Dieulafoy lesion are usually located in the stomach but can also occur in the small or large intestines. It is an uncommon but significant source of massive upper gastrointestinal hemorrhage. A female patient with Dieulafoy lesion was admitted to the Tenth People's Hospital of Tongji University on June 2, 2009. The site of the lesion was diagnosed at the anterior wall of stomach with a bleeding vessel in the center. The size of the lesion was about 1.0 cm×1.0 cm. Partial gastric resection was successfully performed using laparoscopy and endoscopy. The lesion was demarcated by gastroscope, and then it was hung up and removed by laparoseope. Bowel movement recovered at the second day, and the patient was discharged 6 days after surgery. The patient was followed up for 1 month, and no recurrent hemorrhage or other complications were observed. The combined approach of laparoscopy and endoscopy not only resects the lesion completely and widens the scope of minimally invasive surgery but also decreases the risk of operation.

Case based learning was introduced in the teaching ward round on oncology. Our heuristic, interactive, discussion-style teaching model was focused on real clinical cases, by raising questions to discuss strategies for solving problems. Therefore, we can foster clinicians' ability of solving problems, their innovative spirit and team-work spirit so as to meet the requirements of multidisciplinary treatment in new era oncology.

Objective To investigate the effects of postoperative sleep deprivation on the expression of choline acetyltransferase (ChAT) in hippocampi of aged rats.Methods Forty-eight male Wistar rats,aged 20 months,weighing 500-600 g,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C) ; operation group (group O) ; sleep deprivation group (group S) ; postoperative sleep deprivation group (group OS).Sleep deprivation was induced in the rats by housing them on small platforms over water.They fell into the water if they lost muscle tone.All the rats had free access to food and water.In group OS,splenectomy was performed,and all the rats underwent 24 h sleep deprivation after the rats were awake.All the rats underwent 24 h sleep deprivation at the corresponding time point in group S.Morris water maze test was carried out at 24 h after operation.The number of ChAT positive cells in the hippocampal CA1 region was counted after completion of Morris water maze test.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,and the frequency of crossing the original platform and the number of ChAT positive cells in the hippocampal CA1 region were decreased after operation in O and OS groups,and no significant changes were found in the parameters mentioned above in group S.Compared with group O,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,the frequency of crossing the original platform was decreased,and there was no significant difference in the numberof ChAT positive cells in the hippocampal CA1 region in group OS,and no significant changes were found in the parameters mentioned above in group S.Compared with group S,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,and the frequency of crossing the original platform and the number of ChAT positive cells in the hippocampal CA1 region were decreased after operation in group OS.Conclusion The mechanism by which postoperative sleep deprivation induces cognitive decline is not related to the expression of ChAT in hippocampi of aged rats.

Objective To study the clinical efficacy of acupuncture combined with medication plus joint mobilization in the treatment of lumbar intervertebral disc protrusion accompanied with secondary lumbar spinal stenosis.MethodsTotally 66 cases of lumbar intervertebral disc protrusion accompanied with secondary lumbar spinal stenosis were collected randomly and divided into treatment group (34 cases) and control group (32 cases). The control group was given treatment of simple acupuncture and TCM medication, while the treatment group was given joint mobilization treatment besides acupuncture and TCM medication. Functions of lumbar vertebra were evaluated by ODI scale and the degrees of pain were evaluated by VAS. The clinical efficacy in the two groups was compared. Results ODI in both groups were significantly improved after treatment compared with that before treatment. However, the changing range of the ODI of the treatment group was more significant than that in control group (P<0.01). After treatment, VAS scores were relieved (P<0.05) in both groups, and treatment group was more significant than that in control group (P<0.05). The total clinical efficacy was 97.06% (33/34) in the treatment group, and 84.38% (27/32) in the control group, with statistical significance (P<0.05).Conclusion Acupuncture combined with medication plus joint mobilization in the treatment of lumbar intervertebral disc protrusion accompanied with secondary lumbar spinal stenosis has good efficacy.

OBJECTIVEWe aims to evaluate the therapeutic effect of maxillary protraction on maxillary maldevelopment using Coben analysis to illustrate the advantages of Coben analysis in identifying pathogenic mechanisms and in designing treatment plans for Class III malocclusions.

