As an efficient health care system ,the hierarchical medical system is characteristic of its continuation of the division of work at different levels of medical services in the diagnosis and treatment functions .Two major roadblocks hinder the building of such a system ,namely a serious shortage of primary service capabilities ,and lack of incentives in the referral from superior institutions .Success of such a system lies in enhancement of the service capabilities of primary medical institutions by all means , and smooth functioning of a dual referral system .

Objective To discuss the way and effect of washing intestine and pelvic cavity to prevent the fistula of lo place close entrance's in carcinoma of rectum. Methods Cut the rectum and lymph node,used the tip large intestine to connect with washing machine tube. cut vermiform appendix and put urine tube enter ileocecal them use 500ml N.S to wash large intestine for sustained.After se the recturn and large intestine.Use two tube(0.8～1cm) pelvic cavity about 1～6 days. Results The improvement group(38 cases) had not occur leak of lo place cclose entrance, classical group (18 cases) had occur 2 cases (11.1%)leak of lo place close entrance, usestatistics to deal with, P

OBJECTIVE:To observe clinical efficacy and safety of Bifidobacterium triple viable capsules in the adjunctive treatment of Helicobacter pylori(Hp)positive chronic atrophic gastritis(CAG)complicated with anxiety-depression. METHODS:A total of 100 Hp positive CAG patients with anxiety-depression were divided into control group and observation group according to random number table,with 50 cases in each group. Control group was given standard triple therapy (rabeprazole+amoxicillin and clavulanate+levofloxacin). Observation group was additionally given Bifidobacterium triple viable capsules 0.42 g,tid. The treatment lasted for 14 d in both groups. Clinical efficacies,Hp eradication rates as well as HAMA and HAMD scores before and after treatment were all observed in 2 group. The occurrence of ADR was compared. RESULTS:Total response rate of observation group was 94.0%,and Hp eradication rate was 92.0%,which were significantly higher than 76.0% and 78.0% of control group, with statistical significance (P<0.05). Before treatment,there was no statistical significance in HAMA and HAMD scores in 2 groups(P>0.05). After treatment,HAMA and HAMD scores of 2 groups were decreased significantly,the observation group was significantly lower than the control group,with statistical significance (P<0.05). The incidence of ADR in observation group (4.0%)was significantly lower than control group(20.0%),with statistical significance(P<0.05). CONCLUSIONS:Adjunctive use of Bifidobacterium triple viable capsules can significantly improve Hp eradication rate,clinical symptom,anxiety and depres-sion,while reduce the incidence of ADR.

BACKGROUND: The operation on cervical spondylosis is usually done through anterolateral cervical vertebrae to mainly expose cervical vertebrae,intervertebral disc, hook joint and so on. The recent reports are mostly local studies. The observation data of the distance between cervical vertebrae and the corresponding nervus vascularis is limited.OBJECTIVE: The relation of the blood vessels and nerves to cervical vertebrae was observed in neck so as to prevent iatrogenic blood vessels and nerve injuries in the operation on cervical spondyloisis.DESIGN: A single sample trial based on the anatomic samples SETTING: The department of anatomy of a medical college PARTICIPANTS: The experiment was conducted in the Department of Anatomy of Changzhi Medical College from July 2003 to May 2004. Twenty adult antiseptic samples with 40 sides including 36 from males and 4 from the females supported by the Department of Human Anatomy, Changzhi Medical College.METHODS: The accompanying relation of the blood vessels to the nerves,the length of the blood vessels, and the distances from their starting point and end to the neighboring cervical vertebrae were observed and measured in 40 adult antiseptic samples of the neck.the distances from their starting point and end point to the neighboring cervical vertebrae.RESULTS: Totally, 40 sides of 20 samples entered the stage of the result analysis. The facial artery followed the lingual nerve, and the length from its starting point to the neighboring cervical vertebrae C3 was ( 18.5 ± 7.2) mm. The lingual artery followed the hypogolossal nerve, and the distance from its starting point of the lingual artery to C2 -3 was( 19.7 ± 8.4)mm. The superior thyroid artery followed the lateral branch of the superior laryngeal nerve, and the distance rom its starting to the point of the superior thyroid artery to C3 was (17.0 ± 5.7) mm, and the length from the end of the superior thyroid artery to C5 was (18.2 ± 2.5 ) mm. The superior laryngeal artery followed the medial branch of the superior laryngeal nerve, and the distances from its starting point and end point to C3 were( 15.7 ± 6.7) mm and(19. 7± 5.8) mm respectively. As for the inferior thyroid artery, the distances from its starting point and the end point to C7 were ( 17.3 ± 5.5 ) mm and ( 11.3 ± 3.4 ) mm respectively.CONCLUSION: In the operation on cervical spondylosis, attention should be paid to the anatomic stricture of the special position at different positions so as to reduce the iatrogenic blood vessels and nerve injuries.

