Objective:To investigate the effects of enteral nutrition assisted therapy in preventing postoperative anastomotic fistula in patients with esophageal cancer and its influence on immunity,healing process and nutritional recovery.Methods: The clinical data of 90 cases of patients with esophageal cancer who underwent surgical treatment were retrospectively analyzed.According to the mode of postoperative nutritional support,the patients were divided into group A(n=34),B(n=30)and C(n=26)three groups.Group A was treated by immune-enhancing enteral nutrition(Supportan)assisted therapy.Group B was treated with routine enternal nutrition(Nutrison Fibre)assisted therapy.Both of the two groups were treated with 25%,50% and 100% of the full dose on the 1st,2nd and 3rd-7th day after surgery.Later,the dose was reduced day by day till normal diet.Group C was treated by parenteral nutrition assisted therapy.Since the 1st day after surgery,patients in group C were intravenously injected with glucose,vita min and a mino acid mixed liquid calculated by 125.52 kJ/kg.8-10 d later,patients gradually transited to the normal diet.The incidence rates of anastomotic fistula,pulmonary infection and incision infection,wound healing time,total hospitalization time and initial exhaust time were observed and compared between the three groups.The changes of immune index [T lymphocytes and its subsets(CD3+,CD4+,CD8+)],inflammatory factors[C reactive protein(CRP),IL-6]and nutrition indexes[serum total protein(TP),albumin(ALB)]before surgery,on the 1st and 8th day after surgery were recorded.Results: ①There were significant differences in the incidence rates of postoperative anastomotic fistula and pulmonary infection between the three groups(P<0.05),and the incidence rates in group C were significantly higher than those in the other two groups(P<0.05).②There were significant differences in wound healing time,total hospitalization time and initial exhaust time between the three groups(P<0.05)and that of group C group was longer than that of the other two groups(P<0.05).③On the 1st day after surgery,the levels of immune indexes such as CD3+,CD4+,CD4+/CD8+ and nutrition indexes such as TP and ALB in the three groups were significantly lower than those before surgery.CD8+ levels and levels of inflammatory indexes such as CRP and IL-6 were significantly higher than those before surgery(P<0.05).However,there was no significant difference between the groups(P>0.05).On the 8th day after surgery,the nutrition indexes in the three groups were still significantly lower than those before surgery.However,those in group A and B were significantly higher than those in group C(P<0.05);the inflammatory factors were still significantly higher than those before surgery(P<0.05)but those in group A and B were significantly lower than those in group C(P<0.05).Among the three groups,there was no statistical significance in comparing the immune indexes with those in group A(P>0.05).The levels of CD3+,CD4+,CD4+/CD8+ in the other two groups were lower than those before surgery while CD8+ level was higher than that before surgery(P<0.05).Conclusion: To apply enteral nutrition assisted therapy in patients with esophageal cancer after surgery can effectively improve the prognosis.It has positive effects on shortening the healing process,improving the immune function and improving the nutritional status.

Objective To investigate the correlation between the disease activity and the serum levels of anti-nuclear autoantibodies against various nuclear components in the patients with systemic lupus erythematosus (SLE). Methods Two hundred and twenty five SLE patients enrolled from 2000 to 2002 were evaluated retrospectively. All patients fulfilled the ACR 1997 diagnostic criteria for SLE. The patients were divided into three groups according to the disease activity: mild group (Group A), moderate group (Group B)and severe group (Group C), as assessed with SLEDAI score. These cases were also divided into 2 groups according to the serum levels of anti-dsDNA antibody. 52 out of 225 patients were followed up further. Results ①There was no correlation between the serum level of anti-dsDNA antibody and SLEDAI score, and between the serum level of ANA and SLEDAI score in 225 patients. ②The serum level of anti-dsDNA antibody in group C was higher than that in group A or group B (P 0.05). Conclusions A positive correlation between the anti-dsDNA antibody and the disease activity was found in the severe group of SLE, but not found in the mild or moderate group. Although the renal damage was more commonly seen in those with higher level of anti-dsDNA antibody, but there is no correlation between the level of anti-dsDNA antibody and the degree of renal lesion.

[Objective]To study the correlation between the severity of bone marrow edema(BME) and the collapse of osteonecrosis of the femoral head(ONFH),to explore the relationship between the severity and the score of Harris,so as to offer the direction for understanding and judging the prognosis of ONFH clinically.[Method]Fifty-eight cases of ONFH patients(94 hips) without collapse,according to the X-Ray and the MRI examination,made a follow-up visit for 16～28 months,an average of 18 months,and made a retrospective study of the correlation between the severity of BME and the collapse,the Harris of ONFH.[Result]The correlation between the BME degree and the collapse of ONFH:the collapse rate was 4.5% in degreeⅠ,11.8% in degreeⅡ 66.7% indegreeⅢ,90% in degree Ⅳ.The correlation between the BME degree and the Harris:93.0?5.41 in degree Ⅰ,84.1?5.42 in degree Ⅱ,76.4?4.22 in degreeⅢ,66.3+7.46 in degree Ⅳ.[Conclusion](1)BME is the secondary sign of ONFH;(2)The tendency of collapse could be predicted through the BME;(3)There is a negative correlation between the BME degree and the Harris,namely the larger scope of BME is,the lower the score of Harris is.

