Objective To evaluate the effect of late course accelerated hyperfractionation radiotherapy(LCAHR) for esophageal carcinoma. Methods Six clinical trials on LCAHR for esophageal carcinoma were reviewed by means of Meta analysis . Results The 1 and 3 year survival rates in the LCAHR group derived from the fixed effect model were 2.39 (1.58～3.62) and 3.05(1.96～4.74) times higher than the conventional fractionation group. With the random effect model,the 1 and 3 year survival rates in the LCAHR group were 2.43(1.54～3.82) and 2.99(2.08～4.30) times higher than the conventional fractionation group.Conclusion For esophageal carcinoma,the better outcome of LCAHR makes it advisable in extensive clinical practice.

Objective To study the factors affecting the activities of daily life (AOL) of patients after the first stroke of cerebral infarction in order to formulate the intervention strategy for improving the capability of ADL of patients. Method A total of 149 patients with the first stroke of cerebral infarction admitted from Oct. 2008 to Dec.2008 were enrolled in this study. The demographics of patients, cerebral infarction risk factors, apopletic score as per National Institute of Health stroke scale (NIHSS), white blood cell count (WBC) and plasma glucose (PG) were recorded on the first day of admission, and many other laboratory examinations were done on the next morning. The occurrences of infection in lung and urinary tract, and atrial fibrillation were recorded during hospi-talization. The NIHSS score and score of Glasgow Coma Scale (GCS) were taken within 24 hours after admission, on the 14th day and at the end of the third month after cerebral infarction respectively. Barthel index (BI) was taken in the second week as well as at the end of third month by follow-up in the OPD or by telephone. The correlation analysis and multiple linear stepwise regression analysis were used to find the risk factors. Results The PG level, WBC count and NIHSS score were independently associated with ADL in the second week as well as at the end of the third month after cerebral infarction. Besides, the urinary tract infection during hospital stay was also independently associated with ADL at the end of the third month after cerebral infarction. Conclusions The plasma glucose level, WBC count, NIHSS score and urinary tract infection are the risk factors. Positive measures should be taken to control these risk factors so as to improve the capability of ADL of the patients after cerebral infarction.

Objective To explore the values of manual anastomosis with two operations out of anus in laparoscopic anal sphincter preserving resection of ultra low rectal cancer. Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel in 12 patients based on the concept of total mesorectal excision (TME) and ultra low coloreclal/anal anastomosis was performed applying manual anastomosis with two operations out of anus. Results All the operations were finished successfully, without conversions to open for surgery. One case had anastomotic leakage, and there were no bleeding and infection of abdominal cavity, anastomotic stenosis and other complications. The operating time was 185-310 (218 ±10) min, the blood loss was 160-450 (232 ±8) ml,the length of hospital stay was 9-14 (11 ±3) d. All patients were followed up 6-36(18 ± 2) months, local recurrence was not found but 1 case had liver metastasis.Conclusions The manual anastomosis with two operations out of anus in laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive, and has the benefits of less bleeding during the operation and shorter hospital stay. It should be widely used.

Objective To evaluate the efficacy and toxicity of postoperative chemoradiation for D2 dissection gastric cancer,and to compare the difference of toxicity between confromal and traditional radiotherapy.Methods Sixty four patients with T3-4,N + or R1 were enrolled.Radioation was given to a total dose of 46Gy delivered in 23fractions by use of 3D-CRT or 4 fields traditional radiotherapy.Chemothrepy was administered with paclitaxel 135 mg/m2 day 1 and 29,cisplantin 20 mg/m2 day 1 ～3 and day 29 ～31 during radiotherapy.Results The median follow-up time was 40 months.The 3-year overall and relapse-free survival rates were 78.2% and 70.9%,respectively.Eighteen patients had tumor relapse.Fifty-three patients completed chemoradiotheray.Toxicities on grade 3 or above included gastrointestinal toxicity (28.1% ),eutropenia (21.8 % ) and alopecia ( 18.7% ).One patient died of hemorrhage of upper digestion tract.Conclusion Adjuvant radiotherapy with paclitaxol and cisplatin yielded satisfactory overall survival and disease-free survival in gastric cancer patients.The toxicity was manageable.Conformal radiotherapy seems to decrease the gastrointestinal toxicities compared to that occurred in the traditional radiotherapy.