To investigate the effects of Sangen Decoction, a compound Chinese herbal medicine, on osteoclastogenesis and bone resorption function of osteoclasts induced by polymethylmethacrylate particles in vitro.

Objective To discuss the safety and effectiveness of laparoendoscopic single -site surgery (LESS)in cholecystectomy.Methods LESS and conventional laparoscopic(LC)effect were compared and analyzed in cholecystectomy.48 cases were divided into the two groups,24 cases(group LESS)were cheated by laparoendo-scopic single-site surgery;24 cases(group LC)were cheated by laparoscopic cholecystectomy.Contrasted in their operation time,intraoperative amount of bleeding,intraoperative laparotomy rate,body temperature after operation, complications,intestinal recovery time (postoperative exhaust),hospitalization time after operation,postoperative pain index,cosmetic effect,white blood cell (WBC),serum cortisol (Cortisol,Cor),immunoglobulin A (IgA)and comple-ment (C3 ).Results All cases were successful,no cases converted to laparotomy,no postoperative complications.The operation time of group LESS and group LC were (110.2 ±29.3)min and (77.8 ±31.2)min,respectively,the differ-ence was ststictically significant (t=5.07,P<0.05).The intestinal recovery time and hospitalization time after oper-ation in group LESS were less than that in gruoup LC (P<0.05 ).The cosmetic effect in group LESS (3.5 ± 0.5)was higher than that in group LC(2.1 ±0.5)(P<0.05).Cor and C3 in group LESS were higher than those in group LC(P<0.05 ).Conclusion Laparoendoscopic single -site surgery in cholecystectomy is safe and feasible, compared with traditional laparoscopic operation,operation time in LESS is long,but arapid postoperative recovery, beauty effect is obvious.

Objective To explore the effect of pathogenesis,diagnosis,therapy and prevention of portal vein thrombosis(PVT) after devascularization.Methods Data of 86 patients who underwent devascularization because of cirrhotic portal hypertension between January 2009 and December 2014 were retrospectively analyzed.Patients were divided into preventive anticoagulant treatment group (46 cases) and nonpreventive anticoagulant treatment group (40 cases) according to whether or not to receive prophylactic anticoagulant therapy.Compared the causes of PVT and clinical characters.Results The occurrence of PVT was 10.9％ (5/ 46) in preventive anticoagulant treatment group,PVT Ⅰ , Ⅱ, Ⅲ, Ⅳdegree were 2,3,0,0 cases,and that was 32.5％ (13/40) in nonpreventive anticoagulant treatment group, PVT Ⅰ , Ⅱ , Ⅲ, Ⅳ degree were 4,7,2,0 cases, the incidence rate of treatment group was lower than control group (x2 =9.735, P ＜ 0.05).There was no relationship in PVT with sex, age, and intraoperative ligation of splenic artery beforehand (P＞0.05).There were apparent correlation in PVT with centrifugal-flow of portal vein and peak value of platelet count(P＜0.05).All patients discharged uneventfully after anticoagulant treatment, including 2 cases of thrombolytic and 4 cases of blood supply recanalization, no case died from PVT.Conclusion The definite cause of PVT after devascularization is centrifugal-flow of portal vein and the peak value of platelet count (300-499) × 109/L is a pivotal risk factor.The key point of therapy is early diagnosis and early anticoagulant treatment.

