Objective To explore the multidisciplinary treatment for acute massive gastrointestinal (GI) bleeding caused by Dieulafoy's lesion.Methods The clinical data of 48 patients with Dieulafoy's lesions treated at our hospital from April 2007 to April 2012 were retrospectively analyzed.Of the 48 patients,40 were males and 8 were females,with a mean age of 46.7 years (range 21 -52 years).Accurate diagnosis was established by emergency upper gastrointestinal endoscopy, angiography and emergency laparotomy.Results The most common location of the bleeding Dieulafoy's lesion was at the body of stomach (40 cases),followed by the cardia (4 cases),the duodenum (2 cases) and the jejunum (2 cases ),with most lesions being located in the upper part of the stomach within 6 cm of the gastroesophageal junction.Correct diagnosis was made by endoscopy in 46 patients and by emergency laparotomy in 2 cases.Of the 18 patients initially treated endoscopically epinephrine injection and endoscopic hemoclips,2 cases needed angiography to identify the source of bleeding and were cured by transcatheter arterial embolization.23 patients underwent surgical therapy.In this series,47 cases were cured,1 patient died of hypovolaemic shock and multi-organ failure during the hospital stay.Average length hospital stay was (10.8 ± 2.5 ) d.Conclusions Dieulafoy' s lesion is less common cause of gastrointestinal bleeding.Endoscopy plays a key role in the diagnosis and treatment.Topical epinephrine injection and haemoclipping may cure the patients,if it fails angiography and embolization provides a therapy.Most patients may need a laparotomy and surgery as a decisive measure.

Objective To explore the rapid diagnosis and the rational chice of the first-line agents for acute aortic dissection (AAD) in the emergency department.Methods The clinical data of 360 patients with AAD treated at our hospital from March 2007 to March 2013 were retrospectively analyzed.Of them,338 patients with suspected AAD were examined by chest radiography,trans-thoracic echocardiography (TTE),and computed tomography angiography (CTA) successively.The reliabilities of results from each diagnostic method were verified by the gold standard of intra-operative findings and the comparisons of their diagnostic potential were carried out.Results The preoperative diagnostic sensitivity of chest radiography,TTE and CTA in the assessment of AAD were 64％,77％ and 100％,respectively;the specificity is 86％,90％ and 100％,respectively;the accuracy rats were 70％,78％ and 100％,respectively;the positive predictive values were 93％,99％ and 100％,respectively;the negative predictive values were 46％,27％ and 100％,respectively.In the work-up of any patient with suspected AAD,the emergency bedside non-invasive TTE or computed tomography was the first-line initial diagnostic screening,and the best method for the accurate diagnosis of AAD was CTA.Medical management included pain control and deliberate hypotension therapy by using rapidly short-acting vasodilator and beta blockers to lower heart rate,and the hibernation therapy in small dose of specific agents might serve as a useful adjuvant method,and the early combination of vasodilatation medicines was better than the single one.Of them,242 patients fortunately survived on treatment,and 42 died of hypovolemic shock after rupture of AAD and multiorgan failure.Conclusions Acute aortic dissection is the most potentially life-threatening cardiovascular disease,though it is extremely rare in the hypertensive patients,attending doctors should pay more attention.Early rapid diagnosis is the key to AAD treatment.The best method for correctly diagnosing AAD is complementary use of TTE,CTA and magnetic resonance angiography (MRA).Correct and timely diagnosis and strictly deliberate hypotension treatment are the essential determinant of decreasing mortality and improving prognosis of AAD.

Objective To evaluate the validity and surgical outcome of emergency one-stage intestinal resection and tension-free hernioplasty for acutely strangulated inguinal hernia complicated with intestinal necrosis.Methods Clinical data of 58 patients diagnosed strangulated inguinal hernia and intestinal necrosis in our hospital from July 2011 to April 2014 were retrospectively analyzed.Of the 58 patients,33 were males and 25 were females,mean age of (64 ± 18) years (range 52-86).There were 28 strangulated inguinal and 30 femoral hernias undergoing emergency small bowel resection and tension-free mesh hernioplasty.Patients with intestinal perforations,preoperative peritonitis,inflammatory hernia and those who required colon resections were excluded from the study.Results The mean operative time was (92 ± 22) min (range,80-120 min).Average length of hospital stay was (8.6 ± 2.5) d (range,6-21 d).There were three postoperative c omplications (5.2％):one of subcutaneous hematoma,one of superficial surgical site infection and one of scrotal fluid collection,which were all cured by wound dressing,removal of infected prosthetic mesh,vacuum sealing drainage (VSD) and continuous irrigation,intravenous antibiotics and scrotal puncture.During a follow-up period of 6 to 32 months (mean 12 ± 6 months),there was no hernia recurrence.Conclusions Emergency one-stage intestinal resection and tension-free mesh hernioplasty for strangulated inguinal hernia complicated by intestinal necrosis is safe,feasible with a favourable outcome and low rate of postoperative complications.

Objective To evaluate the application value of anterior approach right hepatectomy using the liver hanging maneuver for severe blunt liver trauma.Methods Clinical data of 63 patients with severe blunt liver trauma undergoing right hepatectomy in our hospital from January 2011 to January 2017 were retrospectively analyzed.Among them,31 patients received anterior approach right hepatectomy (anterior approach group,31 cases) while the others did conventional right hepatectomy (conventional approach group,32 cases).Clinical data,intraoperative blood loss,postoperative alanine transaminase (ALT) at POD3,postoperative morbidity and mortality in both groups were analyzed and compared.Results There were eight surgical deaths,one in the anterior approach group and seven in the conventional approach group.All the 31 cases underwent anterior approach right hepatectomy successfully using the liver hanging maneuver.The mean intraoperative blood loss (768 ± 231) ml vs.(1 264 ± 1 248) ml (P ＜ 0.05),postoperative hepatic function ALT value at POD3 (155 ± 89) U/L vs.(689 ± 67) U/L (P ＜ 0.05),postoperative morbidity and mortality of the anterior approach group were markedly superior to conventional approach group (12.9％ vs.34.4％,3.2％ vs.21.9％,all P ＜ 0.05).Conclusions Anterior approach right hepateetomy using the liver hanging maneuver has advantages of decreased intraoperative blood loss,less hepatic function compromise,reduced postoperative morbidity and mortality compared to conventional approach right hepatectomy in cases of severe right liver blunt trauma.

