Digestive tract reconstruction is an important part of gastric carcinoma operation as well as tumor resection and lymph node dissection.Surgeons are seeking the optimal reconstruction method that reduces the occurrence of complications and maintains better quality of postoperative life extremely.Uncut Roux-en-Y anastomosis is a modified procedure in which an artificial jejunal occlusion is devised to avoid Roux stasis syndrome based on Billroth Ⅱ and Braun's anastomosis.Compared to the conventional Roux-en-Y anastomosis,the uncut Roux-en-Y anastomosis retains the advantage of preventing biliary and pancreatic secretions reflux,furthermore,it can decrease the symptoms associated with Roux stasis owing to the abnormal myoelectrical conduction of Roux limb.Because the early studies indicated that there was higher incidence of dehiscence or recanalization of the jejunal occlusion,the uncut Roux-en-Y anastomosis has not been widely applied.Since jejunal occlusion has been optimized recently,the uncut Roux-en-Y reconstruction may be an optional and appropriate method of digestive tract reconstruction after distal gastrectomy.

Objective To investigate the features and influence factors of cardiac function in preterm infants.Methods One hundred and eleven preterm infants were divided into three groups according to the gestational age which was 28-31+6,32-33+6 and 34-36+6 weeks respectively.Fifty term-birth infants at gestational age of 37-41+6 weeks were taken as control group.The cardiac function was examined by SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus.The parameters of cardiac function included heart rate,peak flow rate of aorta valve orifice (AV),peak flow rate of pulmonary artery valve orifice (PV),cardiac output (CO),stroke volume (SV),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),the ratio of early (E) and late (A) diastolic velocities of mitral and tricuspid valves (MVE/A,TVE/A).Within one week after delivery,the cardiac function was examined,and the cardiac function of preterm infants with different gestational age were compared.Another 162 preterm infants were divided into four groups according to the time at examination as 12 h-,24 h-,72 h-and 1 week-28 d.The influence factors of cardiac function were determined by multi-factor linear regression analysis.Results The AV,PV,CO,LVEDV,LVESV and SV increased with the increasing of gestational age.MVE/A (1.13±0.17,1.14±0.18,1.13±0.18) and TVE/A (0.90±0.16,0.90±0.13,0.90±0.15) of 28-31+6,32-33+6 and 34-36+6 weeks group were higher than those of control group (1.28±0.17 and 1.04±0.20),respectively (P＜0.05).PV of 72 h-group and 1 week-28 d group were higher than that of 12 h-group [(79.60±11.22) cm/s and (78.86±13.64) cm/s vs (72.61±8.56) cm/s](P＜0.05).The heart rate of 1 week-28 d group was higher than that of other three groups (P＜0.05).Both CO and SV were positively related to body weight and gestational age (r=0.55 and 0.36,0.61and 0.52,respectively,P＜0.05).Conclusions The left ventricular pump function increases with the increasing of gestational age,while the diastolic function of left and right ventricle of preterm infants does not change significantly in the first month of life.The PV of preterm infants significantly increases 72 h after delivery.The body weight and gestational age are important influence factors of cardiac function in preterm infants.

Objective To investigate the dynamic change and correlation of the pulmonary ventilative function, mechanic and cardiac function in the term infants. Methods Twenty hundred term infants were divided into A 、B 、C and D groups by age which was 0 ～ 24 h, ～ 72 h, ～ 1 w and 28 d respectively. The lung ventilative and mechanical function were measured respectively by using techniques of tidal breathing flow-volume loop(TBFVL)and the single occlusion. The Master screen Paed-lung function devices of Germanic JAEGER Co. was be used in this study. The parameter of pulmonary function including minute volume(MV) ,tidal volume (TV), respiratory system compliance(Crs) and respiratory system resistance (Rrs). The cardiac function were measured by using SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus. The main parameter of cardiac function including cardiac output(CO) and stroke volume(SV). Results The TV of A, B ,C and D group were 20. 2 ± 3.78,21. 1 ± 3.71,22. 3 ± 4. 48 and 23. 9 ±4.90 (ml)respectively, the TV of C and D group were higher than that of A group, and the TV of D group was higher than that of B group (P ＜ 0. 05).There were no significantly difference of Crs, Rrs among A, B, C and D group(P ＞ 0. 05). The CO of A,B,C and D group were 0.93 ±0. 23,0.93 ±0.23,1.02 ±0.21 and 1.08 ±0.27 (L/min) ,the CO of D group was higher than that of A and B groups (P ＜ 0. 05). The CO was negative correlation with Rrs (r = - 0. 16,P ＜ 0. 05) and positive correlation with MV、 TV、 Crs (r was 0. 50、 0. 54、0. 13 respectively, P ＜ 0. 05).Conclusion The lung ventilative function is mature gradually with increasing age. The cardiac output has been obviously improved for postnatal 1 week in the term infants. The pulmonary ventilative function and mechanic parameter are important effective factors of cardiac function.

