Objective To explore the effect of combination application of preoperative carbohydrate loading and sequential enteral nutrition on the recovery of postoperative patients with stomach neoplasm.Methods Ninety-eight patients with stomach neoplasm were randomly divided into three groups.Those were Group A (preoperative fasting + sequential EN,n =33),group B (preoperative carbohydrate loading + postoperative TPN,n =33) and group C (preoperative carbohydrate loading + sequential EN,n =32).Insulin sensitivity (IS) ; Nutritional indicators including pre-albumin (PA) and transferrin (TRF) ; immunity parameters including IgG,IgM and IgA were measured in blood on the day before the operation,the 1st day,4th day and 8th day after the operation.Meanwhile,anal exhaust time after the operation,incidence of complications and postoperative hospitalizing time were also observed.Results The level of IS in group C at 4th day and 8th day after operation were 35.8 ± 3.2 and 36.1 ± 3.5,higher than those in A group and B group (A group:30.7 ±3.3,33.5 ±2.9;B group:33.7 ±3.1,34.0 ±2.2),and the differences were significant((F =20.88,7.28 ;P ＜0.05).At the 4th day after the operation,the levels of PA in group B and group C were (191 ± 11.6) mg/ and (193 ± 12.7) mg/L,significantly higher than those in group A ((176 ± 14.1) mg/L;F =17.15,P ＜ 0.01).At the 8th day after the operation,the levels of PA and TRF in group C were (221.3 ±30.81) mg/L and (86 ± 0.37) g/L,significantly higher than those in group A and group B (group A:(198.0 ± 30.6) mg/L,(1.60 ± ±0.33) g/L;group B:(202.0 ±28.6) mg/L,(1.61 ±0.34) g/L;F =5.42,5.83 ;P ＜0.01).At the 8th day after the operation,the levels of IgA,IgG and IgM in the group C were (2.74 ±0.69) g/L,(14.55 ±2.57) g/ L,(1.08 ± 0.33) g/L,significantly higher than that in group A and group B (group A:(2.30 ± 0.54) g/L,(12.71 ±2.94) g/L,(0.86 ±0.31) g/L;group B:(2.29 ±0.50) g/L,(12.06 ±3.33) g/L,(0.89 ±0.27)g/L;F =6.12,6.13,4.94;P ＜ 0.05).Conclusion The combination of preoperative carbohydrate loading and sequential enteral nutrition can reduce insulin resistance,improve postoperative nutritional status,improve the recovery of immune function and intestinal function,as well as reduce the incidence of postoperative complications.

Objective To To evaluate the efficacy of Guglielmidetachable coil (GDC)F embolization in treatment of intracranial aneurysms and summarize the main points of GDC manipulation.Methods Thirty two patients were examined with digital substraction angiography (DSA) and 34 intracranial aneurysms were found, including 15 aneurysms in the anterior communication artery, 13 in the posterior communi cation artery, 2 in the middle cerebral a rtery, 1 in the anterior cerebral artery and 1 Ophthalmic artery. After wards GDC was used for embolization therapy. Results Thirty two patients with 34 aneurysms were successfully embolized with GDCs. Complete embolization achieved in 20 patients and incomplete in 12 patients; while one aneurysm ruptured during the performance, but all curedafter treatment. Vas cular spasm occurred in 2 patients, one of them had slight hemiplegia. Sixpatients with 7 aneurysms were followed up by DSA examinationl year after operation. No obvious change was observed.Conclusions Treatment of intracranial aneurysms with GDC embolization is a safe, reliable, and effective measure. Skillful techniques of the operator and correct management of complications are important factors affecting the outcome of operation. A period follow up is essential to patients with partial embolism.

Objective To explore the outcomes of endoscopic minimally invasive surgery as a new technique for the treatment of glossopharyngeal neuralgia.Methods From January 2000 to May 2008,16 cases of primary glossopharyngeal neuralgia were treated by endoscopic minimally invasive surgery through suboccipital retrosigmoid approach in our hospital.We made a 6-to 8-cm vertical incision within the inner hairline to drain the cerebrospinal fluid from the cerebellopotine angle cistern(CPA) so that to form an operational path.And then,the adherent arachnoid membrane was freed and the structure of the glossopharyngeal nerve and local arteries were detected.Results After the endoscopic surgery,pharyngeal pain disappeared in all of the 16 cases.Follow-up was available for 3 months to 8 years in the patients(1-3 years in 4 cases,and 3-8 years in 2 cases).Two patients had hoarse voice after the operation.No one had dysphagia or recurrence during the follow-up.Conclusion Endoscopic surgery through suboccipital retrosigmoid approach is a minimally invasive method for primary glossopharyngeal neuralgia with good outcomes,mild surgery-related complications,and quick post-operative recovery.

