Objective To study the clinical effect of escitalopram oxalate in treating patients with depression accompanied with anxiety disorder.Methods Sixty-four patients with depression accompanied with anxiety disorder (met DSM-IV diagnostic criteria)were randomly divided into study group (n =32)who were treated with escitalo-pram oxalate 5-20mg/d and control group (n =32)with mirtazapine 15-45 for eight weeks.Clinical effect was evalua-ted with the Hamilton Depression Scale (HAMD)and the Hamilton Anxiety Scale (HAMA)as well as the adverse reactions with the Treatment Emergent Symptom Scale (TESS).Results There were no statistically significant differ-ences (P >0.05)in HAMD and HAMA scores between the study group and control group before treatment,but after treatment for 8 weeks,HAMD score showed statistically significant difference (P =0.000)and the difference of HAMA score was statistically significant (P =0.010).The total effective rate of the study group was 93.8%,which of the control group was 87.5%,the clinical effect had no statistically significant difference (P =0.391 ).The study group and the control group had equal effect,and there were no serious adverse reactions.Conclusion Escitalopram oxalate has high anti-depressant and anxiolytic effect,fewer adverse reactions,good tolerability and compliance,there-fore,escitalopram oxalate can be popularized in treating patients with depression accompanied with anxiety disorder.

Objective To investigate the condition of defecation function,psychological health and quality of life about patients who underwent low rectal cancer anus preservation operation.Methods We randomly selected 40 cases from patients who went to do rectal cancer anus preservation operation as observation group,who received e-valuation with bowel habit questionnaire (the result using Zhong-fa Xu anal function evaluation method which widely used for subjective evaluation),SF-36 scoring systems at 2 weeks before surgery,postoperative 3 months,6 months, 1 year,and the anorectal manometry postoperative 3 months,6 months,1 year.The normal controls were 40 healthy people without anus-rectal disease and disordered defecation,investigated and detected at the same time point.Results Compared with the control group,the ARP,MSP,RAIA,MTV of the observation group significantly decreased(P <0.05)within 3 months and 6 months after operation[postoperative 3 months:(22.2 ±3.8)mL,(30.3 ±4.1)mL and (4.1 ±15.8)mL,(83.5 ±17.3)mL,32.5%,t or χ2:6.34,8.21,5.34,8.94,4.34;after 6 months,those were (26.3 ±3.5)mL,(37.3 ±4.7)mL and (4.7 ±16.1)mL,(106.2 ±18.2)mL,40%,t or χ2:7.34,7.99,4.75, 7.99,4.75],and 1 year the margin contract (P >0.05).Compared with the control group,in the preoperation,the results of anal function evaluation method and SF-36 scoring systems had no significant differences.Based on the Zhong-fa Xu anal function evaluation,we could draw the following conclusions:anal function was impaired obviously in postoperative 3 months (fine rate was 62.5%,χ2 =16.08,P <0.01 ),and recovered gradually in postoperative 6 months to 1 year,but the impaired performance was still exists in postoperative 1 year.Compared with the control group,3 months,6 months after surgery,the SF-36 life quality comprehensive score of the observation group had no significant difference (P >0.05),but the scores of PF and RF dimension were lower than those of the healthy con-trols:postoperative PF dimension[3 months:(80.12 ±15.12),6 months:(82.19 ±17.01),and 1 year:(83.13 ± 17.12),compared with the control group,t =4.5,3.1,2.5 respectively],postoperative RP dimension [3 months:(58.29 ±40.15),6 months:(59.48 ±41.07),1 year:(60.17 ±42.15),compared with the control group,t =4.1, 2.9,2.7 respectively];there were statistically significant differences (P <0.05).Conclusion For patients who underwent low rectal cancer anus preservation operation,postoperative anal function and life quality were affected,and is significant in a short period of time,part of the quality of life for long-term survival in patients decreased obviously, and it is necessary to assess sufficiently preoperation,do defecation function exercise or biological feedback therapy postoperation.

