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 investigate the effects of different anesthesia methods on oxidative stress in elderly patients undergoing neurosurgery.Methods Totally 60 patients undergoing neurosurgery were randomly divided into 3 groups:propofol group,isoflurane group and sevoflurane group (n-20 each group),heart rate(HR) and mean artery pressure(MAP) in all patients were recorded at the time points of pre anesthesia (T0),incision of skin (T1),incision of dura (T2),end of operation (T3).The activity of superoxide dismuase (SOD),catalase (CAT),and glutathione peroxidase (GSH-Px) were measured at the time of T0,6 h (T4),24 h (T5),48 h (T6),72 h (T7)after operation.The efficacy of anesthesia was evaluated by Glasgow Outcome Score (GOS) at 3 months after operation.Results The activity of SOD,CAT and GSH Px in 3 groups were lower at T5and T6 than at T0 (P＜0.05).The SOD activity at T4,T5,T5and TTwere higher in propofol group [(87.2±11.8) U/ml,(75.1±12.4) U/ml,(84.6±9.3) U/ml,(92.5±12.5) U/ml,respectively]than in isoflurane group [(75.0±12.2) U/ml,(63.8±8.9) U/ml,(70.3±9.0) U/ml,(82.5±13.5) U/ml,respectively] and in sevoflurane group [(79.4±10.4) U/ml,(68.7±10.5) U/ml,(72.0±10.9) U/ml,(85.17±8.41) U/ml,respectively] (all P＜0.05).The CAT activity at T5 was higher in propofol group [(66.59±7.21) U/ml] than in isaflurane group [(51.58±8.19) U/ml] and in sevoflurane group [(58.49±7.27) U/ml] (both P＜0.05).The GSH-Px activity was higher at T4,T5and T6 in group propofol[(159.2 ± 20.8) U,(140.7 ± 16.2) U,(152.3 ± 19.1) U,respectively] than in isoflurane group [(129.4±17.9) U,(108.3±15.9) U,(118.4±14.1) U,respectively] and in sevoflurane group [(140.1±15.8) U,(125.2± 17.1) U,(137.9±10.7) U,respectively] (all P＜0.05).The outcome of neurosurgery had no significant differences among the 3 groups (P＞0.05).Conclusions Propofol has a better effect on oxidative stress than isoflurane and sevoflurane in elderly patients undergoing neurosurgery.

Objective To analyze the literature distribution and research status of depression in the elderly published in Chinese Medical Association journals.Methods The literatures of elderly depression published in 85 kinds of Chinese Medical Association journals from 2003 to 2012 were collected.The publication year,distribution,content,author,institution and region of these literatures were analyzed.Results From 2003 to 2012,there were 85 articles on depression in the elderly published in 15 kinds of journals of the Chinese Medical Association.These literatures were published mostly in 2011 (18 articles,21.2％),secondly in 2010 (13 articles,15.3％) and 2012 (12 articles,14.1％),which were published mostly in Chinese Journal of Geriatrics (29,34.1％).These articles mainly included basic science,inventory survey,diagnostic methods and clinical treatment strategy,and the most published form was treatise (77 articles,90.6％).The author who published the most articles was YUAN Gui yong from Nanjing (3 articles,3.5％),the institution which published the most articles was People's Hospital of Hainan Province (4 articles,4.7％),and the provinces or cities which published the most articles were Beijing (15 articles,17.6％),Shandong (9 articles,10.6％) and Zhejiang (7 articles,8.2％) by turns.Among the 85 articles,31 articles (36.5％) were supported by foundations.The definition,epidemiology,mechanism,influence factors,clinical characteristics,diagnosis and treatment strategy of elderly depression,and especially secondary depression were well discussed in these literatures.Conclusions The literatures of elderly depression published in Chinese Medical Association journals are insufficient in quantity,and more than half of the literatures are published from 2010 to 2012.The distribution of journals is relatively concentrated,but the distribution of author,institution and region in these articles is dispersed.Secondary depression in the elderly is concerned especially.

To adapt to the new training program and requirement of MOE , a reform in Chinese curricula, textbook selection and editing, and teaching evaluation method was carried out to strengthen medical Chinese teaching and improve the students' overall Chinese proficiency. Detailed measures in-cluded adjusting the class hour, formulating Chinese reading and writing syllabus, Chinese listening and speaking syllabus and graded vocabulary, evaluating the effect through Chinese proficiency test, learning evaluation and file cover evaluation. After the reform, attendance rate was improved obviously, plagiarism rate was declined obviously and students were highly praised by teacher during the internship and practice.

