Objective To evaluate endoscopic ultrasound for preoperative staging of ampullar tumors.Methods A total of 31 patients with ampullar tumors who underwent surgery from 2010 to 2015 were retrospectively reviewed.B-US,CT,MRCP and EUS were performed in all patients.The diagnostic rates of EUS and other imaging technology,and the diagnostic accuracy of preoperative staging and postoperative pathological staging were compared.Results Diagoses of 31 patients of ampullar tumors patients undergoing preoperative endoscopic ultrasonography assessment T staging were as the following:uT1,4 cases; uT2,15 cases; uT3,10 cases; uT4,2 cases.Compared with the postoperative pathological diagnosis,the T staging accuracy was 90.3％ (28/31),anong which 1 case was overestimated,2 cases were underestimated.The accuracy of endoscopic ultrasound in preoperative diagnosis of ampullar lesions was superior to other detection technology.Conclusion EUS is a valuable diagnostic tool for patients with suspected ampullar tumors.

[Objective]To observe the clinical results of percutaneous vertebroplasty in the treatment of painful osteoporotic thoracolumbar vertebral body compression fractures in old people.[Method]Six cases of PVP and 2 cases of kyphoplasty were performed with polymethylmethacrylate(PMMA) through unipedicular or bipedicular under C-arm fluoroscopy.[Result]No leakage of PMMA was found in the operation,the pain was clearly relieved or disappeared postoperatively,no severe complication occurred.[Conclusion]PVP is safe,effective and enconomical in the treatment of painful osteoporotic thoracolumbar vertebral body compression fracture.

Objective To discuss the diagnosis and treatment of intraductal papillomatosis. Methods Fifteen cases of intraductal papillomatosis were analyzed retrospectively. Results Of the 15 cases,preoperative diagnosis of intraductal papillomatosis was made in 8 cases who had received fiberoptic ductoscopy,while the rest of 7 cases who had not undergone ductoscopy were wrongly diagnosed.Postoperative pathological findings revealed 2 cases of partial malignant change and 1 case of contralateral infiltrating lobular carcinoma.Reoperation was required in 3 cases because of relapse,the relapse rate being 20%. Conclusions Intraductal papillomatosis is absolutely different from intraductal papilloma.It presents the potentiality of malignancy,and is subject to relapse after local resection.Fiberoptic ductoscopy may improve the diagnosis rate for this disease.

Objective To explore efficacy of mammary ductoscopy in diagnosis and treatment of nipple discharge.Methods 206 cases of nipple discharge underwent 211 examinations of mammary ductoscopy from May 2001 to October 2006.Results Fifty-eight patients diagnosed as non-protrusion lesions under mammary ductoscopy were treated by irrigation therapy and followed up for 3-18 months(mean,12 months) without recurrence.One hundred and forty-eight cases were diagnosed as protrusion lesions,in which 125 cases received operation.115 cases of single mammary intraductal papilloma,7 cases of papillomatosis,and 3 cases of intraductal carcinoma were diagnosed under mammary ductoscopy,while 112 case of intraductal papilloma,10 cases of papillomatosis and 3 cases of ductal carcinoma were confirmed by postoperative pathology.Of the 125 cases,mammary ducts resection was carried out in 120 cases guided by locating needle,segment mammectomy in 1 case,"mammary gland displacement" in 1 case,quadrant resection with nipple-conserving combined with axillary lymph node dissection in 1 case,quadrant resection without nipple-conserving combined with axillary lymph node dissection in 2 cases.Follow-up for 4 to 20 months(mean,10 months) showed no recurrence.3 cases of ductal carcinoma in situ were followed up for 12-18 months,and survived with tumor-free.Conclusions Mammary ductoscopy examination makes accurate diagnosis of nipple discharge induced by intraductal carcinoma before operation,and has important clinical value to choose procedures.Locating needles to locate lesions in mammary ducts may be taken as a guide during operation.

Objective To investigate the clinical effect of lumbar catheter drainage combined with intrathecal injection on patients with cerebrospinal fluid leakage and intracranial infection.Methods A retrospective study was conducted.One hundred and fifty-two cases with cerebrospinal fluid leakage and intracranial infection were selected as our subjects who were hospitalized in the First Hospital of Yuncheng from 2006 to 2014.The patients were divided into lumbar puncture + intrathecal group (A),lumbar (group B) and lumbar intrathecal large pool + group (group C) based on post-processing methods.A experimental data were recorded and compared in terms of the total efficiency of treatment,the therapeutically effective time,bacterial clearance and security differences.Results After treatment,the levels of white blood cells,protein,glucose and intracranial pressure were changed compared with that of before treatment in three group(P ＜ 0.01),but there was no significant difference among the three groups(P ＞ 0.05).The therapy periods in group A,group B and group C were (12.80 ± 2.25) d,(12.64 ± 2.00) d and (9.44 ± 1.50) d respectively and the difference was significant(F =25.94,P ＜ 0.05).Compared with Group C,the therapy periods in group A and B were significant different(t =2.769,2.854;P ＜ 0.05),but there was no significant difference between group A and B (t =0.119,P =0.908).The cases with success.effect was 45 (89.1％) in group A,53 (94.6％) in group B,46 (95.8％) in group C,and there was no significant difference among three groups (P ＞ 0.05).In terms of bacterial clearance rate,33 cases(68.75％) was in group A,35 cases(72.91％) in group C and 23 cases (41.07％) in group B and the effective rate in group A or C were higher than that in group B (x2 =9.478,10.63 ; P ＜ 0.05).Conclusion The methods of lumbar catheter drainage combinedwith intrathecal injection is proved with a high clinical value of therapy,effective treatment can effectively shorten the time and improve the overall treatment effect.