Objective To investigate the time and risk factors for spontaneous closure of patent ductus arteriosus (PDA) in preterm infants. Methods One hundred and seventy-seven preterm infants with arterial ductus unclosed were divided into three groups according to their gestational age as 28-31+6 weeks group (n=44),32-34+6 weeks group (n=59) and 35-36+6 weeks group (n=74).PDA was diagnosed by echocardiography in time of ≤12 h,-24 h,-48 h,-72 h,-96 h,-120 h,-144 h and ＞144 but ≤168 h after birth.The parameters of cardiac function included peak flow rate of aorta valve orifice,peak flow rate of pulmonary artery valve orifice,cardiac output,stroke volume,ejection fraction,the ratio of early (E) and late (A) diastolic velocities of mitral and tricuspid valves.The risk factors of arterial ductus spontaneous closure were determined by Logistic regression analysis.Results The cumulative spontaneous closure rates of preterm infants in three groups were 95.5％,100.0％ and 100.0％ within 168 h after birth respectively. There were significant differences of cumulative spontaneous closure rate in different time among three groups (x2 =4.23,7.45,12.46,7.14,4.75,6.47,3.89 and 3.89 respectively,P＜0.05).After spontaneous closure of PDA during 12-24 h, peak flow rate of pulmonary artery valve orifice increased [(0.69±0.12) cm/s vs (0.65±0.12) cm/s,t=2.37,P=0.02],peak flow rate of aorta valve orifice [(0.65±0.11) cm/s vs (0.69±0.12) cm/s,t=2.51,P=0.02] and ejection fraction [(63.00±8.50) ％ vs (66.00±8.50) ％,t=2.34,P=0.02] decreased.Logistic regression analysis showed that,the risk factors of preterm infants with arterial ductus unclosed within 24 hours after birth were gestation age (OR =1,825,95％CI:1.239-2.689),1 min Apgar score 0-3 (OR=1.946,95％CI:1.572-3.527) and early onset sepsis (OR=3.215,95％CI:1.245-5.463) ; gestation age (OR=3.270,95％CI:1.852-5.774),twins (OR=3.634,95％CI:1.489-8.871),1 min Apgar score 0-3 (OR=3.752,95％CI:2.156-5.436),Ⅲ-Ⅳ stage of respiratory distress syndrome (OR=2.897,95％CI:1.764-5.348) and early onset sepsis (OR=3.172,95％CI:2.134-6.437) were the risk factors of preterm infants with arterial ductus unclosed during 24-48 hours after birth; and gestational age (OR=2.471,95％CI:1.087-5.613),1 min Apgar score 0-3 (OR=2.985,95％CI: 1.469-5.736), Ⅲ-Ⅳ stage of respiratory distress syndrome (OR =3.645,95％ CI:1.879-6.282),fluid volume excess (OR =4.135,95％CI:2.146-7.428) and early onset sepsis (OR=3.246,95％CI:2.146-4.526) for those with arterial ductus unclosed during 48-72 hours after birth. Conclusions The spontaneous closure rate of arterial ductus in the newborn infants whose gestational age over 28 weeks was above 90％ in the first week after birth.There was no difference of left ventricular pump function between before and after the spontaneous closure.Reducing the incidence of premature birth,twins,severe asphyxia,severe respiratory distress syndrome, fluid excess and early onset sepsis might improve the spontaneous closure of arterial ductus.

OBJECTIVE:To investigate the status quo of teachers'teaching ability of standardized training for hospital pharma-cists in Beijing area,and provide reference for strengthening the faculty construction. METHODS:A dynamic assessment of stan-dardized training base for hospital pharmacists of 17 inpatients in Beijing area was conducted to organize evaluation experts to as-sess the teaching ability of outpatient pharmacy,ward pharmacy and clinical pharmacy in training base. Questionnaire was designed and trainees were organized to evaluate the teaching ability,time,attitude,feedback and others and related results of teaching in bases were vegarded as objects for analysis and summary. RESULTS:The overall ability of teaching was high,and the most promi-nent was clinical pharmacy,which was well received by trainees. But there are differences among departments,the ability of ward pharmacy is slightly lower than the clinical pharmacy and outpatient pharmacy. And the teaching ability still had great improvement. CONCLUSIONS:In order to improve the overall teacher strength in training base,competence-based training for hospital pharma-cists must be strengthened to encourage teachers to attend training courses,strengthen cultivation of humanistic quality and enrich students'evaluation forms.

