Objective To evaluate endoscopic ultrasonography (EUS) for diagnosis of gastric stromal tumors (GST) by analyzing EUS features of tumors with different invasive capacities.Methods Clinical data of 34 patients with GST were analyzed retrospectively.The tumors were classified according to Fletcher′s GIST biological behavior ranking system and the corresponding EUS features were analyzed.Results The mean maximal diameter of GST in this cohort was 6.7cm.The echo heterogeneity, big tumors size, irregular shape and ulceration were more common in tumors of high risk (P<0.05).Conclusion Tumor size, shape, echo quality and ulceration detected by EUS are useful features for pretreatment evaluation of GST, and can guide the choice of following managements.

Objective To probe the surgical approach and effect on upper abdominal malignant tumor infiltrating pancrea. Methods Thirty patients with upper abdominal malignant tumor infiltrating pancreas or tissue around pancrea were treated by radical resection on primary tumor combined pancreaticoduodenectomy. Results Three patients died in 1 month after operation due to multiple organ failure. The patients with gallbladder cancer and metastatic lymph nodes fixed behind caput pancreatis were followed up averaged 35 months. The patients with gastric antrum carcinoma infiltrating caput pancreatis were followed up averaged 31 months. The patients with recurrent gastric cancer infiltrating caput pancreatis were followed up averaged 13 months. The patients with pancreatic and duodenal invasion by cancer of hepatic flexure of colon were followed up averaged 41 months. The patients with hilar cholangiocarcinoma and metastatic lymph nodes fixed behind caput pancreatis were followed up averaged 11 months. Conclusion The patients with upper abdominal malignant tumor infiltrating pancreas should be operated by radical resection on primary tumor combined pancreaticoduodenectomy, which can increase the rate of tumor resection, and be expected to prolong the survival period.

Objective To analyse the clinical features,imaging characteristics diversity of deep cerebral veins thrombosis (DCVT).Methods From 2004 to 2013,6 patients diagnosed as DCVT were recorded and a retrospective review of the cases were undertaken for the purpose of this analysis.Results Among the 6 patients with DCVT,4 were male and 2 were female,aged from 28 to 69 years old.The disease duration of 4 cases ranged from 2 to 7 days,remnants were 20 days and 3 months respectively.The first symptoms of 4 cases were headache,1 was feeblemindedness,and the other was hemiplegia.The secondary symptoms were disturbance of consciousness,apathy,diplopia and non-infectious fever.Non-contrast computed tomography showed low signal in the bilateral thalamus in four patients,high signal in the transverse sinus and straight sinus in one patient and high signal in torcular in one patient.Abnormal signal was found in bilateral thalamus on magnetic resonance imaging in all patients and some of them had abnormal signal in the mesencephalon or basal ganglia.The patients were definitely diagnosed as DCVT by magnetic resonance venography (MRV) or digital subtraction angiography (DSA).Among them,2 patients were confirmed by brain biopsy.Four patients were followed up with good outcome and 2 were lost to follow-up.Conclusions The clinical manifestations of DCVT are not specific.For acute-onset DCVT patients,the first symptoms are always headache and vomiting,while the main symptoms are declined cognition and slow reaction for chronic-onset ones.Along with the progress,the main symptoms of DCVT are disturbance of consciousness,psychiatric symptoms and intracranial hypertension.Changes in the bilateral thalamus and basal ganglia are especially main characteristics which are easily misdiagnosed as brain tumor according to the images.DCVT can be definitely diagnosed by no signal of deep cerebral veins on MRV or DSA.

Objective:To investigate the recent and long-term efficacy and safety of pancreaticoduodenectomy for pancreatic head carcinoma and periampullary carcinoma.Methods:82 cases of pancreatic cancer combined with periampullary carcinoma patients admit ted in our hospital from August 2009 to June 2013 were selected and randomly divided into the control group and the observation group With 41 patients in each group.The control group received palliative surgical treatment,while the observation group underwent pancreatoduodenectomy.The operation time,hospitalization time,intraoperative bleeding volume and the incidence of complications,1,2,3-year survival rate and the recurrence rate at 1 year after operation and tumor eradication rate were compared between twp groups.Results:The amount of bleeding,operation time of observation group were significantly higher than those of the control group(P＜0.01),no signif icant difference was found in the hospitalization time between the two groups(P＞0.05);the incidence of complications in the observation group (41.46％) was significantly higher than the control group (22.96％)(P=0.03);the 2-year and 3-year survival rate of observation group were significantly higher than those of the control group (P＜0.05),the recurrence rate at 1 year after operation of observation group was significantly lower than that of the control group (P=0.04),the tumor eradication rate was significantly higher in the observation group than that of the control group (P=0.04).Conclusion:Though pancreaticoduodenectomy could prolong the operation time,increase the risk of bleeding and complications for pancreatic head carcinoma and periampullary carcinoma,but it could effectively reduce the possibility of recurrence after operation,significantly improve the long-term survival rate.

