Objective To compare the difference in clinical prognosis of patients with low malignant obstructive jaundice treated by percutaneous biliary stent insertion across or above the duodenal papilla.Methods 56 patients with malignant biliary obstruction were reviewed retrospectively.Stents were placed above the duodenal papilla in 31 cases (group A) and across the duodenal papilla in 25 cases (group B).Total bilirubin reduction rate after 4-7 days of the procedure, biliary infection rate and stent occlusion rate were evaluated and compared between two groups.Results Mean survival periods were 180.3±142.5 days for group A and 178.6±137.7 days for group B (P=0.840).Total bilirubin level was decreased by 42.0±43.6% for group A and by 41.4±28.7% for group B after 4-7 days of the procedure(P=0.950);clinical success rates were 93.5% for group A and 92.0% for group B (P=1.0).Post-procedure cholangitis occurred in 7 cases (22.6%) in group A and 5 cases (20.0%) in group B (P=0.815).Stent occlusion rates were 22.6% and 28.0% for group A and group B (P=0.642).Conclusion For patients with lower malignant biliary obstruction, both of the two modalities of stent placement are safe and effective treatment.Stent placement across the duodenal papilla do not increase the development of stent occlusion or cholangitis compared with stent placement above the duodenal papilla.

Objective To investigate the estimated values of sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) for diagnosis and prognosis in patients with sepsis according to the new diagnostic criteria in Sepsis 3.0.Methods A retrospective study was conducted.All the clinical data were collected from patients with definite diagnosis of infection and they were admitted into the Intensive Care Unit (ICU) of Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from July 2014 to June 2016.The patients' gender,age,infectious location,respiratory rate (RR),oxygenation index (PaO2/FiO2),Glasgow coma scale (GCS),total bilirubin (TBil),platelet count (PLT),serum creatinine (SCr),serum lactate level,etc.general data on admission were collected to carry out SOFA and qSOFA scorings.And then the septic patients in accord with the diagnostic criteria of Sepsis 3.0 were screened out.According to outcome after admission,the septic patients were divided into survival group and death group,and the differences in diagnosis and in estimation value of prognosis between SOFA scoring and qSOFA scoring were assessed as SOFA group and qSOFA group.Results From 545 septic patients enrolled,189 septic patients consistent with the diagnostic criteria of Sepsis 3.0 were selected.In SOFA scoring group,the morbidity of septic patients was 34.68％,while in qSOFA scoring group,it was 15.96％,the difference between the two groups being statistically significant (P ＜0.01).The mortality was significantly lower in SOFA scoring group than that in qSOFA scoring group [28.04％ (53/189)vs.42.53％ (38/87),P ＜ 0.05].The mortality of qSOFA scoring group was about 1.52 times that of SOFA scoring group.On the aspect of scoring,in patients with SOFA scoring the score of death group was significantly higher than that in survival group (8.74 ± 0.417 vs.7.10 ± 0.235,P ＜ 0.01);in the patients with qSOFA scoring,the score in death group compared with that in survival group showed uo statistical significant difference (2.32 ± 0.48 vs.2.16 ± 0.37,P ＞ 0.05).On the aspect of laboratory indexes,the levels of GCS score in death group was significantly lower than that in the survival group (8.15 ± 0.67 vs.12.48 ± 0.36),blood lactate level in death group was significantly higher than that in the survival group (mmol/L:8.55 ± 4.66 vs.2.31 ± 0.16,P ＜ 0.01);the PaO2/FiO2,TBil,PLT and SCr showed no significant differences between the two groups (all P ＞ 0.05).Conclusions The new diagnostic criteria (Sepsis 3.0) can be used for diagnosis of sepsis in ICU.Compared with qSOFA scoring,the SOFA scoring is more suitable to be used for diagnosis and predicting prognosis of septic patients in ICU;SOFA scoring,GCS scoring and serum lactate level can be applied to estimate outcome of septic patients.

