Objective To evalute the diagnosis and the availability of local excision for the duodenal papilla tumor(DPT).Methods The clinical data of 12 patients with DPT treated by local excision in recent 9 years were retrospectively analysed.In this series,jaundice presented in 100% of patients and always accompanied with abdminal pain.Results There was no operation death in this seties.The preoperative diagnostic rate by biopsy was 75.0%. Ten patients(83.3%)were followed up for 1-5 years,5 patients with benign tumor were survival well.Four patients with early stage T 1 DPT were still survival for 62,31,84and 36months, respectively.Conclusions The indications of local excision for DPT include benign papillary tumor smaller

Objective:To evaluate the analgesic effects of two kinds of preoperative peripheral nerve block drug in patients with tri-geminal neuralgia undergoing radiofrequency thermocoagulation(RFT)of gasserian ganglion.Methods:90 patients with classic trigemi-nal neuralgia of the 3rd branch were scheduled to undergo RFT of the gasserian ganglion and were randomly divided into 3 groups(n =30).The patients in group N without nerve block were served as the controls.The patients in group A and B were treated by the nerve block of inferior alveloar with 2 ml of 2% lidocaine hydrochloride and 2 ml of compound lidocaine hydrochloride for each respectively 2 d before RFT.The pain control was studied by VAS method before and 24,48 h after nerve blocking and during pucture for RFT.Re-sults:Compared with the control group,24 h after nerve blocking,the average pain and the most pain VAS value of group A and B were significantly reduced(P <0.01);sleep quality and analgesia satisfaction were improved in group A and B(P <0.05).48 h after nerve blocking the pain relief and sleep quality improvement of group B were more than those of group A(P <0.05).In addition,during RFT puncture the pain intensity of group A and B were less than that of group N(P <0.05).The pain control in group B was more effective than that in group A.Conclusion:A single peripheral nerve block with long-term narcotic compound lidocaine hydrochloride can be an effective way to relieve preoperative and operative pain for RFT of trigeminal neuralgia.

Endoplasmic reticulum is an important organelle in eu-karyotic cells.Endoplasmic reticulum stress (ERS)is usually triggered under cell hypoxia,carbohydrate undersupply or medi-cal treatment.Now,present studies show that ERS could activate several cell signal pathways and the UPR pathway is most widely researched.When UPR activates cell signal pathway,it can reg-ulate cancer drug resistance by involving with DNA damage re-pair,apoptotic suppression and autophagy.

Objective To compare the clinical effects and safety of surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm.Methods The clinical data of 158 patients with intracranial wide-necked aneurysm from February 2010 to February 2013 were retrospectively analyzed,all patients were divided into two groups:surgical clipping group with 92 cases and intravascular interventional therapy group with 66 cases,the postoperative curative effects,treatment time,hospital stay,hospital expenses and postoperative complications between two groups were compared.Followed up for 10-46 months,the recurrence rate were compared.Results The good prognosis and defective rates between surgical clipping group and intravasular interventional therapy group had no significant difference [90.2％(83/92) vs.90.9％(60/66),9.8％(9/92) vs.9.1％ (6/66)] (x2 =0.298,P ＞ 0.05).The preoperative Hunt-Hess classification and CT Fisher classification between two groups had no significant difference (P ＞ 0.05).Six months after discharge,mRS score was used to evaluate the curative effect,the defective rates in same level patients between two kinds of treatment methods had no significantdifference (P ＞ 0.05).The treatment time,hospital stay in surgical clipping group were significantly longer than those in intravascular interventional therapy group [(4.03 ± 1.01) h vs.(1.61 ± 0.98) h,(15.90 ± 2.03) dvs.(13.20 ± 1.95) d],hospital expenses was significantly lower than that in intravascular intervention therapy group [61 829.4 ±320.6) yuan vs.(99 876.2 ±371.5) yuan] (P ＜0.05).The postoperative complications rate between two groups had no significant difference (P ＞ 0.05).Followed up for 31.3 (10-46) months,the recurrence rate in surgical clipping group was significantly lower than that in intravascular intervention therapy group [1.1％ (1/94) vs.8.8％ (6/68)] (P ＜ 0.05).Conclusion Surgical clipping and intravascular interventional therapy in treatment of intracranial wide-necked aneurysm has their own different characteristics,so patients' treatment methods should be based on their preoperative status (especially preoperative Hunt-Hess and Fisher classification) and patients' economic conditions.

Clinical evaluation proceedings from patient-reported outcomes (PRO) are being concerned increasingly. Based on the concept of PRO, the report discusses the findings in the research recently made at home and abroad. PRO from apoplexy patients with spastic paralysis was taken as an example in the exploration of how to evaluate the curative effects in clinical practice on the basis of PRO.

