Objective To explore the microsurgery technique and outcome of expanding translabyrinthine ap-proach resection large acoustic neuroma .Methods We have retrospectively studied clinical data and follow -up re-sults of 4 patients of large acoustic neuroma (≥5 cm ,the largest was 8 cm ;3 cases with servere sensorineualt hear-ing loss ,1 case with high frequenoy hearing loss ;1 case with blindness) in our hospital between January 2013 and April 2013 .All patients received expanding translabyrinthine approach microsurgery to resecting the tumors .Post-operative follow -up was 6~10 months .Results The large acoustic neuroma of 4 cases were totally removed via MRI reexamination after operation .Facial nerve in 3 cases were dissection retained ,and 1 case received facial nerve anastomosis .Six months after operatin ,one patient’s facial nerve function recovered from level Ⅲ to level Ⅱ ,the patient underwent facial nerve anastomosis with facial paralysis level Ⅵ recovered to level Ⅳ ,and the vision of pa-tient with blindness completely recovered to normal .Conclusion The expanding translabyrinthine approach can to-tally resect large acoustic neuroma and preserve facial nerve function .

The theoretical basis, significance and feasibility of tutor system for undergraduates in medical informa-tion education were studied.It was considered that the tutor system for undergraduates is an effective means for training medical information talents as it can help the undergraduates to know what role they will play in itheir future po-sition and the professional knowledge they should master, ncrease their study interests and stimulate their study motives by providing the professional skill education service in an order form.The management model of tutor system for under-graduates was put forward according to the significant features of undergraduate course education and cross subjects, the various requirements of professional skills, and the low study motives in domestic medical information education.The problems to which attention should be paid in implementing the tutor system for undergraduates were elaborated .

Objective To analyze the clinico-pathological characteristics and prognostic factors of patients with gastric neuroendocrine carcinoma(G-NEC).Methods Clinical data of 40 cases of G-NEC form January 2003 to August 2013 at Ren Ji Hospital of Shanghai Jiaotong University were analyzed.Tumors were classified into different grades and stages according to the 2010 WHO classification and the 2006 European neuroendocrine tumor society (ENETS).Follow-up was conducted by telephone.The survival curves were drawn using Kaplan-Meier method.Univariate analysis was performed by the Log-rank test and multivariate analysis was performed by the COX proportional hazards model.Results Among the 40 G-NECs patients,29 were male(72％) and 11 were female(28％),with an median age of 61 years.Tumors located in the gastric cardia in 20 cases,in the gastric antrum in 11 cases and in the gastric body in 9 cases.Tumor ranged from 1 cm-20 cm.All patients were G-NEC (G3).Follow-up rate was 100％ (40/40).The median overall survival rate was 12 months,and one-year survival rate was 82％.Immunohistochemically G-NEC cells were positive for CgA and Syn in 11 cases.Gender (x2 =5.673,P ＜ 0.05),Ki-67 index (x2 =8.612,P ＜ 0.05),and lymphnode involvement (x2 =0.559,P ＜ 0.05) were prognostic factors of G-NEC patients.Conclusions The symptoms of G-NEC are nonspecific.Its diagnosis relies on pathological examination and immunohistochemistry.Syn and CgA are the most important markers.Female gender,lower Ki-67 index and lower lymph node metastasis predict a survival advantage.

Objective To compare the clinical efficacy of Freka trelumina (FT) vs.feeding jejunostomy (FJ) in carrying out postoperative early enteral nutrition (EEN) in old patients with gastric cancer.Method 168 old gastric cancer cases were derided into FT group (n =54) with EEN, FJ group (n =50) with gastric tube and EEN, and total parenteral nutrition (TPN) group (n =64).Results Compared with TPN group, postoperative body weight, serum albumin and prealbumin level in FT and FJ groups were significantly higher, intestinal function recovery time, days of postoperative hospitalization and costs were significantly lower.The incidence of cough, sputum and sore throat of patients in FT group were significantly higher than those in FJ and TPN groups (P ＜ 0.05).Conclusions Postoperative EEN through FT and FJ was effective to improve nutritional parameter, accelerate intestinal function recovery, reduce the number of days of postoperative hospitalization, total costs, anastomotic stomal leak and gastroparesis rate.

