Objective To study the rationality in the use of proton pump inhibitors (PPI) to stress ulcer(SU) prophylaxis in pa-tients receiving aseptic-contaminative and contaminative incision operation .Methods A retrospective analysis was performed on the use of PPI to SU ,which taken from surgical patients received aseptic-contaminative and contaminative incision operation and hospi-talized from January 2013 to April 2013 .Results Among 1 745 patients in the study ,540(30 .95% ) received a stress ulcer prophy-laxis with PPI .The rate of prophylaxis to ICU ,general surgery ,urology ,thoracic surgery and neurosurgery was higher than other departments(except for between ICU ,thoracic surgery ,neurosurgery and orthopedic) .A total of 232 patients had risk factors , 72 .41% of the patients who received prophylaxis .A total of 1 513 patients did not have risk factors ,24 .59% of the patients who received prophylaxis ,the rate of prophylaxis to general surgery ,thoracic surgery and urology was higher than other departments (except for ICU ,and between thoracic surgery with orthopedics ) .In prevention of SU ,the usage rate of Lansoprazole was higher than that of Omeprazole and Pantoprazole .Preoperative prophylactic usage rate was 14 .44% .Excessive dosage was 0 .93% .Preven-tive medicine treatment longer accounted for 12 .78% .Conclusion The phenomenon such as non-risk factors ,inappropriate of medi-cation time and long course of treatment are existed ,when physicians use the PPI for SU prophylaxis in surgical patients receiving aseptic-contaminative and contaminative incision operation .Therefore ,treatment recommendations for SU prophylaxis are needed to restrict PPI use for justified indications .

Medicine has the close relationship with human beings.The conception of human body in medical science is quite different from that in the other fields.Therefore,the aesthetic sense of medical students has its own characteristics.And the medical science itself also asks the medical students to have the superior aesthetic culture than any other students.Thus,they can perform perfectly in the medical work that needs to contact people directly,and become the qualified doctor to maintain the human's health and rehabilitate the human's aesthetics.

Objective To explore the effects of childhood abuse on leptin level in blood plasma of adult depression patients.Methods 106 depression patients were included in this study.Children abuse status,severity of depression anxiety were assessed with the childhood trauma questionnaire (CTQ),Hamil-ton rating scale for depression ( HAMD) and Hamilton rating scale for anxiety ( HAMA) .According to CTQ score subjects were divided into abuse group ( n=38) and non-abuse group ( n=68) .Leptin levels were de-termined using the Enzyme Linked Immunosorbent Assay.Results Of 106 depression patients 35.85%( n=38) had been abused in childhood according to the result of CTQ score.There were significant differences between the abuse group and the non-abuse group in the age of first onset,sex ratio,the total score of the HAMD-24,the total score of HAMA.Leptin level of abuse group ((4.989±2.820)μg/L) was lower than that in non-abuse group((7.324±4.941)μg/L, P<0.05) and control group ((9.811±7.353)μg/L, P<0.01).Leptin level in non-abuse group was lower than that in control group ( P<0.01).Conclusion Childhood abuse obviously influences lep-tin levels of adult depression patients,which may be a risk factor of adult depression development.

Objective To discuss the safety and feasibility of percutaneous transhepatic biliary preset implantation of after-loading radiotherapy catheter in treating bile duct carcinoma of ampulla.Methods A total of 10 patients with carcinoma of ampulla were collected.After percutaneous transhepatic biliary stent implantation was accomplished,the after-loading radiotherapy catheter was inserted via the guide wire.Based on the lesion's location,the positioning of both the catheter tip and the simulation radioactive source implanted through catheter was conducted.Each time before irradiation,the positions of the catheter and the radioactive source were reset under CT or fluoroscopic guidance in order to ensure that the lesion could get adequate internal irradiation dose.Results Percutaneous transhepatic biliary implantation of after-loading radiotherapy catheter and the positioning of simulation radioactive source were successfully accomplished in all 10 patients,and the total internal irradiation dose was completed within 5-7 days after catheter implantation.No severe complications occurred during the whole therapeutic process.Conclusion The technology of percutaneous transhepatic biliary preset implantation of after-loading radiotherapy catheter is safe and feasible,it carries high success rate with less complications.This therapy can improve the patency rate of biliary stent,and,as a palliative treatment,it is suitable for patients with carcinoma of ampulla.This treatment is worthy of application and promotion.

