Pancreatic adenocarcinoma is a highly lethal disease with a high morbidity and dismal prognosis.A multidisciplinary consultation based on evidence-based medicine has become the main modality for treatment of pancreatic adenocarcinoma.National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology has been widely recognized and implemented.Recently,the guidelines (version 1.2017) in oncology have been published by NCCN.This article will summarize and interpret the updates of the new version of the NCCN guideline for pancreatic adenocarcinoma.

Liver transplantation is one of the main treatments for acute and chronic liver failure currently.In recent years,with the lack of donor liver transplantation and the in creasing number of patients,the major donator of liver transplant is brain dead patients.In brain-dead state,organ functions de cline gradually.Changes in hemodynamics and immunity could lead to inflammation and alter hormone release.Organ survival and patients'prognosis can be unpredictable.The study of the above phenomenal mechanisms is still at an early stage.This article summarized the current liver transplant treatments by explai ning the pathophysiology of donor organ damage and reviewing the prognosis.The aim of this article was to provide a perspective for future study on this topic.

Objective To investigate effects of diabetes mellitus (DM) on pharmacokinetics (PK) of cephradine (CED).Methods DM model was induced by iv.alloxan 60 mg·kg-1.A reversed phase HPLC internal standard method was developed for measurement of CED plasma concentration.After blood collection,rats were sacrificed to collect kidneys for calculating kidney index(KW/BW).DM and normal control (CTL) rats were randomly assigned to receive iv.or ig.CED at a dose of 180 or 90 mg·kg-1.The 3p97 program was used to calculate PK parameters.Results The developed HPLC method was validated to have high specificity,precision,recovery and good storage stability,and met requirements for PK study of CED.The CED in rats of both DM and CTL groups showed the iv.two-compartment PK and ig.one-compartment PK and followed the first-order kinetics.Following iv.dosing,a remarkably decreased t1/2β and MRT,increased CLt were evident in DM group as compared with CTL group (P ＜ 0.05).After ig dosing,a significant decrease in t1/2k and t a remarkable increase in CLt and Cm=were observed for DM group as compared with CTL group (P ＜ 0.05).The DM rats showed a trend of decreased t1/2ka vs CTL rats.There was no significant difference in the oral bioavailability between the two groups (P ＞ 0.05).KW and KW/BW in DM group were increased remarkably compared with CTL group (P ＜ 0.05).Conclusion The DM vs CTL results in faster absorption and elimination of CED in rats,but does not have significantly affect in oral bioavailability.The compensatory hypertrophy and hyperfunction of early-stage diabetic kidneys may constitute one of causes of quick elimination of CED in rats with DM.

Craniofacial pain is a common disease and it is complicated in its diagnosis and treatment.Some common kinds of craniofacial pain are introduced according to the criteria of headache classification of International Headache Society(IHS)2004.Trigeminal neuralgia,glossopharyngeal neuralgia,nervus intermedius neuralgia,supra-orbital neuralgia,occipital neuralgia,acute zoster and postherpetic neuraigia and Tolosa-Hunt syndrome are included with their key points of clinical diagnosis and treatment.

Gastrointestinal stromal tumors(GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Most of these stromal tumors are characterized by mutations in the KTT or platelet-derived growth factor receptor α (PDGFRA) genes, resulting in the constitutive activation of tyrosine kinase signaling. Tyrosine kinase inhibitors(TKI), such as imatinib and sunitinib, provide the standard first-line and second-line therapy for patients with metastatic or unresectable GIST. Imatinib resistance has been a challenging problem in clinical practice and raised great concern. This review introduces the underlying mechanisms of imatinib resistance and advances of treatment strategies. Reasonable individual treatment with the guidance of molecular biology is promising to improve the efficacy and the quality of life for GIST patients.
Antineoplastic Agents ; Benzamides ; Disease Progression ; Drug Resistance, Neoplasm ; Gastrointestinal Neoplasms ; genetics ; therapy ; Gastrointestinal Stromal Tumors ; genetics ; therapy ; Humans ; Imatinib Mesylate ; Indoles ; Mutation ; Piperazines ; Proto-Oncogene Proteins c-kit ; Pyrimidines ; Pyrroles ; Quality of Life ; Receptor, Platelet-Derived Growth Factor alpha

