In recent years,minimally invasive surgery has become the mainstream trend of modern surgery with the rapid development of endoscopic and laparoscopic techniques.However,there are limitations when either technique is used alone.The laparoscopic and endoscopic cooperative surgery (LECS),which combines the advantages and makes up the deficiencies of these two techniques,has expanded the application field of minimally invasive surgery.Laparoscopic wedge resections are increasingly applied for gastric stromal tumor.Base on clinical experience of 43 patients who underwent laparoscopic wedge resections for surgical treatment of gastric stromal tumor,we conclude that this procedure is feasible and safe.

Gastrointestinal stromal tumors (GISTs) is a subset of mesenchymal tumors and represents the most common mesenchymal neoplasm of gastrointestinal tract.In the last decade,GISTs has become well known because of the effectiveness of imatinib mesylate.The molecular targets for tyrosine kinase receptor inhibitor are not only of importance for the treatment of patients but also useful for the development of a novel drug modalities and new strategies in basic cancer therapy.The improved understanding of the molecular mechanism of GISTs has made its diagnosis standardized.Many multicenter phase Ⅱor phase Ⅲ clinical trials have been completed to establish the role of adjuvant and neoadjuvant therapy.It is important to select the correct management strategy,which is multidisciplinary,integrated,and individualized.This paper provides an overview of the rational treatment of GISTs at present.

Objective To evaluate the effect of hyperuricemia on vascular complications of type 2 diabetes and analysis of the possible mechanism. Methods 586 cases with T2DM were divided into two groups: normal serum uric acid (n=397) and hyperuricemia (n=189).The morbidity of macrovascular and microvascular complications and the serum levels of CRP,TNF,IL-1,IL-2,IL-6,IL-8 and PAI-1 were detected. Results (1)Hyperuricemia group showed higher BMI, blood pressure, TG,TC,LDL,WHR ratio and lower serum HDL-C than the group with normal uric acid (all P<0.05).(2)Group with hyperuricemia showed higher morbidities of macrovascular and microvascular complications than the group with normal uric acid (all P<0.05).(3) Group with hyperuricemia had higher levels of CRP,TNF,IL-6,IL-8,PAI-1 (all P<0.05). Conclusions (1) Hyperuricemia is associated with obesity and dyslipidemia.(2) Hyperuricemia may cause atherosclerosis by inflammation of vascular endothelium, resulting macrovascular and microvascular complications.

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is an autosomal recessive hereditary cerebral artery disease in the adolescence,and its main clinical manifestations are dementia,stroke,low back pain and alopecia.At present,most cases are from Japan.3-6 exon point mutations in the HTRA1 gene are associated with the onset of CARASIL.Brain histopathological examination showed a small arterial intimal thickening medial smooth muscle cell loss and hyalinization.Brain MRI showed a diffuse white matter abnormal signal and multiple subcortical infarcts.The diagnosis mainly depends on the characteristic clinical symptoms,imaging characteristics and genetic testing.It should be differentiated from cerebral autosomal dominant arteriopathy with sulcortical infarcts and leucoencephalopathy.

Respiratory tract infection remains a hot clinical topic.Disappointingly, routine microbiology tests do not meet the needs of target antimicrobial therapy.Widespread practice of antibiotic empiricism has lead to dramatic use of broad-spectrum antibiotics and antimicrobial resistance.The application of new clinical microbiology tests to identify the offending pathogen may allow administration of narrow spectrum antibiotic therapy.To do so,the full clinical microbiology armamentarium with newer point-of-care tests and polymerase chain reaction tests must be exploited.The return of the sputum gram stain and introduction of newer molecular tests would provide information for judicious selection of antimicrobials.

This paper analyzed the procedure and organization for developing the clinical guidance by the National Institute for Health and Clinical Excellence(NICE).Focusing on the balancer role of NICE in the UK healthcare system as a statutory criteria maker,it analyzed the implementation and assurance mechanism of the clinical guidance for policy recommendations to the making and effective implantation of such a guidance in China.

