Many studies, both retrospective and prospective, have shown that there is a circadian variation in acute cardiovascular events with a peak during the morning and a trough during the night since the mid 1980s. In addition to the morning peak, a secondary less prominent peak has been observed in the late afternoon in many studies. This circadian variation may well be at least partly linked to the known physiological circadian rhythms. Because the duration of the therapeutic effect of many drugs taken at the conventional time will have reached subtherapeutic levels at the time of waking and commencing activity the following morning, timing of medication is discussed to improve the protection of the patients with cardiovascular disease in the morning waking hours.

Crohn's disease(CD) is a lifelong disease and the precise aetiology is still unknown.Differences in the definitions and diagnosis between clinicians make direct influence on therapeutic efficacy on CD.This article overviewed the progresses on the definitions such as staging,relapse,and diagnosis of Crohn's disease in these years in order to decrease the mistakes and be helpful to institute sensible and effective therapeutic regimen.

Intestinal tract is one of the target organ during surgical stress. When surgical stress becomes overwhelming , the integrity of intestinal mucosal barrier is destroyed. Microorganisms and toxin in the intestinal tract then enter blood circulation through the permeable intestinal mucosa, and trigger SIRS and MODS, This processes reversely aggravate intestinal mucosal necrosis and bacterial translocation, and lead to a vicious cycle. Radical total gastrectomy is a major surgical stress. After extensive abdominal surgery, cytokines and inflammatory mediators may cause intestinal mucosal edema, increased intestinal permeability, intestinal villus height reduced, shrinkage of mesenteric blood vessel, reduced blood flow, and intestinal barrier functional deterioration. Whereas ulinastatin can protect intestinal barrier function by reducing surgical stress,alleviating SIRS and improving immunity etc. This article reviewed the investigations of ulinastatin influencing the recovesy of intestinal barrier function after surgical stress.

Objective To explore the analgesic effect of dicaine combined with penetration en-hancer applied to venipuncture with venous indwelling needle. Methods 60 patients treated with selec-five operation under epidural anesthesia were divided into the control group and the experimental group with 30 patients in each group. The control group was treated with conventional method of venipuncture. The experimental group was externally applied with dicaine combined with penetration enhancer 50 min-utes before the venipuneture in basilic or cephalic vein. Local reactions were observed after venipuncture and the analgesic effects were evaluated with visual analogue scale(VAS 0～100 mm). Results The analgesic ef-fect in the experimental group was obviously better than that of the control group with a significantly lower VAS. The maintaince of analgesic time in the experimental group lasted above 90 minutes. Condusious The analgesic effect of dieaine combined with penetration enhancer can be approved with a very high analgesia rate, its onset time is much shorter than conventional method and maintenance time is much longer.

TNF-?,a pleiotropic cytokine with strong proinflammatory and immunomodulatory properties is known to play an important role in inflammatory bowel disease(IBD).The biological effects of TNF-? are elicited by binding to its two cognate recepters,TNFR1 and TNFR2.For a long time,TNF-R1 was considered to be the predominant mediator of TNF-signaling,whereas TNF-R2 was ascribed only auxilliary function.However,there is increasing clinical and experimental evidence for an important independent role of TNF-?/TNFR2 signaling in chronic inflammatory conditions of IBD.The elucidation of the different effects of TNF-signaling in IBD will lead to a better understanding ot the pathogenesis of these diseases and will be the basis for the development of more specific and more efficient therapeutic approaches.

Objective To study the feasibility and safety of laparoscopically assisted hepatectomy without choledochotomy and T-tube drainage for the treatment of hepatolithiasis.Methods The study included 11 patients with hepatolithiasis in the left intrahepatic duct.Of the 11 patients,8 patients were complicated with choledocholith and 5 patients with cholecystolithiasis.After laparoscopically assisted left hepatectomy,extrahepatic bile duct stone removal and right hepatic duct exploration were carried out under video-assisted choledochoscopy through the left hepatic duct,without choledochotomy and T-tube drainage.Results The operation was successfully accomplished in all the 11 patients.Liver procedures included laparoscopically assisted left lateral lobectomy in 5 patients and left hemihepatectomy in 6 patients.The mean operation time was 128 min(range,110~150 min),and the mean blood loss was 95 ml(range,50~150 ml).No serious postoperative complications occurred.The mean postoperative hospital stay was 7 d(range,5~10 d).The 11 patients were followed for a mean of 7.6 months(range,2~16 months).The curative effects were classified as excellent in 10 patients and good in 1.No residual or recurrent stones were noted.Conclusions Laparoscopically asisted hepatectomy without T-tube drainage for the treatment of hepatolithiasis is feasible and safe for selected patients.This procedure offers advantages of simplicity of performance,short operation time,and fewer complications,being a worthwhile minimally invasive alternative.

Objective To study the feasibility and safety of hand-assisted laparoscopic hepatectomy combined with splenectomy. Methods Hand-assisted laparoscopic hepatectomy combined with splenectomy was performed in 3 patients. A midline epigastric or right subcostal incision was made for hand-assisted port. The attachments of the spleen were dissected with a harmonic scalpel and the pedicle of the spleen was severed with the Endo-GIA. The transection of the liver was conducted using the harmonic scalpel dissection and nonabsorbable polymer clipping. The cut surface of the liver was closed by interrupted sutures. Results The operation was successfully completed in all the 3 patients. The surgical time was 130 min, 115 min, and 145 min, and the blood loss was 350 ml, 50 ml, and 150 ml, respectively. No serious postoperative complications occurred. The postoperative hospital stay was 9, 7, and 11 days, respectively. Follow-up observations for 6, 23, and 5 months showed no recurrence. Conclusions Hand-assisted laparoscopic hepatectomy combined with splenectomy is feasible and safe in selected patients .

Objective To made the animal model which is similar to the human pyelonephritis to strengthen the experimental basis for the therapy of acute urologic infectious disease. Method Using the method of semi-ligation of the ureter on single lateral and the injection of Enterobacter into the bladder to get pathologic transformation. Simultaneously, giving the different preparation of Zishen- tongguan Capsule, Sanjin Pills to intervene the models. Result Zishentongguan capsule middle dosage, western medicine treatment team had get obviously effect on rat body weight increasing, the drug treatment were validity. Conclusion The rat model with the acute nephropyelitis is similar to the character in the break of human, which manifest on the appearance, mental condition, body weight coefficient, kidney weight coefficient and pathologic change of the kidney. Succeed in the model establishment.

In recent years,clinical immunology has an increasing variety of prominent applications in the field of chronic hepatitis B infection.On one hand,the discovery and identification of the mechanisms of pathogen recognition by the innate immune system,novel immune cell subpopulations and immunoregulatory pathways further enriched the immunological pathogenesis of chronic hepatitis B.On the other hand,the development of new immunotherapy strategies aimed at reconstructing the antiviral immunity,including agonists of Toll like receptors,immune cell therapies and therapeutic vaccines,have provided several new targets for the optimization of antiviral therapy strategies and brought new opportunities for patients of chronic hepatitis B to obtain HBsAg clearance and clinical cure.

This article shared opinions on how to effective educate clinical type postgraduates in department of neurosurgery based on the teaching models in the first affiliated hospital of Chongqing medical university. In the proposed training program,medical ethics education and comprehensive training including clinical thinking and practical skills training should be emphasized.Scientific inquisitiveness of the neurological research and the writing and oral communication in English should also be promoted.This training program will be fully committed to produce highly qualified,ethical and caring neurosurgeons for future needs of the society.