Objective To systematically evaluate the safety of laparoscopic distal pancreatectomy (LDP) compared with open distal pancreatectomy (ODP).Methods Databases including Cochrane library,MEDLINE,EMbase,Google Scholar and Chinese National Knowledge Infrastructure were searched to enroll randomized clinical trials (RCT),controlled clinical trials (CCT) or retrospective case-control studies to compare LDP with ODP.All articles received quality assessment according to the inclusion and exclusion criteria,then the selected indices were analyzed using the Review Manager Version 5.0 software (The Cochrane Collaboration,Oxford,United Kingdom).Results 21 manuscripts with a total of 2 797 patients were enrolled.1 150 patients underwent LDP and the remaining 1 647 patients underwent ODP.In 20 studies (n =2 597),the total postoperative complication rates were 33.90％ for the LDP group versus 46.80％ for the ODP group [RR =0.76,95％ CI(0.69 ～ 0.84),P ＜ 0.01].In 8 studies (n =1 869) there was no significant difference [RR =0.51,95％ CI(0.21 ～ 1.24),P ＞0.05] in the perioperative mortality between LDP (4/703) and ODP (18/1 166).In 20 studies (n =2 757) there was no significant difference [RR =0.89,95％ CI(0.75 ～ 1.06),P ＞ 0.05] in the pancreatic fistula rate between LDP (168/1 132) and ODP (281/1 625).In 11 studies (n =1 840) the wound infection rate of LDP (3.24％) was significantly lower than ODP (10.85％) [RR =0.34,95％ CI(0.23 ～ 0.52),P ＜ 0.01].No significance was found between the two groups in the rates of pulmonary complications,peritoneal infection,urinary tract infection,postoperative bleeding,pseudocyst formation,intestinal obstruction and ascites formation between LDP and ODP.Conclusions When compared with the traditional open procedure,LDP has the advantages of significantlylower rates of postoperative complication and wound infection.There were no significant differences in postoperative mortality,and pancreatic fistula rate between LDP and ODP.This meta-analysis suggests that LDP is a safe and feasible operative method.

Objective To analyze the imaging manifestation and feature of congenial pulmonary arteriovenous fistulas (CPAVF) and observe the effect of endovascular treatment. Methods The plain films, CT and DSA of CPAVF retrospective- ly were analyzed. The effect of transcatheter embolization with coil was observed by follow-up. Results Feeding artery was pulmonary artery branches in five cases and was branchial artery in one case. The images of all cases were divided into three types: simple type-3 cases, complex type-2 cases and diffuse type-1 case. Both CT and DSA could give the correct diagnosis, however 3 cases were diagnosed wrongly by X-ray. Three cases were underwent transcatheter endovascular em- bolism with coils, and one case were done three times. Systemic arterial oxygen saturation improved strikingly in two pa- tients after treatment, and the symptoms of hemoptsis disappeared immediately after branchial arterial embolism in other case. Conclusion DSA was the best means in the diagnosis of PAVF. CT and three-dimensional reconstruction can be giv- en correct and direct diagnosis for big PAVF, but can not replace DSA in the diagnosis of small PAVF. Percutaneous tran- scatheter endovascular embolism with coils is an effective and safe treatment for PAVF, but it is only a palliative therapy for diffuse PAVF.

Objective To establish an evaluation index system for the quality and safety of the specialized nursing care in cardiovascular medicine. Methods To screen and evaluate the safety quality evaluation index via a group discussion with Delphi method and analytic hierarchy process referenced to the literatures from the evaluation index of domestic nursing safety quality (NSQ)and on the base ofthe factor quality- quality of links-final quality3-dimensional quality structure theory by Donabedian. Results The first and second round of expert consultation and the recovery rate were 97.05% (33/34) and 94.12% (32/34) respectibely, the effective rate was 100%;The authoritative coefficient of expert of the safety quality evaluation index of the specialized nursing care is 0.867 and 0.879 respectively. In the first round, the average of the importance rating is 3.50-5.00, the standard deviation is 0-0.042 and full mark rate is 34.10%-100%. In the second round, the average of the importance rating is 3.80-4.70, the standard deviation is 0~0.047 and full mark rate is 31.60%-100%. The fluctuation degree of the first round is more than 0.10 with a low coordination degree. However, the fluctuation degree of the second round result is less than 0.10. The coordination coefficients from all qustionnair scores by experts in the two roudns are 0.169 and 0.286. The difference was statistically significant according to the chi-square analysis (X2=6.842, P=0.002). The NSQ evaluatin index included 3 first degree indexes (weight coefficient including 0.2684,link qualing 0.6144,and quality 0.1172),16 second degree indicators (weight coefficient 0.034~0.0859) and 61 third degree indexes ( weight coefficient 0.034~0.0859) and 61 third degree indexes (weight coefficient 0.0052~0.0412). Conclusions This paper preliminary established a specialied NSQ evaluation index with factor quality- quality of links-final quality 3-dimensional quality structure in the field of cardiovascular medicine, which is based on Delphi method and analytic hierarchy process. NSQ provides a measurement tool for nurses in CME.

Abstract: The principles, detection limits, advantages, shortcomings and precautions for procedure of spectrophotometry, atomic absorption spectrometry, potential stripping analysis and osillo-polarography for determination of lead in environmental samples and biological materials were introduced in this paper to provide some reference data for the selecting suitable method for determination of lead based on the various kinds of samples, the samples sizes and the various conditions of analytical instruments and equipments.

