Objective:To investigate the clinical characteristics, diagnosis, and treatment of primary pancreatic lymphoma (PPL). Methods:Clinical data of six PPL cases diagnosed and treated in the Tianjin Medical University Cancer Hospital were retrospectively analyzed. Results:In all cases, the primary clinical manifestations were abdominal pain, jaundice, and weight loss. The tumor marker level, including CA19-9, of all the cases was within the normal range, with five of the cases misdiagnosed as pancreatic cancer and one misdiagnosed as stomach cancer. In three cases, the pancreatic mass was located at the head of the pancreas, whereas in the other three, the mass was located at the body or tail. Pancreaticoduodenectomy was conducted in one case, laparotomy and biopsy in three cases, and B ultrasound-guided biopsy in the other two cases. All cases were diagnosed as PLL (B cell type non-Hodgkin's lymphoma). Ex-cept for one patient who left the hospital after surgery, the other five underwent chemotherapy. In addition to the death in one case be-cause of postoperative gastrointestinal bleeding, the survival times were 133, 73, 35, 12, and 10 months in the remaining cases. Conclu-sion:PPL is extremely rare in clinical practice, and the treatment methods and prognosis for the disease significantly differ from those for pancreatic cancer. PPL is easily misdiagnosed in clinical practice, which results in unnecessary treatment measures.

Objective To explore the role of non-receptor tyrosine kinase(c-Src)in sevoflurane pretreatment for relieving myocardial ischemia-reperfusion injury.Methods By using the random number table,the healthy male Wistar rats were randomly divided into 5 groups (n=10):sham operation group (Ⅰ),ischemia-reperfusion group(Ⅱ),sevoflurane pretreatment group(Ⅲ), sevoflurane pretreatment plus dimethyl sulfoxide(DMSO,Ⅳ)and sevoflurane pretreatment plus c-Src specific inhibitor SU6656 group(Ⅴ)groups.The group Ⅲ,Ⅳ and Ⅴ were performed the sevoflurane aftertreatment before reperfusion;the group Ⅴ was in-jected by SU6656 at 5 min before reperfusion;the group Ⅳ was given the equal volume DMSO.The arterial blood sample in each group was collected at 120 min after reperfusion for detecting serum LDH level and CK-MB activity.Rats were killed for taking the heart and separating the left ventricle to calculate the area of myocardial infarctio;the expression levels of Src,phosphorylated Src (p-Src),CAT and SOD in myocardial tissue were detected in each group.Results Compared with the groupⅠ,the level of serum CK-MB and LDH activity,myocardial infarct area and p-Src/Src,CAT,SOD in the other 4 groups were increased significantly (P <0.05);comparing with the group Ⅲ,the serum CK-MB and LDH activity,myocardial infarct area and SOD,CAT,in the group Ⅱ,Ⅳ and Ⅴ were increased,however the level of p-Src/Src was decreased significantly (P <0.05).Conclusion The c-Src-reactive ox-ygen signaling pathway might mediate the role of sevoflurane pretreatment for reducing myocardial ischemia-reperfusion injury in rat.

objective To clarify the significance and puncture path of 125I radioactive seeds implantation in treatment of postoperative local recurrence and pelvic metastasis in patients with rectal cancer.Methods Clinical data of 8 rectal cancer patients with postoperative local recurrence and pelvic metastasis treated by ultrasound guided 125I radioactive seed implantation were retrospectively analyzed and the therapeutic effects were observed.Results After the treatment,the symptoms of 5 cases suffering from hematochezia and 2 cases with vaginal bleeding disappeared within 21 to 30 days.7 patients with preoperative pain relieved after treatment.There was no tumor progression from postoperative imaging examination.Conclusion 125I radioactive seed implantation can effectively improve the life quality of rectal cancer patients with postoperative local recurrence and pelvic metastasis.

