Objective To evaluate curative effects of treatment of malignant biliary and gastric outlet-duodenal obstruction with endoscopically placed self-expandable metal stents.Methods A retrospective analysis was performed in 17 patients who underwent enteral stenting after placement of the biliary stent.The success rate of insertion,the effective palliation of biliary and duodenal obstruction,the rate of complication,recurrent stent obstruction and the median patency were observed.Results In 17 patients,biliary stenting were all performed for obstructive jaundice and then enteral stents were inserted.The levels of tatal billirubin [from (263.4 ± 62.5) μmol/L to (157.6 ± 25.1) μmol/L],direct billirubin [from (1233.2 ±66.5) μmol/L to (130.9 ± 27.7) μmol/L] and alkaline phosphatase [from (233.2 ± 66.5) IU/L to (130.9 ±27.7)IU/L] decreased significantly (P ＜0.01),and the gastric outlet score increased significandy [from (0.9 ± 1.1) points to (2.1 ±0.7) points] (P ＜0.01).No serious complication in all patients.Lifetime of patients ranged from 70 days to 332 days,and the median survival time was 192 day.Conclusion Combined biliary and enteral stenting is an effective method for palliation of malignant biliary and gastric outlet-duodenal obstruction.

Objective To explore the diagnostic value of alcohol fixation and liquid-based cytology method for malignant stricture of common bile duct and to study the interval time between sampling and fixation for procedure of alcohol fixation.Methods Data of 82 patients were retrospectively studied,who were suspected of having malignant stricture of common bile duct underwent brushing through endoscopic retrograde cholangiopancreatography (ERCP),and were confirmed by follow-up for 2 years or pathology after surgery from October 2008 to June 2013.These patients were randomly divided into alcohol fixation group (n =30),liquid-based cytology group (n =28) and conventional cytology group (n =24).The positive diagnostic rates of brush cytology in each group were compared.The alcohol fixation group were randomly divided into 2-minute group and 5-minute group according to the interval time between sampling and fixation.Positive diagnostic rates were also compared.Results The positive rates were 73.33％ (alcohol fixation group,22/30),75.00％ (liquid-based cytology group,21/28) and 20.83％ (conventional cytology group,5/24),respectively.The positive rate of conventional cytology group was obviously lower than alcohol fixation group (x2 =21.525,P=0.000) and liquid-based cytology group (x2 =22.208,P =0.000) with statistical significance.But the positive rate of alcohol fixation group was similar to the liquid-based cytology group (x2 =0.683,P =0.898).In alcohol fixation group,the positive rate of 2-min group (88.24％,15/17) was significantly higher than the 5-min group (53.85％,7/13) with statistical significance (x2 =4.535,P =0.033).Conclusion Compared with conventional fixation,alcohol fixation and liquid-based cytology can improve positive diagnostic rate of brushing during ERCP.The alcohol fixation is more simple in procedure and low in cost than liquid-based cytology.The interval time between sampling and fixation should be reduced to no more than 2 minutes.

Objective To study lymph node metastasis in early gastric carcinoma. Methods From July 2001 to July 2007, 177 patients with early gastric carcinoma underwent radical gastrectomy and the clinicopathologic data were analyzed by binary logistic regression. Results The overall rate of lymph node metastasis in early gastric carcinoma was 13%, involving 13% and 3% in level I (NI) and level Ⅱlymph nodes (N2), respectively. The rate of lymph node metastasis was 22%(20/89) in cases of submucosal lesion (SM), which was significantly higher than 3%(3/88) in cases of mucosal lesion (M) (X2=14. 222, P<0.01). The rate of lymph node metastasis was 3%(4/117) when the primary tumor was ≤2cmin diameter compared with 32%(19/60) when the tumor was >2cm (X2=27.992, P<0.01). The lymph node metastasis rate was 4%(3/81) and 21%(20/96) in differentiated and undifferentiated lesion (X2=11.402, P=0.001), and it was 33%(2/6)、8%(7/99) and 19% (14/92) in macroscopic type I, Ⅱ and Ⅲ (X2=8.172, P=0.014). Binarylogistic analysis found that the tumour diameter greater than 2.0cm (OR=8.408, P<0.01), infiltration of the submucosal layer (OR=5.926, P=0.009) and undifferentiated lesion (OR=4.880, P=0.020) were the independent risk factors. Conclusion Lymph node metastasis in early gastric carcinoma is significantly cantingent on the depth of infiltration, tumor size and histological type.

