Objective To evaluate the impact of the Blumgart anastomosis in pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodeneetomy (PD),and to study its safety and efficacy.Methods A total of 205 patients who underwent PD between January 2011 and February 2013 were retrospectively studied.The patients were divided into three groups depending on the pancreaticoenteric reconstruction:the Blumgart anastomosis group (n=37),the duct-to-mucosa anastomosis group (n =39) and the traditional invagination group (n=129).Postoperative morbidity were analyzed.Results The incidences of POPF after the Blumgart anastomosis (8.1％) was significantly lower than the duct-to-mucosa anastomosis group (23.1％ ; P=0.037) and the traditional invagination anastomosis group (30.2％ ; P=0.012).Multivariate analysis revealed soft pancreatic texture,pancreatic duct diameter ＜3 mm and non-Blumgart anastomosis were independent risk factors of POPF.On subgroup analysis,the Blumgart anastomosis was superior to the duct-to-mucosa anastomosis in patients with pancreatic duct diameter ＜ 3 mm (P=0.038),and showed advantages over the traditional invagination anastomosis in patients with soft pancreatic texture (P =0.001),as well as in patients with pancreatic duct diameter ＜ 3 mm (P=0.011).Conclusions The Blumgart anastomosis is a safe technique,and it could significantly reduced the rate of POPF.It should be routinely used for pancreatoenteric reconstruction after PD.

Liver is the most common metastatic organ in patients with advanced colorectal cancer. Once colorectal cancer liver metastasis (CRLM) occurs, the prognosis will be poor. Therefore early detection of CRLM has a great clinical significance for improving the prognosis of CRLM patients. Surgical resection of primary and metastatic lesion is the only possible curable option for CRLM, translational therapy, interventional therapy and multidisciplinary team also provide more treatment ideas. Long non-coding RNA, cancer stem cells and phosphatidylinositide-3-kinases/protein kinase B signaling pathway reveal the main mechanism of CRLM from different aspects. This article reviews the recent advances in the early diagnosis, treatments and main mechanisms of CRLM.

OBJECTIVETo analyze and summarize the characteristics and treatment of acute spinal cord decompression sickness. To explore the factors that influence the treatment effect.

METHODS77 cases of acute spinal cord decompression sickness patients should be divided into 4 groups according to the pressurized treatment and drug treatment options. They were group I, group II, group III and group IV. At the same time they were get hyperbaric oxygen therapy and other treatment. The evaluation index, were Frankel function classification and paraplegia index. There were 17 factors that affected the treatment effect.

RESULTSThe rate of early cure was 57.14% (44/77). The rate of late cure was 74.03% (57/77). Their difference was statistically significant (P<0.05). In 3 months and 1 year the cure rate of group IV and group B were the highest. But there was no difference between them(P>0.05). They were higher than group ii and group I (P<0.05). The Frankel function classification in 3months and 1 year in each group was higher than before treatment (P<0.05). The paraplegia index in 3 months and 1 year in each group was lower than before treatment (P<0.05). In 3 months and 1 year the Frankel function classification was increased gradually and the paraplegia index was decreased gradually in group I , group II, group III (P<0.05). In group IV and group III the Frankel function and the paraplegia index had not significant difference (P>0.05). Among the 17 factors that affect the treatment effect there are 9 factors that affect the proportion of the large.

CONCLUSIONSThe first choice of treatment method for the patients with acute spinal cord decompression sickness would be group III. Drug therapy was also imporpant. At the same time the hyperbaric oxygen therapy and other treatments were taken. Although the cure rate was not high in this article. But most of the cure is within 3 months. Within 1 year.the cure rate still could be improved. 9 factors that affect the efficacy of acute spinal cord decompression sickness was more noteworthy.

