Objective To study the technique and to evaluate the clinical value of stent implantation by butt joint of percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangio-pancreatography (ERCP) for the treatment of obstructive jaundice. Methods 24 patients with obstructive jaundice were treated by butt joint of PTBD and ERCP after the ERCP failure, and the clinical results were evaluated. Results A total of 24 cases with obstructive jaundice were successfully operated by butt joint of PTBD and ERCP. In PTBD, 10 cases were punctured from right side, and 14 cases were from left side. PTBD, ERCP and butt joint were done simultaneously in 16 cases, and separately in 8 cases. The total serum bilirubin decreased by 47.07 in 4 days, and the direct bilirubin decreased by 45.43. Infection of biliary tract was the main complication. Conclusion Stent implantation by butt joint of PTBD and ERCP for the treatment of obstructive jaundice may be chosen to treat the patients who failed in ERCP alone.

Objective To evaluate the efficacy and safety of thrombolysis treatment of mesenteric and portal venous thrombosis by TIPSS pathway. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic shunt (TIPSS) pathway. All 6 patients presented abdominal pain, distention, and anorexia etc. No clinical signs of peritonitis were seen. The diagnosis was established by Doppler ultrasound scan and contrast enhanced CT. Control PV-SMV venography was performed after access to the PV branch. As soon as the diagnosis was established the thrombus in the PV and SMV was aspirated and fragmented. After the majority of the clot was cleared away with restoration of blood flow in the main trunk, a 4-French catheter with multiple side-holes was passed into the SMV, and urokinase (UK) was continuously infused for 3 to 13 days. Anticoagulants were given for 6 months therefter. Results The majority of the thrombus in PV and SMV was cleared away resulting in flow restoration in all patients after the procedure. Clinical improvement was seen in 5 patients, characterized by progressive alleviation of abdominal pain, distention, and diarrhea. Prior to removal of the infusion catheter from the SMV, venography revealed a complete resolution of the thrombosis in 3 patients, and residual thrombus in the PV branches in 3 cases without showing clinical symptoms. Follow-up Doppler ultrasound scan performed during 4-36 months after the procedure confirmed patency of the PV and SMV. The symptoms did not recur. Conclusions Through the TIPSS pathway, catheter-directed thrombolysis is safe and effective in the treatment of PV and SMV thrombosis.

Objective To improve the level of the diagnosis and treatment of gastric ectopic pancreas. Methods We reviewed the data of endoscopic ultrasonography(EUS) examination of gastric submucosal mass from 2000 to 2004 and analyze the EUS features of gastric ectopic pancreas. Results Among 241 cases of gastric submucosal mass, 105 cases were diagnosed as benign stromal tumors, 23 as malignant stromal tumors, 48 as lipomas,45 as ectopic pancreas and 20 as cysts. The EUS features of gastric ectopic pancreas included submucosal lesions (39 cases), clear boundary (37cases),hy-perechoic heterogenous internal echo(42 cases), hypoechoic(3 cases), echoless in the center of the lesions (32 cases). After resection,26 cases confirmed by pathology had no complications. Conclusion EUS examination is helpful to confirm the diagnosis'of gastric ectopic pancreas. Resection under endoscopiy is a an effective measure of treatment.

Objective To investigate the necessity of clamping the indwelling catheters before removal in patients with cervical cancer postoperatively. Methods A total of 198 cases of patients with cervical cancer after radical hysterectomy were divided into the study group (70 cases) and the control group (128 cases) randomly according to operation time. In the study group the catheters were clamped intermittently by patients 2 days before removal, while in the control group the catheters were removed without clamping. The rate of recatheterization, urinary tract infection, as well as the residual urinary volume were compared between groups. Results There were no significant differences in the rate of urinary tract infection and recatheterization between the two groups (P>0.05). The residual urinary volume was significantly higher in the study group than that in the control group ( χ2=10.293, P=0.016). Conclusions There may be no positive effect of training the bladder function by clamping the indwelling catheters before its removal in patients after radical hysterectomy, besides, it can not change the risk of recatheterization and can increase the residual urine in the bladder 24 hours after removal of the catheter.

Objective To evaluate the safety and efficacy of endoscopic treatment in patients with primary hepatic carcinoma and gastroesophageal variceal hemorrhage. Methods Thirty cases of hepatic carcinoma with gastroesophageal variceal hemorrhage diagnosed with gastroscopy between January 2008 and June 2015 in Chinese PLA General Hospital and Hainan branch were included. Patients′ clinical data, complications and therapeutic effects of endoscopy were retrospectively analyzed. Results All patients underwent endoscopy successfully. No recurrent bleeding was found in any case after treatment. Eight cases of varicosis nearly disappeared. Six?month follow?up showed three cases of gastrointestinal bleeding, one case of death of bleeding, and no recurrence hemorrhage in 27 others. Conclusion Endoscopic treatment could safely and effectively control the primary liver cancer combined with gastroesophageal variceal hemorrhage, hence may provide opportunity for further treatment of liver cancer.

