Objective To investigate the application value of double-layer continuous suture in pancreatic jejunum anastomosis of pancreatoduodenectomy (PD).Methods A retrospective analysis of 114 consecutive patients (67 men and 47 women) who underwent PD from June 2012 to July 2013 were conducted. There were 79 patients who were treated by double-layer continuous suture technique and 35 patients by double-layer interrupted suture technique .The incidence of pancreatic fistula and other complications after PD with two different suture techniques were compared .Results The operation time of double-layer continuous suture group and double-layer interrupted suture group is respectively ( 284 ±5 ) and ( 288 ±7 ) mins, the intraoperative bleeding volume is respectively (236 ±29) and (282 ±49) ml, the differences between two groups were no statistical significance .The postoperative fasting time in two group was respectively (7.8 ± 0.5) and (9.7 ±0.5) days, the length of hospital stay time was respectively (14.0 ±1.0) and (17.2 ± 10.0) days, the incidence of postoperative pancreatic fistula ( POPF) was respectively 17.1%(6/35) and 39.2%(317/9 ), the differences between two groups were statistically significant (all P<0.05).Grade A POPF was found in 4 patients ( 11.4%) from the double-layer continuous suture group and in 5 patients (6.3%) from the double-layer interrupted suture group.Grade B POPF was identified only in 1 patients (2.9%) from the double-layer continuous suture group and in 23 patients (29.1%) from the double-layer interrupted suture group .The presence of Grade C POPF was only documented in 1 patient from the double-layer continuous suture group and in 3 patients from the interrupted suture group .Conclusions Continuous suture can be safely used in the duct-to-mucosa pancreatojejunostomy .The double-layer continuous suture can be more effective in reducing pancreatic fistula , improving the feeding time , and reducing the length of hospital stay, and it is worthy of clinical popularization and application .

Objective To investigate the clinical effectiveness of gamma knife and microsurgery operation for the treatment of bilateral parasagittal meningiomas.Methods Twenty-six patients with bilateral parasagittal meningiomas were operated by microscopy,and the most parts of the tumor was removed.The remains of the tumor were treated with gamma knife.Results All patients were followed up 5 years.The tumors disappeared in 8 cases,reduced in 11 cases,did not change in 5 cases,and recurred in 2 cases.No severe complications occurred after gamma knife treatment.Conclusion Combined treatment of gamma knife and micriosurgery operation are effective for bialateral parasagittal meningiomas.It not only greatly improves the effectiveness,but also reduces the complications and death rate in patients with bilateral parasagittal meningiomas.

Objective To explore the outcome and prognostic factors of adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL). Methods Forty-nine newly diagnosed adult patients with Ph+ALL were analyzed retrospectively, and the treatment effect and the impact of different factors on prognosis were explored. Results In 49 patients, there were 24 males and 25 females;the median age was 38 years (range 15-77 years). Hematologic complete remission (CR), major molecular response (MMR) and complete molecular remission (CMR) rate in patients received tyrosine kinase inhibitors (TKI) plus chemotherapy were higher than those in patients received chemotherapy only (96.8 % vs. 72.2 %, χ2= 4.308, P= 0.038; 64.5% vs. 16.7 %, χ2=10.468, P= 0.001; 25.8 % vs. 11.1 %, χ2=4.250, P=0.039). With a median overall survival (OS) of 24 months (3-70 months), the 3-year OS and relapse-free survival (RFS) rates were 32.7 % and 21.4 %, respectively. The 3-year OS rate and 1-year RFS rate in TKI plus chemotherapy group were 40.3 % and 67.8 % respectively, which were higher than those in chemotherapy group (11.1 % and 11.1 %) (χ2= 12.725, χ2= 17.401, both P< 0.001). The 3-year OS and RFS rates in the allogeneic hematopoietic stem cell transplantation (allo-HSCT) group were higher than those in the group without allo-HSCT(62.5 % vs.25.7 %,χ2= 6.196,P= 0.013; 41.7 % vs. 15.0 %,χ 2= 8.032, P=0.005).The 3-year OS and RFS rates in patients achieved MMR after 2 circles treatment were higher than those in the others (45.1 % vs. 17.6 %,χ2= 5.446,P= 0.020; 28.9 % vs. 11.7 %,χ 2= 6.484,P= 0.011). Multivariate analysis showed that received TKI (HR= 0.227, 95 % CI 0.094-0.550, P= 0.001) was an independent prognostic factor for OS; received TKI (HR= 0.225, 95 % CI 0.082-0.618, P= 0.004) and allo-HSCT (HR=0.275, 95 % CI 0.077-0.983, P=0.047) were independent prognostic factors for RFS. Conclusions TKI can increase CR,MMR and CMR rates,improve outcome,and give more chance to receive HSCT.In TKI era,allo-HSCT is still the important treatment for Ph+ALL,especially for patients without MMR.

