Enhanced recovery after surgery (ERAS) includes preoperative education,intraoperative effective anaesthetization,analgesia,precision surgical techniques and postoperative early rehabilitation.Because of special location of the pancreas,difficulty of surgical techniques,longtime of learning and high incidence of postoperative complications,the application of ERAS in pancreatic surgery is restricted.While ERAS could reduce the stress after surgery and the incidence of complications,promote the recovery of patients,shorten the duration of hospital stay and reduce the expenses,which are confirmed by clinical practice.ERAS is the trend of the development of pancreatic surgery.How to balance the optimal prognosis and speed recovery is need to be resolved by pancreatic surgeons.

Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH),and influencing factors of severity of PPH.Methods The retrospective case-control study was conducted.The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected.Patients with PPH in the early stage underwent reoperations for hemostasis;patients with PPH in the later stage received conservative treatment,and then DSA and TAE were considered when patients had the stable vital signs.Observation indicators:(1) DSA situations:overall times,positive rate and bleeding sites;(2) TAE situations:successful rate of hemostasis,operating time and postoperative complications;(3) follow-up situations;(4) influencing factors analysis of severity of PPH.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio and proportion.The univariate analysis was done using the Fisher exact probability.Results (1) DSA situations:all the 20 patients underwent DSA,with overall times of 27.The direct sign was 18 times extravasation of the contrast medium,with a positive rate of 66.7％ (18/27).Of 18 times positive DSA,clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump),in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery),in 3 times superior mesenteric artery,in 2 times splenic artery,in 1 time left gastric artery,in 1 time right gastric artery,in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery.(2) TAE situations:of patients with 18 times positive DSA,patients with 15 times positive DSA received TAE,with a successful rate of hemostasis of 13/15,and patients with 5 times positive DSA received successful hemostasis by reoperation.A median operating time of TAE for patients with 15 times positive DSA was 30 minutes.There was no occurrence of adverse reaction,including fever,abdominal pain,melena,elevated aminotransferase and liver abscess.One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery.Of patients with 9 times negative DSA,patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation.All the 20 patients were cured and then discharged from hospital.(3) Follow-up situations:20 patients were followed up for 4-92 months,with a median time of 24 months.During the follow-up,20 patients recovered well,without long-term complications.(4) Influencing factors analysis of severity of PPH:the results of univariate analysis showed that gender,age,preoperative blood sugar,preoperative combined jaundice,preoperative albumin (Alb),preoperative prothrombin time (PT) extended,preserving pylorus,pancreatic duct stent placement,pancreatic operation time,volume of intraoperative blood loss,intraoperative blood transfusion,property of tumor,postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P＞0.05).Conclusion DSA is minimal-invasive in the diagnosis for PPH,and TAE is safe and effective for patients with positive DSA.

Objective To discuss drug application and nursing experience during CT contrast enhancement in infants.Methods CT contrast enhancement with Ultravist,one of the non-ionic contrast media,was performed on 202 infants.Before examination,all the infants were calmed with Diazepam or Chloral Hydrate(10% in concentration).The doses of the drugs were determined by the weight of these infants.Results Non-ionic contrast media was not absolutely safe and a few infants had side effects.Only 7 infants had positive allergic tests.The results of CT contrast enhancement on 202 infants were satisfied.Conclusion During CT enhancement,appropriate use of contrast media and sedatives as well as proper nursing according to the infants’ age will get a better result.

Objective To observe the effect of enhanced extracorporeal counterpulsation (EECP) on intraocular pressure (IOP). Methods 25 patients were measured their IOP bilaterally with Schoitz tonometer before and after EECP. Results The IOP decreased in both left and right eyes after EECP (P<0.01). Conclusion EECP can reduce intraocular pressure.

