Objective　To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods　The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results　Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux-en-Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux-en-Y jejunal p-type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases.　86 patients (76%)have been followed up, the postoperative 1-,3-,5-year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9％,45.7％,37.2％;88.8％,55.5％,33.3％; and 80％,0％,0％ respectively. Conclusions　The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.

Carotid Stenosis ; surgery ; Endarterectomy, Carotid ; Humans ; Stents

Objective To investigate the effect of total gastrectomy for gastric malignancy(GM). Methods The clinical data of total gastrectomy in 113 patients with GM were analysed retrospectively. Results Radical total gastrectomy was performed in 97 cases, palliative total gastrectomy in 16 cases, combined with resection of head or tail of pancreas, splenectomy, transverse colectomy or parital hepatectomy in 19 cases. Reconstruction of digestive tract : Roux en Y esophagojejunostomy in 26 cases, Braun esophagojejunostomy in 19 cases, Roux en Y jejunal p type anastomosis in 68 cases, Postopterative complications occurred in15 cases,including pancreatic fistula in one cases,anastomostic leakage in 3; operative death was happened in 2 cases. 86 patients (76%)have been followed up, the postoperative 1 ,3 ,5 year survival rate in radical total gastrectomy, combined resection organs and palliative total gastrectomy was 77.9%,45.7%,37.2%;88.8%,55.5%,33.3%; and 80%,0%,0% respectively. Conclusions The effect of total gastrectomy for gastric malignancy can be successful, if the indications are stricted and combined with rational viscers resection.

Objective To analyze and discuss how the scanning parameters influence the quality of dual source CT(DSCT) images by the various settings and the corresponding scans.Methods Testees were scanned with corresponding settings of scanning parameters in SOMATOM Definition DSCT produced by SIEMENS and then the results were analyzed and discussed.Results Parameters in relation with the quality of DSCT images could be influenced by the settings of corresponding scanning parameters.Conclusion The settings of scanning parameters have close relationship with the quality of DSCT images,and sometimes one kind of setting can improve image quality in one field but depress image quality in another field,so all factors should be considered synthetically.[Chinese Medical Equipment Journal,2008,29(2):102-104]

Liver cirrhosis in China can be caused by many causes of which the most important one is chronic viral hepatitis. Hemorrhage and ascites were the main manifestations of decompensated liver cirrhosis, and the main cause of hemorrhage is viral hepatitis. The pathological basis of hemorrhage is portal hypertension and its secondary pathophysiological changes. Additionally, the deficiency of coagulation factors and the imbalance of coagulation and fibrinolysis both of which caused by the hypofunction of liver are also important reasons. This article reviews the mechanism of hemorrhage in decompensated liver cirrhosis in order to provide help for further research.

Objective In the previous study completed in Korea, early three-dimensional conformal radiotherapy concurrent with chemotherapy in rectal cancer after radical surgery demonstrated a better prognosis compared with late radiotherapy. However, with the report of MOSAIC trial, the adjuvant chemotherapy regimen had transferred from 5-Fu alone to combined 5-Fu and Oxaliplatin. We need more evidence to clarify the best radiotherapy timing during the whole period of adjuvant therapy . Methods Patients who met the following criteria were accrued in this study: 18-70 years old, lower anterior resection,pathologically proven rectal adenocarcinoma, stage T3-4 and/or N+, no evidence of distant metastases and KPS≥70. Three dimensional conformal Radiotherapy was started at the fourth week after surgery, which included 45 Gy whole pelvic radiation following by 6-10 Gy tumor bed boost. Oxaliplatin of 50 mg/m2 weekly and Xeloda 625 mg/m2 twice a day, every week from d1-5 were used concurrent with radiotherapy.Toxicity was evaluated and graded by common toxicity critera version 3. 0. The study was designed as Simon two-phase design, in the first phase, a total of 15 patients were accrued, and if more than or equal to 9 patients had grade 3 toxicity, we had 85% power to confirm the toxicity caused by early radiotherapy more than 50%. Otherwise, another 15 patients of the second phase were accrued, we would have 85% power to confirm the high toxicity of more than 50% if 18 out of 30 patients had grade 3 toxicity. Results From July 2008 to December 2008, 15 patients were treated with early radiotherapy concurrent with combined chemotherapy, Grade 3 gastrointestinal toxicity occurred in 12 patients and Grade 3 hematologic toxicity occurred in 2 patients. According to Simon design, we had 85% power to confirm the toxicity caused by early radiotherapy more than 50%. Conclusions For locally advanced rectal cancer patients, whole pelvic radiotherapy concurrent with oxaliplatin and xeloda had severe toxicities. Further studies are needed to decrease toxieities.

