Objective To determine quantity of type Ⅰ collagen and mRNA expression of decorin and transforming growth factor (TGF)- β_1 in the upper portion of the anterior vagina in women with pelvic organ prolapse (POP). Methods Transvaginat biopsies were obtained from the anterior vaginal wall in 27 POP(POP group) and 21 non-poP(control group). The concentration of type Ⅰ collagen was determined by ELISA technique. RT-qPCR was used to verify the mRNA level of decorin and TGF- β_1. Results The mean concentration of type Ⅰ collagen in the premenopausal women in POP group [(47.94 ± 6.82) mg/g total protein (TP)]was significantly lower than that in control group [(62.33±6.57) mg/g TP],in the postmenopausal women in POP group, it was (41.82±5.96) mg/g TP, significantly lower than that in control group[(61.21 ± 4.84)mg/g TP](P< 0.01). The mRNA expression of decorin was 1.61 ± 0.10 in POP group, significantly lower than that in control group 2.77±0.60 ,while that of TGF-β_1 was higher in POP greup10.86 ± 0.23 than that in control group 9.87 ± 0.92 (P < 0.05). In the postmenopausal women in two groups, there were no significant difference in the mRNA expression of decorin and TGF-β_1 (P > 0.05). Conclusions A decrease in quantity of type Ⅰ coUagen in the connective tissue of anterior vagina may compromise the tensile strength and an increase susceptibihty to prolapse. Deeorin might be involved in the pathogenesis in premenopausal women with POP. The pathogenesis of POP is muhifactorial.

Objective Through the effect comprison of analgesic calm and side-effect on postoperative analgesia under different concentration dexmedetomidine with butorphanol,to research the best concentration of dexmedetomidine on postoperative analgesia.Methods Ninety patients with lower abdominal surgery with general anesthesia,ASA Ⅰ-Ⅱ grade,were divided into 3 groups by random digits table:group A,group B and group C,each group with 30 cases.The group A received 0.2 μg/ (kg·h) dexmedetomidine.The group B received 0.3 μg/ (kg ·h) dexmedetomidine,both added 0.15 mg/kg butorphanol and 8 mg ondansetron.The group C only received 0.15 mg/kg butorphanol and 8 mg ondansetron.Applied patient controlled intravenous analgesia (PCIA) pump continuous infusion gave total 100 ml,background infusion 2 ml/h,patient controlled analgesia (PCA) 2 ml,lock time 30 min,analgesia was continued 48 h.Below were recorded at 2,6,12,24 and 48 h after the beginning of PCIA:analgesia VAS score,ramsay sedation scale (RSS),adverse reaction.The total number of button pressing of PCA and the consumption of patient controlled liqnid analgesia (PCLA) solution were also recorded.Results There was no statistically significant difference in VAS score after each time point between group A and group B (P＞ 0.05).The VAS scores after each time point in group A and group B were significantly lower than those in group C [(2.7 ±0.8),(2.6 ± 0.8) scores vs.(3.2 ± 0.9) scores; (1.8 ± 0.6),(1.7 ± 0.6) scores vs.(2.5 ± 0.6) scores; (1.0 ±0.6),(0.9 ±0.7) scores vs.(1.8 ±0.6) scores; (1.0 ±0.5),(0.8 ±0.5) scores vs.(1.4 ±0.5) scores; (0.7 ±0.5),(0.7 ±0.4) scores vs.(1.0 ±0.5) scores,P ＜0.05].There was no statistically significant difference in RSS score among 3 groups (P ＞ 0.05).The RSS scores after 6,12,24 and 48 h in group A and group B were significantly higher than those in group C [(2.6 ±0.5),(3.5 ±0.6) scores vs.(2.0 ±0.3) scores; (2.9 ± 0.6),(3.8 ± 1.2) scores vs.(2.4 ± 0.3) scores; (2.8 ± 0.7),(3.9 ± 0.7) scores vs.(2.5 ± 0.4)scores; (2.8 ± 0.6),(3.9 ± 0.6) scores vs.(2.5 ± 0.5) scores,P ＜ 0.05],group A was significantly higher than those in group B (P＜ 0.05).There was no statistically significant difference in rate of hypoxemia among 3 groups (P ＞ 0.05).The rates of nausea and vomit,deliration in group A and group B were significantly lower than those in group C [3.3％(1/30),0 vs.10.0％(3/30) ;0,0 vs.10.0％(3/30),P＜ 0.05].The rates of hypotension and bradycardia in group B were significantly lower than those in group A and group C[16.7％ (5/30) vs.3.3％(1/30),0;20.0％(6/30) vs.3.3％(1/30),0,P＜ 0.05].The total number of button pressing of PCA 24 h and the consumption of PCLA solution in group C were significantly higher than those in group A and group B [(13.9 ±2.4) times vs.(9.7 ±2.2),(7.4 ± 1.5) times; (60.9 ± 1.8) ml vs.(54.5 ± 1.2),(50.7 ± 0.7) ml,P ＜ 0.05].Conclusion Concentration 0.2 μ g/(kg· h) dexmedetomidine with butorphanol has better effects on postoperative analgesia and calm,less side-effect.

