Objective To investigate the clinical application value, efficiency and safety of precut sphincterotomy in endoscopic retrograde cholangio-pancreatography (ERCP) .Methods From January 2008 to June 2011, 930 patients received ERCP in the department of hepatobiliary surgery of the first hospital of Jilin University.Of them 108 cases (11.6%) were diverted to receive precut sphincterotomy, because selective bile duct cannulation with conventional method was difficult.Inclusion criteria: failure of conventional cannulation or repeating pancreatic duct cannulation for more than 4 times.According to the patient's conditions, the examination and treatment of ERCP was carried out.Observation termination are therapeutic success rate and the incidence rate of complications, and comparative analysis on case data of routine ERCP was made.Statistical analysis was executed by SPSS 13.0 software.Comparison of ratio were determined with χ2 test, a value less than 0.05 was considered as significant.Results Of 108 cases, the success rate of ERCP was 95.4% (103 cases) .The incidence rate of complications was 6.5%, and there are no cases of duodenal perforation and death.Amongst 822 cases of routine ERCP, therapeutic success rate was 97.7%, and the incidence rate of complications was 7.7%.The statistics analysis result indicates that there are no statistical differences between precut sphincterotomy group and routine ERCP groups in the success rate (χ2=2.041, P=0.153) and the incidence rate of complications (χ2=0.141, P=0.707) .Conclusion The precut sphincterotomy in ERCP are safe and obviously effective with less complications compared to routine ERCP.The successful probability of difficult ERCP is improved greatly by using the technique of precut sphincterotomy.But the precut sphincterotomy indication is strictly controlled, and the technique should be performed by experienced endoscopist.

The problems in nursing postgraduate training in China are summarized,which include the ambiguity of subject orientation,absence of unified standard on training objective,imperfection of tutor team,uncertainty of research direction,lack of scientific research funds,etc.The countermeasures are then proposed,and the direction of nursing postgraduate education reform in China is discussed.

EML4-ALK fusion oncogene represents a new molecular target which appears mainly in lung adenocarcinoma.EML4-ALK is detected more frequently in young non-small-cell lung cancer patients who never or light smoke.ALK inhibitors(crizotinib)for the treatment of the EML4-ALK-positive non-small cell lung cancer has a high response rate.This finding can improve the individual treatment of non-small cell lung cancer.

Ultra-wide-field fluorescein angiography (UWFA) is a novel breakthrough in ocular fundus imaging technology, which can capture a single, high-resolution, 200° wide image of the ocular fundus that traditional fluorescein angiography cannot reach. This technology has important impacts on the screening, diagnosis, staging, treatment and follow-up of vascular diseases involving peripheral retina (such as diabetic retinopathy, age-related macular degeneration, retinal vein occlusion, uveitis and so on).

Objective To explore the clinical effect of intranasal dexmedetomidine as premedication on sedation and analgesia during painless electronic colonoscopy in children, and to investigate its optimal dose. Methods Ninety children scheduled for painless electronic colonoscopy were divided into three groups by using a computer?generated randomization schedule, 30 per group. Children were pretreated with 0. 2 mg/kg midazolam ( group A) , 1. 0μg/kg dexmedetomidine ( group B) or 2. 0μg/kg dexmedetomidine ( group C) by nasal drip 30 min before operation. The anesthesia protocol was programmed by propofol in the three groups. After eyelash reflex disappeared, the examination was performed. Mean artery blood pressure ( MAP ) , heart rate (HR), respiratory rate (RR) and oxygen saturation (SPO2) of children were recorded at 10 min before intranasal administration ( T0 ) , 30 min after intranasal administration ( T1 ) , at the onset of eyelash reflex disappearance ( T2 ) and the onset of examination initiating( T3 ) , at lens passing through splenic flexure ( T4 ) , or through hepatic flexure ( T5 ) , at the end of examination ( T6 ) and when patients were fully awake ( T7 ) , respectively. Bispectral index ( BIS) and the observer's assessment of alertness/sedation scale ( OAA/S) were performed at 10 min before intranasal administration ( T0 ) , 10 min, 20 min and 30 min after intranasal administration in the three groups. Mood score at parent?children separation and venipuncture acceptance score were also recorded. The adverse reactions during examination were analyzed. The above observed indices were compared among the three groups. If there was statistical difference ( P<0. 05 ) , pairwise comparison was performed ( P<0. 017) . Results The children's haemodynamics were all stable in the three groups. Compared with group A and group B at the same time point, BIS and OAA/S were all lower ( P<0. 017) in 10 to 30 min after intranasal administration in group C. Compared with group A and group B, mood score at parent?children separation and venipuncture acceptance score were both higher ( P<0. 017) in group C. Compared with group A and B, anesthetic revival time and consumption of propofol were shorter or lower in group C (P<0. 017). Compared with group A and group B, the incidences of intraoperative adverse reactions including hypertension, sinus tachycardia, restless moving and postoperative restlessness were all lower in group C(P<0. 017). The rate of intranasal stimulus in group B and group C were both lower than that of group A( P<0. 017) . The rate of injection pain of group C was lower ( P<0. 017 ) than that of group A and B. Conclusion Intranasal administration of dexmedetomidine can be safely applied to children receiving painless electronic colonoscopy, and it can improve children's compliance effectively and yield to satisfactory anesthetic effect. Moreover, the administering efficacy of dexmedetomidine with the dose of 2. 0μg/kg was superior to 1. 0μg/kg.

