Objective To evaluate the value of percutaneous endoscopic gastrostomy (PEG) in the treatment of amyotrophic lateral sclerosis (ALS) patients with dysphagia. Method Sixty-five ALS patients underwent PEG from April 2005 to July 2010 were analysed retrospectively. Results All the 65 patients underwent PEG,and 2 patients failed because of dyspnea. Totally 63 patients were intubated successfully,the successful rate was 96.9%(63/65). The operation time was 8-17 min. Two patients had local infection.After 3 months, the body mass index was increased from (18.3 ± 1.0) kg/m2 to (19.7 ± 1.2) kg/m2(t = 15.8,P ＜ 0.01), without peritonitis, migration of the gastrostomy tube and other complications. Conclusions PEG is a safe method with a low complication for ALS patients to get enteral nutrition. Dyspnea is the main reason of failure.

Objective To investigate the clinical effects of endoscopic pancreatic duct stent insertion.Methods The clinical data of 20 cases of endoscopic pancreatic stent insertion,including 12 cases of chronic pancreatitis,3 cases of recurrent pancreatitis,2 cases of papilla adenoma after resection,3 cases of pancreatic carcinoma,was retrospectively reviewed from June 2004 to September 2006.All the patients underwent endoscopic pancreatic sphincterotomy and pancreatic stent insertion after endoscopic retrograde cholangiopancreatography(ERCP).Results All the 20 patients received 23 procedures of pancreatic stent insertion.Stent-preserving time was 25-105 days(mean,64.5 days).2 cases experienced stent migration and no postoperative pancreatitis occurred.20 patients were followed up for 6 to 12 months,including 17 patients for 12 months.During a follow-up period of 3 months in the 12 cases of chronic pancreatitis,1 case received repair because of duodenal perforation induced by ERCP,and the symptoms of abdominal pain or discomfort disappeared or were distinctively relieved in 9 and 2 cases,respectively,with weight gain 2-5 kg(mean,3.2 kg).A follow-up period of more than 3 months showed that the remission rate of abdominal pain was 92%(11/12).The jaundice was alleviated(with the average of decrease of 61.8 percent of total bilirubin in serum) and weight gained in the 3 cases of pancreatic carcinoma after the biliary and pancreatic duct plastic stents were inserted at the same time.Patients with recurrent pancreatitis had no relapse in the follow-up period.Conclusions The endoscopic pancreatic duct stent insertion is a safe and minimal invasive procedure,and can prevent postoperative pancreatitis,but the main complication of stent migration should be considered.

Objective To evaluate the effects of SHENG JI YU HONG herbs loading on modified gelatin sponges on the wound healing of mechanical trauma.Methods The round size of 1.8cm diameter of full thickness back skin was cut mechanically and covered with petrolatum gauzes,modified gelatin sponges,SHENG JI YU HONG plasters and SHENG JI YU HONG herbs loading on modified gelatin sponges respectively.On day3,day7 and day14 after model mading,the wound surface healing rate,the amount of hydroxyproline,hemoglobin,the number of capillaries and the cells with positive rhVEGF165 by immunochemical method inside granulation of the wound were detected individually.Results On day3,the wound surface healing rate and the number of capillaries and the cells with positive rhVEGF165 of SHENG JI YU HONG herbs loading on modified gelatin sponges were significant enhanced than those in the other groups.On day14,all the experimental indicators of SHENG JI YU HONG herbs loading on modified gelatin sponges were better than those in the other groups with P

Biomarkers ; blood ; Child ; Child, Preschool ; Critical Illness ; Early Diagnosis ; Heart Failure ; blood ; diagnosis ; mortality ; Humans ; Infant ; Intensive Care Units ; Mucocutaneous Lymph Node Syndrome ; blood ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Predictive Value of Tests ; Prognosis ; Pulmonary Heart Disease ; blood ; diagnosis ; Risk Assessment ; Sepsis ; blood ; diagnosis ; Ventricular Dysfunction, Left ; blood ; diagnosis

Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.

Objective:To evaluate the role of spinal cord in anesthesia of isoflurane. Method:The animal models of head bypass were established,which were used to preferentially anesthetized spinal cord, after 9 goats were anesthetized with isoflurane.MAC was determined using tail clamp at prebypass,druing bypass and postbypass. Electroen-cephalogram(EEG),brain stem auditory evoked Potential (BAEP) and visal evoked potential(VEP)were monitored constantly. Result:MAC of isoflurane,the relative power(RP)of ? wave and the latencies of BAEP and VEP were decreased when spinal cord was preferentinally anesthetized (P

Objective To investigate the characteristics of etiology,efficacy of endoscopic management for recurrent idiopathic pancreatitis (RIP).MethodsThe clinical data of 58 cases of RIP diagnosed in our hospital from April 2005 to April 2011 were retrospectively analyzed.All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP),and patients with suspected sphincter of Oddi dysfunction received manometry.According to the clinical and ERCP manifestations,the etiologies of RIP were determined and individualized endoscopic treatment was applied.The patients were followed-up postoperatively about the improvement of abdominal pain and recurrence of RIP.ResuItsFifty-eight patients (29 males,29 females) were suffered from acute pancreatitis from 3 to more than 10 times.The etiologies were as follows:29 cases of biliary microlithiasis,19 case of sphincter of Oddi dysfunction ( 16 cases of pancreatic type,3 cases of mixed type),4 cases of anomalous arrangement of the pancreaticobiliary duct,and 6 cases of normal manifestations at ERCP.Biliary sphincterotomy alone was performed in 33 patients,while both biliary and pancreatic sphincterotomy was performed in 8 patients,and pancreatic sphincterotomy alone was performed in 17 patients,after sphincterotomy,pancreatic stent insertion was performed in 24 patients.The follow-up data was obtained from 41 out of 58 patients,the follow-up period ranged from 3 ～ 67 months ( average 33 months).During this period,9(22.0％ ) patients suffered from RIP,and the treatment efficiency was 78％.ConclusionsBiliary microlithiasis and sphincter of Oddi dysfunction are the main causes of RIP.Drink could induce RIP.ERCP has definite treatment efficacy for RIP.

