanchang，trying to find some evidence for more mental intervention. Methods：Drug users receiving metha-done maintenance treatment in Nanchang were selected by convenience cluster sampling and surveyed with questionnaire including self-rating depression scale（SDS） and self-made general questionnaire. Results：The overall prevalence of depression was 53.91%（207/384） in drug users receiving methadone maintenance treatment in Nanchang；the mean score of depression was （55.03?11.05）. Multivariate logistic analysis indicated that female（OR=0.243），good economic conditions in their own conceit （OR=0.550） and learning more about the knowledge of HIV/AIDS（OR=0.358） had a protective effect on depression；having a drug addiction attack（OR=1.762）and great economic pressure （OR=1.585） were risk factors for depression. Conclusion：The depression are common in drug users re－ceiving methadone maintenance treatment in Nanchang；therefore，we should take appropriate preventive measures in accordance with the patient’s specific situation in the clinical work，so as to prevent the occurrence of depression in drug users receiving methadone maintenance treatment.

Abstract:Objective：To explore the influence of two different feedings，on the basis of parenteral nutrition，on the premature in－fants’ Leptin and Insulin-like growth factor-1（IGF-1）expression levels. Methods：On the first and second day，64 premature infants in ICU，on the basis of parenteral nutrition，were fed with 5 ml/（kg·d） milk each day，and were fed with 15 ml/（kg·d） milk on the third day. Then 31 of them were put into test group and 33 into control group by using random number table 72 hours later. The daily increment of feeding in test group was 30 ml/（kg·d） milk，and the increment was 20 ml/（kg·d） milk in the control，until the feedings of intestine reached 150 ml/（kg·d）. All the infants’ everyday weight and weekly height and head circumference were measured dur－ing the feeding；10 days later，the expression levels of Leptin and IGF-1 in blood serum were tested. Results：After one month，in－fants’ weight in the test group was significantly higher than that of control group （P<0.05）. The expression levels of Leptin and IGF-1 in blood serum in the test group were also higher than those of control group 10 days after the infants were born （P<0.05）. Conclu－sion：Parenteral nutrition mixed with an increasing amount of 30 ml/（kg·d） of enteral feeding can improve the expression levels of Leptin and IGF-1 in blood serum of preterm infants，and is conducive to the their growth.

Abstract:Objective：To investigate the prevalence of cancer，assess the risk factors of cancer and offer the bases for making inter－ventional measures. Methods：30 cancer patients were taken as case group，and with the method of random sampling from the crowd of 4 290 normal data，430 people were extracted as control group. First，Chi-square and t-test were used to discuss the relationship be－tween the various factors，and then Logistic regression analysis was made by statistics software SPSS17.0 based on the results of the 460 people. Results:The prevalence of cancer was 0.69%. Sin－gle factor analysis results showed cancer was relate to age，av－erage annual income，BMI，educational level，family history of cancer，frequency of fruit and vegetable diet，oily and fatty food，smoking，drinking and activity time. Multivariate analysis showed that age，BMI，family history of cancer，frequency of fruit and vegetable diet，oily and fatty food，smoking and activity time were independent risk factors of cancer. Conclusion：Cancer is a kind of disease which correlates to life style；the essential measure to prevent cancer is to change unhealthy life style．

Abstract:Objective:To explore the apparent diffusion coefficient（ADC） feature in normal human brain in various age groups using diffusion tensor imaging（DTI） through voxel-based analysis（VBA） method. Methods:Sixty younger volunteers and sixty older volun－teers underwent DT1，and gained the ADCmean through DTiStudio．The ADCmean was compared by voxel-based analysis，and so were the areas of the brain with significant changes of the ADCmean between the two groups. Results:Compared with the younger vol－unteers，the older volunteers showed increased ADCmean in the bilateralis inferior frontal gyrus，middle frontal gyrus，superior frontal gyrus，middle temporal gyrus，superior temporal gyrus，cerebellum anterior lobe，culmen，precental and postcental gyrus and so on. Conclusion:The normal ADCmean values through VBA in various age groups measured quantitatively provide the changes between the two groups and can be used to explore the microstructure changes in the older.

