Objective To retrospectively evaluate the diagnostic accuracy of endoscopic ultrasonog raphy ( EUS) in pancreatic cancer, analyze the value of EUS in measurement of tumor diameters, TNM staging, and investigate the effectiveness of endoscopic ultrasonography-guided fine needle aspiration ( EUS-FNA). Methods All the data adopted from the patients underwent EUS in PUMC Hospital between 1997 and 2003. Eighty-eight patients with a final diagnosis of pancreatic cancer (56 is proven by surgical pathology, 10 by surgical findings and 22 by clinical diagnosis) and 47 patients with a final diagnosis of benign pancreatic disease were included and analyzed. Results The sensitivity, specificity, accuracy, positive and negative predictive values of EUS in the diagnosis of pancreatic cancer were 95. 5% , 59. 6% , 83. 0% , 81. 6% and 87. 5% respectively. Tumor diameters measured by EUS (2. 8?1. 0)cm were obviously smaller than those by surgical findings (6.5 ? 2. 9) cm. For TNM stage, compared with surgical findings, the accordance rates of EUS in T and N staging were 43. 1% and 61. 1% respectively. The accuracy of EUS-FNA in the diagnosis of pancreatic cancer was 76. 5% ( 13/17). Conclusions The sensitivity of EUS in pancreatic cancer is highest among all imaging procedures. Tumor diameters measured through EUS are smaller than those by surgery.

Objective To summarize the initial application of three dimensional angiography(3D angio) in the diagnosis of carotid stenosis and carotid stenting.Methods 23 patients with carotid stenosis confirmed by conventional angiography (two dimensional angiography, 2D Angio) received 3D Angio including 16 accepted both 2D Angio and 3D Angio before and after carotid stenting and then undengone comparative study. Results 32 stenosed lesions were found, including 5 in common carotid artery, 19 in neck section of internal carotid artery, 3 in patrous section, 2 in caverous sinus and 3 in middle cerebral artery. 3D Angio could demonstrate the changes of stenosed segment from every point of view. The degree and extent of stenosis could be accuratly evaluated. The characterization of lesions including the diminution of lumen and coarse plaques could be clearly displayed. After stenting, the wall of stenosed segment became smooth and the plaques disappeared.Conclusions The diagnosis and treatment of carotid stenosis by 3D Angio is helpful to accurately estimate the extent of stenosis, the characterization of the lesions and monitor the results of stenting.

Four adults of Fasciola hepatica were found from the bile ducts of a patient diagnosed as biliary calculi during a surgi-cal operation. We investigated retrospectively the infection source and concluded that the patient may be infected by eating raw or half-cooked Zizania latifolia,an aquatic plant,which was contaminated with metacercariae of F. hepatica.

Objective To summary the therapy outcome of retroperitoneal laparoscopic treatment on upper ureteral calculi.Methods The retroperitoneal laparoscopic treatment were performed to all cases from Jun.2011 to Jun.2012 in our hospital.All cases were treated with 3-hold method (two 10 mm and one 5 mm ports).The retroperitoneal space was made by a combination of blunt and balloon dissection,and the space was maintained with CO2 Ureteral longitudinal incision was made to remove the stones,and double J catheter was served as stent drainage.Absorbable suture was used to suture ureteral incision.Results A retroperitoneal approach was performed in 12 patients,and another patient was conducted the open surgery because the stone cower in the kidney calices.Operative periods ranged from 55 to 132 min (average was 85 min).There were no significant postoperative complications.Conclusion It is a minimally invasive and effective approach in the therapy of upper urerteral calculi with laparoscopic.

Objective Psoriasis vulgaris (PV) is easy to prone to recur and hard to cure and little research has been done on combined treatment on PV.The article was to study the clinical effects of total glucosides of paeony capsules (TGP) combined with acitretin and compound flumethasone on PV as well as the peripheral blood cytokine levels.Methods 126 patients with PV who visited our hospital from October 2015 to January 2017 were randomly divided into combined treatment group (63 cases) and control group (63 cases).Both groups were treated with oral acitretin and topical compound flumethasone, what's more, the compound flumethasone group received oral TGP treatment, 8 weeks for a course.The clinical therapeutic effects were evaluated by the levels of peripheral blood IL-17, IL-18, IL-23, TNF-α level, PASI score and percentage of total skin lesions before and after the treatment.Results After the treatment, the concentration of IL-17, IL-18, IL-23 significantly decreased(P<0.05), which was significantly less in combined treatment group compared with control group (IL-17 [61.18±8.91] vs [78.64±7.85], IL-18 [68.56±17.95] vs [79.49±18.64], IL-23 [70.13±12.16] vs [91.18±16.89] pg/ML)(P<0.05).Moreover, the TNF-α level, the PASI score and the percentage of total skin lesions significantly decreased in both groups after treatment(P<0.05), which was significantly less in combined treatment group compared with control group (TNF-α level [14.47±7.53] vs [23.49±8.12]ng/L, PASI score [4.09±1.29] vs [7.29±5.13], the percentage of total skin lesions [6.17±4.59]% vs [8.09±5.18]%) (P<0.05).Conclusion TGP combined with acitretin and compound flumethasone can significantly enhance the clinical therapeutic effects and effectively regulate the levels of the IL-17, IL-18, IL-23 and TNF-α level, which results in treating psoriasis vulgaris.

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.

