Objective To sum up the experiences of the application of gastric cancer postoperative gastroin-testinal decompression tube.Methods Retrospectively analyzed the implementation of postoperative gastrointestinal decompression tube undergoing elective surgery.The clinical data of 15 cases of gastric cancer,preoperative education communication,preoperative preparation,intraoperative and postoperative treatment were analyzed.Results 14 cases recovered,1 case was not completely correct anastomotic fistula by malnutrition.The average for the first time the anus exhaust time was (48.7 ±16.4)h,for the first time defecation time was (65.1 ±5.7)h,postoperative length of hospi-tal stay was (12.4 ±3.1)d,postoperative nausea and vomiting occurred in 2 cases,diarrhea in 2 cases,sore throat discomfort in 3 cases.Conclusion Postoperative gastric cancer patients with gastrointestinal decompression tube can reduce stress damage,improve postoperative experience,accelerate the postoperative rehabilitation,does not increase the incidence of postoperative complications,it is safe and feasible.

Objective To compare the effects of celecoxib and amniotic membrane suspension (AMS) on corneal neovascularization (CNV) area and expression of matrix metalloproteinase-2 (MMP-2) and matrix metalloprotein-ase-9 (MMP-9) in the growth of corneal neovascularization after thermal burn in rabbits,and provide a theoretical basis of celecoxib for the clinical treatment of corneal neovascularization.Methods Left corneas of 36 rabbits were burned by the home-made burning-device,and randomly divided to three groups:negative control group (n =12),AMS group (n =12) and celecoxib group (n =12),were respectively sub-conjunctival injected by 90 g · L-1 saline (0.1 mL),AMS (0.1 mL) and 8 mg · mL-1 celecoxib solution (0.1 mL).The histological morphology,growth condition and area of CNV were compared under slit lamp microscope at 4 days,7 days and 14 days after thermal-burned.At 7 days after thermal-burned,four appropriate corneas were randomly taken to detect the expression of MMP-2 and MMP-9 by immunohistochemistry,and the results were analyzed by computer image analysis system.Results At 4 days,7 days,14 days after thermal-burned,the areas of neovascularization were (11.32 ± 1.11)mm2,(38.49 ± 4.64) mm2,(43.30 ± 4.39) mm2 in negative control group,(9.69 ± 1.30) mm2,(31.15 ± 4.85)mm2,(37.19 ± 5.27) mm2 in AMS group,(8.47 ± 1.20)mm2,(30.31 ± 4.93) mm2,(36.69 ± 3.54) mm2 in celecoxib group,respectively.At different time points,neovascularization area in AMS group or celecoxib group was significantly lower than negative control group (all P ＜ 0.05).There was no difference between AMS and celecoxib group (all P ＞ 0.05).At 7 days after thermal-burned,the expression of MMP-2 and MMP-9 was not different between AMS group and celecoxib group (all P ＞ 0.05),and significantly lower than negative control group (all P ＜ 0.05).Conclusion Celecoxib and amniotic membrane suspension can all effectively inhibit CNV after thermal-burned,which may be related to the down-regulated expression of MMP-2,MMP-9 in thermal-burned corneas.

Objective To measure the reconstructed cranial CT images,and to clarify the safety range of unilateral nasal transsphenoidal approach for pituitary surgery.Methods 100 normal pituitary cranial CT images were randomly selected,and the three-dimensional reconstruction was performed by using the CT images of perpendicular and parallel to the edge of the two eyes as base line, and the distance and angle in unilateral nasal transsphenoidal approach for pituitary surgery from the sagittal plane in the middle of the nasal meatus and the plane through the tip of the nose and both ends of dorsum sellae were measured,respectively. The angles and distances were compared when grouped the data by gender and age. Results Angle A1 (the angle between the tip of the nose and the tuberculum sellae and saddle back root line in the sagittal plane)in the sagittal plane of the middle nasal meatus was (11.22±1.35)°,95% confidence interval was 8.92°-13.76°degrees;the distance D1(the distance on the line between tuberculum sellae and saddle back root, and the line was formed by the plate contained the angle A1 and sellar floor)was (16.71 ± 2.07)mm,95% confidence interval was 13.11-19.93 mm.Angle A2 (the angle between the tip of the nose and the saddle back ends)which was in the plane through the tip of the nose and both ends of dorsum sellae was (8.91±1.19)°,95% confidence interval was 7.12°-10.72°;the distance D2(the distance on the line between the saddle back ends,and the line was formed by the plate contained the angle A2 and sellar floor)was (14.23±2.09)mm,95% confidence interval was 10.81-17.92 mm. The four parameter data was normally distributed,and there was no significantly statistic difference between different gender and ages (P>0.05).Conclusion The angle of the movement for unilateral nasal transsphenoidal approach for pituitary surgery operation in the sagittal plane in the middle of the nasal meatus should be less than (11.22 ± 1.35)°,and the distance of the movement should be less than (16.71±2.07)mm. The angle of the movement in the plane through the tip of the nose and both ends of dorsum sellae should be less than (8.9 1 ± 1.1 9 )°, and the distance of the movement should be less than (14.23±2.09)mm.

