Objective To analyze the effect of inner diameter of pancreatic duct following pancreaticoduodenectomy on pancreatic fistula.Methods From January 1995 to December 2008,256 patients underwent pancreaticoduodenectomy were divided into four groups based on the types of pancreaticojejunostomy: end-to-side "mucosa-to-mucosa" anastomosis group(n=115),end-to-end "mucosa-to-mucosa" anastomosis group(n=71),end-to-end invaginated pancreaticojejunostomy group(n=43) and pancreaticogastrostomy group(n=27).Alternatively,238 patients were divided into two groups according to drainage ways: stenting tube for internal drainage group(n=132) and stenting tube for external drainage group(n=106).Furthermore,233 cases were divided into three groups on the basis of inner diameter of pancreatic duct: ≤0.2 cm group(n=54),0.2-0.4 cm group(n=93) and ≥0.4 cm group(n=76).Then,the incidence rate of pancreatic fistula of each group was compared.Results The incidence of pancreatic fistula was 8.20%(21/256).The incidence of pancreatic fistula for different types of pancreaticojejunostomy was as follow: end-to-side "mucosa-to-mucosa" anastomosis group(7.83%,9/115),end-to-end "mucosa-to-mucosa" anastomosis group(7.04%,5/71),end-to-end pancreaticogastrostomy invaginated group(13.95%,6/43) and pancreaticogastrostomy group(3.70%,1/27),in which there wasn't significant difference in 4 groups(?2=2.763,P=0.430).There was no significant difference of the incidence of pancreatic fistula between stenting tube for internal drainage group(9.10%,12/132) and stenting tube for external drainage group(8.49%,9/106),?2=0.126,P=0.722.The incidence of pancreatic fistula in ≥0.4 cm group,0.2-0.4 cm group and ≤0.2 cm group was respectively 0,15.05%(14/93) and 11.11%(6/54),and the difference was significant(?2=12.009,P=0.002).No correlation was found between the incidence of pancreatic fistula of different inner diameter of pancreatic duct and the types of pancreaticojejunostomy (?2=1.878,P=0.598).Conclusion The inner diameter of pancreatic duct is an important factor for postoperative pancreatic fistula. No relationship is found between the types of pancreaticojejunostomy and pancreatic fistula in this study.

Objective To investigate the safety and feasibility of pancreatoduodenostomy com-bined with resection of PV/SMV for carcinoma of the head of pancreas.Methods The clinical data of 12 cases of carcinoma of the haed of pancreas underwent pancreatoduodenostomy in combination with resection of PV/SMV were retrospectively analyzed.Their data were compared with those of 40 cases of carcinoma of the haed of pancreas underoing pancreatoduodenostomy in the same period of time.Results Of the 12 cases, 3 underwent PV resection and reconstruction with ePTEE grafts, 3 PV re-section and reconstruction with end-end anastomosis, 6 PV lateral wall partial resection and recon-struction.There were no significantly differences in age, sex, time of operation, operative bleeding, complication, mortality rate, site of tumor,t umor differentiation, lymphtie metastasis, margin posi-tive resection and survival between the two groups.Conclusion Pancreatoduodenostomy combined with resection of PV/SMV is safe for carcinoma of the head of pancreas.

Objective To explore the pharmaceutical care plan of clinical pharmacist for elderly patients with coronary heart disease and renal insufficiency. Methods To develop the therapeutic schedule in cooperation with clinicians through clinical rounds, in order to offer specific pharmaceutical care and further develop individualized care plan during patient ' s hospitalization. Results Clinical pharmacists paid close attention to the indicators and adjusted administration time when the adverse reactions such as lower blood pressure, leukopenia, and deterioration of renal function occurred, and finally avoided further potential adverse reactions. Conclusion The incidence of adverse drug reactions were reduced, the safety and efficacy of drugs used were guaranteed, which can promote rational and effective use of drugs in clinic. The overall quality of healthcare was improved with pharmacist involvement.