Objective To investigate the feasibility, safety and efficacy of transarterial embolization with low concentration of n-butyl cyanoacrylate(NBCA) in rabbit VX2 liver tumor models. MethodsTwenty-four rabbits were implanted with VX2 hepatic tumors into the left hepatic lobes, and were scanned with CT to measure the volume of the tumor after 14 days. They were randomly divided into three groups with 8 rabbits assigned to each group. Transarterial embolization was conducted with physiological saline in control group A, with pure Lipiodol in group B, with 2.5% NBCA in group C. Hepatic toxicity was evaluated by blood biochemical analysis of the plasma alanine aminotransferase (ALT) and aspartate aminotransferase (AST). One week later, the volumes of the tumors were measured by CT again. Tumor growth rate was the ratio of tumor's volume at 7th day after embolization to the tumors' volume before embolization. The survival periods of the rabbits of the three groups after treatment were also recorded. The data of ALT and AST mean values from each group were analyzed with repeated measurement analysis of variance (ANOVA). Tumor growth rates and survival periods were analyzed by using one-way ANOVA. Results All animal models were successfully established and underwent interventional catheterization. Both ALT and AST mean values of the rabbits in group A, B and C at each time point before and after embolization were significantly different (ALT F=10.508, 16.443, 19.828, respectively; AST F=23.696, 23.334, 15.594, respectively)(P＜0.05). ALT in group A, B, C were (49.4±13.5), (115.2±48.8), (124.7±49.4)U/L, while AST in group A, B, C were (52.3±12.0), (128.3±50.1), (137.0±66.9)U/L 4 days after embolization. The ALT and AST mean values were significantly elevated 4 days after embolization in group B and group C compared with those before embolization and those of group A 4 days after treatment(P＜0.05). However, the ALT and AST mean values showed no statistically significant difference in all the groups before embolization and 7 days after embolization. On the other hand, the growth rates of the tumors differed significantly among the three groups(F=110.865, P=0.000). The group C showed significantly lower tumor growth rate (0.839±0.144)% than the group A(2.978±0.547)%(P=0.000), but no significantly different tumor growth rate compared with group B(0.871±0.0725)%( P=0.845). Consequently, the survival period of the animals in group C(38.9±4.0) days was significantly longer than that in group A(32.1±3.1)days (P=0.006), while it was not significantly different from that in group B(36.9±4.8)days(P=0.366). ConclusionsTransarterial embolization with low concentration of NBCA was feasible and safe. It could be a new option of treatment for HCC and might have potential further clinical value.

Qi-Gui-Yin (QGY) compound, which composes of five herbal medicines of Astragalus membranaceus (Fisch.) Bge., Angelica sinensis (Oliv.) Diels, Lonicera japonica Thunb., Artemisia annua L., and Polygonum cuspidatum Sieb.et Zucc., which is able to treat antibiotic-resistant bacteria with antibiotics, and also to delay or even reverse the bacterial resistance producing. However, QGY compound is a complex mixture. And it is very difficult to elaborate its material foundation. Therefore, chemical constituents in five herbal medicines were summarized through searching of the related literatures. And then, 170 kinds of bioactive ingredients were classi-fied in order to provide evidences for the study on chemical constituent of QGY compound and identify its mate-rial foundation of delaying drug resistance .

