Objective To explore the effect of the application of Rivaroxaban in the treatment of the patients with total hip replacement.Methods 114 patients with total knee arthroplasty were randomly divided into control group and observation group,57 cases in each group.All patients were operated by the standard operation in the department of orthopedics.The control group was given low molecular weight heparin before operation.The patients in the observation group were treated with 8h after the operation,and the color Doppler ultrasound was performed on the patients with double lower limbs and lungs after 2 courses of treatment.Observation of drainage,two groups of patients after total blood transfusion,blood index,adverse reactions and deep vein thrombosis cases.Results In the observation group,the deep vein embolism rate (1.75%)was significantly lower than that in the control group of 12.28% (χ2 =4.25,P <0.05 );The postoperative drainage volume,blood transfusion and blood index of the two groups had no significant differences (t =0.57,0.82,1.03,all P >0.05).During the treatment,the patients in the two groups were adverse reactions.Conclusion The effect of oral administration of Rivaroxaban after hip replacement surgery is remarkable,which can effectively reduce the incidence of deep venous thrombosis,and it is safe,and it is worthy of clinical application.

Objectives:To evaluate the role of percutaneous endoscopic gastrostomy and jejunostomy in postoperative critical patients. Methods:Percutaneous endoscopic gastrostomy and jejunostomy procedures were performed in 22 postoperative critical patients.Indication, procedure-related complication, technical success and clinical outcome were reviewed. Results:The technical success was 100% and there were no death and serious complication.PEG/J feeding tubes was used for enteral nutrition for more than 30 days in 21(95%) of 22 patients. In 3 patients (14%) , local cleansing, drainage and intravenous antibiotics were used for the infection of PEG site. PEG/J tube dysfunction occurred in 6 patients (27%). Conclusions:PEG/J is a safe, minimal invasive, and effective procedure for enteral nutrition in postoperative critical patients.

Purpose:To study the efficacy and the toxic side effects of high dose epirubicin containing combination regimen in the treatment of advanced breast cancer. Methods:16 patients with advanced breast cancer were treated with epirubicin (EPI) 100 mg/m 2,CTX 600 mg/m 2,5 FU 500 mg/m 2,every 21 days,Each patient was given at least 2 cycles. Results:There were 2 CR and 9 PR, the overall response rate was 68.8% (11/16). Main side effects were grade Ⅰ—Ⅱ leucopenia, nausea and vomitting, alopecia.Conclusions:This study confirmed that combination chemotherapy with high dose epirubicin is a safe and effective regimen for patients with advanced breast cancer and is worthy of further clinical trial.

Objective To investigate the expression of Sonic hedgehog(SHH)and WNT/β-cate-nin in human pancreatic cancer and explore its clinical significance.Methods Reverse transcription-polymerase chain reaction (RT-PCR) and Western blot assay were used to determine the mRNA and protein expression of SHH and β-catenin in human pancreatic cancer tissue and normal tissues adjacent to cancer.Results The SHH mRNA and protein expression was detected in 81.6% and 79.6% of pancreatic cancer, respectively.The β-catenin protein expression was 71.4% in pancreatic cancer tis-sues.These were significantly different from those of normal tissue adjacent to cancer (P＜0.05).But the expression level of β-catenin mRNA was low in both pancreatic cancer tissues and normal tissues.There was no significant difference between them (P＞0.05).The expression of SHH and β-catenin protein in pancreatic cancer had no correlation with age, tumor size, pathological type and tumor site (P＞0.05), but had a relationship with lymph node metastasis and TNM stage (P＜0.05).The cor-relation between SHH and β-catenin protein was positive (r=0.352, P＜0.05).Conclusion The SHH and WNT/β-catenin signaling pathways were active in human pancreatic cancer.The crosstalk between these pathways may play an important role in the carcinogenesis and development of pancreat-ic carcinoma.

