Objective To explore the strategies for diagnosis and treatment of anomalous junction of pancreaticobiliary duct (AJPBD) complicated by acute pancreatitis. Methods The clinical dataof 22 patients with abnormal pancreaticobiliary junction were analyzed retrospectively. Results The incidence of acute pancreatitis in this series was 31.8 % (7/22), thereinto, 5 cases(71.4%) in C-Ptype (the common bile duct joining the pancreatic duct) and 2(28.6%) in P-C type (the pancreatic duct joining the common bile duct). Seven patients underwent ERCP+ EST+ ENBD. Two patients with common bile duct stones were treated with stone basket and cholecystectomy was performed in two cases with gallstone. All patients were successfully treated. The follow-up for l year showed that there was no recurrence of pancreatitis. Conclusion Acute pancreatitis usually occurs in patients with AJPBD, especially in C-P type or with gallbladder stone or common bile duct stone. ERCP+EST+ENBD and prophylactic cholecystectomy are effective to prevent and treat acute pancreatitis.

Objective To analysis the clinical effects of biliary-pancreatic double stents in pancreatic cancer patients with obstructive jaundice.Methods From July 2008 to October 2011,a total of 60 patients with advanced pancreatic cancer were randomly divided into two groups to receive biliary-pancreatic double stents (n =28) or biliary stent only (n =32) according to the odd and even numbers of their admission date.Changes in liver function,abdominal pain,quality of life scores (QOL) were compared between two groups.Results The stents were placed successfully in 54 patients (90.0％),in which symptoms were relieved or gradually disappeared in all patients after the procedure.One week after stents placement,the serum total bilirubin decreased significantly from 164.32 ±45.16 μmol/L before ERCP to 63.25 ±27.06 μmol/L (P ＜ 0.05),other parameters including ALT,AST,AKP and r-GT were also decreased significantly compared with those of pre-ERCP (P ＜ 0.01),but there was no significant difference between the two groups (P ＞ 0.05).25 cases in double-stents group and 29 cases in single-stent group had varying degrees of pain relief at 7d after ERCP,but the overall pain relief rate and complete pain relief rate in double-stent group were significantly higher than those in single-stent group (92.0％ vs.55.2％; 64.0％ vs.34.5％,P＜0.05).At 7d and 14d after ERCP,Karnofsky QOL score were improved significantly in double-stent group (P ＜ 0.05).It was significantly better than single-stent group at 14d after ERCP (P ＜0.05).No death or other severe ERCP-related complications were observed.Conclusion Biliary-pancreatic stent placement for pancreatic cancer could significantly improve liver function and relieve obstructive pain.In the ways of alleviating pain and improving quality of life scores,it was better than ERCP biliary stent placement,especially for patients with pancreatic cancer combined obstructive pain.It indicated that biliary-pancreatic stent placement was better than simple biliary stent placement for advanced pancreatic head cancer patients with obstructive pain.

Objective To investigate the litholytic effect of stirring by plastic stem inside biliary tract in large common bile duct (CBD) stone. Methods Forty-five patients with large CBD stones were included in this study (8 with the distal bile duct stricture and 5 with too-small Vater's papilla).Plastic stent of 8.5Fr was inserted into the CBD under the guidance of guide wire in all the 45 patients. Results In 10 of the 45 patients, ERCP showed that there was no stone in CBD 3 months later after stent placement. In 22 cases, repeated ERCP revealed that the stone had become smaller to the extent of more than a half or became stone fragments that were easily extracted by baskets or balloon dilation. Thirteen patients continued to have large stone at the second time ERCP treatment, and a new stent was replaced and follow-up performed by B mode ultrasonography of abdominal region per month. Further endoscopic treatment was performed immediately when the stone became small enough. The percentage of 95.6% (43/45) of large CBD stone were eventually cleared after endoscopic treatment for an average of 2.4 times. There were no severe complications related to ERCP or stent placement. Conclusion Placement of plastic biliary stent is a convenient and effective measure for the treatment of large CBD stones. It is especially appropriate for aged patients of CBD stone of high risk.

