Objective: To investigate the efficacy and safety of sertraline combining with quetiapine in the treatment of obsessive-compulsive disorder (OCD) .Methods: A total of 86 patients who met the criteria for OCD in International Classification of Diseases (ICD-10) were randomly assigned to two groups. One group was treated with sertraline combining with quetiapine and die other with sertraline only for 8 weeks. The efficacy was measured wim the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Hamilton Depression Scale (HAMD) . The side effects were assessed with the Treatment Emergent Symptoms Scale (TESS) . Results: One patient in sertraline group fell off and was out of statistical analysis. At endpoint the significant improvement rate in the combining group was higher than that in the sertraline group (72.1% vs. 47.6% , P = 0.021) . In combining group, the YBOCS score [(25.00 ± 5.19) vs. (11.74 ± 4.50), P < 0.01] and HAMD score [(14.47 ± 4.05) vs. (6. 86 ±2.61), P < 0.001] were decreased after treatment In sertraline group, the YBOCS score [(24.55 ± 3.60) vs. (14.38±4.18), P<0.001] and HAMA score [(14.79 ± 3.77) vs. (8.29 ±3.04), P <0.001] were also decreased after treatment There were significant differences between the two groups (Ps < 0.05) . There were no significant differences between the two groups in the TESS score at the end of 2, 4, 6 and 8 weeks (Ps > 0.05) . The incidence of drowsiness and tachy-heart rate in the combining group was high than that in the control group (37.2% vs. 4.8% , P <0.001; 27.9% vs. 4. 8% , P=0.004) . But most patients with these two kinds of side effects were disappeared in 2 weeks. There were no significant differences between the two groups in other side effects such as nausea, anxiety, headache, and constipation (Ps > 0.05) .Conclusion: The addition of quetiap-ine to sertraline therapy has been found to be effective and well-tolerated approach in patients with OCD.

Objective To compare the clinical value of uterine submucosal myoma classification by two dimensional and three-dimensional contrast-enhanced ultrasonography and surgical pathologic results.Methods The imaging data of ultrasonographic hysterography including 2D and 3D of 124 patients with uterine submucosal myoma were retrospectively analyzed,and the results were compared with the surgical pathologic results.The diagnostic accuracy of uterine submucosal myoma classification and the operation success rate of uterine submucosal myoma for Ⅰ grade by ultrasonographic hysterography including 2D and 3D were compared.Results The patients were diagnosed pathologically with 0,Ⅰ and Ⅱ grade of uterine submucosal myoma in 26 cases,52 cases,68 cases,respectively.The patients were diagnosed by 2D ultrasonic sonohysterography with 0 grade,Ⅰ grade and Ⅱ grade of uterine submucosal myoma in 26 cases,62 cases,58 cases,respectively.The patients were diagnosed by 3D ultrasonic sonohysterography with 0,Ⅰ and Ⅱ grade of uterine submucous myoma in 26 cases,52 cases,68 cases,respectively.For pathological results as thegold standard,the diagnostic sensitivity,specificity and accuracy of uterine submucosal myoma for 0 grade by 2D and 3D ultrasonic sonohysterography were all 100.00％.The diagnostic sensitivity,specificity and accuracy of uterine submucosal myoma for Ⅰ and Ⅱ grade by 2D ultrasonic sonohysterography were 92.32％,79.46％,85.00％,respectively.The diagnostic sensitivity,specificity and accuracy of uterine submucosal myoma for Ⅰ and Ⅱ grade by 3D ultrasonic sonohysterography were 96.24％,88.24％,91.76％,respectively.There were significant differences in the diagnostic sensitivity,specificity and accuracy of submucosal myoma of uterus for Ⅰ and Ⅱ grade by 2 D and 3 D ultrasonic sonohysterography (x2 =3.21,2.78,2.17,2.33,all P ＜ 0.05).The patients diagnosed as uterine submucous myoma for 0 grade all underwent the hysteroscopic surgery for successful resection,while the patients with uterine submucous myoma for Ⅱ grade underwent laparoscopic surgery or open surgery.The operation success rates of uterine submucous myoma for Ⅰ grade by hysteroscopic surgery diagnosed by 2D and 3D ultrasonic sonohysterography were 75.81％,98.07％,respectively.The operation success rate of uterine submucous myoma for Ⅰ grade by hysteroscopic surgery diagnosed by 3D ultrasonic sonohysterography was significantly higher than that diagnosed by 2D ultrasonic sonohysterography (x2 =7.15,P ＜ 0.05).Conclusion The accuracy of uterine submucosal myoma classification by 3D ultrasonographic hysterography is better than 2D ultrasonographic hysterography.

