Objective To study the aplication effect of fiber bronchoscope examination in the treatment of respiratory internal medicine emergency and its effect on the quality of life of patients.Methods 156 patients with emergency were randomly divided into the observation group and control group,each group in 78 cases.The control group was given routine treatment plan according to the primary disease type which was the respiratory treatment of the corresponding diseases,the observation group in the control group was added fiberoptic bronchoscopy based on the treatment.Compared blood clinical curative effect,heart rate and quality of life score changes of the two groups of patients after treatment.Results The total effective rate of the observation group was 94.87%,which was significantly higher than 81.01% of the control group(χ2 =6.28,P <0.05).The pH,PaO2 and SaO2 in the observation group after treatment were(7.35 ±0.04),(73.23 ±9.11)mmHg and(92.33 ±4.32)%,which were significantly higher than the corresponding index in the control group(t =3.97,6.08,4.96,all P <0.05);while PaCO2 and HR were (51.53 ±9.24)mmHg,(91.69 ±12.42)times/min,which were significantly lower than the corresponding index in the control group(t =6.73,5.13,all P <0.05);The quality of life score in the observation group was(54.04 ± 10.94)points,which was significantly lower than(77.23 ±12.32)points of the control group(t =5.86,P <0.05). Conclusion Fiberoptic bronchoscopy for respiratory internal medicine emergency treatment can significantly improve the clinical curative effect of treating disease and patient quality of life.

Objective To assess the correlation between fundic gland polyps and colorectal neoplasia. Methods Clinical records of patients who underwent both gastroduodenoscopy and colonoscopy during the same period were retrospectively analyzed. A total of 195 patients were enrolled into the study,65 diagnosed as having fundic gland polyps and 130 as controls matched with age and sex. Colonoscopic findings were compared between the two groups. Results Colorectal neoplasia was identified in 12 (18. 5%) of 65 patients and in 8 (6. 2%) of 130 controls with significant difference (P =0. 008) . Stratification analysis suggested that the incidence of colorectal neoplasia in fundic gland polyps group was higher in females or aged less than 50 than that of the control group(P=0. 023,0. 008). Conclusion Patients with fundic gland polyps have significantly higher risk for colorectal neoplasia. A screening colonoscopy may be necessary for patients with fundic gland polyps to detect colorectal neoplasia.

Objective To assess the value of acute physiology and chronic health evaluationⅡ (APACHE-Ⅱ) score and extrapancreatic inflammation on abdominal computed tomography (EPIC) score in predicting outcome of patients with acute pancreatitis (AP).Methods One hundred and forty-seven patients with AP who underwent abdominal computed tomography scan within 24 h and acute physiological examination after admission were studied.To assess their value in predicting severe AP and complications,the APACHE Ⅱ score and EPIC score was calculated and evaluated by calculating receiver operator characteristic (ROC)curves,the sensitivity,the specificity,the Youden index and the area under the ROC curve (AUC).Results Forty-three of 147 patients developed severe AP.The mean scores of APACHE-Ⅱ score and EPIC score two criteria systems was significantly higher in severe AP than that in mild AP (P< 0.01).EPIC score had 0.893 sensitivity,0.870 specificity and the largest AUC for predicting severe AP.EPIC score had the largest AUC in predicting local complications.But the EPIC score was equal to the APACHE-Ⅱ score in AUC to predict systemic complications.Conclusion In patients with AP.EPIC score and APACHE-Ⅱ score combination will estimate the prognosis of disease accurately within 24 h of admission.

Objective To investigate the enhanced osteogenesis during bone fracture healing after intracerebroven-tricular (ICV) leptin injection, using rabbit model with created segmental bone defect in right tibial. Method Segmental critical-sized defects were created at the right tibial bone of skeletally mature New Zealand white rabbits. In experiment group (leptin group), recombinant rabbit leptin was injected into cerebellomedullary cistern through foramen magnum. While in control group, normal saline was injected in the same way. Bone Mineral Density (BMD) was evaluated by qCT at 1st, 3rd, 7th, 14th and the 21st days. At the 21st days, all rabbits were euthanized to collect the right tibia for histomorphology, to ex-amine the BMP-2 expression in the bone callus by Fluorescence in situ hybridization (FISH). Result In the leptin group, body weight declined more obviously than control group then it start to arise at the 14th day;qCT showed significant higher BMD in leptin group than in control group at the 7th day;FISH showed a higher BMP-2 expression in leptin group than in control group. Conclusion Cerebellomedullary leptin injection through foramen magnum could accelerate limb fracture healing in rabbit model with right tibial bone defection.

