Objective To observe the effects and benefits of the gastroscopy-assisted thoracoscopic modified Heller operation for the treatment of achalasia of cardia. Methods Retrospective analysis was conducted on the clin﹣ical data of 33 cases in our hospital. The surgical approach was gastroscopy-assisted thoracoscopic modified Heller operation. The intraoperative and postoperative effect and complications were observed. All patients were followed up for six months. Results After operation 33 achalasia patients' symptom of obstruction is alleviated. 1 case changed to open operation because of severe adhesion; 4 cases esophageal mucosal were injured and need to be repair assisted by thoracoscope. 1 case had esophagopleural fistula after operation and was cured by conservative treatment in one month. 1 case had gastroesophageal reflux symptoms after operation and relief symptoms after conservative treatment. All patients were follow-up more than six months, only 1 patient recured eating obstruction in 3 months after opera﹣tion, and was cured by gastroscopic expanding treatment. Conclusions The results of gastroscopy-assisted thoraco﹣scopic modified Heller operation to patients with Achalasia is significant. The operation is easy to perform and the complications is less, it can be promoted and applied in clinical practice.

BACKGROUND:At present, isokinetic testing system has attracted more and more attentions in the evaluation of athlete muscle function, but its application in the detection of waist and abdomen muscle strength characteristics in juvenile male basketbal athletes is rarely reported. OBJECTIVE:To study the biomechanical characteristics of waist flexor and extensor muscles inoutstanding juvenile male basketbal athletes in order to provide the basis for waist and abdominal strength training, scientific selection and prevention of lumbar abdomen injury in basketbal sport. METHODS:Eighteen athletes from the Guangzhou Men’s Basketbal Team were subjected to the detection of muscle strength and work of waist flexor and extensor muscles at 60(°)/s and 180(°)/s using Cybex-Norm isokinetic test system. RESULTS AND CONCLUSION:At the same testing speed, the peak torque and relative peak torque of the extensor muscles were higher than those of the flexor muscles (P<0.01). The increase in the peak torque, relative peak torque and total work of the waist extensor and flexor muscles exhibited a reduced tendency with the increasing of testing speed (P<0.05);the peak torque and relative peak torque of the extensor muscles were decreased more significantly (P<0.01);the relative power of the waist extensor and flexor muscles were increased gradual y with the increasing of testing speed (P<0.01). These parameters were better in perimeter players than in post players. Under the isokinetic concentric contraction, the peak torque ratio of extensor to flexor muscles showed a decreasing trend with the increasing of testing speed and the waist flexor peak torque and extensor muscles flexion showed a decreasing trend, and the trunk stability was weakened. These findings indicate that the muscle strength of the extensor muscles was higher than that of the flexor muscles;the muscles strength of the waist flexor and extensor muscles was better in perimeter players than in post players. In isokinetic rapid movement, the muscle strength of the waist flexor and extensor muscles were reduced and the balance of the muscle strength of the waist flexor and extensor muscles was weakened, suggesting rapid strength training of the waist and abdominal core muscles should be strengthened in juvenile male basketbal athletes.

0.05)indicating no significant loss of correction.The length of the growth of instrumented spine was 13.3 mm.No sever complications in the series. Conclusion The PRSS which dispenses without bony fusion is a safe and an effective instrumen for management of juvenile scoliosis.It provides and maintains desirable scoliosis correction in one stage procedure,while allowing spinal growth.

Objective To investigate the distribution and drug resistance of pathogenic bacteria in children with blood stream in-fection(BSI) in Beihai area .Methods The clinical data of children with blood stream infection from January 2013 to June 2016 were retrospectively analyzed .Results 95 .3% of BSI children patients were community acquired infection .The proportions of Gram-pos-itive cocci and Gram-negative bacilli were 53 .5% and 46 .5% respectively .The resistance rates of vancomycin and linezolid to Gram-positive cocci all were 0% ;which of piperacillin ,piperacillin/tazobactam ,cefepime and meropenem to Gram-negative bacilli were 9 .3% ,0 .0% ,9 .1% and 5 .0% respectively .Conclusion The proportion of Gram-positive cocci and Gram-negative bacilli is basical-ly consistent .Vancomycin and linezolid can be used as the empiric medication of Gram-positive cocci BSI ;piperacillin ,piperacillin/tazobactam ,cefepime and meropenem and can be used as the empiric medication of Gram-negative bacilli BSI .

Objective To study the features and differences of electromyography of diabetic polyneuropathy (DPN) and alcoholic peripheral neuropathy (APN ), and to provide reference basis for the clinical application of electromyography.Methods 58 patients with DPN and 30 patients with APN were used as subjects. Nerve conduction studies (NCS)and sympathetic skin response (SSR)were performed in the patients, all data were analyzed.Results In the patients with DPN, the abnormalities of NCS and SSR were increased with the prolongation of the time diabetes,and the abnormality of SSR was higher than that of NCS(P<0.05).In the patients with APN, both demyelination and axonal loss in motor and sensory nerves were significantly involved, and the abnomalities of NCS and SSR were higher than those of the DPN patients (P<0.05 or P<0.01);but the proximal nerves were just involoved mildly. Conclusion Both DPN and APN have characteristic electrophysiological features.Early electromyography is useful for the early diagnosis of DPN and APN.According to the electrophysiological features of DPN and APN,the reason of peripheral neuropathy in the patients who have diabetes mellitus and alcoholism could be differentiated.

