Objective To observe the effect of treating chronic severe hepatitis modified Yinchen Zhufu Decoction.Methods 46 chronic severe hepatitis patients (belonging to Ymhuang syndrome in TCM) were randomly recruited in to a treatment group (26 cases) and a control group (20 cases). Indexes as symptoms, signs, liver functions, prothrombin activity (PTA), prothrombin (ALB) and complications were used for evaluating therapeutic effects. Results After four weeks' treatment, of all 26 cases in the treatment group, 23 cases were effective (occupying 88.5%) and 3 cases were inefficacy (occupying 11.5%); while of all 20 cases in the control group, 11 cases were effective (occupying 55%) and 9 cases were inefficacy (occupying 45%). There was significant difference between the two group in therapeutic effects( P＜0.05 ). TBIL in both groups were decreased after the treatment(P＜ 0.05 ), and the decrease amplitude in the treatment group was much bigger than the control group (P＜0.05). PTA in the treatment group was increased after the treatment (P＜0.05), but this increase amplitude showed no significant difference comparing with the control group (P＞0.05). ALB showed significant difference between the two groups after treatment, with P＜0.05, but complications demonstrated no significant difference between the two groups after treatment, with P＞0.05. Conclusion Modified Yinchen Zhufu Decoction has good therapeutic effects in treating chronic severe hepatitis of yinhuang syndrome.

Objective To compare two types of digestive reconstruction and postoperative complications after total gastrectomy in patients with gastric carcinoma. Methods Roux-en-Y esophagojejunostomy and P-type Roux-en-Y esophagojejunostomy were performed in 50 patients with gastric carcinoma after total gastrectomy. The operating time and postoperative complications were observed. Results The gastrointestinal symptoms for Roux-en-Y esophagojeju-nostomy and P-type Roux-en-Y esophagojejunostomy serve as : diarrhea ( 11.8% and 12.1% ), dumping syndrome (3.9% and 3.3% ) and reflux esophagitis(5.9% and 6.0% ) ,the incidence of the difference was not significant ( than,P>0.05 ). The postoperative complications in P-type Roux-en-Y esophagojejunostomy( 13.1% ) slightly higher that Roux-en-Y esophagojejunostomy( 11.1% ) ,but the difference was not significant( P>0.05 ). Roux-en-Y esoph-agojejunostomy average operative time(3.1±0.3)h was significantly reduced than P-type Roux-en-Y esophagojeju-nostomy(3.7±0.2)h(t=3.35,P<0.05). Conclusion Roux-en-Y esephagojejunostomy and P-type Roux-en-Y esophagojejunostomy is a suitable type after total gastrectomy for patients with gastric carcinoma, but the former opera-tive time was shorter.

Objective To study the relationship between operative procedures and complication of colorectal carcinoma with acute colonic obstruction in the elderly patients. Methods 65 elderly patients undergoing emergency operation for acute colonic obstruction were analyzed retrospectively. One stage tumor resection and anastomosis was performed in 25 cases with right-side colonic lesion and in 26 cases with left-side colonic lesion, Hartmann operation in 8 cases, Dixon operation in 4 cases and proximal colostomy in 2 cases. Results In 65 cases, 13 cases of postopera-tive complications,the rate was 20.0% (13/65) ,which infected with toxic shock two cases,four cases of pulmonary infection,anastomotic leakage two cases, wound infection, split 2 cases, death three cases, the mortality rate was 4.6%. The rates of postoperative complications in right-side colonic lesion, left-side colonic lesion, Hartmann opera-tion and Dixon operation were 69.2% ,0,30.7% and 0 respectively(P < 0.05 ～ 0.01). Conclusion Acute obstruc-tion of colon cancer,the right-side colonic lesion were safe,feasible and few complications in colorectal carcinoma with acute colonic obstruction.

Objective:To study the efficacy and safety of mirtazapine and paroxetine in patients with first-episode climacteric depression. Methods:A 8-week double-blind study was conducted with 90 female patients suffered with climacteric first-episode depression. Subjects were randomly assigned to either mirtazapine (n=45) or paroxetine (n=45). All subjects were evaluated with Hamilton Rating Scale for Depression-17 (HAMD-17), Hamilton Rating Scale for Anxiety,and Treatment Emergent Symptom scale (TESS) at baseline, the end of week 1, 4 and 8 after treatment. The study had lasted for 8 weeks.Results:The response rate between two groups (mirtazapine 88.9% vs paroxetine 82.2%) was similar. There were significant differences on the scores of HAMD between the two groups at the end of 1st and 8th week, and HAMA at the 1st week after treatment(21.3?3.5/25.2?2.9,18.2?3.2/21.5?2.4,t=-2.367、-3.514,P=0.042、0.032;7.2?3.5/9.8?2.3,t=-3.258,P=0.035). Mirtazapine had increased food appetite(15.6%), body weight(13.3%), hydropsia(8.9%), dry mouth(6.7%), sleep disorder and nausea(4.4%). Meanwhile paroxetine had dry mouth(22.2%), sleep disorder(20.0%), nausea(17.8%), tremor(15.6%), restlessness/agitation(13.3%) and sexual disturbance(11.1%).Conclusion:Mirtazapine has rapid response, strongly antidepressive effect in female climacteric first-episode patients and less side-effects.

