Objective To evaluate the efficacy and safety of endoscopic sphincterotomy(EST)in treating common bile duct stone or strictive papillitis,and then analyze possible related risk factors for long-term complications after EST.Methods We made a retrospective study of 103 out of 158 patients who had EST from January 2005 to December 2006.Results In the 103 patients,there were 13 cases of long-term complications(≥3 m after EST),the incident rate being 12.6%:recurrent calculus of common bile duct in 8 cases,combined cholangitis in 6;cholangitis in 1;acute calculus cholecystitis in 2;residual calculus in 1 case;chronic pancreatitis in 1 case.Conclusion Endoscopic papillosphincterotomy is an effective and safe way to treat biliary tract obstruction.Preoperative jaundice may be the risk factor inducing long-term complications after EST.

Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

Objective To discuss the use of knowledge graph technology to connect various trivial and fragmented knowledge in various medical information systems and support comprehensive knowledge retrieval and intelligent medical applications such as Q & A and clinical decision support.Methods Based on the construction of medical field ontology and semantic labeling of medical knowledge base,the medical knowledge graph was constructed and applied to intelligent medicine,with chronic disease taken as an example.Results The construction method of medical knowledge graph and its application in semantic analysis,reasoning and disease-assisted diagnosis system based on medical knowledge base were put forward.Conclusion The application of intelligent medicine based on knowledge graph will play an important role in contradiction between the supply of high-quality medical resources and increasing medical requirements.

OBJECTIVE:To establish a method for the determination of antibacterial effect of Ofloxacin eye drop. METH-ODS:According to the requirements in Chinese Pharmacopoeia(2015 edition)antibacterial effect test,using Staphylococcus au-reus,Pseudomonas aeruginosa,Escherichia coli,Aspergillus niger and Candida albicans as test bacteria,colonycount method suit-ability test was conducted for Ofloxacin eye drop samples,the verified method was used to determine the number of viable bacteria at each time point,calculate the bacteria number of 1 mL in the sample and the number of bacteria at each time point and convert to lg value. RESULTS:Ofloxacin eye drop sample can reach the standard of antibacterial effectiveness of theB. CONCLU-SIONS:The method can effectively determine whether the antibacterial effect of Ofloxacin eye drop fits the standard.

Objective To evaluate the treatment results and side-reactions of esophageal carcinoma treated with late course accelerated hyperfration radiotherapy plus concurrent chemotherapy(LCAHR+C). Methods A prospective randomized trial was carried out on 173 esophagus squamous carcinoma patients whom were randomized into two groups:1. LCAHR group—89 patients treated by conventional fractionated radiotherapy during the first two-thirds of the whole course with 40Gy in 20-22 fractions, then followed by LCAHR with 20-30Gy in 14-20 fractions, 1.5Gy per fraction, 2 times per day, to a total dose of 60-70Gy in 34-42 fractions over 37-42 days; 2.LCAHR+C group—94 patients were received the same radiotherapy as LCAHR, supplement with concurrent chemotherapy from the first day of radiotherapy. The chemotherapy regimen was LFP: intravenous infusion of cisplatin 20mg/d, calcium folinate 100mg/d and 5-fluorouracil 500mg/d for five consecutive days, every 28d as one cycle to totally 4 cycles. Results The short-term effective rate was 85% and 95% in LCAHR and LCAHR+C group,respectively(?~2=4.45,P=0.035).The 1-,2-and 3-year local control rate was 73%,55%,49% and 83%,73%,65% in LCAHR and LCAHR+C group, respectively(?~2=5.32,P=0.021).The 1-,2- and 3-year survival rate was 74%,53%,41% and 84%,65%,52% in LCAHR and LCAHR+C group,respectively(?~2= 2.85 , P= 0.091 ).The leucocytopenia and gastrointestinal tract side-reactions in LCAHR+C group were more severe than those of LCAHR group(?~2=7.85,15.06;P=0.005,0.000). Conclusions Late course accelerated hyperfractionated radiotherapy plus concurrent chemotherapy can be taken as a effective treatment for esophageal carcinoma. It can improve short-term curative effect and local control rate, in spite of increase in leucocytopenia and gastrointestinal tract side-reactions.

