Pancreatic resection is the treatment choice for pancreatic malignancy and cer-tain benign pancreatic disorders. Althogh, pancreatic resection requires high techndogy whereas current mortality after a pancreaticoduodenectomy has dropped to below 3 % in expe-rienced high-volume centers and post-operative morbidity is still as high as 50%. At pres-ent, the single most significant cause of morbidity and mortality after pancreatectomy is the development of pancreatic leakage and fistula (PF). The occurrence of a PF increases the length of hospital stay and the cost of treatment, requires additional investigations and proce-dures, and can result in life-threatening complications. Early recognition of a PF and prompt institution of appropriate treatment is critical to the prevention of potentially devastating con-sequences; however there is no universally accepted definition of PF that would allow stand-ardized reporting and proper comparison of outcomes between different centers. The present article reviews the conlept evolution of PF and discusses the current preventive strategies.

NF-κB is a nuclear transcription factor with multiple adjustion. The activation of NF-κB can occur by three different mechanisms. The multiple NF-κB activation pathways are important due to the large number of genes that are regulated by NF-κB and their effects on cancer cells. These gene products can promote growth and tumori-genesis, inhibit apoptosis, allow metastasis and invasion, promote angingenesis, and cause chemoresistance. All of these roles in pancreatic cancer make NF-κB a promising target in treatment. Therefore, inhibiting the activity of NF-κB becomes a hot spot and novel idea of preventing and treating pancreatic cancer.

Objective To summarize the experience in the diagnosis and treatment of adenosquamous carcinoma of the pancreas to better our understanding of this rare exocrine pancreatic neoplasm. Methods The clinical data of five cases of adenosquamous carcinoma of pancreas admitted between July 2002 and June 2008 were analyzed retrospectively, and relevant literature was reviewed and discussed. Results Pancreatic adenosquamous carcinoma was found in 3 men and 2 women with a mean age of 64 ± 18 years old. Tumor was located in the head of pancreas in 2 patients, body and tail in 3 cases. One patient was submitted to pancreaticoduodenectomy, three patients underwent distal pancreatectomy and splenectomy and one had cholecystojejunostomy and gastric bypass surgery, as well as 1251 implantation. The mean size of the tumor was 4.5 cm. One patient had posterior stomach wall, descending duodenum, portal vein involvement; spleen was invaded in 2 cases; neural and vessel invasion was present in 2 cases. Lymph node metastasis was present in 1 case. Pathologically primary tumor and liver metastasis were mixture of adenocarcinoma and squamous cell carcinoma. In all 5 patients with complete follow up, 3 died of tumor recurrence or liver metastasis with a mean postoperative survival time of 11.2 momths (8.5 ~ 13.5 months). The other 2 cases survived for 6 and 56 months , respectively. Conclusions Pancreatic adenosquamous carcinoma was likely to be found in patients in their 60s, and confirmative diagnosis was difficult. The prognosis of this rare tumor appeared to be dismal due to the high degree of malignancy.

Objective To construct a simple method for the measurement of activity of S-homocysteine methyltransferase (HMT),and explore the best processing condition for HMT and the preservation of HMT.Methods HMT was expressed in pro-karyotic system by using genetic engineering technology,then was purified by using affinity and Sephadex G1 5 chromatography. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE)was performed to identify the physicochemical and bio-logical properties of target protein.Based on the principle of 5 ,5′-disulfide-double (2- nitro benzoic acid)(DTNB)could react with sulfydryl compounds rapidly,the reduction of homocysteine was detect to evaluate the activity of enzyme,then the best processing conditions of HTM were determined.Activity of enzyme,preserved in preservation solution with or without glycerol and preserved under different temperatures,was detected.Activity remaining ratios were detected and compared between HMT preserved in pres-ervation solution with different protective agents of different concentration and preserved by cryodesiccation.Results The purity of recombined HMT was above 95%,with molecular weight of 36 000 and excellent catalytic activity,and the catalytic activity was 2 000 U/mg.The optimum condition for the detection of biological activity was using HEPES buffer of pH 7.4 at 37 ℃ and reac-tion for 25 min.Glycerol could significantly prolong the preserving time of HMT,and half activity of HMT could be remained for six months.The reservation rates of activity of HMT,preserved in preservation solution with mannitol and trehalose,were 104%and 100%,respectively.Conclusion HMT could be obtained through genetic engineering.A simple test method of HMT was es-tablished,and the best processing conditions and preserving methods of HMT were determined,which laid a foundation for clinical application.

Objective To observe the therapeutic role on monoclonal antibody of alkaline phosphatase(AAP) to vasogenic cerebral edema in rats(VCE).Methods 60 Wistar rats were randomly divided into 3 groups:normal group,VCE group and AAP group.VCE animal model was made by injecting AAP.Brain water content of gray and white matter were measured by Moistrue Analyzer respectively.The permeability of the blood brain barrier (BBB) was determined by Evan's blue(EB) extravasation.Results The brain water content of gray and white matter in AAP group was reduced markedly,so the permeability of BBB was reduced(P0.05). Conclusion AAP can treat VCE well. Morbidity mechanism of VCE is related to the activity of alkaline phosphatase.

