Objective To evaluate the value of percutaneous endoscopic gastrostomy (PEG) in the treatment of amyotrophic lateral sclerosis (ALS) patients with dysphagia. Method Sixty-five ALS patients underwent PEG from April 2005 to July 2010 were analysed retrospectively. Results All the 65 patients underwent PEG,and 2 patients failed because of dyspnea. Totally 63 patients were intubated successfully,the successful rate was 96.9%(63/65). The operation time was 8-17 min. Two patients had local infection.After 3 months, the body mass index was increased from (18.3 ± 1.0) kg/m2 to (19.7 ± 1.2) kg/m2(t = 15.8,P ＜ 0.01), without peritonitis, migration of the gastrostomy tube and other complications. Conclusions PEG is a safe method with a low complication for ALS patients to get enteral nutrition. Dyspnea is the main reason of failure.

AIM:To investigate the effects and mechanisms of microRNA-25 (miRNA-25) on the proliferation of human esophageal squamous-cell carcinoma cell line TE1.METHODS: The abundance of miRNA-25 in different tis-sues was measured by RT-PCR.After silencing or over-expression of miRNA-25 with mimics or inhibitor in TE1 cells, the cell proliferation, cell cycle distribution and the expression of cyclin E1 and cyclin-dependent kinase 2 (CDK2) at mRNA and protein levels were measured by CCK-8 assay, BrdU detection, flow cytometry, RT-PCR and Western blot, respective-ly.RESULTS:miRNA-25 was prominent in esophageal mucosal tissue and highly expressed in TE1 cells (P<0.05).O-ver-expression of miRNA-25 increased TE1 cell proliferation, promoted the cell cycle progression and enhanced the en-trance of the cells into S phase (P<0.05).Inverse results were obtained after down-regulation of miRNA-25 (P<0.05). Furthermore, the expression of cyclin E1 and CDK2 at mRNA and protein levels was significantly increased after over-ex-pression of miRNA-25, but decreased after down-regulation of miRNA-25 (P<0.05).CONCLUSION: miRNA-25 en-hances cell cycle transition by increasing the expression of cyclin E1 and CDK2, thus accelerating TE1 cell proliferation. This study provides a novel mechanism by which miRNA-25 increases the proliferation of human esophageal squamous-cell carcinoma cell line TE1, suggesting that down-regulation of miRNA-25 may be a potential new therapeutic strategy for trea-ting esophageal squamous-cell carcinoma.

Objective To understand the job stressors, coping style and general self-efficacy of emergency nurses and relationship of them. Methods A cross-sectional study involving 83 emergency nurses were conducted through the Chinese Nurses′ Job Stress Sources Scale, Trait Coping Style Questionnaire, General Self-efficacy Scale. Results Job stress among nurses in emergency department was caused by heavy workloads and time distribution (2.88±0.82), issue of patient care (2.78±0.59). The score of emergency nurses′coping propensity was 3.77, indicating more use of positive coping. Negative coping scored higher than the norm (26.99±4.76 vs.21.25±7.41), the difference was significant (t=10.290, P<0.01). The average score of general self-efficacy was 2.40 ± 0.48, lower than the norm (2.86±0.52), the difference was significant (t=-8.07, P<0.01). Active coping style scores were negatively correlated with job stress (r =-0.294, P < 0.05), negative coping style scores were positively correlated with job stress (r =0.239, P<0.05). General self-efficacy and positive coping scores were positively correlated (r=0.270, P<0.05). Conclusions The job stress among emergency nurses was at high level, self-efficacy was not high, but they still have a positive behavior patterns. Nurse managers should take advantage of the positive psychological characteristics of nurses and give reasonable support and guidance, in order to enhance the confidence of nurses and promote self-efficacy, optimize coping, improve the physical and mental health in emergency nurses.

Objective To investigate the clinical effects of endoscopic pancreatic duct stent insertion.Methods The clinical data of 20 cases of endoscopic pancreatic stent insertion,including 12 cases of chronic pancreatitis,3 cases of recurrent pancreatitis,2 cases of papilla adenoma after resection,3 cases of pancreatic carcinoma,was retrospectively reviewed from June 2004 to September 2006.All the patients underwent endoscopic pancreatic sphincterotomy and pancreatic stent insertion after endoscopic retrograde cholangiopancreatography(ERCP).Results All the 20 patients received 23 procedures of pancreatic stent insertion.Stent-preserving time was 25-105 days(mean,64.5 days).2 cases experienced stent migration and no postoperative pancreatitis occurred.20 patients were followed up for 6 to 12 months,including 17 patients for 12 months.During a follow-up period of 3 months in the 12 cases of chronic pancreatitis,1 case received repair because of duodenal perforation induced by ERCP,and the symptoms of abdominal pain or discomfort disappeared or were distinctively relieved in 9 and 2 cases,respectively,with weight gain 2-5 kg(mean,3.2 kg).A follow-up period of more than 3 months showed that the remission rate of abdominal pain was 92%(11/12).The jaundice was alleviated(with the average of decrease of 61.8 percent of total bilirubin in serum) and weight gained in the 3 cases of pancreatic carcinoma after the biliary and pancreatic duct plastic stents were inserted at the same time.Patients with recurrent pancreatitis had no relapse in the follow-up period.Conclusions The endoscopic pancreatic duct stent insertion is a safe and minimal invasive procedure,and can prevent postoperative pancreatitis,but the main complication of stent migration should be considered.

