Objective To assess the feasibility and clinical effect of hand-assisted laparoscopic cholecystojejunostomy and gastroenterostomy combined with()~(125)I seed implantation for the treatment of advanced pancreatic carcinoma.Methods Hand-assisted laparoscopic cholecystojejunostomy and gastroenterostomy combined with()~(125)I seed implantation was performed in 12 patients with advanced pancreatic carcinoma(pancreatic head,10 patients;pancreatic body,2 patients) between February 2002 and August 2004 in this hospital.Results All the operations were successfully accomplished.The operative time was 104~181 min(122?29 min),the operative blood loss was 45~152 ml(60?18 ml),and the length of hospital stay, 6~17 d(8.5?1.3 d).Postoperatively,the jaundice subsided gradually,and the patient's liver functions recovered to normal in 7~10 days.The abdominal pain disappeared in 3 patients and was obviously remitted in 7.Gastrointestinal dysfunction occurred in 2 patients and was cured with symptomatic therapy.Follow-up checkups with CT scannings in 10 patients for 6 months showed partial remission(PR) in 4 patients,no changes(NC) in 4 patients,and progressed disease(PD) in 2.Conclusions Hand-assisted laparoscopic internal drainage combined with()~(125)I seed implantation for the treatment of advanced pancreatic carcinoma is effective and micro-invasive.

Objective To assess the feasibility of the treatment of unresectable late pancreatic cancer with laparoscopic choledochojejunostomy and gastric bypass. Methods From June 2000 to December 2003, laparoscopic choledochojejunostomy and gastric bypass were successfully performed in 15 patients with unresectable late pancreatic cancer. Endoscopic noso biliary drainage (ENBD) was performed before the operation. Results All procedures were completed laparoscopically. Jaundice and hepatic function of the patients were obviously improved after the bypass. Oral nutrition was recovered after operation. The mean operative time was (100?26) min (range 70-200 min); the mean operative blood loss was (60?15) ml (range 30-120 ml); the bowel function recovery was on the 3rd-5th postoperative day; the average hospital stay was (8.1?0.7) days (range 6-13 days). Incision infection ocurred in one patient. No operative complications occurred in other patients. Conclusion Treatment of unresectable late carcinoma of the pancreas with laparoscopic choledochojejunostomy and gastric bypass aided by ENBD is a minimally invasive technique with less postoperative pain,shorter hospital stay, lower procedure related morbidity,and better oral nutrition. The life quality of patients with late pancreatic cancer can be obviously improved.

Objective To explore the impact of juxtapapilary duodenal diverticulum on the formation of choledocholithiasis and biliary manometry after surgery.Methods The clinical data of 97 patients with common bile duct stones who successfully underwent ERCP and biliary manometry treatment from May 2011 to March 2014 were retrospectively analyzed.Ninty-seven common bile duct stone patients were divided to two groups,that is,52 cases of juxta-papilary duodenal diverticulum (experimental group) and 45 cases without juxta-papilary duodenal diverticulum (control group).The biliary manometric results before and after EST of both groups were compared.Results The basal pressure of sphincter Oddi of the experimental group before EST [(84.8 ± 26.1) mmHg] was higher than that of the control group before EST [(75.5 ± 14.6) mmHg] (P ＜ 0.05,1 mmHg =0.133 kPa);and that after EST was also higher than that of the control group after the operation[(19.8 ± 14.2)mmHg VS (15.9 ± 9.8)mmHg,P ＜ 0.05].The biliary pressure of common bile duct stone patients with JPD was higher than those without JPD before and after EST but with no significant difference(P ＞ 0.05).The biliary manometry was performed in 81 patients after one month and it was found that the basal pressure of sphincter Oddi of experimental group was still higher than that of the control group [(34.8 ± 17.1) mmHg VS (29.6 ± 15.3)mmHg,P ＜ 0.05].The biliary pressure of common bile of the experimental group was higher than that of the control group [(19.9 ± 11.2) mmHg VS (17.1 ± 13.1)mmHg,P ＜0.05].Conclusion The existence of juxtapapilary duodenal diverticulum increases the pressure of common bile duct and Oddi sphincter and leads to CBD stones.

