Objective] To explore the treatment of Lanshi Micang disease with tumors related diagnosis and treatment method, in order to have a more comprehensive understanding of anal fistula, so as to broaden the mind, improve the clinical efficacy. [Method] FromLanshi Micang-Anal Fistulaof eight prescriptions for treatment of hemorrhoids and analysis, on the basis of combining the characteristics of compatibility with tumors inDongyuan effect testand the specific prescription, made analysis of anal fistula, diagnosis and treatment of anal fistula for the study of LI Dongyuan thought. [Results] LI Dongyuan from dampness, heat, wind, dryness four on the treatment of anal fistula, with angelica, Gentiana and blood dryness of medicine, to Shufeng pain, Xinrun and blood on regulation of syndrome treatment, paid attention to diet to restore the anal fistula. [Conclusion] LI DongyuanLanshi Micangis rich in content, the treatment of anal fistula has experience, as of today, the diagnosis and treatment on anorectal diseases of clinical thought still has important guiding significance.

Objective Diagnosis related groups ( DRGs) is a system to classify hospital cases into groups , which is effective in the control of medical cost .The article was to explore the DRGs grouping method and quality control indexes of cerebrovascular dis -ease in Nanjing first-class hospitals at grade 3. Methods Polytomous logistic regression for ordinal response was used in the factor analysis of hospitalization cost .E -CHAID decision tree method was applied in the DRGs grouping of cerebrovascular patients . Results Totally 9095 cases were enrolled in this study with the average age was (64.52 ±14.85).The average of stay lengths and expenses were (11.77 ±9.26)d and (25921.04 ±23096.76)rmb respectively.Hospitalization expense was associated with neurologi-cal surgery, main diagnosis, interventional surgery, main complication and ICU days.Taking neurological surgery as the first forced variable, cerebrovascular cases could be divided into 14 DRGs groups. Conclusion The terminal quality control index , the step warning index and case maximum index of cerebrovascular disease established by the DRGs grouping method are suitable in the area .

Objective: To optimize the preparation technique for bifonazole suppositories and evaluate the quality.Methods: The appearance, hardness and melting time of suppositories were used as the evaluation indices to optimize the process conditions, such as suppository matrix, drug particle size, injection molding temperature and stirring conditions, etc.The content of bifonazole was determined by HPLC.Results: The best formula was as follows: the matrix was multiplicated monofatty glyceride-36, bifonazole was sieved by 100 mesh sieve and the best molding temperature was 45 ℃.The quality of the prepared suppositories with the above conditions was controllable in the appearance, melting time limit, hardness and content determination, etc.Conclusion: The formula of bifonazole suppositories is reasonable, the preparation process is feasible, and the quality control methods are reliable.

Objective To study the appropriate neck irradiation volume for neck lymph nodenegative nasopharyngeal carcinoma patients by Meta-analysis.Methods The related references published from Jan 1990 to Jun 2013 were searched in Pubmed,Embase,Cochrane and Wangfang Databases.The qualified references for enrollment criteria were screened and the relative data were collected.The OR (Odds ratio) value by fixed effect model was used to evaluate the data for patients who received radiotherapy between the upper neck and whole neck irradiation.The endpoints including 5-year neck local control rate (LCR),neck-in-irradiation LCR,and neck-outsides-irradiation LCR.Results Five qualified references were screened and belonged to respective research.There enrolled 1 333 patients,including 970 patients who received the upper neck irradiation and 363 patients who received the whole neck irradiation,respectively.The forest plots revealed that there were no significant differences for 5-year neck LCR,neckin-irradiation LCR,and neck-outsides-irradiation LCR for patients received radiotherapy between the upper neck and whole neck irradiation.These OR values were 0.89 (95％ CI:0.41-1.94),1.29 (95％ CI:0.58-2.88) and 0.42 (95％ CI:0.07-2.36),respectively.Conclusions The Meta-analysis results suggest that irradiation to the upper neck for neck lymph node-negative nasopharyngeal carcinoma can be appropriate.

