Objective To discuss the value of choledochoscopy via subcutaneous jejunal blind loop in the diagnosis and treatment of severe complications after pancreatoduodenectomy. Methods A fiber choledochoscope (FCC) was introduced through a subcutaneous jejunal blind loop. Under direct vision, the pancreatojejunal or choledochojejunal anastomotic leakages were coated with biological glue, or the anastomotic bleedings were stopped with hemostatic drugs. Results Five cases of intestinal leakage, 3 cases of biliary leakage and 2 cases of anastomotic bleeding were all cured. Follow-up for 1～3 years in the 10 cases found no recurrence of tumors. Choledochojejunal anastomotic stricture occurred in 1 case 1 year after the surgery and was cured by dilatation under fiber choledochoscope. In the remaining 9 cases, the pancreatic juice and bile fluid were excreted normally. Conclusions Application of FCC through the subcutaneous jejunal blind loop can be employed in the diagnosis and treatment of complications after pancreatoduodenectomy and in the long-term follow-up of pancreatojejunal or choledochojejunal anastomotic stoma under direct vision.

Object To study the anti-arrhythmia effect and acute toxicity of flavonoid from Erysimum cheiranthoides L. Methods To study the anti-arrhythmia of the flavonoid by determination of the ECG of rabbits. To study the acute toxicity effect of the flavonoid by Karber's method. Results The results showed that the flavonoid could remedy to tachycardia caused by Adriamycin and it could remedy to bradycardia caused by Verapamil. Acute toxicity showed that LD 50 of flavonoid is 311.7 mg/kg, 95% CI is 289.9—339.5 mg/kg. Conclusion The flavonoid can rectify tachycardia due to various reasons with very little toxicity.

Objective To improve the technique of pancreatoduodenectomy in order to facilitate the(management) of complications and direct observation on follow up.Methods Pancreatoduodenectomy and Child′s method of digestive tract reconstruction was performed in 42 paltents.A blind loop of jejunum 5 to 6 cm in length was constructed beyond the pancreatojejular anastomosis and it was fixed to the subcutaneous(tissue) of the adjacent abdominal wall.Results Thirty-two cases recovered uneventfully,and 10 cases had complications induding pancreatic and biliary leakage and hemorrhage.These complications were successfully treated under direct vision by choledochoscope passed into the blind jejunal loop.This method of observation was used for long-time follow up in 22 cases,and revealed ercurrent tumor(n=5),bile duct stricture(n=4) and bile duct ascariasis(n=1).Conclusions This operative method did not cause new(complications) and it can be combined with the traditional operation.Postoperatively,direct observation and management of leakage of pancreatojejular anastomosis and biliointestinal anastomosis and hemorrhage can be accomplished,and the anastomoses and pancreatic stump can be directly observed at followup.

OBJECTIVE:To shorten time consuming for dispensing mode of automatic medicine packaging machine(ATC), and improve the efficiency of ATC. METHODS:In the inpatient pharmacy of our hospital,previous dispensing mode that two ATC matched with one tablet case separately was replaced by new mode,i.e. one ATC(another ATC was on standby)matched with two tablet cases(one of them added medicine beforehand),and the information of drug-position coordinate was equipped. The time con-sumed,average daily number of packages,financial expenses and labor costs were recorded and analyzed to evaluated the effect of new mode. RESULTS & CONCLUSIONS:Compared with previous mode,new dispensing mode improve the efficiency of ATC greatly. In previous mode,two ATCs and four pharmacists work simultaneously and spend 4.5 hours for 3 850 bags of medicine, which cost 4 400 000 yuan;in new mode,only one ATC and three pharmacists work simultaneously,and spend 3.0 hours for 4 015 bags of medicine,which cost 2 350 000 yuan. Therefore,double-universal tablet cases greatly improves the efficiency of ATC and reduce the financial expenses as machine maintenance and labor cost.

