Objective To observe and investigate the influence degree of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation.Methods 76 patients with gastric and duodenal ulcer perforation were selected as study subjects,and they were divided into control group(conventional open operation group)and observation group(laparoscopic operation group)according to the random number table,38 cases in each group.The serum body stress hormones and antiinflammatory,proinflammatory related indexes of the two groups at first day before operation and at first,third,seventh day after operation were respectively detected and compared.Results The serum IL -2 levels of the observation group at first,third and seventh day after operation were (3.53 ±0.24)μg/mL,(3.25 ±0.22)μg/mL and (4.37 ±0.33)μg/mL,which were higher than those of the control group(F =5.876,P <0.05),while other serum body stress hormones and antiin-flammatory,proinflammatory related indexes were all obviously lower than those of the control group (all P <0.05), there were significant differences between those postoperative evaluation results of the two groups.Conclusion The influence of laparoscopic operation for the postoperative body stress and inflammatory state of patients with gastric and duodenal ulcer perforation is relatively small,and it shows that the bad body stress degree caused by the operation is relatively smaller.

Objective Turn the CT sectional image into three-dimensional imaging based on VTK, in or-der to make better treatment programs for patients with liver cancer. Methods Establish visualization toolkit (VTK) visualization development environment based on VC6.0, obtain patient's CT images in DICOM format, use VTK filter and Laplacian sharpening template for pre-treatment of the images, and then use Ray-Casting algo-rithm for three-dimensional reconstruction. Results We can get three-dimensional images with higher resolu-tion and faster imaging speed through this method, which can also be cut, rotated and zoomed. Conclusion Ray-Casting algorithm based on VTK can be used for the three-dimensional imaging of human liver. With the as-sistance of three-dimensional images, doctors can detect the location of diseased tissue more easily and observe the shapes of diseased tissue intuitively.

Objective To evaluate the influence of preoperation medical treatment on recurrence of atrial fibrillation(AF) in valve replacement postoperative patients of rheumatic heart disease during in-hospital and other risk factors. Methods One-hundred and eight patients with rheumatic heart disease and AF that underwent valve replacement postoperative patients were randomly divided into 2 groups: the treatment group (n =54)and the control group (n = 54 ). The treatment group were treated with ranipril, felodipine and simvastatin for 1 month and other conventional preoperational treatments before operation . The control group were only treated conventional preoperational therapy. Occurrence of AF postoperation were observed during inhospital. Results The occurrence of atrial fibrillation of the two group was no difference( 35.85% vs 41.51%,P = 0.55) immediately after rebeat. There was significant difference in the occurrence of atrial fibrillation of the 2 groups within 24 h post-operation ( 47.17% vs 69.81%, P = 0.02 ) . Logistic regression showed that intervention before operation had significant effect on the occurrence of AF( OR =0.39,95% CI: 0.17 -0.86,P =0.018) ,as well as the diameter of left atrium (LAD) ( OR= 4.28,95% CI:1.12 - 18.23, P = 0.018 ),pulmonary artery pressure(PAP) ( OR = 3.28,95% CI: 1.14 - 12.25, P = 0.01 ), duration of atrial fibrillation (AFD) (OR = 4.19,95% CI: 1.15 -14.22,P = 0.011). ROC curve showed that the best cut-off of LAD was 46.5 mm to predict AF,with sensitivity of 73% and specify of 85% ;the best cut-off of PAP was 48.5 mm Hg,with sensitivity of 75.6% and specify of 80.3% ;the best cut-off of AFD was 7. 5 months,with sensitivity of 76.1% and specify of 88.3%. Conclusion The recurrence of AF can be effectively reduced during hospitalization by the preoperational triple treatments for patients with rheumatic heart disease successfully underwent valve replacement operation , which is also beneficial for maintenance of sinus rhythm after operation.

BACKGROUND: Prospective studies concerning bone metabolism and bone mineral density variation after fractures have been reported from the 1960s, but these studies are mainly focused on tibia and fibula and ankle fractures in patients with low sample size.
OBJECTIVE:To observe the changes in bone mineral density and bone metabolism indexes in elderly women within 6 to 12 months after hip fractures, and to analyze the correlation.
METHODS:We selected 48 elderly women with hip fractures admitted in the Department of Orthopedics, Beijing Aerospace General Hospital in China from May 2011 to July 2013. Standards for fol ow-up were developed to measure the bone mineral density and bone metabolism indexes in the L 1-4 spinal segments and both sides of the hip. The bone metabolism indexes included bone alkaline phosphatase, osteocalcin, cross-linked C-terminal peptide of col agen I, and serum tartrate-resistant acid phosphatase 5b levels. Multiple linear regression analysis was performed based on measurements of bone mineral density and bone metabolism indexes after fracture healing.
RESULTS AND CONCLUSION:After fracture healing, bone mineral density of the fractured hip and lumbar vertebra was significantly lower than the baseline value. There was no statistical difference in bone mineral density between the healthy hip and the baseline value. At 6 months after fractures, bone alkaline phosphatase, osteocalcin, cross-linked C-terminal peptide of col agen I, and serum tartrate-resistant acid phosphatase 5b levels were significantly higher than the baseline values. At 12 months after fractures, osteocalcin level was significantly higher than the baseline value, while other indexes of bone metabolism measurements showed no statistical difference from the baseline values. When healing of hip fractures met the clinical and radiographic standards, the partial regression coefficient of delta-Z score reached peak in the changes of serum osteocalcin and bone mineral density of the fractured hip. Under clinical healing of fractures, serum osteocalcin level exhibits a higher value for the assessment of recovery speed of bone mineral density. Monitoring corresponding bone metabolism indexes after fracture healing can improve the accuracy of judging bone mineral density changes to reduce the risk of secondary fractures.

