Objective To investigate the neurotoxicity of intrathecal (IT) doxepin in rats.Methods Twenty-four adult male Wistar rats weighing 250-300 g in which intrathecal micro-catheter was successfully implanted without complications were randomly divided into 4 groups ( n =6 each):control group ( group N ) and 3 doxepin groups receiving IT doxepin 40,20 and 10 mmol/L 0.2 μl/g respectively (groups D40,D20,D10 ).In N group normal saline was injected IT instead of doxepin.The animals were killed at 6 h after IT administration.The lumbar segment of the spinal cord was removed for microscopic examination and determination of myelin basic protein (MBP) content in the spinal cord using a double-antibody sandwich (ELISA).Results The severity of neuronal damage and decrease in MBP content in the spinal cord induced by IT doxepin were dose-dependent.Conclusion The neurotoxicity induced by IT doxepin is dose-dependent.

Objective To compare the application value of contrast enhanced ultrasound (CEUS) and contrast enhanced magnetic resonance angiography ( CEMRA ) in the diagnosis of carotid plaque characteristics . Methods Fourty-six patients ( 48 carotid plaques) were performed with carotid CEUS and CEMRA examination prior to carotid endarterectomy . The following characteristics of plaque including the surface of the plaque ,the presence of calcification ,the internal composition and the diameter stenosis were observed and measured ,which were compared with pathologic and digital subtraction angiography ( DSA ) results . Results There were 42 vulnerable plaques and 6 stable plaques in the 48 plaques . Fourty-seven carotid plaques had been correctly diagnosed by CEUS and CEMRA ,and one plaque had been misdiagnosed . The sensitivity ,specificity and accuracy between CEUS and CEMRA had no obvious differences in terms of the overall evaluation of plaque vulnerability ( P > 0 .05) ;CEUS and CEMRA in the diagnosion of the plaque surface situation had no statistical difference in terms of sensitivity ,specificity and accuracy compared with pathological results( P > 0 .05) ;There was no significant difference in diagnostic accuracy rate between two modalities ( P < 0 .05) ;In the diagnosis of plaque internal composition ,they had statistically differences in terms of specificity and accuracy ( P < 0 .05) ,while sensitivity had no obvious difference ( P > 0 .05) . With DSA examination results as the gold standard ,the accuracy of CEUS in the diagnosis of the diameter stenosis was 97 .92% (47/48) ,CEMRA was 100% (48/48) ,they had no significant difference between two groups ( P > 0 .05 ) . Conclusions CEUS and CEMRA in carotid plaques characteristic evaluation have respective advantages ,are highly complementary ,and combining two methods can systematically evaluate for plaque characteristics .

Objective To study the clinical therapeutic effects of early rehabilitation training combined with acupuncture on dysphagia after acute cerebral infarction.Methods One hundred patients with dysphagia caused by acute cerebral infarction were randomly divided into 4 groups:a comprehensive treatment group(25 cases,received rehabilitation training,acupuncture and routine medication),a routine drug group(25 cases,routine medication),a rehabilitation group(25 cases,received comprehensive rehabilitation training and routine mediciation)and an acu-puncture group(25 cases,received acupuncture therapy and routine medication).Dysphagia was evaluated with videofluoroscopic swallowing study(VFSS),and the incidence of pneumonia was observed before treatment and at the 14th day after daily treatment. Results After treatment,the VFSS scores of the 4 groups were significantly higher than before treatment,and VFSS scores in the comprehensive treatment group were significantly higher than those in the other groups.The effectiveness rate in the comprehensive treatment group was significantly higher than that in the other three groups.and the incidence of pneumonia was significantly lower.Conclusions Early rehabilitation com-bined with acupuncture can improve swallowing and reduce the incidence of aspiration pneumonia in acute stroke pa-tients.

