Objective To investigate the effect of a single dose of propofol at the end of surgery on pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia.Methods Sixty pediatric patients for adenotonsillectomy were randomly divided into propofol group and control group (30 cases in each group), they were undergoing sevoflurane induction and maintaince. The pediatric patients in propofol group were received 1 mg/kg 10% of the propofol intravenous injection at the end of surgery,while the pediatric patients in control group were received the same volume physiological sailine intravenous injection. Duration of surgery, sevoflurane administration, anesthesia time, extubation time were recorded. The highest PAED score after extubation in 30 min were recorded. The time spent in PACU and the FLACC pain score were recorded. Results The PAED score in propofol group was significantly lower than that in control group [(7.5 ± 3.9) scores vs (10.9 ±4.5) scores, P＜0.05]. The incidence rate of postoperative delirium in propofol group was significantly lower than that in control group [20.0% (6/30) vs 46.7% (14/30), P ＜ 0.05 ] . Duration of extubation in propofol group was slightly longer than that in control group[(10.2 ± 1.1 ) min vs (9.1 ± 1 .5 ) min, P ＜ 0.05].There was no statistical significant difference in duration of anesthesia, the time spent in PACU and the FLACC pain score (P ＞0.05).Conclusions The administration a single dose of 1 mg/kg propofol at the end of surgery can effectively reduce pediatric anesthesia emergence delirium undergoing adenotonsillectomy during sevoflurane anesthesia, while can't extend the duration of anesthesia and the time spent in PACU. It has some clinical value.

ObjectiveTo evaluate the efficacy of stereotactic body radiotherapy combined with coinstan taneous gemcitabine,and gemcitabine alone for advanced pancreatic cancer.Methods56 advanced pancreatic cancer patients were assigned into observation group,which accepted stereotactic body radiotherapy combined with coinstantaneous gemcitabine 500 mg/m2,d1,d8.Other 50 patients were assigned into the control group which only accepted gemcitabine 1 000 mg/m2,d1,d8,d15.Stereotactic body radiotherapy was delivered with a total dose of 4 000-4 500 cGy in 10 fractions.ResultsCT examinations were carried out 2 months after treatment.The response rate of the observation group and control group was 82％ and 16％ respectively,and the pain relief rate was 67％ and 17％ respectively.The time to progression of the observation group was 14 months,and was better than that of the control group(7.5 months,x2 =7.31,P =0.032).The median survival time of the observation group and control group was 15.8 months and 13.2 months,and the difference had no statistical significance(x2 =3.28,P =0.082).ConcolusionStereotactic body radiotherapy combined with gemcitabine has a better overall response rate and a pain relief rate.It can prolong the time to progression,but can't improve the overall survival.

Objective To analyze the causes of misdiagnosis of esophageal leiomyoma.Methods The clinical data of 20 patients who were preoperatively misdiagnosed as esophageal leiomyoma at our hospital in 16 years were retrospectively analyzed.There were 11 males(55%) and 9 females(45%) with a mean age of(45.9 ± 16.4) years(range, 13-71 years).The initial presentations were obstructive symptoms in 12 patients(60%).CT imaging were performed in 9 patients(45%), of which 4 cases were enhanced CT(20%).Results The misdiagnosed patients included 5 cases of extraesophageal lesions(4 cases of paraesophageal lymph node tuberculosis and 1 case of lymph node hyperplasia), 8 cases of begin interstitial diseases(3 cases of neurinoma, 3 cases of inclusion cyst, 2 cases of angioma), 5 cases of malignant interstitial diseases(4 cases of GIST, 1 case of PNET), and 2 cases of esophageal cancer.The 4 cases of esophageal tuberculosis were misdiagnosed due to the absence of CT examination.The patients with esophageal cancer were treated with esophageal resection and reconstruction without clear staging of the tumor.This might be associated with the neglection of the rapid symptom development and the characteristic lumen stenosis under the gastroscope.The characteristic mucosal ulcer in patients with highly malignant GIST was overlooked.The disease relapsed postoperatively because only tumor enucleation was performed.Conclusion Preoperative diagnosis of esophageal leiomyoma is not uncommon.This disease is most often misdiagnosed as paraesophageal lymph node tuberculosis or esophageal GIST.CT examination is useful in distinguishing esophageal leiomyoma and paraesophageal lymph node tuberculosis.The roles of reoperation and adjuvant therapy in the surgical treatment of esophageal leiomyoma need further investigation.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.

Medical education is the cornerstone of the development of health care.In the context of advance-ments in New Medical Science,the Second Hospital of Jilin University took the reform of the school's clinical medi-cal education system as an opportunity to strengthen the teaching quality assurance capabilities,focus on improving teachers'teaching capabilities,and pay attention to the quality of student training,thus comprehensively building a new pattern of innovative development of medical education.It was also proposed that university-affiliated hospitals should focus on the overall national strategic plan for medical education development and deepen medical education reform,use artificial intelligence to lead the innovative development of medical education,and use the construction of new-era textbooks as the carrier of medical education innovation to promote deeper reforms in medical education.