Objective:To explore the efficacy and safety of 192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with unresectable advanced obstructive extrahepatic cholangiocarcinoma. Methods:A retrospective analysis of the efficacy and safety of 18 patients with unresectable advanced malignant obstructive extrahepatic cholangiocarcinoma admitted to the Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine in Hebei province from January 2014 to January 2018.All patients were pathologically confirmed and received biliary stent implantation, followed by sequential intensity-modulated radiotherapy and 192Ir three-dimensional brachytherapy.The clinical data of all patients were collected, including gender, age, clinical stage, adverse reactions, brachytherapy dose-volume parameters, changes in bilirubin levels before and after treatment, evaluation of efficacy, local control rate and survival rate. Results:All patients successfully completed the treatment.Re-examination was conducted one month after the combined treatment, of the 18 patients, 16 had partial remission (PR) and 2 were stable(SD). Among them, 14 patients had tumor shrinkage after brachytherapy compared with intensity-modulated radiotherapy, and 4 patients showed no significant change.The 6-month local control rate (LC) was 94.4% (17/18). The 1-year survival rate was 55.6% (10/18), and the 2-year survival rate was 38.9% (7/18). Statistical analysis showed that after combined treatment, total bilirubin and direct bilirubin were significantly reduced, and jaundice symptoms were significantly relieved.The adverse reactions of the patient were nausea, vomiting, fever, biliary tract infection, etc.There were no adverse reactions of grade 3 or above.Conclusions:192Ir three-dimensional brachytherapy combined with intensity-modulated radiotherapy in patients with inoperable advanced extrahepatic cholangiocarcinoma has a good local control rate and tolerable adverse reactions, but the impact on long-term survival requires a large sample of controlled studies.

Objective:To evaluate the effect of resection of frontal ethmoid sinus osteomas with nasal endosco-py. Method: Eighteen cases of frontal ethmoid sinus osteoma from 2005 to 2008 were enrolled in our study, including 8 cases of frontal sinus osteomas, 6 cases of ethmoid osteomas and 4 cases of frontal sinus osteomas extending to ethmoid sinus. Seventeen cases were treated by an endoscopic approach alone, and one case treated by a combined endoscopic and an external approach. Result: All cases were resected completely without complications. The preoperative symptoms disappeared without recurrence within the follow-up periods , ranging from 6 months to 3 years. Conclusion: Most frontal ethmoid sinus osteomas can be resected with nasal endoscopy aided by extra nasal incision in some cases.

Objective To evaluate how functional endoscopic sinus surgery(FESS)modifies patients symptom profiles and the quality of life and analyze the influential factors.Methods During 2010 to 2012,90 cases were investigated to evaluate the quality of life of different age groups to use SNOT-20.Results The quality of life after the surgery of different age groups were significantly higher than it before the surgery(P<0.05).The juvenile group:first dimension(nasal congestion,70%),the second dimension (memory,30%),the third dimension(worried about the condition,30%)and the fourth dimension(social influence,40%).The young aged group:first dimension(nasal congestion,73.3%),the fourth dimension(social influence,43.3%),second dimension (quality of sleep,20.0%)and the third dimension(irritability,16.7%).The middle and old aged group:first dimension(nasal con-gestion,66.7%),the third dimension(trepidation,20%),the second dimension(quality of sleep,20.0%)and the fourth dimension (financial burden,40.0%).Preoperative QOL related factors:complications,age,gender,disease duration and urban-rural;Postop-erative QOL related factors:complications,disease duration,age,perioperative management,gender and urban-rural.Conclusion The quality of life of different ages after FESS is improved in different aspects.To increase the level of perioperative compliance can improve the quality of life.

