With the increase of morbidity and mortality, pancreatic cancer will not only become one of the leading causes of death in China, but also a major public health problem in the world. New onset cases of pancreatic cancer all around the world are expected to increase year by year. The prognosis of patients with pancreatic cancer is poor. The 5-year survival rate is only about 6%. The major reason for the poor prognosis is the lack of typical clinical symptoms in the early stage of disease, which makes it difficult to detect and control its relevant recurrence and metastasis. Moreover, lack of effective chemotherapy drugs and resistance to existing chemotherapy drugs are also important reasons for its dismal status. Radical resection surgery is still the most effective treatment. However, even after radical resection surgery, early recurrence and distant metastasis are still the main problems that bother patients. This article reviews recent high quality studies on pancreatic cancer including epidemiological investigation, advances in basic research, and clinical treatment.

[Summary] The aim of this study was to examine the association between obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and microalbuminuria in type 2 diabetes mellitus patients. We found that severe OSAHS significantly increases the risk of early renal damage in type 2 diabetes mellitus patients with HbA1C<7% ( lowest oxygen saturation:OR=2. 41, 95% CI 1. 19-8. 08; apnea hyponea index: OR=2. 91, 95% CI 1. 50-9. 11), suggesting that OSAHS may increase the risk for early renal damage in type 2 diabetes mellitus, especially in those with successful control of glucose.

Objective To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU). Methods The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender,age,amount of bleeding,the bleeding site (basal ganglia,thalamus, brainstem,brain lobe,ventricle,subarachnoid,and cerebellum),disturbance of consciousness,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,systolic blood pressure(SBP),history of hypertension,and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve)was plotted to analyze the independent risk factors and evaluate their power of test. Results 1 185 patients with cerebral hemorrhage were enrolled in the study,293 cases occurred SU,accounting for 24.7%,and 892 cases without SU,which accounted for 75.3%. As shown by univariate analysis,risk factors for cerebral hemorrhage complicated with SU included age,amount of bleeding,the bleeding site,disturbance of consciousness,APACHEⅡscore,SBP. As to the site of bleeding,brain,thalamus,brainstem hemorrhage complicated with SU were higher proportion,45.3%(43/95),39.1%(63/161),36.9%(48/130),which were significantly higher than those of the lobes of the brain 〔26.2% (33/126)〕,cerebellum 〔18.8% (15/80)〕,basal ganglia〔16.1%(78/485)〕,arachnoid the inferior vena cava 〔12.0% (13/108)〕. Multivariate logistic regression analysis showed that amount of bleeding 〔odds ratio (OR)=3.305,P=0.001,95%confidence interval (95%CI)2.213-48.634〕,the bleeding site (OR=1.762,P=0.008,95%CI 0.123-2.743),SBP (OR=1.223,P=0.034,95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC)of amount of bleeding and SBP were 0.846 and 0.597,suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value. Conclusions Cerebral hemorrhage patients with large amount of bleeding,the bleeding site in the ventricle,thalamus or brainstem,high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.

Objective:To investigate the methods and complications of ultrasound-guided percutaneous nephrostomy (PCN) for treat-ing cancer-related hydronephrosis. Methods:From June 2003 to December 2015, 289 patients (342 kidneys) with cancer-related hy-dronephrosis were treated by ultrasound-guided PCN in Fujian Provincial Hospital. Among the 97 cases of renal insufficiency, 4 pa-tients were treated with hemodialysis before PCN. Except for the anterior mid calyx of nine kidneys in nine patients, the posterior mid or lower pole calyx of all other kidneys was punctured with ultrasound guidance. With the one-step PCN technique, 8F pigtail nephros-tomy tubes were placed into six kidneys in six patients;with the Seldinger PCN technique, 14F balloon and Malecot catheters were placed into 25 kidneys in 25 patients and 311 kidneys in 258 patients, respectively. Results:No severe bleeding and injury in the intes-tine, liver, spleen, pleura, or lung occurred. Two pigtail tubes were blocked one week after PCN. Seven balloon catheters failed to drain well because of the tip and balloon of the catheters located in the proximal part of the dilated ureters. Four balloons slipped out of the collection system of the kidney because of the auto-deflation of three balloons and one case of meager renal parenchyma failing to hold the balloon after a severe hydronephrosis was emptied. All, except 1, Malecot catheter drained well, and 8/9 PCNs through anteri-or mid calyx were successful. Serum creatinine levels were significantly decreased in all the 97 patients with renal insufficiency, of which 81 cases returned to normal, and no one needed persistent hemodialysis. Conclusion:Ultrasound-guided PCN is safe and effec-tive for treating cancer-related hydronephrosis. For appropriately selected patients, puncturing the anterior mid calyx may be an op-tion without additional complications. One-step pigtail nephrostomy tubes are recommended for patients with poor systemic condi-tions. For patients with long life expectancy or suspected complicated urinary infection, large sized Malecot catheters should be consid-ered.

