Objective To investigate the feasibility of spleen-and splenic vessels-preserving laparoscopic distal pancreatectomy for the treatment of pancreatic cystic tumor of body and tail.Methods The clinical data of a female patient with pancreatic cystic tumor of body and tail who was admitted to the Sun Yat-Sen Memorial Hospital of the Sun Yat-Sen University in March 2013 were retrospectively analyzed.Spleen-and splenic vesselspreserving laparoscopic distal pancreatectomy was determined as the optimal therapeutic method according to the physical examination and the results of computered tomography scan.Laparoscopic or open operation combined with distal pancreatectomy and splenectomy would be carried out as a candidate choice once it is hard to separate the splenic artery and vein from distal pancreas or to control the serious vessels hemorrhage.The patient was followed up by outpatient examination every 1 to 3 months up to March 2015.Results Spleen-and splenic vessels-preserving laparoscopic distal pancreatectomy was finished successfully.The operation time and volume of intraoperative blood loss were 192 minutes and 50 mL,respectively.The patient took out-of-bed for activity at postoperative day 1 without complications.The multiple severe microcystic pancreatic adenoma was confirmed by postoperative pathological examination,with a maximum diameter of 3.5cm.The leakage tube was removed at postoperative day 5.The levels of serum amylase at postoperative day 1,3,5 were normal.The patient was discharged at postoperative day 8 and got regular follow-up without bleeding,pancreatic fistula,infection and a symptom of epigastric pain or discomfort.Conclusion Spleen-and splenic vessels-preserving laparoscopic distal pancreatectomy has advantages of less traumas,faster postoperative recovery and a preservation of normal splenic function,deserving clinical application.

Objective To observe the clinical efficacy of duloxetine in the treatment of malignant neuropathic pain with depression.Methods 60 patients were randomly divided into two groups as study group(30 cases) and contrdl group(30 cases) and treated for 4 weeks.The patients of study group were treated with duloxetine and oxycontin,and the patients of control group were treated with oxycontin only.Numberical rating scale (NRS) on pain,criteria of pain relief and Hamilton depression scale(HAMD,17 items) score were used to assess the therapeutic effect before and after treatment.Results By the end of the fourth week of treatment,the average usage of oxycontin of the study group was significantly less than control group((45.6±8.5) mg vs (88.2±5.2)mg,P＜0.05).The effective rate of pain relief in the study group was significantly higher than that in control group (93.3％ vs 73.3％,P＜0.05).Comparing pre-treatment,the score of HAMD of the study group had a remarkable decrease ((11.45±4.56) vs (23.07±5.47),P＜0.01).In comparison to the score of control group,study group had a significant effect ((11.45±4.56) vs (18.75±4.21),P＜0.01).Conclusion Duloxetine is one of effective agents in the treatment of malignant neuropathic pain with depression,which can alleviate depression and relieve pain.Duloxetine have mild adverse effects and good tolerance.

Esophagectomy and lymph node dissection are the cornerstones for the treatment of esophageal cancer. Upper mediastinal lymph node dissection is of great value for accurate staging and improving the prognosis of patients. Lymph node dissection along the left recurrent laryngeal nerve is the most challenging procedures in esophageal surgery, and there has been no relevant consensus on the scope and boundary of lymph node dissection. In recent years, with the application of endoscopic technology, especially robotic surgery system in esophagectomy, and the introduction of the concept of superior mediastinal microdissection, the authors have proposed the border of lymph node dissection along the left recurrent laryngeal nerve, so as to achieve precise, radical and standardized dissection. Combined with their own experiences, the authors elaborate on the anatomic boundary, extent and technique of lymph node dissection along the left recurrent laryngeal nerve.

For decades,there have been no systematic studies on the reference intervals of Chinese populations.With the support of the Ministry of Health,the Chinese Society of Laboratory Medicine launches a research project investigating the Chinese reference intervals for common clinical laboratory tests.Up to now,the first batch of reference intervals for common liver function,electrolytes and blood cell analysis have been published in forms of healthy professional standards.Medical institutions are suggested to use these new reference intervals in clinical practice.

