Pancreaticoduodenectomy (PD) is the procedure for treating adenocarcinoma in periampullary region.This involves resection of multiple organs and complex reconstructions.The modern surgery has witnessed the dramatic improvement in outcomes after PD.Mortality has dropped to less than 4％,however,the complication rate remains high,making this procedure still a big challenge for most surgeons. PD is so complicated that even small mistakes could jeopardize the whole procedure and outcomes.With experiences of over 1000 PDs,we discuss the challenges of this procedure and strategies to deal with them.

The da Vinci robotic surgical system assisted colorectal radical resection has been widely applied in many countries and regions.The advantages of the da Vinci robotic surgical system include stable and distinct stereoscopic vision,short learning curve,convenient operation and feasibility of remote manipulation,while its disadvantages are expensive cost,lack of tremor and prolonged operation time.The advantage of da Vinci robotic surgical system is not distinct when compared with traditional laparoscope in radical resection of colorectal cancer.With the accumulation of clinical data and the update of the system,the prospect of da Vinci robotic surgical system assisted colorectal radical resection is promising.

BACKGROUND:Lumbar disc herniation is a clinical syndrome of lumbar pain and radiated pain of the lower limb induced by biochemical changes after intervertebral disc degeneration. Transforaminal endoscopic spine system (TESSYS) and Yeung endoscopic spine system (YESS) are commonly used in the clinic, but their effects are different.
OBJECTIVE:To compare the curative effect of TESSYS and YESS in treatment of lumbar disc herniation. METHODS:Fol ow-up data of 134 cases of lumbar disc herniation were retrospectively analyzed. They were assigned to TESSYS group (n=76) and YESS group (n=58). Intraoperative condition, pain at various time points after repair, and lumbar function changes were compared between the two groups.
RESULTS AND CONCLUSION:(1) No significant difference in Visual Analogue Scale and Oswestry Disability Index scores was detected between the two groups before repair (P>0.05). At 1, 3, and 6 months after repair and during final fol ow-up, above scores were significantly decreased in both groups (P<0.05). Above scores were significantly lower in the TESSYS group than in the YESS group at various time points after repair (P<0.05). (2) No significant difference in Japanese Orthopedic Association score was found between the two groups before repair (P>0.05). Japanese Orthopedic Association score was greater in the TESSYS group than in the YESS group at 1, 3 and 6 months fol owing repair and during final fol ow-up (P<0.05). (3) The excel ent and good rate was significantly greater in the TESSYS group than in the YESS group during final fol ow-up (P<0.05). (4) Operation time and incision length were significantly shorter in the TESSYS group than in the YESS group. No significant difference in the amount of bleeding was detectable between the two groups (P>0.05). Results suggest that TESSYS for lumbar disc herniation was characterized by smal trauma, mild pain and good recovery of function.

Objective To investigate the prevalence of gastroeaophageat reflux disease(GERD)in the end stage renal disease patients(ESRD)with maintenance hemodialysis and the pathogenetic factors of GERD.Methods 60 cases who had heart burn and acid regurgitation symptoms were enrolled,31 cases of them were ESRD patients with maintenance hemodialysis,29 patients who were renal diseases free as control group.GERD was diagnosed by three methods:endoscopy,24h esophageal pH monitoring,endoscopic esophageal biopsy.GERD was established if any of these tests was positive.HP infection and serum gastrin were assessed too.Results (1)The prevalences of GERD in two groups were 83.9%,79.3% respectively and had no significant difference(P＞0.05).(2)The prevalence of HP infection in the ESRD group was significantly lower than control group(19 4% vs 51.7%,P＜0.05).(3)The concentration of serum gastrin in the ESRD group and control group was(102.61±30.80)ng/ml and (83.41±20.61)ng/ml,two group had significant difference(P＜0.05).Conclusion The prevalence of GERD inthe ESRD patients was higher than expected,and was correlated with absence of HP infection and hypergastinemia.

