Objective To explore the feasibility of the small figure-L unilateral transternal incision for the treatment of anterior mediastinal tumor.Methods Twenty patients with anterior mediastinal tumor were enrolled in the study.Under general anesthenai,after a 6 to 10cm middle skin incision was made,a unilateral figure-L partial sternotomy on the side occupied by the tumor was made in the second or third intercostals space,taking into account the tumor size and location.Tumors were resected with excellent exposure.Results All tumors were completely resected during the operation.In 7 cases,tumors encroached on the adjacent lung tissue,and lung tissue was partially resected.In 5 cases,tumors invaded the pericardium,and the pericardium was partially removed.Mean operating time was 110 minutes(85～130 minutes).The mean time of hospital stay was 7days after the operation,and there was no complication.All but one patients were alive with a mean follow-up period of 18 months(6～27 months).Conclusions The figure-L unilateral sternotomy is considered as an effective and useful minimally invisive approach for anterior mediastinal tumors.

Objective To observe the clinical effect of different surgical methods in the treatment of mediastinal tumors.Methods A total of 74 cases of August 2011 -2015 years 7 months in our hospital admissions of patients with mediastinal tumor were divided into observation group (minimally invasive medi-astinal surgery)and control group (conventional thoracotomy),37 cases,compared to two groups of clini-cal curative effect.Results The total efficiency of treatment in the observation group was 89.19%,signifi-cantly higher than that of the control group and observation group complications rate is relatively lower,sig-nificant differences (χ2 =5.33,6.79,P <0.05);observation group the operative time,amount of bleeding and hospitalization time were (15.69 ±3.21)min,(3.541 ±56.29)ml,(597 ±3.11)d were significantly lower than control group,the difference between two groups was significant (t =12.54,11.49,13.54,P<0.05).Conclusions Phase,compared with the traditional surgical treatment for open and minimally in-vasive surgery can achieve a better therapeutic effect,reduce a patient's risk of complications,alleviate the injury of surgery.For patients with postoperative rehabilitation has a positive meaning.

Liver is one of the most commonly metastases in patients with colorectal cancer.Curative hepatic resection is the first choice of liver metastasis of colorectal cancer,which can improve the survival rate ranging from 30％ to 40％ in 5-year.In this article,we will review the operation indication,mode and advance on the current treatment strategies of colorectal liver metastases,and discuss the decision-making process,emphasize a surgery - centered multidisciplinary treatment for the treatment of hepatic metastases from colorectal cancer,to improve the survival rate.

Objective To investigate the expression of CCL20 and CCR6 in the patients with gastric cancer and To examine the relationship between chemokine expression and the occurrence and development of Gastric Cancer. Methods Real-time PCR , flow cytometry and ELISA are used to measure the gene transcription and protein expression levels of chemokine CCL20 and CCR6 in the serum of 50 patients with Gastric Cancer and 30 normal controls. Results The gene expression levels CCL20 and CCR6 in Gastric Cancer group are significantly higher than that in healthy controls. The level protein of CCL20 and CCR6 in peripheral blood of patients with gastric cancer are significantly higher than that in healthy peep le[ (45.4 ±10.9) pg/mL vs (18.6±4.7) pg/mL; (7.11 ±1.03%) vs (1.83±0.43%), P＜0.01. respectively],and the increase significantlyassociated with the clinical stage of Gastric Cancer. Conclusions The method for detecting the expression of CCL20 and CCR6 in patient with Gastric Cancer has been successfully established, and their expression levels were found to be correlated with the occurrence and development of Gastric Cancer. Thus, CCL20 and CCR6 may be involved in the regulatory mechanisms associated with the development of Gastric Cancer, and may be valuable in its diagnosis and prevention.

Elbow stiffness is a common complication after trauma or surgery to this joint. The soft tissue is a primary factor resulting in stiffness of the elbow. Splints increasing passive range of motion (PROM) with creep or stress relaxation principle play a important role in reconstruction for post-traumatic elbow stiffness. The clinician should follow the basic principle in designing and application of splints. With reasonable resign and appropriate regimen, clinical experience and related research show that splints can improve elbow ROM of post-traumatic elbow stiffness efficiently.