Objective To evaluate the curative effect of coenzyme complex and potassium magnesium aspartate on the restoration of rhythm and anti-arrhythmia in postoperative valve replacement patients for rheumatic heart disease.Methods Eight two patients with rheumatic heart disease were randomized into 2 groups,with no statistical significance in the patients' parameters.Treatment group A (n =41 )received i.v.coenzyme complex and potassium magnesium aspartate 30 ml during operation.Group B ( n =41 ) were only given potassium magnesium aspartate 30 ml.Other conventional therapies were the same for the two groups.At the same time,rate of spontaneous restoration of rhythm and severe arrhythmia incidences and low cardiac output syndrome were also recorded.Results The rate of spontaneous restoration of rhythm in the treatment group were higher than that in the control group ( 97.56％ vs 80.49％,x2 =6.12,P =0.01 ).There were significant differences in the severe ventricular tachycardia,ventricle fibrillation and auricular flutter events between the 2 groups ( 19.51％ vs 41.46％,x2 =4.67,P =0.03 ).The rate of low cardiac output in the treatment group were lower than that in the control group( 14.63％ vs 36.58％.x2 =5.18,P =0.02).To evaluate the effect of combination therapy on the spontaneous restoration of rhythm,Logistic regression analysis showed that OR( odds ratio) value was 9.69 and 95％ CI( confidence interval) was 1.15 - 81.55 ( P =0.03 ).Other variables affecting the spontaneous restoration of rhythm included the time of aortic obstruction( OR =9.28,95％ CI 1.21 - 78.18,P =0.02) and cardiac function before operation ( OR =4.95,95％ CI 1.27 - 17.88,P =0.02),operating time (OR=3.99,95％CI 1.18- 11.62,P =0.04),age(OR=2.77,95％CI1.11 -9.74,P=0.04).Conclusion Combined administration of coenzyme complex and potassium and magnesium aspartate in the operation of valve replacement in patients with rheumatic heart disease is able to promote the spontaneous heart rhythm restoration and reduce the chance of severe ventricular tachycardia and low cardiac output events.

Objective To study the effect of behavioral therapy combined with Paroxetine in the treatment of overactive bladder accompanied by depression and anxiety.Methods Over the past two years,a total of 69 cases of patients with overactive bladder accompanied by depression and anxiety were diagnosed by outpatient,they were divided into experimental group (n=33)and control group(n=36).The experimental group were given behavior therapy and Paroxetine in the treatment of anxiety,depression,while the control group were given behavior therapy.Then the overactive bladder symptom score(OABSS),urgency score,SDS,SAS score before and after treatment of the two groups of patients were statistically analyzed.Results (1)The OABSS score ((3.30± 1.01) vs (7.51 ± 0.69)),urgency score((2.60±0.51) vs (3.93±0.69)),SDS score((43.1±6.2) vs (66.4±4.7)) and SAS score ((41.9±0.6) vs (61.4±3.9)) decreased after treatment of the experimental group.There were statistically significant compared with before treatment(t=17.8773,8.9045,17.2039,16.0273,all P＜0.01).(2) The OABSS score,urgency score decreased after treatment of the control group.There were statistically significant compared with before treatment (t=6.1926,6.3483;both P＜0.01).SDS,SAS score before and after treatment of the control group were not statistically significant (t=1.3105,0.5852,bothP＞0.05) (3) The OABSS score,urgency score,of the experimental group were more depressed than the control group,which were statistically significant (t =3.3830,3.6391,both P＜0.01).Conclusion For overactive bladder patients with anxiety and depression,behavioral therapy combined with Paroxetine is better than behavioral therapy alone.

