Background:Gastric cancer is a common gastrointestinal malignancy. The detection rate of early gastric cancer is still low in China,and some gastric cancer patients visit the hospital due to acute disease,such as gastric perforation. Aims:To investigate the influence of acute disease on long-term prognosis in gastric cancer patients. Methods:A total of 318 patients with gastric cancer from Jan. 2009 to Jan. 2015 at Shaoxing People’s Hospital were enrolled,and were divided into acute disease group and non-acute disease group. Clinicopathological characteristics were analyzed. Patients were followed up,and survival rate was compared between the two groups. Results:Fifty-three(16. 7% )patients had acute disease,and the remaining 265(83. 3% )patients were without acute disease. Compared with non-acute disease group, percentage of TNM Ⅳ stage was significantly increased(P < 0. 05),and percentage of radical surgery was significantly decreased in acute disease group(P < 0. 05). Kaplan-Meier assay showed that survival rate in acute disease group was significantly decreased when compared with non-acute disease group( P < 0. 05). After adjusting the TNM stage and surgical treatment,no significant difference in survival rate was found between the two groups. Conclusions:Gastric cancer patients with acute disease have lower survival rate. Acute disease may be not an independent prognostic factor, higher TNM stage and lower proportion of radical surgery are the main reasons for poor prognosis in gastric cancer patients with acute disease.

Objective To evaluate the value and security of the use of medical thoracoscopy in the diagnosis of elderly patients with un‐known pleural effusion and to analyze the finally pathological results .Methods STORZ medical thoracoscopy was used to retrospectively study the 68 patients with unknown pleural effusion .Multiple punch biopsy was taken in the questionable diseased regions under direct vi‐sion .The changes of patients′condition in intraoperative and postoperative ,and the causes of pleural effusion were observed .Results Sixty‐three cases were confirmed in 68 cases of patients with unexplained pleural effusion ,the diagnostic rate was 92 .6% .In all cases ,26 cases (38 .2% ) were tuberculosis ,31 cases (45 .6% ) were malignant tumor ,3 cases (4 .4% ) were chronic pus chest and Aspergillus infection in 1 case(1 .5% ) ,a large number of aspergillus hyphae were found in biopsy tissue .Non‐specific inflammatory changed in 7 cases (10 .3% ) ,in which 2 patients were eventually diagnosed with pleural effusion caused by pulmonary schistosomiasis ,and the rest cases were still un‐known .All cases had no serious complications .Conclusion Medical thoracoscopy have a good effect in diagnosing elderly patients with un‐explained pleural effusion ,which could be easily and safely performed .The primary cause of unexplained pleural effusion in elder patients may be malignant tumor ,followed by tuberculosis .

Objective To investigate the application value of CT/MR image fusing in gross tumor volume (GTV) delineation of esophageal squamous cell carcinoma.Methods Twenty-nine patients with esophageal squamous cell carcinoma to be treated with radical surgery underwent routine CT scanning,MR T2-weighted imaging (T2WI) and diffusion weighted imaging (DWI) before surgery.Diffusion-sensitive gradient b values were taken at 400,600,and 800 s/mm2.GTVs were delineated on the CT image,CT/ MR T2WI,and CT/MR DWI respectively.The MR T2W1 image was used as the intermediary for the fusion of the CT image and MR DWI image.The length of GTVs measured under different imaging conditions were compared with the length of the resected specimen of esophagus.Results The GTV length was (44.94 ± 18.46) and (45.05 ±21.47) mm on the CT images and CT/MR T2WI images respectively.When the b values were 400,600,and 800 s/mm2,the esophageal carcinoma GTV length on CT/MR DWI images was (42.12 ± 17.79),(41.18 ± 17.17) and (39.77 ± 17.66) mm,respectively.The coefficient between the esophageal carcinoma GTV lengths on CT/MR DWI images and the pathological lesion lengths was 0.928,0.926 and 0.927 respectively.Conclusions CT/MR DWI images displays esophageal carcinoma GTV length more accurately,thus guiding the delineation of GTV effectively.

ObjectiveTo explore the effect of the individualized intervention for the anxiety-depression after cardiovascular diseases. Methods80 inpatients with cardiovascular diseases were surveyed with Hospital Anxiety and Depressions Scale (HAD). The patients with anxiety-depression received individualized psychological intervention. Results14 of them suffered anxiety-depression. 13 cases recovered after the intervention. ConclusionThe individualized psychological intervention can improve anxiety-depression in the inpatients with cardiovascular diseases.

