ObjectiveTo determine the diurnal variation,moon phase,and seasonal variation in the onset of stroke. MethodsThe time parameters,including the time,the moon phase and the season of the stroke occurrence for 905 in-patients from 1989-2001 were investigated.ResultsThere was a significant difference (D=0.155,P<0.01) for circadian rhythm in the onset of 321 cases with cerebral infarction,and the incidence frequency at dawn was much higher than that at other time,but the difference of the moon phase and seasonal rhythm in the onset of cerebral infarction were not significant(P>0.05).There were not diurnal variation,moon phase and seasonal rhythms in the onset for cerebral haemorrhage(P>0.05).ConclusionsThe cerebral infarction occur more frequently at dawn time.

Scirrhous gastric carcinoma is a special type of advanced gastric cancer accompanied by extensive interstitial fibrosis and diffuse cellular infiltration. Scirrhous gastric carcinomas are commonly classified as Borrmann 4 gastric carcinomas. Poorly differ-entiated adenocarcinoma and gastric signet ring cell carcinoma are observed during histologic typing. Thickening of the stomach and stenosis are characteristic of scirrhous gastric carcinomas. The prognosis of this type of gastric cancer is poor because of the likelihood of peritoneal metastasis and lymph node metastasis and the limited cure rates of simple surgery. However, operation should be conduct-ed when scirrhous gastric carcinomas are associated with ileus and urinary obstruction induced by peritoneal metastasis. R0 resection and postsurgical chemotherapy with S-1 are necessary for patients who are able to undergo recoverable operations. Preoperative S-1/CDDP combination chemotherapy is the preferred therapy. Moreover, chemotherapy is the best choice for patients who are unable to un-dergo recoverable surgery. Intraperitoneal chemotherapy is practical for controlling the behavior of scirrhous gastric carcinomas, partic-ularly peritoneal metastasis. Moreover, the efficiency of molecular-targeted therapy using bevacizumab and gene therapy through adeno-virus gene therapy still requires further study.

Resection of the automonic nervous system in the process of lymph nodes dissection is a major factor leading to postoperative gastrointestinal dysfunction.The era of blind expansion of the wide excision has been questioned,and safety first,radical dissection of the metastatic lymph nodes,low invasive rate and organ function-saving surgery have been highly emphasized.Preserving the gastric autonomic nerve effectively reduces postoperative diarrhea,shortens the time for weight recovery,and prevents insulin secretion disorders and postoperative cholelithiasis.In the process of laparoscopic or open autonomic nerve preservation in lymph node dissection for gastric cancer,full understanding of the anatomy of the autonomic nervous system,recognizing the landmark of the nerves,proper designing the surgical space,dissecting according to the extracellular space in the membrane of the nerve fibers and nerve plexus are factors which ensures the quality and effects of the surgery.

Objective To investigate the effect of the transpedical interbody bone grafting plus pedicle screw fixation for the treatment of thoracic and lumbar fractures.Methods 67 thoracolumbar fracture patients were treated with transpedicular vertebral body bone graft and pedicle screw internal fixation operation,preoperative,postoperative and follow-up uptake X line inspection,measurement and observation of.vertebral height has no loss,no fracture,internal fixation loosening occurred.Results Patients with neurological injury after operation were improved to different degree,the follow-up of patients with 12 ～ 36(23.8±9.3) average.After 1 year the patient fixation was not removed,internal fixation loosening,fracture,bone graft fusion better,no bone resorption and spinal physiological curvature to maintain good.Postoperative patients,followed for a mean of 36 months of anterior vertebral body height,height of vertebral body,posterior margin of the vertebral body height and the central angle Cobb operation were decreased significantly,the difference was statistically significant(P ＜ 0.05);and 1 week after operation and postoperative follow-up of an average of 36 months each index showed no significant differenec(P ＞0.05).Conclusion Transpedicular vertebral body bone graft and pedicle screw fixation for the treatment of thoracolumbar fractures has good clinical curative effect,which could effectively maintain the vertebral height of the front,with the value of clinical application.

Objective To study the effect of optimized disposition of surgical instrument packages on nurses’efficiency. Methods 200 cases of surgeries were randomized equally into an experiment group and a control group: the former used optimized disposition of surgical instrument packages and the control group convention surgical instruments package.The two groups were compared in terms of time for counting the instruments and recirculation treatment of postoperative apparatus as well as the effect of the packages on the operation space for nurses.Results The time for counting the instruments and recirculation treatment of postoperative apparatus in the experiment group was significantly shorter than those in the control group(both P<0.01).The weight,volume and space of the packages in the experiment group were significantly smaller than those in the control group(all P<0.01).Conclusion The optimized disposition of surgical instrument package may shorten the nursing operation time,reduce consumption of energy, improve the operational settings and increase the working efficiency.