ObjectiveTo investigate the current situation of postoperative fluid therapy in general surgery department of grade Ⅲ-A general hospitals in Beijing and Tianjin. Methods Postoperative patients in general surgery department who were fasting for 3 days were retrospectively investigated, and 600 cases were recruited without considering age, gender, denomination of disease and operation type.The general information of patients, laboratory examination before and after operation, postoperative fluid therapy for 3 days, postoperative complications and infusion reaction were collected.Results In total 588 valid cases, the volume of average fluids supplement was (3030±638)ml per day, With the prescribed glucose (142+67)g per day, potassium chloride (59.9±23.9) mmol per day and sodium chloride (179.5±66.7) mmol per day. 85.2 % of total patients received nutrition support and the ratio of parenteral nutrition/enteral nutrition (PN/EN) was 28/1.There were 549 patients with BMI>18.5 before operation, and among them, 470 cases (85.6%)received parenteral and enteral nutrition treatment. There were 39 patients with BMI < 18.5 and 27 cases (69.2%) received parenteral nutrition support without enteral nutrition treatment. During the 3 days after operation, there were 36 cases with fluid therapy without potassium chloride supplement.ConclusionsThe proportions of receiving nutrition support and parenteral nutrition treatment are relatively high in grade Ⅲ-A general hospitals in Beijing and Tianjin. Ready-to-use preparation canreduce mistake and will be benefit to patients.

Objective To comparative analyze the anorectal function before and after anus-preserving laparoscopic rectal resection in ultra low rectal cancer.Methods Radical excision of ultra low rectal cancer was performed with ultrasonic scalpel on 43 patients based on the concept of TME and ultra low colorectal/ anal anastomosis was perfomed by applying the manual anastomosis with two operations out of anus.The time of guid being controlled in the rectus,rectual rest pressure (RRP),anal rest pressure (ARP) and anal maximal contraction pressure (AMCP) were tested before operation.The function of their rectus and anus was tested,including the number of bowel movement in one day of 1,3,6 months after operation,the time of guid being controlled in the rectus,RRP,ARP and AMCP after 3,6 months of operation et al.Results All the operations were finished successfully,four cases were converted to open surgery,but there was no serious damage.All cases were followed up for 6 to 36 months with average of 20 months.After 3 months of operation,the retention time of liquid in rectus,the defecate feel function,the anus control function,RRP and ARP was statistically significant (P ＜ 0.05) compared to them before operation,there was no statistical significance (including AMCP) (P ＞ 0.05) after 6 months of operation.The results of tests in annus and rectus were near normal level after 6 month of operation.Conclusion The manual anastomosis with two operations out of anus in the laparoscopic anal sphincter preserving resection of ultra low rectal cancer is safe,economical,effective,minimally invasive and shorter hospital stay,it is worth to be widely used.

Objective To evaluate the short-term efficacy and safety of sevelamer hydrochloride in treating maintenance hemodialysis (MHD) patients with hyperphosphemia.Methods A multicenter,open-labeled,self-control study was performed.Phosphate binders were discontinued during a two-week washout period.Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the trial.The dose was adjusted every two weeks as necessary to achieve serum phosphorus control. Sevelamer hydrochloride was administered to 138 MHD patients for 10 weeks and a second two-week washout period followed.Results A total of 111 from 138 patients fulfilled the whole 14-week study. Mean serum phosphorus and calcium-phosphate products starte to decline after two-week sevelamer hydrochloride treatment. By the end of 10-week sevelamer hydrochloride treatment, mean serum level of phosphorus [(1.85±0.50) vs (2.57±0.54) mmol/L,P＜0.01],calcium-phosphate product [(4.16± 1.72) vs (5.79 ± 1.50) mmol2/L2,P＜0.01 ] and low density lipoprotein [(1.64±0.76) vs (2.31 ±0.87) mmol/L,P＜0.01] were significantly decreased,while the adjusted serum level of calcium and serum intact parathyroid hormone kept steady.Both serum phosphorus and calcium-phosphrus product increased after the second washout period, but the levels were still lower as compared to pre-treatment [(2.26±0.71) vs (2.57±0.54) mmol/L; (5.12±1.63) vs (5.79±1.50) mmol2/L2,P＜0.01].Of the 138 patients involved,214 episodes in 106 patients and 121 episodes in 89 patients were reported as adverse events and adverse drug reaction respectively. Gastrointestinal symptoms,of which most were mild or moderate,happened to 68.1％ (94/138) patients. Conclusions Sevelamer hydrochloride can control serum phosphorus and reduce the levels of calcium-phosphorus product and cholesterol.Slight gastrointestinal symptoms like constipation are common during the treatment.

Objective To evaluate management stratagy for patients with traumatic splenic rupture.Methods The clinical data of 124 patients with traumatic splenic rupture admitted to the 422 Hospital of PLA from April 2008 to June 2016 were retrospectively analyzed.38 patients were treated conservatively,while 86 patients underwent surgery.To investigate impact factors of management strategy in patients with traumatic splenic rupture,clinical characteristics and CT features between the two groups were compared.Results Univariate analysis results showed that injury causes,blood pressure,at admission,pulse,CT grade and abdominocentesis were closely related with therapeutic scheme.And multivariate Logistic regression analysis results showed that pulse (OR =4.264,95％ CI 1.206-15.073),CT grade (OR =2.086,95％ CI 1.019-4.271) and abdominocentesis (OR =3.428,95％ CI 1.024-11.479) were the significant determining factors of therapeutic scheme in patients with traumatic splenic rupture.Surgical intervention was carried out in 86 patients accounting for 69.4％ of all patients.The rate of surgical intervention was 58.1％ in the patients with CT grade of 1 and 2,that was 94.7％ in patients with CT grade of 3 and 4.Conclusions Operative management is needed for most traumatic splenic rupture,patients those with hemodynamic stability and CT grade of 1 or 2 may be qualified for watchful non-operative management.