Objective To study the therapeutic effect of EUS-guided rendezvous (EUS-RV) when ERCP failed in patients with malignant obstructive jaundice. Methods 12 cases of malignant obstructive jaundice patients were underwent EUS-RV after unsuccessful ERCP. The operation success rate, liver function recovery 1 week and 1 month after operation, complication rates, hospital stay and patient survival were observed. Results All 12 patients were successfully operated and placed stents by endoscopic ultrasound puncture following by ERCP: 8 patients by the stomach, 4 patients by duodenum, the operation success rate was 100.00%; There were significant difference between the liver function recovery of preoperative and postoperative one week or postoperative one week and postoperative one month (P < 0.05). 1 bleeding occurred and were improved after conservative treatment, the complications rate was 8.33%; the hospital stay was (20.68 ± 5.76) d; the average survival time of patients was 224 d. Conclusion EUS-guided rendezvous may be the alternative treatment due to the diminutive trauma and good effect when ERCP failed in patients with malignant obstructive jaundice.

OBJECTIVEThe National Institutes of Health (NIH) category IIIa chronic prostatitis syndromes (non bacterial chronic prostatitis) were common disorders but with few effective therapies. Alpha-blockers and bioflavonoids had recently been reported in randomized controlled trials to improve the symptom of these disorders in a significant proportion of men. The aim of this study was to confirm these findings in a prospective randomized, placebo-controlled trial.

METHODSForty-five men with category IIIa chronic non bacterial protatitis were randomized into three groups as follows: (1) placebo; (2) phenoxybenzamine-hydrochloride:10 mg two times a day for one month; (3) flavoxate HCI-neptumus: 200 mg three times a day for one month. The NIH chronic prostatitis symptom score was used to grade symptoms at the beginning and conclusion of the study.

RESULTSAll the patients in three groups completed the study except three dropout patients in placebo group because of sever symptoms. The three groups were similar in age, duration of symptoms and initial symptom score. Patients taking placebo had a mean improvement in NIH-CPSI from 21.85 to 19.55 (not significant), while the phenoxybenzamine-hydrochloride group had a mean improvement from 21.95 to 13.75 (P < 0.01), and those taking flavoxate HCI-neptumus had a mean improvement from 21.75 to 16.95 (P < 0.05). The decrease in NIH-CPSI was associated with significant improvement in patients' clinical manifestations.

CONCLUSIONTherapy with alpha-blockers was well tolerated with significant symptomatic improvement in most men having chronic non-bacterial chronic protatitis while the bioflavonoids group had no significant improvement. Mechanism of both medicines needs further study.

Adrenergic alpha-Antagonists ; administration & dosage ; therapeutic use ; Adult ; Chronic Disease ; Flavonoids ; administration & dosage ; therapeutic use ; Flavoxate ; therapeutic use ; Humans ; Male ; Parasympatholytics ; therapeutic use ; Prospective Studies ; Prostatitis ; drug therapy ; Treatment Outcome

BACKGROUNDCurrently, the recommendation when treating acute biliary or pancreatic disease during pregnancy is to perform endoscopic retrograde cholangiopancreatography (ERCP) without radiation exposure, either empirically (with no radiographic guidance) or with ultrasound guidance. However, few published studies compared these two ways. This study aimed to compare ultrasound-guided ERCP with the procedure without radiographic guidance in the treatment of acute pancreaticobiliary disease in pregnant patients.

METHODSThe clinical data of 68 pregnant patients with acute pancreaticobiliary disease admitted to our hospital between January 2004 and May 2010 were reviewed retrospectively. ERCP was performed without radiographic guidance in 36 cases (group A) and with ultrasound guidance in 32 cases (group B). Data on the following variables were compared between the two groups: surgical success rate, rate of complete stone removal, time to resolution of clinical manifestations and laboratory indicators, length of hospital stay, complications, outcome and differences in efficacy of ERCP during different stages of pregnancy.