Decompression Sickness ; therapy ; Diving ; adverse effects ; Humans ; Hyperbaric Oxygenation ; Paraplegia ; physiopathology ; therapy ; Spinal Cord ; physiopathology

Objective To study the changes of cognitive function and brain microstructure of patients with benign epilepsy of childhood with centrotemporal spikes (BECTS) from neuropsychological test and voxel-based morphometry.Methods Sixteen patients with BECTS and 16 healthy volunteers,who were matched in gender,age and education,were enrolled in this study from May 2014 to May 2015 in the Affiliated Hospital of North Sichuan Medical College.The cognitive function and morphometry of the subjects were evaluated by neuropsychological test (full scale intelligence quotient (FSIQ),verbal intelligence quotient (VIQ) and performance intelligence quotient (PIQ)) and high-resolution T1-weighted imaging scanning.Thereafter,these data were analyzed with Student's t test,Chi-squared test and correlation analysis.Results (1) FSIQ(79.3±13.3),VIQ(82.3±12.1) andPIQ(81.3±10.3)ofBECTS group were significantly lower than the control group (107.0 ± 6.4,101.6 ± 6.5,114.8 ± 6.2;t =9.511,7.521,16.360,all P ＜0.01).(2) Patients with BECTS showed significantly increased gray matter volume in the bilateral putamen,paracentral lobule and right supplementary motor area (P ＜ 0.05,FDR-corrected).(3) A significant negative correlation was found between the gray matter volume of the left putamen and age of epilepsy onset (r=-0.586,P=0.017).Conclusions (1) There is a certain degree of cognitive impairment in patients with BECTS.(2) Patients with BECTS have some changes in brain microstructure.Genetic factors could indirectly influence the children's brain developmental trajectory,and the age of onset may be associated with the changes on the brain microstructure.

An atmospheric pressure chemical ionization mass spectrometry (APCI-MS) method was developed for the direct analysis of triglycerides in edible oils.The edible oil sample was dissolved in acetonitrile.Under the optimal conditions such as positive ion detection,800 μL/h of sample flow rate,250℃ of vaporizer temperature and 5000 nA of corona needle current,the repeatability (RSD) of peak intensity rate of m/z 857.76 to m/z 881.76 was less than 5％.Then,different kinds of oil from different manufacturers were analyzed by the proposed method.After a principal component analysis for the analytical results,the peak intensity rate of m/z 857.76 and m/z 881.76 was selected for oil identification.The adulteration of 5％ lard in corn oil could be recognized directly using the peak intensity rate.Three characteristic triglycerides in edible oil were preliminarily identified by collision induced dissociation (CID) experiments.The method was applied to analyze the swill oil and fried oil samples,and the results showed that the swill oil contained both vegetable oil and animal fat,and the fried oil was also different with commercial vegetable oil.

Objective To build the indicators system to collect patient safety monitoring information, focusing on medical complaints. Methods With such methods as literature review and expert advice, building the system for medical complaints collection and monitoring. Such indicators are modified and improved in pilot operations. Results The framework of the medical complaint monitoring indicators system is built in five dimensions, comprising 8 grade-1 indicators including patient complaint causes and hospital cause analysis, and 20 grade-2 indicators. Conclusion These indicators are scientific and operable to detect adverse patient safety events.

The 53rd annual meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago,United States between June 2 and 6,2017.The latest advances in biliary tract cancer research from this meeting were summarized and analyzed in this paper.The adjuvant therapy in biliary tract cancer made a breakthrough in this meeting,the findings could provide the basis for a new standard of changing the current management model in the disease.The precision medicine and targeted therapy will be the development direction in the future.Doctors should attach great importance to the adjuvant and comprehensive therapy in biliary tract cancer and initiate high level multi-center clinical trials to improve the overall the diagnostic and treatment levels of biliary tract cancer.

Objective: To investigate oral health related quality of life and associated factors of adolescents between 12 and 15 years old, and to provide countermeasures and suggestions for oral health promotion of adolescents. Methods: This cross-sectional study recruited 3 840 adolescents aged 12-15 through multi-stage stratified cluster sampling method. The oral clinical examination and oral health questionnaire were conducted. Descriptive analysis, non-parametric testing and logistic regression analysis were used to analyze the oral health-related quality of life and associated factors. Results: Oral problems showed moderate to severe impact on quality of life,especially on eating (27.1%). Ordinal Logistic regression analysis showed that low sugar intake frequency, few teeth with gingival bleeding, no history of dental pain in the past 12 months,no history of tooth injuries, and administrative region of residence (Nanhai, Shunde) were associated with higher oral health-related quality of life,(OR=0.6-0.8，P<0.05). Conclusion The oral health-related quality of life of adolescents in Foshan was slightly better than the average national level. It is recommended to accurately formulate and ensure the full implementation of oral public health measures based on the comprehensive analysis of the local area, and combine various efforts to strengthen education on reducing excessive intake of sugar, prevent gingival bleeding, relieve and treat toothache in time, pay attention to adolescents with histories of dental trauma, and update the concepts of receiving oral health examination for the adolescents themselves, parents and teachers, and help adolescents develop the habit of regular oral examinations.

