Objective To analyze the complications and short-term effects of laparoscopic surgery for achalasia.Methods The clinical data of 41 patients with achalasia who were treated by laparoscopic surgery were analyzed retrospectively.Results The 41 patients were no deaths.All patients underwent Heller cardiomyotomy and fundoplication,39 patients with Dor anterior fundoplication,2 patients had the presence of hiatal hernia with Toupet fundoplication.The mean surgical time was 142 min.Intraoperative complications occurred in 7 cases,including 6 cases of mild complications.The mean follow-up was 21 months.The clinical efficacy excellent in 27 cases,good in 7 cases,generally in 5 cases,poor in 2 cases.Conclusions Heller cardiomyotomy should be the treatment of choice in achalasia patients,because of its short and medium term outcomes,and its low morbidity.

Objective To explore clinical application of coronary artery imaging with 64-slice spiral CT.Methods 46 patients with coronary heart disease were undergone both coronary artery imaging with 64-slice spiral CT and coronary angiography,and the effects on coronary display respectively were compared Results Coronary display in coronary artery imaging with 64-slice spiral CT was better than that of the coronary angiography, which was a inspection pattern of noninvasive coronary display. Conclusion Coronary artery imaging with 64-slice spiral CT can accurately evaluate coronary artery stenosis, which was worth to application.

Objective To understand the drug-resistance of MRSA patients in neurosurgery intensive care unit,raise the prevention of MRSA and provide doctors the basis for controlling it. Methods The 5 year(20012005) MRSA patients were tested by Kirby-Bauer in neurosurgery intensive care unit of a third-tier general hospital in Shanghai. Statistic and analysis the drug-resistance of the patients. Results The rates of 121 MRSA drug-resistance to penicillin G,erythromycin, ciprofloxacin, amikacin and the cephalosporins are 92.3 % to 100 %, totally senaitire to teicoplanin and vancomycin and lower drug-resistance to rifampin,netilmicin and fosfomycin, but it rapidly raised from 10.0 % (2001 ) to 95.2 % (2005) to sulfamethoxazole. Conclusion It is time to take care of the drug-resistance of MRSA. Prevention and use antibiotics properly are the important ways to decrease the hospital infection and to improve the quality of recovered.

Objective To observe the clinical effect of procedure for prolapse and hemorrhoids (PPH) in treating hemorrhoids.Methods 78 patients with symptomatic Ⅱ,Ⅲ and Ⅳ degree hemorrhoids undergoing PPH were selected in this study.The diagnosis,medical history,operative time,blood loss and perioperative complications were recorded.The World Health Organization Quality of Life Scale(WHOQOL-BREF) was observed preoperation and 6 hours,24 hours,1 month postoperation.Results The postoperative pain score measured by visual analogue scale (VAS) at postoperative six hours was (7.6 ± 2.1),which reduced to (1.3 ± 1.1) at 24 hours.There was significant improvement in the overall perception of QOL,health,and in physical and psychological domains (t =1.901,1.805,1.714,P =0.041,0.038,0.029,all P ＜ 0.05).There was modest improvement in environmental domain,while no change was found in social domain (P ＞ 0.05).Conclusion PPH surgery achieves good clinical results,improved quality of life of patients,with a low incidence of complications,patients with hemorrhoids should be recommended for this preferred surgical approach.

