Objective To investigate the safety,efficacy of CO2 insufflations during ERCP.Methods One hundred and forty eligible patients who underwent ERCP in Fuzhou General Hospital of Nanjing Military Command from January to December 2012 were randomized according to random digits in a double blind manner to receive either CO2 insufflations or air insufflations (65 vs 75).The patient's experience of abdominal pain and distension at 1 h,2 h,6 h and 24 h post-ERCP were evaluated by visual analogue scale (VAS).The heart rates,blood pressure,SpO2,PaCO2 were recorded before,during,after ERCP,and 24 h after the examination.Plain abdominal radiographic images were collected to show abdominal distention before and after ERCP,waist circumference,operative time,recovery time,intraoperative and post-ERCP complications were also determined.Results Post-ERCP the VAS of abdominal pain at 3 h was (4.08 ± 1.36) in CO2 group,which was significantly lower than that in air group [(4.59 ± 1.66),P ＜ 0.01].The VAS of abdominal distension at 1 h,3 h,6 h after ERCP were(1.78 ± 1.90),(0.72 ± 1.15),(0.12 ±0.45),which were significantly lower than those in air group [(3.53 ± 2.71),(2.51 ± 2.04),(0.84 ± 1.24),P ＜ 0.05] ; the intraoperative SpO2 was (93.29 ± 1.40)％,which was significantly lower than that in air group [(93.52 ± 1.06) ％,P ＜ 0.01].The waist circumference at 1 h after ERCP increased by (2.48 ± 1.33)cm,which was significantly lower than that in air group [(3.56 ± 2.13) cm,P =0.00).Recovery time was (11.2 ± 2.5) rain in CO2 group,which was significantly longer than that in air group [(9.7 ± 1.7) min,P =0.00].And the difference between the two groups was statistically significant.The plain abdominal radiographic images showed the degree of bowel distension was severer in air group than that in CO2 group (P =0.04).Conclusions CO2 insufflations are safe and efficacy during ERCP.CO2 can better alleviate abdominal pain and distension than air.

Objective To investigate the preventive effect of somatostatin and nitroglycerin on post-ERCP pancreatitis (PEP) and hyperamylasemia.Methods A total of 184 patients who underwent endoscopic retrograde cholangiopancreatograph (ERCP) were enrolled,and randomly divided into three groups to receive somatostatin or nitroglycerin or normal saline according to random number table.Incidence of PEP and hyperamylasemia were observed and compared among the three groups.Results Nine patients stopped the medication and dropped out of the study after occurence of adverse reactions from receiving nitroglycerin injections.The incidence rates of hyperamylasemia were 38.7％ (24/62),51.8％ (28/54) and 37.3％ (22/59) in somatostatin,nitroglycerin and control group respectively,with no significant differences among the three groups (P ＞ 0.05).The incidence rates of PEP were 6.4％ (4/62),9.3 ％ (5/54) and 23.7％ (14/59) in somatostatin,nitroglycerin and control group,respectively.The incidence rates of PEP in somatostatin and nitroglycerin group were both significantly lower than that in control group (somatostatin group vs control group:x2 =7.13,P =0.01 ; nitroglycerin group vs control group:x2 =4.22,P =0.03).There was no significant difference between somatostatin group and nitroglycerin group (x2 =0.32,P =0.41).Conclusion Somatostatin and nitroglycerin injections after ERCP show similar efficacy on preventing PEP,but the former is safer.Both have little effects on the prophylaxis of hyperamylaemia.

Blunt traumatic thoracic aortic injury (BTAI) is an extremely serious medical condition with a high rate of associated mortality. Recent advances in techniques such as thoracic endovascular repair offer new opportunities to manage the critical BTAI patients in an efficacious yet less invasive manner. A 65 year-old-male suffered from multiple injuries after a fall, including BTAI in the aortic arch, which resulted in dissection of the descending thoracic-abdominal aorta and iliac artery, development of an intimal flap in the left common carotid artery, and dissection of the left subclavian artery. Based on the imaging information of this patient and our clinical experience, the combined treatment of fenestrated thoracic endovascular repair and a chimney technique was immediately planned to fully repair these dissections and moreover prevent further dissection of the branching vessels, additionally to ensure sufficient blood flow in the left subclavian artery and left common carotid artery. The intervention yielded satisfactory early outcomes. Follow-up assessment at six months reported no symptoms or complications associated with the stent-graft. Computed tomography angiography further confirmed adequate stent-graft coverage of the aortic injury.

