Objective To evaluate the treatment results and side-reactions of esophageal carcinoma with late course hyperfractionated radiotherapy ( LCHR) plus different chemotherapy. Methods A prospective research was carried out on 287 advanced stage esophageal carcinoma patients whom were randomized into there groups;LCHR + cisplatin +5-fluorouracil +leucovorin group( A group), LCHR +5-fluorouracil polyphase lipo- some group (B group) and LCHR group(C group). 115 patients were in A group and 107 patients in B group and 65 patients in C group. Radiotherapy method; there groups were treated by conventional fractionated radio- therapy during the first two-thirds of the whole course with 40 Cy,then followed by isocenter hyperfractionated radiotherapy to keep away of spinal marrow, 1. 3-1. 5Gy per time,2 times a day and 5 days a week. The total dose was 60-66 Gy in A, B group and 60-70 Gy in C group. The preventive dose was 50 Gy. Results There was no statistically difference among the there groups on the short-term curative effect The 1- ,2- ,3-year local control rate was 80% ,50.4% ,42.6% and 72.9% ,51.4% ,41. 1% and 63.1% ,38.5% ,30.8%

Comprehensive therapy is widely received for esophageal carcinoma in our country and worldwide. The treatment approaches consist of sugery,radiotherapy and chemotherapy,and chemoradiation therapy is very important. Many randomized controlled studies and meta-analysis reveal that preoperative neoad-juvant chemoradiotherapy and radical concurrent chemoradiation are the preferred modalities for local advanced esophageal carcinoma.

Objective To investigate the effect of acupuncture plus astragalus polysaccharide on the expression of Bcl-2 protein in pancreatic islet b cells in db/db mice. Method C57BL/Ksj-db/db mice as an animal model of spontaneous type 2 diabetes were selected for this experiment. Five-week-old db/db mice were randomized into model, acupuncture, medication and acupuncture+medication groups. Meanwhile, db/m mice were selected as a normal group. The acupuncture group received acupuncture at points Housanli (equivalent to Zusanli, ST36), Neiting(ST44) and Yishu(Extra) and the medication group, an oral gavage of astragalus polysaccharide (1400 mg/kg). Both groups were treated once daily, for 12 consecutive weeks. After the end of experiment, blood glucose, insulin and resistin were measured, and the expression of Bcl-2 protein in islet b cells was determined by immunohistochemical method. Result Blood glucose, insulin and resistin levels were significantly lower in the acupuncture+medication, acupuncture and medication groups than in the model group. They were significantly lower in the acupuncture+medication group than in the acupuncture and medication groups and significantly lower in the acupuncture group than in the medication group. The expression of Bcl-2 protein in islet b cells was higher in the medication, acupuncture and acupuncture+medication groups than in the model group; there was a statistically significant difference (P<0.01). The expression of Bcl-2 protein was higher in the acupuncture+medication groups than in the medication group (P<0.01) and it was basically the same in the medication group as in the acupuncture group; there was no statistically significant difference (P>0.05). Conclusion Acupuncture plus astragalus polysaccharide can significantly reduce blood glucose and serum insulin and resistin levels and increase the expression of Bcl-2 protein in islet b cells to effectively inhibit apoptosis in islet b cells in db/db mice. Its effect is better than that of acupuncture alone or medication.

Objective To discuss the problem of upper respiratory tract infection presenting various clinical manifestations in adults thereby likely making misdiagnosis and to put forth the patients with the symptom of acute abdominal pain as examples in order to caution emergency physicians to avoid misdiagnosis and mistreatment.Methods Data of 58 adult patients with upper respiratory tract infection were collected from January 2010 to December 2011.The chief complain of these patients was acute abdominal pain.After analysis of data including clinical history,symptoms and signs,laboratory findings and medication,patients were divided into two groups post hoc:correctly diagnosed group (group A) and misdiagnosed group (group B).In group A,anti-chill medicine such as tylenol cold tablets (a compositus of paracetamol,pseudoephedrine hydrochloride,dextromethorphan and chlorpheniramine) was given to patients,while in group B,anisodamine (muscarine cholinergic blocker) and antibiotics were given instead of anti-chill medicine.The anti-chill medicine such as tylenol cold tablets would be given to patients of group B when abdominal pain was not released 8-48 hours after treatment.The course of treatment and outcome of patients in the two groups were observed.Results Of 28 patients in group A,27 had abdominal pain relieved or disappeared 2-3 hours after treatment and only 1 patient had abdominal pain lasted 12 hours after treatment.Of 30 patients in the group B,only 2 patients presenting the symptom of acute gastroenteritis got totally relived 2-3 hours after treatment,while the rest of 28 patients did not get rid of abdominal pain,or only had brief period of painlessness after anisodamine injection.Alternatively,8-48 hours later as Tylenol Cold Tablets was given to patients of group B,the abdominal pain was relieved or disappeared after 2-3 hours without recurrence in 2-48 hours.Conclusions Upper respiratory tract infection manifests diversely in adults,and acute abdominal pain could be a main clinical manifestation.Anti-chill medicine,such as tylenol cold tablets,has a noticeably therapeutic effect for acute abdominal pain caused by upper respiratory tract infection in adults,while anisodamine injection makes poor efficacy.

