Pancreatic cancer is one of the most common and malignant tumor in the field of digestive system.Surgery still is potential method to cure pancreatic cancer.Laparoscopic surgery with the advantage of minimal invasion has been applied in the treatment of benign and low malignant tumors,but it is in great controversy whether laparoscopic surgery could be used in treatment of pancreatic cancer.This study reviews the literatures of laparoscopic surgery for pancreatic cancer and the clinical outcomes,and explores its current development and prospects.

Objective To investigate the clinical effect of honghua injection on hemorrheology in the prevention of deep venous thrombosis ( DVT) after operation of lower limbs fractures.Methods 100 cases with operation of lower limb fracture meeting the inclusion critera were randomly divided into two groups equally.Besides conventional treatment, the control group was treated with rivaroxaban, while the observation group was treated with honghua injection and rivaroxaban.The incidence of DVT, pro-inflammatory factors, hemorheology indices and adverse reactions were observed and compared. Results The observation group had a total DVT incidence of 10.0%, which was statistically lower than that of 28.0% in the control group(P<0.05). Three days after the operation, pro-inflammatory factors of TNF-α, IL-6 and IL-8 in the observation group was respectively statistically lower than that in the control group(P<0.05).As to hemorheology indices, in comparison with the control group, hematocrit, whole blood viscosity and fibrinogen in the observation group were statistically lower (P<0.05).During the treatment, there were no case of severe adverse reactions, and the incidence of adverse reactions in the two groups were statistically same.Conclusion Treatment of honghua injection in combination with rivaroxaban in the prevention of DVT is reliable, which could significantly reduce the incidence of DVT, alleviate inflammatory reaction and improve blood hypercoagulable state with minor adverse reactions.

Humans ; Laparoscopy ; methods ; trends ; Pancreaticoduodenectomy ; methods

BACKGROUND:Idiopathic interstitial pneumonia is of poor response to treatment. Glucocorticoids are the first medicine for the treatment, however there is only 30% of the patients who are responded. Traditional Chinese drugs (TCD) have been researched hot point for prevention and treatment of pulmonary fibrosis. Many TCD have been used clinically, and with a certain therapeutic effect. Transforming growth factor-β1 and tumor necrosis factor-α are the considerable cytokines to cause pulmonary fibrosis, inhibition of their expression, therefore, may be effective to pulmonary fibrosis.OBJECTIVE: To investigate the interventional effect of qidan granule on pulmonary fibrosis in rats induced by bleomycin A5 and the influence on the expressions of transforming growth factor-β1 and tumor necrosis factorα, and also to compare with those of hydrocortisone.DESIGN:A randomized and interval grouping design.SETTING:Department of Respiratory Medicine, Shandong Provincial Hospital, Shandong University.MATERIALS:The experiment was conducted from May 2003 to March 2004 at Pathological Laboratory of Shandong Provincial Academy of Medical Science. Totally 105 SD male rats, were at random divided into 4groups: normal control group (n= 15 ), model group, qidan group and hydrocortisone group, with 30 rats in each group. Each group was subdivided as7-day, 14-day and 28-day group, with 5 rats in each normal group, and 10in each other groups.METHODS: [1] Model establishment: A perfusion was intrabronchially performed, of 0.25 mL normal saline for rats in normal control group, and of bleomycin A5 0.25 mL ( 5 mg/kg,4 g/L) for rats in other 3 groups, to set up the models of pulmonary fibrosis. [2]Administration: Next day to the beginning of modeling qidan granule (consisting of Radix Astragali seu Hedysari, Radix Salviae Miltiorrhizae, Rhizoma Ligustici Chuanxiong and so on, 3 125 mg/kg) was intragastrically given per day for rats in qidan group, hydrocortisone (25 mg/kg) was intraperitoneally given per day for rats in hydrocortisone group, and normal saline (2 mL/rat) was intragastrically given per day for rats in normal and model groups.[3] Observation indexes: The rats in each group were on the day 7, day 14 and day 28 put to death under the anesthesia, then the lung tissue was taken, stained with hematoxyline-eosin stain for pathological observation of lung tissue. The expressions of transforming growth factor-β1 and tumor necrosis factor-α were detected by immunohistochemistry.MAIN OUTCOME MEASURES:Pathological observation of lung tissue,and the expressions of transforming growth factor-β1 and tumor necrosis factor-α at different time points of rats in each group.RESULTS:Totally 100 rats entered the final result analysis.[1]Pathological observation of lung tissue: In the normal group the structure was normal, in the model group there were alveolitis on the day 7, deterioration of alveolitis on the day 14, and extensive fibrosis on the day 28; the degrees of alveolitis and fibrosis in the qidan group were slighter than those in the model group, and there was normal structure of alveoli; and in the hydrocortisone group the alveolitis on the day 7 and 14 was slighter than that in the model group, but there was no significant difference of fibrosis compared with the model group.[2] Expression of transforming growth factor-β1:In the model group the expression was highest on the day 28 and obviously higher than that in the normal group (3.6±0.4,1.2±0.4,P ＜ 0.01 ); the expression in the qidan group and hydrocortisone group was obviously lower than that in the model group(1.7±0.5,2.5±0.4,P ＜ 0.01), and the expression in the qidan group was lower than that in the hydrocortisone group (P＜ 0.01 ). [3]Expression of tumor necrosis factor-α: In the model group at different time points the expression was continuously increased, the expression in the qidan group and hydrocortisone group was obviously lower than that in the model group(P ＜ 0.05 or P ＜ 0.01), and the expression in the qidan group was lower than that in the hydrocortisone group ( P ＜ 0.01).CONCLUSION: Qidan granule can obviously reduce the extent of pulmonary fibrosis in rats induced by bleomycin A5, lower the expressions of transforming growth factor-β1 and tumor necrosis factor-α, and the effect was better than that of hydrocortisone.