Objective To study the changes in the expression of GABA and its receptors in the dorsal horn of rat spinal cord induced by hind paw formalin injection. Methods Twelve healthy male SD rats weighing 300-325 g were randomly divided into two groups: (A) control group (n=6) and (B) peripheral inflammatory hyperalgesia group in which 5% formalin 50?l was injected subcutaneously into the plantar region of right hind paw to produce persistent pain(n=6). The animals were killed 24h after formalin injection. L_(4-6) segment of the spinal cord was removed. The number of GABA immuno-reactive cells was examined by immuno-cytochemistry technique and the exprpession of GABA_(A?3) and GABA_(B1) receptor mRNA in the spinal dorsal horn were determined by in situ hybridization. Results In control group(A), GABA immuno-reactive cells and GABA_(A?3) and GABA_(B1) receptor mRNA were observed throughout the lumbar spinal dorsal horn. The density of GABA immuno-reactive cells and GABA_(B1) receptor mRNA was highest in the superficial laminae Ⅰ-Ⅲ; while the GABA_(A?3) receptor mRNA was evenly distributed in the spinal dorsal horn. In group B, 24h after formalin injection there was a significant increase in the GABA immuno-reactive cells in the ipsilateral spinal dorsal horn. The expression of GABA_(A?3) and GABA_(B1) receptor mRNA were significantly increased in bilateral dorsal horn compared to group A. The three parameters were positively correlated and their locations in the spinal dorsal horn were not significantly different from those in group A. Conchusion GABA and its receptors may play an important role in nociceptive modulation.

Objective To evaluate the curative effect of Keli-Paoxi power for the treatment of acute paronychia. Methods A total of 144 patients with acute paronychia were randomly divided into a Keli-Paoxi power group, a mupirocin ointment group and an ethanol soaking group, 48 in each group. All patients were treated for 3 weeks and followed-up for 2 months. The time to regression of redness and swelling in the nail groove was recorded. The Visual Analogue Scale (VAS) was used to assess tenderness. The curative effects were evaluated, and recurrence of paronychia was recorded. Results The time to regression of redness and swelling in the nail groove in the Keli-Paoxi power group (2.2 ± 0.6 d) was significantly shorter than that in the mupirocin ointment group (8.1 ± 1.7 d) or ethanol soaking group (7.9 ± 1.2 d; F=344.597, P<0.01). The VAS Scores in the Keli-Paoxi power group (1.2 ± 0.2) was significantly lower than that in the mupirocin ointment group (3.2 ± 0.3) or ethanol soaking group (3.1 ± 0.3; F=831.273, P<0.01). The total effective rate in the Keli-Paoxi power group (100.0%, 48/48) was significantly higher than that in the mupirocin ointment group (83.3%, 40/48) or ethanol soaking group (81.3%, 39/48; χ2=9.700, P=0.008). The recurrence rate of paronychia in the Keli-Paoxi power group (2.1%, 1/48) was significantly lower than that in the mupirocin ointment group (16.7%, 8/48) or ethanol soaking group (14.6%, 7/48; χ2=6.000, P=0.049) at 2 months follow-up. Conclusions Keli-Paoxi power can alleviate tenderness, shorten the time to regression of redness and swelling in the nail groove, decraese recurrence in patients with acute paronychia. The curative effect of Keli-Paoxi power is superior to mupirocin ointment and ethanol soaking in the treatment of acute paronychia.

Objective: To identify the impact of Urban Resident Basic Medical Insurance (URBMI) on medical service utilization. Methods: Based on data of China Health and Nutrition Survey, matching DID model was used to compare the changes in medical service utilization between residents participated in this system and those not participated in this system in 2009. Results:In initial stage of implementation, URBMI in a certain extent promoted medical service utilization of residents participated in the system, but the impact level was still low. The promoting effect on inpatient service utilization was significant, but very limited on outpatient service utilization. Conclusion:Promoting outpatient service utilization and increasing compensation are future priorities for improving URBMI to implement the system.

Objective To investigate the clinical value of the 18F-FDG SPECT-CT combined with the image of CT in the diagnosis of lung cancer.Methods Retrospectively analysis images of 18F-FDG SPECT-CT and CT of 162 patients pulmonary tumor-like lesions from January 2013 to October 2013 were conducted.All the patients have been confirmed by the pathological mechanism or cytologic examination.Each patient has been firstly diagnosed by the 18F-FDG SPECT-CT along and then combined with the images of CT.The sensitive rate and the accurate rate of two methods were compared by x2 test.Results There were 40 benign lesions and 114 malignant ones in 162 patients.The sensitive rates of the two methods were 86.0％ and 96.5％ (x2 =6.63,P ＜ 0.05).The accurate rates of the two ways were 79％ and 96.3％ (x2 =7.76,P ＜ 0.05).The differences were statistically significant.Conclusion 18F-FDG SPECT-CT combined with the images of CT can increase the diagnostic sensitivity and accuracy.It has important clinical value.