Objective To investigate the effect of standardization regional lymphadenectomy in radical resection of ductal adenocareinoma in the pancreatic head.Methods On the basis of routine panereaticoduodenectomy(whipple proceduce),we performed the standardization regional lymphadenectomy,the emphasis of the procedure was the resection of wide nodes,particularly the mesenteric root lymph nodes(14abcd),the paraaortic lymph nodes(16a2b1),the hepatoduodenal ligament lymph nodes(12abpeh),hepatic artery(Group 8)and coeliacus lymph nodes(Group 9). Results Eleven patients underwent this procedure,there was no operative mortality,1 case occurred pancreatic fistula,the lymph nodes metastasis occurred in 7(63.6%)patients,the posterior pancreaticoduodenal lymph nodes(Groupl3)and superior mensenteric artery(Groupl4)was the predominant metastatic site of the tumor,the rate of the second site metastasis to lymph nodes was 57.1%.of the 11 cases follow-up 1 died. Conclusion The radical pancreaticoduodenectomy combined with wide resection of standardization regional lymph nodes is a safe and effective procedure of the treatment of adenocarcinoma of the head of the pancreas.but the long-term survivalrate must be valued objectively with many cases.

Objective To explore the antibacterial activity of garlic solution against Campylobacter jejuni,and to provide theoriti-cal basis for further utilization of garlic.Methods Mashed garlic and extracted garlic solution.Antimicrobial susceptibility was de-termined by usig K-B disk diffusion test and broth dilution method.Results The minimal inhibitory concentration(MIC)of garlic solution against campylobacter jejuni was 40%.It showed positive correlation between bacteriostatic effect and concentration of gar-lic solution.Conclusion Garlic solution has strong bacteriostasis function to campylobacter jejuni.

Objective To investigate the effect of Site-Rite 5 vascular ultrasound on puncturing of grade Ⅱ and Ⅲ veins.Methods Purposive sampling was used and 59 patients with grade Ⅱ and iⅢ veins to receive peripheral intravenous catheteration (PIV) were divided into observation group and control group according to the different wards:30 patients in the observation group and 29 in the control group.The control group received indwelling PIV by routine method and in the observation group,the patients' veins were assessed by Site-Rite 5 ultrasound-guided instrument and marked,followed by puncturing with PIV.The two groups were compared in terms of one-time success rate and incidence of complications.Results The one-time success rate of the observation group was significantly higher than that of the control group.There was no significant difference in the incidence of complications between the two groups (P ＞0.05).Conclusions By the Site-Rite 5 ultrasound-guided instrument,the invisible veins become visible.It is beneficial to improve the success rate of puncturing.

Objective To investigate the diagnosis and treatment of mucin-producing intrahepatic biliary tumor (MPIBT).Methods We retrospectively analyzed the clinical,radiologic,surgical and pathologic findings of 16 MPIBT cases from January 2004 to December 2011.Results There were six men and ten women,age ranged from 44 to 69 years (mean 60 years).Clinical presentation included jaundice with abdominal dull pain in 5 patients,acute cholangitis in 4 patients,painless jaundice in 2 patients,upper abdominal dull pain in 3 patients,no obvious symptoms in 1 patient,body weight loss more than 5 kg within 3 months in 5 patients.The most characteristic appearance of MPIBT on magnetic resonance cholangiopancreatography were asymmetry of intrahepatic bile duct dilatation and the dilatation in both extraand intrahepatic bile duct distal to the hepatic mass and not sudden interruption in extrahepatic bile duct.The primary tumor located in the left hepatic bile duct in 15 cases,in the right hepatic bile duct in one.13 MPIBT cases received hemihepatectomy and extrahepatic bile duct resection and Roux-en-Y anastomosis was done in 8 cases,3 received palliative biliary drainage.Pathologically 13 was papillary adenocarcinoma and 3 was papillary adenoma.The 1-,2-,3-year survival rates for the 16 MPIBT patients were 81％,66％,56％,respectively.Conclusions MPIBT had no specific clinical manifestations,MRCP might be an effective means for the diagnositic strategy and assessment of tumor extension before surgery,radical resection was the first choice of treatment,palliative biliary drainage could prolong the survival time.

ObjectiveTo explore the clinical outcome of one stage posteroanterior decompression and bone implant in the treatment of severe lower cervical spinal bony canal stenosis. Methods The study involved 29 patients with severe lower cervical spinal bony canal stenosis treated with one stage posteroanterior decompression and bone implant from April 2006 to March 2009. There were 11 patients with old fractures, seven with posterior longitudinal ligament ossification and 11 with cervical disc calcification. The course of disease ranged from 2 months to 3.2 years, average 1.4 years. The nerve function was rated as grade B in two patients, grade C in 19 and grade D in eight according to Frankel scale. The average Japanese Orthopaedic Association (JOA) score was 9.8. ResultsAll patients were followed up for 7-28 months (average 15.2 months), which showed bony fusion five months after operation, with fusion rate of 100％. The Frankel grade was increased for average 1.2 grades and the nervous symptoms alleviated remarkably. Mean postoperative JOA score was 13.8 and increased for mean 4.0, with mean amehoration rate of 55.6％. ConclusionsOne stage posteroanterior decompression and bone implant is a safe and effective method for treatment of lower cervical spinal bony canal stenosis, when the intraoperative electrophysiological monitoring can assure the operative safety.

