Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas caused by a variety of causes. The basic treatment principle of CP is to remove the etiology, control the symptoms, improve the pancreatic secretory function and prevent the complications. At present, more and more studies have been conducted on CP treatment strategies. The step-up approach and the surgery first approach are both effective strategies for CP treatment. In clinical practice, endoscopic intervention can be the preferred treatment for pancreatic pseudocyst, pancreatic duct stone, and biliary stenosis. Partington operation is the first choice for dilated main pancreatic duct patients without pancreatic head lesion. Patients with pancreatic head lesions should be intervened with the Beger or Frey operation. For patients without main pancreatic duct dilatation, pancreatectomy should be performed according to the specific lesion location. The total pancreatectomy is advisable for patients with total pancreatic inflammatory disease or multiple lesions of pancreas. Surgeons should follow the individualized and multidisciplinary treatment concepts and strategies in choosing surgical procedures, especially for the control of surgical indications, timing and methods. The authors comprehensively analyze the research progress at home and abroad, elaborate the endoscopic treatment and surgical intervention strategies of CP in order to further optimize the overall efficacy of CP.

Objective To determine the peripheral dose ( PD) of a Trilogy accelerator under different conditions and the feasibility of PD measurement using the semiconductor diode ionization chamber. Methods In a solid water phantom, a CC13 air?filled ionization chamber and a semiconductor diode ionization chamber were used for PD measurements with different distances (13 measurement locations within 1?31 cm) , depth ( 3, 5, 15 cm) , field sizes ( 10, 20, 30 cm) , wedge ( W15, W45, VW15, VW45) , and beam energy (6, 18 MV). The relationship of PD with PDleakage and PDscat er was determined by removing the scatter phantom. Simulating the patients with cervical cancer undergoing radiotherapy, a CIRS phantom received volumetric modulated arc therapy ( VMAT) , step?shoot intensity?modulated radiotherapy ( IMRT) , and sliding?window IMRT to measure PDs of the breast, thyroid, and lens. All the data were normalized to the isocenter. Results PD was gradually reduced with the increase in distance ( 13?41% at 1 cm from the edge to 0?25% at 31 cm from the edge) . With a fixed distance from the edge of the radiation field, there was no significant difference in PD between different depths. A radiation field with a size of 30 cm had a PD about two?fold higher than that with a size of 10 cm. PD increased with the increase in the physical wedge angle and increased by 1% compared with the open field;PD decreased with the increase in the virtual wedge angle and decreased by 2?3% compared with the open field. PD decayed from 13?35% at 1 cm to 0?23% at 31 cm under 6 MV X?ray and from 11?06% at 1 cm to 0?20% at 31 cm under 18 MV X?ray. Dscat er was dominant in the regions close to the edge of radiation field and decreased from 62?45% at 1 cm to 5?71% at 25 cm. In all measurements under 6 MV X?ray, the maximum proportion difference between CC13 ionization chamber and diode ionization chamber was less than 1%. PDs of the breast, thyroid, and lens were 6?72, 2?90, and 2?37 mGy in VMAT mode, 7?39, 4?05, and 2?48 mGy in step?shoot IMRT mode, and 9?17, 4?61, and 3?21 mGy in sliding?window IMRT mode, respectively. Conclusions For the measurement of PDs, the CC13 air?filled ionization chamber and semiconductor diode ionization chamber have good consistency and feasibility under 6 MV X?ray. In clinical practice, the understanding of the relationship of PD with different radiation conditions helps to reduce the doses to organs at risk. Shielding and protective techniques can further reduce dose deposition.

