Objective To evaluate the diagnostic effect of intro-operative tissue puncture biopsy and find its influential factors.Methods The clinical data of 94 patients with pancreatic mass treated in our hospital from July 1994 to December 2007 and undergoing intro-operative tissue puncture biopsy were retrospectively analyzed.Results The sensitivity,the specificity,the positive predictive value and the negative predictive value were 74.6%,93.8%,98.0%and 46.9%,respectively.The single factor analysis showed that the size of pancreatic mass,the number of puncture and complicating with pancreatic fibrosis or not were related to the diagnosis of tissue puncture.The multiple factor analysis showed that the size of pancreatic mass(P=0.014)and the number of puncture(P=0.020)were crucial to the diagnosis of puncture.The sensitivity and specificity of intro-operative tissue puncture biopsy for the pancreatic mass less than 25 mm were lower than that for the mass larger than 25 mm (P=0.000).The sensitivity and specificity would be increased as the number of puncture increased (P=0.000).For the mass less than 25 mm,increasing the humber of puncture would improve the sensitivity(P=0.002).Conclusion Intro-operative tissue puncture biopsy is a simple and accurate procedure for differentiating the pancreatic mass.The sensitivity and specificity could be improved by increasing the number of puncture,especially for the patients with pancreatic mass less than 25 mm.

Objective To determine the value of preoperative clinical, biochemical, cross-sec-tional imaging features and results of fine-needle aspiration for predicting malignancy in cystic neo-plasms of the pancreas (CNP). Methods The medical records of 69 patients receiving operations for CNP between 1994 and 2008 in our hospital were reviewed retrospectively. The predictive effect of va-rious preoperative factors such as sex, location, clinical manifestation, maximum diameters, tumor marker, pancreatic duct obstruction and calcification on the malignant potential of CNP was evaluated by Single and multi-factor analysis, fine needle aspiration (FNA) and intraoperative frozen-section ex-amination of the pancreatic transection margin was investigated. Results All the 69 patients were con-firmed pathologically. Of the 69 patients, 13 suffered from serous cystic neoplasms, 30 from mucinous cystic neoplasms,7 from intraductal papillary mucinous neoplasms,12 from solid pseudopapillary neo-plasms and 7 from cystic neoplasms. Forty-four lesions were diagnosed as malignant or borderline.Univariate analysis should that jaundice, raised CEA and/or CA19-9, maximum diameters and solid component of cystic neoplasmshad were of statistical significance for the risk of malignancy in CNP.The sensitivity was 34.1% (15/44), 47.7 % (21/44), 88.6%(39/44),72.7%(32/44) and specificity 96% (24/25), 84% (23/25), 68% (17/25),72% (18/25), respectively. The last three were identified as independent predictive factors for malignancy by multivariate analysis. Three cases were accurately diagnosed out of the 9 undergoing FNA preoperatively. One of 7 patients with intraductal papillary mucinous neoplasms (IPMN) undenwent total pancreatetomy for transection margin positivity.Conclusion Most malignant CNP can be accurately diagnosed preoperatively from a typical clinical,biochemical and cross-sectional imaging picture. FNA is only used in the patients who are potential candidates for nonoperative management. Margin analysis is necessary for pancreatic resection.

Objective To study the causes of pancreatic fistula following pancreatioduodenectomy, and evaluate the effect of total pancreatic uncinate process resection on the prevention of pancreatic fistula by analyzing the potential aetiology of pancreatic fistula after pancreaticoduodenectomy.Methods The clinical data of 68 patients, who were admitted into the No. 1 ward of Surgical Department of Peking University First Hospital during the period from Jan. 2004 to Jun. 2009, were retrospectively analyzed. The day-average level of amylase higher than 3 times of normal value, as measured from the drainage of peritoneal cavity, serves as the diagnostic criterion of the postoperative pancreatic fistula.Factors relevant to fistula, which result in the abnormal increase of the amylase in the drain, such as the extent of resection of pancreatic uncinate process, the anastomotic manners of pancreas and digestive tract, and the pancreatic fibrosis were statistically analyzed. Results The incidence of pancreatic fistula was 33. 8% according to the diagnostic criterion mentioned above; Single factor analysis showed that the resection extent of uncinate process (P = 0. 000) and the level of serum glucose ( P = 0. 045 ) were correlated with the occurrence of pancreatic fistula. Multivariate analysis identified that the independent risk factor for pancreatic fistula was the resection extent of uncinate process(P =0. 000). Pancreatic fibrosis, the manners of the anastomosis of pancreas and digestive tract were not independent risk factors. Conclusion Total resection of uncinate process could prevent pancreatic fistula from residual pancreatic uncinate process, hence reduce the incidence of pancreatic fistula following pancreaticoduedenectomy.

Humans ; Polyomavirus ; classification ; Polyomavirus Infections ; virology

Aneurysm, Dissecting ; classification ; surgery ; Aortic Aneurysm ; etiology ; Dilatation, Pathologic ; Humans ; Stents ; adverse effects

Child, Preschool ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gastrointestinal Diseases ; drug therapy ; Humans ; Infant ; Male ; Phytotherapy ; Plant Extracts ; therapeutic use

Objective To investigate the association of cysteine aspartic acid specific protease 8 (CASP 8) gene-652 6N Insertion/Deletion polymorphisms and susceptibility of type 2 diabetes mellitus (T2DM). Methods CASP 8 gene -652 6N I/D polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing in 414 controls and 410 patients with T2DM. Results I/I, I/D and D/D genotype frequency were 56.5%, 38.9%, 4.6%in controls and 58.0%, 32.9%, 9.0%in T2DM group respectively (P<0.05). The risk in D/D genotype people was 1.916 times than I/I genotype (adjusted OR=1.916, 95%CI=1.199~3.054, P<0.05). The fasting blood sugar of D/D genotype people was significantly higher than that of I/D and I/I genotype people (P<0.05). Conclusions CASP 8 gene-652 6N I/D polymorphisms are associated with T2DM outbreak.

