Gallbladder-duodenal fistula is a rare disease in clinical practice, and difficult to diagnosis. One patient with high suspicion of gallbladder-duodenal fistula in preoperative examination was performed with percutaneous transhepatic gallbladder drainage due to could not tolerate surgical operation, and gallbladder-duodenal fistula was diagnosed with the gastric and intestinal fluids extracted from the drainage tube. In the later of fistula repair and the patient′s nutritional support management, the jejunal nutrition tube is inserted through the bile duct, and then the nutrition support was performed through this jejunal nutrition tube. This patients was recovered well.

Studies correlated with yttrium-90 (⁹⁰Y) radioembolization for unresectable liver metastases of melanoma (LMM) were analyzed during January 1st, 1991 to September 1st, 2018. A total of 9 reports involving 207 patients were included for the analysis. The most common primary site of melanoma was choroid, followed by cutaneous and rectal. A total of 199 cases were followed-up, and in 181 patient the complete response rate was 1.1%(2/181), partial response rate was 18.2%(33/181), stable disease rate was 46.4%(84/181), and cancer control rate was 65.7%(119/181). The median survival was 10 months. Complications were found in 42 cases (21.5%, 42/195), including radioembolization induced liver disease (n=39), gastric ulceration (n=2), cholecystitis (n=1), and liver failure (n=3). Adverse reaction included fatigue (14.3%~44.0%), nausea (6.3%~23.0%), and abdominal pain (7.0%~38.0%). ⁹⁰Y radioembolization is a promising alternative therapy for the treatment of unresectable LMM, with encouraging effects on disease control and survival. Some complications can occur, and adverse reaction are frequent but mild.

Neuroendocrine tumor liver metastases (NETLM) is a uncommon advanced tumor disease.Patients with unresectable NETLM have a poor outcome.The management of unresectable NETLM is a clinical dilemma.However,Yttrium-90 radioembolization is a safe and effective treatment for NETLM patients.The median disease control rate is 87.1％ (64.7％ ～ 100％);the median overall survival time is 34.4 months;and the median overall survival rate of 1,2,and 3 years are 79.8％ (63％～100％),62％ (57％ ～62.5％),45.5％ (45％ ～ 46％),respectively.Although there is good result of Yttrium-90 radioembolization in treatment of unresectable NETLM,the safety and effectiveness should be further verified.

Malignant biliary tract obstruction is a common disease.Nowadays,endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) have been used to treat such disease.EBD is a first-line intervention for lower segment of biliary duct obstruction caused by pancreatic cancer or other tumors.PTBD is a first-line treatment for gallbladder cancer or other tumors which lead to the hilar and intrahepatic bile duct obstruction and abnormal digestive anatomy.In a word,the proper selection of the drainage should be based on the patients' condition with minimal trauma and maximum therapeutic effect.

Objective To investigate the efficacy and safety of using various sedative regimens during transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods 156 HCC patients were randomly divided into four groups.The control group (n =30):intramuscular injection of 10 ml saline;The diazepam group (n =42):intramuscular injection of 10 mg of diazepam;The promethazine group (n =42):intramuscular injection of promethazine 25 mg;and The combined group (n =42):intramuscular injection of 10 mg of diazepam and promethazine 25 mg.Results The blood pressure and heart rate of the control group was significantly higher than the other three groups,while the combined group was significantly lower than the diazepam and the promethazine groups.The sedative rating:Grade 0 of the four groups were:30,11,18,0 patients respectively;Grade 1 of the four groups were:0,21,15,24 patients respectively;Grade 2 of the four groups were:0,10,9,18 patients respectively;No patients were in grades 3 and 4.The anxiety score of the control group was significantly higher than the other three groups.There was no significant difference in complications among the four groups.Conclusion Diazepam and/or promethazine could be used effectively and safely during TACE,and they could reduce stress response of HCC patients during TACE,and improved tolerance of TACE.

