Objective To summarize the clinical characteristics and investigate the prognostic factors of primary duodenal carcinoma.Methods The clinical data of 122 patients with primary duodenal carcinoma who were admitted to the Shengjing Hospital Affiliated to China Medical University from November 2007 to May 2013 were retrospectively analyzed.All the patients received different operations according to the characteristics of tumors.Primary duodenal carcinomas of patients were confirmed by the postoperative pathological diagnosis.All the patients were followed up by outpatient examination, telephone interview and correspondence till November 30,2014.The treatment process, results of imaging examination and laboratory examination and postoperative survival were recorded.The clinical features, diagnostic criteria, therapeutic regimens and prognostic factors were analyzed.The survival rate and survival curve were analyzed and drawn by the Kaplan-Meier method.The univariate analysis was done using the Log-rank test, and multivariate analysis was done using the COX regression model.Results Among the 122 patients with primary duodenal carcinoma, jaundice as the first symptom was detected in 57 patients, abdominal pain and upper abdomen discomfort in 37 patients, gastrointestinal obstruction in 14 patients,anorexia and reduction of body weight in 4 patients, gastrointestinal hemorrhage in 3 patients, diarrhea in 3 patients, pyrexia in 3 patients and abdominal mass in 1 patient.The positive rates of CT examinations, endoscopic examinations, magnetic resonanced cholangio-pancreatography (MRCP), B-ultrasound examinations and upper gastrointestinal contrast examinations were 69.67％ (85/122), 85.56％ (77/90), 79.76％ (67/84), 12.73％ (7/55) and 75.00％ (36/48), respectively.Among the 122 patients, anemia was detected in 48 patients,positive fecal occult blood test in 94 patients, increasing level of CA19-9 in 71 patients, increasing level of CEA in 22 patients and increasing level of AFP in 9 patients.The tumors located at the descending part of duodenum,duodenal bulb and horizontal part of duodenum were detected in patients of 86.07％ (105/122), 7.37 ％ (9/122) and 6.56％ (8/122), respectively.The mean diameter of tumors was 2.3 cm (range, 1.0-15.0cm).All the 122 patients received operation.Pancreaticoduo-denectomy was performed in 100 patients, including combined with jejunostomy in 17 patients, pylorus-preserving pancreatoduodenectomy in 7 patients, segmental resection of duodenum and gastrojejunostomy in 5 patients, local resection of duodenal papilla in 6 patients and palliative gastrojejunostomy in 11 patients.Nineteen patients with complications were cured by symptomatic treatment.Of the 122 patients, adenocarcinoma, carcinoid tumor, lymphoma, small cell carcinoma, intraepithelial neoplasm combined with differentiated rhabdomyoma and with undifferentiated rhabdomyoma were detected in 116, 2, 1, 1,1 and 1 patients, respectively.The Ⅰ , Ⅱ , Ⅲ and Ⅳ stage of tumors were detected in 10, 4, 74 and 34 patients.There were 100 patients without lymph node metastasis, 13 patients with 0 ＜ metastatic lymph node ratio (MLR) ≤0.2, 4 patients with 0.2 ＜ MLR≤0.4 and 5 patients with MLR ＞ 0.4.One-hundred and twelve of 122 patients were followed up for 1-70 months with a median follow-up time of 20 months.The postoperative survival time, a median of survival time, postoperative 3-and 5-year survival rates were 1-70 months, 18 months, 36.6％ and 13.5％ , respectively.The results of univariate analysis showed that the lymph node metastasis, differentiated grade of tumor, MLR and with invasion of pancreas were risk factors affecting the prognosis of patients (x2 =8.465, 57.355, 16.232, 20.112, P ＜ 0.05).The multivariate analysis showed that the low-differentiation of tumor, invasion of pancreas, lymph node metastasis and MLR ＞ 0.4 were independent risk factors affecting the prognosis of patients (RR =3.330, 3.718, 2.623, 95％ confidence interval: 1.861-5.956, 1.292-10.696,1.624-4.236, P ＜ 0.05).Conclusions Most of the primary duodenal carcinomas are located at the descending part of duodenum without specific clinical symptoms in the early stage.The joint usage of assistant examinations can improve the diagnostic rate of primary duodenal carcinoma, and surgery is mainly therapeutic method.The low-differentiation of tumor, MLR ＞ 0.4 and invasion of pancreas are independent risk factors affecting the prognosis of patients.

