Objective To investigate improvements in the diagnosis and treatment of primary malignant tumor of the duodenum. Methods The clinical data of 54 patients with primary malignant tumor of the duodenum treated during a period of 6 years were analysed retrospectively. Results Tumors located in the first, second, third and fourth parts accounted for 6 cases(11.1%), 44 cases(81.5%), 2 cases(3.7%), and 2 cases(3.7%) respectively; and among them, ampullary tumor accounted for 38 cases(86.4%) of tumor of descending portion of duodenum and 70.4% of the total number of duodenal tumors. The main clinical presentation included jaundice, upper abdominal pain, weight loss, abdominal distention, and gastrointestinal obstruction. Upper abdominal pain, no positive signs and abdominal mass were found in 72.0%, 20.0% and 8.0% respectively on abdominal examination. Preoperative associated cholecystopathy accounted for 37.0%. The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94.4%, and 77.8% respectively. Preoperative diagnostic accuracy rate was 27.8%. Panceaticoduodenectomy was performed in 38 cases, duodenectonmy in 1 case, palliative resection of tumor in 9 cases, and tumor was inoperable in 6 cases. Radical resection rate was 72.2%. The postoperative 3- and 5-year survival rate was 40.6% and 21.9%, respectively. After palliative resection, death occurred from 1month to 24months. Conclusions The tumors in the ampullary region account for the majority of primary malignant tumors of the duodenum and are mainly adenocarcinoma. The symptoms of advanced stage are complicated, and specific signs on abdominal examination are few. Associated cholecystopathy is relatively ferquent and preoperative accurate diagnostic rate is low. The examinations of first choice are duodenoscopy and ERCP, and radical panceaticoduodenectomy can extend survival time.

BACKGROUND: Early withdrawal of invasive mechanical ventilation (IMV) followed by noninvasive MV (NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with acute respiratory failure (ARF). Using pulmonary infection control window (PIC window) as the switch point for transferring from invasive to noninvasive MV, the time for early extubation can be more accurately judged, and therapy efficacy can be improved. This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy (FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV. METHODS: Since July 2006 to January 2011, 106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization. Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used (group A, n=54) or not (group B, n=52) during sequential weaning from invasive to noninvasive MV. In group A, for sputum suction and bronchoalveolar lavage (BAL), a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube, which was accompanied with uninterrupted use of a ventilator. After achieving PIC window, patients of both groups changed to NIMV mode, and weaned from ventilation. The fol owing listed indices were used to compare between the groups after treatment: 1) the occurrence time of PIC, the duration of MV, the length of ICU stay, the success rate of weaning from MV for the first time, the rate of reventilation and the occurrence rate of ventilator-associated pneumonia (VAP); 2) the convenience and safety of FOB manipulation. The results were compared using Student's t test and the Chi-square test. RESULTS: The occurrence time of PIC was (5.01±1.49) d, (5.87±1.87) d in groups A and B, respectively (P<0.05); the duration of MV was (6.98±1.84) d, (8.69±2.41) d in groups A and B, respectively (P<0.01); the length of ICU stay was (9.25±1.84) d, (11.10±2.63) d in groups A and B, respectively (P<0.01); the success rate of weaning for the first time was 96.30％, 76.92％ in groups A and B, respectively (P<0.01); the rate of reventilation was 5.56％, 19.23％ in groups A and B, respectively (P<0.05); and the occurrence rate of VAP was 3.70％, 23.07％ in groups A and B, respectively (P<0.01). Moreover, it was easy and safe to manipulate FOB, and no side effect was observed. CONCLUSIONS: The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU. It can decrease the duration of MV and the length of ICU stay, increase the success rate from weaning MV for the first time, reduce the rate of reventilation and the occurrence rate of VAP. In addition, such a method is convenient and safe in patients of this kind.

A method for the simultaneous determination of 34 pesticides in sunflower oil, soybean oil and corn oil was developed. The samples were extracted and purified by a modified QuEChERS method, and then the supernatant was analyzed by on-line gel permeation chromatography-gas chromatography-mass spectrometry ( GPC-GC-MS ) . The linear range was from 0 . 01 to 0 . 2 mg/L with a good correlation coefficients ( r≥0. 9913). The average recoveries of 31 pesticides (except p,p′-DDE, p,p′-DDD, p,p′-DDT. For detail, please reference to section 3 . 6 ) ranged from 70 . 3% to 115 . 4%, 69 . 5% to 112 . 6% and 70 . 2% to 116 . 1%spiked at 0. 05 μg/g and 0. 1 μg/g with the relative standard deviations (RSDs, n=6) less than 13. 3%, 13. 5% and 12. 1% in sunflower oil, soybean oil and corn oil samples, respectively. The LODs of this method ranged from 0. 0692 to 2. 28, 0. 0559 to 2. 01 and 0. 0584 to 2. 14μg/kg (S/N=3) in sunflower oil, soybean oil and corn oil samples respectively. The convenient operation and versatility of this method are suitable for the fast screening and detection of 34 pesticide residues in sunflower oil, soybean oil and corn oil.

