Objective To compare the effect of emergency abdominal surgery and emergency endoscopic treatment of acute obstructive suppurative cholangitis stone.Methods A retrospective analysis of acute obstructive suppurative cholangitis stones were carried out within 30 cases.Among them,15 patients underwent emergency laparotomy choledocholithotomy + T-tube drainage,15 underwent routine emergency laparotomy choledocholithotomy + T tube drainage and cholecystectomy.Results All patients were successfully implemented treatment.In resection group,blood loss was (128.32 ±46.17) mL,with average length of stay (7.3 ±3.6) days.Blood loss was significantly higher than the amount retained (148.13 ± 2.07) mL(t =13.75,P ＜ 0.05) ; average length of stay (8.5 ± 2.9) days (t =8.73,P ＜ 0.05),the difference was statistically significant.Conclusion Emergency laparotomy choledocholithotomy + T tube drainage and cholecystectomy is not superior efficacy of emergency laparotomy choledocholithotomy + T tube drainage treatment.

Objective This study aimed to evaluate the relationships between preservation of the intercostobrachial(ICB) nerve and abnormal sensation of the arm,the total time of the surgery,and the number of dissected nodes in patients submitted to axillary lymphadenectomy in surgical treatment of breast cancer.Methods An prospective,randomized,and double blind intervention was performed on 85 patients at the Qinhuangdao Military Hospital in Hebei Province from July 2007 to August 2010.The patients according to whether the ICB nerve was preserved or not were randomly divided into two groups.The surgeries were performed by the same two surgeons.The postoperative evaluations were performed at 2 days,30 days,and 90 days.The abnormal sensation of the arm was subjectively evaluated with an questionnaire and objectively assessed with a neurologic examination.Results In the never preserved group,questionnaire found asymptomatic patients' proportion is up to 16/42,19/41,25/41 after 2 d,30 d and 90 d respectively; while in the resection group the result is 12/43,7/43,12/42.In the never preserved group,neurologic examination reported asymptomatic patients' proportion is up to 22/42,16/41,22/41 after 2 d,30 d and 90 d respectively; while in the resection group the result is 5/43,3/43,7/42.The results suggests that the abnormal sensation propotion in the intercostobrachial nerve preserved group is significantly less than the control group at the three above time points over (P ＜ 0.05).No significant difference was observed on the total time of the surgery and the number of dissected nodes between the two groups.During the 36 months follow up,no local relapse was found in the two groups.Conclusions The research support that the preservation of the ICB nerve is feasible and can lead to a significant decrease in the alteration of abnormal sensation of the arm,without interfering with the total time of the surgery,the number of dissected nodes,and local relapse rate.

Objective:To study the chemical components in the root of Asparagus cochinchinensis(Lour.)Merr.Methods:Chemical components of Asparagus cochinchinensis root were isolated by column chromatography on macroporous resin,Sil-gel,Sephadex LH-20,ODS,etc.and the structures of the components were identified by physiochemical and spectral analysis,such as MS,1HNMR,and 13CNMR.Results:The following 5 components were isolated and identified:diosgenin-3-O-?-D-glucopyranoside(Ⅰ),smilagenin(Ⅱ),26-O-?-D-glucopyranosyl-furost-3?,22,26-triol-3-O-?-D-glucopyranosyl(1→2)-O-?-D-glucopyranoside(Ⅲ),26-O-?-D-glucopyranosyl-furost-5,20-en-3?,2?,26-triol-3-O-\[?-?-rhamnopyranosyl(1→2)\]-\[?-?-rhamnopyranosyl-(1→4)\]-?-D-glucopyranoside(Ⅳ),and 26-O-?-D-glucopyranosyl-furost-3?,26-diol-22-methoxy-3-O-?-L-rhamnopyranosy(1→4)-O-?-D-glucopyranoside(Ⅴ).Conclusion:All the 5 compounds isolated from Asparagus cochinchinensis in this study is reported for the first time.

