Objective To study the diagnosis and treatment of duodenal papilla tumor (DPT). Methods Analyses were made on the clinical data of 22 patients with DPT proved by operation and pathology from 1977 to 1999. Results There were 17 patients with duodenal papillary carcinoma, 5 with duodenal papilloma in this series. Discomfort of the upper abdomen (16 cases) and jaundice (22 cases) were the main symptoms. Barium meal examination, BUS, CT and ERCP were very useful in the diagnosis of DPT. In this series, 19 of 22 patients received pancreaticoduodenctomy, and 3 received local reseciton, the resection rate was 100%. 15 patients (88.2%) were followed up, the 5 years survival rate was 73.3%, 7 years survival rate was 46.7%. Conclusions Duodenoscope and ERCP are credible methods for diagnosis of this disease, resection is the main way of treatment.

Objective To investigate the feasibility,safety and efficacy of laparoscopic and endoscopic cooperative surgery (LECS) for elderly patients with gastric gastrointestinal stromal tumor (GIST).Methods 54 cases with GIST aged 65 years and over in Department of Gastrointestinal Surgery in Beijing Hospital from Dec.2008 to Dec.2012 were selected.31 cases underwent LECS and 23 cases underwent open surgery.Clinical data including operation time,intraoperative blood loss,complications,tumor size,length of incision,postoperative gastrointestinal function recovery time,postoperative in hospitalization and follow up data were retrospectively analyzed in patients.Results There were 17 males and 14 females in the LECS group,and the mean age was (72.8±5.9)years.29 patients underwent laparoscopic-assisted partial gastrectomy,and 2 cases underwent laparoscopicassisted endoscopic dissection in LECS group.All operations were successful with no conversion to open surgery and death.There were 13 males and 10 females in the open surgery group,and the mean age was(73.3±6.1)years.The mean operation time was longer in LECS group than in open surgery group [(120.6±32.8) min vs.(86.3±33.5) min].The mean intraoperative blood loss,mean tumor size,mean length of incision,mean time of gastrointestinal function recovery,mean postoperative hospitalization were less or smaller in LECS group than in open surgery group [(40±23.4) ml vs.(130±65.6) ml,(2.3±1.2)cm vs.(3.6 ±1.8)cm,(3.6±1.1) cm vs.(14.4±3.5) cm,(47.7± 10.4)h vs.(61.4±11.9)h,(5.1±2.3)d vs.(7.2±2.5)d,respectively,t=3.192,1.831,5.212,2.014,3.519,P=0.002,0.012,0.000,0.015,0.001].According postoperative tumor risk assessment,13 cases were at very low risk,15 cases at low risk and 3 cases at middle risk in LECS group; 4 cases were at very low risk,14 cases at low risk and 5 cases at middle risk in open surgery group.The risk degree was lower in LECS group than in open surgery group (x2 =5.63,P=0.017).During a follow-up of 5 53 months,death without GIST was found in 5 patients in LECS group and 4 cases in open surgery group.Hepatic metastasis was found in 1 case in open surgery group.Conclusions LECS is a safe and feasibility alternative approach for elderly patients with gastric GISTs.It has more minimal invasion,fast recovery and satisfaction with short term outcomes as compared with conventional open surgery.

Objective To study the nutritional evaluation and clinical effects of perioperative enteral nutrition (EN) versus parenteral nutrition support (PN) in elderly patients undergoing gastrectomy for gastric carcinoma.The safety,feasibility and superiority were also compared between EN and PN.Methods Totally 50 cases (aged 65 years and over) undergoing gastrectomy for gastric carcinoma in Department of Gastrointestinal Surgery of Beijing Hospital were recruited and divided randomly into two groups of EN and PN (25 cases for each).NRS2002 nutritional assessment scoring system was used to evaluate the patients.The patients in EN group were given Rui Su at 2 d before surgery,then Wei wo,Bai pu li and Rui su were sequentially given from 12 h after the surgery.The patients in PN group were received total parenteral nutrition (TPN) via central venous for 7 days.Results The average absolute lymphocytes[(1.22±0.23) ×109/L and (1.31±0.27) ×109/L vs.(1.02±0.21) × 109/ L and (1.14 ± 0.23 × 10)9/L],pre-albumin[(151.442± 48.15) mg/ L and (167.38± 46.23) mg/ L vs.(115.22 ± 47.34) mg/L and (131.27 ± 43.58) mg/L] and transferring [(1.71±0.33)g /L and (1.83±0.31)g/L vs.(1.50±0.32)g/L and (1.65±0.32)g/L,all P＜0.05] levels after surgery of 3 d and 7 d in EN group were higher than those of PN group (P＜0.05).The CRP levels at 3 d and 7 d after surgery were increased in PN group compared with EN group [(63.71±35.26)mg/L and (41.58 ± 22.55)mg/L vs.(54.26±29.13)mg/L and (18.12 ±14.35)mg/L,P＜0.05].The blood sugar and insulin levels of EN group at 3 d and 7 d after surgery were (5.93±1.12) mmol/L and (5.61± 1.03)mmol/L,(6.72±5.14) U/L and (6.21±2.63) U/L,which were decreased compared to PN group (8.31 ± 2.62) mmol/L and (8.85 ± 2.92) mmol/L,(12.81±7.26) U/L and (15.21±8.24) U/L (P＜0.05).ALT in the PN group was (38.43±18.37) U/L at 7 d after surgery,higher than EN group (23.91± 14.82) U/L(P＜0.05).The perioperative average costs of EN group was (2714.5± 1391.7) yuan,lower than PN group (5041.6± 3007.7) yuan (P＜0.05).For the patients complicated with delayed gastric emptying after surgery,nutrition cost reduction was more evident.There were no significant difference between the two groups of patients in the liver and kidney function changes and postoperative complications.Conclusions It is safe and feasible for elderly gastric cancer patients with perioperative EN sequential therapy in view of its reduced stress response of surgical trauma and insulin resistance,improvement of hyperglycemia,reduction of medical costs compared with PN for elderly gastric cancer patients.

