Objective To study the relationship between juxtapapillary duodenal diverticulum (JPDD) and pancreaticobiliary diseases, and the effect of JPDD on the diagnosis and treatment of ERCP. Methods A retrospective analysis was performed on data of 1230 patients who had received ERCP in general surgery departments of Shengjing Hospital of China Medical University from January 2012 to January 2017. The patients were divided into JPDD group ( n=360) and non-JPDD group ( n=870) according to whether JPDD was found. Patients with JPDD were divided into intradiverticular papilla group ( n=41) and non-intradiverticular papilla group ( n=319) according to whether the papilla located in diverticulum. The incidence of pancreaticobiliary diseases, success rate of cannulation, success rate of stones removal, and incidence of postoperative complications among each group were compared by using chi-square test or Fisher's exact probability. P < 0. 05 was statistically significant. Results The incidence of choledocholithiasis, primary choledocholithiasis and recurrent choledocholithiasis were 87. 78％ (316/360), 31. 11％ (112/360), and 6. 67％ (24/360), respectively, in the JPDD group, and 75. 52％ (657/870),19. 08％ (166/870), and 4. 02％ (35/870), respectively, in the non-JPDD group. There were significant differences between the two groups (χ2=23. 158, P<0. 001; χ2=21. 068, P<0. 001; χ2=3. 897, P=0. 048) . No significant differences were observed in the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia between the two groups ( all P>0. 05) . The incidence of recurrent choledocholithiasis in the intradiverticular papilla group and the non-intradiverticular papilla group were 14. 63％ ( 6/41) and 5. 64％ (18/319), respectively, with significant difference (χ2 =4. 721, P=0. 030). There were no significant differences between the two groups in the incidence of choledocholithiasis and primary choledocholithiasis, the success rate of cannulation and complete stones removal during the first ERCP session, as well as the incidence of postoperative hemorrhage, pancreatitis and hyperamylasemia ( all P>0. 05) . Conclusion JPDD is associated with the occurrence of primary choledocholithiasis. JPDD patients, especially the patients with intradiverticular papilla, are more likely to have recurrent choledocholithiasis after ERCP treatment.

Objective To explore the therapeutic effect and clinical significance of pelvic floor rehabilitation technique in female with myofascial chronic pelvic pain (MCPP) by detecting the pressure pain thresholds (PPTs). Methods One hundred healthy female (control group) and 324 female MCPP patients (observation group) from January 2009 to December 2016 were selected. Automatic body surface and vaginal pressure pain detector was applied to detect two groups′PPTs of the 34 spots. The difference of PPTs at each spot was analyzed in two groups. In addition, 51 patients with moderate and severe MCPP were selected to record the changes of PPTs and pain scores before and after the treatment of pelvic floor rehabilitation technique. Results The average PPTs of the abdomen, vulva, pelvic floor and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament in the observation group were significantly lower than those in the control group (P<0.01 or<0.05). The average PPTs of the abdomen, vulva, pelvic floor muscles and vaginal front and back fornix, bilateral adnexa uteri and sacrouterine ligament of 51 MCPP patients after treatment were significantly higher than those before treatment (P<0.01). After treatment, PPTs and pain scores of the pelvic floor muscles, bilateral adnexa uteri, bilateral sacrouterine ligament, bilateral sacral spine ligament and vaginal front and back fornix were negatively correlated (r =- 0.78 to- 0.19, P = 0.01 to 0.04); there was a negative correlation between the PPTs and pain scores of the left and right latissimus dorsi (r=-0.28, P=0.04;r=-0.32, P=0.02). The complete remission rate with the pelvic floor rehabilitation technique in 51 patients with MCPP was 9.8％(5/51), the significant remission rate was 90.2％(46/51), and the total remission rate was 100.0％ (51/51). Conclusions Compared with the normal healthy ones, female with MCPP has lower PPTs in the abdomen, perineum, vagina and pelvic floor. The effect of pelvic floor rehabilitation technique on MCPP is well, which can increase patients′PPTs to reduce pain scores. It is a worthwhile method to treat these diseases.