Objective To compare and analyze the dosimetric characteristics of the intensity-modulated arc therapy (RapidArc) combined with active breathing coordinator (ABC) in the thoracic esophageal carcinoma radiation therapy. Methods Ten thoracic esophageal carcinoma patients undergoing radiotherapy were selected for this study.The CT simulations were performed under three breath patterns respectively:moderate deep inspiration breath-hold (mDIBH) with ABC aid; Set the trigger threshold to 80％ of the peak of the respiration curve; and free breathing (FB).Based on the corresponding CT image sets,three treatment plans were generated for each patient respectively:Arc-ABC( three small arcs),ArcFB (consisted of two coplanar full arcs) and IMRT-FB plan.The following dosimetric parameters were compared among different plans:D2％,D98％,V95,homogeneity index ( HI),conformal index ( CI ) the percentage of volume receiving dose of over x Gy (Vx),monitor unit (MU),control points and treatment time.Results The planning target volume ( PTV ) of FB was 376 cm3 which decreased to 260 cm3 after using ABC.For mDIBH and FB patients,the total lung volumes were 5964.6 cm3(35％ more than FB) and 3838.8 cm3 respectively; the heart volumes were 524.4 cm3 and 642.7 cm3 respectively. No significant difference was observed among Arc-ABC,IMRT-FB and Arc-FB in terms of D2,D98,V95,CI and HI.For Arc-ABC plans,there were significant decreases of radiation dose in total-lung's V10,V20,V30,V40 and mean lung dose ( F =4.38,5.34,4.07,3.89,4.28,P ＜0.05).Various dose decreases of heart V20,V3,V40,Dmean and spinal cord Dmax were observed,yet no statistically significant difference existed.The MUs and total control points of Arc-ABC plans were significantly lower than other plans ( F =26.86,12.56,P ＜ 0.05 ).Conclusions When thoracic esophageal carcinoma patients were treated with radiotherapy,the combined utilization of RapidArc and ABC can potentially decrease the volume of irradiated lung yet escalate the dose in target.

Objective To determine the methods and results of treating traumatic pseudoaneurysms in siphon segment of internal carotid artery(ICA)by interventional therapy.Methods Twelve cases of traumatic pseudoaneurysms in siphon segment of internal carotid artery were treated.The collateral circulation of Willis circle was observed after DSA.Different methods of treatment were applied according to the collateral circulation of Willis circle.Ten cases were treated by occlusion of ICA completely,1 case was embolized by guglielmi detachable coil(GDC)only.Results Nine of 12 treated by occlusion of ICA were cured.In the 3 cases who had poor collateral of Willis circle,one was cured by GDC embolization alone;one died 48 hours later after ICA occlusion though his consciousness and the activity of extremities were normal during the temporary balloon test occlusion(BTO)of ICA.One died during the training to improve the collateral of the Willis circle.Conclusion ICA embolization is feasible for treatment of traumatic pseudoaneurysms in siphon segment of internal carotid artery after evaluating the collateral circulation of Willis circle.

Objective To observe the clinical effect of drug moxibustion in the treatment of chronic obstructive pulmonary disease (COPD).Methods A total of 90 patients with acute myocardial infarction in Taihe Hospital emergency department were randomly divided into the control group (n=30) and the treatment group (n=90).The patients in the control group were treated with routine western medicine, while treatment group was treated with drug moxibustion on the basis of the control group treatment. Both groups were treated for 6 weeks.The pulmonary function was assessed, and the clinical effect was evaluated.Results The total effective rate was 86.7% (52/60) in the treatment group and 70.0% (21/30) in the control group. The difference between the 2 groups was statistically significant (χ2=6.059,P=0.048). After treatment, the forced expiratory volume in 1 second (FEV1) (1.07 ± 0.3l L vs. 1.05 ± 0.41 L,t=15.272) in the treatment group were significantly higher than that in the control group (P<0.01).Conclusions The drug-separated moxibustion can improve the curative effect and improve the lung function of patients with stable COPD.