Objective To compare the effect oropivacaine combined with fentanyl or sufentanil in labor anal-gesia.Methods 116 cases of maternal birth in obstetrics and gynecology were selected.According to the random number table method,116 cases of parturients were randomly divided into observation group (58 cases,received ropiv-acaine and sufentanil analgesia)and control group (received ropivacaine and fentanyl).In two groups of maternal anesthesia before induction (T0 ),used the drug after 30min(T1 ),60min(T2 ),180min(T3 )detection of the mean arterial pressure (MAP)and heart rate (HR),and digital evaluation table Rating Scale (NRS).The complications of maternal and infant in the two groups were recorded,the change of the mode of delivery and the Apgar score of neo-nates in the two groups were analyzed.Results There were no significant differences in the levels of MAP and HR between the two groups in T0-T3 (tMAP =0.123,1.078,0.212,0.047;P =0.903,0.283,0.832,0.963;tHR =0.033, 0.289,0.288,0.036;P =0.974,0.773,0.774,0.972).The NRS scores in T1 -T3 of the two groups were significantly lower than those in the T0;the T1 -T3 scores of the observation group were (2.21 ±0.36 )points,(1.78 ± 0.24)points,(1.83 ±0.25)points,which were significantly lower than (3.61 ±0.75)points,(3.22 ±0.12)points, (2.84 ±0.26)points of the control group(t =12.816,40.871,21.325,P =0.000,0.000,0.000).In the observation group,there was 0 case (0.00%)had cardiac arrhythmia,the control group had 4 cases (6.90%),and the differ-ence was statistically significant(χ2 =4.143,P =0.042).Two groups of labor analgesia,the way of delivery and birth of the newborn after birth,1min,5min of Apgar score were compared,the differences were not statistically significant (χ2 =0.703,t =0.631,1.149,P =0.402,0.530,0.253).Conclusion Ropivacaine combined with sufentanil or fentanyl in analgesia have no effect in childbirth and maternal vital signs and neonatal,and have good analgesic effect, but ropivacaine combined with sufentanil has stronger analgesic effect,higher safety.

Objective To sum up the experience of diagnosis and treatment of paraduodenal hernia. Methods The clinical data of 18 cases of paraduodenal hernia treated by surgery were analyzed retrospectively. Results The average age of the patients was 34 years old.There were 15 cases with left paraduodenal hernia and 3 cases with right paraduodenal hernia.Ten patients usually had no clinical symptoms,while acute abdominal pain occurred after full food in 7 cases,and after vigorous movement in 10 cases respectively.Abdominal X-ray revealed complete or incomplete intestinal obstruction in 16 cases,while abdominal CT revealed abnormal cystic loops of small intestine between the pancreas and the stomach in 10 cases.All 18 cases underwent surgical operation,recovered 10-15 days after operation.After 2-8 years follow-up,there was no hernia recurrence.Conclusion Paraduodenal her-nia is difficult to diagnosis before operation,and the key to correct diagnosis and treatment is to explore the positive exploratory laparotomy.

