ObjectiveTo evaluate the effect of laparoscope and open repair on treating upper gastrointestinal(UGI) ulcer perforation.MethodsRetrospective analysis was performed in consecutive series of 143 patients undergoing UGI ulcer perforation repairing.Among the total 143 patients,98 cases underwent laparoscope repair(laparoscope group),45 cases were with open repair (open group).The operation methods included either simple interrupted suture or pedicled omental patch.Postoperative management of triple therapy included proton pump inhibitor,β -lactam antibiotics and arilin was conducted.Therapeutic effects were compared between two groups.ResultsOperating time in laparoscope group was significantly longer than that in open group [ ( 83.88 ± 19.67 ) min vs.( 63.33 ± 12.06) min,P ＜ 0.01 ].Time of passage of gas by anus,hospital stay,cost of hospitalization and postoperative dosage of opiates in laparoscope group were significantly lower than those in open group [ (29.45 ± 9.24) h vs.( 46.40 ± 49.21 )h,(6.92 ± 1.06) d vs.(7.71 ± 2.48 ) d,(6929.39 ± 832.40) yuan vs.(7546.67 ± 1393.92) yuan,(5.7 ±8.3 ) mg vs.( 10.9 ± 9.5 ) mg,P＜ 0.01 ].There was no significant difference between two groups in perforated diameter,perforated position and flushing dose of abdominal cavity (P＞ 0.05 ).The rate of complication was 14.29％ (14/98) in laparoscope group,while 26.67％ (12/45) in open group,there was no significant difference between two groups (P＞ 0.05 ).ConclusionsLaparoscope repair of UGI ulcer perforation is a safe and feasible procedure compared with open repair.Although operating time of laparoscope repair is longer than open repair,the rate of complication does not increase.

Objective To investigate the causes of clinical misdiagnosis for gastric mucosa associated lymphoid tissue lymphoma (GMALT). Methods The clinical manifestations of and accessory examination for GMALT in 32 cases were retrospectively analyzed. Results Clinical misdiagnosis was made on 32 out of 78 cases (41%) of GMALT for a period of 5 days to 13 months. Radiographic misdiagnosis rate was 40% and endoscopic misdiagnosis rate was 37%. Conclusion The preoperative diagnosis of GMALT was difficult because the incidence of GMALT is low, the symptoms are nonspecific, and radiologic and fibergastroscopic features were very similar to those of gastric carcinoma and peptic ulcer.

Objective: To investigate constitutional and phys ical stamina status in soldiers with different adaption periods in Tibetan areas . Methods: Two hundred and eithty-two male soldiers from a barr acks at an elevation of 3 600 m were divided into 2 groups: the veteran group ( n=143) in Tibet for 1.45±0.22 year, and the recruit group (n=139) in Ti bet for 0.33±0.00 years. The test items included body weight, cirumference, st a nding long jump, chin-up, 100 m dash and 3 000 m jogging, all were evaluated ac cording to the national military standard, which were Comprehensive Evaluation o f Health in Troops, and Examination and Evaluation of the Physical Stamina of So ldiers. Results: The physical stamina indexes of both the vetera ns and the recruits were up to the national military norm on the whole, ranking as moderate. The veteran group showed no significant difference in standing long jump and 100 m dash,（P<0.05), but obvious lower level in chin-up and 3 00 0 m jogging（P<0.01）, compared with the national military norm. The recr ui t group showed significant lower level in chin-up, 100 m dash, 3 000 m jogging as compared with the national military norm（P<0.01）, and also significant lower level in chin-up and 3 000 m jogging （P<0.05 or P<0.01) as compa red with the veteran group. Conclusion: The physical stamina of both the veterans and the recruits meet the basic national military requirements , ranking as moderate. The soldiers who have been in service for over 1 year hav e better explosive force, but they need more tolerance and aerobic exercises. Th e newly recruited need more exercise to raise tolerance to the hypoxic environme nt in plateau areas so as to shorten the adaption time to high altitude.

Objective To investigate the clinical manifestation and management of acute cholangitis severe type (ACST) with different typos of obstruction. Methods From January 1997 to December 2006, 164 consecutive patients with ACST had been admitted to Chengdu First People's Hospital. All patients were divided into extrahepatic type group (n=122), intrahepatic type group (n=18) and mixed type group (n=24) accord-ing to the types of obstruction. Clinical manifestation and therapeutic outcome of the 3 groups were analyzed using chi-square test, continuity correction test or Fisher exact test. Results There was no significant difference in clinical manifestation between patients with extrahepatic type and those with mixed type (P>0.05). The incidence of jaundice and abdominal pain in patients with intrahepatic type is significantly lower than those with extrahepatic type (P<0.05). The incidences of distention in consciousness and response to initial medical treat-ment were higher than those with extrahepatic type (P<0.05). The total mortality rate was 9.8% (16/164). Of all patients, 123 received open surgery. There was no significant difference in morbidity and mortality in patients with intrahepatic type and mixed type (χ~2=0.172,0.789; 1.769, 1.948, P>0.05). In emergency operation, the incidence of biliary high pressure and postoperative vital sign improvement rates were significant higher in patients with extrahepatic type than the other 2 types (P<0.05). The morbidity and mortality of patients who received emergency operation were higher than non-emergency operation (P<0.05). Conclusions The clinical manifestation of ACST is different between intrahepatic obstructive type and the other 2 types. There is no signi-ficant difference in morbidity and mortality among the 3 types of obstruction. The morbidity and mortality are high in patients who received emergency operation. Proper management of surgical timing is helpful in decreasing the morbidity and motality of ACST.

