Objective To explore the treatment effect and prognosis of BiPAP non-invasive ventilator of sequential mechanical ventilation for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary encephalopathy,and to provide the basis for clinical therapy.Methods According to the digital table,62 AECOPD patients with pulmonary encephalopathy were selected and randomly divided into the two groups.And 30 cases in the control group received routine treatment,and 32 cases in the observation group received BiPAP non-invasive ventilator sequential ventilation.The partial pressure of oxygen (PaO2),partial pressure of carbon dioxide (PaCO2) and oxygen saturation (SaO2) before and after treatment,the changes of heart rate,respiratory rate and average arterial pressure of the two groups and the improvement time were observed.Results PaO2 and SaO2 of the two groups after treatment were higher than those before treatment (t =12.30,10.37,11.42,13.71,all P ＜0.05).PaO2 and SaO2 of the observation group after treatment were (77.14 ±4.16)mmHg and (90.37 ± 2.04) ％,which were higher than the control group after the treatment (72.96 ± 3.22) mmHg and (85.80 ± 1.96) ％(t =6.58,7.14,all P ＜ 0.05).PaCO2 of the two groups after treatment was lower than that before treatment (t =9.25,10.22,all P ＜ 0.05).PaCO2 of the observation group after treatment was (50.12 ± 2.86) mmHg,which was lower than that before treatment (54.27 ± 3.01) mmHg (t =6.29,P ＜ 0.05).The heart rate,respiratory rate and mean arterial pressure of the control group and the observation group after treatment were lower than before treatment (t =10.11,9.43,8.66,11.28,8.56,9.15,all P ＜0.05).The heart rate,respiratory rate and mean arterial pressure of the observation group after treatment were (76.52 ± 4.35) times/min,(20.35 ± 1.08) times/min and (83.26 ±3.07)mmHg,which were lower than those of the control group after treatment (t =6.44,5.82,6.70,all P ＜ 0.05).The blood gas improvement time,ventilation time and hospitalization time of the observation group were (4.06 ±1.17)d,(4.53 ±0.90) d and (16.18 ±2.20) d,which were lower than the control group (t =6.13,7.05,5.97,all P ＜ 0.05).Conclusion The BiPAP non-invasive ventilator sequential ventilation for the treatment of AECOPD with pulmonary encephalopathy has good treatment effect,which can improve the difficult ventilation of patients,avoid hypoxia and CO2 retention,shorten treatment time.

Objective To evaluate the approaches and surgical technique for resection of the lesions occupying different parts of the caudate lobe of the liver. Methods The clinical data of cases undergoing resection of lesions originating in the caudate lobe were retrospectively analysed. The operative procedures were chosen according to lesion location. Results A total of 32 patients were operated on. The surgical technique included left, right and anterior transhepatic approach. The mean operative time was (198?73)min (range 60～345 min) and the mean intraoperative blood loss (917?914)ml (range 100～4?500 ml). There was no operative death, with complications occurring in 4 patients (12%). The patients with benign hepatic tumor are all alive after operation and the 1, 2, 3 and 4 year survival rates for the patients with malignant hepatic tumor were 87%, 59%, 43% and 43%, respectively. Conclusion Resection of the caudate lobe lesions different both in sizes and locations varies greatly in operative complexity, with combined hepatectomy being most difficult. Bilateral surgical approaches are suitable for almost all caudate lobectomies.

Objective To analyze the implementation effect of formative assessment in nutri-tion and food hygiene. Methods 55 students of Class One from grade 2010 majoring in preventive medicine were taken as the control group, with 56 students of Class Two as the experimental group.The control group used the summative assessment , while the experimental group used the formative assessment. Results were analyzed by course examinations and questionnaire surveys. SPSS 17.0 soft-ware was used and the measurement data were expressed by x±s. Statistical analysis was performed using t test, test, rank sum test, a Yuan linear correlation analysis, with the level of test α=0.05. Results The experimental scores and final scores of experimental group students were significantly higher than the control group and the difference was statistically significant(P values were 0.001, 0.000). The experimental group's overall result is closer to the negative skewed distribution. The ex-perimental group's average score of 89 points is significantly higher than the control group's average score of 79 points(P<0.01), and the usual results and the final results were positively correlated(r=0.865, P<0.001). The survey indicated that the students recognized the application of formative assess-ment in teaching process . Conclusion Formative assessment can help improve the teaching and learning quality in nutrition and food hygiene.

