Objective To explore the effect of truncal vagotomy on biliary dynamics in dogs.Methods After fasted for 18 h, 12 adult mongrel dogs underwent bilateral truncal vagotomy at the diaphragmatic level and pyloroplasty in the experiment group,and only pyloroplasty in the control group.All dogs were performed ultrasonograph to determine the size of the common bile duct(CBD) and sphincter of Oddi manometry(SOM) to detect biliary dynamics at postoperative 8 weeks,then the bile was collected from gallbladder for further analysis.Results In the experiment group,the CBD pressure,inner diameter of CBD,and SO basal pressure(SOBP) increased significantly,and sediments were found in the bile of all dogs,but SO amplitude(SOAP),frequency and duration of SO phasic contraction did not change.Conclusion Bilateral truncal vagotomy at the diaphragmatic level leads to significant increase of SOBP,resulting in a great change of biliary dynamics.

Objective To evaluate the feasibility and safety of direct peroral cholangioscopy (DPCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases.Methods Patients with unexplained choledochal stenosis and choledocholithiasis underwent standard ERCP.Native papilla was dilated using endoscopic papillary large balloon dilation (EPLBD)according to the size of papilla and the diameter of common bile duct.DPCS was performed using routine straight-view endoscope,and biopsy or laser lithotripsy was performed according to imaging of DPCS.General data of patients,procedure of ERCP,diagnosis of DPCS,and complications were recorded.Serum amylase after 2 hours and 24 hours,total bilirubin,direct bilirubin,leukocyte count,neutrophilic granulocyte percentage,and C-reactive protein were measured.Results A total of 15 patients underwent DPCS,including 5 cases of huge common bile duct stones and 10 cases of common bile duct stricture.The diameter of common bile duct ranged from 1.5 cm to 2.5 cm.Single EPLBD was required in 3 cases,endoscopic sphincteropapillotomy and EPLBD was required in 12 cases to facilitate DPCS.DPCS was successfully completed in 14 cases,including 11 cases in distal common bile duct,3 cases in proximal common bile duct.Among the 14 cases,4 cases used ordinary gastroscope,and 10 cases used ultrathin gastroscope.Laser lithotripsy was successfully completed in 4 choledocholithiasis patients.DPCS was successfully completed in 9 patients of common bile duct stenosis.The reasons of stenosis included 5 calculi,2 normal,1 scar and 2 adenoma.There were 1 case of cholangitis and 4 cases of hyperamylasemia after operation.No procedure related death occurred.Conclusion Freehand DPCS using ordinary gastroscope or ultrathin gastroscope is feasible and safe,and may be clinically useful for diagnosis and therapy of unexplained choledocholithiasis and common bile duct stenosis.

Objective To investigate whether pulse pressure variation (△PP) reflect the effects of PEEP and fluid resuscitation (FR) on hemodynamic effects.Methods Twenty critical patients with acute lung injury was ventilated with volume control (VT =8 mL/kg,Ti/Te = 1: 2) ,and PaCO2 was kept at 35 to 45 mm Hg.PEEP was setted as 5 cm H2O and 15 cm H2O in randomized order.Hemodynamic parameters including cardiac index, pulse pressure, central venous pressure, etc.were monitered by PiCCO system.Measurements were performed after the application of 5 cm H2O PEEP (PEEPs group)and 15 cm H2O PEEP (PEEP15 group) respectively.When the PEEP-induced decrease in cardiac index (CI) was > 10%, measurements were also performed after fluid resuscitation.Results Compared with PEEPs group, CI was decreased significantly in PEEP15 group(P < 0.05), and APP was increased significantly (P < 0.05).In 14 patients whose PEEP-induced decrease in CI was > 10%, fluid resuscitation increased CI from (3.01±0.57)L · min-1· m-1to (3.62±0.68)L · min-1 · m-2(P<0.01),and decreased △PP from (17±3)% to (10±2) % (P < 0.01).PEEP15-induced decrease in CI was correlated negatively with APP on PEEP5 (r =-0.91,P < 0.01) and with the PEEP15-induced increase in △PP (r =-0.79, P < 0.01).FR-induced changes in CI correlated with APP before FR (r = 0.96, P < 0.01) and with the FR-induced decrease in APP (r =-0.95, P < 0.01).Conclusions In ventilated patients with ALI, △PP may be a simple and useful parameter in predicting and assessing the hemodynamic effects of PEEP and FR.