Objective To evaluate the effects of curcumin on the expression of phosphorylated extracellular signal-related kinase (p-ERK) and phosphorylated cAMP response element binding protein (p-CREB) in the spinal dorsal horn and dorsal root ganglion (DRG) in type 2 diabetic neuropathic pain (DNP) in rats.Methods Type 2 diabetes mellitus was induced by high-fat and high-sucrose diet and intraperitoneal streptozotocin (STZ) 35mg/kg,and confirmed by fasting blood glucose level≥ 16.7 mmol/L in male Sprague-Dawley rats.Type 2 DNP was confirmed by the mechanical withdrawal threshold (MWT) and thermal withdraw latency (TWL) measured on day 14 after STZ administration ＜ 80％ of the baseline value,and the rats with type 2 DNP were randomly divided into 3 groups (n =27 each):type 2 DNP group (group DNP),curcumin group (group Cur) and solvent control group (group SC).Curcumin and corn oil 100 mg/kg (25 mg/ml) were injected intraperitoneally once a day for 14consecutive days starting from 14 days after administration of streptozocin in Cur and SC groups,respectively.Another 27 normal rats were served as control group (group C) and were fed with common forage.MWT and TWL were measured at 3,7 and 14 days after curcumin injection (T1 3),and the lumbar segment 4-6 of the spinal cord and DRGs were removed at the same time for determination of the expression of p-ERK and p-CREB (by Western blot).Results Compared with group C,MWT was significantly decreased,TWL was shortened,and the expression of p-ERK and p-CREB in spinal dorsal horn and DRGs was up-regulated at T1-3 in DNP and SC groups,and at T1 in Cur group (P ＜ 0.05).Compared with group DNP,MWT was significantly increased,TWL was prolonged,and the expression of p-ERK and p-CREB in spinal dorsal horn and DRGs was down-regulated at T2,3 in Cur group (P ＜0.05).There was no significant difference in the MWT,TWL and expression of p-ERK and p-CREB between DNP and SC groups (P ＞ 0.05).Conclusion Curcumin can attenuate type 2 diabetic DNP by inhibiting up-regulation of the expression of p-ERK and p-CREB in the spinal dorsal horn and DRG in rats.

Objective To evaluate the safety and effectiveness of multi-mode interventional therapy for complications occurring after renal transplantation.Methods The clinical data of 26 patients with complications occurring after renal transplantation were retrospectively analyzed.Vascular and non-vascular complications were treated with different interventional techniques,and the curative effects were analyzed.Results Vascular complications were observed in 19 patients and non-vascular complications were seen in 7patients.The technical success rate of interventional therapy was 100％.One week after the treatment,the total creatinine level (SCr) was significantly improved,which decreased from preoperative (372.7±295.5)μmol/L to postoperative (184.3±138.4) μmol/L (P＜0.001).No severe complications occurred.Further analysis indicated that no statistically significant differences in patient's general condition,kidney donor source,anastomosis method existed between vascular intervention group and non-vascular intervention (P＞0.05).However,the onset time of vascular complications was markedly earlier than that of non-vascular complications (1.8± 1.4 months vs.118.3 ±54.4 months),the difference was statistically significant (P＜0.001).During the follow-up period lasting for 4-55 months (mean of 18.6 months),3 patients developed recurrence of complications;interventional therapy had to be carried out in 2 patients and their creatinine level returned to normal after treatment,and transplanted renal artery embolization had to be performed in the other patient as whose pseudoaneurysm became enlarged.Conclusion For the treatment of complications occurring after renal transplantation,interventional therapy is less-invasive,rapidly-effective and safe,this technique can timely and effectively improve the renal function and save the transplanted kidney.

ObjectiveTo investigate emergency diagnosis and treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder,and to improve the success rate of treatment on pelvic fracture.MethodsClinical data of 52 cases of pelvic fracture complicated with traumatic rupture of urethra and bladder in department of emergency and urology from 2000 to 2010 was retrospectively analyzed.Results Among the 52 patients,there was 41 cases of pelvic fracture complicated with posterior urethral disruption,15 cases complicated with rupture of bladder and 4 cases complicated withtraumatic rupture of urethra and bladder at the same time.In 41 cases with posterior urethral rupture,6 individual's condition were relatively so severe that they onlyunderwent bladder puncture nephrostomy,and 29 cases underwent traction urethral realignment,the other 6 cases didn't undergo surgery; In 15 cases of patients with bladder rupture,2 patients were performed urethral realignment and bladder repair,11 patients underwent the bladder repair only and the other 2 patients were not performed surgery.There were 8 patients died and the mortality rate was 15.4％.Six died cases failed to conduct emergency surgery because of uncontrollable bleeding and another 2 cases died due to multiple organ failure.ConclusionPelvic fractures is a disease with more complications,it should be diagnosed as early as possible.Patients invalid for conventional anti-shock should be performed pelvic external fixation and emergency embolization to stop bleeding in the emergency department,and undergo associated processing after they are in stable condition.