Objective To discuss the expression and significance of platelet ultrastructure and platelet acti-vating factor(PAF)relationship in patients with acute cerebral infarction.Methods 40 patients with cerebral infarc-tion were chosen onset in 6-24 hours as the observation group,while at the same time 20 cases of healthy adults were selected as the control group.The observation group was given 1-7d of aspirin enteric-coated metformin hydrochloride 300mg,qd,and 8-14d had worship of aspirin enteric-coated metformin hydrochloride 100mg,qd.And before and 1,7, 14 days after treatment,control group and observation group respectively preclude the use of transmission electron microscopy ultrastructure of platelets,before and 1,14 days after treatment automatic blood cell analyzer test was used to analyze the average platelet volume (MPV),platelet count (PLT),platelet volume distribution width (PDW)of the two groups.And 1,2,3,7,14 days after treatment,enzyme-linked immunosorbent determination of double clamp method was used to test the concentration of PAF.Results Before treatment,MPV,PDW and PAF in peripheral blood of the observation group were (9.22 ±1.30)fL,(17.89 ±1.23)%,(211.31 ±11.22)pg/mL,which were sig-nificantly higher than those of the control group (8.68 ±1.03)fL,(16.06 ±1.03)%,(155.49 ±8.70)pg/mL(t =2.082,2.563,14.401,all P <0.05),while PLT was (173.22 ±63.40)×109 /L,which was significantly lower than that in the control group (231.22 ±56.76)×109 /L(t =3.048,P <0.05).After treatment in patients with acute cer-ebral infarction,the MPV,PDW of peripheral blood were (8.43 ±1.28)fL,(16.66 ±1.11)%,which were signifi-cantly lower than before treatment (9.22 ±1.30)fL,(17.89 ±1.23)% (t =1.937,3.320,all P <0.05),while PLT (195.33 ±61.45)×109 /L was significantly higher than before treatment (173.22 ±63.40)×109 /L(t =1.915, P <0.05).PAF peaked in the treatment of 3 days,which was (240.12 ±13.78)pg/mL,and gradually declined after 7 days,which was (215.33 ±16.43)pg/mL,and that after 14 days was(170.27 ±11.40)pg/mL,compared with before treatment (211.31 ±11.22)pg/mL,the difference was statistically significant (t =16.24,P <0.05).Before treatment,platelet shape had irregular,increased pseudopodia,several visible platelet aggregation,and was blend together.And after 14 days treatment in the observation group,platelet ultrastructure greatly recovered.Conclusion Monitoring of MPV,PDW,PAF and PLT in peripheral blood of patients with acute cerebral infarction before and after treatment has important clinical value for disease diagnosis and treatment.

Objective To explore the clinical characteristic,level of plasma renin angiotensin (PRA),plas-ma angiotensin Ⅱ(Ang Ⅱ)and plasma aldosterone(Aldo)in the sleep apnea hypopnea syndrome (SAHS)patients, and to investigate the association between SAHS and hypertension.Methods The patients were selected for the study who were monitored with polysomnography.They were divided into SAHS group and non-SAHS group according to apea-hypopnea index(AHI),and there were 180 patients in the SAHS group,175 patients in the non-SAHS group. The systolic blood pressure(SBP),diastolic blood pressure(DBP)and the level of PRA,plasma Ang II and plasma Aldo were compared by variance analysis.Results The gender composition was different between the two groups,and had statistically significant difference(χ2 =16.30,P <0.01).The data of age,body mass index,neck circumference, waistline,DBP,SBP in SAHS group were significantly higher than those in non-SAHS group,and the differences were statistically significant(t =6.84,8.19,9.84,6.63,7.08,5.45,all P <0.01 ).The prevalence of hypertension in SAHS group was 46.58%,which was higher than 18.20% in non-SAHS group,and the difference had statistically significant(χ2 =46.71,P <0.01).The AHI had positive correlation with SBP,DBP,and they had statistically signifi-cant differences (rs =0.162,0.228,all P <0.01).The levels of PRA and plasma Ang Ⅱ were lower in SAHS group than those in non-SAHS group,while the level of plasma Aldo was higher in SAHS group than that in non-SAHS group,and had statistically significant differences(F =15.41,14.21,17.67,all P <0.01).In the SAHS group,the levels of PRA and plasma Ang Ⅱ were lower in hypertension group than those in non-hypertension group,while the level of plasma Aldo was higher in hypertension group than that in non-hypertension group,and had statistically signif-icant differences (F =15.41,14.21,17.67,all P <0.01).Also,the levels of PRA and plasma Ang Ⅱ were lower in SAHS group with hypertension than those in non-SAHS group with hypertension,while the level of plasma Aldo was higher in SAHS group with hypertension than that in non-SAHS group with hypertension,and the differences were sta-tistically significant(F =15.41,14.21,17.67,all P <0.01).Conclusion The occurrence of SAHS is correlated with the gender composition,age,body mass index,neck circumference,waistline,DBP and SBP.In SAHS complica-tions in each system,the highest incidence is hypertension.And the AHI has positive correlation with SBP,DBP,and the difference is significant.In the SAHS group,if the AHI is higher,the risk of hypertension is greater.In the SAHS patients with hypertension,the level of plasma Aldo is significantly elevated,while the levels of PRA and plasma AngⅡ are decreased significantly.