Objective To evaluate the effect of butorphanol combined with dexmedetomidine on postoperative hyperalgesia induced by remifentanil in patients.Methods One hundred and twenty patients,of ASA physical status Ⅰ or],aged 20-64 yr,weighing 45-88 kg,undergoing elective gynecological laparoscopic surgery,were randomly allocated into 4 groups (n =30 each) using a random number table:control group (group C),butorphanol group (group B),dexmedetomidine group (group D) and dexmedetomidine + butorphanol group (group B+D).In group D,dexmedetomidine 1.0 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.7 μg·kg 1·h-1 until the end of operation.In group C,the equal volume of normal saline was given instead before skin incision.In group B,butorphanol 20 μg/kg was injected immediately before skin incision.In group B+D,dexmedetomidine 0.5 μg/kg was infused at 10 min before induction of anesthesia,followed by continuous infusion at 0.5 μg· kg-1 · h-1 until the end of operation,and butorphanol 15 μg/kg was injected immediately before skin incision.Anesthesia is induced with iv midazolam 0.05 mg/kg,sufentanyl 0.2-0.3 μg/kg,rocuronium 0.7 mg/kg and propofol 2.0 mg/kg.After tracheal intubation,all the patients are mechanically ventilated,and PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with iv infusion of remifentanil 0.3 μg · kg-1 · min 1 and propofol 4-6 mg·kg 1·h-1 and intermittent iv boluses of rocuronium 0.3 mg/kg.BIS value was maintained at 40-60.Patient-controlled intravenous analgesia (PCIA) with sufentanil was used after operation,and VAS score was maintained ≤ 3.At 30 and 60 min and 6,12,24 and 48 h after operation,the sufentanil consumption was recorded.The development of bradycardia and hypotension during operation and postoperative nausea and vomiting,dizziness and somnolence was recorded.Results Compared with group C,the sufentanil consumption and incidence of nausea and vomiting were significantly decreased in B,D and B+D groups,the incidence of dizziness and somnolence was increased in group B,and the incidence of bradycardia and hypotension was increased in group D.There was no significant difference in sufentanil consumption between B,D and B+D groups.The incidence of dizziness and somnolence was significantly lower in group B + D than in group B.The incidence of bradycardia,hypotension and somnolence was significantly lower in group B + D than in group D.Conclusion Butorphanol combined with dexmedetomidine provides better efficacy than either alone in reducing postoperative hyperalgesia induced by remifentanil in patients.

Objective To evaluate the clinical value of adriamycin injection via the foramen ovale and around peripheral trigeminal branches under the guidance of X-ray for treatment of primary trigeminal neuralgia by comparison with the three-dimensional computed tomography (CT).Methods A total of 91 patients with primary trigeminal neuralgia of both sexes,aged 33-76 yr,with the course of disease 6 months-24 yr,with visual analogue scale score of 6-9,were divided into 2 groups using a random number table:X-ray group (n =43) and CT group (n =48).Hartel anterior approach was used to puncture the foramen ovale in 2 groups.One point five percent adriamycin 0.2,0.3 and 0.5 ml were injected via the supraorbital foramen,infraorbital foramen and oval foramen.When pain relief was poor (visual analogue scalc scorc≥ 4) within 1 yr after treatment,oxcarbazepine and adjuncts (tramadol,flupentixol and melitracen tablets,etc.) were taken orally.The requirement for oxcarbazepine and adjuncts was recorded during 1 day-1 week,1 week-1 month,1-3 months,3-6 months and 6 months-1 yr after treatment periods.The operation time,the nuinber of puncture,and developinent and recurrence of complications during treatment and within 1 yr after treatment were recorded.Results Compared with CT group,the number of puncture and incidence of facial hematoma during treatment were significantly increased (P ＜ 0.05 or 0.01),and no significant change was found in the operation time,requirement for oxcarbazepine and adjuncts,incidence of dizziness,nausea and vomiting during treatment,or the incidence and recurrence rate of masticatory muscle weakness and facial numbness after treatment in X-ray group (P＞0.05).Conclusion Compared with the three dimensional CT,X-ray provides similar efficacy and safety when used to guide adriamycin injection via the foramen ovale and around peripheral trigeminal branches for treatment of primary trigeminal neuralgia,showing that X-ray guidance has significant clinical value.