Objective To investigate the effects of different DO2-directed hemodynamic man-agement on postoperative prognosis of orthotopic liver transplantation (OLT)patients with different degrees of liver function insufficiency.Methods Seventy patients (male 48 cases,female 22 cases, aged 37-66 years,ASA grade Ⅲ or Ⅳ)scheduled non veno-venous bypass OLT were divided into two groups (n = 35 each ).The oxygen delivery (DO2 )maintained respectively between 350 ml·min-1 ·m-2 and 500 ml·min-1 ·m-2 (group control)and more than 500 ml·min-1 ·m-2 (group study).After induction of anesthesia,the left radial artery was cannulated,allowing continu-ous blood pressure monitoring as well as serial blood sampling,then the Swan-Ganz catheter was in-serted via the right internal jugular vein to continuously monitor CI and S-vO2 .After anesthesia induc-tion and before operation (T1 ),10 min before anhepatic phase (T2 ),30 min after onset of anhepatic phase (T3 ),30 min after neohepatic phase (T4 )and the end of surgical procedure (T5 ),the SaO2 , PaO2 ,Hb,CI and S-vO2 were recorded to calculate the DO2 ,VO2 and ERO2 .Postoperatively,ICU and hospital length of stay,quality of life (QOL)and 1-5 year survival rate were recorded.Results In the two groups,CI,DO2 and VO2 declined at T3 to a statistically significant degree in comparison with T1 (P <0.05).CI,DO2 and VO2 in group study significantly higher than those of group control (P <0.05).ERO2 in group study was lower than that of group control significantly (P <0.05).ICU and hospital length of stay were significantly shorten in group study in comparison with group control (P <0.05).Survival rate and QOL in group study tended to be slightly higher than those of group control until the end of study period,but there was no significant difference.Conclusion The DO2-directed hemodynamic management can improve prognosis with enhanced DO2 in OLT patients with different degrees of hepatic insufficiency.It has a positive impact on their outcome of shortening ICU stay and the hospitalization days.

This study was aimed to diffuse the lung and promote urination for the observation of cardiopulmonary re-lated index change of cor pulmonale rats to further explore the treatment effect on the pulmonary function, pulmonary arterial hypertension (PAH) and the influence of right heart hypertrophy of rats, in order to further illustrate the ef-fect of diffusing the lung and promoting urination for cor pulmonale. Sixty Wistar rats were randomly divided into the control group, model group and Xiao-Qing-Long decoction (XQLD) group with 20 rats in each group. The AniRes2003 animal lung function analysis system was applied to measure the pulmonary function of rats. And the multi-guide physiological recorder was used in the recording of the pulmonary artery pressure of rats. The conven-tional weighing method was applied to calculate and obtain the change of right heart hypertrophy. The results showed that compared to the control group, symptoms in the model group became severe obviously, which include reduced activity, slow movement and occasional airway sputum sound, and the right heart hypertrophy index of the model group increased obviously (P < 0.01). Compared to the model group, the pulmonary function and pulmonary artery pressure of the XQLD group have obvious difference (P< 0.05). It was concluded that to diffuse the lung and pro-mote urination can effectively improve the pulmonary function, PAH and the right heart hypertrophy index of rats with cor pulmonale (fluid retention). The effect of this method is definite in the treatment of cor pulmonale.

Objective To observe the change of the serum ABCG2 level of patients with non‐small cell lung cancer(NSCLC)be‐fore and after chemotherapy ,and explore its clinical significance .Methods Venous blood specimens of 15 healthy adults and 50 pa‐tients with NSCLC were collected before and chemotherapy ,the serum ABCG2 level of these specimens were detected by ELISA . the relation between the ABCG2 level and the chemosensitivity was investigated .Results The serum ABCG2 level of patients with NSCLC before chemotherapy was significantly higher than that in healthy adults(P<0 .05);the serum ABCG2 level was not related with TNM stage in NSCLC(P<0 .05);The serum ABCG2 level of patients with NSCLC after chemotherapy was significantly high‐er than that of before(P<0 .05);in chemosensitive patients ,the different of serum ABCG2 level was not significantly before and af‐ter chemotherapy(P>0 .05);among chemoresistant patients ,the serum ABCG2 level of patients with NSCLC after chemotherapy was significantly higher than that of before(P<0 .05);the serum ABCG2 level was higher in patients with pleural effusion than the patients without pleural effusion ,but the different was not significantly(P>0 .05) .Conclusion The serum ABCG2 level of patients with NSCLC is higher than that of healthy adults ;serum ABCG2 level may become a useful indicator in predicting the effect of NSCLC chemotherapy .

