Objective To evaluate the application value of focused assessment with sonography for trauma (FAST) in treatment of emergency thoracic and abdominal closed injury.Methods FAST examination was performed in 85 patients with thoracic and abdominal closed injury,to determine whether the thoracic and abdominal cavity,pericardial free effusion and abdominal parenchyma organ injury,and the results were compared with conventional ultrasonography,CT scan and operation results.Results FAST was (2.85 ± 1.15) min,conventional ultrasonography was (15.48 ±5.17) min,there was statistically significant difference (t =21.99,P ＜ 0.05).In 85 patients,10 cases were FAST positive,5 cases of abdominal cavity in that amount or a large number of free effusion,underwent emergency operation,postoperative intra abdominal parenchymal organs were confirmed as rupture and hemoperitoneum; 2 cases of renal rupture with perirenal hematoma,confirmed by the whole abdominal CT examination; 2 cases of thoracic free pneumatosis,effusion,confirmed by thoracic CT examination or closed thoracic drainage; 1 case of prompt hemopericardium,confirmed by the pericardium puncture.Conventional ultrasonography was positive in 11 patients,no statistically significant difference between them (P ＞ 0.05).The sensitivity,specificity,accuracy rate of FAST screening thoracic and abdominal closed injury was 10/12,100.0％ (73/73),97.6％ (83/85).Conclusions FAST has high sensitivity and specificity for thoracic and abdominal cavity,pericardial free effusion,check with short time,low environmental requirements,without moving the trauma patients,and may be out of sync with the fluid resuscitation and other emergency measures.For large quantities of trauma patients and patients with severe multiple trauma,FAST can quickly,accurately determine the existence of thoracic and abdominal closed injury,and provide guidance for clinical treatment,which has good application value.

Objective:To evaluate the short-term effect of robotic pancreaticoduodenectomy (RPD) and laparoscopic pancreaticoduodenectomy (LPD) in the treatment of ampullary and periampullary tumor systematically.Methods:A systematic search of the PubMed, Embase and Cochrane library database using the key words "pancreaticoduodenectomy, duodenopanreatectpmy, whipple, laparoscopic, robotic, Da Vinci" . A systematic search of the Sinomed, Wangfang, VIP and CNKI databases including the key words "胰十二指肠切除" , "腹腔镜" , "机器人" , "达芬奇" . To investigate the differences of the conversion rate of laparotomy, incidence of postoperative complications, and the postoperative hospital stay between the RPD group and the LPD group. The software RevMan5.3 was used in this meta-analysis.Results:A total of 4 retrospective cohort studies and 1 001 patients were included in this meta-analysis, including 451 patients in the RPD group and 550 patients in the LPD group. The results of the meta-analysis showed that there were significant differences between RPD group and LPD group for the conversion rate laparotomy ( OR=0.35, 95% CI: 0.24-0.50, P<0.05). There were no significant differences between RPD group and LPD group for the incidence rate of overall complication( OR=1.23, 95% CI: 0.95-1.58, P>0.05), hemorrhage ( OR=0.71, 95% CI: 0.50-1.00, P>0.05), pancreatic fistula ( OR=1.09, 95% CI: 0.80-1.49, P>0.05), delayed gastric empty ( OR=0.81, 95%CI: 0.57-1.14, P>0.05) and hospital stay after surgery ( WMD=-2.87, 95% CI: -1.44-1.70, P>0.05). Conclusions:RPD is as safe as LPD, with the same complication rate. Therefor it is worthy for further application in medical institutions with relevant conditions.

Objective To study the diagnosis and treatment of pancreatic sinistral portal hypertension with splenomegaly.Method From January 2010 to December 2012,twenty-six cases of pancreatic sinistral portal hypertension with splenomegaly were retrospectively analyzed.Results The underlying pancreatic diseases were chronic pancreatitis (n=12,46 ％),pancreatic pseudocyst (n=5,19％),mass of pancreatic body and tail (n=6,23％),autoimmunie pancreatitis (n=2,8％) and pancreatic trauma (n=1,4 ％).All the 26 patients presented with splenomegaly,but there was no evidence of cirrhosis or abnormal hepatic function.Three cases presented with a history of upper gastrointestinal bleeding.Gastroscopy or upper gastrointestinal visualization revealed all 26 patients had varices in the gastric fundus and 6 patients had inferior segment oesophageal varices simultaneously.19 patients underwent operative treatment,2 patients underwent splenic artery embolization and 5 patients were treated conservatively.22 patients were followed up for 6 months to 30 months,the follow-up rate was 85 ％,and there were no upper gastrointestinal bleeding.Hypersplenism disappeared in all the 19 patients after operation.2 patients succumbed to pancreatic malignant tumor.Conclusions Splenomegaly is one characteristic clinical manifestation of pancreatic sinistral portal hypertension.It could be cured by operation.The choice of treatment depends on the patient's condition.The management of the primary pancreatic disease should also be emphasized.