AIM: To evaluate the effect of carbon monoxide(CO) on the permeability of brain blood barrier(BBB) in cerebral ischemic rats. METHODS: SD rats were divided into three groups. Saline, hemin or ZnPP were injected intraperitoneally 12 h before middle cerebral artery occlusion (MCAO), respectively. The concentration of blood CO and the permeability of BBB at 24 h after MCAO were measured. RESULTS: The CO concentration in blood in hemin group was higher than that in saline group( P 0.05). CONCLUSION: CO reduced the permeability of BBB as a messenger gas molecular when its intrinsic concentration was elevated.

A novel transferrin modified non-viral gene delivery system Tf-PLPD was developed and the related characteristics was investigated. Blank procationic liposomes were prepared by film dispersion-filteration method. PLPD was prepared as follows by first mixing the plasmid DNA and protamine together, then the resulted polyplexes were incubated for 10 min at room temperature, followed by addition of preformed blank procationic liposomes. Transferrin was adsorbed at the surface of PLPD via electrostatic interactions to form Tf-PLPD. Central composite design (CCD) was employed to optimize the formulation. The HepG2 cells were transfected using lacZ as reporter gene and characteristics such as the morphology, the mean particle size, the zeta potential and the transfection efficiency in HepG2 cells were further investigated by different methods. The resulting PLPD had a regular spherical surface with an average size of (228. 9 +/- 8. 0) nm (polydispersity index, PDI = 0. 122 +/- 0. 02, n = 3) , a zeta potential of ( - 25. 08 +/-2. 50) mV (n = 3) and a transfection efficiency of (12. 18 +/- 3. 80) mU x mg(-1) (protein). The Tf-PLPD had an average size of (240 +/- 12) nm (polydispersity index, PDI = 0. 150 +/- 0. 03, n = 3), a zeta potential of ( - 24. 10 +/- 2. 50) mV ( n = 3) and a transfection efficiency of (24. 26 +/- 2. 60) mU x mg(-1) (protein) , 20 times greater than that of the naked plasmid DNA. The presence of serum didn' t affect the tansfection activity of PLPD or Tf-PLPD. Compared to one kind of cationic liposomes (liposome-protamine-DNA, LPD), the PLPD and Tf-PLPD had much less cytotoxicity to three hepatic cell lines (including HepG2, SMMC7721 and Chang' s normal hepatocyte). The results indicated that the Tf-PLPD is a perspective non-viral vector for gene delivery systems.
Cations ; chemistry ; Cell Line ; Cell Line, Tumor ; Cell Survival ; DNA ; chemistry ; genetics ; Hepatocytes ; cytology ; metabolism ; Humans ; Liposomes ; chemistry ; Liver Neoplasms ; genetics ; pathology ; Particle Size ; Plasmids ; chemistry ; genetics ; Protamines ; chemistry ; Transfection ; methods ; Transferrin ; chemistry ; genetics

OBJECTIVETo evaluate the effect of Chinese guidelines issued on December 2001 on in-hospital management and prognosis of patients with acute myocardial infarction.

METHODSA retrospective study was carried out in patients hospitalized in our hospital with acute myocardial infarction from January 1994 to December 2004.

RESULTSThere were 1783 patients enrolled in our study. Reperfusion therapy was undergone in 21.7% of patients hospitalized between 1994 and 2001, and in 35.8% of patients hospitalized between 2002 and 2004 (P < 0.001). Beta-blockers, ACE inhibitors and/or angiotensin receptor blockers, lipid regulating agents and antithrombins were used more extensively between 2002 and 2004 than before (all P < 0.001). There were no significant differences in the usage of nitrates and antiplatelets before and after the guidelines was issued (98.8% vs 97.9%, P = 0.172; 97.4% vs 98.6%, P = 0.113 respectively). After the guidelines issued, the incidence of angina pectoris, heart failure and death in hospital were lower than before (32.2% vs 41.2%, P < 0.001; 17.2% vs 26.2%, P < 0.001; 6.4% vs 9.4%, P = 0.038).

CONCLUSIONSChinese guidelines issued on December 2001 have great effect on the management and prognosis of patients with acute myocardial infarction. After the guidelines was issued the management became more standardized and the incidence of in-hospital complications was lower than before.