Objective To develop a noninvasive diagnostic model comprising of transabdominal ultrasonography and serum markers for assessing esophageal varices in liver cirrhosis.Methods Totally 230 liver cirrhosis patients were randomly allocated to either an estimation group(161 cases)or a validation group(69 cases).Gastroscope was performed and whether esophageal varices existed or not was assessed in every patient.Seventeen common ultrasonographic and serum markers were analyzed initially in the estimation group to derive a predictive model.The model created was then assessed with ROC analysis.It was also applied to the validation group to test its accuracy.Results Among seventeen variables associated with esophageal varices selected by univariate analysis,splenic thickness,diameter of portal vein,prothrombin time were indentified by multivariate Logistic regression analysis as independent risk factors of varices.A varices index constructed from the above three markers was established.In ROC analysis,the AUC was 0.853(0.764,0.942)for predicting existence of varices using the optimal cutoff score 6.3.The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 81.2%,85.7%,92.35%,68.21%,82.77% respectively.For the validation group,the AUC and diagnostic accuracy were 0.889(0.814,0.965)and 82.86% respectively.Conclusion A noninvasive model consisting of splenic thickness,diameter of portal vein and prothrombin time is helpful in predicting existence of esophageal varices in cirrhosis.

Objective To investigate the relationship between the expressions of angiotensin converting enzyme 2(ACE2)/ACE mRNA in myocardium-nephors and the blood pressure in spontaneously hypertensive rats (SHR).Method A total of 18 male of 12 weeks old SHRs and 18 male of 12 weeks old Wistar Kyoto(WKY)rats were got for the experimental study.Nine SHRs and 9 WKY rats were randomly taken out as controls and sacrificed for detecting the mRNA expressions and protein of ACE2 and ACE.Other halves of rats of both groups were fed for 12 weeks and then sacrificed for detecting of the same biomarkers as in controls.The mRNA expressions of ACE2 and ACE were determined by real-time quantitative RT-PCR.The protein level of ACE2 and ACE were determined by immunohistochemistry.Results Systolic blood pressure(SBP)in SHRs of 12 and 24 weeks old increased compared with that in WKY(all P＜0.01).SBP in SHRs of 24 weeks old increased compared with that in SHRs of 12 weeks old(P＜0.01).The cardiac and renal expressions of ACE2 mRNA in SHRs of 12 and 24 weeks old were all significantly lower than those in WKY rats(P＜0.01).The expressions of ACE mRNA in SHRs of 12 and 24 weeks old were all significantly higher than those in WKY rats(P＜0.05,P＜0.01).The cardiac and renal expression of ACE2 mRNA in SHRs of 24 weeks old was significantly lower than that in SHRs of 12 weeks(P＜0.01).The myocardial and renal expression of ACE mRNA in SHRs of 24 weeks old was significantly higher than that in 12 SHRs of weeks old(P＜0.01).The positive reactions of ACE2 protein found in kidney displayed in brown colur.The ACE2 proetin appeared in uniform distribution of brown granules in WKY rats and comparatively scanty distribution of brown granule in SHRs.Conclusions There are correaltions between the expressions of ACE2/ACE mKNA as well as protein and blood pressure.

