Objective To study the clinical efficacy of acupuncture combined with medication plus joint mobilization in the treatment of lumbar intervertebral disc protrusion accompanied with secondary lumbar spinal stenosis.MethodsTotally 66 cases of lumbar intervertebral disc protrusion accompanied with secondary lumbar spinal stenosis were collected randomly and divided into treatment group (34 cases) and control group (32 cases). The control group was given treatment of simple acupuncture and TCM medication, while the treatment group was given joint mobilization treatment besides acupuncture and TCM medication. Functions of lumbar vertebra were evaluated by ODI scale and the degrees of pain were evaluated by VAS. The clinical efficacy in the two groups was compared. Results ODI in both groups were significantly improved after treatment compared with that before treatment. However, the changing range of the ODI of the treatment group was more significant than that in control group (P<0.01). After treatment, VAS scores were relieved (P<0.05) in both groups, and treatment group was more significant than that in control group (P<0.05). The total clinical efficacy was 97.06% (33/34) in the treatment group, and 84.38% (27/32) in the control group, with statistical significance (P<0.05).Conclusion Acupuncture combined with medication plus joint mobilization in the treatment of lumbar intervertebral disc protrusion accompanied with secondary lumbar spinal stenosis has good efficacy.

Objective To discuss the effects and the main operative techniques of laparoscopic highly selective vagotomy(LHSV) in the treatment of perforating duodenal ulcer. Methods In twenty patients with perforating duodenal ulcers, laparoscopic repair of the perforation and laparoscopic freeing of the vagus nerves and highly selective vagotomy(LHSV) were performed, using ultrasonic dissector. Results In all twenty cases the operation was successful. No patient was converted into open HSV. Ulcer symptoms of 15 patients disappeared after operation, and follow up gastroscopy after 6 months showed that the ulcers had healed. The postoperative ulcer symptoms of 5 patients were markedly relieved and were easily controlled by medication. Conclusions The treatment of perforative duodenal ulcer by LHSV has the advantages of minor trauma, rapid postoperative recovery and good results. LHSV is a good procedure for the treatment of perforative duodenal ulcer .

ObjectiveTo explore the effect of carotid artery sympathetic net exfoliation combined with hyperbaric oxygen therapy on athetosic type cerebral palsy (CP).Methods46 CP children (athetosic type) were divided into the treatment group (n=25) and control group (n=21). All cases of two groups were treated with carotid artery sympathetic net exfoliation as well as children of the treatment group were added with drug and hyperbaric oxygen therapy. Therapeutic effect of two groups was compared.ResultsOne week after operation, the effect rate was 66.67% in control group and 64% in treatment group with no significant difference between two groups. 3 months after operation, the effect rate of the treatment group increased to 96.00%, but that of the control group was not changed, there was a significant difference between two groups (P<0.05).ConclusionCarotid artery sympathetic nerve net exfoliation can improve the symptoms of athetosic type CP children, if combined with hyperbaric oxygen therapy, the curative effect will be further improved.

OBJECTIVE:To provide reference for cultivating high-level comprehensive medical talents with high quality. METHODS:Based on the market and social needs,the teaching reform was conducted from the concepts of educational ideas, modes,curriculum system,contents,management and other aspects. RESULTS:In order to adapt to the needs of society and era, it should establish large education educational ideas to cultivate student's independent ability to obtain knowledge and self-develop-ment to make people change into community basic services and service and dedicate society with modes of cultivating inter-disci-plinary talents,including combination of prduction and study,foundation strengthening,professional expanding,penetration of sci-ence and technology and combination of arts and science;generally optimize curriculum system with theprinciple of precise defini-tion,clear classification,and optimized combination based on market and social needs;and update contents timely and teaching materials;the teaching management should be changed from closed off management of the past to the external management which dominated by the market assessment. CONCLUSIONS:Reform of medical higher education based on the market and social needs can cultivate the talents with high quality and comprehensive medical knowledge for the social needs,which is conductive to the de-velopment of medical industry.

Posterior reversible encephalopathy syndrome is a clinical imaging syndrome associated with multiple pathogenic factors.The main clinical manifestations were headache,seizures,psychotic symptoms,visual disturbance,disturbance of consciousness,etc.The parieto-occipital reversible white matter lesions are the main manifestations of the imaging.If this disease can be diagnosed and treated in time,the clinical symptoms and imaging changes of most patients can be disappeared.If the diagnosis and treatment cannot be obtained in time,it may happen some irreversible damage,serious and even life-threatening,so it is very important to strengthen the understanding,diagnosis and treatment of this disease.At present,the pathogenesis of the disease is still not clear,now reviewed its pathogenesis and imaging manifestation in order to strengthen the clinician's understanding of the disease's pathophysiological mechanism and improve the level of diagnosis.