Objective Through investigate dissection of 14v group lymph node of patients with gastric cancer and its metastasis , to explore the influence factors and prognosis of dissection of 14v group lymph node .Methods 120 cases of gastric cancer patients who underwent radical gastrectomy and dissected 14v group lymph node since Mar .2004 to Mar .2012 were analyzed ,through his-topathological and immunohistochemical examination to detect the 14v group lymph node metastasis and calculation .Results Gas-tric antrum carcinoma were detected 176 nodes ,29 nodes were metastasis ,but there were none in other places .About TNM classifi-cation ,14v group lymph node metastasis among patients in stage Ⅳ(5 cases) was 50 .0% ,in stage ⅢC(7 cases)was 33 .3% ;About Borrmann classification ,14v group lymph node metastasis among patients in borrmann type Ⅳ (4cases) was 80 .0% ,in stage Ⅲ(11cases) was 30 .6% ,which were higher than that of other types(P<0 .05) .Among the 18 cases which had 14v group lymph node metastasis ,15 cases(83 .3% )invaded serosa ,invading the surrounding organs .The 5 year rate of 14v group metastasis patients was 7 .7% .Conclusion Gastric carcinoma tumor size ,tumor stage ,Borrmann classification ,invading the surrounding organs and tissues and metastasis in 14v group lymph node have a certain relationship .14v lymph node dissection for lately TNM stage gastric tumor has no certain significance .

Objective\ To investigate the possible mechanism of fasicular ventricular tachycardia(FVT).Method\ Ten cases of FVT with different ECG manifestion and treatment were analysed.Of the 10 cases,8 exhibited LAD and 2 RAD.Ablation was performed on 5 cases;3 cases were treated with verapamil,1 case with lidocaine;in another case ventricular rate was 68bpm,and ventricular escape rhythm was considered.One case exhibited Wenckenbach conduction.Reentry seemed unlikely in these 2 cases.Result\ Reentry was the basis in most cases of FVT,but in some,enhanced automaticity could be the underlying mechanism.

It is proved that there are significant differences in individual susceptibility to lung cancer.Genetic polymorphisms of several enzymes involved in the detoxification and biotransformation might be related to the lung cancer susceptibility.Cytochromes P450,N-acetyltransferases,microsomal epoxide hydrolase,NQO1 are the most frequently investigated genes in recent years.All theses genes appear to be the candidates for lung cancer susceptibility genes.The studies of the relationship between polymorphisms of metabolic enzymes and lung cancer susceptibility will help to find useful biomarkers.An improved understanding of genetic polymorphisms may help to identify individuals who are at increased risk for lung cancer and decrease the incidence of lung cancer.

Objective To investigate the relationship between sonic hedgehog(SHH)signaling pathway and chronic pancreatitis.Methods Thirty Wistar rats were randomly divided into the model group,experimental control group and blank control group,and there were 10 rats in each group.Trinitrobenzene sulfonic acid was infused into the pancreatic duct of the rats to induce pancreatitis in the model group.The pancreatic duct of the rats in the experimental control group were infused with 0.9％ sodium chloride solution.No treatment was performed on rats in the blank control group.The serum levels of bilirubin and amylase of the 3 groups were determined,and the histopathological alterations were studied.Expressions of patched-1(PTCH-1),smoothened (SMO)and SHH were detected by immunohistochemistry.All data were analyzed using the analysis of variance or Student's t test.Results The levels of total bilirubin(TBil)in the model group,experimental control group and blank control group from day 1 to day 35 were(3.17 ±0.21)μmol/L-(9.28 ±2.15)μmol/L,(3.44 ±0.54)μmol/L-(3.76 ± 0.15)μmol/L,(2.45 ± 0.32)μmol/L-(3.27 ± 1.43)μmol/L,respectively.The levels of amylase in the model group,experimental control group and blank control group were(1124 ± 143)U/L-(1522 ± 169)U/L,(1123 ± 104)U/L-(1007 ± 141)U/L,(1014 ± 115)U/L-(1013 ± 142)U/L,respectively.Compared with the experimental group and the blank control group,the serum levels of TBil and amylase in the model group were increased significantly from day 7 to day 35(F =14.81,16.27,18.13,11.49,17.91;11.54,10.24,12.64,21.11,15.38,P ＜ 0.05),and fibrotic proliferation of pancreatic tissues were found at day 35;the expressions of PTCH-1,SMO and SHH in the pancreatic tissue was increased significantly in the model group.Conclusion SHH signaling pathway is activated in the tissue of pancreatitis in rats,it might play an important role in the genesis of pancreatitis.

