The function of Medical Engineering profession in military hospitals becomes more and more important,so does the development of the professional person troops.There is an urgent need of a professional person troop with high-tech professional knowledge,rigorous science style and good managerial ability.Therefore,it is necessary to develop the professional person troops in Medical Engineering in military hospital.

ObjectiveThe efficacy and safety of nitrous oxide-sedated transnasal gastroscopy for high-risk patients of intravenous anesthesia were evaluated. MethodsA total of 157 patients were randomly assigned to the nitrous oxide group ( n =80) and the oxygen group ( n =77). Heart rate, blood oxygen saturation, blood pressure and electrocardiogram were monitored. Complications in both groups were recorded.Satisfaction degrees of patients and endoscopy physicians were evaluated with a questionnaire and visual analog scale (VAS) score. The questionnaire questions for physicians included the procedure evaluation ( steady, ok, unsteady). Patients' questionnaire questions included discomfort (light, moderate, severe), the patients' tolerance ( fine, moderate, weak) and the patients' willingness to undergo a second procedure. Statistical analysis was performed between the two groups. ResultsSix of the toal 157 patients were removed because of the operation failure (difficulty in access to nasal cavity in 5 patients and nose bleeding in one patient), 151 patients underwent the transnasal gastroscopy successfully and completed the questionnaires. In experimental group, there were 37 males and 41 females (mean age was 67.7 years, ranging 16-88 years, 7 patients were grade 1 of ASA, 61 were grade 2, and 11 were grade 3). In the control group, there were 36 males and 37 females (mean age was 67.9 years, ranging 17-86 years, 6 patients were grade 1 of ASA, 57 were grade 2, and 9 were grade 3). There was no differences in sex, average age and ASA grade between the two groups (P ＞ 0. 05 ). There was no difference in the mean operation time between the two groups, either (200. 1 s vs 200. 3 s) ( P ＞ 0. 05 ). There were no significant differences between the two groups in changes of blood oxygen saturation, blood pressure, electrocardiogram and complication rates ( P ＞ 0. 05 ).Both physicians' and patients' positive evaluations of the experimental group were more than that of the control (P ＜ 0. 05 ), while physicians' and patients' negative evaluations of the experimental group were less than the control (P ＜0. 05). VAS of physicians' satisfaction in the experimental group was higher than that of the control group (84 vs 70, t =14. 67, P ＜ 0. 05), and VAS of patients' satisfaction in the experimental group was superior to the control group (82 vs 71, t =11.56, P ＜ 0. 05). The number of patients wiring to undergo a second procedure in the experimental group was higher than that of the control (89. 7％ vs 69. 9％, P ＜ 0. 05). ConclusionNitrous oxide-sedated transnasal endoscopy is an effective and safe procedure for high risk patients of intravenous anesthesia.

Purpose To explore the clinicopathologic characteristics, immunophenotype, diagnosis and differential diagnosis, molecu-lar genetic feature, treatments and prognosis of intra-abdominal EIMS. Methods Two cases of intra-abdominal EIMS were studied with clinical manifestations, histology and immunohistochemical staining, and its clinical and pathological findings were further ana-lyzed with review of the literature. Results Case 1 was a 15-year-olds male and case 2 was a 21-year-olds female both of whom pres-ented with abdominal pain. Two patients were treated by surgical excision. Microscopically the tumor consisted of two different histolog-ical types, one of which was of high cell density and the other with low cell density and myxoid stroma. Both of these areas contained inflammatory cells, mainly neutrophils with few lymphocytes and plasmocytes. Tumor cells had an epithelioid phenotype with round nu-clei and small nucleoli, various nuclear atypia and mitotic figures were also found, which consistented with the diagnosis of epithelioid inflammatory myofibroblastic sarcoma. Immunohistochemical analysis revealed that the tumor cells were positive for ALK, vimentin, desmin, and CK(AE1/AE3) (focal), and were negative for Calretinin, CD30, CD31, CD33, SMA, HHF35, Myogenin, S-100, HMB-45, CD20, CD79a, CD3, CD5, CD45 and CD68. ALK rearrangement was identified in both cases by FISH using ALK break-a-part probe. Conclusions As an extremely rare tumor, the distinguishing between epithelioid inflammatory myofibroblastic sarcoma and conventional inflammatory myofibroblastic tumor is important. ALK inhibitors are theoretically useful for treating these tumors.

