Objective To investigate the mechanism of anireflux procedures in treating sliding hiatal hernia and the effectiveness of the method of cardia position by clock to evaluate the outcome of antireflux procedures. Methods From 1992 to 2008, 136 patients with sliding hiatal hernia underwent transabdominal antireflux surgery: 27 patients received Nissen procedure and 109 recieved floppy Nissen operation. Results There is no postoperative death. Within one month after operation, in the Nissen group, 2 patients developed severe dysphagia and 1 had regurgitation; in the floppy Nissen group, 9 patients had regurgitation, and 3 had dysphagia. During the over-2-year follow-up period, 2 patients developed severe dysphagia,1 had nausea and 2 had significant reflux in the Nissen group. While 3 patients recturred, 2 had dysphagia and 7 had significant reflux in the floppy Nissen group. The effective rates of the Nissen group and the floppy Nissen group were 81.5% and 88.1%, respectively. There was no significant difference in postoperative tests between two groups ( P ＞ 0.05 ). Tests of cardia position by o'clock showed that cardia positions of 80. 1% patients before surgery were located at sites between 10 and 11 o'clock and those of 91.7% after surgery being at 9 o' clock or less. Conclusions The Niseen and the floppy Nissen fundoplication can reach good long-term results in treatment of sliding hiatus hernia. Mechanism of these antireflux procedures include, by fundoplication, increasing esophageal sphincter pressure, prolonging the sphincter length, deepening His angle and prolonging abdominal esophagus, etc. Among them, the last one, descending the cardia position to 9 o'clock or less is vital to antireflux.The test of cardia position by o'clock is practically important to reach the successful result.

AIM: To investigate the possible impact of conductive keratoplasty(CK)on intraocular pressure( IOP ).METHODS: 36 eyes of 20 patients with hyperopia underwent IOP measurement with non-contact tonometer (NCT), Goldmann applanation tonometer (GAT) and Schiotz tonometer before and after CK.RESULTS: After CK, a significant decrease was observed by NCT, GAT and Schiotz measurements. The change in IOP readings was not correlated with age, sex,keratometric readings, or attempted correction.CONCLUSION: The applanation tonometer atend to underestimate the true IOP after CK.

Objective To identify the possible risk factors for esophageal delayed bleeding after endoscopic submucosal dissection ( ESD ) of early esophageal carcinoma and precancerous lesions. Methods Data of 281 patients with early esophageal carcinoma and precancerous lesions treated by ESD were reviewed. Risk factors for esophageal delayed bleeding were investigated by univariate analysis and logistic multivariable regression analysis. Results Esophageal delayed bleeding occurred in 22 patients ( 7. 83%) . Univariate analysis showed there was significant difference between delayed bleeding group and non?delayed bleeding group in regard of age ( P=0. 046 ) , lesion size ( P=0. 013 ) , and lesion infiltration depth( P<0. 001 ) . Together with three factors above, the intraoperative bleeding ( P=0. 068 ) was also analyzed by Logistic multivariable regression analysis which showed only infiltration depth was the independent risk factor of early esophageal carcinoma and precancerous lesions treated by ESD( P=0. 002, OR=6. 88,95%CI:1. 07?39. 28) . Conclusion Patients older than 60 years and diameters more than 3 cm might be prone to delayed bleeding, but the direct factor is infiltration depth. The deeper lesions infiltrate, the delayed bleeding is more likely to occur.

Objective To investigate the effect of ischemic preconditioning (IPC) on coronary microcirculation function in short-term hibernating myocardium(SHM) animal model.Methods Twelve little domestic Chinese pigs were established as the model of SHM by interventional method (closed-chest) and divided into 2 groups at random: the control group (CON group, n =6) and ischemic preconditioning group (IPC group, n =6).IPC was elicited by 2 cycle of 5 min of ischemia followed by 5 min of reperfusion before the establishment of model.Intracoronary Doppler guidewire was used to measure average peak velocity (APV),diastolic systolic velocity ratio(DSVR) and coronary flow reserve(CFR) of the distal to the stenosis at the baseline and 10 min,30 min,60 min,120 min after the establishment of model.Results APV,DSVR and CFR all decreased significantly in SHM model in both groups( P 0.05 ),at 60 min CFR of the CON group decreased significantly than before( 0.96 ? 0.27 vs 1.74 ? 0.49 , P 0.05 ).Conclusions The coronary microcirculation dysfunction happened at the time point of 60 min after coronary stenosis in SHM model,IPC can protect the coronary microcirculation function in SHM model.

[Objective]To analyze the biodegradation properties and active osteogenesis features of implanted composites of gelatin microspheres(GMs) impregnated with calcium phosphate cement(CPC) and recombinant human bone morphogenetic protein-2(rhBMP-2) in bone defect.[Method]rhBMP-2 loaded gelatin microspheres was incorporated in rhBMP-2/CPC during setting.Thirty rabbits were divided into groups A,B and C(10 each).The rhBMP-2/GMs /CPC,GMs/cpc and rhBMP-2/cpc was implanted into the rabbits of group A,B and C,respectively.The biodegradation properties and active osteogenesis features of implanted composites bone substitute was evaluated by radiography,histology,bone mineral density(BMD)after the composites were implanted into the bone defects at rabbit radius for 6,12 weeks respectively.[Result]Significant implant resorption and bone ingrowth were observed in all rhBMP-2/GM/CPC treated defects while the defects treated with rhBMP-2/CPC implants showed slight resorption of CPC and the defects treated with GM/CPC implants showed slight formation of new bone.[Conclusion]The result of this study suggested that the rhBMP-2/GMs/CPC composite could be used as material for bone graft substitute.