Background The operation mode of automobile manufacturing industry (AMI) makes workers have different degrees of occupational stress and burnout, which may lead to negative emotions and depressive symptoms. Objective To study the relationship between occupational stress, job burnout, and depressive symptoms in AMI workers. Methods In this study, 1300 workers from a Guangzhou AMI company were selected as subjects by cluster random sampling method. Occupational stress, job burnout, and depressive symptoms of the workers were assessed by using the Effort-Reward Imbalance (ERI) questionnaire, the Maslach Burnout Inventory general survey questionnaire, and the Patient Health Questionnaire-9, respectively. Hierarchical regression was used to analyze the effects of occupational stress and job burnout on depressive symptoms in AMI workers. Mediating effect model was used to analyze the mediating effect of job burnout on the relationship between occupational stress and depressive symptoms. Results There were 1300 questionnaires distributed, 1228 valid questionnaires collected, with a 94.5% recovery rate. The ERI ratio of 1228 AMI workers was 1.06±0.72, and the positive rate of occupational stress was 37.3% (458/1228). The score of job burnout was 2.18±1.37, and the positive rate of job burnout was 62.6% (769/1228). The score of depressive symptoms was 10.27±6.42, and the positive rate of depressive symptoms was 47.1% (578/1228). The dimensional scores of effort and over-commitment in occupational stress as well as emotional exhaustion and depersonalization in job burnout of AMI workers were positively correlated with the depressive symptom scores (r_s=0.415, 0.571, 0.573, 0.593, P＜0.05). The dimensional scores of reward and personal achievement were negatively correlated (r_s=−0.454, −0.339, P＜0.05). The percentages of variance in depressive symptoms score explained by occupational stress and job burnout were 26.7% and 16.6%, respectively. Job burnout had a partial mediating effect between the three dimensions of occupational stress and depressive symptoms, and the mediating effect values were −0.2832 (95%CI: −0.3250– −0.2434), 0.3553 (95%CI: 0.3071–0.4041), and 0.4193 (95%CI: 0.3681–0.4725), respectively. Conclusion AMI workers' occupational stress affects job burnout, but also indirectly affects depressive symptoms. Job burnout partially mediates the association between occupational stress and depressive symptoms. Reducing occupational stress and burnout levels of AMI workers may alleviate depressive symptoms.

Imatinib is the key medication for adjuvant therapy in gastrointestinal stromal tumors(GIST) and the first line therapy for patients with metastatic or recurrent GIST. Preoperative treatment with imatinib may improve R0 resection rate and provide the chance of metastasectomy for cytoreduction as well as prolonging patient's survival. We investigate the significance of neoadjuvant therapy of imatinib and the timing of surgery by reviewing clinical trials and consensus in recent years.
Antineoplastic Agents ; Chemotherapy, Adjuvant ; Gastrointestinal Neoplasms ; Gastrointestinal Stromal Tumors ; Humans ; Imatinib Mesylate ; Neoadjuvant Therapy

Objective:The paper aims at developing a method of defining and visualizing the scope of the basic medical insurance pharmacy service, and provides a new way of thinking for the designated pharmacy planning. Methods:Collecting the basic data and information on administrative divisions in the planning area taking equity and efficiency as the guidance, using ArcGIS and its function modules to define and visualize the scope of the medical in-surance pharmacy service. The procedure of issue focus, method improvement, data simulation, expert consultation, methodology perfecting were followed to define and visualize the scope. Results:Forming a whole set of operative pro-cedures of defining and visualizing the scope of the medical insurance pharmacy service based on medical resources allocation standard, and the operation commands and procedures in ArcGIS were clarified. Conclusion:Operating ac-cording to the appropriate method steps, the following can be achieved:(1) The adjacent scope of medical insurance pharmacy service are adjacent to each other but do not overlap or cross;(2) Spatial relations can be clearly and ef-fectively expressed;(3) The shape is flat and regular;(4) The data collected at different times can be comparable in space, providing good prerequisites for medical insurance designated pharmacy planning.