This paper explores the existing gene doping problems of athletes in bioethical aspect,describes the development of gene doping,and points out that strengthening the anti-doping education,further improving legal system and strengthening an effective supervision and anti-doping research are main focus of anti-doping work currently.

Objective To discuss the application of Chaperon guiding catheter system in endovascular treatment of intracranial aneurysms. Methods A total of 20 patients with intracranial aneurysms were enrolled in this study. The patients hadⅡorⅢtype of aortic arch (n=11) or sclerotic plague at the orifice of internal carotid or vertebral artery (n = 9). Endovascular embolization of the intracranial aneurysm was carried out in all patients. By using Cordis guiding catheter system the catheter was placed into the target artery. Chaperon guiding catheter system was used during the procedure in order to determine whether the Chaperon guiding catheter could be smoothly placed into the target artery or not. Results When the Chaperon guiding catheter system was employed in the endovascular procedure, the difficulties of catheterization caused by the distortion of the aorta or by the plagues on the walls of arteries could be basically overcome. The Guiding catheter could be smoothly placed into the target arteries. Conclusion The Chaperon guiding catheter system can be successfully used in the endovascular treatment for the intracranial aneurysms, especially when the patient has tortuous aorta or there is sclerotic plague on the artery wall. (J Intervent Radiol, 2014, 23:281-283).

Objective To evaluate the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis of middle cerebral artery (MCA). Methods Thirty-two cases with recurrent symptomatic MCA stenosis resistant to medical therapy treated by self-expanding stent were reviewed retrospectively [average (49±19) years old, 13 women]. All patients underwent angioplasty and stenting with the Gateway balloon-Wingspan stent system. After 6 months, all patients were followed up by telephone or clinic, and advised followed up with DSA or TCD. Results Thirty-two patients were successfully stented during the first treatment session. The mean degree of stenosis reduced from (76.5±15.4)% to (19.3±9.2)%. The number of complicating subarachnoid hemorrhage was one, and occlusion occurred on one patients related to balloon angioplasty. During a follow-up of 6 months, there was no recurrence of transient ischemic attack or stroke in 32 available patients. Cerebral hemodynamics using transcranial Doppler monitoring were normal in 19 follow-up patients. Six-month angiographic follow-up was obtained in 5 patients, demonstrating good patency in 5 stenting vessels. The other patients refused to perform TCD or DSA. Conclusions Wingspan stent for symptomatic stenosis of middle cerebral artery appears to be a safe and feasible under strict control of periperformeral project. However further study is needed to evaluate the long-term effect.

Objective To analyze the plasty of the tip framework and the nasal tip in insufficient-lining cases with auricular and septal cartilage.Methods The tip framework was formed by using septal extension graft (SEG) and columellar strut (CS) to construct the main framework of nasal tip,and then according to the size of the graft the next processes were chosen for supporting structure.When the graft size met the tip position,the caudal margin of the framework could be beyond the maximum stretch position of the lower lateral cartilage and reached or was close to the expected tip position.When the graft size was insufficient,auricular cartilage was used to hold the caudal margin of the framework to extend or to heighten the framework further.Refined plasty of nasal tip was as follows:when the end of framework was higher than or equal to the dome above 3 mm,auricular cartilage strip was used to reconstruct the dome;when less than 3 mm,multilayer onlay grafts were used to heighten the dome.Results From May 2013 to May 2015,42 cases were followed up from 6 months to 18 months.18 cases belonged to the type 1,including 13 cases using ear cartilage to reconstruct dome,5 cases using onlay graft;24 cases belonged to the type 2,including 14 cases using onlay graft and 10 cases using ear cartilage to reconstruct the dome.They all got good results.Conclusions To the insufficient lining cases,the appropriate method can be chosen to form stable tip framework according to the preoperative design and the graft size.Then onlay grafts or dome reconstruction technique is used to form the tip.Most of the insufficient-lining cases can get satisfactory results.

