Three alkaloids were isolated from Huperzia serrata (Thunb. ) Trev. Their structure were identified as 8-deoxyserratinine (Ⅰ), lycodiue (Ⅱ) and phlegmariurine B (Ⅲ ) by means of spectral analysis (UV, IR, NMR, MS ). compoundⅡ and Ⅲwere isolated for the first time from this species

Four alkaloids were isolated from Huperzia serrata (Thunb. ) Trev., The structures of these alkaloids were identified as des-N-methyl-?-obscurine (Ⅰ),lycopodine (Ⅱ),lycodoline (Ⅲ),and 6-?-hydroxy-lycopodine (Ⅳ) by means of spectral analysis (UV, IR, NMR, MS ). Compounds Ⅰ and Ⅳ were isolated for the first time in the species.

Objective To investigate diagnostic significance of detecting p53 protein in cytologic specimens by endoscopic pancreatic duct brushing for pancreatic cancer. Methods p53 protein in cytologic specimens was detected by immunohistochemistry, and the resules were compared with cytologic specimens by HE staining. Results Sensitivity, specificity, and accuracy of HE staining for pancreatic cancer is 53%, 100% and 70% respectively. Sensitivity, specificity, and accuracy of detecting p53 protein for pancreatic cancer is 59%, 100%, 74% respectively. Sensitivity, specificity, and accuracy of HE staining and detecting p53 protein for pancreatic cancer is 71%, 100%, 81% respectively. Conclusions HE staining combined with detecting p53 protein in cytologic specimens by endoscopic pancreatic duct brushing is a useful stool for diagnosis of pancreatic cancer. It is helpful to differentiate benign diseases of pancreas from malignant tumor of pancreas.

Objective To investigate the clinical, rad iographic and pathological features of intraductal papillary-mucinous tumor of the pancreas(IPMT). Methods The features, imaging manifestation and pathological find ings of 9 patients with IPMT were reviewed. Results There were 6 male and 3 female in this series with ag e ra nging from 37 to 76 years(average 68.4 years). The common complaint was upper ab dominal pain. Most of the tumors located at the head of pancreas. The feature of ERCP findings include dilation of the orifice of the papilla of Vater, swelling of the papilla of Vater, massive mucin production and dilation of main pancreat ic duct. The pathological finding is adenoma or adenocarcinoma. Conclusions IPMT is a kind of pancreatic tumor and its prognosis i s better than pancreatic duct cancer. We should differentiate IPMT from other pa ncreatic tumors.

Objective To investigate the diagnostic value of detecting K ras gene codon 12 mutations in cytologic specimens by endoscopic pancreatic duct brushing for pancreatic cancer. Methods Thirty five patients at Changhai hospital between 1999 and 2001 were enrolled. Cells from pancreatic duct burshings during ERCP were suspended with PBS. DNA of the cells was extracted and K ras gene codon 12 mutations were detected by means of PCR SSCP. Results K ras gene mutation rate of pancreatic cancer was 70%, which was higher than that of chronic pancreatitis (14%, P

BACKGROUND:Heart valve surgery combined with coronary artery bypass grafting has been gradual y used for treatment of coronary heart disease combined with cardiac valve disease.
OBJECTIVE:To retrospectively summarize the experience of combined coronary artery bypass grafting and valvular procedure.
METHODS:Total y 51 patients who underwent combined heart valve surgery and coronary artery bypass grafting were retrospectively analyzed, including 10 cases with aortic valve replacement, 14 cases with mitral valve replacement, eight cases with mitral valve replacement combined with tricuspid annuloplasty, four cases with aortic valve and mitral valve replacement, three cases with aortic valve and mitral valve replacement combined with tricuspid annuloplasty, seven cases with mitral valvuloplasty, and five cases with mitral valvuloplasty combined with tricuspid annuloplasty.
RESULTS AND CONCLUSION:Biovalve replacement was performed in nine patients, mechanical valves replacement in 31 cases, mitral valvuloplasty in 11 cases and tricuspid annuloplasty in 16 cases. There were total y 109 bypass graft vessels, and the average number of coronary artery bypass grafts was (1.92±0.73) branches. Four cases died within 30 days postoperatively, and 47 patients were successful y discharged from the hospital. Forty-five of 47 discharging patients were fol owed for 3-48 months. One case died of cerebral infarction within 6 months postoperatively, and another case died of cardiac dysfunction over 1 year after operation. The heart function of 45 survival patients was significantly improved. The comprehensive analysis showed that improving the heart function preoperatively, strengthening myocardial protection, shortening operation and myocardial ischemia time, and complete revascularization are the key factors for successful operation.

BACKGROUND:Flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures are two common methods in the clinic. It remains controversial which fixation methods are better. OBJECTIVE:To systematicaly evaluate the therapeutic effects of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures. METHODS: A computer-based search was performed on PubMed, Embase, Medline, and Cochrane library for literatures on clinical controled trials of flexible intramedulary nailing and external fixation for pediatric femoral shaft fractures published before November 25, 2014. Literature language was not limited. The age of subjects was from 3 to 15 years. Modified Jadad was utilized to assess methodological quality of the included studies. Meta-analysis was carried out using Stata 12.0 software. RESULTS AND CONCLUSION:Six papers involving 237 patients were included. Meta-analysis results showed that compared with external fixation, a low incidence of overal complications [relative risk (RR)=0.30, 95% confidence interval (CI): 0.19-0.46;P < 0.001] and pin-hole infection (RR=0.286, 95%CI: 0.13-0.61;P= 0.001), but a high risk of needle tail irritation (RR=1.86, 95%CI: 1.35-2.56;P < 0.001) were found folowing flexible intramedulary nailing. No significant differences in other complications were found between the two groups. These results confirm that compared with external fixation, elastic intramedulary nail has fewer complications and faster fracture healing. Elastic intramedulary nail is recommended for single pediatric femoral shaft fractures. However, external fixation is a better option for high energy injury of lower limbs, multiple trauma or severely soft tissue injury.