Preliminary exploration on subject librarian mechanism and service is carried out in college and university libraries in Chi-na. The paper introduces actual needs, implementation modes, service contents and forms of subject librarian service in Library of China Medical University;hopefully the good experience would provide reference to other medical colleges and universities.

Objective To evaluate the clinical efficacy and safety of injection azithromycin in the treatment of the acute bacteria pneumonia of infant. Methods A randomized controlled open trial was carried out. Erythromycin as a controll drug was compared the clinical efficacy and safety with azithromycin as a test drug. Results In azithro-mycin group,the clinical effective rate was 90.6% ;the fully recovered rate was 75.5%. While those of erythromycin group were 68.0% ,36.0% respectively. The incidence of adverse reaction was 9.3% and 30.4% respectively in two groups. Conclusion Injection azithromycin of new macrofides type is a kind of effective and safe anti-bacterial drug.

Objective To investigate the clinical effect of low molecular weight heparin (LMWH) and pressure pump on perioperative deep vein thrombosis (DVT) in patients with hip fracture and analyze the effect of LMWH on coagulation function. Methods Retrospective analysis of 95 cases hip fractures patients with clinical data, according to the preventive medication of DVT were divided into LMWH group of 42 cases and LMWH joint pressure pump group of 53 cases. The incidence rate of DVT and the degree of limb swelling after operation in two groups were observed. The differences of blood coagulation function indexes, blood rheology and hip function recovery were compared between the two groups. Results The the incidence rate of DVT in combination group was 1.89% (1 cases ), lower than LMWH group of 14.29% (6 cases )(χ2=5.278,P=0.022). After two weeks' treatment, the difference of anterior thigh circumference and calf circumference in combination group was less than LMWH group (P<0.05). The prothrombin time (PT) and activated partial thromboplastin time (APTT) in two groups post-treatment were lower than those pre-treatment, the D-dimer (D-D) was higher than that pre-treatment(P<0.05), but there was no significant difference between two groups. After 3 months' treatment, the Harris functional independence measure (FIM) in combination group was higher than that in LMWH group (P<0.05). Conclusion LMWH combined with pressure pump could significantly reduce the incidence of perioperative DVT in patients with hip fracture, improve the blood coagulation function and hip function.

Objective To investigate the accuracy of the plasma DNA concentration in evaluating the prognosis in patients with sepsis.Methods One hundred and sixty patients with sepsis were enrolled as the sepsis group (group SE).Another 109 patients without sepsis hospitalized during the same period served as the control group (group C).The venous blood sample was taken on admission for determination of plasma DNA concentration by polymerase chain reaction,C reactive protein (CRP) concentration by ELISA.APACHE Ⅱ score and SOFA score were evaluated at 24 h after admission.The 160 patients with sepsis were divided into two groups according to the result of prognosis:survival group ( n =103) and death group ( n =57).Results Compared with group C,the plasma DNA concentration,CRP concentration,APACHE Ⅱ score and SOFA score were significantly increased in group SE (P＜0.05).Compared with survival group,the plasma DNA concentration,APACHEⅡ score and SOFA score were significantly increased in death group ( P ＜ 0.05).The areas under receiver operating characteristic (ROC) curves of the plasma DNA concentration was significantly larger than those of APACHE Ⅱ score and SOFA score (0.81(95％ CI,0.74-0.88) versus 0.68(95％ CI,0.60-0.77),or 0.72(95％ CI,0.63-0.82)).Conclusion The plasma DNA concentration can accurately evaluate the prognosis in patients with sepsis.As compared with the plasma CRP concentration,APACHE Ⅱ score and SOFA score,the plasma DNA concentration is more accurate to evaluate the prognosis in patients with sepsis.