Objective To evaluate percutaneous transampulla stent implantation in treating lower malignant obstructive jaundice, and to discuss the related factors that may influence the stent patency time. Methods The clinical data of a total of 104 patients with lower malignant obstructive jaundice, who received percutaneous transampulla stent implantation during the period from January 2010 to March 2016, were retrospectively analyzed. The parameters, including gender, age, primary tumor type, preoperative external drainage, total bilirubin (TBIL), albumin (ALB), glutamic-pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), white blood cell (WBC) count, platelet (PLT) count, hemoglobin (HGB) and length of biliary stricture, were used to evaluate the risk factors related to postoperative patency time. Results Single Cox regression analysis showed that primary tumor type, ALB, WBC count, length of biliary stricture were the related factors that significantly affected the stent patency time. The Cox regression analysis further indicated that primary tumor type and length of biliary stricture were the important related factors that significantly affected the stent patency time. Conclusion In treating lower malignant obstructive jaundice with percutaneous transampulla stent implantation, primary tumor type and length of biliary stricture may be the important related factors that affect the stent patency time. These parameters are of great value in estimating the stent patency time.

Objective To evaluate the dosimetric effect of three-dimensional(3D)printed headrests made of different materials in radiotherapy for head and neck tumor,and to evaluate whether the existence of customized 3D-printed headrest can be neglected during planning phase by comparing differences in target area doses,homogeneity index(HI),conformity index(CI),monitor units(MU),and organ-at-risk(OAR)dose.Methods Ten patients with head and neck tumors,including 5 cases with nasopharyngeal carcinoma and 5 with other head and neck tumors,were enrolled.The headrest contours were outlined using Monaco treatment planning system,and with the same calculation parameters,treatment plans were generated for scenarios without a headrest,with a standard headrest,and with 3D-printed headrests made of 10%filled polylactic acid and thermoplastic polyurethane.The target area doses,OAR dose,MU,and other results were recorded and subjected to statistical analysis.Results No significant differences were observed among the 4 groups(ignoring headrest,standard headrest,3D-printed headrests with 10%filled polylactic acid and thermoplastic polyurethane)in parameters such as D95,D5,Dmean,HI,CI,MU,and OAR dose(the maximum dose to the spinal cord)(P>0.05).Considering the presence of the headrest,significant differences were found in CI for nasopharyngeal carcinoma and other head and neck tumors(P<0.05).Conclusion During the planning phase,the existence of customized 3D-printed headrest can be ignored,but it should be noted that the presence of a headrest may reduce the MU in radiotherapy plans.When considering the headrest,the average CI of patients with other head and neck tumors is significantly higher than that with nasopharyngeal carcinoma.

Objective To investigate the curative effect of transarterial embolization (TAE) for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma (HCC),and to discuss the factors influencing prognosis.Methods A total of 57 patients with HCC complicated by spontaneous rupture and bleeding,who received initial TAE during the period from June 2012 and June 2016,were enrolled in this study.The last follow-up visit was in October 2016.Kaplan-Meier method was used to calculate the cumulative survival rate,and Cox regression model was adopted to analyze prognostic factors.Results In this series of 57 patients,the median survival time was 208 days.The 6-month,1-year and 2-year cumulative survival rates were 50.3％,35.9％ and 14.7％,respectively.Multivariate Cox regression analysis indicated that tumor size,Child-Pugh classification,history of shock,and the used embolization materials were the independent prognostic factors.Conclusion The use of selective TAE,as an initial therapy,for HCC complicated by spontaneous rupture and bleeding is safe and effective.This study reveals that larger diameter of the tumor,poor Child-Pugh classification,the presence of shock history indicate a poor prognosis.TACE using lipiodol combined with gelatin sponge particles can expect a better prognosis than TACE using PVA particles alone.