Objective To evaluate the effects of combination of dexmedetomidine and mild hypothermia on global cerebral ischemia-reperfusion (I/R) injury in neonatal rats.Methods Ninety-six neonatal Sprague-Dawley rats,aged 6-7 days,weighing 18-22 g,were randomly divided into 4 groups (n=24 each) using a random number table:I/R group,mild hypothermia group (group H),dexmedetomidine group (group D) and combination of dexmedetomidine and mild hypothermia group (group DH).Global cerebral ischemia was induced in rats anaesthetized with chloral hydrate by bilateral common carotid artery clamping (for 15 min) combined with hypotension followed by reperfusion.Dexmedetomidine 75 pg/kg was given intraperitoneally at 30 min before ischemia in D and DH groups,while the equal volume of normal saline was given in I/R and H groups.The temperature in the temporal muscle was maintained at 36.7-37.2℃ in I/R and D groups,and at 34.8-35.3℃ in H and DH groups.At 12,24 and 72 h of reperfusion,8 rats were randomly chosen in each group,and neurological deficit score (NDS) was determined.The animals were then sacrificed,and their brains were removed for determination of myeloperoxidase (MPO) activity (by spectrophotometry) and contents of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in brain tissues (using ELISA).Results Compared with I/R group,the NDS,MPO activity and contents of TNF-α and IL-6 were significantly decreased in the other three groups.The NDS,MPO activity and contents of TNF-α and IL-6 were significantly lower in DH group than in H or D group.Conclusion Dexmedetomidine can optimize cerebral protection providedby mild hypothermia against global cerebral I/R injury through inhibiting inflammatory responses in brain tissues of neonatal rats.

Objective:To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach.Methods:In the study,27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively.The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine.The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles.Once the space between the muscles was achieved,20 mL of 0.5％ (mass fraction) ropivacaine was injected and a catheter was inserted.Whether the tip of catheter was in right place was evaluated by ultrasound image.The block dermatomes of cold sensation were recorded 10,20 and 30 min after the bolus drug was given.Then 0.2％ ropivacaine was infused with 6 mL/h via the catheter by an analgesia pump postoperatively.The block dermatomes of cold sensation and pain score were recorded 1,6,24 and 48 h postoperatively.Results:The first attempt success rate of catheteration was 81.48 ％ (22/27);the tips of catheter were proved in right places after the second or third attempt in 5 patients.The median numbers of the block dermatomes 10,20 and 30 min after the bolus drug was given were 2,3,4;the median numbers of block dermatomes were 5,5,5,4,and of pain score were 1,1,2,2 at 1,6,24,48 h postoperatively;no case of bilateral block,pneumothorax or vessel puncture occurred.Conclusion:Thoracic paravertebral block using laterally intercostal approach is feasible,which has high success rate of block and low rate of complications.

Objective To evaluate the efficacy and safety of ligation-assisted endoscopic dissection (ED-L) technique for the removal of gastric tumors originating from muscularis propria.Methods A total of 33 patients with gastric tumors originating from muscularis propria less than 10 mm were treated with ED-L procedures.The tumor was ligated by elastic bands.Endoscopic dissection was performed until the tumor was partially or completely dissected from muscularis propria by using Hook knife and/or IT-knife.The wound was closed with metallic clips and medical adhesive.The patients were followed up 1 week,1 month,3 months,6 months and 12 months thereafter with endoscopy,respectively.Results Of the 33 gastric tumors,there were 25 partial dissections and 8 complete dissections.All of the tumors sloughed completely.Pathological diagnoses of all the patients were acquired.No complications like perforation occurred except for one self-limiting and non-life-threatening hemorrhage.There was no recurrent case during the 3-18 months of follow-up period.Conclusion ED-L is a safe,effective and relatively simple technique for excision of small gastrointestinal tumors originating from muscularis propria,providing a histopathological diagnosis as well.

We reported a case of polyglandular syndrome induced by programmed death-1(PD-1) inhibitors. The patient was a 51-years-old male with non-small cell lung cancer, treated with PD-1 inhibitor nivolumab/pembrolizumab because of postoperative subcarinal lymph node metastasis indicated by PET-CT. During 14 cycles of PD-1 inhibitor treatment, the patient successively developed primary hypothyroidism, and type 1 diabetes mellitus(T1DM). More than five months after the withdrawal of pembrolizumab, the patient experienced recurrentce. Laboratory examinations showed mild hyponatremia and hypopituitarism including ACTH and growth hormone(GH)/insulin-like growth factor-1(IGF-1) insufficiency. This is the first report of a patient diagnosed as polyglandular syndrome caused by PD-1 inhibitor. In particularly, the hypothyroidism and T1DM did not improve after drug withdrawal, while hypopituitarism was further aggravated. This case reminds us that we should pay more attention to the changes of endocrine function during and after the treatment of PD-1 inhibitor, so that we can make the correct diagnosis and take proper medical measures timely, to avoide missed diagnosis, and improper treatment.

