ObjectiveTo review our experience in the diagnosis and surgical treatment of solid pseudopapillary neoplasm (SPN) of the pancreas which can be used as a reference for other doctors to avoid misdiagnosis and to provide a better treatment.MethodThe clinical,laboratory,radiological,pathological and operative data of 24 patients with SPN of the pancreas operated between February 2001 to December 2009 were collected and retrospectively analyzed.Results23 of 24 patients were female and the mean age was 31 years.The most common clinical presentations were vague abdominal pain and abdominal mass.In most cases,abdominal imaging showed a solid or a solid-cystic mass in the tail or head of pancreas.All patients received surgery.20 of 22 patients who received curative resection were alive with no evidence of tumour recurrence.One patient who had a R1 resection died 42 months after surgery.The remaining patient was alive after a second operation.ConclnsionsSPN of the pancreas is a tumour with low malignancy.A correct diagnosis of SPN of the pancreas is made on its clinical,radiological and histopathological characteristics.Radical surgical resection is the treatment of choice.For patients with an advanced disease,palliative resection is beneficial.

Objective To investigate the killing effect of hematoporphyrin derivative photedynamic therapy (PDT) on cultured human pancreatic cancer cell,and to explore the mechanism of this effect.Methods Biolitec PDT 630 semi-conductor laser therapeutic apparatus was used as the light source.After pancreatic cancer cell PANC1 was incubated 8 h with different concentrations of Photosan(hematoporphyrin derivative) as photosensitizer (0.5mg/L,1 mg/L,2 mg/L,4 mg/L),the cells were given different doses of 630nm laser irradiation(1 J/cm2' 5 J/cm~2,10 J/cm~2 ).The A492 value was determined in each group with MTT method.Cell apoptosis rate was detected by flow cytometry after PDT.Results There was no killing effect when no Photosan was administrated;10 J/cm~2 irradiation had killing effect on PANC1 when Photosan was administrated as 1 mg/L(0.140±0.013 vs 0.213±0.008,P＜0.05);5 and 10 J/cm~2 irradiation all had killing effect on PANC1 when Photosan was administrated as 2 mg/L (0.081±0.024 and 0.049±0.013vs 0.211±0.031,P＜0.05 and P＜0.01 );all doses of irradiation had killing effect when Photosan was administrated as 4 mg/L.There was no significant difference between 5 and 10 J/cm~2 irradiation in term of killing effect.Cell apoptosis rates with 0 or 2 or 4 mg/L Photosan and 10 J/cm~2 irradiation were(13.8±1.8) %,(40.9±1.6)%,(62.5±2.0)%,the difference was statistically significant(P＜0.05).Conclusions Photosensitizer or irradiation alone did not produce PDT effect.With certain dose of photosensitizer and irradiation,the PDT effect increased accordingly.

Objective To investigate the value of modified T staging system in the diagnosis and treatment of hilar cholangiocarcinoma (HCCA).Methods The clinical data of 95 patients with HCCA who were admitted to the Memorial Sun Yat-Sen Hospital from December 1995 to January 2010 were retrospectively analyzed.Based on the results of imaging examination,preoperative staging was determined according the modified T staging system.The prognosis of the patients in difference T stages were compared.The data were analyzed by using the chi-square test and Fisher exact test.The survival curve was drawn by Kaplan-Meier method and the survival rate was compared by using the Log-rank test.Results The diagnostic rates of ultrasound + magnetic resonance cholangiopancreatography (MRCP),ultrasound + computed tomography (CT) or spiral CT were 93％ (37/40) and 66％ (23/35),respectively.The diagnostic rates of ultrasound + CT or spiral CT and endoscopic retrograde cholangiopancreatography (ERCP),ultrasound + CT or spiral CT and MRCP were 14/15 and 15/15,respectively.Of the 95 patients,44 received operation (including 28 cases of radical resection and 16 cases of palliative resection),16 received exploratory laparotomy,and 35 received simple internal or external drainage.For patients in T1,T2 and T3 stages,the resection rates were 71％ (30/42),50％ (12/24) and 7％ (2/29),respectively,with significant differences (x2 =30.182,P ＜0.05).The negative rates of the resection margins of patients in T1 and T2 stages were 77％ (23/30) and 5/12,respectively,2 patients in T3 stage were found with tumor residuals at the resection margin.There was a significant difference in the radical resection rate among patients in different T stages (x2 =8.204,P ＜ 0.05).Of the 44 patients who received surgical treatment,30 (68％) received concomitant partial hepatectomy.The ratios of patients in T1 and T2 stages who received concomitant partial hepatectomy were 70％ (21/30) and 9/12,respectively,with no significant difference (x2 =0.101,P ＞ 0.05).Fourteen (32％) patients received tumor resection.The incidences of complications and perioperative mortalities were 53％ (16/30) and 10％ (3/30) for patients who received concomitant partial hepatectomy,and 5/14 and 1/14 for patients who received tumor resection,with no significant differences between the 2 groups (x2 =1.188,0.094,P ＞ 0.05).The median survival time of patients who received concomitant partial hepatectomy was 29 months,which was significantly longer than 19 months of patients who received tumor resection (x2 =11.317,P ＜0.05).Eighty-six patients were followed up,and the median time of follow up was 15.6 months (range,3-70 months).The 1-year cumulative survival rates of patients in T1,T2 and T3 stages were 73.8％,58.0％ and 9.2％,respectively,and the 3-year cumulative survival rates of patients in T1,T2 and T3 stages were 33.5％,12.1％ and 0,respectively.The median survival time of patients in T1,T2 and T3 stages were 24,16 and 7 months,respectively.The prognosis of patients was getting poor as the increase of the T stages (x2 =37.07,P ＜ 0.05).Conclusions The modified T-staging system is beneficial to preoperative evaluation of patients with HCCA.Concomitant partial hepatectomy could improve the radical resection rate and prolong the median survival time of HCCA patients.