A diving decompression procedure is a specific rule that divers should follow when they ascend and get out of water. It comes from the decompression theory and algorithm and is designed for the prevention of decompression sickness. With the ， ， development of diving technology and diving medicine the decompression procedures are constantly innovated and the new ， decompression procedure can be used in diving practice after safety verification. In principle the safety verification of ， decompression procedures should be conducted on animal experiments before human experiments and the risks of ， decompression sickness and oxygen toxicity should be systematically assessed. However the assessment methods used in ， ， ， different studies differ greatly thus it is urgent to establish a standard and universal verification system. Traditionally the risk ， ， assessment of decompression sickness and oxygen toxicity is mainly carried out by observing the incidence detecting bubbles ， theoretical calculation and lung functional test. Furthermore biochemical indicators are increasingly becoming important ， ， supplements. Due to the special underwater environment the diving operation is prone to accidents. Therefore in addition to ， verifying the safety of the new decompression procedure exploring its safety decompression limit is of great significance for the formulation of emergency decompression procedures in emergency situations. The specific approach is to shorten the decompression time and assess the safety until the critical time for detecting bubbles without the occurrence of decompression ， ， sickness is found. Future studies should continue to optimize safety assessment methods explore sensitive biochemical markers ， clarify species associations and improve verification efficiency and reliability of results.

Adolescent ; Adult ; Automobile Driving ; China ; Electrocardiography ; Female ; Heart ; physiopathology ; Humans ; Male ; Middle Aged ; Noise, Occupational ; adverse effects ; Occupational Exposure ; adverse effects ; Stress, Psychological ; etiology ; physiopathology ; Vibration ; adverse effects

Objective:To explore the effect of ulinastatin on prevention of acute respiratory distress syn-drome (ARDS).Methods:A prospective multicentral cohort study was conducted.The patients from three intensive care units (ICUs)of grade A tertiary hospitals in Beijing and a ICU of grade A tertiary hospitals in Cangzhou from January 2012 to December 2014,included 77 ARDS at-risk patients with uli-nastatin treatment and 108 ARDS at-risk patients without ulinastatin treatment (control)were eligible. Both groups received normal treatment;additionally,the intervention group received 600 000 units of uli-nastatin via intravenous infusion for 5 days.The control group received the same amount of saline via in-travenous infusion for 5 days.Venous blood human neutrophil elastase (HNE)and peptidase inhibitor 3 (PI3)levels were measured on days 1,3,and 7,respectively.Other outcomes included acute physiolo-gy and chronic health evaluation scoring Ⅱ (APACHE Ⅱ),body temperature,respiratory rate,heart rate,mean arterial pressure,white blood cell counts,PaO2 /FiO2 ,ARDS incident,mechanical ventila-tion time,ICU treatment and hospitalization duration,28 days mortality.Results:The PI3 levels showed no statistical difference on day 1,but significant differences on day 3 and day 7 between the two groups (P <0.01).HNE /PI3 ratio showed no statistical difference on day 1,but significant differences on day 3 and day 7 (P <0.05).PaO2 /FiO2 was significantly higher in ulinastatin group on day 3 and day 7 (P <0.05).The incident rate for ulinastatin group was 15.58%,lower than that for the control group (33.33%),and the difference was statistically significant (P <0.05).The mechanical ventilation time and ICU treatment time in ulinastatin group was shorter than that in the control group,and the difference was statistically significant (P <0.05).There were no significant effects in other factors.Conclusion:Increased dose of ulinastatin can recover the balance of HNE and its antagonist,lower the HNE’s damage to lungs,and further reduce the ARDS incident rate.

BACKGROUND: With an aging population increasing, the incidence of senile femoral intertrochanteric fractures is on a rise because of osteoporosis. Due to the aged usually accompanied with systematic diseases, conservative treatment will lead to high mortality after long-term bedridden. Thereafter, early surgery is recommended. OBJECTIVE: To investigate the incidence of femoral intertrochanteric fractures and its epidemiological features. METHODS: The digital radiography data and basic information of 179 patients (over 50 years of age) with femoral intertrochanteric fractures admitted in the General Hospital of Tianjin Medical University from 2013 to 2015 were analyzed retrospectively. The data including age, gender, injury causes, fracture types, complications, treatment procedures, and hospitalization time were recorded and compared. RESULTS AND CONCLUSION: All the 179 cases of femoral intertrochanteric fractures were enrolled, including 66 (36.9%) males and 113 (63.1%) females. The mean age was (76.98±9.73) years, and the number of patients aged 80-90 years was the most (n=71, 39.7%). With the age increasing, the incidence of fall-induced hip fractures was increased. By AO classification, type 31-A1 was the most common fracture type (46.4%), and type 31-A3 was the least common type (22.9%). By Evans classification, type I was the most common type (50.3%), and type V was the least common type (2.2%). There were 93.3% patients underwent surgical treatment (167/179), and 6.7% received conservative treatment (12/179). In the age group of 51-60 years, the male patients were more than females; in the age group 61-70 years, the male patients were more than females except in 2013; in the age groups of 71-80, and 81-90 years, the female patients were more than males; in the age group of over 90 years, there was no significant difference between female and male patients. These results manifest that the majority of hip fracture patients are the elderly, and slipping and osteoporosis are the leading causes. In spite of accumulating operative risks with aging, surgical treatment remains the predominant management strategy. Besides, the incidence of femoral intertrochanteric fractures shows a trend of increase yearly, with the highest incidence in the age group of 71-90 years, especially in females.