Objective To investigate the effect of percutaneous transhepatic gallbladder drainage(PTGBD) on different American Society of Anesthesiologists(ASA) grading of laparoscopic cholecystectomy in patients with acute cholecystitis. Methods The 324 patients with acute cholecystitis undeigoing laparoscopic cholecystectomy who were hospitalized in Department of Hepatobiliary Surgery, Xianyang Central Hospital from March 2010 to December 2014 were enrolled in the retrospective analysis. According to the history of the patients with or without PTGBD before laparoscopic cholecystectomy, all patients were divided into 2 groups. One hundred and eighty four patients who underwent directly laparoscopic cholecystectomy were the control group, and the other 140 patients who underwent PTGBD + elective laparoscopic cholecystectomy were the study group. The rates of conversion to laparotomy, total days of hospitalization, hospitalization days after cholecystectomy incidence, postoperative complications incidence, postoperative drainage were compared between two groups. The difference of clinical data between the two groups were compared under different ASA classification. Measurement data were expressed as ((x)±s) and t-test were used for comparison between groups. Count data were compared by X2 test. Results The rate of intraoperative laparotomy was 23.6％(33/140) in the study group and 20.7％(38/184) in the control group; the mean length of hospital stay was (7.3 ±3.3) days in the study group and (6.8 ±2.3) days in the control group; the postoperative complication rate was 2.8％(4/140) in the study group and 0.5％(1/184) in the control group; the abdominal cavity drainage rate was 80.0％(112/140) in the study group and 73.9％(136/184) in the control group; intraoperative laparotomy rate, postoperative hospital stay, postoperative complications incidence, and abdominal cavity drainage rate between the two groups had no significant difference(P> 0.05). The total length of hospital stay was(17.6 ±4.4) days in the study group and(10.6 ±3.0) days in the control group, and there was a statistically significant difference between the two groups(P <0.001). According to the subgroup analysis by ASA classification, the two groups of ASA-I patients in the experimental group were significantly higher than the control group in the temperature, C reactive protein and the total number of days of hospitalization, and the difference was statistically significant(P< 0.05). The two groups of ASA-Ⅱ patients in the experimental group were significantly higher than those of the control group in age, white blood cell count, C reactive protein and total hospitalization days, and the difference was statistically significant(P<0.05). In ASA-Ⅲ patients, the rate of intraoperative laparotomy was 28.3％ (13/46) in the study group and 32.1％ (9/28) in the control group; the mean hospital stay after surgery was(10.8 ± 3.7) days in the study group and(11.2±4.8) days in the control group; The total length of hospital stay was (19.7 ±7.2) days in the study group and (16.8 ± 8.6) days in the control group; the rate of intraoperative laparotomy, the mean length of hospital stay and postoperative hospital stay in the two groups of ASA-Ⅲ patients had no statistically significant difference(P>0.05). Conclusions PTGBD has different effects on laparoscopic cholecystectomy in patients with different ASA grading of acute cholecystitis. PTGBD combined with laparoscopic cholecystectomy is a safe and effective method that can turn emergent operation intoselective operation. It is worthy of extensive application.

Objective To compare the efficacies of laparoscopic versus open splenectomy plus portaazygous devascularization in the treatment of patients with portal hypertension with recurrent upper gastrointestinal bleeding.Methods The clinical data of patients who underwent laparoscopic (n =60) versus open (n =52) splenectomy plus open portaazygous devascularization in the Department of Hepatobiliary Surgery,the Center Hospital of Xianyang City,Xi'an Jiaotong University Health Science Center from March 2014 to February 2017 were retrospectively analyzed.Results There was no perioperative death in the 2 groups.The amounts of intraoperative bleeding,the durations of the operation,the time of first flatus passed after operation and the duration of postoperative hospitalization were compared,and the differences were significantly different (t =3.288,2.533,3.325,2.823,P ＜ 0.05).There was no significant difference in the total hospitalization expenses (t =0.651,P ＞0.05).The incidence of postoperative complications was significantly higher in the open surgery group (x2 =7.622,P ＜ 0.05).At 1-month after surgery,color doppler flow imaging (CDFI) showed no significant difference on the portal blood flow between the two groups (t =0.625,P ＞ 0.05).On gastroscopy,the esophageal and gastric varices were significantly improved,and there was no significant difference between the two groups (x2 =0.718,P ＞ 0.05).Liver function was better in the laparoscopic group than the open group (x2 =3.765,P ＜ 0.05).Comparison of the rebleeding rates and the incidences of hepatic encephalopathy for the two groups at 1 year after operation showed significantly better outcomes for the laparoscopic group (x2 =2.351,1.245,P ＜ 0.05).The 1-year and 3-year survival rates after operation (x2 =0.218,0.361,P ＞ 0.05) were not significantly different.Conclusion Compared with laparotomy,laparoscopic splenectomy plus portaazygous devascularization had the advantages of less trauma,better short-term and long-term efficacies.

Objective To investigate the therapeutic effect of total laparoscopic vs open surgery for gallbladder carcinoma.Methods Clinical data of 51 cases of laparoscopic surgery and 41 cases of open operation for gallbladder cancer from Mar 2012 to Dec 2016 were analyzed retrospectively.Results There were no perioperative death in both groups.The blood loss during operation,operative time,the first anal exhaust after operation and the hospital stay were in favour of laparoscopic procedure (t =2.756,2.325,1.362,2.252,P ＜ 0.05).There was no significant difference in total hospitalization expenses (t =0.655,P ＞ 0.05),the short-term postoperative complications were in favor for laparoscopic surgery (x2 =5.522,P ＜ 0.05).The 1,3,5-year survival rates of laparoscopic group and laparotomy group were comparable (x2 =0.356,0.428,0.388,P ＞0.05).Conclusion Laparoscopic radical surgery for gallbladder cancer is safe,feasible and less traumatic than open surgery,with long term survival comparable to open surgery.