Objective To study the efficacy and safety of endobiliary radiofrequency ablation (RFA) with stent placement in treatment of unresectable extrahepatic cholangiocarcinoma (EHCC).Methods The patients with unresectable EHCC in Hangzhou First People's Hospital between October 2013 and January 2015 were enrolled in a prospective, randomized, single-blind cohort study, and were assigned randomly into two groups: RFA+stent group and stent-only group.The jaundice fade time, stent patency period, overall survival rate, and postoperative adverse events were analyzed between two groups.Results Among 59 patients with non-resectable EHCC, 28 were divided into RFA+stent group, and 31 were in stent-only group.There was no statistical difference in preoperative serum total bilirubin between the two groups.Mean serum bilirubin decrease time was significantly lower in the RFA+stent group than that in the stent-only group[17.9 d(7-22 d) VS 29.9 d(10-55 d),P=0.03].The biliary patency period in RFA+stent group was significantly longer than that of stent-only group (8.9 months VS 4.5 months, P=0.02).The mean survival time in RFA+stent group was significantly longer than that of stent-only group[13.3 months(6.2-16.5 months) VS 8.6 months(4.5-11.7 months), P=0.000).Incidence of postoperative adverse events showed no statistical difference between the two groups(P=0.727).Conclusion RFA with stent placement is effective and safe as a palliative measure in the treatment of non-resectable EHCC, and it can significantly shorten the jaundice fade time, prolong the biliary patency period and overall survival, while without increase of the incidence of adverse events.

OBJECTIVEUse proteomic technique to research the effects of Qishenyiqi formula in acute myocardial infarcted rats, and further explore its protein-level mechanism.

METHODThe rat hearts of sham, myocardial infarcted and Qishenyiqi formula treated groups were collected. Analyzing and comparing the differences of protein expressions in each groups with two-dimensional electrophoresis, computer-assisted image analysis and matrix-assisted laser desorption/ionization mass spectrometry.

RESULTCompared with myocardial infarcted group, there were 14 protein expressions changed in Qishenyiqi formula treated group. The result showed that 9 protein expressions were up-regulated, and 5 ones were down-regulated significantly. These proteins are associated with energy metabolism, mitochondrial function, oxidative stress, cytoskeleton and others.

CONCLUSIONMyocardial protective effects of Qishenyiqi formula in myocardial infarcted procedure might be closely related to the recovery of energy supply, the reduction of oxidative stress, as well as the promotion of cell recovery.

Animals ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Electrophoresis, Gel, Two-Dimensional ; Gene Expression Regulation ; drug effects ; Male ; Myocardial Infarction ; drug therapy ; metabolism ; Myocardium ; metabolism ; Proteomics ; methods ; Rats ; Rats, Sprague-Dawley

Objective To investigate the teaching effects of flipped class model on the Surgery Intensive Care Unit (SICU) nurses' ability of autonomic learning. Methods From July to December 2015, a total of 38 nurses who worked in SICU of Zhejiang Cancer Hospital were selected as the research objects by convenience sampling method. The nurses were trained in postoperative pain management knowledge by flipped class model, and were evaluated before and after the training by rating scale of self-directed learning competence for nurses. Results The total score of rating scale of self-directed learning competence for nurses, self motivation belief, task analysis, self monitoring and regulation, self evaluation were (128.26±18.69), (54.50±7.65), (22.05±3.66), (37.57±5.82) and (14.13±2.67) after the training, which all improved than (108.89±15.71), (47.18±6.61), (18.03±3.33), (31.37±5.24) and (12.32±2.14) respectively before training. The differences were statistically significant (t=-4.889, -4.460, -5.013, -4.883, -3.266; P<0.05). Conclusions Flipped class teaching model improves nurses' autonomous learning ability comprehensively and provide a new teaching mode for nurses' training.

Objective To explore the application value of simple manual rubber traction device in endoscopic submucosal dissection(ESD)of colorectal laterally spreading tumor(LST).Methods A retrospective cohort study was used to collect patients who underwent ESD for colorectal LST from June 1,2022 to June 9,2023.According to the use of the manual rubber traction device,patients were divided into colorectal traction ESD group(tESD group,n=22)and colorectal conventional ESD group(cESD group,n=44),the differences were compared between the two groups in the number of intraoperative hemostasis,the number of titanium clips used,the success rate of ESD,incidence of postoperative complications,hospital stay time,and treatment costs.Results The tESD group had relatively longer operation time and shorter hospitalization days than those of cESD group,but the difference was not statistically significant(P>0.05);There were no statistically significant differences in the number of titanium clips used,postoperative complication rates,and hospitalization costs between the two groups(P>0.05).Conclusion Colorectal traction ESD can be used as a remedial plan when traditional ESD is difficult to perform,and the use of traction does not increase the hospitalization cost of patients,and the postoperative complications of the two methods are similar.It is worthy of clinical application.