Objective To evaluate the effect of applying extracorporeal shock wave therapy (ESWT) to alleviate triceps surae spasticity after a stroke and to explore the electrophysiological mechanisms involved.Methods Sixty hemiplegic stroke patients with triceps surae spasticity were recruited and randomly assigned to either an ESWT group or a control group,each of 30.Both groups were given routine medication and rehabilitation training.The ESWT group additionally received 3000 shots of ESWT at 0.089 mJ/mm2,1.5 bars and 8 Hz applied once a week for 4 weeks.Before the treatment,immediately afterward,and then 1 and 4 weeks later the subjects were assessed using the composite spasticity scale (CSS),passive range of motion (PROM) measurements,the 10-meter walk test (10MWT),H reflex latency and the Hmax/Mmax ratio.Results The ESWT group showed significant improvement in their average CSS,PROM and 10MWT results at t1,t2 and t3 compared with t0,while the control group had significant improvement in their average CSS and 10MWT scores,but their average PROM score improved significantly only at t1 and t2.The ESWT group showed significantly better progress in terms of their average CSS score at t1 and t2.The groups' average PROM scores were not significantly different,but the ESWT group had faster 10MWT times at t1,t2 and t3.In the ESWT group H reflex latency had lengthened significantly by t1 and the Hmax/Mmax ratio had decreased significantly,but the only significant difference from the controls was in the average H reflex latency at t1.The ESWT was well tolerated and did not cause any severe adverse effects.Conclusions ESWT improves triceps surae spasticity effectively after stroke quite safely.

Objective To investigate the clinical features of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated hypertrophic pachymeningitis (HP).Methods Clinical data of 4 casesdiagnosed with MPO-ANCA vasculitis complicated with HP in our hospital were analyzed retrospectively and the related literaturewere reviewed.Results Four male patients with an age range from 44 to 66 years were diagnosed with ANCA-associated HP.The main clinical manifestations included headache and withvarious degree ofmultiple cranial paralysis.During active phase of the disease,all patients showed perinuclear(p)-ANCA positive,elevated levels of inflammatory biomarkers and titers of MPO-ANCA,whereas renal function,cytoplasmic (c)-ANCA and protease 3 (PR3)-ANCA were negative.Contrast-enhanced cranial magnetic resonance imaging (MRI) scan showed obviously thickened dura mater and sinusitis or mass in paranasal sinus.Four patients were sensitive to glucocorticoid.Three patients had a relapse during glucocorticoid tapering and were undercontrol when the dosage of glucocorticoid was increased and immunosuppressive agents were added.Levels of inflammatory biomarkers,titers of MPO-ANCA and p-ANCA recovered to normal,and the dural thickness on MRI was reduced in the remission stage.Conclusion MPO-ANCA associated HP is a type of central nervous system involvement in ANCA associated vasculitis (AAV).It involves the upper respiratory tract more frequently,and less frequently progresses to systemic AAV.This should be taken into consideration when middle-aged and elderly patients presented with headache and multiple cranial neuropathies.Enhanced MRI is the preferred examination for diagnosis,and dural biopsy should be done when necessary.