Objective To comparatively investigate the characteristics of bone metabolism in forelimb malformation WHBE rabbits based on the OPG/RANK/RANKL system.Methods Healthy male 2-2.5-month old WHBE rabbit ( HWR) , Healthy Japanese rabbit ( HJR) and forelimb malformation WHBE rabbit ( FMWR) were used in this study and divided into 3 groups, HWR, HJR and FMWR groups, with 10 rabbits in each group.The shape of forelimb and mean gray value observed from X-ray film were examined, and the bone tissue micro-morphology was analyzed using HE staining.Re-al-time fluorescence quantitative PCR was used to determine the expression of osteoprotegerin ( OPG) and receptor activator of NF-KB ligand ( RANKL) mRNA.The expressions of OPG, receptor activator of NF-KB ( RANK) and RANKL protein in serum and bone tissue were assayed by enzyme-linked immunoassay ( ELISA) and immunohistochemistry, respectively. Results Compared with the HWR and HJR groups, rabbits in the FMWR group appeared abnormal in toutuous forelimb and thinner bone cortex.The mean gray values of X-ray in the FMWR group were lower than that in the HWR group ( P<0.05).There were significant differences between the FMWR and healthy rabbits (HWR and HJR) in the following pa-rameters:RANKL mRNA expression and RANKL/OPG mRNA ratio in the liver(P<0.05, P<0.01), serum protein expression of RANK and RANKL and RANKL/OPG ratio (P<0.05, P<0.01), and positive index of expression of RANKL protein and RANKL/OPG ratio in the bone tissue(P<0.05, P<0.01).Furthermore, the gene expression lev-els of OPG and RANKL of HWR were significantly higher than that of HJR(P<0.05, P<0.01).Conclusions The FMWR show some abnormal symptoms in bone metabolism as well as decrease of bone quality and histological changes of bone micro-structure, due to the significant increase of RANKL/OPG ratio of FMWR.The breed differences between WHBE and Japanese rabbits in RANKL mRNA expression level may be one of factors inducing limb malformation in the WHBE rabbits.

BACKGROUND: Calcium sulfate (CS) is a good bone conduction material due to its good biocompatibility and degradability. However, simple CS lacks of osteoinductive capability, so it can not satisfy clinical requirements.OBJECTIVE: To verify the potential ofCS/bone matrix gelatin (BMG) composite biomaterial in the repair of segmental bone defects.DESIGN, TIME AND SETTING: An in vivo multi-dimensional observation was performed in the Laboratory Animal Center, Nanfang Hospital, Southern Medical University between December 2004 and April 2006.MATERIALS: Twenty-one healthy adult New Zealand rabbits, weighing 2.5-3.5 kg, were included. The segmental ulnar defects of 15 mm were created bilaterally. CS and BMG were self-prepared.METHODS: CS and BMG were composited at 2:1 and then implanted into 15-mm rabbit ulnar bone defect. The present study consisted of 3 groups: CS/BMG group, defects were filled with CS/BMG; CS group, defects were filled with CS; and blank control group, untreated control defects.MAIN OUTCOME MEASURES: At weeks 4, 8, and 12 post-surgery, repair of bone defect was observed by gross observation, radiographic, histomorphological and tetracycline tracing analysis.RESULTS: Surgical incisions all primarily healed. No inflammatory or foreign reaction was found around all the defects. Both CS/BMG and CS were almost completely absorbed at week 8 post-surgery. In the CS/BMG group, newly formed bone was found throughout the defects after 4 weeks; all defects were repaired with a well-organized trabecular pattern and a thit neocortex after 12 weeks. In the CS group, mass of new bone tissue formed at the periphery of the defect at week 4 post-surgery, but the development of new bone in the center of defect was latter compared with the CS/BMG group: at 12 weeks, all defects were bridged by newly formed bone tissue with little adjacent medullary bone. In the blank control group, slight new bone was found at the periphery of the defect region, and the defects were filled with fibrous tissue.CONCLUSION: CS/BMG composite is totally bioresorbable and biocompatible. The composite can repair bone defects effectively as a bone graft substitute.

