Objective To study the risk factors of complications of 364 cases in treatment of rad-ical esophagectomy.Methods 364 patients underwent two or three-incision radical esophagectomy and the clinic data were retrospectively analyzed.After review of the reference,ten factors were regarded as the potential risk factors of postoperative complications,then univariate and multivariate analyses were per-formed.Results In 364 patients,66 patients had complications of this research field within postoperative 6 months.By univariate analysis,preoperative nutritional risk score、T-staging、preoperative complications、operation time、operation experience、anastomotic position、anastomotic extra manual suturing were deter-mined as influence factors.By multivariate analysis,preoperative nutritional risk score≥3、T-staging score≥3、preoperative complications、operation time≥240 min、cervical anastomosis were determined as risk factors,anastomotic extra manual suturing was determined as a protective factor.Conclusion The risk factors of the complications after radical esophagectomy are preoperative nutritional risk score≥3、T-stag-ing score≥3、preoperative complications、operation time≥240 min、cervical anastomosis;and the protective factor is anastomotic extra manual suturing.Paying attention and controling these risk factors may reduce the occurrence of postoperative complications.

Objective Through the optical microscopic observation to investigate the pathological influence of topical oxygen therapy on wounds of rats' muscles in hot and humid environment. Method The rat traumatic models were established. Twenty-four rats were randomly divided into four groups, including normal envi-ronment comparison group (NEC group, n=6), normal environment oxygen therapy group (NEO group, n=6). hot and humid environment comparison group (HHE group, n=6), hot and humid environment oxygen therapy group (HHO group, n=6).Then all rats were sampled to observe the changes of rats' muscle under optical microscope. Results Pathologic histology of muscle cells were obviously changed in HHE group. In these rats. disorganized myofibrillae with some loss of myofilaments. The damage of the muscle fibers in HHO group were better than that in HHE group. The damage of muscle ceils in NEC group were slighter than that in HHE group, the muscle of rats in NEO group are all normal. Conclusion In hot and humid en-vironment pathologic histology changes of wounds were serious, topical oxygen therapy could relieve muscle tissue ultrastructures change.

Objective To study the effects of different hypertonic saline (4.5%and 7.5%) in fluid resuscitation on hemodynamics in traumatic rabbits with hemorrhagic shock.Methods Thirty-two healthy rabbits ( male or female, 2.0-3.0 kg body weight) were divided into 4 groups randomly:SHAM group, SWT group ( shock without treatment) , 4.5%group (resuscitation with 4.5% hypertonic saline), and 7.5% group ( resuscitation with 7.5% hypertonic saline), 8 rabbits in each group.The rabbit model of uncontrolled hemorrhagic shock was established after anesthesia.The fluid used in the two methods of fluid resuscitation was infused into the rabbits at designed times.The hemodynamic data including the left intraventricular systolic pressure ( LVSP) and maximal change rate of left intraventricular pressure ( ±dp/dtmax) were determined at 0 min, 30 min, 60 min, and 90 min.Results (1) The rabbit models of uncontrolled hemorrhagic shock were generated successfully.At 30 min, data of SWT in the 4.5%and 7.5%groups had no significant difference through pairwise comparison (P>0.05).(2) The hemodynamic parameters changed similarly during the experiment.At 60 min, the values of the 7.5%group ( LVSP=115.00 ±8.37 mmHg, +dp/dtmax=4.29 ±0.50 mmHg/ms, -dp/dtmax=-3.25 ±0.25 mmHg/ms) were significantly higher than those in the 4.5%group ( ( LVSP=104.14 ±7.73 mmHg, +dp/dtmax=3.35 ±0.39 mmHg/ms, -dp/dtmax=-2.27 ±0.12 mmHg/ms) (P<0.05).At 90 min, the data of the 7.5%group were higher, but statistically not significantly different ( P>0.05 ) .Conclusions Fluid resuscitation can improve the hemodynamic function in traumatic rabbits with uncontrolled hemorrhagic shock.Comparing with the 4.5%hypertonic saline, 7.5% hypertonic saline can improve the hemodynamic function more apparently.Our results may provide an experimental support for the treatment of clinical patients with uncontrolled hemorrhagic shock.

