The setups of internal medicine and surgery, confronted with the challenges of the development of modern clinical sciences, must be regrouped so as to conform to the demands of technological development. The set ups of internal medicine and surgery have the following drawbacks in division: ①hindering the scientific research on modern clinical medicine for lacking the theoretical basis of preclinical medicine; ②making it difficult for diseases to get treated systematically; ③affecting innovations in advanced medical technology; ④resulting in a greater number of problems of medical control; ⑤leading to an increasingly worsening situation of hospital economy. It is, therefore, necessary to regroup departments of internal medicine and surgery, set up a mode of treatment by systemic diseases, and readjust the structure of human resources and medical regimens according to this mode. Other departments, such as gynecology and obstetrics, otorhinolaryngology, ophthalmology, hematology, and endocrinology, can be treated as independent medical setups.

Objective To explore the clinical effects of laparoscopic surgery combined with marvelon,gestrinone and leuprolide in treatment of chronic endometriosis.Methods 50 cases of endometriosis were collected.They were randomly divided into observation group and control group,each group having 25 cases.The control group underwent laparoscopic surgery and the observation group underwent laparoscopic surgery combined marvelon,gestrinone and leuprolide for 3 months.The two groups were compared in clinical effects,recurrence and pregnancy rate,as well as the operation situation.Results The effective rate was 92.0％ (23/25) in the observation group and 64.0％ (16/25) in the control group.The effective rate of observation group was obviously higher than that of the control group(P ＜ 0.05).The recurrence rate was 8.0％ (2/25)in the observation group,and 32.0％ (8/25) in the control group.The recurrence rate of combination group was obviously lower than that of the simple surgical group(P ＜ 0.05).The pregnancy rate was 80.0％ in the observation group;and 48.0％ in the control group after treatment.The pregnancy rate of the observation group was obviously higher than that of the control group(P ＜ 0.05).Liver damage or other adverse reactions didn't occur to any group after the treatment.The mean time of leaving bed was (1.4 ± 0.4) d after operation in the observation group vs (3.6 ± 1.5) d after operation in the control group.Length of hospital stay was (7.6 ± 3.5) d in the observation group vs (11.5 ± 3.9) d in the control group.The difference had statistical significance(all P ＜ 0.05).Conclusions Laparoscopic surgery combined with marvelon,gestrinone and leuprolide is superior to pure surgery group in treatment of endometriosis.It can improve the effective and pregnancy rate,and reduce the recurrence rate.No obvious adverse reactions can be found,thus it is worth of clinical promotion.

ObjectiveTo investigate the influence of nateglinide treatment of newly diagnosed patients with type 2 diabetes on the state of inflammatory response. MethodsThe clinical data of 74 newly diagnosed patients with type 2 diabetes were retrospectively reviewed,and treated with nateglinide,before and after treatment,the fasting blood glucose (FBG), postprandial blood glucose 0.5h ( 0.5 hPG), 1 h postprandial blood glucose ( 1 hPG) ,2h postprandial blood glucose(2hPG) ,fasting insulin(FINS) ,0.5h postprandial insulin(0. 5hINS) ,postprandial 1h insulin( 1 bINS),2h postprandial insulin(2hINS),interleulin-2(IL-2) and C-reactive protein(CRP) levels were observed. ResultsAfter treatment,the FBG,0. 5hPG, 1hPG,2hPG, FINS,0. 5hINS, 1hINS,2hINS, IL-2 and CRP of patients were ( 8.0 ± 1.5) mmol/L,(12.0±1.8)mmol/L,(10.2 ± 1.3) mmol/L,(10.5 ±1.2) mmol/L,(168.2 ±11.5) pmol/L,(213.5±23.5) pmol/L,(197.0 ±21.5) pmol/L,(189.5 ±12.0) pmol/L,(14.0 ±1.5) μg/L, (13.5 ±1.5) mg/L,compared with( 10. 5 ± 1.0) mmol/L, ( 14. 5 ± 1.5) mmol/L, ( 12. 5 ± 1.4) mmol/L, ( 11.6 ±2.0) mmol/L,(180.7 ±12.0) pmol/L,(229.8 ±26.0) pmol/L,(218.5 ±23.0) pmol/L, (197.0± 14.5) pmol/L,(12.5 ±2.0) μg/L, (22.8 ±2.0) mg/L before treatment decreased significantly(t =11. 9293,9. 1785,10. 3561,4. 1115,6. 4696,4.0009,5. 8744,3. 4279,5. 2307,32.0006, all P ＜0. 05). There was no serious adverse events in treatment process. ConclusionNateglinide treatment of newly diagnosed patients with type 2 diabetes could significantly improve the patient's inflammatory response state,and there was no serious adverse events in treatment process.

