Pancreatic cancer is the highest degree of malignancy in the digestive system tumors,longterm prognosis is poor.Pancreatic head cancer has the highest proportion of pancreatic cancer,so its treatment is the focus of the treatment of pancreatic cancer.Radical pancreaticoduodenectomy is the hope of patients with pancreatic head cancer to be cured,but also is the most important treatment for patients with long-term survival.Choosing the appropriate surgical methods and techniques can improve the rate of radical resection of the tumor and reduce the postoperative complications.Combined with timely and appropriate adjuvant therapy,it may improve the quality of life and prolong the survival of resected pancreatic head cancer patients.

Objective To determine the nucleic acid content of hepatitis B virus with different clinical types of hepatits B before、after liver transplantation patients and explore the approach for detection of hepatitis B.Methods The HBV DNA content in before the liver transplantation, 7 day, 30 day, 90 day after the liver transplantation was detected with fluorescent quantitative PCR and HBV M with ELISA in 275 liver transplantation patients.Results HBsAg、HBcAb was positive of 275 patients;HBV DNA was positive in all HBsAg(+)/HBeAg(+)/HBcAb(+) specimens;79( 73.8 % )out of the 107 HBsAg(+)/HBeAb(+)/HBcAb(+) specimens; 48( 67.6 % )out of the 71 HBsAg(+)/HBcAb(+) specimens in before the liver transplantation.HBV DNA was negative in out of the 275 HBsAg(-) in 7 day after the liver transplantation; 48( 69.6 % ) out of the 69 HBsAg(+) in 30 day after the liver transplantation;104( 75.9 % ) out of the 137 HBsAg(+) in 90 day after the liver transplantation.Conclusions The recurrent hepatitis B were higher in the different clinical types of hepatitis B after liver transplantation,Detection of HBV DNA with fluorescent quantitative PCR can accurately reflect the state of HBV infection and HBV replication and HBV DNA was complementarity with HBV M,it can be used to guide clinical diagnosis with recurrent hepatitis B.

Objective To analyze the clinical prevalence,distributed characteristic of different ages,clinical characteristics and pathogenic factors of chronic abdominal pain in children.Methods A database in which outpa-tient and inpatient of abdominal pain during 2 -14 years old were collected from January 2011 to December 2015 was established by utilizing HIS system.A statistical analysis was made in age,sex,onset time,time of duration,mesenteric lymph node status and surgical situation.Results A total of 13 256 times abdominalgia were enrolled from January 2011 to December 2015.7 390 patients were diagnosed as unexplained abdominal pain,including 1 005 patients (13.59%)were diagnosed as chronic abdominal pain.A male -to -female ratio was 1.06:1.The average age was 6 years(ranged 2 -14 years).The average age of the boys was (6.02 ±2.87)years,which of the girls was (5.93 ± 2.79)years,there was no statistically significant difference between them(t =0.47,P =0.63).The peak age of chro-nic abdominal pain in children was mainly from 3 to 7 years old.The incidence decreased with age increased.The average time of duration was (16.70 ±11.69)months,that of the boys was (17.39 ±12.12)months,and that of the girls was (15.96 ±11.19)months,there was statistically significant difference between them(t =1.93,P =0.05). Mesenteric lymphadenectasis was detected in 731 patients(72.74%).The age constituent ratio decreased with age increased.The peak age of the prevalence coincided with peak age of the mesenteric lymphadenectasis.21 patients underwent surgical procedures,organic lesions accounted for 2.08%.Conclusion The peak age of the prevalence of chronic abdominal pain in children is mainly from 3 to 7 years old.Potential organic causes are rarely linked to chronic abdominal pain in children.Most of them are functional abdominal pain.The appendix and mesenteric lymphadenecta-sis might play an important role in children with chronic abdominal pain.The therapeutic aim of CAP in children is to make the children back to their normal life by exclude the organic causes and relieve their pain.The natural history of chronic abdominal pain suggests that symptoms remit spontaneously with increasing age.

ObjectiveTo study the effect of a fast-track surgery (FTS) program on the clinical outcomes in cirrhotic patients with portal hypertension.Methods42 cirrhotic patients with portal hypertension were randomly allocated into the FTS group (n=21) and the conventional therapy control group (n=21).The postoperative time to first defecation,hospital stay,hospitalization cost,and postoperative complications were compared between the two groups.ResultsCompared with the control group,the postoperative time to first defecation was significantly shorter in the FTS group (P=0.0287).Furthermore,the postoperative hospital stay was significantly shorter in the FTS group than the control group (P=0.002).Additionally,hospitalization cost was significantly lower in the FTS group than the control group (P＜0.001).The postoperative complication was also significantly different between the two groups (7.15 ％ vs 21.5 ％,P=0.001).ConclusionA FTS program contributed to better postoperative rehabilitation in cirrhotic patients with portal hypertension.

