Tumor removal is the only curative method of pancreatic cancer.Although much progress has been made in pancreatic surgery,the most important one is the decline of the perioperative mortality.There were many randomized clinical trials including studies of the extension of the standard operation.1ymphadenectomy and resection margin.However,the long-term survival has not increased,and the median survival no longer than 20 months.According to the situation that many patients should not select resection,we think that it is important to control the surgical complications and to encourage the patients to receive surgery.

Objective　To make a preliminary analysis of orthokeratology(OK) for treating myopia.Methods　OK lenses were chosen to treat myopia with or without astigmatism according to the myopia characterizations, then changes of their visions, refractions, corneal curvature and eccedtricities after being treated for ld, 1、2、3、4 weeks were observed once every 4weeks and were followed up for 18 months.Results　Significant changes were observed after being treated. Slight myopia: the diopters decreased-2.75D±0.50D,the horizontal meridians flattened 1.64±0.21, the vertical 0.92±0.27 and the eccedtricities declined 0.47±0.11; Middle myopia: the diopters decreased -5.50D±0.75D,the horizontal meridians flattened 2.16±0.45, the vertical 1.61±0.67, and the eccedtricities declined 0.38±0.07; High myopia:the diopters did -6.75D±0.50D,the horizontal did 3.86±0.56, the vertical 2.97±0.67 and the eccedtricities did 0.32±0.10. The predicabilities of slight and middle myopia were superior to high myopia's.Conclusion　Orthokeratology is a non-traumatic therapy and the clinical application should be careful and scientific.

Objective To identify the pmgnesfic factors influencing the recurrence and metastasis of adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy. Methods A retrospective study was carried out on the clinical manifestation, pathological behavior and survival data in 101 patients with Vater's ampullary adenecarcinoma receiving pancreaticoduodenectomy from Jan 1980 to Dec 2003. Results According to TNM system, there were 42 cases (41.6%) of stage Ⅰ, 32 cases (31.7%) of stage Ⅱ, 27 cases (26.7%) of stage Ⅲ. During postoperative follow-up period [ median, 46(2-192) months] 25 patients (24.8%) suffered from recurrence or/and metastasis with the median recurrence time of 20 (2-93) months, among which there were 11(10.8%) cases of local recurrence and 20 (19.6%) cases of distant metastasis. The differences were statistically significant between the patients with recurrence or/and metastasis and those without in the following parameters: tumor size larger than 2 cm (64% vs. 39%, X2=4.56, P=0.033), positive lymph node metastasis in the primary specimens (52% vs. 17%, X2=11.98, P=0.001), postoperative complications (51% vs. 20%, X2=7.50, P=0.006). Logistic regression showed only lymph node status (OR=5.14, P=0.0037) was independent factors of tumor recurrence and metastasis. The median non-recurrent time in those without lymph node metastasis was 49 (2-192) months, significantly longer than the median 32(12-152) months in those with metastasis (X2=5.43, P=0.0198, log-rank test). Conclusions Recurrent metastasis is the main problem in patients with ampullary adenocarcinoma after pancreaticoduodenectomy. The lymph node status is an independent prognostic factor.

Objective To evaluate the use of stapling anterior resection for rectal cancer. Methods Data of 1036 patients undergoing anterior resection for rectal cancer during 1983 to 2000 were reviewed retrospectively. Clinical results were compared statistically between patients who received stapling anastomosis (group A, n=652) and those did not (group B, n=384). Results The annual average stapler anterior resection increased from 5 cases per year (during 1983-1987) to 147 cases per year (1998-2000). The 0? Ⅰ? Ⅱ stage patients accounted for 53% in group A, and 62% in group B (P=0.004). There was higher percentage of patients in group A (66%) than in group B (39%) in which the distance from the lower edge of the tumor to anal verge was less than 8 cm (P

Objective To investigate the postoperative complications, survival and the prognostic factors of surgical treatment of distal cholangiocarcinoma . Methods The clinical data of 23 patients with distal cholangiocarcinoma treated by operation in our department in recent 12 years were reviewed retrospectively. Results The persistent period of symptoms befor operation in patients without postoperative complications ( 1.29?0.23 months) was significantly longer than that in patients with complications (0.50?0.18 months) (P

Objective To investigate the clinical and pathologic characteristics of rectal gastrointestinal stromal tumor (GIST),and to evaluate the management of rectal GIST. Methods The clinical and pathological data of 19 cases of rectal GIST in recent 19 years were studied retrospectively. Results The diagnosis of 19 cases of rectal GIST were identified by surgery and pathology. Most rectal GISTs were spindle cell type. Immunohistochemical analysis displayed positive reactivity for CD117(100%) and CD34(73. 7% ). Graded by aggressive behavior there were 4 cases of high risk, 3 cases of intermediate risk, 5 cases of low risk and 7 cases of very low risk. Conclusions Rectal GISTs have a low prevalence and have no specific symptom in the early stage. Most tumors are low risk in aggressive behavior. It is difficult to get an accurate pathological diagnosis before operation and difficult to decide whether a sphincter preserving procedure is justified however trans-anal local resection is the therapy of choice for low risk submucosal rectal GIST(