Objective:To investigate the effects of different doses of dexmedetomidine on intestinal mucosal barrier function, cognitive function and brain protection in patients undergoing heart valve replacement.Methods:The clinical data of 135 patients with heart valve replacement from April 2019 to April 2020 in the First Affiliated Hospital of Chengdu Medical College were retrospectively analyzed. Among them, 54 patients received low-dose of dexmedetomidine after induction of anesthesia (low-dose group), 38 patients received high-dose of dexmedetomidine (high-dose group), and 43 patients did not use dexmedetomidine (control group). Before surgery (T 1), 1 h after surgery (T 2), end of surgery (T 3) and 72 h after surgery (T 4), the levels of intestinal mucosal barrier function indexes D-lactate and diamine oxidase (DAO) were detected by spectrophotometry, the levels of brain injury indexes central nervous system specific protein (S100β) and neuron-specific enolase (NSE) were detected by double antibody sandwich enzyme-linked immunosorbent assay; before surgery and 3 d after surgery, the cognitive function was assessed by the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scale before and 3 days after surgery. Result:There was no statistical difference in T 1, T 2 and T 4 D-lactic acid among 3 groups ( P>0.05); the T 3 D-lactic acid in low-dose group was significantly lower than that in high-dose group and the control group: (7.87 ± 1.59) mg/L vs. (8.99 ± 1.82) and (9.32 ± 1.74) mg/L, the high-dose group was significantly lower than the control group, and there were statistical differences ( P<0.05). There was no statistical difference in T 1 and T 2 DAO among 3 groups ( P>0.05); the T 3 and T 4 DAO in low-dose group was significantly lower than that in high-dose group and control group: (2.77 ± 0.23) kU/L vs. (3.58 ± 0.25) and (4.30 ± 0.26) kU/L, (2.08 ± 0.25) kU/L vs. (2.40 ± 0.20) and (2.71 ± 0.23) kU/L, the high-dose group was significantly lower than the control group, and there were statistical differences ( P<0.05). There were no statistical differences in MMSE score and MoCA score before surgery among 3 groups ( P>0.05); the MMSE score and MoCA score 3 d after surgery in low-dose group were significantly higher than those in high-dose group and control group: (22.76 ± 0.54) scores vs. (21.41 ± 0.47) and (20.21 ± 0.43) scores, (24.90 ± 0.51) scores vs. (24.01 ± 0.48) and (23.12 ± 0.49) scores, the high-dose group was significantly higher than the control group, and there were statistical differences ( P<0.05). There was no statistical difference in T 1, T 2 and T 4 S100β among 3 groups ( P>0.05); the T 3 S100β in low-dose group was significantly lower than that in high-dose group and control group: (4.09 ± 2.01) μg/L vs. (5.48 ± 1.10) and (6.10 ± 1.58) μg/L, and there were statistical differences ( P<0.05). There was no statistical difference in T 1 and T 4 NSE among 3 groups ( P>0.05); the T 2 and T 3 NSE in low-dose group was significantly lower than that in high-dose group and control group: (17.20 ± 4.13) μg/L vs. (20.29 ± 3.77) and (22.35 ± 3.80) μg/L, (19.40 ± 3.92) μg/L vs. (23.46 ± 5.26) and (25.18 ± 5.32) μg/L, and there were statistical differences ( P<0.05). Conclusions:Administration of 0.5 μg/(kg·h) dexmedetomidine during heart valve replacement under cardiopulmonary bypass can reduce intestinal mucosal damage, protect brain against injury in a certain degree, and improve cognitive function.

Objective: To explore the dietary patterns and related factors among urban middle school students in Guangzhou, and to provide the scientific reference for conducting nutritional education and intervention among the middle school students. Methods: Questionnaire survey was conducted for students in two grades (grade 1 of 27 junior and senior high schools) and their parents along with the physical examination for urban primary and secondary school students in Guangzhou. Dietary patterns were established by exploratory factor analysis. Multinomial Logistic regression model was used for analyzing influencing factors of dietary pattern. Results: Three major dietary patterns were identified. Type I (37.09%) was a healthy dietary pattern; type II (33.37%) and III (29.54%) were classified into western dietary patterns. Multinomial Logistic regression models showed that living on campus (ORⅡ=1.57, 95%CI:1.33-1.85; ORⅢ=1.28, 95%CI:1.07-1.52), screen time≥2 h/d (ORⅡ=2.89, 95%CI:2.51-3.33; ORⅢ=2.14, 95%CI:1.85-2.48) were positively associated with type II and III. The monthly household income per capita≥5 000 yuan (ORⅢ=1.31, 95%CI:1.14-1.51) was positively associated with type III. Senior students (ORⅡ=0.83, 95%CI:0.73-0.95; ORⅢ=0.74, 95%CI:0.64-0.85), the level of parental education (ORⅡ=0.64, 95%CI:0.52-0.79; ORⅡ=0.67, 95%CI:0.54-0.82; ORⅢ=0.72, 95%CI:0.58-0.90; ORⅢ=0.73, 95%CI:0.59-0.89) had a negative association with type II and III. Conclusion There are three dietary patterns among urban middle school students in Guangzhou. The main influencing factors include parental education, screen time, grade, resident situation, and monthly household income per capita.