Objective To investigate the elationship between the expression of Cathepsin D and Laminin receptors with the invasion and metastasis of gastric cancers.Methods Cathepsin D and Laminin receptors immunoreactivities were evaluated in 96 patients with gastric cancer using streptavaclin pemxidase method.Results Over expression of Cathepsin D in gastric cancer tissue was significantly related with the depth of invasion,lymphnode metastasis and grade of differentiation (P<0.01,P<0.01 and P<0.05, respectively).Moreover,the high expression of Lamninin receptors in gastric cancer had significant correlations with the invasion depth and grade of differentiation(P<0.05 and P<0.01);The positive expression of Laminin receptors were not significantly related with lymph node metastasis(P>0.05).By statistics analysis Cathepsin D had a significant positive correlation with Laminin receptors (P<0.05). Conclusion Cathepsin D and Laminin Receptors play all important role in the invasion and metastasis of gastric Cancers.

Little is reported about the role of PTEN gene in the progression and prognosis of GISTs. This study examined the clinical implications of the tumor suppressor gene PTEN as a prognostic factor in the GISTs. Immunohistological staining and immunoblotting were employed to examine the PTEN protein expression, and its association with clinical measures. Clinicopathological features were reviewed by a retrospective examination of medical records. Reduced PTEN expression was significantly associated with tumor diameter, mitotic figure count, metastasis and pathological stage of tumor (P<0.05), and was not correlated with age, gender and tumor location (P>0.05). The 3-year survival rate of the patients with reduced PTEN expression was significantly lower than those with high PTEN expression (P<0.01). These results suggest that the expression of PTEN gene was significantly linked with the progression and metastasis of GISTs and it is an independent prognostic factor.

Objective To indicate the restriction profiles of pbps in Streptococcus pneumoniae(S.pneumoniae), and relationship between pbps profiles and the penicillin MIC.Methods The E-test MIC method was used to determinate penicillin susceptibility of 132 S.pneumoniae strains consisting of 69 penicillin susceptible S.pneumoniae (PSSP) strains and 63 nonsusceptible S.pneumoniae (PNSP) strains. Furthermore, we compared these strains by detecting restriction fragment length polymorphism (RFLP) of the PBPs genes pbp1a, pbp2b and pbp2x.Results The RFLP results showed that 9 genotypes were founded for pbp1a, in which 2 were detected from PSSP and some PNSP strains. The other 7 ones were founded mainly in the PNSP with penicillin MIC≥0.25 ?g/ml. Ten genotypes were founded for pbp2b, in which 3 were detected from PSSP and some PNSP strains. The other 7 ones, similar with pbp1a, were founded mainly in the PNSP with penicillin MIC≥0.25 ?g/ml. Thirty-one restrictive patterns were founded for pbp2x. Seventeen patternss from them were detected in PSSP, and 13 ones were founded only in PSSP. The other 14 patterns all were covered PNSP strains. A total of 47 patterns were found according to the three pbps types. Twenty-three patterns from them were detected in PSSP, and 17 ones were founded only in PSSP. The other 24 patterns all were detected in PNSP.Conclusions Results of the study are consistent with the concept that mutations in PBP1a, PBP2b and PBP2x play an important role in the development of resistance to ?-lactam antibiotics by S.pneumoniae. In the meantime, the profiles of pbps can predict penicillin susceptibility.