Objective To investigate the clinical and immunohistochemical features,diagnosis and treatment of gastrointestinal stromal tumor(GIST). Methods Clinic and pathological datas of 38 cases with GIST were retrospectively analyzed. Results The most common clinal maifestions were abdominal pain,distention or discomfort in 24 cases(50%), abdominal mass in 10,melena and liematemesis in 8 cases. The tumor was located in the stomach in 20 cases, the small infestine in 14,the colorectum in 4.All the cases underwent operation. Conclusion Endoscopy and imaging examination are main methods to detect GIST. Surgical resection is the main mothod of pathologic diagnosis and treatment.

Objective To investigate the influences of Bi-level positive airway pressure(BiPAP)to night-time hy- poxemia and change of sleep structure in the patients with overlap syndrome(OS).Methods 25 patients with OS,19 with primary snoring(PS)were monitored and diagnosed by nocturnal polysomnography(PSG)for parameters of sleep efficiency(SE)and sleep architecture.The data of patients with OS were rechecked after 2-month's BiPAP treatment. Results In OS group,the level of FEV1%,FEV1/FVC,SaO2 A,SaO2 L,SE,REM and S3+4 were significantly lower than those in PS(P

This paper reviews and analyzes 50 articles concerning the treatment of climacteric syndrome by acupuncture and moxibustion therapries. The therapies were single acupuncture, acupuncture combining other methods, auricular-plaster therapy, and some other therapies. Clear diagnostic criteria were found in 39 articles, and the most common-used criteria were Combination of TCMand Western Medicine Diagnostics and Therapeutics, Kupperman Index Scoring and Criterion of Diagnosis and Treatment Effect of TCM Diseases and Syndrome. All together 2946 cases were treated, and the therapeutic effect rates ranged from 58.1% to 100%. There were control group in 16 articles. The syndromes have been classified as 27 types in 15 articles, including type of yin-deficiency of the liver and the kidney, yang-deficiency of the spleen and the kidney, yang-deficiency of the kidney, yindeficiency of the kidney, disharmony between the heart and the kidney, and the liver stagnation, etc.Some effects have been got in treating female climacteric syndrome with acupuncture and moxibustion therapy, however, there were fewer strict randomized controlled trials (RCT).

To review the general situation of acupuncture in treating vascular headache between 1949-2004 in an attempt to promote acupuncture practice, clinical references concerning acupuncture treatment of vascular headache were analyzed on the basis of Chinese Modern Acupuncture Database. From 1956, these references increased annually and steadily. In clinical practice, needling is cardinally used, and the acupoints are selected adjacent to diseased part and on syndrome differentiation.

International medical community has seen the prevail of outpatient teaching for medical students in recent years. A student-centered and faculty-run teaching clinic was set up based on current outpatient resources in 2008 by Division of General Internal Medicine (DGIM) in Peking Union Medical College Hospital (PUMCH). We concluded that teaching clinic was an effective teaching mode for medical students to improve clinical skills, diagnostic proficiency and health-care professionalism in internal medicine.

Objective To summarize and analyze clinical characteristics of glycogen storage disease (GSD)typeⅠcomplicated with hepatocellular carcinoma to improve clinical recognition to it.Methods First case of GSD type Ia complicated with hepatocellular carcinoma(HCC)in China was reported and another 14 cases with detailed clinical data reported in literatures were reviewed in this paper.Results The case was man at age of 19 with chief complaint of hepatic mass founded casually.For all the 15 cases(other 14 from literature reports),mean age at diagnosis of HCC was 32.3 years and average time interval from diagnosis of GSD to diagnosis of HCC Was 23.1 years,as compared to 23.3 years and 14.6 years,respectively in three cases with both hepatitis B virus(HBV)and hepatitis C virus(HCV)seropositive.Serum level of alpha fetoprotein(AFP)was elevated in six patients.Tumor could be located at all lobes of the liver and mainly in the right lobe(eight of 15 cases),with varied size and solitary or multiple tumor.Conclusions Symptoms in GSD typeⅠcomplicated with HCC Was latent at onset.and AFP measurement was questionable in its diagnosis.It is important that physicians should keep more alert to risk of HCC in patients with GSD for its early diagnosis.