Digestive System Surgical Procedures ; methods ; Humans ; Image Interpretation, Computer-Assisted ; Minimally Invasive Surgical Procedures

OBJECTIVE:To investigate therapeutic efficacy and safety of linezolid and teicoplanin in the elderly patients with severe MRSA infection. METHODS:97 elderly patients with severe MRSA infection were collected and divided into linezolid group (42 patients) and teicoplanin group (55 patients). Linezolid group was given linezolid 600 mg intravenously,bid;teico-planin group was given teicoplanin 400 mg intravenously,qd,double dose for the first day. Treatment course lasted for 7-21 d. Clin-ical effective rate,bacterium clearance rate and ADR were compared between 2 groups after treatment. RESULTS:The bacterium clearance rate of teicoplanin group was 52.6%,and that of linezolid group was 73.5%;the linezolid group was significantly higher than the teicoplanin group,with statistical significance(χ2=12.57,P=0.034). Clinical effective rate was 78.6% in linezolid group and 58.2% in teicoplanin group;the linezolid group was significantly higher than the teicoplanin group,with statistical significance (χ2=9.56,P=0.018). After 14 days of treatment,APACHEⅡ score of teicoplanin group and linezolid group were (14.56±3.04) and(10.29±4.84),respectively;the teicoplanin group was lower than the linezolid group,with statistical significance(t=10.97, P=0.014). The incidence of ADR was 11.9% in linezolid group and 20.0% in teicoplanin group,with statistical significance(χ2=1.13,P=0.287). CONCLUSIONS:Linezolid has superior curative effect to teicoplanin in the treatment of severe MRSA infection in elderly patients with good safety.

Objective To investigate the clinical treatment effect of tubular stomach substitute for esophagus anastomosis in the radical surgery of esophageal cancer.Methods Ninety-seven patients diagnosed with esophageal cancer in the First Affiliated Hospital of Soochow University from June 2013 to June 2015 were selected.They were divided into two groups,51 patients using the gastric tube substitute for esophagus anastomosis in the gastric tube group,and 46 patients using the traditional full stomach substitute for esophagus anastomosis in the whole stomach group.The operation times,intraoperative blood losses,the amount of postoperative gastrointestinal decompression,hospital stays,pathologic stages and incidences of complications after surgery in the two groups were observed and compared.Results There were no preoperative death in the two groups.The gastric tube group took more operating time than the whole stomach group [(287.43 ± 23.64) min vs.(266.13 ±26.47) min],with a significant difference (t =2.279,P =0.031).In the comparison of the amount of gastrointestinal decompression,the gastric tube group was less than the whole stomach group [(1 908.14 ±327.97) ml vs.(2 221.93 ± 323.87) ml],with a significant difference (t =-2.591,P =0.015).There were not significant differences in blood losses [(325.00 ± 64.30) ml vs.(356.67 ± 49.52) ml;t =-1.490,P =0.147],the numbers of lymph nodes [(10.73 ± 4.83) vs.(10.36 ± 5.31);t =0.238,P =0.813],hospital stays [(15.32 ± 3.69) d vs.(16.45 ± 3.80) d;t =-1.005,P =0.320] and pathologic stages (P =0.713) in the gastric tube group and whole stomach group.The incidence of gastroesophageal reflux in the gastric tube group was significantly less than that in the whole stomach group,with a significant difference (1.96％ vs.15.22％;x2 =5.617,P =0.025).The occurrence of the complications like anastomotic leakage (5.88％ vs.10.87％;x 2=0.795,P =0.471),postoperative pulmonary complications (13.73 ％ vs.23.91％;x2 =1.661,P =0.296)and anastomotic stenosis (7.84％ vs.13.04％;x2 =0.707,P =0.510) had no statistical difference in the gastric tube group and whole stomach group.Conclusion In the surgical treatment of esophageal cancer,tubular stomach substitute for esophagus anastomosis is better than the full stomach substitute for esophageal surgery,which can improve the life quality of postoperative patients and is worthy of clinical promotion.

Objective To observe the efficacy of treating allergic rhinitis majorly by needling three nasal acupoints, and to provide a safe convenient and effective method for the treatment of allergic rhinitis.Method Sixty-two patients were randomly divided into an acupuncture group (31 cases) and a Western medication group (31 cases), and the acupuncture group was mainly treated by three nasal acupoints, and the Western medication group was by Clarityne. By comparing the symptoms and signs, the clinical efficacies were evaluated.Result The total effective rate was 87.1% in the acupuncture group, significantly higher than 76.7% in the Western medication group (P<0.01).Conclusion It’s effective to treat allergic rhinitis by adopting acupuncture at the three nasal acupoints as the major method.

ObjectiveTo testify the therapeutic efficacy of acupuncture in treating diarrhea-predominant irritable bowel syndrome (D-IBS) based on brain-gutinteraction.MethodEighty D-IBS patients were randomized into brain-gut interacted acupuncture group (treatment group) and a group with acupoints selected based on conventional syndrome differentiation (control group), 40 in each group. The treatment group was intervened by acupuncture by selecting the thirteen ghost acupoints (invented by SUN Si-miao) plus Tianshu (ST25), Dachangshu (BL25), etc., while the control group was by acupuncture based on conventional point selection, including Zusanli (ST36),Tianshu (ST25), Dachangshu (BL25), Ganshu (BL18), Pishu (BL20), etc., three times a week, and 10 sessions as a treatment course. The clinical efficacies were evaluated after 2 treatment courses.ResultThe two groups were generally equal to each other incomparing each dimension of the Short-form Health Survey (SF-36) before treatment, while the scores were increased after treatment in both groups; the treatment group was significantly superior to the controlgroup in comparing the scores ofrole-physical,bodily pain, general health, vitality, social role functioning, and reported health transition from the SF-36 (P<0.05).ConclusionAcupuncture based on brain-gut interaction can produce a more significant effect in treating D-IBS compared to conventional acupuncture.

