From the first Laparoscopic pancreaticoduodenectomy (LPD) in 1994 to the first Da Vinci robotic pancreaticoduodenectomy(RPD) in 2003, minimally invasive pancreaticoduodenectomy has achieved a breakthrough after 20-year exploration and development.It is a well-established procedure for periampullary carcinomas in some specialized centers now.Some outstanding reports including large clinical trials more than 100 cases of L/RPD in a single center and review analysis about the short and long outcomes between L/RPD and open PD for large cases have been published.For the sake of increasing popularity and acceptance of L/RPD, it is very important for researchers to update the current status of L/RPD and summarize experience and development.

Objective To assess atrophy of the multifidus in elderly patients with low back pain using magnetic resonance imaging.Methods Thirty patients with low back pain were recruited,and 15 healthy subjects formed a normal group.The cross sectional area (CSA) and signal strength of the multifidus muscles at the L4-5 and L5-S1 levels were measured along with the signal strength of the hip fat for all of the subjects in both groups using a superconducting magnetic scanner.Results There was no statistically significant CSA difference between the groups at either level.The contrast between multifidus muscle and adipose tissue was significantly different between the groups at both levels.Conclusion In evaluating atrophy of the multifidus muscle in elderly patients with low back pain,the contrast between multifidus muscle and adipose tissue at either level L4-5 or L5-S1 can be used for assessment.It is more reliable,specific and sensitive than the CSA of the muscle.

BACKGROUND: Traditionally,UV/visible spectra,conductivity,electrophoresis and other methods are commonly applied for studying the interaction of metal ions and amino acids,but UV-Vis spectroscopy and fluorescence spectroscopy for L-histidine reacted with silver ion in aqueous solution is rarely reported.OBJECTIVE: To investigate the interaction between silver ion and histidine using UVNIS and fluorescence spectra.METHODS: The influence of pH,multicomponent concentration such as histidine,silver ion,formaldehyde,sodium dodecyl sulfate and trihydroxymethyl aminomethane,as well as illumination strength and time,on the interaction between silver ion and histidine were investigated,and the mechanism of reaction was also explored.RESULTS AND CONCLUSION: Applied pH potentiometer titration method,the dissociation constants of histidine was defined 9.21.The stepwise stability constants of histidine-silver was logK1=5.56 and logK2=4.05,respectively by using half(n)method.At 20 ℃,the electric potential of histidine-silver system was 2.10×10-4 V.According to pH potentiometer titration and lob method,the compound was consisted of histidine: Ag=2:1.Compared with histidine,histidine-silver systems reached a shoulder peak at 295.3 nm,which was assigned to conjugate double bond of imidazole ring that easily generated π-π*transition.And an absorption peak close to 242 nm can be assigned to n-π*transition of the C=O group of the histidine-silver.The fluorescence emission spectra of histidine-silver systems belonged to 5D0→7F2 electric dipole transition.Compared with reference solutions under the same conditions,it not only emitted wavelengths blue shift,but also induced fluorescence quenching.Results showed that,imidazole ring was involved in the bonding action with silver ion.The reaction process is to firstly generate six-coordination complex,secondly reduce the silver ion into ultrafine silver particles which are bound by histidine.

Objective To investigate the effect of tripterysium glycosides combined with isotretinoin in cysticacne and its effect on serum inflammatory factors, insulin like growth factor 1 (IGF-1) and dehydroepiandrosterone (DHEA).Methods 118 cases of cysticacne patients were divided into observation group (n=59) and control group (n=59) according to the random number table method.Patients in the control group were treated with isotretinoin capsule, while the observation group were treated with tripterysium glycosides tablets on the basis of the control group.The course of treatment was 8 weeks in two groups.Results The total efficiency of the observation group (89.83%) was higher than the control group (71.19%) (P<0.05); the number of cyst after treatment in the observation group were less than the control group (P<0.05);the serum IL-2 and IL-4 levels in the observation group after treatment reduced, and lower than the control group (P<0.05);the serum IGF-1 and DHEA levels in the observation group after treatment reduced, and lower than the control group (P <0.05); the recurrence rate of the observation group (11.86%) was lower than the control group (30.51%) (P<0.05);the adverse reactions in two groups had no statistically significant.Conclusion Tripterysium glycosides combined with isotretinoin capsule has obvious curative effect in the treatment of cysticacne patients, and can reduce the serum IL-2, IL-4 levels and IGF-1 and DHEA levels, with lower recurrence rate, fewer adverse reactions.