Objective To observe and analyze cupping therapy for chronic wound healing.Methods Thirty-nine patients with chronic wounds were collected and randomly divided into cupping therapy group (n =20) and control group (n =19).The control group was treated with route dressing change once every other day,while the cupping therapy group was added cupping therapy.Compared the two groups of patients in general view,positive ratio of wound germiculture,area percentage of wound healing and pain score (VAS score).Results The pus of wounds was mostly drained out and the fresh tissue fluid leakage when patients were treated with cupping therapy.After three days of treatment ,the positive ratio of wound germiculture of the cupping group (6 5 % )was lower than that of the control group(79%),but the difference was not significant.After one-week treatment,the positive ratio of wound germiculture of the cupping group(40%)was significantly lower than that of the control group(73%)(χ2 =4.496, P =0.034).And the VAS score of the cupping group (2.20 ±1.00)was significantly lower than that of the control group (4.16 ±0.96)(t =-12.929,P =0.001).After two-week treatment,the area percentage of wound of the cup-ping group (80.68%)was significantly lower than that of the control group (92.28%)(t =-13.675,P =0.000). And 4 cases of the cupping group cured,while no patient was cured in the control group.Conclusion Cupping thera-py based on route dressing change has positive therapeutic effect on chronic wounds.And the advantages of lower cost and easier operations would make it suitable for middle-and low-income individuals and primary hospitals.

Objective Perioperative fluid therapy has always been the most basic and important measure to maintain the stability of patients'cyclic system.Colloid and crystalloid,as common perioperative fluid,play different roles in clinical application due to the different molecular sizes.In the recent years,besides their contribution to maintain the stability of cyclic system,scientists have begun to pay attention to the effect on coagulation,especially their comparison.This paper mainly discusses the study status of the influence on coagulation produced by different liquids.

Objective To analyze the application value of optical coherence tomography (OCT)in the diagnosis of normal tension glaucoma (NTG).Methods 50 NTG patients (92 eyes)were selected as control group, at the same period 50 cases in our hospital physical examination center for the health examination were selected as the observation group.The optic disc and retinal nerve fiber layer thickness were measured by OCT.The disc diameter, disc area,depending on the cup diameter,optic cup area in the optic disc parameters were observed and compared between the two groups.Results The optic disc diameter between the control group and the observation group had no significant difference (t =1.02,P >0.05),the differences among the remaining nine parameters were significant (t =3.11,2.85,5.63,5.21,4.13,3.06,3.10,6.58,4.36,all P <0.05).Conclusion OCT can measure and analyze the optic disc and retinal nerve fiber layer quantitatively,it is reproducible,clinical early diagnosis of NTG is of great significance,it is worth popularization and application.

Objective To discuss the application value of diffusion weighted imaging(DWI)in the diagnosis and treatment of synovial sarcoma.Methods 48 patients with synovial sarcoma were selected.All patients were given conventional magnetic resonance imaging (MRI)and DWI detection examination,DWI diffusion sensitive factor examination was 500 s/was(b).All the patients'imaging results and disease detection were analyzed.ROC curve was used to analyze the value of DWI,MRI examination in the diagnosis of synovial sarcoma.Results DWI examination detection of synovial sarcoma was much higher than that of MRI,the difference was statistically significant(χ2 =5.62, P <0.05).ROC curve analysis showed that MRI examination in the diagnosis of synovial sarcoma specificity was 72.58%,sensitivity was 79.12%,the accuracy was 86.82%,DWI examination in the diagnosis of specificity was 76.81%,sensitivity was 85.79%,the accuracy was 95.18%.The sensitivity,specificity and accuracy of DWI were significantly higher than conventional MRI,the differences were significant(χ2 =5.72,5.68,5.12,all P <0.05). Conclusion DWI can effectively improve the detection rate of synovial sarcoma,and has higher diagnostic sensitivity, specificity and accuracy,it's conducive to the physician for treatment in a timely manner,and worthy of further clinical promotion.