Objective To explore the value of carbox dioxide(CO2 )for the upper gastrointestinal endoscopic mucosal dissection(ESD).Methods A total of 158 patients who underwent ESD from January 2012 to May 2014 at Endoscopy Center of Dongguan Hospital were enrolled in the study.The patients were randomly divided into air group and CO2 group.The arterial partial pressure of CO2 (PaCO2 ),the monitering results of SpO2 before,during,afte operation,abdominal pain after operation and postoperative complications were assessed.The safety and advantage of CO2 of the upper gastrointestinal ESD were comparative ana-lyzed.Results PaCO2 of air group and CO2 group during the ESD procedures [(47.8 ±5.4)mmHg, (45.1 ±5.5)mmHg]was significantly higher than that before[(37.2 ±4.6)mmHg,(36.3 ±3.9)mmHg] (P <0.05)and after the operation[(39.9 ±4.0)mmHg,(39.4 ±4.2)mmHg](P <0.05).Preoperative, intraoperative and postoperative PaCO2 were not significantly different between the two groups(P >0.05);all the SpO2 were greater than 90%,and it was not significantly different between the two groups(P >0.05). The abdominal pain score of CO2 group was significantly lower than that of air group less than 2 h after wake-up (P <0.05),but there was no difference between the two groups at 12 h and 24 h after operation(P >0.05).The bleeding rate of air group and CO2 group during and after operation was not significantly different (P >0.05),and there were no other serious complications.Conclusion CO2 is safe in the upper gastroin-testinal ESD,and it can reduce postoperative abdominal pain,so it is suitable for clinical application.

The present study attempted to observe the protective effects of tungsten (W) on hepatic injury induced by endotoxic (ET) shock in rats and to study its mechanisms. 28 male Wistar rats were randomly divided into 3 groups: (1) ET group (n=11): a bolus injection of disintegrated E. Coli (5?4?10~(10) organisms/kg); (2) ET+W group: (n=11) an equivalent E. Coli was given after being pretreated with sodium tungstate rich food and water for 3-4 weeks; (3) Control group (n=6): NS. The results showed that pretreatment with W significantly attenuated the decrease of BP, total count of WBC and% of PMN, and increased the survival rate. In ET+W group, Plasma level of malondialdehydc decreased; activity of XO in hepatic tissue also decreased; the ratio of W/Mo increased, the serum GPT level decreased (P

Objective To evaluate the usefulness of color Doppler ultrasonography in differential diagnosis of cervical lymphadenopathy by depicting the intranodal vascular pattern. Methods One hundred and twenty lymph node lesions in 113 patients who underwent color Doppler flow imaging were grouped as reactive lymphadenitis ( n =25), tuberculosis ( n =14), lymphoma ( n =41), and metastasis ( n =40). The vascular patterns of hilar type, central type, peripheral type and mixed type were assessed. Results Most reactive lymph nodes( 92.0%) and lymphomatous nodes( 75.6%) showed hilar vessels,lymphomatous nodes also frequently demonstrated peripheral vessels( 75.6%).Central vessels or peripheral vessels were frequent in metastatic nodes( 60.0% and 57.5%, respectively).The intranodal vascular distribution in tuberculous nodes was simulated malignant disease. Avascularity was observed in 2 of 25 reactive lymph nodes and 1 of 14 tuberculous nodes. Conclusions Central vessels or peripheral vessels were mainly found in malignant lymphadenopathy,and the presence of hilar vessels is suggestive of benign lymphadenopathy. However, there is overlap of appearance between benign and malignant disease.

Objective To investigate the relationship between preoperative prognostic nutritional index(PNI) and prognosis in elderly patients with gastric cancer.Methods The clinical data of 62 patients over age 65 with gastric cancer who underwent radical gastrectomy for gastric cancer were retrospectively analyzed.PNI values were calculated and the relationship between PNI and untoward reactions and prognosis were discussed.Results PNI value is closely related with patient age(t=5.576,P<0.001),tumor size(x2=4.846,P=0.033),lymphatic metastasis(x2=13.742,P<0.001),preoperative CEA level(t=5.226,P<0.001).Among the 62 patients,12 cases with high-PNI had recurrence and 5 patients died during the follow-up period, while 11 case in low-PNI had a recurrence and 7 patients died.The recurrent rate(x2=4.055,P=0.044) and mortality rate(x2=4.630,P=0.043) of the high-PNI group were significantly lower than the low-PNI group.Conclusion PNI is a simple and useful marker for predicting the long-term outcomes of elderly gastric cancer patients, which should be included in the routine assessment of gastric cancer patients.

Due to the limit of large number of students,the traditional teaching mode of lecture in morality and politics theory simply emphasizes teaching lectures in theory and basic knowledge,while ignores the connection between theory and practice.This paper holds that only by creating a novel teaching mode which integrates lecture teaching and multiple chains of practice teaching,together with the mechanism guarantee,can an effective teaching be realized.