Objective:To investigate the possibility of predicting facial nerve involvement in the pa-tients with parotid tumors using facial electroneurography (ENoG).Methods:In the study, 53 patients with primary parotid tumors were included in the study , 28 were benign tumors and 25 were malignant . There was no significant difference of tumor locations and sizes between the two groups . House-Brackmann facial nerve function evaluation was gradeⅠin all the patients who received examination of fa-cial electroneurography , including stimulation strength , amplitude , and latent time bilaterally .The facial electroneurography results in the affected side were compared with the results of contralateral normal side , intraoperative appearance and postoperative histopathological diagnosis .The facial electroneurography results were analyzed by Wilcoxon signed rank test and receiver operator characteristic ( ROC) curve. Results:During the facial electroneurography examination , the mean stimulation strength in the patients with benign parotid tumor was 20.0 mA.There was significant decrease in the amplitude at the affected side compared with the normal side upon posterior auricular stimulation ( P<0 .05 ) .But there was no significant difference in the latent time between the bilateral sides (P>0.05).However, in the patients with malignant parotid tumor , the mean stimulation strength was higher at 24.5 mA.There was signifi-cant decrease in the amplitude or even no response at the affected side compared to the normal side upon posterior auricular stimulation ( P<0 .05 ) .No response was detected in the multiple branches of facial nerve of affected sides in 36 .0%patients upon posterior auricular stimulation .The amplitude of branchesⅢand Ⅳwas significantly lower at the affected side than that at the normal side upon anterior auricular stimulation (P<0.05).The area under the ROC curve for ENoG was 0.884.Conclusion: When the facial nerve was involved by the parotid tumors , the stimulation strength in the electroneurography was larger .There was significant difference in the amplitude and the latent time of the facial nerve between the affected side and the normal side upon the posterior auricular stimulation .The rate of absence of reac-tion wave was higher in the patients with malignant tumors .It was feasible to predict the facial nerve in-volvement by ENoG for the parotid gland tumor patients without clinical appearances of facial paralysis .

In recent years,laparoscopic total gastrectomy (LTG) with lymphadenectomy is increasingly utilized for the management of gastric cancer located in the middle or upper third of the stomach.However,esophagojejunostomy is the key technical difficulty in operation.Compared with conventional extracorporeal esophagojejunostomy via mini-laparotomy,pioneers are attempting to perform intracorporeal anastomosis in order to gain better manipulation and minimally invasive benefits,as well as reducing the difficulties in digestive tract reconstruction.

Objective To investigate the effects of environmental intervention on growth hormone (GH) and insulin-like growth factor 1(IGF-1) in very low birth weight infants in NICU.Methods 60 cases of very low birth weight infants were randomly divided into the experimental group and control group (30 cases in each group) in NICU from June 2012 to June 2013.By adjusting the light,reducing the noise,focusing the nursing time,the levels of growth hormone and insulin-like growth factor-1 were detected and the growth indexes were measured including body weight,length,and head circumference on the 7th day and 14th day.Results The indicators of growth and development in the experimental group on the 7th day and 14th day after birth were significantly better than those of the control group.The IGF-1 level in the experimental group on the 7th day was significantly higher than that of the control group.The GH and IGF-1 level in the experimental group was significantly higher than that of the control group.Conclusions Effective environmental intervention in NICU can improve the GH and IGF-1 lev-el of very low birth weight infants and improve their quality of life.

