Objective:To evaluate the clinical efficacy of endoscopy for early cancer of duodenal papilla.Methods:A retrospective analysis was performed on data collected from 23 consecutive patients with early cancer of duodenal papilla, who underwent endoscopic treatment from January 2015 to January 2021 in Beijing Friendship Hospital. Baseline data, endoscopic and pathological data, occurrence and outcome of complications were studied.Results:Twenty-three patients successfully received endoscopic treatment. The maximal diameter of lesions evaluated under endoscopy was 1.90±0.83 cm. Among the 23 cases, 20 underwent endoscopic mucosal resection and 3 underwent endoscopic piecemeal mucosal resection. Delayed bleeding occurred in 5 cases (21.7%), 3 patients (13.0%) developed postoperative hyperamylasemia, 6 patients (26.1%) developed mild acute pancreatitis, and 1 patient (4.3%) had pancreatic duct stent displacement after the operation, which improved after medical or endoscopic treatment. No perforation occurred during the perioperative period. In terms of final pathology, the en bloc resection rate was 82.6% (19/23), and the complete resection rate was 78.3% (18/23). Preoperative endoscopic ultrasonography showed that 19 lesions were confined to the mucosal layer, which were all demonstrated by postoperative pathology. Four other cases were suspected to be involved in the submucosa or the end of the pancreaticobiliary duct under endoscopic ultrasonography, two of which were confined to the mucosal layer, and the other 2 cases involved the submucosal layer, so additional surgery was performed. A total of 18 patients were followed up, among whom 14 achieved complete resection of postoperative pathology, and 2 patients (14.3%, 2/14) were found to have recurrence at 12 and 51 months respectively after the treatment and did not relapse after surgical treatment and endoscopic treatment respectively. Among 4 other patients of follow-up whose pathology did not achieve complete resection, 1 had no recurrence, and the other 3 received additional surgical treatment without recurrence.Conclusion:Endoscopic treatment for early cancer of duodenal papilla is safe and effective. It is necessary to improve preoperative evaluation, stay alert to perioperative complications, and pay attention to regular postoperative endoscopic follow-up.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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Objective:To discuss the clinical efficacy of Xuesusheng granule for cancer related fatigue （CRF） deficiency of both Qi and blood in clinical practice， and to investigate its effect on immune function and quality of life. Method:According to random number table method， 118 patients were divided into observation group （59 cases） and control group （59 cases）. Patients in control group got Ejiao Huangqi oral liquid， 10-20 mL/time， 2 times/day. Patients in observation group got Xuesusheng granule， 10 g/time， 3 times/day. The treatment was continued for 8 weeks in both groups. Before and after treatment， scores of cancer fatigue scale （CFS）， functional assessment of cancer therapy （FACT） and Qi and blood deficiency syndrome were graded， and degree of fatigue was discussed with brief fatigue inventory scale-Chinese （BFI-C）. Levels of white blood cell count （WBC）， neutrophil count （NEU）， platelet count （PLT）， red blood cell count （RBC）， and hemoglobin （Hb） were compared before and after treatment.T lymphocyte subsets of （CD3⁺， CD4⁺， CD8⁺） levels， natural killer （NK） cells， interleukin-1（IL-1）， IL-6， IL-8 and tumor necrosis factor -α （TNF -α） were also detected， and the safety was evaluated. Result:After treatment the scores of each factor in CFS scale and the total score of CFS in the observation group were lower than those in the control group （P<0.01）， and the degree of fatigue was lower than that in control group （Z=2.101， P<0.05）. The total score of FACT and the scores of four dimensions of physiology， society/family， emotion and function in the observation group were lower than those in the control group （P<0.01）. Levels of WBC， NEU， RBC and Hb in the observation group were higher than those in the control group （P<0.01）. Scores of BFI-C， deficiency of Qi and blood were lower than those in control group （P<0.01）. Levels of NK， CD3⁺， CD4⁺ and CD4⁺/CD8⁺ in the observation group were all higher than those in the control group （P<0.01）， while the IL-1， CD8⁺， IL-6， IL-8 and TNF-α levels in observation group were lower than those in the control group （P<0.01）. Not observed， there was no adverse reaction related to Xususheng granule. Conclusion:Xuesusheng granule can improve the symptoms of fatigue， reduce the degree of fatigue， improve the quality of life， reduce the degree of bone marrow suppression， improve immune function， and regulate immune inflammatory factors with high clinical efficacy in the use for patients with CRF and deficiency of Qi and blood.