Objective To establish a rapid, accurate and low-cost screening method for the detection of calreticulin (CALR) mutations in myeloproliferative neoplasms (MPN).Methods Seventy cases diagnosed with MPN were collected from 2012 to 2016. PCR combined with high resolution melting (HRM) analysis were used to screen the CALR mutations, and Sanger sequencing and T-A sequencing were applied to verify the HRM positive samples. CALR wild type DNA, type 1 and type 2 mutant DNA samples were selected and analyzed 4 times/day for 5 days to detected the CVs of Tm (melting temperature) respectively. JAK2 mutations were also analyzed in MPN patients to compare the association between JAK2 and CALR mutations.Results PCR-HRM analysis showed 7 cases (26.9%) and 5 cases (20.8%) patients with CALR mutations were screened out from 26 essential thrombocythaemia (ET) cases and 24 primary myelofibrosis (PMF) cases, but no CALR mutations were found in cases with polycythaemia vera (PV). All mutations were confirmed by direct sequencing or cloning sequencing. The CVs for HRM analysis of CALR wild type DNA, type 1 and type 2 mutant DNA samples were 1.91%,1.59% and 1.43%, respectively.There were 47 cases with JAK2 V617F and 1 case with exon12 mutation. No coexistence of JAK2 mutation and CALR mutations were found in a single sample.Conclusion PCR-HRM can be used for rapid screening of CALR mutation. Subsequent sequencing can be applied for rapid diagnosis of MPN patients in clinical practice.

Objective To assess the efficacy and safety of interventional techniques for the management of symptomatic portal vein (PV) and superior mesenteric vein (SMV) thrombosis. Methods Six patients with thrombosis of the PV and SMV were treated by transjugular intrahepatic portosystemic (TIPS) approach. Contrast PV SMV venography was carried out to verify the access to the PV branch. Then a 8F large bore catheter was used to aspirate thrombus. A J shaped guide wire and pig tail catheter were used to fragment the thrombus. Local thrombolysis with urokinase (UK) was delivered through a catheter in the SMV. An 4 French multiple side hole catheter was put into the SMV and UK was continuously infused for 3 to 13 days.Results The procedure was successful in all cases. One patient died of intra abdominal sepsis 12 days after. Five patients were followed up by color Doppler ultrasonography for 4～36 months with confirmed patency of the PV and SMV in all these patients. Conclusions This procedure is both safe and effective in the treatment of symptomatic PV and SMV thrombosis.

Objective To evaluate the tolerance and safety of sorafenib for elderly patients with advanced renal cell carcinoma.Methods Forty cases with advanced renal cell carcinoma were enrolled,26 were males and 14 were females,the average age was 70 years.Recurrence or metastasis was found in 32 patients who had received nephrectomy,22 of the 32 cases had received cytokine therapy before recurrence or metastasis.Primary renal lesions of 8 cases could not be resected,so patients get renal tumor biopsy.Pathological type of all patients was clear cell carcinoma.KPS of all the patients were ≥70 points.Sorafenib was used as first-line treatment,with 400 mg twice per day,until intolerance or disease progression occurred.Results The average treatment time was 7.5 months (3-18 months),CR 0 case,PR 6 cases,SD 29 cases,PD 5 cases.The overall objective response rate and disease control rate were 15.0% (6/40)and 87.5%(35/40),respectively.The median follow-up period was 11 months.The adverse reaction included hand-foot skin reaction(70.0%),alopecia (62.5%),rash(52.5%),diarrhea(37.5%),loss of appetite(32.5%),fatigue(27.5%).Most adverse reactions occurred around the second week after drug therapy initiation,their duration did not equal.And most of these adverse reactions could be released by symptomatic treatment,they did not affect the treatment.Conclusions The types of adverse reactions of sorafenib for elderly patients with advanced renal cell carcinoma are similar to those reported in the literature.Generally the degree of adverse reactions is minor,with good tolerance and safety.

In recent years, cases of illegal addition of chemical substances into the TCMs and health-care products happened regularly. Therefore, it is particularly important to develop fast, sensitive and accurate analysis methods for detection of the adulterated chemical substances. Through literature survey of relevant papers published in 2016-2017, this article summarizes the application of various analytical techniques for adulterated chemical substances to the TCMs and health-care products with useful information for the further development of new methods and technologies in this field.

Objective To investigate the predisposing locations of active hemorrhage in patients with esophageal variceal bleeding. Methods Data of 823 patients with acute esophageal and gastric variceal hemorrhage receiving emergency gastroscopy diagnosed from January 2003 to December 2013 were retrospectively studied. The location and site of active hemorrhage or stigmata were analyzed and its relationship with active hemorrhage was discussed. Results A total of 372(45. 2%,372/823) patients with active bleeding and stigmata were found under emergency endoscopy. Among 372 patients, 190 got accurate hemorrhage and stigmata location and site description. Bleeding or stigmata in 58(30. 5%) patients was 28-32 cm from incisor in group A, and that in 132 (69. 5%) patients was more than 35 cm in group B ( χ2＝57. 642, P＜0. 000 1). In 190 cases, the proportion of bleeding or stigmata at 3:00 point was the highest (37%,70/132), followed by those at 12:00 point(30%,58/132),6:00 point(24%,45/132),and 9:00 point (9%,17/132). The change trend of the percentage of each point in group A and group B was the same as that in all cases. The percentage of almost all points in group B was significantly higher than that in group A except that at 9:00 point ( P＜0. 000 1).Conclusion Esophageal variceal bleeding in cirrhosis is more common at 3:00 point, 6:00 point and 12:00 point of esophagus, and the high risk area is 35 cm below the incisors.