Objective To compare the effectiveness of hyperbaric oxygen (HBO) therapy and normal pressure oxygen inhalation for lung infection in patients with severe brain injury and tracheotomy.Methods Sixty lung infection patients with severe brain injury and tracheotomy were stratified by age and Glasgow coma scale (GCS) score into an HBO group (30) and a conventional therapy group (30).Both groups were given treatments to reduce intracranial hypertension and protect the brain,surgery,antibiotics,and symptomatic and support therapy.In the conventional group the patients received oxygen therapy at normal oxygen pressure by tracheal cannula.In the HBO group,the patients received HBO therapy through self-made oxygen devices by the authors.The body temperature,cough and expectoration,respiratory sounds and white blood cell (WBC) count were compared between the groups.Results There were statistically significant differences in body temperature,cough and expectoration,respiratory sounds and the normalized time for the count and classification of WBC between the groups.Conclusion HBO had good treatment effectiveness for excretion and expectorant in lung infection patients with severe brain injury and tracheotomy.

Objective To evaluate the clinical characteristics,diagnosis and treatment method of pancreatic sinistral portal hypertension caused by tumors in the body and tail of the pancreas.Methods A retrospective review of 40 patients diagnosed with pancreatic sinistral portal hypertension at Peking Union Medical College Hospital from January 2007 to December 2012 was performed.Results The Initial symptoms were epigastric pain and discomfort (n =12),emaciation (n =5),low-back pain (n =4),splenomegaly (n =2),hematemesis and melena (n =4),hypoglycemic coma (n =1).All 40 patients had splenomegaly and varices in the gastric fundus with normal liver function.8 had combined esophageal varices.24 had hypersplenism and 26 had elevated serum CA19-9 level.25 patients received surgical intervention and 15 were treated conservatively.Pathology confirmed malignancy in 29 patients and benign lesions in 11.Thirty-five patients (35/40,88％) were followed up for 12 to 72 months.For patients undergoing surgery,hypersplenism and varices in the gastric fundus were all relieved.There was no upper gastrointestinal bleeding occurred during follow-up.For patients treated conservatively,hypersplenism remained stable and among them 4 patients had upper gastrointestinal bleeding,and successfully treated by medication,therapeutic endoscopy and interventional therapy.Conclusions Patients with pancreatic sinistral portal hypertension caused by tumor in the body and tail of the pancreas can be cured successfully by surgery.In those patients portal hypertension can present as initial clinical manifestation.

OBJECTIVETo examine the effect of ONO-AE3-208, an EP4 antagonist, on the formation of bone metastasis from prostate cancer in mice.

METHODSThirty-four 6-week old nude mice were divided into an experimental and a control group of equal number to be treated by intraperitoneal injection of ONO-AE3-208 and double distilled water, respectively. Then PC3/LUC cells were constructed by stably transfecting luciferin to prostate cancer PC3 cells and inoculated into the left ventricle of the mice to establish an animal model of systemic bone metastasis. The time of metastasis formation, photon tumor burdens, and changes of the survival curves after modeling were compared between the two groups of mice.

RESULTSAt 30 days after modeling, bioluminescence imaging analysis showed that the photon tumor burdens were significantly increased in a time-dependent manner in the control group in comparison with those in the experimental group (P < 0.01). The rate of metastasis formation was significantly higher in the former than in the latter (93.3% vs 33.3%, P < 0.001). The median time of metastasis formation was 29 d (95% CI 26.547 - 35.262) in the experimental animals as compared with 21 d (95% CI 17.213 -24.787) in the controls (P < 0.001).

CONCLUSIONEP4 antagonist ONO-AE3-208 can inhibit the formation of bone metastasis from prostate cancer in mice.

Animals ; Bone Neoplasms ; prevention & control ; secondary ; Cell Line, Tumor ; Disease Models, Animal ; Humans ; Male ; Mice ; Mice, Nude ; Naphthalenes ; pharmacology ; Neoplasms, Experimental ; prevention & control ; Phenylbutyrates ; pharmacology ; Prostatic Neoplasms ; pathology

Objective To investigate the pathogenesis of gallbladder chaotic dynamics after partial gastrec-tomy. Methods 140 cases operated by partial gastrectomy after 6 months were randomly examined, they in-cluded one group of 40 cases by Billroth type and the other 100 cases by Eiselsberg type. The ultrasonograph was applied to evaluate the function of gallbladder dynamics and radio-immunity method to determine the content of CCK at the time of having no food and 30 minutes after med. Results BV and RV of Eiselsberg group were bigger than Billroth Ⅰ obviously P<0.05. Gallbladder contraction rate displayed not well obvi-ously as too. The plasm level of CCK had no manifested distinctions in empty stomach cases of the 2 groups, but the increasing gradient plasm level of CCK in Billroth Ⅰ exceeded Eiselsberg type. Conclusions The pathogenesis of gallbladder chaotic dynamics after partial gastrectomy was correlated with the alterative type of partial gastrectomy, the reduction of CCK plasm level, the damage of anterior vagal trunk hepatic branches during the operations and so on led to the disorder of gallbladder emptying and induced cholecystolithiasis.

