Radical resection is crucial in the surgical treatment of adenocarcinoma of the body and tail of pancreas.It usually refers to negative resection margin and dissection of regional lymph nodes.In recent reports,the definition of R0 margin has been updated,and radical antegrade modular pancreatosplenectomy (RAMPS),which was first described by Strasberg et al,contributes to achieving negative tangential margins.In some cases,extended radical resections were adopted in an attempt to achieve R0 margin.However,it would increase operation related morbidity and mortality,which should be taken into account before the procedure.Lymph nodes metastasis is an important prognostic factor.Extended lymph nodes dissection does not seem to bring survival benefits,while itg helpful in assessing the tumor stages and patients' prognosis.Laparoscopic distal pancreatectomy (LDP) has been applied in the treatment of ductal adenocarcinoma of the pancreas in reports with small sample sizes.But it remains controversial whether LDP is superior comparing to conventional open methods in regards to oncological outcomes.Curently,surgery is the promising method that may cure adenocarcinoma of the body and tail of pancreas.Highlighting radical resection will bring more survival benefits to patients.

Objective To study and analyze the clinical observation and nursing measures of prednisone acetate combined leflunomide in the treatment of IgA nephropathy.Methods 100 patients with IgA nephropathy treated in our hospital from February 2015 to September 2016 were randomly divided into the control group and the experimental group,with 50 patients in each group.Patients in the control group were treated with prednisone and dropped to 0.5 mg/kg after 12 weeks.The patients in the experimental group were treated with leflunomide and dropped to 20 mg after 3 days.The patients in the experimental group and the control group were treated for 3 months.The two groups of patients were given reasonable nursing measures, and compared the treatment effect.Results The effective rate of treatment in the experimental group was 94.0％, significantly higher than that in the control group (64.0％),with statistical difference(P<0.05).After treatment,the level of 24 hours proteinuria in the experimental group was (0.541±0.322)g/L, significantly lower than that of the control group (1.516±0.568)g/L,with statistical difference (P<0.05) .The adverse reaction rate of the experimental group was 0％, and that of the control group was 8％,with statistical difference(P<0.05).Conclusion Prednisone acetate combined leflunomide was effective in the treatment of IgA nephropathy, and can significantly improve the efficiency of treatment, and has clinical significance.

The clinical manifestations of the disease lacked specificity,and the clinical symptoms were nasal obstruction, any blood in snively and slightly swelling pain on face. The neoplasm with unsmooth surface looked taupe and maroon, and was brittle and easy blooding. Paranasal sinus CT:crumbly mass lesion within the shadow filled in the left side of the maxillary sinus,and the sinus stopped up,sinus wall bone was absorpt and thinned, front and rear wall and inner wall bone were boundedness broken off, knuckle partly to the nasal cavity. Direct reinforcement MRI:in addition to the result of paranasal sinus CT,enhance examination found obviously asymmetrical intensify of the focus. The pathological diagnosis of postoperation was malignant melanoma on the left side of the maxillary sinus.
Humans ; Male ; Maxillary Sinus Neoplasms ; Melanoma ; Middle Aged

Objective To investigate the clinical features and prognosis of the patients with renal cell carcinoma and venous tumor thrombus.Methods Fifty-six patients with renal cell carcinoma and venous tumor thrombus were selected as our subjects,who underwent radical nephrectomy and thrombectomy in the Second Hospital of Tianjin Medical University from June 2002 to May 2014.There were 28 patients with stage Ⅰ tumor thrombus,l5with stage Ⅱtumor thrombus,9 with stage Ⅲ tumor thrombus and 4 with stage Ⅳtumor thrombus.All patients underwent renal tumor resection and embolectomy,and were follow-up.Results Of all the patients,46 were male and 10 were female with a mean age of 61.7(age ranging from 42 to 83).Twenty-four were presented on the left kidney and 32 were right.The clinical features were as follows:The tumor size was 2.5 to 14 cm in diameter(mean:6.2 cm),there were 21 cases with low back pain,18 cases with hematuria,lcases with abdominal.Pathological results showed that 39 with clear cell carcinoma,9 with papillary cell carcinoma,3 with chromophobe cell carcinoma,1 with low-differentiated cell carcinoma and 1 with undifferentiated cell carcinoma,3 with sarcomatoid differentiation.Forty-three patients were followed up,and the median follow up period was 20.4 months (2-90 months).The median survival time for the patients was 47 months and the 5 year overall survival was 45.2％.The survival time of the patients with early tumor thrombus(below hepaticvein) was (55.3 ± 4.9) month,significantly longer than that of the patients with advanced tumor thrombus (above hepaticvein) ((24.8 ± 5.3) months,P =0.047).Conclusion Patients with renal cell carcinoma and venous tumor thrombus are characterized with high malignancy and poor prognosis.Surgical operations are effective therapies for the patients.Long term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor.