The Arabidopsis thaliana glutathione S-transferases zeta class (AtGSTZ) is a multi-functional enzyme, which plays important role in cellular metabolism and environmental purification. Error-prone PCR and cycles of DNA shuffling were used to construct a mutagenesis library of AtGSTZ. The screening of the resultant libraries was carried out by a pH indicator dye-based colorimetric assay. Nine mutants which enhanced the dichloroacetic acid dechlorination activity were obtained. Among them, NN23 contained 25 amino acid substitutions with the activity improving 120%, whereas NN20 contained 24 amino acid substitutions with the activity improving 102%. EC1 contained 2 amino acid substitutions with the activity improving 47%. The rest 6 mutants contained one amino acid substitution with their activity increasing from 9% to 60%. The enzymatic characterization showed that all the evolved enzymes increased their catalytic efficiencies towards dichloroacetic acid and binding affinity towards glutathione whereas some of them increased the renaturability. However there is no obvious change in their thermostability. Based on these data, functional residues related to catalysis and refolding of AtGSTZ were discussed.

To popularization and improvement of on-the-spot rescueability is a vital means to reduce the accidental disability rate and the mortality rate,which is also a prospective concept of health.To popularize on-the -spot rescue knowledge and to improve self and mutual medical aid is a strongly public welfare and is the manifestation of social responsibility as well as respect for life.Based onthe investigation of on-the-spot rescue ability among three higher vocational college students in Shaanxi,this paper pointed out that the popularity rate of on-the -spot rescue knowledge was low among higher vocational college students,which no longer kept pace with the demand of social development and occupational requirement.It also analyzed the importance and urgency of improving higher vocational students'on-the-spot rescue ability from the perspective of social ethics.Strengthening the propaganda and training self-rescue skills might be a possible way to enhance students' on-the-spot rescue ability.

Objective To evaluate the imaging characteristics of atypical teratoid/rhab doid tumor (AT/RT) of central nervous system(CNS), and to improve the diagnostic ability of the disease. Methods The clinical and imaging findings of 9 patients were retrospectively analyzed. There were 5 male and 4 female, ages 7 months to 5 years,median age was 1.4 years. MR enhancement studies were obtained in all the cases. One case had CT enhancement examination. Results The lesions were seen in brain in 8 cases and in lumbosacral spinal cord in one case. The tumors size varied from 4.8—7.8 cm, Necrosis was seen in nine cases, cystic change in eight cases and hemorrhage in five cases. The tumors had high signal on DWI, and low signal on ADC map. Dura matter invasion(2 cases), cerebrospinal fluid spread(2 cases)and intracerebral metastasis were seen. Conclusion There are some relatively specific imaging findings of primary CNS AT/RT that could assist their diagnosis.