Objective To investigate the correlation between the plasm level of homocysteine(Hcy) and carotid intimal-medial thickness(IMT) in type 2 diabetes(T2DM).Methods 54 patients with preliminary diagnosis of T2DM were divided into two groups according to IMT level:normal IMT group and IMT increased group.30 healthy people were chosen as control.Hcy were detected in all patients and healthy people.Results Hcy levels in T2DM was (24.77 ± 10.17) μmol/L,which was higher than that in healthy people [(10.95 ± 2.60) μmol/L] (P ＜ 0.05).Hcy levels in IMT increased group was (19.80 ±4.97)μmol/L,which was higher than that in normal IMT group [(15.00 ±4.83) μmol/L] (P ＜ 0.05).The positive correlation between Hcy and IMT in T2DM was shown (r =0.6384,P ＜ 0.05).Conclusion High Hcy was an independent risk factor of atherosclerosis in patients with type 2 diabetes.

Objective To compare the curative effect of transumbilical single port laparoscopic appendectomy and conventional laparoscope appendectomy .Methods 80 cases with acute appendicitis were divided into single hole group and routine group according to the operation mode ,40 cases in each group .The two groups were given transum-bilical single port laparoscopic appendectomy and conventional laparoscopic appendectomy ,respectively.The clinical efficacy was compared between the two groups .Results The patients in two groups were given successful operation without converted laparotomy .The postoperative anal exhaust time of the single hole group was (21.7 ±6.2)h,which was significantly shorter than that in the routine group [(26.9 ±7.3)h](t=2.18,P<0.05).However,the operation time,intraoperative bleeding amount ,postoperative length of stay ,intraoperative and postoperative complication had no obviously statistical differences between two groups (P>0.05).The patients were followed up for 3-21 months,no appendix stump inflammation , appendiceal stump fistula , adhesive ileus and other remote complication appeared . Conclusion Transumbilical single hole has safe and minimal invasive advantages on appendectomy , which can be favorable for the postoperative recovery of bowel function and cosmetic result .If it′s difficult to excise appendix , relevant operation skills shall be applied in accordance with the appendiceal lesions ,which can effectively reduce the occurrence of complication .

Objective To investigate the clinical application value of the determination of carcinoembryonic antigen (CEA),car-bohydrate antigen 125 (CA125)and lactate dehydrogenase (LDH)in the differential diagnosis of malignant hydrothorax and asci-tes.Methods The Beckmancoulter ACCESS2 automatic micro particle chemiluminescence immunoassay analyzer was adopted to determine the CEA and CA125 levels in hydrothorax and ascites,and the Roche C501 automatic biochemical analyzer was used to determine the LDH level in hydrothorax and ascites.The clinical application value of these three indicators in the evaluation of be-nign and malignant hydrothorax and ascites was evaluated.Results The differences in the expression levels of CEA,CA125 and LDH between benign and malignant hydrothorax and ascites had statistical significance (P <0.01 );the positive rate of CEA, CA125 and LDH in malignant hydrothorax and ascites were 84.21%,92.98%,75.44%.Conclusion The combined detection of CEA,CA125 and LDH has an important value in differential diagnosis of benign and malignant hydrothorax and ascites.

Surgery for gastric cancer is based on basic surgical techniques and modern theory of surgery.Accurate and safe surgical procedures are carried out based on application of scientific principles.The knowledge of gastric anatomy,physiology and pathophysiology is the basis of the gastric cancer surgery.The technical aspects of vascular control,lymph node dissection,digestive tract resection and reconstruction are important for the gastric cancer surgery.Full use of these techniques and mastery of the technology is an important guarantee for reducing surgical complications,improving the quality of life and longterm survival of gastric cancer patients.

Radical operation is very essential for gastric cancer, and the reasonable digestive tract reconstruction is an important part affecting the prognosis and quality of life of patients.After gastrectomy, the most basic requirements for reconstruction include prevention of gastrointestinal fluid reflux, keeping food storage and emptying function, physiological pathways and endoscopic inspection of biliary tract, pancreas and gastric remnant.In addition, technical level of reconstruction,safe operation, low invasion and suture technique cannot be ignored.Since complex digestive tract reconstruction can cause many complications, the method in the research stage should be carefully chosen.