Objective To explore the multidisciplinary treatment for acute massive gastrointestinal (GI) bleeding caused by Dieulafoy's lesion.Methods The clinical data of 48 patients with Dieulafoy's lesions treated at our hospital from April 2007 to April 2012 were retrospectively analyzed.Of the 48 patients,40 were males and 8 were females,with a mean age of 46.7 years (range 21 -52 years).Accurate diagnosis was established by emergency upper gastrointestinal endoscopy, angiography and emergency laparotomy.Results The most common location of the bleeding Dieulafoy's lesion was at the body of stomach (40 cases),followed by the cardia (4 cases),the duodenum (2 cases) and the jejunum (2 cases ),with most lesions being located in the upper part of the stomach within 6 cm of the gastroesophageal junction.Correct diagnosis was made by endoscopy in 46 patients and by emergency laparotomy in 2 cases.Of the 18 patients initially treated endoscopically epinephrine injection and endoscopic hemoclips,2 cases needed angiography to identify the source of bleeding and were cured by transcatheter arterial embolization.23 patients underwent surgical therapy.In this series,47 cases were cured,1 patient died of hypovolaemic shock and multi-organ failure during the hospital stay.Average length hospital stay was (10.8 ± 2.5 ) d.Conclusions Dieulafoy' s lesion is less common cause of gastrointestinal bleeding.Endoscopy plays a key role in the diagnosis and treatment.Topical epinephrine injection and haemoclipping may cure the patients,if it fails angiography and embolization provides a therapy.Most patients may need a laparotomy and surgery as a decisive measure.

Objective To explore the rapid diagnosis and the rational chice of the first-line agents for acute aortic dissection (AAD) in the emergency department.Methods The clinical data of 360 patients with AAD treated at our hospital from March 2007 to March 2013 were retrospectively analyzed.Of them,338 patients with suspected AAD were examined by chest radiography,trans-thoracic echocardiography (TTE),and computed tomography angiography (CTA) successively.The reliabilities of results from each diagnostic method were verified by the gold standard of intra-operative findings and the comparisons of their diagnostic potential were carried out.Results The preoperative diagnostic sensitivity of chest radiography,TTE and CTA in the assessment of AAD were 64％,77％ and 100％,respectively;the specificity is 86％,90％ and 100％,respectively;the accuracy rats were 70％,78％ and 100％,respectively;the positive predictive values were 93％,99％ and 100％,respectively;the negative predictive values were 46％,27％ and 100％,respectively.In the work-up of any patient with suspected AAD,the emergency bedside non-invasive TTE or computed tomography was the first-line initial diagnostic screening,and the best method for the accurate diagnosis of AAD was CTA.Medical management included pain control and deliberate hypotension therapy by using rapidly short-acting vasodilator and beta blockers to lower heart rate,and the hibernation therapy in small dose of specific agents might serve as a useful adjuvant method,and the early combination of vasodilatation medicines was better than the single one.Of them,242 patients fortunately survived on treatment,and 42 died of hypovolemic shock after rupture of AAD and multiorgan failure.Conclusions Acute aortic dissection is the most potentially life-threatening cardiovascular disease,though it is extremely rare in the hypertensive patients,attending doctors should pay more attention.Early rapid diagnosis is the key to AAD treatment.The best method for correctly diagnosing AAD is complementary use of TTE,CTA and magnetic resonance angiography (MRA).Correct and timely diagnosis and strictly deliberate hypotension treatment are the essential determinant of decreasing mortality and improving prognosis of AAD.

Objective To evaluate the validity and surgical outcome of emergency one-stage intestinal resection and tension-free hernioplasty for acutely strangulated inguinal hernia complicated with intestinal necrosis.Methods Clinical data of 58 patients diagnosed strangulated inguinal hernia and intestinal necrosis in our hospital from July 2011 to April 2014 were retrospectively analyzed.Of the 58 patients,33 were males and 25 were females,mean age of (64 ± 18) years (range 52-86).There were 28 strangulated inguinal and 30 femoral hernias undergoing emergency small bowel resection and tension-free mesh hernioplasty.Patients with intestinal perforations,preoperative peritonitis,inflammatory hernia and those who required colon resections were excluded from the study.Results The mean operative time was (92 ± 22) min (range,80-120 min).Average length of hospital stay was (8.6 ± 2.5) d (range,6-21 d).There were three postoperative c omplications (5.2％):one of subcutaneous hematoma,one of superficial surgical site infection and one of scrotal fluid collection,which were all cured by wound dressing,removal of infected prosthetic mesh,vacuum sealing drainage (VSD) and continuous irrigation,intravenous antibiotics and scrotal puncture.During a follow-up period of 6 to 32 months (mean 12 ± 6 months),there was no hernia recurrence.Conclusions Emergency one-stage intestinal resection and tension-free mesh hernioplasty for strangulated inguinal hernia complicated by intestinal necrosis is safe,feasible with a favourable outcome and low rate of postoperative complications.

