Enhanced recovery after surgery (ERAS) includes preoperative education,intraoperative effective anaesthetization,analgesia,precision surgical techniques and postoperative early rehabilitation.Because of special location of the pancreas,difficulty of surgical techniques,longtime of learning and high incidence of postoperative complications,the application of ERAS in pancreatic surgery is restricted.While ERAS could reduce the stress after surgery and the incidence of complications,promote the recovery of patients,shorten the duration of hospital stay and reduce the expenses,which are confirmed by clinical practice.ERAS is the trend of the development of pancreatic surgery.How to balance the optimal prognosis and speed recovery is need to be resolved by pancreatic surgeons.

Adult ; Aged ; Endoscopy ; Female ; Headache ; etiology ; pathology ; Humans ; Male ; Middle Aged ; Nasal Mucosa ; pathology ; Nose ; abnormalities ; pathology

Objective To investigate the effect of nikethamide combined with noninvasive ventilator in the treatment of chronic obstructive pulmonary disease ( COPD) complicated with respiratory failure.Methods 127 cases with COPD complicated with respiratory failure in our hospital from February 2014 to March 2016 were selected and randomly divided into observation group (72 cases) and control group (55 cases), the control group was treated with noninvasive ventilator therapy, and the observation group was treated with the therapy of nikethamide on the basis of the control group, the therapeutic effect, blood gas changes, etc of two groups were observed.Results The effective rate of the observation group was 80.56%, significantly higher than that of the control group (63.64%), the difference was statistically significant (P<0.05), the observation group after treatment 24h and 72 h pH and oxygen partial pressure (PaO2) were significantly higher than the control group, while the carbon dioxide partial pressure (PaCO2) was significantly lower than the control group, the difference was statistically significant (P<0.05), after treatment 24h and 72 h APACHE II scores in the observation group were (20.20 ±2.71) and (18.01 ±1.16), significantly lower than that of the control group, the difference was statistically significant (P<0.05), the hospitalization time, tracheal intubation rate and mortality rate of the observation group were (14.82 ±4.61) d, 11.11%and 4.17%, which were significantly less than those in the control group, the difference was statistically significant ( P <0.05 ) . Conclusion Noninvasive ventilator combined with nikethamide in the treatment of COPD combined with respiratory failure , can improve the effect of noninvasive ventilation, reduce the rate of tracheal intubation in patients.

bjective To induce a treatment program of evidence-based acupuncture and moxibustion for oculomotor paralysis by retrieving and analyzing the current literature for improving clinic technology.MethodsOne case was used as example and it was introduced how to raise clinical questions,retrieve relative literature,evaluate the retrieval literature and at last,stipulate treatment program based on the retrieval evidences.ResultsThe acupuncture and moxibustion treatment program for oculomotor paralysis established by evidence-based medicine was adopted to treat the patient for 10 times,as a result the patient got much better.Conclusion: Through clinically raising questions,searching for evidence,analyzing evidence,making a strategy decision,practicing evidence-based course,the patient could attain satisfactory therapeutic effect,and the physician could raise theoretical level and clinical ability.

Objective To investigate the differences in the inhibition of return (IOR) capacity of attention between expert and novice pilots.Methods Compared the capacity of IOR of 10 expert pilots and 10 novice pilots under the conditions of adjacent and spaced clueing positions by experiment and by means of simultaneous cueing processes.Results These data suggested that in simultaneous cueing processes,no matter that the clueing positions were adjacent or spaced,the reaction time of expert pilots( adjacent:(428.01 ± 64.89) ms,spaced:(425.24 ± 63.94 ) ms) was slower novice pilots ( adjacent:( 363.05 ± 38.95 ) ms,spaced:( 360.61 ± 41.70 ) ms )(P ＜ 0.01 ) ; the capacity of IOR in no matter that the clueing positions were adjacent or spaced.The expert pilots showed IOR at only one location when the 5 clues all appearance in simultaneous cueing processes (P＜ 0.05 ),and no IOR could be see in the other locations.The novice pilots showed IOR when the from 3 to 5 of clues appearance in simultaneous cueing processes,the disparity was significantly predominance(P＜ 0.01 ).Conclusion The expert pilots of stability of capacity of IOR is better than novice pilots,and show solidly and highly efficient space searching ability.

Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH),and influencing factors of severity of PPH.Methods The retrospective case-control study was conducted.The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected.Patients with PPH in the early stage underwent reoperations for hemostasis;patients with PPH in the later stage received conservative treatment,and then DSA and TAE were considered when patients had the stable vital signs.Observation indicators:(1) DSA situations:overall times,positive rate and bleeding sites;(2) TAE situations:successful rate of hemostasis,operating time and postoperative complications;(3) follow-up situations;(4) influencing factors analysis of severity of PPH.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio and proportion.The univariate analysis was done using the Fisher exact probability.Results (1) DSA situations:all the 20 patients underwent DSA,with overall times of 27.The direct sign was 18 times extravasation of the contrast medium,with a positive rate of 66.7％ (18/27).Of 18 times positive DSA,clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump),in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery),in 3 times superior mesenteric artery,in 2 times splenic artery,in 1 time left gastric artery,in 1 time right gastric artery,in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery.(2) TAE situations:of patients with 18 times positive DSA,patients with 15 times positive DSA received TAE,with a successful rate of hemostasis of 13/15,and patients with 5 times positive DSA received successful hemostasis by reoperation.A median operating time of TAE for patients with 15 times positive DSA was 30 minutes.There was no occurrence of adverse reaction,including fever,abdominal pain,melena,elevated aminotransferase and liver abscess.One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery.Of patients with 9 times negative DSA,patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation.All the 20 patients were cured and then discharged from hospital.(3) Follow-up situations:20 patients were followed up for 4-92 months,with a median time of 24 months.During the follow-up,20 patients recovered well,without long-term complications.(4) Influencing factors analysis of severity of PPH:the results of univariate analysis showed that gender,age,preoperative blood sugar,preoperative combined jaundice,preoperative albumin (Alb),preoperative prothrombin time (PT) extended,preserving pylorus,pancreatic duct stent placement,pancreatic operation time,volume of intraoperative blood loss,intraoperative blood transfusion,property of tumor,postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P＞0.05).Conclusion DSA is minimal-invasive in the diagnosis for PPH,and TAE is safe and effective for patients with positive DSA.