Abstract:Objective：To investigate the therapeutic effect of tiotropium bromide in combination with nocturnal oxygen therapy on nocturnal hypoxemia in patients with chronic obstructive pulmonary disease（COPD） and to evaluate indirectly the efficacy of tiotropi－um bromide for nocturnal hypoxemia. Methods：Totally 40 patients with stable moderate to severe COPD and nocturnal hypoxemia were recruited and randomly divided into the observation group （n=20） and the control group （n=20）. The patients in the observation group were given inhalative tiotropium bromide（18 μg，once every afternoon） in combination with nocturnal oxygen therapy（2 L/min） while those in the control group were treated with nocturnal oxygen therapy（2 L/min） only. Nocturnal oxygen saturation （SaO2），arte－rial blood gases and pulmonary function were examined before and four weeks after the treatment. Results：After the treatment，noc－turnal mean SaO2 （MSaO2），nocturnal minimum SaO2 （MmSaO2），arterial partial pressure of oxygen （PaO2），arterial SaO2，first second forced expiratory volume（FEV1），percentage of FEV1 in the predicted value （FEV1%Pred），forced vital capacity（FVC），forced inspira－tory capacity （IC） and percentage of peak expiratory flow rate in the predicted value （PEF%Pred） were significantly increased in the observation group. In the control group，MSaO2，MmSaO2，PaO2 and SaO2 were significantly increased，but no change in FEV1，FEV1%Pred，FVC，IC and PEF%Pred was observed. Both groups showed significant decreases in the percentage of the time with noc－turnal SaO2<90% in the total sleep time （T90）. Arterial partial pressure of carbon dioxide （PaCO2） was significantly decreased in the observation group；however it was remarkably increased in the control group. After the treatment in the observation group，MSaO2，MmSaO2，PaO2 and SaO2 were significantly increased；T90 and PaCO2 were significantly decreased；FEV1，FEV1%Pred，FVC，IC and PEF%Pred were notably increased compared with those in the control group. Conclusion：Tiotropium bromide in combination with nocturnal oxygen therapy could significantly improve the symptoms of nocturnal hypoxemia in patients with stable COPD，which is su－perior to nocturnal oxygen therapy alone. Meanwhile，tiotropium bromide could also improve the symptoms of nocturnal hypoxemia in patients with stable COPD.

Abstract:Objective：To analyze and compare CT manifestations and clinical pathology of bronchioloalveolar carcinoma in young people，so as to improve the diagnosis of this disease. Methods：78 young patients of bronchioloalveolar carcinoma confirmed by sur－gical pathology were retrospectively analyzed. According to the pathological manifestation，the patients were divided into 3 groups as follows: isolated-nodule group （28 cases），multiple-nodules group （24 cases），and lobar-consolidation group （26 cases）. The imag－ing features of lung cancer in different groups were compared and studied. Results：In isolated-nodule group，specific signs such as lobulation，air bronchogram，and pleural indentation were showed relatively more than those in the other two groups. Multiple-nodules group showed diffuse multiple nodules in both lungs，broken stone road signs，and were often accompanied by pleural traction. Lobar-consolidation group showed low density of lungs，honeycomb lung sign，angiography sign，dry branches sign and multiple acinar nod－ules. Conclusion：Understanding CT manifestations and clinical pathology of bronchioloalveolar carcinoma in young patients can help to improve preoperative diagnosis of this disease.

Abstract:Objective：To be compared to the clinical efficacy of sufentanil or remifentanil by target-controlled infusion（TCI） on gyne－cologic laparoscopy surgery. Methods：A total of 92 ASA I or II patients undergoing elective gynecologic laparoscopy operation were randomly divided into tow groups: sufentanil group （group S，n=46） and remifentanil group （group R，n=46）. Sufentanil of group S was administered by TCI at a target effect-site concertration of 0.5 ng/ml and propofol was 3 μg/ml during induction of anesthesia. Sufentanil of group S was administered by TCI at a target effec-site concertration of 0.3 ng/ml and propofol was 3 μg/ml during main－tenance of anesthesia. Remifentanil of group R was administered by TCI at a target blood concertration of 4 ng/ml and propofol was 3 μg/ml during induction of anesthesia. Remifentanil of group R was administered by TCI at a target blood concertration of 4 ng/ml and propofol was 3 μg/ml during maintenance of anesthesia.Systolic blood pressure（SBP），diastolic blood pressure（DBP）and heart rate（HR） at the time of preanesthesia（T0），3 min after induction（T1），intubation（T2），incision（T3），exploration with laparoscopy （T4） and extubation（T5） were recorded. The time from recovery profiles after operation were compared. Propofol of two groups were counted. Results：HR of two groups at T1 were lower those at T0（P＜0.05）， while at T1 SBP and DBP of group R were lower those of group S（P＜0.05）；SBP，DBP and HR of two groups were on different at T2，T3 and T4（P＞0.05）；SBP，DBP and HR of group R at T5 were high－er those of group S（P＜0.05）；The time of group R from stoping infusion to extubation was lower that of group S（P＜0.05），while recov－ery profiles of group S after operation were better than those of group R. Conclusion：Perioperation sufentanil or remifentanil by TCI on gynecologic laparoscopy operation are hemodynamics stability both，but the patients of remifentanil by TCI shoud give opioid drugs ahead the time termination operation.