18 F?FDG PET/CT has been increasingly used in diagnosis, staging, treatment response assessment and prognosis prediction of malignant tumors. As the main organ of carbohydrate metabolism, liv?er is commonly taken as reference organ in disease diagnosis and imaging quality control. Hepatic FDG up?take in healthy people is affected by various physiological, potential pathological and imaging technical fac?tors, as well as inter?individual variation. Besides, variation of SUV caused by different calibrating methods cannot be neglected. The factors that affecting hepatic FDG uptake based on findings in recent studies are summarized in this review.

Exercise is one of the important techniques of cardiovascular rehabilitation. Exercise can reduce inflammatory response to improve endothelial function, and improve mitochondrial function to increase myocardial cell activity. For cardiovascular risk factors, exer-cise can promote the activity of lipoprotein, increase the level of high-density lipoprotein;improve the function of insulin receptor to reduce insulin resistance, reduce platelet aggregation and improve endothelial function to reduce blood pressure. For the respiratory system, aerobic exercise can improve the function of respiratory muscle, thus relieve the dyspnea. Exercise can promote the activation of immune factor and increase metabolism, to increase immune function and anti-aging. Resistance exercise can improve mitochondrial function and promote fi-ber type conversion, to improve the function of skeletal muscle system.

Objective To summarize the experience in performance of hepatopancreatoduodenostomy for hilar cholangiocarcinoma. Methods The clinical data of 11 cases of hilar cholangiocarcinoma receiving hepatopancreatoduodenostomy in our hospital from June 2000 to January 2008 were retrospectively analyzed. Results For Bismush-corlitte classification, 8 cases were grade Ⅲ the others Ⅳ.Quadrate lobectomy plus pancreaticoduodenectomy was performed in 2 patients, caudate lobectomy plus pancreaticoduodenostomy in 5, hepatectomy in right half plus caudate lobectomy, pancreaticoduodenostomy and PV lateral wall partial resection and reconstruction in 1, hepatectomy in left half and pancreaticoduodenostomy in 3. There were no death. Three patients had the complication of biliary fistula,1 pancreatic fistula, 2 pulmonary infection and 1 liver functional failure. The follow-up in 8 patients showed that the longest survival was 63 months. Conclusion HPD is safe and feasible for treatment of hilar cholangiocarcinoma invading the region of pancreaticoduodensum and it can promote the life quality of patients.

Objective To investigate the value of brain natriuretic peptide(BNP)in differential diagnosis of dyspnea in renal transplant recipients.Methods A total of 25cases of renal transplant recipients,admitted from Sep.2007to Mar.2010,developing dyspnea were reviewed retrospectively.All the patients accepted ultrasoundcardiogram examination,and serum BNP was determined,at the onset of dyspnea and 48hafter symptomatic treatment.According to the International Expert consensus document on BNP in 2008,the ideal content of serum BNP was less than 100pg/ml,and once the serum BNP exceeded 400pg/ml it was considered to be a premonitory sign of to cardiac insufficiency or excessive volume loading.Based on the results of serum BNP determination,all the patients were divided into two groups.19cases with serum BNP higher than 400pg/ml were referred as the groupⅠ,while 6cases with BNP lower than 400pg/ ml were categorized as the groupⅡ.Results The serum BNP in groupⅠwas considerably elevated reaching 1893.21?350.34pg/ml. Ultrasoundcardiogram results demonstrated impaired heart function with lower left ventricular ejection fraction(LVEF)(42.38%? 6.74%).Among the 19patients with acute heart dysfunction,12were attributed to excessive fluid loading,and in 7cases it was induced by graft dysfunction complicated by severe infection.Dyspnea was ameliorated with decreased serum BNP(305.35?45.21pg/ml)and increased LVEF(55.36%?6.26%)in groupⅠ48hafter treatment for heart failure.Serum BNP in groupⅡwas 78.52?23.26pg/ml,which was much lower than that in groupⅠ.Ultrasoundcardiogram results demonstrated that the patients in groupⅡhad better LVEF (59.72%?4.92%)than that in groupⅠ.Five of the patients in groupⅡhad normal graft renal function but severe pneumonia,and in the remaining one dyspnea was caused by allergic response when anti-lymphocyte antibody was given as an induction therapy against rejection. Symptomatic treatment did not show evident effects on both BNP and LVEF in groupⅡ.Conclusions Fast detection of serum BNP is an effective index of blood volume,beneficial in the differential diagnosis of cardiac or non-cardiac dyspnea,and provides a valuable reference to the blood volume control in patients after renal transplantation.

