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 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 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.

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 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.

Objective The article was to speed up the dissolution rate of poorly soluble drugs, reduce the configuration time and improve the allocative efficiency by analysis on factors influencing dissolution and adoption of proper allocative approaches accord-ing to different characteristics of insaluble drugs. Methods 5 insaluable drugs were chosen for the study, which were ornithine as-partate, mezlocillin sodium and sulbactam sodium, teicoplanin, omeprazole sodium injection and imipenem and cilastatin sodium.The control group were allocated by routine configuration approach, while the experiment group were improved by increasing the amount of solvent, loosing the powder inside the bottle before configuration, reducing the bubble, adopting special solvent and increasing the dis-solution temperature.Observation and comparative experiment were made on two groups along with the timing from configuration to com-plete dissolution into clear transparent liquid. Results As to the average complete dissolution time of 5 drugs, significant difference was found between two groups([42±5]s vs [246±35]s, [3±1]min vs [30±3]min, [5±1]min vs [10±3]min, [5±3]min vs [10± 5]min, [2±1]min vs [10±1]min, P<0.05).Compared with the control group, the dissolution time of 5 drugs was cut down by 83%, 90%, 50%, 50%, 80%in experiment group. Conclusion Appropriate increase of solvent, loose powder, bubble reduction, special solvent and increased solution temperature contribute to shortening the dissolution time of insoluble drugs and improving the configura-tion efficiency of pharmacy intravenous admixture.

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.

Objective To evaluate the effect of Chinese gentian extracts on the proliferation of,apoptosis and phosphorylation of epidermal growth factor receptor (EGFR) in HaCaT cells induced by epidermal growth factor (EGF).Methods Methyl thiazolyl tetrazolium (MTT) assay was performed to evaluate the proliferation of HaCaT cells pretreated with EGF of 20 μg/L for 24 hours followed by 24 hours of treatment with various concentrations of Chinese gentian extracts.Flow cytometry was carried out to detect apoptosis in HaCaT cells pretreated with EGF of 20 μg/L for 24 hours followed by 4 hours of treatment with different concentrations of Chinese gentian extracts.Western blot was conducted to measure the level of phosphorylated EGFR in HaCaT cells treated with different concentrations of Chinese gentian extracts for 24 hours followed by treatment with EGF of 20 μg/L for 10 minutes.Results Chinese gentian extracts inhibited the proliferation (r =-0.991,P ＜ 0.01),but promoted the apoptosis (r =0.996,P ＜ 0.05) of HaCaT cells induced by EGF in a dose-dependent manner.At the same time,the extracts suppressed the phosphorylation of EGFR in HaCaT cells induced by EGF,and the suppressing effect increased with the rise in the concentration of the extracts.Conclusions Chinese gentian may inhibit the proliferation,but promote the apoptosis of keratinocytes by decreasing EGFR phosphorylation and blocking relevant intracellular signaling pathways.

Objective To design a post-peripheral intervention observation form that uses the timepoint and observation project as the framework of contents,and to evaluated its clinical application effect.Methods Non-concurrent patients were used to make a control study.By using the convenient sampling method,101 patients,who received peripheral interventional therapy during the period from June 1,2014 to December 31,2014,were collected and used as the control group;routine nursing care was adopted and the results were documented.A total of 102 patients,who received peripheral interventional therapy during the period from January 1,2015 to June 30,2015,were used as the intervention group,for whom routine nursing care was carried out and self-designed post-peripheral intervention observation form was employed to record the nursing observation.The results of the two groups were statistically analyzed.After using the form,every month 10 patients,5 visiting physicians and 5 responsible nurses were asked to make an evaluation of nursing quality satisfaction.Results The incidence of main postoperative complications in the intervention group was lower than that in the control group,the chi-square test showed that the difference between the two groups was statistically significant (P＜0.05).The average hospitalization days and the mean medical expense of the intervention group were lower than those of the control group,the chi-square test indicated that the difference between the two groups was statistically significant (P＜0.05).After using this form,the nursing quality satisfaction of patients and visiting physicians was improved,the self-rating satisfaction assessed by responsible nurses was also improved,the chi-square test revealed that the difference between the two groups was statistically significant (P＜0.05).Conclusion All the evaluation indexes of the patients in the intervention group are better than those of the patients in the control group,indicating that this observation form is reasonably designed,meets the specialty characteristics,heightening the dynamic observation for patients after peripheral intervention,strengthens the effectiveness of monitoring postoperative complications,and is helpful for the implementation of the observation after peripheral intervention.Therefore,this observation form is worth promoting use.