Objective To review the experience of 162 cases of coronary artery bypass grafting (CABG) via a lower median ministernotomy. Methods CABG through a lower median ministernotomy was conducted in 162 cases from April 1998 to June 2003, including 77 cases of CABG under extracorporeal circulation, 13 cases of CABG concomitant with intracardiac surgery, and 72 cases of off-pump coronary artery bypass grafting (OPCABG). Results There were 1 case of surgery-related death (0.6%) and 1 case of re-operation (0.6%). Postoperative complications occurred in 9 patients (5.6%). In conventional CABGs, the aortic cross-clamp time, cardiopulmonary bypass time, and operation time were 74.8?23.1 min, 113.6?31.3 min, and 255.5?54.5 min, respectively. The operation time of OPCABG was 195.6?50.6 min. The number of anastomoses ranged 1~5 (2.4?0.7). The length of postoperative tracheal intubation was 0~364 h (median, 11 h). The length of postanesthesia care unit (PACU) stay and hospital stay were 1~28 d (median, 3 d) and 5~60 d (median, 10 d), respectively. The chest drainage volume was 607.2?443.0 ml, or 8.6?6.0 ml/kg. A blood transfusion was required in 38 cases, with a transfusion amount of 1161.3?741.2 ml. Conclusions A less invasive approach is possible in coronary artery bypass grafting via a lower median ministernotomy. This procedure provides satisfactory outcomes and good cosmetic results, during which a complete revascularization for multiple vessels and concomitant intracardiac operations are available.

Objective To review the experience of 460 cases of cardiac operations through a lower median ministernotomy. Methods A total of 460 cardiac operations via a lower median ministernotomy route were carried out between January 1997 and August 2003 in this hospital, involving 100 operations for congenital heart diseases, 178 valve operations, 168 coronary operations, 12 operations for aneurysms, and 2 other operations. On operation no special instruments were required. Results Within the hospitalization period 4 patients died (0.9%) and 3 underwent a re-operation (0.7%). Postoperative complications occurred in 29 patients (6.3%). Off-pump operations were employed in 73 patients, while in the remaining 387 patients the cardiopulmonary bypass time was 25~1 115 min (median, 80 min) and the aortic cross-clamp time was 0~164 min (55.8?31.9 min). Of the 460 patients, the length of postoperative tracheal intubation was 0~364 h (median, 10 h), and the postoperative chest drainage was 20~3 290 ml (median, 350 ml), or 0.3~42.2 ml/kg (median, 5.8 ml/kg). Blood transfusion were required after surgery in 280 patients with an amount of 951.1?644.6 ml. The postoperative ICU and hospital stay were 1~28 d (median, 2 d) and 1~60 d (11.6?6.0 d), respectively. A follow-up for 7~80 months (59.2?29.6 months) in 371 patients was conducted. No long-term deaths were noted and symptoms were significantly improved. Heart function was classified as grade Ⅰ in 169 patients, grade Ⅱ in 135 patients, and grade Ⅲ in 67 patients, respectively, with significant difference as compared with that in pre-operation ( Z =-12.57 , P =0.000). No significant difference was observed in the cardiothoracic ratio (0.50?0.11, 0.41~0.67) between postoperative and preoperative period ( t =-1.63, P =0.104). The left ventricular ejection fraction was significantly higher postoperatively (0.36~0.71, 0.606?0.113) than preoperatively ( t =3.43, P =0.001). Conclusions In properly selected cases, heart operations through a lower median ministernotomy provides many advantages including mini-invasion, high reliability, excellent cosmetic results, simplicity to performance, and good surgical outcomes.