Objective To determine the efficacy of liver cancer resection combined with splenectomy for patients with hepatocellular carcinoma with hypersplenism.Methods Among 35 patients with hepatocellular cancer and hypersplenism treated from March 2004 to January 2006 at our hospital,12 patients accepted simultaneous liver cancer resection and splenectomy (the splenectomy group)and 23 only accepted liver cancer resection (the non-splenectomy group).The liver function,platelets and white blood cells were analyzed retrospectively.Results All the operations were successfully carried out.Within 1 week after operation,the white blood cell count increased from (3.2 ± 1.7) × 109/L to (8.5±-5.3) × 109/L,the platelet count increased from (52.6±23.7) × 109/L to (245.3±94.6) ×109/L(P＜0.01) in the group of patients with combined splenectomy,while little change occurred in the non-splenectomy group.The liver function in the splenectomy group recovered to the preoperational value within 1 week.Two years after operation,7 (58.3％) patients were still surviving in the splenectomy group and the mean tumor-free survival was (16.4 ± 4.3) months compared with (14.3 ±5.2) months in 10 (43.5％) patients in the non-splenectomy group,(P＜0.005).Conclusion Liver cancer resection combined with splenectomy was efficacious to hepatocellular cancer with hypersplenism.

Objective To analyze the emergercy epidemiological characteristics of coeualties with head in-jury in Shanghai. Method By a prospective study,the data of 18 076 casualties with head injury during the whole year 2004 collected from 12 joint hospitals in Shanghai were documented well in the unified survey tables with wide-range items failed in by the attending physician, who got the firsthand information from patients and witness.The data were analyzed by using SPPS version 11.5 software. Results Of 18 076 casualties with head injury,the ratio of male to female was 2.11: 1.The mean age of female was older than that of male (t=10.575, P<0.01).The highest incidence of casualties occurred in people of twenties (24.7 % ). The local residents of Shanghai ac-counted for 34.2% of casualties. More casualties often occurred in December,January,Mareh and August than in he rest. Of 5.1% casualties with head injury were assochted with labour work.The leading cause of injury was dif-ferent in patient cohorts of different ages. Fall was the most main cause of trauma in children cohort (aged<14)and the senile patients cohort (aged > 60). The violert assault and traffic accident caused the most head injuries in the adolescent people cohort ( aged 15～34 years old) and the young people cohort ( aged 35～59 year old). The majority of casualties (85.5%) received CT scan.The scalp laceration (40.2% of patients) was seen more often than other types of injury . The mortality of easualties with traumatic brain injury was 0. 5 % . Conclusions The kmowledge of epidemiologieal aend of emergency deparhnent visitors with head injury is amportant guidance to physicians arranging emergency medical resources rationally and formulating a comprehesive prevention stategy of castahies with head injury.

A liquid chromatography-tandem mass spectrometry ( LC-MSMS ) method has been developed for the simultaneous determination of N3-methyladenine ( N3-MeA ) and N3-ethyladenine ( N3-EtA ) in calf thymus DNA. The DNA samples has been purified and enriched by cation exchange cartridge ( Waters Oasis MCX) . d3-N3-MeA and d5-N3-EtA were used as isotope internal standard. The DNA samples were injected with autosampler. The injected volume was 3 μL and analysis time was 13 min. The sample separation was carried out on hydrophilic interaction chromatograph ( Waters XBridge HILIC ) with 10 mmol/L ammonium formate-acetonitrile (5:92, V/V, pH=4. 0) as mobile phase. The flow rate was set at 250 μL/min. Mass spectrometry was performed by electrospray ionization ( ESI ) with multi-reactions monitoring ( MRM ) . The optimized operation conditions of MS were as follows: nebulizer gas 369 Pa; curtain gas 185 Pa, turbo ionspray temperature 400 ℃, ionspray voltage 5500 V, dwell time 40 ms. The limits of detection were 0. 043 and 0. 007 μg/L for N3-MeA and N3-EtA, respectively. The recoveries were between 87. 8% and 103. 0%for N3-MeA and N3-EtA. This method was successfully applied to the determination of N3-MeA and N3-EtA in calf thymus DNA by cigarette smoke condensate ( CSC) exposure. This method is appropriate for routine analysis and accurate quantification of N3-MeA and N3-EtA by CSC exposure.

