Objective To summarize the experiences of middle pancreatectomy. Methods Eleven female and 4 male with a mean age of 49.4 years (23.8-73.1 years) who underwent middle pancreatectomy from January 2001 to October 2005 were collected. Eight patients with neuroendocrine tumor (non-function of 5 cases), 5 with serous cystadenomas and 2 with mucinous cystadenomas were included. The proximal apical end of pancreas was sutured, while distal end of pancreas was anastomosed to a Roux-en-Y jejunal loop. Results Mean operative time was 275 min (179-370 min), mean length of resected pancreas was 45 mm (30-60 mm) and max diameter of tumor was 23 mm (15-40 mm). Complication after operation was pancreatic fistula 4 cases (26.7%), in which 3 cases (20.0%) had intraabdominal blood. The mean time of follow-up was 23 months (3 months-5 years). one patient was died of multiple organs failure for pulmonary infections in month 3 after operation, and the others were alive without novo-diabetes. Conclusion Middle pancreatectomy is an effective operation for benign and borderline tumors of neck and body of pancreas without a significant increase of postoperative morbidity.

Objective To review the experience in perioperalive management of 324 consecutive cases of pancreatico-duodenectomy(PD).Methods The clinical data of 324 cases of PD were analyzed retrospectively.All underwent PD successfully,275 cases received the standard PD,while,49 cases had pylorus preserving PD.Digestive tract reconstruction was done by Child method.Pancreatointestinal anastomosis was performed by pancreas stump intussussception in 303 cases,and end-to-side anastomosis in 21 cases.Results The 30 day mortality rate was 0.3%(1/324).Complicalion rate was 8.0%,included one case of liver dysfunction,7 cases with pancreatic fistula and intraabdomind bleeding,1 case of stenosis of pancreaticoenteral anastomosis,3 cases with pancreatic dysfunction,4 cases with gastroenteral anastomosis ulcer,6 cases with delayed gastric emptying,1 with reflux of bile and 3 with lymphatic fistula.Conclusions Perioperative managemen for pancreaticoduodenectomy is crucial for patient prognosis.Carful perioperative management can decrease postoperative complications and ensure smooth recover of these patients.

Objective To explore the therapeutic modalities and clinical characters of acute pancreatitis (AP) in the middle or late stage of pregnancy.Methods There were 26 cases of AP in the middle or late stage of pregnancy, among which 18 cases (69.2 %) received conservative therapy, and 8 cases (30.8 %) underwent operation for removal of necrotic tissue and termination of pregnancy.Results Two cases of both fetus and mother death occurred, whereas 24 mothers were cured. 15 (57.7 %) fetuses were healthy but 11(42.3 %) died.Conclusions The women in middle and late stage of pregnancy are inclined to pancreatitis because of hormonal changes, especially in those with history of cholecystitis and cholelithiasis. The main method of management is active non-operative therapy and surgical intervention when necessary, so as to decrease the tragedy of both maternal and fetal death.

Objective To observe the effects of hypoxia preconditioning on the mitochondria ultrastructure of hepatocyte during liver transplantation in rats.Methods A modified orthopotic liver autotransplantation model was used to simulate liver transplantatation.Seventy two Sprague-Dawley rats were randomly divided into the following three groups:the normal control(group NC),the autotransplantation group(group AT),and the hypoxia preconditioning group(group HP),with twenty four rats in each group.Group HP were given an 8% oxygen atmosphere for 90 minutes before the operation.At 1,6,and 24 hours after the operation,the rats were killed and the following tests were conducted:1.The morphology of mitochondria was observed under transmission electron microscopy(TEM);2.Mitochondria were quantitatively analyzed by a MiVnt image analysis system.ResultsHepatic cells in group AT showed typical injury signs under TEM,the appearance of hepatocytes and mitochondria in group HP were much better than the group AT,and the areas,perimeters and diameters of mitochondria in group HP were much smaller than those in group AT by a significantly amount(P

