Reflux is a common post-gastrectomy complication due to the destruction of physiological antireflux mechanism,which affects patients' post-surgery life quality greatly.It's one of the basic requirements of digestive tract reconstruction to reduce the incidence of post-surgery reflux,and nowadays there are many kinds of anti-reflux surgical methods,which are also hot topics both at home and abroad.The non-surgical anti-reflux treatments are mainly focused on gastrointestinal motility promotion,mucosa protection,acid suppression,and so on.There are still some controversies concerned with which surgical or non-surgical way to choose.It's of great significance to have a deep insight into the associated mechanisms and make a wise decision on the surgical management with proper non-surgical assistance.

Objective To investigate the risk factors of post-pancreaticoduodenectomy complications.Methods The clinical data of 207 patients with pancreatic carcinoma or peri-ampullary carcinoma who underwent pancreaticoduodenectomy at the Anhui Provincial Hospital from Dec.2007 to Dec.2012 were studied.Seventeen clinicopathologic factors to correlate with the postoperative mortality and methods were selected for univariate analysis and multivariate analysis using logistic regression.Results Univariate analysis showed the major risk factors of postoperative mortality and morbidity were a history of previous operation,pre-operative drainage,total serum bilirubin level,alanine aminotransferase level,serum albumin level,serum pre-albumin level,parenchyma texture and pancreatic duct diameter (P＜0.05).Multivariate analysis showed alanine aminotransferase level,parenchyma texture and pancreatic duct diameter were independent risk factors of postoperative complications.Pancreatic duct diameter was the independent risk factor of pancreatic fistula.Pancreatic fistula was the independent risk factor of hemorrhage.Conclusion The postoperative complications of pancreaticoduodenectomy was closely related to alanine aminotransferase level,parenchyma texture and pancreatic duct diameter.

Objective To investigate the difference of efficacy of interlocking nails and dynamic compression plate in tibial shaft fractures.Methods The clinical data of 137 cases with tibial shaft fractures were reviewed retrospectively.They were divided into two groups according to the various treatments which included interlocking nails group(72 cases with 79 fractures) and dynamic compression plate group(65 cases with 70 fractures).The efficacy,healing fineness rate,function score after operation and complications were compared.Results After operation,the patients were followed up 21.4 months on average.The postoperative callus time,weight-bearing limb time,healing time and postoperative fixation time taken in interlocking nails group was shorter than that in dynamic compression plate group [(2.36 ± 0.46) months vs.(3.12 ± 0.57) months,(2.42 ± 0.51) months vs.(3.14 ± 0.63) months,(7.65 ± 1.29) months vs.(9.33 ±1.54) months,(12.64 ± 3.76) months vs.(16.38 ± 3.15) months],and there was significant difference (P＜ 0.05).The healing fineness rate was 97.5％(77/79) in interlocking nails group,and 92.9％(65/70) in dynamic compression plate group,and there was nosignificant difference (x2 =1.76,P ＞0.05).The incidence of comphcations in interlocking nails group was higher than that in dynamic compression plate group[25％(2H9) vs.12.9％(9H0)],and there was significant difference(P ＜ 0.05).Condmions Interlocking nails have better biomechanical features with high union rate,low infective rate and good recovery of joint function.The clinical result of interlocking nails for the tibial shaft fractures is also better than that of dynamic compression plate.

Objective To research the association between the prognosis of Acinetobacter baumannii infection and drug resistance among patients in the intensive care unit( ICU). Methods Eighty-four patients with Acine tobacter baumannii infection from February 2003 to April 2009 in Peking University Shenzhen Hospital ICU were retrospectively analyzed and divided into alive group(59 patients) and dead group(25 patients) by using 30-day mortality. The impact of drug resistant Acinetobacter baumannii on mortality was assessed by binary logistic regression. Results The mortality of patients with Acinetobacter baumannii infection was related to age, haematological malignancy, the Chanson Comorbidity Index, APACHEII score, multidrug-resistant Acinetobacter baumannii ( MDRAB) , carbapenem-resistant Acinetobacter baumannii (CRAB ) , septic shock and antimicrobial inappropriate therapy by univariate analysis( P < 0.05). Binary logistic regression revealed that CRAB( OR = 3. 360,95%CI: 1. 563 ～7.223,P< 0.05)and the Charison Comorbidity Index( OR = 1. 633,95% CI: 1. 201 ～2. 221 ,P <0.05) were independent risk factors. Conclusions The prognosis of Acinetobacter baumannii infection was closely correlated with drug resistance. The patients with CRAB infection had a higher mortality.

