Objective To investigate the clinical application value, efficiency and safety of precut sphincterotomy in endoscopic retrograde cholangio-pancreatography (ERCP) .Methods From January 2008 to June 2011, 930 patients received ERCP in the department of hepatobiliary surgery of the first hospital of Jilin University.Of them 108 cases (11.6%) were diverted to receive precut sphincterotomy, because selective bile duct cannulation with conventional method was difficult.Inclusion criteria: failure of conventional cannulation or repeating pancreatic duct cannulation for more than 4 times.According to the patient's conditions, the examination and treatment of ERCP was carried out.Observation termination are therapeutic success rate and the incidence rate of complications, and comparative analysis on case data of routine ERCP was made.Statistical analysis was executed by SPSS 13.0 software.Comparison of ratio were determined with χ2 test, a value less than 0.05 was considered as significant.Results Of 108 cases, the success rate of ERCP was 95.4% (103 cases) .The incidence rate of complications was 6.5%, and there are no cases of duodenal perforation and death.Amongst 822 cases of routine ERCP, therapeutic success rate was 97.7%, and the incidence rate of complications was 7.7%.The statistics analysis result indicates that there are no statistical differences between precut sphincterotomy group and routine ERCP groups in the success rate (χ2=2.041, P=0.153) and the incidence rate of complications (χ2=0.141, P=0.707) .Conclusion The precut sphincterotomy in ERCP are safe and obviously effective with less complications compared to routine ERCP.The successful probability of difficult ERCP is improved greatly by using the technique of precut sphincterotomy.But the precut sphincterotomy indication is strictly controlled, and the technique should be performed by experienced endoscopist.

Objective To explore the effect of failure mode and effect analysis (FMEA) method in strengthening the management of critical value of blood specimens in hospital. Methods According to the procedures of FMEA, critical values management team were established, drew flow chart of generating test specimens and crisis value, explored the potential failure mode and failure cause, analyzed the severity, possibility and critical value, and formulate and implement countermeasures according to the research outcome. Results The crisis value of the failure mode fell from 1 320 to 151 after the implementation of FMEA, and rate of decline was 88.56%; number of unqualified blood samples decreased from 510 cases to 78 cases, and the difference is statistically significant (χ2=407.27, P<0.05);critical value processing defects decreased from 85 cases (a total of 236 cases) to 3 cases (a total of 229 cases), and the difference was statistically significant (χ2=91.26, P<0.05). Conclusions FMEA method is helpful to improve the accuracy and precision of critical value management of clinical blood samples, so as to ensure the safety of patients in hospitals.

By collecting literatures on apoplexy recorded in"Database of Basic TCM disease"from 2001 to 2005,we statistically analyzed changes on volume of documents,major authors,major journals,and contents of study in these literatures.

Objective To develop a questionnaire for factors influencing the quality of nursing interns.Methods The factors influencing the quality of nursing interns were formulated through literature review,interview and expert consultation.The pre-questionnaire was developed after modification.Exploratory factor analysis and correlation analysis were used to examine the reliability and validity of this questionnaire.Results Six common factors were extracted by exploratory factor analysis.Factor loading ranged from 0.487 to 0.889 for each item.The Cronbach α of the total scale was 0.814,and that of subscales ranged from 0.802 to 0.863.Retest-reliability coefficient of the total scale was 0.863,and that of subscales ranged from 0.794 to 0.931.Conclusions The self-designed questionnaire for factors influencing the quality of nursing interns has good reliability and validity,and can be used to measure the influencing factors for nursing interns.

Combined therapy consisting of radiotherapy,chemotherapy and palliative surgery is the primary management for locally advanced pancreatic cancer,with the purpose of prolonging survival and improving life quality.Gemcitabine is the standard chemotherapy at present.Gemcitabine-based combinations show a definite effect,and the combination with targeted drugs also has a certain degree of efficacy.The development of new chemotherapy drugs and targeted drugs provides more ways for the teatment of locally advanced pancreatic cancer.

Objective To investigate the clinical value of the 18F-FDG SPECT-CT combined with the image of CT in the diagnosis of lung cancer.Methods Retrospectively analysis images of 18F-FDG SPECT-CT and CT of 162 patients pulmonary tumor-like lesions from January 2013 to October 2013 were conducted.All the patients have been confirmed by the pathological mechanism or cytologic examination.Each patient has been firstly diagnosed by the 18F-FDG SPECT-CT along and then combined with the images of CT.The sensitive rate and the accurate rate of two methods were compared by x2 test.Results There were 40 benign lesions and 114 malignant ones in 162 patients.The sensitive rates of the two methods were 86.0％ and 96.5％ (x2 =6.63,P ＜ 0.05).The accurate rates of the two ways were 79％ and 96.3％ (x2 =7.76,P ＜ 0.05).The differences were statistically significant.Conclusion 18F-FDG SPECT-CT combined with the images of CT can increase the diagnostic sensitivity and accuracy.It has important clinical value.