Systolic anterior motion of mitral valve ( SAM) is a relatively uncommon complication , but it can result in se-vere left ventricular outflow tract(LVOT) obstruction and/or mitral regurgitation(MR), even can be life-threating.Echocardio-graphy is still the first-line method of SAM diagnosis.Due to LVOT obstruction and MR reducing the long-term prognosis of pa-tients with SAM, it is necessary to carry out surgical treatment for patients with SAM for whom conservative treatment are not ef-fective.Then mitral valve repair(MVREP) is the first choice.Besides, surgical techniques for treatment and prevention of SAM have made great progress which have promoted the popularization of MVREP , and the rate of MVREP in mitral valve oper-ation has been greatly improved .

microRNAs combined with specific mRNAs are 19-25 nucleotide-long small-molecule RNA that mediate sequence-dependent post-transcriptional gene expression.Accumulating evidences indicate that microRNAs target critical signal transduction molecules of immune system,and involve in regulation of immune tolerance.Recently,microRNAs have been a potential biomarker,and are widely useded in diagnosis and prognosis of cancer,infectious disease,autoimmune disease,and transplantation.If we can further identify regulatory mechanism of microRNAs and their target genes,which makes possible the successful induction of immune tolerance and exert a huge push on organ transplantation.

Objective To explore risk factors of cardiac surgery in neonates with low body weight.Methods Retrospective analysis was made in neonates weighing less than 3 kg at surgery(n =192;group 1) and 3 to 6 kg(n =517;group 2),who had undergone open cardiac repairs from January 2006 to December 2015 at our institution.Patients were grouped according to the primary procedure performed and analyzed according to their weight at the time of surgical intervention.Patients were also analyzed according to preoperative risk scores.Univariate versus multivariate risk analysis was performed.Results Hospital early mortality in group 1 was 25.0％ (n =48) versus 14.5 ％ (n =75) in group 2 (P =0.001).Compared with group 2,neonates in group 1 had a significantly higher mortality for simple arterial switch procedure.Lower body weight remained strongly associated with mortality risk after stratifying the population by preoperative risk scores category levels 2.Within group 1,age,weight at surgery,preoperative risk score and type of procedure were not associated with significant differences in early mortality.Cardio-pulmonary bypass time,aortic cross-clamp time and the presence of a surgical complication were independent risk factors for early mortality in group 1.Conclusion Among neonates weighing less than 3.0kg who underwent open cardiac surgery,perioperative hemodynamic status,reflected by bypass time,cross-clamp time,and surgical complications,strongly influenced early mortality.In contrast,low body weight itself was not associated with early mortality.

Objective To evaluate the clinical effect of breast implant on congenital mammary dysplasia with mild pigeon chest deformity. Methods From January 2003 to July 2009,10 cases of female mammary dysplasia (between 20 to 31 years of age) underwent breast implant surgery. Subpectoral placement and transaxillary incision were selected. The surgeon marked the range of the operation on the skin, made a 3-4 cm incision in the armpit, separated the tissue until the pectoral lateral margin, cut the pecto-ralis fascia and bluntly created a suitable pocket under the pectoralis major for the implant. After the implant was placed in the pocket, the incision was closed. Results Ten cases of breast implant surgery did not pose the complications of local skin necrosis, infection, implant shift, heart and lungs dysfunction after one year follow-up. The appearance of anterior chest wall deformity was markedly improved. Conclusions The application of breast implant surgery in the treatment of congenital mammary dysplasia with mild pigeon chest deformity should be promoted, because of the double surgical effect of easy performing, minimal surgical damage, perfect breast shape and concealed deformity.