Objective To investigate the safety and efficacy of the modified laparoscopic radical cystectomy and standard pelvic lymph node dissection for female bladder cancer patients.Methods Fortyone female patients with bladder cancer who underwent laparoscopic radical cystectomy(LRC) and standard pelvic lymph node dissection(sPLND) in our hospital from June 2003 to January 2016 were retrospectively analyzed.The patients were divided into two groups according to the surgical procedure.There were 15 patients with ≤ cT2 tumor and 1 patient with cT3 in the modified group.The average age was (62.2 ± 11.5) years.The median BMI was 20.7 kg/m2,ranging 18.4 to 22.2 kg/m2;The ASA level was less than Ⅱ in 9 (56.2％) cases and was level Ⅲ in 7 (43.8％) cases.There were 22 patients with ≤ cT2 tumor and 3 patients with cT3 in the traditional group.The average age was (60.4 ± 12.9)years.The median BMI was 21.7 kg/m2,ranging 18.4 to 23.1 kg/m2.ASA was less than level Ⅱ in 15(60.0％) cases and level Ⅲ in 10(40.0％) cases.All operations are performed under general anesthesia.In the traditional group,the plane between rectus and uterus is separated first.Then open the posterior cervical fornix and cut off the lateral bladder pedicle,cardinal ligament of uterus and urethra.The bladder and uterus are removed together.The sPLND is performed at last.In the modified group,the sPLND is performed first.Then separate the bladder and uterus until the anterior wall of the vagina can be exposed.The bladder and uterus are removed separately.Data of the operation and the complications were collected and analyzed.Results All patients were performed the operation successfully.No open conversion was recorded during the operation.No patient died during the peripheral operative phase.In modified group,10 patients received orthotopic ileal neobladder (OIN),5 patients received ileal conduit and 1 patient received ureterostomy.In traditional group,19 patients received OIN,3 patients received ileal conduit and 3 patients received ureterostomy.No significant difference of surgical method was noticed in those group.The median operative time in modified group and traditional group was 290 min (ranging 265-335 min) and 315 min (ranging 270-380 min),respectively(P ＞ 0.05).The median estimated blood loss in modified group and traditional group was 100ml (100,100) and 200ml (200,400),respectively (P ＜ 0.05).The rate of transfusion in modified group and traditional group was 6.3％ (1/16) and 18.5％ (5/27),respectively (P ＜0.05).The incidence of early complications between two groups showed no statistically difference.No major (Clavien grade 3 to 5) complications occurred in modified group.However major complications occurred in 3 patients in traditional group,followed by 2 neobladder vagina fistula,1 ileal anastomotic stoma fistula.All those complications were cured by operation.All patients were diagnosed urothelium carcinoma.In modified group,the tumor stage included carcinoma in suit in 2 cases,pTa-pT1 in 7 cases,pT2 in 6 cases,pT3 in one case.In traditional group,the tumor stage included pT1 in 12 cases,pT2 in 10 cases,pT3 in 3 cases.The numbers of resected lymph node in modified group and conventional group were 16 (ranging 7-19) and 10 (ranging 7-13),respectively (P ＞ 0.05).Conclusions The modified laparoscopic radical cystectomy and pelvic lymph node dissection for female bladder cancer patients could reduce the blood loss and incidence of neobladder vaginal fistula comparing with the traditional operation.

Objective:To determine whether chewing gum during the postoperative period facilitates the recovery of bowel function in patients after radical cystectomy with ileum urinary diversion.Methods:In the study,60 patients who underwent radical cystectomy followed by ileum urinary diversions during Nov.2014 and Nov.2015 in Department of Urology of Peking University First Hospital were randomized into three groups:gum chewing group,placebo group treated with the abdomen physical therapy machine and control group treated with ordinary method.Time to flatus,time to bowel movement,incidence of postoperative distension of the abdomen and abdominal pain,and gut related complications (such as ileus,intestinal fistula,and volrulus)of all the patients were recorded and analysed.Results:In gum chewing group,the median time to flatus was 57 hours (49 -72 hours),and the median time to bowel movement was 95 hours (88 -109 hours),which were significantly shortened compared with the other two groups of patients (82 hours,109 hours in placebo group and 81 hours,108 hours in control group, respectively).No significant difference of the median time to flatus and to bowel movement was observed between placebo group and control group.There were no significant differences in the incidence of post-operative distension of the abdomen and abdominal pain,and gut related complications among the three groups.Conclusion:Chewing gum had stimulatory effect on bowel function recovery after cystectomy fol-lowed by ileum urinary diversion.Chewing gum was safe and simple,and could be routinely used for postoperative treatment after cystectomy and ileum urinary diversion.

