Objective To investigate the efficacy and safety of oestradiol valerate (E2V) combined with dienogest (DNG) for menorrhagia without organic pathology.Methods Sixty-two menorrhagia without organic pathology patients were randomized divided into observation group (31 cases ) and control group (31cases).E2V combined with DNG were given in observation group while control group with E2V only.Both of the treatment lasted for 3 cycles.The changes in menstrual blood loss was assessed by the pictorial blood loss assessment chart (PBAC).The time of control bleeding,stop bleeding,the level of hemoglobin and adverse reaction were compared.Results The time of control bleeding,stop bleeding in observation group were significantly lower than those in control group[ ( 16.5 ± 2.2) h vs.(23.4 ± 2.9) h,(23.3 ± 8.4) h vs.(40.9 ±4.6) h] (P＜0.01).The level of hemoglobin and PBAC scores between two groups had no significant difference before treatment (P＞0.05).After treatment for 3 cycles,the level of hemoglobin in observation group was higher than that in control group,but had no significant difference (P＞0.05 ),the PBAC scores in observation group was lower than that in control group after treatment for 1,2,3 cycles(P＜0.01 ).Both of the rate of adverse reaction in two groups was 12.9％ (4/31 ).No severe adverse reaction happened in two groups.Conclusions E2V combined with DNG is more rapid and effective in reducing menstrual blood loss.It does not increase the rate of adverse reaction and worthy of clinical application.

With the deeply thought of military hospital reform and medical support system,the analysis and suggestions for present situation are put forward.

Objective To evaluate the effect of dexmedetomidine on quality of wake-up test in the patients undergoing posterior osteotomy correction surgery.Methods Ninety-seven patients of both sexes,aged 17-59 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index 18.5-25.0 kg/m2 and global kyphosis angle＞60°,scheduled for elective posterior osteotomy correction surgery under general anesthesia,were randomly divided into 2 groups using a random number table:control group C (n=46) and group D (n =51).In group D,dexmedetomidine 1.0 μg/kg was infused over 15 min before induction of anesthesia,and group C received the equal volume of normal saline instead.Anesthesia was induced with iv midazolam,propofol,fentanyl,vecuronium and dexamethasone in C and D groups.Mechanical ventilation was performed after tracheal intubation.Anesthesia was maintained with infusion of cisstracurium,propofol and remifentanil.Dexmedetomidine 0.3 μg · kg-1 · h-1 was infused throughout the surgery in group D,and meanwhile normal saline was given throughout the surgery in group C.The anesthetic drugs for maintenance except dexmedetomidine were discontinued at the beginning of the wake-up test.The wake-up time was recorded and the wake-up quality was assessed.Ramsay sedation scores and Riker sedation-agitation scale scores were also recorded when all the patients were successfully awakened.The development of cardiovascular events during wake-up test and intraoperative awareness was recorded.Results The wake-up quality was significantly higher,Riker sedation-agitation scale scores were lower,Ramsay sedation scores were higher,the incidence of nausea and vomiting was lower,and no significant change was found in wake-up time in group D.No intraoperative awareness was observed in the two groups.Conclusion Dexmedetomidine can raise wake-up quality without prolonging wake-up time and with stable hemodynamics and fewer side effects in the patients undergoing posterior osteotomy correction surgery.

Objective To reproduce a pulmonary carcinoma model by injecting VX2 tumor tissue block suspension into rabbits' lung,and to compare the result with that of injecting VX2 tumor cells suspension.Methods A total of 50 New Zealand white rabbits were divided into two groups randomly with 25 in each.The VX2 tumor tissue block suspension and cell suspension were injected respectively into the right lower lung of each rabbit in two groups.The growth and metastasis of tumor in the thorax were observed with CT scan.The general condition of the animals was observed as well.Results The pathological pictures of the VX2 tumors were the same in two groups.The ratio of successful transplantation was 100% in the tissue block suspension group,while it was 48% in the cells suspension group,a remarkable difference in the success rate of tumor transplantation was found between the two methods(P

Objective To understand biochemistry study situation in clinical medicine undergraduates and to improve biochemistry teaching quality.Methods Totally 120 clinical medicine undergraduates were enrolled randomly to receive investigation on problems related to biochemistry.Corresponding statistic analysis was made using softwares of Excel and SPSS 16.0 in view of the main problems.Results One hundred and twenty copies of survey questionnaires were finished.There were 114 effective copies and the effective rate was 95％ after checking on these questionnaires.61.4％ of the students neither liked nor disliked biochemistry course; 56.1％ of the students thought that learning biochemistry was difficult; students thought that chapter 4 sugar metabolism,chapter 5 lipid metabolism and chapter 6 biological oxidation to be very difficult.Only 11％ of the students did preview,further analysis found positive relation between preview and understanding (rj =0.288,P ＜ 0.01 ).Conclusion Clinical medicine undergraduates like biochemistry insufficiently with few doing preview.It suggests that teachers should pay attention to the cultivation and stimulation of students' interest in biochemistry course,improve teaching method for the difficult sections,strengthen experiment teaching and try combination and separation teaching mode.

Objective To summarize the observation points and nursing experience after minimally invasive ventriculo-atrial shunt. Methods 45 patients after minimally invasive ventficulo-atrial shunt were given preoperative psychological care and preparations, postoperative observation of vital signs, con-sciousness, pupil, with or without intracranial hypertension, inadequate shunt or transitional symptoms, in-fectious symptoms, specific and basic care, awareness of postoperative complications and detailed guidance for discharge and follow-up jobs. Results Half month after shunt 28 cases regained consciousness, 9 cases with alleviated consciousness dysfunction, 8 cases with unchanged consciousness dysfunction, 5 cases with shunt blockage; 3 cases with over-shunt; 5 cases with inadequate shunt, 1 case with blood-borne in-fection, 1 case with shunt exposed, no intracranial infection, air embolism, complications such as endocardi-tis took place. Conclusions Adequate preoperative preparation and close postoperative observation, ef-fective specific care and basic care can increase success rate of ventriculo-atrial shunt and improve the quality of life of patients.