Objective To evaluate total laparoscopic splenectomy combined with pericardial devascularization. Methods In this study,40 patients with portal hypertension and hypersplenism underwent total laparoscopic splenectomy combined with pericardial devascularization,in which 26 cases had a history of up-GI bleeding. Results Procedures were successful in 36 patients.There was four conversions to open surgery.The operations were completed in a mean time of (224 ± 54) min,with a mean estimated blood loss of (296 ± 209) ml and with no serious complication. Conclusion Total laparoscopic splenectomy combined with pericardial devascularization is a safe and effective available minimally invasive procedure in patients with portal hypertension and hypersplenism.

This paper specifically elaborated the ethics committee of China and the United States review meet-ing in the project report , project FAQ, ethical discussion , voting and so on each link , analyzes the ethical review mode difference between the two countries , and according to the mode of ethical review meeting in China and the United States are compared , and the model helps to find their own ethical review meeting , improve their efficiency of ethical review committee meeting .

Objective To evaluate the clinical value of iohexol contrast agent in patients with malignant tumor by spiral CT scan combined with endoscopy.Methods 100 patients with pathologically confirmed malignancies were selected and randomly divided into two groups, with 50 cases in each group, the experimental group received iodohexanol contrast agent combined with spiral CT scan and endoscopy , the osmotic pressure of iohexol at 37℃600 mOsm/kg, 5 minutes before the injection of intravenous injection of 10 mg prophylaxis of dexamethasone, and then spiral CT scan was performed.The control group were treated with diatrizoate contrast agent combined with spiral CT scan and endoscopy.The osmotic pressure of diatrizoate was 1500 mOsm/kg at 37℃, and 10 mg of prophylactic drug dexamethasone was injected intravenously 5 minutes before the injection.And then a spiral CT scan was performed.Results The adverse reaction in experimental group was 4%, which was mild compared with 12% in control group ( P<0.05 ) .The tolerance and spiral CT image quality of experimental group were better than those of control group ( P<0.05 ) .Conclusion Iohexol contrast agent, whether adverse reaction or image quality than the effect of diatrizoate contrast agent , in the spiral CT scan combined with endoscopy in patients with malignant tumors of higher clinical value, can be more accurate diagnosis of malignant tumors.

Objective To investigate the regulation on extracellular signal regulated kinase (ERK )1/2 and p38 signaling pathways and immune expression by moist exposed burn therapy/moist exposed burn ointment(MEBT/MEBO)in diabetic foot and their relationship ,to explore the repair mechanism of MEBT/MEBO on diabetic foot ulcers .Methods Totally 40 diabetic foot pa‐tients were treated by MEBT/MEBO ,to take wound tissue before and after treatment and detect the expression of ERK 1/2 ,p38 , MAPKK6 ,c‐myc ,Akt ,ATF2 ,IgA ,IgM ,IgG ,C3c and C4c by immunohistochemistry ,to investigate their relationship .Results Af‐ter treatment with MEBT/MEBO ,the area of foot wounds in 39 patients was reduced in different degree .Only one patient had no obvious change .14 patients(35 .00% ) were markedly effective ,25 patients(62 .50% ) and 1 patient(2 .50% ) were ineffective .Before andaftertreatment,allpositiveexpression,positiveimmunoreactivity(anyindex)andpositiveexpression(specificindex)ofsignal pathway molecules were statistically significant (P<0 .05) .While the positive rate of molecular expression in wound pathway in‐creased ,the positive expression rate of immune factor increased .Before treatment ,a small amount of immune factors were found in the wound tissue .After treatment ,the immune factors IgA ,IgM ,IgG ,C3c ,C4c were distributed widely and diffusely .Before treat‐ment ,the wound tissue showed a very small number of signal molecules .After treatment ,the signal pathway molecules MEBT/MEBO and p38 ,MAPKK6 ,c‐myc ,Akt ,ATF2 showed broad and diffuse distribution .Conclusion MEBT/MEBO may promote the expression of ERK1/2 and p38 signaling molecules and immune in diabetic foot ,p38 and ERK1/2 signaling pathway may promote the healing of diabetic foot wound by increasing the expression of immune .

Chronic lung diseases, including bronchial asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, allergic rhinitis and repeated respiratory tract infection (RRTL) in infants, exacerbate frequently in winter because of respiratory viral infections and low temperature. Summer acupoint application therapy (SAAT) is thought to be effective in reducing exacerbation frequency of chronic lung diseases in winter. It is a kind of therapy using a herbal mixture for external application on special acupoints during summer. The herbal mixture basically contains Semen Sinapis Albae, Herba Asari, Radix Euphorbiae Kansui and Rhizoma Corydalis. The acupoints include Feishu (BL13), Dazhui (GV14) and Danzhong (CV17). Through a large-scale multicenter trial based on three years of clinical observation, and retrospective and prospective analyses, this study aims to explore the efficacy of SAAT.