Carotid Body Tumor ; surgery ; Humans ; Hypertension ; Pressoreceptors

Objective To differentiate colorectal sessile serrated adenoma(SSA)and large hyperplastic polyp(HP)with white light endoscopy and narrow band imaging. Methods Retrospective analysis was performed on the clinical data of 953 patients who underwent endoscopic screening for colorectal cancer at digestive endoscopy center of Peking Union Medical College Hospital from January 2015 to December 2015.Endoscopic features were compared with white light endoscopy and narrow band imaging between SSA and large HP in location, size, Paris classification, surface mucus, NICE classification and varicose microvascular vessel(VMV). Results A total of 28(2.9%)SSAs and 25(2.6%)HPs of diameter not less than 0.5 cm were detected in the total of 953 patients.Statistically significant difference was found in right hemi-colon, diameter not less than 1.0 cm and VMV in two groups(P<0.05). The sensitivities of the above three markers for SSA were 89.3%, 67.9% and 46.4% respectively. The specificities were 64.0%,76.0% and 84.0% respectively. Diagnostic accuracies were 77.4%,71.7% and 64.2% respectively. And the sensitivity, specificity and accuracy of three markers combined(at least two markers)were 75.0%, 88.0% and 81.1%, respectively. Conclusion SSA and large HP could be differentiated with a systemic consideration of lesion location, size, and surface of microvessels by using white light endoscopy and image-enhanced technique.

Objective: To observe the distribution of occupational activity disorders of extremely severe mass burn patients in recovery period after injury. Methods: From December 2014 to December 2015, 65 extremely severe burn patients conforming to the inclusion criteria involved in August 2 Kunshan factory aluminum dust explosion accident were admitted to Kunshan Rehabilitation Hospital. They received comprehensive rehabilitation treatment after burns, including wearing pressure clothes, ultrasound treatment, semiconductor laser and red light irradiation, motor function training, and so on. Over 2 years after injury, a cross-sectional survey was conducted on the patients′ occupational activity disorders. Modified Barthel index (MBI) was used to assess the degree of activities of daily living (ADL) disorder of patients and to grade the independent level of completing each item of MBI, and then the independent level of patients completing self-care MBI items (bathing, dressing, grooming, eating, going to the toilet, urine control, and stool control) was compared with that of mobility items (going up and down stairs, bed and chair transfer, and walking). The Canadian Occupational Performance Measure (COPM) was used to assess the distribution of occupational activity disorders of patients. The distribution of the five most serious occupational activity disorders was counted, then the frequency and probability of which with frequency greater than or equal to 16 times were calculated. Data were processed with Pearson Chi-square test. Results: Over 2 years after injury, the MBI score of patients was (76±22) points, and the ADL of 83.08% (54/65) patients reached completely self-care or light ADL disorder level. The MBI items arranged according to the completing independent level of patients from high to low were urine control/stool control, walking, bed and chair transfer, going up and down stairs, going to the toilet, eating, grooming, dressing, and bathing. The independent level of patients completing self-care MBI items was lower than that of mobility items (χ²=62.298, P<0.001). Over 2 years after injury, the five most serious occupational activity disorders in COPM dimension were mainly concentrated in the self-care dimension, accounting for 55.38% (180/325), followed by 22.46% (73/325) of production activities and 22.15% (72/325) of recreational activities, and the centrally distributed item was the personal self-care item under self-care dimension, accounting for 42.46% (138/325). Over 2 years after injury, the five most serious occupational activity disorders with frequency greater than or equal to 16 times were dressing and undressing, bathing, perineal cleaning, wearing pressure clothes, caring for children, visiting relatives and friends, 31, 25, 16, 17, 18, and 22 times respectively, with a probability of 47.69%, 38.46%, 24.62%, 26.15%, 27.69%, and 33.85% respectively. Conclusions: Over 2 years after injury, most of the patients with extremely severe burns caused by the aluminum dust explosion were completely or basically self-care in their daily life. The disorder of self-care ADL was more serious than that of mobility, and the disorder of individual self-care activity was still the most serious occupational activity disorder of patients in this stage. Clinical trial registration Chinese clinical trial registry, ChiCTR-OOC-16009188.

Objective:To explore the value of "conceive, design, implement, and operation" (CDIO) combined with cluster training mode in clinical teaching of cardiopulmonary resuscitation (CPR).Methods:A total of 108 interns of General Hospital of Southern Theater Command from January 2019 to November 2020 were included in the study, and they were randomly divided into control group ( n=54) and observation group ( n=54). The control group used the cluster training mode for CPR teaching, and the observation group used CDIO combined with the cluster training mode for CPR teaching. The theoretical performance, operation performance, comprehensive ability, chest compression quality and CPR time of the two groups of interns were compared, and the scores of post competency and satisfaction of the two groups of interns were evaluated. SPSS 22.0 was used for t test and chi-square test. Results:The scores of theory, operation and comprehensive ability in the observation group were higher than those in the control group. Compared with those before training, the compression depth, compression frequency and chest rebound rate of the observation group were higher than those of the control group. The observation group found that the patients' unconscious judgment of pulse free time, the time from the occurrence of ventricular fibrillation to the start of automated external defibrillator (AED), and the time to complete AED were lower than those in the control group. The five dimensions of practical ability, critical thinking ability, coordination ability, career development ability, psychological characteristics and the total score of post competency in the observation group were higher than those in the control group ( P < 0.05). The satisfaction of the observation group with the teaching teacher, practice content, practice form and practice effect was higher than that of the control group ( P<0.05). Conclusion:The application of CDIO combined with cluster training in clinical CPR teaching can improve the interns' theoretical performance, operational performance and comprehensive ability, improve the quality of external chest compression and CPR time, make the interns have good communication ability and post competency, and finally improve the interns' satisfaction.