Objective: To study the influence of preoperative transcatheter arterial chemoembolization (TACE) by selection on survival rate of resectable hepatocellular carcinoma (HCC) patients. Methods: Jan. 1996 to Jan. 1997, TACE was performed before surgery in 62 of 126 patients undergoing resection and the other 64 patients without TACE from. Results were retrospectively analyzed with regard to the changes of pathological examination after operation, recurrence rate and survival rate 1, 2, 3 years after operation. Results: Pathological examination showed that there were 13 total necrosis in TACE group, but no one in contrast group. There were no significant difference of recurrence rate 1, 3 years after operation between 2 groups. Recurrence rate 2 years after operation was 29.8% in TACE group, but 58.3% in contrast group. There were significant difference of recurrence rate 2 years after operation between 2 groups (P<0.05). Survival rate 3 years after operation was 54.4% in TACE group, but 33.3% in contrast group. Survival rate of TACE group was higher than that of contrast group (P<0.05). There were not significant difference of recurrence rate 1, 2 years after operation between 2 groups. Conclusion: Proper preoperative TACE for resectable HCC can improve the outcome of the operation to some extent.

Objective　To study the value of B type ultrasonography guiding percutaneous radiofrequency ablation (PRFA) for hepatic cancer (HC). Methods　70 patients with primary or metastatic hepatic malignancies were treated by PRFA under ultrasound guidance through LeVeen multipolar array needle electrode and RF 2000. All patients were followed up by turnor marker, B type sounography and MRI monthly. Results　PRFA were performed in 53 patients with hepatocellular carcinoma (HCC) and 17 cases with metastatic liver cancer. Liver function classfication was 53 cases in Child class A, 15 in class B and 2 in class C. In 21 patients with non-operated small HCC (≤5 cm), 12 of 17 patients with AFP positive were decreased to normal (70.6%) and decreased markedly in 4 (23.5%), and MRI showed the treated tumors were completely necrosis in 16 patients (76.2%). The 3, 6 month survival rates were 90.5%, 100% respectively in small HC groups, and 66.7% to 72.7% and 27.6% to 72.7% in large HC groups.Conclusions　PRFA as a local thermal therapy is becoming a kind of new palliative treatment for hepatic malignancies, which not only is safe, minimally invasive, and effective for small ones; but also can be used with combination of TACE for larger ones.

Blood Replenishing Angelica Decoction [Danggui Buxue Tang (DGBXT)]is a wellknown TCM prescription composed of Radix Angelicae Sinensis and Radix Astragali with the actions ofinvigorating "Qi" and enriching blood. Its action to curtail endothelial permeability induced by histaminewas studied. Endothelial cells isolated from the aorta of neonatal calf were cultured on polycarbonate mi-croporus filter membrane to develop a confluent endothelial monolayer. After purfused with either plainHank's balanced salt solution or that containing 5 g/L albumin, the monolayer was treated with 10-4 mol/L histamine for 30 min either with or without preincubation for 60 min with 10-4 g/mL of DGBXT. Fluidfiltration coefficient (Kf), filtration volume (Jv) and osmotic reflective coefficient (σ) of protein were thenmeasured. The findings showed that DGBXT could curtail the lowering of Kf and Jv and elevation of σ in-duced by histamine, indicating that DGBXT could inhibit the action of histamine on endothelial permeabili-ty, but its mechanism of action needs further study.

AIM: To analyze the results of phacovitrectomy with internal limiting membrane(ILM) peeling to treat foveoschisis in ultra-high myopia.METHODS: Totally 32 eyes of 32 ultra-high myopia patients with foveoschisis were selected retrospectively.The preoperative refractive errors ranged from-12.00D to-20.00D with the mean of-15.78±2.16D.The best corrected visiual acuity(BCVA) were converted to LogMAR acuity, and the average BCVA was 4.1±0.4.Conventional phacovitrectomy with ILM peeling by ICG dying were performed.Gas tamponade were performed to end the operation.The BCVA and the foveoschisis cavity were observed by 1-9mo after the surgery, with the mean of 4.5mo.RESULTS: The foveoschisis cavity of 30 eyes were healed with BCVA increased and visual distortion alleviated distinctly (94%)(t=-7.91, P<0.05).CONCLUSION: Phacovitrectomy with ILM peeling is useful in treating foveoschisis in ultra-high myopia with visual function preserving.

