ObjectiveIn order to enhance the curative resectability rate of pancreatic carcinoma. MethodsSixteen consecutive patients received an extended resection, which is referred to systemic dissection of regional lymph nodes and combined resection of the diseased PV/SMV based on traditional Whipple operation or the distal pancreatectomy. ResultsMean operation time was 8.5 hours. Mean intraoperative blood infusion was 1250mL. The procedure was considered curative in 11 (68.8 % ) and palliative in the other five. Postoperative complications occurred in 7 (43.8% ). Perioperative death occurred in one patient(6.25% ). Median length of hospital stay was 35 days. In nine patients undergoing curative resection,two cases survived for 1/2～1 year, six patients survived for 1～2 year and another patient has survived for more than 32 months without evidence of recurrence. ConclusionExtended resection for pancreatic cancer is technically feasible and two- third of pancreatic carcinoma invading PV/SMV alone can be expected to obtain curative resecetion.

Objective To explore the risk factors analysis of infection after total hip replacement and its early diagnosis .Methods 86 patients with total hip replacement were selected ,the clinical data and surgical process were obtained retrospective ,to analysis the risk factors analysis of infection after total hip replacement .Results The age of infected patients with total hip replacement was significantly higher than non-infected patients (P< 0 .05) .The surgery time and postoperative drainage time in infected patients were significantly longer than non-infected patients(P<0 .05) .The risk of infection of patients who had long-term application of hormone ,complicated with diabetes mellitus ,history of hip surgery and lower serum albumin content were significantly higher (P<0 .05) .Intraoperative blood loss ,sex ,patient bone cement application and antimicrobial drug use had no obvious relation with post-operative infection(P>0 .05) .After the early diagnosis and treatment ,the joints function of infected patients were recovery good , and without serious effects .Conclusion The infection after total hip replacement is associated with a variety of factors ,it should give positive prevention in the clinical work .For suspected patients should be early diagnosis ,and should choose suitable treatment according to the patient′s specific situation .

Objective To investigate the effects of intrathecal (IT) ketamine on the synapsis remodeling in the spinal dorsal horn during devolopment of morphine tolerance in a rat model of neuropathic pain (NP). Methods Male SD rats weighing 200-250 g were used in this study. IT catheter was placed in the subarachnoid space according to Yaksh. Forty-eight SD rats in which IT catheter was successfully placed were randomly divided into 6groups (n=8 each): group sham operation (group S); group NP; group normal saline 20 μl IT(group NS);group morphine 20 μg IT (group M); group ketamine 50 μg IT (group K) and group morphine 20 μ g + ketamine 50 μg IT (group MK). NP was induced by compression of right L4,5 dorsal root ganglions with steel wire inserted through L4,5 intervertebral foramen in NP,M,K and MK groups. Normal saline or morphine and/or ketamine were injected IT once a day for consecutive 14 days. Paw withdrawal threshold (PWT) to mechanical stimulation and paw withdrawal latency (PWL) to a thermal nociceptive stimulus were measured on 0, 1, 3, 5, 7, 9, 11, 14 days during the consecutive 14 days of administration. The animals were sacrificed after the final IT administration. The lumbar segment of the spinal cord was removed for determination of the number of synapsis in the spinal dorsal horn by immuno-histochemistry in 4 animals in each group and observation of synaptic structure remodeling using electron microscope in another 4 animals in each group. Results Compared with group S, PWT was significantly decreased and PWL was shortened in the other 5 groups, and the number of synapsis was significantly increased and the synaptic structure was thickened in NP, NS, M and K groups (P ＜ 0.05). Compared with group NP,PWT was significantly increased and PWL was prolonged in M, K and MK groups, and the number of synapsis was significantly decreased and the thickness of synaptic structure was significantly reduced in group MK ( P ＜ 0.05).Compared with group M, PWT was significantly increased, PWL was prolonged, the number of synapsis was significantly decreased and the thickness of synaptic structure was significantly reduced in group MK ( P ＜ 0.05). Conclusion IT ketamine can inhibit the synaptic remodeling in the spinal dorsal horn during development of morphine tolerance in a rat model of NP.

Objective To study the effect of RF catheter ablation of verapamil-sensitive idiopathic left ventricular tachycardia according to the re-entrant route mapped during electrophysiologic test. Methods 6 patients (4 male & 2 female) suffered from the ioliopathic left venticulan tachycondia (ILVT). After placing the catheter in the right ventricular apex and the coronary sinus, a radiofrequency (RF) catheter and a octapolar catheter (mapping catheter) with an interval of 2-8-2 min were introduced through the right and left femoral arteries. The mapping catheter recorded the His potential (HP), the left bundle potential (LBP), the left posterior fascicle Purkinje potential (PP) and V electrogram sequentially, PP was the first potential to be detected with the RF catheter during TV, we searched for the earliest PP recording site near the couple of electrodes of the mapping catheter recording PP and ablated it. Results In the first 3 cases, ablation didn′t have effect at sites recording the earliest V electrogram without PP and it was finally successful at the sites recording the earliest PP. Since the fourth case all patients needed only one application because ablation was carried out only at the site recorded the earliest PP. Patients have been followed for 6-20 months without antiarrhythmic drugs, and none of them has had a recurrence of VT. Conclusion The mapping on the left ventricular septum is not only important to study the reentrant route in ILVT, but also helpful for clinical treatment of ILVT. It shortens the operation time and minimizes injury of cardiac muscle due to noneffective ablation.

