Objective To evaluate the preoperative diagnosis and treatment of primary duodenal adenocarcinoma ( PDA). Methods Clinical data of 89 PDA cases undergoing laparotomy from 1985 to 2009 in three hospital in Beijing and Zhengzhou were analyzed retrospectively. Results The prevalence rate of PDA is comparatively low and its clinical manifestations are not specific. The correct diagnostic rate of auxiliary examination were 93% by endoscopy,90% by gastrointestinal X-ray air barium double radiography,82% by MRCP,42% by BUS,70% by CT/MRI. The most common location of the adenocarcinoma(65% ) was at the second portion of the duodenum. Among 67 PDA cases 48 cases underwent pancreatoduodenectomy, 19 cases received segmental deodenectomy. The 5 year's survival rate was 47% and 50% respectively. Conclusions Endoscope and X-ray radiography are mainstays for the diagnosis of PDA. Early diagnosis and radical operation are the key to improve the resection rate and the long term survival.

Objective To study the effect of NEDD9 silence by using siNEDD9-2 on the apoptosis,proliferation and migration or invasion of gastric cancer cell lines BGC823.Methods Three pairs of NEDD9 siRNA primer were designed and synthesized,and then transfected into BGC823 cells respectively,it was found that siNEDD9-2 was the most powerful siRNA interference.The effect of siNEDD9-2 on BGC823 cell's proliferation,apoptosis,migration and invasion was observed.Results The relative quantity expression of mRNA and protein of BGC823 cells transfected with siNEDD9-2 significantly decreased and IR increased in both time and concentration dependent manner compared with control groups.Cell apoptosis and apoptosis index significantly increased compared with control groups.Cell migration and invasion assay showed that siNEDD9-2 inhibits BGC823 cells migration and invasion in vitro.Conclusions NEDD9 siRNA down-regulates expression of NEDD9,induces apoptosis,suppresses proliferation,migration or invasion of BGC823 cells.

Objective To study the expression level and related prognostic significance of protein NEDD9,Ki67,P53 in gastric carcinoma. Methods A total of 30 normal stomach tissues were used as control group. The expression level of NEDD9,P53,Ki67 in early gastric carcinoma of 54 cases and advanced gastric car-cinoma in 51 cases were detected by immunohistochemistry ,respectively. Results (1) The expression level of protein NEDD9,P53,Ki67 in normal stomach tissues,early gastric carcinoma and advanced gastric carcinoma were increased(P<0.05).(2)The expression level NEDD9 protein in gastric carcinoma was associated with the depth of invasion and the degree of differentiation(P < 0.05). The expression of protein Ki67 was associated with clinical staging and the depth of invasion(P<0.05). The expression of protein P53 was associated with degree of differentiation,the depth of invasion,lymph node metastasis and clinical staging(P<0.05).(3)NEDD9 protein expression has a positive correlation with Ki67. The difference has statistical significance(r = 0.216,P = 0.027). Conclusions The expression level of protein NEDD9 ,Ki67 ,P53 increased in normal stomach tissues ,early gastric carcinoma and advanced gastric carcinoma. The expression level were significantly higher in early gastric carcinoma. Combined detection of NEDD9 ,P53 ,Ki67facilitatesearlydiagnosis and malignant degree of gastric carcinoma.

Chest compression cannot be effectively applied under certain situations, such as chest wall deformity, rib fracture, or hemopneumothorax. Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) could reach better resuscitation outcomes in certain cardiac arrest (CA) patients. AACD-CPR can strengthen the high quality of cardiopulmonary resuscitation (CPR) in "2015 American Heart Association for cardiopulmonary resuscitation and emergency cardiovascular care update guide". The two methods can complement each other in opposite direction, and implement the "2016 national consensus on cardiopulmonary resuscitation on CPR in China", which is an important part of the wisdom to the Chinese CPR. In the article, we compared chest compression in standard single rescuer cardiopulmonary resuscitation (STD-CPR) and AACD-CPR with their aspects of the cause, mechanism, methods and application. We will provide an important reference about techniques of STD-CPR and AACD-CPR.

Objective:To investigate the factors that influence the return of spontaneous circulation (ROSC) in elderly patients suffering from out-of-hospital cardiac arrest (OHCA).Methods:A retrospective study was used to collect the clinical data of OHCA patients admitted to the emergency center of Zhengzhou People's Hospital from July 2016 to July 2019 based on the pre-hospital emergency database of Utstein model. Patients' gender, age, cardiac arrest (CA) etiology, presence or absence of bystander cardiopulmonary resuscitation (CPR), emergency response time, initial cardiac rhythm, ventilation method, use of epinephrine, defibrillation and ROSC were included. The patients were divided into elderly and young groups according to whether age ≥ 60 years old, and the differences in various indicators between the two groups were compared. Univariate Logistic regression analysis was used to analyze the relationship between emergency response time and ROSC in elderly patients and multivariate Logistic regression analysis was used to identify factors influencing ROSC in elderly patients.Results:A total of 3?429 adult OHCA patients were enrolled in this study, including 2?105 elderly patients (61.39%), and 1?324 young and middle-aged patients (38.61%). Compared to the young group, the proportion of females, non-cardiac causes and asystole as the initial rhythm was higher in the elderly group, the emergency response time was shorter, the rate of defibrillation and tracheal intubation, and the success rate of ROSC were lower (all P < 0.05). Among them, the proportion of cardiac arrest as the initial rhythm in elderly male patients was significantly higher than that of young male patients ( P < 0.05); the proportion of non-cardiac causes in elderly female patients was significantly higher than that of young female patients, and the proportion of defibrillation was significantly lower than that of young female patients (all P < 0.05). Multivariate Logistic regression analysis showed that cardiac arrest as the initial rhythm was strongly associated with ROSC in elderly male patients [odds ratio ( OR) = 0.126, 95% confidence interval (95% CI) was 0.045-0.352, P < 0.05]. Univariate Logistic regression analysis of the relationship between emergency response time and ROSC in elderly patients showed that although there was no significant difference in the ROSC success rate among elderly patients with various emergency response times, an emergency response time within 10 minutes was beneficial for ROSC in elderly patients. Conclusion:The success rate of ROSC is very low in elderly OHCA patients aged ≥60 years. Although the CPR-related indicators of elderly patients are significantly different from those of young patients, there are gender differences. The association between the elderly male patients and cardiac arrest as the initial rhythm is stronger, while OHCA caused by non-cardiac diseases is more common and defibrillable rhythm is less common in elderly female patients. It may be more beneficial for elderly patients to shorten the emergency response time and increase bystander CPR.