Objective To evaluate the clinical application of multi-slice spiral CT(MSCT) and X-ray plain film in congenital scoliosis.Methods 40 cases with congenital scoliosis were undergone MSCT scan,the imaging data were reconstructed with maximum intensity projection(MIP),multiple planar reconstruction(MPR),surface shaded display(SSD) and surface volume rendering(SVR),the applied value of these various reconstructed images were analysed comparatively with X-ray plain film.Results Based on the preoperative X-ray plain films,the spinal formation failure,segmentation failure and mixed failure of spine were found in 18,15 and 7 cases respecitvely.However MSCT scan showed that 13 cases had formation failure,12 cases had segmentation failure and 15 cases were mixed failure of spine,and in combination with spinal bifida in 6,rib deformity in 8 and bony ridge inside vertebral canal in 4.The relative features of congenital scoliosis could be comprehensively evaluated by SVR images.Conclusion The reformatted images of MSCT is remarkedly superior to conventional X-ray images in judging the classification and area of spinal deformity accurately.

Currently, bacterial resistance situation in health care settings is very serious in China, and the prevalence of a variety of common multidrug-resistant bacteria and pan-resistant bacteria are relatively high. Drug-resistant bacteria in Gram-positive bacteria are mainly methicillin resistant Staphylococcus aureus ( MRSA ) and macrolide-resistant Streptococcus, while glycopeptide-resistant enterococci are still at a low level.The clonal distribution of MRSA and mechanisms of Streptococcus resistance in China are different from those in European and American countries.Cephalosporins and quinolones resistance are the marked characteristic of Enterobacteriaceae with a high occurrence over 60%. Carbapenem-resistant Klebsiella pneumoniae shows a rapid upward trend, and producing KPC-2 type carbapenemases is the main mechanism of its resistance.Resistance in Pseudomonas aeruginosa is relatively stable, with resistant rates ranging from 20%to 30%.Multi-drug resistant Acinetobacter baumannii is a big problem in clinic.More than 50% Acinetobacter baumannii strains are resistant to carbapenems and cephalosporins, and tigecycline-resistant Acinetobacter baumannii is increasing.This paper systematically reviews the status and characteristics of bacterial resistance in last five years with referring to the surveillance data of antimicrobial resistance and the findings of related mechanisms.

Objective To explore the clinical diagnostic value of narrow-band imaging combined with magnification chromoendoscopy for suspicious neoplasia lesions of early gastric cancer.Methods A total of 115 patients which had been diagnosed as having suspicious lesions byconventional endoscopy were enrolled from Jan.2010 to Dec.2012.They were observed by magnifying endoscopy(C-WLI), magnifying endoscopy combined with narrow-band imaging (ME-NBI), magnification chromoendoscopy and magnification chromoendoscopy combined with narrow-band imaging, respectively.The lesion outline sharpness, opening of the gland sharpness and microvascular morphology sharpness were recorded and the subtypes of opening of the gland and microvascular morphology were compared.The histological examination was performed on the most significant changes in lesion site and the accuracy, sensitivity and specificity of the four procedures were calculated.Results The score of outline sharpness was 377 and the score of pit sharpness was 458 by magnification chromoendoscopy combined with narrow-band imaging, higher than those of ME-NBI (340 and 408 respectively) and magnification chromoendoscopy (354 and 386 respectively) (P ＜ 0.05), significantly higher than those of C-WLI (276 and 280 respectively) (P ＜ 0.01).The score of microvascular morphology sharpness was 380 by magnification chromoendoscopy combined with narrow-band imaging,higher than that of ME-NBI (348, P ＜ 0.05), C-WLI (267, P ＜ 0.01) and magnification chromoendoscopy (280, P ＜ 0.01).The detection rate of C type by magnification chromoendoscopy combined with narrow-band imaging was higher than that by magnification chromoendoscopy (93.0％ VS 79.7％, P ＜ 0.05).The accuracy, sensitivity and specificity of magnification chromoendoscopy combined with narrow-band imaging was 92.17％, 88.33％ ,96.36％ respectively.Conclusion Narrow-band imaging endoscopy combined with pigment amplification can yield more clear image of the microvascular morphology and opening of the gland, significantly improve the lesion detection rate, reduce the missing rate, and is worthy of further clinical observation and promotion.