Objective To investigate the characteristics of population and the changes of disease spectrum in patients treated by endoscopic retrograde cholangiopancreatography ( ERCP ) . Methods Data of 20170 patients, who underwent ERCP in the First People' s Hospital of Hangzhou from May 2004 to February 2018, were enrolled in the retrospective analysis. According to the year of diagnosis and treatment,patients were divided into 2004-2008, 2009-2013, and 2014-2018 group; according to the postoperative diagnosis of ERCP, they were divided into biliary tract diseases ( including calculus, benign stenosis, malignant stenosis, and other causes ) and pancreatic diseases ( including acute pancreatitis, chronic pancreatitis, pancreatic malignant tumor, and other causes ) group; and according to the age, they were divided into the younger age (0-18 years old), young and middle age (19-65 years old), old age (66-85 years old), and advanced age (>85 years old) group. Statistical analysis was performed in the different groups. Results Among the 20170 patients, there were 10260 males and 9910 females, with age of 62. 65± 17. 11 years. The proportion of the younger age group and the advanced age group was 1. 04％( 24/2308 ) , 1. 69％ ( 127/7520 ) , 2. 39％ ( 247/10342 ) , and 2. 95％ ( 68/2308 ) , 4. 19％( 315/7520 ) , 6. 15％ ( 636/10342 ) , respectively, in the 2004-2008, 2009-2013 and 2014-2018 subgroups, with a rising trend (P<0. 017). A total 20032 patients had a clear postoperative diagnosis, including 15618 ( 77. 97％) of biliary diseases and 4414 ( 22. 03％) of pancreatic diseases. Biliary stones accounted for the majority of biliary diseases (63. 2％, 9863/15618), and its proportion increased from 59. 9％ ( 1191/1987 ) in 2004-2008 to 64. 5％ ( 5118/7939 ) in 2014-2018 ( P= 0. 000 ) . Acute pancreatitis accounted for the majority of pancreatic diseases (67. 4％, 1973/4414), and its proportion increased from 52. 4％ ( 162/309) in 2004-2008 to 69. 9％ ( 1636/2340) in 2014-2018 ( P=0. 000) . The top 3 diseases in the younger group and the advanced age group were acute pancreatitis ( 32. 58％, 129/396) , biliary stones ( 25. 25％, 100/396 ) , chronic pancreatitis ( 22. 22％, 88/396 ) , and biliary stones (56. 46％, 568/1006), malignant biliary stenosis (12. 52％, 126/1006), benign biliary stricture ( 10. 34％, 104/1006) , respectively. Conclusion The main disease of patients receiving ERCP is biliary stone, and the proportion of acute pancreatitis is increased. The overall age of the patients is old, and the proportion of the elderly and underaged patients is gradually increasing. Biliary diseases and pancreatic diseases are the main diseases in elderly patients and younger patients, respectively.

Objective To explore predictive value of modified STOP-BANG questionnaire(MSBQ)for hypoxemia during painless gastroscopy.Methods A total of 300 patients were selected as the study subjects who underwent painless gastroscopy in Zhejiang Cancer Hospital from October to December 2021.The MSBQ and STOP-BANG questionnaire(SBQ)were used for assessment before the examination,and patients were divided into high risk group(total score≥3 points)and low risk group(total score<3 points)according to their scores.The incidence of hypoxemia in high risk group and low risk group of the two scales was observed.The predictive value of MSBQ and SBQ for the risk of hypoxemia during painless gastroscopy was evaluated by receiver operating characteristic(ROC)curve.Results The incidence of hypoxemia in high risk group was significantly higher than that in low risk group(P<0.05).The sensitivity of MSBQ and SBQ to predict the occurrence of hypoxemia in painless gastroscopy was 81.01%and 83.54%,the specificity was 78.28%and 66.06%,and the area under the curve was 0.81 and 0.79,respectively.The prediction efficiency of MSBQ was better.Conclusion MSBQ has a high predictive value for the risk of hypoxemia in painless gastroscopy.