Objective To determine the effectiveness and safety of endoscopic botulinum toxin injection versus pneumatic dilation in treatment of achalasia.Methods A systematic review of all the relevant randomized controlled trials was performed according to international Cochrane Collaboration.Results Twelve trials involving 559 patients were included in the systematic review.Meta analysis showed:(1)Pneumatic dilation was superior to botulinum toxin injection in short term symptom relief(83.21% VS 71.27%.P=0.0007);(2)It was also superior to botulinum toxin injection in long term symptom relief(54.59% vs 27.60%,P=0.005);(3)The recurrent rate is lower in botulinum toxin injection than in pneumatic dilation(55.66% vs 18.84%,P<0.0001);(4)There were more side-effects and complications in pneumatic dilation than in botulinum toxin injection(13.01% VS 1.35%,P=0.0008).Conclusion The limited current evidence showed that endoscopic botulinum toxin injection and pneumatic dilation are safe and effective in the short term treatment for achalasia.Pneumatic dilation is more effective than endoscopic botulinum toxin injection in the long term treatment for achalasia.

[Objective]To investigate the effects of the seed extract of Clausena lansium,N-methyl-N-cis-styryl-cinnamamide,on the penicillin-induced epilepsy in rats.[Methods]Thirty-two Sprague-Dawely rata were randomly divided into four groups with 8 rats in each group:normal control(20 mL/L Tween 80+Normal Saline),model control(20 mL/L Tween 80+Penicillin),low dose treatment(Cinnamamide 75 mg/kg+Penicillin),hish dose treatment(Cinnamamide 150 mg/kg+Penicillin).The epilepsy rat model was established by localized intracortical injections of penicillin.The effects of pretreatments of the rats with N-methyl-N-cis-styryl-cinnamamide(intraperitoneal injection,ip)on the penicillin-induced seizure activities and the epileptiform discharges recorded by electrocorticogram(ECoG)were observed.[Results]The penicillin-induced seizure was significantly lightened in both the pretreatment groups(75 and 150 mg/kg N-methyl-N-cis-styryl-cinnamamide),compared with the model group.N-methyl-N-cis-styryl-cinnamamide(75 and 150 mg/kg)could significantly prolonged the latency of epileptiform activities,shorten the duration of epileptiform discharges and decreased the mean spike frequency in the late stage(P＜0.05 or P＜0.01).However,there was no significant difference in the highest value or the lowest value of the epileptiform waves between the model and cinnamamide treatment groups.[Conclusion]The seed extract of Clansena lansium,N-methyl-N-cis-styryl-cinnamamide,can significantly inhibit the seizure and epileptiform discharges caused by penicillin-localized injections in the cortex of rats,suggesting that the natural substance has an anticonvulsive function.

Objective To investigate the curative effect of synchronous radio-chemotherapy in medium-term and advanced cervical carcinoma. Methods 168 cases of medium-term and advanced cervical carcinoma were selected. The treatment group(grout A) included 84 pathologically verified cases of stage Ⅱ～Ⅳ cervical carcinoma. Each patient was given DDP with hydration at the dose of 40 mg/m2 intravenously.The treatment cycle was performed once every week for 3--4 circles. Radiotherapy was given at the same time. 60Co was used for external radiation with a total dose of 50 Gy, 192 Ir afterloading unit was used for brachytherapy at the dose of 7 Gy per week at point A with a total dose of 42 Gy. The control group (group B)included 84 cases of cervical carcinoma at the same stage in the corresponding period who received radiotherapy only.Short-term effect ,2-year survival rate and complications were observed. Results Effective rate was 92.85 %(78/84) in group A and 79.76 %(67/84) in group B respectively 3 months after radiotherapy, showing a significant difference(χ2 =6.10,P <0.05). 2-year survival rate was higher in group A (83.95 %) than in Group B(60.98 %) (χ2 =9.4,P<0.05). Local recurrent and distant metastasis were lower in Group A than Group B. In group A, there were tolerable bone marrow inhibition and reaction of digestive tract. Conclusion Synchronous radiotherapy and chemotherapy can remarkably improve the survival rate of medium-term and advanced cervical carcinoma. The application of DDP is effective and safe,and its side effect can be accepted by patients, but the long-term effect needs further observation.

