Objective To study the diagnosis and therapy of recurrent cholelithiasis caused by peripapillary duodenal diverticulum.Methods The clinical data of 40 patients with repeated formation of bile duct stones caused by peripapillary duodenal diverticulum were retrospectively reviewed,and the data on surgical treatment were analyzed.Results All the patients underwent duodenal diverticulum operation and subtotal gastrectomy (Billroth Ⅱ).Twenty-one patients in addition underwent R-Y cholangiojejunostomy,14 patients and 5 patients underwent choledochotomy with T-tube drainage and duodenotomy with Oddi sphincterotomy,respectively.In forty patients,three patients presented temporarily biliary fistula,two patients lost touch,three-eighty fully recover from an illness in three years.Conclusion Recurrence of bile duct stones caused by peripapillary diverticulum may be cured by duodenal diverticulum operation combined with bile duct surgery,which is a feasible and efficacious treatment.

Objective To examire the effects of hydroxyethyl starch (HES 200/0.5 6%) on lung capillary permeability in endotoxemic rats.Methods Forty-two male Wistar rats weighing 250-300 g were randomly divided into 7 groups with 6 animals in each group: group 1 served as control; group 2 received lipopolysaecharide (LPS) 6mg?kg-1 intraperitoneally (i.p.); in group 3-6 1 min after LPS 6 mg?kg-1 i.p. HES 3.75 ml?kg-1 (group 3), 7.5 ml? kg-1 (group4), 15 ml? kg-1 (group 5) or 30 ml?kg-1 (group 6) was infused i. v. at a rate of 0.2 ml ? min-1 ; group 7 received only HES 30 ml ? kg . The animals were anesthetized with urethane. Right external jugular vein was cannulated for continuous intravenous infusion. Animals were sacrificed at 2 h and 4 h after LPS challenge respectively. Lung capillary permeability, lung wet/dry weight ratio and lung PMN accumulation were measured at 4 h after LPS challenge and nuclear factor Kappa B (NF-?B) activation in the lungs at2 h after LPS challenge.Results HES 3.75 ml?kg-1 and 7.5 ml ? kg-1 significantly reduced LPS-induced increase in lung capillary permeability, lung wet/dry weight ratio and lung PMN accumulation ( P

Different preparations of Hydroxyethyl starch (HES) each have unique molecular weight, degree of substitution and manner of substitution, which are responsible for their intravascular volume expansion and half-life. HES solutions have notable effects on ameliorating hemodynamic and hemorrheological parameters, as well as unique capacity to prevent and reduce capillary leak. Compared with other colloid solutions, HES is more effective, safe and economical. It is an ideal volume expander.

Objective To explore the diagnosis and treatment of iatrogenic bile duct injury during choledochocystectomy. Methods Clinical data of 24 cases of iatrogenic bile duct injury were analyzed retrospectively from 2005 to 2009. Results Eight patients underwent early repair of bile duct within 4 days after the injury. 14 patients with later recognized bile duct injury underwent selective operations, and two patients were discharged after their jaundice were relieved without any surgical treatment. Supporting T tubes were left in place in 22 patients for 8 to 14 months after operations, without any biliary obstruction found after one year and six months to five year follow-up. Conclusions Early bile duct injury within 4 days was easily treated, but later bile duct injury should have selective operation. The patients with jaundice could be diagnosed with PTCD and ERCP to observe the bile duct injury. During operation membrane-to-membrane wide hepatojejunostomy helps prevent later anastomotic stenosis. The left in drainage tube in anastomotic stoma for more than 8 months improves success rate in the process of injuried bile duct repair.

