Purpose:To select a better operation approach for esophageal carcinoma. Methods:From 1958 to 1997, 945 patients of the middle third esophageal carcinoma of our hospital were underwent 5 types of operation.namely: left thoracic approach esophagectomy and esophagogastrostomy; right thoractomy anterolateral and abdomen esophagectomy and esophagogastrostomy; right thoractomy anterolateral and abdomen and cervical approach esophagectomy and esophagogastrostomy; right thoractomy posteriolateral, abdomen and cervical approach esophagectomy and esophagogastrostomy; simple right thoracic approach esophagectomy and esophagogastrostomy. The rate of resectability, rate of complication, rate of mortality and rate of survival of the 5 types of operation were using SAS package and significance test of contingency table. Results:The rate of resectability and the rate of 5 year survival in the five groups were 84.19% and 29.00%, 81.69% and 28.57%,83.65% and 26.19%,90.74% and 34.70%, 93.67% and 39.74%, respectively. Conclusions:Right thoracic approach esophagectomy and esophagogastrostomy are considered superior the operation approach of esophageal carcinoma.

Objective To study the effect of different doses of Zhengan xifeng decoction on Raf-1 mRNA and protein expression in the cardiovascular tissue of spontaneously hypertensive rats( SHR). Methods A total of 50 male SHR,24 weeks old,were randomly divided into the model,low dose,medium dose,high dose of Zhengan xifeng decoction and the compound apocynum groups,10 in each group. Ten homologous male rats( WKY)served as the normal control group. After gavaged for 5 weeks,western blotting and RT-PCR were used to detect the Raf-1 protein and mRNA expression in the cardiovascular tissue,respectively. Results Compared with the model control group,both Raf-1 protein and mRNA expressions significantly increased in all treatment groups( P〈0. 01 ). Conclusion The Zhengan xifeng decoction can stimulate cell proliferation and inhibit cell apoptosis by up-regulating the expression of Raf-1.

Objective To explore the value of waring score of potential critical disease in predicting changes in condition of patients with multiple injuries. Methods From January 1, 2013 to July 31, 2013, all patients with multiple injuries were included prospectively. Patients were observed as soon as ICU admission. The waring score of potential critical disease and MEWS of all patients and the rates of changes in condition of patients were calculated then statistic analysis was performed. Results Of 50 patients enrolled, 44 were survived and 6 were died and 295 changes were found. The maximum , minimum median (P25, P75) of waring score of potential critical disease were 22, 0, 5 (3, 7). The maximum, minimum median (P25, P75) of MEWS were 12, 0, 4 (2, 6). The area under the ROC of waring score of potential critical disease was 0.880 (95% CI, 0.813-0.947, P < 0.001). Youden index was the biggest when waring score of potential critical disease was 6.5. The area under the ROC of MEWS was 0.767 (95% CI, 0.661-0.873, P < 0.001). Youden index was the biggest when MEWS was 5.5. Conclusion The waring score of potential critical disease was effective to predict changes in conditions of patients with multiple injuries and better than MEWS.

Objective To explore the application value of pulse induced contour cardiac output (PiCCO) monitoring in diagnosis and treatment of patients with neurogenic pulmonary edema (NPE).Methods With review of literature, the data of 4 patients of severe neurological disease complicated by NPE admitted into Department of Critical Care Medicine of Huangshan People's Hospital Affiliated to Wannan Medical College from 2011 to 2013 were retrospectively analyzed and discussed in their PiCCO hemodynamic characteristics and processes of treatment.Results The PiCCO of 4 patients with NPE showed that the extravascular lung water index (EVLWI) was increased significantly (EVLWI was 12 - 42 mL/kg on admission and 10 - 22 mL/kg after hospitalization for 24 hours), all revealing a high permeability pulmonary edema type. The capacity balance of the first 24 hours in the 4 cases was all of positive balance (+1 130, +1 200, +1 750, +1 120 mL respectively). In the treatment, the supplementary colloid was strengthened, the vasoactive drugs such as, dopamine, dobutamine, milrinone, etc were applied to improve the circulatory oxygenation, then the EVLWI was declined; finally the disease situation in 3 cases was improved and one died.Conclusions The clinical diagnosis and treatment of NPE is complex, and many contradictions appear in the therapeutic course. PiCCO monitoring is valuable in early diagnosis, identification of pulmonary edema type, guidance in fluid supplement and vascular active drug application, and assessment of disease severity and prognosis.

Objective To explore the value of Oxford acute severity of illness score in evaluating the severity and prognosis of critical illness patients.Methods All adult patients admitted to the Department of Critical Care Medicine from August 2012 to July 2014 were retrospectively analyzed.The severity in survivors and non-survivors was evaluated by using Oxford acute severity of illness score and APACHE Ⅲ score,and then statistic analysis were performed.Results Of 470 patients,321 (68.297％) were male,the range of age and ((x) ±s) age were 18 to 97 years and (59 ± 18) years respectively,and 123 patients (26.170％) were in non-survivors group and 347 patients in survivors group.The area under the ROC of Oxford acute severity of illness score was 0.760 (95％ CI:0.712-0.808,P ＜ 0.001),and Youden index was biggest when Oxford acute severity of illness score was 30.5.The area under the ROC of APACHE Ⅲ score was 0.844 (95％ CI:0.806-0.882,P ＜ 0.01),and Youden index was biggest when APACHE Ⅲ score was 70.5.Mortality was high (above 70％) as Oxford acute severity of illness score increased (＞ 40),and Spearman r was 0.976 (P ＜ 0.01).Conclusions Oxford Acute Severity of Illness Score was useful to evaluating the severity and prognosis of critical illness patients and it was easy in clinical practice.

20) were analyzed.ResultsMODS was staged according to "Lu shan conference" diagnostic criteria.In this group of patients there were 27 deaths(24.7%),of which 1 patient(3.9%) was stage I,7 patients(15.6%) stage II,9 patients(45%) stage III,and 10 patients(90.9%) stage IV.Prognosis varied with stage of MODS.The incidence of MODS increased with higher scores of body injury, and mortality rate increased with the increase of the number of failured organs.Conclusions The diagnostic classification of MODS has obvious clinical significance. It (provides) clinicians with an important basis for early diagnosis and treatment of MODS.