AIM To establish anti-osteosarcoma antibody producing hybridoma cell lines and to study the characterization of the monoclonal antibodies. Methods BALB/c mice were immunized with human osteosarcoma cells OS-9607 and the immunized spleen cells were fused with SP2/0 cells to raise hybridoma. The propert of antibody and it's cytotoxic effect were studied respectively with immunohistochemistry methods using OS-9607 and normal hepatocytes、 Western Blot methods and MTT method. Results A hybridoma cell line named 3D9 was established and it secreted high quality mAbs steadily. 3D9 cell had all the characteristics of hybridoma. The mAb's corresponding antigens was specifically and highly expressed in human osteosarcoma. With enzyme-labeled immunohistochemical staining on formaldehyde -fixed sections from human osteosarcoma,it was found that 83％ of the specimens expressed the corresponding antigen. Most of them were expressed on the nuclear of cells, no positive expression was observed in kinds of normal tissues. Western Blot showed 3D9's corresponding molecule weight is Mr54 000. MTT assay proved that the cytotoxicitis of effective groups were higher than control groups. Conclusion A high quality hybridoma is cultured and the mAb secreted by it has osteosarcoma specificity and obvious cytotoxic effect. It may be a new biochemical mark of osteosarcoma, and it's clinical prospect of immunotherapy will be wide.

Objective To evaluate the impact of different factors on long-term results in cervical carcinoma patients initially treated by surgery followed by radiotherapy. Methods In 1998, 525 cervical carcinoma patients were admitted, among whom 346 patients were first treated by surgery. 302 of these 525 patients were given postoperative radiotherapy. The stage distribution of these 302 patients were: stage I 142;stage Ⅱa 121;stage Ⅱb 23;and stage Ⅲa 16. ~ 60 Co ? or 6MV X-ray was used for radiotherapy. Perpendicular portals were alternately irradiated to 44-50Gy/4-5 week. Extending the portal, increasing the dose after constricting portal, adding intracavitary afterloading irradiation and adjuvant chemotherapy were carried out according to the different clinical requirements. Results The 5-year survival rate was 89.4%,77.7%,56.5% and 56.3% in stage I, Ⅱa, Ⅱb and Ⅲa lesion, respectively(?~2=22.22,P

Objective To investigate the application value of pancreatic duct guide wire and transpancreatic septotomy with precutting technique in difficult endoscopic retrograde cholangiopancreatography.Method258 patients who underwent difficult endoscopic retrograde cholangiopancreatography from April 2014 to April 2016 were selected as study subject, 128 patients among them received the technique of pancreatic duct guide wire, the other 130 patients received transpancreatic septotomy with precutting techniques. The success rate, intubation time and incidence of complications were compared between these two methods for cannulation.Result There was no signiifcant difference in preoperative clinical data between the two groups, the success rate did not differ signiifcantly between the two groups (93.75 % vs 93.85 %). Compared with transpancreatic septotomy with precutting techniques group, pancreatic duct guide wire group is less intubation time consuming (5.92 ± 0.69 vs 12.81 ± 3.67) min, the difference was statistically significant (t = -2.27,P < 0.05). 25 patients experienced complications, with 6 cases of acute pancreatitis, 2 cases of biliray tract infection in pancreatic duct guide wire group, and 8 cases of acute pancreatitis, 3 cases of hemorrhage,6 cases of biliray tract infection in transpancreatic septotomy with precutting techniques group. The pancreatic duct guide wire group had a signiifcantly lower incidence of complications (6.25 % vs 13.08 %). the difference was statistically signiifcant (χ2 = 3.27,P < 0.05). The incidence of acute pancreatitis did not differ signiifcantly between the two groups (4.69 % vs 6.15 %).ConclusionsPancreatic duct guide wire and transpancreatic septotomy with precutting techniques both can further improve the success rate of bile duct cannulation with ERCP. The incidence of acute pancreatitis did not differ significantly between two groups. But pancreatic duct guide wire group is less intubation time consuming, and had a significantly lower incidence of complications. Because of the convenience and safety of the pancreatic duct guide wire technique, and the insertion of the pancreatic duct does not increase the risk of postoperative acute pancreatitis. We think that this method is more worthy of Clinical promotion.

Rapid development in medical technology has posed new challenges to higher medical education,especially to education of eight-year program students.How to survive the challenges has thus become a question for medical institutions.By analyzing the features of medical development and the new demand of medical education,we proposed the following innovations for education in eight-year program.It should emphasize combination of different disciplines and construction of integrated medical course system.Research on translational medicine should be conducted,and cooperation between institutions should be promoted.

Objective To study the relationship between the neovascula rization of carotid atherosclerotic plaques with real-time contrast-enhanced ultrasonography(CEUS),plasma myeloperoxidase (MPO)concentration and cerebral infarction.Methods Seventy-three cases with eighty-nine carotid atherosclerotic plaques were examined with real-time CEUS.According to the imaging features,the seventythree cases were divided into three groups:soft plaques group,hard plaques group and mixed plaques group.The differences of the incidence rate of cerebral infarction events,plasma MPO concentration and contrast media persistent enhancement time with real-time CEUS in plaques among the three groups were analyzed.The cerebral infarction events were diagnosed by CT or MRI routinely.Results The incidence rate of cerebral infarction events,plasma MPO concentration and contrast media persistent enhancement time of soft plaques group were significantly higher than that in hard plaques group and mixed plaques group.The risk of cerebral infarction was higher in the patients with elevated level of MPO.It showed positive correlation between the contrast media persistent enhancement time and plasma MPO concentration,and the correlation coefficient was 0.838. Conclusions The type of the plaque is correlated with the neovascularization of plaques and plasma MPO concentration.The study of relationships among them can help to evaluate the plaques,stability thoroughly and guide the clinician to prevent the incidence of cerebral infarction events.

