Purpose:To observe the curative effect and the clinical-benefit-response of patients with advanced pancreatic cancer who used a combine of Gemcitabine,5-FU and PDD.Methods:The treatment with Gemcitabine (800 mg/m 2) was followed by 5-FU(600 mg/m 2) and DDP (30 mg/m 2),administered on days 1,8 and 15 of 28-day schedule. The curative effect was estimated according to the standard of WHO and the clinical benefit response was evaluated at the same time. The standard of CBR included pain,physical states and body weight. Results:Twenty-five (25/29) patients received over two cycles chemotherapy. 6(24%) partial response (PR), 12 (48%) stable disease and 7(28%) progressive disease were observed. According to the standard of CBR, 18(62.1%) patients achieved the clinical-benefit-response level. Therapy was well tolerated. The main toxicities included that the alimentary tract reactions and the marrow depression. Grade 3-4 thrombocytopenia was reported in 8 (27.6%) patients. Conclusions:The combination of GEM, 5-FU and DDP is a moderatedly active treatment with tolerable side-effects. It has definite response rate and high CBR rate in pancreatic cancer.

Objectives: To evaluate the clinical application of emergency extracorporeal circulation(ECC) in cardiac surgery. Methods: Emergency open heart surgery was performed in 24 ECC cases. Warm blood left heart bypass was performed in 3, hypothermic cardiopulmonary bypass in 21. The vena cava-aorta extracorporeal circulation was built in 16,vena cava-femoral in 4, left atrium-femoral in 3 and femoro-femoral in 1. Retrograde or antegrade perfusion through aortic root were applied to protect the heart. Results: There were 2 hospital deaths, the hospital mortality rate was 8.3%. The cardiopulmonary bypass was established in 10 to 15 minutes with an average duration of cardiopulmonary bypass of 78～132 minutes. Twenty-two patients were discharged from the hospital and have resumed a normal and active life style. Conclusions: Emergency cardiopulmonary bypass support is a powerful resuscitative tool that may stabilize the condition of patients with cardiogenic shock and mutiorgan dysfunction to allow for definitive intervention. The femoro-femoral cannulation is the first choice for emergency. The time to establish extracorporeal circulation should be as short as possible.

Objective To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy (CSP). Methods From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate (MTX) 50 mg/m2 intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5 - 10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β(β-hCG) descent less than 30% in every 48 hours for 3 times after curettage, then MTX (50 mg/m2) intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage.Group C: 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss( M), lesion diameter (-x±s), blood β-hCG level (M)before treatment, the number of cases with myometrial thickness anterior to the CSP ≤3 mm, the resistant index (RI) ≤0. 5,expense(-x ± s), hospital days(-x ±s) in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied. Results ( 1 ) Clinical manifestation: bleeding loss were 20 ml in MTX +curettage of group A, 10 ml in curettage + MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B ( P ＜ 0. 01 ).The lesion diameter were ( 23 ± 15 ) mm in curettage + MTX of group A and ( 30 ± 14 ) mm of group B ,which were higher than ( 16 ± 8 ) mm of MTX + curettage of group A (P ＜ 0. 01 ). The lesion diameter of (52 ± 7 )mm in group C were significantly bigger than those in the other groups ( P ＜ 0. 01 ). The level of blood β-hCG levels were 21 592 U/L in MTX + curettage of group A, 979 U/L in curettage + MTX of group A,which reach statistical difference ( P ＜0. 05). The level of blood β-hCG levels were 11 312 U/L in group B and 101 U/L in group C. Among 28 cases with Rl≤0. 5,there was 8 cases in group A (24% ,8/33),18 cases in group B ( 30%, 18/60) and 2 cases in group C (2/3). Among 23 cases with myometrial thickness anterior to the CSP ≤ 3 mm, there was 21 cases in group B (35%, 21/60 ), which were significantly higher than 2 in group A (6%, 2/33 ) and none in group C ( P ＜ 0. 05 ). The expense were ( 5578 ± 3679) yuan in MTX + curettage of group A and (5346 ± 2765 ) yuan in curettage + MTX of group,which did not reach statistical difference (P＞0. 05). The expense were (7860 ±2104) yuan in group B,which were significantly higher than those in group A and (5004 ± 421 ) yuan in group C (P ＜ 0. 05 ). The hospital days were ( 15 ±8) days and ( 19 ± 14) days of group A, ( 16 ± 10) days in group B and ( 17 ±8)days in group C, there was no significant difference among those treatments ( P ＞ 0. 05 ). (2) Correlatin:there was positive correlation between bleeding loss and lesion diameter( r = 0. 31, P ＜ 0. 05 ) or blood β-hCG level ( r = 0. 35, P ＜ 0. 05). Conclusions MTX intravenously guttae, MTX uterine artery injection and embolization, and laparotomy lesion excision were all properly used in treatment of CSP. MTX uterine artery injection and embolization was recommended for those with big lesion, high β-hCG level, less myometrial thickness anterior to the CSP or plentiful blood supply of the lesion but the expense might be high.