OBJECTIVETo explore the clinical application of mandibular-driven simultaneous maxillo-mandihular distraction to correct hemifacial microsomia with rapid prototyping technology.

METHODSThe patient' s skull resin model was manufactured with rapid prototyping technology. The osteotomy was designed on skull resin model. According to the preoperative design, the patients underwent Le Fort I osteotomy and mandibular ramus osteotomy. The internal mandible distractor was embedded onto the osteotomy position. The occlusal titanium pin was implanted. Distraction were carried out by mandibular-driven simultaneous maxillo-mandihular distraction 5 days after operation.

RESULTSThe distraction in five patients was complete as designed. No infection and dysosteogenesis happened. The longest distance of distraction was 28 mm, and the shortest distance was 16 mm. The facial asymmetry deformity was significantly improved at the end of distraction. The ocelusal plane of patients obviously improved.

CONCLUSIONSRapid prototyping technology is helpful to design precisely osteotomy before operation. Mandibular-driven simultaneous maxillo-mandibular distraction can correct hemifacial microsomia. It is worth to clinical application.

Face ; abnormalities ; surgery ; Facial Asymmetry ; congenital ; surgery ; Goldenhar Syndrome ; surgery ; Humans ; Hyperplasia ; surgery ; Mandible ; surgery ; Maxilla ; surgery ; Osteogenesis, Distraction ; methods ; Osteotomy ; methods ; Osteotomy, Le Fort

Objective To explore the therapeutic effects of different surgery methods on early hypertensive intracerebral hemorrhage(HICH)in basal ganglia region in elderly patients and on prognostic factors analysis.Methods 89 elderly patients with early HICH were randomly divided into four groups according to surgery methods and whether their ICP was monitored.Group A(n=21)was given minimally invasive hematoma drainage,group B(n=23)was given small bone window for removal of hematoma,group C(n=21)and group D(n=24)was given ICP monitoring and corresponding management of ICP on the basis of group A and group B,respectively.The changes of intracranial pressure before and after operation,prognosis and post-operative complications were compared.Results The intracranial pressure was significantly decreased at 3rd day,7th day after operation in group C and D as compared with those in group A and B at the same time points(F=11.76,P<0.05),and the score of GCS was also higher in group C and D at 7th day after operation than in group A,B at the same time points(F=4.72,P<0.05).At 14th and 28th day after operation,the score of GCS was higher in group C than in group A and B(F=19.24,P<0.05),and higher in group C than in group D at 28th day after operation(F=22.26,P<0.05).The dosage of mannitol was significantly lower in group C and group D than in group A and group B(F=18.87,P<0.05).The incidence rate of post-operative complications was 14.3% in group C vs.28.6% in group A(P<0.05)and 20.8% in group D vs.47.8% in group B(χ2=7.04,P<0.05).The proportion of a good recovery and a light disability was significantly higher in group C and D(76.2% and 75.0%)than in group A and B(42.9% and 39.1%)respectively(χ2=14.99,all P<0.05).Conclusions Minimally invasive hematoma drainage shows the advantages of small trauma and a few complications for the treatment of elderly patients with early HICH,and its combination with ICP can early change intracranial pressure and further improves the prognosis.

Objective: To learn the awareness of the Three Level Social-psychological Service in Zhejiang Province and its influencing factors, so as to provide the basis for promoting the construction of social-psychological service system. Methods: The counties (cities, districts) in Zhejiang Province were divided into three levels: high, medium and low, according to economic development. The residents are selected by multistage stratified random sampling method. A questionnaire survey was conducted to collect the general information of residents and their awareness of the Three Level Social-psychological Service.The influencing factors for the awareness were analyzed by multivariate logistic regression model. Results : Of 7 114 questionnaires sent out, 6 577 valid ones were recovered, with the response rate of 92.45%. The overall awareness rates of the Three Level Social-psychological Service and service sites was 63.02% and 59.91%, respectively. The multivariate logistic regression analysis showed that the age of 40-<50 years ( OR=1.376, 95%CI: 1.077-1.758 ), permanent residence ( OR=1.474, 95%CI: 1.319-1.647 ), being the national pilots ( OR=1.200, 95%CI: 1.079-1.334 ) and having the experience of seeking mental health services before 2018 (OR=1.323, 95%CI: 1.191-1.469) were the influencing factors for the awareness of the Three Level Social-psychological Service; under 50 years old ( OR: 0.610-0.768, 95%CI: 0.423-0.991 ), permanent residence ( OR=1.571, 95%CI: 1.407-1.755 ), being the national pilots ( OR=1.368, 95%CI: 1.232-1.519 ) and having the experience of seeking mental health services before 2018 ( OR=0.733, 95%CI: 0.661-0.812 ) were the influencing factors for the awareness of the Three Level Social-psychological Service sites. Conclusions It is necessary to improve the awareness of the Three Level Social-psychological Service among Zhejiang residents. Age, permanent residence, being the national pilots, seeking mental health service experience before 2018 are associated with the awareness of the Three Level Social-psychological Service.