Objective To investigate the efficacy of endoscopic papillary balloon dilation (EPBD) and endoscopic sphincterotomy (EST) in the treatment of non-dilated extrahepatic biliary stones. Methods The clinical data of 317 patients with non-dilated extrahepatic biliary stones who were admitted to the Taiyuan Iron and Steel Corporation Hospital from January 1999 to April 2008 were retrospectively analyzed. Of all patients, 119 received EPBD treatment, and the remaining 198 received EST treatment. Sixty-two patients treated by EPBD (EPBD group) and 62 by EST (EST group) were selected to conduct the matched-pair analysis. In the EPBD group, a cylindrical balloon was inserted under the guidance of a guidewire after the conclusive diagnosis by endoscopic retrograde cholangiopancreatography. After the dilation, stones were extracted by a stone basket or a balloon, and then conventional endoscopic nasobiliary drainage was carried out. In the EST group, stones were extracted by a stone basket or a balloon under the monitor of the digital subtraction radiography after incision of the duodenal papilla. The efficacy of the two methods was compared using the chi-square test. Results The stonefree rate in one session was 92% (57/62) in the EPBD group and 94% (58/62) in the EST group, with no significant difference between the two groups ( χ 2 = 0.222, P > 0.05 ). The number of patients who were complicated with hyperamylasemia and pancreatitis was slightly greater, and the number of patients who were complicated with duodenal perforation was smaller in the EPBD group than those in the EST group, while there was no significant difference between the two groups ( χ 2 = 0. 286, 1. 000, 2.000, P > 0.05 ). The numbers of patients who were complicated with duodenal papilla bleeding or biliary infection in the EPBD group were significantly smaller thanthose in the EST group ( χ 2 = 4. 000, 7. 000, P < 0.05 ). All patients were followed up for 24 months. The recurrence rate of bile duct stone and the incidence of biliary infection in the EPBD group were significantly lower than those in the EST group at the end of 6, 12 and 24 months (χ2 =4. 000, 5. 000, 6.000; 6.000, 8.000,11. 000, P < 0.05 ). Conclusions Combined application of EPBD and ENBD has the advantages of minor trauma and quick recovery of patients. It can preserve the function of duodenal papilla, so it is the first choice for treating non-dilated extrahepatic biliary stones.

Objective To explore the traits of error-related negativity (ERN) in generalized anxiety disorder (GAD) patients. Methods Thirty GAD patients and thirty normal controls were enrolled in this study. Use the Hamilton Anxiety Scale and State-Trait Anxiety Inventory to assess the severity of symptoms. Error-related negativity was elicited by the modified Eriksen Flanker task, recorded by Brain Products' EEG/ERP recording system,and the EEG signals were analyzed off line by Brain Analyzer software. Results There were no significant differences between two groups at age, gender composition, handedness and education (P ＞ 0.05 ), the scores of HAMA, SAI and TAI were significantly higher in GAD group than NC group( t = 8.225, P ＜ 0.001; t = 4.093, P ＜0.001; t = 6.742, P ＜ 0.001 ) ,there were no significant difference in behavioral reactions between two groups (P ＞0.05) except for non-response rate(GAD:(15.29 ± 18.18)% ,NC:(7.23 ±7.99)%; t=2.184, P=0.035).The ERN amplitudes of GAD group were larger than these of NC group( FCz: GAD: ( -8.76 ±5.74) μV,NC:( -6.91 ± 3.07 )μV, F = 6.924, P = 0.012), yet the ERN latency did not show any significant group difference.There were no significant correlations between HAMA scores and ERN amplitudes/latencies. Conclusion The increased amplitudes of ERN possibly reflect the abnormally activated internal error monitoring process in GAD patients.

he blood supply of corpus callosum is rich, its function is complex, and the incidence of infarction is low. The risk factors and etiology for callosal infarction do not have any difference with the infarction in other parts of the brain. The clinical manifestations of the disease are complex and diverse. The two classical clinical manifestations are callosal disconnection syndrome and frontal-type gait disorder, but hemiplegia, monoplegia, apraxia, and mental retardation are common in clinical practice. The positive rate of CT scan is lower. MRI has higher sensitivity and specificity for callosal infarction. The diagnosis of callosal infarction is not difficult according to the history and imaging examination, however, it needs to be differentiated with other diseases that likely involve corpus callosum. Most of the patients with callosal infarction have good prognosis.

