Objective To explore the clinical characteristics of multiple primary carcinoma (MPC) in elderly patients and the effects of postoperative adjuvant chemotherapy on the prognosis and advanced cancer genesis. Methods The study population consisted of 220 elderly patients with malignant tumor. Thirty-seven elderly patients with MPC were selected in the study. The characteristics including onset age, carcinoma sites, effects of postoperative adjuvant chemotherapy, interval and survival time between first and advanced cancer were analyzed. Results of the 220 subjects,37(16.8%) patients were MPC, among whom 2 patients were synchronous multiple primary carcinomas (SMPC) and 35 patients were metachronous multiple primary carcinomas(MMPC). The median ages at onset were 70,77 and 77.5 years old for the first,second and third tumor respectively. Among a total of 82 tumor focus, the most predilection site of MPC was gastrointestinal tract, with a 34.2%(28 cases) in colorectum and a 13.4%(11 cases) in stomach. The postoperative patients were divided into two groups: 23 accepted adjuvant chemotherapy (chemotherapy group) and 14 accepted no adjuvant chemotherapy (no chemotherapy group). The survival time of chemotherapy group was significantly longer than no chemotherapy group (x2= 4.63, P = 0.0427 ). The median intervals between the first and the second cancer were 6 years and 4 years in chemotherapy group and no chemotherapy group, respectively(x2=1.63, P = 0.207), while the median intervals between the second and the third cancer were 7 years and 2 years, respectively(x2 = 4.255,P=0.043). The mediansurvival time of the third cancer postoperative patients were 3.5 years and 7 months in chemotherapy group and no chemotherapy group, respectively (x2 = 4.62, P = 0.0316 ) . ConclusionsPostoperative adjuvant chemotherapy may prolong the survival time and delay the advanced cancer genesis in elderly patients with MPC.

Objective The study aimed to explore the application of fast track surgery in nursing of patients with colon cancer in a primary hospital.Methods The 60 colon cancer patients were identified with numbers to indicate randomization into the fast tract surgery group (group A) and the conventional treatment group (group B) with 30 cases in each group.Group A used the concept of fast track surgery (FST) perioperative nursing care,whereas traditional perioperative nursing care for colon cancer was used in group B.Patients in both groups were observed for postoperative time for passage of gas by anus,time for first food intake,length of stay in hospital,fee for hospitalization as well as incidence of postoperative complications,and comparative analysis was carried out.Results Time for passage of gas by anus(t value was 3.571),time for first food intake (t value was 8.944),length of stay in hospital (t value was 3.397),fee for hospitalization (t value was 3.950) as well as incidence of postoperative complication in group A were lower than those of group B.The satisfaction degree of group A was 96.67％(29/30) while 83.33％(25/30) in group B and the satisfaction degree between the two groups was statistically significant.Conclusions In the primary hospital,the fast track surgery care used in colon cancer can not only speed up the recovery process of the patients,shorten hospital stay,reduce hospital cost and the incidence of postoperative complications,but also can reduce the workload of nurses and improve the satisfaction degree of patients.

Objective: to observe the effect of Roux-en-Y Gastric Bypass (RYGB)on STZ induced type 2 diabetic rat model, and to clarify its initial mechanism. Methods: 42 type 2 diabeticrats were randomly allocated into operation group(group O 12 rats); sham group(group S 10 rats); diet control group(group F 10 rats); control group(group C 10 rats). Fasting glucose, Insulin Growth Factor-1 ( IGF1), fasting plasma insulin levels, weight and food intake were measured before and 1st , 2nd, 3 rd ,4th, 8th and 16 th week after operation. Results: 16 weeks after operation in the Group O, fasting glucose fell to (8.8?4.9)mmol/L, IGF1 increase to (148.6?7.3)ng/L ,fasting plasma increase to (74.7?9.2)mIU/L and weight decline to (212.6?15.1)g ,there was statistical significance compared with the levels of preoperation (P

Studies have shown that erythropoietin (EPO) may have neuroprotective effect on cerebral ischemia, and exogenous EPO may also exert neuroprotective effect on cerebral ischemic injury through blood-brain barrier. Its mechanisms may include the upregulation of the expressions of apoptosis inhibiting genes bcl-2 and bcl-xl, the expression of key proteases during the process of inhibiting apoptosis, inhibiting nitric oxide oversynthesis, protecting against glutamate-induced excitotoxicity, etc.

Objective:To analyze the effect of bisoprolol on the cardiopulmonary function in the patients with CHF complicated with COPD. Methods:A retrospective study was used. Totally 60 cases of patients were divided into the observation group(30 cases) and the control group(30 cases)according to the different treatment method. The patients in the control group were treated with con-ventional methods including cardiotonic drugs,vasodilators,anticoagulation,myocardial nutrition and so on,while the patients in the observation group were treated with bisoprolol additionally at the initial dose of 1. 25mg,and the dose was increased to 10mg at the rate of 1. 25 mg/1-2 weeks. The cardiopulmonary function,clinical efficacy and adverse reactions of the two groups were compared after 3-month treatment. Results:The complete response rate and effective rate of the observation group were both higher than those of the control group(P<0. 05). All indices of cardiac function were improved in the two groups after the treatment(P<0. 05),and the im-provement of the observation group was better than that of the control group(P<0. 05). There was no obvious change in the pulmonary function before and after the treatment(P>0. 05). The incidence of adverse reactions in the two groups showed no significant differ-ence(P>0. 05). Conclusion:Bisoprolol combined with conventional treatment can improve cardiac function of the patients with CHF and COPD. The adverse effect on lung function is mild. Bisoprolol is safe and effective,which is worthy of promoted application.