Objective To observe the effect of the electroacupuncture ( EA) on the expression of cyclin-de-pendent kinase 5 ( Cdk5 ) in rats with muscle contusion and to explore its mechanism. Methods Thirty-two Sprague-Dawley rats were randomly divided into a normal group of 4, a model group of 4, a natural recovery group ( NR) of 12 and an EA group of 12. All except those in the normal group had acute skeletal muscle contusion induced through a heavy blow. The EA group was treated with 15 minutes of EA daily beginning 48 h after the injury while the other rats received no EA. The model group was sacrificed 24 h after modeling, and rats from the NR and EA groups were sacrificed on the 7th, 14th and 21st day after the modeling to collect tissues. Hematoxylin eosin ( HE) staining, Western blotting and quantitative real-time fluorescence PCR were used to observe any histological changes, as well as Cdk5 protein and mRNA expression. Results The HE staining showed that the other 3 groups displayed larger a-mounts of muscle fiber fracture, dissolution and inflammatory cell invasion than was observed in the normal group. Compared with the NR group, quicker recovery was seen in the EA group as evidenced by faster muscle satellite cell proliferation and more new muscle fiber generation. The average Cdk5 protein expression in both the NR and EA groups was higher than in the normal group, and that of the EA group was significantly lower than that of the NR group. Conclusions Muscle contusion can increase Cdk5 expression in skeletal muscles, at least in rats. EA can promote the restoration of skeletal muscle function, probably by inhibiting CDK5 protein and mRNA expression.

BACKGROUNDLung cancer is easy to occur in patients older than 70 years, whose special health condition makes their treatment more difficult. The aim of this study is to investigate the best surgical treatment and perioperative management for high risk elderly patients with lung cancer.

METHODSAfter 5 years' follow-up, 120 high risk elderly patients with lung cancer were analyzed retrospectively.

RESULTSOf 120 patients, there was no operative death. Four patients died of respiration failure and 2 died of myocardial infarction. Perioperational death rate was 5.0%. The overall 1-, 3-and 5-year survival rate was 67.7%, 41.7% and 28.1%, respectively.

CONCLUSIONSAppropriate management of complications is the key point to decrease perioperative death rate, and it may influence the quality of life of patients. To resect tumor maximally may be not the best choice for elderly patients. Lobectomy or segmental resection combined with positive lymph node dissection may be the considerable patterns.

Objective To compare the effects of ticagrelor and clopidogrel on platelet aggregation rate, myocardial perfusion and prognosis in patients with acute myocardial infarction. Methods One hundred and sixty-nine patients with acute ST segment elevation myocardial infarction (STEMI) and emergency percutaneous coronary intervention (PCI) were recruited and randomly divided into ticagrelor group (85 cases) and clopidogrel group (84 cases). The TIMI blood flow before and after PCI was recorded, and the ST segment fall rate of 1 h ECG after PCI was calculated. The platelet aggregation rate was measured. After 12 months' follow-up, the incidence of major adverse cardiac events (MACE) was recorded. The Logistic regression analysis was used to discover the factors of MACE. Results One hundred and sixty-nine patients with acute STEMI were recruited including 85 cases treated with ticagrelor and 84 cases in clopidogrel group. The ECG ST segment fall rate after PCI in ticagrelor group was significantly higher than that in clopidogrel group: (61.3 ± 30.7)％ vs. (47.8 ± 26.6)％, P<0.05. The platelet aggregation rate 2 h, 24 h and 7 d after PCI in ticagrelor group was significantly lower than that in clopidogrel group (P<0.05). MACE occurred in 19 cases (22.4％) in ticagrelor group and in 21 cases (25.0％) in clopidogrel group, and there was no significant difference (P > 0.05). Multiple Logistic regression analysis revealed that age and ECG ST segment fall rate were independent risk factors for MACE (P<0.05). Conclusions Compared with clopidogrel, ticagrelor can effectively reduce platelet aggregation rate and accelerate ST segment fall in STEMI patients, but their long-term prognosis is similar.

BACKGROUNDTo detect the micrometastases status in peripheral blood and regional lymph nodes of lung cancer patients by reverse transcription-polymerase chain reaction (RT-PCR).

METHODSCK19 mRNA expression in peripheral blood and regional lymph nodes was detected in 78 patients with lung cancer, and 30 patients with pulmonary benign lesions and 10 healthy volunteers as controls by RT-PCR. Meanwhile, all lymph nodes were also examined by traditional pathological method.

RESULTSThe positive rate of CK19 mRNA expression was 38.5% in peripheral blood of lung cancer patients, and 6.7% in patients with pulmonary benign lesions (6.7%) (Chi-square=10.505,P=0.001). No positive CK19 mRNA expression was found in peripheral blood of 10 healthy volunteers. The positive rates of CK19 mRNA of lymph nodes were 36.9% and 0 in lung cancer patients and pulmonary benign disease patients respectively (Fisher's exact=0.014). In lung cancer group, the metastatic rate of lymph nodes was 17.9% by traditional pathological examination, which was much lower than that by RT-PCR (Chi-square=7.664, P=0.006).

CONCLUSIONSRT-PCR amplification of CK19 mRNA is an sensitive method to detect early haematogenous and regional lymph nodes dissemination of cancer cells for patients with lung cancer. This method may lead to an earlier diagnosis and treatment of patients with subclinical metastasis in circulation and regional lymph nodes.