Objective To observe the protective effect of rhein-arginine (RhA) on rats ankylenteron and to explore the anti-inflammatory mechanism. Methods Sixty male SD rats were randomly divided into 6 groups:normal control group,model group,dexamethasone group (in the dose of 10 mg?kg-1) and low-,medium-and high-dose RhA groups (in the dose of 7.5 mg?kg-1,15 mg?kg-1,30 mg?kg-1 respectively). Except that the normal control group,the rats in other groups were induced ankylenteron. Intraperitoneal injection of saline was administered to the rats in the normal control group and the model group,and dexamethasone group and RhA groups were given the corresponding drugs according to the experimental design. The treatment lasted 7 days. On the 8th day after surgery the blood samples of each group were collected. The levels of interleukin-1?(IL-1?),interleukin-4(IL-4)and tumor necrosis factor-?(TNF-a)were determined by enzyme linked immunosorbent assay. Grades of ntestinal adhesion were ranked by macroscopic observation. The adhesive tissues between cecum and abdominal wall were taken for pathological observation and the determination of hydroxyproline (Hyp) content. Results RhA significantly relieved the experimental intestinal adhesion,Obviously decreased the levels of IL-1?and TNF-?,and inhibited the hyperplasia of fibrous connective tissue. However,there was no significant impact on the level of IL-4. Conclusion RhA can effectively prevent the information of postoperative ankylenteron by inhibiting the expression of inflammatory cytokines and reducing the inflammatory response.

The means of survival of genomic dsRNA of reoviruses from dsRNA-triggered and Dicer-initiated RNAi pathway remains to be defined.The present study aimed to investigate the effect of Grass carp reovirus (GCRV) replication on the RNAi pathway of grass carp kidney cells (CIK).The dsRNA-triggered RNAi pathway was demonstrated unimpaired in CIK cells through RNAi assay.GCRV-specific siRNA was generated in CIK cells transfected with purified GCRV genomic dsRNA in Northern blot analysis; while in GCRV-infected CIK cells,no GCRV-specific siRNA could be detected.Infection and transfection experiments further indicated that replication of GCRV correlated with the increased transcription level of the Dicer gene and functional inhibition of in vitro synthesized egfp-siRNA in silencing the EGFP reporter gene.These data demonstrated that although only the genomic dsRNA of GCRV was sensitive to the cellular RNAi pathway,unidentified RNAi suppressor protein(s) might contribute to the survival of the viral genome and efficient viral replication.

Objective To study the applicability of unilateral and bilateral antegrade cerebral perfusion during deep hy-potbermia circulatory arrest (DHCT) surgery and to determine a better method of brain protection. Methods 60 patients un-derwent aortic arch surgery were random divided into either unilateral cerebral perfusion group with a cannula in the innominate artery (n = 30 ) , or bilateral cerebral peffusion gToup with an additional cannula in the left carotid artery ( n = 30 ). S-100β,neuron specific enolase (NSE) were assayed at the following time points: the beginning of cardiopulmonary bypass (T_1), the beginning of circulatory arrcst( T_2 ), antegradc cerebral perfusion (ACP) 25 min( T_3 ), the end of ACP( T_4 ), the end of car-diopulmonary bypass ( T_5 ) , 1h( T_6 ) , 6h ( T_7 ) and 24h( T_8 ) after operation. Neurological deficit incidence and mortality were also obtained. Results There is no statistical significance for S-100β and NSE plasma concentration among time points of T_1、T_2 and T_3. But every time point among T_4、T_5、T_6、T_7 ,Ts do have statistical significances. The incidence of central nervous system dysfunction in group unilateral ACP was higher than that in group bilateral ACP ( 33.33% vs. 10.00%, P = 0.028 ).But there is no significant difference between the two groups in mortality( 3.33% vs. 6.66% ,P = 1. 000 ). Conclusion There is no significant difference between unilateral ACP and bilateral ACP in 25 min during DHCA. But as the DHCA time extends, the effect of bilateral ACP will be better.

