Enhanced recovery after surgery (ERAS) includes preoperative education,intraoperative effective anaesthetization,analgesia,precision surgical techniques and postoperative early rehabilitation.Because of special location of the pancreas,difficulty of surgical techniques,longtime of learning and high incidence of postoperative complications,the application of ERAS in pancreatic surgery is restricted.While ERAS could reduce the stress after surgery and the incidence of complications,promote the recovery of patients,shorten the duration of hospital stay and reduce the expenses,which are confirmed by clinical practice.ERAS is the trend of the development of pancreatic surgery.How to balance the optimal prognosis and speed recovery is need to be resolved by pancreatic surgeons.

OBJECTIVE: To review latest researches about the restoration of hair cells loss and injury by stem cells at home and abroad, and probe into the development in investigations about stem-cell substitutive therapy of auditory injury.DATA SOURCES: A computer-based online search was conducted in El-sevier database for English literatures about restoration of hearing impairment by stem cells published from January 1990 to May 2005 by using the key words of "stem cells and hearing cell regeneration".STUDY SELECTION: Collected literatures were screened. Inclusion criteria: ①Articles about hearing impairment and loss. ②Literatures on hearing impairment and restoration. ③Studies about stem-cell substitutive therapy of hearing impairment. Exclusion criteria: ①Literatures about the oncogenicity of stem cells.②Reviews and repetitive studies.DATA EXTRACTION: A total of 54 literatures about restoration of hearing loss were collected, and 17 papers were in accordance with the criteria,9 papers in which made analysis and evaluation on application of stem cells.DATA SYNTHESIS: Degeneration of inner ear cells, especially sensory hair cells and associated neurons, results in hearing impairment and balance disorders. Since the regeneration capacity of hair cells in cochlear and vestibule of mammals are limited, the loss of sensory hair cells is a major cause of neurosensory deafness, which can be hardly restored and regenerated by themselves. Cell substitutive therapy has a wide prospect in treatment of deafness, which is a hot issue in recent investigations of audition. The best method in transplantation treatment of deafness is to utilize otogenous stem cells. Recently, researchers have isolated embryo-like stem cells respectively from the organ of Corti in adult and newborn rats as well as vestibular utricles of adult mice. Therefore, the inner-ear stem cells are an important source of cells for remodeling the regeneration of hair cells and recovering the auditory function.CONCLUSION: Stem cells play an important role in treatment of hearing impairment induced by hair cells loss, which has a promising prospect in cell substitutive therapy as development of further investigation.

Objective:To establish the quality standard for Tangkening Granule.Methods:Gardenia,Gold Theragran and batatatis in Tangkening Granule were identifi ed by TLC,the content of geniposide was determined by HPLC.Result:The spots in TLC was clear,the negative control had no interference,the average recovery was 99.9%,RSD was 2.9%(n=6).Conclusion:The method was accurate,reproducible and specifi c.It can be used for quality control of Tangkening Granule.

Objective To explore the improvement effect of rehabilitation nursing on joint swelling and pain after total knee arthroplasty.Methods According to the digital table,100 patients with total knee arthroplasty were randomly divided into observation group and control group,50 cases in each group.The control group after operation used routine nursing care,the observation group was given targeted rehabilitation nursing.They were compared with visual analogue scale (VAS),American Knee Society Score (AKSS),range of motion (ROM),length of hospital stay,joint swelling degree.Results Mter treatment,the VAS score of the observation group was lower than the control group[(2.43 ±0.51) points vs.(4.58 ± 0.81) points,t =15.882,P ＜ 0.05],AKSS scores and ROM were higher than those in the control group[(69.94 ± 14.23)points vs.(53.23± 12.91)points,(103.47 ± 14.84)° vs.(91.23 ±12.53) °,t =6.149,4.456,all P ＜ 0.05].The hospitalization time of the observation group was shorter than that of the control group[(14.23± 3.81)d vs.(17.82 ± 4.03) d,t =4.577,P ＜0.05].At 3d and 7d after operation,the swelling degree of the observation group was lower than those of the control group[(1.23 ±0.26)mm vs.(1.97 ±0.38)mm,(0.62 ± 0.21) mm vs.(1.38 ± 0.35) mm,t =11.364,13.166,all P ＜ 0.05].Conclusion The application of rehabilitation nursing after total knee joint surgery can effectively relieve joint swelling and pain,and it is worth to be popularized.

