Objective To explore the diagnostic and therapeutic value of endoscopic retrograde cholangiopancreatography ( ERCP) in teenagers with chronic pancreatitis. Methods Thirteen teenagers with chronic pancreatitis diagnosed and treated by consecutive ERCP procedures in our hospital from Feb 1997 to Feb 2002 were studied retrospectively. Results Of the 13 patients 12 had abdominal pain and 10 had history of acute/chronic pancreatitis. The ERCP findings were as follows: pancreatic duct stricture and/ or dilation 12, pancreatic duct stones 7, pancreatic pseudocysts 2, pancreas divisum 3, and cholecystolithia-sis 1. Therapeutic interventions included EST 7 , basket stone extraction 6, placement of pancreatic duct stent 5 , pancreatic duct stricture bougie or balloon dilation 4, accessory papillotomy 2 and endoscopic papillary dilation 1. In the 6 - 68 months follow - up, 11 (84. 6% ) never had recurrence of pancreatitis or abdominal pain ,2 patients had no abdominal pain after the second ERCP procedure. There were procedure -related complications of hyperamylasemia in 4 cases(30. 8% ) and pancreatitis in 3 cases(23. 1% ). Conclusion ERCP has significant value in diagnosing and treating chronic pancreatitis in teenagers, but has a rather high rate of complication . It suggested that the restrict selection of indication and safe application of the procedures in pediatric patients may be expected to decrease the adverse events of ERCP.

Shenjufencilu (SFL) is a liniment prepared from Dedsnthema mordelium,Angelica dahurica,Sophora fiavescens,Dictamnus dasycarpus and a mumber of other herbal midicines for the treatment of puberal acne.The presence of the above four contituents was identified by TLC and the content of matrine,the active principle from Sophora fiavescens was determined quantitatively by TLC scanning,to establish the quality standard of SFL. The methods were simple,sensitive,reproducible and accurate

BACKGROUND: The establishment of animal models is of important significance for understanding the pathogenesis, prevention, and treatment of intervertebral disc degeneration. OBJECTIVE: To develop rabbit models of intervertebral disc degeneration by acupuncture and to analyze the effects of acupuncture on intervertebral disc height and degeneration by X-ray and MRI examinations. DESIGN: A randomized and controlled observation. SETTING: Department of Orthopaedics, Changhai Hospital, Second Military Medical University of Chinese PLA. MATERIALS: This study was performed at the Animal Cener, Changhai Hospital, Second Military Medical University of Chonese PLA between June 2005 and April 2006. Six healthy New Zealand white rabbits of either gender, averaging 6 months old, weighing 2.5 kg on average, were provided by Animal Cener, Changhai Hospital, Second Military Medical University of Chinese PLA [permission No. SCXK (hu) 2002-0006], and recruited for this study. The protocol was performed in accordance with ethical guidelines for the use and care of animals.METHODS: ① Operation was made in experimental rabbits via the anterior retroperitoneal approach. The management for the intervertebral discs was as follows: L3-4 was the control disc without exposure or needle stab; L4-5 was subjected to sham-operation with only exposure; L5-6 was the experimental disc with three times of anterior-lateral needle stab after exposure. Lumbar lateral X-ray film was respectively taken with a CR machine (Simens Company) prior to and 4 weeks after surgery for measuring L3-4, L4-5, and L5-6 intervertebral disc height and calculating the ratio with intervertebral disc height prior to surgery. Each segmental lumbar intervertebral disc T2-weighted signal was measured with a 1.5 T medical superconductive magnetic resonance scanner (Simens Avanto). According to signal intensity, intervertebral disc degeneration was graded: a score of 4 indicated normal intervertebral disc without apparent degeneration but with bright signal, a score of 3 indicated slight degeneration with a little decrease in T2-weighted signal, a score of 2 indicated moderate degeneration with apparent decrease in T2-weighted signal, and a score of 1 indicated severe degeneration with apparent decrease in both T2-weighted signal and intervertebral disc height. MAIN OUTCOME MEASURES: Intervertebral disc height change revealed by lumbar lateral X-ray film; Intervertebral disc degeneration degree analyzed through magnetic resonance imaging (MRI) examination. RESULTS: All 6 experimental rabbits were included in the final analysis. The postsurgery-to-presurgery ratio of intervertebral disc height was 0.982 5±0.017 08 and 0.972 5±0.017 08 for L3-4 and L4-5 respectively, which was higher compared to that for L5-6 (0.550 0±0.02 582). Significant statistical difference existed (P ＜ 0.01). T2-weighted singal score was (4.00±0.0) and (3.75±0.5) for L3-4 and L4-5 intervertebral disc, respectively, which was higher compared to that for L5-6 intervertebral disc. Significant statistical difference existed (P ＜ 0.01). CONCLUSION: After 4 weeks of acupuncture, intervertebral disc height is decreased and interterbral disc degeneration obviously appears.

