With the advances in techniques of localization, numerous minimally invasive parathyroid surgery were developed including open minimal incision and endoscopic approaches. According to the research results and the experiences from Peking Union Medical College Hospital, the indication and preoperative preparation were discussed in this paper. Some suggestions were given for minimally invasive parathyroid surgery in China.
Beijing ; China ; Humans ; Minimally Invasive Surgical Procedures ; Parathyroidectomy ; methods ; Preoperative Care

Hedgehog (Hh) signaling is critical for embryonic development and in differentiation,proliferation,and maintenance of multiple adult tissues.Deregulation of the Hh pathway is associated with Multiple pathological steps of PDAC(Pancreatic ductal adenocarcinoma).A prominent desmoplastic stromal reaction is the pathological hallmark of PDAC,it contributes to the formation of the hypovascular and hypoxic microenvironment of PDAC.And Hedgehog signaling is one of the most crucial pathways that maintains and activates the stroma.Clinical trials of Hedgehog signaling inhibitors in treatment of PDAC has been conducted,but results have been disappointing.Recently,to undercover the reason of the failure of clinical trial,more work has been done to uncovering the underlying role of stroma in PDAC.

Objective To discuss the sedative and hypnotic effect of Jiaotai Pills on insomnia in PCPA rat model .Methods The PCPA ( PCPA acid) rats insomnia model was established, and the rats were divided into the model group, high, middle and low dosage of Jiaotai Pills group, and diazepam positive control group.The high performance liquid detective method was adopted to observe the effect of Jiaotai Pills on rat insomnia and hypothalamus neurotransmitters 5-HT and GABA.Results Compared with the model group, there existed significant difference in the insomnia state of rats and the central neurotransmitters 5 -HT in the high and middle dosages of Jiaotai Pill group and diazepam group.However, in the comparison of the high and middle dosages of Jiaotai Pill group and the model group, there was no significant difference in GABA in the central nervous system .Conclusion Jiaotai Pills has sedative and hypnotic efficacy.Its mechanism may be related to the effects of central neurotransmitter 5 -HT.Its relationship with GABA in the central nervous system is not obvious.The research has significant influence on the further development of Jiaotai Pills.

Objective To retrospectively analyze the factors associated with the occurrence of occupation exposure in 75 medical workers,and to explore the effective intervention countermeasures.Methods The occurrence situation of the whole staff occupation exposure from January 2012 to December 2013 was retrospectively analyzed.Results In 75 medical personnel of occupation expo-sure,the nursing staff had the highest occurrence rate of occupation exposure,accounting for 81.33%,followed by doctors,account-ing for 13.33%;The major departments with the occupation exposure occurrence were the oncology,hematology and nephrology, accouting for 17.33%,followed by the general surgery(14.67%)and neurology(13.33%);the main links of occupation exposure were the used items settling after operating,accounting for 37.67%,followed by withdrawal of infusion needle,accounting for 37. 33%;the main instruments of occupation exposure were the injection needle(37.67%),followed by the infusion needdle(37.33%);top three of the occupation exposure source were unidentified source,negative pathogen and hepatitis B(48%,36%,12%);75 cases of occupation exposure did not develop infection after the timely wound treatment,preventive medication and regular follow-up. Conclusion Perfecting the occupation exposure management system,establishing and perfecting the occupation safety protection system,strengthening the training,increasing the overall occupation safety awareness,improving the nursing manpower shortage and standardizing the operation process are the effective measures and means for reducing the medical staff occupation exposure.

Multicellular spheroid (MCS) can simulate many aspects of the in vivo physiological and pathological conditions in many aspects,better reflect the in-vivo behavior of cells in tumors.So it's increasingly accepted as a valuable tool for evaluating the efficacy of therapeutic intervention including chemotherapy,radiotherapy,immunotherapy and combined therapy.Various spheroid co-culture approaches have been presented to study heterologous cells interaction in solid tumors.The present review briefly introduces the methodology and applications of MCS with focus on the up-to-date information.

Pancreatic cancer is one of the most malignant cancer of all neoplasm.85% cases are not suitable for surgery when at first counsultation to doctors.The effects of chemotherapy and radiotherapy are not satisfactory either.With the advancement of the study of molecular biology,the research of the molecular targeted drugs such as EGFR inhibitor and VEGF inhibitor,become one of the hot spots.This article reviews progress in the research of molecule-targeted therapy.

Pancreatic cancer is a highly malignant tumor.It is of great importance to improve the effectiveness of treatment by studying the mechanisms which lead to invasion and metastasis in pancreatic cancer.In some malignant tumors,tumor associated macrophage (TAM) plays an important role in tumor progression and invasion.TAM also plays an important role in pancreatic cancer which consists mainly of stromal elements.Research into the mechanisms for occurrence and development of pancreatic cancer,the role played by TAM as well as TAM transformation between the different phenotypes may bring a breakthrough in the treatment of pancreatic cancer.