Objective To evaluate the clinical value of multiple bladder biopsies in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC) during transurethral resection of bladder tumor(TURBT).Methods The data of 408 NMIBC patients from January 2009 to December 2013 was analyzed retrospectively.There were 302 males and 106 females.The mean age of these 408 patients was 65 years old from 33 to 86 years.Bladder multipoint biopsies were performed in 216 patients (biopsy group),and were not performed in the other 192 patients (control group).The multipoint biopsies were taken from right and left bladder walls,anterior and posterior walls,dome,trigone,prostatic urethra and abnormal mucosa.There were 127 males and 89 females in the biopsy group,with a mean age of 64 years old (from 18 to 87 years).In the control group,118 males and 74 females aged between 15 and 92 years have an average age of 66 years old.There was no statistically significant difference in regard to gender and age between the two groups.The positive rate of biopsy and whether the diagnosis and treatment plan changed in the study group were recorded and the recurrence and progression rates were compared between study and control groups.Results Of these 216 multiple mucosa biopsies,the total abnormal detection rate was 48.1％ (104/216).There were urothelial carcinoma in 12.5％ (39/216),carcinoma in situ in 5.6％ (12/216),dysplasia in 9.7％ (21/216),cystitis in 20.4％.The final diagnosis were changed in fifteen patients (6.9％) due to the biopsy results,and 38 patients(17.6％) treatment plans were changed.The 1-,3-,and 5-year recurrence-free survival rates (RFS) of biopsy group and control groups were 96.3％ vs.85.4％(x2 =14.955,P=0.000),85.2％ vs.69.8％ (x2 =13.183,P =0.000) and 69.9％ vs.64.1％ (x2 =1.574,P =0.245);progression-free survival(PFS) were 99.1％ vs.96.3％ (x2 =8.253,P =0.006),94.0％ vs.87.0％ (x2 =5.901,P=0.017) and90.3％ vs.85.4％ (x2 =2.273,P=0.169).The 1-and 3-year RFS and PFS of biopsy group were higher than control group.There was no significant difference in the 5-year RFS and PFS between the two groups.Conclusions Multiple bladder biopsies could be helpful for pathological diagnosis and the post-TUR treatment of NMIBC.Furthermore,it may reduce the early recurrence and progression rates of NMIBC,but have no effect on long-term prognosis.

Objective To compare T and N staging of esophageal and cardia cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) before operation, and to evaluate clinical value of EUS.Methods Twenty-eight patients received examination of EUS and CT preoperatively, and the T and N staging was determined. The accuracy rates of both T, N staging were compared by the postoperative pathological results, at the same time, the accuracy rates of lymph node metastasis were compared, and the value of application of EUS was investigated. Results In the twenty-eight cases, the accuracy rates of EUS were higher than that of CT by 89.3% ( 25/28 ) to 46.4% ( 13/28 ) in T staging. And the difference had statistical significance( P = 0. 004 ,P ＜ 0.01 ). The N stagings of both were 82.1% (23/28) and 50.0% ( 14/28), and the difference had statistical significance ( P = 0. 035, P ＜ 0. 05 ). The accuracy rates of lymph node metastasis of both were 88.7% and 72.2% respectively, and the difference had statistical significance (χ2 = 7.031,P = 0.008, P ＜ 0. 01 ). Conclusions EUS has very important value in preoperative staging for esophageal cancer and cardia cancer, and the T staging of EUS is better than that of CT. The short axis and the ratio of short to long axis (S/L) combined with the lymph node ultrasonography image can improve the accuracy rates of lymph node metatsasis and N staging.

Objective To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration. Methods Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct (CBD) stones. After extraction of stones, an 8F J-stent (pigtailed) was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed. Results The stent dislodged and was discharged with stool at the 13th (10-18) postoperative day . Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD. Conclusions Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of choledochoscpe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.

Objective To investigate the properties of proliferation and differentiation of neonatal rat retinal progenitor cells (RPCs) in vitro. Methods RPCs were isolated from neonatal SD rats neural retina and cultured in DMEM/F12+N2 with EGF and bFGF (suspension medium )or 10%FBS without EGF and bFGF (differentiation medium). The cells grew as suspended spheres or adherent monolayers, depending on different culture conditions. The neural stem cells or retinal progenitors, neurons, astrocytes, retinal ganglion cells, rod photoreceptors and the proliferating cells were evaluated with immunofluorescence analysis by Nestin or Pax6, Map2, GFAP, Thy-1, Rhodopsin and BrdU antibodies respectively. Results RPCs could propagate and differentiate in suspension or differentiation medium and express the markers of Nestin (92.86%) or Pax6 (86.75%), Map2 (38.54%), GFAP (20.93%), Thy-1 (27.66%) and Rhodopsin(13.33%)in suspension medium; however, Nestin (60.27%), Pax6 (52%), Map2 (34.94%), GFAP (38.17%), Thy-1(30.84%) and Rhodopsin (34.67%) in differentiation medium. 96.4% of the population in the neurospheres was BrdU-positive cells. The cells could spontaneously adherent forming some subspheres and retinal specific cell types. Conclusion Neonatal rat RPCs possess the high degree of proliferation and can differentiate into neurons, astrocytes, retinal ganglion cells and rod photoreceptors in vitro. There are different proportions for RPCs to differentiate into specific cell types.