Objective To determine the influence of Fe2O3 coloring method to the mechanical and transparency parameter of dental zirconia.Methods Presintered zirconia blocks were coverd with zirconia powder blended with different ratio of Fe2O3,then sintered to 1450℃.Mechanical property and transparency parameter were calculated.Results The L* value was in the range from 64.91 to 90.94.The a* value was in the range from 1.27 to 12.70.The b* value was in the range from 1.02 to 38.66.There was no significant difference (P ＞ 0.05) of the flexural strength and in each group with the increase of Fe2O3.Conclusion This method produced dental zirconia specimens with light yellow to amber brown colors with the increase of Fe2O3 and no significant influence of mechanical property and transparency.

Objective To investigate the effect of using evidence - based nursing (EBN) in the course of nursing patients with severe craniocerebral injury combined pulmonary diseases. Method Divided 160 patients into research group and control group randomly, there were 80 patients in each group. Using EBN in the research group, and routine nursing measures was used in the control group, and then compare the rehabilitation of patients in 2 groups. Result The condition of rehabilitation in research group was significant better than that of in control group, P

Objective To evaluate the therapy effect and prognosis of upper digestive tube hemorrhage resulted from Portal Hypertension,which is dealed with combined devascularization with stitching instrument.Methods Summarized the therapy and prognosis of 41 patients of upper digestive tube hemorrhage resulted from Portal Hypertension,dealed with combined devascularization with stitching instrument.Results All the patients above had no one die for operation and no one had complication of hepatoencephalopathy.after operation 22 patients of this group had complication with medium quantity of ascite.All the patients had no complication with gastric fistulas.Conclusions Combined devascularization with stitching instrument is the best operation for upper digestive tube hemorrhage resulted from Portal Hypertension.

ObjectiveTo investigate the efficacy and safety of aripiprazole in treating schizophrenia with clozaping as control.Methods70 cases with schizophrenia were randomly divided into the experimental and control group with 35 cases in each group.The effectiveness and safety were evaluated with positive and negative syndrome scale and treatment emergent symptoms scale before and at the ends of week 1,2,4,6,and 8 after starting treatment respectively.ResultsThere was no significant difference in effectiveness between two groups.However,the score reduce rates about cognitive factors and negative symptoms of the aripiprazole group was better than that of the clozaping group(P<0.05).The main side effects in aripiprazole group were mild headache,anxiety,insomnia and etc.ConclusionAripiprazole is an effective and safe neuroleptic,specifically in improving cognitive function and negative symptoms.

Comparing with the world level, the bibliometric indicators of Chinese medical journals in oncology field are rather lower, but our medical journals have big development space. In the world journals with high impact index, the papers published by Chinese authors are fewer; in the papers number, the superiority of Chinese authors is in tumor clinical therapy field. Most papers are written by researchers from large institutions with plenty of medical resources.

Objective To evaluate the efficacy and safety of Xuebijing combined with corticosteroid injection treating paraquat poisoning with regression analysis. Methods 146 patients of paraquat poisoning in 3 years were divided into two groups: control group and therapeutic group. 50 patients in the control group were treated with Methylprednisolone, while 96 patients in the therapeutic group were treated with Xuebijing injection (300～400 ml/d, intravenous drip) and Methylprednisolone. The patients' clinical symptoms, signs and the levels of white blood cell (WBC), Neutrophils (N), C-reactive protein (CRP), glutamic-pyruvic transaminase (ALT), aspartate aminotransferase (AST), serum creatinine (Scr) and arterial partial pressure of oxygen were collected. And patients did chest CT examinations every three days. All the data were compared between the two groups. Results ① The biochemical indicators of the control group in the 14th day [WBC,N,CRP, and PaO2 is (16.49±4.30), (84.22±21.07), (24.58±7.06), and (83.20±22.95) respectively]were better than those in the third day[WBC, N, CRP, and PaO2 is (19.21 ±5.34), (85.04± 12.33), (27.98±6.51), and (73.42±11.43)respectively], but there was not significant difference between them(P>0.05). While the biochemical indicators of the therapeutic group in the 14th day [WBC,N, CRP, and PaO2 is (9.16 ± 3.23 ), (70.48 ± 10.79), ( 17.48 ± 4.7), and (95.04± 11.93) respectively] were much better than those in the third day [WBC,N,CRP, and PaO2 is (16.96±9.95),(84.82±9.34), (27.34± 10.03), and (89.12±9.47) respectively], and there was significant difference between them( P< 0.05 ). ② The survival rate in the control group was 32% comparing to 67.71% in the therapeutic group, showing significant difference between the two group (x2=9.588, P<0.05) . ③ The patients' chest CT examinations in the therapeutic group were better than those in the control group. Conclusion Xuebijing injection combined with methylprednisolone had good effects m treating paraquat poisoning.