Objective To evaluate the value of intraduetal ultrasonography (IDUS) in diagnosing biliary and pancreatic disorders. Methods The findings by endoscopic retrograde cholangiopancreatography (ERCP) and IDUS from 19 patients with suspected biliary and pancreatic disorders from July 2006 to August 2007 in our hospital were analyzed retrospectively. Results Of the 19 patients, 17 had obstructive jaundice (including 6 eases of cholangiocarcinoma, 2 pancreatic adenocareinoma, 2 gallbladder carcinoma, 2 chole-docholithiasis with bile duct stricture, 2 autoimmune pancreatitis, 1 papillary adenocarcinoma, 1 papillary adenoma, and 1 sclerosing cholangitis) and 2 intraduetal papillary mueinous tumor (IPMT). The diagnosis was confirmed by surgery and pathological findings in 11 patients. The diagnostic accuracy of ERCP and IDUS was 73. 7% (14/19) and 84. 2% (16/19), respectively, and that of ERCP combined with IDUS was 89. 5% (17/19). The sensitivity and specificity of ERCP to differentiate benign bile duct strictures from ma-lignant ones were 100. 0% (11/11) and 83.3% (5/6), respectively; and those of IDUS were 100. 0%(11/11) and 100. 0% (6/6), respectively. The sensitivity and specificity of ERCP in diagnosing cholan-gioeareinoma were 83.3% (5/6) and 60% (3/5), respectively; and those of IDUS were 100. 0% (6/6) and 40. 0% (2/5), respectively. Conclusion Combination of ERCP with IDUS can improve the diagnostic accuracy of pancreaticobiliary disorders. Additionally, IDUS shows higher sensitivity and specificity in differ-entiation between benign and malignant bile duct strictures, but it is still difficult to identify the etiologic factors of malignant bile duet strictures by IDUS.

ObjectiveTo study the mechanisms and related factors and preventive managements of the stress ulcer complicating with acute cervical spinal cord injury. MethodsThe clinical findings of eight cases of the acute cervical spinal cord injury with stress ulcer were reviewed retrospectively.ResultsFive cases were cured by conservative treatment, one case was cured after operations, two cases died of breath and circulation failure.ConclusionStress ulcer is a critical complication of acute cervical spinal cord injury. It should be prevented actively.

Objective To evaluate endoscopic ultrasonography (EUS) for TN restaging and predicting response to advanced gastric cancer after neoadjuvant chemotherapy. Methods A total of 22 patients,15 males and 7 females, mean age 64 (36-80 years ), with advanced gastric cancer were recruited to the study from June 2007 to December 2009 with written informed consents. All patients underwent 3 cycles of neoadjuvant chemotherapy ( Folfox 6 ), and subsequent surgery ( R0 resction) in 3-4 weeks after chemotherapy. EUS was performed 1-2 weeks before and 1-2 weeks after chemotherapy. EUS TN staging was compared with pathological findings. The correlation of peri-chemotherapy EUS TN staging with postoperative pathological response was evaluated. Results After chemotherapy, the overall accuracy of EUS T staging was 63.6% (14/22), with overstaging (36. 4%, 8/22) more frequent than understaging (0). The overall accuracy of N staging was 54. 5% (12/22) with 4 ( 18. 2%, 4/22) overstaging and 6 ( 27. 3%, 6/22 ) understaging. EUS revealed T and/or N downstaging ( concyrrence of T and N downstaging was accounted once) after chemotherapy in 10 patients, with 9 T downstaging (4 from T3 to T2, 5 from T4 to T3) and 4 N downstaging (4 from N1 to N0). TN downstaging was correlated with pathological response, with 7 patients achieving pathological response 2 and 1 patient 3. Conclusion T and N restaging by EUS after neoadjuvant chemotherapy in patients with locally advanced gastric cancer is not accurate enough. However, T and/or N downstaging confirmed by EUS is well correlated with a better degree of pathological response to chemotherapy.

