Local resection of duodenal papillary neoplasm has the advantages of small trauma,few complications and retaining the normal function of digestive tract.While this surgical procedure is not widely applied because of high demand of surgical techniques,difficulty in the management of complications and its efficacy still needs the verification of evidence based medicine.From January 2000 to June 2012,4 patients received local resection of duodenal papillary neoplasm at the Renji Hospital of Shanghai Jiaotong University.All patients were confirmed as with duodenal papillary neoplasm by endoscopic retrograde cholangiopancreatography,and the diameters of the tumors were under 1 cm.The results of duodenal papillary biopsy showed that 3 cases were with hyperplasia and 1 case with adenocarcinoma.Lymph node metastasis or distal metastasis was excluded by computed tomography and magnetic resonance imaging preoperatively.The results of postoperative pathological examination confirmed that 1 case of duodenal papillary adenoma and 3 cases of duodenal papillary adenocarcinoma were with negative margin and no metastasis in the hepatoduodenal ligament was detected.There was no complications except 1 case of pancreatic leakage.There was no recurrence during a follow-up period of 3-24 months.Strictly abiding the indications and technical manual of local resection of duodenal papillary neoplasm is a key point to acquire good clinical effect.

The function of β-cells is closely correlated with the onset of type 2 diabetes mellitus.Currently the bariatric surgery has been considered to be the most effective therapy for ameliorating the complications and improving the prognosis of type 2 diabetes mellitus,while the mechanism remains unknown.The improvement of β-cells function following bariatric surgery might play important roles in the remission of type 2 diabetes mellitus.In this article,the relationship between the changes of related factors after bariatric surgery and the function of pancreatic β-cells is reviewed.

Objective To evaluate the preoperative localization value of MRI and MRCP for congenital biliary dilatation.Methods 30 cases of congenital biliary dilatition diagnosed by either surgery or pathology were studied.MRI and MRCP findings of all these cases were analyzed.Results MRI and MRCP preoperative examination manifested the place of choledochal cyst and the relation between choledochal cyst and the biliary ductal system around in all 30 patients.Through surgery findings as follow,using Todani's classification,the accuracy of MRI and MRCP in evaluating the site and classification of congenital biliary dilatation was 100%,the accurate visualization rate of pancreatic duct was 73.3% and the junction of pancreaticobiliary duct was 33.3%.Conclusion MRI and MRCP manifestations are very reliable in preoperative localization of congenital biliary dilatation.

In critically ill patients,evoked potential(EP) testing is an important tool for measuring neurologic function,signal transmission,and secondary processing of sensory information in real time.EP potential measures conduction along the peripheral and central sensory pathways with longer-latency potentials representing more complex thalamocortical and intracortical processing.In critically ill patients with limited neurologic exams,EP provides a window into brain function and the potential for recovery of consciousness.Brainstem auditory EP and cortical event-related potentials are most commonly used in ICU.The primary indications for EP in critically ill patients are prognostication in anoxic-ischemic or traumatic coma,monitoring for neurologic improvement or decline,and confirmation of brain death.Historically,EP has been regarded as a negative prognostic test,that is,the absence of cortical potentials are associated with poor outcomes while the presence cortical potentials are prognostically indeterminate.In recent studies,the presence of middle-latency and long-latency potentials as well as the amplitude of cortical potentials is more specific for good outcomes.Event-related potentials,particularly mismatch negativity of complex auditory patterns,is emerging as an important positive prognostic test in patients under comatose.In infants,other than anoxic-ischemic or traumatic brain injury,brainstem auditory is also widely used in premature baby,bilirubin encephalopathy and detection of possible hearing loss.

Humans ; Stem Cell Transplantation

Cardiomyopathy, Hypertrophic ; complications ; Fatal Outcome ; Heart Septal Defects, Atrial ; complications ; Humans ; Infant

Chronic Disease ; Heart Failure ; diagnosis ; Humans ; Medicine, Chinese Traditional

OBJECTIVETo assess the feasibility and safety of robot-assisted laparoscopic radical prostatectomy (RLRP) in the treatment of prostate cancer.

METHODSUsing the da Vinci robot surgical system, we performed RLRP for 34 patients with localized prostate cancer and analyzed the intraoperative and follow-up data.

RESULTSThe procedures were performed successfully in all the patients, with the mean operation time of 198 min (range 135-340 min), average blood loss of 257 ml (range 50-700 ml), and 1 case of blood transfusion, but no postoperative complications. Three cases had positive surgical margins. Postoperative examination at 4 weeks showed PSA > 0.2 microg/L in 2 cases, suggestive of residual tumor, for which maximal androgen block therapy was administered. The other 32 patients were followed up for 3-10 (mean 7.5) months, during which the average level of serum tPSA remained < 0.2 microg/L. Urinary continence was found in 94% (32/34) and 97% (33/34) of the patients at 3 and 6 months, respectively, of whom 77% (26/34) and 88% (30/34) had no urinary leakage (0 pad per day).