ObjectiveTo evaluate the efficacy and safety of combination therapy of tamsulosin and solifenacin for benign prostatic hyperplasia ( BPH ) with overactive bladder ( OAB ).Methods82 patients with OAB and coexisting BPH were randomly divided into tamsulosin group ( n = 38 ) and combination group ( n = 44). The ages were from 50 to 75 y ( averaged, 56.8 ± 8.6). Inclusion criteria: the mean frequency of micturition ≥8 times per day, the frequency of nocturia ≥2 times per day, voiding volume ＜200 ml each time; for the overactive bladder symptom score ( OA BSS), the 3 rd score ＞ 2, total score ＞ 3. The tamsulosin group accepted tamsulosin 0.2 mg once daily, the combination group accepted tansulouxin 0.2 mg and solifenacin 0.2 mg once daily. Both groups were maintained the corresponding therapy for 12 weeks.The international prostate symptom score (IPSS), Qmax, residual urine volume, OAB score and adverse reactions were recorded.ResultsThe values of IPSS ( 19.5 ±2.2 vs 15.6 ±2.4, P =0.027), the voiding symptom score ( 15.6 ± 2.4 vs 3.4 ± 1. 7, P = 0. 022) and Qmax ( 13.7 ± 3.8 vs 16.6 ± 4.1, P = 0. 034 )improved significantly after treatment in tamsulosin group ( P ＜ 0. 05 ). The values of IPSS ( 19.7 ± 2.3 vs 9.7 ± 3.0, P ＜0. 001), the storage symptom score (13.8 ± 1.9 vs 5.6 ± 1.6, P ＜0. 001 ), OABSS (10.3 ±1.8 vs 5.3 ±1.3, P ＜0.001) and Qmax(14.1 ±4.1 vs 17.2 ±3.5, P=0.027) also improved significantly after treatment in combination group ( P ＜ 0. 05 ). The values of IPSS ( 9.7 ± 3.0 vs 15.6 ±2.4, P ＜ 0.001 ), the storage symptom score (5.6 ± 1.6 vs 12.0 ± 1.6, P ＜ 0.001 ) and OABSS ( 5.3 ±1.3 vs 9.7 ± 2.7, P ＜ 0. 001 ) improved significantly in combination group than those in tamsulosin group ( P ＜0.001 ). There were no difference between two groups in values of the voiding symptom score, Qmax and residual urine volume ( P ＞ 0.05 ). The incidences of adverse reactions in tamsulosin group and combination group were 7.9％ (3/38) and 20.5％ (9/44) without significant difference. There was no acute urinary retention in both groups.ConclusionsIt is effective and safe for patients with BPH and OAB to accept combination therapy of tamsulosin and solifenacin.

Objective To investigate the characteristics of etiology,efficacy of endoscopic management for recurrent idiopathic pancreatitis (RIP).MethodsThe clinical data of 58 cases of RIP diagnosed in our hospital from April 2005 to April 2011 were retrospectively analyzed.All the patients underwent endoscopic retrograde cholangiopancreatography (ERCP),and patients with suspected sphincter of Oddi dysfunction received manometry.According to the clinical and ERCP manifestations,the etiologies of RIP were determined and individualized endoscopic treatment was applied.The patients were followed-up postoperatively about the improvement of abdominal pain and recurrence of RIP.ResuItsFifty-eight patients (29 males,29 females) were suffered from acute pancreatitis from 3 to more than 10 times.The etiologies were as follows:29 cases of biliary microlithiasis,19 case of sphincter of Oddi dysfunction ( 16 cases of pancreatic type,3 cases of mixed type),4 cases of anomalous arrangement of the pancreaticobiliary duct,and 6 cases of normal manifestations at ERCP.Biliary sphincterotomy alone was performed in 33 patients,while both biliary and pancreatic sphincterotomy was performed in 8 patients,and pancreatic sphincterotomy alone was performed in 17 patients,after sphincterotomy,pancreatic stent insertion was performed in 24 patients.The follow-up data was obtained from 41 out of 58 patients,the follow-up period ranged from 3 ～ 67 months ( average 33 months).During this period,9(22.0％ ) patients suffered from RIP,and the treatment efficiency was 78％.ConclusionsBiliary microlithiasis and sphincter of Oddi dysfunction are the main causes of RIP.Drink could induce RIP.ERCP has definite treatment efficacy for RIP.

Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.

Objective To analyze the effect of urinary ostomy bag on reduction of urinary tract infection in ICU patients with diarrhea.Methods A total of 445 diarrhea patients with indwelling catheter were admitted from June 2013 to May 2014,patients were divided into two groups according to the occurrence of diarrhea after admission,219 cases were in the observation group,226 cases were in the control group.The observation group used urinary tract ostomy bag connected with Kangwei anti-inverse drainage device,the control group used traditional methods of perianal care.Then,the incidence of urinary tract infection between two groups and the results of urine culture between patients of two groups with urinary tract infection were compared.Results The incidence of urinary tract infection in the observation group was 5.5％ (12/219),significantly lower than that of the control group,10.6％ (24/226),x2=3.952,P＜0.05.The urine culture results showed that 4 cases were intestinal strains in the observation group,and 17 cases in the control group,the difference was significant,x2=4.629,P＜0.05.Conclusions Urinary tract ostomy bag connected with Kangwei anti-inverse drainage device can effectively reduce the incidence of urinary tract infection in patients with diarrhea,it is simple to operate,and can reduce the workload of nurses and increase the comfort degree of patients,which is worthy of clinical application.

Objective:To evaluate the role of spinal cord in anesthesia of isoflurane. Method:The animal models of head bypass were established,which were used to preferentially anesthetized spinal cord, after 9 goats were anesthetized with isoflurane.MAC was determined using tail clamp at prebypass,druing bypass and postbypass. Electroen-cephalogram(EEG),brain stem auditory evoked Potential (BAEP) and visal evoked potential(VEP)were monitored constantly. Result:MAC of isoflurane,the relative power(RP)of ? wave and the latencies of BAEP and VEP were decreased when spinal cord was preferentinally anesthetized (P