Pancreatic fistula, a common complication after pancreaticoduodenectomy, is a severe condition with a high mortality. Therefore, early diagnosis of this condition and effective prevention and treatment measures are essential. This article reviews the diagnostic criteria for pancreatic fistula, the risk factors for its development, and research advances in the prevention and treatment of pancreatic fistula.

AIM: To study and analyze the clinical effect of phacoemulsification and intraocular lens(IOL)implantation combined with goniosychialysis in treatment of acute angle-closure glaucoma with cataract.

METHODS: From June 2010 to October 2018, 40 patients(40 eyes)with acute angle-closure glaucoma and cataract which anterior chamber angle adhesion is less than 180°admitted to our hospital were enrolled in this study. They were divided into observation group and control group according to different surgical methods. The patients in the control group were treated by phacoemulsification and IOL implantation. The observation group was treated with phacoemulsification and IOL implantation combined with goniosychialysis. The difference between the two groups was compared.

RESULTS: At 3mo, 6mo after operation, the visual acuity, intraocular pressure, anterior chamber depth, anterior chamber angle grading of the observation group were better than those of the control group(P<0.05).

CONCLUSION: Regarding the treatment of acute angle closure glaucoma, who has cataract and less than 180° peripheral anterior synechia, phacoemulsification and IOL implantation combined with goniosychialysis showed significant clinical effect.

The choroidal neovascularization(CNV)secondary to pathological myopia is a common cause of irreversible central vision loss, with high incidence and serious impact on the quality of life of the patients. The traditional therapeutic modalities for CNV secondary to pathologic myopia include thermal laser photocoagulation, transpupillary thermotherapy, and photodynamic therapy with verteporfin. However, the long-term outcome of these treatments are disappointing. Recently, the intravitreal injection of anti- vascular endothelial growth factor(VEGF)treatment can improve the visual acuity and reduce the central retina thickness more effectively than the traditional method. Therefore, these anti-VEGF agents may become first-line drugs for the treatment of CNV secondary to pathological myopia. This review is aim to discuss the pathogenesis of myopic CNV, the molecular structure and mechanism of anti-VEGF drugs, and compare the therapeutic efficacy and safety of anti-VEGF drugs to CNV secondary to pathologic myopia.

Objective Loop mediated isothermal amplification(LAMP)was used to detect the distribution of pathogens in sputum samples,namely combined nucleic acid detection of respiratory pathogens(13 pairs),so as to provide provide reference for clinical accurate diagnosis and treatment.Methods A total of 1642 patients with lower respiratory tract infection admitted to Tongren City People's Hospital from January to December in 2022 were selected.Each patient collected sputum specimens/bronchoalveolar for detection by using LAMP(13 pairs).The detection of pathogenic bacteria in respiratory tract and the relationship with sex,age and season were analyzed.Results The overall detection rate of 13 respiratory pathogens was significantly higher in males than in females(P<0.01);In different age groups,the detection rates of Haemophilus influenzae and Streptococcus pneumoniae in patients aged 3-6,Mycoplasma pneumoniae in patients aged 6-18,and methicillin-resistant Staphylococcus aureus,Streptococcus maltophilus,and Klebsiella pneumoniae in patients aged over 60 were significantly higher than those in other groups(P<0.05);In different seasonal groups,Streptococcus pneumoniae and Chlamydia pneumoniae were more prevalent in spring,while Mycoplasma pneumoniae had the highest infection rate in autumn,and the differences were statistically significant(P<0.05).Conclusion LAMP can be used to detect the pathogen rapidly and provide the basis for clinical diagnosis and treatment.

Objective: To evaluate the effect of thoracic paravertebral nerve block (TPVB) at different time points on postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer. Methods: One hundred and fifty patients of both sexes, aged 25-64 yr, with body mass index of 18-24 kg/m², of American Society of Anesthesiologists physical status Ⅰor Ⅱ, scheduled for elective radical resection of lung cancer, were divided into 3 groups (n=50 each) by a random number table method: preoperative TPVB group (P₁ group), TPVB at the end of operation group (P₂ group) and preoperative TPVB combined with TPVB at the end of operation group (P₃ group). In group P₁, TPVB was performed at T_{4, 6} points on the affected side under ultrasound guidance before anesthesia induction, and 0.5% ropivacaine 10 ml was injected in total.In group P₂, TPVB was performed at T_{4, 6} points on the affected side under ultrasound guidance at the end of operation, and 0.5% ropivacaine 10 ml was injected in total.In group P₃, TPVB was performed at T_{4, 6} points on the affected side under ultrasound guidance before anesthesia induction and at the end of operation, and 0.5% ropivacaine 10 ml was injected each time.The analgesia pump was connected at the end of operation in three groups.The patients were followed up after operation, and 5 ml solution extracted from the analgesic pump was intravenously injected when VAS score was greater than or equal to 4.The occurrence of postoperative chronic pain in the 3 groups was recorded though telephone follow-up at 6 and 12 months after surgery, and the effect of pain on daily life and treatment measures were scored.A concise health-related quality of life scale was used to evaluate patients′ quality of life, and the physical and mental health scores were calculated. Results: There was no significant difference in the incidence of chronic pain at 6 and 12 months after surgery among the three groups (P>0.05). The physical and mental health scores were significantly decreased at 12 months after surgery than at 6 months after surgery in the three groups (P<0.05). Compared with P₁ and P₂ groups, the scores of effect of pain on daily life and treatment measures were significantly decreased, and the physical and mental health scores were increased at 12 months after surgery in group P₃ (P<0.05). Conclusion The combination of preoperative TPVB and TPVB at the end of operation can effectively improve postoperative long-term quality of life in the patients undergoing thoracoscopic radical resection of lung cancer.