Objective To explore the clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children, and to investigate its optimal dose. Methods Ninety children scheduled for painless electronic colonoscopy were divided into three groups by using a computer?generated randomization schedule, 30 per group. Children were pretreated with 0. 2 mg/kg midazolam ( group A) , 1. 0μg/kg dexmedetomidine ( group B) or 2. 0μg/kg dexmedetomidine ( group C) by nasal drip 30 min before operation. The anesthesia protocol was programmed by propofol in the three groups. After eyelash reflex disappeared, the examination was performed. Mean artery blood pressure ( MAP ) , heart rate (HR), respiratory rate (RR) and oxygen saturation (SPO2) of children were recorded at 10 min before intranasal administration ( T0 ) , 30 min after intranasal administration ( T1 ) , at the onset of eyelash reflex disappearance ( T2 ) and the onset of examination initiating( T3 ) , at lens passing through splenic flexure ( T4 ) , or through hepatic flexure ( T5 ) , at the end of examination ( T6 ) and when patients were fully awake ( T7 ) , respectively. Bispectral index ( BIS) and the observer's assessment of alertness/sedation scale ( OAA/S) were performed at 10 min before intranasal administration ( T0 ) , 10 min, 20 min and 30 min after intranasal administration in the three groups. Mood score at parent?children separation and venipuncture acceptance score were also recorded. The adverse reactions during examination were analyzed. The above observed indices were compared among the three groups. If there was statistical difference ( P<0. 05 ) , pairwise comparison was performed ( P<0. 017) . Results The children's haemodynamics were all stable in the three groups. Compared with group A and group B at the same time point, BIS and OAA/S were all lower ( P<0. 017) in 10 to 30 min after intranasal administration in group C. Compared with group A and group B, mood score at parent?children separation and venipuncture acceptance score were both higher ( P<0. 017) in group C. Compared with group A and B, anesthetic revival time and consumption of propofol were shorter or lower in group C (P<0. 017). Compared with group A and group B, the incidences of intraoperative adverse reactions including hypertension, sinus tachycardia, restless moving and postoperative restlessness were all lower in group C(P<0. 017). The rate of intranasal stimulus in group B and group C were both lower than that of group A( P<0. 017) . The rate of injection pain of group C was lower ( P<0. 017 ) than that of group A and B. Conclusion Intranasal administration of dexmedetomidine can be safely applied to children receiving painless electronic colonoscopy, and it can improve children's compliance effectively and yield to satisfactory anesthetic effect. Moreover, the administering efficacy of dexmedetomidine with the dose of 2. 0μg/kg was superior to 1. 0μg/kg.

Objective To design a new portable vital signs monitor for family use. Methods TMS320F2812, a kind of digital signal processor, was applied as the main processor to control the functional mod-ules including A/D convertor, LCD display. Bluetooth communication module was introduced to achieve real-time fast transfer of data between the system and the PC. Results Not only can the system monitor electrocardiogram (ECG), breath rate, pulse rate, body temperature and other vital signs accurately, but also it runs stably. Conclusion The features of DSP and Bluetooth were well combined in the design of the family-oriented, easy to use, multi-functional monitor with small size, low power consumption and convenience. A broad application and market prospects can be predicted.

Objective To study the effect of estrogen on cardiac injury and cardiomyocyte apoptosis of rat induced by isoprotere-nol by modeling cardiac inj ury induced by bilateral ovariectomized (OVX)and isoproterenol (ISO).Methods Fifty female SD rats with bilateral ovariectomy and sham operation (Sham)were randomly divided into 5 groups:sham operation group (Sham group), bilateral ovariectomy group (OVX group),cardiac injury group (OVX+ISO+Vehi group),low dose estrogen treatment group (OVX+ISO+E2 a group,4μg·kg-1 ·d-1 ),high dose estrogen treatment group (OVX+ISO+E2 b group,40μg·kg-1 ·d-1 ). these status were separately measured:rats′general features,hemodynamics parameters monitored of carotid artery,morphological observation and cardiomyocyte contraction change of single-cardiomyocyte separate cultured,cardiomyocyte apoptosis protein ex-pression were detected by immunoblotting.Results ISO significantly reduced myocardial pump function,increased hypertrophy and apoptosis of cardiomyocytes,reduced contractility of single cardiomyocytes (P<0.05).High-dose estrogen (40μg·kg-1 ·d-1 ) replacement therapy significantly improved ISO induced cardio inj ury and cardio functions decreasing,also inhibited Bax expression and caspas-3 activation and decreased myocardial hypertrophy and cardiomyocytes apoptosis through increasing Bcl-2 expression (P<0.05),significantly.while low dose estrogen (4μg·kg-1 ·d-1 )treatment showed marginally protection effects on ISO in-duced cardio inj ury with no statisticly significance.Conclusion Appropriate dose estrogen replacement therapy can decrease cardio-myocyte apoptosis,improve cardiomyocytes contractility,so as to protect ISO-induced cardiomyocyte apoptosis.

Prostate cancer is one of the most common malignant tumors among males, and nearly all patients will inevitably de-velop castration-resistant prostate cancer (CRPC). The prognosis of CRPC patients is very poor. How to implement the individualized treatment plan with minimal side effects and optimum benefit as well as how to prolong the patients' lives have recently become impor-tant issues. Current staging and grading systems fail to provide accurate prognoses of most CRPC, which have complicated biological behaviors. Over the past few years, a host of tumor molecular markers have been discovered and can provide prognostic information for CRPC. This review summarizes the molecular prognostic biomarkers that affect the prognosis of CRPC.