Objective:To observe the differences in the dynamic change of the EB virus antibody between general population and first-degree relatives (FDR) of nasopharyngeal carcinoma patients during follow-up study one year after initial screening and discuss the difference among the nasopharyngeal carcinoma detections. Methods: Serologic data of all subjects that participated in the fol-low-up study were collected. Changes in EB virus antibodies were investigated and correlation of these changes with gender and age level was analyzed. Differences in the nasopharyngeal cancer detection rate of different populations were also compared. Results:NA1/IgA negative conversion rate was higher in the family group than in the control group (χ2=20.28, P<0.001). This rate was also higher in both male and female family groups than in the male and female control groups (χ2=22.59, P<0.001;χ2=4.03, P<0.05, respectively). NA1/IgA positive conversion rate was lower in the family group than in the control group (χ2=7.79, P<0.05). Likewise, this rate was lower in both male and female family groups than in the male and female control groups (χ2=9.46, P<0.05;χ2=0.74, P=0.39, respective-ly). VCA/IgA negative conversion rate was higher in the family group than in the control group (χ2=1.90, P<0.001). This rate was also higher in the male and female family groups than in the male and female control groups (χ2=7.50, P<0.05; χ2=no expression, P=0.108, determined by Fish exact test, respectively). VCA/IgA positive conversion rate was higher in the family group than in the control group (χ2=0.10, P=0.70). This rate was again higher in both male and female family groups than in the male and female control groups (χ2=0.02, P=0.90,χ2=0.51, P=0.48, respectively). Ten cases from the control group manifested nasopharyngeal carcinoma;the same disease was not observed in the family group. Nasopharyngeal carcinoma detection rate was significantly higher in the control group than in the family group, but the difference was not statistically significant (χ2=1.05, P=0.31). Conclusion:a. Reactivation of the EB virus is not closely linked with genetic factors. b. The detection rate of NPC in FDR was lower compared with the general population after initial screening;thus, the rule of selective follow-up is not applicable for FDR.

Objective To discuss the application values of image reconstructive technique in 16-slice helical CT scanning. Methods 32 cervical spinal cord lesion images which have processed in MPR, MIP and VR were reviewed to discover the best image reconstructive form. Results By grading, reconstruction score of MPR, MIP and VR was 4.75, 1.75 and 4.5, MPR and VR in top. Conclusion 16-slice CT scanning with MPR and VR image reconstructive of cervical spinal cord can be satisfied the clinical demands.

Objective To investigate the correlation between non-alcoholic fatty liver disease and serum and histological viral parameters in patients with chronic hepatitis B (CHB).Methods Clinical and laboratory data from patients with CHB who received liver biopsy from 2009 to 2015 were collected. Patients were divided into steatosis and non-steatosis groups based on the presence of steatosis in liver biopsies.Propensity score matching (PSM)was conducted to adjust the confounding bias including age, sex,body mass index (BMI),total cholesterol (TC)and triglyceride (TG).Correlation of liver fatty and viral parameters was compared between steatosis and non-steatosis groups.Student t test,χ2 test,rank sum test and Pearson correlation test were employed to analyze the data.Results A total of 874 patients with a mean age of (37.0±10.1)years were enrolled in the study,with 690 males and 184 females,and 270 (30.9%)patients were diagnosed with steatosis by liver biopsy.Age,gender,BMI,TC and TG were significantly different between the two groups before PSM (all P <0.05),but those were comparable after PSM (all P >0.05 ).Serum hepatitis B virus (HBV)DNA,hepatitis B surface antigen (HBsAg) level,proportion of hepatitis B e antigen (HBeAg )positivity,HBsAg and hepatitis B core antigen (HBcAg)immunohistological staining in liver tissue were not significantly different between steatosis and non-steatosis groups after PSM (all P >0.05).Patients in steatosis group were stratified into two groups according to the degree of steatosis confirmed by liver biopsies:mild steatosis group (F1 )and medium to severe steatosis group (F2-F4).The serum alanine aminotransferase (ALT),HBV DNA,HBsAg level, proportion of HBeAg positivity,immunohistological HBsAg and HBcAg staining in liver tissue between those two groups showed no differences (all P >0.05).The mean rank of liver inflammation and fibrosis in F1 group were 129.9 and 128.2,respectively,which were both significantly higher than those in F2-F4 group (105 .9 and 108.5 ,respectively;both P <0.05).Steatosis was negatively correlated with either inflammatory grade (r=-0.183,P =0.005)or fibrosis stage (r=-0.150,P =0.020).Conclusions There is no correlation between serum viral factors and hepatic steatosis. Hepatic steatosis is not associated with the expressions of HBsAg and HBcAg in liver tissue.The severity of steatosis is negatively correlated with both liver inflammation and fibrosis.