Objective: To investigate the clinical application values of computed tomography (CT), ischemic modified albumin (IMA) and D-dimer (D-D) levels in the disease assessment of patients with acute pulmonary embolism (APE). Methods: From June 2015 to June 2018, 100 suspected APE patients in our hospital were selected as the study subjects, after the CT " gold standard" inspection, the 80 patients diagnosed with APE were as APE group, including 38 cases in high-risk group and 42 cases in low-risk group: 20 non APE cases and 60 healthy volunteers at the same time were selected as control group. The serum IMA level was detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA), and the plasma D-D level was detected by immunoturbidimetry. Receiver operating characteristc (ROC) curve was used to analyze the diagnostic values of IMA and D-D for APE disease. Results: The levels of IMA and D-D in APE group were significantly higher than those in non APE group and control group (P<0.05); the levels of IMA and D-D in non APE group were significantly higher than those in control group (P<0.05), while those in high-risk group were significantly higher than those in low-risk group (P<0.05); CT examination after admission was as the gold standard for diagnosing APE disease; ROC curve showed that, the area under curve (AUC) of D-D and IMA in diagnosing APE was 0.875 and 0.763, respectively, with corresponding sensitivity 90.01% and 93.87%, specificity 52.21% and 95.65% respectively; the AUC of IMA combined D-D level in diagnosing APE was 0.834, the sensitivity was 95.87%, and the specificity was 78.69%; the AUC of D-D and IMA in diagnosing high-risk APE was 0.950 and 0.914, respectively, with the corresponding sensitivity 97.21% and 93.98%, specificity 31.58% and 76.98%, respectively. The AUC of IMA combined D-D level in diagnosing high-risk APE was 0.958, with sensitivity 96.39%, specificity 76.87%. Compared with CT results, in the 80 patients diagnosed with APE, there were 4 patients with negative IMA and 6 patients with negative D-D, and the control group samples test showed negative IMA and D-D levels were all negative. The consistency of CT combine with D-D ( Kappa=0.734, P=0.000), and CT combine with IMA (Kappa=0.819, P=0.000) were good. Conclusions According to the results of CT examination, IMA combined with D-D level has a good sensitivity and specificity in the diagnosis of APE, which can effectively improve the diagnostic rate of APE diseases, and provide an important basis for clinical rapid and reliable detection and treatment of APE diseases.

Liver diseases are associated with complex abnormalities in the coagulation system as the liver is involved in the synthesis of various coagulation-related proteins. Laboratory and clinical evidence suggests that patients with liver disease may achieve a state of rebalanced hemostasis, but such balance is relatively unstable, and thus bleeding and thrombosis events are observed in clinical practice. Patients with acute or chronic liver diseases might be admitted to the intensive care unit (ICU) due to serious complications such as bleeding and thrombosis. Gastrointestinal bleeding, systemic or local thrombosis, and coagulation events in extracorporeal circulation are common complications observed in patients with liver disease in the ICU. An individualized management plan of thromboprophylaxis and a wait-and-see policy for limited blood transfusion are reasonable for patients with liver disease.

With the rapid development of surgery and the expansion of indications for surgical treatment ，the number of non-obstetric operations during pregnancy and infant operations has been increasing. Most of these operations need to be performed under general anesthesia，and the developing brain of fetus and infants are inevitably exposed to general anesthetics. Therefore，in recent years，the neurotoxicity effects of general anesthetics on the developing brain have become the focus and controversy in the medical sciences. Especially in 2016，US Food and Drug Administration（FDA）added black box for warning of general anesthetics commonly used in clinic，which caused confusion among doctors，patients and staffs in the related fields. Therefore，we will elaborate the preclinical and clinical studies of neurotoxicity of general anesthetics in combination with the characteristics of developing brain.

At present, several clinical practice guidelines for the treatment of osteoarthritis have been developed by institutes or societies. The ultimate purpose of developing clinical practice guidelines is to formulate the process in the treatment of osteoarthritis effectively. However, the methodologies used in developing clinical practice guidelines may place an influence on the transformation and application of that in treating osteoarthritis. The present study summarized the methodological features of individual clinical practice guideline and presented the tools for quality evaluation of clinical practice guideline. The limitations of current osteoarthritis guidelines of China are also indicated. The review article might help relevant institutions improve the quality in developing guide and clinical transformation.

Objective: To investigate the corrective effect of modified Brisson technique to treat concealed penis in children. Methods: From July 2015 to July 2017, 32 patients(3-10 years old, mean 7.2 years old )with concealed penis were treated with the modified Brisson technique in the Children′s Hospital of Zhengzhou University. All the children with concealed penis were treated by the modified Brisson technique, complications, postoperative results and followed-ups were retrospectively analyzed. Results: 32 cases of concealed penile children had pain on the postoperative day, 2 cases required patient controlled analgesia device. No infection and dehiscence were noticed after discharge. All the children were followed up for 6 months to 1 year, and the results were satisfactory. Review showed that the penile body was similar to the appearance after circumcision, with obvious extension exposure, normal exposure of penile scrotal Angle and penile pubic Angle, and no obvious retraction. The internal plate of the prepuce in 5 cases was slightly edema, and edema dissolved within 2 months. Conclusions Modified Brisson is a better method to treat concealed penis in children, which can correct the pathological structure and retain the integrity of penile skin to the greatest extent.