Objective To investigate the cachexia morbidity among hospitalized patients with digestive system cancer and evaluate its impact on clinical outcomes.Method By analyzing the clinical data of 5 118 hospitalized patients with digestive system cancer in Zhongshan Hospital,Fudan University from January 2012 to December 2013,we investigated the cachexia morbidity and compared the clinical outcome between cachectic patients and noncachectic patients.Results The overall cachexia morbidity of hospitalized patients with digestive system cancer was 15.7％ (803/5 118).The highest cachexia morbidity was 34.0％ (89/173),found in patients with pancreatic cancer.In cachectic group and non-cachectic group,the overall completion rate of radical resection was 67.1％ (539/803) and 74.5％ (3 214/4 315),respectively (P =0.000).Compared to the non-cachectic group,the cachetic group had significantly longer postoperative hospital days [(11.5 ±6.2) d vs (9.4 ±4.9) d,P =0.003],slower postoperative recovery of bowel function [(3.4 ±0.9) d vs (3.2 ±0.8) d,P =0.013],longer postoperative time to intake semifluid [(4.4 ± 1.5) d vs (3.9 ± 1.3) d,P =0.002],and more postoperative complications in 28 days after surgery [8.9％ (48/539) vs 5.8％ (186/3 214),P=0.006].After surgery,131 patients in the cachectic group were transferred to the ICU,and 646 patients in non-cachectic group transferred to the ICU (24.3％ vs 20.0％,P=0.026).Compared to the non-cachecic group,the reoperation rate [3.2％ (17/539) vs 1.5％ (48/3214)],ventilator support rate [8.0％ (43/539) vs 5.7％ (184/3 214)],and mortality [2.4％ (13/539) vs 1.1％ (35/3 214)] of the cachectic group were all significantly higher (P =0.006,0.042,0.011).Conclusions Cachexia is common in hospitalized patients with digestive system cancer,especially in patients with pancreatic cancer.Cachexia has negative impact on the clinical outcomes.

Objective To study the expressions of Cx43,CD105 and VEGF in HBV related HCC tissues and the relationships between Cx43 expression and recurrence and prognosis after cancer radical resection in HCC patients stratified by serum AFP levels. Methods The expressions of Cx43,CD105,VEGF in 234 HBV related HCC tissues were examined by tissue microarray and two-step methods of PV-6000 of immunohistochemistry and the expressions of Cx43 in 20 frozen HCC specimens were examined by RT-PCR. Results Cx43 in HCC tissues was positive as examined by both immunohistochemistry and RTPCR methods.Positive Cx43 expression is correlated with lower early recurrence ( Log Rank P =0.001 ),longer disease free survival (Log Rank P =0.026 ) and overall survival( Log Rank P =0.000 ) as showed by the Kaplan-Meier analysis in patients with AFP ＜ 400 μg/L. The expression of Cx43 is an independent prognostic factor.The positive expression of Cx43 related with lower positive expression of CD105 and VEGF (P =0.018,0.023 ),and correlated with histological differentiation (P =0.002),the number of focus (P =0.033 ),blood vessel tumor embolism ( P =0.029 ). Conclusions The expression of Cx43 is correlative with the expression of CD105 and VEGF,and is predictive of HCC early recurrence and poor prognosis after radical hepatectomy in HBV related HCC patients with serum AFP ＜ 400 μg/L.

Objective To study the clinical significance of expression of survivin gene in transitional mucosa(TM) adjacent to rectal carcinoma.Methods Mucinhistochemical methods were used to observe the distribution of TM adjacent to rectal carcinoma, and using immunohistochemical methods to observe the expression of survivin gene product in TM,normal mucosa,atypical dysplasia and cancer tissue.Results The positive expression level of survivin gene product was lowest in normal rectal mucosa,and gradually increase in TM,dysplasia and carcinoma tissue(all P