After the current situation in medical information construction and the training of health information management undergraduates in Anhui Province were analyzed, suggestions were put forward, such as further strengthening the training of health information management professionals and establishing their positions in medical information construction, in terms of new student enrolment, offered curriculum, and graduate employment.

After the feasibility to reform the blended teaching model for health information management and its im-plementation were described , the reform of blended teaching model for health information management and its prob-lems were analyzed in terms of its model establishment , process implementation and effect assessment according to the target of professional training in Bengbu Medical College .

ObjectiveTo systematically review the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) versus endoscopic sphincterotomy combined with large balloon dilation (ESBD) in the treatment of large common bile duct stones (≥10 mm). MethodsPubmed, Embase, Cochrane Library, CNKI, Wanfang Data, and VIP were searched for related articles published up to March 2020. Two reviewers independently performed article screening, data extraction, and quality assessment, and RevMan 5.3 software was used for statistical analysis. ResultsA total of 11 studies (6 randomized controlled trials and 5 non-randomized controlled trials) were included, with 1282 patients in total. The meta-analysis showed that in the 6 randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate (odds ratio ［OR］=0.71, 95% confidence interval ［CI］: 0.45-1.12, P=0.14), overall stone clearance rate (OR=1.39, 95%CI: 0.65-2.96, P=0.39), rate of use of mechanical lithotripsy (OR=1.19, 95%CI: 0.75-1.89, P=0.46), and incidence rate of early complications (OR=1.10, 95%CI: 0.60-2.03, P=075); in the 5 non-randomized controlled trials, there were no significant differences between the EPLBD group and the ESBD group in initial stone clearance rate (OR=0.64, 95%CI: 0.35-1.15, P=0.13), overall stone clearance rate (OR=0.46, 95%CI: 0.19-112, P=009), and incidence rate of early complications (OR=1.20, 95%CI: 0.65-2.21, P=0.56), but the EPLBD group had a significantly higher rate of use of mechanical lithotripsy than the ESBD group (OR=1.96, 95%CI: 1.26-3.05, P=0.003). ConclusionEPLBD and ESBD have similar efficacy and safety in the treatment of large common bile duct stones, while EPLBD may increase the risk of the use of mechanical lithotripsy. More high-quality randomized controlled trials are needed to confirm this conclusion.

BACKGROUNDTo investigate the methylation and deletion of p16 gene and its diagnostic value in non-small cell lung cancer.

METHODSA total of 50 lung cancer tissues and 54 normal lung tissues were examined for p16 gene methylation in exon 1 and deletion in exon 2 by PCR based methylation analysis and duplex PCR respectively.

RESULTSOut of 50 lung cancer tissues, 16 were positive for the p16 gene exon 1 methylation (32.0%), and 14 for the p16 gene exon 2 deletion (28.0%). However, in 54 cases of normal lung tissues, only 2 showed the p16 gene exon 1 methylation(3.7%), and none showed the p16 gene exon 2 deletion. There were significant differences in methylation rate (Fisher's exact= 0.000 ) and deletion rate (Fisher's exact= 0.000) between the two groups.

CONCLUSIONSThe methylation and deletion may be important mechanisms for p16 gene inactivation in non-small cell lung cancer. The detection of p16 gene status may contribute to the diagnosis of lung cancer.