Objective To investigate the effect and the possible mechanism of the apoptosis of neurons and the expression of bcl-2 gene in the neonatal rat brain after different courses of Dexamethasone (DXM). Methods Thirty-four Sprague-Dawley(SD) pregnant rats were randomized into four groups and received different courses of antenatal DXM at the dose of 0.8mg/(kg?d) intramuscularly: (1) Group 1 (n=8) received DXM on the 17th day of gestation only; (2) Group 2 (n=8) received DXM consecutively on the 17th,18th and 19th day of gestation; (3) Group 3 (n=10) received DXM consecutively for 4 days(on 17th,18th,19th and 20th day of gestation); (4) The control group (n=8) received equivalent volumes of isotonic saline intramuscularly consecutively for 4 days (gestational day 17, 18, 19, 20). On the postnatal day 1(P_1), day 7 (P_7) and day 14 (P_ 14 ), sixteen newborns in each group were randomly selected and sacrificed. The weights of the body and the whole brain were measured. Tunel was used to evaluate the apoptosis of neurons, and the content of bcl-2 protein was examined by improved Western Blot. Results (1) The brains weight of the newborn mice on P_1 were (0.301?0.030)g, (0.302?0.026)g, and (0.296?0.025)g in Group 1, 2 and 3, respectively and all significantly lower than that of the control [(0.363?0.041)g, P0.05). Conclusions Repeated doses of antenatal DXM therapy could significantly increase the apoptosis of neurons by down-regulate the bcl-2 expression and handicap the development of newborn mice′ brain.

Objective To observe the curative effect of refractory ascites with ascitic ultrafiltration and reinfusion into abdominal cavity.Methods Thirty-seven patients diganosed as refractory ascites were given ultrafiltration and reinfusion into abdominal cavity.The following parameters were detected respectively:24h urine volume,abdomen circumference,heart rate,blood pressure,serum electrolytes,serum albumin,total serum bilirubin.Results After treatment,the 24h urine volume increased and abdomen circumference decreasd significantly (P ＜ 0.01 ).There was no significant difference in heart rate,blood pressure,serum electrolytes,serum albumin and total serum bilirubin before and after treatment (P ＞0.05).Conclusion Ascitic ultrafiltration and reinfusion into abdominal cavity has some effects on refractory ascites.

[Objective]To evaluate the value of diffusion weighted imaging(DWI)in breast disease.[Methods]7 cases suspected by molybdenum target and clinic were detected by MRI.we calculated ADC through two different b,also make time-signal plot.Then we compared the diagnostic conclusion to the normal MRI conclusion acquired with histopathological demonstration.[Results]3 cases were malignant,2 cases were benign and 2 cases were normal.The diagnostic coincidence rate of DWI and normal MRI was 100%.[Conclusion]DWI is a rapid and feasible method in detecting breast lesions.ADC is an effective parameter in discriminating malignant and benign breast lesions.

Objective To observe interference effect of Ambroxol (AMB) hydrochloride injection on chronic obstructive pulmonary disease in rats caused by cigarette smoking exposure.Methods Chronic obstructive pulmonary disease (COPD) rat models were established by simple cigarette smoking exposure,interfered with AMB inhalation.Rats were divided into three groups.Cell counts were examined routinely in bronchoalveolar lavage fluid (BALF).The concentrations of Matrix metalloproteinase-9(MMP-9)、interleukin-8 (IL-8) and tumor necrosis factor-? (TNF-?) in BALF were measured.Quantitative analysis of pulmonary mean linear intercept (MLI),mean alveolar numbers (MAN),pulmonary alveolar area (PAA) and the relative area of elastic fibers were measured.Results Concentrations of MMP-9,IL-8 and TNF-? in BALF of COPD rats were positively correlated with total counts of white blood cell (WBC),percentage of neutrophil and absolute counts of neutrophil in BALF.Pulmonary elastic fibers were severely damaged in COPD rats;MLI,PAA were higher than those in control group (P0.05).Conclusion Simple cigarette smoking can cause COPD in rats.MMP-9,IL-8 and TNF-? in airway and alveoli pulmonum probably participate in the destruction of elastic fibers and forming of COPD.AMB inhalation can inhibit release of IL-8 and TNF-? in airway and alveoli pulmonum of COPD rats,alleviate the inflammation of local airway caused by cigarette smoking,playing a role in preventing and curing experimental COPD of rats.