RESULTSIn group A, the rates of surgical success and complete removal of stones were 69% and 60%, respectively; the corresponding values were 91% and 89% in group B (P < 0.05). Postoperatively, clinical manifestations improved rapidly in all patients; there was no statistically significant difference between the groups (P > 0.05). Leukocyte counts and liver function had improved significantly after one week in all patients; they recovered more quickly in group B ((8.64 ± 1.83) days vs. (14.57 ± 3.74) days, (14.29 ± 4.64) days vs. (20.00 ± 5.40) days, P < 0.01). The hospital stay was shorter in group B ((16.28 ± 7.25) days vs. (28.00 ± 6.83) days, P < 0.001). The complication rate was 14% in group A and 3% in group B (P < 0.05). There were no significant differences between the two groups in the procedure's efficacy during different stages of pregnancy.

CONCLUSIONSIn the treatment of acute pancreaticobiliary disease during pregnancy, ultrasound-guided ERCP is safer and more effective than performing the procedure empirically without radiographic guidance when performed by experienced practitioners. Its more widespread use is recommended.

Acute Disease ; Adult ; Biliary Tract Diseases ; surgery ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Female ; Humans ; Pancreatic Diseases ; surgery ; Pregnancy ; Pregnancy Complications ; surgery ; Retrospective Studies ; Ultrasonography, Interventional

OBJECTIVETo evaluate the correlation between programmed death-ligand 1 (PD-L1) expression in primary lung cancer cells, tumor associated macrophages (TAM) and patients' clinicopathological characteristics.

METHODSFrom 2008 to 2010, 208 non-small cell lung cancer patients who underwent surgery or CT-guided biopsy were recruited from Huadong Hospital, Fudan University. Immunohistochemistry staining was performed to evaluate the PD-L1 expression in both primary lung cancer cells and CD68 positive TAM. The relationship between PD-L1 expression and the clinical pathology was evaluated using χ(2) test. Spearman's rank correlations were used to determine the correlation between PD-L1 expression in tumor cells and macrophages.

RESULTSPositive PD-L1 expression in primary cancer cells was found in 136 (65.3%) patients, which were negatively correlated with lymph node metastasis (P=0.009) and smoking history (P=0.036). Besides, TAM with PD-L1 expression (found in 116 patients) was positively associated with smoking history (P=0.034), well-differentiation (P=0.029) and negative lymph node metastasis (P=0.0096). A correlation between PD-L1 expression in primary tumor cells and non-small cell lung cancer associated macrophages was found (r=0.228, P=0.021).

CONCLUSIONPD-L1, secreted from TAM, might induce cancer cells apoptosis, and decrease lymph node metastasis.

Adult ; Aged ; Aged, 80 and over ; Apoptosis ; B7-H1 Antigen ; secretion ; Carcinoma, Non-Small-Cell Lung ; pathology ; secretion ; Cell Line, Tumor ; Female ; Humans ; Lung Neoplasms ; pathology ; secretion ; Lymphatic Metastasis ; Macrophages ; pathology ; secretion ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo identify the impact of age and gender on cardiac structure and left ventricular function in normal Chinese by echocardiography.

METHODSCardiac structure, valve flow velocity and cardiac function were measured by echocardiography in 15,692 healthy volunteers. Subjects were grouped by age at 5 years interval in population older than 5 years. Children under 5 years were divided into 3 age groups (< 1 years, 1 - 3 years, 4 - 5 years). Hierarchical cluster analyses were performed for ages, based on indexes of cardiac structure and function respectively.