Objective To evaluate the change of the amount of collagen in the viemedic RF ASC01IC non-ablative photorejuveantion,in order to provide reference for effective clinical treatment.Methods Twenty rats were randomly divided into two groups,with ten rats in each group.The rats'skin was dividied into two areas by spine.The left side was used as control,and the right side was experiment side,which was treated with RF by viemedic RF ASC011C for five times at interval of seven days,and ten minutes in each time.The content of collagen in the dermis was measured by immunohistochemical method,the thickness of collagen bundles in the dermis was measured under HE staining and the quantity of collagen fibers was compared by collagen fibers staining.Results Epidermis was more smooth,the collagen fiber was thicker and the content of fibroblasts,collagen was higher in experiment side.Image quantitative analysis showed significant improvement in area density of collagen fibers.Conclusions RF is a very safe and effective method for non-ablative photorejuvnation.

The hydrophobicity assay and DNA probe hybridization assay were compared for analysis of enterotoxigenic Escherichia coli(ETEC), heat-labile enterotoxin(LT) and heat-stable enterotoxin (ST). The ETEC isolated from diarrheal patients were serotyped and investigated for the presence of colonization factor antigens CFA/1, CFA/II, CFA/III and CFA/IV with the expression of mannose-resistant hemagglutination(MRHA) and the levels of surface hydrophobicity. The following results were obtained. 1. Out of these 48 strains, 34 strains were found to be positive for LT production by DNA probe hybridization assay. Out of 34 strains, 1 strain was ST producer, 25 strains were LT producers, and 8 strains were produced both ST+LT producers by DNA probe hybridization assay. 2. Out of 34 strains of positive DNA probe hybridization test, 31 strains was positive in the hydrophobicity test. Among strains of positive hydrophobicity test, 20, 1, and 7 strains produced only LT, only ST and both ST-LT, respectively. Screening efficiency for identifying ETEC by salting out test was 82.4% in sensitivity and 78.6% in specificity. For ETEC detection, the hydrophobicity assay was the least sensitive but was simple, rapid and a good substitute for the DNA probe hybridization assay. 4. CFAs were identified in 43.8% of ETEC strains; 2.1% of the CFAs strains with CFAs harbored CFA/I, 29.2% carried CFA/II, 16.7% carried CFA/III and CFA/IV. And 35.4% expressed none of these CFAs. CFA/I was found in ETEC of serotype 0128: K67, CFA/II was 0128: K67, 0142: K+ and 0159: K+, CFA/III was 086a: K15 and 0128: K67, CFA/IV was 0 86a: K15, 0128: K67, 0125: K70 and 0148: K+.
Colon ; DNA* ; Enterotoxigenic Escherichia coli* ; Enterotoxins ; Escherichia ; Humans ; Hydrophobic and Hydrophilic Interactions* ; Mass Screening ; Sensitivity and Specificity

Objective To discuss the way of open reduction and internal fixation for fractured condylar neck and mandible ramus via intraoral approach aiming to avoid the facial incision. Methods Fifteen cases (17 sides) with mandibular condyle fractures underwent open reduction and osteosynthesis with plates and screws. After the mandibular ramus was under vertical osteotomy with an oscillating saw, the posterior border bone block of mandibular ramus as well as the free condyle neck were taken out. The fractured condyle neck and the posterior border bone block of mandibular ramus were fixated with a titanium miniplate in vitro. The reunion bone was implanted and reposited in the mouth incision. Of all, two cases suffered fracture of the condyle neck in the other hospital when they received esthetic surgery and resection of prominent mandible angle (PMA). Results Anatomic reduction was achieved in all cases, without damage to facial nerve and major auricular nerve or salivary fistula. There were slight bony resorption and good temporomandibular joint function one year after surgery, with range of mouth opening for 25-40 mm (mean 35.8 mm). Two cases regained their occlusion before their PMA operation. One case had premature contact of the buccal teeth,with 1 mm diverging to medline of the incisor teeth. Intraoral approach not only could avoid large facial scars and facial nerve injury, but also allow visualization of the occlusion during the procedure. Conclusions As more and more consideration is taken to cosmetology, the transoral approach is a reliable surgical alternative for fractures of the condyle neck, without leaving extensive visible scars or damaging facial nerve. The disadvantage is vertical osteotomy of the posterior border of the mandibular ramus.