Purpose:To study the efficacy and safety of combination of methylprednisolone (MP) and ondansetron (OND) in the prevention of acute and delayed nausea and emesis induced by cisplatin base chemotherapy. Methods:This was a randomized, self cross over study. 47 patients receiving cisplatin based chemotherapy were randomized to enter one of the two following groups:Group 1:the combination of 80mg MP and 8 mg OND were iv injected to the patients before the first cycle of chemotherapy and then 8 mg OND was iv injected to the same patients before the second cycle of chemotherapy (23 cases); Group 2:8mg OND was iv injected to the patients before the first cycle of chemotherapy and then the combination of 80 mg MP and 8mg OND were iv injected to the same patients before the second cycle of chemotherapy (24 cases). The dosage of chemotheraputic agents and the times of anti emesis agents were the same in the two different cycles of chemotherapy for each patient.Results:The complete and partial control of the acute emesis were significantly superior in the combination of MP and OND than in the OND alone(93.6% versus 70.2%, P

Objective To investigate the influence of difference ileocecal junction length on the efficacy of laparoscopic subtotal colectomy combined with antiperistaltic cecorectal anastomosis (LSCACRA) in treatment of slow transit constipation (STC). Methods Ninety- two STC patients undergoing LSCACRA were divided into 2 groups by random digits table method:10-15 cm group (10-15 cm ascending colon preserved above ileocecal junction, 46 cases) and 2-3 cm group (2-3 cm ascending colon preserved above ileocecal junction ,46 cases). All the patients were followed up for 24 months, and the Wexner incontinence score (WIS), ileocecal junction emptying time of barium enema, Wexner constipation score (WCS), abdominal pain intensity score (NRS), gastrointestinal quality of life index (GIQLI), abdominal pain frequency score and abdominal bloating frequency score were compared between 2 groups. Results All the patients successfully completed LSCACRA, with no conversion to open surgery and death occurred. There were no statistical differences in amount of bleeding, operative time, hospitalization time, exhaust time, incidences of postoperative intestinal obstruction and pulmonary infection, defecation time, WIS and abdominal bloating frequency score between 2 groups (P>0.05). The WCS, GIQLI, NRS and abdominal pain frequency scores 6, 12 and 24 months after operation in 2-3 cm group were significantly better than those in 10 - 15 cm group, WCS: (1.7 ± 1.3) scores vs. (4.2 ± 2.3) scores, (1.7 ± 1.1) scores vs. (4.1 ± 1.9) scores, (1.2 ± 0.5) scores vs. (3.9 ± 2.5) scores;GIQLI:(116.8 ± 6.2) scores vs. (98.5 ± 14.7) scores, (122.9 ± 7.5) scores vs. (104.7 ± 16.5) scores, (124.3 ± 5.9) scores vs. (108.3 ± 15.1) scores; NRS: (1.3 ± 0.5) scores vs. (2.5 ± 1.7) scores, (0.9 ± 0.3) scores vs. (2.3 ± 1.4) scores, (0.8 ± 0.3) scores vs. (2.2 ± 1.5) scores;abdominal pain frequency score:(0.9 ± 0.3) scores vs. (1.6 ± 1.2) scores, (0.7 ± 0.3) scores vs. (1.4 ± 1.1) scores, (0.7 ± 0.2) scores vs. (1.2 ± 1.0) scores, and there were statistical differences (P<0.05). The ileocecal junction emptying time of barium enema 24 months after operation in 2-3 cm group was significantly shorter than that in 10-15 cm group: (17.6 ± 8.4) h vs. (21.3 ± 10.8) h, and there was statistical difference (P<0.05). Conclusions STC patients with LSCACRA is safe and effective. The shorter length of ascending colon preserved above ileocecal junction can improve the efficacy of LSCACRA in the treatment of STC and the prognosis of patients. The 2-3 cm length of ascending colon preserved above the ileocecal junction should be recommended.