Objective To investigate the distribution characteristics of hepatitis B virus (HBV) genotypes and the variation situ-ation of drug resistance gene in Shenyang area by the gene chip technology .Methods Serum samples were randomly collected from 90 inpatients of hepatitis B in 202 Hospital of PLA from August 2012 to July 2013 .The HBV genotypes and drug resistance associ-ated 5 sites in common 3 types of antiviral drug were detected by the gene chip technology of nested PCR (NPCR) combined with reverse dot blot(RDB) .Results Among 90 samples ,HBV genotypes included type B 6 .7% (6/90) ,type C 86 .6% (78/90) ,mixed type B and C 6 .7% (6/90) .The serum HBV DNA level in the patients with HBV-C genotype were significantly higher than that with genotype HBV-B and mixed genotype B and C .There were 4 cases of drug resistance gene mutation in the detected samples ,3 cases of mutation were placed in 180M+204V ,1 case of mutation was placed in 180M+204I .All the drug resistance mutations ap-peared in the patients with HBV-C genotype .Conclusion The main HBV genotype is the genotype C in Shenyang area .Genotype B and genotype mixed B and C are unusual .The HBV DNA level in the patients with the genotype C is relatively high ,which is more likely to happen resistance to lamivudine .Moreover the mixed mutation in 180M is more likely to happen .

Objective:To obtain the morphological data of permanent teeth excavated from the Long County in Shaanxi Province about 2 000 years ago.Methods:Morphological methods were used to measure all teeth of 59 human skulls excavated from the Long County in Shaanxi Province about 2 000 years ago and conserved in Chinese Academy of Science.The information included length of tooth,height of dental crown,length of dental root,breadth of the dental crown,thickness of the dental crown,breadth of the dental neck and thickness of the dental neck.The data were analyzed by SPSS 13.0 software.Results:Length of tooth,height of dental crown,length of dental root,breadth of the dental crown,thickness of the dental crown,breadth of the dental neck and thickness of the dental neck of all teeth of 59 human skulls were reported.Conclusion:It suggests that the measured data may be useful in anthropological research.

Objective To evaluate the left ventricular mechanical dyssynchrony in patients with chronic heart failure(CHF)by two dimensional speckle tracking imaging(2D-STI).Methods 37 CHF patients were enrolled in this study.According to left ventricular ejection fraction(LVEF),the patienst were classified into two subgroups:group A,LVEF≤ 35 ％;group B,35 ％＜LVEF＜50 ％.35 healthy volunteers constituted the control group(group C).Standard 2D images were acquired in the 2-,3-and 4-apical views as well as the parasternal short-axis views at the level of the mitral valve and papillary muscles.The time to peak-systolic strain and strain rate were measured for each segment in the level of the mitral valve and papillary muscles in Qlab software.Dyssychrony parameters were defined as the standard deviation and the maximal time delay of the time to peak-systolic strain and strain rate for 12 segments.Parameters were compared among the three groups respectively.The correlation between dyssynchrony parameters and LVEF were analysed in CHF patients.The cut-off value of each parameter were derived from group C based on statistical principles.Dyssychrony rate of each parameter were calculated in group A and B,and compared within each group respectively.Results Compared with group C,all the dyssychrony parameters in group A were significant higher(P＜0.05),and part of the parameters(Tsl-12SD,Tsl-12Dif,Tslr-12SD,Tslr-12Dif and Tsr-12SD)in group B were remarkable higher(P＜0.05).Dyssychrony parameters in CHF patients correlated closely with LVEF(P＜0.05).Significant differences among dyssychrony rates were noted in both group A and B(P＜0.05),and Ts1-12SD showed the highest value in both subgroups.Conclusions 2D-STI is useful in quantifying left ventricular systolic dyssychrony in CHF patients,and the longitudinal parameters are more efficient to detect mechanical dyssychrony than the radial parameters and circumferential parameters.