Objective: To compare the clinical effects of different minimally invasive surgeries in the treatment of varicose veins of lower extremities, and to explore their application values. Methods: A total of 201 patients with varicose veins of lower extremities were selected and treated with different operation methods. 52 cases were treated by endovenous laser therapy (EVLA group), 46 cases were treated by transilluminated powered phlebectomy (TIPP group), 49 cases were treated by EVLA combined subfascial endoscopic perforator surgery (SEPS) (EVLA + SEPS group) and 54 cases were treated by TIPP combined SEPS (TIPP + SEPS) group. The operation time, the intraoperative blood loss, the postoperative hospitalization cost, the hospitalization time, the incidence rates of postoperative complications (residual varicose veins, subcutaneous induration, superficial phlebitis, skin necrosis differences in the operation time, the intraoperative blood loss and the postoperative hospitalization time, the hospitalization cost of the patients between various groups (P<0.05). Compared with EVLA group, the incidence rats of residual varicose veins, superficial phlebitis, and lower extremity swelling and ecchymosis of the patients in TIPP group were significantly decreased (P<0.05); the incidence rates of subcutaneous induration, wound hematoma, saphenous nerve injury and skin numbness were increased, but there were no significant differences (P>0.05). Compared with EVLA group and TIPP group, the incidence rates of reidual varicose veins and superficial phlebitis in EVLA + SEPS group and TIPP + SEPS group were significantly decreased (P<0.05). The healing rates of the patients 3 months after operation in TIPP group, EVLA + SEPS group and TIPP + SEPS group were significantly increased compared with EVLA group (P<0.05). The recurrence rates 1 year after operation in TIPP group, EVLA + SEPS group and TIPP + SEPS group were lower than that in EVLA group (P<0.05). Conclusion: The curative effects of EVLA combined with SEPS and TIPP combined with SEPS in treatment of varicose veins in lower extremities are superior to EVLA and TIPP, with the advantages of safe and reliable methods, complete varicose vein resection, less postoperative complications, quick ulcer healing and low recurrence rate and so on.

Objective To investigate the effect of curcumol on apoptosis of human gastric carcinoma cell line BGC823 and the molecular nechanisms.Methods BGC823 cells were cultured and treated with different curcumol concentration (12.5,25,50 and 100 mg/L) for 24 h and 48 h,and the growth inhibition were tested by thiazolyl blue terazolium bromide (MTF) assay.Flow cytometry (FCM) were used to measure the cell apoptosis rate and cell cycle of BGC823 cells.Caspase-3 activity was assessed by colorimetric assay.Cells treated with 100 mg/L curcunol for 48 h were collected and subjected to RTPCR and Western blot assays for the expression of Caspase-3,Bcl-2,Bax and Survivin.Results There was a time-and dose-dependent inhibition of cell proliferation of BGC823 cells by curcumol.Tbe cells in G0/G1 phase increased,and in S phase decreased on exposure to curcumol for 24 h.FCM analysis also indicated that the apoptosis rate of BGC823 cells increased in dose-dependent manner (P ＜ 0.05).Curcumol increased the activity of Caspase-3 dose-dependently (P ＜ 0.05).RT-PCR and Western blot indicated that curcumol decreased Bcl-2 and Survivin expression as well as increased Caspase-3 and Bax expression (P ＜ 0.05).Conclusions Curcumol inhibits BGC823 cell growth,arresting cells in G0/G1 phase and inducing cell apoptosis.The mechanism may be related with increasing the activity of Caspase-3,down-regulating the expression of Bcl-2 and Survivin,and up-regulating the expression of Caspase-3 and Bax.

ObjectiveTo explore the diagnostic value of Tei index of right ventricle and serum level of NT-proBNP in patients with high-altitude heart disease (HAHD).MethodsRight ventricle Tei index and serum NT-proBN level were calculated and tested in 32 local healthy volunteers and 34 cases of HAHD patients hospitalized in our hospital in Golmud city (2808 meters above sea level) from 2008 to 2010,and a correlation study was conducted thereafter.ResultsThe pulmonary arterial systolic pressure and right ventricle Tei index,elevated significantly in HAHD patients compared with the control group [(86.61 vs 9.72)mm Hg(1 mm Hg=0.133 kPa) and(0.90 vs 0.33)respectively,P＜0.05].Patients diagnosed as mild pulmonary hypertension without alteration in cardiac structure showed higher pulmonary arterial systolic pressure and the Tei index compared with the control group [( 57.1 vs 9.72 )mm Hg and (0.78 vs 0.33 ) respectively,P ＜ 0.05 ].In addition,the level of serum NT-proBNP was significantly higher in HAHD group than that of control group [( 1246.8 ± 512.6) ng/L and (98.6 ± 21.7 ) ng/L respectively,P ＜ O.05 ].ConclusionRight ventricle Tei index and serum NT-proBNP level are sensitive indicators for right ventricular function and thus of favorable clinical significance for the diagnosis of HAHD.