Objective To evaluate the results of less invasive surgical treatment of high energy tibial plateau fracture, which involves limited open reduction, percutaneous screw fixation and Hybrid external fixation. Methods From 1999 to 2002, 12 cases of high energy tibial plateau fracture were treated with Hybrid external fixation. They were 8 males and 4 females. According to Schatzker classification, there were 9 cases of Type Ⅴand 3 cases of Type Ⅵin the group. The average age of the patients was 39.3 years old (ranging from 27 to 48). Results All were followed up for an average of 15 months (ranging from 6 to 27). All the fractures got united, with an average healing time of 3.2 months. All patients achieved 0 to 5 degrees of extension and more than 100 degrees of flexion. The patients had an average knee score of 88.7 and an average functional score of 85.2(Knee Society clinical rating system). 1 case had infection of pin holes, and 2 knees had Grade 2 arthrosis at radiographic check up two years after the operation. Conclusion Hybrid external fixation combined with limited open reduction is appropriate for treatment of the complex tibial fractures, especially those with a poor soft tissue envelope.

Objective Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex and a fragment of variable size containing the lesser trochanter. This paper is to discuss whether it is necessary to perform reduction and fixation for this fragment. Methods 67 cases of intertrochanteric fractures were treated by dynamic hip screw (DHS) fixation between March 2001 and September 2002 and followed up for a minimum of 1 year. Their treatment results were retrospectively analyzed. Results No nonunion, coxa vara or failure of internal fixation occurred in all these patients. Conclusion If DHS provides stability, screw fixation of the lesser trochanteric fragment is unnecessary.

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 investigate the curative effect of benidipine hydrochloride on patients with coronary slow flow angina pectoris(CSFA).Methods Sixty cases patients with CSFA were randomly divided into two groups of 30 patients each.In the control group patients were received aspirin(100 mg,1 times/d) and atorvastatin(20 mg,1 times/d) as basic treatment;in the treatment group patients were received basic treatment plus benidipine hydrochloride(4 mg,1 times/d).Follow up for 6 mouths,the effectiveness rate of treatment(relief of angina and electrocardiogram of myocardial ischemia),the correction of thrombolysis in myocardial infarction(TIMI) frame count(CTFC) before and after the different intervention,and the incidence of adverse cardiovascular events were compared between the treatment group and the control group.Results The effectiveness rate of treatment in the treatment group(86.7%,26/30) was significantly higher than that in the control group(63.3%(19/30);χ2=4.356,P=0.037).There were significant reductions of CTFC in both groups after the different intervention(treatment group:(28.43±3.95) frames vs.(18.40±3.73) frames,t=10.254,P=0.000;control group:(27.87±4.14) frames vs.(21.87±4.17) frames,t=5.580,P=0.000).There was more significant reductions of CTFC in the treatment group as compared to the control group(t=2.138,P=0.037).The incidence of adverse cardiovascular events in the treatment group(10.0%(3/30)) was significantly lower than that in the control group(33.3%(10/30),P=0.028).Conclusion Benidipine hydrochloride is effective in the treatment of CSFA.

Objective:To evaluate p53,c erbB 2,p21 and nm23 oncoprotein expression in diagnosis and treatment of gastric cancer.Methods:The expression of p53,c erbB 2,p21 and nm23 oncoproteins was detected with immunohistochemical method in 63 surgically resected specimens and its endoscopic biopsy specimens of gastric cancer.Results:The positive rates of p53,c erbB 2,p21 and nm23 oncoprotein expression were 37 6%～46 2%,34 6%～56 8%,37 8%～61 5%,70 3%～30 8% respectively.Oncoprotein expression was not observed in non tumor endoscopic biopsy specimens.The expression of c erbB 2,p21 was correlated with grade of tumor differentiation and the expression of p21,nm23 oncoproteins was correlated with the depth of tumor invasion and clinical different stage,namely tumor metastasis.Positive rates of p53,c erbB 2,p21 and nm23 oncoproteins between biopsy and resected specimens was of coincidence.Conclusion:Determination of p53,c erbB 2,p21 and nm23 oncoprotein expression was might be useful in diagnosis and treatment of gastric cancer,differentiating benign and malignant tumor and clinical stages,of gastric cancer. [