Objective: To explore the prognosis of patients with T1b stage gallbladder carcinoma underwent different surgical procedure. Methods: The clinicopathological data of 97 patients with T1b stage gallbladder carcinoma came from 8 clinical centers from January 2010 to December 2016 and 794 patients who were admitted to the SEER database of USA from January 1973 to December 2014 were analyzed.There were 891 patients including 254 males and 637 females (1.0∶2.5) with age of (69.5±12.0)years. There were 380 patients who were less than 70 years old, 511 patients who were more than 70 years old. And there were 213 patients with the diameter of tumor less than 20 mm, 270 patients with the diameter of tumor more than 20 mm, 408 patients were unclear. There were 196 patients with well differentiation, 407 patients with moderately differentiation, 173 patients with poorly differentiation, 8 patients with undifferentiated, 107 patients were unclear. In the 891 patients with T1b stage gallbladder carcinoma, there were 562 cases accepted the simple cholecystectomy, 231 cases with simple cholecystectomy plus lymphadenectomy, and 98 cases with radical cholecystectomy. The time of follow-up were until June 2017. χ² test was used to analyze the enumeration data, rank-sum test was used to analyze the measurement data, the analyses of prognostic factors were used Cox proportional hazards model, the survival analysis was performed using Kaplan-Meier method. Results: The results of Cox proportional hazards model indicated, age, differentiation, surgical procedure were the risk factors of prognostic(1.929(1.594-2.336), P<0.01; 1.842(1.404-2.416), P<0.01; 1.216(0.962-1.538), P<0.01). The results of Kaplan Meier test indicated, the overall survival of T1b stage gallbladder carcinoma were (85.5±3.8)months, the overall survival of patients with simple cholecystectomy were (71.3±4.4)months, the overall survival of patients with cholecystectomy plus lymphadenectomy were(87.6±5.8)months, and the overall survival of patients with radical cholecystectomy were(101.7±9.3)months. The overall survival of patients with cholecystectomy plus lymphadenectomy and radical cholecystectomy were more than simple cholecystectomy(P<0.05). There were 329 patients with Lymph nodes examined in and after operations(231 patients with cholecystectomy plus lymphadenectomy, 98 patients with radical cholecystectomy). There were 265 patients with negative lymph node metastasis, the overall survival were(98.3±4.2)months. There were 64 patients with positive lymph node metastasis, the overall survival were(75.5±3.1)months. The overall survival of 38 patients with cholecystectomy plus lymphadenectomy were(62.7±2.6) months, and 26 patients with radical cholecystectomy were (82.2±3.7)months. The overall survival of patients with radical cholecystectomy were more than cholecystectomy plus lymphadenectomy(P<0.05). Conclusions The T1b stage gallbladder carcinoma patients with cholecystectomy plus lymphadenectomy or radical cholecystectomy has improved the prognosis comparing with simple cholecystectomy, significantly. When lymph node metastasis occurs, radical cholecystectomy has improved the prognosis comparing with cholecystectomy plus lymphadenectomy.

Intrahepatic cholangiocarcinoma (ICC) is the second most frequently occurring primary liver cancer. It has been reported that the causes of late diagnosis of ICC are a high degree of malignancy, early metastasis, and diffusion. Most patients visit the hospital because of jaundice or discomfort due to the surrounding compression. ICC commonly recurs after resection, and chemotherapy is not sensitive. Therefore, patients have a poor prognosis and a low survival rate. Currently, a multidisciplinary approach based on surgery is recommended for ICC patients who can undergo surgical excision, and local treatment combined with chemotherapy is the main com-prehensive treatment for patients with advanced ICC who cannot undergo surgical resection. In recent years, it has been found that immunotherapy can involve the autoimmune system to remove tumor cells, and molecular-targeted therapy can kill tumor cells by in-hibiting cell membrane surface molecules that promote tumorigenesis and development. At present, these two treatment modalities have become the research focus of ICC therapy, and progress has been made. The research status is reviewed in this paper.