Objective To analyze the characteristics ot lymph node metastasis and prognostic factors for carcinoma of papilla of Vater (CPV) after pancreaticoduodenectomy (PD).Methods From January 2005 to December 2010,94 patients with CPV underwent PD and dissection of regional lymph nodes at the Eastern Hepatobiliary Surgery Hospital.We carefully evaluated nodal involvement in the patients to determine the lymphatic spread of CPV and analyzed the clinicopathological variables in relation to prognosis.Results The overall rate of nodal involvement was 46.8％.Using the UICC staging (7th edition),lymphatic invasion in pT1,pT2,pT3 and pT4 were 15.4％ (2/13),62.7％ (32/51),80.0％ (8/10) and 100％ (2/2),respectively.The metastatic rates in the posterior pancreaticoduodenal lymph nodes,the mesopancreatic lymph nodes,the hepatoduodenal ligamental lymph nodes and the proper hepatic periarterial lymph nodes were 30.9％ (29/94),21.3％ (20/94),11.7％(11/94) and 6.4％ (6/94),respectively.Significant prognostic factors were tumor pT stage (P＜0.01),duodenal wall infiltration (P =0.001),liver metastasis (P =0.001),pancreatic paren chymal invasion (P=0.004),nodal involvement (P＜0.01) and different regional lymph nodes invasion (the posterior pancreaticoduodenal,P＜0.01; the mesopancreatic,P＜0.01; the hepatoduodenal ligamental,P＜0.01; the proper hepatic periarterial,P=0.010).Cox regression analysis for overall survival revealed that the posterior pancreaticoduodenal nodal involvement (P＜0.01),the mesopancreatic nodal involvement (P＜0.01) and duodenal wall infiltration (P=0.019) were significant independent prognostic risk factors.Conclusions The mesopancreatic lymph nodes and the posterior pancreaticoduodenal lymph nodes should equally be regarded as the first stop in lymphatic spread of CPV.Therefore,we should pay much attention to these regional lymph node dissections,especially to ensure complete resection of the uncinate process and the mesopancreas.

Objective To investigate application of diffusion tensor tractography (DTT) on evaluating motor dysfunction degree of patients with cerebral infarction and explore the relationship between infracted focus and cortical spinal tract(CST).Methods Forty patients with cerebral infarctions in the different periods and 30 healthy volunteers were enrolled our study.They all underwent DTT check and then established CST.Meantime,all the patients were measured ADL score according to activities of daily living (ADL) on admission and two months after the onset.Results DTT image was made for both in patients and health control people.The CST was built in people in control group and its shape was like the adults'.Its shape was from the precentral gyrus down to internal capsule and continued to pontine and medulla oblongata.Each successive was form good consistency.The DTT image of patients' health side was like normal and injury corticospinal tract was affected by influence of infarction area at different level,manifested as loss of discontinuity and anatomical configuration consistency.Based on the degree of CST,there were 9 cases in grade Ⅰ,20 cases in grade Ⅱ and 11 cases at grade Ⅲ.DTT image showed that the damage level of CST had an negative relation with ADL score at 2 month after therapy (r =-0.914,P ＜ 0.05).Conclusion DTT can show the spatial positions of infarctions and CST at non-invasive lesion and analyze the influence of infarctions and corticospinal tract.Therefore,it can serve as the objective proof for judging the injury of the motor function and evaluating prognosis.