AIM:In human being,the exposure of lumbar Intervertebral discs usually requires the anterior transperitoneal or lateral retroperitoneal approaches. To study the feasibility of retropedtoneal approach to the lumbar spine in the New Zealand white rabbits.METHODS: The experiment was carried out between April 2005 and April 2006 in the Animal Center of Changhai Hospital.Second Military Medical University of Chinese PLA.Thirty New Zealand white rabbits,aged 6 months old, of either gender, weighing 2.5 kg,provided by the Animal Center of Changhai Hospital,Second Military Medical University of Chinese PLA [permission No.SCXK (hu) 2002-0006],were used in this study.During the experiment,the management of animals corresponded to Animal Ethical Standard.This study was approved by the Experimental Animal Ethics Committee,Changhai Hospital,Second Military Medical University of Chinese PLA.Transperitoneal approach was used to exposure the lumbar spine of experimental rabbits. The skin was disassociated, and a blunt dissection was made backwardly along the juncture of the maximum back muscle and external oblique muscle of abdomen,and lumbar intervertebral disc was exposed gradually.Observation index:①Operative effect of exposure.②Postoperative general condition (food intake,urination and defecation,activity,incision healing and death or not).RESULTS: Thirty experimental rabbits were involved in the final analysis.①The operative effect of exposure:The dght retroperitoneal approach was chosen,with satisfactory anesthesia and excellent exposure of rabbit lateral lumbar spine. And the exposure was usually accomplished within 15 minutes, with Less bleeding and no retroperitoneal rupture. ②Postoperative general condition: All animals recovered their consciousnesses within about 1 hour. They were intravenously injected continuously for supplementing blood volume,and after that,they were raised in the separate cases and were allowed to move freeLy.On the day of operation.they were fasted and forbidden to access to water.Their appetites began to decrease on the postoperative 1 day.restored from the 3rd day postoperatively and restored to normal on the 40th day postoperatively.All animals survived until after 4 weeks.They could move freely,without paralysis occurred or incontinence. There was one experimental animal whose surgical Incision broke.Debridement and resuture were given, and its wound healed. In all the other animals, the surgical incision healed well.CONCLUSION: Retroperitoneal approach can give an excellent access to the lumbar spine with easy operation and less complications.

Objective To investigate the therapeutic value of endoscopic papillectomy (EP) for duodenal papilla lesion.Methods Patients with duodenal papilla lesion treated with EP from June 2007 to December 2015 were enrolled.The clinical characteristics,EP technical features,complications,the treatment,postoperative recurrence were analyzed.Results A total of 43 patients were enrolled.The mean diameter of the lesion was 22.8±1.2 mm.Thirty-two patients (69.8％) received en bloc resection,and 11 (25.6％) received endoscopic piecemeal mucosal resection (EPMR).After the operation,duodenal papilla lesions recurred in 3 patients (7.0％),5 patients (11.6％) had delayed bleeding,4 (9.3％) had postoperative pancreatitis,6 (14.0％) had long-term bile duct stricture.Intraoperative pancreatic stenting (OR =0.000,95％ CI:0.000-) was the independent protective factor for postoperative pancreatitis.Pancreatic duct dilation (OR =13.500,95％ CI:1.400-130.191) was the independent risk factor for postoperative bile duct stenosis.Conclusion EP is minimally invasive with rapid recovery and less cost,and could be recommended for duodenal papilla lesions.

Objective To evaluate the efficacy and safety of endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) for gastroesophageal junction (GEJ)submucosal tumors (SMTs) originating from the muscularis propria(MP) layer.Methods Clinical data of sixty-one patients with GEJ SMTs originating from the MP layer who were treated with ESE(ESE group,n=39) or STER(STER group,n=22) between January 2013 and December 2015 in Changhai Hospital were retrospectively analyzed.Outcomes and complications in the two groups were compared.Results Single lesion in 61 patients were all resected by therapeutic endoscopy successfully.Operation time in the STER group was shorter than that of the ESE group(47.27±20.89 min VS 66.56±40.07 min,P＜0.05).There was no significant difference in number of hemostatic clips between the two groups[7.10±5.57 VS 8.00± 1.88,P＞0.05].Hospitalization time of STER group was shorter than that of the ESE group [3.0(1.25) d VS 4.0 (1.00) d,P＜0.05].One patient developed delayed hemorrhage in ESE group,while no other complications occurred in either group.The wound healed in both groups under gastroscopy,and no residual or recurrent tumors were detected during the follow-up period.Conclusion Both STER and ESE can be used for GEJ SMTs originating from the MP layer,but STER is more safe and efficient.

Objective To design a hemostatic clip and evaluate its efficacy and success rate of closure of stomach wall defect after full thickness resection (FTR).Methods A full thickness circular or linear resection (3 to 5 cm) was made on each model's antrum with needle knife and insulated-tip knife.The specimens were divided into 2 groups, using either an interrupted or continuous suturing method.Then the closure condition, suturing time, number of clips required and success rate of closure were compared.Results All 12 defects were successfully closed.The average closing time of interrupted and continuous suturing group were 13.33 ± 1.09 and 10.17 ±2.11 minutes, and the mean number of clips used were 4.67 ± 0.82 and 2.67 ± 0.82.The success rate was 100％.Conclusion This newly designed clip is a fast, reliable and convenient tool for stomach wall defect closure after FTR.