OBJECTIVE To investigate the opportunity and method of surgery for removing tracheobronchial foreign bodies. METHODS A retrospective study was carried out among 500 children with tracheobronchial foreign bodies treated in our hospital from June, 2005 to June, 2009. RESULTS The foreign bodies were successfully removed in 4(0.8%) patients with fiberoptic-bronchoscopy, 2(0.4%) patients with thoracotomy, 20(4%)patients with endoscope or rigid bronchoscopy via tracheostomy, 32(6.4%) patients with direct laryngoscopy, 436(87.2%)patients with rigid bronchoscopy . There were 6 patients (1.2%) need another operation to fully remove the foreign bodies. CONCLUSION Proper method should be choose for removing tracheobronchial foreign bodies according to the history, location and kind of the foreign bodies.

Objective To determine the effects and mechanisms of somatostatin analogues (sandostatin) on pancreatic repair and regeneration in caerulein induced pancreatitis. Methods Acute pancreatitis was induced by intra abdominal infusion of caerulein in rats, sandostatin was administered intra abdominally at the time of induction of pancreatitis and 24, 48 and 72 hours after. Rats were sacrificed at 6, 24, 48, 72 and 96 hours after the operation. The mRNA expression for Transforming growth factor ? 1 (TGF ? 1) was evaluated by reverse transcription polymerase chain reaction, pancreatic tissue DNA synthesis was measured by 3H thymidine method in vitro and protein content was detected by Lowry's method. Results The serum amylase level was decreased significantly in the sandostatin treated group. Expression of TGF ? 1 mRNA was undetectable in the normal pancreas and the treated group at 6 hours. TGF ? 2 was observed at 24 hours after the induction of pancreatitis, reaching maximum at 72 hours. It could be detected in the sandostatin treated group at 6 hours, reaching maximum at 24 hours, the expression of TGF ? 1 was increased significantly in the sandostatin treated group as compared with the non treated group at 24, 48 hours. Pancreatic tissue DNA synthesis showed a significant decrease during the first 72 hours following the induction of pancreatitis and a marked increase was observed at 96 hours after treatment with sandostatin. Within 48 hours of the induction of pancreatitis, total protein content in pancreatic tissue declined, and there was a significant increase in the sandostatin treated group at 48 hours, reaching maximum at 96 hours. Conclusions Effects of somatostatin analogues (sandostatin) on pancreatic tissue regeneration in acute pancreatitis in rats might be attributed to the enhancement of TGF ? 1 gene expression which subsequently stimulates formation of extracellular matrix components, increases protein content and DNA synthesis, thus accelerates pancreatic repair and regeneration.