BACKGROUND: In the patients with congenital scoliosis, the spinal motor units exhibit developmental disorders and poor range of motion. It has been found that the compensation ability of coronal lumbosacral region (L4-S1) is associated with the occurrence of non-compensable trunk migration postoperatively.OBJECTIVE: To establish the three-dimensional finite element models of coronal lumbosacral region of normal and patients with congenital scoliosis and to compare the strain, displacement, stress and stiffness under different loading conditions among models.METHODS: One normal subject and two congenital scoliosis patients with different coronal lumbosacral region flexibility were selected, DICOM image datawere obtained by spiral CT scanning at the lumbosacral region, and then imported into MIMICS software, and a three-dimensional model was established according to the gray values of each tissue on CT,followed by simplified by GEOMAGIC, and finally imported into ABAQUS foftware to conduct a mechanic analysis under different loading conditions.RESULTS AND CONCLUSION: (1) Under different lateral forces, in the three models, the maximum stress mainly distributed on the frontal region of L4 cortical bone, and maximum displacement concentrated on L5. (2) There was no significant change in the stress distribution in the two scoliosis models, but the compensable model showed larger displacement change, and its stiffness was significantly less than that of the non-compensable model, indicating that the compensable model is easy to deform. (3) These findings suggest that three-dimensional finite element model is helpful to perform a biomechanical analysis for coronal lumbosacral region of congenital scoliosis, among which, a compensable model exhibits large displacement, suggesting a good flexibility.

Objective To evaluate the efficacy of visual analog scale international prostate symptom score (VAS-IPSS) in patients with benign prostate hyperplasia (BPH).Methods Three hundred and ninety patients with BPH were recruited to participate in this study and were randomly assigned to one of two groups:the standard IPSS group and the VAS-IPSS group.In each group,sub-groups were further divided to non-interpretation arm (A) and interpretation arm ( B),based on the availability of medical professionals to interpret patientsˊ VAS-IPSS score.In the same way,the similar sub-groups were established in VAS-IPSS group with non-interpretation arm (C) and interpretation arm (D).All the patients were required to fill out the same questionnaires at first consultation and second consultation with an interval of two weeks.Eventually,all the data were collected and analyzed.Results The ICC index was as follows for arms A through D:0.87 (95％CI0.72-0.94); 0.88 (95％CI0.74-0.95); 0.82 (95％CI0.59-0.92); 0.97(95％ CI 0.93-0.99).The optimal prediction factor for arm A was frequency (F =14.70,P =0.010)and the sub-optimal was nocturia ( F =12.10,P =0.000) and urgency ( F =11.80,P =0.000).The optimal prediction factor for arm B was nocturia ( F =6.02,P =0.000 ) and the sub-optimal was urinary incontinence ( F =5.79,P =0.008 ).The optimal prediction factor for arm C was nocturia ( F =30.98,P =0.000) and the sub-optimal was urinary incontinence ( F =22.42,P =0.000).The optimal prediction factor for arm D was nocturia ( F =20.20,P =0.000) and the sub-optimal was urinary incontinence ( F =18.00,P =0.000) and weak urine steam (F =15.30,P =0.000).Conclusions VAS-IPSS is more stable than the standard IPSS.The questionnaire explanation to patients is helpful for improving the VASIPSS stability.

Objective To build the access standard and role function of cancer case manager which is suitable for China.Methods The draft indicators of access standard and role function of cancer case manager were formulated based on literature review,group discussion and Delphi method.All the indicators were appraised by using two-round Delphi method.Results Round 1 consulting experts 43,and round 2 consulting experts 41.The experts showed high degree on the access standard and role function of cancer case manager during the two rounds of expert advice (two advisory Kendall coordination coefficients were 0.300,0.358 and 0.375,0.358,P ＜ 0.01).The access standard of cancer case manager included 4 first-level indicators and 34 secondary indicators,and the system of role functions included 7 first-level indicators,35 secondary indicators.Conclusions It indicates that the outcome is high reliability.The finding provide scientific basis for the selection of cancer case manager as well as clear identify of role functions which are significant for improving their work efficiency.