Objective To evaluate the application value of inhibitor enhanced modified carbapenemase inactivation method (imCIM) in the detection of class B carbapenemase.The differences between imCIM and EDTA disc potentiation test (EDPT) were comparatively analyzed.Methods A total of 181 strains of carbapenem insensitive strains were collected,among which there were 44 strains of Klebsiella pneumoniae,44 strains of Escherichia coli,43 strains of Acinetobacter baumannii and 50 strains of Pseudomonas aeruginosa.The 83 strains of carbapenem-sensitive strains were composed of 25 strains of Klebsiella pneumoniae,16 strains of Escherichia coli,25 strains of Acinetobacter baumannii and 17 strains of Pseudomonas aeruginosa.The class B carbapenemase in the 264 strains of pathogenic bacteria was screened by imCIM and EDPT,and PCR results were used as gold standard.The statistical analysis wasperformed with consistency check,related-sample Wilcoxon signed rank sum test,independent samples Kruskal-Wallis H test and ROC curve.Results Among the 181 strains of carbapenem insensitive strains,PCR results of 144 strains were positive for drug resistance gene.The samples of class A,B and D of carbapenemase were 39,77 and 28 strains respectively.The results of imCIM showed that 70 strains were positive,and the other 111 strains were negative.The imCIM results of 166 strains were consistent with those of PCR.The results of EDPT showed that 72 strains were positive,and the other 109 strains were negative.The EDPT results of 134 strains were consistent with those of PCR.The results of PCR,EDPT and imCIM of 83 carbapenem sensitive strains were negative.The sensitivity and specificity of imCIM were 85.71％ (66/77) and 97.86％ (183/187),and the value of Kappa was 0.859.The sensitivity and specificity of EDPT were 66.23 ％ (51/77) and 88.77 ％ (166/187),and the value of Kappa was 0.561.The difference of inhibition zone of imCIM (AdimCIM) was different from EDPT(AdEDPr) and the difference was statistically significant (Z =-6.941,P ＜ 0.05).In the imCIM detection,the AdimciM level of class B carbapenemase showed different population distribution position from class A and D carbapenemase with the statistically significant difference (x2 =108.887,P ＜ 0.05).The areas under the ROC curve of imCIM and EDPTwere 0.988 (95％CI:0.977 to0.999) and0.936 (95％CI:0.909 to0.963),respectively.Conclusion imCIM should be accurate,efficient and convenient for screening of carbapenem phenotype for its high sensitivity and specificity,and suitable for epidemiological monitoring.

We reported perioperative nursing care of a patient with autogenous frozen ovarian pelvic transplantation after cervical cancer radical hysterectomy.Nursing priorities included:preoperative multidisciplinary assessment of the patient,including assessment of physical condition,activity of frozen frozen ovarian tissue and appropriate recovery time,autologous transplantation site,psychological status,and corresponding nursing interventions were provided.Nurses cooperated with surgeons during frozen ovarian resuscitation and other related operations.Health education and discharge guidance were provided after surgery,and the patient was informed about the importance of revisit and self-monitoring.The surgery was successful and the patient was discharged 3 days after surgery.There was no significant change in endocrine levels during revisit one month after surgery,but the patient considered symptoms of menopause had alleviated.

Objective To investigate the feasibility of modified rapid Carba NP test for the detection of carbapenemase,and analyze the differences between the modified method and Carba NP test.Methods A total of 264 strains of gram-negative bacillus,including 164 carbapenem-resistant strains and 100 sensitive strains,were collected,and their carbapenemase were detected by Carba NP test and the modified rapid Carba NP test,respectively.The differences between the two tests were evaluated based on PCR as a reference.Results Among 164 carbapenem-resistant strains,carbapenemase gene was detected in 144 strains by PCR.The carbapenemase gene was negative in 100 sensitive strains.Among 164 carbapenem-resistant strains,135 were positive for the Carba NP test,while 130 for the modified rapid Carba NP test.One hundred of sensitive strains were negative for the two Carba NP tests.Compared with the results of PCR,the sensitivity,specificity and Kappa value of the Carba NP test were 91.7％ (132/144),97.5％ (117/120) and 0.886,respectively,while those of the modified rapid Carba NP test were 89.6％ (129/144),99.2％ (119/120) and 0.879,respectively.There was no significant difference in the positive rates between Carba NP test and the modified rapid Carba NP test (x2 =1.45,P ＞ 0.05).Conclusion The modified rapid Carba NP test which has high consistency with the PCR method,is faster and cheaper than the Carba NP test,and may be applied to epidemiologic survey and the early monitoring of nosocomial infections.

