Objective To explore the application value and clinical efficacy of one half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced in pancreaticoduodenectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 17 patients with pancreatic neoplasms and ampullar neoplasms who underwent pancreaticoduodenectomy at the Second Affiliated Hospital of Harbin Medical University from May to September 2015 were collected.One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced method was applied to the digestive tract reconstruction after pancreaticoduodenectomy in the 17 patients.Observation indicators included:(1)surgical situations:surgical procedures,operation time,time of pancreaticojejunostomy,volume of intraoperative blood loss,tumor sizes,(2) postoperative situations:recovery time of gastrointestinal function,postoperative complications,duration of postoperative hospital stay,(3) postoperative pathological examinations,(4) follow-up.Patients were followed up by outpatient examinations including color Doppler ultrasound or abdominal computed tomography (CT) and telephone interview detecting abdominal pain or distention and general situations (diet,sleep) up to October 2015.Measurement data were represented as average (range).Results (1) Surgical situations:all the 17 patients underwent successful operations without perioperative death,including 16 undergoing radical pancreaticoduodenectomy and 1 undergoing pancreaticoduodenectomy and left liver resection.The average operation time,average pancreaticojejunostomy time,average volume of intraoperative blood loss and average tumor size were 276 minutes (range,230-440 minutes),12 minutes (range,9-16 minutes),310 mL (range,200-950 mL) and 3.25 cm2(range,1.92-5.60 cm2),respectively.(2) Postoperative situations:the average recovery time of gastrointestinal function was 3 days (range,1-7 days).Three patients had postoperative complications,including 1 patient with pancreatic fistula (Grade A) and 2 patients with delayed gastric emptying,and all of them had been healed after symptomatic and supportive treatments.The results of T-tube cholangiography or CT before hospital discharge showed that there was no leakage around the anastomoses.The average duration of postoperative hospital stay was 10 days(range,6-20 days).(3) The postoperative pathological examinations showed 5 patients of pancreatic ductal adenocarcinomas,4 of common bile duct ampulla area adenocarcinomas,3 of duodenal papillary adenocarcinomas,3 of pancreatic intraductal papillary mucinous neoplasms and 2 of duodenal ampullary adenocarcinomas.(4) Followup:all the 17 patients were followed up for 1-4 months and the abdominal color Doppler ultrasound or CT showed that there was no evidence of tumor recurrence or leakage around anastomoses.Conclusion One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced is safe and feasible,and it can reduce the rate of pancreatic fistula successfully.

Objective To explore the characteristics of operation,curative effects and operative management in elderly patients of age older than 70 years with coronary heart disease receiving coronary artery bypass grafting.Methods 108 elderly patients of age older than 70 years with coronary heart disease were divided into two groups:OPCAB group(n = 76) and CCABG group (n = 32) The clinical curative effects, early postoperative mortality and complications of the two groups were compared and analyzed respectively. Results OPCAB group was better than CCABG group in these series(P ＜ 0.05): The early postoperative mortality (5.8%, 11.2%)、 myocardial infarction (2.9%, 10.6%), respiration failure(8.7%, 17.5%), pulmonary complications: (11.8%, 31.5%) 、complication of CNS:(1.8% ,9.8%) 、acute renal failure(1.8% ,6.2%) ,the time of intubation: (9.3 ±4.5), (25.4 ±7.5) h,ICU stay(3.1 ± 1.8) ,(7.1 ±2.9) d,hospital stay(15.5 ±8.6) ,(26.4 ±8.6)d. Conclusion OPCAB could reduce operative mortality and complication, it should be the first option for the surgery of elder patients with coronary heart disease;surgical skills and correct perioperative management were the key factors to assure surgical outcome.

Hepatolenticular degeneration was one of the rare several genetic metabolic diseases in clinic that could be cured by liver transplantation method, developing slowly and being irreversible. Metabolic disorders of copper lead to abnormal copper accumulation in various of tissues and organs. So that, the disease′s clinical manifestations were lacking in specificity and many patients missed the best opportunity of drug treatment. With the maturity of technologies and innovation of theory of liver transplantation, there were more and more methods that will be applied to personalized treatment. In this paper, a review of the research progress in the treatment of hepatolenticular degeneration with liver transplantation was made with reference to the relevant literature at home and abroad.

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Toxoplasma gondii infection during pregnancy can result in abortion,premature delivery,fetal death,deformity,and impact the physical and intellectual development of the newborns.This is an investigation on the consequences of pregnancy in Toxoplasma gondii-infected women,the development of their babies,and the effect of pyrimethamine treatment during 1990-1996 in Baoding City.