Objective To investigate the diagnostic value of intraductal ultrasonography (IDUS) for unconfirmed microlithiasis under endoscopic retrograde cholangiography ( ERC). Methods The data of 22 patients who were definitely diagnosed as having microlithiasis by IDUS and endoscopic sphincterotomy (EST) from July 2007 to September 2009 were retrospectively analyzed. Microlith was defined as choledo-cholith equal to or less than 3 mm in diameter. Using IDUS plus EST findings as golden standard of bile duct microlithiasis, the accuracy of diagnosis and rate of missed diagnosis of transabdominal ultrasonography, magnetic resonance cholangiography (MRC) and ERC were evaluated and compared. Results Diagnosis rates of trans-abdominal ultrasonography, MRC and ERC for extra-hepatic duct microlithiasis were 27. 3% (6/22), 38. 5% (5/13) and 27. 3% (6/22) , respectively. Detection rates of common bile duct dilation by 3 methods were 68. 2% (15/22) , 84. 6% (11/13) and 68. 2% (15/22) , respectively. The microlithiasis in 2 patients, which manifested as repeated acute pancreatitis, were missed by transabdominal ultrasonography , MRC and ERC, and were finally confirmed by IDUS. Conclusion Sensitivity of ERC in diagnosis of extra-hepatic microlithiasis is not superior to that of transabdominal ultrasonography or MRC. IDUS is a technically easy, safe, highly sensitive and accurate procedure, which is helpful in differentiation of etiology of recurrent acute pancreatitis.

Objective To analyze the characteristics of EUS imaging in the patients with autoimmune pancreatitis(AIP).Methods Eleven cases of AIP were studied retrospectively,and features of EUS were analyzed.Results EUS revealed diffuse or focal enlargement of pancreas along with hypoechoic parenchyma and a wavy margin.In addition to dilation,the bile duct had a prominently thickened wall with homogenous mild hypoechoic image.Peripancreatic lymph nodes could be enlarged.No pancreatic duct dilation.calcification or cysts were found.No peripheral vessels were involved.Conclusion EUS could demonstrate specific images which is helpful in diagnosis of AIP.

Objective To investigate the basic status of healthcare-associated infection(HAI)in a hospital,and provide evidence for strengthening HAI management.Methods A cross-sectional study was conducted to investi-gate the prevalence rates of HAI in all hospitalized patients at 0 ∶00 -24∶00 of May 7,2014.Results A total of 2 262 patients were supposed to be investigated,while 2 253 (99.60%)patients were actually investigated,586 of whom (26.01%)came from pulmonary hospital(specialized in tuberculosis)affiliated to the general hospital.53 patients devel-oped 58 times of HAI,prevalence rate and case prevalence rate was 2.35% and 2.57% respectively;1 073 patients devel-oped 1 265 times of community-acquired infection (CAI),prevalence rate and case prevalence rate was 47.63% and 56.15% respectively.Rates of HAI and CAI were high in intensive care unit(ICU,21.28%)and pulmonary hospital (99.49%)respectively;the main infection site was lower respiratory tract,which accounting for 46.55%(n =27)and 69.72%(n=882)respectively.The major pathogens causing HAI were gram-negative bacteria(n = 19),and the major pathogens causing CAI were Mycobacteria(n=141)and fungi (n=89).The rate of antimicrobial usage and etiological ex-amination was 34.80%(n=784 )and 81.48%(n=550 )respectively.Conclusion In order to prevent cross infection of tuberculosis and reduce the incidence of HAI,lower respiratory tract and ICU should be one of the key infection sites and departments of HAI surveillance,treatment and management of patients with tuberculosis should be stand-ardized,professional precaution of health care workers should be enhanced.

Objective To analyse the negative predictive value of endoscopic ultrasonography (EUS)for detecting pancreatic cancer and to evaluate its clinical value of ruling out malignant cancer. Methods The medical records of patients who were referred to pancreatic EUS with suspected pancreatic cancer and normal EUS findings from January 2005 to December 2013 were reviewed. Moreover,the follow-up data were reviewed to evaluate whether the patient developed pancreatic cancer or other malignancy that could cause the abnormality mentioned above. The follow-up data were obtained by examining the inpatient/outpatient records as well as conducting brief telephone interviews. Results A total of 122 patients were in-cluded in our study. The follow-up data of 108 were accessible,and the mean follow-up period was 52. 4 months. One patient was histopathologically diagnosed as having pancreatic cancer 6 years after the proce-dure,and 107 other patients with a normal pancreatic EUS were free of pancreatic cancer as well as other malignancy during the follow-up period. The negative predictive value of pancreatic EUS was 99. 1%(107/108). Conclusion For patients with suspected pancreatic cancer but normal EUS findings,there is no need for further exploratory surgery. However,if there is a high suspicion of malignancy in the pancreas,a repeat-ed EUS is necessary in case of a false negative EUS result.

