Objective To investigate the correlation of platelet activating factor(PAF)with cortisol(Cor) ,as well as their rela-tionship with patients after sepsis prognosis .Methods 102 patients with sepsis admitted in the ICU of Chongqing Emergency Med-ical Center from April 2012 to August 2013 were enrolled into sepsis group ,and 40 cases of volunteers served as control group .All the patients were divided into survival group and non-survival group ,according to their prognosis during hospitalization .Plasma PAF and Cor level in control group ,survival group and non-survival group were compared with each other ,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)in survival group and non-survival group were compared .The correlations of plasma PAF with Cor level in control group ,survival group and non-survival group were analyzed ,respectively .Results Plasma PAF and Cor level in survival group and non-survival group were significantly higher than that in control group(P<0 .05) .Plasma PAF ,Cor lev-el and APACHEⅡ scores were higher in non-survival group than that in survival group(P<0 .05) .The correlation of plasma PAF with Cor level in control group was not significant(P>0 .05) ,while the plasma PAF level positively correlated with Cor level in survival group and non-survival group(P<0 .05) .Curves of receiver operating characteristics(ROC)showed that PAF ,Cor and A-PACHEⅡ score could be used as predictors of mortality during hospitalization(Area=0 .708 ,0 .715 ,0 .787) .Conclusion The plas-ma PAF level positively correlates with Cor level in patient with sepsis .PAF ,Cor and APACHEⅡ score have certain guiding signif-icance for the assessment of prognosis during hospitalization in patients with sepsis .

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 find out the optimal operative methods for the patients with osteonecrosis of the femoral head according to age and the staging. Methods The current study assessed 202 patients(242 hips)from 1998 to 2008 with an average follow-up of 6.3years (range,1 -10 years), who were operated according to age and staging by Ficat or Catterall. The mean age of the patients was 35.3 years(range,4 -81 years). All patients were evaluated with both clinical and radiographical criterion. Results The postoperative excellent and good rate were 87.2% ,88.8% and 85.7% in each group respectively. The mean Hariss score increased (P <0.05) and the mean VAS score decreased (P < 0.05) in youth group and old group. Conclusions Children who were younger than six years of age and with Catter-all Ⅱ-Ⅲ involvement should be treated by ascularized iliac or greater trochanter bone periosteal flaps. Patients who were less than forty years of age, with Ficat Ⅱ-Ⅲ should be treated by ascularized iliac or greater trochanter bone flaps. For patients with age older than 50 years or younger than 50 years but with severe forms, hybrid or cememtless total hip arthroplasty may be the optimal operation.

Objective To investigate the diagnosis and treatment of mutinous cystadenoma of the pancreas.Method The clinical data of 12 cases with pancreatic mutinous cystadenoma was confirmed by pathology from May 2000 to May 2009 was retrospectively analysed.Results The accuracy rates of ultrasound,CT and MRCP were 50.0%(5/10),66.7%(6/9)and 83.3%(5/6)respectively.Pancreaticoduodenectomy,duodenum-preserving pancreatic head resection,distal pancreatic resection,distal pancreaticresection and splenectomy,segment pancreatic resection were performed according to the site of tumors.Completed resectable rate was 91.7%(11/12),palliative resection in 1 case,postoperative pancreatic leakage in 3 cases.2 cases cured;1 case died of intra-abdominal infection caused by pancake fistula 1 month later;1 case died of tumor recurrence and metastasis 25 months later.Conclusions Pancreatic cystic neoplasms is lack of specific clinical manifestations.Combined with application of imaging methods,can improve the diagnosis rate.Operation is the most effective therapy.The feasible procedures for mucinous cystadenoma of the pancmas should be choiced according to the site of tumors.

Objective To study the mechanism of dermal fibroblasts as a feeder layer to support the growth of human keratinocytes. Methods Human dermis fibroblasts were isolated and cultured and then treated with mitomycin-C. The expression of type Ⅰand type Ⅲ precollagen mRNA and relevant protein in feeder layer were examined by RT-PCR and Immunohistochemistry. KCs were cultured both on FB and NIH3T3 feed layer as control, the adhering numbers and the time of fusion were recorded. Results RT-PCR showed an increase of type Ⅰprecollagen mRNA in FB feeder layer as compared with that of normal fibroblasts (P

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 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 surgical approach of Siewert Ⅱ and Ⅲ gastroesophageal junction adenocarcinoma.Methods A total of 148 cases with Siewert Ⅱ,Ⅲ type patients were prospectively studied.The patients were divided into two groups,including transthoracic approach group (58 cases) and transabdominal approach group(90 cases).The results of surgery were compared.Patients were followed up for 2 years and survival rate were compared.Results In transthoracic approach group and transabdominal approach group,operative time ((329.5 ± 84.3) min vs.(202.4± 84.5) min,t =15.431,P ＜ 0.001),the positive rate margin stump (8.62％ vs.1.11％,x2 =5.763,P =0.012),pleural effusion (13.79％ vs.2.22％,x2 =10.462,P ＜0.001) and pulmonary infection rate (15.52％ vs 1.11％,x2 =12.574,P＜ 0.001) were significantly higher than transabdominal approach group,and number of lymph node dissection ((16.7 ± 4.3) vs.(22.6± 5.5),t =6.321,P =0.004) was significantly less than transabdominal approach group.In incidence of blood loss,tumor diameter,anastomotic leakage (or bleeding) and discharge time,there was no significant difference (P ＞0.05).One-year survival rate of transthoracic approach group was 73.24％,and 2-year survival rate was 53.43％.Oneyear survival rate of transabdominal approach group was 78.42％,and 2-year survival rate was 57.51％.Survival rate of two groups showed no significant difference (P =0.453,0.311).Conclusion Transabdominal surgical approach in Siewert Ⅱ,Ⅲ patients is better than transthoracic approach,can better carry out abdominal lymph node dissection,does not destroy the integrity of the chest,and avoid the occurrence of related complications.

Objective To evaluate clinical use of adaptive statistical iterative reconstruction (ASiR) method in low-dose scan on children temporal bone by comparison of radiation dose delivered by GE Discovert HD CT 750 scan and GE Lightspeed VCT64 scan.Method Sixty patients with congenital deafness were divided into two groups according to gender,age (each N =30).Group a received low-dose CT scan on temporal bone by GE Discovery HDCT 750 (preset NI =12),and the original images were reconstructed with ASiR (weighted value =40％).Group B received CT scan by GE Lightspeed VCT 64 (preset NI =8),and the original images were reconstructed with filter back projection (FBP).Data were collected and analysed using the SPSS 18.0 software.Resultes The mean value of electric current of average tube and CTDIvol were significantly different between group A and B [(110.40 ± 21.72) mA vs.(168.56±24.36) mA,and (26.43 ±3.48) mGy vs.(39.66 ±4.17) mGy,respectively (t=-9.76,-3.31,P＜0.05)].The noise index was (33.13 ±2.68) in group A and (33.79 ±2.93) in group B respectively,and the results had no statistical significance (P ＞ 0.05).Subjective scores of the images were (4.06 ± 0.03) and (4.05 ± 0.03),with no statistical significance either (P ＞ 0.05).Conclusions On a condition of achieving same image quality,CT scan program using GE Discovery HD CT 750 with 40％ ASiR reconstruction and 4 units NI value enhancement could effectively reduce radiation dose on children's temporal bone compared to FBP method using GE Lightspeed VCT 64.