This paper analyzes the problems existing in the current theory of divergent meridian (""), such as the unclear route of divergent meridian, the controversy in the "---" and the lack of in-depth research on the theory of "", clarifies the source and privides insights. The author analyzed the word "" by means of the four proofreading methods combined with philology method to explore the origin of " ". The divergent meridians is the remnant of the original meridians system in the bamboo and silk documents, which was put into the meridians system after being sorted out by doctors. The twelve meridians are combined in two, forming the "" point, which is located in the neck, and has a great influence on the blood circulation of the head and neck. "" point and theory can guide the differentiation of acupuncture and moxibustion, and has an important guiding significance for the treatment of empirical, emergency and head and face diseases.

Hemorrhagic shock refers to the pathophysiological process of reduced effective circulating blood volume,insufficient tissue perfusion,disorder of cell metabolism,and impaired organ function caused by the body's massive blood loss due to various causes.The key to improving the success rate of its treatment is to recover effective tissue perfusion as soon as possible to improve the oxygen supply to tissue cells,rebalance oxygen supply and demand,and restore normal cell functions while eliminating the cause of shock.The key to emergent care of hemorrhagic shock is timely and effective fluid resuscitation,which can directly affect the prognosis of patients.How to effectively provide fluid resuscitation is a clinical challenge that doctors must take into consideration.Direct peritoneal resuscitation represents a new approach by which the required infusion fluid is administered into the peritoneal cavity by means of abdominocentesis and absorbed through the peritoneal blood vessels and lymphatic vessels.This fluid resuscitation technique is characterized by fixed puncture points and easy operations,and it is less affected by environmental factors.Using this technique,the fluid can be infused at once in a short time.When it is difficult to establish an intravenous infusion pathway,a fluid resuscitation pathway can be quickly established,which can effectively improve hemodynamic indicators and achieve fluid resuscitation against shock.In addition,at the same time of intravenous fluid resuscitation,direct peritoneal resuscitation can improve the effect of intravenous resuscitation,which is of great significance in improving micro-circulation,increasing organ blood flow,reducing organ and tissue edema,and inhibiting systemic inflammation.This article attempts to review the merits,fluid selection and mechanism of direct peritoneal resuscitation,aiming to provide new ideas for fluid resuscitation of hemorrhagic shock.

OBJECTIVETo investigate the effect of alantolactone on perliferation and apoptosis of multiple myeloma (MM) RPMI-8226 cells, and to explore its possible mechism in vitro and in vivo.

METHODSThe RPMI-8226 cells were treated with alantolactone (1, 2.5, 5, 7.5 and 10 µmol/L) for 48 h, cell viability was detected by CCK-8 assay and the value of IC50 was calculated; The RPMI-8226 cells were treated with alantolactone (2.5, 5 and 7.5 µmol/L) for 48 h, the apoptotic rate was detected by flow cytmetry with Annexin V/PI staining; the expression level of cleaved caspase-3 and phosphorylation of ERK were measured by Western blot; the nude mice was used to further confirm the proapoptotic effect of alantolactone on MM cells in vivo.

RESULTSThe alantolactone inhibited RPMI-8226 cell viability remarkably with a dose-dependent manner; the IC50 value of RPMI-8226 cells at 48 h was 4.32 ± 0.15 µmol/L; the apoptotic rate increased observably with a dose-dependent manner; the levels of cleaved-caspase-3 increased and the phosphorylation of ERK decreased significantly; as compared to control, the volum of tumor was much smaller, the expression levels of Ki67 and p-ERK decreased.

CONCLUSIONThe alantolactone can efficiently inhibit the proliferation and induce the apoptosis of multiple myeloma RPMI-8226 cells in vitro and in vivo through inhibiting the activation of ERK signal pathway.