BACKGROUND: Inherent modal analysis and harmonic response analysis on the human normal lumbosacral vertebraehave been reported, but there is a lack of comparative research on their modal analysis results before and after pediclescrew fixation.OBJECTIVE: To explore the dynamic characteristics of human lumbosacral vertebrae using three-dimensional finiteelement method.METHODS: Finite element model of lumbosacral vertebrae (L1-S1) before and after pedicle screw fixation was developedand validated based on CT images, and the modal analysis and harmonic response analysis were then conducted.RESULTS AND CONCLUSION: (1) Representative nodes were selected at the spinous process segments of L1, L3 andL5, and numbered as A, B, and C, respectively. (2) The maximum displacement of each node in Y and Z directions oflumbosacral vertebral model after internal fixation was significantly decreased compared with those of the normallumbosacral vertebral model, suggesting that screw fixation system plays a protective role in lumbosacral vertebrae, andreduces its amplitude under external load, thus diminishing its sensitivity to external load. (3) The lumbosacral vertebralmodal analysis can provide basis for further study on dynamic analysis, and the parameters such as natural frequency,modal shape and vibration amplitude of the lumbar spine have been determined.

Objective: To investigate the survival status and influencing factors of HIV/AIDS patients after receiving highly active antiretroviral therapy（HAART）in Shangluo,Shaanxi Province,so as to provide evidence for improving the effect of HAART. Methods: HIV/AIDS patients who received HAART for the first time in Shangluo from 2010 to 2018 were investigated. Life table method was used to analyze the survival rate,mortality rate and median survival time of the subjects. A proportional hazards model was used to analyze the influencing factors for the survival time of HIV/AIDS patients. Results: A total of 286 HIV/AIDS patients were collected,and 27 of them died of AIDS. After HAART,the 1-year,cumulative survival rates of less than 1 year,4 years and 8 years were 93.95%,89.71% and 88.39%,respectively. The results of multivariate proportional hazards regression analysis showed that the patients aged 30 years when first received HAART had higher risk of death than those aged 18-29 years（RR：4.208-24.095,95%CI：1.219-79.491）;patients with AIDS had higher risk of death than those with HIV（RR=38.590, 95%CI：15.451-96.382）;patients by homosexual transmission（RR=3.425,95%CI：1.385-8.470）and non-sexual transmission（RR=10.299,95%CI：3.602-29.446）had higher risk of death than those by heterosexual transmission;patients with baseline CD4+T lymphocytes number of 200/μL and more（RR：0.133-0.170,95%CI：0.048-0.604）had lower risk of death than those with less than 200/μL. Conclusions The survival rate of HIV/AIDS patients in Shangluo after receiving HAART is relatively high. Age at the start of treatment,course of disease,route of infection and the number of CD4+T lymphocytes at baseline are the influencing factors of survival time.

Objective To compare the clinical efficacy and safety of carbon dioxide (CO2) versus high-frequency electroacupuncture based on the assistance of drilling and blunt dissection in the treatment of steatocystoma multiplex.Methods A randomized,self-controlled study was performed in 15 patients.The median line of the body served as the dividing line,and the lesions on the two sides of the median line of the body were randomly divided into 2 groups to be treated with CO2 laser or high-frequency electroacupuncture,which left micropathways into the cyst cavity.After the above treatment,contents in the cysts were squeezed out or drawn out with a mosquito clamp,and the cysts were bluntly dissected.The decrustation time,erythema subsiding time,adverse reactions and recurrence were compared among lesions at different sites or with different sizes.Results For the lesions at the same sites or with similar sizes after treatment,the decrustation time and erythema subsiding time were both significantly shorter in the CO2 laser group than in the high-frequency electroacupuncture group (both P ＜ 0.05).There were significant differences in the decrustation time and erythema subsiding time among lesions at different sites or with different sizes (all P ＜ 0.05).Mild pain occurred in the 2 groups,and no hematoma or secondary infection occurred.There were significant differences in the incidence of scar formation or pigmentation between the 2 groups (both P ＜ 0.05).During the follow-up of 6-18 months,relapse occurred in 1 patient in each group.Conclusion Compared with the high-frequency electroacupuncture,CO2 laser assisted by drilling and blunt dissection shows better efficacy in the treatment of steatocystoma multiplex,and it can remove lesions at various sites at one time.