Microcirculation disturbance and ischemia of the pancreas are important pathophysiological changes in the onset of acute pancrea-titis,and organ hypoperfusion is a risk factor for poor prognosis.During the first 12 to 24 hours after admission,fluid resuscitation is the most important medical treatment for the early stage of acute pancreatitis,and timely and rational fluid infusion helps to improve prognosis. However,there lacks high -quality clinical evidence for type of fluid,infusion speed,and monitoring methods,and more randomized con-trolled trials are needed.

目的观察金钠多结合早期康复治疗急性缺血性脑卒中的临床疗效。方法将80例缺血性脑卒中患者随机分为金钠多加早期康复组和低分子右旋糖酐加早期康复组(对照组)。观察两组患者治疗前后血脂及血液流变学、神经功能缺损、肢体运动功能及日常生活活动能力评分的变化。结果金钠多加早期康复组治疗后血脂、红细胞压积、纤维蛋白原均降低,神经功能缺损评分减少值、肢体运动功能及日常生活能力增加值均高于对照组(P<0.05～0.01)。结论金钠多结合早期康复能减轻急性缺血性脑卒中患者的神经功能缺损,提高患者独立生活能力,改善功能结局,提高康复效率。

ObjectiveTo explore the effect of neuromuscular facilitation combined with faradism on limbs motor function in hemiplegic patient with early stroke.Methods108 patients were randomly divided into the therapy group(who accepted neuromuscular facilitation combined with faradism) and control group (who accepted neuromuscular facilitation only). The limbs motor function was evaluated with Fugl-Meyer Assessment (FMA) before and after 10 weeks by the same doctor. ResultsThere were not significant difference of scores of FMA between the two groups before rehabilitation(P>0.05), but there were significant difference 10 weeks after rehabilitation(P<0.01). ADL in therapy group was significantly higher than that in control group(P<0.01).ConclusionFaradism can significantly improve the effect of neuromuscular facilitation on limbs motor function and ADL.

Objective The aim of this study is to present two novel technique?Lying on position and rotational board TSEI in which uniform dose to the whole body as well as the soles and vertex of scalp can be achieved in one electron beam treatment fraction. Methods Patients are treated with two groups in prone and supine position by leaning on inner rotational board in prone and supine position, each group can further be separated into two subgroup with tilting and rotation positions for treatment. By incorporating all these setting on the aswirl board with the optimal gantry angle, the patient will final accumulate compensated dosages on whole body surface. Results The dose uniformity for the rotational board?TSET or Lying on position could be control within ±10%. Conclusions The two TSEItechnique?Lying on and Rotational board TSEI techniques presented in this study is able to deliver a uniform dose to the patient’s skin surface as well as to the vertex and the soles all in one time, eliminating the troubles of having to further boost fields for these two regions when using the Stanford Six Field Technique.

Aim To analyze the expression of phosphatidylethanolamine-binding protein(PEBP) and ERK in critical brain regions of psychological dependence rats.Methods Morphine-induced rats conditioned place preference(CPP) model was established to mimic different stages of morphine psychological dependence, during which PEBP expression and ERK activity were assayed in different brain regions.Results PEBP expression in hippocampus, prefrontal cortex, striatum and nucleus accumbens showed no change at three stages of psychological dependence.However, ERK activity increased notably in prefrontal cortex on CPP formation, and decreased remarkably in hippocampus on CPP reinstatement.Conclusions The formation and retrieval of associated memory between morphine effects and environment involve different neural circuits, in which ERK activity is critical, and PEBP might not be involved in such a memory-related ERK regulation.

Tyrosine kinase inhibitors (TKIs) are used as the primary first-line treatment for advanced hepatocellular carcinoma, and the combination of immune checkpoint inhibitors (ICIs) and angiogenesis inhibitors have also been recommended as first-line treatment recently. For hepatocellular carcinoma patients with portal vein tumor thrombus, hepatic artery infusion chemotherapy (HAIC) is supported by progressively more evidence in improvement in the overall survival benefit. Based on relevant literatures and combined with clinical practices, the authors investigate the clinical application and development trends of TKIs, ICIs and HAIC in the first-line treatment for advanced hepatocellular carcinoma.