Medical professionalism is an important part of competencies which physicians are acquired to own.Team of physician's competency model construction and education revolution project concluded the current situation and theoretical cognition of physician's professionalism of experts from medical education and administration organizations in China according to the results of the first round of Delphi.Meanwhile,suggestions for the further improvement of physician's professionalism were pro

Objective To make a comparative assessment on both the therapeutic effects and side effects between percutaenous lauromacrogol injection therapy(PLIT) and percutaenous ethanol injection therapy(PEIT) for simple hepatic or renal cyst.Methods In group A,55 patients with simple hepatic or renal cysts underwent ultrasound-guided aspiration and successive PLIT.The intra-operative side effects were investigated and the therapeutic effects assessment by using ultrasonography was conducted 3 months after the treatment.In group B,60 patients with simple hepatic or renal cysts had received ultrasound-guided aspiration and PEIT sometime before.The intra-operative side effects and therapeutic effects on the thirdmonth ultrasonography were independently reviewed according to their case records.Results In group A,3 patients(5.5 ％) expressed slight discomfort but not pain while receiving lauromacrogol injection.Follow-up ultrasound examination at the end of third month demonstrated the cysts in 43 patients completely regressed,while cysts in rest 12 patients shrank over 50 ％ in size,showing the overall response rate(ORR) and completely cure rate(CCR) were 100％ (55/55) and 78.2％ (43/55) for PLIT respectively.In group B,12 patients(20％) suffered from slight to moderate irritating pain or drunk performance.The third-month ultrasound examination disclosed that cysts in 47 patients completely vanished,and cysts in the other 13patients shrank more than a half,indicating the ORR and CCR were 100％ (60/60) and 78.3 ％ (47/60) for PEIT respectively.Conclusions Although their therapeutic efficacy are perfectly similar,PLIT is much more superior to PEIT in term of less and minor side effects.

[Abstract ] Objective Stenosis is a common complication of Crohn′s disease (CD), different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging(DWI) and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD (18 males and 13 females;mean age:38.90 ±13.65 years) were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient (ADC) of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group (n=21) and fibrotic group (n=10). We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were (1.01 ±1.83) ×103 mm2/s and (1.40 ±0.23) ×103 mm2/s, whereas (0.53 ±1.03) ×103 mm2/s and (0.80 ±0.16) ×103 mm2/s in the fibrotic group(P<0.05).The area under receiver operating characteristic curve was 0.981 (95%confidence interval 0.943-1.000), taking 1.11 ×103mm2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.

Objective To investigate the serum prostate specific antigen tPSA),ratio of serum free PSA to total PSA (f/t),prostate volume (PV) and prostate specific antigen density (PSAD),their correlation with prostatic intraepithelial neoplasia (PIN) and their clinical diagnostic significance. Methods Retrospectively evaluate 165 cases of patients with PIN ( including 31 cases of LGPIN,134 cases of HGPIN),which confirmed by pathology,and 252 cases of benign prostatic hyperplasia (BPH),49 patients with prostate cancer (PCa),both diagnosed by pathology,as control.The average age of BPH,LGPIN,HGPIN,PCa groups were 70.13 ± 0.43,70.97 ± 1.28,70.74 ± 0.64,70.37 ± 1.40,the International Prostate Symptom Score (IPSS) were 20.20 ± 0.88,14.71 ± 3.42,20.19 ± 1.239,19.27 ± 2.73,and the PV were 58.07 ± 3.58,56.01 ± 7.52,60.74 ± 4.81,47.56 ± 6.54,respectively.The data of PSA,f/t,PV and PSAD were analyzed and compared within the four groups. Results Age,IPSS score and PV had no significant difference among the four groups (P ＞ 0.05).The PSA level of BPH,LGPIN,HGPIN,PCa groups were 5.65 ±0.38,5.86 ±0.81,8.91 ±0.71,13.80 ±1.83,the f/t ratio were 0.26 ±0.01,0.24 ±0.02,0.22 ±0.01,0.167 ± 0.01,and the PSAD level were 0.11 ± 0.01,0.10 ± 0.02,0.19 ±0.03,0.48 ±0.12,respectively.PSA,f/t and PSAD were not significantly different between HGPIN and LGPIN ( P ＞ 0.05 ),and likewise between LGPIN and BPH patients ( P ＞ 0.05 ).PSA,f/t and PSAD were significantly different between LGPIN and PCa patients ( P ＜ 0.05),and likewise between HGPIN and BPH patients (P ＜ 0.05 ).PSA and PSAD were significantly different between HGPIN and PCa (P ＜ 0.05 ).The areas under the ROC curve of PSA and PSAD of HGPIN were 0.6281 (P ＜0.01 ) and 0.5919 (P ＜0.05).Conclusions PSA and PSAD are correlated with HGP1N and can predict the existence of HGPIN early;PSAD can identify HGPIN and PCa,when PSA and f/t are normal.The clinical features of LGPIN are similar to BPH,and HGPIN is easy to develop to PCa.