Objective To compare the effect of postoperative intercostal nerves cryoanalgesia and patient controlled epidural analgesia (PCEA) in patients undergoing thoracic surgery. Methods From April 2006 to May 2008,89 patients undergoing thoracic surgery were randomly divided into intercostal nerves cryoanalgesia group (group A,47 cases) and PCEA group (group B,42 cases). The scores of pain, use of pain medication and time of out-of-bed activity after the operation were used to evaluate the effect of pain between two groups. Results The scores of pain in group A and group B were (1.49 ± 0.80) and (2.43 ± 1.21) scores respectively. There were significant differences in the scores of pain. The use of pain medication [(1.28 ± 0.62) times vs (2.02 ± 1.05) times]and time of out-of-bed activity after the operation [(43.15 ± 12.22) h vs (64.10 ± 14.25) hi were significant difference between the two groups(P< 0.05). Conclusions For reducing the post- thoracotomy pain,intercostal nerves cryoanalgesia is superior to PCEA. Intercostal nerves cryoanalgesia can provide satisfactory analgesia after thoracic surgery.

Objective To evaluate the therapeutic effect of transanal local excision in the treatment of low rectal cancer.Methods The data of 49 cases of low rectal cancer patients treated by transanal local excision (group A,37 cases of T1 patients and 12 cases of T2 patients) were reviewed retrospectively,and compared with the group of 45 cases treated by radical resection( group B,11 cases of T1 patients and 34 cases of T2 patients).The 5-year survival rates,recurrence rates and postoperative complications between the two groups were compared.Results The incidence of postoperative complications in group A was significantly lower than that in group B(4.1％ vs 15.6％,x2 =4.69,P ＜0.05 ).The 5-year survival rate of group A was 97.9％ and the 5-year survival rate of group B was 95.6％.There was no significantly statistical difference on the 5-year survival rate between the two groups( x2 =0.439,P ＞ 0.05 ).But for the T2 patients,the recurrence rates in group A was 33.3％,which was significantly higher than the T2 patients in group B(5.9％ ) ( x2 =5.89,P ＜0.05 ).All patients with low histopathological grade tumor in group A showed postoperative recurrence and metastasis.Conclusion Transanal local excision with a rigid criteria can get good curative effect in the T1 patients,but not suitable for the T2 patients or patients with low histopathological grade tumor.

Objective To detect the expressions of VEGF and nm23 in non-small cell lung cancer (NSCLC) tissues and their relationships,and explore their clinical value in the diagnosis and treatment.Methods lmmunohistochemistry(SP method) was used to detect the expressions of VEGF and nm 23 in NSCLC and peritumor tissues.Results The positive expression rate of VEGF in NSCLC(63.3 ％,38/60)was significantly higher than in the peritumor tissues(16.7 ％,10/60)(x2=27.22,P＜0.01).nm 23 is on the contrary (53.3 ％,32/60)(x2=17.79,P＜0.01).The positive expression of VEGF in NSCLC was positively correlated significantly with the lymph node metastasis and histological classification(P＜0.05).The positive expression of nm 23 in NSCLC was negative correlated significantly with lymph node metastasis,P＜0.01.2-year survival rate of the VEGF-positive patients was significantly lower than that of VEGF-negative patients,and nm 23 is on the contrary(x2=5.55,P＜0.05).No correlation was found between the expressions of VEGF and nm 23 in NSCLC (x2=1.83,P＞0.05) Conclusion The VEGF and nm 23 may be closely associated to carcinogenesis and progression of NSCLC.Detection of VEGF and nm 23 are beneficial to indicate the biologic behavior of NSCLC.It has positive effect on diagnosis and treatment of NSCLC.

Objective To explore the diagnostic value of the concentration of plasma circulation microRNA155 (miRNA155) in ulcerative cilitis (UC) and its correlation with clinical characteristic of UC.Methods From October 2010 to August 2012,a total of 136 patients diagnosed as UC were enrolled,and at same time,170 healthy individuals were set as healthy control.The blood samples of all participants were obtained and plasma was isolated.The adsorption column was used for RNA extraction according to miRNeasy kit instruction.RNA was reverse-transcribed into cDNA with miScript reverse transcription kit.cDNA was a template and miRNA155 real-time quantitative polymerase chain reaction (PCR) was performed with miScript SYBR Green PCR kit.The relative quantity of miRNA155 expression was calculated with 2-△△Ct method.Analysis of variance were performed for comparison between groups.Receiver operating characteristic curve analysis was used for the diagnostic value of miRNA155 concentration in UC.Multiple linear regression analysis was used for the correlation between miRNA155 concentration and clinical characteristics of UC.Results The concentration of plasma circulation miRNA155 of patients with UC ((1357.43±326.15) fmol/L)was higher than that of healthy controls ((1140.70 ± 312.47) fmol/L) and the differences were statistically significant (F=35.56,P＜0.01).The area under receiver operating characteristic curve of the concentration of plasma circulation miRNA155 of patients with UC was 0.847,and the 95 ％CI was 0.806 to 0.888 (P＜0.01).When the concentration of plasma circulation miRNA155 was 1404.51 fmol/L,its specificity in the diagnosis of UC was 94.7％,and sensitivity was 40.4％.There was correlation between the concentration of plasma circulation miRNA155 and the disease activity in patients with UC (F=12.91,P＜0.05).However there was no correlation with the severity and location of the disease (both P＞0.05).Conclusion Plasma circulation miRNA155 highly expressed in patients with UC,and its concentration is correlated with the disease activity.

In order to further promote the development of the TCM industry, promote and encourage social capital to organize TCM institutions, according to the national policy and system regulations on private TCM institutions, this article analyzed and studied policies factors affecting private Chinese medical institutions, concluded the advantaging policies for the development of private TCM institutions, teased out the unreasonable regulations to hinder and restrict the private TCM institutions, and finally proposed relevant suggestions and advice, with a purpose to promote the attention of government in the process of promoting private TCM institutions policy.