ObjectiveTo investigate the influence on efficacy and quality of life of amisulpride in schizophrenia with predominantly negative symptoms.MethodsSeventy cases of schizophrenia with predominantly negative symptoms were randomly assigned to amisulpride group and clozapine group for 12weeks.The clinical efficacy and side effects were evaluated with SANS,BPRS and TESS before and 1,2,4,8,12 weeks after treatment respectively. GQOLI-74 were used to evaluate the patients' quality of life before and after drug administration.ResultsFor the last assessment,the score of BPRS decrease to 30.68 ±4.62 in amisulpride group,was significantly lower than the beginning(P＜0.01 ) ; the score of BPRS decrease to 31.31 ±4.78 in clozapine group,was significantly lower than the beginning (P ＜ 0.01 ).Two groups showed similar effects,with no significance.12weeks after treatment,the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in amisulpride group were 12.31 ± 4.43,9.66 ± 3.07,8.91 ± 2.56,10.29 ± 2.68,5.58 ± 1.43 ; and the scores of emotional dull,poverty of thought,volition abulia,interest-social lack,attention dysfunction in clozapine group were 14.62 ± 4.27,9.32 ± 2.81,8.22 ± 2.60,9.54 ± 2.67,6.62 ± 1.59,and the efficacy of amisulpride in emotional dull and attention dysfunction were better than those of clozapine.And the scores of material life,physical function,psychological function,social function in amisulpride group were not higher than those in clozapine group(P＞ 0.05).And the scores of four domains in GQOLI-74 had been improved significantly in two groups(P＜0.01).The domains of physical function,psychological function,and social function in amisulpride was superior to clozapine(P＜0.01).The side effects were more in clozapine group than those in amisulpride group.ConclusionAmisulpride is as effective as clozapine for the treatment of schizophrenia with predominantly negative symptoms,but it has more advantage than clozapine to improve emotional dull,attention dysfunction and quality of life in schizophrenia with predominantly negative symptoms.

10.3969/j.issn.1000-3606.2013.06.009

Objectives To study the signiifcance of ifbrin related markers such as ifbrin monome (FM), D-dimer (D-D), fibrinogen and fibrin degradation products (FDP) in diagnosis of pre-disseminated intravascular coagulation (pre-DIC) state in children with severe pneumonia. Methods A total of 213 children with severe pneumonia in pediatric intensive care unit were divided into pre-DIC group and case control group according to the occurrence of pre-DIC. And 40 healthy children were included as normal control group. FM、D-D、FDP、prothrombin time (PT)、activated partial thromboplastin time (APTT)、ifbrinogen (FIB)、platelet count (PLT)、thrombomodulin (TM) levels were analyzed. Receiver operating characteristic curve was used to evaluate the above indexes. Results All the markers but FIB showed signiifcant difference among the three groups (P<0 . 05 ). The differences of FM、D-D、FDP、APTT in paired comparison among the three groups were also signiifcant (P<0.01), Pre-DIC group had the highest level and case control group was the second. Pre-DIC group had higher PT than that of the other two groups (P<0 . 05 ), but PT levels in normal control group and the control group are of no signiifcant difference (P>0 . 05 ). Compared with those in normal control group, TM and PLT levels were signiifcantly higher in the other two groups (P<0 . 01 ), but the differences of TM and PLT in pre-DIC group were not signiifcant in comparison to those in case control group (P>0 . 05 ). FM、D-D、FDP had larger area under curves (AUC) for pre-DIC than other indexes ( 0 . 84、0 . 76、0 . 64 , respectively). The AUC for the joint detection of the three indexes was 0 . 85 . Conclusions Fibrin related markers such as FM、D-D and FDP are valuable indexes in diagnosis of pre-DIC state in children with severe pneumonia, the joint detection of the three indexes would help to improve diagnostic accuracy.

Objective To assess the efficacy of early detection of breast cancer and the prognostic value of breast self-examination(BSE).Methods Randomized controlled trials(RCTs)involving BSE were included the present meta-analysis based on their qualities.The pooled analysis was performed with RevMany 4.2.8.Results Three RCTs were identified and then they were included the present metaanalysis.In women who conducted a BSE.the rate of biopsy fora lump in breast was 1.27%in the first 5 years,2.47%in more than 5 years but less than or equal to 10 years,and 2.50%in more than 10 years, respectively,all of which were significantly higher than in those who could not conduct a BSE(P<0.05) There was no significant difierence in the rate of final diagnosis and the mortality for breast cancer between the two populations in any follow-up time(P>0.05).Conclusion The rate of biopsy for a lump in breast in women could be increased by a BSE.which should not have been discarded from the early detection of breast cancer completely despite it is not helpful in increasing the rate of final diagnosis and decreasing the mortality for breast cancer.