Objective To investigate the safety and efficacy of endoscopic duodenal papillary muscle small incision(EST)combined with duodenal papillary balloon dilation(EPBD)in the treatment of elderly patients with bile duct stones.Methods 100 elderly patients with bile duct stones were treated with endoscopic stone removal. Among them,55 patients were treated with SEST combined with EPBD(EPBD group),45 patients were treated with a single EST(EST group),the rate of stone removal,the occurrence rate of lithotripsy and the incidence of complications were compared between the two groups.Results The SEST +EPBD group at a time calculi clearance rate,postopera-tive hyperamylasemia,post pancreatitis,cholangitis were 98.2%,7.3% and 3.6%,1.8%,the EST group were 97.7%,6.7%,6.7%,3.6% and the difference between the two groups had no significant(all P >0.05).The SEST+EPBD group of gravel formation rate was 3.6%,lower than 13.3% in the EST group,the difference was statistically significant(χ2 =9.647,P <0.05).The SEST +EPBD group had no bleeding,bleeding in EST group incidence rate was 11.1%,the difference was statistically significant(χ2 =11.235,P <0.05);The recurrence rate of the SEST +EPBD group was 1.8%,which was lower than 11.1% in the EST group,the difference was statistically significant (χ2 =10.113,P <0.05 ).Conclusion EST combined with EPBD in the treatment of elderly common bile duct stones is safe and effective,which can significantly reduce the incidence of debris and bleeding,reduce the recurrence rate of common bile duct stones.

Objetive To explore the feature and influence of psychological trauma of severe physical violence (SPV) perpetrators with or without violent pedigree,and to provide theoretical basis in the intervention of domestic violence.Methods The cases of domestic violence were identified based on appeals for help to police stations,local Women' s Federations,Residents' Community Committee,Center of Community Health Services,the judicial branch of city governments.The subjects were screened,recruited and divided into the group of the abusers with violent pedigree(AP,n=136),the group of abusers without violent pedigree (ANP,n =105),the group of non-abusers with violent pedigree(NAP,n=105) and the group of non-abusers without violent pedigree(NANP,n =198).The features and influence of psychological trauma in four groups were compared.Results (1) In AP group,above 6 traumatic events got 66.1 percent.The median of the number of traumatic events in AP group was 7,and outstanding statistical significance existed among four groups(P＜0.01).(2)The scores of avoidance (1.37± 0.79) and intrusion(1.40±0.80) and added scores of IES-R(4.08±2.30) in AP group were significantly higher than the other groups,while the scores of hyper-vigilance (1.31 ± 0.88) were higher than NAP (0.95 ± 0.75) and NANP group(0.94±0.83).The scores of intrusion(1.22±0.83) and hyper-vigilance (1.14±0.85) in ANP group were significantly higher than those in the NANP group(P＜0.05).(3)The scores of witness DV,childhood emotional,physical and sexual abuse and the numbers of traumatic events were positively related with the traumatic symptoms.Conclusion The traumatic experiences are significantly correlated with severe physical violence behavior among violence perpetrator with violent pedigree.Some traumatic experiences may be the protective factors of domestic violence behavior.In the violent pedigrees,abusers have the most severe traumatic symptoms and their traumatic symptoms,especially intrusion and hyperarousal symptoms,are positively correlated with severe physical violence behavior.

Objective To investigate the effects of left dorsolateral prefrontal cortex with 10HZ , 80%motor threshold repetitive transcranial magnetic stimulation ( rTMS ) on the cognitive function in unipolar depression. Method Sixty-nine patients with unipolar depression were randomly assigned to either the real rTMS group or the sham rTMS treatment( the control group) ,all patients were given extended releasing venlafaxine. the cognitive function was evaluated using P300 and Repeatable battery for the assessment of neuropsychological status ( RBANS-immediate memory, visuospatial, language, attention, delayed memory, total score), Wisconsin card sorting test ( WCST-Right responses, Completed categories, Total errors , Preservative errors, Nonpreservative errors ). The depression severity was assessed with the 24-item Hamilton Rating Scale for Depression(HAMD-24). All of tests were examined before and after six weeks with thirty times rTMS. Results At the end of six weeks treatments, regarding the WCST,real rTMS group showed better improvement in the right responses than control group(33.23±10.29 vs 27.09 ± 9.82, F= 16. 116 , P= 0. 000), besides right responses, real rTMS group had better performance in the rest items than control group(F=4.862 ～ 17.758, P= 0.031 ～ 0.000) ;concerning the RBANS, real rTMS group was significantly superior to control group in total score( (88.83 ± 16.48 ) vs (78.85 ± 13.51 ), F= 8. 425,P = 0. 005 ), besides total score , the real rTMS group had better performance in some rest factors than control group (F= 10.088 ～20. 801, P=0. 002 ～0.000);real rTMS group showed better improvement in the amplitude of P3than control group( (8.27 ± 2.97 ) μV vs ( 7.37 ± 2.66) μV, F= 5. 838 , P=0.018 ) ;real rTMS group demonstrated better improvement in HAMD-24 than control group( (4.7 ±2.4)vs ( 11.2 ±5.1 ), F= 29.537, P=0. 000).Conclusion rTMS can significantly improve cognitive function and depressive symptoms with unipolar depression.