OBJECTIVE:To investigate the curative effects of alfacalcidol soft capsules combined with calaium carbonate tablet on secondary hyperparathyroidism(SHPT)associated with chronic renal failure(CRF).METHODS:55patients were assigned to dialysis group(28cases)and non-dialysis group(27cases),both groups had taken oral alfacalcidol soft capsules in combination with calcium carbonate tablet continuously for3months.Then the changes in serum Ca 2+ ,P 3- ,PTH,AKP and Cr levels were observed.RESULTS:After treatment,serum Ca 2+ concentration was significantly increased(P

Objective To investigate the effects of intravenous fluid restriction on complications after biliary surgery.Methods The clinical data of 168 patients who received biliary surgery at the Nanjing General Hospital of Nanjing Military Command from October 2006 to March 2008 were prospectively analyzed.All patients were randomly divided into test group(85 patients received fluid restriction treatment)and control group(83 patients received conventional treatment)by the sealed envelope method.The difference in the fluid volume between the 2groups was observed.Differences in systemic complication rate,local complication rate,general complication rate,time to bowl movement,length of hospital stay and mortality between the 2 groups were compared.All data were analyzed using the chi-square test,t test,Fisher exact test,Results The median total volumes of fluid in test group and control group were 1450 ml and 2420 ml,respectively,with significant difference between the 2 groups (t=-5.067,P<0.05).The median volumes of erystalloid solution in the test group was 850 ml,which was significantly lower than 1500 ml of the control group(t=-15.190,P<0.05).The postoperative systemic complication rate and general complication rate of the test group were 9%(8/85)and 19%(16/85),which were lower than 22%(18/83)and 30%(25/83)of the control group.There was a significant difference in the postoperative systemic complication rate between the test group and the control group(x2=4.837,P<0.05).The time to bowl movement and length of hospital stay were 2 days and 9 days in the restriction fluid group,which were significantly shorter than4 days and 12 days in the control group(t=-8.102,-2.003,P<0.05).The mortalities of test group and control group were 2%(2/85)and 4%(3/83),respectively,with no significant difference between the 2 groups(P>0.05).Conclusion Fluid restriction reduces the complication rate,shortens the length of hospital stay and accelerates recovery after biliary operation.

Objective To analyze the clinical, radiological, pathological and microbiological features of invasive pulmonary aspergillosis (IPA) to improve clinical management.Methods Retrospective analysis of 20 pathologically and/or microbiologically confirmed IPA cases in our hospital from January 2005 to August 2008. Results Group A (with underlying diseases) included 13 patients (underlying malignancy in 9 patients, including 5 cases of hematological malignancy, COPD in 2 patients, pulmonary tuberculosis and bronchiectasis in 1 each). Group B (without underlying disease) included 7 patients (2 patients with a long time of fluffy toy contact, another 1 had exposure to moldy rice, and 3 had exposure to polluted water). All these 20 patients had pulmonary invasion revealed by CT imaging. Multiple changes were identified in 16 patients. Bilateral pulmonary infiltrates and/or consolidation were revealed in 7 patients. Multiple nodules were seen in 9 patients. Four patients had solitary lesions, including isolated nodules in 2 patients and segment consolidation in the other 2 patients. Pulmonary cavity without fluid level was found in 8 patients (40.0%). Eighteen cases received antifungal therapy. The overall efficacy rate was 55.6%. The efficacy rate in group A and B was 45.5% and 5/7 respectively. The average time to symptomatic relief was (12.0±2.8) days. The time to lung lesion improvement on CT was (17.4±2.9) days. The time to significant CT improvement was (34.3±9.9) days. The time to the resolution of active lesion was (56.4±6.2) days.Conclusions IPA may occur in immunocompetent patients without underlying disease. Most IPA patients have bilateral multiple pulmonary nodules and cavities on CT. The time to the resolution of active pulmonary lesions is about 6 weeks.

Objective To investigate the accuracy and promptness of thromboelastography (TEG) to assess the blood transfusion requirements after abdominal operation in comparison with conventional assessments including vital signs (MAP,heart rate,breathing rate),urine output,hemoglobin and hematocrit.Methods From June to December in 2010,there were 57 patients were suspected bleeding in abdominal cavity after operation in SICU.Recorded data including vital signs (MAP,heart rate,breathing rate,oxygen saturation),urine volume per hour,the coagulation tests (Fib,PT,aPTT,INR),TEG parameters (R,K,Angle,MA,CI),the results of blood routine (Hb,Hct,Ph) and whether bleeding or not,blood product requirements within 24 h.Results Vital signs (MAP,heart rate,breathing rate,oxygen saturation),urine output per hour and the coagulation tests (Fib,PT,INR) showed no significant correlations (P ＞ 0.05) with blood transfusion requirements,but aPTT (R =0.513,P =0.000) and MA (R =0.578,P =0.000) correlated with the blood transfusion requirement.Patients with reduced MA needed more blood transfusion requirements.Patients were divided into active bleeding group and insidious bleeding group.MA had significant difference between two groups (P =0.025),but aPTT had not.Conclusions Thrombelastography is a more accurate indicator of blood transfusion requirements,especially in active bleeding patients.

This paper introduces the development and the key technology of image guided Surgery Systems (IGSS) and analyses its prospect in this paper. IGSS can be used in clinical surgery as an assistant tool, and it would be an advanced medical equipment combined with medical robotics.
Robotics ; Surgery, Computer-Assisted ; instrumentation ; methods