Objective To study genotypes,antibiotic resistance and epidemiology of extendedspectrum β-lactamases (ESBL)-producing Shigella isolated in Tianjin,and to discuss the relationship between ESBL-producing Shigella and drug-resistance plasmid.Methods A total of 136 Shigella spp.were isolated from stool specimens of patients with diarrhea who presented mainly with bloody purulent stool from Tianjin Children's Hospital,Tianjin Medical University No.2 Hospital and Tianjin No.1 Central Hospital between May 2009 and September 2010.Suspicious ESBL-producing isolates were screened by K-B disc diffusion method. The conjugation experiment was performed in the confirmed ESBL-producing strains and antibiotic resistance was compared between clinical strains and transconjugants to confirm the plasmid-mediated resistance. The genotypes of these isolates were detected by polymerase chain reaction (PCR) using universal primers for TEM,SHV,CTX-M-1 group,CTX-M-2 group,CTX-M-9 group,respectively.Intergenic consensus PCR (ERIC-PCR) was employed to understand the molecular homology of the ESBL-producing isolates. The data were analyzed by x2 test.ResultsESBL were identified in 14.7％ (20/136) of Shigella isolates,but no AmpC enzyme were detected.Among all the Shigella isolates,16 strains were genotype CTX-M-14,4 were genotype CTX-M-15.The strains with CTX-M ESBL were resistant to multiple antibiotics,while 100％ sensitive to imipenem.The transconjugant test of 18 ESBL-producing isolates were positive,and these conjugations were only resistant to β-lactamases. Conclusions CTX-M type is the common genotype of ESBL-producing Shigella isolates in Tianjin. ESBL-producing is the main cause of multiple resistance to β-lactams.The transmission of CTX-M producing strains is mainly mediated by plasmids.

Objective To investigate the drug resistant genes and genotypes of carbapenem-resistant Klebsiella pneumoniae in Tianjin First Center Hospital. Methods A total of 52 strains of carbapenem-non-susceptible Klebsiella pneumoniae were collected from 2012 to 2015. The MICs of antimicrobial drugs were detected using agar dilution methods. Phenotypes of carbapenemases were screened using modified Hodge test. Drug resistant genes were detected by multiplex-PCR assay. Multilocus sequence typing ( MLST) was used to determine the genotypes and homology of these carbapenem-resistant Klebsiella pneumoniae strains. Results Susceptibility of antimicrobial agents indicated that all these strains with multiple drug resistance. The resistance rate to piperacillin/tazobactam, ceftriaxone, ceftazidime, cefepime, aztreonam imipenem,meropenem was 100%( 52/52 ) . The resistance rate of ST11 type to amikacin was 93. 5%( 43/46), ciprofloxacin was 97. 8%(45/46), levofloxacin was 97. 8%(45/46), compound sulfamethoxazole was 17. 4%(8/46), tigecycline was 0. The resistance rate of ST101 type to amikacin was 3/3, ciprofloxacin was 2/3, levofloxacin was 3/3, compound sulfamethoxazole was 3/3, tigecycline was 0. The resistance rate of ST709 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. The resistance rate of ST1393 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. The resistance rate of ST2068 type to amikacin was 1/1, ciprofloxacin was 1/1, levofloxacin was 1/1, compound sulfamethoxazole was 1/1, tigecycline was 0. PCR results showed that 43 isolates were blaKPC-2 positive and 5 isolates were blaOXA-48 positive, 1 isolate was blaDNM-1 positive. There were 46 strains of ST11 type. The 43 strains of Klebsiella pneumoniae producing KPC-2 type carbapenemase were all ST11. While among 5 strains of Klebsiella pneumoniae carrying OXA-48 carbapenem resistant gene, 3 strains were ST101, 1 was ST709, 1 was ST1393. One strain of Klebsiella pneumoniae harboring DNM-1 type carbapenemase was ST2068. Conclusions Drug resistant genes of carbapenem-resistant Klebsiella pneumoniae were KPC-2 dominant, OXA-48 and DNM-1 were sporadical;the genotype was mainly ST11 by MLST in the hospital. The research provided effective basic and reference for the hospital infection t control.