Objective To evaluate the application of 1H-MRS in chronic liver diseases related with hepatitis B, and to investigate the method of eliminating breathing influence to proton MR spectroscopy (1H-MRS) on liver. Methods Liver spectroscopy of 46 subjects were obtained by single-voxel PRESS sequence with respiratory gating with GE 1.5T scanner. The subjects were divided into 4 groups: the normal male group (10 cases), the normal female group (10 cases), the male hepatitis B cirrhosis group (14 cases) and the male liver cancer after hepatitis B group (12 cases) according to clinical data, MR manifestations and pathologic findings. Glutamine and glutamate complex (Glx) peak height served as a reference standard to judge the choline (Cho) peak height. The differences of Cho peak height of each group were compared. Results The peaks of Cho were lower than those of Glx in normal male group. The peaks of Cho were higher than those of Glx in 8 women of normal female group. The peaks of Cho were higher than those of Glx in 11 patients of the male hepatitis B cirrhosis group. The peaks of Cho were higher than those of Glx in 10 patients of the male liver cancer after hepatitis B group. The differences of Cho peak were statistically significant between normal male group and normal female group, the male hepatitis B cirrhosis group and the normal male group, the male liver cancer after hepatitis B group and the normal male group. Conclusion The peaks of Cho in normal males are lower than those of Glx. The peaks of Cho in the majority of normal females are higher than those of Glx. The peaks of Cho increase in male hepatitis B cirrhosis and liver cancer after hepatitis B. Respiratory gating can effectively eliminate the impact of breathing movement on proton MR spectroscopy of liver.

Objective To analysis of preoperative preparation,operation,character,advantage and deficiency of two non-robotic TIMAH approach in MIDCAB,and to observe the short-term follow up result.Methods 7 male CAD patients with classic unstable angina pectoris,the age ranged from 52 to 75 years,average (63.8 ± 8.5) years,underwent TIMAH and MIDCAB,in which 6 single LAD disease patients and one patient for reoperation with saphenous vein graft (SVG) graft failure to LAD and progressive obtuse marginal(OM) coronary artery disease.These patients were intubated with a double-lumen endotracheal tube,and one-lung ventilation were used to facilitate the procedure.In the approach of two incisions TIMAH for 4 patients,the thoracoscope was placed at the third intercostals space(ICS) on the anterior axillary line,and LIMA was dissected with endo-instruments placed from the two angles of mini-thoracotomy at fifth ICS on the midclavicular line.In the approach of three incisions TIMAH for 3 patients,LIMA was dissected with endo-instruments placed from two ports at the fourth ICS on the anterior axillary line and at the fifth ICS on the midclavicular line,and the thoracoscope was placed at the second or third intercostals space (ICS) on the anterior axillary line.Anastomosis of LIMA and LAD followed through mini-thoracotomy at fifth ICS with the heart stabilizer after TIMAH.SVG graft was used from LIMA to OM in the reoperation patient.Results All patients underwent TIMAH and MIDCAB safely without transferece to stenotomy,only one LIMA was extended with 2 cm SVG for injure at the distal.In 6 single vessel disease patients the length of mini-thoracotomy incision was (6.0 ± 0.9) cm,TIMAH time was (112 ±18) min,operation time was (293 ± 75) min,bleeding volume was (233 ± 52) ml,endotracheal tube time was (14.2 ± 10.7) h,ICU time was (1.8 ±0.4) d and hospital stay time was (10.1 ±6.7) d.All patients were uneventful discharged and with no recurrence of cardiac symptoms in short-term follow up.Conclusion TIMAH can perform safely in both approaches for LIMA prepare to MIDCAB as described before.The minimally invasive procedure need not enlarge incision for LIMA harvesting with good short term results.

Objective To explore the feasibility and safety of total laparoscopic radical resection for a patient of Bismuth type Ⅲ a hilar cholangiocarcinoma.Methods This patient underwent right hemihepatectomy combined caudate lobectomy,radical regional lymphadenectomy and Roux-en-Y hepaticojejunostomy under total laparoscopic techniques.Preoperatively the volume of future liver remnant estimated by CT scan was 46％,and indocyanine green retention rate at 15 min (ICG R15) was 6.0％.Results The total laparoscopic surgery was carried out successfully with operation time of 540 min and intraoperative blood loss 300 ml,without blood transfusion.The results of pathological examination showed well-differentiated adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis(0/13).The postoperative recovery was uneventful with hospital stay time of 10 days and without any complications.Conclusion At experienced hands,total laparoscopic radical resection of Bismuth type Ⅲ a hilar cholangiocarcinoma is feasible and safe for selected patients.