Objective To establish an animal model of pancreatic juice reflux esophagitis, and compare the roles of single pancreatic juice with pancreatic juice plus bile acids reflux in the pathogenesis of gastroesophageal reflux disease (GERD). Methods Fifty SD rats were randomly divided into 3 groups, group A: gastrectomy and end- to- side esophagojejunostomy (pancreatic juice and bile combination group, n=20); group B, gastrectomy and end-to-side esophagojejunostomy and bile-duct-jejunostomy (single pancreatic juice group, n = 20 ); group C: simple laparotomy ( n = 10). The rats were sacrificed 1, 2, 4 weeks after operation, and the change of weight of the rats and esophageal morphology was observed. Results Four rats in combination group died during or after operation, and the success rate of the model was 80%, 6 rats in single pancreatic juice group died, and the success rateof the model was 70%, both group A and B rats lost more weight significantly than that in control group, and the weight gradually increased 2 weeks later, but it was still lower than that in control group [(218 ±21), (216 ±20)g vs. (286 ±28)g, P＜0.05]. Reflux esophagitis of different degree was present in both groups, which was more severe in the lower part of esophagus, and severity increased with time. The main histologic changes were inflammation, erosion, ulcer and epithelial cell hyperplasia and metaplasia. The severity of esophagitis was not significantly different between group A and group B. Conclusions The models of single pancreatic juice reflux esophagitis can be successfully made. It establishes the foundation for experimental research of pancreatic juice induced esophageal mucosa injury.

Objective To study the role of nuclear factor-?B(NF-?B) and peroxisome proliferation activator receptor-?(PPAR-?) in the development of Barrett's esophagus(BE) and esophagus adenocarcinoma(EA).Methods Fifty BE patients including 25 EA patients admitted in Fuzhou General Hospital of Nanjing Command from Jul.2005 to Jul.2006 were involved in the present study.The expressions of NF-?B and PPAR-? in squamous epithelial cells of normal esophagus,BE and EA were investigated with immunohistochemical staining.The correlation between the expression of both NF-?B and PPAR-? and their clinicopathological features were analyzed.Results Positive staining of NF-?B was situated in cytoplasm,and that of PPAR-? in nuclei.No expression of NF-?B and PPAR-? was found in normal esophageal squamous epithelium,while they expressed in a medium extent in BE(positive staining in cytoplasm of goblet cells and surface glandular epithelium),and extensively expressed in EA.There existed significant difference in expression of NF-?B and PPAR-? in EA compared with those in BE and normal esophageal squamous epithelium(P

Objective To compare the efficacy of transumbilical-ultrafine gastroscope sympathectomy for severe palmar hyperhidrosis using two distinct levels of T3 and T4.Methods A total of 84 cases with severe primary hyperhidrosis were randomly allocated to undergo either T3 sympathectomy treatment (T3 group, n =42) or T4 sympathectomy treatment (T4 group, n =42) with no difference between the two groups.The operation time, postoperative hospital stay, patient's hands hyperhidrosis, axillary hyperhidrosis,complications were recorded at follow-up in 1,3,6,12 months.Results Operation on 84 patients were successful with mean operative time of T3 group being 55.02 ± 10.61 min and T4 group being 55.36 ± 10.51 min(P ＞ 0.05).The mean postoperative hospital stay were both 1.5 days.Patients were followed up for diaphragmatic hernia, umbilical hernia, Horner's syndrome and other serious complications for 12 months.No postoperative recurrence of palmar hyperhidrosis, severe compensatory sweating occurred in either group.The number of improved patients in T3 group's palmar hyperhidrosis,axillary hyperhidrosis, and foot hyperhidrosis were :42/42 cases, 10/16 cases, 21/29 cases, while those in T4 group were: 42/42 cases,16/17 cases 18/28 cases.Axillary hyperhidrosis improved to a larger extent in T4 group than in T3 group (P ＜0.05).There were 16(15 mild and 1 moderate)compensatory sweating in T3 group and 7(6 mild and 1 moderate) compensatory sweating in T4 group (P ＜ 0.05).Conclusion T3 and T4 thoracic sympathectomy using transumbilical-ultrafine gastroscope for primary palmar hyperhidrosis are safe, effective, and feasible.T4 sympathectomy is more effective in improving axillary hyperhidrosis than T3 and shows lower occurrence of postoperative compensatory hyperhidrosis.