Objective To investigate the effectiveness of the SF-36 health survey questionnaire used to investigate the quality of life (QOL) of the patients undergoing tibial bone transport.Methods Reliability analysis,correlation analysis and validity analysis were performed to evaluate the reliability and validity of the SF-36 scale.According to treatment time,94 patients who underwent tibial bone transport were divided into 3 groups:group A were 30 patients who had just started bone transport,group B 43 patients who had completed bone transport and removal of external fixation within 2 years,and group C 21 patients who had completed bone transport and removal of external fixation beyond 2 years.A mean comparison of items in the SF-36 scale was further carried out.Results The questionnaires were completed well.The Chonbach α indexes of all the items were more than 0.8,showing good reliability of the scale.Most of the correlation coefficients were almost or more than 0.5,indicating acceptable content validity of the scale.The QOL of the patients undergoing tibial bone transport was differentiated from that of normal people,proving good discriminant validity of the scale.Groups B and C obtained significantly better scores in all items of the scale than group A (P ＜ O.05).Group C scored significantly higher in physical functioning (PF) and role-emotional (RE) than group B (P ＜ 0.05),but there were no significant differences between the 2 groups regarding other items of the scale (P ＞ 0.05).Conclusions With good reliability and validity,the SF-36 health survey questionnaire can be used to assess the QOL of the patients undergoing tibial bone transport.The treatment of bone transport in the tibia can significantly and durably help improve the QOL of the patients.

Hereditary renal diseases (inherited kidney diseases) include glomerular diseases,tubular diseases and cystic diseases.The incidence of inherited kidney diseases is relatively low, but the variety of clinical insufficient understanding of the disease, the means test about inherited kidney diseases is also not standardized, easily lead to missed diagnosis and misdiagnosis.As the common clinical manifestation of hereditary renal disease and congenital/hereditary renal disease are mainly low blood potassium, kidney stones, polyuria, growth retardation, and may develop renal failure without treatment.Therefore, clinicians should pay special attention to the diagnosis of congenital/hereditary renal disease, and early interventions are recommended.

This article consults the literature on acupuncture-moxibustion treatment for the non-spastic stage of cerebral stroke published from 2001 to 2014, makes a summary and analysis from meridians, point selection, acupuncture reinforcing-reducing techniques and electoacupuncture application and points out some problems such as valuing acupuncture and neglecting moxibustion, valuing acupuncture and neglecting medicine, and neglecting point selection based on syndrome differentiation in acupuncture-moxibustion treatment for the non-spastic stage of cerebral stroke. The article also objectively assesses the position of acupuncture-moxibustion treatment, puts forward relevant solving ideas and emphasizes the importance of acupuncture manipulation and the necessity for combining Chinese herbal medicine to treat the non-spastic stage of cerebral stroke.

Exosome is nanoscale vesicles with bilayer membrane structure, is secreted by multiple living cells in vivo, capable of carrying biological materials such as nucleic acids, proteins and lipids etc.Exosome can protect the information material (such as miRNA), which is easy to be inactivated or degraded in the circulatory system, so that they can be safely transferred to the specific target cells to participate in signal regulation, and play an important role in the information transmission between cells.Exosome is widely found in human blood, urine, pleural effusion and other body fluid samples, and can provide rich, stable, sensitive and specific biological information.As a kind of liquid biopsy specimen, exosome has a very high clinical application value in the future.

With the emergence of new endocrine drugs and the development of research in resistance mechanisms,significant progress has been achieved in the endocrine treatment of breast cancer in recent years. Fulvestrant,the combination of endocrine drugs and the combination of targeted therapy with endocrine therapy will be effective treatments for postmenopausal women with hormone receptor positive in advanced breast cancer.

OBJECTIVE:To explore the treatment effect and complication prevention of various stent materials for intracranial arteriostenosis.METHODS:A computer-based online search of Science Direct and Ei database (1998-01/2009-10) was performed for English articles with the key words of "intracranial arteriostenosis,stent placement" In addition,CNKI and CBM database (1998-01/2009-10) were searched for related Chinese articles with the same key words in Chinese.Moreover,related works were manually searched.Studies regarding various stent materials for intracranial arteriostenosis were included,including basic and clinical experiments.RESULTS:Multicenter studies of worldwide show that stent implantation displays obvious advantages in treating carotid artery stenosis compared with carotid endarterectomy.Recently,with developing of balloon and stent compliance,as well as stent technology,and application of various novel materials and cerebral protection device,stent has become a safe and effective therapy for intracranial arteriostenosis.However,complications following stent implantation,such as restenosis,ischemic stroke,cerebral hemorrhage hypertransfusion syndrome,and cerebral angiospasm,limit its application.CONCLUSION:The safety and efficacy of intracranial stent implantation remains validation of multicenter and perspective studies.High incidence of restenosis following stent implantation requires further improvement.