Objective To discuss the reasons,surgical procedures and prognosis of multiple-operations for intra-and extrahepatic cholangiolithiasis.Methods The retrospective cohort study was adopted.The clinical data of 85 patients with intra-and extrahepatic cholangiolithiasis who underwent multiple-operations at the Second Affiliated Hospital of Anhui Medical University from January 2006 to January 2015 were collected.Individualized operations were determined according to the distribution of stones and liver functional reserve,including stones removal by incising bile duct and external biliary drainage,Roux-en-Y hepaticojejunostomy and hepatolobectomy or segmental hepatectomy.The treatment followed the principles as complete removal of stones,complete resection of lesions,correction of stenosis and adequate drainage.Bile was extracted during operation for bacilli culture.Patients received the postoperative symptomatic treatments,including anti-inflammation,hemostasis,liver protection,acid inhibition and nutritional support.The observation indicators included reoperation reasons,operation method,operation time,volume of intraoperative blood loss and transfusion,hepatic inflow occlusion,stone clearance rate,postoperative complications and treatments,bacilli culture of bile,results of pathological examination and duration of hospital stay,results of follow-up.The follow-up using outpatient examination and telephone interview was performed to detect postoperative living conditions and results of abdominal ultrasound once every 3 or 6 months in patients without stone residue and once every 1 month in patients with stone residue from postoperative week 6 to December 2015.Measurement data with normal distribution and with skewed distribution were represented as x ± s and M (range),respectively.Results (1) Reasons of reoperation:85 patients had stone residue or recurrence,including 7 combined with stenosis of bilioenteric anastomosis,5 with secondary malignant biliary tumors and 2 with gastrointestinal stromal tumor invading intrahepatic bile duct.(2) Intraoperative status of reoperation:of 85 patients,25 received partial hepatectomy + stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage,21 received partial hepatectomy + stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,13 received stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage,8 received stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,5 received partial hepatectomy + removal of former bilioenteric anastomosis + choledochoscopy exploration + T-tube drainage,4 received former intestinal Y-loop resection + stones removal by choledochoscopy + Roux-en-Y hepaticojejunostomy,3 received stones removal by incising intrahepatic bile duct + choledochoscopy exploration + T-tube drainage,3 received partial hepatectomy + residual gallbladder resection + stones removal by incising common bile duct + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy,2 received partial hepatectomy + residual gallbladder resection + stones removal by incising common bile duct + choledochoscopy exploration + T-tube drainage and 1 received residual gallbladder resection + removal of former bilioenteric anastomosis + choledochoscopy exploration + Roux-en-Y hepaticojejunostomy.Operation time and volume of intraoperative blood loss of the 85 patients were (259 ± 66) minutes and (180 ± 142) mL,respectively.Seven patients underwent intraoperative blood transfusion and 17 underwent first hepatic hilum occlusion.ALl the 85 patients received intraoperative choledochoscopy exploration.The immediate and final stone clearance rates were 62.4％ (53/85) and 87.0％ (67/77).(3) Postoperative status of reoperations:of 85 patients,45 had postoperative complications.Sixteen patients with incision infection were improved by wound drainage and dressing,anti-infection and supporting treatments without other treatments.Ten patients with pleural effusion were out of hospital after effective anti-infection and nutritional support treatments.Eight patients with biliary fistula were discharged from hospital after abdominal drainage.Six patients with incision infection combined with pleural effusion were discharged from hospital after wound drainage and dressing,anti-infection and nutritional support treatments.Among 5 patients with bile duct bleeding,1 was self-healing,1 underwent reoperation and 3 were improved by conservative treatment.The bacilli culture of bile in 68 patients was positive,and bacteria mainly consisted of Escherichia coli,Enterobacter cloacae,Pseudomonas aeruginosa and Klebsiella pneumoniae.Of 85 patients,78,5 and 2 patients were respectively confirmed with hepatolithiasis,bile duct cell adenocarcinoma combined with stone recurrence and choledocholithiasis combined with interstitialoma by pathological examination.Duration of hospital stay was (21 ±8)days.(4) Results of follow-up:77 patients were followed up for a median time of 32 months (range,6-108 months) with an overall follow-up rate of 90.6％ (77/85).During follow-up,50 patients had good survival,27 had poor survival including 11 with stone residue,9 with stone recurrence and 7 with bile duct canceration,and 7 died of no operation of secondary tumors.Conclusions Stone residue and recurrence are the main reasons for reoperation.The individualized surgical methods are determined according to preoperative stone distribution,with or without atrophy of liver lobe,with or without canceration and condition of liver function,which can increase the stone clerance rate,reduce the stone residue and recurrence rates and avoid reoperation.