Objective To evaluate the right ventricular function in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) by 2-dimensional speckle imaging (2D-STI).Methods 46 patients with CHF were divided into responders to CRT and non-responders to CRT according the standard of a decline in LV end-systolic volume ≥ 10％.All the patients received echocardiography examination 1-3 days before CRT and 6 month after CRT.Tissue Doppler imaging (TDI) indices included SD of time to peak velocity in systole (Ts-SD) among 12 segments.Right ventricular diameters included RV basal transverse diameter (D1),RV middle transverse diameter (D2) and RV longitudinal diameter (D3) in apical four views.2D-STI indices included systolic strain (S) and stain rate (SR) of basal or middle segment of RV free wall.Results Compared with before CRT,LVEDd,LVEDV,LVESV and Ts-SD significantly decreased,LVEF significantly increased in responders 6 months after CRT.Before CRT,compared with nonresponders,there was no significant difference of D1,D2 and D3 in responders,while S and SR in basal or middle segment of RV free wall were higher than non-responders.Compared with before CRT,D1,D2 and D3 in responders decreased significantly,S and SR in basal or middle segment of RV free wall increased significantly,while there was no difference in non-responders.There were significant negative correlation between S and SR in basal or middle segment of RV free wall and Ts-SD in responders.Conclusions The remodeling and systolic function of RV are improved after CRT.It may help for improving the efficacy of CRT when takes RV function data into account before CRT.

Objective To evaluate the diastolic function in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT) by conventional echocardiography or Doppler tissue imaging (TDI).Methods 31 patients with CHF were divided into responders to CRT (group R) and nonresponders to CRT (group N) according the standard of a decline in left ventricular(LV) end-systolic volume ≥10％.All the patients received echocardiography examination 1-3 days before CRT and 6 month after CRT.Color M-mode echocardiography indices included Vp,E/Vp.TDI indices included the peak velocity in early diastole (e) at 4 sites of mitral annulus,E/e,time to peak velocity in systole (Ts),Ts-SD and maximum difference of Ts (Ts-Dif) among 12 segments.Results Compared with before CRT,Ts-SD and Ts-Dif significantly shortened in group R;Vp increased significantly,E/e at each 4 site and mean value at 4 sites of mitral annulus,E/Vp decreased significantly; but there were no significant difference in group N.There were significant positive correlation between mean value at 4 sites of E/e,E/Vp and Ts-SD in group R.Conclusions The diastolic function in responders to CRT improved after CRT,which was associated with the decreased LV filling pressure and improved LV relaxation.

Objective To evaluate the value of predicting functional improvement of viable myocardium after percutaneous transluminal coronary angioplasty(PTCA) by strain rate imaging(SRI) combining with low-dose dobutamine stress echocardiography(LDDSE).Methods PTCA was performed in 20 patients with old myocardial infarction and 72 segments of resting dyskinetic wall motion at baseline were observed.Peak systolic strain rate(SSR) and systolic peak velocity(Vs) were measured in abnormal walls at baseline and SRI combined with LDDSE one day before PTCA.Increment of SSR and Vs was defined during stress echocardiography(?SSR% and ?V_S%).The follow-up analysis was performed 6 weeks after PTCA.Results The dyskinetic motion of 48/72 segments was improved according to the follow-up echocardiography 6 weeks after PTCA while that of 24/72 segments was not.Considering ?SSR%≥(2.02%),?V_S%≥(8.5%) in 5 ?g?kg~(-1)?min~(-1) stress and ?SSR%≥(24.7%),?V_S%≥(28.5%) in 10 ?g?kg~(-1)?min~(-1)stress as cut-offs for motion improvement of the left ventricular dyskinetic segments,the sensitivities were(93.8%),(89.6%) and(95.8%),(91.7%),respectively.At baseline SSRs of two groups were significantly different while Vs did not have significant difference.Conclusions Combined with LDDSE,SRI can more accuratly predict the motion improvement of viable myocardium than tissue velocity imaging can.