BACKGROUND: As it results in minimal trauma and physical influence or interference, and a better curative effect, the minimally invasive surgery is preferred in clinic. However, the perioperative stress reaction of minimally invasive surgery needs further study.OBJECTIVE: To evaluate the levels of neurohormone, C-reactive protein (CRP) and the changes of resting energy expenditure (REE) resulted from the operative stress reaction due to minimally invasive surgery in arthroscopy on knee joint.DESIGN: Controlled observation and analysis.SETTING: Department of Orthopaedics, Affiliated Hospital of Xiangnan University and Department of Orthopaedics,Xiangya Hospital of Central South University.PARTICIPANTS: Sixteen patients with meniscal lesions in knee and 26 with cruciate ligament injury, which were closed injury, were selected from the Department of Orthopaedics of Affiliated Hospital of Xiangnan University and Xiangya Hospital of Central South University between January 2003 and April 2004. Meniscal lesions were diagnosed according to the physical examination, drawer test combined CT and MRI examination, and the patients were in accordance with the indication of arthrotomy; cruciate ligament injury according to the physical examination, grinding test combined CT and MRI examination. Those with open injury, body multiple injury, combined injury and emergency operation were excluded. Ten patients with meniscal lesions and 12 with cruciate ligament injuries underwent minimally invasive surgery on knee joint as minimally invasive surgery group (MIS). The others were given traditionally invasive surgery on knee joint as the traditional group. The informed consent was obtained from the patients.METHODS: Fasting venous blood was taken on the morning of 1 day before, and 1 and 3 days after operation, which was analyzed within 2 hours after sampling. ①All hormones were quantitatively assayed. Serum insulin was determined by competitive radioimmunoassay (RIA); growth hormones levels by double-antibody RIA; serum cortisol by competitive RIA; CRP by nephelometry, respectively. ②Energy metabolism detection: The energy consumption was assessed by indirect calorimeter on the morning of 1 day before, 1 day and 3 day after operation, respectively. All the detection was performed by medical graphics critical care monitor desktop analysis system. Based on the indirect calorimeter theory,REE and respiratory quotient (RQ) were figured out.MAIN OUTCOME MEASURES: ①Concentrations of insulin, growth hormones and cortisol of patients at 1 day before, 1 day and 3 day after operation; ②Resting energy consumption, RQ and CRP of patients at 1 day before, 1 day and 3 day after operation.RESULTS: Totally 42 patients were involved in the result analysis. ①On the third postoperative day, the insulin levels of the traditional group were lower than those before operation [(12.4±1.1), (17.5±2.2) mlU/L, P ＜ 0.05]; On the first postoperative day, the levels of growth hormone of the traditional group were significantly higher than the MIS group [(2.8±0.9), (5.3±2.4) μg/L, P ＜ 0.05], and on the third day after operation, the levels of the MIS group were remarkably increased compared with those before operation [(1.4±0.5), (1.0±0.3) μg/L, P ＜ 0.05]; the cortisol levels of the traditional group on the first postoperative day were higher than the MIS group [(1.12±0.25), (0.59±0.11) μmol/L, P ＜ 0.05]. ②REE levels of the traditional group and MIS group on the first day after operation were(1437.8±415.9) and (1223.8±179.9) K,higher than those before operation [(1 186.4±297.4), (1 160.7±158.6) K, P ＜ 0.05]; on the first and third days after operation, REE levels of the MIS group were higher than the traditional group [(1 223.8±179.9), (1 151.7±150.8) K;(1 437.8±415.9), (1 329.4±350.5) K, P ＜ 0.05]. ③RQ of the traditional group and MIS group on day 1 after operation were all (0.8±0.05), lower than that before operation (0.9±0.11, 0.9±0.15, P ＜ 0.05). ④On the first and third days after operation, CRP of the MIS group were lower than the traditional group [(14.8±2.5), (34.37±7.5) mg/L; (64.1±14.4),(93.87±12.7) mg/L, P ＜ 0.05], but higher than that before operation [(8.0±0.11) mg/L, P ＜ 0.05].CONCLUSION: Minimally invasive surgery on knee joint results in less trauma, low stress reaction and slight influence on metabolism of patients, moreover, it benefits the restoration of stress hormones, nitrogen balance and energy metabolism.

Objective To observe the curative effect of pure 1 25 I treatment to non-small cell lung cancer combined obstructive pneumonia.Methods 28 cases with non-small cell lung cancer combined obstructive pneumonia were enrolled.Treatment planning system was used to calculate the dosage of tumor and make up the therapeutic plan.CT-guided radiation treatment of particle im-plantation was then conducted.Follow-up was done to evaluate the curative effect one to two months after treatment.Results The total effective rate of therapeutic evaluation was 89.3%.Clinical symptoms including chest distress,hard breathing and fever were ameliorated remarkedly.Life quality score of appetite and fatigue was also improved.White blood cell reduced significantly in blood routine examination.Conclusion There is a definite curative effect of pure 1 25 I treatment to non-small cell lung cancer combined ob-structive pneumonia.

Objective To explore the technique of breast reconstruction after mastectomy. Methods 30 cases of patients with breast cancer who were not suitable for breast conservative surgery were sum-marized. Among them, immediate breast reconstruction with prosthetic implants after mastectomy was used in 16 patients, transverse rectus abdominis musculocutaneous flap (TRAM flap) in 10 patients, and latissimus dorsi musculocutaneous flap in 4 patients. There were 27 patients who underwent immediate breast reconstruction, while 3 patients underwent delayed breast construction. Results The appearance was good in 16 cases of breast reconstruction with prosthetic implants and no complications were found. Two out of the ten patients who had the transevarse rectus abdominis musculocutaneous flap (TRAM flap) breast reconstruction had partly necrosis of skin flap, and one lateral ventral syndrome. The appear-ance of the 7 cases after the TRAM flap breast reconstruction evaluated well, 2 cases moderate, and one case less satisfactory. The appearance of 4 patients who had breast reconstruction with latissimus dorsi musculocutaneous flap evaluated well. Conclusion Breast reconstruction is an important part of combined therapy for the breast cancer, especially for the patients who have strong desire to conserve breast, while incompetence for breast conserving surgery. In such a case breast reconstruction is a good choice. Imme-diate breast reconstruction is better than delayed breast construction. The appropriate method of breast reconstruction depends on each individual patient. Patients with locally advanced breast carcinoma can se-lectively choose immediate breast reconstruction.