Objective To study the efficacy of combining Entecavir with TACE to treat patients with primary hepatocellular carcinoma with undetectable levels of HBV-DNA.Methods From Aug 2011 to Sep 2013, patients with HBV-related hepatocellular carcinoma but with undetectable levels of HBV DNA who underwent TACE were divided into the treatment group (treated with Entecavir antiviral therapy) and the control group.The endpoints of the study were HBV reactivation rates, liver function, and survival rates.Results Using our predefined inclusion and exclusion criteria, 64 patients with primary liver cancer were divided into the treatment group (n =32) and the control group (n =32).The transaminase and bilirubin levels were raised and the albumin level was reduced at 5 days after TACE.However, there were no significant differences between the 2 groups (P ＞0.05).At 12-month follow-up after TACE, 8 (25.0％) patients developed HBV reactivation in the control group and 2 (6.3％) in the treatment group, the difference was significant (P ＜ 0.05).The level of transaminase was significantly higher in the HBV reactivation group when compared with the no HBV reactivation group (P ＜ 0.05).The overall 6-and 12-month survival rates in the treatment group and the control group were 93.8％ and 84.4％ vs 90.6％ and 59.4％ respectively.There were significant differences in the 12-month survival rates (P ＜ 0.05).Conclusion Entecavir combined with TACE to treat patients with HBV-related primary liver cancer with undetectable HBV-DNA effectively reduced HBV reactivation and improved survival at 12 months.

OBJECTIVETo compare the safety of haemophilus influenzae type b (Hib) vaccine vaccination on vastus lateralis muscle and deltoid muscle of infant.

METHODSA total of 408 3-4 months old infants were divided into vastus lateralis muscle group and deltoid muscle group in Beijing, 2014. They were divided into the vastus lateralis muscle group (204) and deltoid muscle group (204) by extracting random number. Each observation object was given 3 doses of Hib vaccine according to the program. Collected systemic and local reactions after vaccination and calculated the incidence of adverse reactions.

RESULTSA total of 61 infants were quitted during the study, 1 132 doses were observed. The total reactions incidence of Vastus lateralis muscle group and Deltoid muscle group were 33.0% (186/564) and 27.6% (157/568) with no statistical differences (χ² = 3.818, P = 0.059). The two groups incidence at the same day of vaccination (day 0) which the highest were 23.2% (131/564) and 20.6% (117/568), then declined with time (linear trend test vastus lateralis muscle group χ² = 36.600, P < 0.001,deltoid muscle group χ² = 29.947, P < 0.001), day 1 were 20.4% (115/564) and 17.6% (100/568), day 2 were 16.0% (90/564) and 13.4% (76/568), day 3 were 10.3% (58/564) and 10.6% (60/568), day 4-7 were 11.2% (63/564) and 11.3% (64/568). No serious adverse events (SAE) were reported during the study. The local reactions incidence of two groups were 7.1% (40/564) and 7.7% (44/568)with no statistical differences (χ² = 0.176, P = 0.675). The systemic reactions incidence of two groups were 25.9% (146/564) and 20.6% (117/568) with obvious statistical differences (χ² = 4.437, P = 0.035). The fever incidence of vastus lateralis muscle group (11.5% (65/564)) was higher than Deltoid muscle group (4.4% (25/568)) with obvious statistical differences (χ² = 4.868, P = 0.027). The 1st dose incidence of fever and abnormal crying of vastus lateralis muscle group (fever 11.3% (23/204), abnormal crying 19.1% (39/204)) was higher than deltoid muscle group (fever 4.4% (9/204), abnormal crying 11.8% (24/204)) and the 2nd dose of diarrhea of deltoid muscle group (11.6% (22/190)) was higher than vastus lateralis muscle group (5.9% (11/187)) with obvious statistical differences (fever χ² = 15.288, P < 0.001, abnormal crying χ² = 4.224, P = 0.040, diarrhea χ² = 3.829, P = 0.046).

