Cystic liver metastasis, which lacks specific clinical manifestations and standardized treatment, rarely occurs after radical gastrectomy. This study presented two gastric cancer cases with cystic liver metastasis treated in Wuxi People's Hospital from September 2008 to November 2012. The two female patients were 66 and 65 years old, respectively. Poorly differentiated ulcerated adenocarcinoma classified as stage III B [Tumor, Node, and Metastasis Classification (T4aN2M0)] and clinical manifestations of abdominal distension and ascites were detected in both patients. Cyst fluids were subjected to cytological analysis. Results confirmed the presence of liver metastasis of gastric cancer. The two patients benefited from local intracavitary chemotherapy or systemic intravenous chemotherapy.

Objective To study the significance and feasibility of modified early warning scores (MEWS) assessing the conditions and death prediction among the pre-hospital acute poisoning patients.Methods We performed a prospective,observational study of the pre-hospital acute poisoning patients between January 1,2010 and December 31,2010.Data was collected to calculate the MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was expressed in mean with standard deviation,and P ＜ 0.05 was considered to be different with statistical significance.Observation lasted for 90 days after admission to get the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.The patients without vital signs and unsuccessful resuscitation were not included in this study.Results It showed 287 person times with 0 ～ 6 scores,accounting 94.4％,17 person times with 7-13 scores,accounting 5.59％,among the dead patients,MEWS were more than those of the survival group with statistical significance (P ＜ 0.05).The area under ROC was 0.99 indicating that MEWS≥7 was the board line for severe pre-hospital acute poisoning patients with sensitivity of 91.7％,specificity of 97.9％,accuracy of 97.7％ and Youden of 0.896 for predicting death.It showed high significance of the application of MEWS in assessing acute poisoning patients and death prediction.Conclusions MEWS assess pre-hospital acute poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.

Objective To explore osculating value method combined with rank sum ratio method in evaluation of nursing quality in the hospital nursing management application, to provide a scientific basis for decision making. Methods By reference, from the working efficiency, the quality of nursing, 3 dimensions of nursing skill training, the choice of 11 commonly used in the evaluation of nursing quality indicators, the raw data of each index was normalized, the school of nursing quality with 2004-2013 years of osculating value method analysis was assessed, the development of nursing quality combined with rank and file classified score method. Results The nursing quality of the overall upward trend, according to the grading each year osculating value and ranking in 2011, nursing quality best, osculating value was 0.000, the worst quality of nursing in 2004, osculating value was 3.248;the annual nursing quality grading was reasonable, 2011, 2012 and 2013 were in good quality grade, 2004, 2005 and 2006 were of poor quality grades, the rest of the year at a medium level, with statistically significant difference of the file, P<0.05. Conclusion Osculating value method combined with rank sum ratio method in comprehensive evaluation of nursing quality in the hospital has the objectivity and practicability.

Objective To observe the clinical efficacy and safety of calcipotriol betamethasone ointment for the treatment of pso‐riasis vulgaris in the stable stage of patient .Methods This was a randomized ,parallel controlled clinical trials ,in which 90 patients with psoriasis vulgaris were randomly divided into experimental group and controlled group .All of them received 4 weeks of thera‐py .We compared the efficacy and safety 1 ,2 ,4 week after treatment by calcipotriol betamethasone ointment .Results About the clinical efficacy ,according to the decrease in percentage of psoriasis area and severity index (PASI) were:23 patients in the experi‐mental group were effective(efficacy rate is 76 .67% ) ,14 patients in control group Ⅰ was effective(efficacy rate is 46 .67% ) ,15 pa‐tients in control group Ⅱ was effective(efficacy rate is 50% ) .The differention between experimental group and the two control groups was significant(P< 0 .05 ,P< 0 .01) .After 1 ,2 ,4 weeks of therapy ,the decrease in percentage of PASI of experimental group is higher than that in the control groups .The scores of the observed erythema ,infiltration ,scale were decreased ,and the total scores of PASI are also decreased 4 weeks after therapy .The decrease score of experimental group is higher than that of control group Ⅰ(P<0 .01) and control group Ⅱ(P<0 .01) .The side effects of the experimental group are mild such as itching ,folliculi‐tis ,erythema ,and the laboratory examinations had no abnormal changes .Conclusion Calcipotriol betamethasone ointment was more effective to treat the stable stage psoriasis vulgaris patients compared with single use of halometasone or calcipotriol .It takes effect quickly ,and could be more feasible and safe .

