Objective To investigate the clinical application value of pancreatoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma.Methods The clinical data of a patient with pancreatic head carcinoma who underwent pancreatoduodenectomy combined with vascular resection and reconstruction at the Southwest Hospital in March 2014 were retrospectively analyzed.Preoperative imaging examination showed no gap between vascular wall of portal vein (PV) and pancreatic head space-occupying lesion,vascular compression and stenosis at intersection of PV,splenic vein (SV) and superior mesenteric vein (SMV),but not excluding adjacent main PV invasion.During the operation,it was difficult to separate pancreatic head carcinoma from PV,indicating vascular wall invasion at intersection of PV,SV and SMV.Therefore,the pancreatic head,bile ducts,duodenum,partial jejunum,invasive vein vessels,lymphatic and nerve tissues were radically resected,then PV,SMV and SV were reconstructed.The patient was followed up by outpatient examination and telephone interview after surgery till April 2015.Results The patient underwent pancreatoduodenectomy combined with vascular resection and reconstruction successfully without blood transfusion.The operation time was 285 minutes and volume of intraoperative blood loss was 300 mL.The patient had a smooth postoperative recovery,resuming diet at postoperative day 5.The abdominal drainage tube and stitches were removed at postoperative day 6 and day 12,and the patient was discharged from hospital at postoperative day 15.Computed tomography reexamination showed clear vascular anastomose.The patient was not complicated with pancreatic fistula,biliary fistula,intra-abdominal hemorrhage and vascular embolism.The postoperative pathological examination confirmed the diagnosis of pancreatic head moderately differentiated adenocarcinoma accompanied by PV invasion and lymph node metastasis,with a negative margin.The patient began a course of single drug common chemotherapy using gemcitabine at postoperative day 40.No cancer recurrence was detected during the one-year follow-up.Conclusion Pancreatoduodenectomy combined with vascular resection and reconstruction is safe and feasible for the treatment of pancreatic head carcinoma with good surgical effects.

Novel optical materials are crucial for environmental monitoring. Metal nanoclusters ( metal NCs) , typically consisting of several to tens of metal atoms, have attracted more and more attention for recent years. Due to their ultrasmall size, strong fluorescence, low toxicity, excellent stability and unique core-shell structure, metal NCs have been considered as promising optical materials for the construction of excellent fluorescent sensors. In this review, we mainly focus on the recent progress in their applications in environmental monitoring, including the detection of pH, heavy metal ions, inorganic anions and nitroaromatic explosives.

Objective To investigate the effects of thrombopoietin (TPO) on the proliferation of megakaryocytic line-HEL cells co-cultured with human umbilical cord blood-derived stromal cells (hUCBDSCs), which is supposed to further elucidate the mechanism of TPO-mediated functions. Methods HEL cells were co-cultured with hUCBDSCs, and with human bone marrow stromal cells (hBMSCs), and suspended HEL was used as control. HEL The concentration of TPO in supernatant of hUCBDSCs and hBMSCs was detected by ELISA assay. The expression of c-Mpl membrane-bound protein of HEL cells was detected by laser scanning confocal microscopy and flow cytometry, and the expression of c-Mpl mRNA was detected by RT-PCR. Results It was revealed by ELISA assay that the concentration of TPO secreted by hUCBDSCs was higher than that by hBMSCs, even though the passage was done. The secretion peak in hUCBDSCs group appeared at the 8th day of culturing, somewhat delayed to that in hBMSCs group which the peak appeared at the 6th day. The expression of C-mpl protein displayed uniform green fluorescence on the surface of HEL cell line as determined by laser confocal microscopy, and mean fluorescence intensity detected by flow cytometry was 22.19?2.15, 29.65?0.82 and 37.43?1.69 in HEL suspended culture group, HEL/hBMSCs co-culture group and HEL/ hUCBDSCs co-culture group, respectively. The expression of C-mpl protein in HEL/ hUCBDSCs co-culture group was higher than that in the two other groups (P0.05). Conclusion TPO-pathway might be the important intermediate process for hUCBDSCs to promote megakaryocyte proliferation. The promotion as such may be realized by up-regulating the c-Mpl expression in translation or post-translational modification phase.