BACKGROUND: Previous studies demonstrated that recombinant human bone morphogenetic pretein-7 (hBMP-7) can effectively promote the synthesis of extracellular matrix, repair of damaged disc matrix, restore of degenerative disc height. It is hoped that BMP-7 can be used to control and reverse the intervertebral disc degeneration. However, because of the short half-life of recombinant protein and low biological activity, it is difficult to maintain BMP-7 high concentrations on degenerative disc. Gene therapy can prevent these defects effectively.OBJECTIVE: To study the effect of hBMP-7 gene transfeotion on biological activity of primary cultured rabbit nucleus pulposus cells in vitro, to determine the feasibility of hBMP-7 gene which will on gene therapy research of intervertebral disc degeneration,and to provide basis for further study.DESIGN, TIME AND SETTING: A randomized and controlled observation was performed at the Institute of Cardiothoracic Surgery of Changhai Hospital from December 2005 to September 2006.MATERIALS: Six healthy New Zealand white rabbits of either gender, averaging 4 weeks old and weighing 500 g, were used in this study, and Ad-hBMP7 was constructed by the Cardiothoracic Surgery Institute of Changhai Hospital.METHODS: After rabbits sacrifice under aseptic condition, the nucleus pulposus was got. After digested with Pronase, type Ⅱcollagenase and type Ⅱ DNAase (4 hours, 37 "(2), the cells were seeded in the Petri dishes and were kept in the incubator. After 7 days and then twice a week, the media were refreshed. The nucleus pulposus cells were infected by adenovirus integrated with hBMP7 gene. The cells which were transfected by adenovirus vector for Lac-Z gene and which were not transfected were adopted as control.MAIN OUTCOME MEASURES: The expression of hBMP-7 was determined by RTopCR and Western blot. The effect of hBMP-7 on cell proliferation was surveyed by MTT. Furthermore, the effect of hBMP-7 gene on synthesis of proteoglycan and type Ⅱcollagen was detected by modified dimethylmethylene blue method and ELISA, respectively.RESULTS: Gene sequencing and PCR showed that hBMP-7 gene was inserted correctly and no mutation happened. The pdmary cultured rabbit nucleus pulposus cells were identical with those reported in literature. After Ad-hBMP7 transduct into the nucleus pulposus cells, high level of hBMP-7 expression was observed and lasted over 3 weeks. Also hBMP-7 gene can promote cell proliferation and synthesis of proteoglycan and type II collagen with significant difference compared with control groups (P < 0.05).CONCLUSION: hBMP-7 gene mediated by adenovirus can be the target gene for the further study on gene therapy of intervertebral disc degeneration.

Objective To explore the efficacy and safety of choledochoscopy combined with laser lithotripsy for refractory residual biliary calculi after operation. Methods Clinical data of 22 patients, who underwent choledochoseopy together with laser lithotripsy for refractory intra- and extra-hepatic calculi after operation from February 2007 to February 2009, were retrospectively studied. Results The success rate of stone removal was 95.5% (21/22) , with one session success rate of 86. 4% (19/22), and two sessions of 9. 1% (2/22). Stone removal could not be performed in one patient due to multiple intra-hepatic calculi, difficult calculi location at bile ducts of grade Ⅱ, and wide biliary angle with no access. No biliary duct hem-orrhage, perforation, or infection occurred. Conclusion Choledochoscopy combined with laser lithotripsy is an effective and safe procedure for refractory residual biliary calculi after operation.

Objective To evaluate the endoscopic papillectomy (EP) for ampullary adenoma (AA). Methods The resection rate, complications, local residual rate and local recurrence of EP for AA at endoscopy center of Changhai Hospital were retrospectively reviewed. Results From July 2005 to July 2009, a total of 19 patients with endoscopically diagnosed and pathologically confirmed AA underwent EP, in which 18 cases were scattered AA (94. 7%) including 1 case of multiple adenomas in duodenum, and 1 (5.3%) was familial adenomatous polyposis (FAP). The lesion was resected en bloc in 11 cases (57.9%) , and piecemeal in 8 (42. 1%). All patients were followed up at a mean period of 24. 5 months (range 7-48 months). The residual rate after first EP was 21. 1% (4/19), and the total success rate was 89.5% (17/19). Short-term complications after EP included 3 cases of bleeding, 3 cases of mild acute pancreatitis and 2 cases of acute cholangitis. Long-term complications were 1 case of stenosis of the common bile duct (CBD) orifice accompanied with acute cholangitis, 1 case of CBD stone and 1 case of acute cholangitis after stent placement. No such severe complications as perforation or procedure-related death was observed.Conclusion EP is a safe and effective modality for ampullary adenoma.