Objective To investigate the causes of intractable abdominalgia after simple choleystectomy and analyse the therapeutic effect of endoscopic sphincterotomy (EST).Methods 84 patients undergoing EST were retrospectively viewed from 1987 to 1998. Results Sixty five out of 84 patients were followed up, in which the clinical signs disappeared completely in 51 cases (78%), and there were 6 cases with relapsing symptom(9%),3 cases with intermittent relapsing symptom (4%). Therapy was ineffective in 5 cases. The intractable abdominalgia is a specific sign of postcholecystectomy syndrome. EST is effective in removing the nervous structure in duodenal papilla submucosa and sphincter muscle layer responsible for abdominal pain, therefore eliminated or relived the pain.Conclusion EST has a significant effect on intractable abdominalgia after simple cholecystectomy in the majority of patients.

Objective To explore the pathogeny, pathology, ultrasonic and clinical expression of upper extremity deep venous flow obstruction and superior vena cava syndrome. Methods Retrospective analysis and summarize the disease changes of 10 cases in recent 5 years. Results 7 patients of 10 cases were superior vena cava syndrome, in which 4 cases caused by upper right lung malignant tumor, 3 cases caused by upper and media mediastinal malignant tumor. 2 patients of 10 cases were found thrombosis in right subclavian vein caused by duct of artificial pacemaker. The left 1 patient was no reason thrombosis in right axillary vein. Conclusion Ultrasonography combine with color and spectral Dopper image can evaluate the clinical development and therapeutic efficiency, which is a useful and effective non-invasive examination.

10.3969/j.issn.1007-3969.2013.05.011

Objective:To explore the communication problems among nursing students in early clinical prac-tice, and to provide reference for clinical nursing education .Methods:Introspecting diary of the clinical communi-cation in nursing students were classified and analyzed by using qualitative research method .Results:5 themes were extracted as following: barriers for communication between nurses and patients , reflection on patient , nurse occupation , clinical teaching and critical reflection on public opinion .Conclusion:Introspecting diary is important to help teachers in teaching , to guide and cultivate nursing students to develop their interpersonal communication competence .

Objective To observe the therapeutic effect of ultrasonic microbubble combined with bevacizumab (Avastin) on choroidal neovascularization induced by photocoagulation in rabbits.Methods CNV was induced by photocoagulation with argon laser in 30 rabbits (60 eyes).All of the rabbits underwent fundus fluorecein angiography (FFA) 21 days after photocoagulation;6-8 hours later,3 rabbits were randomly chosen to be executed to having the immunohistochemical examination.Twenty-one days after photocoagulation,27 rabbits were divided randomly into 3 groups:bevacizumb,ultrasonic microbubble+bevacizumb,and control group;each group has 9 rabbits (18 eyes).The rabbits in control group had no interference treatment;while the rats in bevacizumb and ultrasonic microbubble+bevacizumb group underwent injection with bevacizumb or ultrasonic microbubble+bevacizumb respectively.FFA was performed on all of the rabbits 7,14,and 28 days after photocoagulation to observe the inhibition of CNV;immunofluorecence and Western blot were used to detect the expression of VEGF in retina and choroid.Twenty-eight days is the time point to determine the therapeutic efficacy.The expression of VEGF and the results of FFA were the sdandards of the judgement of therapeutic efficacy.Results Proliferaion of CNV to the retinal inner layer and the obvious leakage of fluoresein in the photocoagulation area indicated that the model of CNV was set up successfully.Twenty-eight days after injection,obvious fluorescent leakage was found in the control group,and the average fluorescent leakage in bevacizumab group differed much from the control group(t=16.2952,P<0.05);while the difference between ultrasonic microbubble+bevacizumb group and bevacizumab group was also significant (t=4.7955,P<0.05).At the same time point,the expression of VEGF in bevacizumab group detected by immunofluorecent assay and Western blot differed much from the control group (t=7.0327,9.2596;P<0.05),and the difference of VEGF between ultrasonic microbubble+bevacizumb group and bevacizumab group was significant (t=2.9724,17.1937;P<0.05).this experiment show that ultrasound combined bevacizumab intravitreal injection of the therapeutic effect of CNV superior to other groups(P<0.01).Conclusion Ultrasound microbubble combined with bevacizumab injection may improve the therapeutic effect on CNV by inhibiting the expression of VEGF.

