ObjectiveTo determine the clinical effect and the prospect of cervical side-to-side stapled esophagogastric anastomosis. MethodsEighteen cases of upper and middle thoracic esophageal carcinoma were treated with esophagectomy and cervical side-to-side stapled esophagogastric anastomosis. The clinical data were collected and retrospectively analyzed. The average age of patients was 60.7 years and the ratio of male to female was 17∶1. The tumor included 4 upper part and 14 middle thoracic parts. The length of tumors was from 1 cm to 7 cm, with an average of 3.2 cm.ResultsThe post-operative TNM staging(AJCC) included 4 Stage Ⅱa,9 Stage Ⅱb,and 5 Stage Ⅲ. The operative incisions included 8 nontransthoracic cervical and abdominal double incisions, 9 right cervico-thoraco-abdominal triple incisions, and 1 left cervico-thoracic incision. One (5.56%) patient complicated with anastomotic leakage and was cured in 2 weeks by cervical drainage and absolute diet. All the 18 patients were followed up for 1 to 5 years,and no anastomotic stricture was found. Reflux esophagitis was found in 2 and the incidence rate was 11.11%.ConclusionCervical side-to-side esophagogastric anastomosis is a safe procedure with larger resection of margins and fewer complications. It is worth replicating.

80 years)in China is increasing.As a special type of hypertension,the hypertension in the very elderly has some specificities in pathogenesis,clinical manifestation,treatment and prognosis.The topic to effectively cure and prevent hypertension in the very elderly is increasingly emphasiced.This article presents an overview of recent progress in clinical characteristics,and treatment strategy related to hypertension in the very elderly.

Objective To discuss and analyze the reliability and validity of the application Chinese version of Caregiver Grief Scale (CGS) on caregivers of patients with advanced hepatocarcinoma. Methods To translate the original English scale into Chinese and adapt it to the culture of China, forming a Chinese CGS. Totally 330 patients were selected with advanced hepatocarcinoma who were hospitalized in a gradeⅢ, class A hospital by the convenient sampling method. They were carried out exploratory factor analysis and confirmatory factor analysis respectively. Results For Chinese CGS, the critical value of every purpose has statistical significance (P < 0.05) by comparison. Exploratory factor analysis showed:KMO value was 0.923;Bartlett's sphericity test value was 794.31;cumulative variance contribution rate was 67.532%;four common factors can be extracted. Confirmatory factor analysis showed that the structural model of the scale was good: χ2/d?=1.11<3.0,goodness of fit index=0.995,root mean square error of approximation=0.021,adjusted goodness-of-fit index=0.968,normed fit index=0.973, comparative fit index=0.957,Tucker-Lewis index=0.993,incremental fit index=0.943. Each correlation coefficient of the scale has statistical significance and expert validity is between 0.832 and 0.973. Reliability analysis shows that the total Cronbach'sαof the scale was 0.908;Cronbach'sαcoefficient of every dimension was between 0.896 and 0.913; Guttman's split-half reliability was 0.917; test-retest reliability was 0.831. ROC curve showed that when the total score of the scale ≥24.5, specificity and sensitivity were good. Conclusions Chinese version of CGS has good reliability and validity, which is suitable for preliminary screening grief emotion of caregivers of patients with advanced hepatocarcinoma.

Attention Deficit Disorder with Hyperactivity ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Phytotherapy ; methods

Objective To investigate the value of the acupuncture with Medicinal herbs in the treatment of the intractable hiccup after severe craniocerebral injury. Methods Sixty patients diagnosed of intractable hiccup after severe craniocerebral injury were randomly recruited into a therapeutic group and a control group. The therapeutic group was treated with acupuncture and medicinal herbs, while the control group was treated with western medicine. The therapeutic course for both groups was one week. The efficacy was evaluated by observing the cure rate, improvement rate and non effective rate respectively. Results In the therapeutic group :23 patients were cured and the total effective rate was 96.67%;While in the control group: 12 patients were cured and the total effective rate was 70.00%. The effective rate of therapeutic group was obviously better than the control group. Conclusion Acupuncture with medicinal herbs in the treatment of the intractable hiccup after severe craniocerebral injury has good efficacy.

Objective To observe the efficacy of treating cerebral hemorrhage with operation combined with Chinese medicines with the functions of stopping endogenous wind, eliminating phlegm and removing blood stusis. Methods A total of 142 patients after surgery for cerebral hemorrhage were randomly recurited into two groups: a treatment group (n= 41 ) was administrated with Chinese medicines of stopping endogenous wind, eliminating phlegm and removing blood stasis, and a control group (n=41) accepted conventional treatment after the surgery. Results The therapeutic effects in the treatment group was superior to that in control group (X2=13.12, P<0.05) . Conclusion It is effective to treat cerebral hemorrhage with operation combined with Chinese medicines with the functions of stopping endogenous wind, eliminating phlegm and removing blood stasis.

