Objective To investigate the causes of intractable abdominalgia after simple choleystectomy and analyse the therapeutic effect of endoscopic sphincterotomy (EST).Methods 84 patients undergoing EST were retrospectively viewed from 1987 to 1998. Results Sixty five out of 84 patients were followed up, in which the clinical signs disappeared completely in 51 cases (78%), and there were 6 cases with relapsing symptom(9%),3 cases with intermittent relapsing symptom (4%). Therapy was ineffective in 5 cases. The intractable abdominalgia is a specific sign of postcholecystectomy syndrome. EST is effective in removing the nervous structure in duodenal papilla submucosa and sphincter muscle layer responsible for abdominal pain, therefore eliminated or relived the pain.Conclusion EST has a significant effect on intractable abdominalgia after simple cholecystectomy in the majority of patients.

Targeted drug delivery can significantly increase the concentration of the drug in treatment site, and decrease the dosage of drugs, cost of treatment and the drug's adverse effects on the body. So targeted drug delivery is the hotspot of recent studies. This paper reviews the development of targeted drug delivery research in recent years, including three areas: passive targeting, active targeting, and physical and chemical targeting.

Objective To explore the pathogeny, pathology, ultrasonic and clinical expression of upper extremity deep venous flow obstruction and superior vena cava syndrome. Methods Retrospective analysis and summarize the disease changes of 10 cases in recent 5 years. Results 7 patients of 10 cases were superior vena cava syndrome, in which 4 cases caused by upper right lung malignant tumor, 3 cases caused by upper and media mediastinal malignant tumor. 2 patients of 10 cases were found thrombosis in right subclavian vein caused by duct of artificial pacemaker. The left 1 patient was no reason thrombosis in right axillary vein. Conclusion Ultrasonography combine with color and spectral Dopper image can evaluate the clinical development and therapeutic efficiency, which is a useful and effective non-invasive examination.

Objective　To establish the method of noninvasive measuring the new indexes of cardiac functions by echocardiography and illustrate the diagnostic values of the indexes.Methods　By use of simultaneous screen display of echocardiography, phonocardiography and electrocardiography and synchronously monitoring blood pressure (BP) technique, the values of LV end-systolic and end-diastolic long and short- axis dimensions, wall thickness and area sizes,and synchronous BP were measured in the patients with myocardial infarction (MI) of defferent sites and area sizes before and during BP were altered to defferent degrees. The values of maximum elasticity (Emax) and average maximum myocardial elasticity stiffness (maxEav) and ejection blood fraction (EF) were calculated through computer programmed process.Results　The order of values of Emax,maxEav and EF among MI patients of defferent sites was control group>inferior MI group>anterior MI subgroup>multi-wall MI subgroup. Their order among MI patients of defferent area sizes was control group > small area MI subgroup > larger MI subgroup. Emax was associated with the MI parts and 　maxEav was associated better with the MI area sizes.Conclusions　The study has established a noninvasive method of examining cardiac function by use of echocardiography and reflected the special diagnostic values of Emax,maxEav and EF in MI patients of defferent parts and area sizes.

Objective: To explore value of 6-minute walking in rehabilitation therapy of patients with chronic heart failure (CHF). Methods: A total of 78 CHF patients were selected from department of geriatrics of our hospital. They were randomly and equally divided into 6min walking test (6MWT) group (received 6-min walking training based on routine treatment, twice/d) and routine treatment group. After six weeks, 6min walking distance (6MWD), heart rate and left ventricular ejection fraction (LVEF) were compared between two groups before and after treatment. Results: After six weeks, there were significant improvements in related indexes in both groups, P<0.05 all; compared with routine treatment group, there were significant increase in 6MWD [(307.6±39.3) m vs. (503.4±44.4) m] and LVEF [(45.3±17.9) % vs. (58.7±19.2) %], and significant decrease in heart rate of recovery period after 6MWT [(73.3±2.9) times/min vs. (65.7±2.1) times/min] in 6MWT group, P<0.05 all. Conclusion: Six-minute walking can significantly improve symptoms of heart failure and enhance exercise tolerance, and it possesses important value for recovery of heart function in these patients.