Objective To investigate the effect of disodium cantharidinateon in vitro lymphocyte immune response in lung cancer patients.Methods Twenty non-small cell lung cancer patients diagnosed by pathological diagnosis were selected.The effects of different concentrations of disodium cantharidinate and vitamin B6 on lymphocyte proliferation and CD4 + CD25 + T cells,CD25 + FOXP3 + T cells,CD4 + and CD8 + T cells were detected by methyl thiazolyl tetrazolium assay and flow cytometry.Results When the concentrations of disodium cantharidinate and vitamin B6 was less than 10 μg/ml,with the growth of concentration,it stimulated the proliferation of peripheral blood lymphocytes.When the concentration was more than 10 μg/ml,with the growth of concentration,the absorbance value decreased,and the stimulating effect weakened.When the concentration of disodium cantharidinate and vitamin B6 injection was less than 10 μg/ml,with the growth of concentration,CD4 +/CD8 + ratio increased significantly,and CD4 + CD25 +/CD4 + and CD25 + FOXP3 + T cells were significantly lower,which showed statistically significant differences (t =2.171,P =0.032 ; t =2.103,P =0.041 ; t =3.662,P =0.002 ; t =3.201,P =0.003 ; t =3.233,P =0.003).But when the concentration was more than 10 μg/ml,The differences of CD4 +/CD8 + ratio,CD4 + CD25 +/CD4 + and CD25 + FOXP3 + T cells in 10,15,20 μg/ml groups were not statistically significant,which showed that disodium cantharidinate and vitamin B6 injection had a positive effect on enhancing the immune function of lymphocytes in lung cancer in a concentration dependent manner,but high concentration was unhelpful.Conclusion Disodium cantharidinate and vitamin B6 injection can promote lung cancer in vitro lymphocyte proliferation as well as increase its immunity in a certain range.

Objective To design and construct a new non-fusion soluble expression vector pTIG-mSUMO(small ubiq-uitin-related modifier) using the widely used solubility promoting protein SUMO and based on the translational coupling phenomenon in order to enable the non-fusion soluble expression of the broad-spectrum antiviral protein RA in Escherichia coli by pTIG-mSUMO.Methods The smt3 gene coding for SUMO protein was cloned from yeast genome DNA by PCR. After directed-site silent mutation to eliminate the EcoRⅠsite, the mutant mSUMO was inserted into pET-22b to obtain the translational coupling expression vector pTIG-mSUMO.The RA was subject to PCR amplification and cloned into the pTIG-mSUMO to obtain the expression plasmid pTIG-mSUMO/RA which was supposed to direct the soluble expression of RA by the translational coupling with mSUMO.Results A translational coupling expression vector pTIG-mSUMO which could di-rect/drive the SUMO and heterogonous protein non-fusion expression simultaneously was designed and constructed.The Western blotting result indicated that pTIG-mSUMO could direct the high-level expression of RA, around 40%of which was soluble.Conclusion A translational coupling expression vector pTIG-mSUMO is obtained.After coupling with SUMO, RA is highly expressed in E.coli and both the expression level and solubility are greatly improved.pTIG-mSUMO might contrib-ute to soluble expression of other proteins.

Objective To investigate the effect of oxytocin on the expression of MKP-1 level in the hippocampus of post-traumatic stress disorder rats.Methods Eighteen SD rats were randomly divided into the control group,administration group and the experimental group with 6 rats in each group.The administration group and the experimental group were treated with internationally recognized single prolongation stress (SPS) method to stimulate the rats in order to establish PTSD models.The 14-day oxytocin intervention was given to rats of the administration group after the SPS stimulation within 8 hours.And the behavioral changes of rats were observed by open-field test and Morris water maze test.The changes of MKP-1 mRNA in the hippocampus of rats were detected by real-time quantitative PCR (qRT-PCR),and the levels of MKP-1 Protein in the hippocampus of rats were detected by Western Blot.Results (1) Compared with the model group (2.50± 1.05 and 22.16±7.14),the times of the standing and crossing grid section quantities in the open-field test in the administration group(5.16± 1.17and 32.83±5.71) and control group (6.67±2.16 and 39.83± 4.62) significantly decreased (P＜0.05).Morris water maze showed that the incubation of the model group was markedly prolonged (P＜0.05) compared with that of the administration group,while in spatial probe test,the incubation period of the rats in administration group was prolonged,and the number of wearing stage decreased (P＜0.05).(2) Compared with the administration group (1.30±0.03),the expression of MKP-1 mRNA in hippocampus of rats in model group (4.04±0.46) was notably up-regulated (P＜0.05).And the protein level of MKP-1 in model group(1.95±0.68) was also increased compared with that in administration group (1.46±0.27) (P＜0.05).Conclusions Oxytocin can protect the learning and memory ability and reduce the stress-related performance of rats via regulating the expression of MKP-1.