Objective To retrospectively investigate the clinical features of localized primary small bowel stromal tumors (SBSTs) and the impacting factors for prognosis.Methods The clinical and pathological data of 89 consecutive SBSTs patients,with pathologically confirmed,who underwent complete resection in Ruijin hospital between January 2003 and September 2007 were collected and analyzed.All patients were followed up for assessment of tumor recurrence and metastasis.The impacts of clinical and pathologic factors on rate of disease free survival (DFS) of the patients was evaluated.Results In total of 89 follow-up patients,15 patients were diagnosed with tumor recurrence and 9 of them died.The tumor size,mitotic index and pathological risk stratification were statistically related with DFS (P=0.000,P=0.006,P=0.000,respectively) by using Kaplan-Meier univaritate analysis.Tumor size and mitotic index were proved to be independent prognostic factors for tumor recurrence by multivariate analysis COX regression model.Conclusions Tumor size and mitotic index are related with tumor recurrence,and can be regarded as independent predictive factors of tumor recurrence.

Objective To evaluate the effect of cisplatin on analgesia with morphine in rats with incisional pain.Methods Forty-two adult male Sprague-Dawley rats,weighing 180-220 g,were randomly divided into 6 groups (n =7 each) using a random number table:normal saline group (group C),normal saline + Pglycoprotein inhibitor LY335979 group (group CL),normal saline + morphine group (group CM),cisplatin group (group S),cisplatin + morphine group (group SM) and cisplatin + morphine + LY335979 group (group SML).Cisplatin 2 mg/kg was injected intraperitoneally once every two days for 5 times in S,SM and SML groups,while the equal volume of normal saline was injected intraperitoneally in C,CL and CM groups.At 2 days after the end of administration,the incisional pain models were established.At 10 min after establishing the model,normal saline 2 ml was injected subcutaneously in C and S groups; LY335979 20 mg/kg was injected via the caudal vein and normal saline 2 ml was injected subcutaneously in group CL; morphine 2 mg/kg was injected subcutaneously in CM and SM groups; LY335979 20 mg/kg was injected via the caudal vein and morphine 2 mg/kg was injected subcutaneously in group SML.Cumulative pain score was used to evaluate analgesia.Results Compared with group C,cumulative pain scores were significantly decreased in group CM,and no significant change was found in cumulative pain scores in CL and S groups.Compared with group CM,cumulative pain scores were significantly increased in group SM,and no significant change was found in cumulative pain scores in group SML.Cumulative pain scores were significantly lower in group SML than in group SM.Conclusion Cisplatin can weaken analgesia induced by morphine in rats with incisional pain through enhancing P-glycoprotein function in the blood-brain barrier.

Objective To investigate the value of double-balloon endoscopy (DBE) and multi-slice CT enteroclysis (MSCTE) in diagnosis of Crohn's disease (CD) in small intestine. Methods DBE and MSCTE were performed in 71 patients with suspected Crohn's disease in small intestine. The two methods were compared in terms of diagnosis, extents of disease, existance of complications and activity of the disease according to the pathologic findings and the outcome of follow-up. Results The diagnostic yields of DBE and MSCTE were comparable with no significant difference (χ2=2.29, P> 0.05). The positive and negative likelihood ratios were 22.5 and 0. 022 in DBE respectively, and were 1.6 and 0. 240 in MSCTE respectively. The results of DBE was consistent with MSCTE in diagnosis of mild bowel stenosis, but was inconsistent with MSCTE in diagnosis of moderate-severe bowel stenosis (χ2=11.298, P=0.001). The concordance of two methods in diagnosis of disease activity was 95.8%. Conclusions The first choice in diagnosis of small bowel CD is DBE. The combination of two methods will be helpful in diagnosis and evaluation of CD severity.

Objective To evaluate the clinical value of double-balloon enteroscopy( DBE)in as-sessing the effect of mucosal healing in patients with moderate small bowel Crohn's disease( CD)treated with low-dose azathioprine. Methods CD patients who were naive to any immunomodulators or biological a-gents with lesions mainly located in ileu were screened by multislice CT enterography and anal-route DBE at baseline. Lesions at 150 cm proximal to ileocecal valve were assessed by DBE with Simple Endoscopic Score for CD( SES-CD)after 12 and 24 months of low-dose azathioprine treatment,respectively. Results A total of 36 patients were enrolled and the average tolerated dose of azathioprine was(61. 8 ± 17. 2)mg/day. The total rates of complete,near-complete,partial and no mucosal healing in 36 patients were 19. 4%(7/36), 5. 6%(2/36),27. 8%(10/36),and 47. 2%(17/36)at month 12 and 30. 6%(11/36),25. 0%(9/36), 33. 3%(12/36),and 11. 1%(4/36)at month 24,respectively. The baseline SES-CD score(OR=2. 71, 95%CI:1. 11-6. 63,P=0. 029)and duration of disease(OR=1. 27,95%CI:1. 10-1. 47,P =0. 001) were two relevant factors associated with mucosal healing of small bowel CD. Conclusion DBE has a signif-icant advantage in assessing post-therapy mucosal healing for patients with small bowel CD. The optimal time point for the first follow-up by DBE is at least 12 months after low-dose azathioprine treatment.