Objective To study the influence of long-term home noninvasive positive pressure ventilation (HNPPV) on respiratory muscle strength in patients with stable severe chronic obstructive pulmonary disease (COPD).Methods Sixty-four patients with stable severe COPD discharged from Huabei Oil-field Hospital,Renqiu,Hebei were divided into two groups,one (n=24) with HNPPV plus conventional therapy,and the other (n=40) with conventional therapy plus long-term oxygen therapy as controls.All parameters were followed-up for one-year and compared for the two groups,including maximal iuspiratory pressure (MIP),transdiaphragmatic pressure (Pdi),maximal transdiaphragmatic pressure (Pdimax),ratio of Pdi/Pdimax,arterial partial pressure of carbon dioxide (PaCO2),forced expiratory volume in one second (FEV1),6-min walking distance (6MWD),mortality and re-hospitalization rate.Results Age,gender,course of the disease,body mass index (BMI),arterial PaCO2,PaO2,MIP,Pdi,Pdiraax,ratio of Pdi/ Pdimax,FEV1,ratio of FEV1/FVC%,6MWD and re-hospitalization rate of the patients between the two groups were all comparable (P>0.05).In one-year follow-up,PaCO2averaged (52±8)mm Hg,MIP (64±7) cm H2O,Pdi (33±5) cm H2O,Pdimax (101±9) cm H2O,Pdi/Pdimax (0.31±0.04),FEV1 (35±4) %,FEV1/FVC% (44±4) %,6MWD (272±26) m and (2.6 ± 0.8) admissions per year in the HNPPV group,significantly different from those in the control group [ (57 ± 6) mm Hg,(59 ± 6) cm H2O,(31±4) cm H2O,(84±7) cm H2O,(0.35±0.05),(33±3)%,(41±4)%,(212±28) m,and (3.7±0.8) admissions per year] (P<0.05).One death was observed in the HNPPV group (1/24) and three in the control group (3/4 0) in one - year follow - up,with no statistically significant difference (X2=0.00,P>0.05).Conclusions Long-term use of HNPPV for patients with stable severe COPD could efficiently improve their respiratory muscle strength and endurance,thus improving their pulmonary ventilation and treatment efficcacy.

Objective To detect the positive rate of anti-endothelial cell antibody (AECA) in patients with pulmonary arterial hypertension (PAH) associated with connective tissue diseases(CTD)and to investigate the specific target antigen.Methods Sera of 68 patients with CTD associated PAH were collected to detect AECA by Western blotting with extracted membrane protein of the endothelial cell line EA.hy926.Sera of 61 CTD patients without PAH,20 with idiopathic pulmonary arterial hypertension(IPAH),20 with chronic obstructive pulmonary diseases and pulmonary arterial hypertension (COPD-PAH) and 20 healthy donors were collected as controls.The correlation between PAH and specific bands of AECA was studied by X2 test.Liquid chromatography-electrospray ionization mass spectrography was used to detect the target antigens related to PAH associated with CTD.Results The specific molecular size of antigen was 78 000.The AECA-78 000positive rate of CTD patients with PAH was 79% (54/68).not significantly ditierent from that of CTD with glomerulonephritis(71%,15/21),but significantly higher than those of CTD with interstitial lung disease (ILD)(15%,3/20)and CTD without systemic involvement(P<0.01 and P<0.05 respectively).also higher than those of IPAH(8%,1/12).The AECA-78 000 was negative in COPD-PAH and healthy controls.The target antigen of AECA-78 000 was identified by proteomic techniques as moesin.Conclusion CTD patients with different target organ involvement have different AECA-78 000 positive rates,which could be frequently detected in CTD associated PAH and those with glomerulonephritis.The common antigen is moesin.