In recent years,with the continuous development of endoscopic and interventional techniques,many new devices and methods have been used in clinical practice,and the application of endoscopic retrograde cholangiopancreatography (ERCP)in biliary and pancreatic diseases has developed rapidly.This paper reviews and summarizes the recent progress in ERCP among patients with biliary and pancreatic diseases,including those with altered gastrointestinal anatomy,pregnant patients,patients with benign and malignant biliary strictures,and patients with pancreatic pseudocysts,as well as the application of SpyGlass,photodynamic therapy,and radiofrequency ablation,the man-agement of ERCP-related duodenal perforation,and the prevention of post-ERCP pancreatitis.All the progress has made a great contribu-tion to the diagnosis and treatment of biliary and pancreatic diseases.

Objective To explore the influencing factors of heart failure among patients with continuous ambulatory peritoneal dialysis(CAPD).Method Clinical data were collected from the histories of 158 patients receiving CAPD to investigate the factors inducing heart failure for the purpose of finding out the potential independent influencing factors using t test or chi-square test for univariate analyses and logistic regression in multivariate analyses.Results The incidence of heart failure was 36.71%among the enrolled CAPD patients.Single factor analysis showed that level of volume management,age,hemoglobin,serum pre-albumin, cholesterol and c-reactive protein were related to heart failure.Analysis of multiple variables logistic regression revealed that levels of volume management,serum pre-albumin and blood urea nitrogen were related to heart failure.Conclusions It is an easy,effective and cheaper way for nurses to increase patients’ability of volume control.The strategy including remedying malnutrition and decreasing the level of uremic toxins might be effective for delayed exacerbation of cardiac function among CAPD patients.

Objective To explore the application of laparoscopy in non-traumatic acute abdominal emergency. Methods The authors retrospectively analyzed 201 cases of emergency laparoscopy between March 1999 and May 2002. Results All the 201 patients were unequivocally diagnosed during operation. Laparoscopic operations were successfully completed in 190 cases (139 cases of acute appendicitis, 21 cases of acute cholecystitis, 19 cases of upper gastrointestinal tract perforation, 10 cases of intestinal obstruction and 1 case of common bile duct stones accompanied with acute cholecystitis), with a success rate of 94.5% (190/201). The remaining 11 patients underwent a conversion to open surgery. Conclusions Emergency laparoscopic exploration can not only clarify a diagnosis for acute abdominal emergency with unknown causes but also simultaneously offer a therapeutic method in at least 90% of cases.

Objective To analyze the effect of calcitonin combined with alfacalcidol on clinical outcome,lumbar vertebrae bone mineral density and safety in patients undergoing internal fixation of humeral shaft fracture.Methods 80 patients with humeral shaft fracture treated with internal fixation in Xunwu county people's hospital from June 2010 to June 2016 were selected,and randomly divided into control group and observation group,40 cases in each groups.The control group was given calcium carbonate D3 tablets and functional exercise therapy,the observation group treated calcitonin combined with alfacalcidol on the basis of control group,analysis and comparison the clinical effects,lumbar spine BMD and safety.Results Compared with before treatment,serum calcium level of two groups increased significantly at treatment 2 weeks and 3 weeks(P<0.05);The control group BMD of lumbar spine was significantly increased in treatment 12 weeks(P<0.05),the observation group BMD of lumbar spine was significantly increased in treatment 4 weeks and 12 weeks(P<0.05).Compared with control group,the level of serum calcium in observation group was higher at treatment 2 weeks and 3 weeks (P<0.05),BMD of lumbar spine was higher at treatment 4 weeks and 12 weeks(P<0.05);The total adverse reaction rate of observation group was 10%,the difference was not statistically significant to control group 15%.Conclusion The combination of calcitonin and alfacalcidol treatment of internal fixation of humeral shaft fractures in patients with significant results, can improve serum calcium levels in patients with and improve bone mineral density, and less adverse reactions.

Based on the extensive experience in circuit serving for military medical equipment,problems in managing military medical equipment are discussed and solutions are proposed so as to strengthen management standardization of medical equipment in basic unit army and enhance the support ability of medical equipment.

Objective:The fingerprint chromatograms were established for quality evaluation of Sedum aizoon L.collected from different habitats by HPLC.Methods:The analysis was performed on a Diamonsil C18 column(4.6mm? 250mm,5?m)with acetonitrile-water(acidified to 0.5%with phosphoric acid)as mobile phase in a gradient mode at a flow rate of 1.0 mL/min,and at a column temperature of 25℃.The detection of wavelength was at 254 nm.Results:2lpeaks were selected as the common fingerprint peaks.The relative standard deviations for relative retention values and relative peak areas were less than 3%in the precision and repeated test.The similarity of l0 batches of samples were no less than 0.9.Conclusion:The method was reliable and can be helpful on the quality control of Sedum aizoon L.