Objective:To compare the therapeutic and adverse effects of concurrent raltitrexed plus oxaliplatin and radiotherapy with those of PF synchronous radiotherapy in the treatment of advanced esophageal cancer. Methods:A total of 84 pathologically con-firmed patients with advanced esophageal carcinoma were randomly distributed to the concurrent raltitrexed plus oxaliplatin and ra-diotherapy group (experimental group, n=40) and to the PF synchronous radiotherapy group (control group, n=44). All patients were treated with 3DCRT at a total dose of 60 Gy/30f. The chemotherapy in the experimental group consists of raltitrexed at 2.5 mg/m2, d1, plus oxaliplatin at 130 mg/m2, d2. The chemotherapy of the control group consists of DDP at 25 mg/m2, Dd1-3, plus 5-FU 500 mg/m2, d1-5. Two cycles of concurrent chemotherapy were administered during radiotherapy on d1 and d29. The comparison results were used to estimate the therapeutic and adverse effects of the two groups. Results:The rerponse rate, complete response, and one-year overall survival rate of the experimental group were higher than those of the control group [(87.50%vs. 79.54%, P=0.3293), (32.50%vs. 18.18%, P=0.13), and (82.50%vs. 79.50%, P=0.701)], but the difference was not statistically significant. The incidence rates of nau-sea and vomiting, appetite degression, leucopenia, radiation-induced esophagitis, and cardiotoxicity were significantly lower (P<0.05) in the experimental group than in the control group. Other adverse effects of the two groups were similar (P>0.05). Conclusion:Simi-lar to PF chemotherapy and radiotherapy, the concurrent raltitrexed plus oxaliplatin and radiotherapy achieved a similar short-term therapeutic effect but lower adverse effects on patients with esophageal cancer.

Objective To study the apoptosis-inducing effects and mechanisms of influenza virus A H_ 3 N_ 2 on a self-established endometrial adenocarcinoma cell line JEC. Methods JEC cells were infected with different concentrations of H_3N_2, the apoptosis were detected using the HE staining, DNA agarose gel electrophoresis and flow cytometry. The expressions of Fas, FasL and TGF-? were examined by immunocytochemical staining. Results After infection, the JEC cells showed the morphological apoptosis; DNA agarose electrophoresis demonstrated a ladder-like pattern of DNA fragments; FITC/PI stained FCM showed the apoptotic rate of JEC had been decreased along with the prolonging of infected time and elevated with the increase of the virus concentrations. Immunocytochemical staining showed that enhanced expression of Fas, attenuated expression of TGF-?, and no expression of FasL after H_3N_2 infection. Conclusion Influenza virus A H_3N_2 can induce JEC cells to apoptosis in time- and concentration- dependent manners, which may be related with the expressions of Fas and TGF-?.

This study was aimed to explore the mechanism of electroacupuncture (EA) on improvement of Parkinson’s disease (PD). A total of 40 SD male rats were randomly divided into 4 groups, which were the normal group, sham-operation group, model group, and EA group (n=10). The 6-hydroxydopamine (6-OHDA) was used to prepare PD rat rotational model. The 0.2% Vitamin C of physiological saline was injected in the sham-operation group. EA on GV16-Fengfuand LR3-Taichongwas given for 30 min in the EA group after the model was successfully established, once a day, 7 days a treatment course. The treatment was given for 2 courses. Behavioral test was used to detect PD rat rotational behavior changes. Glu concentration in the striatum was detected by HPLC assay. The expression levels of GS and PAG were detected with western blot. The results showed that there were significant differences in the rotational behavior before and after treatment in the EA group (P < 0.01). Compared with the normal group and sham-operation group, Glu concentration significantly increased, GS expression obviously decreased, and PAG expression significantly increased in the model group (P < 0.01). Compared with the model group, Glu concentration obviously decreased (P < 0.05), GS expression significantly increased, and PAG significantly decreased in the EA group (P < 0.01). It was concluded that the protective effect of EA in PD may be associated with EA improving the expression of GS, reducing the expression of PAG, and relieving the cytotoxicity induced by Glu in the brain.