Objective To investigate the effect of radial artery calcification (RAC) on survival of arteriovenous fistula (AVF) and the patients in end?stage renal disease. Methods Adult ESRD patients undergoing AVF surgery between January 2013 and January 2016 at the Eighth Affiliated Hospital of Sun Yat?sen University were enrolled in this study. The clinical and biochemical data were collected. Segment of radial artery were obtained from the operation of AVF. RAC at the site of anastomotic were observed by alizarin red S and hematoxylin and eosin staining. According to RAC, the patients were divided into calcification group and non?calcification group. Kaplan?Meier analysis was performed to analyze the survival rates of the two groups, and Cox proportional hazards regression——model was used to estimate the risk factors of AVF dysfunction and all?cause mortality in ESRD patients. Results Among 180 cases of ESRD patients, 38 cases (21.1％) were developed RAC at the site of anastomotic in different degrees. Compared with the non?calcification groups, the calcification groups had a longer dialysis vintage, a higher proportion of diabetes and higher level of HbAlc (all P﹤0.05). Binary logistic regression analysis showed that dialysis vintage>5 years and diabetics were two independent risk factors of RAC at the site of anastomotic. Kaplan?Meier survival analysis demonstrated that there were no statistical differences between two groups in AVF survival (χ2=0.009, P=0.926). Calcification group had higher all?cause mortality than non?calcification groups (χ2=9.809, P=0.002). Multivariate Cox regression analysis demonstrated that homocysteine was independent risk factor for AVF dysfunction (HR=1.027, 95％CI: 1.003-1.051, P=0.027). Age was independent risk factor for all?cause mortality (HR=1.078, 95％CI: 1.035-1.122, P=0.000). Conclusions Dialysis vintage>5 years and diabetes were two independent risk factors of RAC at the site of anastomotic in ESRD patients. RAC at the site of anastomotic had no effect on AVF survival, but increased all?cause mortality.

OBJECTIVETo improve the diagnosis and treatment of carcinoma of head of pancreas.

METHODSA retrospective study was carried out to evaluate 178 patients suffering from carcinoma of head of pancreas.

RESULTSPain in the epigastrium and obstructive jaundice were observed in 70% and 74.2% of these 178 patients, both of which were of significance (P < 0.001) between stage I, II and stage III, IV disease. Only 18% of patients had pain in the back, 81.3% of whom belonged to the stage IV category. The detection rate of the tumor by B-ultrasound, CT and MRI were 74.2%, 87.3% and 85.5%, respectively. The success rate of pancreatoduodenectomy was 10.1%. The postoperative 1-, 3- and 5-year survival rates were 67.5%, 36% and 5.6%. Internal drainage was performed in 115 patients. The median survival time was 7 months in patients with unresectable tumor who received radiotherapy and/or chemotherapy.

CONCLUSIONPain in the epigastrium and obstructive jaundice are the most common symptoms. Hyperglycemia is the most common complication. Pain in the back implies an advanced lesion. CT is the most important way of diagnosis and the combination of B-ultrasound, CT and MRI may improve the rate of diagnosis up to 96.6%. By now, pancreaticoduodenectomy is still the only effective treatment for the carcinoma of head of pancreas and internal drainage is an important palliative measure.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Hyperglycemia ; etiology ; Male ; Middle Aged ; Neoplasm Staging ; Pain ; etiology ; Pancreatic Neoplasms ; complications ; diagnosis ; mortality ; surgery ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.

Objective:To investigate the effect of combining repeated high-frequency transcranial magnetic stimulation (rTMS) with escitalopram in treating the neurological functioning and post-stroke depression of stroke survivors.Methods:Eighty persons with post-stroke depression were randomly divided into an observation group and a control group, each of 40. The control group was treated with oral escitalopram, while the observation group also received transcranial magnetic stimulation at 5Hz. The magnetic stimulation intensity was 80% of each person′s resting motion threshold. The rTMS was administered once a day, 5 days a week for 8 weeks. Neurological functioning and depression were evaluated using National Institutes of Health stroke scoring (NIHSS) and the Hamilton depression scale before and after the 8 weeks of treatment. The levels of tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2) and interleukin-6 (IL-6) in serum samples from the two groups were detected using enzyme-linked immunosorbent assays.Results:After treatment, the NIHSS and Hamilton scores and TNF-α, IL-2 and IL-6 levels in both groups had improved significantly, but in each case they were significantly better in the treated group, on average.Conclusion:Supplementing escitalopram with high-frequency transcranial magnetic stimulation more effectively improves depression and neurological functioning after a stroke.