Pancreaticoduodenectomy,which is also known as Whipple surgery,is a complex of high-risk surgery,while the majority of patients have postoperative complications.As a serious complication,pancreatic fistula has been prevented and treated by a variety of methods.Currently,the main methods include improved surgical methods,somatostatin analogues,the use of support tube and medical adhesive,and so on.However,prevention and treatment of pancreatic fistula remains to be controversial.Here,the author will review the research progress of pancreatic fistula.

MicroRNA (miRNA) plays a regulating function in translation stage of gene expression.MiRNA has been found directly involving in the occurrence and development of pancreatic cancer,and its abnormal expression is closely related to early diagnosis of pancreatic cancer and may provide new therapeutic target for pancreatic cancer patients.MiRNA detection will have good application prospect in on the diagnosis and treatment of pancreatic cancer.

Objective　To study the clinico-pathological features of primary adrenal lymphoma (PAL).　Methods　2 cases of PAL were reviewed and studied.　Results　The age of the 2 patients was 45 and 57.The presenting symptoms were nonspecific.Histologically,the neoplasm was composed of numerous medium-sized cells with round nucleus,usually 1-2 in number and with relatively abundant basophilic cytoplasm.The neoplastic cells showed frequent mitosis.Immunohistochemically,the tumor cells were strongly positive for LCA,L26 and CD74 while negative for UCHL-1,S-100 protein and CK. One case was discharged 3 months after operation because of dyscrasia and the other was lost on follow up.Prognosis of PAL was poor.　Conclusions　PAL is extremely rare with a high grade of malignancy.The diagnosis could be made on histopathological studies and immunohistochemical studies.

BACKGROUND:There is no effective treatment for muscle atrophy caused by peripheral nerve damage. Skeletal muscle cel s, a structural unit of muscle contraction, can be used for studies on muscle atrophy when cultured in vitro.
OBJECTIVE:To investigate the promotion effect of neuron-secreted factors on the growth of skeletal muscle cel s in vitro.
METHODS:Skeletal muscle cel s primary cultured in vitro were divided into two groups:experimental group with neuron-secreted factors, and control group with common culture medium, respectively. Afterwards, the number of skeletal muscle cel s and expression level of alpha actin were detected by hematoxylin-eosin staining and immunohistochemical staining, respectively.
RESULTS AND CONCLUSION:The number of skeletal muscle cel s and expression level of alpha actin in the experimental group were significantly higher than those in the control group (P<0.05). In conclusion, neuron-secreted factors have the ability of promoting the growth of skeletal muscle cel s and may be helpful for denervated muscle atrophy.

Objective To investigate the criteria of hemodynamic parameters for diagnosis of intracranial segment vertebral artery stenosis with transcranial color-coded sonography (TCCS ). Methods A total of 622 outpatients or inpatients with suspected posterior circulation ischemia were enrolled retrospectively,from which 216 patients were selected with TCCS,color Doppler flow imaging (CDFI)screen,and digital subtraction angiography (DSA)examination,including 33 patients (15. 3%) had normal intracranial vertebral arteries,the stenosis rates<50% were 45 cases (20. 8%),50%-69%were 44 cases (20. 4%),and 70%-99% were 94 cases (43. 5%). The mean velocity (MV)of intracranial segment,the ratios SPRP (PSV1/PSV2 ),SPRE (EDV1/EDV2 )of the systolic and end diastolic flow velocity between the intracranial segment and the intervertebral space segment were calculated respectively by detecting the intracranial segment of vertebral artery,the intervertebral space segment peak systolic velocity (PSV1 ,PSV2 )and end diastolic velocity (EDV2 ,EDV1 ). The DSA findings were used as the criteria,the area under the receiver operating characteristic (ROC ) curve was calculated and the optimal cut-off points were obtained. Results The optimal cut-off points of TCCS diagnosis of intracranial vertebral artery stenosis were as follows:the parameter standards of stenosis rate <50% were 110 cm/s≤PSV1≤145 cm/s and 65 cm/s≤MV≤85 cm/s,the parameter standards of stenosis rate 50%-69%were 145 cm/s≤PSV1≤190 cm/s and 85 cm/s≤MV≤115 cm/s,and the parameter standards of stenosis rate 70%-99% were PSV1≥190 cm/s and MV≥115 cm/s. Conclusion TCCS may effectively evaluate the hemodynamic changes of intracranial vertebral artery stenosis and provide reference for the ultrasound evaluation criteria of intracranial vertebral artery stenosis.