Objective To analyze the differential expression of proteins among patients with pancreatic cancer,chronic pancreatitis and choledocholithiasis in order to find potential biomarkers for diagnosis of pancreatic cancer and to differentiate pancreatic cancer from chronic pancreatitis. Methods The pancreatic juice were connected from 5 pancreatic cancer patients,6 chronic pancreatitis patients and 3 choledocholi-thiasis patients by naso-pancreatic drainage using endoscopic retrograde cholanglopancreatography(ERCP).The proteins in pooled pancreatic juice were separated by two-dimensional gel electrophoresis (2-DE).The differential expression of proteins were analyzed by image analysis software and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS).Results ①There were 35-200 ml of pancreatic juice collected,and protein concentration were ranged from 0.8 to 4.6 μg/μl.The 2-DE showed that the protein spots in pancreatic cancer,chronic pancreatitis and choledocholithiasis juice were 196±12,209±15 and 199±10,respectively.The matched proteins among three groups all exceeded 75%.②MALDI-TOF-MS revealed that the expression of chain A of a covalent dimer of transthyretin in pancreatic cancer was up-regulated(＞2-fold)while the expressions of chain A of crystal structure of lipid-free human apolipoproteinA-1,chain of human lithostathin and regenerating islet-derived 1 beta precursor were down-regulated. Conclusions Protein spectra are different in patients with pancreatic cancer,chronic pancreatitis and choledocholithiasis.Transthyretin,apolipoproteinA-1,human lithostathin and regenerating islet-derived 1 beta might be the biomarkers of human pancreatic cancer and may be useful in distinguishing pancreatic cancer from chronic panceatitis.

Objective To investigate the effect of early enteral nutrition.Methods 248 patients with esophageal and gastric carcinoma were randomly divided into two groups,and received enteral nutrition(EN)and parenteral nutrition(PN)each continuously for 6 days after operation.The body weight,blood routine test,liver function,and postoperative day 8 were compared with those before operation.Results The body weight,red blood cell count,and the levels of hemoglobin,serum albumin and transaminase decreased less in EN group than those in PN group(P＜0.01).The complication rates of anastomotic fistula,pulmonary infection,and delayedincision healing and average volume of pleural effusion were 0,13.8%,0,780ml in EN groups,while 3.2%,28.2%,7.2%,1842ml in PN group.Conclusion Early postoperative enteral nutirtion after esophageal carcinoma surgery can improve nutritional status and reduce complications in comparision with parenteral nutrition.

Objective To investigate the application of 3D printing technique in the treatment of obsolete pelvic and acetabular fractures.Methods The clinical data of 23 patients with obsolete pelvic and acetabular fractures were retrospectively analyzed who had been surgically treated in our hospital from January 2006 through January 2016.3D printing technique was used in surgical planning in 11 of them,including 8 males and 3 females,with an average age of 33.8 ±4.9 years (3D group).The other 12 patients received conventional surgery without using 3D printing technique.They were 9 males and 3 females,with an average age of 34.8 ± 8.3 years (conventional group).The primary pelvic fractures in both groups were all type C according to the Tile classification system.The patients complicated with acetabular fracture in the 3D group and the conventional group were 10 and 11 cases respectively.The operative time,blood loss,blood transfusion.intraoperative fluoroscopy,visual analogue score (VAS) and Majeed score were compared between the 2 groups.Results The 2 groups were compatible in terms of preoperative general data (P ＞ 0.05).For the 3D group and the conventional group,operative time was 166.4± 24.2 min versus 222.5 ± 49.0 min.blood loss 2,063.6 ± 484.3 mL versus 2,700.0 ± 597.0 mL,blood transfusion 13.2 ± 3.2 U versus 17.6 ± 4.5 U,and intraoperative fluoroscopy 7.4 ± 1.3 times versus 11.7 ± 3.6 times.There were significant differences between the 2 groups in the above indexes (P ＜ 0.05).The 3D group and the conventional group obtained an average follow-up of 18.4 months and 21.7 months,respectively.The postoperative VAS scores were respectively 1.8 ±-0.9 points and 3.4 ± 1.0 points for the 2 groups,showing a significant between-group difference (P ＜0.05).The Majeed scores at the last follow-ups were respectively 85.7 ± 4.2 points and 84.9 ± 3.1 points for the 2 groups,showing no significant between-group difference (P ＞ 0.05).There were no such complications in the 3D group as iatrogenic nerve injury,vascular injury,nonunion or internal fixation failure.One patient in the conventional group suffered transient iatrogenic injury to the sciatic nerve.Conclusions 3D printing technique can provide helpful guidance for diagnosis and fracture classification preoperatively.It improves the patient's perioperative safety by benefiting intraoperative reduction,shortening operative time,and reducing intraoperative blood loss and intraoperative fluoroscopy.