Objective To investigate the feasibility of pancreatic cancer muhieellular spheroids in chemosensitivity study. Methods Pancreatic adenocarcinoma cell lines SW1990, PCT-3 and ASPC-1 were cultured in collagen gel. When the muhicellular spheroids were formed, the drug chemosensitivities of Fluorouracil ( 5-FU ), Gemzar ( GEM ) and Oxaliplatin ( OXA ) were detected by CD-DST and CCK-8 methods. The results were compared with those of scattered cells model. Results The chemosensitivities of three pancreatic lines in form of multicellular spheroids were significantly lower than those of scattered cells model (P < 0. 05). The inhibitory rates of 50 μg/ml 5-FU on SW1990, PCT-3, ASPC-1 were (53.96 ±4.32)% ,(58.49±5.98)%, (49.57±4.36)% ;the inhibitory rates of 25 μg/ml GEM on SWI990,PCT-3, ASPC-1 were (53.02 ± 4.06) %, (61.90 ± 4.80) %, (38.09 ± 4.88 ) % ;the inhibitory rates of 10 μg/ml OXA on SW1990, PCT-3, ASPC-1 were (57.33 ± 6.27 ) %, (50.90 ± 4.80) %, (47.26 ± 4.29) % ;which were significantly lower than those of scattered cells model ( P < 0.05 ). Conclusions In collagen gel, formation of the multicellular spheroids of pancreatic cells caused less chemosensitivity and promoted anticancer drug resistance, which was consistent with in vivo state.

Objective To summarize the clinical experience of diagnosis and treatment of solid-pseudopapillary tumor of pancreas(SPTP),and to work out the diagnosis and treatment process which matches the conditions of China.Methods The clinical data of consecutive 50 patients with SPTP who had been admitted to our hospital from January 2001 to March 2007 were retrospectively analyzed.Of all patients,3 were male and 47 female.Their median age Was 24 years(13-60 years).Preoperative imaging examination revealed typical findings and tumor markers were negative.SPIP of 23 cases were located in the head of pancreas,3 in the neck of pancreas,2 in the uncinate process of pancreas.3 in the body of pancreas,18 in the tail of pancreas,and the location of SPTP of 1 case was uncertain.Forty-eight patients underwent the operation of SPTP resection,1 of exploratory laparotomy and 1 of CT-guided fine-needle aspiration biopsy of metastatic lesions.Results Forty-nine out of 50 patients were diagnosed"pancreatic mass"preoperatively.Eighteen of the 32 patients with intact tumor capsule and 11 of the 16 patients without intact tumor capsule underwent operation without pathological examination.Thirty-two patients were followed up for 3-55 months,and no metastasis or invasion of the SPTP was observed.Conclusions Yong females are in the high risk group of SPTP.CT is the most valuable preoperative imaging test.Complete surgical resection is the first choice treatment with good prognosis.Resection of the head of pancreas with the preservation of duodenum and resection of body and tail of pancreas+splenectomy are the commou modalities used for the treatment of SPTP.The intactness of the tumor capsule is an important factor in making surgical plan and deciding the necessity of intraoperative frozen section pathological examination.The most common postoperative complication of SPTP resection is pancreatic fistula.

Objective To investigate the clinical characters of pancreatitis in patients with primary hyperparathyroidism (PHPT).Methods The clinical data of patients with PHPT undergoing parathyroidectomy from Jan.2009 to May.2014 in Peking Union Medical College Hospital were retrospectively analyzed for coexistent pancreatitis.Results 571 patients received parathyroidectomy due to PHPT during this period.Thirteen patients (2.3％)with PHPT were confirmed with coexistent pancreatitis by clinical manifestation and abdominal imaging evaluation,including acute pancreatitis in 9 patients and chronic pancreatitis in 4 patients.PHPT with pancreatitis was associated with preoperative serum intact parathyroid hormone(iPTH)higher than 500 pg/ml (P=0.025)and occurrence of hypercalcemic crisis (P=0.013).The age and sex of patients,preoperative serum calcium,gallstones,urinary calculi and bone fracture were not related with pancreatitis in this group.The average follow-up period for these patients was 34(ranging from 13 to 68)months.All patients were free from hyperparathyroidism recurrence.Only one young lady with chronic pancreatitis suffered from repeated pancreatitis after surgery.Conclusions Serum iPTH higher than 500 pg/ml and occurrence of hypercalcemic crisis were possible risk factor of pancreatitis in patients with PHPT.Parathyroidectomy can help to prevent the recurrence of pancreatitis in these patients.