Carcinoma of pancreas is the most common primar y pancreatic malignancy. Symptoms usually are nonspecific and include abdominal pain, jaundice, loss of appetite, weight loss, nausea, and vomiting. CT usually demonstrates a mass with ill-defined margins but also solid components and dil atation of the main pancreatic duct. This tumor is usually smaller and virtuall y never contains calcification. Following contrast material administration,all masses were enhanced less than the surrounding pancreas. Tumors were oval, rou nd or lobular,and is almost always locally invasive. These features can be used to differentiate carcinoma of pancreas from other pancreatic tumors.

Objective To analyze the expression and the role of Toll-like receptor 4 (TLR4) and the effect of N-acetylcysteine (NAC) on hepatic ischemia- reperfusion (I/R) injury.Methods The rat model of 45 min hepatic ischemia followed by 24 h reperfusion was used. Animals were divided into 3 groups: the pseudoperated control group (P), I/R group and treated group with NAC at a dose of 300 mg/kg at 5 min before reperfusion (I/R-NAC). Plasma concentrations of ALT, AST and lipopolysaccharide (LPS) at various time points were measured. The expression of TLR4 protein and mRNA was detected in liver tissue by using immunohistochemistry and RT-PCR.Results The TLR4 expression, plasma ALT, AST and LPS levels were markedly increased during 45 min hepatic ischemia and 24 h reperfusion, but they were lower in I/R-NAC group and no alteration almost in group P. The plasma concentrations showed a significant correlation between ALT, AST and LPS at different time points in I/R group and I/R-NAC group.Conclusion LPS and TLR4 play a prominent role in the pathophysiological processes of I/R and NAC can be of therapeutic potential for reducing the expression of TLR4 mRNA and alleviating endotoxemia derived from gut.

Objective To analyse the clinical characteristics of drug-fever caused by ?-lactams antibiotics and provide the basic information for diagnosis of patients with drug-fever,and profile the drug fever due to antimicrobil agent.Methods In this study,64 hospitalized cases between 2000 and 2006 were enrolled who had drug-fever during antiinfective treatment.Results Most medications can cause fever,so as ?-lactams Antibiotics,with or without concomitant clinical manifestations.The fever could arise from the drug's pharmacologic action,its effects on thermoregulation,a local complication following parenteral administration,or an idiosyncratic response.Patients with drug-fever caused by ?-lactams,their temperature droped to normal level while ?-lactams discontinued for about 24h~48h,and without any linger effect.Conclusions Drug-fever is mainly caused by ?-lactams antibiotics like piperacillin sodium.It is important that doctors should bear the drug-fever in mind to avoid misdiagnosis.

Objective To properly choose and employ an air disinfect-purifying machine in ICU. Method This paper analyses the principle of air disinfect-purifying machine and put forward some attention-deserved problems such as the value of CADR in clinical application. Conclusion. The disinfect-purifying machine with different CADR value should be chosen according to the area of air disinfect-purifying district, thus can really bring the machine into full play.

Objective To discuss the practical application effect of the work process oriented teaching model that based on flipped classroom in the teaching of higher vocational Chinese medicines.Method We chose 97 students from Grade 2012 higher vocational Chinese traditional medicine,set them into experimental group (47 students) and comparison group (50 students).The experimental group was applied with the flipped classroom teaching,combined with the teaching mode of working process and the comparison group was applied with the traditional teaching mode from September 2014 to July 2015.At the end of the experiment,through the questionnaire survey,the differences of the experimental group students' autonomous learning ability and problem solving ability were compared between before the experiment teaching and after the teaching.The difference of post adaptation ability of the experimental group and the control group was also compared,and besides,the students' satisfaction degree to flipped classroom combined with working process teaching mode was investigated and analyzed.SPSS 16.0 software was used for statistical analysis,and t test was used to compare two groups' measurement information and count data with chi-square test.Result The score of independent learning ability after teaching in the experimental group was significantly higher than before [(77.50 ± 7.10) vs.(88.51 ± 9.30);t=6.451,P=0.000].However,there was no statistically significant difference in problem-solving capability before and after the teaching[(83.70 ± 2.32) vs.(84.30 ± 2.11);t=1.312,P=0.193].The score of five aspects of the adaptability to work in the experimental group and total score were higher than the comparison group and the difference was statistically significant [work attitude (18.72 ± 2.01) vs.(16.78 ± 3.33),t=3.447,P=0.001;service ability (17.99 ± 1.98) vs.(16.05 ± 2.15),t=4.614,P=0.000;professional ability (18.19 ± 2.46) vs.(15.37 ± 2.79),t=5.267,P=0.000;completion of work (19.01 ± 1.75) vs.(16.88 ± 1.83),t=5.851,P=0.000;strain capacity:(18.33 ± 2.09) vs.(17.01 ± 2.46),t=2.839,P=0.006;the total score of job adaptability (92.24 ± 3.89) vs.(82.09 ± 4.05),t=12.574,P=0.000].Experimental group's satisfaction showed that 91.48％ of students liked the teaching model,87.23％ thought that it improved their learning interest,82.98％ believed that it was beneficial to improving their communication skills.Conclusion Teaching mode of flipped classroom combined with working process helps to improve teaching quality.