Objective To investigate the relation ship between the changes of platelet parameters and intracranial hemorrhage in premature children with low birth weight. Methods 73 premature children with low birth weight were selected as research subjects and divided into PIVH group (35 cases) and non PIVH group (38 cases) according to intracranial hemorrhage or not,and 20 normal newborns were selected as controls. The neonatal platelet parameters of three groups were detected and compared. Results There were 35 cases of 73 premature children with low birth weight occurred intracranial hemorrhage, the incidence rate was 47. 9%. The gestational age and birth weight of PTVH group were (29.3 ± 1.2) weeks and (1 653.0 ± 182. 1) g and which were significantly lower than the non PIVH group( all P ＜0.05) ; the asphyxia rate of PIVH group was 60.0% and which was significantly higher than the non PIVH group(P＜0.05). The PLT and PCT of PIVH group were (187.52 ±52.03) × 109/L and (0.127 ± 0.05) % and which were significantly lower than the control group (all P ＜ 0. 05) ; The PLT and PCT of non PIVH group were(223.48 ±42.15) × 109/L and (0. 189 ±0. 06)% and which were significantly lower than the control group(all P＜0. 05) ; The PLT and PCT of PIVH group were significantly lower than the non PIVH group(all P ＜ 0.05) ; while the MPV and PDW among the three groups had no significant difference ( all P ＞ 0. 05 ). Conclusion The abnormal decrease of PLT and PCT should be involved in the pathogenesis of intracranial hemorrhage in premature children with low birth weight, clinical attention should be paid to the monitoring of platelet parameters in premature children so as to alert and minimize its incidence.

Laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection is still difficult to accomplish,which restrains its application in total gastrectomy for advanced proximal gastric cancer.Based on our anatomical understanding of pre- and retropancreatic spaces,features of splenic vessels and distribution of perigastric lymph nodes,we combined the characteristics of laparoscopic surgery and developed a novel technique for laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection through retropancreatic space.The key lies in mobilization of the splenic pedicle through retropancreatic space,dissection of peri-vascular lymph nodes in sequence of trunk-to-branch,in-sheath vascularization of the splenic vessels.From August 2009 to December 2010,this technique was performed on 6 patients in Nanfang hospital.The initial results suggested that this technique could be safe and feasible for skillful surgeons.Further studies on the application of this technique in total gastrectomy for advanced proximal gastric cancer would be needed.

Correct implementation of laparoscopic total gastrectomy with D2 lymph node dissection depends on the understanding of anatomical features of peripancreatic space, the landmark of pancreas and blood vessels, and the diverse perigastric vascular anatomy and standardized surgical procedures designed according to the regional distribution of lymph nodes.From September 2006 to November 2009, laparoscopic total gastrectomy with D2 lymph node dissection surgery were completed in 12 cases in the Nanfang Hospital. A reasonable anatomy method and a simple, effective surgical procedure of laparoscopic D2 lymph node dissection were introduced.

Objective To explore the effect of different states of the environment to the rehabilitation process and complications of preterm infants in the different environment in neonatal intensive care unit (NICU). Methods 120 premature infants were divided into observation group and control group with 60 cases in each group by random digital table method. The control group was treated with routine nursing model, while observation group was treated with bird nest nursing, lower noise and using cyclic lights. Oxygen time and hospitalization time, increasing about body weight, sleeping time on the twenty-eighth days and the incidence of complications between the two groups were compared. Results The hospitalization and oxygen time were (41.79±2.51)days and (11.45±5.22)days respectively in the observation group, those were shorter obviously than that in the control group [(45.32±3.85)days and(15.52±5.89)days, t=5.95, 4.01, P<0.01].The growth of body weight was (17.36±2.94) g/d, the sleeping time on the twenty-eighth day was (21.18 ±0.39)hours in the observation group. It was increased than that in the control group [(13.48±4.63)g/d and(19.56±0.45)hours], and the difference was significant(t=5.48, 21.07, P<0.01). The incidences of nosocomial infection and feeding intolerance in the observation group were reduced significantly, the difference was significant ( X2=7.06, 8.71, P<0.01). Conclusions Improving the environment in NICU can prevent the adverse factors on premature infants, promote the recovery and growth of premature infants.

Based on the clinical informatization construction of large comprehensive hospitals , as required by information -based closed-loop management of medical advices , the paper analyzes the objectives and contents of informatization constructization in the closed-loop management of medical advices in modern hospitals , introduces the application effects of closed -loop management of medi-cal advices , and points out that such a management mode is the basis for future development of smart health care .