Objective To evaluate the efficacy and safety of ureteral stenting after transurethral resection ( TUR) of bladder tumors involving the ureteral orifice.Methods From March 2009 to November 2015,34 cases of non-muscle invasive bladder tumor including 28 male and 6 female aged from 26 to 79 years( mean 51 years) were treated by TUR.14 cases had single tumor and 20 had multiple tumors,and 29 were primary and 5 were recurrent.All the patients had tumors involving the ureteral orifice without preoperative hydronephrosis revealed by IVU or CTU examination.The tumors were resected into the deep muscle layer and the involved ureteral orifices were resected during the procedure,and after that a double-J ureteral stent was placed in 18 cases.All patients received one immediate intravesical instillation of 50mg epirubicin after TUR, and further scheme of adjuvant intravesical chemotherapy instillations were made according to the pathological diagnosis.Ureteral stents were removed 10-12 weeks after TUR,and cystoscopy and urinary tract ultrasound examinations were performed every 3 months for 1-2 years postoperatively. Results The operations were successful without complications.No serious adverse reaction occurred in immediate and further adjuvant intravesical chemotherapy.During the follow-up period of 3-71 months, no ureteral stricture, hydronephrosis or tumor recurrence in the upper urinary tract occurred in all the 18 patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine.Hydronephrosis was observed in 3 of 16 patients without ureteral stent including 2 cases of nontumoral stenosis at the ureterovesical junction requiring ureteral reimplantation and 1 case of lower ureteral tumor on the involved side requiring nephroureterectomy and bladder cuff excision.No patient complained of symptoms secondary to vesicoureteral reflux or continuous unrelievable lower urinary tract symptoms.2 cases of bladder tumor recurred out of the resected area.Conclusions Ureteral stenting after TUR of bladder tumors involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract.The existence of a double-J ureteral stent does not increase complications of adjuvant intravesical chemotherapy, and also won't cause intolerable lower urinary tract symptoms.

Poly-hemoglobin is the active component of hemoglobin-based blood substitutes. The excess reactivity of glutaraldehyde with hemoglobin in solution leads to poly-hemoglobin of a wide molecular weight distribution and a high average molecular weight. A new polymerization method has been tested to decrease the molecular weight distribution and the average molecular weight. The poly-hemoglobin with lower degree of modification (polymerization) was found enriched on the cation exchange columns and further polymerized with glutaraldehyde. The poly-hemoglobin of narrower molecular weight distribution has been prepared in this way.
Blood Substitutes ; chemical synthesis ; chemistry ; Chromatography, Ion Exchange ; methods ; Hemoglobins ; chemical synthesis ; chemistry ; Humans ; Pyridoxal Phosphate ; analogs & derivatives ; chemical synthesis ; chemistry

Objective To explore the effects of the new melatonin nonselective agonists Neu-P11 on intraocular pressure (IOP) and glial fibrillary acid protein (GFAP) expression in the retina of acute high IOP rat.Methods Twenty-four male Sprague-Dawley rats were randomly divided into 4 groups (6 cases in each group):Normal IOP with local treatment (NIL) group,high IOP with local treatment (HIL) group,HILwith melatonin treatment (HIL-M) group,HIL with Neu-P11 treatment (HIL-N) group.10 μL normal saline was instilled in NIL group and HIL group,while 10 μL 100 μmol · L-1 Mel/Neu-P11 treated in HIL-M group and HIL-N group.After 2 hours of rest,rats were placed in the Trendelenburg position duration 45 minutes.And then,IOP was measured every hour for 6 hours,and repeated it for a week.The excessive sodium pentobarbital was injected to SD rats at the end of the experiment.The rat eyeballs were took out to perform HE and immunohistochemical staining to detect retina GFAP protein expression.Results After a week,IOP in HIL group was (41.26 ± 1.73) mmHg (1 kPa =7.5 mmHg),NIL group was (13.61 ± 0.55) mmHg,which mean the Trendelenburg could induce high IOP in SD rats.Compared with the NIL group,the retinal becoming thick,the level of organization was not clear and the expression of GFAP protein was quite high in HIL group.At the same time,the GFAP protein expression and IOP were significantly weakened in HIL-M group and HIL-N group compared with HIL group.Conclusion Neu-P1 1 can reduce IOP,inhibit the activation of gliocyte,and decrease the expression of GFAP to protect the retina.