0.05]. During the (6.5?2.4) month (range 1 to 10 months) follow-up, the angina incidence rate of the Firebird group was lower than the BMS group (21.0%, 35 5%, P

Objective To investigate the clinical value of intraoperative iodine-125 seed implanttation in treating pancreatic carcinoma. Methods Seventy-five patients (fourty-one men, thirty-four women;median age 54 years) with pancreatic adenocarcinoma were enrolled into the study. Thirty-one patients (group A) were accepted tumor resection,eighteen patients(group B) were implanted radioactive iodine-125 seeds into the tumors by a combination of bypass surgery, twenty-six patients(group C) were treated by bypass surgery.Results Sixty-seven patients were followed up. The median survival time was 19, 12 and 7 months in group A,B,C respectively, among which the difference was significant (P ＜ 0.05). The response rate(CR+PR) was 50 % and the effective rate of pain relieving was 80% in the group B. The 97.4 % of accordance rate of seed number was demonstrated by CT film, but the accordance rate of seed space distribution was only 56 %.Conclusion At present, the active resection of the pancreatic carcinoma, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection. The combination of Intraoperative iodine-125 brachytherapy and bypass surgery is safe and effective for pancreatic carcinoma.The seed space distribution completed by seed computer therapeutic plan needs further study.

Objective To investigate the efficacy and toxicity of low dose of docetaxel and cisplatin (TP) combined with radiotherapy in the treatment of elderly patients with esophageal cancer.Methods The data of 65 elderly patients with esophageal cancer were studied retrospectively, including 33 patients treated by TP combined with radiotherapy (chemoradiotherapy group) and 32 patients by radiotherapy only (radiotherapy group).Patients in both groups received 3D conventional radiotherapy (3D-CRT).In chemoradiotherapy group, 40 mg/1f docetaxel and 40 mg/1f cisplatin were administered once a week on the 1st, 8th, 15th, 22th, 36th day of five successive weeks.Results In chemoradiotherapy group and radiotherapy group, the response (CR+RR) rates were 87.8 ％ (29/33) and 65.6 ％ (21/32), respectively (P ＜ 0.05), the median TTPs were 5.5 months and 4.3 months, and the difference had statistically significant (P ＜ 0.05).The 1-year survival rate was 69.6 ％ and 59.3 ％ in chemoradiotherapy group and radiotherapy group, respectively, and there was no statistically significant difference between both groups (P ＞ 0.05).The incidences of esophagitis and gastrointestinal tract were slightly higher in chemoradiotherapy group than those in radiotherapy group (P ＜ 0.05).Conclusion Concurrent radiotherapy and chemotherapy with low dose TP can treat effectively esophageal cancer in elderly patients with the tolerable toxic reactions.

Objective To investigate the distribution and drug resistance of genital tract pathogens in pregnant women with premature rupture of membranes (PROM),and provide guidance for clinical rational use of antibiotics.Methods From 2011 to 2013,3 162 cases of patients with premature rupture of membranes were cultured for bacteria,Mycoplasma and Chlamydia.Identification and drug sensitive test of the bacteria were detected by VITEK II system;all of the data were ana-lyzed by WHONET5.6 software.Results The rate of infection was 33.30%,in which the positive rate of bacteria,Fung, Mycoplasma culture and Chlamydia trachomatis antigen detection were 13.19%,4.87%,24.89% and 2.72% respectively. The ratio of Escherichia coli producing extended spectrum beta lactamases (ESBLS)were 13.76%.The ratio of Methicillin resistant Staphylococcus aureus (MRSA)and Methicillin resistant coagulase negative Staphylococcus (MRCNS)were 27.27%and 66.25% respectively.Mycoplasma was most sensitive to minocycline,doxycycline.Conclusion Mycoplasma in-fection was the first,followed by bacteria.clinical should strengthen the surveillance of pathogen infection,and rational use of antibiotics according to the results of drug sensitive test.

Objective To evaluate the methylation status of RASSF2A in epithelial ovarian cancer (EOC) tissues and plasma, and to explore the correlations in two kinds of samples with clinicopathological characteristics. Methods The frequency of methylation of the RASSF2A gene in tissues and corresponding plasma samples from 60 EOC patients, 20 patients with benign ovarian tumors and 10 patients with normal ovarian tissues were detected respectively. The methylation-specific PCR was used to determine the methylation status. Results The frequency of aberrant methylation of RASSF2A was 58.3% (35/60) in EOC tissues and 43.3%(26/60) in corresponding plasma samples respectively, however, such hypermethylation was not detected in the benign ovarian tumors and normal ovarian samples, and there was significant difference between them (P<0.05). Besides, RASSF2A methylation levels in serum of EOC patients correlated reasonably well with methylation status in tumor samples (r=0.739, P=0.000). No significant differences were observed between the promoter hypermethylated status of the RASSF2A and clinicopathological characteristics (P>0.05). Conclusions The promoter methylation of RASSF2A gene is an early and frequent epigenetic event in EOC. Detection of promoter hypermethylation in plasma specimens can help the early diagnosis of EOC.

The high incidence of postoperative recurrence of hepatocellular carcinoma ( HCC) is a most difficult obstacle for improving the prognosis of patients.Several adjuvant modalities have been developed to prevent recurrence in patients after surgery; nevertheless , there is no consensus regarding the standardized adjuvant therapy in terms of indications , clinical efficacy and interactions.In this article we review the currently available evidence in the medical literature on adjuvant therapy in HCC after radical resection.