Objective To investigate the safety and efficacy of technical modification for laparoscopic repair of giant hiatal hernias.Methods A total of 49 patients with giant hiatal hernia underwent modified laparoscopic repair by dissecting sac, closing hiatal, mesh placement and fundoplication from June 2010 to May 2014.The operation time, hospitalization time, postoperative complications, upper gastrointestinal imaging and improvement of postoperative symptoms were observed.Results The average operation time was (103.6 ±31.7) min(88-173min).The average length of post operation hospitalization was (4.2 ± 1.8) d (range,3-12d).Postoperative complication occurred in 4 patients,including pleural effusion (1 patient),respiratory failure (1 patient), difficulty in swallowing (2 patients)with complication occurrence rate being 8.2％ (4/49).No conversion or death occurred.The average time of follow-up was (28.3 ± 12.7) months (6-50 months) in 49 cases.During the follow-up, main symptoms were relieved and no recurrence was found by barium swallow.Conclusion Technical modification for laparoscopic repair of giant hiatal hernias is safe and effective.

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Objective To investigate the effect of continuous care provided by midwife group personnel to pregnant women.Methods 100 cases of pregnant women were screened out and divided into the study group and the control group with 50 patients in each group randomly.The study group received continuous care provided by midwife group personnel,the control group received traditional nursing.Effect of different nursing measures on mothers and neonates were compared.Results Antenatal cognition and rate of natural delivery of the study group were higher than the control group.The rate of neonatal asphyxia and postpartum depression occurred in the study group were lower than the control group,Maternal and family sarisfaction and rates of breasffeeding of the study group were higher than the control group.Conclusions Continuoas care provided by midwife group personnel can increase antenatal cognition and rate of natural delivery,maternal and family satisfaction.breast feeding rates and the overall quality of nursing staff,reduce rate of neonatal asphyxia with few postpartum depression,then improve the quality of perinatal care.

Background:Inflammatory bowel disease( IBD)is a group of chronic and non-specific intestinal inflammatory diseases of undetermined origin. Functional impairment of macrophages has been associated with the dysregulation of mucosal immunity in intestinal tract of patients with IBD. Aims:To investigate the correlation of serum levels of macrophage polarization-related cytokines with the development and disease activity of IBD. Methods:A total of 105 IBD patients admitted from May 2013 to May 2014 at Shanghai Ruijin Hospital were recruited,of them 65 were Crohn’s disease (CD)and 40 were ulcerative colitis( UC). Twenty-four patients with colonic polyps were served as controls. Serum samples were obtained and the levels of interleukin-1beta(IL-1β),IL-6,IL-10,IL-13,interferon-gamma(IFN-γ)and inducible nitric oxide synthase(iNOS)were determined by ELISA method. Results:Serum levels of IL-1β,IL-6,IL-10, IL-13 and IFN-γ were significantly higher in CD group than in control group(P < 0. 05),and serum levels of IL-10,IL-13 and IFN-γ were significantly higher in UC group than in control group(P < 0. 05). Logistic regression analysis revealed that serum IL-13(OR = 1. 009,P = 0. 005)and iNOS( OR = 0. 982,P = 0. 013)were correlated with CD,while Spearman correlation coefficient demonstrated a link between serum IL-10 and disease activity of CD(rs = - 0. 432,P =0. 014). No correlations were observed between serum levels of these cytokines and development and disease activity of UC (P > 0. 05). Conclusions:Serum levels of macrophage polarization-related cytokines increase to varying degrees in IBD patients,but these cytokines have no obvious correlations with IBD and its disease activity. Presumably,theses cytokines are only involved in but not the triggers in the development of IBD.