Objective To systematically review the efficacy and safety of drug-eluting stent(DES) versus coronary artery bypass grafting(CABG) in the treatment of left anterior descending coronary artery(CAD) stenosis.Methods Literature about the efficacy and safety of DES versus CABG for LAD stenosis was retrieved from digital databases of MEDLINE, EMbase, PubMed, and the Cochrane Library by November 2016.Data extraction and quality assessment of included studies were conducted by two independent reviewers.RevMan 5.3 software was used to perform meta-analysis.Results Ten studies involving 9771 patients were finally included.The results of meta-analysis showed that there was no significant difference in mortality [RR=0.88,95%CI(0.70,1.11),P=0.28],major adverse cardiovascular events[MACE,RR=1.04,95%CI(0.88,1.24),P=0.63] or myocardial infarction [MI,RR=0.92,95%CI(0.56,1.53),P=0.75], but PCI-DES significantly increased the risk of TVR [OR=2.43,95%CI(1.61,3.69),P<0.0001].Conclusion For LAD stenosis, PCI-DES strategy causes as high a rate of mortality, MACE and MI as CABG or DES, but PCI-DES can significantly increase the risk of TVR, so we should be cautious clinically.

Objective To study the changes of insulin-like growth factor-1(IGF-1) in serum of patients with obstructive jaundice.Methods The clinical data of 20 patients with obstructive jaundice were collected and the measurement of serum TNF-?,ALT, ALP, endotoxin and IGF-1 were performed. Results The serum IGF-1 in obstructive jaundice was significantly lower than that in gallbladder stone(P

Objective To evaluate the differences in image quality and radiation dose in the neck CTA between low tube voltage scanning method combined with exact calculation of contrast dosage and conventional scanning methods.Methods Ninety patients who had undergone neck CTA examination from October 2012 to June 2013 were prospectively selected to perform study.Patients were randomly divided into Group A,B and C,each with 30 cases.Tube voltage and contrast amount were,respectively,120 kV and 70-80 ml for Group A (conventional group),100 kV and exact calculation for Group B,80 kV and exact calculation for Group C.Using ANOVA test,radiation dose,contrast amount,CNR were statistically analyzed among three groups.Subjective evaluations were made of image quality by two experienced radiologists based on a 5-point system.Results The effective doses in Group B and C were (4.5 ± 0.7) mSv and (2.1 ± 0.4) mSv,respectively,significantly lower than (6.6 ± 0.9) mSv in Group A,with statistically significant difference(F =72.4,P ＜ 0.05).The amounts of contrast were significantly lower in Group B and C than that in Group A,which respectively were (73.2 ± 8.2) ml for Group A and (48.2 ± 5.1) for Group B and (48.6 ± 5.4) ml for Group C,with statistically significant difference (F =56.8,P ＜ 0.05).CNRs increased respectively by 42.2％ in Group B and by 42.2％ in Group C compared with Group A,with statistically significant difference (F =72.6,P ＜ 0.05).Venous artifact images were found in 10 patients of Group A,having different effects on image quality,whereas in Group B and C,there were not vein artifacts to found.Conclusions The low tube voltage (80 kV) scanning method combined with exact calculation of contrast features not only significantly lower radiation dose and lower contrast amount used,but also improved image quality in comparison with conventional method.

Objective To analyze the factors that influence joint function after plate fixation of unstable pelvic fractures.Methods A retrospective study was conducted to analyze the 109 patients with unstable pelvic fracture who had been treated with plate fixation from January 2007 to September 2014.They were 69 men and 40 women,23 to 72 years of age (average,46.3 years).By the Tile classification,15 cases were type B1,37 type B2,14 type B3,19 type C1,16 type C2,and 8 type C3.Their postoperative joint function was evaluated according to the Majeed criteria for functional evaluation.There were 86 cases in the good-to-excellent group (78.9％) and 23 in the fair-to-poor group (21.1％).Their data were analyzed in terms of gender,age,preoperative injury severity scale (ISS),body mass index (BMI),operation time,fracture type,reduction quality,postoperative complications,bone density,and postoperative weight bearing time.The influential factors were determined using Logistic regression analysis.Results All the 109 patients obtained a mean follow-up of 18.7 months (from 12 to 53 months).Preoperative ISS (P =0.000),fracture type (P =0.008),reduction quality (P =0.009) and postoperative complications (P =0.000) were identified as the factors influencing joint function after plate fixation of unstable pelvic fractures.Conclusion Preoperative assessment by ISS,a clear understanding of the pelvic fracture type,anatomical reduction of the fracture and efforts to reduce postoperative complications can effectively improve functional recovery of the joint after plate fixation of unstable pelvic fractures.