Objective:To evaluate the efficacy and safety of using platelet-rich plasma (PRP) eyedrops for the treatment of moderate to severe dry eye disease (DED).Methods:A total of 395 patients (790 eyes) with moderate to severe DED diagnosed and treated in the Armed Police Liaoning Corps Hospital and the PLA 967 Hospital from March 2018 to October 2019 were collected. Random number table method was used to divide into autologous PRP treatment group (196 cases, 392 eyes) treated with autologous PRP and control group (199 cases, 398 eyes) treated with artificial tears. The changes of subjective symptoms of DED, Schirmer test (ST), corneal fluorescein staining (CFS) and Ocular Surface Disease Index (OSDI) before and after treatment were observed in both groups.Results:After 1 course of treatment, the ST values of both groups increased, which was statistically significant compared with before treatment ( P<0.05). After treatment, the OSDI and CFS scores of the two groups were reduced. The difference in OSDI and CFS scores of the PRP treatment group before and after treatment was statistically significant ( P<0.05), and there was no statistically significant difference in the control group before and after treatment ( P>0.05). After treatment, the OSDI and CFS scores of the PRP treatment group were lower than those of the control group [(16.8 ± 18.7) scores vs. (43.2 ± 14.5) scores, (0.21 ± 0.53) scores vs. (1.62 ± 0.69) scores], the differences were statistically significant ( P<0.05). After one course of treatment, the total effective rate of the autologous PRP treatment group was higher than that of the control group [80.1% (157/196) vs. 51.76% (103/196)], the difference was statistically significant ( P<0.05). Conclusions:Autologous PRP can treat patients with moderate-to-severe autologous PRP treatment group, which can greatly improve patients' eye discomfort and other symptoms.

Objective:To investigate the pelvic floor muscle functioning of persons with pelvic floor dysfunction (PFD) at different ages in order to provide a reference for clinical treatment.Methods:A total of 580 PFD patients were divided into group A ( n=163, ≤29 years old), Group B ( n=161, 30-39), Group C ( n=114, 40-49), Group D ( n=128, 50-59) and Group E ( n=14, ≥60 years old). All were given a surface electromyography (sEMG) examination of their pelvic floor muscles. Average sEMG amplitude and its variability were recorded in the pre-resting and post-resting stages. The maximum sEMG amplitude and its rise time and recovery time during rapid contraction of pelvic floor muscles were recorded. Average sEMG amplitude and variability were also recorded during slow muscle contraction. The observations were correlated with the age. Results:Significant differences among the 5 groups were found in all of the measurements. Spearman correlation analysis showed that age was positively correlated with the variation in the sEMG amplitudes in the pre-resting stage, with the rise time and with the recovery time. Age also correlated with the maximum sEMG amplitude in the rapid stage, the variation of the EMG amplitude in the slow-muscle stage, and the EMG amplitude in the post-resting stage. But it was negatively correlated with the average sEMG amplitude during pelvic floor contraction.Conclusions:The stability and coordination of the pelvic floor muscles gradually deteriorates with age. The rate of activation and recovery become slower, with prolonged recruitment, slower response and poor excitability.