Objective To evaluate the application value of anterior approach right hepatectomy using the liver hanging maneuver for severe blunt liver trauma.Methods Clinical data of 63 patients with severe blunt liver trauma undergoing right hepatectomy in our hospital from January 2011 to January 2017 were retrospectively analyzed.Among them,31 patients received anterior approach right hepatectomy (anterior approach group,31 cases) while the others did conventional right hepatectomy (conventional approach group,32 cases).Clinical data,intraoperative blood loss,postoperative alanine transaminase (ALT) at POD3,postoperative morbidity and mortality in both groups were analyzed and compared.Results There were eight surgical deaths,one in the anterior approach group and seven in the conventional approach group.All the 31 cases underwent anterior approach right hepatectomy successfully using the liver hanging maneuver.The mean intraoperative blood loss (768 ± 231) ml vs.(1 264 ± 1 248) ml (P ＜ 0.05),postoperative hepatic function ALT value at POD3 (155 ± 89) U/L vs.(689 ± 67) U/L (P ＜ 0.05),postoperative morbidity and mortality of the anterior approach group were markedly superior to conventional approach group (12.9％ vs.34.4％,3.2％ vs.21.9％,all P ＜ 0.05).Conclusions Anterior approach right hepateetomy using the liver hanging maneuver has advantages of decreased intraoperative blood loss,less hepatic function compromise,reduced postoperative morbidity and mortality compared to conventional approach right hepatectomy in cases of severe right liver blunt trauma.

Objective To investigate the expression feature of cx43 and E-cadherin protein in non-small cell lung cancer and its clinical significance. Methods Paraffin embedded tissue from 50 cases of primary lung carcinomas and 20 non lung carcinomas cases were investigated for expression of Cx43 and E-cadherin by immunohistochemistry(ABC method), and the relationship between Cx43, E-cadherin and the clinical pathology of lung carcinomas was analyzed. Results Positive rate of Cx43 and E-cadherin expression in lung cancer was 54 % and 46 %, respectively. There were expression of Cx43 and E-cadherin in all 20 non lung carcinomas cases. The positive rate of Cx43 and E-cadherin expression gradually decreased with tumor progression. There were a distinct statistic difference between stageⅠ, stageⅡand stage Ⅲ, stage Ⅳ. The expression of Cx43 and E-cadherin in well-moderate pathological grading were higher than those in poor. Significant relationship was found between the positive rate of E-cadherin and lymph node metastasis. Primary lung carcinoma with lymph node metastasis showed no higher expression of Cx43 than lung carcinoma without lymph node metastasis. The positive rate of Cx43 expression in adenocarcinoma was significantly higher than that in squamous cell carcinoma and large cell un-differentiated carcinoma. The expression of E-cadherin was not related to pathological typing. Conclusion Cx43 and E-cadherin can be looked as the important index for judging the metastasis and prognosis of lung cancer.

Objective To investigate the role of smear examination of wound secretion in early diagnosis and treatment of gaseous gangrene after trauma.Methods The data of 10 881 patients,who were carried to our hospital more than one hour after injuries from April 2003 to April 2006,were collected.Smear examination of wound secretion had been performed in these patients.Results Among the 10 881 wounded patients,11 patients developed gaseous gangrene,taking up 0.10%.Among the 11 gaseous gangrene patients,5 were caused by vehicle crash,3 by machine,2 by stone,1 by gun-shot injury.As for the wounded locations,7(63.6%)patients were in lower extremity,and 3(27.3%)patients in upper extremity,and 1 patient in mandible with head and neck wounds.The onset time of gaseous gangrene was(3.3?2.2)d.The 11 patients were completely cured.Seven patients with open comminuted fracture and lost limb function were performed with wound limb amputation,3 patients with injuries without fractures and 1 patient with mandible combined head and neck wounds were immediately treated with surgical debridement,cephalosporins,and hyperbaric oxygen(HBO). Conclusion Gas gangrene was extremely rare in injury patients but it was life-threatening,so doctors should pay more attention.Cleaning-up the wounds and debridement were critical for prevention of infection,and HBO might serve as an useful assistant method.Smear examination of wound secretion was helpful in early diagnosis and treatment of gaseous gangrene after trauma.