Vaccination is the most cost-effective measure to prevent infectious diseases in both children and adults. At present, the global burden of infectious diseases in adults is still heavy. With the continuous development and improvement of vaccines, vaccination has shown great potential to prevent infectious diseases, further reduce the morbidity and mortality of infectious diseases in adults and improve people's life quality. This article summarizes the current status of adult immunization, immunization strategies of representative countries, different adult vaccination strategies, and the advantages and challenges of adult immunization to provide reference for further exploring adult immunization strategies and improving adult vaccination recommendations. More attention should be paid to the immunization strategies for different adult populations, and effective measures should be taken to improve the vaccination coverage for the better protection of people's life and health.

Influenza is a contagious respiratory disease caused by influenza viruses, and the burden of severe disease is commonly seen in high risk populations. Influenza vaccination is an effective way to prevent influenza and its complications, especially for high risk populations. Although some countries have included influenza vaccine in their national immunization programs, influenza vaccination rates remain low globally in high risk populations. The influenza vaccine in China is still a non-immunization program vaccine that is voluntarily vaccinated at its own expense, and the influenza vaccine immunization strategy is different across the country. There is still a gap between the vaccination rate of the influenza vaccine and that of developed countries. It is an urgent problem to further optimize the whole population immunization strategy of influenza vaccine in China, strengthen the publicity of the whole population immunization strategy of influenza vaccine, and reduce the disease burden of influenza in China.

Objective To compare the efficacy of transversus fascia plane block combined with rectus sheath block(TFP-RSB)and transversus fascia plane block(TFP)in alleviating postoperative pain and in-flammation in patients with type 2 diabetes undergoing gynecologic laparoscopic total hysterectomy.Methods A total of 90 patients with type 2 diabetes who underwent gynecologic laparoscopic total hysterecto-my in the Second Hospital of Shanxi Medical University from December 2021 to September 2022 were ran-domly divided into the TFP-RSB group(n=30),the TFP group(n=30),and the blank control group(n=30).The TFP-RSB group received ultrasound-guided TFP-RSB for postoperative analgesia,and the TFP group received TFP block after surgery.The drug was 0.375％ropivacaine.Both groups received combined with pa-tient-controlled intravenous analgesia(PCIA)and those in the control group were treated with PCIA only.The efficacy of perioperative analgesia,postoperative sleep quality and Visual Analog Scale(VAS)scores at 6 h,12 h,and 24 h after operation were compared among the three groups.The levels of IL-6 and Apelin-13 were measured before surgery and at 6 h,12 h,and 24 h postoperatively,and blood glucose was measured at 6 h,12 h,and 24 h postoperatively.Results The blood glucose levels at 6 h,12 h,and 24 h after operation in the TFP-RSB and the TFP groups were lower than those in the blank control group(P＜0.05).The blood glucose in the TFP-RSB group was lower than that in the TFP group at each time point after operation(P＜0.05).There was no statistical difference in the dosage of sedatives and analgesics used during surgery between the TFP-RSB group and the TFP group(P＞0.05).VAS scores at 12 h and 24 h postoperatively were generally lower in the TFP-RSB group compared to the TFP group(P＜0.05),as well as compared to the blank control group(P＜0.05).There was no significant difference in VAS scores at 6h postoperatively between the TFP-RSB and TFP groups(P＞0.05),but both were lower than the blank control group(P＜0.05).The con-sumption of sufentanil at 24 h postoperatively was slightly lower in the TFP-RSB group than in the TFP group(P＜0.05).The PQSI sleep quality in the TFP-RSB group was better than that in the TFP and the blank control groups(P＜0.05).The levels of inflammatory factor IL-6(at 6 h,12 h,and 24 h postoperative-ly)were generally lower in the TFP-RSB group compared to the TFP group and the blank control group(P＜0.05),with no significant difference between the TFP group and the blank control group at 24 h postopera-tively(P＞0.05).Apelin-13 levels were lower at all postoperative time points compared to preoperative levels in all three groups(P＜0.05).Serum Apelin-13 levels at 6 h,12 h,and 24 h postoperatively were lower in the TFP-RSB group than in the TFP group(P＜0.05),and both were lower than the blank control group(P＜0.05).The incidence of postoperative nausea and vomiting was lower in the TFP group(26.6％)than in the blank control group(50.0％),but the difference was not statistically significant(P＞0.05).The incidence in the TFP-RSB group(3.3％)was lower than in the TFP group(26.6％)and the blank control group(50.0％),P＜0.05.Conclusion Compared with TFP block,TFP-RSB block has better postoperative analge-sia effect,less blood glucose fluctuations,and more obvious inhibitory effect on inflammatory response in dia-betic patients undergoing gynecological laparoscopic total hysterectomy.