Objective To know about the current status of the work engagement of the clinical nurses and its influencing factors,to explore the influencing factors of work engagement of clinical nurses so as to provide basis for improving the level of the work engagement of the clinical nurses.Methods The work engagement scale,hardiness scale,role pressure scale,perceived organizational support scale and questionnaire of family care index were used to investigate a total of 630 clinical nurses.The results were analyzed.Results The average score of work engagement,hardiness,role pressure and perceived organizational support were showed respectively as following:(3.28±0.51),(2.60±0.53),(3.00±0.50),(3.43± 1.04) scores.Clinical nurses number of the total point between 7 and 10 of family support accounted for 70.9％(447/630).Hardiness,perceived organizational support,family support and work engagement were in obvious positive correlation,whereas role pressure was in obvious negative correlation with work engagement.Hierarchical regression analysis showed after the variable of demographic was controlled,the hardiness and perceived organizational support respectively had significant positive predictive function on work engagement as respective independent variables.Role pressure had obvious negative predicative function on work engagement.Conclusions Hospital managers should create a good working environment for clinical nurses,measures should be taken from individual and organizational aspects so as to improve the hardiness and perceived organizational support,reduce role pressure and the work positivity of the clinical nurses,so that the nurse more positively devoted to their work.It has important practical significance to improving the quality of their services and stabilizing nursing troop.

Objective To investigate the dosimetric characteristics of hippocampal?avoidance prophylactic cranial irradiation ( HA?PCI ) in fixed?field intensity?modulated radiotherapy ( IMRT ) and volumetric modulated arc therapy ( VMAT) and the feasibility and risks of hippocampal avoidance. Methods Prophylactic cranial irradiation (PCI) was performed for 16 patients with localized small cell lung cancer ( SCLC) who were treated in our hospital from January to August, 2014, and achieved complete response ( CR) after chemoradiotherapy, with a prescribed dose of 25 Gy in 10 fractions. CT localization image was fused with brain MRI image to contour the hippocampus on the fused image, and the boundary of the hippocampus was extended 5 mm outward to form the area for reduced dose. IMRT and VMAT plans with hippocampal avoidance were developed separately, and the dose distribution in the whole brain, the hippocampus, and the 5?mm area outside the hippocampus was evaluated for these two plans. Independent?samples t test was applied to evaluate the difference between the two groups. Results The mean hippocampal volume in the 16 patients was 2. 76 cm3 ( range 2. 56 ?3. 01 cm3 ) . The mean radiation dose ( Dmean ) in the hippocampus during IMRT and VMAT was 9. 04± 0. 20 Gy and 10. 32± 0. 28 Gy, respectively, reduced by 66. 0% and 61. 2%, respectively, compared with the prescribed dose ( P=0. 55);Dmean in the area for reduced dose during IMRT and VMAT was 13. 57± 0. 90 Gy and 14. 86± 0. 60 Gy, respectively, reduced by 49. 0% and 44. 1%, respectively, compared with the prescribed dose (P=0. 88). Conclusions HA?PCI in IMRT and VMAT meets the clinical requirements, and can reduce the dose in the hippocampus while ensuring the whole?brain radiation dose, and therefore can be applied in PCI and provide a technical support to protect the patient’ s neurocognitive function.

Objective To establish a method for the chiral separation and determination of S-isomer in epinephrine hydrochloride injection by HPLC with chiral mobile phase additives. Methods Column of Purospher? STAR RP-18 (4. 6 mm×250 mm, 5 μm) was used. The mobile phase was acetonitrile-10 mmol·L-1 sodium dihydrogen phosphate buffer containing 10 mmol·L-1 sulfobutylether-b-cyclodextrin (pH adjusted to 3. 0 with phosphoric acid) (98. 5:1. 5), detection wavelength was 280 nm, the flow rate was 0. 8 mL·min-1 , and the column temperature was 30 ℃ . Results Good linear relationship was established between the peak area and the concentration of S-isomer over the range of 5. 02-1501. 50 μg·mL-1 (R2 =0. 999 7). The detection limit was 0. 05 μg·mL-1 . Conclusion The proposed method shows high repeatability and durability. It can be employed for the quality control of S-isomer in epinephrine hydrochloride injection.