Objective To investigate the expressions and clinical significances of MUC1-mRNA and CK20-mRNA in peripheral blood of esophageal cancer patients.Methods MUC1-mRNA and CK20-mRNA were detected in 53 patients with esophageal cancer,10 patients with esophageal benign tumor and 20 healthy volunteers by RT-PCR technique.Results The expressions of MUC1-mRNA,CK20-mRNA and combining group were 35.85 % (19/53),49.06 % (26/53) and 62.26 % (36/53) in peripheral blood of 53 esophageal cancer patients.In control group,there was no expression of MUC1-mRNA and CK20-mRNA in peripheral blood of 10 patients with benign esophageal disease and 20 healthy volunteers.The positive rate increased by combining test(x2 =11.0228,P ＜0.05).Conclusion MUC1-mRNA and CK20-mRNA might be specific and sensitive markers to detect circulating tumor cells in peripheral blood and their expressions are closely related to TNM stages of the esophageal cancer patients.The combining test might be of high value of the diagnosis of micrometastasis.

Objective To assess the effect of preoperative carbohydrate preconditioning on postoperative insulin resistance and inflammatory response in patients after gastroenteric tumor resection.Methods Sixty patients with elective gastroenteric tumor resection were divided into preoperative carbohydrate preconditioning group and control group by random digits table with 30 cases each.Preoperative carbohydrate preconditioning group was given oral containing 50 g glucose carbohydrate 300 ml 2 h before surgery,and control group was given traditional method,fasting 12 h before surgery and water deprivation 6 h before surgery.The blood samples were collected to measure the level of fasting blood glucose (FBG),fasting insulin (FINS),interleukin (IL)-6 and C-reactive protein (CRP),3 h before surgery and 1,3,7 d after surgery respectively.Homeostasis model assessment insulin resistance index (HOMA-IR) was computed.Results There were no statistical differences in FBG,FINS,IL-6,CRP and HOMA-IR 3 h before surgery between the 2 groups (P ＞ 0.05).The FBG,FINS,IL-6,C RP and HOMA-IR in the 2 groups at 1,3 d after surgery were significantly higher than those 3 h before surgery,but those except for FBG in control group were significantly higher than those in preoperative carbohydrate preconditioning group [1 d after surgery:(39.67 ± 10.37) mU/L vs.(25.78 ± 12.43) mU/L,(98.67 ± 12.42) μg/L vs.(65.36 ± 16.72)μg/L,(121.74 ±11.32) mg/L vs.(82.18 ±4.36) mg/L,19.07 ±5.49 vs.11.67 ±6.32;3 d after surgery:(24.34 ±6.78) mU/L vs.(16.23 ±7.56) mU/L,(116.43 ± 18.57) μg/L vs.(78.53 ± 10.38) μg/L,(151.30 ± 10.46) mg/L vs.(129.29 ± 10.24) mg/L,8.56 ±2.87 vs.5.12 ±2.11],there were statistical differences (P ＜0.05).There were no statistical differences in FINS and HOMA-IR in preoperative carbohydrate preconditioning group between 7 d after surgery and 3 h before surgery (P ＞ 0.05),but there was statistical difference in control group (P＜ 0.05).There were no statistical differences in FBG,IL-6 and CRP in the 2 groups between 7 d after surgery and 3 h before surgery (P ＞ 0.05).There was no aspiration during anesthetic stage.Conclusion Preoperative carbohydrate preconditioning may shorten the insulin resistance time after gastroenteric tumor resection,reduce the intensity of insulin resistance,and improve inflammatory response,thus contributing to the rehabilitation of patients.

Objective:To examine the plasma soluble interleukin 2 receptor (sIL-2R)and the expression of IFN-γR in helper T (Th)cells in peripheral blood of patients with recurrent oral ulcer(ROU).Methods:The peripheral blood was obtained from 21 pa-tients in active stage of ROU and 21 healthy controls.Flow cytometry was used to detect the quantity of IFN-γR in CD +4 T cells,ELISA was used to detect the level of sIL-2R.Results:The expression of IFN-γR in CD +4 T cells and sIL-2R content in plasma of the patients with ROU were significantly higher than those in the healthy controls(P <0.05).Conclusion:Over expression of IFN-γR in CD +4 T cells and sIL-2R in peripheral blood may be related to the genesis of ROU.

Objective To investigate the efficiency and application value of CT-guided percutaneous puncture biopsy in the diagnosis of lung disease.Methods The clinical and imaging data of 60 patients with CT-guided percutaneous lung biopsy were analyzed retrospectively.Results Among all the 60 patients, 57 had finally to be proved by pathological diagnosis, including 47 primary lung cancer (21 squamous cell carcinoma, 18 adenocarcinoma, 3 small cell lung cancer and 5 bronchioloalveolar carcinoma), 7 metastatic lung cancer and 3 tuberculosis.In addition, 3 cases were chronic inflammation and did not make a definite diagnosis, in which 2 were proved to be caseous pneumonia and 1 was proved to be fungus infection by postoperative pathology.The successful rate of punctures,the diagnostic accuracy and the total complications rate of lung puncture biopsy in 60 cases was 100%, 95.0% and 21.7% [11.7% pneumothorax (7/60), 8.3% hemoptysis (5/60) and 1.7% needle bleeding(1/60)].Conclusion CT-guided percutaneous puncture biopsy is a safe, accurate and significant clinical method in the diagnosis and differential diagnosis of lung lesions.