This article was aimed to study the therapeutic effect of Chinese medicine Kun-Bao-W an (KBW) on sleep disorders among ovariectomized mice. A total of 60 female KM of adult mice were randomly divided into four groups, which were the sham-operated group, model group, diazepam group, and KBW group, with 15 rats in each group. Rats in the sham-operated group were only removed small amount of fatty tissue around the ovaries. Bilateral oophorectomy was given on mice in other groups. In the KBW group, 28 days after the operation, KBW was intragastrically administered (1.667 g·kg-1) every day for 28 days. Mice in the diazepam group were intragas-trically administered (1.25 g·kg-1) 1 h before testing. The observation was made on effects of KBW on locomotor activity, sleeping time of mice induced by pentobarbital sodium and the organ coefficients of uterus. The results showed that compared with sham-operated group, locomotor activity and rearing behavior increased obviously in the model group (P < 0.01). The diazepam group can significantly reduce locomotor activity in ovariectomized mice (P < 0.01), and decrease the number of rearing behavior mildly with no statistical difference. KBW can reduce lo-comotor activity mildly but without effect on rearing behavior in ovariectomized mice. Diazepam can markedly pro-long the pentobarbital sleep time in ovariectomized mice (P < 0.01). KBW can prolong the pentobarbital sleep time and shorten the process of falling into sleep mildly with no statistical difference. There was no significant ef-fect on organ coefficients of uterus in ovariectomized mice by KBW or diazepam. It was concluded that KBW had mild effect on improving sleep disorders in ovariectomized mice.

This article was aimed to study the sedative and hypnotic effects of different eluents of Shuangxiatang (SXT). The effects of SXT water decoction, water eluent, 20%, 70% and 95% alcohol eluent on spontaneous ac-tivity and the sleeping induced by subthreshold dose of pentobarbital sodium were measured. The results showed that the SXT decoction, 20% and 95% alcohol eluent can significantly decrease the number of rearing in mice with the percentage of 78.5%, 78.3% and 62.5%, respectively. SXT water eluent and 70% alcohol eluent can significantly decrease the spontaneous activity of mice (P < 0.01), the number of rearing (P < 0.01) and grooming time (P < 0.05). SXT water decoction can significantly shorten sleep latency (P < 0.05), prolong sleep time (P <0.05), and increase rates of sleeping in mice. SXT water eluent can significantly shorten sleep latency in mice (P< 0.05), increase rates of sleeping in mice. SXT water decoction and water eluent have the sedative and hypnotic effects. And the effects are more than alcohol eluents.

Objective To assess clinical outcomes of FasT-Fix technique in repair of meniscal injury under arthroscope. Methods A total of 36 cases (37 knees) of mensical tears were repaired with FasF-Fix technique. There were 26 males and 10 females, at mean age of 26 years (14-51 years). Eighteen meniscal tears were located in zone Ⅱ, 16 in zone Ⅲ and 3 in zone Ⅳ. The average length of the tear was 2.2 cm (1.0-3.0 cm). Results There were no any signs of early complications after sur gery. All cases were followed up For 6-26 months (mean 16 months). According to Lysholm scoring scale system ,the average score of operated knees was increased from preoperative 44.13+12.56 to postopera tive 80.24+12.67 (P<0.01). After operation, all the patients could move the knee joint at normal range, except for one case who had a limitation of 20 degree flexion, with no pain or interlocking symptom. All cases returned to original work and/or could continue sports game. Conclusion The FasT-Fix technique is a simple, safe and effective method for repair of properly selected meniscal tears.

Objective To investigate the characteristics of health related quality of life(HR-QOL) in Chinese patients with early Parkinson' s disease(PD), to identify the motor and non-motor factors that are associated with a poorer quality of life in patients with early PD. Methods All 391 patients with early PD were identified in a clinical-based study. Motor functions were measured by Unified Parkinson' s Disease Rating Scale (UPDRS) and Hoehn-Yabr Scale. Non-motor variables were assessed by Center of Epidemiological Survey Depression Scale (CES-D) for depressive symptoms, Pittsburg Sleep Quality Index (PSQI) for sleep disturbance, Fatigue Severity Scale (FSS) for fatigue, Alzheimer' s Disease Assessment Scale-Cognitive Sections (ADAS-Cng) for cognitive function, and Constipation Severity Scale for constipation. HR-QOL was measured by SF-36. Motor and non-motor variables were collected at the baseline assessment of a clinical trial and determined during a structured interview and by clinical examination by movement disorder specialists. The results were compared with those in healthy elderly people. Multiple regression analyses were used to determine which variables were strongly associated with lower levels of quality of life. Results Patients with early PD had a lower score on all dimensions of SF-36, except bodily pain dimension. Motor factors, particular physical disability and disease severity, contributed to decreased HR-QOL, but to a lesser extent. The motor score of the UPDRS (23. 8±11.8), Hoehn-Yahr stage(2. 0± 0.7), together with the rigidity score (4.4 ± 3.1), only accounted for 18.9 % (R2=0. 189) of the variance of SF-36 total score. The variables that most strongly predicted a low total SF-36 score were non-motor factors, particularly depressive symptoms, sleep disorders and fatigue. When the CES-D, FSS, and PSQI score were included in the model, the R2 increased from 0. 189 to 0.617, indicating that 61.7% of the variance in HR-QOL could be explained if additional CES-D, FSS and PSQI scores were known. Depressive symptoms, as measured by CES-D, had an overwhelming impact on HR-QOL. When CES-D score was included, the R2 change was 0.433, which indicated that additional 43.3% of the variability in HR-QOL could be explained by adding depressive symptoms. Conclusions PD has a substantial impact on HR-QOL, even if in its early stage. Depressive symptoms, sleep disorders and fatigue correlated strongly with lower quality of life. Depressive symptoms appeared to be the strongest determinant of HR-QOL in early PD patients. Every effort should be made to recognize and treat these conditions, thus improving all aspects of PD and giving these patients as good a quality of life as possible.