Objective To evaluate the sensitive indicator of left ventricular rotation/torsion assessed by two-dimensional speckle tracking imaging (STI) and Logistic regression analysis,and to investigate the clinical value of the sensitive indicator for assessment of left ventricular dysfunction in patients with chronic cor pulmonale (CCP).Methods 36 patients with CCP (CCP group) and 38 healthy controls (control group) were included in this study.Imaging in parasternal short-axis view (in basal and apical level) were selected.Parasternal short-axis views at mitral valve and apical levels were collected.Basal peak rotation,apical peak rotation,peak torsion,basal end-systolic rotation,apical end-systolic rotation and end systolic torsion were measured with Echo PAC software.Relevant indicators of left ventricular rotation/torsion were selected by using logistic regression analysis and the regression equation was established.Optimal values of specific parameters (Peak torsion and end-systolic torsion) were calculated with receiver-operating characteristic (ROC) curve.Results Specific parameters of rotation/torsion were significantly reduced in patients with CCP as compared with controls (all P＜0.01).Logistic regression analysis showed that end-systolic torsion and peak torsion were correlated with CCP (OR=0.473 and 0.706,P=0.007 and 0.011).Cut-off value of peak torsion for predicting left ventricular dysfunction was 12.070°,the area under the ROC curve (AUC) was 0.819 (95％ CI:0.683-0.956),the sensitivity was 84.6％,and the specificity was 73.9 ％.Cut-off value of end-systolic torsion for predicting left ventricular dysfunction was 10.680°,AUC was 0.875(95％CI:0.744 1.000),the sensitivity was 84.6％,and the specificity was 91.3％.Conclusions Two-dimensional speckle tracking imaging can sensitively assess left ventricular torsion and evaluate the left ventricular dysfunction in patients with CCP.

Objective:To study the efficacy of direct intrahepatic portosystemic shunt (DIPS) in treatment of Budd-Chiari syndrome (BCS).Methods:From January 1, 2015 to June 31, 2017, consecutive patients with BCS who were treated with DIPS at the Department of Interventional Therapy of Beijing Shijitan Hospital, the Liver Disease Research Center of Beijing Friendship Hospital and the General Surgery Department of Beijing Ditan Hospital were retrospectively analyzed. The symptoms, physical signs (including abdominal distension, ascites, pleural effusion, splenomegaly, hepatic encephalopathy) and perioperative laboratory results of these patients were collected and analyzed. Biochemical indicators including alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), direct bilirubin (DBil), and portal pressure gradient were compared before and 2 weeks after treatment. The patients were followed up for at least 3 years to assess their clinical symptoms, patency of shunt, oncological status and survival.Results:Of 67 patients with BCS who were included in the study, there were 45 males and 22 females, aged (38.12±23.22) years. The BCS classification of these patients were hepatic vein type ( n=65), including 62 patients with complete hepatic vein obstruction, 3 patients with hepatic vein occlusion due to thrombosis, and 2 patients with mixed hepatic vein and inferior vena cava occlusion. All 67 patients underwent DIPS with 93 stents being implanted. In addition, 43 patients underwent gastric coronary vein embolization, and 2 patients with mixed type of BCS underwent inferior vena cava stenting. The portal pressure gradient decreased from (22.17±9.16) mmHg (1 mmHg=0.133 kPa) to (9.87±4.75) mmHg, the difference was statistically significant ( P<0.05). Abdominal distension was relieved, at one month and ascites completely subsided in 3 months after operation. The liver congestion and swelling were obviously relieved. Comparison of patients 2 weeks after operation and before operation, ALT decreased from (65.28±27.75) U/L to (28.43±13.46)U/L, AST from (68.75±29.23) U/L to (26.92±13.33)U/L, TBil from (175.31±80.48)μmol/L to (45.08±26.54)μmol/L, DBil from (127.55±44.65)μmol/L to (35.12±10.77)μmol/L, and albumin increased from (31.56±7.22) g/L to (44.18±11.36)g/L, the difference was statistically significant (all P<0.05). All patients were followed up for at least 3 years. Shunt stenosis was detected in 5 patients (7.46%) with shunt expansion being performed, variceal bleeding in 2 patients (2.99%), ascites recurrence in 4 patients (5.97%) and hepatic encephalopathy in 2 patients (2.99%). No patients were diagnosed with hepatic cancer, and no patients died. Conclusion:DIPS was efficacious, safe and reliable to that BCS patients. It rapidly reduced portal venous pressure, relieved liver congestion, and restored liver morphology and liver function in these patients.