Porcine reproductive and respiratory syndrome virus (PRRSV) has a high degree of genetic variation. In this study, we characterized the genetic variation and evolutionary relationships among circulating PRRSV strains in southern China. We analyzed 29 NSP2 strains and 150 ORF5 strains from clinical samples collected in southern China during 2007–2014. The alignment results showed that the nucleotide identity similarities of the two genes among these strains were 80.5%–99.7% and 80.9%–100%, respectively. Phylogenetic analysis based on the NSP2 gene showed that highly pathogenic (HP)-PRRSV was still the dominant virus in southern China from 2013 to 2014. Compared with reference strains CH-1a and VR-2332, the field strain 131101-GD-SHC, which shared high homology with JXA1-P170, had a novel 12 amino acid deletion at position 499–510. Phylogenetic analysis based on the ORF5 gene showed that HP-PRRSV, VR2332-like strains, and QYYZ-like strains were simultaneously circulating in southern China from 2007 to 2014, suggesting that, in recent years, the type 2 PRRSV was more diverse in southern China. In conclusion, mutations in the decoy epitope and primary neutralizing epitope could be markers of viral evolution and used to study evolutionary relationships among PRRSV strains in China.
China ; Genetic Variation* ; Porcine Reproductive and Respiratory Syndrome* ; Porcine respiratory and reproductive syndrome virus*

Outbreaks of pseudorabies (PR) have occurred in southern China since late 2011, resulting in significant economic impacts on the swine industry. To identify the cause of PR outbreaks, especially among vaccinated pigs, 11 pseudorabies virus (PRV) field strains were isolated from Guangdong province during 2013–2014. Their major viral genes (gE, TK, gI, PK, gD, 11K, and 28K) were analyzed in this study. Insertions or deletions were observed in gD, gE, gI and PK genes compared with other PRV isolates from all over the world. Furthermore, sequence alignment showed that insertions in gD and gE were unique molecular characteristics of the new prevalent PRV strains in China. Phylogenetic analysis showed that our isolates were clustered in an independent branch together with other strains isolated from China in recent years, and that they showed a closer genetic relationship with earlier isolates from Asia. Our results suggest that these isolates are novel PRV variants with unique molecular signatures.
Asia ; China* ; Disease Outbreaks ; Genes, Viral ; Herpesvirus 1, Suid* ; Pseudorabies* ; Sequence Alignment ; Swine

The spike gene of porcine epidemic diarrhea virus (PEDV) was sequenced from 55 South China field strains isolated from pigs with symptoms of diarrhea. The sequences were compared within the set of field strains as well as with reference strains available in GenBank. Within the 55 South China PEDV field strains, the deduced amino acid sequence identities ranged from 93.8% to 99.9 % and ranged from 90.7% to 99.5% when compared with the foreign reference strains in GenBank. Our phylogenetic analysis showed that 10 of the 55 South China PEDV strains belonged to G1b and 45 belonged to G2b.
Amino Acid Sequence ; China* ; Databases, Nucleic Acid ; Diarrhea ; Porcine epidemic diarrhea virus* ; Sequence Analysis* ; Swine

Objective To explore a new index for reflecting the topological information of brain functional networks in patients at high risk of Alzheimer disease using characteristics of resting-state functional connectivity strengths(FCS) in patients with amnestic mild cognitive impairment(aMCI). Methods Thirty-one aMCI patients and 42 age, gender and years of education matched normal controls were enrolled between September 2009 and April 2011 in this study. The resting-state functional MRI (rs-fMRI) data of all participants were acquired and preprocessed. Then the whole-brain functional connectivities were constructed for exploring the distribution characteristics of hub regions which had higher FCS values. Using two-sample t test to compare group differences in age, years of education and each neuropsychological assessment. In addition, using Chi-squared test to compare group differences in gender. Group differences in FCS values were analyzed by general linear model. Finally, correlation analyses were used to evaluate the relationships between the FCS values of the brain regions with group differences and behavioral scores in aMCI patients. Results The hub regions of the functional networks in the aMCI patients were mainly located in the association cortices such as the precuneuses, posterior cingulate cortices, medial prefrontal cortices, angular gyri, superior occipital gyri, fusiform gyri and lingual gyri. The distribution models in the aMCI patients were consistent with those in the normal controls. However, the FCS values of these brain regions were significantly lower in the aMCI patients than those in the normal controls. In comparison to the normal controls, the aMCI patients had significantly decreased FCS values in the bilateral fusiform gyri, lingual gyri, superior occipital gyri, left middle occipital gyrus and postcentral gyrus (the cluster was 389, 230, 187 and 107 voxels, respectively;P<0.05, respectively), and they had decreased trends of FCS values in the bilateral posterior cingulate cortices and right insulas. The correlation analysis with uncorrected conditions showed that the FCS values of the left postcentral gyri were correlatid with the clock drawing test (CDT) scores (r=0.436, P=0.026). Conclusions aMCI mainly attacks the hub regions of brain functional networks. The changes of functional connectivities in aMCI may reflect the early pathophysiologic alterations of AD.