Objective To identify the impact factors for community doctors with the essential medicine system in place,in support of mobilizing them and successful implementation of the essential medicine system in the community.Methods Based on the theory of ERG hierarchy of needs,the pathway analysis method was called into play to identify the three factors affecting community doctors,namely personal survival,interpersonal relations and self-development.Results Major factor of which is the interpersonal factor,with a score of 0.549,while the latter two factors do not directly affect the survival and development.The two however work on each other,and work on the interpersonal factor as well,with the impact coefficients of 0.320 and 0.402 respectively.Conclusion With the essential medicine system in place,the largest impact factor for community doctors'enthusiasm is the interpersonal one,involving the doctor-patient communications among others.This serving as the breakthrough point may improve the enthusiasm of the community doctors,paving the way for the system in the communities.

Objective To investigate the effect of progressive neurological deterioration ( PND) of cerebral watershed infarction on early prognosis. Methods The consecutive patients with cerebral watershed infarction admitted in the Department of Neurology,Jinling Hospital,Nanjing University School of Medicine and their cerebral watershed infarctions confirmed by the imaging examination from March 2009 to March 2014 were enrolled. The clinical features, laboratory indicators and imaging features of internal watershed infarction,cortical-type watershed infarction,and mixed watershed infarction were identified and analyzed. The National Institutes of Health Stroke Scale was used to score neurological deficit. The modified Rankin scale ( mRS) was used to score the prognosis of patients. Single factor analysis was used to compare the differences between the groups. At the same time,the correlation between PND and poor prognosis of cerebral watershed infarction at day 90 was analyzed by multivariable Logistic regression analysis. Results A total of 89 patients with cerebral watershed infarction were enrolled,including 43 cortical-type watershed infarctions,36 internal watershed infarctions, and 10 mixed watershed infarctions. Single factor analysis indicated that the incidences of PND of internal watershed infarction and mixed watershed infarction were significantly higher than the cortical-type watershed infarction (36. 1% [n=13],50. 0% [n=5], and 16. 3% [n=7],respectively;P=0. 018). At day 90,28 patients had poor prognosis,and mRS was (3.4±1. 0) scores at day 90. There was significant difference in the types of infarction between the patients with poor prognosis and patients with good prognosis (P<0. 05). In patients with poor prognosis, most of them were internal watershed infarctions,accounting for 50. 0% (14/28),while in patients with good prognosis,most of them were cortical-type watershed infarctions(57. 4% [35/61]). The incidence of PND in patients with poor prognosis was significantly higher than that in patients with good prognosis (57.1% [16/28] vs. 14. 8% [9/61];P<0. 05). The result of multivariate Logistic regression analysis showed that after adjustment for confounding factor, PND was independently associated with the poor prognosis of cerebral watershed infarction at day 90 (OR 6. 969,95%CI 2. 451-19. 869;P<0. 01). Conclusion Compared with the cortical-type watershed infarction, the patients with internal watershed infarction is more prone to have PND, and PND is independently correlate with the poor prognosis at day 90.

Objective To investigate MRI manifestations of lumbar and proximal femoral bone marrow changes before and after recombinant human granulocyte colony stimulating factor (rhG-CSF) was subcutaneous injected for healthy adults.Methods Twenty healthy blood stem cell donors without hematologic disease were enrolled in this study. All of them underwent lumbar sagittal and proximal femur coronal MRI examination with spin echo T1 WI and fat-suppressed T2WI.The first examination were performed before subcutaneous injection of rhG-CSF for comparison. In 4-7 days and 30-60 days after injection, the other two examinations were performed. The signal changes of lumbar and proximal femoral bone marrow were investigated by reading pictures and calculating the contrasted noise ratio (CNR).ResultsBefore rhG-CSF injection, all patients presented normal signal intensity of hone marrow. In 4-7 days after injection, all the 20 cases presented homogeneous signal decrease in lumbar vertebral bodys on T1 WI, accompanied by reduced fatty signal. In proximal femur, patchy or stripped hypointensity areas were found in intertrochanteric and subtrochanteric areas on T1 WI. On fat-suppressed T2 WI images, the signal of lumbar and proximal femoral bone marrow changed to equal or slightly-high signal intensity. In all cases,abnormal signal areas presented in lumbar and proximal femoral bone marrow occurred simultaneously in the same case.In the 10 cases received the third MRI during 30-60 days after rhG-CSF injection, signal intensity of lumbar bone marrow turned to normal in all sequence, but abnormal signal intensity areas were still existed and extended to distal part in femoral bone marrow, which appeared as symmetric stripped or patchy equal or slightly-low signal intensity on T1 WI and equal or slightly-high signal intensity on T2 WI. The CNR of lumbar bone marrow to subcutaneous fat before rhG-CSF injection, in 4-7 days and 30-60 days after rhG-CSF injection were 114. 11 ± 15. 11,71.04 ± 12. 25 and 91.64 ± 1 I. 68, respectively. Significant difference was found between before rhG-CSF injection and 4-7 days after injection ( P ＜ 0. 05 ) , but no significant difference between the others( P ＞ 0. 05 ). Conclusion After injection of rhG-CSF, the short-term changes of hematopoietic cells and fat content in bone marrow can be displayed on MRI, which provided non-invasive information for bone marrow transplantation.