The paper elucidated the necessity of programmed operation in competence education of medical postgraduate students.This paper introduced the specific methods of programmed operation mode,exactly as selection of the best,scientific combination,coordination and arrangement,allocation of responsibility to individual,exact procedures,succession and development.The seven years practice experience in their colleges testified that these operational methods aroused the enthusiasm of postgraduate students' participation in campus activities and trained postgraduate student cadres.Meanwhile,these methods activated the campus culture and atmosphere and enhanced the comprehensive competence of postgraduates wholly.

Objective To investigate the clinical effects of lactobacillus acidophilus combined with glutathione in the treatment of nonalcoholic fatty liver disease.Methods 120 patients with nonalcoholic fatty liver disease were selected,and they were randomly divided into control group (60 patients used glutathione alone) and observation group (60 patients received lactobacillus acidophilus on the basis of control group).The clinical efficacy,liver function index,blood lipid index and the ultrasonography grading of fatty liver before and after treatment of the two groups were compared.Results The clinical total effective rates of the control group and the observation group were 76.67％,91.67％,respectively.The total effective rate of the observation group was significantly higher than that of the control group(x2 =10.52,P ＜ 0.05).The levels of AST,ALT and GGT of the observation group after treatment were significantly lower than those of the control group and before treatment [(36.89 ± 7.14) U/L,(36.89 ± 7.14) U/L,(36.89 ±7.14) U/L vs.(49.36 ± 11.08) U/L,(45.91 ± 10.24) U/L,(90.28 ± 20.70) U/L;(36.89 ± 7.14) U/L,(36.89 ± 7.14) U/L,(36.89 ± 7.14) U/L vs.(92.90 ± 24.3) U/L,(81.11 ± 17.37) U/L,(147.27 ± 34.19) U/L,t =2.88,2.54,2.91;3.01,3.36;3.18,3.48;3.41,3.87;all P ＜0.05).The levels of TG,TC,HDL-C and LDL-C of the observation group after treatment were significantly better than those of the control group and before treatment [(1.66 ± 0.42) mmol/L,(4.05 ± 0.77) mmol/L,(1.69 ± 0.60) mmol/L,(2.44 ± 0.38) mmol/L vs.(2.13 ± 0.80) mmol/L,(4.64 ± 0.94) mmol/L,(1.45 ± 0.48) mmol/L,(2.97 ± 0.57) mmol/L;(1.66 ± 0.42) mmol/L,(4.05 ± 0.77) mmol/L,(1.69 ± 0.60) mmol/L,(2.44 ± 0.38) mmol/L vs.(2.71 ± 1.33) mmol/L,(5.42 ± 1.27) mmol/L,(1.08 ± 0.36) mmol/L,(3.49 ± 0.71) mmoL/L,t =2.43.2.13,2.55,2.07;3.02,3.41;3.11,3.65;2.81,3.30;2.87,3.15;all P ＜ 0.05).In the control group,normal in 6 cases,mild in 24 cases,moderate in 21 cases and severe in 9 cases as fatty liver degree;in the observation group,normal in 13 cases,mild in 30 cases,moderate in 13 cases and severe in 4 cases as fatty liver degree.The ultrasonography grading of fatty liver of the observation group after treatment were significantly better than those of control group and before treatment (U =3.74,5.20,all P ＜ 0.05).Conclusion Lactobacillus acidophilus combined with glutathione in the treatment of nonalcoholic fatty liver disease can efficiently promote the recovery process of liver function,regulate blood lipid levels and is helpful to improve the imaging grading.

Objective To explore the relationship between homocysteine(HCY),glycosylated hemoglobin(HbA1c),lipids and posterior circulation ischemia and the clinical significance of their levels in the posterior circulation ischemic (PCI)diseases. Methods Difference between PCI were diagnosed in 140 examinees and a healthy control group,with fasting serum,HCY, HbA1c,total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C)and low-density lipoprotein cholesterol (LDL-C)were detected.Results HCY and HbA1c were significantly higher,HDL-C was significantly lower in the patients with PCI,two independent sample t-test showed a significant difference between the test group and control group (P <0.001 and P =0.001),the remaining lipid indicators was not statistically significant.Spearman rank correlation analysis showed that HCY levels had significant positive correlation (P <0.001)and TG levels had significant negative cor-relation (P =0.013)with the subjects age,HCY levels had significant negative correlation with TG levels(P = 0.028), HbA1c levels had significant positive correlation with TG levels and LDL-C levels(P =0.001 and P =0.027).Conclusion High levels of HCY and HbA1c were closely associated with PCI,which HCY and HbA1c should be attached great impor-tance to the effective prevention and treatment and improve of PCI.