Objective To analyze the clinical characteristics of glenoid labral tear combined with rotator cuff tear so as to provide references for arthroscopic surgery.Methods A total of 50 patients (28 males and 22 females)at mean age of 45 years old(ranged from 30 to 58 years)were enrolled in the study.Clinical data including the mechanism and time of injury,symptoms,results of physical examination,X-ray and MRI were collected.Location and degree of rotator cuff and glenoid labral tears found during arthroscopic surgery were also recorded.There were 37 patients with anterior labral tears,eight with superior labrum tears and five with posterior labral tears.The rotator cuff tear was slight in 36 patients,moderate in 10 and severe in three.One patient had extra-large tear.Anterior part of rotator cuff was found torn in 21 patients,middle part in 16 and posterior part in 13.MRI of glenoid labral tears manifested disappearance of triangular appearance and enlarged joint capsule.MRI manifestations of rotator cuff tear were high signal in torn part and continuity loss.Results All patients were followed up for average 36 months(6-72 months),which showed satisfactory results.UCLA score was(15±3)points preoperatively and(32±3)points postoperatively(P＜0.01).Conclusions More attention should be paid to glenoid labral tear to avoid misdiagnosis and delayed treatment,for it is usually combined with rotator cuff tear.Location of rotator cuff tear has some relation to the range of glenoid labral tear,ie,the larger range of glenoid labral tear may induce more posterior part of rotator cuff torn.

Objective To investigate the prevalence,characteristics and risk factors of fatigue in a large cohort of subjects with early Parkinson's disease (PD).Methods A total of 391 individuals with PD,recruited in Linzhi trial,were re-screened.Early,non-depressed subjects [Center for epidcmiological survey depression scale (CES-D)＜16]underwent further fatigue assessment.Subjects who scored＞4 on fatigue severity scale (FSS) were classified as fatigue.Motor symptoms and PD severity were assessed using the unified Parkinson's disease rating scale (UPDRS) and Hoehn-Yahr scale.Other clinical measures,including sleep disorder by Pittsburg sleep quality index (PSQ-Ⅰ),mental function by Alzheimer's Disease assessment scale-cognitive sections (ADAS-Cog) and quality of life by medical outcomes study short form 36 (SF- 36) were also evaluated.Results Among 204 subjects who completed fatigue measures,82 (40.2％) were classified as fatigue.The fatigue group had significantly more neurological impairment by higher scores on each subsets of UPDRS including mentation (P＜0.05),activities of daily living (P＜0.01) and motor (P＜0.01),while the subjects with fatigue had worse scores on SF-36 (P＜0.01).Multiple regression analyses showed that motor subset of UPDRS was the variable that had the predictive value for FSS score.The full model explained 6.4％ of the variance of the FSSscore (β=0.039,95％CI:0.019-0.059).However,other factors,including levodopa dosage,PSQ-Ⅰ,and ADAS-Cog score did not significantly contribute to the model.Conclusions Fatigue is a frequent symptom in carly,non-depressed patients with PD,affecting over 40％ of the patients in this cohort.The small correlation between fatigue and motor score,and the lack of association with dosage of dopaminergic treatment suggest that dopaminergic pathways might be only moderately involved in pathogenesis of fatigue.