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.

Objective To explore the effect of failure mode and effect analysis (FMEA) method in strengthening the management of critical value of blood specimens in hospital. Methods According to the procedures of FMEA, critical values management team were established, drew flow chart of generating test specimens and crisis value, explored the potential failure mode and failure cause, analyzed the severity, possibility and critical value, and formulate and implement countermeasures according to the research outcome. Results The crisis value of the failure mode fell from 1 320 to 151 after the implementation of FMEA, and rate of decline was 88.56%; number of unqualified blood samples decreased from 510 cases to 78 cases, and the difference is statistically significant (χ2=407.27, P<0.05);critical value processing defects decreased from 85 cases (a total of 236 cases) to 3 cases (a total of 229 cases), and the difference was statistically significant (χ2=91.26, P<0.05). Conclusions FMEA method is helpful to improve the accuracy and precision of critical value management of clinical blood samples, so as to ensure the safety of patients in hospitals.

Objective To investigate the protective effects of polysaccharide from Radix Codonopsis Lanceolatae on acute alcoholic hepatic injury in mice.Methods The model of CCl4-induced acute hepatic injury was set up in mice, and then treated with polysaccharide from Radix Codonopsis Lanceolatae to observe the activities of ALT, AST and TG in serum and the levels of SOD, GSH and MDA in hepatic tissue and Observed the pathological changes in the liver of mice.Results Compared with model control group, the lance asiabell root polysaccharide liver injury in mice all dose groups in the activity of serum ALT(97.5 ± 22.12 U/L, 108.8 ± 22.15 U/L, 125.2 ± 19.68 U/Lvs. 152.3 ± 17.32 U/L), AST (72.5 ± 21.3 U/L, 89.2 ± 17.47 U/L, 104.3 ± 19.34 U/Lvs.1215 ± 22.31 U/L) and TG(0.75 ± 0.32 mmol/L, 0.80 ± 0.22 mmol/L, 0.96 ± 0.21 mmol/L vs.1.44 ± 0.23 mmol/L) reduce, can increase the liver damage the activity of SOD(215.6 ± 22.68 U/mg, 203.2 ± 22.18 U/mg, 186.2 ± 18.34 U/mgvs.164.3 ± 17.54 U/mg), GSH(17.74 ± 2.12μmol/g, 14.84 ± 1.12μmol/g, 13.93 ± 2.15μmol/gvs.12.23 ± 2.09μmol/g) in liver tissue of mice, decrease the activity of MDA(6.22 ± 2.12 nmol/mg, 6.22 ± 2.12 nmol/mg, 8.36 ± 1.84 nmol/mgvs.9.35 ± 1.68 nmol/mg) in liver tissue, showing significant differences (P<0.05), and there was certain dose dependent, and can improve the pathological injury of liver tissue.Conclusion Polysaccharide from Radix Codonopsis Lanceolatae had protective effects on acute liver induced by acute alcoholic hepatic injury in mice.

Objective To investigate the Sedative effect and safety of intravenous Sufentanil combined with Propofol in painless gastroscopy.Methods 270 patients with ASA Ⅰ-Ⅱ were randomly divided into three groups:Group A (the Propofol group),Group B (the Fentanyl combined with Propofol group) and Group C (the Sufentanil combined with Propofol group).HR,MAP and SpO2 were monitored at three different time points:before placement of the gastroscope,during and 5 minutes after gastroscopy.The time required for consciousness recovery,the time required for regaining orientation,the operating time for gastroscopy and the dosage of Propofol were recorded.Results HR,MAP and SpO2 were obviously lower during operation than before or after operation in each group (P＜0.05) and were significant different among the groups (P＜ 0.05).The times required for consciousness recovery and for regaining orientation,respectively,were significantly longer in Group A than in Group B or C,and there was a significantly difference between Group B and Group C (P＜0.05).The total dose of Propofol in Group A was significantly larger than that in Group B or C (P＜0.05).Conclusions Compared with Propofol alone or Fentanyl combined with Propofol,Sufentanil can be used in combination with lower does of Propofol in painless gastroscopy to produce rapid and effective Sedation,with fewer side effects and higher patient satisfaction.

ObjectiveTo explore the content of isorhynchophylline in different medicinal parts of Ramulus Uncariae Cum Uncis.MethodsHPLC was adopted to determine 8 batches of different Ramulus Uncariae Cum Uncis of different origin and different medicinal parts. The Waters Symmetry C18 color(4.6 mm×250 mm, 5μm) was used with mobile phase of methanol -0.01 mol/L ammonium acetate buffer(pH 8.0)(60∶40), column temperature of 25℃ , 20μl sample volume, velocity of 1.0 ml/min, and detection wavelength of 246 nm. ResultsIsorhynchophylline can be detected in all 8 batchs of Ramulus Uncariae Cum Uncis in different regions, and different content were found among different origins. The content of isorhynchophylline in different parts of the same origin showed a decreasing sequence of the rhabd, stem with hook, stem without hook, and twig without hook and leaves.ConclusionMost of medicinal part of Ramulus Uncariae Cum Uncis contains isorhynchophylline, which provide a lab basis for exploring medicinal parts of this herbal medicine.

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.

Objective To investigate the expression and clinical significance of bcl-2 and NF-κB/ p65 in different subgroups of diffuse large B-cell lymphoma (DLBCL). Methods Immunohistochemical staining was used to detect the expressions of CD10, bcl-6, and MUM-1 in the DLBCL patients. According to immunohistochemical algorithm of Hans et al. DLBCL were subdivided into GCB and non-GCB/ABC subgroups and the expressions of bcl-2 and NF-κB/p65 were detected. The expressions of bcl-2 and NF-κB/ p65 in GCB DLBCL were compared with that in ABC DLBCL,and the correlation of bcl-2 and NF-κB/p65 expressions with survival in the two major subgroups of DLBCL were analyzed. Results The expression rates of bcl-2 and NF-κB/p65 proteins in DLBCL were 67.1% and 77.1%, and there was significant correlation between them. The expression rates of bcl-2 and NF-κB/p65 were 52.0 % and 56.0 % in GCB DLBCL, but were 75.6 % and 88.9 % in ABC DLBCL. The expression rates of two proteins were higher in ABC DLBCL than in GCB DLBCL. There was no significant correlation between bcl-2 and NF-κB/p65 protein expressions and overall survival within the GCB DLBCL subgroup, but bcl-2 and NF-κB/p65 expressions had a significant effect on overall survival within the ABC subgroup. Conclusion bcl-2 and NF-κB/p65 expressions are associated with poor survival in the ABC subgroup only. Hence, the significance of bcl-2 and NF-κB/p65 protein expressions should be assessed in the context of DLBCL subgroups in the future.

Objective To develop a questionnaire for factors influencing the quality of nursing interns.Methods The factors influencing the quality of nursing interns were formulated through literature review,interview and expert consultation.The pre-questionnaire was developed after modification.Exploratory factor analysis and correlation analysis were used to examine the reliability and validity of this questionnaire.Results Six common factors were extracted by exploratory factor analysis.Factor loading ranged from 0.487 to 0.889 for each item.The Cronbach α of the total scale was 0.814,and that of subscales ranged from 0.802 to 0.863.Retest-reliability coefficient of the total scale was 0.863,and that of subscales ranged from 0.794 to 0.931.Conclusions The self-designed questionnaire for factors influencing the quality of nursing interns has good reliability and validity,and can be used to measure the influencing factors for nursing interns.

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).