Objective To explore clinical results of posterior spinal approach microendoscopic disectomy(MED) for the treatment of lumbar disc herniation in adolescents.Methods A total of 25 consecutive patients treated by MED from February 2000 to August 2004 in this hospital were analyzed retrospectively.Clinical results were assessed with the modified Macnab criterion.Pre-and post-operative symptoms and functional states were evaluated by the Chinese version Oswestry Disability Index(ODI).Results A conversion to open procedure was required in 1 patient.The operating time was 35～65 minutes(mean,44.8?9.0 minutes);the estimated blood loss during operation was 30～80 ml(mean,51.3?14.6 ml);the postoperative hospital stay was 6～10 days(mean,7.5?1.0 days).All incisions healed by first intention.There were no dural tears,nerve root injuries,intervertebral space infections,or great vessel injuries.Twentg-two patients were followed for 7～57 months(mean,33.4?17.8 months).There were significant differences between preoperative ODI(46.2%?8.5%) and postoperative ODI(1.8%?3.0%).The improvement rate of ODI was 44.4%?9.2%(t=21.61,P=0.00).Clinical results assessment by the modified Macnab criterion revealed "excellent" in 19 patients and "good" in 3 patients,the rate of excellent or good results being 100%. Conclusions Microendoscopic disectomy can be performed safely and effectively for lumbar disc herniation in adolescents,resulting in little trauma,fast recovery,and excellent clinical results.

This article is concerned about the practice and exploration on medical electronics teaching project and teaching pattern we have done before and the Active Participation Pattern thus formed. That is guiding, putting for ward questions, discussing, debating and summarizing in class while setting research problem after class. We also have made media courseware in medical electronics and have used it in our teaching process, which has aroused the students' interest in study and has enhanced the teaching efficiency and quality. This new method of teaching pattern helps us gain the strong feedback and affirmation and is welcome by the students.

Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted.Biopsy or surgical pathological findings served as the golden standard.The main outcome measure was the diagnostic accuracy of alarm features.Results Among 921 gastrointestinal outpatients,39 patients (4.2％) with malignancy were detected,including 13 (33.3％) with esophageal cancer,24 (61.5％) with gastric cancer and 2(5.1％) with duodenal ampulla cancer.36 patients (92.3％) were found with advanced cancer.In 137patients who had alarm features,21 (15.3％) were found to have malignancy and all were advanced.The sensitivity,specificity,positive predictive value and negative predictive value of alarm features were 53.8％(21/39),86.8％ (766/882),15.3％ (21/137) and 97.7％ (766/784),respectively.Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy.Noninvasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.

Objective To evaluate the clinical value of the three-category classification of severe acute pancreatitis (SAP).Methods Clinical data of 337 traditional SAP patients,who were admitted to Peking Union Medical College Hospital (PUMCH)from January 2001 to December 2012,were retrospectively studied.These patients were classified into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) according to the latest 2013 Atlanta Classification.SAP patients were further categorized as critical acute pancreatitis (CAP) and non-CAP.Disease severity,therapy and prognosis among three groups were compared.Results Among the total 337 traditional SAP patients,253 were classified as MSAP and 84 as SAP.In the group of SAP,40 patients were categorized as CAP and 44 as non-CAP.Compared with non-CAP patients,CAP patients had significantly higher mortality rate which was 70％ (28/40).Other results were all significantly higher in CAP group rather than non-CAP group,including ICU admission rate 77.5％(31/40),length of ICU stay (15.5 ± 20.6) days,Ranson,APACHE Ⅱ,BISAP,MCTSI,modified Marshall scores 4.6 ± 1.4,16.8 ± 5.8,3.0 ± 1.0,8.6 ± 1.7,and 7.4 ± 2.9,respectively (P ＜ 0.01 in each endpoint).These parameters of SAP group were also significantly higher than those of MSAP group (P ＜0.01).Conclusions Using the new three-category classification to distinguish traditional severe acute pancreatitis,namely MSAP,SAP,and CAP,can better reflect the severity of disease,predict outcome and guide clinical management.