OBJECTIVE:To provide reference for rational use of antibacterial drugs in the clinic. METHODS:In retrospective study,outpatient and emergency antibacterial drugs prescriptions were randomly selected from a hospital during 2013-2014,and then analyzed statistically. DDDs of antibacterial drugs were analyzed by using DDD method. RESULTS:From 2013-2014,the ap-plication rate of antibacterial drugs in the hospital declined substantially from 13.8% to 11.9%,and the rate of irrational use dropped from 2.7% to 1.2%. The application rate of antibacterial drugs was higher in pediatric department,emergency department and urology department;drug cost per capita was higher in infectious department,nephrology department and emergency depart-ment. The application rate of antibacterial drugs in pediatric department decreased greatly in 2014,compared with 2013,maintain-ing about 40%. The application rate of antibacterial drugs in emergency department during Jan.-Sept. in 2014 was lower than corre-sponding period in 2013,and that of the hospital during Jan.-Sept. in 2014 was lower than corresponding period in 2013,but dur-ing Oct.-Dec. in 2014 was slightly higher than corresponding period in 2013. Single type of antibacterial drugs were mainly used in outpatient department,accounting for 91.50% and 90.77% of antibacterial drug prescriptions in 2013 and 2014;two-drug account-ed for 8.44% and 9.11%. The top 3 antibacterial drugs in the list of DDDs during 2013-2014 were roxithromycin,cefuroxime and cefminox. CONCLUSIONS:The use of antibacterial drugs is up to the requirements of Nation Special Rectification Actirity for Clin-ical Application of Antibacterial Drugs in 2013. The prescription comment improve the quality of antibacterial drug prescriptions and rational use index greatly in outpatient department,but the application rate of antibacterial drugs is too high in some depart-ment. There still is irrational use of antibacterial drugs.

Objective To prospectively assess the influence of intensity-modulated radiotherapy (IMRT) and conventional radiotherapy on quality of life (QOL) in patients with head and neck cancer (HNC) for clinical guidance. Methods From May 2007 to May 2008, 102 HNC patients were enrolled in this study. Fifty-two patients were treated with IMRT and 50 with conventional radiotherapy. In patients with IMRT, at least one parotid gland was spared, and the contralateral submandibular gland was spared in 24 patients. The parotid and submandibular gland were not spared in patient with conventional radiotherapy.QOL was assessed using EORTC QLQ C30 and HN35 questionnaires at 4 time points (before radiotherapy,end of radiotherapy, 2 months and 6 months after radiotherapy). A change of 10% in scores of the instru-ment range had been previously demonstrated to be clinically significant. Results In the study, 94% (31/33) of the QOL domains were worse after IMRT or conventional radiotherapy, including 49% (16/33) with significant difference (U=2.72-5.98, all values of P<0.01) and 33% (11/33) with clinical signifi-cance. At 2 months after radiotherapy, 12% (4/33) of the domains showed clinically significant improve-ment, however, 15% (5/33) of the domains did not show any improvement (U=3.10-5.93,all value of P < 0.01). Continuous improvement in most domains of QOL was shown at 6 months after radiotherapy. Clini-cally and statistically significant improvement were shown in 21% (7/33) of the domains, and some were even better than pretreatment except in dry mouth and sticky saliva scales (U=4.49 , P<0.01 and U=4.87 ,P <0.01). Compared with conventional radiotherapy, the dry mouth and sticky saliva caused by IM-RT were milder (U=4.57,P <0.01 and U=5.57, P < 0.01) and continuous improvement were shown over time after radiotherapy (U=7.23, P <0.01 and U = 7.57, P < 0.01). Similar improvement weren't shown in patients with conventional radiotherapy. Conclusions QOL in HNC patients is significant worse after ra-diotherapy. QOL can be improved continuously over time after treatment except dry mouth and sticky saliva which are the main factors affecting QOL. IMBT, causing less dry mouth and sticky saliva when compared with conventional radiotherapy, has benefits for the preservation of QOL.