Toxoplasma gondii is a medically and agriculturally important protozoan parasite that can infect virtually all the mammalian and avian species. Previous studies showed that the family of rhoptry proteins (ROPs) plays a key role in the invasion process of T. gondii, and its several members can be potential marker for population genetic researches of Toxoplasma. In order to estimate whether other member is also suitable as the novel genetic marker, the variation of ROP41 gene among 11 T. gondii isolates from different hosts and geographical locations and two reference strains was examined in this study. Our results showed that all the examined sequence of TgROP41 gene was 1473 bp in length, and their A+T contents were between 48.47% and 48.88%. Sequence analysis presented 14 nucleotide mutation positions (0%-0.54%), leading to 5 amino acid substitutions (0%-0.61%) through alignment with T. gondii ME49 strain (ToxoDB: TGME49_266100). Furthermore, phylogenetic analyses by MP and BI methods based on deduced amino acid sequences of TgROP41 gene was only able to distinguish the type I strain, but not able to separate the two classical genotypes (Type II and III) into the respective clusters. These results indicated limited sequence diversity in the TgROP41 gene.

?AIM: To investigate the compliance in patients with topical glaucoma therapy, and identify the most frequent barriers to adherence.?METHODS: One-on-one interview and questionnaire were taken to investigate the compliance with hypotensive eye drops in 366 patients who had been diagnosed as glaucoma and received the therapy for at least 6mo in Wuhan and suburban district from July 2014 to June 2015 in Wuhan Aier Eye Hospital.?RESULTS: The proportion of compliance was 44. 3%( 162/366 ) . Factors significantly influencing compliance included severity of the better eye, the severity of symptom when attacked, duration of medication and whether to administrate on the same time daily ( OR=5. 700,0. 554,0. 336,0. 558,P<0. 05). Age, gender, marital status, education level, economic status, domicile, knowledge of the disease, suffering from other diseases with medication, type of glaucoma, type of eye drop, frequency were not associated with a higher rate of non-compliance.? CONCLUSION: Compliance in patients with topical glaucoma therapy in Wuhan is poor. Regularly carrying out relevant health education and interventions is very important.

Abstract?AIM: To assess the efficacy and adverse reactions of two concentrations of diluted botulism toxin A ( BTX-A) for blepharospasm.?METHODS:Totally 220 patients (440 eyes) confirmedas blepharospasm in our department ( from January 2013 to January 2015 ) , were divided randomly into two groups:110 in high concentration group and 110 in low concentration group.The two groups were given local injections with 25 U/mL or 40 U/mL concentration of botulism toxin type A to the upper and lower eyelids orbicular muscle, corrugator, reducing eyebrow muscle and procerus respectively.We observed dosage of two groups, the treatment effect, the duration of the effect and the incidence of adverse reactions.?RESULTS: The high concentration group was given the BTX-A with 48.33 ±4.02U, the low concentration group was given the BTX-A with 28.51 ±3.42U,the differences were statistically significant( P<0.05).The differences of post-operative evaluation of curative effect, onset time and duration of the effect between the groups were not statistically significant ( P >0.05 ). Sixteen cases had ptosis in different levels in the high concentration group, and 2 in the low concentration group, the differences were statistically significant ( P<0.01).There were no serious complications such as intoxication, drug allergy in both groups.Ptosis relieved after using naphcon-A and disappeared in 2-3 wk.?CONCLUSION: The efficacy of local injection with two concentrations of diluted botulinum toxin A for blepharospasm was positive. Considering the high incidence of ptosis in high concentration group, we recommended the 25U/mL botulism toxin A for blepharospasm.

To improve the quality of health care by improving the quality of residency training,the Accreditation Council for Graduate Medical Education of USA has renewed the standards and methods of residency training to improve health care,and issued the compe- tence-based training standards. The residents have to achieve six key competences when they finish the training. The University of Washington,School of Medicine,responds to the new re- quirements and standards by reforming its residency training pathway,enriching formal teach- ing/training activities,and improving its supervision and the evaluation. We should use for refer- ence reforming the residency training in China.

Thrombelastography (TEG) is an image presenting the viscoelasticity changes of blood clot in the process of blood clotting,consequently reflecting the ability of blood clotting and fibrinolysis.TEG is increasingly used in the field of guiding intraoperative blood transfusion,monitoring the Blood coagulation function,treating trauma patient,and monitoring the blood coagulation and fibrinolytic function of a variety of diseases,due to its rapid and accurate results.We discuss the clinical applications progress of TEG in this article.