Objective To explore the clinical effect of CSDP combined with losartan treatment on type 2 diabetic nephropathy with stage Ⅲ.Methods Sixty patients suffered from type 2 diabetic nephropathy with stage Ⅲ were recruited as our subjects.They were randomly divided into Candesartan group and Candesartan + CSDP group,each for 30 patients.Patient in Candesartan + CSDP group were administrated with candesartan 4 mg,once per day,the CSDP 15 capsules and three times / day for 3 months.Patients in Candesartan group were given:candesartan 4 mg once/day for 3 months.The level of urinary albumin,serum urea nitrogen (BUN) and creatinine (Cr) were measured of subjects before and after treatment.Results The levels of BUN,Cr were lower after any treatment than before treatment in 2 groups.The difference of BUN,Cr in Candesartan + CSDP group were(-14.6 ± 8) mg/L,(-11.9 ± 3.3) μmmol/L,(-0.7 ± 0.2) mmol/L,higher than that of Candesartan group (-7.1 ± 7.8) mg/L,(-8.5 ± 0.8) μmol/L,(-0.4 ± 0.1) mmol/L] (P ＜ 0.01).Conclusion The treatment strategy of Candesartan joint CSDP can be method regarding of reducing urinary albumin and BUN,Cr in patients of type 2 diabetic nephropathy with stage Ⅲ.

Objective:To investigate the mainstream view and statusof people on body donation in Yunnan province, and provide references. Methods:Random sampling questionnaire survey was used, the obtained data was statistically analyzed. Results:Only 48. 0% of the people understand the body donation, 20. 6% of people know body donation ways and procedures, 27. 8% of people have heard of body receiving station, 11. 4% of people know the body receiving station in yunnan province, 17. 2% of the people to understand body donation of relevant laws and regulations. 47. 4% of people that are willing to donate his body. Conclusion:Make perfect laws and reg-ulations, respect for the body, giving donors and their families allowance, body donation monument, to carry out education and publicity of the body donation form to the whole society support and participate in the good atmos-phere of body donation has great benefits.

Objective To study the changes of oral flora in patients with diabetic ketoacidosis,in order to provide evidence for making oral nursing intervention and hygiene education. Methods 35 patients with diabetic ketoacidosis were named as group A,35 non-diabetic patients with chronic periodontitis (diagnostic criteria:periodontal pocket 14 mm) were named as group B,35 nonketotic patients with diabetes mellitus were named as group C,then all the patients were detected for the oral disease and the oral hygiene was evaluated. Results The gingival index,plaque index,tooth mobility,probing depth and hemorrhage after the detection of three groups had no significant differences. The detection rate of streptococcus oralis, lactobacillus,fusobacterium nucleatum,black-pigment bacteria,Capnocytophaga gingivalis,actinomycetes, escherichia coli,staphylococcus aureus and pseudomonas aeruginosa had no significant differences,there was a positive correlation between quantity of black-pigment bacteria, Capnocytophaga gingivalis and fasting blood glucose and glycosylated hemoglobin of patients with diabetic ketoacidosis. Conclusions Diabetic ketoacidosis strengthened the bacterial invasion and oral colonization of patients.