In order to explore the value of assessment in measuring S-100 beta protein (S-100B protein) and neuron-specific enolase (NSE) present in cerebrospinal fluid (CSF) from patients with brain insult in central nervous system infections, S-100B protein and NSE in CSF were measured dynamically by ELISA in 42 patients with Herpes Simplex Encephalitis (USE), 19 patients with purulent meningitis, 17 patients with cryptococcus meningitis and 22 unrelated control patients. It was found that the levels of CSF S-100B protein in all the three groups were higher than that of the control group (P0. 05). There were dynamic changes of CSF S-100B protein and NSE concentrations in all three groups correlating with the severity of disease. It is suggested that elevated concentrations of S-100B protein and NSE in CSF related to the damage of glia and neurons could be used as CSF markers of brain insult in patients with central nervous system infections.

Objective To analysis the time of acute cerebral stroke occurrence. Methods The occurrence time of 2675 patients with cerebral infarction (1925 cases,CI group) and intracerebral hemorrhage(750 cases,ICH group) were statisticed by 1 time unit per 2 h from 0∶00. Results There was a time-curve with double peaks of stroke occurrence,like as circadian rhythms of blood pressure in 24 h. ⑴ In CI group,the first peak was 6∶00~10∶00, the second peak was 18∶00~22∶00. The value of the first peak was higher than that of the second(P

目的观察大剂量纳洛酮对急性脑卒中患者的疗效。方法144例急性脑卒中患者随机分为常规治疗组(对照组)和纳洛酮治疗组,前者给予脱水、降颅压、保护脑细胞等常规治疗,后者在常规治疗的基础上加用纳洛酮(2.0mg/d,静滴),比较两组患者的清醒时间及疗效。结果纳洛酮组患者清醒时间早于对照组(P<0.01),疗效明显优于对照组(P<0.01)。结论纳洛酮对急性脑卒中疗效确切,可使患者清醒时间提前。

Objective To investigate the concentration of S-100 protein presenting in cerebrospinal fluid (CSF) and blood serum in patients with Guillain-Barr? syndrome (GBS), and discuss the value of assessment in measuring S-100 protein level to Schwann′s cell insult. Methods S-100 beta protein was measured dynamically by ELISA in CSF and blood serum from 50 patients with GBS and 22 referencesThe patients were divided into two categories by disease severity: the severe group and the mild groupMeanwhile, CSF cytology was also detected. Results (1) The level of CSF S-100 beta protein in both severe and mild groups were higher than that of the control group (P0.05)(2) The percentage of CSF monocyte in severe group was higher than that of the mild and the control groups(P0.05)(3) There was a dynamic change of CSF S-100 beta protein level in GBS patients correlated with the percentage of CSF monocyte and the severity of disease. Conclusions CSF and blood serum S-100 beta protein level in patients with GBS may be related to the severity of the disease.

Objective To evaluate the effect of ulinastatin on Th1/Th2 cell balance in a rat model of stress-induced gastric ulcer (GU).Methods Twenty-four male SPF Sprague-Dawley rats,aged 6-8 weeks,weighing 180-220 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),stress-induced GU group (group GU) and ulinastatin group (group U).The rats were subjected to water-immersion and restraint stress for 3.5 h to establish GU model in S and U groups.At 10 min before water-immersion,normal saline 0.4 ml and ulinastatin 100 000 U/kg were injected via the tail vein in GU and U groups,respectively.After GU model was established,the abdomen was opened after anesthesia.The whole stomach was exposed,and the gastric mucosal damage was evaluated under microscope,ulcer index (UI) was recorded,and the pathological changes of the gastric mucous membrane were observed.Spleen samples were obtained to detect T-bet,Gata-3,interferon-γ (IFN-γ),and interleukin-4 (IL-4) mRNA expression by RT-PCR.The ratio of T-bet mRNA expression/Gata-3 mRNA expression (T-bet/Gata-3) was calculated.Results Compared with group C,T-bet mRNA expression was significantly down-regulated,Gata-3 mRNA expression was up-regulated,T-bet/Gata-3 ratio was decreased,UI was increased,and no significant changes were found in IFN-γ and IL-4 mRNA expression in GU group,and UI was increased,and no significant changes were found in the other parameters in group U.Compared with group GU,the ratio of T-bet/Gata-3 was significantly increased,and UI was decreased,and no significant changes were found in T-bet,Gata-3,IFN-γ,IL-4 mRNA expression in group U.The gastric mucosal damage was significantly mitigated in GU group as compared with group U.Conclusion The mechanism by which ulinastatin mitigates stress-induced GU may be related to correction of Th1/Th2 cell imbalance in rats.