Objective To investigate the basic data and quality control indicators of infection monitoring in 67 hospitals in Chongqing area ,and provide basic data for the exploration of hospital infection monitoring norms .Methods According to the sur‐vey of the basic data and quality control index of hospital infection monitoring by the national health planning commission ,a ques‐tionnaire survey was conducted in some medical institutions in Chongqing area ,and the data were collected and analyzed .Results A total of 67 valid questionnaires were collected ,21 for tertiary hospitals ,46 for secondary hospitals ,of which there were 5 teaching hospitals ,47 general hospital ,11 hospital of traditional Chinese medicine ,3 factories hospitals ,1 private hospital .Electronic medical records management system in 67 hospitals accounted for 71 .64% ,the hospital infection information system accounted for 83 .33% ,surgical anesthesia system accounting for 31 .34% ,antimicrobial drug management and monitoring system accounted for 68 .65% .Hospital infection monitoring was mainly based on routine monitoring and target monitoring ,the correct rate of monito‐ring objects was 74 .62% ,and the usage of antibiotics was 44 .78% in the operation room .Monitoring statistics took month as a u‐nit ,accounting for 73 .13% ,the correct rate of P75 value was not high when calculating the risk factors of NNIS operation ,opera‐tion and diagnosis and treatment operation confusion accounted for 97 .01% ,the knowledge and technology of microbiological exam‐ination was relatively low .Conclusion Basic data of hospital infection monitoring and quality control survey can understand the sit‐uation of hospital infection management ,it can help to improve the monitoring level of nosocomial infection by investigating the weak links and strengthening the intervention .

AIM: To observe the expression of proteins induced by whole-body irradiation in mice with low dose X-rays and their biological activity. METHODS: To analyse the expression of protein induced by whole-body irradiation with 75mGy X-rays and sham-irradiation, the method of gel filtration with Sephadex G-100 and HPLC were used. The biological activity of protein expressed in thymocytes was observed by mouse splenocyte proliferation and chromosome aberration of human peripheral blood lymphocytes. RESULTS: HPLC analysis showed that there was a marked decrease in expression of 24.5 kD protein molecule in the fractions of thymocyte extract in comparison with the corresponding fractions from the sham-irradiated control mice. These protein fractions from the thymocytes of the irradiated mice at the concentration of 6.25 mg/L showed both inhibitory effect on normal T cell proliferation and protective effect on the chromosome damage induced by high dose radiation. CONCLUSION: Down regulation of 24.5 kD protein molecule expression may have implications in the mechanism of immunoenhancement and cytogenetic adaptive response induced by low dose radiation.

Objective To explore the efficacy and postoperative survival times of stereotactic radiosurgery by X-knife in the treatment of brain metastatic tumors.Methods Between March 1996 and March 2008,520 patients with brain metastatic tumors were treated in our hospital by stereotactic radiosurgery using X-knife.Among the cases,336 had single metastatic lesions,and 184 presented with multifocal tumors(2 lesions in 51 patients,3-5 lesions in 63,and 6-10 lesions in 70).The tumors sized 5 to 35 mm in diameter with a mean of 16.4 mm.Stereotactic radiosurgery was carried out in the cases with a mean central dose of 22 Gy(20 to 25 Gy),and mean marginal dose of 12 Gy(10 to 14 Gy).Over 80% of the lesions were encircled with the dosage.Results The 520 patients were followed up for 8 to 36 months(mean,20 months).CT and MRI performed in the 6th months postoperation showed complete response in 218 patients(41.9%),partial response in 182(35.0%),no response in 78(15.0%),and progressed disease in 42(8.1%).The overall control rate of the tumors were 91.9%(478/520).In this series,the 6-months survival rate was 85.0%(442/520),12-month survival rate was 68.1%(354/520),and the 1-year and 3-year survival rates were 40% and 5.5% respectively.The medium survival time was 12.6 months.Conclusions Stereotactic radiosurgery is an effective method for brain metastatic tumors.It can improve the life quality and survival time of the patients.

To study the anti tumor effect of "Compound" granules on mice bearing sarcoma 180 and its possible mechanism, We observed the effect of "Compound" granules on tumor weight and expression of p53 and PCNA in mice bearing sarcoma 180 by means of immunohisto chemistry. After treatment with "Compound" anti tumor granules, anti tumor granules (Ⅰ,Ⅱ,Ⅲ) and CTX, the results showed that "Compound" granules and the other four drugs could inhibit sarcoma 180 growth to various extent, and the rates of inhibition were 20 31%, 6 56%, 15 0%, 19 06% and 30 3%, respectively. Meanwhile,we found the expression of p53 and PCNA in mice bearing sarcoma 180 was affected in various groups.It suggested that compound anti tumor granules had antitumor effect and its possible mechanism might be associated with inhibition the expression of mutate p53 and PCNA.