Objective To determine the impact of progressive rehabilitation intervention based on the FITT principle on the recovery of elderly patients with acute ST-segment elevation myocardi-al infarction(STEMI)after percutaneous coronary intervention(PCI).Methods A total of 184 STEMI patients admitted to our hospital between December 2021 and June 2023 were enrolled and randomly divided into a study group(n=92)and a control group(n=92).Routine rehabilita-tion intervention was given to the control group,and progressive rehabilitation intervention based on the FITT principle was given to the study group.Both groups were intervened for 12 weeks.Metabolite equivalents(MET)of the two groups were evaluated before and at 4,8 and 12 weeks after intervention.Their cardiopulmonary reserve function and quality of life were evaluated with cardiopulmonary exercise testing and myocardial infarction multidimensional assessment scale(MIDAS)before and at 12 weeks after intervention.The incidence of adverse cardiovascular events such as ventricular arrhythmia and heart failure(HF)during 6 months of follow-up was recorded.Results There were significant differences in two sets of MET value groups,time points,and group time point interactions(P＜0.01).No statistical difference was found in MET values be-tween the two groups before intervention(P＞0.05).The MET values were increased in both groups at 4,8 and 12 weeks after intervention than before intervention,and those in the study group were higher than those in the control group at above three time points(P＜0.05).Com-pared with before intervention,the peak oxygen uptake and anaerobic threshold oxygen uptake in 2 groups increased after intervention(P＜0.05).The peak oxygen uptake and anaerobic threshold oxygen uptake in the study group were higher than those in the control group[(23.52±1.86)ml/(min·kg)vs(21.36±2.60)ml/(min·kg),P＜0.01;(14.33±2.02)ml/(min·kg)vs(12.08±1.76)ml/(min·kg),P＜0.01];Compared with before intervention,the carbon dioxide ventilation equivalent slope of 2 groups decreased after intervention(P＜0.05).The carbon dioxide equivalent slope of the study group was lower than that of the control group(26.12±2.34 vs 28.10±2.52,P＜0.01).Compared with before intervention,the MIDAS score was decreased in both groups af-ter intervention(65.30±5.20 vs 96.64±7.33,P＜0.01;70.46±5.87 vs 95.80±7.26,P＜0.01),and the score of the study group was lower than that of the control group(65.30±5.20 vs 70.46±5.87,P＜0.01).After a 6-month follow-up,there was no significant difference in the incidence of adverse cardiovascular events between the two groups(P＞0.05).Conclusion Progressive reha-bilitation interventions based on the FITT principle can promote exercise tolerance,improve car-diopulmonary reserve function,and enhance the quality of life of elderly STEMI patients after PCI.

Objective To observe the clinical efficacy of drilling and drainage combined with atorvastatin calcium tablets in treatment of chronic subdural hematoma (CSDH).Methods Totally,46 patients with CSDH,admitted to and received therapy in our hospital from January 2014 to January 2017,were selected for this research.These patients were divided into control group (n=16) and experimental group (n=30) according to therapeutic schemes.The patients from the control group underwent drilling and drainage.Besides that,the patients from the experimental group were given atorvastatin calcium tablets additionally,20 mg/d×2 months.Two months after that,the curative efficacy,hematoma volume before and after operation,pneumocephalus volume one week after operation,duration of tube drainage,length of hospital stay,China stroke scale (CSS) scores,activities of daily life-Barthel index scale (ADL-BI) and visual analog scale (VAS) score were compared between the patients from the two groups.Results Two months after treatment,patients from the experimental group had significantly decreased hematoma volume as compared with those from the control group (P＜0.05).The hematoma volume in both groups 2 months after treatment was significantly decreased as compared with that before treatment (P＜0.05).The pneumocephalus volume,indwelling time of drainage tube,and hospital stays in the experimental group were significantly shorter/lower than those in the control group (P＜0.05).The CSS scores and VAS scores in the experimental group 2 months after treatment were significantly lower than those in the control group (P＜0.05).The ADL-BI scores in the experimental group 2 months after treatment were significantly higher than those in the control group (P＜0.05).The ADL-BI scores in both groups 2 months after treatment was significantly increased as compared with those before treatment (P＜0.05).Conclusion As compared with simple use of drilling and drainage,drilling and drainage combined with atorvastatin calcium tablets can help hematoma absorption,decrease incidence of pneumocephalu,and improve prognosis effectively.