The study aimed to establish a population pharmacokinetic/pharmacodynamic (PPK/PD) model of warfarin. PCR-RFLP technique was used to genotype the CYP2C9 and VKORC1 polymorphisms of 73 patients. RP-HPLC-UV method was used to determine the 190 plasma concentrations of warfarin. Application of NONMEM, the clinical information and 263 international normalized ratio (INR) monitoring data were used to investigate the effect of genetic, physiological, pathological factors, other medication on clearance and anticoagulant response. The final model of warfarin PPK/PD was described as follows: CL = θCL · (WT/60)θWT · θCYP · eηCL (if CYP2C9*1/*1, θCYP = 1; if *1/*3, θCYP = 0.708); EC50 = θEC50 · θVKOR · eηEC50 (if VKORC1- 1639AA, θVKOR = 1; if GA, θVKOR = 2.01; V = θV; K(E0) = θK(E0); Emax = θEmax; E0 = θE0 · eηE0. Among them, the body weight (WT), CYP2C9 and VKORC1 genotype had conspicuous effect on warfarin PK/PD parameters. The goodness diagnosis, Bootstrap, NPDE verification showed that the final model was stable, effective and predictable. It may provide a reference for opitimizing the dose regimen of warfarin.
Anticoagulants ; pharmacology ; Body Weight ; Cytochrome P-450 CYP2C9 ; genetics ; Genotype ; Humans ; International Normalized Ratio ; Nonlinear Dynamics ; Polymorphism, Genetic ; Vitamin K Epoxide Reductases ; genetics ; Warfarin ; pharmacokinetics

Objective To study the differences in clinical characteristics and etiology in bronchopneumonia and lobar pneumonia,and provide the basis for the clinical diagnosis and treatment.Methods A retrospective study was performed on 100 children with lobar pneumonia and 200 children with bronchopneumonia from Dec.2005 to Dec.2007.Antibodies of mycoplasma(MP) and chlamydia(CP) were detected with quantitative enzyme linked immunosorbent assay of serum samples which were collected on addmission.On the second day morning,axenic sputum samples of laryngeapharyngis at pars were collected with onetime asepsis aspiration sputum tube by negative pressure for bacterial culture,and the common seven viruses were detected with direct immunofluorescence,and MP DNA,CP DNA were detected.The results and the clinical data and the characters of sternum were analyzed.Results Lobar pneumonia was more in the elder children,and the features were fever and cough in clinic,absence in physical sign of bellow,and inflammation of one pulmonary lobe in X-ray.Sixty-one percent of childhood lobar pneumonia had MP infection in laboratory examination.But bronchopneumonia was found more in infants and young children,whose features were cough,dyspnea and catarrhus in clinics,wheezy phlegm and stridor in physical sign of bellow,pulmonic shadow of spot and lamellar in X-ray.Bacteria were the most common pathogen in bronchopneumonia.Conclusions Lobar pneumonia was different from bronchopneumonia in age and clinic features and sternum characters of patients,and much more different in etiology.Bacterial infection was important in bronchopneumonia.But in lobar pneumonia,MP infection occupied 61.0%,which was different from traditionaletiology.Moreover,the MP infection rate in infant and young children tend to increase obviously.

Objective To study the change in sodium channel current(ⅠNa)in the developement of the left ventricular hypertrophy in spontaneously hypertensive rat(SHR).Methods ⅠNa and membrane capacitance(MC)were measured in myocytes of 10,24 and 34-week SHR by the whole-cell patch-clamp technique.Systolic blood pressure(SBP)and left ventricular mass index(LVMI)were detemined.10-week old Wistar rats served as controls.Results LVMI and MC of SHR were significantly higher than those of Wistar rat(P0.05),however the density of ⅠNain 34-week SHR were higher than those of Wistar rat(-18.3?1.9)vs(-15.3?2.0)pA/pF,P

Tort Liability Law set tougher requirements on the validity and authenticity of medical records,featuring explicit protection of patient rights of informed consent.Based on the changes in the law since its enforcement,the authors studied existing deficiencies of electronic medical records and came up with the following suggestions.Establish sound legal accreditation system for electronic medical records; perfect related laws and regulations to ensure standard application of the electronic medical records; and work out regulations to make medical staff aware of their legal responsibilities when applying electronic medical records.These recommendations will enable electronic medical records better fit the current legal environment onto the track of healthier development.

Objective To establish multiple short tandem repeat (STR) amplification by fluorescence labeling polymerase chain reaction (PCR) for monitoring the effect of allogeneic hematopoietic stem cell transplantation .Methods Sixty‐five patients were analyzed .DNA from peripheral blood of donors and recipients in pre transplantation and post transplantation were extracted , 15 STR loci and sexual loci were amplified by PCR .Results After allo‐HSCT ,54 patients obtained type of donors ,but 3 patients did not ;eight patients showed mixed chimerism .Two cases of type of donor converted into mixed chimerism and two cases of mixed chimerism converted into type of donors after some time .The time of earliest detection ,duration and transformation of each state was different .The earliest detection showed on the 16th day after surgery ,and the last one showed five months later .As to the du‐ration ,the shortest and longest were two months and seven months ,respectively .Conclusion The key factors that significantly in‐fluence the application of STR‐PCR in monitoring the effect of allogeneic hematopoietic stem cell transplantation were samples ,STR loci and proper monitoring time .So to establish the suitable method for this region could truly take maximum advantage of the PCR‐STR method .While a appropriate detecting time and STR loci should be chose .

Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.