ObjectiveTo investigate the value of early fluid resuscitation endpoints in evaluating blood volume in patients with acute pancreatitis. MethodsA retrospective analysis was performed for the clinical data of 445 previously untreated patients with acute pancreatitis who were admitted to The First Affiliated Hospital of Guangxi Medical University from 2003 to 2016 and had an onset time of less than 24 hours, and according the fluid resuscitation endpoints of mean arterial pressure (MAP), hematocrit (HCT), and blood urea nitrogen (BUN), the patients were divided into standard-reaching group (MAP ＞65 mm Hg, BUN ＜7.14 mmol/L, and HCT ≥0.35 and ≤044, n=219) and non-standard-reaching group (MAP ≤65 mm Hg or BUN ≥7.14 mmol/L or HCT ＞0.44 or ＜0.35, n=226). The standard-reaching group represented normal volume, while the non-standard-reaching group represented insufficient volume. The two groups were compared in terms of symptoms, signs, etiology, severity, complication, and prognosis. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of continuous data between two groups. ResultsCompared with the standard-reaching group, the non-standard-reaching group had significant increases in white blood cell count, BUN, and Computed Tomography Severity Index of the pancreas (Z=-2.85, -6.725, and -2.293, all P＜0.01). As for local complications, compared with the non-standard-reaching group, the standard-reaching group had significantly lower incidence rates of peripancreatic exudation (45.2% vs 54.9%, χ2=4.15, P＜0.05) and pancreatic necrosis (10.0% vs 186%, χ2=6.59, P＜0.05). As for systemic complications, compared with the non-standard-reaching group, the standard-reaching group had significantly lower incidence rates of acute respiratory distress syndrome (ARDS) (0.5% vs 4.4%, χ2=7.26, P＜0.05) and renal dysfunction (1.4% vs 6.6%, χ2=7.95, P＜0.05). The standard-reaching group had significantly lower proportion of patients with severe pancreatitis and hospital costs than the non-standard-reaching group (both P＜0.05). ConclusionFluid resuscitation endpoints can be used to evaluate the blood volume of patients with acute pancreatitis in the early stage after admission, and the patients not reaching the standard of fluid resuscitation tend to develop the complications such as peripancreatic exudation, pancreatic necrosis, ARDS, and renal dysfunction and may have higher hospital costs.

Anopheles minimus was once a main malaria vector in Hainan Island and had been e-liminated basically through the campaign of indoor residual spraying launched in 1959. It again became an incriminated vector of some focal malaria outbreaks in recent years. The present study was conducted in a selected county-Danxian and a typical hilly area-Feibar in the west part of Danxian county in 1989-1990.An. minimus was found in 50% and 62. 5 % of the surveyed sites at mountainous and hilly area of Danxian county,but not found in coastal region. An. minimus was found in all 18 sites surveyed in Feibar district constituting 52% of anopheline composition. Man-biting rate made by human-baited collection was 3. 2 before midniaght and 38. 2 when collected through whole night in some sites. However, the behaviour characteristics of An. minimus has changed. It has become exophilic,exophagic, and has an equal preference for man and cattle. The vectorial capacity of An. minimus estimated by quantitative data was in accord with malaria infection rate in Feibar district ,and the malaria infection rate among the inhabitants in three types of residential quarter with different socioeconomic conditions. Malaria infection rates of residential quarter of land-reclamation outcomers, villagers and state farm residents were 10%,2. 9% and 0. 5% respectively during 40 days from July to August,1990.Owing to the fact that An. minimus has become a secondary vector only next to An. dirus, with a wide range of distribution and a considerable different characteristics in behaviour compared to that before spraying campaign , it is suggested that a malaria control programme must be seriously planned to adjust the new problem of malaria epidemiology in Hainan Province.

Objective: To evaluate the surgical treatment of calcaneal fracture malunion. Methods: A retrospective analysis was conducted of the 19 patients with calcaneal fracture malunion (19 feet) who had been treated from January 2011 to September 2017 at Departments of Joint Surgery and Orthopedic Trauma, The Third Affiliated Hospital, Sun Yat-Sen University. They were 16 males and 3 females with the average age of 36.2 years (from 22 to 57 years). According to Stephens-Sanders classification, the malunion was defined as type Ⅰ in 10 cases, as type Ⅱ in 6 and as type Ⅲ in 3. The patients with malunion of type Ⅰ were treated by lateral wall osteotomy and decompression of long and short peroneus muscles to preserve the subtalar joint, those with malunion of type Ⅱ by lateral wall osteotomy and decompression of long and short peroneus muscles followed by subtalar joint fusion, and those with malunion of type Ⅲ by lateral wall osteotomy, decompression of long and short peroneus muscles, medial oblique osteotomy for correction of varus deformity and subtalar joint fusion via both the medial and lateral approaches. The Maryland functional scores were used to assess the postoperative surgical efficacy. Results: No such complications happened as incision or implant infection, screw breakage or joint non-fusion. Of the 19 patients, 17 were followed up for 18 to 26 months (mean, 20.5 months). The Maryland scores at the final follow-ups were 90.2±7.3, significantly higher than the preoperative values (38.6±5.5) (t=53.370, P<0.001). Conclusions In the surgical treatment of calcaneal fracture malunion, satisfactory clinical efficacy can be achieved by lateral wall osteotomy and preservation of the subtalar joint for patients with maunion of Stephens-Sanders type Ⅰ, and by subtalar fusion for those with maunion of Stephens-Sanders types Ⅱ-Ⅲ.