Objective:To investigate the association between grade 3 hand-foot syndrome(HFS)in colorectal cancer(CRC)patients treated with capecitabine and variation of cytidine deaminase(CDA)genes.Methods:The polymorphisms of the key gene CDA in-volved in capecitabine metabolism were genotyped and 149 CRC patients were included in this study.The association between these polymorphisms and susceptibility to HFS were analyzed.Additionally,peripheral blood mononuclear cells(PBMCs)of 91 CRC patients were collected for mRNA expression analysis, and the levels of mRNA expression according to different CDA genotypes were com-pared.Results:The prevalence of the polymorphism-451G>A,which is located in the promoter region of CDA,were correlated with HFS. The results were as follows: GG genotype, 109 cases (73.15%); GA genotype, 38 cases (25.50%); and AA genotype, 2 cases (1.36%).The minor allele frequency of-451G>A was 0.14.The distribution of the three genotypes were in accordance with Hardy-Weinberg Equilibrium(P=0.516).Logistic analysis indicated that GA/AA genotypes were associated with grade 3 HFS(odds ratio=2.53, P=0.011).Additionally,another insert polymorphism-33delC located in the promoter region of CDA was in linkage disequilibrium with-451G>A (D'=0.92). Of the 91 PBMC mRNA expression analyses, the GA/AA genotype of-451G>A was associated with higher CDA mRNA expression compared with GG genotypes(4.01±0.53 vs.3.13±0.61,P<0.001).Conclusions:The polymorphism-451G>A of CDA may influence occurance of grade 3 HFS induced by capecitabine by influencing CDA mRNA expression.

Objective To study the effectiveness and safety of abdominal lifting and compression method in patients sufferred from cardiac arrest (CA).Methods According to the inclusion and exclusion criteria,72 patients from Hainan People's Hospital and Zhengzhou People's Hospital were enrolled for study of abdominal lifting and compression (ALC) method from January 2014 to June 2015.The markers of respiratory and circulatory performance of all patients were recorded,and re-collected after CPR with ALC.In addition,the data of demographics and clinical signs of patients were collected.The rates of restoration of spontaneous circulation (ROSC) and successful resuscitation were calculated.Differential analysis of singlegroup design univariate quantitative and qualitative data was carried out.Results A total of 72 patients were included finally.The ROSC rate was 15.3％ (11/72) after using ALC equipment,and there was no statistically significant difference in rate of ROSC (P =0.566) between ALC and pre-test (13.0％).However,compared with NT group resuscitated without using ALC method or with using chest compression method,the rate of ROSC was significantly improved in the ALC group (15.3％ vs.O.1％,P ＜ 0.01).Conclusions Abdominal lifting and compression CPR equipment is stable,portable and safe in practice.Abdominal lifting and compression CPR method has its prominent role in saving patients from respiratory and cardiac arrest,and it is sufficient to overcome the disadvantages of conventional CPR method.

The animal model of cardiac arrest-cardiopulmonary resuscitation (CA-CPR) is the cornerstone of resuscitation research, serving as a tool to address adverse outcomes after cardiac arrest (CA). However, due to the different causes of CA, the pathophysiological changes of CA are not identical. Therefore, the preparation of similar animal models for different types of CA is the basis for studying the pathophysiological changes of CA. Rats are favored by researchers because of their low experimental cost, easy operation, and similar hemodynamic parameters and pathophysiological changes during resuscitation. This paper reviewed the common methods of animal models of CA-CPR in rats. In this review, the methods, criteria, advantages, disadvantages and precautions of each model were analyzed, which would provide useful reference for cardiopulmonary resuscitation (CPR) researchers.

Objective:To explore the clinical efficacy of venovenous extracorporeal membrane oxygenation(V-V ECMO)in patients with severe acute respiratory distress syndrome(ARDS)caused by Pneumocystis pneumonitis(PJP)after kidney transplantation(KT).Methods:Cal data of 9 KT recipients on V-V ECMO were retrospectively analyzed. Timing of V-V ECMO support, complications during treatment and V-V ECMO performance were summarized.Results:All 9 patients with confirmed PJP adopted V-V ECMO with oxygenation index of 25~92 prior to V-V ECMO and average time from admission to initiating V-V ECMO was 5.56(1~17)days. Except for one death from hemorrhagic shock due to abdominal hemorrhage, the remainders were successfully weaned. Another recipient died from sepsis after weaning and there were 7 survivors. V-V ECMO support time was 215.5 h among 8 successfully weaned recipients. Among 7 survivors, 1 had premorbid deterioration of graft function and no fatal complications occurred.Conclusions:V-V ECMO is an effective treatment for severe ARDS caused by P. pneumoniae post-KT. And its early application is recommended for reducing complications and improving patient prognosis.

Objective To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA). Methods A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months. Results A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L):24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001). Conclusion After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.