Objective To review the effect of neoadjavunt chemotherapy on advanced gastric carcinoma.Methods The CNKI,CBM,VIP and PubMed online databases of clinical study about neoadjavunt chemotherapy in treatment of advanced gastric carcinoma were searched,according to inclusion and exclusion criteria for pooling of essay and Jadad scale was used.Revman software (version 4.2) was used to undertake Meta analysis for evaluating the overall effectiveness.Results Sixteen compared clinical study,1937 patients in total had been included.The results showed that neoadjuvant chemotherapy group was higher than conventional surgery group on radical resection rate and survival rate (OR =1.900,95％ CI1.30-2.77,P ＜ 0.01 for radical resection rate,OR =1.83,95％ CI 1.43-2.33,P ＜ 0.01 for survival rate)and neoadjuvant chemotherapy group was lower than conventonal surgery group on palliation resection rate (OR =0.54,95％ CI 0.33-0.88,P=0.01).But there was no significant difference on pathological stage betwee two groups (OR =1.03,95％ CI 0.62-1.73,P =0.90).Conclusions Existing clinical evidence suggest that neoadjuvant chemotherapy can improve the rate of radical resection and survival.But selection bias due to the existence of including studies and the possibility of measurement bias can affect the outcome of argument strength.So looking forward to more high-quality,randomized and double-blind controlled trial to provide higher quality evidence to guide the rationalization of clinical medicine is work in clinical search.

Objective To evaluate the safety and efficacy of suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy in basic hospital.Methods The clinical datas of 85 patients with large volume and high-risk benign prostatic hypertrophy for suprapubic transvesial prostatectomy in our hospital were retrospectively analyzed.The operating time,intra-operative blood loss,the mean bladder irrigating time,catheration time,hospital stay and operative complications were observed.The indices such as IPSS,QOL,Omax and PVR were recorded preoperatively,and at 6 and 12 months postoperatively.Results The mean operating time was (63.5 ± 18.2) min,the intra-operative blood loss was (121.3 ± 10.6) ml,the mean bladder irrigating time was (4.2 ±0.6)days,the catheration time was (5.1 ± 1.7) days and the hospital stay was (7.8 ±2.3)days.At 6 and 12 months postoperatively,IPSS,OOL,Omax and PRV were significantly different compared with those preoperatively(all P ＜0.05).There were few complications and great patients satisfaction with the post-operative results.Conclusion suprapubic transvesial prostatectomy for the treatment of patients with large volume and high-risk benign prostatic hypertrophy has significant advantages of good safety,simple operation,reliable efficacy in basic hospital.It is an effective and alternative method.

In recent years,with the continuous development of endoscopic and interventional techniques,many new devices and methods have been used in clinical practice,and the application of endoscopic retrograde cholangiopancreatography (ERCP)in biliary and pancreatic diseases has developed rapidly.This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases,including those with altered gastrointestinal anatomy,pregnant patients,patients with benign and malignant biliary strictures,and patients with pancreatic pseudocysts,as well as the application of SpyGlass,photodynamic therapy,and radiofrequency ablation,the man-agement of ERCP-related duodenal perforation,and the prevention of post-ERCP pancreatitis.All the progress has made a great contribu-tion to the diagnosis and treatment of biliary and pancreatic diseases.

Objective To quantitatively assess the neovascularization within human carotid atheroclerltic soft plaque in patients with cerebral infarction using real-time contrast-enhanced uhrasonography. Methods One hundred and forty-two patients with carotid athemselerotic soft plaque were divided into two groups: cerebral infarction group (n = 44)and control group (n = 98).Real-time contrast-enhanced ultrasonography was examined. Acoustics quantitative analysis was made by auto-tracking contrast quantification (ACQ)technology. Results The enhanced intensity (EI)in cerebral infarction group was significandy higher than that in control group[(14.58±4.19)dB vs (11.26±3.77)dB, P< 0.01]. The difference of arrival time (DAT)and the difference of time to peak (DTrP)in cerebral infarction group was significantly shorter than those in control group [(2.21±0.42)s vs (2.46±0.51)s,(2.13 + 0.37)s vs (2.43±0.48)s, P all < 0.01]. Conclusions The real-time contrast-enhanced uhrasonography can provide a new non-invasire and quantitative tool to assess the neovascularizafion within carotid atheroselerofic soft plaque. EI is re-garded as an independent risk factor correhtes strongly with cerebral infarction.

