Objective To compare of clinical effect between radiotherapy and chemoradiotherapy and investigate the prognostic factors in elderly patients with esophageal squamous cell cancer.Methods 229 elderly patients with esophageal squamous cell cancer who received radiotherapy and chemoradiotherapy from January 2009 to December 2013 were retrospective analyzed.The Local control rate and survival rate were calculated by Kaplan-Meier method,and the short effect and long term effect between radiotherapy and chemoradiotherapy were compared.Cox regression model was used for invariant analysis and multivariate analysis.Results The follow up time was 15.3months.The short effect of radiotherapy group was not better than that of chemoradiotherapy group,with CR 35.6％ vs 45.8％,RR 61.0％ vs 53.0％,SD 2.7％ vs 0 and PD 0.7％ vs 1.2％ (P=0.211).The 1-,2-,3-year local control rates of radiotherapy group were significantly poorer than that of chemoradiotherapy group,with 82.8 ％,60.5 ％ and 52.7％ vs 89.5％,85.4％ vs 80.9％,respectively (P=0.009).However,there were no significance difference between the 1-,2-,3-year survival rates of radiotherapy group and chemoradiotherapy group,with 66.4％,29.5％,17.1％ vs.65.9％,40.3 ％,30.8 ％,respectively (P =0.071).In invariant analysis,T stage,N stage,clinical stage and radiotherapy dose (＜ 60 Gy,60 ～66 Gy,＞66 Gy) were related with the prognosis of esophageal carcinoma.The COX regression model showed that T stage,N stage and radiotherapy dose were independent prognostic factors that effected survival rate.Conclusion In elderly patients with esophageal squamous cell cancer,chemoradiotherapy can improve the local control rates,but not benefit the survival rate.T stage,N stage and radiotherapy dose were independent prognostic factors that effected survival rate,which could provided evidence for prognosis judgement and clinical practice.

Objective To improve the non?surgical N staging system for esophageal carcinoma ( EC) . Methods A retrospective analysis was performed in 501 patients newly diagnosed with esophageal squamous cell carcinoma who received radiotherapy in our hospital from 2009 to 2013. The impacts of the supraclavicular lymph nodes and mediastinal lymph nodes on the overall survival ( OS) rate were analyzed. The original non?surgical N staging system was improved and the proposed N staging system was evaluated. The OS rates were calculated using the Kaplan?Meier method and analyzed using the log?rank test. The univariate and multivariate analyses were performed using the log?rank test and Cox regression model, respectively. Results The 3?and 5?year sample sizes were 404 and 205, respectively. In all patients, the 1?, 3?, and 5?year OS rates were 64?9%, 26?5%, and 18?3%, respectively;the 1?, 3?, and 5?year distant metastasis?free ( DMF) rates were 86?2%, 68?9%, and 67?3%, respectively;the 1?, 3?, and 5?year local control rates were 72?7%, 53?1%, and 43?6%, respectively. The univariate analysis showed that the incidence, 3?year OS rate, and 3?year DMF rate of supraclavicular lymph node metastases in patients with cervical and upper?thoracic EC were significantly higher than those in patients with middle?thoracic and lower?thoracic EC ( 25?7% vs. 14?2%, P=0?034;24?2% vs. 11?5%, P=0?016;84?8% vs. 69?2%, P=0?007) . The multivariate analysis also showed that the number of metastatic lymph nodes was an independent prognostic factor for the OS and DMF rates in patients ( P= 0?000;P= 0?007 ) . Conclusions It is reasonable to classify upper?thoracic EC with supraclavicular lymph node metastasis into stage N1 diseases. The proposed N staging system with the factor of the number of metastatic lymph nodes is more scientific and objective than the original N staging system.

With the development of economy and society, the change of heath concept and increased demands for health care , the cultivation of postgraduates majoring in clinical medicine is facing a lot of problems which seriously affects the quality of culti-vation.The article analyzed the problems and reasons in the clinical medicine postgraduate cultivation.We stated the competency of clinical medicine postgraduates according to the transition of health demands, global medical development and practical requirements for clinical personnel in China.We elaborated the required post competence for clinical medicine postgraduates on the basis of its con-tent and characteristics.We proposed to strengthen the cultivation of clinical medicine postgraduates by the reform and support of the government, enhanced construction of teachers, improved course plan and cultivation process, perfected assessment system in order to make the students competent to their posts.