Objective To investigate the occupational risk awareness levels of higher vocational nursing students before and after the clinic practice.Methods Five-year higher vocational nursing students were investigated by filling out questionnaires before and after the clinic practice.Results Nursing students' occupational risk awareness improved after the clinic practice.They hoped to acquire knowledge about occupational risk and thought that the school was supposed to offer professional ethics courses and strengthen the occupational risk education.Conclusions The majority of nursing students knew the protective measures of occupational exposure in nursing.But there were also someone who did not know these.Relevant knowledge was in high demand.Therefore,schools and internship units should provide a variety of ways to reduce the risks during the internship of nursing students.

Objective To observe the clinical efficacy of puerarin injection combined with levodopa in the treatment of Parkinson. Methods 126 Parkinson patients were grouped into two groups randomly. Control group was treated with levodopa and observation group was added to Gegensu injection. Results 3 months later, UPDRS scale score, ADL and HAMD score of observation group were lower than that of control group(P<0.05).Serum Hcy and plasma hs-CRP level of observation group were lower than that of control group( P<0.05).Adverse reactions of observation group was 6.35％ during treatment, compared with the control group 9.52％ had no significant difference. Conclusion Gegensu injection can help improve cognitive ability and improve self-care ability in patients with Parkinson, alleviate symptoms and medication safety.

Objective To evaluate accuracy of preoperative tumor grade and intracperative gross examination of myometrial invasion in patients with clinical stage Ⅰ endometriod adenocarcinoma for lymphadenectomy. Methods Clinic-pathological data were retrospectively collected from 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent operation in Women's Hospital, Zhejiang University School of Medicine from January 1999 to December 2008. According to postoperative histology diagnosis, accuracy of preoperative tumor grade by curettage and depth of myometrial invasion by intraoperative gross examination was evaluated, and clinic-pathological factors associated with accuracy were analyzed. Results Sensitivity, specificity, accuracy, false negative rate, false positive rate, and positive and negative predictive value for the prediction of needing for intraoperative lymphadenectomy in patients with clinical stage Ⅰ endometriod adenocarcinoma were 70. 4% ,80. 2% ,77.6% ,12.0%, 43.0%, 57.0% and 88.0%, respectively. Analysis of mutil-factors shown that patient age, tumor size, lymph node metastasis and extrauterine spread lesions were independent factors affected the accuracy of prediction(P ＜ 0. 05 ). Conclusion Prediction of needing for lymphadenectomy by preoperative tumor grade and intraoperative gross examination of myometrial invasion is reliable in clinical stage Ⅰ endometriod adenocarcinoma patients, while there is a highly false negative rate in prediction of not needing for lymphadenectomy, while other prognostic factors such as patient age, tumor size, lymph node metastasis and extrauterine spread lesion should be together considered.

OBJECTIVE: To analyze the effects of social and psychological factors on rehabilitation status of end stage renal disease (ESRD) patients under peritoneal dialysis. METHODS: From August in 2005 to March in 2007, 171 patients experienced peritoneal dialysis were diagnosed at the Center of Peritoneal Dialysis, Department of Nephrology, First Hospital, Peking University, including 66 males and 105 females, aged (60±13) years, with an average dialysis time of 22.8 months. They were studied with questionnaires and interview. Rehabilitation status was investigated from two aspects of activity and participation by Karnofsky activity index, Social Dysfunction Screening Scale. Hamilton depression and anxiety scales, Medical Coping Modes Questionnaire and Social Supporting Rating Scale were used to investigate social and psychological factors.RESULTS: A total of 200 questionnaires were handed out and 171 (85.5%) of them were drawn in. 134 patient had normal activity status, 78.4% of them had Dysfunction and 129 patients (75.4%) had normal social function status. Forty-two (24.5%) of patients had the symptom of anxiety, 15 (8.2%) had depression. The score of "Acceptance-Resignation" was significantly higher in this group than patients with other chronic diseases. There were no significant differences in scores of "Confrontation" and "Avoidance". Activity of rehabilitation outcome and participation index served as dependent variable, whereas depression and anxiety, coping mode and social supporting as independent variable. Using multiple stepwise regression analysis, factors that affected patient rehabilitation were found, including depression, utilization of social support and the facing coping mode. CONCLUSION: Depression, utilization of social support and the facing coping mode have important effects on patient rehabilitation.

Triple negative breast cancer is a special subtype of breast cancer , including basal -like breast cancer and unclassified breast cancer .Since it was defined in 2005 ,the differences from other subtypes in biological characteristics and poor prognosis of TNBC have became priorities and hotspots which are researched by epidemiologists ,pathologists and clinicians .According to the research ,the risk factors of TNBC include race ,obe-sity,age,women′s reproductive process,oral contraceptive use,physical activity,abortion history,family history, socio-economic factors and so on .This review focuses on race ,obesity,age,women′s reproductive process ,oral contraceptive use ,according to the latest research results of risk factors of TNBC ,helping healthy people get a bet-ter understanding of TNBC and preventing the incidence of TNBC ,suggesting clinicians combine the biological characteristics and epidemiological features and further instructing people to take precautions .This paper also pro-vides theoretical basis for researcher on the further investigaticans of the etiology of TNBC .