The core-crosslinked polymeric micelles were used as a new drug delivery system, which can decrease the premature drug release in blood circulation, improve the stability of the micelles, and effectively transport the drug into the therapy sites. Then the drug bioavailability increased further, while the side effect reduced. Most drugs were physically entrapped or chemically covalent with the polymer in the internals of micelles. Based on the various constitutions and properties of polymeric micelles as well as the special characteristics of body microenvironment, the environment-responsive or active targeting core-crosslinked micelles were designed and prepared. As a result, the drug controlled release behavior was obtained. In the present paper, the research progress of all kinds of core-crosslinked micelles which were published in recent years is introduced. Moreover, the characteristic and application prospect of these micelles in drug delivery system are analyzed and summarized.
Animals ; Antineoplastic Agents ; administration & dosage ; chemistry ; therapeutic use ; Cross-Linking Reagents ; chemistry ; metabolism ; Drug Carriers ; chemistry ; metabolism ; Humans ; Micelles ; Molecular Structure ; Neoplasms ; drug therapy ; Particle Size ; Pharmaceutical Preparations ; administration & dosage ; Polyethylene Glycols ; chemistry ; metabolism ; Polymers ; chemistry ; metabolism

Objective To explore the value of cardiovascular magnetic resonance feature tracking (CMR-FT) in quantita tive evaluation of myocardium deformation in patients with hypertrophic cardiomyopathy (HCM).Methods Sixteen HCM patients (HCM group) and 18 healthy volunteers (control group) were enrolled and measured with CMR-FT.The differences of left ventricular (LV) end diastolic volume (LVEDV),LV end systolic volume (LVESV),LV ejection fraction (LVEF),left ventricular mass (LVMASS) and LV global radial strain (RS),LV global circumferential strain (CS) were compared between the two groups.The correlations between segmental wall thickness and segmental RS and CS were studied.And the correlation among global RS,CS and LVEDV,LVESV,LVEF,LVMASS were analyzed.Results LVMASS in HCM group was higher than that in control group ([133.74±79.13]g vs [76.87±14.15]g,P=0.01).No sig nificant differences of LVEDV,LVESV,LVEF were found between HCM group and control group (all P＞0.05).Global RS and CS were significantly lower in HCM group than those in control group (RS:[27.05 ± 13.35]％ vs [40.62 ± 4.92] ％,P＜0.01;CS:[-8.68± 5.56] ％ vs [-20.73 ± 1.56] ％,P＜0.01).No significant correlations was observed between segmental wall thickness and segmental RS (r=-0.41,P＜0.01),CS (r=0.28,P＜0.01),respectively.In HCM group,no significant correlations was observed between global RS (r=-0.36,-0.41,0.22,-0.36),CS (r=0.34,0.10,0.22,0.42) and LVEDV,LVESV,LVEF,LVMASS,respectively (all P＞0.05).Conclusion CMR-FT is conducive to quantitative evaluate myocardial deformation in HCM patients.

Objective To investigate clinical efficacy of Easy First strategy in laparoscopic pancreaticoduodenectomy (PD) for borderline resectable pancreatic cancer.Methods The clinical data of 9 patients with borderline resectable pancreatic cancer who were admitted to the Sir Run Run Shaw Hospital of Zhejiang University (8 patients) and Zhejiang Provincial People's Hospital (1 patient) from June 2013 to March 2015 were retrospectively analyzed.Nine patients underwent laparoscopic pancreaticoduodenectomy based on the Easy First strategy (to sequentially dissect and amputate jejunum,stomach,hepatoduodenal ligament,common bile duct,main portal vein,head of pancreas,second segment and third segment of the duodenum,uncinate process and neck of pancreas).The operation time,volume of intraoperative blood loss,postoperative pathological examination,complications and duration of hospital stay were recorded.Patients were followed up once every 3 months by outpatient examination and telephone interview up to June 2015.Results Of 9 patients,4 received totally laparoscopic PD (2 received partial resection and repair of portal venous wall),1 received laparoscopic assisted resection and digestive tract reconstruction,and 4 received laparoscopic transection of jejunum,bile tract and stomach and conversion to open surgery for resection and digestive tract reconstruction (1 with severe adhesion between tumor and portal vein,3 with bleeding due to dissection of neck and unciform process of pancreas).The operation time and volume of intraoperative blood loss in all patients and in 4 patients with totally laparoscopic PD were (404 ± 49) minutes and (456 ± 348) mL,(395 ± 61) minutes and (188 ± 25) mL,respectively.Of 9 patients,5 with postoperative complications were cured without perioperative death,including 2 with Grade B pancreatic fistula,1 with biliary leakage,1 receiving reoperation due to gastric stump bleeding at postoperative day 7 and 1 with abdominal infection.The extubation time of right drainage tube and left drainage tube was (9 ± 5) days and (11 ± 4) days,respectively.The duration of hospital stay was (24 ± 10)days.All patients were diagnosed as with pancreatic cancer by pathological examinations with the tumor diameter of (3.2 ± 0.8) cm.The number of harvested lymph nodes in all patients and in 4 patients with totally laparoscopic PD were 16.8 (range,6.0-25.0) and 19.8 (range,15.0-25.0).All the patients were followed up for mean time of 12 months (range,4-24 months),including 1 death at postoperative month 3,1 with tumor survival of 20 months and others with tumor-free survival.The postoperative survival time of 4 patients was more than 18 months at the end of follow-up.Conclusion Easy First strategy in laparoscopic PD is safe,feasible and practical for borderline resectable pancreatic cancer.

