The choledocho-pancreatico-duodenal junc-tion is located at the central part of choledocho-pancreatico-duodenal region. During early embryogenetic stage, the primary duodenum develops from the end of foregut and the beginning part of the midgut. The dorsal pancreas, hepatic diverticulum and the ventral pancreas which arises from the basic part of hepatic diverticulum are growing and rotating following the duodenum. During the course, the formations of the choledocho-pancreatico-duodenal region and the central part of choledocho-pancreatico-duodenal junction are complete. The injuries in cho-ledocho-pancreatico-duedenal junction may be caused by metal probe or lithotomy forceps for exploring, dilatating the distal bile duct or taking out the stones from the bile duct. Even if the injuries of choledocho-pancreatico-duodenal junction are deve-loped in a limited scope of several centimeters, several adjacent organs may be involved. Injuries in choledocho-pancreatico-duo-denal junction are hard to be identified during operation and may develop into serious pathological procedures.

Conflicts may occur between patients' independent decision right,family members' interference right,and medical interference right.This article clarifies the applicable premise of medical interference right and explores its realistic predicaments from the ethical and legal perspectives.Reasonable system construction is a good solution to medical disputes,promoting a harmonious development of physician-patient relationship.

Objective To invetigate clinical characteristics,pathogenesis and its risk factors of neuropsychi-atric lupus erythematosus(NPLE).Methods 160 cases of SLE patients,including 30 cases of diagnosed NPLE,were analyzed retrospectively.The relationship between the appearance of NPLE and common autoantibodies,other organ involvement and SLE disease activity score(SLEDAI)were analyzed.Results Such antibody positive rates of anti nuclear antibody(ANA),anti Sm antibody,anti -RNP antibody,anti SSA antibody,anti ds -DNA antibody had no significant difference between NPLE and non NPLE,the value of χ2 was 0.947,0.013,1.194,0.023,0.745 respectively,the value of P was 0.194,0.910,0.274,0.879,0.388 respectively.Renal involvement,raynaud phenomenon,interstitial pneumonia,pulmonary thromboembolism,oral ulcer,arthritis,facial erythema,pleuritis,pericarditis,fever,pulmonary hypertension,photo -allergy and alopecia in the two groups had no difference,the value of χ2 was respectively 0.419,1.383,0.721,0.201,1.368,1.194,0.055,0.946,0.262,2.503,0.628,2.898 and 0.075,the value of P was 0.517,0.324,0.396,1.000,0.242,0.274,0.815,0.331,0.609,0.114,0.428,0.089 and 0.785 respectively.But the occurrence of hand and foot vasculitis in NPLE was significantly higher(χ2 =3.996,P =0.046).SLEDAI of NPLE was higher than non NPLE(t =8.446,P =0.000).Conclusion There was no correlation with the occurrence of NPLE and common autoantibodies,other organ involvements.Hand and foot vasculitis and higher SLEDAI(more than 15 points)were the risk factors of NPLE.Encephalopathy may be the initial manifestation to some of SLE cases. Early diagnosis and methylprednisolone pulse treatment combined with immunosuppressive therapy can effectively improve the remission of the disease,reduce mortality and improve prognosis.

Objective To evaluate the effect of exogenous epidermal growth factor (EGF) on promoting nerve regeneration after terminolateral neurorrhaphy (TLN). Methods Thirty-two adult Wistar rats were randomly divided into 2 groups. In the EGF group,the left peroneal nerve was transected,then an 1mm epineural window was created on the neighbouring tibial nerve. The distal end of peroneal nerve was sutured to the windowed tibial nerve by means of end-to-side attachment. in the control group,nerve TLN was performed as In the EGF group. Injection of EGF/normal saline (20?g/10?l) and normal saline (10?l) was done at the distal site of peroneal nerve transected in the EGF group and control group for two weeks respectively. Histological,morphological and electrophysiological examinations were performed in 4 and 8 weeks after the operation. Results The cross area of the regenerated myelinated nerve fibres,axon numbers,motor nerve conduction velocity were significantly better in the EGF group than in the control group ( P

Objective To study the clinical significance of Raynaud phenomenon (RP) in systemic lupus erythematosus(SLE).Methods One hundred and twelve cases with SLE were divided into two groups according to the condition of RP and were analyzed retrospectively.The similarities and differences were investigated in system injury and laboratory examination in two groups.Results The occurrence rates of pulmonary arterial hypertension (PAH),interstitial lung disease (ILD),pericarditis,fatigue,pulmonary embolism (PE) and deep venous thrombosis (DVT) in patients with RP were higher than those in patients without RP [89.3％(25/28) vs.2.4％(2/84),57.1％(16/28) vs.16.7％(14/84),75.0％(21/28) vs.39.3％ (33/84),67.9％(19/28) vs.33.3％(28/84),21.4％(6/28) vs.4.8％(4/84),14.3％(14/28) vs.1.2％(1/84) ](P ＜ 0.05 ).The positive rates of anti-cardiolipin (ACL) antibody,anti-RNP antibody,anti-Sm antibody and LA in patients with RP were higher than those in patients without RP [46.4％(13/28) vs.9.5％(8/84),75.0％(21/28) vs.33.3％(28/84),57.1％(16/28) vs.23.8％(20/84),17.9％(5/28) vs.2.4％(2/84)] (P ＜0.05),while leucopenia in patients with RP was lower than that in patients without RP [7.1％(2/28) vs.45.2％ (38/84)] (P =0.001).Conclusion Heart,lung and vascular lesions such as PAH,ILD,pericarditis,PE and so on are easier to occur in SLE with RP,furthermore the positive rates of ACL,anti-RNP antibody,anti-Sm antibody,and LA are higher than those without RP.