Objective To investigate color Doppler flow imaging (CDFI)and transcranial color-coded sonography (TCCS)for detection and evaluation of severe stenosis of intracranial vertebral artery (IVA) before and after stenting,as well as the hemodynamic changes of restenosis and their clinical value. Methods A total of 102 patients with severe stenosis of IVA confirmed by CDFI plus TCCS and DSA from November 2011 to November 2013 were analyzed retrospectively. Extra- and intracranial segments peak systolic velocity (PSV),end-diastolic velocity (EDV),IVA pulsatility index (PI),extracranial resistance index (RI),tube diameter,spectrum morphology,and hemodynamic parameters before stenting and 1 week, 3,6 and 12 months after stenting were compared. According to the results of TCCS,they were further divided into either a restnosis group (n=16 )or a non-restnosis group (n=86 ). Results (1 )The results of TCCS detection showed:PSV,EDV,and PI of the stenotic segments were improved significantly at 1 week after stenting,they were 109 ± 40 cm/s vs. 258 ± 63 cm/s,47 ± 18 cm/s vs. 132 ± 45 cm/s,0. 91 ± 0. 15 vs. 0.75 ± 0. 18,respectively. There were significant differences (all P<0. 01). PSV and EDV of the restenosis group were increased gradually from 3 to 12 months after procedure. There were significant differences between 12 months after procedure and one week after procedure (all P<0. 01). There were no significant differences in PSV,EDV,and PI of the non-restenosis group between the 12-month observation period after procedure and one week after procedure (P>0. 05). (2)The results of CDFI showed:PSV and EDV of the ipsilateral extracranial segment were improved significantly after procedure compare with those before procedure, they were 64 ± 15 cm/s vs. 51 ± 15 cm/s and 24 ± 6 cm/s vs. 19 ± 7 cm/s (all P<0. 05). The RI value and vertebral artery diameter of the extracranial segment were improved gradually,and they reached the peak at 12 months after procedure (0. 61 ± 0. 07 vs. 0. 63 ± 0. 12,P=0. 038;3. 6 ± 0. 4 mm vs. 3. 4 ± 0.5 mm,P=0. 009). Conclusion CDFI in combination with TCCS can objectively evaluate the extra-and intracranial hemodynamic changes before and after IVA stenting,and provide reference information for the effectiveness of stenting and the imaging evaluation of restenosis.

Objective To quantitatively assess renal hemodynamic changes in hypertensive acute kidney injury in rabbits induced by L-NAME using 64-slice spiral CT functional imaging techniques,and to explore the application of these techniques in evaluation of early kidney functional changes.Methods Fourteen female New Zealand white rabbits were randomly divided into normal control group (n=6)and L-NAME group (n=8).The control group was injected NaCl solution and the L-NAME group was injected the same amount of L-NAME solution to make hypertensive acute kidney injury model.64-slice spiral CT and SPECT were scanned af-ter injection.Blood samples were collected before and after injecting NaCl and L-NAME solution to detect serum creatinine (Cr).Cr level and CT perfusion parameters of the two groups were analyzed and compared with the pathology results.GFRCT detected by con-trast-enhanced CT and GFRSPECT detected by SPECT were analyzed by the rank correlation test.Results Renal blood volume,blood flow,permeability surface,time to peak,and peak value had statistically significant differences between the control and L-NAME group (P <0.05).GFRCT and GFRSPECT had obvious correlation.GFRCT of L-NAME group was obviously lower than that of the con-trol group.The kidneys of L-NAME group showed obviously injured under both light microscope and microscope.Conclusion 64-slice spiral CT functional imaging techniques can dynamically observe and quantitatively assess early hypertensive kidney dysfunc-tion,especially unilateral renal blood flow abnormalities.It is an effective examination in quantitatively assessing kidney function.