Objective To explore the relationship of hepatocholangiocarcinoma and hepatolithiasis and to(increase) the early diagnosis of this disease.Methods The clinical data of 24 cases of(hepatocholangiocacinoma) associated with hepatolithiasis were retrospectively analyzed.Results The occurrence rate of hepatolithiasis concomitant with hepatocholangiocarcinoma was 2.8%(24 of 860 cases),and all of the tumors were located in the area of the bile duct with hepatolithiasis.Biliary atypical epithelial hyperplasia and cholangiocarcinoma were simultaneously present in some of the pathological sections.In this series,the correct diagnostic rate of hepatolithiasis associated with a space-occupying lesion in the liver before operation by ultrasonograph was 40.9%,by CT was 53.8% and by MRI/MRCP was 66.7%.17 cases(70.8%) were resected,and the radical resection rate was 33.3%(8/24).Palliative resection was done in 37.5%of cases(9/24).The 1-and 3-year survival rate was 62.5%,and(25.0)% respectively,in the group of radical resection;was 33.3% and 11.1% respectively,in the group with palliative resection;and 0% in the pathological biopsy group.Conclusions Long-term recurrent hepatolithiasis is an important cause for the development of hepatocholangiocarcinoma.The misdiagnostic rate of the disease was high,and the treatment results and prognosis were poor.It is important to pay more attention to the reasons for delaying the diagnosis of hepatolithiasis-related cholangiocarcinoma and take the appropriate preventative measures to assist in its early diagnosis.

AIM:To investigate the preparation techniques and anti-tumor effects both in vitro and in vivo of a novel nanoparticles control-releasing preparation of 5-fluorouracil(5-FU)by intravenous injection.METHODS:With polylactic acid(PLA)as marix materials,we adopted ultrasound emulsification method to prepare PLA enveloped 5-FU nanoparticles(5-FU-NPs).Scanning electricity microscopy was used to observe the morphology of 5-FU-NPs and laser optical scattering experiment was conducted to determine its diameter distribution.The drug-carrying capacity(ratio)of the nanoparticles was determined by means of high-power liquid chromatography(HPLC)and MTT test was used to observe cytotoxicity in vitro.The anti-tumor effects were determined at different dosages,frequencies of taking drugs in vivo.RESULTS:Scanning electron microscopy showed that the 5-FU-NPs were globular particles with smooth surface in an average particle diameter of 191.9 nm with a normal distribution,and the drug-carrying capacity of 5-FU-NPs was 15.2%.5-FU-NPs had the same anti-cancer effect as unenveloped drug in vitro and showed typical dose-effect relationship.Compared to naked 5-FU,5-FU-NPs presented significant difference(P

Objective To compare the effect of pericardial devascularization with that of the modified Sugiura procedure in management of portal hypertension. Methods From 1990 to 2008, 236patients with portal hypertension underwent operations including pericardial devascularization in 147and modified Sugiura in 89 in our hospital. Results There were 12 perioperative deaths (8.2 % ), and 2 rebleedings (2 % ) in the pericardial devascularization group, and 7 perioperative deaths (7.9 % ) and 2 rebleedings(3.4 % ) in the modified Sugiura group. The follow-up rate was 91.9 % in the pericardial devascularization group and 87.8% in the modified Sugiura group respectively, in a period from 6 months to 19 years. The 1-, 3-and 5-year rebleeding rates were 5.7%,15.2% and 25.5% in the pericardial devascularization group and 6.9%, 16.3%, 29.5 % in the modified Sugiura group, respectively. The 1-, 3- and 5-year survival rates were 87.8% ,79.1% and 69.7% in the pericardial devascularization group and 95.8 %,85.0%, 76.9 % in the modified Sugiura group, respectively. Conclusion Modified Sugiura procedure and pericardial devascularization have differences in perioperative mortality as well as rebleeding and survival rates.