Objective To investigate the feasibility and outcome of resection and reconstruction of hepatic artery in hilar cholangiocacinoma (HCC).Methods The data of 29 patients with HCC with hepatic artery reconstruction carried out from March 2009 to August 2013 in our center were retrospectively analyzed.23 right hepatic arteries and 6 common hepatic arteries were involved.In-situ anastomosis was carried out in 20 patients and a double anastomosis using gastrodoudenal artery grafts was carried out in 9 patients.Results There were no arterial thrombosis or other related complications on prolonged follow-up.Conclusion Hepatic artery resection and reconstruction should be carried out if the artery was invaded by a hilar cholangiocarcinoma to produce a high resection rate and a better outcome.

Objective To investigate the influence of double-effect activation of cholinergic antiinflammatory pathway on the liver injury and inflammatory response in obstructive jaundice rats by applying cholinesterase inhibitor and cholinergic M receptor blocker to activate alpha 7 nicotinic acetylcholine receptor.Methods 22 adult male Wistar rats were randomly assigned into three groups:sham operation (SO) group (n=6),bile duct ligation (BDL) induced obstructive jaundice with (BDL treatment group) or without treatment (BDL control group) (n=8 each).The medicine treatment group was given anisodamine (25 mg/kg) and neostigmine (25 μg/kg) daily via intraperitoneal injection after surgery,the control group was given equal amount of normal saline.The body weights of rats in each group were measured every other day.After 12 days,the rats were killed,and the pathological changes of liver injury,liver function and the expression levels of proinflammatory cytokines in the serum and liver tissue were observed.Results The body weight of BDL rats was significantly lower than the SO group rats,and the growth rate of BDL treatment group rats was the same as the rats in BDL control group 3 days after the starting of treatment.The AST,ALT,bilirubin and gamma-GT levels of BDL control and treatment groups were significantly higher than the SO group (P＜0.05),but there was no significant difference between BDL control and treatment groups.The serum albumin level of BDL treatment group was obviously higher than that of BDL control group,but the pathological liver injury was significantly slighter.The gene expression levels of TNF-alpha,IL-1 beta and IL-6 in the liver tissue were significantly higher in BDL groups than SO group (P＜0.05),but BDL treatment group was significantly lower than BDL control group (P＜0.05).In addition the serum TNF-alpha and IL-1 beta concentrations of BDL treatment group and control group were significantly higher than the SO group (P＜0.05),but the BDL treatment group was obviously lower than that BDL control group (P＜0.05).Conclusion The combine application of cholinesterase inhibitor and cholinergic M receptor blocker to activate the cholinergic anti-inflammatory pathway can significantly inhibit the obstructive jaundice induced proinflammatory gene expression and liver injury.

Objective To explore the effect of rehabilitation training on self-care ability of patients with senile dementia. Methods One hundred and one senile dementia patients were divided into two groups with 53 cases in experimental group receiving targeted rehabilitation training besides routine nursing and 48 in control group only receiving routine nursing.Self-care ability of patients in the two groups was comparatively evaluated according to the activity of daily living scale (ADL).Result The ADL score and the total score of the experimental group were both higher than those of the control group (P<0.05).Conclusion Rehabilitation training according to the specific conditions of patients with senile dementia can improve their self-care ability in adapting to the society, delaying the progress of the disease and improving the quality of life.