OBJECTIVE: To construct and evaluate nomogram prediction model for periprosthetic fractures in patients undergoing total hip arthroplasty (THA). METHODS: A total of 538 patients who underwent THA from April 2013 to February 2019 were selected as the research subjects, including 318 males and 220 females, aged 40 to 60 years old with an average age of (50.79±6.37) years old. All patients with THA were divided into non-fracture group (506 patients) and fracture group (32 pathents) according to the 3-year follow-up results. Univariate and multivariate Logistic regression analyses were performed to analyze the influencing factors of postoperative periprosthetic fractures in patients with THA. A nomogram prediction model for periprosthetic fractures in patients undergoing THA was constructed, and the validity and discrimination of the prediction model were evaluated. RESULTS: The proportion of patients with osteoporosis, trauma history, and hip revision in the fracture group were higher than those in the non-fracture group(P<0.05), and the proportion of bone cement prosthesis was lower than that in the non-fracture group(P<0.05). The osteoporosis status[OR=4.177, 95%CI(1.815, 9.617), P<0.05], trauma history[OR=7.481, 95%CI(3.104, 18.031), P<0.05], and hip revision[OR=11.371, 95%CI(3.220, 40.153, P<0.05] were independent risk factors for postoperative periprosthetic fractures in patients undergoing THA, cemented prosthesis [OR=0.067, 95%CI(0.019, 0.236), P<0.05] was an independent protective factor for postoperative periprosthetic fractures in patients undergoing THA(P<0.05). Hosmer-Lemeshow goodness of fit test showed that χ²=7.864, P=0.325;the area under the curve (AUC) for periprosthetic fractures in patients undergoing THA was 0.892 with a sensitivity of 87.5% and a specificity of 77.7% by receiver operating characteristic(ROC) curve. CONCLUSION The nomogram prediction model for periprosthetic fractures after THA constructed in this study has good discrimination, which is beneficial to clinical prediction of periprosthetic fractures in patients undergoing THA, and facilitates individualized fracture prevention.
Male ; Female ; Humans ; Adult ; Middle Aged ; Arthroplasty, Replacement, Hip/adverse effects* ; Periprosthetic Fractures/surgery* ; Nomograms ; Reoperation/adverse effects* ; Risk Factors ; Osteoporosis/surgery* ; Retrospective Studies ; Hip Prosthesis

Objective: To investigate the influence of bigeminy drug regimen on short-term clinical effects, quality of life and recurrence rate in children with adenoid hypertrophy. Methods: One hundred and thirty patients with adenoid hypertrophy were chosen in the period from January 2014 to December 2016. They were randomly divided into 2 groups:control group (65 patients, nasal glucocorticoid used alone) and observation group (65 patients, montelukast sodiumon the basis of control group). The short-term clinical effect, the levels of A/N, serum inflammatory cytokine and OSA-18 score before and after treatment and recurrence rate of 2 groups were compared. Results: The short-term clinical effects of control group and observation group were separately 73.85%(60/65) and 92.31% (48/65). The levels of A/N after treatment in observation group were significantly lower than those in control group and before treatment: 0.60 ± 0.07 vs. 0.74 ± 0.10, 0.94 ± 0.15 (P<0.05). The levels of IL-1β, IL-2 and IL-4 after treatment in observation group were significantly lower than those in control group and before treatment:IL-1β: (1.50 ± 0.48) ng/L vs. (2.21 ± 0.44), (3.42 ± 0.68) ng/L; IL-2: (21.80 ± 2.08) ng/L vs. (24.28 ± 2.50), (26.61 ± 3.35) ng/L; IL-4: (179.12 ± 35.91) ng/L vs. (244.70 ± 44.42), (284.07 ± 51.87) ng/L (P<0.05). The OSA-18 score after treatment in observation group was significantly lower than that in control group and before treatment (P<0.05). The recurrence rate in control group and observation group was separately 32.31%(21/65) and 15.39%(10/65). The recurrence rate in observation group was significantly lower than that in control group (P<0.05). Conclusions Bigeminy drug regimen in the treatment of children with adenoid hypertrophy can efficiently relieve the respiratory obstruction degree, reduce the levels of inflammatory response, improve the quality of daily life and be helpful to prevent long-term recurrence.