Objective To explore the clinicopathological characteristics of pancreatic neuroendocrine neoplasms ( P-NENs) and the prognosis .Methods The clinicopathological data of 72 patients with P-NENs in Sun Yat-Sen Memorial Hospital from December 2011 to September 2017 were analyzed retrospectively , and the gender, age, tumor size, local infiltration, neural invasion and distant metastasis were collected .According to the diagnostic criteria of P-NENs ( Chinese edition 2013 ) , tumor classification was determined by histological mitotic figure count and cell proliferation index ( Ki67 ) proliferation activity .Expressions of Syn , CgA, NSE and CD56 were determined by immunohistochemical staining .Results Seventy-two patients with P-NENs were enrolled, including 33.3％male(n=24) and 66.6％ female (n=48), and the median age was 56 years old (range:12-76).24 patients (33.3％) were NET G1,44 patients (61.1％) were NET G2 and 4 patients (5.6％) were NET G3.The mean size of tumor was 38.2 ±19.2 cm3 ( range:0.1-371 cm3 ). Immunohistochemistry staining positive rates for Syn , CgA, NSE and CD56 were 98.6％, 95.8％, 88.9％and 90.3％ respectively.Tumor classification was correlated with tumor size , local infiltration, perineural infiltration and distant (liver) metastasis (all P<0.05).There was no statistically significant differences on positive rate of Syn, CgA, NSE and CD56 among G1, G2 and G3.Conclusions Tumor classification, size, local invasion , perineural infiltration and distant ( liver ) metastasis were all important clinicopathological features and prognostic factors of P-NENs.Syn, CgA and Ki67 were essential immunohistochemical markers to diagnose P-NENs.

Objective To investigate the effect of implementing dynamic post management in the emergency day ward, which has plenty of urgent, time-concentrated work every day.Methods In January 2015, the Cangzhou Central Hospital Nursing Department passed the plan that set a process for the dynamic post qualification requirements, screening test, the system training, quality control, performance evaluation, salary allocation in day ward and our nursing department created a perfect dynamic post management system. From December 2014 (before implementation) to December 2015 (after implementation), the effects were investigated from the patients' waiting time, the degree of satisfaction, the human cost, and the stability of the nursing team. Results After the implementation of the dynamic post management in the emergency day ward, the patients' waiting time decreased from (19.23±2.73)min to (10.14±1.18)min (t=93.09,P<0.01)and the degree of satisfaction increased from 85.45%(171/200) to 95.50%(191/200)with the differences of statistical significance (χ2=11.631,P<0.01). A total of 50 qualified nurses obtained qualification via admittance examination. We had arranged 820 classes and accumulatively worked 2300 hours, which had saved at least 10 of nursing personnel.Conclusions Dynamic nursing station is beneficial to the reasonable allocation of human resources and the stability of the nursing team.

Lateral position is a common surgical position in neurosurgery, it is also a susceptible position for pressure ulcers. The reasons not only consist of the common causes of general surgery, but also consist of unique factors due to its special position. The technique and rationality of body position placement is significant for the prevention of pressure ulcers. This article reviews the causes and preventive measures of pressure ulcers with lateral position in neurosurgery operation after consulting extensive literature. We will expound and analyze the way of body position placement, placement techniques of every part, selection of material for various body positions, and precautions of position nursing in perioperative period of lateral position surgery, etc. We hope to provide references for the prevention and management of pressure ulcers in neurosurgery operation with lateral position.

Objective To detect the application effect of position management process in patients with lateral position in the Department of Neurosurgery.Methods We recruited 506 patients undergoing elective neurosurgery posed lateral position from August 2015 to May 2016 in Cangzhou Central Hospital and divided them into control group and experimental group by their surgery date, with 253 cases in each group. The patients received routine method for position arrangement while patient in experimental group underwent position management process. The rate of ulcer and length of position arrangement were compared between two groups. Results The length of moving patients to the end of position arrangement required (11±4.25) min averagely in experimental group and (15±3.86)min in control group, and there was statistical significance between two groups (t=11.077,P<0.01). The ulcer happened 2 cases in experimental group and 7 cases in control group (P>0.05).Conclusions For patients with lateral position applied position management process in Department of Neurosurgery, it can improve work efficacy, reduce the complications of perioperative circulatory system, ulcer happened.