OBJECTIVE To analyze the value of modified sinus CT score in olfactory function evaluation before and after functional endoscopic sinus surgery in chronic rhinosinusitis with nasal polyps(CRSwNP). METHODS Fifty-four patients who underwent functional endoscopic sinus surgery for CRS with nasal polyps were enrolled in this prospective study by inclusion criteria and exclusion criteria. T&T methods and olfactory function VAS were used to analyze the subjective olfactory function and were performed preoperatively and at 6 months after surgery. In modified sinus CT score, middle turbinate and superior turbinate associated olfactory cleft areas were used to evaluate the anterior olfactory cleft score(AOCS) and posterior olfactory cleft score(POCS). Sinus CT scans Lund-Mackay scores were also collected before surgery. The correlation between the status of the olfactory cleft on CT, Lund-Mackay score and the preoperative and postoperative olfactory results were investigated.RESULTS Among 54 patients, there were 36 male and 18 female, with average age of 47.9 years old(from 24 to 67 years). There were 30 patients followed 6 months after surgery. The findings of olfactory cleft opacification and the CT Lund-Mackay scores had a positive correlation with preoperative olfactory results(P<0.001). The olfactory cleft opacification showed a stronger correlation with the preoperative olfactory results than the CT Lund-Mackay score. The AOCS was more significantly correlated with the postoperative olfactory results than the other parameters.CONCLUSION Preoperative CT findings, especially the anterior portion of the olfactory cleft had a statistically significant association with the postoperative olfactory results in patients with CRS with nasal polyps.

OBJECTIVE To investigate the correlation between nasal obstruction score, Lund-Mackay score,congestion index and tissue remodeling degree of nasal mucosa in patients with chronic rhinosinusitis(CRS) and to study the role of diagnosing remodeling.METHODS Forty-three patients with CRS who underwent endoscopic surgery were studied.Congestion index of nasal mucosa was obtained by acoustic rhinometry.Nasal obstruction score was obtained by visual analogue scale.CT score was obtained by Lund-Mackay.The mucosa specimen of uncinate process from nasal cavity of the patients was used to evaluate the fibrosis degree.Statistical analysis was performed using SPSS11.5.RESULTS Nasal obstruction and Lund-Mackay score had no correlation with fibrosis degree of mucosa(r=0.77,P=0.40),whereas congestion index of nasal mucosa had a negative correlation with fibrosis degree of mucosa(r=-0.348, P=0.022).CONCLUSION Nasal congestion index can reflect the degree of remodeling in submucosal tissue.Nasal congestion index with obstruction symptoms and CT scan can be used to guide the CRS treatment strategies.

Objective To establish a molecular technique of internal transcribed spacer (ITS) sequencing to identify pathogenic fungi species from the fungal sinusitis tissues. Methods Total 270 sinusitis tissues samples were collected by endoscopic surgery from 2006 to 2008. The histopathology, organize spring clip culturation and ITS region (ITS region region of fungal rRNA, including ITS1-5. 8S rRNA-ITS2) sequencing were employed simultaneously. And then to evaluate the ITS sequencing as the tool for identification of pathogenic fungi directly from clinical samples. Results Of the 270 samples, histopathology positive rate was 80.0% (216/270) , organize spring clip positive rate was 80.0% (216/ 270), fungal culturation positive rate was 53.0% (143/270) , ITS region sequencing positive rate was 63. 0% [ (134 +28 +8)/270], There were 22 species and 6 genera identified by fungal culturation, and 32 species identified by ITS region sequencing. Conclusion ITS region sequencing will become a applicable tool in clinical laboratory in future.