Objective · To investigate antiemetic effect of aprepitant for moderately chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancer. Methods · From 2014 July to 2015 August, 130 cases of gastrointestinal cancer patients were collected in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, who received moderate emetogenic risk of chemotherapy for at least four courses. One hundred and nine patients were treated with aprepitant, palonosetron and dexamethasone on day 1, and aprepitant and dexamethasone on day 2 and 3. Twenty-one patients only received aprepitant and dexamethasone on day 1 and dexamethasone on day 2 and 3 in the first course of chemotherapy. During subsequent courses of chemotherapy they received aprepitant and treated in the same way as 109 patients. MASCC antiemetic tool (MAT) was used to evaluate the intensity of nausea. The primary endpoint was complete response (CR, no emesis and use of no rescue antiemetics) during the overall study phase (0-120 h after chemotherapy) at the second course. The secondary endpoint was complete protection (CP, CR plus no significant nausea) during the overall, acute (0-24 h), and delayed (24-120 h) phases at the second course. Results · The CR rates were 90.0%, 94.6% and 90.8% of patients in the overall, acute and delayed phases, respectively. The corresponding CP rates were 83.8%, 87.8% and 84.6 %, respectively. The CR rate increased from 42.9% to 57.1% during acute phase and increased from 9.5% to 90.5% during delayed phase for 21 patients after treatment with aprepitant. The main adverse reactions include constipation, anorexia and hiccups. Conclusion · Aprepitant combined with palonosetron and dexamethasone can effectively prevent moderately chemotherapy-induced nausea and vomiting in patients with gastrointestinal cancer. Aprepitant therapy can effectively maintain antiemetic effect in patients with many chemotherapy courses.

For chronic transit constipation (STC), surgery should be considered when all pharmacological interventions, biofeedback, and sacral nerve stimulation failed to relieve severe symptoms. Chronic functional constipation can be subdivided into three subtypes: colonic slow-transit constipation, outlet obstruction and mixed refractory constipation. The pathological changes of colonic slow transit and outlet obstruction constipation can influence each other. Mixed refractory constipation accounts for 90.2% of chronic constipation. Therefore the surgery procedure should solve two types of pathological changes at the same time. The Jinling procedure combines subtotal colectomy and side-to-side cecorectal anastomosis, aiming to solve the coexistence of obstructive defecation and slow-transit constipation in one operation. A total of 1 768 patients with mixed refractory constipation received Jinling procedure from January 2001 to June 2016. Our clinical practice indicates that the Jinling procedure is safe and effective for refractory slow-transit constipation associated with obstructive defecation, with minimal major complications, significant improvement of quality of life, and a high satisfaction rate after long-term follow up. The safety and efficacy of Jinling procedure are improved continually with the progress of minimally invasive surgery, surgical instruments, recovery after surgery and perioperative management. Through long-term clinical and basic research, our institute has formed the comprehensive treatment strategy, such as Jinling procedure, intestinal microecological treatment, medication, biological feedback and sacral nerve stimulation in the treatment of functional constipation.

ERAS (enhanced recovery after surgery) has made significant progress since it was first introduced into China a decade ago. Series of studies on ERAS has been carried out in Jinling Hospital, Nanjing University, and brought out many exciting achievements for gastrointestinal cancer surgery. Merely in the year of 2015, advance in ERAS has been achieved in China. The first ERAS Group in China was founded. The first China ERAS Congress was inaugurated in 2015, publishing several Chinese Experts consensuses on ERAS clinical practice. All these show that ERAS are gradually brought to the attention of the Chinese surgeons and their active participation. It is believed that ERAS will have a promising future in China.
China ; Digestive System Surgical Procedures ; Humans ; Length of Stay

Although with the higher prevalence, the overall treatment result of functional constipation is still not satisfied at home and abroad. The diagnosis and treatment of functional constipation are still to focus on colon itself. Functional constipation has complex interactions among intestinal flora, intestinal autonomic nerve and central nervous system. Patients with functional constipation have different degrees of mental and psychological dysfunction, and abnormal brain function can result in disorders of colon dynamics, secretion and immune function. At the same time, there is a significant imbalance of intestinal flora in patients with functional constipation. Intestinal flora plays an important role in the release of neurotransmitter and the activity of hypothalamic-pituitary-adrenal axis (HPA axis). Intestinal flora is an important regulator of development, maturity and activity of central nervous system. Therefore, the interaction in the brain-gut-microbiota axis may provide a broader strategy for the diagnosis and treatment of functional constipation and neuropsychiatric disorder.