Objective To investigat the safe time of SVC interruption in New Zealand rabbits, and help to find the safe time ofSVC interruption in chnical operation. Methods 25 New-Zealand rabbits were separated into 3 groups randomly. Bi-SVC was cross-clamped for one hour, two hours in animal models. The femoral artery or SVC pressures were monitored. The control group (sham op-eration group, 5) were opened chest both sides and monitored femoral artery pressure and SVC pressure for 2 hours. Samples of cere-brum, cerebellum and medulla of rabbits immediately post-operation were studied for water content, light and electric microscopies.The tiny change of brain cells in brain mantle, hippocampus and thalamencephal were observed under electron microscope. Results(1) The SVC pressure of rabbits varied regularly in occlusion groups, which displayed as "upgrade-degression- upgrade again-retain".(2) There was no obvious difference in water content of brain between the one hour group and the control group, both of which weremuch lower than two hours group. (3) The brain tissues were almost in normal construction in one hour group, but encephaledema wasobserved in two hours group. The pathological change of cony brain cells was light and reversible in one hour group. However, in twohours group, necrosis of neuron ceils in brain could be observed, which was irreversible. Concerto The animal model of acuteSVC obstruction was built successfully. Interruption of the SVC for 1 hour was proved safe, with longer interruption of SVC 2 hours,obvious encephaledema and necrosis of neuron cells can be observed.

Objective To explore the effect of nutritional intervention on nutritional status,weight,physical strength and quality of life of patients with head and neck cancer treated by radiotherapy.Methods 77 patients with head and neck malignant tumors treated by radiotherapy were divided randomly into two groups,nutritional intervention group (NI) had 38 cases and control group (CG) had 39 cases.The status of nutrition,weight,physical strength and quality of life before radiotherapy,the end of radiotherapy and 3 months after radiotherapy in two groups were compared.Results The nutritional risks in two groups had no difference before radiotherapy.At the end of radiotherapy,the assessment score of the nutrition in NI was significantly lower than that in CG [(5.41±2.36) scores vs.(6.92±2.74) scores,t =4.935,P ＜ 0.05],and the average weight in NI was significantly higher than that in CG [(57.07±8.01) kg vs.(46.53±9.82) kg,t =2.670,P ＜ 0.05].At the end of radiotherapy and 3 months after radiotherapy,the physical strength in NI [(57.07± 8.01),(41.48±7.92) kg] were significantly higher than those in CG [(36.43±6.48),(37.94±8.03) kg] (t =2.670,P =0.021;t =2.361,P =0.037);the index of quality of life in NI [(51.37±6.56),(52.07±6.23) scores] were also significantly higher than those in CG [(46.93±6.98),(48.13±7.12) scores] (t =2.292,P =0.041;t =2.076,P =0.037).Conclusion Nutritional intervention can effectively maintain the nutritional status of head and neck cancer patients with radiotherapy,and improve continuously the physical strength and the quality of life.

Description of the security grading protection used in the security protection system for information systems in medical organizations. Elaboration of the research ideas, process and some outcomes for the Fundamental Requirements for Security Grade Protection of Information Systems in Medical Organizations, from the five aspects of system modeling, grading guidance for industries, threat and risk analysis, security objective output, and security adjustment.

Objective:To observe the clinical efficacy and adverse reactions of paroxetine combined with olanzapine in the treat-ment of depression complicated with sleep disorders. Methods: Totally 150 cases of sleep disorder patients were selected, and then randomly divided into the control group and the observation group with 75 ones in each. The control group was given paroxetine treat-ment, the observation group was given paroxetine combined with olanzapine treatment, and the treatment course was four weeks. The sleep latency, total sleep time, wake-up time and the number of awakening in the two groups were recorded, and the HAMD scale score and treatment efficacy were compared. Results:Compared with those in the control group, the sleep latency, total sleep time, wake-up time and the number of awakening in the observation group were obviously improved (P<0. 05). The clinical cure rate, the HAMD scale score and the incidence of adverse reactions between the two groups all had significant differences (P<0. 05). Conclu-sion:Paroxetine combined with olanzapine in the treatment of depression with sleep disorders shows fast efficacy, which can improve the sleep disorder symptoms and reduce the incidence of adverse reactions significantly.

HPLC-ELSD was used to determine the content of Ophiopogonin D in Zhe Opiopogon japonicus(Thunb.) Ker-Gawl. and Chuan Ophiopogon japonicus(Thunb.) Ker-Gawl. The chromatographic conditions were as follow: Alltima C18 column (250mm?4.6mm) and the column temperature at 30℃, drift tube temperature at 98 ℃with Gas flow rate being 2.8 L/min and acetonitrile : water (55∶45) as mobile phase with the flow rate being 1.0 mL/min. There was a good linearity (r=0.9992) within the range of 0.2565～6.4125 ?g. The average recovery rate was 102.0%and RSD=2.1%.

Objective To study the relationship of cataract with lens epithelial cell apoptosis and autophagy by observing the ultrastructure of age-related and diabetic cataract lens epithelial cells.Methods Transmission electron microscope was used to observe the apoptotic and autophagic morphology of the lens epithelial cells in 5 cases with age-related and diabetic cataract respectively,and in 2 cases with normal lens.Results The apoptosis and autophagy of lens epithelial cells was found in cases with age-related and diabetic cataract,while no expression was observed in control lens epithelial cells.Conclusion The apoptosis and autophagy of lens epithelial cells are closely related to age-related and diabetic cataract formation.

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.