[Objective]This paper sums up professor Wang Xu's experience of differentiating and treating Pidan. [Methods]Through summarizing professor Wang Xu's experience of differentiating and treating principles of prediabetic state, final y we use a case to analyze the specialty of professor Wang Xu's differentiating and treating prediabetic state.[Results]When my teacher deals with the clinical symptoms, she always relegates prediabetic state to Pidan. She establishes the theory from the organ of spleen. In the therapy, she confirms the treatment through trading off among the phlegm, the turbid, the lipid and the stagnated blood. The major therapy is damaging the remaining pathogenesis, replenishing the deficiency, clearing the heat, removing the blood stasis, tradding off al kinds of factors. One sentence summing up is removing the pathological and physiological metabolites generating from the body. Also, she applies the traditional Chinese drugs flexibly which can strengthen the spleen, nourish ying, or adjust the blood according to the deficiency and heat which is more obvious. The most importantly, she suggests the theory that strengthening the spleen can prevent the procession of prediabetic state.[Conclusions] When professor Wang Xu deals with the clinical symptoms, she always relegates prediabetic state to Pidan. And she confirms the therapeutic principles rooting in the spleen. Most of al , the clinical therapeutic effect is notable.

After the connotation and application of Lib2.0 technology were described, how to construct the subject service platform in Library of Second Military Medical University using Lib2.0 technology was elaborated and the service-oriented subject service platform construction plan was proposed .

Objective To investigate the efficacy and safety of tropisetron combined with sulpiride in treatment of chemotherapy-induced cisplatin program nausea and vomiting,so as to explore the effect to motilin and gastrin.Methods A total of 84 patients with chemotherapy-induced cisplatin program nausea and vomiting were divided into study group (44 cases) and control group (40 cases) by random digits table method,the patients in two groups were given tropisetron hydrochloride intravenous injection,and the study group was added sulpiride.The efficacy and side effects and effect to motilin and gastrin were observed.Results The fully control rate and efficient rate in acute nausea was 59.09％ (26/44),37.50％ (15/40),and 90.91％ (30/44),72.50％ (29/40) in study group and control group,and there was significant difference (P ＜ 0.05).The fully control rate and efficient rate in acute vomiting was 61.36 ％ (27/44),37.50％ (15/40),and 88.64％ (39/44),67.50％ (27/40) in study group and control group,and there was significant difference (P ＜0.05).The fully control rate and efficient rate in delayed nausea was 54.54％ (24/44),32.50％ (13/40),and 79.55％ (35/44),57.50％ (23/40) in study group and control group,and there was significant difference (P ＜ 0.05).The fully control rate and efficient rate in delayed vomiting was 45.45 ％ (20/44),22.50％ (9/40),and 75.00％ (33/44),52.50％ (21/40) in study group and control group,and there was significant difference (P＜ 0.05).The plasma motilin after treatment was lower than that before treatment in study group and control group[(308.35 ± 14.59) ng/L vs.(370.59 ± 15.72) ng/L and(341.87 ± 18.38) ng/L vs.(365.36 ± 23.72) ng/L],gastrin was higher than that before treatment in study group and control group [(206.97 ± 12.29) ng/L vs.(164.56 ± 14.17) ng/L and (171.58 ± 13.53) ng/L vs.(158.42 ± 17.29) ng/L],and there was significant difference (P ＜ 0.05).There was significant difference in the plasma motilin and gastrin after treatment between two groups (P ＜ 0.05).There was no significant difference in the occurrence of adverse drug reactions between two groups (P ＞ 0.05).Conclusion Tropisetron combined with sulpiride than the routine use of tropisetron can obtain the better the antiemetic effect.

Objective:To explore the therapeutic effect and safety of oral ibuprofen (INN)on patent ductus arterio-sus (PDA)in neonates.Methods:A total of 160 neonates,who hospitalized in our hospital and were diagnosed as PDA by color echocardiography from Feb 2011 to Dec 2013,were enrolled.According to number table method, they were randomly and equally divided into high dose group (received INN 10mg/kg on the first day,then 5mg/kg on the second and third day)and low dose group (received INN 5mg/kg for 3d).PDA closure was observed,com-pared and analyzed between two groups after INN therapy.Results:After INN therapy,PDA closed in 57 cases (71.3%)in high dose group,it was significantly higher than that of low dose group (48.8%,39/80),P <0.01;there were no significant difference in incidence rates of adverse reactions between two groups (P >0.05 all).Con-clusion:High-dose ibuprofen possesses better therapeutic effect on patent ductus arteriosus in neonates;its adverse reactions are few;which can avoid postoperative pain in partial children.