This study was aimed to analyze the domestic relevant documents since 1991 involving Si-shen Decoc-tion and its individual component drugs with knee osteoarthritis biomarkers. This article took medical journal databases of CBMdisc, CNKI, SWIC and Wanfang as sources of information, and searched respectively with key words such as knee osteoarthritis and biomarkers, Si-shen Decoction or Leguminosae, Dendrobium,Achyranthes bidentata, Polygala tenuifolia Willd, Lonicera Japonica and biomarkers such as matrix metalloproteinase, cartilage oligomeric matrix protein, collagen type II C-telopeptide. Bibliometric analysis was given on the acquired relevant documents. The results showed that among 340 documents about knee os-teoarthritis and biomarkers, IL-1, TNF-α and MMPs are mostly used to respond the index of cartilage degenera-tion. Among 565 documents about Si-shen Decoction and its individual component drugs with biomarkers, they are mostly concentrated on the index of TNF-α, IL-1 and oxygen free radical, and the research methods are relatively mature. It was concluded that the bibliometrics method has certain significance in the effect of Si-shen Decoction in the treatment of knee osteoarthritis. More study is required to provide evidence in the development of Si-shen Decoction into a specific prescription for the treatment of knee osteoarthritis.

Objective To evaluate the efficacy of double-lumen central venous catheter (DLCVC) for airway management in children undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.Methods Twenty-nine ASA physical status Ⅰ or Ⅱ podiatric patients,aged 1-9 yr,weighing 10-35 kg,scheduled for elective resection of laryngeal papilloma under self-retaining laryngoscope,were included in this study.Anesthesia was induced with inhalation of 8 ％ sevoflurane and the children kept spontaneous breathing.The larynx was sprayed with 2％ lidocaine for topical anesthesia.A self-retaining laryngoscope was inserted and a 7F DLCVC was placed below the glottis via the self-retaining laryngoscope.4％-6％ sevoflurance was insufflated via the main lumen of DLCVC (14G) to maintain anesthesia.PETCO2 was monitored through the branch lumen of DLCVC (18G).Before surgery (T1),at 20 min after the beginning of surgery (T2),and at the end of surgery (T3),arterial blood samples was obtained for blood gas analysis,and body movement,hypoxemia (SpO2 ＜ 95 ％ during oxygen inhalation),and airway management failure (SpO2 ＜ 90％ during oxygen inhalation) were also recorded.Results Compared with the baseline value at T1,although there were significant changes in PaCO2,base excess,pH value and PaO2 at T2 and T3 (P ＜ 0.05),they were all within the clinical reference ranges.There were no significant differences between PaCO2 and PETCO2 at T1,T2 and T3 (P ＞ 0.05).The incidence of body movement and hypoxemia was 10％,and the rate of airway management failure was 3％ (due to degree Ⅲ laryngeal obstruction).Conclusion DLCVC can be safely and effectively used for airway management in children with degree Ⅰ or Ⅱ laryngeal obstruction undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.

Objective To observe the clinical efficacy and sperm density of Bushen Yijing decoction and tamoxifen,zinc and vitamin E in treating oligospermia with kidney deficiency syndrome .Methods 450 patients with oligospermia were randomly divided into 3 groups.150 patients of the treatment group were treated by Bushen Yijing decoction,tamoxifen,zinc and vitamin E,150 patients of the control group I were treated by Bushen Yijing decoction , zinc and vitamin E,150 patients of the control group II were treated by tamoxifen ,zinc and vitamin E.3 groups were treated for 3 months,pregnancy terminating of treatment and otherwise continued to observe for 3 months after the end of treatment,the sperm density and other sperm parameters (sperm amount,pH,sperm motility,sperm survival rate, sperm normal modality rate ) were evaluated before and after treatment .Results The total effective rates of the treat-ment group,control group I and II were 90.21%,85.11%,72.22%respectively.The total effective rate of the treat-ment group was higher than that of the control group I (χ2 =9.53,P<0.05) and II(χ2 =23.38,P<0.01).The pregnancy rates of the treatment group ,control group I and II were 42.66%,25.53%,20.83%,respectively.The pregnancy rate of treatment group was significantly better than that of the control group I (χ2 =9.26,P<0.01) and II (χ2 =15.78,P<0.01).There were significant differences between before and after treatment on sperm density , sperm motility,sperm survival rate and sperm normal modality rate in the treatment group ( t=-22.22,-18.07,-33.48,-28.46,all P<0.01).Conclusion Bushen Yijing decoction combined with tamoxifen ,zinc and vitamin E can evidently improve the sperm density and other sperm qualities and conception rate of oligospermia with kidney deficiency syndrome .

This paper was based on clinic and basic experiments,and the new teaching mode of"practice,laws,and teaching quality"was especially emphasized.The teaching experience of medical ethics in medical postgraduate was summarized in the study,and a good effect of study has been achieved after the new mode of teaching was put into practice.