BACKGROUND:Studies have shown that percutaneous pedicle screw internal fixation in repair of single segment of thoracolumbar fracture can overcome quadrilateral effect, get better biomechanical properties, meanwhile, it also can provide three-point fixation, reduce suspension effect, and reduce the formation of kyphosis. OBJECTIVE: To investigate the clinical efficacy and incidence of complications of the percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures. METHODS:Totaly 36 patients with single segment thoracolumbar fractures treated by percutaneous pedicle screw internal fixation were enroled. A total of 36 vertebral bodies were treated: T11=5, T12=8, L1=17, L2=6. The visual analog scale scores before treatment and at 3, 6 and 12 months after treatment, the Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment, the Cobb angle before treatment, the first day and at the 12th month after treatment were compared and observed. The incidence of complications was recorded. RESULTS AND CONCLUSION:The visual analog scale scores at 3, 6 and 12 months after treatment was significantly lower than those before treatment (P < 0.001). The Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment were significantly lower those that before treatment (P < 0.001).The Cobb angle before treatment, at the first day and at the 12th month after treatment was significantly smaler than that before treatment (P < 0.001). Only three (8%) patients had complications, including pedicle screw penetrating pedicle into the spinal canal, pedicle screws loosing and the infection in puncture site. These results suggest that percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient’s back pain, and the incidence of complications is low.

Objective To observe the effects of intensive lower extremity motor control training on the motor function of lower extremity, balance and walking capability of stroke patients. Methods 40 stroke patients were randomized into the intervention group (n=20) and control group (n=20). Both groups received the routine rehabilitation, while the intervention group accepted the lower extremity motor control training in addition for 6 weeks. Before and after 6 weeks of treatments, they were assessed with Fugl-Meyer Assessment of lower extremity (FMA-L), Berg Balance Scale (BBS), Holden Functional Ambulation Category (FAC); their gaits were analysesd with footprint. Results Both groups improved significantly in scores of FMA-L, BBS, FAC and average step length, stride width, walking velocity (P<0.01) after treatment, and improved more in the intervention group than in the control group (P<0.05). Conclusion Intensive motor control training of lower extremity may promote the recovery of motor function of lower extremities, balance and walking ability of stroke patients.

ObjectiveTo evaluate the impact of patient's heart rate(HR)on coronary CT angiography(CTA)image quality(IQ)and reconstruction timing in dual-source CT(DSCT).Methods Ninety-five patients with suspicion of coronary artery disease were examined with a DSCT scanner(Somatom Definition.Siemens)using 32×0.6 mm collimation.All patients were divided three groups according to the heart rate(HR):group 1,HR≤70 beats per minute(bpm),n=26;group 2,HR＞70 bpm to≤90 bpm, n=37;group 3,HR＞90 bpm,n=32. No beta-blockers were taken before CT scan.50-60 ml of nonionic contrast agent were injected with a rate of 5 ml/s. Images were reconstructed from 10%to 100% of the R-R interval using single-segment reconstruction. Two readers independently assessed IQ of all coronary segments using a 3-point scale from excellent(1)to non-assessable(3)for coronary segments and the relationshiD between IQ and the HR. ResuitsOverall mean IQ score was 1.31 ±0.55 for all patients with 1.08±0.27 for group 1,1.32±0.58 for group 2 and 1.47±0.61 for group 3. The IQ was better in the LAD than the RCA and LCX(P＜0.01).Only 1.4%(19/1386)of coronary artery segments were considered non-assessable due to the motion artifacts.Optimal image quality of all coronary segments in 74 patients(77.9%)can be achieved with one reconstruction data set.The best IQ was predominately in diastote(88.5%)in group 1,while the best IQ was in systole(84.4%)in group 3. ConclusionsDSCT can achieve the optimal IQ with a wide range of HR using single-segment reconstruction. With the increasing of HR,the timing of data reconstruction for the best IQ shifts from mid-diastole to systole.