Objective To investigate the diagnostic value of detecting K ras gene codon 12 mutations in cytologic specimens by endoscopic pancreatic duct brushing for pancreatic cancer. Methods Thirty five patients at Changhai hospital between 1999 and 2001 were enrolled. Cells from pancreatic duct burshings during ERCP were suspended with PBS. DNA of the cells was extracted and K ras gene codon 12 mutations were detected by means of PCR SSCP. Results K ras gene mutation rate of pancreatic cancer was 70%, which was higher than that of chronic pancreatitis (14%, P

Objective To investigate diagnostic significance of detecting p53 protein in cytologic specimens by endoscopic pancreatic duct brushing for pancreatic cancer. Methods p53 protein in cytologic specimens was detected by immunohistochemistry, and the resules were compared with cytologic specimens by HE staining. Results Sensitivity, specificity, and accuracy of HE staining for pancreatic cancer is 53%, 100% and 70% respectively. Sensitivity, specificity, and accuracy of detecting p53 protein for pancreatic cancer is 59%, 100%, 74% respectively. Sensitivity, specificity, and accuracy of HE staining and detecting p53 protein for pancreatic cancer is 71%, 100%, 81% respectively. Conclusions HE staining combined with detecting p53 protein in cytologic specimens by endoscopic pancreatic duct brushing is a useful stool for diagnosis of pancreatic cancer. It is helpful to differentiate benign diseases of pancreas from malignant tumor of pancreas.

Objective To investigate the clinical, rad iographic and pathological features of intraductal papillary-mucinous tumor of the pancreas(IPMT). Methods The features, imaging manifestation and pathological find ings of 9 patients with IPMT were reviewed. Results There were 6 male and 3 female in this series with ag e ra nging from 37 to 76 years(average 68.4 years). The common complaint was upper ab dominal pain. Most of the tumors located at the head of pancreas. The feature of ERCP findings include dilation of the orifice of the papilla of Vater, swelling of the papilla of Vater, massive mucin production and dilation of main pancreat ic duct. The pathological finding is adenoma or adenocarcinoma. Conclusions IPMT is a kind of pancreatic tumor and its prognosis i s better than pancreatic duct cancer. We should differentiate IPMT from other pa ncreatic tumors.

Three alkaloids were isolated from Huperzia serrata (Thunb. ) Trev. Their structure were identified as 8-deoxyserratinine (Ⅰ), lycodiue (Ⅱ) and phlegmariurine B (Ⅲ ) by means of spectral analysis (UV, IR, NMR, MS ). compoundⅡ and Ⅲwere isolated for the first time from this species

Four alkaloids were isolated from Huperzia serrata (Thunb. ) Trev., The structures of these alkaloids were identified as des-N-methyl-?-obscurine (Ⅰ),lycopodine (Ⅱ),lycodoline (Ⅲ),and 6-?-hydroxy-lycopodine (Ⅳ) by means of spectral analysis (UV, IR, NMR, MS ). Compounds Ⅰ and Ⅳ were isolated for the first time in the species.

BACKGROUND:Heart valve surgery combined with coronary artery bypass grafting has been gradual y used for treatment of coronary heart disease combined with cardiac valve disease.
OBJECTIVE:To retrospectively summarize the experience of combined coronary artery bypass grafting and valvular procedure.
METHODS:Total y 51 patients who underwent combined heart valve surgery and coronary artery bypass grafting were retrospectively analyzed, including 10 cases with aortic valve replacement, 14 cases with mitral valve replacement, eight cases with mitral valve replacement combined with tricuspid annuloplasty, four cases with aortic valve and mitral valve replacement, three cases with aortic valve and mitral valve replacement combined with tricuspid annuloplasty, seven cases with mitral valvuloplasty, and five cases with mitral valvuloplasty combined with tricuspid annuloplasty.
RESULTS AND CONCLUSION:Biovalve replacement was performed in nine patients, mechanical valves replacement in 31 cases, mitral valvuloplasty in 11 cases and tricuspid annuloplasty in 16 cases. There were total y 109 bypass graft vessels, and the average number of coronary artery bypass grafts was (1.92±0.73) branches. Four cases died within 30 days postoperatively, and 47 patients were successful y discharged from the hospital. Forty-five of 47 discharging patients were fol owed for 3-48 months. One case died of cerebral infarction within 6 months postoperatively, and another case died of cardiac dysfunction over 1 year after operation. The heart function of 45 survival patients was significantly improved. The comprehensive analysis showed that improving the heart function preoperatively, strengthening myocardial protection, shortening operation and myocardial ischemia time, and complete revascularization are the key factors for successful operation.

BACKGROUND:Flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures are two common methods in the clinic. It remains controversial which fixation methods are better. OBJECTIVE:To systematicaly evaluate the therapeutic effects of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures. METHODS: A computer-based search was performed on PubMed, Embase, Medline, and Cochrane library for literatures on clinical controled trials of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures published before November 25, 2014. Literature language was not limited. The age of subjects was from 3 to 15 years. Modified Jadad was utilized to assess methodological quality of the included studies. Meta-analysis was carried out using Stata 12.0 software. RESULTS AND CONCLUSION:Six papers involving 237 patients were included. Meta-analysis results showed that compared with external fixation, a low incidence of overal complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46;P < 0.001] and pin-hole infection (RR=0.286, 95%CI: 0.13-0.61;P= 0.001), but a high risk of needle tail irritation (RR=1.86, 95%CI: 1.35-2.56;P < 0.001) were found folowing flexible intramedulary nailing. No significant differences in other complications were found between the two groups. These results confirm that compared with external fixation, elastic intramedulary nail has fewer complications and faster fracture healing. Elastic intramedulary nail is recommended for single pediatric femoral shaft fractures. However, external fixation is a better option for high energy injury of lower limbs, multiple trauma or severely soft tissue injury.