Objective:To explore the role of activated CD4 + T cells in cardiac remodeling after myocardial infarction (MI). Methods:① Experiment in vitro: naive CD4 + T cells were isolated in mouse spleen, and then stimulated with plate-bound anti-CD3 and anti-CD28 for 48 hours. Exosomes isolated from the supernatant of activated CD4 + T cells were incubated with cardiac fibroblasts (CFs) for 48 hours, and then the ability of CFs proliferation, migration and differentiation were detected by cell counting kit-8 (CCK-8) assay, Transwell assay, and immunofluorescence assay. ② Experiment in vivo: 40 male C57 mice were divided into 4 groups according to random number table method, including control group (Ctrl group), sham operation group (Sham group), MI group, and exosome treatment group (MI+Exo group), with 10 in each group. The mice model of MI was established by ligating the left anterior descending coronary artery. In MI+Exo group, 40 μg/d exosomes were injected intravenously into the tail after modeling. Cardiac function and cardiac fibrosis post-MI were assessed by echocardiography and quantitative polymerase chain reaction (qPCR) at 4th week. Results:① In vitro: exosomes derived from activated CD4 + T cells significantly promote CFs proliferation, migration and differentiation [proliferation ability ( A value): 0.31±0.01 vs. 0.21±0.01, migration capability (cells/MP): 79.20±3.34 vs. 48.80±2.13, differentiation ability (α-smooth muscle actin, α-SMA; fluorescence intensity): 1.56±0.03 vs. 1.00±0.02, all P < 0.05]. ② In vivo: echocardiographic analysis showed that exosomes derived from activated CD4 + T cells aggravated the deterioration of cardiac dysfunction post-MI than MI group, as indicated by left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased significantly [LVEF: 0.185±0.008 vs. 0.257±0.022, FS: (9.72±1.72)% vs. (14.08±1.08)%, both P < 0.05], left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) increased significantly [LVEDD (mm): 5.43±0.29 vs. 4.62±0.35, LVESD (mm): 4.94±0.12 vs. 3.69±0.29, both P < 0.05]. Additionally, qPCR showed that exosomes derived from activated CD4 + T cells remarkably promoted myocardial fibrosis post-MI than MI group, as indicated by the mRNA expression of α-SMA, collagens (Col1a1, Col3a1) in MI+Exo group was significantly higher than that in MI group [α-SMA (2 -ΔΔCT): 4.72±0.89 vs. 3.58±0.78, Col1a1 (2 -ΔΔCT): 6.59±0.56 vs. 4.23±0.42, Col3a1 (2 -ΔΔCT): 13.40±1.03 vs.4.96±0.36, all P < 0.05]. Conclusion:Activated CD4 + T cells promote cardiac remodeling following MI through transferring exosomes to CFs.

Objective To evaluate the effectiveness of filter membranes made from different materials in monitoring the health status of rodents in barrier environment facilities by investigating their microbial capture performance. Methods Pasteurella pneumotropica (Pp) and Staphylococcus aureus (Sa) were used as representative strains to simulate the process of microbial capture by filter membranes under laboratory conditions. The microbial capture effectiveness of five self-selected filter membranes (M1, M2, M3, M4, and M5) with adsorption and breathability properties and a commercial filter membrane (T1) were comprehensively evaluated based on captured dust mass, minimum detection limit, and differences in Ct values obtained through fluorescence quantitative PCR detection. The best-performing self-selected filter membrane was placed in the ventilation ducts of cage racks within the barrier facility, with sentinel mice in corresponding cage racks as the control group. Staphylococcus epidermidis and Escherichia coli were used as indicator bacteria to calculate the positive detection rate and coincidence rate, thereby exploring the feasibility of using microbial capture filter membranes to monitor the health status of experimental animals in barrier facilities. Results In terms of the captured dust mass, the self-selected filter membrane M3 (non-woven filter membrane with a diameter of 0.1 um)；showed a capture effectiveness second only to T1, with a capture mass of 0.126 g. For Sa, all filter membranes except M4 had a minimum detection limit of 10² CFU/g. For Pp, the minimum detection limit for all filter membranes was 10² CFU/g. However, the Ct value of the quantitative fluorescence PCR amplification results for M3 was significantly lower than that of other materials, indicating that M3 had the best capture performance among the five self-selected materials. In the filter detection verification experiment, the positive detection rate of Staphylococcus epidermidis in sentinel mouse feces and M3 was 50.00% (6/12) and 58.33% (7/12), respectively, with a coincidence rate of 92%. The positive detection rate of Escherichia coli in both sentinel mouse feces and M3 was 50.00% (6/12), with a coincidence rate of 100%. Conclusion Among the 5 self-selected filter membranes, M3 exhibits the best capturing performance. Within the barrier environment facilities, M3 outperforms sentinel mice in monitoring Staphylococcus epidermidis. Therefore, non-woven filter membrane with a diameter of 0.1 um； can be used as the material for microbial capture filter membranes, providing valuable insights for the selection and application of microbial capture filter membranes used in PCR monitoring of cage exhaust air dust.