Objective To investigate the serum expressions and clinical significance of Dickkopf-1 in patients with rheumatoid arthritis (RA). Methods The clinical data of 139 patients with RA were retrospectively analyzed, including the disease history, tender joint count (TJC), swollen joint count (SJC), platelet, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), anti-nuclear antibody (ANA), antikeratin antibody (AKA), anti-perinuclear factor (APF), anti cyclic citrullinated peptide antibody (anti-CCP), Dickkopf-1 and radiological (X-ray) staging. The disease activity scale (DAS) was evaluated, and the ESR and CRP levels were included. The relationship between Dickkopf-1 and the clinical data of RA, DAS44 score was analyzed. Results The serum level of Dickkopf-1 in patients with RA was (2.70 ± 0.46) μg/L. There was no relationship between serum Dickkopf-1 level and gender, age, course of disease, CRP, platelet, ANA, AKA, APF, RF, radiological staging in patients with RA (P>0.05). The serum Dickkopf-1 level was significantly associated with TJC, SJC, ESR, DAS44-ESR score, DAS44-CRP score and anti-CCP (r = 0.200, 0.291, 0.178, 0.222, 0.199 and 0.278, P = 0.019, 0.001, 0.037, 0.009, 0.028 and 0.012). Conclusions The serum Dickkopf-1 expression level is closely related to the occurrence and development of RA. Dickkopf-1 may contribute to diagnose the disease activity in patients with RA.

[Objective]Primarily discuss cases selection and operation skill of hip joint superficial substitution.[Method]From Oct.2004 to Feb.2007,10 hip joints of 8 cases were made superficial substitution,paying attention on cases selection and operation skill.[Result]All cases had no such complications as femur neck fracture,infection,joint dislocation,vessel or nerve injury,deep vein embolism or ectopic ossification in early stage.The patients' score increased to 93~99 and average 95 from 35~56 and 45 before operation,the unequal limbs were corrected for DDH cases.On X-ray measurement:40?~50?for acetabula abduction angle,44?in average;134?~143?,139?for short-handle eversion angle of femur lateral;average off-set rate was 0.20 for femur neck;no loose prosthesis or narrow femur neck,no bright zone around short-handle.[Conclusion]Hip joint superficial substitution is very fit for young people with much sports,but we should pay attention to case selection and operation skill.

Objective To find out the microalgae species in the spring water and the pollution route in the production process of drinking spring water. Methods 42 samples were collected from the workshop, the spring source, the product line and the repeated barrels in a water plant. The microalgae were examined by microscope, CCD imaging system and scanning electron microscope. Results 18 microalgae species were detected from the 42 samples including 4 species in Cyanophyta, 9 in Chlorophyta, 4 in Bacillariophyta and 1 in Euglenophyta. The dominant species occurred in samples of the floor around the workshop and the floor beside the wellspring bump were Achnanthes biasolettiana and Cymbella affinis, in the spring source were Chlamydomonas sp. and Ulothrix tenerrima, in the spring water barrel was Scenedesmus obliquus. Chlorella vulgaris was detected in all processes before the super-filter,and after filtered, no microalgae was detected, but in the product water, Chlorella vulgaris was still detected after enriched culture. Conclusion Usually, the microalgae polluted drinking spring water products is mainly Chlorella vulgaris and the pollution route is reusing of barrels.

Objective:To explore the effect of Citalopram on clinical symptoms of chronic schizophrenia and life quality of female patients.Methods:52 female patients with chronic schizophrenia were divided into the research group(n=30)and the control group(n=22).Originally used drugs were retained for both groups , Citalopram was added in research group, and placebo was added in control, both for 12 weeks.PANSS, GQOLI-74, CGI-SI were used to evaluate the effects. Results:At the end of treatment, the total scores of PANSS, factor scores of negative symptoms, general psychopathology, lack of reaction, and depression significantly decreased in the research group (data P

The purpose of this study is to explore the clinical application of an improved operating astral lamp. Most operating astral lamps now used in hospitals are not equipped with protective equipment for sudden power cut. Once the power cut occurs, the operation will be influenced and a medical dispute between patients and medical staffs can not be avoided.