Objective To investigate etiology and clinical features of acute pancreatitis (AP) in young patients. Methods In total, 423 patients with AP admitted to Renmin Hospital of Wuhan University, Wuhan, Hubei province during January 2006 to December 2009 were retrospectively analyzed, 55 cases aged 34 years or less as young group and another 55 cases aged more than 34 years as middle- and elderly-age group. Their etiology, clinical features and illness scores based on some standard criteria were assessed. Results Proportion of varied etiologies of AP in young group was different from that in middle- and elderly-age one (x2 = 17. 107, P = 0. 009) , mainly as biliary and idiopathic pancreatitis in young group and as biliary and alcoholic pancreatitis in middle- and elderly-age one. Incidence of diet-related and idiopathic pancreatitis were higher in young group than that in middle- and elderly-age one ( x2 =4. 853, P = 0. 028 and x2=4. 274, P = 0. 039 ). Scores of the acute physiology and chronic health evaluation II ( APACHE II ) , Ranson criteria and the bedside index for severity in acute pancreatitis ( BISAP) were all lower in young group than those in middle- and elderly-age one (t = 5. 381 , P = 0. 000; t = 4. 388 , P = 0. 000 and t=3. 083, P = 0. 003 ) . There was no statistically significant difference in scores of computed tomography severity index ( CTSI) between young group and middle- and elderly-age one (t = ±0. 750, P > 0. 05 ) . Recurrence rate of AP was lower in young group than that in middle- and elderly-age one ( x2 =4. 251, P = 0. 039). Cholecystitis was more complicated in young group, pregnancy was more complicated in young group (x2 =4. 151 , P =0. 042) , and elevated blood glucose was more complicated in middle- and elderly-age one (x2 = 13. 285 , P = 0. 000 ) . Conclusions Etiology of AP varies in young patients with more dietary factors, occurrence of systemic complications and risks for death are lower in young group than those in middle- and elderly-age one, and there was no statistically significant difference in local complications and severity of illness between the two groups.

The reproduction of Helicoverpa armigera nucleopolyhedrovirus in the midgut epithelia cells and the other sensitive tissues was observed by electron microscopy. The reproducing viruses in the midgut epithelia cells were mostly without envelopes, and thte polyhedrons were seldom formed. The reproduciing viruses in the other sensitive cells were with envelopes, and packed in polyhedrons.

OBJECTIVE To find out fulminate epidemiological features of Stenotrophomonas maltophilia in ICU and the ways to prevent and treat this nosocomial infection.METHODS The case histories from 4 inpatients who developed S.maltophilia infection in the same ward from Feb 5 to 16,2006,were studied retrospectively to find out the reasons of its onset and its treatment based on the sputum culture results.RESULTS The fulminate S.maltophilia was found from the rail of the patient bed,the connection part of water container of 2 respiratory machines of exhalation valve assembly and the liquid of ultrasonic aeriation machine.CONCLUSIONS The infection is a localized one.The main reasons of the infection are unthorough disinfection of respiratory machine and the contamination of medical treatment environment.Whenever the infection is found in the ward,the thorough disinfection needs immediately,and no new patient admitted.

Objective To explore MRI features of mucinous breast carcinoma.Methods MR data of 34 patients with mucinous breast carcinoma confirmed by histopathology were analyzed retrospectively,including lesions morphology,maximum diameter,T1WI and T2WI signal characteristics,features of internal reinforcement,time-intensity curve (TIC) type,DWI and ADC characteristics.Results There were 22 cases of pure tumors and 12 mixed tumors;21 cases were mass types,6 cases were non-mass types,and 7 cases were multiple nodular types.On T1WI,there were low signal intensity in 22 case,equal signal in 10 cases,and mixed high signal in 2 cases.On fat suppression T2WI,20 cases showed high signal,13 cases showed mixed high signal and 1 case showed low signal,and 19 cases showed low signal fiber separation inside.Dynamic contrast enhancement showed typical circinate enhancement in 11 cases.TIC of 11 cases were wash-in types,18 cases were lateau types and 5 cases were wash-out types.Conclusion MRI features of mucinous breast carcinoma has certain characteristics.MRI is helpful to diagnosis of mucinous breast carcinoma

Objective To study CD40 expression on melanocytes induced by IFN-?and its significance. Methods CD40 expression was detected by flow cytometry. The capacity of melanocytes to stimulate T lymphocytes was evaluated by mixed ly mphocyte reaction and the supernatant cytokine levels were determined by ELISA. ResultsHuman melanocytes(MC) cultured in vitro expressed low but detectable CD40 surf ace protein. The surface expression of CD40 was markedly up-regulated by stimul ation with interferon(IFN)-?with different concentrations for 24 hours,48 hour s and 72 hours, respectively. The expression of CD40 was correlated with IFN-? levels after 24 hour incubation. MC underwent a morphologic change with an incre ased capacity to stimulate allogenic lymphocytes to proliferate after IFN-?sti mulation. Optimal enhancement of stimulating index(SI) was observed at an IFN-?concentration of 300 IU/ml after 72 hour treatment. Meanwhile concentrations o f interleukin-12 but not interleukin-8 or 10 were obviously increased in the s upernatants of cultured MC. Furthermore, ligation of CD40 via soluble CD40 ligan d(SCD40L) could enhance CD80 and ICAM-1 expression, which could be blocked by s pecific monoclonal antibody to CD40L. Conclusions Since CD40-CD40L is a pair of important and special costimulating signal, it is of great value to elucidate t he fact that CD40 is functionally expressed on MC, thus for a better understandi ng of MC′s role in cellular immune responses. MC might activate cytotoxic T lym phocyte directly and not via CD4 positive lymphocyte.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Lymphohistiocytosis, Hemophagocytic ; Male