Objective To evaluate the efficacy of zoledronic acid combined with radiotherapy for bone meta-static cancer. Methods 71 cases with bone metastatic cancer were randomly divided into observation group (40 ca-ses) and control group (31 cases). The observation group was treated with zoledronic acid, 4 mg intravenously and local radiotherapy. The control group was treatd by radiotherapy alone. Results Pain relief was noted in 90% pa-tients in the observation group and 83.9% in the control group, respectively. The statistical difference was not signif-icant(P > 0.05). After the treatment had finished 3 months pain alleviation situation:Pain relief was noted in 87.5% patients in the observation group and 67.7% in the control group, respectively. The difference between the two groups was significant(χ2 =4.09, P =0.043). No serious radiotherapy and serious adverse drug reactions was found. Conclusion Zoledronic acid combined with radiotherapy was superior to radiotherapy alone for metastatic cancer bone pain relief, analgesic effect maintain a longer time.

This experiment was designed to investigate the expression profile of miRNAs (microRNA) in human gastric cancer tissues.Methods The expression profiles of miRNAs were compared between 3 pairs of GC and adjacent normal tissues using an Exiqon miRNA array,following which quantitative PCR (qPCR) was employed to confirm the results of the miRNA array,and 10 miRNAs were selected.Bioinformatics was used to analyze the biological function of the differentially expressed miRNAs and its target genes in gastric cancer.Results Compared with adjacent mucosal tissues,95 miRNAs were up-regulated and 16 miRNAs were down-regulated in GC (＞ 2 folds,P ＜ 0.05).The qPCR results were consistent with microarray-based expression analysis (P =0.049).Furthermore,the online GO and pathway analysis revealed that miRNAs might involve RNA transcription,RNA metabolism,gene expression,gene silencing,and other biological functions in GC.Conclusion There is abnormal expression of miRNAs in gastric cancer,and the abnormal expression of miRNAs may be related to GC tumorigenesis.

Objective To evaluate the concept of artery first and total mesopancreatic excision in radical resection of pancreatic head carcinoma through both anterior and posterior approaches.Method The anterior approach was to identify the superior mesenteric artery (SMA) and the posterior approach to confirm the possibility of negative margin at the origin of SMA,on the posterio-lateral vascular wall of superior mesenteric vein (SMV) and the supposed posterior of the mesopancreas.The resection scope were with the celiac trunk and common hepatic artery as the upper boarder,the SMA as the left boarder,the inferior mesenteric vein (IMA) level as the lower boarder,to achieve a complete mesopancreatic excision,namely the en bloc resection of all the involved nerve,the lymph tissue and vascular tissue along the right side of the axial composed by SMA and celiac trunk.Results Of the 15 patients,11 had radical Whipple procedure,among which 2 had a combining SMV resection and reconstruction.1 case suffered from delayed gastric emptying and 2 cases from bile leakage.There was no mortality.The postoperative pathology reported carcinoma in all 11 cases,with duodenum and low bile duct involved in 4 cases,with the duodenum involved in 6 cases,no surrounding tissue involvement was identified in 1 case.Nerve involvement was found in 7 (7/11),vascular involvement in 10 (10/11),and lymphnode metastasis was (2.5 ± 3.8/12.9 ± 4.9).Conclusions The radical resection of pancreatic head carcinoma using the concept of artery first and the total mesopancreatic excision is helpful for an early evaluation of the possibility of radical resection and guarantees negative margins.

Objective To explore a new method for improving healing of skin graft donor sites.Methods A total of 40 patients who needed intermediate thickness skin graft from thigh,from January 2014 to December 2015,were randomly devided into experiment group and control group.Skin graft donor sites of the experiment group were covered with Physiotulle Ag and Allevyn foam dressing,while donor sites of the control group were covered with petrolatum impregnated gauze,sterile gauze,and compression bandage.Postoperative infection rate,pain scoring during the first dressing change,time of dressing change between operation and complete healing,duration for complete healing,and the area of non-healing two weeks after operation were compared and statistical analysis was performed with SPSS17.0.Results There was no infection in the experiment group.Two patients developed infection in the control group,with wound exudate culture positive for pseudomonas aeruginosa,and the wounds healed after dressing change.The experiment group was significantly better than that of the control group in pain scoring during the first dressing change,time of dressing change between operation and complete healing,duration of complete healing (U=81.5,P=0.001;U=109.5,P=0.011;t=0.769,P＜0.001).Conclusions The Physiotulle Ag combined with Allevyn foam dressing can enhance healing of skin graft donor sites,alleviate pain of the patient,and reduce dressing change.This method is easy to perform,and skin graft donor sites heal well in two weeks,which may lead a prospected application.