Objective To evaluate the efficacy and safety of combination therapy of oxaliplatin and S-1 vs oxaliplatin and docetaxel for advanced gastric cancer (AGC)patients.Methods From April 201 1 to Janu-ary 201 3,62 cases of AGC were collected in the Fifth People′s Hospital of Qinghai Province.All cases were randomly divided into group A (31 cases)and B (31 cases)by random number table.In group A,oxaliplatin plus S-1 was administered,and in group B,oxaliplatin plus docetaxel was applied.The response rate (RR), time of diseases controlled rate (DCR),progression-free survival (PFS),overall survival (OS)and adverse reactions of the two groups were observed and compared.Results There were no statistically differences between group A and group B in RR (48.4% vs 54.8%),DCR (67.7% vs 77.4%),mPFS (5.4 months vs 6.2 months),mOS (9.0 months vs 9.8 months),and the statistical values were as follows:χ2 =0.26,P =0.71 1 ;χ2 =0.73,P =0.393;χ2 =0.51 ,P =0.473;χ2 =0.03,P =0.829.The incidence of degrees Ⅰ-Ⅱperipheral neuropathy (9.7% vs 22.6%),nausea and vomiting (1 2.9% vs 32.3%)in group A were signifi-cantly lower than those in group B (χ2 =5.78,P =0.002;χ2 =4.63,P =0.01 6).Conclusion Both the two chemotherapies are similar in therapeutic effect for patients with AGC.Oxaliplatin plus S-1 treatment may be better than oxaliplatin plus docetaxel in the tolerance of patients.

Objective To investigate the efficacy of a modified duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis.Methods The clinical data of 109 patients with chronic pancreatitis who received modified DPPHR at the Union Hospital of Huazhong University of Science and Technology from January 2004 to June 2013 were retrospectively analyzed.Of the 109 patients,66 were with mass in the head of the pancreas,29 were with calcification of the head of the pancreas,14 were with atrophy of the head of the pancreas and stones in the main pancreatic duct.The level of glucose of 56 patients were normal,34 patients had glucose tolerance abnormalities and 19 were complicated with diabetes mellitus.Modified DPPHR was carried out after confirming the diagnosis of chronic pancreatitis and excluding the malignancies by frozen pathological examination.The head of the pancreas was completely resected.The posterior pancreaticoduodenal aortic arch running parallel to the duodenum was preserved to guarantee the blood supply to the remaining duodenum.A thin sheet of the pancreatic tissue behind the intrapancreatic common bile duct and between the common bile duct and the duodenum was preserved to guarantee the blood supply to the common bile duct.The gastrointestinal tract was reconstructed with an anastomosis of the distal pancreas and the jejunum and an end-to-en anastomosis of the proximal jejunum and the distal jejunum.Patients were followed up via out-patient examination to learn the frequency of abdominal pain,analgesics usage and the endocrine function.The pain scale,life quality and endocrine function were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30),Gastrointestinal Quality of Life Index (GLQI) questionnaire,and oral glucose tolerance test (OGTT),respectively.Patients were followed up till January 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results No patients died during the operation.The operation time,volume of blood loss and blood transfusion were (3.5 ± 0.7) hours,(360 ± 125) mL and (260 ±220) mL,respectively.After the operation,5 patients were complicated with pancreatic leakage,5 with bile leakage,2 with duodenal fistula and 1 with peritoneal bleeding,and all the patients were cured after conservative treatment.Four patients were complicated with abdominal abscess,1 patient of whom was treated by conservative treatment,and the remaining 3 patients were cured by drainage guided by B sonography.The duration of hospital stay was 13.8 days (range,10.0-32.0 days).The median time of follow-up was 18.0 months (range,3.0-24.0 months).A total of 102 patients were followed up for more than 9 months.At postoperative month 9,the ratio of patients with abdominal pain was decreased from 78.90％ (86/109) to 18.63％ (19/102),and the ratio of patients administered analgesics was decreased from 76.47％ (78/102) to 12.75％ (13/102),with significant difference between the indexes before and after operation (x2=76.57,74.31,P ＜ 0.05).The score of the EORTC QLQ-C30 was decreased from 58 ±36 before operation to 15 ±4 after operation,with significant difference (t =11.39,P ＜ 0.05).The score of GLQI was increased from 69 ± 8 before operation to 87 ± 15 after operation,with significant difference (t =20.05,P ＜ 0.05).The patient with diabetes mellitus was cured,and no newly onset of diabetes was found.Two patients received reoperation because of recurrence of stones in the distal pancreatic duct and pancreatogenic portal hypertension.Conclusion Modified DPPHR is effective for the treatment of chronic pancreatitis with low incidence of postoperative complications.