Animals ; Apoptosis ; Caspase 3 ; metabolism ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; drug effects ; Humans ; Lactones ; pharmacology ; Mice ; Mice, Nude ; Multiple Myeloma ; pathology ; Sesquiterpenes, Eudesmane ; pharmacology ; Signal Transduction

Objective To study the percutaneous permeability through mouse skin of lidocaine hydrochloride-loaded destran-based niosomes(LID-HLD-BNs)in vitro and in vivo. Methods HPLC was employed to exam lidocaine hydrochlo?ride. Lidocaine hydro-chloride-loaded conventional liposomes (LID-CLs) and lidocaine hydrochloride injection (LID-IJ) were used as control. Isolated mouse skin was added into Franz diffusion cell to evaluate the permeability of LID-HLD-BNs in vitro. Confocal Laser Scanning Microscopy(CLSM)was used to observe the permeation depth of mouse skin in vivo. Re?sults The permeation rate and cumulative permeation amount were significantly higher in LID-HLD-BNs group than those of LID-CLs and LID-IJ groups (P<0.05). CLSM studies also confirmed that HLD-BNs reached deeper layers of the skin. Conclusion LID-HLD-BNs has good transdermal ability.

This study was aimed to investigate the effect of MEK inhibitor AZD8330 on proliferation and apoptosis of multiple myeloma IM9 and NCI-H929 cell lines and its possible mechanism. These two cell line cells were exposed to different concentrations of AZD8330 for 48 h. The CCK-8 assay was used to detect cell viability and the IC50 value at 48 h. These above-mentioned IM9 and NCI-H929 cells were treated with 5,10 and 100 nmol/L of AZD8330, then the change of cell cycle was analysed by flow cytometry with PI staining. The Wester blot was used to detect the expression levels of cyclin D and cyclin E, and multiple myeloma cells were treated with 10, 100, 1000 and 2000 nmol/L of AZD8330, the AnnexinV/7-AAD double staining was used to analyse cell apoptosis and the Western blot was used to detect the expression level of caspase-3. The results showed that AZD8330 could significantly inhibit the cell viability of IM9 and NCI-H929 cell lines in a time-and dose-dependent manner, the IC50 value (48 h) of IM9 and NCI-H929 were 19.88 ± 2.7 nmol/L and 29.3 ± 2.03 nmol/L respectively, these two cell lines were arrested on G1 phase of cell cycle, the apoptosis cells increased along with enhancement of AZD8330 concentration, and the expression level of cleaved caspase-3 protein was up-regulated. It is concluded that AZD8330 can efficiently inhibit the proliferation of NCI-H929 and IM9 cell lines, and induce apoptosis, suggesting that the AZD8330 may be a potential chemotherapeutic candidate for multiple myeloma therapy.
Apoptosis ; drug effects ; Caspase 3 ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cyclin E ; Dihydropyridines ; pharmacology ; Humans ; Multiple Myeloma ; pathology ; Oncogene Proteins ; Protein Kinase Inhibitors ; pharmacology

Objective To investigate the clinical features of unexpected sudden death (SUD) clustered in families in Yunnan province.Methods This retrospective study analyzed the clinical features of SUD occurred between July to September 2005 in 7 families in Yunnan province.Results All 16 SUD patients shared common clinical features such as fatigue and repeated syncope and one group of SUD patients (n = 8 from 4 families) presented with the gastric intestinal tract manifestations including nausea, vomiting, abdominal pain and diarrhea with suspected dietary history and abnormal laboratory enzyme findings (GOT/ GPT,CK/CKMB,LDH/LDH1 etc.).In SUD patients without gastric intestinal tract manifestations (n = 8 from 3 families), there were no clear symptoms before death and repeated ventricular tachycardia and ventricular fibrillation were recorded in one survivor.There was no clear evidence for the involvements of hereditary and infectious factors for observed SUD.conclusion The reason for the unexpected sudden death clustered in 7 families in Yunnan remains unclear.Repeated syncope and fatigue served as the common clinical features in the presence or absence of gastric intestinal tract manifestations in all SUD cases.Further studies are needed to clarify the pathology and detailed clinical manifestations of SUD occurred in this area.

Objective To explore the value of galactography in diagnosis of nipple discharge diseases. Methods Galactographies in 101 cases with nipple discharge confirmed by operation and pathology were analyzed restrospectively. Results There were breast duct ectasia in 23 cases, breast cystic hyperplasia in 12 cases , ductal inflammation in 8 cases, intraductal papilloma in 46 cases, ductal carcinoma in 9 cases, ductal tuberculosis in 1 case and normal duct in 2 cases. Conclusion The galactography is beneficial in diagnosis of the pathogenesis of galactorrhea and is of great value in differential diagnosis between benign and malignant lesions.