Objective To investigate the role of mitochondrial apoptotic pathway in intrathecal doxepin?induced apoptosis in rat neurons. Methods Twenty?four adult male Wistar rats, weighing 250-300 g, in which intrathecal catheters were successfully implanted without complications, were randomly divided into 4 groups ( n=6 each) using a random number table: control group ( group C) and different concentrations of doxepin groups (D5, D10 and D20 groups). In D5, D10 and D20 groups, 5, 10, and 20 mmol∕L doxepin 0. 2 μl∕g were injected intrathecally, respectively. In group C, the equal volume of normal saline was given instead. At 6 h after intrathecal administration, the animals were sacrificed, and the lumbar segments of the spinal cords were obtained for detection of the cell apoptosis ( by TUNEL assay) , expression of Bax and Bcl?2 ( by immunohistochemistry) , release of cytochrome c ( Cyt c) , and expression of caspase?3, caspase?8 and caspase?9 mRNA ( using real?time reverse transcriptase polymerase chain reaction) . Apoptosis rate and Bcl?2∕Bax ratio were calculated. Results Compared with group C, the expression of Bax was significantly up?regulated, the expression of Bcl?2 was down?regulated, Bcl?2∕Bax ratio was decreased, the release of Cyt c and apoptosis rate were increased, and the expression of caspase?3 and caspase?9 mRNA was up?regulated in D10 and D20 groups, the expression of Bcl?2 was down?regulated in group D20 ( P<0.05 or 0.01) , and no significant change was found in the parameters mentioned above in group D5 (P>0.05). The expression of Bax was significantly up?regulated, Bcl?2∕Bax ratio was decreased, the release of Cyt c and apoptosis rate were increased, and the expression of caspase?3 and caspase?9 mRNA was up?regulated in D10 and D20 groups, and the expression of Bcl?2 was down?regulated in group D20 as compared with group D5 ( P<0.05 or 0.01) , and in group D20 as compared with group D10 ( P<0.05) . There was no significant difference in the expression of caspase?8 mRNA among the four groups ( P>0.05) . Conclusion Mitochondrial apoptotic pathways, but not death receptor pathway, is involved in intrathecal doxepin?induced apoptosis in rat neurons.

Objective To evaluate the effectiveness and safety of needle-knife fistulotomy (NKF)for difficult cannulation during endoscopic retrograde cholangiopancreatography (ERCP). Methods Data of patients, who received NKF on the back of major papilla when bile duct could not be accessed by conventional cannulation and/or other pre-cut methods during ERCP, were retrospectively reviewed. The success rate of deep cannulation and its complications were observed and analyzed. Results NKF was performed in 108patients due to difficult cannulation, which succeeded in 97 (91.2%) in access to the bile duct and failed in 11 patients with malignant biliary strictures. The failure rate in patients with distal malignant obstruction was higher (25. 8%, 8/31) than those with proximal lesions (5.3%, 3/57) (P = 0. 014, χ2 = 5. 983).Post-ERCP pancreatitis occurred in 5 cases (4. 6%), with the incidence significantly higher in NKF-failure group (18. 2%, 2/11) than that in NKF-suocess group (3.1% ,3/97) (P = 0. 006, χ2 = 7.418). Intestinal perforation occurred in 1 patient and cholangitis developed in 4 others, which all recovered after conservative managements. Conclusion NKF for difficult cannulations in ERCP is safe and effective, especially in hands of experienced operators, but cannulation success rate is relatively low in distal malignant biliary obstruction.

Objective:Esophageal cancer has high morbidity in China, and surgery is the main treatment for this disease. Postop-erative nutrition is also important for the patients. In this article, we discuss the possibility of retrosternal route gastrostomy feeding (RGF). Methods: The data of 127 esophageal cancer patients between 2011 and 2013 were retrospectively analyzed. RGF was per-formed in all the patients, and post-operation complications were studied. Results: Bowel obstruction, catheter displacement, and wound infection did not occur. Conclusion:RGF is a safe and effective nutrition method for patients who underwent retrosternal recon-struction.