Objective:To explore the influence of intensive analgesia on the incidence of post-traumatic stress disorder (PTSD) in acute trauma patients, and to develop new ideas for the prevention and treatment of PTSD.Methods:From January 2018 to November 2019, a prospective study was conducted on trauma patients who visited the Emergency Center of Affiliated Hospital of Xuzhou Medical University and met the enrollment criteria. The patients were divided into the intensive analgesia group (< 4) and non-intensive analgesia group (≥ 4) according to the mean pain score in 30 days. The epidemiological data, trauma-related parameters, analgesic schemes, VAS score, PCL-5 score, HADS score and incidence of PTSD of enrolled patients were collected. Appropriate statistical methods were used to analyze differences among the indicators between the two groups.Results:Eighty-four acute trauma cases were included in the study, 39 cases in the intensive analgesia group and 45 in the non-intensive analgesia group. There was no significant difference in baseline data between the two groups (all P>0.05). The incidence rate of PTSD and PCL-5 score of patients in the intensive analgesia group were all significantly lower than those in the non-intensive analgesia group in 1 month after the trauma (all P< 0.05). The HADS anxiety and depression scores of patients in the intensive analgesic group were significantly lower than those in the non-intensive analgesic group (all P< 0.05). All the analgesics were converted into the dosage of dezocine for comparison. The total dosage of analgesics (dezocine) used in patients of the intensive analgesia group was significantly higher than that in the non-intensive analgesia group within 30 days after injury ( P< 0.05). Conclusion:In the acute trauma patients, intensive analgesia after trauma can significantly reduce the incidence of PTSD as well as improve anxiety and depression symptoms.

Objective:To investigate the relationship between the changes in inflammatory markers levels and the onset of post-traumatic stress disorder (PTSD) in the early stage of acute trauma..Methods:From January 2018 to June 2020, patients with acute trauma who were admitted to the Affiliated Hospital of Xuzhou Medical University were selected as subjects. Peripheral venous blood was collected on admission, on the 3rd and 7th day after trauma for routine blood test, C-reactive protein (CRP) and procalcitonin (PCT). The neutrophil to lymphocyte ratio (NLR) was calculated. The PCL-5 scale was used to evaluate PTSD symptoms one month later. The patients were divided into the PTSD group and non-PTSD group with the score of 38 as the boundary. The change rule of NLR in the PTSD group and the non-PTSD group were analyzed.Results:Ninety-one trauma patients were enrolled, including 23 patients in the PTSD group and 68 patients in the non-PTSD group. Compared with the healthy control group, the NLR of 91 trauma patients on admission, on the 3rd and 7th day were significantly higher (all P< 0.01). The NLR of the PTSD group was increased on the 7th day after trauma, which was significantly higher than that of the non-PTSD group ( P= 0.025). The non-PTSD group showed a decreasing trend, of which NLR on the 7th day was significantly lower than that on admission ( P= 0.001). In addition, high level of NLR on the 7th day after trauma (β= 0.206, P= 0.01) was a risk factor for PTSD onset. Conclusions:Dynamic monitoring of the changes in NLR after acute trauma would be of great clinical value to early warning of PTSD.

Objective To evaluate magnifying endoscopy combined with narrow-band imaging ( ME-NBI) for diagnosis of early gastric cancer (EGC).Methods A total of 150 focal lesions from 143 patients over 35 years old identified by white light endoscopy (WLE) from March 2010 to December 2010 in our tertiary referential institution were recruited in the prospective study with written informed consent.Focal lesions were defined as any small local mucosa with abnormal shape or color based on an assessment of findings of WLE without any specified criteria, including superficial, depressed and elevated lesions.The patients with local advanced gastric cancer, submucosal lesions and history of gastrectomy were excluded from the study.All the patients received ME-NBI.Based on literature, national criteria of early diagnosis with ME-NBI were established.All the lesions underwent biopsy and pathological examination.Diagnostic accuracy of ME-NBI for EGC was assessed with reference to histopathology.Results In 150 focal lesions, 19 were pathologically diagnosed as EGC, 8 of which were treated by endoscopic resection and 11 were resected surgically.The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of conventional WLE for diagnosing EGC were 94.7%, 53.4%, 22.8%, 98.6% and 58.7%, respectively.The counterparts of ME-NBI for diagnosing EGC were 73.7%, 99.2%, 93.3%, 96.3% and 96.0%, respectively.The diagnostic accuracy of ME-NBI was significantly better than that of conventional WLE (96.0% vs.58.7%, P＜0.05).With regard to the findings of EGC on ME-NBI, irregular or absent microsurface pattern and microvascular pattern were characteristic features of EGC.Conclusion Conventional WLE is still an important and mandatory screening modality, which is significant for further procedures of suspected lesions, preferably accompanied with biopsy.ME-NBI achieved superior accuracy in the differential diagnosis of focal lesions detected with conventional WLE, but needs further verification.