Objective To investigate the spontaneons recovery of calculation and number processing in patients with stroke.Methods Assessment of calculation and number processing were performed in 30 stroke patients with stable conditions (21 cerebral infarction and 9 cerebral hemorrhage) within 3 weeks after stroke,and they were followed up for one year.Calculation and number processing was assessed using the Revised EC301 Calculation and Number Processing Battery in Chinese version at 3,6,and 12 months after stroke onset.Results The scores in the areas of numerical sequences,numerical understanding,numerical transcoding,numerical calculation,numerical knowledge and the total scores increased significantly with the passage of time (all P ＜0.001).There were significant differences between each area and total scores at 3,6,and 12 months after stroke and those at 3 weeks (all P ＜0.01),however,there were no significant differences among the three time points.The total scores and the scores in each area increased significantly with the passage of time in the cerebral infarction group and the hemorrhage group (all P ＜0.001),however,there were no significant differences in each area at the same time point between the two groups.There was significant difference in the recovery of the total scores between the cerebral hemorrhage group and the cerebral infarction group (P =0.008).Pearson correlation analysis showed that the recovery of the calculation and number processing in all patients (R =0.452,P =0.012) as well as in the cerebral infarction group (R =0.683,P=0.001) and the cerebral hemorrhage group (R =0.250,P =0.049) within one year showed a significant positive correlation with the total score of the first assessment.Conclusions The impaired calculation and number processing may partly spontaneously recover after stoke,and it shows significant improvement within 3 months after onset.The recovery in patients with cerebral hemorrhage may be better than that in those with cerebral infarction.The more serious the impairment in initial calculation and number processing,the worse the spontaneous recovery will be.

Objective To study the effect of itraconazole/IFN-gamma on IFN-? and IL-10 in nude mice and mice and clinical significance. Methods Systemic infection of animals that induced by abdominal injection of Candida albicans and Cryptococcus neoformans, Expression of IFN-? and IL-10 were detected by enzyme-linked immunosorbent assay (ELISA).Results After treated with Itraconazole and IFN-gamma, the levels of IFN-gamma were increased and ones of IL-10 were decreased significantly. Conclusions Itraconazole and IFN-gamma may play key roles in the immune function of those animals.

Objective At present , there is only a small amount of survey scale of caregivers′cognitive level on continuous nursing care for premature infants , which had not been subject to stringent testing of reliability and validity .This paper aims at developing a suitable survey scale of caregivers′cognitive level oncontinuous nursing care for 0-1 year premature infants , and testing its reliability and validity. Methods Convenience sampling method was used and totally 495 caregivers of premature infants of Army General Hospi-tal affiliated BaYi Children hospital from April to August 2016 has been investigated .After we had preliminary content of the question-naire, two-round Delphi consultations were used to identify the draft of the scale , and the reliability and validity were tested . Results Totally 419 valid questionnaires from 495.Questionnaires effective recovery was 84.65%.Critical ratio for each entry was 9.355-23.179 ( P<0.05) , which suggested that entries had good distinction .Coeffi-cient of correlation between scale items and total score was 0.500-0.775(P<0.05), whichindicated highly homogeneity between entries and table.By exploratory factor analysis , 5 entries were removed and 77 entries remained .The final scale of caregivers′cognitive level on continuous nursing care for premature infants included 4 indicators in level one , 15 indicators in level two and 77 indicators in level three .The Cronbach′s alpha was 0.985 for overall questionnaire and 0.848-0.939 for each dimension .The split-half reliability was 0.895 for overall questionnaire and 0.814-0.939 for each dimension .The content validity index was 0.963.The cumulative contribution rate of each dimension was 64.645%-83.236%. Conclusion The scale content was scientific and comprehensive .It can be used to investigate the caregivers′cognitive level on continuous nursing care for 0-1 year pre-mature infants, direct nurses to provide continuous care for premature infants , and evaluate the continuous nursing effect .