Targeted drug delivery can significantly increase the concentration of the drug in treatment site, and decrease the dosage of drugs, cost of treatment and the drug's adverse effects on the body. So targeted drug delivery is the hotspot of recent studies. This paper reviews the development of targeted drug delivery research in recent years, including three areas: passive targeting, active targeting, and physical and chemical targeting.

Objective To explore the expression and clinical significance of two oncogenes,CerbB-2 and p53,on cervical squamous carcinoma.Methods The immunohistochemical S-P process was performed on 45 cases of cervical squamous carcinoma.The expressions of CerbB-2 and p53 on 15 cases of CIN(cervical intraepithelial neoplasia)and on 10 cases of normal cervical tissues were chosen and the relationship between the expressions and the related clinicopathological factors were analyzed.Results The positive expression rate of CerbB-2 on normal cervical tissues, CIN and cervical squamous carcinoma was 0,26.7% and 66.7%, respectively; that of p53 was 0,13.3% and 68.9% ,respectively.From the normal cervical epithelium to the CIN and to the cervical squamous carcinoma,the positive rate of CerbB-2 and p53 was increased significantly(P<0.05);the positive rate of CerbB-2 was associated with the pathological grade and the metastasis of lymph node(P <0.05) and that showed no statistic significance with the clinical stage ,the diameter of tumour,the infiltration of vessel and infiltrative depth(P > 0.05) ;the positive rate of p53 is only associated with the pathological grade(P <0.05) ;the difference between the CerbB-2 and p53 expressions on cervical squamous carcinoma were not statistically significant(P> 0.05).Conclusion The expressions of CerbB-2 and p53 have some practical values on the occurrence, the development and the clinical prognostic evaluation for the cervical squamons carcinoma.

Objective Summarized the therapeutic effect of colonic irrigation by mannitol in one-stage resection and primary anastomosis for left hemicolon obstruction. Method For 31 cases of left hemicolon obstruction in our hospital, After process was cut, firstly we had done coloclysis with normal saline, metron-idazole and 20% mannitol,then one-stage anastomosis. Results With the exception of three cases of in-cision infection, the rest who start eating 4～5 days after operation were cured and no anastomotic fistula. Conclusion During the colon resection in left hemicolon obstruction, coloclysis with normal saline, met-ronidazole and 20% mannitol, then one-stage anastomosis, the intestinal function were quick recovery and can prevent colonic anastomotic fistula.

Objective　To establish the method of noninvasive measuring the new indexes of cardiac functions by echocardiography and illustrate the diagnostic values of the indexes.Methods　By use of simultaneous screen display of echocardiography, phonocardiography and electrocardiography and synchronously monitoring blood pressure (BP) technique, the values of LV end-systolic and end-diastolic long and short- axis dimensions, wall thickness and area sizes,and synchronous BP were measured in the patients with myocardial infarction (MI) of defferent sites and area sizes before and during BP were altered to defferent degrees. The values of maximum elasticity (Emax) and average maximum myocardial elasticity stiffness (maxEav) and ejection blood fraction (EF) were calculated through computer programmed process.Results　The order of values of Emax,maxEav and EF among MI patients of defferent sites was control group>inferior MI group>anterior MI subgroup>multi-wall MI subgroup. Their order among MI patients of defferent area sizes was control group > small area MI subgroup > larger MI subgroup. Emax was associated with the MI parts and 　maxEav was associated better with the MI area sizes.Conclusions　The study has established a noninvasive method of examining cardiac function by use of echocardiography and reflected the special diagnostic values of Emax,maxEav and EF in MI patients of defferent parts and area sizes.

A service system was created that the tertiary hospitals as the leader, the secondary hospitals as the core and the basic hospi-tals as the foundation, formed the one-stop three level medical rehabilitation service system. It made the referral process more convenient with the operation of the one-stop service, along with the integrated management, the homogenization treatment and the one-stop three level medical institutions;and also solved the problems of the inadequate of rehabilitation medical institutions, the lackage of rehabilitation profes-sionals and the uneven professional and technical condition, that realized hierarchical rehabilitation and two-way referral to meet the rehabil-itation needs of patients.