METHODSA total of 120 patients were diagnosed to have skeletal Class I maloc- clusions with maxillary maldevelopment. These patients were selected as the subjects of the present research. Maxillary protraction was exerted to promote maxilla growth. Cephalometric analysis was conducted by using Coben analysis and angle analyses of Beijing Medical University to collect data before and after maxillary protraction.

RESULTSAccording to Coben analysis measurements, the height of facies cranii increased after maxillary protraction. The depth of lower face decreased, whereas that of mid-face increased and the Ptm-A value increased significantly in the mid-face (P < 0.001). In the angle ana- lysis of Beijing Medical University, SNA, ANB, U1/NA, U1/SN, MP/SN, and Y-axis angles increased significantly (P < 0.001), whereas SNB, U1/L1 (P < 0.001), and L1/MP (P < 0.05) decreased.

CONCLUSIONMaxillary protraction has a significant effect on growing skeletal Class III malocclusions withthe chief mechanism of Ptm-A value just diagnosed as minor by Coben analysis. Coben analysis is visual and clear in identifying pathogenic mechanisms of Class III malocclusions.

A total of1415 elderly individuals in Nanchang were included in the study and were divided into normal glucose tolerance group, impaired glucose regulation group, and diabetes mellitus group.The results showed that HbA1C was significantly correlated with fasting plasma glucose (FPG) and 2 h postprandial plasma glucose.When HbA1C 6.3% was applied as the cut point of diabetes, the sensitivity was 85.19% and the specifity was 99.45%.When HbA1C 6.5% was applied, the sensitivity was 75.56% and specifity was 99.61%.It seems that HbA1C 6.3% had higher specifity and sensitivity for diagnosing diabetes than HbA1C 6.5% and FPG 7.0mmol/L in studied population.

Objective To summarize the characteristics and clinical value of multi-slice spiral computed tomography (MSCT) examination in the biliary gallbladder-duodenal fistula.Methods The imaging data of 28 patients with gallbladder-duodenal fistula who were admitted to the Wuxi No.2 Hospital of Nanjing Medical University between June 2012 and March 2015 were retrospectively analyzed.All the 28 patients received MSCT examinations,and the imaging changes were observed and analyzed,including the location of lesions,figures of fistulous tract,shrinking or enlarging gallbladder,pneumotosis and stones of gallbladder or bile duct.Results Of the 28 patients,fistula located at the duodenal bulb were detected in 14 patients,junction of the bulb and the descending part of the duodenum in 2 patients,ascending duodenum in 7 patients,horizontal part in 5 patients.Indirect signs of biliary gallbladder-duodenal fistula included that gallbladder volume in 28 patients was significantly reduced,cross sectional area of gallbladder was 2 cm × 1 cm-6 cm × 2 cm,and gallbladder wall was thickened with an average thickness of 5 mm (range,4-9 mm).Adhesion of gallbladder and duodenum,unclear boundary,structure disorder and visible effusion surrounding gallbladder were detected.Among 21 patients with biliary gas,19 patients had pneumotosis of gallbladder and 17 had biliary pneumatosis.Biliary stones were detected in 23 patients including cholecystolithiasis in 19 patients,gallbladder neck stones in 6 patients,common bile duct stones in 13 patients and intra-and extra-hepatic cholangiolithiasis in 1 patient.The diverticulum signs appeared in the duodenum of 11 patients.The direct signs of MSCT in the biliary gallbladder-duodenal fistula included that fistulous tract of 13 patients clearly showed and some were dumbbell-shaped.Two and 2 patients were complicated with gallstone ileus and multiple liver abscesses,respectively.The diagnostic results of MSCT in 28 patients were compared with the results of operative exploration,with an diagnostic concordance rate of 78.6％ (22/28),and the diagnostic concordance rate of gallbladder stones was 82.1％ (23/28).Conclusions The indirect signs of MSCT in patients with biliary gallbladder-duodenal fistula include pneumotosis of gallbladder or/ and biliary gas,gallbladder neck stones or common bile duct stones,gallbladder shrank,adhesion of gallbladder and duodenum,unclear boundary,diverticulum signs in the adhesions of duodenum and gallbladder,and clear orificium fistulae of gallbladder-duodenum is a direct sign of MSCT.

