Objective To investigate the application effect of fast secure multipath exposure of portal vein ( PV) and superior mesenter-ic vein ( SMV) in pancreaticoduodenectomy. Methods Retrospective analyzed the clinical data of 80 cases of pancreatic head cancer pa-tients who underwent pancreatoduodenectomy in our hospital from October 2005 to October 2013. According to the different PV/SMV expo-sure methods, they were divided into 2 groups with 40 cases in each group. The observation group used fast secure multipath exposure meth-od while the control group were given traditional method of exposure, and curative effect of the 2 groups were compared. Results In the ob-servation group, the success rate of operation was 90. 0%(36/40) which is significantly higher than 72. 5% (29/40) in the control group;in the observation group , operation time was ( 3 6 0 . 6 ± 5 8 . 7 ) min and intraoperative bleeding was ( 6 0 0 . 4 ± 3 6 . 8 ) mL which were significantly lower than that(414. 2 ± 81. 3)min and (788. 8 ± 57. 9) mL in the control group;3 year mortality rate in observation group was 65.0%(26/40) which was significantly lower than 86. 1% (31/36) in control group, these differences were statistically significant (P<0. 05). Conclusion Fast and secure multipath PV/SMV applied in pancreatoduodenectomy could improve the operation success rate, shorten the operation time, reduce the intraoperatve blood soss and postoperative adverse reactions, and improve the long-term survival rate.

Telemedicine is a combination of modern computer technology, communication technology and medical technology. It has a promising application potential. This paper mainly overviews the history of telemedicine, especially the development of wireless telemedicine. With the classification and comparison, the opinion on the future of wireless telemedicine is given according to the author's research work. Portable telemedicine system is the trend of telemedicine.

Objective: To explore the imported medicine price’s pass-through effect on domestic western medicine’s price. Methods: Based on the time-series data from January 2003 to March 2013, the empirical research studied the effect of imported medicine’s price and other variables on domestic western medicine price. Results: The imported medicine’ price has short significant effect on domestic medicine. Conclusion: To reduce the effect of imported medicine price’s fluctuation, the government should intervene the medicine price moderately; the drug company and the hospital should pay attention to the efficacy and the promotion of the domestic western medicine.

Objective To explore the risk factors of the chronic subdural hematoma(CSDH) drilling drainage recurrence.Methods The clinical data of 252 CSDH patients were retrospectively analyzed.All patients underwent trephination and drainage treatment,there were 40 cases with postoperative recurrence of hematoma.Multivariate logistic analysis of linear regression was used to analyze the risk factors for postoperative hematoma recurrence.Results In this study,of 252 CSDH patients received trepanation and hematoma,the probability of recurrence was 15.9 ％ (40/252).Single factor analysis showed that the size of hematoma,CT shows the density of hematoma,postoperative drainage volume,operation time,review the CT intracranial pneumatosis,age,hematoma midline shift could increase the recurrence possibility.Logistic multivariate analysis showed that he size of hematoma,CT shows the density of hematoma,postoperative drainage volume,age were independent risk factors of recurrence of hematoma drainage in patients with CSDH after drilling.Conclusion The influence factor of recurrence of hematoma in CSDH patients received trepanation and drainage is complex,we should strengthen the intraoperative,postoperative nursing and operation to reduce postoperative recurrence of CSDH.

Objective To explore the clinical application of lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft taken from the groin area for reconstruction of the distal one third of anterior tibia,.around the ankle. Methods A distally based lesser saphenous.sural nerve adipofag.cial flap accompanied with a full-thickness skin graft which was taken from the groin area was studied and used to treat 12 patients with soft tissue defects in the distal one third of anterior tibia,3 cases with soft tissue defects and tibia osteomyelitis,2 cases with soft tissue defects and tibia osteomyelitis.The size of the soft tissue defects ranged from 3 cm×5 cm to 9 cm×13 cm,and the biggest donor flap was 13 cm×18 cm.The donor sites at the posterior aspect of the leg and at the groin area were closed primarily. Results All 17 patients were followed up for 6-12 months(average 9 months).All 17 flaps had good perfusion and survived completely,which successfully treated all 17 patients with soft tissue defects or with both soft tissue defects and osteomyelitis.The donor and recipient sites of adipofascial flaps and the groin area healed primarily,and satisfactory appearance and function were achieved.Conclusion Distally based lesser saphenous-sural nerve adipofascial flap accompanied with a full-thickness skin graft which was taken from the groin area can reconstruct the distal one third of anterior tibia,around the ankle,and even treat osetomyelitis successfully,in the same time,which can preserve the function and appearance of the involved limb to the utmost.