Objective To investigate the molecular epidemiology and risk factors of the expression of the efflux pumps of multidrug resistant Pseudomonas aeruginosa (Pa). Method From April 2014 to October 2014 , clinical features of 100 patients infected with multidrug resistant Pa were retrospectivly analyzed . Results MexAB-OprM was expressed in all multidrug resistant Pa strains (100%). The expression rates of MexEF-OprN and MexCD-OprJin the multidrug resistant Pa strains were 50% and 36%, respectively. The risk factor of the three efflux pumps expression was analyzed and the results were as follows: the use of carbapenems and glycopeptides antibiotics was the risk factor of MexAB-OprM overexpression which was induced. The use of macrolide and carbapenems antibiotics was the risk factor of the induced MexEF-OprN and MexCD-OprJ expression. Invasive procedures, low WBC, anaemia, chronic fundamental disease and hospitalized in ICU ward were the common risk factors of communicable expression or overexpression of the three efflux pumps. Invasive procedures, low WBC, anaemia, chronic fundamental disease and hospitalized in ICU ward were commonly independent risk factors of expression of the three efflux pumps. Conclusion The normalized use of carbapenems and glycopeptides antibiotics , the reduction of unnecessary invasive procedures , the severely grasped standard of hospitalized in ICU ward , curing the fundamental diseases and improving the immunonity played important roles in the prevention of the expression or overexpression of the efflux pumps of multidrug resistant Pa.

Objective To study the change and clinical significance of coagulation and fibrinolytic function in neonatal sepsis. Methods 86 neonates inpatients in the neonatology department of our hospital were selected and divided into the ordinary infection group(30 cases)and the sepsis group(56 cases),and 30 healthy neonates were selected as the normal control group.Plasma AT-Ⅲactivity,DD level and PLT count were detected immediately after admission and the detection results were analyzed.Results Com-pared with the control group and the ordinary infection group,the AT-Ⅲ activity and the PLT count in the sepsis group were sig-nificantly decreased,while the DD level was significantly increase,the difference had statistical significance(P <0.01).The differ-ences of the three indexes had no statistical significance between the normal control group and the ordinary infection group(P >0.05);however,the AT-Ⅲ activity and the PLT count in the DIC group were significantly decreased and the DD level was signifi-cantly increased(P <0.01),the occurrence rate of abnormal three indexes was 83.33%(15/18)in the DIC group,which was signifi-cantly higher than that in the non-DIC group(χ2 =17.75,P =0.00).Conclusion The obvious dysfunction of coagulation and fibri-nolysis exists in neonatal sepsis,which is related with the severity degree of disease.The joint detection of AT-Ⅲ activity,DD level and PLT count is helpful for the early diagnosis of DIC in neonatal sepsis.

Objective To study the clinical value of serum N-terminal pro-brain natriuretic peptide (NT-ProBNP) and cardiac troponin I (cTnI) levels in children with severe pneumonia. Methods A total of 72 children with severe pneumonia in pediatric intensive care unit were divided into heart failure (HF) group and non-HF group according to the occurrence of heart failure, and 30 healthy children were selected as control group. Serum NT-ProBNP and cTnI levels were detected and analyzed. Results Compared with control group, NT-ProBNP and cTnI levels were signiifcantly higher (P<0.01) in HF and non-HF group. The levels of NT-ProBNP and cTnI in HFgroup were both signiifcantly higher (P<0.01) than that in non-HFgroup. Serum NT-ProBNP level was positively related to the level of cTnI(P=0.000) in children with severe pneumonia. The abnormal rate of cTnI in HF group was significantly higher (P=0.037) than that in non-HFgroup. The difference of the abnormal rate of NT-ProBNP between the two groups was not signiifcant (P=0.375), however, the abnormal rate of NT-ProBNP was signiifcantly higher (P=0.036) than that of cTnI in non-HF group. Conclusions There was obvious myocardial damage in children with severe pneumonia. NT-ProBNP and cTnI could be important serological markers to assist diagnosis of myocardial damage and its severity.