Objective To investigate the surgical procedure selection for chronic pancreatitis.Methods The clinical data of 80 patients with chronic pancreatitis who were admitted to the Peking University First Hospital from January 2000 to August 2013 were retrospectively analyzed.Thirty-eight patients were with or without pancreatic duct stone,and the dilation of the pancreatic duct was above 7 mm,44 patients were with common bile duct dilation,32 patients were with inflammatory mass in the head of the pancreas,and 3 patients were with splenomegaly and esophagogastric varices.Surgical procedures were selected according to the symptoms and results of imaging examination.The remission or recurrence of pain was judged according to the visual analog scales.Patients were followed up via out-patient examination,mail or phone call till December 2013.Results Choledochojejunostomy was done on 27 patients,Partington-Rochelle pancreaticojejunostomy on 24 patients,PartingtonRochelle pancreaticojejunostomy + choledochojejunostomy on 6 patients,pancreaticoduodenectomy on 7 patients,resection of the body and tail of the pancreas on 4 patients,Beger's procedure on 3 patients,splenectomy on 3 patients,Frey's procedure + fenestration of bile duct in the head of the pancreas on 3 patients,Frey's procedure on 2 patients,common bile duct exploration + T tube drainage on 1 patient.The remission rate of abdominal pain was 95.2％ (60/63).One patient died of abdominal infection and multiple organ dysfunction syndrome perioperatively.Three patients were complicated with abdominal infection,2 with pancreatic fistula,1 with biliary fistula and 1 with abdominal bleeding.All the complications were cured by conservative treatment.Seventy-nine patients were followed up,and the mean time of follow-up was 58.6 months (range,4-156 months).Thirty patients had recurrence or new onset of abdominal pain,and the recurrence rate was 38.0％ (30/79).Of the 32 patients with inflammatory mass in the head of the pancreas,17 received choledochojejunostomy,and the recurrence rate of abdominal pain was 9/17 ; the other 15 patients received pancreatoduodenectomy,Beger' procedure or Frey's procedure,and the recurrence rate of abdominal pain was 1/15.Of the 41 patients without inflammatory mass,10 received choledochojejunostomy,and the recurrence rate of abdominal pain was 7/10; 30 received PartingtonRochelle pancreaticojejunostomy,and the recurrence rate of abdominal pain was 33.3％ (10/30).Conclusions Complete drainage could relieve the symptoms for patients with pancreatic duct dilation.Surgical resection or combined surgical procedure is effective for the treatment of patients with inflammatory mass in the head of the pancreas.

Objective To investigate the expression and regulation of FGFR1 protein and mRNA in human pancreatic cancer cell lines.Methods The expressions of FGFR1 protein and mRNA in pancreatic cancer cells were tested by Western blot,Northern blot and RT-PCR.The effects of exogenous growth factors and tyrosine kinase inhibitors on expression of FGFR1 protein and mRNA was observed.Results FGFR1 protein and mRNA expressed in 7 pancreatic cancer cell lines in different levels.After stimulation of several exogenous growth factors,we found that IGF-1,EGF and FGF2 up-regulated the expression of FGFR1 in Mia PaCa-2 significantly;EGF and FGF2 up-regulated the expression of FGFR1 in PANC-1 significantly (P＜0.05).The effect of FGF2 on the expression of FGFR1 was in time-dependent manner.ERK1/2 special inhibitor UO126 and p38 MAPK special inhibitor SB203580 down-regulated the expression of FGFR1.Conclusion Expression of FGFR1 is up-regulated by growth factors and may be modulated through ERK1/2 and p38 MAPK signal transduction pathway.

OBJECTIVETo develop and test a scoring system to predict the risks of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy(PD).

METHODSClinic data and postoperative complications of the 445 consecutive patients who underwent a PD procedure between January 2008 and April 2015 in Peking University First Hospital were retrospectively collected and analyzed.The patients were randomly selected to modelling and validation sets at a ratio of 3∶1, respectively.The patient data were subjected to univariate and multivariate analysis in the modelling set of patients.A score predictive of POPF was designed and tested in the validation set.

RESULTSPOPF occurred in 88 of 334 patients(26.4%) in the modelling set.The multivariate analysis showed that body mass index (BMI, P<0.01) and pancreatic duct width(P=0.001) are associated with POPF independently.A risk score to predict POPF was constructed based on these factors and successfully tested.The area under the receiver operating characteristic curve were 0.829(95% CI: 0.777-0.881) on the modelling set and 0.885(95% CI: 0.825-0.945) on the validation set, respectively.