Pregnant women are a group of people in a special period, once sudden cardiac arrest (CA) occurs, it will threaten the life of both mother and child. It has become a great challenge for hospital, doctors and nurses to minimize maternal mortality during pregnancy. All the efforts should ensure the safety of both mother and child throughout the perinatal period. Because difference of the cardiopulmonary resuscitation strategies for common CA patients of the same age, the resuscitation strategies for CA patients during pregnancy need consider the patient's gestational age and fetal condition. Different resuscitation techniques, such as manual left uterine displacement (MLUD), will involve perimortem cesarean delivery (PMCD). At the same time, drugs should be reasonably used for different causes of CA during pregnancy, such as hypoxemia, hypovolemia, hyperkalemia or hypokalemia and other electrolyte disorders and hypothermia in 4Hs, as well as thrombosis, pericardial tamponade, tension pneumothorax and toxicosis in 4Ts. In view of the fact that many causes of CA in pregnancy are preventable, it is more necessary to introduce guidelines for CA in pregnancy in line with our national conditions for clinical guidance. This paper systematically reviewed the pathophysiological characteristics of CA during pregnancy, the high-risk factors of CA during pregnancy, and identified the correct resuscitation methods and prevention and treatment strategies of CA during pregnancy.

Objective:To investigate the expression of Col9a1 gene in ankle tissue of rat model of idiopathic congenital talipes equinovarus (ICTEV) . Methods:ICTEV rat model was established. Immunofluorescence staining and immunohistochemical dyeing technology were used to detect the expression of Col9a1 protein in ankle tissue of model group and control group. Results:The expression level of Col9a1 protein in ankle tissue in model group was higher than that in the control group (P<0.05),Col9a1 gene expressed primarily in soft tissue and cartilage membrane. Conclusion:The increasing expression level of Col9a1 gene in ankle tissue of ICTEV rats may be related to clubfoot deformity.

OBJECTIVEThis research estimated shear bond durability of zirconia and different substrates cemented by two self-adhesive resin cements (Clearfil SA Luting and RelyX U100) before and after aging conditioning.

METHODSMachined zirconia ceramic discs were cemented with four kinds of core material (cobalt-chromium alloy, flowable composite resin core material, packable composite resin, and dentin) with two self-adhesive resin cements (Clearfil SA Luting and RelyX U100). All specimens were divided into eight test groups, and each test group was divided into two subgroups. Each subgroup was subjected to shear test before and after 10 000 thermal cycles.

RESULTSAll factors (core materials, cements, and thermal cycle) significantly influenced bond durability of zirconia ceramic (P<0.00 1). After 10 000 thermal cycles, significant decrease was not observed in shear bond strength of cobalt-chromium alloy luted with Clearfil SA Luting (P>0.05); observed shear bond strength was significantly higher than those of other substrates (P<0.05). Significantly higher shear bond strength was noted in Clearfil SA Luting luted with cobalt-chromium alloy, flowable composite resin core material, and packable composite resin than that of RelyX U100 (P<0.05). However, significant difference was not observed in shear bond strength of dentin luted with Clearfil SA Luting and RelyX U100 (P>0.05).

CONCLUSIONSDifferent core materials and self-adhesive resin cements can significantly affect bond durability of zirconia ceramic. 
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Adhesives ; Ceramics ; Chromium Alloys ; Composite Resins ; Dental Bonding ; Dental Cementum ; Dentin ; Humans ; Materials Testing ; Resin Cements ; Zirconium