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 summarize the clinical characteristics of neonates with non-immune hydrops fetalis.Methods The clinical data of ten neonates with non-immune hydrops fetalis, who were admitted to the Department of Neonatology, Gynecology and Obstetrics Hospital of Fudan University between January 2012 and June 2014, were retrospectively studied.Prenatal characteristics, causes, clinical features and prognosis were explored and analyzed with descriptive statistical methods.Results (1) One of the ten neonates was diagnosed after birth presented with hydroderma and abdominal distension, and the rest ones were diagnosed antenatally.There were six males and four females, and eight premature and two term neonates with the average gestational age of (33.6±2.4) weeks and birth weight of(2 680±478) g.(2) The mean maternal age was (30.3 ±4.6) years.Two of the mothers had gestational diabetes mellitus and one had gestational diabetes mellitus complicating with hyperthyroidism.The blood types of all mothers were O and Rh(+).None of the mothers were tested for parvovirus B19 and no fetus was reported with abnormal chromosome karyotype in the five cases received fetal karyotype analysis.(3) The average gestational age at initial identification of hydrops fetalis by fetal ultrasound was (31.3 ± 2.4) weeks (25.1～37.0 weeks) among nine cases diagnosed prenatally.By ultrasound screening, there were seven cases with hydrothorax, six with seroperitoneum, five with polyhydramnios and four with hydroderm.(4) Two neonates had normal non-stress test results during labor, and eight were abnormal and suffered from severe neonatal asphyxia at birth and resuscitated by endotracheal intubation.Ten neonates had hydroderm, seven had hydrothorax, six had seroperitoneum and one had hydropericardium.One complicated with multiple malformations and one had chromosome abnormality.Four cases received thoracentesis and three had abdominal paracentesis after parturition.(5) Prognosis: One neonate survived and nine died among which six due to resuscitation failure in delivery room, two died one day after giving up treatment after one day, and one died due to treatment failure six months after birth.(6) The causes of hydrops fetalis were anemia (two cases) and congenital diaphragmatic hemangioma, recurrent atrial premature beat, Down's syndrome, congenital pulmonary lymphangiectasia, paroxysmal supraventricular tachycardia, placental chorioangioma, suspicious genetic syndrome and idiopathic (one for each).Conclusions The prognosis varies because of different etiology of non-immune hydrops fetalis.Neonates with hydrops fetalis might have a higher rate of asphyxia and mortality rate, and difficulties in resuscitation at birth.

Objective To assess the reproducibility of vascularization measurement in cervical carcinoma using transvaginal three-dimensional power Doppler angiography (3D-PDA) with virtualorgan computer-aided analysis ( VOCAL), and compare the reproducibility of two different contour mode (manual and automatic mode) of VOCAL. Methods Eighty patients with cervical carcinoma were examined by observer 1 using transvaginal 3D-PDA. The two acquired volume datasets were analyzed using manual and sphere automatic contour mode of the VOCAL imaging program for assessing carcinoma vascularization index( VI), flow index(FI), and vascularization flow index(VFI). Forty patients of them were examined randomly by observer 2 by the same method. Reproducibility of vascularity measurement was assessed by calculating intraclass (intra-CC) and interclass (inter-CC) , limits of agreement, 95% confidence interval definition. The contribution of various factors (examiner, measurement, contour mode and patient) to intrasubject variance was estimated using different analysis of variance models (ANOVA). Results For intraobserver,manual contour mode was more valid than sphere automatic contour mode for each observer (0. 92～0. 99 vs 0. 75～0. 94) ,and it also had smaller standard deviation,narrower limit of agreement range, 95% confidence interval and higher intra-cc than those of sphere automatic contour mode. Interobserver agreement of manual contour vascular measurements was similar to the intraobserver agreement for manual contour vascular measurements ( 0. 89 ～ 0. 97 vs 0. 92 ～ 0. 99 ) , but interobserver agreement for sphere automatic contour vascular measurements dramatically reduced (0. 52～0. 72). Conclusions Manual contour mode for 3D-PDA vascular measurement has better reproduciblity than sphere automatic contour mode, especially useful for irregular shape tissue.