Objective To analyze the effectiveness of doctor-patient communication course on improvement of doctor-patient communication ability.Methods Totally 360 eight-year program medical students of clinical medicine from Shanghai Jiaotong University School of Medicine were chosen as the research object and were divided into educational group(n＝l80) and control group(n＝180).Students in educational group study doctor-patient communication course while those in control group do not.SEGUE Framework was used to conduct exploratory research between educational group and control group.Accuracy of questionnaire database was examined by Excel software and logical test.KoImogorov-Smimov(K-S test) was applied to analyze the scores and (x ± s) was used to express the data through SPSS 16.0 statistical software.Comparison between group differences are statistically significant(P＜0.05).Results Overall score was higher in educational group than in control group.Concerning of communication initiation,infomation collection and understanding of patients,scores of educational group were significantly higher than those of control group(P=0.001,P=0.002 and P=0.007,respec-tively).Furthermnore,KoInogorov-Smimov(K-S test) and (x ± s) statistical results showed that scores of detailed items were higher in educational group than in control group as well.Conclusions Doctor-patient communication course is of great importance to help medical students practice physician-patient communication based on related knowledge learning,but course content setting remains to be further improved.

Objective: To investigate the bonding strength of different resin composites .Methods:Methacrylate-based resin APX and silorane-based resin composite P90 were chosen in this study , with their corresponding adhesives Clearfil SE Bond ( SE) and Filtek P90 System Adhesive ( SA) .The speci-mens were divided into three groups:(1) bulk group, filling each block with the same composite , then curing;(2) direct filling group, curing and polishing one composite , then filling a new composite direct-ly;( 3 ) bonding group , after curing and polishing one composite , conditioning the surface with adhe-sives, then filling a new composite.Cut each resin blocks into 1 mm ×1 mm ×14 mm each piece, detec-ting the microtensile strength , and analyzing by One-Way ANOVA and LSD .Results: ( 1 ) The micro-tensile strength of the bulk group was the highest .(2) In direct filling group, the microtensile strength of 4 subgroups showed no statistical significance with each other but lower than that of the bulk group .(3) In bonding group, the microtensile strength of repairing with APX was higher than that with P 90.When repairing with same composite , the microtensile strength was higher if the resin type of substrates was same with restorations than that was different .The microtensile strength of adhesives SE was higher than that of SA.(4) The sorting of the microtensile strength: bulk>SE bonding APX >SA bonding APX>SE bonding P90=direct filling>SA bonding P90.Conclusion:Retention force is higher when substrates are repaired with methacrylate-based resins and corresponding adhesives .Retention force is lower when repaired with silorane-based composites and corresponding adhesives .Types of the substrate composites show no influence on the bonding strength .

Objective To evaluate the effect of serum LH level on the day of superovulation start on the prolonged gonadotropin-releasing hormone ngonist therapy on the outcomes of in vitro fertilization and embryo transfer (IVF-ET) in patents with ovarian endometriomas. Methods 75 patients with ovarian en-dometriomas were treated by laparoscopic cystectomy or laparotomy cystectomy or ultrasound-mediated cysts puncture, and gonadotropin-releasing hormone agonist (GnRH-α) was given for 3 to 4 times every 28 days after the operation. Superovulation started after 14 ～ 84 days of the last injection. All the patients were di-vided into two groups according to the level of serum LH. Group A included 30 patients whose level of LH was less than 0. 5IU/L, and group B included 45 patients whose level of LH was over 0.5IU/L and less than 1.5IU/L. The outcomes of IVF-ET were evaluated. Results The total ampoules of Gn administration and the ampoules of hMG needed in group A[(32.28±7.7) ampoules, ( 12.0±8. 9) ampoules,]were sig-nificantly more than that in group B[( 25.84±7. 1 ) ampoules, ( 6. 19±7.4) ampoules, P < 0.05] . The successful embryo implantation rate in group A( 18. 1% ) was lower than group B(26. 7% ), and the differ-ence has statistical significance ( P <0. 05). Conclusion The low level of serum LH on the superovula-lion day on the prolonged gonadotropin-releasing hormone agonist protocol will increase the ampoules of Gn administration and decrease the successful embryo implantation rate of IVF-ET, thus LH should be a more important reference parameter of superovulation start.

Adult ; Aged ; Aged, 80 and over ; DNA Primers ; Female ; Humans ; Lymphoma ; genetics ; Male ; Middle Aged ; Mutation ; Myeloid Differentiation Factor 88 ; genetics ; Polymerase Chain Reaction