OBJECTIVE:To observe the analgesic efficacy and adverse reactions of fentanyl transdermal in the treatment of advanced carcinoma pain.METHODS:43patients suffering from advanced carcinoma pain were administered with fentanyl transdermal system every3days with the dosage regulated accordingly until the patients feel painless or almost painless in24h.RESULTS:The general remission rate was90.7%for fentanyl transdermal in the treatment of moderate and severe cancer pain.Its main manifestations of adverse reactions were dizziness,drowsiness,nausea,vomiting and constipation,which have low incidence rates and degree of which were also low.CONCLUSION:Fentanyl transdermal system has durable and stable analgesic effect with its distinct way of transdermal slow-release,which is simple in operation and minor in adverse reactions;and it can be used as the substitutes for oral hadro-opioid.

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.

ObjectiveTo modify the technique of whole small bowel transplantation in rats to improve the survival.MethodsOne hundred and six SD rats served as donors and recipients to establish a homogeneous and orthotopic model of small bowel transplantation without fistula.Anastomosis of aorta and vein was done with three- cuff technique,the vena mesenterica superior of recipient was done under a surgical microscope.End-to-end anastomosis was performed between donor proximal small intestine and receptor jejunum,and also between the remote and receptor ascending colon.Surviving more than 3 days after surgery was defined as the operation was successful.ResultsThe operation was successfully carried out in 48 cases with the survival rate of 90.6％ (48/53).The average warm ischemic time was 0 minute,and the average cold ischemic time was(30 ±2.48)min.The survival rate( ＞7 d) was 97.9％ (47/48).ConclusionsOn the basis of three-cuff technique,the survival of SBT was greatly improved.When the vena mesenterica superior of recipient was done under a surgical microscope,the surgical training time was shortened.

Objective To evaluate the therapeutic efficacy of transcather arterial chemoembolization for hepatic carcinoma and its influence on hepatic function. Methods Patients with HCC were divided into three groups according to repeated TACE times. The therapeutic efficacy was assessed with survival rate, car-cionma size and biologic response (AFP). Hepatic function was evaluated according to some hepatic param-eters(ALT,AST,ALB,DB,TB,PT). Results All three groups responses rates were 4.3%, 23.1% and 31.6% ;srespectively,liver function in group 1 and group 2 returned to its pretreatment level(P <0.05) ,but in group 3, liver function did not return to its pretreatment level associated with more repeated TACE times. The 1-,2-and 3-year survival rates of group 1 were 27.0%, 10.8%, 5.4% ; respectively, while those of group 2 were 57.1%, 33.3%, 19.0% ; respectively, which were not significantly different from those of Team 3 ,which was 62.5%, 37.5%, 18.8%, respectively. Conclusions (1) three to four repeated times TACE was an effective palliative treatment that prolongs survival of patients with HCC,while 1 to 2 re-peated times had a limited benefit; (2) Irreversible hepatic impairment induced by TAEC could affect its therapeutic efficacy.

Objective To evaluate the relationship between the risk of breast cancer and abortions among nulliparous women. Methods Searched the data of Cochrane Library and PubMed before June 2014 to identify potentially studies which involved the relationship between the risk of breast cancer and abortions among nulliparous women. Data was extracted by two independent authors from each study. STATA software was used for statistical analysis. Calculated the pooled RR and 95% CI as the assessment of the link between abortions and breast cancer in fixed effects models. Results 13 studies were included. The study showed the RR and 95%CI of the relationship between the risk of breast cancer and abortions was 0. 98[0. 89,1. 08],P>0. 05 in nulliparous women, and the number of abortions was not associated with the risk of breast cancer. The RR and 95%CI of the relationship between the risk of breast cancer and induced abortions or spontaneous abor-tions were 0. 96[0. 88,1. 04],1. 01[0. 88,1. 14], respectively. Conclusion There is no correlation between breast cancer and abortions a-mong the nulliparous women, and the risk of breast cancer would not increas as the number of abortions increase.

Hemolymphangioma is a kind of deformity of the lymphatic vessel and venule,which is rarely seen in clinical practice.A 66-year-old female patient who had a chief complaint of distention in left upper quadrant of the abdomen for 6 months was admitted to the General Hospital of Chengdu Military Region of PLA.Examination of computed tomography and B ultrasound confirmed that the patient had a retroperitoneal cystic mass.During the exploratory laparotomy,the soft mass was found at the left upper quadrant of the abdomen and had invaded to the pancreas.Postoperative pathological examination confirmed that the mass was a pancreatic hemolymphangioma.