Appropriate selection and measurement of lead biomarkers of exposure are critically important for health care management purposes, public health decision making, and primary prevention synthesis. Lead is one of the neurotoxicants that seems to be involved in the etiology of psychologies. Biomarkers are generally classified into three groups: biomarkers of exposure, effect, and susceptibility.The main body compartments that store lead are the blood, soft tissues, and bone; the half-life of lead in these tissues is measured in weeks for blood, months for soft tissues, and years for bone. Within the brain, lead-induced damage in the prefrontal cerebral cortex, hippocampus, and cerebellum can lead to a variety of neurological disorders, such as brain damage, mental retardation, behavioral problems, nerve damage, and possibly Alzheimer's disease, Parkinsons disease, and schizophrenia. This paper presents an overview of biomarkers of lead exposure and discusses the neurotoxic effects of lead with regard to children and adults.
Alzheimer Disease ; chemically induced ; metabolism ; pathology ; physiopathology ; psychology ; Animals ; Behavior ; drug effects ; Biomarkers ; metabolism ; Brain ; metabolism ; pathology ; physiopathology ; Brain Diseases ; chemically induced ; pathology ; physiopathology ; Environmental Exposure ; adverse effects ; Humans ; Lead ; pharmacokinetics ; toxicity ; Lead Poisoning ; etiology ; metabolism ; pathology ; physiopathology ; psychology ; Neurotoxicity Syndromes ; etiology ; metabolism ; pathology ; physiopathology ; psychology ; Parkinson Disease, Secondary ; chemically induced ; metabolism ; pathology ; physiopathology ; psychology ; Schizophrenia ; chemically induced ; metabolism ; pathology ; physiopathology

Objective To investigate the present situation on therapy and secondary prevention of coronary heart disease (CHD) in the elderly,and to improve treatment and secondary prevention.Methods Cross sectional,non-intervention and multicenter survey was used in this study.All 7962 effective interviewed cases were with aged ≥60 years from 116 hospitals of 21 provinces and cities during April and July of 2011.Among them,male was 63.4％,aged (73.0±7.9) years,24.1％cases were aged ≥80 years.The current treatment and risk factors of elderly CHD were investigated by questionnaire including basic information,health check,types and severe degree of CHD,its therapy and prevention,and control of the risk factors.Results (1) All cases were received drugs and percutaneous coronaryintervention (PCI) or surgery,27.5％ cases of PCI,2.6％ of coronary artery bypass grafting(CABG),70.4％ cases of expectant treatment.(2) The ratio of cases with angina pectoris and myocardial infarction was 76.5 ％,the attack of angina pectoris ≥3 times/weeks in recent month was 48.3％,Canadian Cardiovascular Society(CCS) Ⅱ scores and over was 79.3％.(3) The utility ratio of prevention drugs recommended by the guidelines were 70.3％ antiplatelet drug,54.9％ lipid regulating agents,47.5％ BB,29.0％/22.2％ ACEI/ARB.(4)The situation of risk factor control was as followed:among all the cases,38.9％ of them with active smoking≥1 counts/day,28.4％ of them with passive smoking,57.6％ of them with BMI ≥24,46.4％ of male with waistline ≥90 cm,41.1％ of female with waistline≥85 cm.In our cases,67.6％ of them with hypertension and 56.6％ achieved the level of blood pressure＜140/90 mm Hg; 23.4％ with diabetes mellitus and 49.5％ achieved the level of HbA1c ＜7.0％; 33.2％ with Lipids disorder and 26.6％ achieved the level of TC＜4.1 mmol/L,27.5％ of LDL-C＜2.6 mmol/L.(5) The analysis showed that there were more attacks of angina pectoris in the groups of male than female(P=0.0050),those HbA1c ≥7.0％ than those ＜7.0％ (P=0.019),and those LDL-C≥2.6 mmol/L than those ＜2.6 mmol/L (P =0.044),and that there were less attacks in those with CABG than without it (P＜0.001) and in those with PCI than without it (P＜0.001).Conclusions Inadequate control of symptom,insufficient utility ratio of prevention drugs and control of risk factors appear in elderly CHD.Coronary revascularization,drug use of guidelines recommend and control of high risks are the key points of high curative effect of elderly CHD.

Objective To study the proliferation of human skin fibroblast and synthesis of extracellular matrix which were regulated by LATS1-YAP pathway. Methods They were divided into three groups:control groups, LATS1 siRNA intervention group and YAP siRNA treatment group. Using LATS1 siRNA transferred human skin fibroblasts cell lines HS27 in LATS1 siRNA intervention group, and using YAP siRNA transferred HS27 in YAP siRNA treatment group. Expression of LATS1,YAP and collageⅠwere detected by western-blot 48 h later, and the activity of HS27 cells was determined by MTT. Results Compared with control group,expression of LATS1 protein decreased while expression of YAP protein and collagenⅠprotein increased 48 h after LATS1 siRNA transfection. Expression of LATS1 protein remains un-changed and expression of YAP protein and collagenⅠprotein decreased 48 h after YAP siRNA transfection. Conclusion LATS1-YAP pathway could regulate proliferation of human skin fibroblast and synthesis of extracellular matrix. It provides a potential therapeutic targets for skin wound repair and cicatrization.