Objective To investigate the application and clinical effect of uncut Roux-en-Y (uncut RY) anastomosis in laparoscopic distal radical gastrectomy of gastric cancer.Methods The retrospective crosssectional study was adopted.The clinical data of 23 patients with gastric cancer who were admitted to the Northern Jiangsu People's Hospital from December 2014 to July 2015 were collected.All the 23 patients underwent laparoscopy-assisted distal gastrectomy (LADG) and total laparoscopic distal gastrectomy (TLDG) according to the individual situations.The indexes of observation were collected,including (1) intraoperative indexes:operation time,uncut RY anastomosis time and volume of inraoperative blood loss,(2) postoperative indexes:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay,occurrence of complications and results of pathological examination,(3) results of follow-up.The follow-up was performed by outpatient examination and telephone interview up to November 2015,including postoperative discomfort after diet intake,barium meal examination of gastrointestinal tract at postoperative month 1 (anas-tomotic stenosis,recanalization and dehiscence of occlusion),detecting situations of gastric remnant and anas-tomotic stoma at postoperative month 3 by gastroscopy and occurrence of gastrointestinal obstruction.Measurement data with normal distribution were presented as x ± s.Results (1) Intraoperative situations:all the 23 patients underwent successful uncut RY anastomosis,including 18 receiving LADG and 5 receiving TLDG.The operation time,uncut RY anastomosis time and volume of intraoperative blood loss were (165.9 ± 11.6) minutes,(18.2 ± 2.2) minutes,(48 ± 6) mL in all the 23 patients and (172.0 ± 8.5) minutes,(26.6 ± 1.5) minutes,(46 ± 4) mL in 5 patients with TLDG,respectively.Two patients received hemostatic treatment using suture and hemostatic forceps due to anastomotic bleeding.(2) Postoperative situations:time to anal exsufflation,time for initial water intake,time for semi-fluid diet intake,time for out-off-bed activity,duration of hospital stay and incidence of complications in all the 23 patients were (2.2 ± 0.4) days,(2.7 ± 0.4) days,(3.5 ± 0.4) days,(2.7 ± 0.3) days,(10.6 ± 1.4) days and 8.7％ (2/23),respectively.No patient was dead in the perioperative period.Two patients complicated with incisional infection and high fever were cured by symptomatic treatment,without occurrence of anastomotic leakage,bleeding and anastomotic-related complications.All the patients received postoperative barium meal examination of upper gastrointestinal tract,with unblocked anastomotic stoma and without leakage of barium meal.Diameter of tumor and number of lymph node dissected were (3.2 ± 1.2) cm and 30 ± 4,with negative upper and lower resection margins.Numbers of patients with tumor differentiation,T stage,N stage and TNM stage were 12 and 11 in differentiated and undifferentiated tumors,1,9 and 13 in T1,T2 and T3 stages,9,11 and 3 in N0,N1and N2 stages,1,4,9,6 and 3 in Ⅰ a,Ⅰ b,Ⅱ,Ⅲ a and Ⅲ b stages,respectively.(3) All the 23 patients were followed up by outpatient examination for 3-11 months.One patient had discomfort in upper abdomen with vomiting at postoperative week 3,and no anastomotic leakage,bleeding and anastomotic-related complications were occurred in other patients.Conclusion As a modified anastomotic method,uncut RY anastomosis is safe and feasible,and it is also an ideal method of digestive tract reconstruction after laparoscopic distal radical gastrectomy.

Objective Study the concentration of the hepatocyte growth factor(HGF) the expression product of recombinant human hepatocyte growth factor naked plasmid ,and whether the body generates immune responseafter wsing HCF. Methods Selected 21 patients with severe ischemic disease of lower extremity (Rutherford classification 4-6 class) , after signing the informed consent and divided them into four dosage groups( 4 mg, 8 mg, 12 mg and 16 mg) random.In each group the dosage was the lower limbs partly intramuscular injection following the feeding artery in experimental stage Dl and D15. The plasma samples were collected to determine the HGF concentration in Dl ( before administration), D8, D15 ( before administration) , D21, D59, and the HGF-antibody concentration in Dl, D15, D28, D59, D91. Results (1)The concentrations of HGF in the subjects ranged from 216 pg/mL to 1189.75 pg/mL.(2) HGF-antibodies were not dectected in the subjects' plasma. Conclusions After using recombinant human HGF naked plasmid through intramuscular injection, the concentration of HGF expression product in subjects' peripheral blood does not have abnormally changed and using the drug the human body immune response does not generate.

Objective To explore the effect of health education through different postoperative follow-up method, including telephone、Email and QQ, on patients with indwelling D-J stents. Methods 319patients with indwelling D-J stents were divided into the control group(88 cases), the telephone group(89 cases), the Email group (70 cases) and the QQ group (72 cases). M1 patients received rourine health education during hospitalization and before discharge, the latter three groups received follow-up by telephone、Email and QQ after discharge respectively. The rehabilitation effect was observed in the four groups. Results The complication rates of the telephone group, the Email group and the QQ group was significantly less and the mastering of knowledge about prevention and handling of complication was better than the control group during the follow-up. Conclusions Different types of follow-up can be selected by patients according to their actual status. Decreasing complication rate, favorable social benefit and approval of the patients family members will be seen due to involvement of the patients family in health education.