Objective To study the effects of permissive hypercapnia (PHC) on inflammatory factors of pulmonary tuberculosis patients with one-lung ventilation (OLV).Methods Sixty pulmonary tuberculosis patients with selective thoracic operation who were hospitalized at Hangzhou Red-cross Hospital from October 2010 to October 2013 were randomized into three groups by means of random digits table.Twenty patients were enrolled as control group whose arterial partial pressure of carbon dioxide (PaCO2) was maintained at 35-45 mmHg (1 mmHg=0.133 kPa),20 patients as lower PHC group whose PaCO2 were maintained at 50-55 mmHg,and 20 patients as higher PHC group whose PaCO2 were maintained at 56-60 mmHg.The concentrations of serum interleukin (IL)-6 and IL-8 were measured at the time when the patients were in supine position by two-lung ventilation after induction of anesthesia (T1),15 minutes (T2) and 30 minutes after OLV (T3) in lateral position,two hours (T4) and 6 hours after operation (T5).Quantitative data were analyzed by t-test.Results IL-6 at T3 time point in the three groups increased significantly compared with T1 time point (control group:[4.94± 1.60] pg/mL vs [3.32±1.34] pg/mL,t=3.47,P＜0.01; lower PHC group:[5.38±1.42] pg/mL vs [3.69±1.35] pg/mL,t=3.86,P＜0.01; higher PHC group:[5.57±± 1.34] pg/mL vs [3.50 ± 1.22] pg/mL,t=5.11,P＜0.01).IL-8 at T4 time point increased significantly compared with T1 time point (control group:[342.09±56.12] pg/mL vs [194.58 ± 30.07] pg/mL,t =10.36,P＜0.01; lower PHC group:[349.48±43.49] pg/mL vs [193.16±26.27] pg/mL,t=13.80,P＜0.01; higher PHC group:[351.55±38.13] pg/mL vs [186.02±21.08] pg/mL,t=16.99,P＜0.01).IL-6 at the T4 and T5 time points in both lower PHC group and higher PHC group decreased significantly compared with control groupatthe same time points (T4..[38.49± 9.70] and [43.41± 9.01] pg/mL vs [62.35±7.83] pg/mL,t=8.56 and 7.10,both P＜0.01; T5:[56.39±7.47] and [54.77±7.12] pg/mL vs [107.32± 13.97] pg/mL,t=-14.38 and-14.99,both P＜0.01].Conclusions The serum IL-6 and IL-8 levels in pulmonary tuberculosis patients with OLV increase after selective thoracic operation.PHC through low tidal volume could decrease the release of IL-6 and attenuate the pulmonary inflammatory injury in the tuberculosis patients with operation.

Objective To investigate the effects of hyperbaric Oxygen (HBO)exposure on Caspase-3 and Bcl-2 mRNA ex-pressions in both internal carotid artery (ICA)and basal artery (BA)in rabbits.Methods Twenty-four healthy adult New Zealand rabbits were randomly divided into 2 groups:HBO group and the control group,with each group consisted of 12 animals.The rab-bits in the HBO group were exposed to HBO at 2.2 ATA for 60 minutes each day for 3 successive days.The rabbits in the control group were normally fed without any treatment.Real-time PCR was used to detect Caspase-3 and Bcl-2 mRNA expressions in both ICA and BA in 2 groups.Results HBO significantly decreased the Caspase-3 mRNA expression [(0.038 ±0.006 )vs .(1.000 ± 0.225)]and increased the Bcl-2 mRNA expression [(1.877 ±0.1 69)vs .(1.000 ±0.364)].In ICA,HBO similarly decreased the Caspase-3 mRNA expression [(0.41 9±0.091)vs .(1.000 ±0.1 75)]and increased the Bcl-2 mRNA expression [(1.269 ±0.270) vs .(1.000±0.1 1 7)]in BA.All the differences mentioned above were of statistical significance (P <0.01).Conclusion HBO ex-erts an inhibition effect on apoptosis in cerebral vascular endothelial cells.The mechanism may be related to inhibiting the expres-sion of Caspase-3 mRNA and promoting the expression of Bcl-2 mRNA.

Objective To analyze the characteristics of iatrogenic urerteral injury and summarize the experiences in prevention,diagnosis and treatment of iatrogenic urerteral injury. MethodsA review was made on the injurycauses,the injury locations,the treatment time,the methods of surgical procedures and the results of treatment in 17 patients with iatrogenic ureteral injury treated surgically from 1997 to 2003. Results Of 17 cases of iatrogenic ureteral injuries,gynecological,general surgical and urological procedures resulted in ureteral injuries in 12 cases (71%),four (24%) and one (6%),respectively. Of all the injuries,65% (11/17) appeared in the lower part of the ureter,18% (3/17) in the middle part of the ureter and 18% (3/17) in the upper part of the ureter. The main injury causes were ligation,partial ligation,complete transection and perforation,accounting for 29% (5/17),41% (7/17),24% (4/17) and 6% (1/17),respectively. Four cases were found during operation,nine at days 2-11 after operation and four were treated 3-6 months after injury. Treatment methods included end-to-end ureteral anastomosis in seven cases,ureteroneocystostomy in three,ureteral lithotomy in one,pure ureteral lysis in three and post-lysis double-J tube insertion in three. All patients were cured. The follow-up ranging from six months to three years showed no patients suffering from urinary tract infection,hydronephrosis or atrophy. Conclusions The location and type of injury determine the type of surgical repair. A thorough knowledge of pelvic anatomy and mastering the basic steps of diagnosis and treatment are critical for prevention and management of the iatrogenic urerteral injury.