AIM:To investigate the inhibition of breviscapine on apoptosis of cultured myocardial cell of neonatal rat induced by hypoxia/reoxygenation. METHODS:Myocardial cell hypoxia/reoxygenation model was established by culturing primary myocardial cells of neonatal rats in vitro. Cultured myocardial cells were divided into 5 groups:control group,hypoxia/reoxygenation group and 3 groups pretreated with breviscapine of final concentration 25,50 and 100 mg/L,respectively. The cell viability was measured with MTT; apoptotic rates were determined by AnnexinV-FITC/PI; the expression of Bcl-2 was detected by immunohistochemical method. Expressions of Cytochrome C (CytC) and Caspase-3 were detected by Western blot. RESULTS:Compared with the control group,the viability of myocardial cell decreased and apoptosis rate elevated after hypoxia/reoxygenation. However after pretreatment with 25,50 and 100 mg/L breviscapine,respectively. Cell viabilities increased and apoptotic rates lowered,and the protective effect on myocardial cell had concentration-dependent. In addition,Expression of Bcl-2 decreased but Caspase-3 activity and CytC release increased in myocardial cells induced hypoxia/reoxygenation. Pretreated with breviscapine,expression of Bcl-2 elevated but Caspase-3 activity and CytC release reduced obviously. CONCLUSION:It is associated with the increase in Bcl-2 expression,inhibition of CytC release and Casepase-3 activity that breviscapine could significantly protect myocardial cell against apoptosis induced by hypoxia/reoxygenation.

Objective:To explore the communication problems among nursing students in early clinical prac-tice, and to provide reference for clinical nursing education .Methods:Introspecting diary of the clinical communi-cation in nursing students were classified and analyzed by using qualitative research method .Results:5 themes were extracted as following: barriers for communication between nurses and patients , reflection on patient , nurse occupation , clinical teaching and critical reflection on public opinion .Conclusion:Introspecting diary is important to help teachers in teaching , to guide and cultivate nursing students to develop their interpersonal communication competence .

Objective Summarized the therapeutic effect of colonic irrigation by mannitol in one-stage resection and primary anastomosis for left hemicolon obstruction. Method For 31 cases of left hemicolon obstruction in our hospital, After process was cut, firstly we had done coloclysis with normal saline, metron-idazole and 20% mannitol,then one-stage anastomosis. Results With the exception of three cases of in-cision infection, the rest who start eating 4～5 days after operation were cured and no anastomotic fistula. Conclusion During the colon resection in left hemicolon obstruction, coloclysis with normal saline, met-ronidazole and 20% mannitol, then one-stage anastomosis, the intestinal function were quick recovery and can prevent colonic anastomotic fistula.

Objective To observe the therapeutic effect of ultrasonic microbubble combined with bevacizumab (Avastin) on choroidal neovascularization induced by photocoagulation in rabbits.Methods CNV was induced by photocoagulation with argon laser in 30 rabbits (60 eyes).All of the rabbits underwent fundus fluorecein angiography (FFA) 21 days after photocoagulation;6-8 hours later,3 rabbits were randomly chosen to be executed to having the immunohistochemical examination.Twenty-one days after photocoagulation,27 rabbits were divided randomly into 3 groups:bevacizumb,ultrasonic microbubble+bevacizumb,and control group;each group has 9 rabbits (18 eyes).The rabbits in control group had no interference treatment;while the rats in bevacizumb and ultrasonic microbubble+bevacizumb group underwent injection with bevacizumb or ultrasonic microbubble+bevacizumb respectively.FFA was performed on all of the rabbits 7,14,and 28 days after photocoagulation to observe the inhibition of CNV;immunofluorecence and Western blot were used to detect the expression of VEGF in retina and choroid.Twenty-eight days is the time point to determine the therapeutic efficacy.The expression of VEGF and the results of FFA were the sdandards of the judgement of therapeutic efficacy.Results Proliferaion of CNV to the retinal inner layer and the obvious leakage of fluoresein in the photocoagulation area indicated that the model of CNV was set up successfully.Twenty-eight days after injection,obvious fluorescent leakage was found in the control group,and the average fluorescent leakage in bevacizumab group differed much from the control group(t=16.2952,P<0.05);while the difference between ultrasonic microbubble+bevacizumb group and bevacizumab group was also significant (t=4.7955,P<0.05).At the same time point,the expression of VEGF in bevacizumab group detected by immunofluorecent assay and Western blot differed much from the control group (t=7.0327,9.2596;P<0.05),and the difference of VEGF between ultrasonic microbubble+bevacizumb group and bevacizumab group was significant (t=2.9724,17.1937;P<0.05).this experiment show that ultrasound combined bevacizumab intravitreal injection of the therapeutic effect of CNV superior to other groups(P<0.01).Conclusion Ultrasound microbubble combined with bevacizumab injection may improve the therapeutic effect on CNV by inhibiting the expression of VEGF.

10.3969/j.issn.1007-3969.2013.05.011