Objective To assess whether the delivery of 100% of the nutritional target from days 4 to 8 in the ICU with enteral nutrition plus supplemental parenteral nutrition(SPN) could optimize clinical outcome .Methods A total of 300 critically ill patients who had received less than 60% of their energy target from enteral nutrition(EN) were randomized to treatment group(n=150) and control group (n=150) .After using the stochastic indicator method after day 3 of admission to the ICU ,one received EN and the other received EN plus SPN during days 4 to 8 ,then we calculated energy targets with indirect calorimetry repeatedly .Results The mean energy delivery between day 4 and 8 was 28 kcal? kg -1 ? d-1 for the EN plus SPN group ,compared with 20 kcal?kg -1 ?d-1 for the EN group .Between days 9 and 28 ,the EN plus SPN group had a lower incidence of nosocomial infection com‐pared with EN group (P<0 .05) ,the mechanical ventilation time of the patients without nosocomial infection in EN plus SPN group was significantly lower than that of the EN group (P<0 .05) .The in-hospital mortality and the in-ICU mortality were similar in the two groups(P>0 .05) .Conclusion Individually optimized nutritional supplementation with enteral nutrition plus supplemen‐tal parenteral nutrition starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strate‐gy to improve clinical outcome in patients in the ICU for whom EN is insufficient .

OBJECTIVETo investigate the application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis.

METHODSFrom July 2005 to June 2013, 25 patients with multi-segmental myelopathic cervical spondylosis were treated by the expanding forming under the plate through cervical spatium intermusculare approach including 16 males and 9 females with an average age of 56.5 years old ranging from 35 to 78 years old. Among them, 10 cases were onset without causes slowly, 7 cases were onset without causes suddenly, 8 cases were onset after mild trauma or tired. JOA scoring, incidence of postoperative axial symptoms and imaging studies were used to evaluate the effect.

RESULTSTwenty-five cases were followed up for 6 months to 7 years and 6 months with an average of 2 years and 9 months. There were no infection, cerebrospinal fluid leakage after the operation, and complications such as nerve damage were occurred. The operation time was 120 to 150 min, the bleeding was 300 to 500 ml. Imaging examination showed vertebral canal sagittal diameter increased, the vertebral canal increased significantly in the cross sectional area of the spinal cord, cervical curvature was straighten in 4 cases (2 cases of them became normal sequence). There were no more cases of cervical protruding and segmental instability increased. Postoperative walking ability enhanced, the finger activity of majority of patients improved on flexibility, grip strength, and accuracy of using chopsticks improved, numbness and chest waist band feeling had different degree of reduce, preoperative urine impairment were improved to varying degrees. Preoperative JOA scores were 3 to 13 points with an average of (8.86 ± 4.25) points; Postoperative 12 months' JOA scores were 7 to 17 points with an average of (13.76 ± 3.56) points, period was 60.19% in average, JOA score had statistically difference between before and after operation (P < 0.05). The result were excellent in 14 cases, good in 6 cases, and fair in 4 cases and poor in 1 case.

CONCLUSIONApplication of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi-segmental myelopathic cervical spondylosis, through muscular clearance, can retain complete cervical back muscle, maintain stability of cervical spine, and vertebral canal can get effective decompression at the same time.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; Female ; Humans ; Laminectomy ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Spondylosis ; surgery

OBJECTIVETo explore the surgical method and its effects of adjacent spinal segment degeneration after anterior cervical fusion.

METHODSFrom March 2000 to March 2011, 27 patients with spinal segment degeneration who had accepted the operation of anterior cervical fusion were treated with surgical treatment. There were 16 males and 11 females with an average age of 55.3 years (ranged from 48 to 72 years). JOA scores and image examination were used to evaluate the clinical effects.

RESULTSAll patients were followed up for 1.8 to 7.2 years with an average of 3.6 years. All pathological segments obtained fully decompression with good spinal bombe, no internal fixation loosening and cervical spine instability were found. Nerve root pain had disappeared and nerve function had significantly improved. Before operation, 3 days after operation and at last follow-up, JOA scores were 9.15 +/- 3.46, 13.96 +/- 2.79 and 13.52 +/- 2.91, respectively, and there was significant difference between preoperation and postoperation (P < 0.05). Intervertebral height and physiological curvature improved obviously than preoperation (P < 0.05).

CONCLUSIONIn order to relief spinal compression and rebuild spinal stability, a surgical treatment will be recommend to adjacent spinal segment degeneration combining spinal nerve symptoms and physical sign as soon as possible. Selecting an appropriate surgery to treat different compressed segment would receive satisfactory results.

Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; adverse effects

Objective: To analyze the influences of implementing essential medicine system on primary medical institutions and give suggestions. Methods: Using system dynamics method to construct the compensation mechanism model for primary medical institutions. Compare the growth in revenue and expenditure of primary medical institutions before and after essential medicine system implementation. Results: After the implement of essential medicine system, the growth in total expenditure and total income of primary medical institutions is steadier; when the annual growth rate of government financial subsidies invested more than 13%, the growth in total receipts will keep balance. Conclusion: It’s better to guarantee the government financial subsidies invested in time, raise medical service price properly and establish comprehensive compensation mechanism for implementing compensation mechanism of primary medical institutions.

It's a new financial management system that our country implemented the management of separating the income and expenditure in the community health services.Beijing is one of the former pilot cities which carried on the management of separating the income and expenditure.To know the effectiveness of the implementations and its influence to the health services,this article analyses the status of community health services,the financial investment and the performance results in Beijing.Considering the above,this paper also provides policy recommendations on the development of health services in Beijing to improve the new urban medical service system which based on the community health services.