Objective To investigate the security and result of operation of one side polycystic kidney removal and homonymy kidney transplantation simultaneously for giga-polycystic kidney di-sease of terminal stage. Methods Forty-five patients with polycystic kidney of transplantation were retrospectively analyzed. The patients were divided into 2 groups. Patients of group A (n=23) under-went resection of the cystic kidney by extraperitoneum and the other 22 patients(group B) didn't re-move the cystic kidney. The data including average length of hospital stay, variance of blood pressure, lessen of abdominal circumference, lung capacity, total lung capacity, FEV1.0/FVC, incidence rate of delayed graft function (DGF) and 1 year patient/kidney survival rate of the 2 groups were compared. Results The average length of post-operative hospital stay of group A was (14.5±2.6)d,lessen of blood pressure was (30.0±0.7/13.34±8.4)mm Hg, lessen of abdominal circumference was (11.0+ 6. 3) cm, lung capacity increased (1.4±0.3)L, total lung capacity increased (2.0±1.0)L, FEV1.0/ FVC increased (5.3±1.0) %, the incidence rate of DGF was 8.7% (2/23), 1 year patient/ kidney survival rate was 100.0%/95.7%. The average length of post-operative hospital stay of group B was (28.45±7.9)d,lessen of blood pressure was (3.9±11.2/2.9±12. 0)ram Hg, lessen of abdominal circumference was (3.3±2.2)cm, lung capacity increased (0.44±0.3)L, total lung capacity increased (0.8±0.2) L, FEV1.0/FVC increased (2.0±0.9)%, the incidence rate of DGF was 9.1%(2/22), 1 year patient/kidney survival rate was 100.0%/95.5%. There were no significant differences of the incidence rate of DGF and 1 year patient/kidney survival rate between the 2 groups. While there were significant differences of the other data between the 2 groups(P＜0.05). Conclusions It is safe and convenient for one side polycystic kidney removal and homonyrny kidney transplantation simultaneous-ly for giga-polycystic kidney disease of terminal stage. The procedure could be applied to the patients of graveness complication or giga-polycystie kidney hampering operation of transplantation.

Objective To summarize the experiences of the diagnosis and treatment of the intraspinal tumors. Methods One hundredand twenty-three cases of the intraspinal tumors were analyzed retrospectively. Results The intraspinal tumors in those patients included meningiomas/neurofibroma in 32 cases (19.5%), neurinoma in 32 cases (26.0%), ependymoma in 8 cases (6.5%), astrocytoma in 13 cases (10.6%), lipoma in 10 cases (8.1%), metastatic tumors and hemangioma each in 5 cases (4.1%), arachnoid cyst in 9 cases (7.3%), and others in 17 cases (13.8%). The extramedullary subdural, epidural and intramedullary tumors accounted for 56.9%, 21.1% and 22.8%. According to the locations, 30.1% tumors located at cervical region, 37.4% at thoracic region, 19.5% at lumbar region and 13.0% at sacral segments. The total removal rates of tumors were 69.1% (the total removal rates of extramedullary tumors were 70.1%, and the removal rates of intramedullary tumors were 60.7%).The improvement rates of different degree of movement, sense and sphincter function were 75.2%, 73.8% and 77.8%. Conclusion Most of the intraspinal tumors are benign, and the surgical outcome is satisfied. The keys of therapeutic efficacy were MRI and microsurgical techniques application. The spinal stability reconstruction is in the extreme need if spinal stability is breached in surgery.

Objective To evaluate the effect of high-frequency chest well oscillation expectoration system on ventilator-associated pneumonia (VAP) and time for withdrawing mechanical ventilation (MV) system in ICU patients with invasive mechanical ventilation (IMV). Methods 100 ICU patients with IMV were divided into observationgroup (n = 50) and control group (n = 50). The high-frequency chest well oscillation expectoration was used in the former group and the mechanical vibration expectoration was used in the latter. The two groups were compared in terms of amount of sputum, vital signs (heart rate, breathing, systolic blood pressure and blood oxygen saturation), time for withdrawing MV system and VAP rate. Results On days 1, 2, 3, 4 and 5, the amount of sputum in the observationgroup was (33.5 ± 4.2)mL/d, (41.1 ± 3.0)mL/d, (38.2± 3 .5) mL/d, (34.8 ± 2.5) mL/d and (31.1 ± 2.1) mL/d, and those of the control group respectively was (27.4 ± 3.1) mL/d, (30.3 ± 3.6) mL/d, (28.1 ± 2.2) mL/d, (25.7±1.8)mL/d and (20.8 ± 1.7)mL/d. The differences between the two groups were statistically significant (P < 0.05). After sputum expectoration, the blood oxygen saturation of the observationgroup was significantly higher than the control group [(97.5 ± 0.9) vs. (95.2 ± 1.0)] (P <0.05), but there were no statistical differences in heart rate, breathing and systolic blood pressure (P > 0.05). The time for withdrawing MV system in the observationgroup and the control group respectively was (5.8 ± 2.2)d and (9.5 ± 1.8)d, (P < 0.05). The rates of VAP in the observationgroup and the control group respectively was 30.0% (15/50) and 52.0% (26/50), with significant difference between them (P < 0.05). Conclusion The high-frequency chest well oscillation expectoration for ICU patients with invasive mechanical ventilation can promote sputum expectoration , improve blood oxygen saturation , shorten the time for withdrawing the ventilator, and prevent the incidence of VAP.