Objective To prepare an in situ gel system for nasal delivery of menthol and to evaluate the safety of this formulation.Methods Menthol in situ gel was prepared with deacetylatedgellan gum.The nasal mucocilia toxicities of this formulation was evaluated using in situ toad palate model.Guinea pig skin sensitization test and the rabbit skin irritation test were conducted.Skin allergy and irritation reaction were monitored and scored.Results No significant effect on nasal mucosa ciliary movement and the morphology of rat nasal mucosa were observed.The formulation did not induce any dermal irritation in rabbits.Skin allergic reaction was not found in guinea pigs.Conclusion The preparation of menthol in situ nasal gel with low ciliary toxicity was easily achieved.This gel has good physiological flexibility.The further investigation was warranted for this formulation as an intranasal drug delivery system.

Objective To research the epithelial-mesenchymal transition (EMT) effects of cuprous oxide nanoparticles (CONPs) on melanoma.Methods Cuprous oxide nanoparticles were prepared hydrothermally.The B16 cells were cultured with cuprous oxide nanoparticlesat different concentrations (5,25,50 μg/ml).The changes of the morphology of the B16 cell were observed under the inverted microscope.The effects of CONPs on B16 cell migration ability were detected through the Wound healing assay and the Transwell assay.Then cell immunofluorescence and western blotting were used to test the EMT related molecular markers, including E-cadherin, N-cadherin, Cytokeratin, and Vimentin.Results The synthesized cuprous oxide nanoparticles distribute uniformly with a diameter of 40 nm.Our study indicated that CONPs inhibited the EMT of B16 cell.A conversion process was discovered in this study.In B16 cells, CONPs inhibited B16 cell migration, promoted the expression of E-cadherin, Cytokeratin and Desmoplakin, while the expression of N-cadherin and Vimentin was repressed in protein level.Conclusion Cuprous oxide nanoparticles can significantly restrain the invasion and metastasis of melanoma cells and inhabit the EMT of B16 cells.

Ametropic visual impairment has become a public health problem in China and even in the world, especially the prevention and control of myopia development, and the Chinese government attaches great importances to the eye health of school-age children and adolescents.The establishment of visual health archives and the screening of refractive errors are important managements prevention and control.However, there has always been a lack of relevant domestic or international screening specifications, and which may result in screening implementation subject confusion, inconsistent screening indicators and boundary values, unscientific operation methods and feedback in the routine screening work in China.With the push and support of National Health Commission, a recommended national health standard Specification for Screening of Refractive Error in School-age Children and Adolescents (WS/T 663-2019) was officially issued on January 11, 2020 and will be implemented from June 1, 2020, which clarified the technical standardization for the specific requirement, methods, referral recommendation and management during screening of refractive error in school-age children and adolescents.Implementing an effective screening and prevention of ametropic visual impairment in school-age children and adolescents according to the standard is an important task and responsibility of medical and educational institutions.