Objective To identify impacts of infection status of chronic hepatitis viruses and biochemical parameters of liver function on hepatic FDG uptake.Methods The results of 18F-FDG PET/CT,liver function biochemical tests and hepatic virus tests of 713 healthy adults (504 males,209 females,age 24-74 years) were retrospectively analyzed.Two-sample t test,correlation analysis,partial correlation analysis and multiple linear regression were performed to identify correlations of liver SUV with the biochemical parameters and hepatic viral infection status.Results HBsAg tests were performed in 449 subjects,with the results of 65 (14.5％) positive and 384 (85.5％) negative.HCV antibody tests were performed in 477 subjects,with 53 (11.1％) positive and 424 (88.9％) negative.The average SUV of the total subjects was 1.86±0.38.There was no significant difference of SUV between HBsAg positive group and negative group (t=1.042,P＞0.05),or between HCV antibody positive group and negative group (t=1.283,P＞ 0.05).Serum conjugated bilirubin,globulin and AST were significantly correlated with liver SUVmean(r'=-0.191,-0.087 and 0.132,all P＜0.05).These parameters were independent variables on predicting variance of liver SUV with globulin showing the largest predicting value (standardizedβ' =-0.112,P＜0.05).Conclusions Functional status of liver may affect liver 18F-FDG uptake.Serum conjugated bilirubin,globulin and AST may be the independent variables on predicting variance of liver SUV.Liver functional test results should be taken into consideration when hepatic 18F-FDG uptake is interpreted.

ObjectiveTo investigate the relationship between the social disability and emotion disorder of the patients with irritable bowel syndrome (IBS). Methods168 patients with IBS were assessed with Social Disability Screening Schedule (SDSS), Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. The patients with SDSS≥2 were divided into 2 groups, and accepted the medical routine therapy and explanatory psychotherapy for 2 months, while the patients in the research group (n=35) received the antidepressive. Then they were assessed with SDSS again. ResultsThe incidence of social disability in IBS patients was 40.5%, and increased in those who combined with anxiety and/or depression. The SDSS score of the research group was lower than that of the control group after the treatment. ConclusionThe social disability can be found in the patients of IBS, especially in those with emotion disorder, and can be improved by the antidepressive.

BACKGROUND:Valgus-varus constrained polyethylene insert is selected in strict accordance with the principle of“to obtain reliable stability using minimum restriction”. The stability of the prosthesis is elevated, but the restriction is not increased.
OBJECTIVE:To retrospectively analyze the application experience of constrained polyethylene insert in valgus and varus instability of primary total knee arthroplasty for older patients and to summarize the indications and clinical effects of this kind of implements.
METHODS:From March 2010 to March 2012, a total of 70 patients combined valgus and varus malfomation who accepted primary total knee arthroplasty were enrol ed in this study, including 56 varus patients (averagely 15°-30°) and 14 valgus patients (averagely 10°-20°). Constrained polyethylene insert was performed in 23 patients (25 knees) who stil had remaining unilateral valgus or varus<6 mm (18 patients were varus instability and 7 patients were valgus instability) when finished operation of standard osteotomy and soft tissue balancing. The bone cement knee prostheses in 23 cases were purchased from Smith&Nephew. The stem implant was not used in al cases. Cement or autografts were used in 11 valgus knees to fil the bone defects.
RESULTS AND CONCLUSION:Patients were fol owed up for 2 years on average (18-42 mouths). The knee pain symptoms of al cases disappeared. The joint stability was obviously improved. The lower limb power lines were correct. The Knee Society Score scores were improved from an average of 39.4 points preoperation to an average of 88.5 points postoperation. Al cases did not need the protection of knee braces. The maximum degree of flexion was 110°(96°-130°). The satisfaction degree of 36-Item Short Form Health Survey was 98%. No dislocation or infection happened. Results indicated that constrained polyethylene insert could be applied in the cases of less than 6 mm valgus and varus instability when finished operation of standard osteotomy and soft tissue balancing in total knee arthroplasty for older patients. This kind of implements can preserve bone mass, simplify operational process and have good clinical outcome in a short period.