Abstract:Objective：To study 9-year survival rate of undiagnosed diabetes patients with heart failure. Methods：All patients with first-time discharge diagnosis of acute heart failure in the cardiology department of our hospital received a retrospective cohort obser－vational study. Results:100 cases of the 65 patients died，48 patients of whom died of cardiovascular disease. Kaplan-Meier survival curves illustrated the clinical patients with diabetes and asymptomatic diabetic patients had higher all-cause and cardiovascular dis－ease mortality risk.Asymptomatic diabetic patients were similar with clinical patients with diabetes in all-cause mortality risk ，and significantly higher than those without diabetes. Conclusion:We should pay more attention to the diagnosis of abnormal blood glucose for the inpatients with heart failure at admission.

Abstract:Objective：To explore the variation factors in the implementation of clinical pathway in ST elevation myocardial infarction，so as to further improve the quality of clinical pathway implementation. Methods：In our hospital from March 2010 to September 2011，clinical path data of 203 cases of acute ST elevation myocardial infarction patients for were analyzed，and correction analysis was con－ducted to the variation analysis interrelated factors. Results：A total of 122 patients with 203 cases did not complete a clinical pathway （60.10%），the patient or family member factors in 114 cases （93.44%），medical personnel factor in 6 cases （4.92%），equipment factors in 2 cases（1.64%），which includes medical cost problems in 45 cases（36.89%），and complications in 42 cases（34.43%）. Conclusion：Clinical pathway variations analysis for STEMI helps to find out the reasons for variation and to reduce variation. Clini－cal pathway can be smoothly fulfilled through timely and effective intervention，and by supplementing and completing the clinical pathway content，so as to improve the treatment and caring quality.

Abstract:Objective：To discuss the early diagnosis and emergency treatment of aortic dissection （AD） in order to enhance its im－portance. Methods：The clinical data of 42 patients with AD from January 2007 to December 2010 were retrospectively analyzed and their diagnosis and treatment were summarized. Results：Twenty-three cases of AD were diagnosed correctly in the first time and were received emergency medical treatment， among which 17 cases survived（73.9%），6 cases died（26.1%） and 3 cases refused the treatment and died within 24 hours. There were 19 cases experienced the delay in the diagnosis，among which 7 cases survived （36.8%），12 cases died （63.2%） including 2 instant death cases and 2 cases had disputes. Conclusion：Timely and accurate emer－gency diagnosis can gain the time for further treatment，which is the key to the treatment of AD.Meanwhile，effective doctor-patient communication can reduce the disputes.

Abstract:Objective：To comparatively analysis the treatment effects of three minimally invasive surgical approaches for great saphenous vein varicosity（GSVV）. Methods：To retrospective analysis 248 cases GSVV from January 2008 to January 2011. All samples were respectively treated by new minimally invasive stripper（NMIS，103 cases），endovenous laser ablation （EVLA，87 cases） or transilluminated powered phlebectomy （TIPP，58 cases）；It was compared each group that the hospitalization fee、amount of bleeding、mean length of hospital stay、time of surgery、postoperative complications and skin ulcers drying and healing time. Results：NMIS group mean hospitalization fee was least in three groups（P<0.01），Amount of bleeding was least in EVLA group and most in TIPP group（P<0.01）. Mean length of hospital stay in EVLA group was notable shorter than that in NMIS and TIPP groups（P<0.01）. The skin ulcers drying and healing time in TIPP groups was shorter than that in NMIS group（P<0.01），and all skin ulcers was cured in TIPP groups.Postoperative complication rate and the time of surgery were similar in three groups（P>0.01）. Conclusion：The therapeutic effect of surgery for GSVV with NMIS was as good as surgery with EVLA，and the complication rate was similar.The former has obviously economic advantage，the latter has obviously cosmetic and time advantage. TIPP has obviously therapeutic advantage for GSVV patients with skin ulcers.

Abstract:Objective：To review the clinical experience of video-assisted thoracoscopic lobectomy for lung cancer. Methods：From January 2009 to January 2011，52 patients with lung cancer underwent VATS lobectomy.Among them，38 were males and 14 were fe－males，aged 38~72 years old.The average age was 58.Video-assisted thoracoscopic surgical approach included lobectomy and lymph node dissection. Results：Because of 5 cases of pleural adhesion and 2 cases of bleeding，VATS was converted to transit-assisted small incision.All operative time was 90～240 min，with an average of 120 min. Intraoperative bleeding volume was 50～300 ml，with an average of 120 ml.7～19 pieces of lymph nodes were removed，with an average of 14.8. The length of hospital stay was 6～10 days，with an average of 7 days. Postoperative complications：there were no postoperative chylothorax，lung infection，or respiratory insuffi－ciency. Conclusion：VATS lobectomy for lung cancer is a feasible operation with minimal invasion and fewer perioperative compli－cations，whose effect is comparable to thoracotomy lobectomy.