Objectives To explore the expression of HER4 and VEGF in NSCLC and elucidate the relationship between their expression and the characteristic of clinical pathology. Methods 82 cases of paraffin-embedded tissues from informative NSCLC were used to detect the expression of HER4 and VEGF by means of immunohistochemical assay. Results HER4 is overexpressed in 65;9%of NSCLC cases. The overexpression of HER4 is correlated with the lymph node metastasis and TNM staging. VEGF is expressed in 53.7%of NSCLC cases. The expression of VEGF is also correlated with the lymph node metastasis and TNM staging, and the expression of VEGF is correlated with the overexpression of HER4.Conclusions HER4 and VEGF are the protein to regulate the growth of NSCLC and it might be a good way for the treatment of NSCLC by suppressing the overexpression of HER4 and VEGF.

Objective To investigate the role of double-balloon enteroscopy (DBE) in the evolution of detection and surgical treatment of small bowel stromal tumors (SBSTs),based on nine years experience.Methods In this retrospective study,193 patients with localized SBSTs were divided into the CT-enterography (CTE) and/or DBE group (n =100) and conventional modalities group (n =93).These patients were further divided into the open surgery group (n =126) and laparoscopy-assisted resection group (n =67).The development of clinical diagnosis and surgical treatment strategies were compared before and after the introduction of DBE.Results The average age and tumor size were significantly smaller in the CTE and/or DBE group than those in the conventional modalities group,respectively (age:50.9 ± 12.1 vs.56.9 ± 11.6 years; tumor size:3.6 ± 1.3 vs.6.1 ± 2.6 cm,P ＜ 0.01).Before the introduction of DBE (from January 2001 to December 2002),all patients underwent conventional modalities,and only 4 cases/year for open surgery.Afterward,from January 2003 to December 2004,84.6％ (11/13) of SBSTs were detected by DBE.From January 2005 to December 2008,50.0％ (23/46) of SBSTs were found by CTE combination with DBE.From January 2009 to December 2011,80.5％ (33/41) of SBSTs were diagnosed by CTE,and the number of patients underwent operation increased up to 25 cases/year,which was nearly 5.3 folds higher than that before the introduction of DBE.Sixty-seven patients were successfully operated by laparoscopy-assisted resection,82.1％ (55/67) of them were detected by CTE ands/or DBE,89.1％ (49/55) of whom had low-or intermediate-risk SBSTs.Conclusion DBE plays an important role in optimizing the algorithm of detection and treatment of SBSTs.

Objective To evaluate the diagnostic efficiency of double-balloon enteroscopy in small bowel Crohn’s disease. Methods In sixty five patients with suspected small bowel Crohn's disease double-balloon enteroscopy were performed, and some of them received enteroscopy and enteroclysis, capsule endoscopy as well.Results The first enteroscopy was performed via mouth in 20 of 65 cases, and the lesions were detected in 11 cases (55%), 5 of 9 cases(55.6%) had lesions detected in enteroscopy via anus while nothing was found in mouth route. Among 45 cases examed by enteroscopy firstly via anus, 34 cases had lesions detected (75.6%), 8 of 11 cases(72.7%) had lesions found in following exam via mouth. Totally 58of 65 had lesions detected through enterosocpy examination, the overall diagnostic yield was 89.2%. Twenty four of 46 cases had positive findings with enteroclysis. The diagnosis of Crohn's disease was comfirmed in 14 of 22 patients(63.6%) underwent capsule endoscoy. The diagnosis was finally confirmed by enteroscopy only in 11 patients(78.6%).Conclusion The entire small intestine could be examined by enteroscopy with combination of mouth and anus route. Double-balloon enteroscopy was an ideal diagnostic modality for small bowel Crohn's diseases, which was also valuable in assessment on extent and severity of the disease. Small bowel enteroclysis was a useful screening alternative for selecting procedure route in DBE.

Objective To systematically evaluate the clinical outcomes of patients with multivessel diseases treated by fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) or other forms of treatment .Methods Some keywords inclu-ding FFR or fractional flow reserve ,percutaneous coronary intervention or PCI ,multivessel coronary artery disease were used to search randomized control trails(RCT) ,which compared outcomes of patients with multivessel disease treated by FFR guided PCI with other forms of treatment ,in Chinese and English database including CNKI ,VIP ,Wanfang ,Pubmed ,EMBASE and the web of science .The quality of included studies was evaluated by Jadad quality score and all the data was analyzed by stata 10 .0 .Results A total of 7 english literatures accumulating 2024 cases in experimental group and 7 284 cases in control group were included in this study .Compared with other forms of treatment ,patients with multivessel diseases treated by FFR-guided PCI had significantly low-er risk of myocardial infarction (RR=0 .72 ,P=0 .008) .Although the risk of death and major adverse cardiovascular events were al-so be reduced ,there were no statistically significant difference .Conclusion FFR-guided PCI is an effective treatment for multivessel disease ,but it is still needs further verification for the application in Chinese population .