OBJECTIVE: The current fertilization methods for Chinese yam are uneconomic and unfriend to environment. A rational one is very important to achieve desired balance of high yield of Chinese yam, economic and friend to environment. Here, we studied the effects of nitrogen (N), phosphorus (P), and potassium (K) fertilizers on the yield of 'Qinfeng' Chinese yam in shallow-groove directional cultivation. METHODS: The experiments were conducted in Dehua County, Fujian Province, China using a "3414" optimal design. Overall, three fertilizer factors (N, P, and K) were evaluated at the following four levels: 0, no fertilizer; 1, 0.5-fold the typical rate; 2, typical fertilization rate; and 3, 1.5-fold the typical rate. There were 14 different fertilization treatments. RESULTS: Treatment 6 (N₂P₂K₂) produced the longest (75.6 cm) and thickest tubers (4.9 cm) with the highest tuber fresh weight (1311.9 g) and yield (41 015.9 kg/hm²), whereas, treatment 1 produced the shortest (65.6 cm) and thinnest tubers (3.9 cm) with the lowest fresh weight (953.4 g) and yield (28 532.8 kg/hm²) among the 14 fertilizer combinations. The experimental data could be fitted to single-variable quadratic and binary quadratic models but not to a ternary quadratic polynomial model. Appropriate N, P, and K fertilizer application rates increased Chinese yam yield. However, excessive fertilization lowered the yield. Chinese yam yield was significantly and strongly correlated with the amounts of N, P, and K fertilizer applied. CONCLUSION Based on the single variable quadratic and binary quadratic models, we propose that the quantities of N, P, and K fertilizer used to grow 1 hm² 'Qinfeng' Chinese yam should be 360-388.3, 90-100.95, and 416.3-675 kg, respectively.

OBJECTIVETo raise the awareness of adenosquamous carcinoma of pancreas and discuss the treatment of it.

METHODSClinical data of 80 cases of pancreas adenosquamous carcinoma patients in the Department of Pancreas Surgery of Changhai Hospital of Second Military Medical University from December 2003 to October 2011 were analyzed. The diagnose and treatment methods were discussed. There were 61 male cases and 19 female cases who aged from 28 to 81 years, with an average age of 60 years. The primary symptoms included 46 cases (57.5%) of abdominal malaise, 6 cases (7.5%) of low back pain, 4 cases (5.0%) of abdominal swelling pain with low back pain, 15 cases (18.8%) of abdominal swelling pain with jaundice, 5 cases (6.3%) of painless jaundice, 3 cases (3.8%) of significantly decreased body-weight and 1 case (1.3%) of no symptom. All the patients had been identified as pancreas tumor suffers by ultrasound, enhanced CT scan or MRI. Totally there were 43 cases of head/unciform process tumors, 15 cases of pancreas body tumors and 22 pancreas tail cases.Health situation of all cases were follow-up observed in the outpatient department or telephoned every 3 months till 24 months after the surgery.

RESULTSAmong the 80 patients, 19 patients underwent pancreaticoduodenectomy (PD) , 19 patients received pylorus-preserving PD, with 4 cases of palliative resection and 1 case of total pancreatectomy. The volume of bleeding during the surgery varied from 50 to 3 500 ml with a blood transfusion volume varied from 0 to 4 000 ml. Consumed time for PD procedures was 90 to 260 min with 60 to 150 min for body and (or) tail resection with or without lienectomy. The mean diameter of tumor was (4.9 ± 2.2) cm. Pathological tests showed 35 cases of positive lymph nodes, adjacent organ invasion happened in 35 patients, however, nerve invasion were found in 68 cases.Eighteen cases occurred postoperative complications, including bleeding, pancreatic fistula, gastric emptying, incision fat liquefaction and infection, pleural effusion, ascites and nervous diarrhea. There were only 48 effective follow-up patients, with a loss ratio of follow-up by 40.0%, reasons for the loss includes change of contact information, refuse or unable to provide useful information by the relatives of the patients.Sixteen patients received chemotherapy, and 8 patients received radiotherapy after operation. All patients were dead in the effective follow-ups. The postoperative median survival time was 6 months (0.1 to 23.0 months).

CONCLUSIONSAdenosquamous carcinoma of pancreas is a rare kind of malignant tumor, nerve invasion can be found in almost all the cases. Patients with adenosquamous carcinoma of pancreas have an unfavorable prognosis. The principle treatments are surgery, radiotherapy and chemotherapy.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Adenosquamous ; mortality ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; pathology ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Postoperative Complications ; mortality ; Prognosis ; Young Adult