Objective To study the radiologic features and the diagnostic value of multi-slice spiral CT (Multi-slice CT, MSCT) in cholecysto-duodenal fistula.Methods A retrospective analysis was conducted on 33 patients with cholecysto-duodenum fistula.Plain and IV enhanced MSCT were carried out on these patients.Results Of the 33 patients, the fistula was located at the duodenal bulb in 15 patients (45.5％) , the junction of the bulb and the descending part of the duodenum in 3 patients (9.1％) , the horizontal part in 5 patients (15.1％) and the ascending of the duodenum in 10 patients (30.3％).The CT signs of cholecysto-duodenum fistula included in 16 cases.The fistulae were clearly displayed including some fistulae being dumbbell-shaped.The indirect signs of cholecysto-duodenum fistula included in 2 cases the gallbladders were unclearly shown.In 1 case the gallbladder volume increased because of cancer and in another case because of acute cholecystitis.In 29 cases, the gallbladder volume was significantly reduced,with an average volume which ranged from 6 cm × 2 cm to 2 cm × 1 cm, and an average gallbladder wall thickening of 5 cm.There were extensive adhesions between the gallbladder and duodenum with visible effusion.In 26 cases, gas was present in the biliary system with 22 cases showing gallbladder gas, and 19 cases showing biliary pneumatosis.Biliary stones were present in 26 patients (gallbladder stones in 22 cases, gallbladder neck stones in 6 cases, common bile duct stones in 13 cases).At the site between the duodenum and the gallbladder there were radiological changes simulating a diverticulum.In 11 cases the changes were like a duodenal diverticula.The complications of cholecysto-duodenal fistula included 5 cases of gallstone ileus and 2 cases of multiple liver abscesses.Conclusions MSCT is important in depicting presence and location of cholecysto-duodenal fistula.The morphology and shape of the gallbladder, the presence of gas in the biliary system, the presence of stones and the surrounding adhesions could be fully demonstrated by MSCT.MSCT are important for diagnosing cholecysto-duodenal fistula and in the planning of surgery.

To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and TACE alone for hepatocellular carcinoma (HCC), Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI) and Wanfang Datebases were searched for the randomized controlled trials (RCTs) and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were undertaken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously associated with higher 1-, 2-, and 3-year overall survival rates (OR1-year=3.98, 95% CI 2.87-5.51, P<0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P<0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P<0.00001) than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone (OR=13.86, 95% CI 8.04-23.89, P<0.00001). And there was a significant difference in local recurrence rate between two different kinds of treatment (OR=0.24, 95%CI 0.14-0.44, P<0.00001). Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy. TACE-plus-RFA treatment was associated with a higher response rate (RR) than the TACE-alone treatment (OR=3.90, 95% CI=2.37-6.42, P<0.00001). TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease (SD) rate (OR=0.38, 95% CI=0.11-1.26, P=0.11). Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease (PD) rate (OR=0.15, 95% CI=0.05-0.43, P=0.0005). The rate of AFP reducing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group (OR=4.62, 95% CI 2.56-8.34, P<0.00001). The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients' overall survival rate, tumor necrosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.

Objective To investigate the clinical features of and GJB2 gene mutations in a Chinese Han patient with keratitis-ichthyosis-deafness syndrome (KID syndrome),in hope to offer evidence for the clinical and genetic diagnosis of KID syndrome.Methods Clinical data were collected from a patient with KID syndrome.DNA was extracted from peripheral blood of the patient and his two family members (mother and brother).PCR was performed to amplify the exon 2 and its flanking splicing sites of GJB2 gene followed by bidirectional direct DNA sequencing. Results The patient presented with the typical triad of vascularizing keratitis,ichthyosis and congenital deafness.A G148A mutation in the exon 2 of GJB2 gene,resulting in the substitution of aspartic acid by asparagine at position 50 of the junction protein connexin 26 (Cx26),was identified in the patient,but not in either of his family members.Conclusion The G148A mutation in GJB2 gene may be responsible for the clinical phenotype of KID syndrome in this Chinese patient.