CONCLUSIONSBMI and pancreatic duct width were associated with POPF after PD. The preoperative assessment of a patient's risk for POPF is feasible.The present risk score is a valid tool to predict POPF in patients undergoing PD, to make the selection on anastomosis types, and to take precautions against POPF.

Anastomosis, Surgical ; Body Mass Index ; Humans ; Intestines ; surgery ; Multivariate Analysis ; Pancreas ; pathology ; surgery ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; pathology ; Pancreaticoduodenectomy ; adverse effects ; Postoperative Complications ; Postoperative Period ; ROC Curve ; Retrospective Studies ; Risk Factors

Objective To investigate the effect of teaching method using students as standardized patients on clinical practice teaching of neurology.Methods We randomly assigned 80 undergraduate majoring in clinical medicine into two groups:a control group where students were instructed with traditional clinical teaching methods,and an experimental group where students acted as standardized patients.Following the clinical placement,we administered an Objective Structured Clinical Exam-ination(OSCE)and a satisfaction survey to all participants.Results The experimental group performed significantly better than the control group in history taking and neurological examination in the OSCE(P＜0.05).The results of the questionnaire showed that the experimental group scored significantly higher than the control group in improving clinical thinking,stimulating learning interest,and improving communication skills(P＜0.05).Conclusion The teaching methods using student as standardized pa-tients in the process of clinical practice in neurology helps to improve the history taking and neurological physical examination skills of clinical students,yielding good educational outcomes.

Objective:To investigate risk factors for vascular cognitive impairment(VCI)in elderly patients 12-18 months after the onset of acute partial anterior circulation infarction(PACI), and to establish a diagnostic and predictive model.Methods:This was a prospective study. Demographic characteristics, vascular risk factors and laboratory data of 148 patients with acute PACI were collected, and patients were followed up for 12-18 months.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate patients' cognitive function.Logistic stepwise regression was used to screen risk factors for VCI.We established a diagnostic and predictive model.The area under the receiver operating(ROC)curve(AUC)was used to evaluate the efficiency of the model.Results:A total of 126 subjects completed the 12-18 month follow-up.Multivariate logistic regression analysis found that high homocysteine(Hcy)( OR=1.082, 95% CI: 1.002-1.167), high glycated hemoglobin(HbA1c)( OR=1.653, 95% CI: 1.052-2.598), high National Institutes of Health Stroke Scale(NIHSS)score( OR=1.291, 95% CI: 1.098-1.518), high hypersensitive C-reactive protein(hs-CRP)( OR=1.026, 95% CI: 1.005-1.047)and low education level( OR=2.485, 95% CI: 1.231-5.018)were independent risk factors for VCI in patients 12-18 months after PACI( P<0.05). The AUC of the diagnostic and predictive model was 0.828(95% CI: 0.755-0.902). Conclusions:High Hcy, NIHSS score, hs-CRP and low education level are independent risk factors for VCI in patients 12-18 months after PACI.The diagnostic and predictive model can help to screen patients at high-risk for VCI, so that timely clinical recognition, diagnosis and treatment can be made after acute PACI.

OBJECTIVE To investigate the current status of quality management of cold chain medicines in direct-to-patient （DTP） pharmacies and propose measures for pre-emptive risk management， providing references for the quality risk management of cold chain medicines. METHODS Based on the requirements of national regulations， a survey was conducted on the quality management of cold chain medicines in DTP pharmacies of J Province from November 2023 to February 2024， focusing on the receipt， storage， distribution， and delivery processes， using questionnaires， telephone interviews， and on-site visits. Common quality management issues in the operation of cold chain medicines were identified， and the causes of these issues were analyzed to propose feasible pre-emptive risk management measures. RESULTS & CONCLUSIONS A total of 122 DTP pharmacies participated in the questionnaire survey， and personnel from 30 DTP pharmacies participated in on-site and telephone interviews. Typical problems were identified in some DTP pharmacies， including insufficient personnel allocation or training， incomplete or inadequate implementation of quality system documentation， inadequate provision or management of cold chain facilities and equipment， and non-compliant storage and distribution of cold chain medicines. These issues posed certain risks to the quality management of cold chain medicines. It is recommended that DTP pharmacies strengthen personnel allocation and training， improve quality system documentation， enhance the provision and management of facilities and equipment， standardize storage and transportation operations， and strengthen supervision and assessment as pre-emptive measures. In addition， all sectors of society should also collaborate in governance from the perspective of ensuring the safety of cold chain drug storage and transportation， in order to mitigate the risk of quality and safety issues during the distribution of cold chain drugs and guarantee the safe and effective use of medications for patients.

Immune Checkpoint Inhibitors ; Transcriptome ; Immunotherapy ; Biomarkers, Tumor