Objective To investigate the prevalence of chronic non-communicable diseases among farmers,land less peasants and urban population in a certain area of Anhui Province,to explore the relationship between the lifestyles of landless peasants and their chronic non-communicable diseases.Methods A total of 761 valid questionnaires were collected by cross-sectional epidemiological study,including 119 farmers,259 landless peasants and 383 urban groups.The enumeration data was analyzed by x2 test and the measurement data analyzed by variance.The risk of chronic non-communicable diseases in each group was analyzed by Logistic regressions.Results General demographic characteristics showed that there were differences in three groups of people in the respects of drinking,eating habits and physical activity and other lifestyles (all P ＜ 0.05).Logistic regression analysis showed that the onset risk of hypertension and overweight obesity in the famer group and the landless peasant group was lower than that in the urban group,but higher than that in the peasant group.After adjusting for confounding factors,the prevalence of hypertension in the farmer group (OR =0.20,95％ CI:0.12-0.33) and the lost land group (OR =0.65,95％ CI:0.44-0.95) was lower than that in the urban group,the overweight obesity in the farmer group (OR =0.44,95％ CI:0.27-0.74) and the lost land group(OR =0.67,95％ CI:0.47-0.96) was lower than that in the urban group.The incidence of atherosclerosis in the farmer group (OR =2.48,95 ％ CI:1.45-4.23) and the lost land group(OR =2.00,95％ CI:1.33-3.02) was higher than that in the urban group.Conclusions The living style of landless peasants is different from those of rural group and urban group,and the incidence of hypertension and overweight obesity is higher than that of farmers.We should take interventions against chronic non-communicable diseases in landless peasants.

Objective To explore the treatment and efficiency of high blood flow vascular malformations of oral maxillofacial region with super-selective arterial embolization. Methods 18 cases underwent angiography of the head and neck before treatment and then followed by super-selective catheterization with microcatheter to embolize the feeding vessels of the vascular malformations with PVA. 8 cases underwent surgical excision within 72 hours after the embolization and the other 10 cases passed through the arterial radical emboliztion treatment. Results Technical success ratio reached 100% with no complications causing skin necrosis or incorrect arterial embolization else where in the skull. All 8 cases undergone preoperative embolization showed obviously less bleeding, easier removal of the mass and reduction of operation time. 10 cases with radical arterial embolization manifested reduction of swelling and improvement of organ function within 1 to 24 months after the procedure. 5 patients were cured with only once operation, 4 cases with twice operation and 1 with the thrice. Conclusions Aterial embolization is a safe and effective method in the treatment of high blood flow vascular malformations of oral maxillofacial region.

Objective To research the feasibility of using three-dimensional CT (3DCT) associated with active breathing control (ABC) in determination of the individual internal tumor volume (ITV) for hepatocellular carcinoma (HCC) comparing the four-dimensional CT (4DCT).Methods After 4DCT scans of 15 HCC patients who had accepted TACE,completed the 3DCT scans associated with ABC in three ways of breathing:free breathing ( FB),end inspiration hold ( EIH),end expiration hold (EEH).4DCT images were sorted into 10 phases and the maximum intensity projection (MIP) images were constructed.The GTVs were manually contoured on 4DCT and 3DCT images (labeled as GTV0,GTV10.….GTV90,GTVMIP,,GTVFB,GTVEIH and GTVEEH).GTV0…GTV90,GTV0 and GTV50,GTV0,GTV20 and GTV50,GTVEIH and GTVEEH were respectively merged into IGTV1,IGTV2,IGTV3,IGTV4.The volume and geometry displacement of GTVs and IGTVs were compared.Results All patients were compatible with the ABC technique and completed the CT scans in two ways.The motion of diaphragm measured between 4DCT and 3DCT images was not significantly different ( 1.39 cm and 1.39 cm,t =-0.02,P =0.983 ),it was similar to the volume difference among GTV0,GTV20,GTV50,GTVEIH,GTVEEH and GTVFB (56.4,54.6,55.5,55.6,55.2,59.7 cm3,F =0.01,P =1.000 ).The comparison result of volume difference among IGTV1,IGTV2,IGTV3,IGTV4 and GTVMIP (77.9,71.4,73.4,72.3 and 66.3 cm3,F =0.02,P =1.000)were similar to the differences of geometry displacement in x,y and z axial among them (F =0.48,0.04,0.02,P =0.750,0.997,0.999,respectively).Conclusion The application of 3DCT associated with ABC in determination of the individual IGTV for HCC is feasible and safe comparing to 4DCT.