Objective:To explore the application value of sevoflurane inhalation anesthesia in mitral valve replacement.Methods:A total of 94 patients who underwent mitral valve replacement in our hospital (October 2016-October 2018) were randomly divided into the control group ( n=47) and the observation group ( n=47). The control group received target-controlled infusion of propofol, and the observation group inhaled sevoflurane.The postoperative conditions [intensive care unit (ICU) stay time, extubation time of tracheal tube, spontaneous cardiac rebound], hemodynamic indexes [mean arterial pressure (MAP), heart rate (HR)], serum creatine phosphokinase isoenzyme (CK-MB), cardiac troponin I (cTnI), malondialdehyde (MDA) and superoxide dismutase (SOD) in the two groups were analyzed. The patients were followed up for one month. The incidence of major adverse cardiovascular events (MACE) was calculated. Results:⑴ Postoperative situation: the time of stay in ICU and extubation of tracheal tube in the observation group was shorter than that in the control group, and the rate of spontaneous cardiac rebound (93.62%) was higher than that in the control group (72.34%) ( P<0.05); ⑵ Hemodynamic index level: there was no statistically significant difference in MAP and HR levels between two groups before operation, before cardiopulmonary bypass, after cardiopulmonary bypass, and after operation ( P>0.05); ⑶ CK-MB and cTnI: the levels of serum CK-MB and cTnI in the two groups were higher at 2, 6, 24, and 48 h after aortic cross-clamp release than before anesthesia induction, but the indicators of the observation group were lower than those in the control group; ⑷ MDA and SOD: the serum SOD level in the two groups at 2, 6, 24, and 48 h after aortic cross-clamp release were lower than before anesthesia induction, and the MDA level in the two groups at 2, 6, 24, and 48 h after aortic cross-clamp release were higher than before anesthesia induction. The level of SOD in the observation group was higher than that in the control group, and the level of MDA was lower than that in the control group ( P<0.05); ⑸ MACE: the incidence of MACE in the observation group (12.77%) was lower than that of the control group (29.79%) ( P<0.05). Conclusions:During mitral valve replacement, sevoflurane inhalation anesthesia can maintain hemodynamic stability. The duration of ICU stay and tracheal tube extubation time is shorter, and the fluctuation of serum CK-MB, cTnI, MDA and SOD is small, and it can reduce the risk of MACE.

“Stasis generating deficiency” is considered to be an important pathogenesis of recurrence after catheter ablation of atrial fibrillation （AF）. Blood stasis is commonly seen after ablation together with various pathogens such as phlegm-fire， qi stagnation and retained fluid， and will lead to depletion of zang-fu （脏腑） organs and then the failure of the nourishment of the heart. Therefore， it is advised to emphasize on the importance of considering zang-fu organs depletion caused by blood stasis and various excess pathogens in dealing with the recurrence after catheter ablation. The method of dissolving stasis and supplementing deficiency simultaneously has been proposed before catheter ablation， and it is critical to calm heart and dissolve stasis， regulate and supplement internal deficiency so as to prevent the postoperative recurrence of AF. For recurrence of AF after ablation， attention should be paid to dissolving stasis and dispelling pathogens， regulating vessels and supplementing deficiency， as well as the excess pathogens such as stasis binding and phlegm fire， stasis binding and qi stagnation， stasis binding and retained fluid， and the depletion of zang-fu organs should be considered. Accordingly， the method of dissolving stasis and dispelling phlegm， subduing fire and unblocking vessels， regulating and supplementing heart and spleen； dissolving stasis and move stagnation， unblocking qi and blood， supplementing lung and boosting qi； dispelling stasis and dissolving rheum， warming yang and activating blood， consolidating the root and nourishing heart can be used respectively， so as to treat both the root and the branch simultaneously.

Coronary microcirculation disorder after myocardial ischemia reperfusion （MIR） is a prominent problem in the treatment of coronary heart disease. According to the physiological commonality between “collaterals-sweat pore qi and fluid” and coronary microcirculation， and the evolution of the course of MIR， it is believed that “heart collateral stasis obstruction， sweat pore constraint and block” is the cause of coronary microcirculation disorder. The evolution of the pathogenesis can be divided into three periods. During the myocardial ischemia period， the pathogenesis is heart collaterals obstruction and sweat pores empty， while during the ischemia reperfusion period， it is internal formulation of deficiency wind， spasms of collaterals or slight heart collaterals obstruction； in the coronary microcirculation disorder period， sweat pores constraint and block， constraint transforming into heat， qi and fluid failing to diffuse are the pathogenesis. The corresponding treatment principle is assisting dredge with supplementation， and supplementing deficiency to dispel stasis； treating wind and blood simultaneously， and extinguishing wind to arrest convulsion； clearing heat and cooling blood， and diffusing qi and unblocking qi and fluid. Moreover， it is recommended to treat the heart and lungs simultaneously， and regulate the heart and liver at the same time.