Aged ; China ; Female ; Guidelines as Topic ; Humans ; Inpatients ; Male ; Middle Aged ; Myocardial Infarction ; diagnosis ; therapy ; Prognosis ; Retrospective Studies

Objective To investigate the association of the levels of serum oxidized low density lipoprotein ( ox-LDL), C-reactive protein (CRP) and matrix metalloproteinase -9(MMP-9) with carotid artery plaque in atherosclerotic cerebral infarction patients.Methods One hundred -ten patients with atherosclerotic cerebral infarction ( ACI ) selected as the observation group , and 100 healthy subjects as control group were selected to detect the level of serum ox -LDL, CRP and MMP-9 by enzyme-linked immunosorbent assay and the ACI patients were measured by carotid artery ultrasound.Results The levels of serum ox-LDL, CRP, and MMP-9 in observation group were higher than those in control group [ ( 261.54 ±24.51 ) vs ( 146.51 ±19.59 )μg· mL-1;(4.54 ±1.21) vs (0.87 ±0.15) μg· mL-1;(139.76 ±41.22) vs (65.76 ±23.48 ) ng· mL-1 , and there was significantly different ( all P<0.01 ).The levels of serum ox -LDL, CRP, and MMP-9 in ACI patients with plaque were higher than those in ACI patients without plaque [(205.27 ±20.11) vs (162.50 ±19.71)μg· mL-1;(4.32 ±1.03) vs (1.21 ±0.10 ) μg· mL-1;(90.71 ±24.03 ) vs (71.71 ±23.21 ) ng· mL -1 , and there was significantly different ( P<0.01 ).Serum ox-LDL, CRP and MMP-9 levels were the independent risk factors for the formation of carotid plaques of ACI patients , and had significantly positive correlation.Conclusion The high level of serum ox -LDL, CRP, and MMP-9 are the independent risk factors for carotid plaques of ACI , which could be used as important reference indexes for diagnosis of the formation of carotid artery plaque on ACI patients.

Objective To ensure the medical security of the astronauts,new targeted strategies were adopted after summarizing the experience in Chinese astronauts rescue and medical aid at the main landing site,the specialty and characteristics of landing were analysied.Methods Search the publications about astronaut medical aid domestic and abroad,summarize the rescue and medical aid experiences from Shenzhou 5 to Shenzhou 10.In consideration of prolonged on-orbit time,the cold weather conditions at the landing zone of Shenzhou 11,new targeted strategies were presented.Results On the basis of the original helicopter emergency platform and first aid equipment,the emergency aid procedures were optimized,personal warm clothing,a heat preservation box,insulation blanket,self-heating pads and intraosseous rapid infusion system were used to ensure the medical security of astronauts in cold weather at the main landing site.Conclusions With the procedures optimized and the targeted strategies performed,the astronauts' s rescue and medical aid project was fully meet the cold and complex conditions at main landing site.

OBJECTIVETo evaluate the advantages, disadvantages and their indications of total nasal reconstruction with different techniques.

METHODSA series of total nasal reconstruction were treated with four methods from 1975 to 2003. These methods were tubed flap of arm,midline forehead flap with skin graft, midline forehead flap with bilateral frontotemporal flaps for repairing the donor site, and expanded forehead flap.

RESULTSAll of the patients were treated successfully. The shape and function of the reconstructed noses were satisfactory. However, the traditional forehead flap with skin graft may leave a unsightly big and black scar on the forehead. The technique of the tubed flap of arm could provide enough tissue without remaining forehead scar and be easily shaped, but it required long period, multiple procedures and body fixation for three weeks.

CONCLUSIONSMidline forehead flap with bilateral frontotemporal flaps for repairing the donor site may be good for small nose reconstruction while expanded forehead flap could reconstruct a big nose. Tubed flap of arm may be used to the patients who do not wish to leave any scar on the forehead. Forehead flap with skin graft to repair the donor sit- should generally be avoided for nose reconstruction.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; transplantation ; Nose Deformities, Acquired ; surgery ; Reconstructive Surgical Procedures ; methods ; Reproducibility of Results ; Retrospective Studies ; Skin Transplantation ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVETo investigate the clinical efficacy of colonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation.

METHODSA retrospective analysis of 8 patients with iatrogenic colonic perforations from January 2009 to March 2011 was performed. Self-made drainage tubes with balloon were placed in the bowel lumen endoscopically after perforations were closed with endoclips or endoloops under endoscope. The inflatable balloon at the front-end of the tube was fixed at the mouth side of colonic perforation to achieve continuous drainage of stool and intestinal juice.

RESULTSEndoscopic bypass continuous drainage by using self-made drainage tube with balloon was successfully carried out in all the 8 patients. All the perforations healed and no surgical intervention required. Bypass drainage continued for 3-10 days(mean 7.6 days). One patient received colonoscopy 3 days after the procedure, and displacement of the drainage tube was noticed requiring endoscopic adjustment. All the drainage tubes were removed uneventfully, and no ulceration or perforation occurred at balloon fixed site after removal. After follow up ranging from 12 to 36 months, no chronic fistula, adhesive obstruction, or abdominal infection occurred.

CONCLUSIONColonic bypass drainage by self-made drainage tube with balloon for iatrogenic colonic perforation is simple, feasible, safe and reliable.

Aged ; Colonic Diseases ; surgery ; Drainage ; instrumentation ; methods ; Female ; Follow-Up Studies ; Humans ; Iatrogenic Disease ; Intestinal Perforation ; surgery ; Male ; Middle Aged ; Retrospective Studies