Objective To investigate the effect of sevoflurane on adriamycin-induced damage to primary neonatal rat cardiomyocytes.Methods Primary neonatal rat cardiomyocytes were isolated from Sprague-Dawley rats (within 24 h after birth) and cultured in DMEM liquid culture medium.The cells were seeded in 96-well plates (200μl/hole) or 6-well plates (2 ml/hole) with a density of 5 × 104/ml and randomly divided into 4 groups (n =24 each):control group (group C),adriamycin group (group A),sevoflurane group (group S) and adriamycin + sevoflurane group (group AS).In groups A and AS,adriamycin 1 μmol/L was added to the cultured medium,the equal volume of PBS was added instead in groups C and S,and the cells were then incubated for 24 h.The cells were exposed to 2.4％ sevoflurane for 2 h starting from 24 h of incubation in groups A and AS.The cell viability,concentrations of cTnI and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the culture medium,and expression of Bax and Bcl-2 were detected 2 h after the end of exposure to sevoflurane.The Bax/Bcl-2 ratio was calculated.Results Compared with group C,the cell viability and expression of Bcl-2 were significantly decreased,while the concentrations of cTnI and NT-proBNP in the culture medium,expression of Bax and Bax/Bcl-2 ratio were significantly increased in group A,and the cell viability was decreased in group AS (P ＜ 0.05).The expression of Bcl-2 was significantly higher and the concentrations of cTnI and NT-proBNP in the culture medium,expression of Bax and Bax/Bcl-2 ratio were significantly lower in group AS than in group A (P ＜ 0.05).Conclusion Sevoflurane can reduce adriamycin-induced damage to primary neonatal rat cardiomyocytes and inhibition of cell apoptosis is involved in the mechanism.

Objective To analyze the risk factors of Gram‐negative bacterial blood‐stream infection in ICU for conducting the risk evaluation and guiding medication .Methods The inpatients were diagnosed with Gram‐negative bacterial blood‐stream infec‐tion in ICU of the Renmin Hospital of Wuhan University from January 2013 to December 2014 were retrospectively surveyed and analyzed .The risk factors of blood‐stream infection caused by Gram‐negative bacteria were analyzed and screened by the Logistic re‐gression analysis method .Results A total of 172 case‐times of blood‐stream infection occurred in ICU during this period ,including 93 case‐times of Gram‐negative bacterial infection .The Gram‐negative pathogenic bacteria were Acinetobacter baumanii ,Klebsiella pneumoniae ,Acinetobacter calcoaceticus baumanii ,E .coli ,pseudomonas aeruginosa ,etc .Except E .coli was mainly originated from community acquired infection ,other bacteria were mainly originated from nosocomial infection .In order to differing from other pathogenic bacterial blood stream infection ,the Logistic regression analysis results showed that the independent risk factors of G‐negative bacterial blood‐stream infection in ICU had serum PCT levels over 10 .0 ng/mL (OR= 60 .52 ,P= 0 .001) ,receiving the therapy of carbapenem and third generation cephalosporins (OR=16 .09 ,P=0 .03) ,hospitalization duration less than 2 weeks be‐fore suffering from disease (OR=13 .79 ,P=0 .03) and digestive system basic disease(OR=12 .94 ,P=0 .01) .Conclusion Gram‐negative bacterial blood‐stream infection in ICU of the Renmin Hospital of Wuhan University is mainly caused by multi‐drug resist‐ant bacteria .Serum PCT level over 10 .0 ng/mL ,hospitalization duration less than 2 weeks before infection ,receiving the therapy of carbapenem and third generation cephalosporin and basic diseases of digestive system are the independent risk factors influencing the occurrence and diagnosis of blood‐stream infection .

Vasovagal reflex is one of complications from cardiac intervention.The major causes of vasovagal reflex postprocedure are commonly believed to be associated with mental stress,pain,low blood volume,visceral dilation,local hematoma and cardiac function.The incidence of vasovagal reflex may be effectively reduced with standard intervention training,strictly selected indications for PCI,adequate fluid replacement after procedure,anesthetic lidocaine to reduce pain,improved manual compression for vascular hemostasis and elimination of risk factors.

Objective To detect the expression and activation level of nuclear factor ?B (NF-?B) in synovium of rheumatoid arthritis (RA).Method Forty-six specimens including 17 RA, 24 osteoarthritis (OA) and 5 normal synovial tissues were subjected to RT-PCR to determine the mRNA level of NF-?B p65,p50,inhibitor of NF-?B (I?B),interleukin-1? (IL-1?) and matrix metalloproteinase 9 (MMP-9).Thirty-nine sections including 14 RA,21 OA and 4 normal synovium were subjected to immunohistochemistry to determine the expression level of NF-?B p65.Synoviocytes from 14 synovial specimens including 8 RA and 6 OA were cultured and the nuclear protein was extracted and reserved for western blot.Results The mRNA level of p65,IL-1(,MMP-9 were higher in RA group than that of control (P