Objective To investigate the influence of gonadotropin-releasing hormone (GnRH) analogues on ovarian cancer and ovarian function in vivo.Methods ES-2 cells were cultured and xenotransplanted into 36 nude mice,which were divided into 6 groups:normal saline (NS) group:NS 0.1 nd/day subcutaneous injection,and then NS 0.2 ml/week peritoneal injection; cisplatin (DDP) group:NS 0.1 ml/day subcutaneous injection,and then DDP 5 mg/kg ( diluted to 0.2 ml ) per week peritoneal injection; goserelin group:100 μg goserelin ( diluted to 0.1 ml) per day subcutaneous injection,and then NS 0.2 ml/week peritoneal injection; goserelin + DDP group:100 μg goserelin ( diluted to 0.1 ml) per day subcutaneous injection,and DDP 5 mg/kg (diluted to 0.2 ml) per week peritoneal injection; cetrorelix group:100 μg cetrorelix (diluted to 0.1 ml) per day subcutaneous injection and NS 0.2 ml/week peritoneal injection; cetrorelix + DDP group:100 μg cetrorelix (diluted to 0.1 ml) per day subcutaneous injection and DDP 5 mg/kg ( diluted to 0.2 ml) per week peritoneal injection.All the peritoneal injection started from subcutaneous injection one week later.To compare the weight of nude mice,the volumes of transplanted tumors,the expression of Ki-67 antigen in transplanted tumors,the estrus,the ratio of atretic follicles,the ratio of primary and preantral follicles,the levels of serum anti-Mullerian hormone ( AMH ),folliclestimulating hormone ( FSH),estradio ( E2 ) and progesterone (P) in each group.Results There were no significant difference in the weight of nude mice among 6 groups ( P ＞ 0.05 ),which on day 29 in NS group was ( 19.8 ±2.2) g,DDP group (20.5 ± 1.4) g,gosereline group ( 19.6 ±0.9) g,goserelin + DDP group ( 19.7 ± 1.6) g,cetrorelix group (20.7 ±2.2) g,and cetrorelix + DDP group ( 19.0 ± 1.7) g.The tumor volumes of different groups on the 12th day:NS group (241 ± 179) mm3,DDP group (78 ±20) mm3,gosereline group (78 t±55) mm3,goserelin + DDP group (64 ±48) mm3,cetrorelix group (78 ±64) mm3,or cetrorelix + DDP group (70 ± 19) mm3,in which there were significant difference between NS group and the other groups ( P ＜ 0.05 ) ; and the same result was obtained on day 15,19,22,26 and 29 ( P ＜ 0.05 ).The expression of Ki-67 in NS group was ( 33 ± 10 ) ％,in which it was higher than those in DDP group 3.5％,goserelin group 8.8％,goserelin + DDP group 1.5％,cetrorelix group (23 ± 11 ) ％,or cetrorelix + DDP group ( 8 ± 6 ) ％ ( P ＜ 0.05 ).The ratio of primary and preantral follicles in goserehn group was (71.5 ± 8.1 ) ％,in goserelin + DDP group was (62.4 ± 4.1 ) ％,in cetrorelix group was (71.2 ± 7.4) ％,and in cetrorelix + DDP group was (63.8 ±3.1 )％,in which they were much higher than that in DDP group ( 47.0 ± 4.8 ) ％ ( P ＜ 0.05 ).The level of AMH in goserelin group was ( 98 ± 27 ) ng/ml,which was much higher than that in NS group (66.2 ± 17.4) ng/ml (P ＜0.05),while there were no difference in the levelsof FSH,E2 or P among different groups ( P ＞ 0.05).Conclusion GnRH analogues could inhibit the growth of transplanted tumors in nude mice,meanwhile increase the secretion of AMH,decrease the frequencies and prolong the lasting time of estrus,decrease the ratio of atretic follicles,raise the ratio of primary and preantral follicles,which may be protect the ovarian function of nude mice.

Prominent problems of clinical teaching in Tibet University school of medicine were analyzed and countermeasures were proposed from aspects of management system construction, facul-ty construction, curriculum construction, base construction and quality evaluation system construction. The aim was to increase students' opportunity, enhance students' learning interest and improve stu-dents' ability of analysis and problem solving so as to improve the practical effects of clinical teaching. All countermeasures taken above laid the foundation for future clinical work and provided help for clinical medical personnel in Tibetan border areas.

Objective To understand the mainstream view of ethnic minorities and Han nationality in Yunnan province on Body donation, understand the present status and possible issues about body donation in Yunnan province, so as to provide reference for Yunnan province on body donation. Methods We conducted questionnaire survey by random sampling. Results Yi,Dai,Han on the body donation knowledge and Donation rate was low,and the Yi, Dai was lower than Han.promoting development of medicineandthat is the continuation of lifebecame the main factors affecting the willing to donate body,there was significant difference between the three ethnic groups ( <0.05) .After death should be laid to rest,family and public pressure,fear of being free to use,religious beliefbecome the main factors affecting the unwilling to donate body, three nations also had significant difference ( <0.05) .Conclusions Most people think that the whole society should pay close attention to body donation, that body donation is a very meaningful thing. Joint effort should be made by both the government and civil society for body donation programs in Yunnan Province.

Objective:To investigate the clinical efficacy of interlocking intramedullary nailing in the treatment of patients with traumatic long tubular fractures of the lower limbs.Methods:From April 2018 to October 2019, 114 patients with traumatic long tubular bone fractures of the lower extremity who were treated in the Department of Orthopaedics of the People's Hospital of Dongyang were selected.They were divided into two groups according to the random number table method, with 57 patients in each group.The control group received plate internal fixation, the observation group used interlocking intramedullary nailing.The treatment effect, operation time and complications of the two groups were compared.Results:The total effective rate in the observation group (98.25%) was higher than that in the control group (66.67%), the operation time [(69.87±3.46)min] and the incidence of complications (5.26%) were lower than those in the control group [(90.14±7.47)min, 19.30%], and the differences were statistically significant (χ 2=19.646, 5.211, t=18.589, all P<0.05). Conclusion:Compared with traditional steel plate internal fixation, interlocking intramedullary nail internal fixation is more effective in the treatment of patients with traumatic long tubular bone fractures of the lower extremities, the operation time is shorter, and the probability of postoperative complications is lower and has certain clinical value.