Objective To evaluate the clinical value of 64-slice spiral CT,MRI + magnetic resonance cholangiopancreatography (MRCP) on suspected biliary obstruction.Methods Eighty-five patients with suspected biliary obstruction were examined by 64-slice spiral CT,MRI + MRCP,compared with the pathological results.The accuracy rate of CT,MRI + MRCP,CT + MRI + MRCP in evaluating the sites and nature of obstruction were calculated.Results The accuracy rate of evaluating the site of obstruction in CT was 96.5％ (82/85),MRI + MRCP was 97.6％ (83/85),difference was not statistically significant (P ＞ 0.05).The accuracy rate of evaluating the nature of obstruction in CT was 81.2％ (69/85),MRI + MRCP was 87.1％ (74/85),CT +MRI + MRCP was 94.1％ (80/85),there was no statistically significant difference between MRI + MRCP and CT with CT + MRI + MRCP (P ＞ 0.05),difference was statistically significant between CT and CT + MRI + MRCP (P ＜ 0.05).Conclusion A comprehensive analysis of CT,MRI + MRCP can increase the accuracy of diagnosis biliary obstruction.

Objective To explore the effect of flexible laser endotracheal intubation optical device (patent number 201520785723.7) on oral and maxillofacial intubation operations. Methods Forty-two patients with the oral and maxillofacial intubation optical device for general anesthesia were included in this study. The patients were from 16 to 73 years old and ASAⅠ-Ⅱ. Surface anesthesia was prepared for airway and nasal cavity. There were 27 patients whose mouth opening were smaller than 3 cm. After intravenous injection of midazolam 0.05 mg/kg and sufentanil 0.2μg/kg, reinforced endotracheal tube was inserted into throat 13-15 cm, then the probe shape to 120° and optical device were placed into the tube respectively, guided the tube according to the light spot in front of neck. There were 15 patients whose mouth opening were not smaller than 3 cm. The quick guidance optical device and larygoscope were adopted to help the intubation. After intravenous injection of midazolam 0.05 mg/kg, sufentanil 0.5 μg/kg, propofol 2 mg/kg, cisatracurium 0.2 mg/kg, the reinforced endotracheal tube was inserted into the oral cavity nasally, and completed intubation with laryngoscope. The success rate of intubation, time of intubation, the real-time blood pressure before and after intubation, heart rate and related complications were recorded before intubation and after intubation. Results In the 42 patients, 41 patients were successful for guidance intubation, and the success rate of intubation was about 97.6%. The average intubation time was(124.5±38.2) seconds. The shortest intubation time was 12 seconds and the longest was 276 seconds. During intubation, the increases of blood pressure and heart rate were in the normal range (<30%). Levels of SpO2 were maintained at 0.92-1.00. All the patients were without agitation. There were no serious complications such as hoarseness and pharyngalgia after operation.Conclusion The flexible laser endotracheal intubation optical device can be used quickly for oral and maxillofacial intubation, and the 45° bevel design for optical device can form two kinds of zones with bright light upward and downward. It is a new tool for nasal intubation that is more convenient for location of light guidance, and has high success rate and small stimulation.

Objective To evaluate the therapeutic effect of lamivudine in the treatment of HBV-related liver failure.Methods We collected the literature on lamivudine used to treat liver failure in randomized control trail or clinical control trial studies from January 1989 to July 2007.All these clinical trials were carried out by comparing lamivudine treatment with routine medical treatment for liver failure.The literature must concern about mortality,total bilirubin(TBIL)or prothrombin activity(PTA).Odds ratio(OR)was applied to evaluate the effect of glucocorticoid to improve case fatality.Weighted mean differences(WMD)was applied to evaluate the effect of lamivudine to improve TBIL and PTA.Results There were only 13 literatures obtained,among them all about mortality,and 10 about TBIL and PTA.Effective index was 0.29(95%CI:0.21,0.40),-0.88(95%CI:-1.27,-0.48)and 0.60(95%CI:0.42,0.78)respectively for the 3 indexes.Conclusion Combination with lamivudine is more effective in treatment liver failure than only routine medical treatment.

Objective To study the sectional anatomy of the cardiac septum to provide the reference for clinical imageology and surgery. Methods Sixteen normal adult hearts without organic lesions were verified macroscopically. After vascular perfusion, the specimens were embedded with gel, fixed with 5% formalin, and cryopreserved for a week, and then were sectioned with the Digital Sectioner. Results A total of 1 608 slices (thickness: 0.2 mm) of the heart were obtained. Cardiac septum and the surrounding structures were shown clearly. The demarcation of connective and muscular tissues was clear. The diameters of the cardiac apex, fossa ovalis, brawny intraventricular septum, left ventricle, right ventricle, left and right fibrous trigone were measured with Photoshop6.0. Conclusion The clear images can display tiny structures that could be measured, which could provide anatomical references clinical imageology and surgery.