CONCLUSIONBoth vastus lateralis muscle group and deltoid muscle group had lower incidence of adverse reactions after vaccination. No serious adverse events were associated with vaccination. Vastus lateralis muscle vaccination as well as deltoid muscle vaccination demonstrated safe.

Bacterial Capsules ; China ; Deltoid Muscle ; Fever ; Haemophilus Vaccines ; Haemophilus influenzae type b ; Humans ; Incidence ; Infant ; Quadriceps Muscle ; Vaccination

Objective To solve the clinical blood transfusion problem of the major cross-match compatibility and the minor cross-match incompatibility by using the microcolumn agglutination technique in the cross matching of the patients with non-auto-immune hemolytic anemia(non-AIHA).Methods The process was set up to analyze the reasons of the minor cross-match incom-patibility by reviewing the sample information from the patient and the blood donor,re-detection of ABO and Rh blood group,direct anti-globulin test (DAT),comparison of the agglutination intensity between DAT and minor cross-match,and antibody screening tests,etc.,and the corresponding laboratory treatment was carried out.Results The problem of minor cross-matching incompatibil-ity in 3 014 cases of non-AIHA were treated by this process,the result showed that the main reason leading to minor cross-match incompatibility was the DAT positive(98.6%).Those patients were infused with the RBC suspension with minor cross-match in-compatibility,comparing the occurrence rate(0.52%)of blood transfusion adverse reaction and the blood transfusion effectiveness (87.4%)had no statistical differences compared with the occurrence rate(0.48%)of blood transfusion adverse reaction and the blood transfusion effectiveness(85.4%)in the transfused RBC suspension with major and minor cross-matching compatibility,the differences had no statistical significance(P >0.05);other causes leading to the minor-cross-matching incompatibility were the sam-ple or blood group errors(0.8%),irregular antibody from the donor(0.6%),in such situation,the blood could be exchanged and the blood cross-matching could be performed again,the RBC suspension with major and minor compatibility was transfused.Conclusion This process can quickly and safely solve the clinical blood transfusion problem of minor cross-match incompatibility in the non-AIHA patients and is suitable for the laboratory adopting the microcolumn agglutination technique for conducting the cross-matc-hing test.

Objective To investigate the effects of the low-osmolar nonionic contrast media on renal function in elderly patients suffering from ischemic cerebral vascular disease and undergoing angiography.To study the incidence and risk factors for contrast-induced nephropathy (CIN).Methods 276 elderly patients who were going to receive selective cranial angiography and bilateral renal angiography were included.The 0.9 ％ sodium chloride (1 ml · kg-1 · h-1) was administered in all patients 6 hours before and 12 hours after contrast media administration.No patients suffered from obviously congestive heart failure.The levels of serum creatinine (Scr) and serum urea nitrogen (SUN) were measured 3 days before and at day 1,2,6 after the administration of contrast media respectively.Then creatinine clearance rate (Ccr) was calculated.Multivariate predictors of contrastinduced nephropathy were determined by logistic regression.Results Among the 276 patients,CIN occurred in 19 patients (6.9％),among whom 4 patients suffered from severe renal artery stenosis and received percutaneous transluminal renal angioplasty (PTRA) at 1 week after undergoing angiography.The renal function in the other 15 cases with CIN were recovered to baseline 1evel 3 months after the use of contrast media.No patients underwent a maintenance hemodialysis.In the 19 patients with CIN,the levels of SUN and Scr were higher and Ccr was lower at day 1 and 2 after angiography than before the procedure (all P ＜ 0.05),but the parameters were decreased to preoperative level at day 6 after angiography (all P＞0.05).Logistic regression analysis showed that renal dysfunction,diabetes mellitus and severe renal artery stenosis were the major risk factors for contrast-induced nephropathy.Conclusions Low-osmoiar nonionic contrast used in angiography is safe for elderly patients if adequately hydrated with 0.9 ％ sodium chloride.The clinical risk factors for CIN are renal dysfunction,diabetes mellitus and severe renal artery stenosis.