Objective To evaluate the dose distribution of target volume and normal tissues in forward intensity modulated radiotherapy (fIMRT) and inverse intensity modulated radiotherapy (iIMRT) modes for breast cancer after radical mastectomy.Methods Both fIMRT and iIMRT plans were developed for 10 patients with breast cancer after radical mastectomy.On each patient's CT images the supraclavicular area, chest wall, and internal mammary area were delineated.The prescription dose was 50 Gyin 25fractions.In the fIMRT plan X-ray irradiation at the dose of 6 MV was adopted for the supraclavicular and the chest wall areas and electron irradiation at the dose of 9 - 12 MeV was adopted for the internal mammary area, and the doses of cold and hot spots were adjusted according to the fitting doses of these 3 regions.In the iIMRT plan the supraclavicular area, chest wall, and internal mammary area were taken asa whole target, 6 MV X-rays was used, and inverse optimal design was performed.The dose distribution oftarget volume and normal tissues, conformal index (CI) , and heterogeneous index (HI) , and acceleratormonitor unit (MU) were analyzed using dose-volume histogram (DVH)for the two intensity modulated modes.Results The maximum dose of PTV of the iIMRT plan was significantly lower than that of the fIMRT plan(t = -3.23,P ＜0.05), the minimum dose and V95% of PTV of the iIMRT were significantly higher than those of the fIMRT plan(t = 4.08, -2.69, both P ＜0.05).The CI level of the iIMRT plan was significantly higher than that of the fIMRT plan and the HI level of the iIMRT plan was significantly lower than that of the fIMRT plan (t = -3.13, 2.74, both P ＜0.05).There were not significant differences in V10, V20, V25, V30, and Dmean of the ipsilateral lung between these 2 groups.However, the V15 of ipsilateral lung of the iIMRT group was significantly lower by 4.2% than that of the fIMRT group (t= 3.2, P ＜ 0.05).There were not significant differences in the mean dose (Dmean) and V30 of heart, and Dmean of contralateral lung and contralateral breast between these 2 groups.Conclusions Compared with fIMRT, the iIMRT plan results in more PTV coverage, higher conformity index, and more homogeneous dose distribution, with lower dose upon the lung at the affected side, and better protection of the contralateral lung, heart, and breast.

Radial-cephalic arteriovenous fistula (RCAVF) is considered the first choice for hemodialysis vascular access because of its high patency rate and less complications.But up to 50％ of the fistula can not mature.This is mainly due to persistent low blood flow or difficulty in cannulation can not lead to adequate hemodialysis.Inflow or outflow stenosis,anastomotic stenosis,exceedingly deep location of the vein,flow diversion into accessory veins are the common causes of impaired maturation.In addition,thrombosis is a common of stenosis.Preoperative assessment by physical examination and ultrasound examination of blood vessels,select the appropriate blood vessels for the fistula is of great significance.Choose the appropriate treatment for the cause of maturation disorders.Postoperative aspirin is widely used to prevent thrombosis and reduce the occurrence of stenosis;Surgery has the advantage of bypassing the damaged area but creating a new stoma;in recent years,endovascular technique because of its characteristics of minimally invasive in most of the time is the first choice.In this paper,the definition,etiology,diagnosis and treatment of fistula maturation disorder are reviewed.

目的探索脑瘫患儿早期发现、早期干预的工作模式。方法临床、保健、康复相结合 ,采用产前检查、孕妇学校、产时儿科医生进产房、新生儿行为神经评定测定、高危儿抚触训练室、婴儿期儿童保健监测、各街道防治站常规体检筛查转诊等多种形式结合早期发现并干预脑瘫高危儿。结果此工作模式较模式前显著提高了脑瘫的早期诊断率及康复疗效。结论临床、保健、康复相结合的方式整合了医疗资源,起到了促进脑瘫早发现、早诊断、早治疗的作用 ,值得推广。