Objective To analyze peripheral blood hemogram, lymphocyte micronucleus and chromosomal aberrations of radiologists, so as to provide basis for occupational protection and health monitoring of radiologists. Methods Lymphocyte micronucleus, chromosome and blood hemogram analysis were performed on 127 radiologists who received health examinations in 2015, 2017 and 2019, and they were assigned to the radiation group. In addition, 133 medical staff with no history of radiation exposure were selected as the control group. Results The micronucleus rate and chromosome aberration rate of the radiation group were higher than those of the control group, and the white blood cell and platelet counts were lower than those of the control group, both of which were statistically significant (P < 0.05). The total number of white blood cells in peripheral blood of 127 radiologists decreased gradually with the increase of exposure time to ionizing radiation, and the chromosome aberration rate increased gradually, all of which had statistical significance (P < 0.05). The rate of chromosomal aberration was higher in radiologists with damage work age of more than 20 years than in the low-work age group, and there was no statistical significance between different damage work age (P > 0.05). The chromosome aberration rate of nuclear medicine and interventional therapy was higher than that of other types, with statistical significance (P < 0.05). Conclusion Long-term exposure to low-dose ionizing radiation can reduce the total number of white blood cells and increase the chromosome aberration rate of radiologists. It is necessary to strengthen the protective measures for radiologists to reduce the degree of ionizing radiation damage, especially to strengthen the occupational protection for radiologists in nuclear medicine and interventional therapy.

Objective To evaluate the role of autophagy in the treatment of neuropathic pain(NP)with hydrogen-rich saline.Methods Forty adult male Sprague-Dawley rats with successful intubation were randomly divided into 5 groups(n= 8)using a random number table:the sham operation group(group S),the neuropathic pain group(group C),the hydrogen-rich saline group(group H),the autophagy inhibitor group(group M)and the hydrogen-rich saline + autophagy inhibitor group(group HM).There were 8 rats in each group.The NP model was established by chronic constriction of the sciatic nerve(CCI)in rats.The autophagy inhibitor 3-methyladenine(3-MA)was intraperitoneally injected with 30μg/kg in the group M and the group HM.The hydrogen-rich saline(0.6 mmol/L)was intraperitoneally injected with 10 mL/kg in the group H and the group HM.The other groups were intraperitoneally injected with the same amount of normal saline twice a day for 7 consecutive days.Paw withdrawal threshold to mechanical stimulation(MWT)and paw withdrawal latency to thermal stimulation(TWL)were measured at 1 day before and 1,3,5,7 and 14 days after modeling(T0-T5).After the last measurement of pain threshold,the L4-L6 segment of spinal cord was removed for determination of the expression of autophagy-related proteins microtubule-associated protein light chain 3(LC3)Ⅱ,Beclin-1 and p62 proteins by Western blot assay.The expression levels of superoxide dismutase(SOD)and malondialdehyde(MDA)in spinal cord tissue were detected.Results Compared with the group S,MWT and TWL were decreased in the group C at T2-5,the expression levels of LC3 Ⅱ,Beclin-1 and p62 were increased,SOD activity was decreased,and MDA content was increased at T5(P＜0.05).Compared with the group C,MWT and TWL were increased in the group H at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were increased,p62 protein expression levels were decreased,SOD activity was increased,and MDA content was decreased at T5(P＜0.05).MWT and TWL were decreased in the group M at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were decreased,p62 protein expression levels were increased,SOD activity was decreased,and MDA content was increased at T5(P＜0.05).Compared with the group M,MWT and TWL were increased in the group HM at T2-5,LC3 Ⅱ and Beclin-1 protein expression levels were increased,p62 protein expression levels were decreased,SOD activity was increased,and MDA content was decreased at T5(P＜0.05).Conclusion Hydrogen-rich saline can alleviate neuropathic pain and inhibit oxidative stress in spinal cord in rats,and the mechanism may be related to the increase of autophagy.