AIM: To explore the effect and mechanism of endothelin receptor antagonist on local angiotensin system of hypertrophic myocardial tissue. METHODS: Twenty four rats were randomly divided into 3 groups, control group (CG), hypertrophy group (HG) and endothelin receptor antagonist group (EG). The ratios of left ventricle weight to body weight (LVW/BW) and left ventricle weight to heart weight (LVW/HW) were measured to reflect myocardial hypertrophy. Protein expression of AT1R was detected by immunohistochemistry. The concentration of Ang Ⅱ was determined by ria. Activity of ACE was examined by spectrophotometry. A piece of myocardial tissue was observed in light microscope after HE or VG dyeing. RESULTS:(1) In comparison to CG, LVW/BW, LVW/HW, ACE activity, the concentration of Ang Ⅱ and the expression of AT1R of HG were increased significantly (P

0.05),between the two groups,but in body mass index [(24.451?3.752) vs(22.468?2.434),P=0.030],previous history of pancreatitis(23.8% vs.7.5%,P=0.046) and bloody ascites(95.24% vs.46.24%,P0.05).MODS rate was higher in HL-group(52.4% vs.29%,P=0.04).The two groups had similar operation rates(66.7% vs 80.6%,P=0.178),hospitalization days [(25.476?14.383) vs(22.796?7.191),P=0.216] and mortality rate(28.6% vs.11.8%,P=0.069).Conclusions Hyperlipidemic severe acute pancreatitis has the characters of heavier weight habitus,history of frequent recurrence,high incidence of bloody ascites and prone to develop MOF.

Objective To evaluate the mechanism of external branch of the superior laryngeal nerve (EBSLN) injury during thyroid surgery as showed by intraoperative neuromonitoring.Methods 70 patients with 109 nerves at risk were enrolled in this study from March 2011 to October 2011.A positive signal is determined by observing contractions of the cricothyroid muscle.The relationship between EBSLN and the upper pole of the thyroid or the inferior constrictor muscle was studied.Results 108 nerves (99.1％) were located successfully,42 of which were visualized (38.9％).55 nerves (50.9％) crossed the superior thyroid artery more than 1 cm apart,while the other 53 nerves (49.1％) went less than 1 cm including 24 nerves(more than 0.5 cm,less than 1 cm) and 29 nerves (less than 0.5 cm) or coursed below the superior pole of the thyroid.The rate of the latter type was significantly elevated in patients with the top to botton diameter of the gland more than 5 cm.One patient suffered from impairing in the production of high tones postoperatively.Conclusions Intraoperative neuromonitoring is useful and helpful in providing instructive information for operations by locating EBSLN.

To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and TACE alone for hepatocellular carcinoma (HCC), Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Datebases were searched for the randomized controlled trials (RCTs) and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were undertaken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously associated with higher 1-, 2-, and 3-year overall survival rates (OR1-year=3.98, 95% CI 2.87-5.51, P<0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P<0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P<0.00001) than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone (OR=13.86, 95% CI 8.04-23.89, P<0.00001). And there was a significant difference in local recurrence rate between two different kinds of treatment (OR=0.24, 95%CI 0.14-0.44, P<0.00001). Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy. TACE-plus-RFA treatment was associated with a higher response rate (RR) than the TACE-alone treatment (OR=3.90, 95% CI=2.37-6.42, P<0.00001). TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease (SD) rate (OR=0.38, 95% CI=0.11-1.26, P=0.11). Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease (PD) rate (OR=0.15, 95% CI=0.05-0.43, P=0.0005). The rate of AFP reducing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group (OR=4.62, 95% CI 2.56-8.34, P<0.00001). The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients' overall survival rate, tumor necrosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.

Objective To study the correlation between the rescue time and the spot survival rate.Method The data of spot-rescued victims in a large public place of Dujiangyan City from 14:35 on May 12,2008 to 11:40 on May 15,2008 were analyzed.The searched-out victims included the spot death and spot survival,and they were statistically analyzed with Chi-Square test and Partitions of X2 method in order to find out correlation between rescue time and survival rate.Results Out of the 366 spot-rescued victims from the ruins,87 ones survived and the spot survival rate was 23.77%.The spot survival rate in the first 24 hours was much higher than that in the second 24 hours(X2=22.62,P＜0.0125)and that in the third 24 hours(X2=37.84,P＜0.0125),and no obvious difference in the spot survival rate between the second and the third 24 hours was found(X2=1.92,P＞0.0125).The first 24 hours was further divided into 3 periods in equal length of time in order to find more subtle differences in early rescue.The spot survival rates in the first and the sccond 8 hours were much higher than that in the third 8 hours(x2=19.33 and 7.11,respectively,P＜0.012 5)while there was no statistical difference in the spot survival rate between the first 8 hours and the second 8 hours(X2=1.75,P＞0.012 5).Conclusions The"golden time"for spot rescuing the victims is the first 24 hours after seismic disaster,the chances to find the survivals is decreasing as the time elapsing.The earlier spot rescue starts in the first golden24 hours,the higher spot survival rate of the seismic victims will be.