Objective To establish the orthotopic bladder cancer model of multidrug resistance as the human' s, and detect its resistance condition. Methods Two groups of nude rats 4-6 weeks of age were inculated with 1×107 cell of T24 or T24-ADM, following with observation and putting down their meat, drink,mental condition, urine and abdominal mass growth. Animals were sacrificed after 4 weeks later, then their bladder were weighted and measured, histopathologic assessment was performed,mdr1 was detected by PCR,and cells from the bladder tumors were detected of multidrug resistence by MTT. Results Group of nude rats inculated with T24-ADM generated tumors about 80 % (8/10), the one inculated with T24 was 90 % (9/10)and about 2-3 days early. The blank group had no rats emerge tumors in bladder mucosa at all. Bladder weight and volume: (0.8±0.3) g, (1.0±0.5) g, (875±158) mm3, (903±192) mm3, difference between the two groups had no significant (t = 1.332 and t = 1.215, P＞0.05). Histopathologic detection: The two groups of bladder cancer tissue biopsies can be seen more chaotic arrangement of cell structure, cell body shape is irregular, to the depth of myometrial invasion in different without breaking the film. Between the two groups there were no significantly differences. PCR detection of mdr1 expression differences between the two groups was significant (t = 3.612, P ＜0.01). Cytological detection of drug-resistant cell volume is slightly larger, and no significant difference in morphology. MTT detection: cells from the inculated T24-ADM mice bladder tumor were more resistance to ADM than the ones from the inculated T24 mice bladder tumor (F = 412.107, P＜0.01), and for several other drugs were also resistant. Conclusion Cell transplantation was successfully used to establish bladder cancer model in situ of T24-ADM, and with multi-drug resistance characteristics. The model laid the foundation for further multi-drug resistance research of bladder cancer.

Objective:To investigate the efficacy of laparoscopic treatment of gangrenous appendicitis at the base using barbed wire for closure of the residual appendiceal stump.Methods:A case-control study was conducted among 58 patients with acute gangrenous appendicitis at the base who were admitted to the Department of General Surgery at Fujian Tingzhou Hospital from January 2018 to December 2022. Based on the type of suture used for burying the residual appendiceal stump during the procedure, the patients were divided into two groups: the control group ( n = 28, intermittent full-thickness suture embedding of the appendiceal stump using absorbable sutures) and the observation group ( n = 30, continuous full-thickness suture embedding of the appendiceal stump using barbed sutures). Intraoperative and postoperative related indicators, as well as the incidence of postoperative complications, were compared between the two groups. Results:In the observation group, the time for closure of the residual stump was (4.17 ± 0.66) minutes, which was significantly shorter than that in the control group ( t = 10.98, P < 0.001). The rate of conversion rate to open surgery in the observation group was significantly lower than that in the control group [3.33% (1/30) vs. 21.42% (6/28), χ 2 = 15.13, P < 0.001]. The recovery time of gastrointestinal function and the length of hospital stay in the observation group were (39.40 ± 8.10) hours and (4.33 ± 0.80) days, respectively, which were significantly shorter than those in the control group [(65.70 ± 11.30) hours, (6.11 ± 1.13) days, t = 10.26, 6.92, both P < 0.001]. Conclusion:The use of barbed wire sutures for burying the appendiceal stump in laparoscopic surgery for gangrenous/perforated appendicitis at the base effectively shortens the closure time of the stump, reduces the conversion rate to open surgery, minimizes postoperative complications, and shortens the length of hospital stay, making it a valuable technique for promotion in primary care hospitals.

Objective:To analyze of hot spots and cutting-edge dynamic researches on Traditional Chinese Medicine (TCM) treatment for atopic dermatitis (AD).Methods:The data were abstracted from the literature of AD from CNKI, VIP and WanFang database, during January 1st, 2000 to May 31st, 2021. CiteSpace was used to map Knowledge and visualize information on the law, research hot spots and trendency of TCM in the treatment of atopic dermatitis in recent 20 years.Results:A total of 478 articles were included, mainly from TCM colleges and universities in various provinces. Most of the cooperative institutions have subsidiary relationships, and there is less cross-agency and cross-regional cooperation. Hot research topics included AD, clinical research, TCM therapy, TCM syndrome differentiation, compound Glycyrrhizin, TCM external treatment, and TCM formular, forming 8 main clusters. Integrated Traditional Chinese and Western Medicine was the developing trend in the treatment of AD, and the establishment of animal models to evaluate the therapeutic effect is the research frontier.Conclusion:Knowledge mapping can show the evolution path, research hotspot and frontier of TCM in the treatment of AD, and lay a foundation for high quality researches.