Objective To evaluate the feasibility of a low-dose contrast medium protocol for 64-slice CT angiography (CTA) of head using a low-tube-voltage setting.Methods ① Phantom study:64-slice spiral CT respectively sets 80,100,120,140 kV and 100,200,300,400,500 and 600 mA as scanning parameter lines.Analysis of the best Signal-to-noise ratios (SNR) and contrast to noise ratios (CNR).②Clinical study:to prospectively continuous select sixty-six patients with suspected intracranial aneurysm and arteriovenous malformation and so on from April to October of 2012 to perform hand CTA inspection.The random number table method for A,B two groups,33 patients in each group.Group A (conventional group)scanning parameters:120 kV,400 mA and amount of contrast agent:1 ml/kg; Group B(test group) scanning parameters:80 kV,600 mA,amount of contrast agent 0.5 ml/kg.Using independent samples t test for each group radiation dose,SNR,CNR were statistically analyzed.By two experienced radiologists to 5 points on two groups of image quality subjective evaluation.Mann-Whitney U test was used for statistical analysis of subjective evaluation.Results Group A and B group CTDIvol respectively is 59.1,27.5 mGy.Group B than in group A,CTDIvol decreased by 53.5％.A,B groups of the SNR,CNR were 71.5 ± 10.7,92.0 ± 7.4; 58.5 ± 10.5,79.6 ± 7.7,Group B than in group A SNR,CNR were enhanced by 22.3％,26.4％,differences were statistics significance (t =584.0,388.6,P ＜ 0.01).The subjective image evaluation of group B was bigher than group A (Z =31.2,23.4,P ＜ 0.05),differences were statistics significance.Two physicians on CTA images to assess the consistency of uniform height(Kappa =0.904,P ＜0.05).Conclusion In the head CTA examination,use of low tube voltage combined with low contrast dose not only can improve the image quality but also radiation dose were significantly lower.

ObjectiveTo evaluate the effectiveness of PBL teaching model for medical students in surgery bed side teaching.MethodsThe method of meta-analysis.ResultsFinally,twenty-six documents met the requirement.The resuhs of Meta-analysis showed that,in the aspect of theory improvement for medical students,WMD=6.46,95 ％ CI 为 2.56 ～ 10.36,P＜0.01 ; in the aspect of skill ability improvement,WMD=5.32,95 ％ CI 为 2.47 ～ 8.16,P ＜0.01.ConclusionThe model of PBL teaching could significantly improve the effectiveness in theoretical knowledge and skill ability.

Objective To probe the feasibility of gemstone spectral CT in imaging pulmonary angiography with low dose contrast medium.Methods A prospective study with multi-slice spiral CT pulmonary angiography was performed in consecutive 48 patients suspected with pulmonary embolism.Two groups (n=24 respectively)were divided at random including Group A used Gemstone spectral CT with 35 mL of contrast medium and Group B using 64-slice CT with conventional 80~90 mL of contrast medium.The CT values of the pulmonary trunk,lobe artery,pulmonary vein and ascending aorta were measured.The contrast to noise ratio of the pulmonary artery was also calculated.In addition,the image quality of CTA was evaluated independently by two experienced ra-diologists.Results The CT values of the pulmonary trunk and the subsegmental branches,and the CNR in Group A were signifi-cantly higher than those in group B,exhibiting statistical differences (t=8.6,P <0.001;t=12.2,P <0.001;t=1 1.3,P <0.001 respectively).However,the CT value of aorta in Group A was significantly lower than that in Group B (t=-7.6,P <0.001).The evaluation results of the CTA images by two radiologists showed that the image quality in Group A was better than that in Group B (Z =-8.6,P <0.001;Z =-9.0,P <0.001 ).Conclusion The image quality of pulmonary angiography with gemstone spectral CT using low contrast medium dose can be improved compared with the conventional spiral CT.