In order to evaluate the pharmacokinetic profile of cefotiam hexetil hydrochloride tablet in Chinese healthy volunteers, a sensitive, specific and rapidprotein precipitation-liquid chromatography-tandem mass spectrometry method was developed and validated in human plasma. Chromatographic separation was achieved on a Waters Symmtry-C18 column (50 mm × 4. 6 mm, 5 μm), using a gradient mobile phase consisting of methanol and 1 mmol/ L ammonium acetate in water at a flow rate of 1. 0 mL/ min. Cefotiam and diazepam (internal standard) were detected without interference in the multiple reaction monitoring (MRM) mode with positive electrospray ionization. The calibration curve was linear from 5. 0 ng / mL to 5000 ng / mL (r>0. 99) with limit of quantitation of 5. 0 ng / mL. The assay met the published acceptance criteria. This rapid, sensitive and reproducible method was successfully applied to the pharmacokinetic study of cefotiam hexetil hydrochloride tablet in healthy Chinese volunteers and therefore provided a considerable mirror for quantification of other cephalosporins in human matrix.

Anterior shoulder instability is a very difficult issue to treat,especially with glenoid bone defect.When the defect is small,there is little influence on shoulder instability.The larger the defect is,the more influence there will be.Most authors agree that glenoid bone reconstruction should be considered when glenoid bone defect is more than 20％-25％.In this condition soft tissue procedures alone are not enough to provide stability to the shoulder.To date,there is still not an ideal typing of glenoid bone defect.There are many methods of assessing the size of bone defect.Pico system is one of the most common methods,as it is easier and more precise.Numerous surgical procedures have been described to address the bone defect.The Bristow procedure,the Latarjet procedure and the Eden-hybinette procedure are effective and most popular around the world.The Latarjet procedure can provide more bone blocking than the Bristow procedure,and is more popular.The Eden-hybinette procedure dose not need coracoid transfer and then has no damage of normal anatomical structure.But it also lack the hanging effect of the conjoint tendon.After all,each procedure has its advantage and disadvantage in treating anterior shoulder instability associated with glenoid bone defect and should be chosen depending on the characteristics of each patient and the preference of each surgeon.Furthermore,more new and effective treatments are still needed.

Objective To evaluate the clinic application effects of laparoscopy in the diagnosis and treatment of abdominal difficult and complicated diseases.Methods The clinical data of 64 cases of agnogenic abdominal diseases underwent laparoscopic exploration and biopsies were retrospectively analyzed.All the patients were difficult cases to diagnose,who have one or more clinical situations,such as abdominal pain,ascites of unknown origin,abdominal mass and intestinal obstruction,and obscure hemorrhage of small intestine.Results Definite diagnosis was made in 62 patients after laparoscopy (96.9％).In patients with ascites,abdominal mass,intestinal obstruction and hemorrhage of small intestine,the definite diagnostic rate were 93.3％,100.0％,100.0％ and 6/6,respectively.The complication rate of laparoscopic exploration was 1.6％ (1/64).Underwent laparoscopic exploration,14 of 64 cases (22％) were treated by operation.Among them,8 cases (8/14) were treated by therapeutic laparoscopy,and other 6 cases (6/14) were treated by abdominal surgery without any comliactions.Conclusion Laparoscopic exploration is safe and effective in diagnosis and treatment of abdominal difficult and complicated diseases.

Objective To investigate the chemcial constituents in Hedysarum polybotrys and their antitumor activities.Methods The chemical constituents were isolated by various column chromatographic methods,and their structures were elucidated mainly by NMR and MS evidences;Cytotoxicities of the purified compounds against human cancer cell lines HepG2 were evaluated by MTT method.Results Eleven compounds were isolated and identified as: n-tetracosanoic acid(Ⅰ),n-hexacosanic acid(Ⅱ),trioleic glyceride(Ⅲ),glycerol monopalmitate(Ⅳ),cetyl ferulate(Ⅴ),(+)syringaresinol(Ⅵ),7-hydroxy-4′-methoxyisoflavane(Ⅶ),isoliquiritigenin(Ⅷ),3-hydroxy-9-methoxypterocarpan(Ⅸ), ?-sitosterol(Ⅹ),and daucosterol(Ⅺ).Conclusion Compounds Ⅰ—Ⅳ and Ⅵ are isolated from this plant for the first time.Compound Ⅸ shows the inhibitory activity on HepG2 with IC50 values of 10.69 ?mol/L.