Objective To investigate changes in number of endothelial progenitor cells(EPCs)from bone marrow and circulation in mice with acute pancreatitis.Methods BALB/c mice were assigned randomly to saline group and cerulein group.Animals were sacrificed at 12, 24 and 48 hours after injection.Bone marrow and circulating EPCs were detected by flow cyzometric analysis.Plasma VEGF, TNF-α and ET-1 were determined by enzyme-linked immunosorbent assay.The expression of VEGF in the pancreas was assessed by Western blotting.Apoptosis in situ was detected by TUNEL.Results The amounts of EPCs in bone marrow and circulation increased remarkably after cerulein injection(P < 0.05), also the levels of plasma VEGF TNF-α and ET-1(P < 0.05), the EPCs levels in bone marrow and circulation seen in the study closely mirrors the levels of VEGF detected in the circulation(r = 0.77, 0.67 individually).VEGF expression in pancreas was up-regulated after 12 h of cerulein injection compared with that of control group.Apoptosis of endothelial cells also increased in the cerulein group.Conclusion EPCs were mobilized by acute pancreatitis, which may be due to the mobilizing effect of increased levels of VEGF, EPCs may participate in the repair process of injured endothelium induced by acute pancreatitis.

Objective To study the mechanism of high intensity ultrasound (HIU) on COX-2 mRNA expression and apoptosis in breast cancer cell line MDA-MB-231 cells.Methods Human breast cancer cells MDA-MB-231 in vitro were exposed in HIU (50 w/cm2).RT-PCR was performed to detect the level of COX-2 mRNA before and after exposure.The ultrastructural changes in apoptotic cells were examined by transmission electron microscopy.Results The relative level of COX-2 mRNA decreased gradually along with the increase of exposure time and apoptotic bodies in MDA-MB-231 cells considerably increased under electron microscope.When exposure time was increased to 30 seconds,a few cells died.Conclusion HIU promotes apoptosis of breast cancer MDA-MB-231 cells in a COX-2 mRNA depended way.

Objective To investigate the optimal gamma passing rate of intensity-modulated radiotherapy (IMRT) dosimetric verification in the treatment of esophageal cancer using a three-dimensional dose verification system EDoseTM.Methods Twenty five esophageal cancer patients treated by 7-field IMRT were retrospectively reviewed.Measured dose distribution were reconstructed on CT image and evaluated by gamma analysis and DVH metrics using the EDoseTM system.Plans with DVH metrics dose difference ＜ 5％ or with gamma passing ＞ 90％ under 3％/3 mm criteria were accepted.The optimal gamma passing rate for criteria of 5％/3 mm,3％/3 mm,2％/2 mm were investigated by drawing the receiver operating characteristic (ROC) curves and calculating the Youden Index.The sensitivity and specificity of the these optimal thresholds in the plan verification were also analyzed.Results The optimal thresholds for global gamma indices with 5％/3 mm,3％/3 mm,2％/2 mm were 98.66％,94.84％,78.56％,respectively.In the 90％ common threshold,The sensitivity and specificity for common 90％ threshold and optimal threshold under 3％/3 mm criteria were 0.17 vs.0.85 and t 0.84 vs.0.27,respectively.The sensitivity and specificity were 0.89,0.65 and 0.23,0.47 for optimal thresholds under 5％/3 mm and 2％/2 mm criteria,respectively.Conclusions The sensitivity of optimal threshold gamma passing rate improved significantly compared with the common threshold (90％) at 3％/3 mm criteria.,The sensitivity and the specificity were more balanced at the 2％/2 mm criteria compared with those at 3％/3 mm criteria.

Objective:To comprehensively evaluate the correlation between migraine and the risk of hemorrhagic stroke using Meta-analysis.Methods:The published observational studies on migraine and the risk of hemorrhagic stroke in PubMed, EMbase, Cochrane library, Chinese Biomedical Database, China Journal Full-text Database, Wanfang Database and VIP Database were retrieved by computers. The retrieval time limit was from the establishment of the databases to December 31, 2019. Two reviewers independently conducted the literature screening and data extraction, and evaluated the quality according to Newcastle Ottawa scale. Stata SE 12.1 software was used for Meta-analysis.Results:Six case-control studies and 7 cohort studies met the inclusion criteria, all of which were in English. The results of Meta-analysis showed that exposure to migraine increased the risk of hemorrhagic stroke (odds ratio [ OR] 1.47, 95% confidence interval [ CI] 1.23-1.76; P<0.001). Sensitivity analysis showed that the results were robust. Subgroup analysis showed that migraine with aura ( OR 1.38, 95% CI 1.05-1.81; P=0.019), migraine without aura ( OR 1.46, 95% CI 1.19-1.80; P<0.001), male ( OR 2.10, 95% CI 1.72-2.56; P<0.001) and female ( OR 1.53, 95% CI 1.22-1.92; P<0.001) migraine could increase the risk of hemorrhagic stroke. Conclusion:Regardless of the gender of patients and presence or absence of migraine aura, migraine can significantly increase the risk of hemorrhagic stroke.