Objective To investigate the health-related quality of life (HRQoL) and its influencing factors in patients with gastric remnant cancer (GRC).Methods A total of 130 patients received gastrectomy more than 10 years ago because of early gastric cancer.According to the gastric remnant canceration after the surgery,patients were divided into GRC group (80 cases) and gastric remnant group (50 cases).Both the patients of these two groups accepted questionnaires of cancer patients' quality of life questionnaire (QLQ) C30 and gastric cancer specific questionnaire QLQ-STO22,the HRQoL were evaluated.The comparison between two groups with normal distribution of data was aralyzed by t test.Wilcoxon rank sum test was applied for the comparison between two groups with non-normal distribution of data.Optimal scaling regression analysis was used for screening HRQoL related clinical influencing factors.Results All the research objectives finished the questionnaires survey.Compared with health control group,the scores of GRC group were lower,which included quality of life evaluation,physical function,role function,emotional function,cognitive function and social function,and the differences were statistically significant (t =-6.678,-7.111,-10.605,-5.748,-4.765 and-21.170,all P＜0.01).The scores of fatigue,pain,diarrhea,nausea and vomiting,loss of appetite,economic difficulties,dysphagia,abdominal pain,reflux symptoms,diet restricted,anxiety,physical appearance and hair loss were higher,and the differences were significant (t=6.925,4.218,4.728 and Z=-5.236,-7.890,-7.698,-10.058,-3.612,-6.914,-9.711,9.940,-7.987 and-4.966,all P＜0.01).Compared with gastric remnant group,the scores of GRC group were lower,which included quality of life evaluation,physical function,role function,emotional function,cognitive function and social function,and the differences were statistically significant (t=-5.861,-5.821,-7.077,-7.999,-2.808and-5.710,all P＜0.01).However the scores of fatigue,pain,diarrhea,nausea and vomiting,loss of appetite,economic difficulties,dysphagia,diet restricted,anxiety,physical appearance and hair loss were higher,and the differences were significant (t=9.363,6.842 and Z=-2.654,-6.256,-3.266,-4.132,-2.854,-7.996,-4.258 and-2.005,all P＜0.01).Compared with health control group,the score of social function of gastric remnant group was lower and the difference was significant (t =-9.820,P＜ 0.01); the scores of diarrhea,nausea and vomiting,economic difficulties,dysphagia,reflux symptoms,diet restricted,physical appearance and hair loss were higher,the differences were statistical significant (t=3.020 and Z=-1.981,-3.775,-6.505,-6.098,-8.032,-3.369 and-3.147,all P＜0.05) ; the symptom scores of fatigue and pain were lower,the differences were significant (t=-2.890 and-2.439,all P＜0.05).HRQoL of patients was positively correlated with education degree,marital status,family income and the disease course of gastric remnant.Conclusions HRQoL of GRC patients decreased to certain degree.Education degree,marital status,family income and the disease course of gastric remnant were the influential factors of HRQoL in GRC patients.

Objective To understand the screening results and positive lesion situation of colonoscopy screening among high risk urban population of colon cancer in Chongqing Nan'an District to provide a basis for the community heath guidance.Methods The high risk subjects of colon cancer screened according to the item of the Early Diagnosis and Early Treatment of China Urban Cancer and in our center for completing colonoscopy screening during 2013-2016 were collected and analyzed on the positive rates of various lesions.Results A total of 435 subjects were included,141 positive cases were found with the total positive rate of 32.41％ (141/435),in which 75 cases were male positive with the positive rate of 47.47％ (75/158),and 66 cases were female positive with the positive rate of 23.83 ％ (66/277),the polyps detective rate was 28.27 ％ (123/435),tumor-like lesion detective rate was 7.59％(33/435),the adenocarcinoma detection rate was 0.46％ (2/435);the total positive rate of male was higher than that of female(x2 =25.669,P＜0.01).Conclusion The sequential screening mode in which the high risk population preliminarily screened out by community then performs colonoscopy examination has an important significance for discovering the intestinal tract lesion.

Objective To investigate characteristics of symptoms, tongue and pulse of high-risk group of stroke, and provide evidence of differential treatment for stroke prevention, diagnosis and treatment of stroke, thus laying a solid foundation on further study of differential treatment system of high-risk groups of stroke. Methods With prospective observational method, 2536 cases of stroke were selected by multi-center screening, and characteristics of TCM symptoms, tongue, pulse and syndrome distribution in different gender and age were observed. Results The top five symptoms were:blurred vision (1670 cases, 65.9%), irritability (1458 cases, 57.5%), limp or pain on waist and knees (1445 cases, 57.1%), dizziness (1286 cases, 50.7%) and dry eyes (1274 cases, 50.2%). The top five tongue and pulse were:white moss (1401 cases, 55.2%), thin moss (1260 cases, 49.7%), string pulse (1201 cases, 47.4%), dark tongue (1168 cases, 46.1%) and red tongue (1027 cases, 40.5%). The detection rate of dizziness, insomnia, white coating, thin coating, etc. were higer in women than that in man (P<0.01). The detection rate of teeth shaking, greasy fur, yellow fur, string pulse, etc. were higher in man than that in woman (P<0.01). The detection rate of teeth shaking, dry eyes, thirst, dark tongue, red tongue, string pulse, etc. in the elderly group were higher than the middle-aged one (P<0.01). The detection rate of irritability, numbness, shortness of breath, scalloped tongue, thin coating, deep pulse, etc. in the middle-aged group was higher than the aged one (P<0.01). Conclusion The clinical manifestations of high-risk group of stroke are complicated. There were root deficiency such as deficiency of spleen and kidney, and branch excess such as wind-fire and phlegm-stasis. Difference and regularity were showed in different gender and different age groups to some extent.