Objective To study the effect of UHRF1 expression inhibition by RNA interference on the radiosensitivity of esophageal cancer cell line TE-1 and its mechanism.Methods Short hairpin RNA (shRNA) targeting UHRF1 gene was introduced into TE-1 cells by lentivector-mediated transfer.The cells were divided into three groups:non-transfected group,negative control (NC)-shRNA-transfected group,and UHRF1-shRNA-transfected group.The mRNA and protein expression levels of UHRF1 in TE-1 cells were measured by RT-PCR and Western blot before and after transfection.After transfection and X-ray radiation,the radiosensitivity of TE-1 cells was evaluated by colony formation assay; the cell cycle and cell apoptosis were determined by flow cytometry; the γ-H2AX (as a marker of DNA damage) level was measured by Western blot.Results After transfection with UHRF1-shRNA,the mRNA and protein expression levels of UHRF1 were significantly decreased in TE-1 cells,as compared with those in the NC-shRNA-transfected group and non-transfected group (0.11 vs 0.96 and 0.98,F =124.21,P =0.000;0.10 vs 0.89 and 0.94,F =125.25,P =0.000).The UHRF1-shRNA-transfected group had sensitization enhancement ratios of 1.53 (D0 ratio) and 1.95 (Dq ratio).X-ray radiation could cause G2/M arrest and increase apoptotic rate and γ-H2AX expression in TE-1 cells.Compared with the two control groups,the UHRF1-shRNA-transfected group showed significantly less G2/M arrest (F =500.15,P =0.000),a significantly higher apoptotic rate (F =100.10,P =0.000),and significantly higher residual γ-H2AX expression (F =61.00,P =0.000) at 24 hours after X-ray radiation.Conclusions RNA interference can effectively inhibit the UHRF1 expression and enhance the radiosensitivity of TE-1 cells.The mechanism may be related to cell cycle regulation,cell apoptosis,and DNA damage repair.

Some traditional Chinese medicine technologies,with strong safety, quick and significant effect, standerdized manipulation, simple operation and good prospect for promotion and application are selected in the research project for application and demonstration of rural health appropriate technology. Through the application of the project, we have new experience in medical teaching.

Objective To explore the clinical significance of tumor pathological length in evaluation of prognosis of esophageal squamous cell carcinoma.Methods 421 patients with esophageal squamous cell carcinoma were selected as study subjects.Each patient's data of gender,age,pathological examination(tumor pathological length),survival time,cancer stage,operation mode were collected.The patients were divided into two groups:≤4 cm group(189 cases) and >4 cm group(232 cases), and the constituent ratios of gender,age,or operation mode and the survival rate between the two groups were analyzed.Results There were no significant differences in gender composition,age structure and operation mode between the two groups(x2=2.03,2.41,0.06,all P>0.05);There was positive correlation between tumor pathological length and TNM stage(CMH=68.07,P<0.01).The 25%,50% and 75% quantiles of survival period in the group whose tumor length was less than or equal to 4 cm were 28,40 and 58 months,respectively,which in the group whose tumor length was more than 4 cm were 19,31 and 61 months,and there was significantly difference between the two groups(x2=44.88,P<0.01), the group whose tumor length was less than or equal to 4 cm had higher survival rate than the group whose tumor length was more than 4 cm.In the further stratification analysis by TNM stage,the group whose tumor length was less than or equal to 4 cm had higher survival rate than the group whose tumor length was more than 4 cm in theⅠstage patients(x2=5.61,P<0.05);the group whose tumor length was less than or equal to 4 cm had higher survival rate than the group whose tumor length was more than 4 cm in theⅡstage patients(x2=4.62,P<0.05);the group whose tumor length was less than or equal to 4 cm had higher survival rate than the group whose tumor length was more than 4 cm in the Ⅲ stage patients(x2=4.88,P<0.05).Conclusion Tumor pathological length is an effective prognostic factor for esophageal squamous cell carcinoma,and the critical value can be determined as 4 cm.

Metabolism is the necessary process for cell growth and survival,and it is dramatically altered in cancer cells compared with that in normal cells,and these alterations are known as the Warburg effect.Glutamine plays a decisive role in the metabolic processes.And the glutaminase as a enzyme in the processes has also become a hot topic of research in recent years.This article could focus on the recent research progress on glutaminase.