Objective To investigate kupffer cells (KCs) expressing indoleamine 2,3-dioxygenase(IDO)in the inhibition of allogeneic T-cell proliferation in vitro. Methods Real-time PCR was used to investigate the expression of IDO mRNA and FasL mRNA in KCs pretreated with or without IFNγ. High performance liquid chromatography was used to analyze the catabolism of tryptophan by IDO from KCs. Allogeneic T-cell response was used to confirm the inhibition of KCs in vitro. The proliferation of lymphocytes was detected using [3 H] thymidine incorporation. Cell cycle and lymphocyte apoptosis were evaluated by flow cytometric assay. Results Real-time PCR revealed IDO mRNA and FasL mRNA expression in KCs pretreated with IFN-γ. IDO catabolic effect was confirmed by a decrease in tryptophan and increase in kynurenine concentration. KCs expressing IDO and FasL from BABL/c mice acquire the ability to suppress the proliferation of T-cells from C57BL/6, which could be blocked by the addition of 1-methyl-tryptophan and anti-FasL antibody. The co-cultured T-cells with KCs expressing IDO and FasL could induce allogeneic T-cell apoptosis and exhibited cell-cycle arrest in G1. Conclusion In addition to the Fas/FasL pathway, IDO may also play an important role in KCs to inhibit allogeneic T-cell proliferation in vitro.

Objective To construct Z-score models for normal fetal heart size measurements derived from fetal echocardiography.Methods Fetal echocardiography were performed in 910 normal singleton fetuses from 14th to 40th gestational weeks.Fetal transverse heart diameter (HD),heart length (HL),heart circumference (HC) and heart area (HA) were derived from a standard four-chamber view during end diastole.Using fetal somatic sizes as independent variables and heart sizes as dependent variables,the regression analyses of the mean (M) and the standard deviation (SD) for each parameter were calculated separately.A group of fetal heart diseases were assessed using these models.Results Strong correlations were found between fetal heart sizes and somatic sizes.Linear-cubic regression equations were each fitted to the models of the means of the heart sizes,whereas linear-quadratic equations were fitted to the models of the SDs.HD (r =0.984-0.986) was a dependent variable that provided the highest correlation coefficient with all of the fetal sizes,followed by HL (r =0.981-0.984),HC (r =0.981-0.982) and HA (r =0.978-0.979).All fetuses with Ebstein' s anomaly and most with homozygous α thalassemia-1 demonstrated Z scores reflective of increased heart sizes.Conclusions The fetal heart sizes Z-scores models had been constructed.The calculation of Z-scores for heart sizes as a function of fetal somatic size is feasible and simple.They might be useful for quantitative assessment of some cardiac diseases and used as new predictive indicators for homozygous α-thalassemia-1 particularly.

To examine the changes in matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) in the development and progression of endometriosis, real time quantitative polymerase chain reaction, enzyme-linked immunoabsorbent assay and gelatin zymography were employed to determine the mRNA and protein levels and activities of MMP-2 and MMP-9 from the first day to the 21(st) day after the induction in mice with induced endometriosis (experimental group) and sham-operated animals (controls). The results showed that the mRNA and protein levels and activities of the MMP-2 and MMP-9 were significantly increased on the first day after the induction and the level of MMP-2 stayed at a level higher than that in the control group. MMP-9 had two or three peaks during the 21 days, taking place at day 1, 4 and 15. It is concluded that the changes in the MMP-2 and MMP-9 might be involved in pathogenesis of endometriosis.

Objective To explore the gray matter changes in aggressive patients with schizophrenia,and the relationship between the gray matter and aggression in patients.Methods Eighteen aggressive patients with schizophrenia (SZ1),18 age-and gender-matched un-aggressive patients with schizophrenia (SZ2) and 18 normal controls (NC) were enrolled in the study.Then a 3.0 T magnetic resonance imaging (MRI) scan was conducted for each participant.The voxel-based morphometry (VBM) approach and the Chinese version of Buss & Perry aggression questionnaire (B&P) were used to explore imaging data and to assess the aggression,respectively.Results Compared with NC,patients with schizophrenia showed changes in gray matter volume (GMV) in the frontal,temporal and the occipital lobes (P＜0.05,AlphaSim corrected).Compared with SZ2,SZ1 showed increased GMV in the right supramarginal gyrus,right postcentral gyms,bilateral insula and orbito-frontal gyri (P＜0.05,AlphaSim corrected).The GMV of the right insula,right postcentral gyms and right supramarginal grus were positively associated with B&P scores in patients with schizophrenia (P＜0.01,AlphaSim corrected),respectively.Conclusions These preliminary findings support that the aggression in schizophrenia is associated with GMV changes of brain regions in patients with schizophrenia.The right postcentral gyrus,the right insula and the right supramarginal gyrus may be involved in the neural mechanism of aggression in schizophrenia.

A 44-year-old pregnant woman (G5P3) who had delivered two children with DMD was admitted and underwent prenatal diagnosis at Peking Union Medical College Hospital in 2019. (1) The karyotype of the fetus in 2019 was 47,XXY. The fluorescence in situ hybridization (FISH) result showed a nucish(CSPX×2, CSPY×1)[100] and multiplex ligation-dependent probe amplification (MLPA) suggested sex chromosome abnormality. Based on the above results, the fetus was diagnosed with Klinefelter syndrome. Fetal short tandem repeat (STR) linkage analysis and Sanger sequencing indicated a heterozygous mutation of c.9543delG(p.Trp3181CysfsTer2). (2) Sanger sequencing of the proband found a novel frameshift mutation of c.9543delG(p.Trp3181CysfsTer2 ) in exon 65 of the DMD gene. (3) The male fetus performing prenatal diagnosis in 2008 was found to have the same maternal gene markers as the proband with the same genotype. While the genotype of the fetus in 2009 obtained a different maternal gene marker from the proband and did not detect the same DMD gene mutation. This fetus was delivered at full term and was good during follow-up. (4) The elder brother and cousin of the proband had the same frameshift mutation in exon 65 of the DMD gene as the proband. The mother of the proband was a heterozygous carrier of the mutation.