Objective To investigate the influential factors for the outcome of the first 131I therapy in patients with PTC after total thyroidectomy.Methods One hundred and fifty-nine patients (45 males,114 females,average age (43.4± 12.2) years) with PTC after total thyroidectomy who underwent 131I therapy from July 2014 to December 2015 were retrospectively analyzed.Curative efficacy was evaluated 6 months after 131I therapy.Therapeutic outcome was evaluated according to TSH stimulated Tg (sTg) level,Dx-WBS and evidences of other imaging modalities.Twelve possible factors affecting therapeutic outcome of 131I therapy,including patients' age,gender,time interval between thyroidectomy and 131I therapy,primary tumors size and extrathyroidal extension,number and range of primary tumor lesions,lymph node metastases in surgery,status of thyroid remnant in 99TcmO4-imaging,pre-treatment laboratory measurements (TSH,sTg and TgAb),131I therapeutic dose,results of Rx-WBS and SPECT after 131I therapy,were analyzed with univariate and multivariate logistic regression.ROC curve and diagnostic critical point were analyzed to evaluate the predictive value of influential factors for the outcome of 131I therapy.Results The cure rate of the first 131I therapy was 64.2％ (102/159).Univariate logistic regression analysis showed that age,gender,lymph node metastases,sTg and 131I therapeutic dose (all P＜0.01) were the influential factors for the outcome of 131I therapy.Multivariate logistic regression analysis showed that lymph node metastases (regression coefficient:1.118) and sTg (regression coefficient:0.314) were influential factors (both P＜0.05).The regression equation was:Logit P =-4.155+ 1.118×lymph node metastases+0.314×sTg (x2 =93.7,P＜0.001).Taking sTg as a predictive factor for the outcome of 131I therapy,the AUC of ROC curve was 0.926 (95％ CI:0.888-0.963).The cut-off value of sTg was 2.97 μg/L with a sensitivity of 94.7％ (54/57) and a specificity of 76.5％ (78/102).Conclusions PTC patients with low sTg levels and few lymph node metastases after total thyroidectomy are more likely to be cured in the first 131I therapy.

Objective: To explore the clinical and molecular genetic features of a Chinese patient with catecholaminergic polymorphic ventricular tachycardia (CPVT). Methods: Clinical data including resting electrocardiography, echocardiography and treadmill exercise testing of a patient with CPVT admitted to our department in March 2013 were analyzed, and the peripheral venous blood samples of the patient and his family members and 400 ethnicity-matched healthy controls were obtained. All exons and exon-intron boundaries of the six CPVT-related genes including RYR2, CASQ2, TRDN, CALM1, KCNJ2 and ANKB were sequenced to detect the variants related to CPVT. The relationship between the genotypes and phenotypes was analyzed to direct the target therapy. Results: Recurrent syncope induced either by exercise or extreme frightened fear was observed in this patient. There was no positive family history of syncope or sudden death. The resting electrocardiography and echocardiography of the patient were normal, while the exercise testing revealed bidirectional and polymorphic ventricular tachycardia. A cardiac ryanodine receptor gene mutation (R2401H) was identified in this patient, while this mutation was absent in his parents and sister and 400 controls. No variant was detected in the remaining five candidate genes. Treatment with high dose of metoprolol succinate (118.75 mg/d) was effective and patient was free of syncopal attack during the 2 years follow-up. Conclusion This is the first report on RyR2-R2401H mutation in Chinese patient with CPVT, and high dose of metoptolol is the effective therapy option for CPVT related to RyR2 mutation.

Objective To explore the effects of repetitive transcranial magnetic stimulation (rTMS) on the motor function of lower limbs of patients with cerebral infarction.Methods Sixty stroke survivors with lower limb dysfunctionwere randomly assigned to an rTMS treatment group or a control group,each of 30.Both groups were given routine medication and rehabilitation treatment,while the treatment group was additionally provided with 4 weeks of rTMS treatment of the contra-lesional M1 at 1 Hz and 90％ motor threshold.The Fugl-Meyer motor assessment (FMA) and maximum walking speed (MWS) were used to assess both groups before and after the treatment and 2 weeks later.Adverse reactions were also recorded.Results Before the intervention,no differences were found between the two groups.After the treatment and two weeks after that,significant improvement was observed in the average FMA and 10 m MWS of both groups,with significantly more improvement in the treatment group than among the controls.No obvious adverse reactions were observed in either group.Conclusions rTMS can improve the motor function of the affected lower limbs of stroke patients safely.