Objective To evaluate the activation patterns in the cortexes of expressive aphasics after stroke so as to explore the pathogenic mechanism of expressive aphasia.Methods Blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) was the method of choice.It was administered to 9 subjects with expressive aphasia at 1 to 3 months post-stroke onset and to 10 healthy controls.Active areas in the patients' brains were observed using a block-designed picture-naming task,and language function was tested with the China Rehabilitation Research Center's aphasia examination (CRRCAE).The control group received BOLD-fMRI only.SPM8 software was used to process the fMRI data.Results Differences were observed in the mapping of activated areas between the two groups,but many activated areas showed no difference.Significant differences in activation were observed in areas associated with vision,language and cognition,including the bilateral inferior frontal gyrus,the bilateral superior temporal gyrus,the bilateral insula,the bilateral basal ganglia,the left superior frontal gyrus,the left middle frontal gyrus,the left precentral gyrus,the left thalamus,and the left middle temporal gyrus.All the patients had activated cortex regions associated with visual processing in the left and/or right hemisphere,such as the middle frontal gyrus,the middle temporal gyrus,the lingual gyrus and the fusiform gyrus.The activation volumes in the left hemisphere were significantly smaller than those in normal adults.Regions related to language such as the left inferior frontal gyrus (Broca's area),the left middle frontal gyrus,and the right inferior frontal gyrus (the mirror region of Broca's area) were activated in some of them.While the activation frequency,activated volume and activation intensity generally were all less in the patients than in the controls,the activation intensity in the right superior temporal gyrus,the bilateral superior parietal lobule and the left inferior temporal gyrus were stronger.Conclusions Language production may be associated with multiple,interconnected regions.The right hemisphere participates in natural language processing.Aphasia damages both linguistic and cognitive areas,reducing activation in Broca's aphasia.Activation areas in the left hemisphere and the right inferior frontal gyrus decrease significantly,while some regions in the right hemisphere are relatively more activated.The right inferior frontal gyrus may play a different role in language recovery at different periods of aphasia after stroke.

Objective To investigate the small-world property of default mode network in relapsingremitting multiple sclerosis (RRMS) compared with the (matched) healthy control subjects,using a graph theory for resting-state functional network analysis.Methods Twenty four patients with RRMS and 24 age-,and sexmatched healthy controls were exanined with resting-state functional MRI (R-fMRI) and 3D-T1WI on Trio 3.0 Tesla.The R-fMRI data were preprocessed,then 20 regions of interest (ROIs) was defined and extracted from the default mode network.The functional connectivity between a pair of regions was defined as the Pearson's correlation coefficient in the time courses.Graph theoretical analysis was implemented and compared with the property of binary functional network.Further,the relationships were examined between the topological property of functional networks and the clinical parameters.Results In this study,functional network in the default mode network was conducted,and the small-world characteristics were observed in both RRMS and healthy control group.In the range of densities (Dmin:0.01∶0.48 ;Dmin =0.42),compared with healthy control group,RRMS groups had a slightly smaller normalized clustering coefficient (P＞0.05),a slightly larger normalized path length (P＞0.05),and a slightly decrease small-world index (P＞0.05).The left posterior cingulated cortex showed a significantly larger clustering coefficient in RRMS group (P=0.031) on the network threshold at Dmin.The area under a curve (AUC) for clustering coefficient measure curves of the left posterior cingulated cortex (density range of 0.42:0.01:0.48) between two groups were compared.The AUC result was similar to the Dmin result (P=0.031).Negative correlation was observed between the clustering coefficient of left posterior cingulated cortex and the Paced Auditory Serial Addition Test (PASAT) in both the Dmin(P=0.023) and the AUC (P=0.020).Conclusion The default mode network has small-world property in RRMS group.The significantly increased clustering coefficience is observed in the left posterior cingulated cortex,which may be a side effect.

Objective To evaluate the clinical significance of intraoperative accurate localization of bleeding slte for acute intestinal hemorrhage. Method Twenty-two patients with acute intestinal hemorrhage,admitted from January 1995 to June 2007,were reviewed retrospectively.GrouD A included 5 patients who were treated with intestinal resection following intervention radiological marking.Group B included 5 patmnts who were treated by intestinal resection without intervention radiological marking.Group C included 12 patients who were treated by interventional embolization.The exact diagnostic rate,the recurrence of hemorrhage,the length of intestine removed and the operative time were calculated and analyzed respectively.Results All the cases in group A were correctly diagnosed.The diagnostic rale of group A was higher than that of group B significantly(x2=6.667,P=0.024).The average length of intestine removed in group A was(12±7)cm shorter than that in group B(108±23)cm significantly (t=-8.574,P=0.000).The procedure lasted(119±12)min in group A shorter than the(218±45)min in group B significantly(t=-4.730,P=0.001).There was no case with recurrent hemorrhage in group A,but the recurrence of hemorrhage was up to 60.0%(x2=4.286,P=0.083)in group B and 66.7%in group C(x3=6.296,P=0.020). Conclusions The treatment outcome after intestinal removal following intervention radiological marking is better than those of non-marking groups.The locating method with alloy coil made of Nickel-Platinum is rapid and accurate.C-arm X ray device helps to find the metal marker hence to give an accurate guide for bowel resection.