Objective To approach the effect of prosthetic valve at preventing reflux esophagitis.Methods After the total gastrectomy and esophagojejunostomy,interrupted suture was apphed to form a prosthetic valve at output and input beyond Braun's stoma.Results Only one got light reflux esophagitis in 15 patients.Conclusion Prosthetic valve can prevent reflux esophagitis,and the operation is convenient and safe,which is deserved to be in generalization and approach the latest method.

Objective To investigate the effectiveness of arthroscopic reduction and percutaneous fixation (ARPF) for the treatment of tibial plateau fractures. Methods Seventeen cases of tibial plateau fractures from April 1999 to June 2002 were reviewed. The fractured tibial plateau was reconstructed by “drag-and-draw” reduction and iliac crest bone graft under arthroscope. And percutaneous cancellous bone screw fixation was conducted. Results Clinical bone union was achieved in all the patients at the third postoperative month. No infection or severe osteoarthritis occurred. Conclusions ARPF for tibial plateau fractures has advantages of reduction under direct view, reliable fixation and facilitation for early activities.

BACKGROUND: Most of the literatures only reported that there is a great difference between diabetics who have a high 24-hour urinary albumin excretion rate and those without renal damage, but there is no obvious difference between cases of microalbuminuria and those without renal damage.OBJECTIVE: To probe into the relationship between diabetic nephropathy and osteoporosis.DESIGN: A case-control study.SETTING: Department of Endocrinology, West China Hospital of Sichuan University.PARTICIPANTS: According to the diagnostic standard set by the American Diabetes Association in 1997 (fasting blood glucose ≥ 7 mmol/L,postprandial blood glucose ≥ 11.1 mmol/L), 96 diabetic patients were selected, including 56 males ＜ 60 years old and 40 females who had not entered the menopausal period, excluding the influence of age and osteoporosis caused by menopause. The average age of the subjects was (48.7±10.5)years, their duration were from one month to twenty-one years with the aver age of (7.85±2.56) years, and their general information had no significant differences.METHODS: According to the urine albumine excretion rate and renal function, the patients were divided into four groups: normal albuminuria group (n=48), microalbuminuria group (n=28), macroalbuminuria group (n=15), renal failure group (n=5). The bone mineral densities of lumbar spines (L2-4), femoral neck, Ward's triangle and trochanter were detected with Dual energy X-ray absorptiometry, and then the fasting blood glucose,2-hour postprandial blood glucose, glycosylated hemoglobin A, alkaline phosphatase, calcium, phosphorus, blood urea nitrogen, creatinine and urine albumine excretion rate were compared between the patients with and without osteoporosis.MAIN OUTCOME MEASURES: The fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin A, alkaline phosphatase, calcium, phosphorus, blood urea nitrogen, creatinine and urine albumine excretion rate, as well as the bone mineral density, were observed in all the patients.RESULTS: The L2-3 bone mineral density in the macroalbuminuria group was significantly different from that in the microalbuminuria group (P ＜ 0.05). The proximal femur bone mineral density in the microalbuminuria group was significantly different from that in the normal albuminuria group (P ＜ 0.05). The bone mineral densities of proximal femur and lumbar spine in the renal failure group were significantly decreased as compared with those in the other groups (P ＜ 0.01). The disease course,glycosylated hemoglobin A, alkaline phosphatase and body mass index were significantly different between the patients with and without osteoporosis (P ＜ 0.05).CONCLUSION: The incidence rate of osteoporosis is increased with the aggravation of nephropathy, and diabetic nephropathy may be closely correlated with the decrease of bone mineral density and the occurrence of osteoporosis.