OBJECTIVE: To observe the effects of Jianpi Yishen Recipe (JPYSR), a compound Chinese herbal medicine, on recurrence, metastasis and life span of mice transplanted with proventriculus squamous carcinoma cells after tumorectomy. METHODS: JPYSR was orally administered to 615 mice transplanted with proventriculus squamous carcinoma cells in the palma of left hind limb after tumorectomy. The local tumor recurrence, lung metastasis and life span of the mice were evaluated and compared with those of the 5-FU-treated mice and untreated mice. RESULTS: The pulmonary metastasis rate was 94.4% and the recurrence rate was 94.44% in untreated group. The pulmonary metastasis rate was 68.4%, the inhibition rate of pulmonary metastasis was 27.5%, the recurrence rate was 78.95%, and the inhibition rate of tumor recurrence was 65.35% in JPYSR-treated group. The average and median life spans were obviously prolonged in JPYSR-treated group, as compared with those in untreated group. The life-prolonging rate was 100%. CONCLUSION: JPYSR can effectively inhibit the local recurrence and pulmonary metastasis of the transplanted proventriculus squamous carcinoma in mice after tumorectomy, and prolong the life span.

Objective To investigate the safety and feasibility of the reversed π-shaped esophagojejunal anastomosis in laparoscope-assisted total gastrectomy (LATG) for gastric cancer (GC).Methods The retrospective corss-sectional study was conducted.The clinicopathological data of 18 GC patients who were admitted to the Subei People's Hospital of Jiangsu Province between January 2015 and October 2016 were collected.All the 18 GC patients underwent LATG,surgical procedures included free stomach and lymph node dissection firstly,side-to-side jejunal anastomosis secondly and laparoscopic gastrointestinal reconstruction using reversed π-shaped anastomosis finally.Observation indicators:(1) surgical situations:side-to-side jejunal anastomosis method,conversion to open surgery,operation time,reversed π-shaped anastomosis time,volume of intraoperative blood loss and number of lymph node dissected;(2) postoperative situations:time for initial out-of-bed activity,time to initial anal exsufflation,time for postoperative water intake,time of drainage tube removal,postoperative complications and duration of hospital stay;(3) postoperative pathological examination;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect diet intake,anastomosis patency,gastrointestinal obstruction and patients' survival up to March 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:18 patients underwent successful LATG and reversed π-shaped esophagojejunal anastomosis,without conversion to open surgery and perioperative death.Five patients used in vitro hand-sewn side-to-side esophagojejunal anastomosis through small incision of specimens sampling,and 13 completed all surgery under laparoscopy.Operation time,reversed π-shaped anastomosis time,volume of intraoperative blood loss and number of lymph node dissected of 18 patients were (187±12)minutes,(37±5) minutes,(735±18)mL and 29±2,respectively.(2) Postoperative situations:time for initial out-of-bed activity,time to initial anal exsufflation,time for postoperative water intake and time of drainage tube removal in 18 patients were (1.6±0.5) days,(2.3±0.4) days,(2.5±0.5) days and (7.5± 1.5) days,respectively.One patient complicated with esophagojejunal anastomosis fistula at postoperative day 3 was cured by drainage and symptomatic treatment and then discharged from hospital.Eighteen patients received regularly angiography using oral water-soluble contrast medium after recovering fluid diet intake,showing anastomosis patency and no contrast medium leakage,and then discharged from hospital.Duration of hospital stay of 18 patients was (12± 11) days.(3) Postoperative pathological examination:of 18 patients,15 were diagnosed with adenocarcinoma and 3 with signet-ring cell carcinoma.T2,T3 and T4 of T staging were respectively detected in 3,3 and 12 patients.N0,N1,N2 and N3 of N staging were respectively detected in 8,3,2 and 5 patients.Stage Ⅰ,Ⅱ and Ⅲ of TNM stage were detected in 3,5 and 10 patients,respectively.(4) Follow-up and survival situations:17 of 18 patients were followed up for 6-25 months,with a median time of 12 months.During the follow-up,2 patients were complicated with sour regurgitation and vomiting after eating at month 6 and 12 postoperatively and received gastrointestinal contrast examination,showing anastomotic stenosis,and then were cured by endoscopic dilation and discharged form hospital.Other patients had good diet and survival,without anastomotic complications.Conclusion The reversed π-shaped esophagojejunal anastomosis in LATG for GC is safe and feasible,with good short-term outcomes.