ObjectiveTo explore the effects and possible actions mechanisms of β-sitosterol on the proliferation of hepatocellular carcinoma （HCC） cells. MethodsThe target of β-sitosterol was predicted by SwissTarget and TargetNet data platforms. The up-regulated gene in GSE101728 HCC data set was analyzed by GEO2R， and the common gene between the target and the up-regulated gene was analyzed. According to the analysis of TCGA_LIHC data matrix， the relationship between cell division cyclin 25B （CDC25B） and clinical staging， prognosis of HCC was obtained. The activities， proliferation， cycles distribution and apoptosis of HCC cells （HepG2， Hep3B） treated with β-sitosterol were detected by CCK-8， colony-forming assay and flow cytometry. The models of nude mice with subcutaneous xenografted tumors in HepG2 were constructed and divided into control group and β-sitosterol group. The β-sitosterol group was intraperitoneally injected with β-sitosterol （50 mg/kg·d）. The volume and mass of tumors were measured. The expression level of Ki67 was detected by immunohistochemistry. The levels of CDC25B protein in HepG2 and Hep3B cell lines treated with different concentrations of β-sitosterol for different action time were detected by Western blot. HepG2 and Hep3B cell lines with stable overexpression of CDC25B were constructed， and then which were treated with β-sitosterol. The activities， proliferation， cycles distribution and apoptosis of HepG2 and Hep3B cell lines were detected by the above-mentioned methods. ResultsThe expression level of CDC25B in HCC tissues was higher than that in para-carcinoma tissues （P<0.05）. The expression level of CDC25B in patients with TNM staging at stage T2-4， clinical staging at stage Ⅱ-Ⅳ， G3-4 differentiation， recurrence and poor prognosis was higher than that with TNM staging at stage T1， clinical staging at stage I， G1-2 differentiation， non-recurrence and good prognosis， respectively （P<0.05）. The overall survival rate in high-expression CDC25B group was lower than that in low-expression group （P<0.05）. The activities of Hep3B and HepG2 cells were decreased with the increase of β-sitosterol dose and the prolongation of action time. The relative number of clone cells and the percentages of cells during S phase in Hep3B （15 μmol/L β-sitosterol） and HepG2 （18 μmol/L β-sitosterol） were significantly lower than those in control group （P<0.05）， while percentage of cells during G0/G1 phase and apoptosis rate were significantly higher than those in control group （P<0.05）. The volume and mass of xenografted tumors， and relative expression level of Ki67 in β-sitosterol group were significantly lower than those in the control group （P<0.05）. The expression of CDC25B protein in Hep3B and HepG2 cells was decreased with the increase of β-sitosterol concentration and the prolongation of action time. The cells growth， relative number of clone cells， and percentages of cells during S phase in Hep3B and HepG2 cells were all significantly higher than those in β-sitosterol group （P<0.05）， while percentage of cells during G0/G1 phase and apoptosis rate were significantly lower than those in β-sitosterol group （P<0.05）. ConclusionThe β-sitosterol can promote apoptosis of HCC cells and inhibited their proliferation. The inhibition of cells proliferation may be related to inhibition of CDC25B protein.

Objective To evaluate the safety and feasibility of endoscopic transumbilical thoracic sympathectomy.Methods The technique was performed in 4 swine models.Under general anesthesia,a newly developed long abdominal trocar (60 cm in lengths) was placed through the umbilicus,which was also used to establish pneumoperitoneum.After insertion of gastroscope through this trocar,two small incisions of diagrams were created by needle-knife,through which the gastroscope was sent into the thoracic cavity to ablate the T3 ganglia by Hot biopsy forceps under One-lung ventilation.The animals were killed at the completion of the procedure.Results This procedure was completed in four pigs.The sympathetic chain was successfully ablated in all swine,as confirmed by gross surgical pathology and histology,the mean operative time was (81.7 ±15.4) minutes.There was no major bleeding.All bilateral T3 sympathetic chains were successfully ablated in the 4 swines as confirmed by gross surgical pathology and histology.There was no severe bleeding and damage to peripheral organs during the operation in any of the cases,and no prominent pneumothorax was revealed by postoperative chest X-ray radiography.Conclusion Endoscopic transumbilical thoracic sympathectomy is safe,feasible and effective with good cosmetic result.