OBJECTIVE:To observe the clinical efficacy and safety of enhanced immunosuppressive therapy in the treatment of refractory nephrotic syndrome (RNS). METHODS:Totally 76 RNS patients were selected from 2 hospitals during Jan. 2012-Mar. 2015,and then divided into control group and observation group according to random number table,with 38 cases in each group. Two groups were given Prednisone acetate tablet 50 mg,qd;decreasing to 15 mg,qd,after urine protein returned to normal. Based on it,control group was given Leflunomide tablets 50 mg,qd;decreasing to 20 mg,qd,3 days later. Based on con-trol group,observation group was additionally given Mycophenolate mofetil dispersible tablet 750 mg,bid;decreasing to 500 mg, qd,3 months later. Both groups were treated for 6 months. Clinical efficacies,follow-up recurrence rate as well as renal function in-dexes and inflammatory cell factors before and after treatment,and the occurrence of ADR were compared between 2 groups. RE-SULTS:The total response rate of observation group(92.11%)was significantly higher than control group(73.68%),and fol-low-up recurrence rate(5.26%)was significantly lower than control group(23.68%),with statistical significance(P<0.05). Be-fore treatment,there was no statistical significance in renal function indexes or inflammatory cell factors between 2 groups(P>0.05). After treatment,24 h urinary protein quantification,urinary IL-6 and IL-8 levels of 2 groups decreased significantly,while the content of serum protein increased significantly;the observation group was significantly better than the control group,with sta-tistical significance(P<0.05). There was no statistical significance in the content of serum creatinine between 2 groups before and after treatment(P>0.05). The incidence of ADR in the control group and the observation group was 34.21% and 44.74% respec-tively,without statistical significance between 2 groups(P>0.05). CONCLUSIONS:Enhanced immunosuppressive therapy in the treatment of RNS can improve renal function,reduce inflammatory reaction and long-term recurrence risk,and have good therapeu-tic efficacy and safety.

Glycyrrhiza uralensis Fish Polysacchoride(GPS)was observed to have mitogenic activity on murine spleen cell proliferation in vitro,The results showed that this mitogenic activity of GPS may be directed to B Iymphocytes,i.e.GPS is a new mitogen of murine B lymphocytes.Furthermore,it was found that B lymphocytes stimulated by GPS was M? depedent and T cell-indepedent.On the contrary,antibodies and IL-2 production was inhibited by GPS in vivo.

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel used in patients undergoing laparoscopic gynecological surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 21-64 yr, weighing 4590 kg, undergoing elective laparoscopic gynecological surgery, were randomized into 2 groups ( n = 30 each):LMA i-gel group (group Ⅰ) and LMA Supreme group (group S) . Mallampatti test was performed before operation in both groups. Anesthesia was induced with target-controlled infusion of propofol (target plasma concentration 2.5-4.0 μg/ml) and remifentanil (target plasma concentration 3-6 ng/ml) . After the patients lost consciousness, rocuronium 0.6 mg/kg was given to facilitate the LMA insertion. LMA i-gel and LMA Supreme were inserted in I and S groups respectively. A gastric tube was inserted through the drain tube of the LMA. In group S the air was injected into the cuff to make intracuff pressure reach 60 cm H2O after successful LMA insertion. The LMA placement time, the number of attempts of LMA insertion, the number of attempts of gastric tube placement, the airway sealing pressure, the parameters of hemodynamics and ventilation, and complications (sore throat, odynopliagia,hoarseness) were recorded. The fiberoptic laryngoscopy scores were assessed after successful LMA placement. The anesthesia time and recovery time were also recorded. Results There was no significant difference in the anesthesia time, recovery time, LMA placement time, fiberoptic bronchoscopy scores and the parameters of hemodynamics and ventilation between the two group. The success rates of LMA and gastric tube placement were 100% in both groups. The airway sealing pressure was significantly higher, while the incidence of sore throat and odynopliagia was significantly lower in group I than in group S. Conclusion LMA i-gel provides adequate ventilation during operation with fewer complications and can be used effectively for gynecological laparoscopic surgery.

Objective: To investigate the factors related to the of disc displacement in temporomandibular joint disorder(TMD). Methods: The angles of disc anterior displacemen were measured on arthrography of temporomandibular joints in 90 patients with TMD, then the relationship between the angles and symptoms, signs, condyle positions, osteoarthrosis and mouth opening degree were analysed. Results: ①AOB angle in the patients with reducibility of anterior disk displacement(ADwR) was smaller than in those with non reducible anterior displacement (ADw/oR); ②Patients suffered from chronic ADw/oR had smaller degree of mouth opening and larger disc displacement than those with ADwR's. Conclusion: The disc anterior displacement and condyle displacement in glenoid fossa may be correlated with articular remodeling.Prolonging coursees may not always result in the changing of disc structures.