Congenital Abnormalities ; diagnosis ; Ear, Inner ; abnormalities ; Humans ; Vestibular Evoked Myogenic Potentials

Objective:To investigate the relationship of etiology and complications of rhabdomyolysis with its prognosis in the elderly.Methods:Patients with rhabdomyolysis at the emergency department of our hospital from January 1, 2018 to December 31, 2019 were retrospectively analyzed.Based on age, patients were divided into the non-elderly group(<65 years old)and the elderly group(≥65 years old). The frequency distribution of etiological factors, concurrent acute kidney injury, and their association with prognosis were analyzed.Results:The number of patients with rhabdomyolysis caused by 2 or more etiologies was higher in the elderly group than in the non-elderly group(40.3% or 48/119 vs.17.0% or 16/94, χ2=13.582, P=0.000). The frequency distribution of etiological factors was different between the two groups.The top-five etiologies were infection, muscle ischemia/hypoxia, endocrine metabolic abnormalities, trauma and muscle fatigue in the elderly group and muscle fatigue, infection, endocrine metabolic abnormalities, drugs/toxicants and trauma in the non-elderly group.Compared with the non-elderly group, the elderly group had fewer patients with typical clinical manifestations(32.8% or 39/119 vs.48.9% or 46/94, χ2=5.067, P=0.024). In contrast, patients who newly presented with disturbance of consciousness were more likely to be found in the elderly group than in the non-elderly group(40.3% or 48/119 vs.21.3% or 20/94)( χ2=7.923, P=0.005). There were 37 patients with AKI(38.9% or 37/95)in the elderly group and 13 of them died(35.1%), and there were 17 patients with AKI in the non-elderly group(19.3% or 17/88)and 4 died(23.5%), indicating the elderly were prone to AKI( χ2=7.545, P=0.006). There was a significant correlation between AKI and prognosis in the non-elderly group( χ2=7.196, P=0.007). Conclusions:Rhabdomyolysis caused by multiple etiologies is more common in elderly patients than in non-elderly patients.The etiological classification of rhabdomyolysis in the elderly is different from that in the non-elderly.Elderly patients are less likely to have typical clinical manifestations and are more prone to AKI.Elderly patients with rhabdomyolysis combined with AKI have a poor prognosis.

Objective The aims of this study were to investigate the prognostic value of CEA and CA19-9 expression in advanced gastric cancer and the prognostic factors of advanced gastric cancer.Methods A total of 255 patients with advanced gastric cancer who underwent radical R0 radical surgery were enrolled in the Department of Gastrointestinal Surgery,Harbin Medical University Cancer Hospital from January 2010 to December 2010,and were divided into group A(CEA<2.19ng/mL and CA19-9<10.78U/mL),group B(CEA≥2.19ng/mL or CA19-9≥10.78U/mL)and group C(CEA≥2.19ng/mL and CA19-9≥10.78U/mL).These groups were analyzed the differences in gastric cancer patients with clinical pathology and survival,and prognostic factors of patients with advanced gastric cancer factors.Results There were statistically significant differences in clinical N staging,clinical TNM staging and pathological TNM staging in three groups of patients with advanced gastric cancer(P<0.05).There was no significant difference in the median survival time in three groups of patients with advanced gastric cancer(P>0.05).The 1-year,3-year and 5-year survival rates of group A were higher than those of group B and group C(P>0.05).The factors affecting the prognosis of gastric cancer included the degree of tumor differentiation,pathological T staging,pathological TNM staging,the total number of lymph nodes,the number of positive lymph nodes and lymph node metastasis.Conclusion Combined detection of CEA and CA19-9 expression indicates a certain reference value for prognosis of gastric cancer.

OBJECTIVE:To develop and improve the quality standard for Kanggu zengsheng tablet. METHODS:TLC was used for the qualitative identification of Drynaria fortunei,Epimedii Folium and Spatholobus suberectus;HPLC was used for the contents determination of icariin and acteoside:the column was Diamonsil C18 with mobile phase of acetonitrile-0.1% formic acid solution (gradient elution) at a flow rate of 1.0 mL/min;detection wavelength was 270 nm for icariin and 334 nm for acteoside, Cdumn temperature was 25 ℃,and the injection volume was 10 μL. RESULTS:The TLC spots of D. fortunei,Epimedii Folium and S. suberectus were clear and well separated,negative control without interference. The linear range was 0.0188-1.88 μg for ac-teoside(r=0.9999)and 0.107-2.14 μg for icariin(r=0.9999);RSDs of precision,stability and reproducibility tests were lower than 2.0%;recoveries were 100.2%-105.0%(RSD=1.6%,n=9) and 96.2%-99.5%(RSD=1.4%,n=9). CONCLUSIONS:The improved standard can more effectively control the quality of Kanggu zengsheng tablet.