Objective:To study the effectiveness and safety of perioperative lactated Ringer solution (LRS) in prevention and alleviation of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) under different fluid replacement regimens to arrive at the most precise quantitative fluid replacement regimen.Methods:Pubmed, Embase, Cochrane Library Database, Wanfang Database, CNKI, and VIP were searched from inception to February 2020. Randomized controlled trials on LRS in prevention and alleviation of PEP under different fluid replacement regimens were collected. The experiment group was actively rehydrated with LRS during the perioperative period, and the amount of rehydration was significantly higher than that of the control group. The control group was given standard dose of LRS or normal saline. Two researchers independently selected the articles based on predetermined inclusion and exclusion criteria, extracted the data, and evaluated the risk of bias. RevMan 5.3 software was used for statistical analysis.Results:Ten studies with 2 261 patients were included, with 1 140 patients in the experiment group, and 1 121 patients in the control group. Meta-analysis showed that when the experiment group was given LRS at a rate of 5.0 ml·kg -1·h -1 during the perioperative period for about 9 hours and compared with the control group, the incidence of PEP in the experiment group was significantly reduced ( OR=0.32, 95% CI: 0.21-0.48, P<0.05). The incidence of moderate to severe PEP was also significantly reduced ( OR=0.28, 95% CI: 0.09-0.84, P<0.05). There was no increase in the incidence of adverse reactions related to fluid replacement. However, there were no significant differences in the incidence of PEP, and in moderate to severe PEP between the two groups when LRS was given at a rate of 4.0~4.5 ml·kg -1·h -1 within 9 hours, and less than 4.0 ml·kg -1·h -1 within 24 hours of total rehydration time (all P>0.05). Conclusion:During the perioperative period, the current evidence showed that it is most reasonable to give the fluid replacement regimen with aggressive hydration using LRS at a rate of 5.0 ml·kg -1·h -1 in about 9 hours to prevent and alleviate PEP. This is recommended for clinical practice and is worthy of further future studies.

Objective:To study the relationship between pancreaticobiliary maljunction (PBM) with cholangiopancreatic diseases, and to evaluate the efficacy and safety using endoscopic therapy for PBM.Methods:The clinical data of 734 patients treated with ERCP at the Affiliated Hospital of Guizhou Medical University from May 2016 to April 2020 were analyzed retrospectively. Of 31 PBM patients who were finally included in this study, there were 23 patients with benign diseases and 8 patients with malignant diseases. Using the diameter of bile duct, these patients were divided into two groups: dilated bile duct group and the non-dilated bile duct group. The general characteristics of patients, incidences of cholangiopancreatic disease, endoscopic treatment, therapeutic efficacy and follow-up data were analyzed.Results:Of the 31 patients with PBM, 11 were males and 20 were females, aged (56.7±16.2) years. There were 4 patients with choledochal cyst (12.9%) and 6 patients with biliary cancer (19.4%). The incidences were significantly higher than those in non-PBM patients (0.9% and 5.3%, respectively, P<0.05). All 31 patients with PBM underwent endoscopic EST treatment, including 15 patients (48.4%) treated with endoscopic naso-biliary drainage (ENBD), 9 patients (29.0%) with endoscopic retrograde biliary drainage (ERBD), 4 patients (12.9%) with endoscopic papillary balloon dilatation (EPBD)+ ENBD, 1 patient (3.2%) with endoscopic metal biliary endoprothesis (EMBE)+ ENBD, 1 patient with ERBD+ endoscopic retrograde pancreatic drainage (3.2%), and 1 patient with EPBD+ ERBD+ EMBE (3.2%). The operative success rate was 100%. Serum AST, ALT, ALP, GGT, TBil and DBil levels of patients in the benign group and malignant group were significantly decreased postoperatively when compared with the preoperative levels (all P<0.05). One patient (3.2%) developed post ERCP pancreatitis. The preoperative and postoperative NRS scores of the patients in the benign group were 7(6, 8) points compared to 0 (0, 1) points, respectively ( P<0.05). All the 23 patients in the benign group were followed up for (25.13±12.90) months. There were no patients who were loss to follow-up. There was no malignant transformation. Three PMB patients with dilated bile ducts still had attacks of abdominal pain or jaundice. The symptoms of the remaining 20 patients were completely relieved, giving a treatment efficacious rate of 87.0% (20/23). Conclusions:PBM was closely related to choledochal cysts, biliary cancer and other diseases. Endoscopic treatment was efficacious and safe, and provided a safe and feasible treatment in preventing future cholangiopancreatic attacks.