Objective To analyze health status and characters of health service demand and utilization among farmers and herdsmen in Kangxiwa and Saitula border areas from the altitude of 3700m to 4300m for offered scientific advices to the health management institutions for optimizing the allocation of health resources.Methods A total of 51 families in the Kangxiwa and Saitula areas in Karakorum-Kunlun Mountains were randomly chosen with stratified sampling method for the family health survey.Physical and biochemical examination were carried out for each herdsman.Results Among the participants,the most disease the two-week medical consultation rate was 1.74％.the hospitalization rate was 0.98％.The two-week medical consultation and hospitalization rate of herds were lower than the national and Xinjiang level for rural area.Herdsmen's doctor poor accessibility and low-income may be the main reasons for the underutilization of health services ;The difficult situation of herdsmen has been initially improved after participating in the new rural cooperative medical care.Conclusion The health status of native herdsmen in Kara Kunlun mountains was poor,and the provision of health services cannot meet the demand for health service of native herdsmen.It's necessary to improve efficiency of utilization of health service and optimize the allocation of health resources.

ObjectiveTo investigate the optimal reconstruction windows for coronary angiography using 320-detector row dynamic volume CT (DVCT) and evaluate their effects on image quality,radiation dose and diagnostic accuracy.MethodsFrom 77 patients [mean heart rate (70 + 13) bpm,range:46-102 bmp] were scanned with retrospective ECG-gating 320-detector row DVCT.The relationship between heart rate and optimal reconstruction windows was analyzed.From 53 patients [mean heart rate ( 75 ±11 ) bpm,range:57-114 bpm] were scanned with prospective ECG-gating 320-detector row DVCT.The effects of prospective ECG-gating on image quality,radiation dose and diagnostic accuracy were evaluated.Friedman test was performed for image quality scores in random groups.Linear regression and Spearman correlation were performed to test bivariate data.ResultsThe proportion of systolic duration in the cardiac cycle increased significantly with higher heart rate (r =0.78,P ＜0.01 ).The image quality in systolic and diastolic phases were significantly influenced by heart rate ( r =0.38,0.82 ; P ＜ 0.01 ).According to the regression analysis of image quality score in different heart rate groups,the optimal reconstruction windows were determined as followed:when heart rate was ＜ 70 bpm,the optimal reconstruction windows should be preset at 65％-80％ ; 70 to 80 bpm,70％-85％ ; 81 to 90 bpm,70％-90％ ; ＞90 bpm,35％-50％.Compared with retrospective ECG-gating,prospective ECG-gating which preset reconstruction windows according to the phases mentioned above,could decrease radiation dose [(6.1 ± 3.8 )vs (12.4 ± 7.0) mSv],without deteriorating the image quality (t =6.5,P ＜ 0.01 ).However,in higher heart rate,the radiation dose of prospective ECG-gating DVCT was still higher ( r =0.64,P ＜ 0.01 ).ConclusionsDVCT can provide high image quality in a wide range of heart rate with prospective ECG gating.It is still recommended to control heart rate strictly since the radiation dose increases significantly in high heart rate.

Five groups were assigned to include intrahepatic cholangiocarcinoma ( ICC, n=30 ) , liver cirrhosis (LC,n=30),metastatic carcinoma (MCA,n=30) and 30 healthy subjects.The serum level of GPC3 was measured by a sandwich method of enzyme-linked immunosorbent assay ( ELISA ) and alpha-fetoprotein (AFP) by microparticle enzyme immunoassay (MEIA).The serum levels of GPC3 and AFP were significantly higher than those of other groups (P<0.05).At a cut-off value of 3.5μg/L,the sensitivity and specificity of GPC3 in the diagnosis of HCC was 83.3%and 76.7%respectively.The sensitivity of combined measurement of GPC3 and AFP was better than GPC3 or AFP alone.Detectable GPC3 was significantly correlated with the presence of viral hepatitis markers and tumor size.However there was no obvious difference in tumor thrombi in portal vein ( PVTT), tumor number, age, gender or hepatic function of HCC.Thus,as a sensitive serum diagnostic marker for HCC ,GPC3 may be a good supplement to AFP in differentiating HCC from non-malignant chronic liver diseases and other liver cancers.