Clinical management of radioiodine-refractory differentiated thyroid cancer (RR-DTC) is extremely diffcult. Re-differentiation compounds, such as retinoids, peroxisome proliferator-activated receptor (PPAR) agonists, DNA methyltransferase inhibitors and histone deacetylase inhibitors, have been used in trials to increase iodine uptake in RR-DTC. However, data on these drugs failed to meet the initial high expectations. In recent years, targeted agents have been increasingly used in pre-clinical and clinical studies to induce re-differentiation and mediate131I therapy, and the outcomes are encouraging.

Objective To evaluate the changes of hepatic blood perfusion of liver cirrhosis patients and the role of pericardial devascularization (PCDV)on them.Methods Hepatic artery and portal vein perfusions of 22 liver cirrhotic patients (LC) pre and post P CDV compared with control were evaluated with rheohepatogram(RHG) and ultrasonogram(USG).Results Compared with control,both hepatic and portal effective perfusion of LC were decreased on RHG, PCDV could increase portal perfusion of LC patients without significant effect on hepatic artery.USG showed that portal vein diameter and blood quantity of LC increased and PCDV didn't influence liver perfusion;No correlation between RHG and USG parameters were seen by STATA analysis. Conclusions RHG is an effective way to evaluate comprehensive blood perfusion of cirrhotic livers,the effect of operation on blood perfusion and prognosis.

Objective To investigate the effect of hypertension on carotid atherosclerosis ,and the clinical significance of BFI technique in the diagnosis of carotid atherosclerosis .Methods Using BFI technique and CDFI technique to detect 198 cases of pa-tients with hypertension(hypertension groups) and 200 cases with normal blood pressure(control group) of carotid internal-media thickness(IMT) and the number of atherosclerotic plaque .To explore the relationship between hypertension and carotid atheroscle-rosis .Results IMT and the detection rate of plaque of hypertension groups was significantly higher than which of control group (P<0 .01) .In hypertension groups ,the higher of blood pressure levels ,the higher carotid IMT and the detection rate of plaque(P<0 .01 or P<0 .05) .The detection rate of plaque in BFI technique was higher than which in CDFI technique (P<0 .01) .Conclusion hypertension can aggravate carotid atherosclerosis ,and the higher blood pressure levels ,the more obvious of carotid atherosclerosis . BFI technique is useful for the detection of carotid atherosclerosis .

Objective To study on effects of Alprostadil on 24-hour urinary albumin(U-Alb)in patients with diabetic nephropathy.Methods:38 patients with diabetic nephropathy were included in the study.The test group involving 20 patients were grouped into group A(pristine diabetic nephropathy) and group B(clinical diabetic nephropathy)randomly according to urinary albumin.The control group including 18 patients were grouped into two groups according to the same way.The subjects in both groups have the same therapy in terms of control of blood glucose,blood pressure,plasma lipids,and other therapy methods.Besides,the test group was injected Alprostadil(凯时)10ug from vein,one time a day,14 day continuously,but Alprostadilas well.Results After the treatment of two groups,the level of the urinary albumin decreased obviously compared with the index before treathent,and decreased significantly compared with normal control group.Conclusion Alprostadil can lower urinary albumin with diabetic nephropathy.

Objective To evaluate the efficacy of thalidomide combined with NP regimen in treatment of non-small cell lung cancer (NSCLC) and to analyse the change of VEGF and bFGF in peripheral blood in patients with advanced NSCLC. Methods 57 patients with advanced NSCLC were divided randomly into NP plus thalidomide treatment group and NP contrast group,and VEGF and bFGF were measured by ELISA. Results The response rate was 44.4 % in trial group and 23.8% in control group (P>0.05). The clinical benefit rate were 77.8% in trial group and 42.9% in control group (P>0.05). The median TIP was 5.1 months and 3.0 months for trial group and control group respectively(P=0.05). Patients in benefit in trial group had a remarkable decrease in the number of VEGF (P<0.05) while patients in benefit in control group had a little decrease in the number of VEGF (P>0.05). Patients out of benefit in trial group and control group had a increase in the number of VEGF (P<0.05). Patients in benefit in trial group and control group had a tendency of decrease in the number of bFGF (P>0.05) while patients out of benefit in trial group and control group had a remarkable increase in the number of bFGF(P<0.05). Conclusion The addition of thalidomide to NP regimen results in significantly and clinically meaningful improvement in response rate, median time to tumor progression, and clinical benefit rate compared with NP alone in advanced NSCLC patients.Thalidomide in combination with chemotherapy shows a favorable toxic profile in advanced cancer patients.VEGF and bFGF can be detected in patients with advanced NSCLC.

This article is concerned about the practice and exploration on medical electronics teaching project and teaching pattern we have done before and the Active Participation Pattern thus formed. That is guiding, putting for ward questions, discussing, debating and summarizing in class while setting research problem after class. We also have made media courseware in medical electronics and have used it in our teaching process, which has aroused the students' interest in study and has enhanced the teaching efficiency and quality. This new method of teaching pattern helps us gain the strong feedback and affirmation and is welcome by the students.