Objective To observe the clinical efficacy ofToutongning Formula in the treatment of migraine. Methods Totally 100 cases of migraine patients (wind disturbance, blood stasis syndrome) were randomly divided into two groups. Patients in the experimental group were treated withToutongning Formula orally, and patients in the control group were treated with flunarizine capsules 5 mg orally, for 30 d. The scores of number, degree, duration and accompanying symptoms of episodes before and after treatment were observed, the total scores were calculated, and adverse reactions were recorded, to evaluate the clinical efficacy and safety.Results Clinical total efficiency was 92.0% (46/50) in experimental group and 64.0% (32/50) in the control group; the incidence rate of adverse reactions was 20.0% (10/50) in experimental group and 80.0% (40/50) in the control group; there was statistical significant differences in efficacy and adverse reactions between the two groups (P<0.05). After the treatment, the differences in the scores of number, degree, duration and accompanying symptoms of episodes, and in the total scores between the two groups was statistically significant (P<0.05). There was statistical significance in the different value of above indexes before and after treatment between the two groups (P<0.05).ConclusionToutongning Formula can not only improve symptoms significantly in patients with migraine (wind disturbance, blood stasis syndrome), but also reduce adverse reactions, with more safety and efficacy than flunarizine capsules.

Objective To investigate the causes of hearing loss for people over 60 years old. Methods People more than 60 years old in 14 provinces, 22 districts were investigated with a self-designed questionnaire, and a hearing test was also done for every subject. Results Among all the subjects, the etiological factors of hearing loss were otitis media (10.5%), hereditary deafness (2.9%), noise-induced hearing loss (3%), ototoxic deafness (6.4%), traumatic deafness (2%), presbycusis (33.8%), sudden deafness (1%) and other reasons (36.2%), respec-tively, with 11.3%unknown. Conclusion Presbycusis is the main reason of hearing loss for old people, and otitis media is the second. The cause of hearing loss is different with ages, districts, and whether in rural areas.

Objective:To explore dynamic change of heart rate variability (HRV) before and after circumferential pulmonary vein ablation (CPVA ) in patients with paroxysmal atrial fibrillation (PAF) and its relationship with postoperative recur‐rence .Methods:A total of 108 PAF patients undergoing left atrial circumferential pulmonary vein electrically isolated ra‐diofrequency ablation were selected .According to 12‐lead DCG on 3d and three months after operation ,patients were di‐vided into early recurrence group (n=10) ,late recurrence group (n=21) and no recurrence group (n=77) .HRV changes were followed up and compared among all groups .Results:Compared with before ablation ,on 3d after ablation ,there were significant reductions in standard deviation of normal to normal RR intervals calculated over the 24 h period (SDNN) , standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording (SDANN) ,root‐mean square of differences betweensuccessive normal to normal intervals (rMSSD) ,low frequency (LF) ,high frequency (HF) in no recurrence group ;significant rise in mean heart rate ,and significant reductions in SDNN ,LF and LF/HF in early recur‐rence group ( P< 0.05 or <0.01);compared with no recurrence group ,there were significant rise in mean heart rate [(69.3 ± 11.2) beats/min vs .(75.4 ± 14.0) beats/min] ,SDANN[(66.9 ± 25.7)ms vs .(137.5 ± 92.3)ms] ,rMSSD [(22.1 ± 10.6)ms vs .(46.2 ± 19.2)ms] ,LF [(233.1 ± 31.4)ms vs .(251.7 ± 17.3)]and HF[(228.0 ± 82.4) ms2 vs . (508.0 ± 13.5) ms2 ] ,and significant reduction in LF/HF[(1.13 ± 0.53) ms2 vs .(0.41 ± 0.13) ms2 ]in early recurrence group (P<0.05 or < 0.01);significant rise in rMSSD [(23.9 ± 11.10) ms2 vs .(52.0 ± 28.7) ms2 ]and HF[(344.4 ± 103.2) ms2 vs .(482.1 ± 100.6) ms2 ] ,and significant reduction in LF/HF[(1.16 ± 0.41) vs .(0.85 ± 0.43)]in late recur‐rence group , P<0. 05 or <0. 01. Conclusion:Vagal tone reduction may reduce recurrence after CPVA in PAF patients .

Anti-endothelial cell antibodies (AECA) are heterogeneous autoimmune antibodies, which target at a group of antigens expressed in endothelial cells. In 1971, AECA was reported by Lindquist and Osterland for the first time. Since then, an increasing number of researches have showed that AECA exists and plays potential pathogenic role in the immune or inlfammation-related diseases, especially in systemic vasculitis. AECA may be a useful sera marker for the diagnosis and prognosis judgment of related autoimmune diseases. In this review, we summarize the recent progress on the relationship between AECA and systemic vasculitis.

ObjectiveUsing the single cell fluid to establish a kind of practical experimental method,to detect the HER-2 gene and protein of breast cancer,and to provide reliable basis for pathology diagnosis.MethodsThe single cell fluid of breast cancer was preparaed by Medimachine system.Sucking a little of the single cell fluid spreaded on the slide and to be examined by immunohistochemistry using antibodies to HER-2 and fluorescence in situ hybridization.ResultsThe cell membrane of breast cancer was positive for HER-2 by immunohistochemistry according to American society of clinical oncology of American pathologists guideline recommendations for HER-2 testing in breast cancer and the HER-2 gene of the single cell amplified obviously by fluorescence in situ hybridization which the ratio of the average of HER-2 and the average of CEP17 exceeded 2.2.ConclusionThe single cell fluid could be used as positive control when we detected the HER-2 gene or protein of breast cancer,which guaranteed the correction of the results of the sample to be detected.