Objective To analyze the clinical characteristics of severe retinopathy of prematurity (ROP) in extremely low birth weight infants (ELBWI),and to evaluate the management model of ROP screening of ELBWI and the clinical effects and treatment timing of photocoagulation with intravitreous injection of vascular endothelial growth factor inhibitor (Avastin).Methods Forty-five cases of ELBWI (birth weight ＜ 1000 g) survived finally in our neonatal intensive care unit from July 1,2004 to June 30,2011 were reviewed.ROP screening was regularly performed in 4 ～ 6 weeks postpartum with binocular indirect funduscope by ophthalmologists.Newborns with severe ROP were treated with laser photocoagulation in the fundus.Some newborns that developed aggressive posterior ROP(APROP) were treated with combined intravitreous injection of Avastin and photocoagulation.Results Thirteen of 45 cases (28.89％) had not developed to ROP finally.Six cases (13.33％) developed to stage 1 ～ 2 ROP and then spontaneous recovery during the follow-up period.Twenty-six newborns (57.78％) developed to severe aggressive posterior ROP (APROP) and need to be treated with photocoagulation.All 3 APROP infants (6.67％) were received intravitreous Avastin injection prior to photocoagulation.The visual acuity of all 45 patients (100％) in this study was preserved.Conclusion ELBWI have a higher morbidity of severe ROP.Timely screening and intervention are effective to prevent disease progression.Intravitreous Avastin injection prior to photocoagulation may be necessary to preserve the visual acuity of infants with APROP.Respiratory management is the key for post-operation care.

Objective To investigate the application of 3D printing technique in the treatment of obsolete pelvic and acetabular fractures.Methods The clinical data of 23 patients with obsolete pelvic and acetabular fractures were retrospectively analyzed who had been surgically treated in our hospital from January 2006 through January 2016.3D printing technique was used in surgical planning in 11 of them,including 8 males and 3 females,with an average age of 33.8 ±4.9 years (3D group).The other 12 patients received conventional surgery without using 3D printing technique.They were 9 males and 3 females,with an average age of 34.8 ± 8.3 years (conventional group).The primary pelvic fractures in both groups were all type C according to the Tile classification system.The patients complicated with acetabular fracture in the 3D group and the conventional group were 10 and 11 cases respectively.The operative time,blood loss,blood transfusion.intraoperative fluoroscopy,visual analogue score (VAS) and Majeed score were compared between the 2 groups.Results The 2 groups were compatible in terms of preoperative general data (P ＞ 0.05).For the 3D group and the conventional group,operative time was 166.4± 24.2 min versus 222.5 ± 49.0 min.blood loss 2,063.6 ± 484.3 mL versus 2,700.0 ± 597.0 mL,blood transfusion 13.2 ± 3.2 U versus 17.6 ± 4.5 U,and intraoperative fluoroscopy 7.4 ± 1.3 times versus 11.7 ± 3.6 times.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The 3D group and the conventional group obtained an average follow-up of 18.4 months and 21.7 months,respectively.The postoperative VAS scores were respectively 1.8 ±-0.9 points and 3.4 ± 1.0 points for the 2 groups,showing a significant between-group difference (P ＜0.05).The Majeed scores at the last follow-ups were respectively 85.7 ± 4.2 points and 84.9 ± 3.1 points for the 2 groups,showing no significant between-group difference (P ＞ 0.05).There were no such complications in the 3D group as iatrogenic nerve injury,vascular injury,nonunion or internal fixation failure.One patient in the conventional group suffered transient iatrogenic injury to the sciatic nerve.Conclusions 3D printing technique can provide helpful guidance for diagnosis and fracture classification preoperatively.It improves the patient's perioperative safety by benefiting intraoperative reduction,shortening operative time,and reducing intraoperative blood loss and intraoperative fluoroscopy.

Objective To analyze the differential expression of proteins among patients with pancreatic cancer,chronic pancreatitis and choledocholithiasis in order to find potential biomarkers for diagnosis of pancreatic cancer and to differentiate pancreatic cancer from chronic pancreatitis. Methods The pancreatic juice were connected from 5 pancreatic cancer patients,6 chronic pancreatitis patients and 3 choledocholi-thiasis patients by naso-pancreatic drainage using endoscopic retrograde cholanglopancreatography(ERCP).The proteins in pooled pancreatic juice were separated by two-dimensional gel electrophoresis (2-DE).The differential expression of proteins were analyzed by image analysis software and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS).Results ①There were 35-200 ml of pancreatic juice collected,and protein concentration were ranged from 0.8 to 4.6 μg/μl.The 2-DE showed that the protein spots in pancreatic cancer,chronic pancreatitis and choledocholithiasis juice were 196±12,209±15 and 199±10,respectively.The matched proteins among three groups all exceeded 75%.②MALDI-TOF-MS revealed that the expression of chain A of a covalent dimer of transthyretin in pancreatic cancer was up-regulated(＞2-fold)while the expressions of chain A of crystal structure of lipid-free human apolipoproteinA-1,chain of human lithostathin and regenerating islet-derived 1 beta precursor were down-regulated. Conclusions Protein spectra are different in patients with pancreatic cancer,chronic pancreatitis and choledocholithiasis.Transthyretin,apolipoproteinA-1,human lithostathin and regenerating islet-derived 1 beta might be the biomarkers of human pancreatic cancer and may be useful in distinguishing pancreatic cancer from chronic panceatitis.