Objective To investigate the prevalence of thyroid disorders and positive thyroid autoantibodies,and evaluate the necessity for universal thyroid screening during the second and third trimesters of pregnancy.Methods The pregnant women during the second and third trimesters who visited Shanghai Jiaotong University Affiliated First People's Hospital between June 2006 and February 2008 were chosen for thyroid screening by determining serum free triiodothyronine,free thyroxine,thyrotropin,thyroid peroxidase antibody (TPOAb),and thyrotropin receptor antibody.A personal and family history of thyroid disease and other autoimmune diseases was investigated by questionnaire.The pregnant women were divided into high risk or low risk groups for thyroid disease based on their personal or family histories.Results A total of 2 101 pregnant women were screened,712 ( 33.89％ ) of them were identified to suffer from thyroid disorders or with positive thyroid autoantibody.The prevalence of thyroid dysfunction was increased in high risk group.While in low risk group( n =1 983 ),the prevalence of clinical hypothyroidism was 2.27％ ( n =45 ),subclinical hypothyroidism 11.60％ ( n =230 ),clinical hyperthyroidism 0.20％ ( n =4 ),subclinical hyperthyroidism 1.06％ ( n =21 ),hypothyroxinemia 6.45％ ( n =128 ),and euthyroid with positive TPOAb 10.74％ ( n =213 ) in our study.Pregnant women with positive TPOAb were susceptible to thyroid dysfunction.It was shown that 79.74％ of pregnant women with thyroid disorders were diagnosed by universal thyroid screening.Conclusions 33.89％ of pregnant women in the second and third trimesters were identified to suffer from thyroid disorders or positive thyroid autoantibody by universal thyroid screening.Increased prevalence of thyroid dysfunction was found in pregnant women with positive TPOAb.79.74％ of pregnant women with thyroid disorders might be missed if screening was made only in the high risk cases.

ObjetiveTo investigate the obstetrical and neonatal outcomes of pregnant women with hypothyroidism or subclinical hypothyroidism.MethodsOne hundred and sixty-eight pregnant women with clinical or subclinical hypothyroidism during pregnancy,including 9 controlled hypothyroidism,29 uncontrolled hypothyroidism and 130 subclinical hypothyroidism,were enrolled in this study.The general clinical information,obstetrical complications and neonatal outcomes of these pregnant women were compared with that of 180 healthy pregnant women who delivered during the same period.ResultsCompared with control group,there were no significant differences in the levels of serum free triiodothyronine( FT3 ),free thyroxine ( FT4 ),thyrotropin-stimulating hormone (TSH) in the controlled hypothyroidism group in the third trimester [(3.68 ±1.11 ) pmol/L vs (3.19 ±0.33) pmol/L,(15.48 ±4.14) pmoL/L vs (13.95 ± 1.68) pmol/L,1.87 mU/L vs 1.76 mU/L,P ＞0.05].However,in the second and third trimester,the levels of FT3,FT4 in the uncontrolled hypothyroidism group were lower,while the levels of TSH were higher than in control group [(2.71 ±0.80) pmol/L vs (3.14 ± 0.34) pmoL/L,(10.94 ± 2.68) pmol/L vs (14.25 ±2.01) pmol/L,5.62 mU/L vs 2.28 mU/L,( 2.34 ± 0.70 ) pmol/L vs ( 3.19 ± 0.33 ) pmol/L,( 10.16 ± 1.65 ) pmol/L vs (13.95 ± 1.68) pmoL/L,7.13 mU/L vs 1.76 mU/L,t =2.754～9.15,P ＜0.01],the levels of TSH in the subclinical hypothyroidism were higher than in control group ( t =18.28,18.57,P ＜0.01 ).There was no adverse perinatal outcome of neonate happened in controlled hypothyroidism group.In contrast,the incidences of adverse perinatal outcomes and complications in the uncontrolled hypothyroidism group were higher than that in the control group ( 17.2％ vs 2.8％,37.9％ vs 5.6％,x2 =11.47,28.97,P ＜0.01 ).Compared with that of control group,the incidences of adverse obstetrical outcomes in pregnant women with subclinical hypothyroidism were increased (40.0％ vs 5.6％,x2 =52.97,P ＜ 0.01 ).ConclusionsThe rate of adverse obstetrical outcomes and complications is increased in women with clinical or subclinical hypothyroidism.But the incidence of adverse outcomes would decrease if hypothyroidism is controlled by treatment.