Objective To evaluate the curative difference of laparoscopic cholecystectomy (LC)between elder and middle age.Methods Patients with gallbladder disease who underwent LC from 2006 to 2011 were collected and divided into elder group (≥65 years old,35 patients) and middle age group(＜ 65years old,353 patients).The operation time,conversion rate,postoperative complications,time to first oral intake,time to first ambulation and hospitalization time were compared.These patients were divided into simple gallbladder disease group (included recurrent biliary colic,chronic cholecystitis,gallbladder polyps)and the complex gallbladder disease group (included acute cholecystitis,gallbladder empyema,acute cholecystitis perforation).The age,WBC,operation time,postoperative complicantions and hospitalization time were evaluated.Results The operation time,conversion,postoperative complications rate,time to first oral intake,time to first ambulation and hospitalization time had no significant difference between elder group and middle age group (P ＞ 0.05).The age,conversion rate between simple gallbladder disease group and complex gallbladder disease group had no significant difference (P ＞ 0.05).But the WBC,operatian time,postoperative complications,hospitalization time in simple gallbladder disease group had significant difference compared with complex gallbladder disease group [(7.32 ± 2.12) × 109/L vs.(11.35 ± 4.62) × 109/L,(62.3 ±29.5) min vs.(79.5 ±49.2) min,3.1％(10/322) vs.9.8％(5/51),(5.0 ±3.7) d vs.(7.9 ± 6.5) d,P ＜ 0.01 or ＜ 0.05].Conclusions Age is not the risk factor of LC in elderly patients,but the disease type has a significant effect on the choice of LC.

Both of "Medical Microbiology"and "Medical Immunology"are two important basic and required medical courses for college students.There is something worth discussing in some respects,including the composing of teaching materials,designing of curriculum,key points of teaching and practical application.It's necessary to deal with the relationships well between the teaching effects and the issues such as arrangements of class period,selection of teaching material and the design of teaching.Particularly,we should emphasize close connection between the basic and clinical course.

BACKGROUND: With development of modern medical sciences, the out comes after meningioma surgery cannot be fully assessed using morbidity,livability and mortality merely. Quality of life (QOL) is a health-related multivariable index, which provides integrated inf ormation associated with physiological,sychological and social adaptation status of the patients to doctors. Assessment of the QOL in meningioma patients may be one of a relatively good method for guiding surgery and reducing reoccurrence of tuOBJECTIVE: To evaluate the QOL in meningioma patients and then to provide relevant data for assessing the outcomes of meningioma surgery comprehensively.DESIGN: It was a single-sample investigation. SETTING: Neurosurgery Department, Second People's Hospital of Wuxi City of Nanjing Medical University.PARTICIPANTS: Totally 147 patients underwent meningioma surgery in the Neurosurgery Department of the Second Affiliated Hospital of Wuxi City affiliated to Nanjing Medical University between January 1995 to January 2001 were selected, 61 males and 86 females, with a male/female ratio of 2:3 and an age ranging from 5-77 years old, in average of 43 years old, and the median was 43 years old.METHODS: Based on World Health Organization Quality of Life 100item questionnaire (WHOQOL-100) and Karnofsky Performance Scale (KPS), we designed a questionnaire on QOL in patients with meningioma.Outcomes of the transverse investigation on 147 meningioma patients were compared with healthy controls. Surgery-related QOL curve was used for identifying the threshold satisfactory point of QOL. In addition, with selfcontrol, influence of surgery on QOL was assessed.MAIN OUTCOME MEASURES: Relationship between QOL and clinical histories, radiological analysis, operation grading, histological properties and reoccurrence were investigated.RESULTS: All of the 147 patients entered the statistical analysis. ①In patient with meningioma, Cronbach's coefficient was 0.9521 and the correlated coefficient was 0.8685, which suggested that QOL questionnaire for patients with meningioma had a good reliability and validity. ②QOL ≥70 represented that the patient was satisfied with the QOL. ③In patients underwent surgical treatment, their physiological functions, self-help and self-care except for psychological functions were significantly improved (P ＜ 0.001 ).CONCLUSION: Surgical treatment enables patients to get a satisfied QOL. QOL questionnaire for patients with meningioma is helpful to provide relevant data for meningioma operation.

Objective To study the effeciency of endoscopic balloon dilat ation(EBD) for benign structures of colorectal anastomosis. Methods Fifteen cas es with benign stenosis of colorectal anastomosis(BCAS) were treated with endosc opic balloon dilatation,of which sigmoidectomy was performed in one case,and ant erior resection was performed in 14 case;stapler was used in 13 case,and hand su tura was used in 2 cases.Diameters and lengths of strictures were ranging from 0 .2～ 0.7 cm and 0.5～ 2.0 cm respectively. Results Strictures of all 15 patients were dilated successfully.There were no complications in this series.Follow－ u p has been from 3～ 30 months without recurrence of symptoms. Conclusion EBD is safe,efficient and well tolerated,and should be considered as the first choice o f treatment of BCAS.

Objective To investigate the correlation between levels of erythrocyte natrium(EN),magnesium(EM),adenosine triphosphate enzyme(Na + K + ATPase,Ca 2+ Mg 2+ ATPase) activity versus urine natrium(UN),urine endogenous digitalis like substances(UEDLS) change in patients with acute cerebral infarction(ACI) Methods 35 patients with ACI were measured in UEDLS,the changes of UN,erythrocyte membrane ATPase activity,and levels EN,EM,and compared with the normal controls Results Levels of UN,UEDLS,EN were significantly elevated( P

Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( ? 2 =19.5 and 16.33; P