Objective The expression of agr and sigB regulation system in Staphylococcus aureus with different infection types were assessed by analyzing the characteristics of m /z value generated by MALDI-TOF-MS.Methods A total of 50 isolates with specific genotypes were collected from Tianjin First Center Hospital during Jun 2013 to Feb 2014 for retrospective study .The pattern profiles of these isolates were obtained by MALDI-TOF-MS with RUO model, and the m/z value was also analysed to evaluate the expression the agr and sigB regulation system .The phylogenetic tree based on mass spectrum peak feature was constructed using SARAMIS software .Results A total of 50 strains of Staphylococcus aureus were divided into two groups: acute infection and chronic persistent and recurrent infection .The expression of delta toxin in acute infection and in chronic infection was 99.2 ±4.1 and 60.5 ±10.1 ( t =16.83, P<0.05), respectively.The regulation of stress proteins of sigB system was enhanced in chronic persistent and recurrent infections , and the expression intensities of SAS 030, SAS049 and SA0772 were 27.1 ±14.7, 54.8 ±21.5 and 51.6 ±19.2, respectively; while in acute infections , those were 4.9 ±1.9, 12.4 ±2.8 and 15.7 ±6.9, respectively.The t values between the two groups were -6.88 (P<0.05),-8.98 (P<0.05) and -1.87 (P<0.05), respecitively.The expression of phenol-soluble modulins (PSMs) was inconsistent , and the relative strength of PSMα3 was 100%in the colony variants small strains .Conclusions Different types of the Staphylococcus aureus infections could be evaluated through the assessment of the agr and sigB regulation system .The m/z value obtained by MALDI-TOF mass spectrometry is a marker for the expression of agr and sigB regulation system .The application of this technology needs further development .

Objective To understand the underlying mechanism of mites-induced pediatric asthma by bioinformatic analysis on speciifc microRNA (miRNA) array and target gene screening. Methods This is a case control study of 62 pairs of dust mites-induced asthma children with age and gender matched healthy controls. Twelve pairs were randomly selected for miRNA array. The abnormal expression of miRNAs was compared between asthma and control children. The results were validated by RT-qPCR and bioinformatic analysis in remaining pairs of children. Results Six miRNAs (miRNA-151a-5p, 625-5p, 126-3p, 513a-5p, 27b-3p, 22-3p) were signiifcantly down-regulated more than two folds in dust mites-induced asthma children than those in controls. The enriched bioinformatics analysis showed that these miRNAs and their target genes CBL, PPARGC1B, ESR1, ONECUT2, EGFR, SYK, and STAT1 were related to inlfammatory cytokine signaling pathway. Conclusion It is suggested that miR-22-3p, 513a-5p, 625-5p, 27b-3p, and miRNA-target genes form a network through co-regulation to target genes to participate dust mites-induced asthma in children.

OBJECTIVE To study the mechanisms of quinolones resistance in Escherichia coli.METHODS Forty E.coli clinical isolates were randomly collected from clinical specimens at the Tianjin First Central Hospital from Mar 2004 to Dec 2005.Then we detected the susceptibility to antibiotics in 40 clinical isolates of E.coli by MICs and K-B disk diffusion method.In order to investigate the mutations in the target genes,we amplified the QRDR of gyrA and parC by PCR.Later we analyzed the PCR products by single strand conformation polymorphism analysis(SSCP).In the meantime,the PCR products of marOR region were sequenced to detect the possible gene changes which contributed to the increasing expression of MarA and then lead to the Mar phenotype.RESULTS The alterations in gyrA were found in all quinolones-resistante strains.Asp87→Asn and Ala84→Pro were found besides the common amino acid alteration.The alterations in parC were found in thirty-six strains resistant to quinolones.There were no parC alterations in ECO24 which was nalidixic acid-resistant and ofloxacin/gatifloxacin-susceptible.ECO11 Which was resistant to quinolones only had no gene changes in marOR region.Six gene changes in marOR region were found in ECO5 which was resistant to mutiple antibodies.The alteration in 1879 bp changed the terminator.CONCLUSIONS The alterations in gyrA and parC are responsible for the resistant phenotypes in E.coli.That is,the alterations in the gyrA are primarily responsible for resistance to quinolones,and the alterations in the parC may play a complemental role in enhancing resistance to fluoroquinolones.Moreover,the randomly collected strains resistant to quinolones,have found some mutations in marOR.It may be play certain roles in multiple antibiotic resistance of E.coli.

OBJECTIVE To analyze the pattern of antibiotic usage and antibiotic resistance tendency in our hospital.METHODS The use of antibiotics was evaluated by calculating DDDs;the bacteria were isolated and identified,and the susceptibility was tested by using microdilution method.Ten species of the most common bacteria,such as Staphylocccus aureus,and their antibiotic resistance tendency in two years were evaluated.RESULTS The average antibiotics days were 11.6 in two years.Ten species with 8967 strains were isolated in which 57.70% bacteria were Gram-negative.The rate of extended spectrum ?-lactamases(ESBLs) of Enterobacteriacae was 31.18%.42.3% Bacteria were Gram-positive,the isolation rate of MRSA was up to 76% and 56.8%,respectively.CONCLUSIONS The total cost of antibiotics remains at a high level.The ESBLs is still the major problem in gram negative germ.Vancomycin-resistant Enterococcus has been discovered.It is urgent to conduct epidemiological investigation and to take appropriate measures to control bacterial resistance and antibiotics usage.