RESULTSSix groups (< 1 years, 1 - 3 years, 4 - 5 years, 6 - 10 years, 11 - 20 years, > or = 21 years) were generated after the age hierarchical cluster analyses based on index of cardiac structure. Four groups (< or = 30 years, 31 - 50 years, 51 - 80 years, > or = 81 years) were generated based on spectral current flow. Six groups (< 1 years, 1 - 3 years, 4 - 5 years, 6 - 10 years, 11 - 15 years, > or = 16 years) were generated based on left ventricular systolic function and five groups (< or = 15 years, 16 - 30 years, 31 - 50 years, 51 - 80 years, > or = 81 years) were generated based on left ventricular diastolic function. Cardiac structure index were similar between male and female in age groups < or = 10 years and significantly lower in females than males in age groups > or = 11 years (P < 0.05). Valve flow velocity was similar between male and female in various age groups (P > 0.05). Left ventricular systolic function was similar between male and female in age groups < or = 10 years but was significantly higher in males than females in age groups > or = 11 years (all P < 0.05). Left ventricular diastolic function was similar between female and male in various age groups (P > 0.05) and equally decreased with aging in both female and male subjects.

CONCLUSIONSThe cardiac development in Chinese population can be divided in 6 phases and becomes stable in subjects older than 21 years, left ventricular systolic function becomes stable in subjects older than 16 years and the left ventricular diastolic function declines physiologically with aging.

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Child ; Child, Preschool ; Cluster Analysis ; Echocardiography ; statistics & numerical data ; Female ; Heart ; physiology ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Sex Factors ; Ventricular Function, Left ; Young Adult

Objective:To study influence of Status-Background-Assessment-Recommendation(SBAR)communi-cation mode intervention on patients with heart failure(HF).Methods:According to intervention method,a total of 187 HF patients treated in our hospital were divided into routine intervention group(n=96,received routine in-tervention based on routine treatment)and SBAR group(n=91,received SBAR communication mode intervention based on routine treatment).Both groups were intervened for six months.General clinical data,LVEF,left ven-tricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),scores of Morisky medi-cation compliance scale and the medical outcomes study 36-item short-form heath survey(SF-36),patients'satis-faction and incidence rate of major adverse cardiovascular events(MACE)within six-month follow-up were com-pared between two groups.Results:Compared with routine intervention group,after intervention,there were sig-nificant rise in LVEF[(53.44±2.11)%vs.(57.72±1.80)%],scores of Morisky medication compliance scale[(2.00±0.77)scores vs.(3.63±1.07)scores]and SF-36[(68.83±7.62)scores vs.(76.81±9.68)scores],and significant reductions in LVEDV[(132.63±5.59)ml vs.(119.15±6.89)ml]and LVESV[(64.36±5.82)ml vs.(56.62±4.21)ml]in SBAR group(P=0.001 all).Patients'satisfaction of SBAR group was significantly higher than that of routine intervention group(89.01%vs.73.96%,χ2=6.958,P=0.008),and incidence rate MACE during follow-up was significantly lower than the latter(5.49%vs.15.63%,LogRankχ2=5.043,P= 0.025).Conclusion:SBAR communication mode intervention can significantly improve heart function,medication compliance and quality of life in patients with heart failure,with high patients'satisfaction.

MicroRNA （miRNA） belongs to a class of endogenous non-coding small RNA molecules with a length of 18-24 nucleotides. The expression of miRNA is highly conservative, has time sequence and is highly tissue-specific. MiRNA could not be easily degraded by ribonuclease, and is resistant to changes in environmental factors such as temperature and pH value. Moreover, miRNA can even be detected in corrupt tissue. As a result, miRNA has broad application prospects in many fields of forensic medicine such as source identification of body fluid and estimation of cause of death. This article briefly summarizes the application of miRNA in forensic practice, such as body fluid identification, determination of postmortem interval and cause of death analysis.
Forensic Genetics ; Forensic Medicine ; Genetic Markers ; Humans ; MicroRNAs/genetics*