Objective To investigate the long-term prognostic factors and the significance of serum cardiac troponin T (cTnT) and C-reactive protein (CRP) in maintenance hemodialysis (MHD) patients.Methods Clinical data of 76 MHD patients in our hospital from January 2002 to January 2003 were retrospectively analyzed.Time and cause of death in the next 10 years were recorded.Survival rate was calculated by Kaplan-Meier and impact factors of long-term prognosis were explored.Significance of cTnT and CRP was elucidated by COX regression analysis.Results CRP was positive in 28 cases (36.8％) and cTnT was positive in 22 cases (28.9％) among 76 patients.The median survival time was 37.9 months,2-year survival rate was 65.9％ and 10-year survival rate was 24.2％.Univariate analysis found positive CRP,positive cTnT,old age,diabetes,cardiocerebrovascular disease,anemia,low serum albumin,Kt/V decline were associated with long-term prognosis.Multivariate analysis showed that increased age (P =0.010),cardiocerebrovascular disease (P =0.048),positive cTnT (P =0.036),positive CRP (P =0.009) were independent risk factors of the 10-year survival of MHD patients.Ten-year mortality of cardiocerebrovascular diseases in positive cTnT group was not significantly different as compared with negative cTnT group (50.0％ vs 35.4％,P =0.248).But the positive cTnT group had higher 2-year mortality than negative cTnT group (40.9％ vs 14.6％,P =0.015).Mortality of cardiocerebrovascular disease was higher in positive CRP group as compared to negative CRP group at both 2-year and 10-year time (48.1％ vs 7.0％,P =0.000; 66.7％ vs 23.3％,P =0.000).Compared with both negative cTnT and CRP group,both positive cTnT and CRP group had much higher all-cause mortality (92.9％ vs 55.6％,P =0.030),higher mortality of cardiocerebrovascular disease at 10-year (64.3％ vs 25.0％,P =0.009),and higher mortality of cardiocerebrovascular disease at 2-year (57.1％ vs 5.6％,P =0.000).Conclusions Aging,cardiocerebrovascular disease,positive cTnT and positive CRP are independent risk factors of long-term prognosis for MHD patients.Positive cTnT can predict cardiocerebrovascular mortality of MHD patients in 2 years,while positive CRP can predict short-and long-term cardiocerebrovascular mortality.Positive cTnT combined with positive CRP may be more valuable in predicting the poor prognosis of MHD patients.

Objective To compare the medical economics and safety of colonic metallic stent implantation as a bridge to elective resection with traditional emergency resection.Methods Data of colonic cancer obstruction cases in emergency room from 2008 to 2013 were retrospectively analyzed and divided into stent group(colonic stent as a bridge to surgery) and control group(emergency surgery).Main parameters between the two groups were compared,including surgery-associated mortality and morbidity,colostomy rate and re-anastomosis rate,ICU admitted rate,average days and costs in hospital,and colonic stent insertion associated clinical success rate and mortality.Results Ten and 11 patients were included in stent group and control group respectively.Surgery associated morbidity and colostomy rates were both 0 in stent group,and 18.2％ and 100.0％ in control group.Days of hospitalization and costs were 23 days and 67 742 Yuan in stent group,and 49 days and 92 553 Yuan in control group.The surgery associated mortality rates both were 0 in the two groups.ICU admitted rates were 20％ and 18％ respectively.Conclusion Colonic stenting as a bridge to surgery has a high clinical success rate and has a lower morbidity and colostomy rate,shorter hospitalization days,less cost compared with traditional emergency surgery.This strategy for colonic cancer obstruction is of safety and great health economic value.

Objective To evaluate the feasibility of diagnostic and therapeutic peroral direct cholan-gioscopy (PDCS)using an ultra-slim upper endoscopy assisted by a snare.Methods Between November 2014 and January 2015,8 patients underwent PDCS with assistance of an ultra-slim endoscopy.After endo-scopic papillary balloon dilation,the duodenoscopy was withdrew,an ultra-slim endoscopy was inserted di-rectly into the biliary tract assisted by a snare,and biopsy or laser lithotripsy was performed.The snare was closed tightly in the bent portion of the scope,and the snare was pulled while scope shaft had to become the form of U loop by counterclockwise rotation,in order to advance the scope into common bile duct.Results PDCS succeeded in all eight cases,one common hepatic duct adenoma was diagnosed by biopsy,and con-firmed by surgery;one benign biliary stricture was diagnosed by PDCS;laser lithotripsy was successfully per-formed in 4 patients with large CBD stones;bile duct clearance was verified by PDCS in two patients who was suspected of residual CBD stones.No perforation,bleeding or post-operative pancreatitis was found.Con-clusion PDCS using an ultra-slim gastroscopy assisted by a snare is a safe,simple and practical procedure in the diagnosis and treatment of biliary tract diseases.