OBJECTIVE: To establish the quality standards for Qudu capsules. METHODS: TLC was used to identify Rheum Palmatum, Phellodendron Amurense, Angelica Sinensis and Pheretima Aspergillum in Qudu capsules. HPLC was used to determine the content of the effective ingredient Paeonia Lactiflora. RESULTS: The spots characteristic of Rheum Palmatum, Phellodendron Amurense, Angelica Sinensis and Pheretima Aspergillum were found through detection by TLC. The linear range of Paeonia Lactiflora was 0. 094 4～ 0. 944 0? g( r=0. 999 8) . The average recovery was 99. 94% ( RSD=1. 74) . CONCLUSIONS: This standard can be used for the quality control of Qudu capsules.

Objective To observe the inhibitory effects and characteristics of intravitreal injection with bevacizumab on laser-induced choroidal neovascularization (CNV).Methods Twelve male brown norway (BN) rats were divided into the bevacizumab group and control group with six rats in each group.One eye of rats were received a series of 8 diode laser esions around optic disc to induce CNV,then the rats in bevacizumab group and control group underwent intravitreal injection with 2 μl bevacizumab and ringer's lactate.On days 7,14,and 21,the morphology and leakage of CNV were observed by fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA).On day 21 after photocoagulation,thephotocoagulated eyes were enucleated and processed for histopathologie examination,including hematoxylin and eosin (H&E) staining and immunohistochemistry staining for vascular endothelial growth factor (VEGF).Results On day 7 after photocoagulation,ICGA showed that CNV developed in the bevacizumab group and the control group.FFA showed that leakage intensity in the bevacizumab group was significantly lower than that in the control group,but the bevacizumab group gradually increased over time.The mean thickness of CNV significantly decreased in the bevacizumab group.The CNV in the bevacizumab group were negative for VEGF according to the result of immmuohistochemistry staining.Conclusions Early intravitreal injection with 2 μl bevacizumab can reduce the thickness of CNV and inhibit the leakage of CNV.However,bevacizumab could neither block the formation of CNV,nor suppress the permeability permanently.Combined other therapies with bevacizumab may be more potential to treat CNV effectively.

Objective To study the mechanism of arecoline on damage to DNA through the bone marrow cell experiment in vivo. Methods Laser Confocal Microscope was adopted to measure DNA and RNA of the bone marrow cells marked by AO probe. Influences of arecoline on cell cycle were observed by the Flow Cytometer. Results Injection of arecoline to 20, 10, and 5 mg/kg posologic group, the fluorescence pixel ratio apparently higher than that in blank control group of the bone marrow cell inside RNA/DAN, the difference was significant (P

Education to medical postgraduates is relatively special. Their study and research work have something to do with their clinical practice. Based on their technical training for thoracic surgery,postgraduates were demanded to follow up and instruct their patients on postoperative recovery from surgery. In this way,these postgraduates were trained not only in clinical practice but also in other aspects,such as communication techniques,how to take care of patients,professional moral education. Instruction to outpatients is helpful to cultivate post-graduates and promote their abilities in self-thinking,self-acknowledging,initiative,creation,and so on. Instruction to outpatients is an important way to bring up excellent medical postgraduates.

Objective To observe the clinical efficacy of electroacupuncture in treating herpes zoster.Method Ninety patients with herpes zoster were randomized into treatment group 1, treatment group 2, and a control group, 30 cases in each group. Treatment group 1 was intervened by surround needling at Ashi points (deep needling, by 33 mm) plus electroacupuncture; treatment group 2 was by surround needling at Ashi points (superficial needling by 16 mm) plus electroacupuncture; the control group was by oral administration of Valacyclovir Hydrochloride tablets plus Vitamin B1. After 10-day treatment, the blister-breaking time, crust-forming time, and the time of falling-off of the crust, and Visual Analogue Scale (VAS) were observed, and the clinical efficacies were compared.Result The recovery rate and total effective rate were respectively 73.3% and 93.3% in treatment group 1, versus 46.7% and 86.7% in treatment group 2, and 33.3% and 63.3% in the control group. The recovery rate of treatment group 1 was significantly different from that of treatment group 2 and the control group (P<0.01,P<0.05). The total effective rates of treatment group 1 and 2 were both significantly different from that of the control group (P<0.01,P<0.05). The blister-breaking time, crust-forming time, and crust falling-off time of treatment group 1 were significantly different from that of treatment group 2 and the control group (P<0.01,P<0.05). The crust-forming time and falling-off time of treatment group 2 were significantly different from that of the control group (P<0.05). The VAS scores were markedly changed after the intervention in the three groups (P<0.01). After the treatment, the VAS scores of treatment group 1 and 2 were significantly different from that of the control group (P<0.01). The VAS score of treatment group 1 was markedly different from that of treatment group 2 after the treatment (P<0.05).Conclusion Electroacupuncture is an effective method in treating herpes zoster, while deep surround needling at Ashi points plus electroacupuncture can effectively inhibit the development of blisters, promote crust-forming, release the neural pain, and reduce the incidence of postherpetic neuralgia.