CONCLUSIONRLRP, with its advantages of less perioperative blood loss, low rate of positive margin, and good urinary continence, is a safe and effective surgical option for the treatment of prostate cancer.

Aged ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Retrospective Studies ; Robotics

Objective To investigate the distribution and antibiotic resistance characteristics of pathogen in mastitis patients and to provide important foundation for clinical rational antibiotic use .Methods The bacterial isolates from 114 mastitis specimens were collected .Identification and antimicrobial susceptibility testing were carried out .Results A total of 67 strains were isolated from clinical specimen ,in which Staphylococcus aureus[50 .7% (34/67)] and Staphylococcus epidermidis[44 .8% (30/67)] were themostcommonisolate,also Escherichiacoli[1.49% (1/67)],Klebsiellapneumoniae[1.49% (1/67)]andAcinetobactercalcoace-ticus[1 .49% (1/67)] were isolated .The rates of methicillin-resistant Staphylococcus aureus(MRSA) and methicillin-resistance to coagulase-negative Staphylococci(MRCNS) were 8 .8% and 46 .7% ,respectively .The sensitive rates of minocycline ,vancomycin , teicoplanin ,furadantin to MRSA strains were 100 .0% .The sensitive rates of vancomycin ,teicoplanin ,levofloxacin ,furadantin and oxacillin to methicillin-sensitive Staphylococcus aureus(MSSA) were 100 .0% .The sensitive rates of minocycline ,rifampin ,furadan-tin ,vancomycin ,teicoplanin and oxacillin to methicillin-sensitive to coagulase-negative Staphylococci(MSCNS) were 100 .0% .The sensitive rates of vancomycin ,teicoplanin ,minocycline and furadantin to MRCNS were 100 .0% .The resistance rates of penicillin to MRSA ,MSSA ,MSCNS ,MRCNS were 100 .0% .Conclusion Staphylococcus is the main pathogen of mastitis patients .Penicillin is not a first selective drug for acute mastitis .

Objective: To observe the effect of the acupuncture plus medication on the expression of silent information regulator of transcription 1 (SIRT1) and transcription factor forkhead box protein O3a (FOXO3a) in the hippocampus, the malondialdehyde (MDA) content, and the superoxide dismutase (SOD) activity of rats with Alzheimer disease (AD), and to explore the possible mechanism of combining acupuncture and medication in improving AD-related neurological symptoms. Methods: Sixty male Sprague-Dawley rats were divided into a normal group, a model group, an electroacupuncture (EA) group, a drug group, and an acupuncture-medication combined group by the random number table method, with 12 rats in each group. The model was established by micro-injection of streptozotocin into the bilateral lateral ventricles. After successful modeling, rats in the EA group received EA at Zusanli (ST36) and Dazhui (GV14), those in the drug group received intragastric administration of resveratrol at a dose of 44 mg/(kg·bw), and those in the acupuncture- medication combined group received the combined intervention of EA and resveratrol. Rats in each group received intervention once a day for 4 consecutive weeks. Morris water maze was used to detect the rat behavioral changes. Nissl staining method was used to observe the cell morphology and changes in the number of rat hippocampal neurons. Western blotting and immunohistochemical staining methods were used to observe the expression changes of SIRT1 and FOXO3a. The thiobarbituric acid method was used to detect the MDA content. SOD activity was determined by the hydroxylamine method. Results: Compared with the normal group, the escape latency was significantly prolonged (P<0.05); the percentage of stay in the target quadrant was reduced (P<0.05), the hippocampal neuronal cells were shrunken, nucleoli were unclear, and cell number was reduced (P<0.05); the SIRT1 expression and SIRT1 positive cell number were decreased, while the FOXO3a expression and FOXO3a positive cell number were increased significantly (P<0.05); the MDA content was increased significantly, and the SOD activity was decreased significantly (P<0.05) in the model group. Compared with the model group, the escape latency was shortened (P<0.05); the percentage of stay in the target quadrant was increased (P<0.05); the shape and number of hippocampal neurons tended to be normal (P<0.05); the SIRT1 protein expression and the SIRT1 positive cell numbers were increased, the FOXO3a protein expression and the FOXO3a positive cell number were decreased (P<0.05); the MDA content was significantly decreased, and the SOD activity was significantly increased (P<0.05) in the EA group, the drug group, and the acupuncture-medication combined group. The changes in the acupuncture-medication combined group were more obvious (P<0.05). Conclusion: Both EA and resveratrol improve the learning and memory ability of AD rats by regulating the expression of SIRT1 and FOXO3a and improving the levels of MDA and SOD in the hippocampus and protect the hippocampal neurons, while the combined use of EA and medication is more effective than EA or resveratrol alone, suggesting that this combined treatment is more effective in AD treatment.