Objective To determine epidemiology and risk factors for nosocomial infections in severe patients.Methods The study included 434 patients (7394 patient-days)during a 2-year period (2010-2011).The incidence rate of infection,pathogenic bacteria,correlation factor of infected were analyzed.Results A total of 225 infections were identified in 113 patients(26.0％).The incidence and infection rates were 56.8 in 1000-patient days and 51.8％,respectively.The infections were pneumonia (40.9％),bloodstream (30.2％),urinary tract (23.6％) and surgical site infections (5.3％).Pseudomonas aeruginosa (22.6％),methicillin-resistant Staphylococcus aureus (22.2％) and Acinetobacter spp.(11.9％) were frequently isolated micro-organisms.Median length of stay with nosocomial infection and without were 13 days (Interquartile range,IQR,20) and 2 days (IQR,2),respectively (P ＜ 0.01).In logistic regression analysis,mechanical ventilation[odds ratio(OR):16.35 ;95％ confidence interval(CI):8.26 ～32.34;P ＜0.01),coma(OR:15.04;95％ CI:3.41 ～66.33;P ＜0.01),trauma(OR:10.27 ;95％ CI:2.34～45.01 ;P ＜0.01),nasogastric tube(OR:2.94 ;95％ CI:1.47 ～ 5.90; P ＜ 0.01),tracheotomy (OR:5.77 ;95％ CI:1.10 ～30.20;P ＜0.05) and APACHE Ⅱ scores 10 ～ 19(OR:10.80;95％ CI:1.10 ～ 106.01 ;P ＜0.05) were found to be significant risk faetors for nosocomial infection.Rate of nosocomial infection increased with the number of risk factors(P ＜0.01).Mortality rates were higher in infected patients than in non-infected patients(60.9 vs 22.1％ ;P ＜0.01).Conclusion These data suggest that,in addition to underlying clinical conditions,some invasive procedures can be independent risk factors for nosocomial infection in ICU.

Objective To observe the synergetic action of Zhenqi Fuzheng granule in prevention and treatment of critically ill patients with severe infection. Methods A retrospective study was conducted. 154 cases with critical illness were enrolled in the First People's Hospital of Baiyin in Gansu Province from January 2009 to December 2013. The control group consisted of 76 cases and only basic treatments were given;in the treatment group, there were 78 cases,besides the basic treatments,they also taken nasal feeding of Zhenqi Fuzheng granule 5 g twice a day,7 days constituting for 1 therapeutic course,a total of 1-3 courses. The incidences of pulmonary infection, urinary tract infection,deep venous catheter-related infections,rate of using antibiotics,fatality rate,infection relapse rate,disease course,pathogen flora distribution were observed in the two groups. Results Compared with the control group,the rates of lung infection,urethral infection,deep vein catheter-related infection,the rate of using antibiotics, fatality rate,infection relapse rate,the discovery rates of drug resistant Acinetobacter baumannii,Pseudomonas aeruginosa,Stenotrophomonas maltophilia,Staphylococcus aureus,and Blastomyces albicans were obviously reduced in treatment group〔lung infection:15.38%(12 cases)vs. 47.37%(36 cases),urethral infection:7.69%(6 cases) vs. 23.68%(18 cases),deep vein catheter infection:5.13%(4 cases)vs. 18.42%(14 cases),antibacterial drug using rate:48.72%(38 cases)vs. 77.63%(59 cases),fatality rate:10.26%(8 cases)vs. 18.42%(14 cases),infection relapse rate:28.21%(22 cases)vs. 48.68%(37 cases),the discovery rate of Acinetobacter baumannii:3.85%(3 cases) vs. 11.84%(9 cases), of Pseudomonas aeruginosa:2.56%(2 cases) vs. 9.21%(7 cases), of Stenotrophomonas maltophilia:5.13%(4 cases)vs. 13.16%(10 cases),of Staphylococcus aureus:5.13%(4 cases) vs. 6.58%(5 cases),of Blastomyces albicans:6.41%(5 cases)vs. 10.52%(8 cases),all P<0.05〕;the therapeutic course was obviously shortened(day:5.79±1.89 vs. 13.65±2.73,P<0.05). Conclusion In critically ill patients with severe infection,treatment of Zhenqi Fuzheng granule can reduce the incidences of severe lung infection, urinary tract infection,deep venous catheter-related infection,the 5-year relapse rate,fatality rate,and shorten the therapeutic course,lower the usage of antibiotics and detection rate of drug-resistant bacteria,therefore,clinically it is effective in such patients.