Objective To investigate the probable risk factors for type 2 diabetic patients complicated nonalcoholic fatty liver disease (NFLD)in elderly, through comparing the body composition, serum lipid profile, incidences of abdominal obesity and metabolic syndrome (MS) between elderly type 2 diabetic patients with and without NFLD. Methods The enrolled elderly type 2 diabetic patients were divided into NFLD group (n=83) and non-NFLD group (n=85). Their clinical data including body composition, serum lipid profile, incidences of abdominal obesity and MS were analyzed retrospectively and compared. Results Compared with non-NFLD group, the BMI [(26.9±2.5) kg/m~2 vs. (24.1±2.5) kg/m~2, P=0.000], waist-hip ratios (WHR) ((0.92±0.07) vs. (0.87±0.06), P=0.000], total body fat percentage [(29.6%±6.6%) vs. (25.3%±5.5%),P=0.000], abdominal fat [(11.0±2.5) kg vs. (8.7±2.3) kg, P=0.000], visceral fat [(3.0±0.7) kg vs. (2.3±0.6)kg, P=0.000], visceral fat area [(97.6±22.2) cm~2 vs. (75.5±21.1) cm~2,P=0. 000], serum triglyceride [(1.98±0.94) mmol/L vs. (1.22±0.61) mmol/L, P=0.000]were all increased, while serum HDL [(1.23±0.32) mmol/L vs. (1.40±0.37) mmol/L, P=0.002]was decreased in NFLD group. The incidences of over-body fat (68.7% vs. 36.5%, P=0. 000),dyslipidemia (47.0% vs. 21.2%, P=0. 000), abdominal obesity (69.9% vs. 43.5%, P=0.001) and MS (49.4% vs. 9.6%, P=0.000) were obviously increased. But there were no statistical differences in serum TC [(4.93±0.94) mmol/L vs. (4. 73±1.07) mmol/L, P=0.219]and LDL [(3.23±0.80) mmol/L vs. (3. 07±0.89) mmol/L, P=0. 229]between the two groups. Logistic regression showed that high BMI (β=1.268, P=0.000, OR=3.56), over-total body fat percentage (β=0.902, P=0.023, OR=2.47)and the existence of MS (β=1. 664, P=0. 000, OR=5.28) were related to elderly type 2 diabetic patients complicated NFLD. Conclusions The high BMI, over-total body fat percentage are related to elderly type 2 diabetic patients complicated NFLD, and NFLD is probably one of components of metabolic syndrome.

Objective Feedback of 35 graduates from a Sino-Australia cooperation program was investigated at 1 -year fulfillment of clinical practice,and reflect some of the issues in the process of cultivation and utilization of nursing talents from the program. Methods 32 nursing talents from a Sino-Australia cooperation program at 1 -year fulfillment of clinical practice was selected as research object.Self made questionnaires baaed on the goal of the program were used,which included both open and close questions.The investigation results were analyzed. Results The nursing talents considered that the main advantages of the program were as followed:cultivation of their ability in active communication,improving English level,broaden international vision,and internationalization of courses. Conclusions Stratified and individualized teaching strategies need to be implemented.English study and nursing specialty study are to be appropriately combined.Routes of employment should be broadened.In addition,imported courses are to be adjusted according to domestic situation.While attaching importance in teaching,faculty should also emphasize advising.Finally,it is not to be ignored for the hospitals that they are responsible for greater utilization and cultivation of the nurses with both nursing and English ability.

Objective To study the effect of serum leptin in “two hits” of nonalcoholic fatty liver disease (NAFLD).Methods Fasting serum leptin(LEP) ,malondialdehyde(MDA) ,hyaluronic- acid(HA) ,type Ⅲ procollagen ( PCⅢ), laminin ( LN), and type Ⅳ collagen ( Ⅳ-C ) were detected in 43 simple nonalcoholic fatty liver( NAFL ) patients ,41 NASH patients and 40 healthy subjects. Insulin resistance was estimated by HOMA value and its relatio nship with leptin level in NAFLD was analyzed. The severity of lipid peroxidation was estimated by MDA and its relationship with leptin level in NAFLD was analyzed. The relationship of serum fibrosis markers with leptin level in NAFLD also was analyzed. Results Serum leptin, HOMA value in NAFLD were higher than those of healthy controis. MDA,PC Ⅲ 、Ⅳ-C 、LN 、HA in NASH were higher than those of healthy controls or simple NAFL patients. ,HOMA value, in NAFLD positively correlated with leptin. MDA, PC Ⅲ、 Ⅳ-C 、LN、HA in NASH positively correlated with leptin. Conclusion Serum leptin closely correlated with insulin resistance which results in “First hit” of NAFLD. There was certain relationship of leptin with “Second hit” of NAFLD. Leptin should be one of the factors which result in liver fibrosis.

Immunological alterations and changes in neurotransmission are considered to be crucial in the pathological process of depression. An immune activation including increased production of proinflammatory cytokines has repeatedly been described in depression, which shines a clue for new anti-depression therapy. Immune activation will lead to depression through serotonin and glutamate systems. This paper is attempted to review the immune mediated alterations on serotonin and glutamate systems.