Objective:To survey the status quo of ADR occurred in our hospital. Methods:Totally 277 ADR reports were collect-ed and analyzed statistically in our hospital from January 2010 to June 2013. Results:Among the ADR cases,the ratio of male to fe-male was 1∶1. 565, and 59. 93% of ADR occurred in the people over 50 years old. Totally 240 ADR cases (86. 64%) were induced by intravenous administration and 32 ADR cases (11. 87%) were induced by oral administration. Totally 167 ADR cases were caused by antibiotics (60. 29%), among them, 54 cases wero by cephalosporins (32. 34%), 47 cases by quinolones (28. 14%) and 32 ca-ses by cephamycins (19. 16%). Totally 42 ADR cases were caused by traditional Chinese medicine injections (15. 16%), and 18 ca-ses were caused by cardiovascular system drugs (6. 5%). The main clinical manifestations were lesion of skin and its appendant organr and digestive system injury with 162 cases (58. 48%) and 62 cases (22. 38%), respectively. Conclusion: It is necessary to strengthen clinical ADR monitoring, rationally use antibiotics and emphasize the importance of safe medication of traditional Chinese medicine injections.

Objective To investigate the value of cystatin CysC on early renal damage in patients with essential hypertensive.Methods Hundred-four patients who were diagnosed as essential hypertensive with microalbuminuria (Urinary microalbumin:20-200 mg/L) with essential hypertensive (58 males and 46 females) were enrolled and 54 healthy subjects (30 males and 24 females) were selected as controls.Serum CysC (CysC)、Crea(Cr) 、BUN、uric acid (UA) were measured and ROC curve was established based on the examination.Results There were significant difference on the level of Serum CysC[1.22(0.91,1.51 ) mg/L vs 0.73 (0.61,0.79 ) mg/L,Z=3.30,P＜0.01],BUN [6.40 ( 4.43,9.06 ) mmol/L vs 5.10 ( 4.34,5.93 ) mmol/L,Z=5.94,P＜0.01],Cr [96.3 (72.6,122.0 ) μmol/L vs 70.5 (56.2,76.0 ) μmol/L,Z=8.30,P＜0.01],UA [375.7 ( 312.3,431.8 ) μmol/L vs 328.7 ( 271,379.3 ) mmol/L,Z=3.28,P＜0.01] between essential hypertensive group and control group.According to ROC curve,the area of CysC under the ROC curve (AUC) in 104 patients was 0.87,significantly different with CR(0.78),BUN(0.66),UA(0.66) (P＜0.05 or P＜0.01 ) The Youden index of CysC was 0.69,and the corresponding sensitivity and specificity of CysC were 76％ and 93％ respectively.Conclusion The diagnostic value of serum CysC on early renal damage in patients with essential hypertensive is superior to Cr,BUN and UA,and changes of renal function can be found earlier according to the level of serum CysC,It plays a key role in the diagnosis,treatment and prognosis of the early renal damage in patients with essential hypertension.

Objective To investigate the relationship between the polymorphisms of plasminogen activator inhibitor-1(PAI-1)gene and the level of endothelium-dependent vasodilatation (EDF) in patients with type 2 diabe- tes(T2DM).Methods The polymorphisms of PAI-1(4G/5G)gene were determined by polymerase chain reaction (PCR)and the EDF was assessed by non-invasive hish resolution B-mode ultrasonography in 66 T2DM patients and 33 controls.Plasma plasminogen activator inhibitor type-1(PAI-1)and fibrinogen(Fg)were measured.Results Frequencies of PAI-1 alleles and genotypes in T2DM patients and controls were all in accordance with the Hardy Weinberge quilibrium,without significant differences between T2DM patients and controls(P>0.05).PAI-1 and Fg were significantly higher in T2DM patients than in controls.There were significant differences in EDF and PAI- lamong different genotypes of PAI-1(P<0.05).Conclusion The PAI-1 genotype may affect EDF in T2DM pa- tients.

Objective To study the DSA hepatoarteriography manifestations in hepatic carcinoma after endocare cryocare system (ECS)treatment for improving the comprehensive therapy of hepatic carcinoma.Methods Thirty eight male patients with primary liver cancer ( n =32) and hepatic metastasis (n=6) were enrolled in this study. Common hepatic arteriography or super-selection angiography was performed in all patients after ECS treatment in 7 days and 30-60 days.Results The foci covered with ice ball were shown as round or ovoid. Single tumor less than 5 cm was covered completely, while the shape of focus covered with more ice ball showed irregularity, mass-like and diffuse nodulss with diseminated tumor vessels and tumor stains. The shortcoming of ECS included 18 missed areas, hepatic A-V shunt and hepatic A-portal V shunt in 4, bleeding in puncture tract 5, and extravasation of contrast material in 6 cases. Delineated margin existed between the frozon area and surrounding tissues.Conclusions ①ECS is effective on liver tumor 5 cm. ③ Tendency of missed areas in huge tumor and widespread nodes accurs after ECS. ④Complication occurs easily during ECS performance near the hepatic capsule and porta hepatis. ⑤TACE would improve comprehensive therapy effect of liver cancer about7 days after cryotherapy.

ObjectiveTo explore the effect of statin in reduction of my ocardial injury in patients undergoing percutaneous coronary intervention(PCI).MethodsTotal of 185 patients undergoing PCI were included,140 patients were received atorvastatin before PCI,while 145 were not given statins at the time of PCI.Creatine kinase-MB and troponin Ⅰ were measured at baseline and at 8 and 24 hours after the procedure.ResultsPost procedurul peak levels of troponin Ⅰ and creatine kinase-MB were(0.12 ±0.26) μg/L and(2.61 ± 3.07) μg/L in the observation group,which were significantly lower than(0.51 ± 1.14) μg/L and( 6.85 ± 14.38 ) μg/L in the control group( t =3.951,3.414,P ＜ 0.05).ConclusionPretreatment with atorvastatin for 7 days could significantly reduces procedural myocardial injury in elective PCI.