Objective To describe the clinical and radiological characteristics, diagnosis, and treatment of bronchobiliary fistula (BBF). Methods From December 1975 to June 2007, 6 patients with BBF were successfully diagnosed and treated in this hospital. A retrospective analysis was performed and literatures on the disease were reviewed. Results All the cases were acquired BBF. The etiologies included liver abscess (3 cases), trauma (2 cases), and postoperative complication of hepatic carcinoma (1 case). The main symptoms the patients complained of were fever (6 cases), cough (6 cases), biliptysis (6 cases), dyspnea (4 cases), abdominal pain in right quadrant (4 cases) and pleuritic chest pain (2 cases). On physical examination, tenderness in the right upper quadrant (4 cases), dull percussion (3 cases), abnormal breath sounds (3 cases), percussion tenderness over hepatic region (2 cases) were main abnormalities. All the 6 patients underwent antibiotics treatment and percutaneous transhepatic biliary/abscess drainage. One of them underwent radiological coil embolization of the fistula. All the patients showed clinical improvement. Follow-up survey showed 1 case of cure, 1 case of long-term drainage until death of biliary tract bleeding one year later, and 4 cases of lost in follow-up. Conclusion Bronchobiliary fistula is characterized by biliptysis. Minimally invasive treatment should be the first therapeutic option.

Objective To investigate the influence of lumbar epidural anesthesia on cell apoptosis in rat kidneys with ischemia-reperfusion injury.Methods Thirty male Wistar rats were divided into three groups at random,including a sham-operated group,a model group,and an anesthesia group.Then the local norepinephrine,local angiotensin Ⅱ,plasma superoxide dismutase,plasma malondialdehyde and cell apoptosis index were observed at the 24 h after the reperfusion in rat kidneys of ischemia 60 min.Results Compared to the sham-operated group,ischemia-reperfusion of kidney caused a significant increase in contents of local norepinephrine,local angiotensin Ⅱ],and malondialdehyde in the model group and anesthesia group as well as increasing in the cell apoptosis index (P ＜ 0.05),and those parameters above were lower in the anesthesia group than those in the model group (P ＜0.05).Meanwhile,the activities of plasma superoxide were higher than those in model group (P ＜ 0.05).Conclusions The lumbar epidural anesthesia can reduce the excessive accumulation of neuroendocrine hormone in kidney,alleviate oxidative stress,which plays an important role in restraining the ischemia-reperfusion injury and cell apoptosis.

OBJECTIVE:To observe the effects of Xingnaojing injection on the efficacy and safety of patients with acute cere-bral infarction merge blood stasis syndrome. METHODS:70 patients with acute cerebral infarction merge blood stasis syndrome were randomly divided into observation group(35 cases)and control group(35 cases). Control group received conventional treat-ment according to 2014 edition of Chinese guideline for diagnosis and management of acute ischemic stooke. Patients within throm-bolysis time window were given intravenaus infusion of rt-PA,and those out of thrombolysis time window orally received 0.3 g As-pirin tablet every evening,then 0.1 g after 1 week+40 mg Atorvastatin calcium tablet every evening,and if patients have arfficulty suallowing,gavage administiation was implemented. Observation group additionally received 30 ml Xingnaojing injection,adding in-to 250 ml 0.9% Sodium chloride injection,intravenous infusion,once a day. The treatment course for both groups was 14 d. Clini-cal efficacy,γ-interferon(IFN-γ),interleukin-13(IL-13),interleukin-4(IL-4),high-sensitivity C-reactive protein(hs-CRP)lev-els,the US National Institutes of Health Stroke Scale(NIHSS)rating,improved Barthel index(BI),infarction size before and af-ter treatment and the incidence of adverse reactions in 2 groups were observed. RESULTS:There was no significant difference in the total effective rate and incidence of adverse reactions in 2 groups(P>0.05). Before treatment,there were no significant differ-ences in IFN-γ,IL-13,IL-4,hs-CRP levels,the NIHSS rating,BI and infarction size in 2 groups(P>0.05). After treatment,the IFN-γ,hs-CRP levels,the NIHSS rating and infarction size in 2 groups were significantly lower than before,and observation group was lower than control group,IL-13,IL-4 and BI were significantly higher than before,and observation group was higher than control group,the differences were statistically significant (P<0.05 or P<0.01). CONCLUSIONS:Based on conventional treatment,Xingnaojing injection shows obvious efficacy the efficacy and safety of patients with acute cerebral infarction merge blood stasis syndrome,it can reduce the levels of inflammatory cytokines,improve neurological deficits,daily living skills and in-farct volume,with good safety.