With the development of minimally invasive concept, the treatment mode of severe acute pancreatitis has changed greatly. The tendency of surgical intervention has changed from excessive intervention to inadequate intervention. The timing of intervention has changed from earlier to later, and the mode of intervention has changed from openness as the main way to minimally invasive as the guidance. The transformation of surgical intervention tendency conforms to both minimally invasive trend and the step-up approach, but there are still some shortcomings: inadequate surgical intervention, inappropriate timing and indications, and over dependence on minimally invasive surgery. Correctly grasping the indications of surgical intervention, accurately grasping the timing of surgical intervention, and reasonably choosing the mode of surgical intervention are the keys to solve the insufficiency of surgical intervention. Laying emphasis on multidisciplinary team and correctly recognizing the role and status of surgical intervention can effectively reduce the mortality of severe acute pancreatitis patients.

Objective To investigate the expression of CK2α' in hepatocellular carcinoma (HCC) tissues and its prognosis value. Methods Tissue microarray was made from tumor and adjacent normal tissues of 83 patients with HCC. Immunohistochemical was used to stain the microarray for semi-quantitative analysis, and the expression of CK2α' in HCC tissues and adjacent normal tissues was compared. The associations between CK2α' expression and clinicopathologic features of HCC patients were analyzed with χ² text. The prognostic value of CK2α' was estimated using Kaplan-Meier approach. Results The average positive expression rate of CK2α' was 47.8% in HCC and 65.4% in adjacent normal tissues. The positive expression rate of CK2α' in HCC tissues was lower than that in adjacent normal tissues (P < 0.01). The expression level of CK2α' in the cancer tissues of 74.7% cases was significantly lower than that in the adjacent tissues. HCC patients with low CK2α' expression had higher risk of recurrence and shorter overall survival time (P < 0.05). The expression of CK2α' was significantly correlated with CK19 (P < 0.05). Conclusion CK2α' is down-regulated in HCC tissues and correlated with the prognosis of patients. It could be a potential prognostic marker for HCC.

Background:The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma (NPC) in the intensity?modulated radiotherapy (IMRT) era. Methods:We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center (South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging (MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniifcant explanatory variables. Results:The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiifcant prognostic fac?tor for local failure (P=0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho’s location of the cervical lymph nodes were signiifcant prognostic factors for both distant failure and disease failure (allP<0.05). Intracranial extension had signiifcant prognostic value for distant failure (P=0.040). Conclusions:The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiifcant prognostic parameters for local control have also been altered substantially.

The second "death peak" in the late stage of severe acute pancreatitis (SAP), dominated by infectious pancreatic necrosis (IPN), is a challenge in clinical management. Surgeons play an important role in choosing the indication, timing, strategy and mode of the surgical intervention. Simultaneously, the early prediction and recognition, post-operative management and cooperation of IPN need to be strengthened. Nowadays, some new characteristics including minimal invasiveness, staging, multi-disciplinization, profe-ssionalization and diversi-fication emerge in the modern surgical intervention of IPN. Clinicians should establish a comprehensive treatment system centered on diseases. In addition, clinicians should also pay attention to non-infectious local complications of SAP to prevent the diseases. Based on clinical practice, the authors investigate the clinical practice of surgical intervention for local complications of SAP in order to further improve the overall cure rate of SAP patients in the later period.