Objective To investigate the diagnosis and treatment value of digital subtraction angiography (DSA) and transcatheter arterial embolization (TAE) for post pancreatectomy hemorrhage (PPH),and influencing factors of severity of PPH.Methods The retrospective case-control study was conducted.The clinicopathological data of 20 patients with PPH who were admitted to the Zhongshan Hospital of Fudan University from August 2009 to November 2016 were collected.Patients with PPH in the early stage underwent reoperations for hemostasis;patients with PPH in the later stage received conservative treatment,and then DSA and TAE were considered when patients had the stable vital signs.Observation indicators:(1) DSA situations:overall times,positive rate and bleeding sites;(2) TAE situations:successful rate of hemostasis,operating time and postoperative complications;(3) follow-up situations;(4) influencing factors analysis of severity of PPH.Follow-up using outpatient examination and telephone interview was performed to detect occurrence of complications after discharging from hospital up to April 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio and proportion.The univariate analysis was done using the Fisher exact probability.Results (1) DSA situations:all the 20 patients underwent DSA,with overall times of 27.The direct sign was 18 times extravasation of the contrast medium,with a positive rate of 66.7％ (18/27).Of 18 times positive DSA,clear bleeding sites were located in 5 times gastroduodenal artery (3 times with pseudoaneurysm of gastroduodenal artery stump),in 4 times common hepatic artery (3 times with pseudoaneurysm of common hepatic artery),in 3 times superior mesenteric artery,in 2 times splenic artery,in 1 time left gastric artery,in 1 time right gastric artery,in 1 time left hepatic artery (pseudoaneurysm of left hepatic artery) and in 1 time inferior mesenteric artery.(2) TAE situations:of patients with 18 times positive DSA,patients with 15 times positive DSA received TAE,with a successful rate of hemostasis of 13/15,and patients with 5 times positive DSA received successful hemostasis by reoperation.A median operating time of TAE for patients with 15 times positive DSA was 30 minutes.There was no occurrence of adverse reaction,including fever,abdominal pain,melena,elevated aminotransferase and liver abscess.One patient complicated with splenic abscess after transcatheter splenic arterial embolization underwent puncture drainage and then had a good recovery.Of patients with 9 times negative DSA,patients with 8 times negative DSA were cured by conservative treatment and patient with 1 time negative DSA received successful hemostasis by operation.All the 20 patients were cured and then discharged from hospital.(3) Follow-up situations:20 patients were followed up for 4-92 months,with a median time of 24 months.During the follow-up,20 patients recovered well,without long-term complications.(4) Influencing factors analysis of severity of PPH:the results of univariate analysis showed that gender,age,preoperative blood sugar,preoperative combined jaundice,preoperative albumin (Alb),preoperative prothrombin time (PT) extended,preserving pylorus,pancreatic duct stent placement,pancreatic operation time,volume of intraoperative blood loss,intraoperative blood transfusion,property of tumor,postoperative pancreatic fistula and time of PPH were not factors affecting the severity of PPH (P＞0.05).Conclusion DSA is minimal-invasive in the diagnosis for PPH,and TAE is safe and effective for patients with positive DSA.

OBJECTIVE: To study the effect of BSO administration on the multidrug resistance (MDR) transformation of human breast cancer cell line in vitro. METHODS: The intracellular GSH content was measured by glutathione reductase recycling assay; the 50% inhibitory concentration (IC50) of ADM was measured by MTT assay, then the multidrug resistance property and multidrug resistance reversal times were determined; the apoptosis rate and cell cycle of MCF-7/ADM cell both before and after BSO administration were measured by flow cytometry. RESULTS: The level of GSH in MCF-7/ADM cells was significantly higher than that in MCF-7 cells; the BSO treatment exerted significant inhibitory effect on the synthesis of GSH in MCF-7/ADM while slight effect on MCF-7 cell; The IC50 of ADM in MCF-7/ADM cells was decreased by BSO of certain doses, the multidrug resistance reversal times by BSO at concentrations of 50, 100, 200, 400, and 800 μmol · L-1 were 1.25, 2.02, 8.42, 12.65, and 9.71 respectively, but BSO had no such effect on MCF-7 cell. The value of apoptosis rate and the cells accumulated in Go/GI phase increased significantly when BSO and ADM were simultaneously used compared with using ADM merely. CONCLUSION: BSO can potentially reverse the MDR of MCF-7/ADM cells by inhibition of GSH synthesis in vitro, and the effect may be achieved by inducing apoptotic cell death. Copyright 2012 by the Chinese Pharmaceutical Association.

Aneurysm, Dissecting ; Aortic Aneurysm ; Humans ; Male ; Middle Aged ; Twins

Objective To investigate clinical features, outcomes and laboratory findings of thrombotic thrombocytopenic purpura (TTP).Methods Patients with TTP admitted between April 2006 and January 2013 were identified by a retrospective review of records.Totally 21 patients were available,15 females and 6 males,with a median age of 46 years (ranged 18-66).The diagnostic criteria were defined by:(1)thrombocytopenia (<100 ×9 L-1)without other identifiable causes;(2)a negative Coombs'test and hemolytic anemia with schistocytes on the peripheral blood smear;and only those patients meeting the criteria for TTP,both on clinical presentation and their clinical course,were included in this study. Exclusion criteria were:(1)patients discharged or dead within 24 hours after admission;(2)patients treated with plasma exchange therapy in other hospitals;(3)medical data were incomplete;(4)cannot be followed up;and (5 )other causes of thrombotic microangiopathies.General condition of patients,etiology, clinical features,treatment and prognosis were analyzed by using the SPSS 20.0 software.P value of <0.05 was considered as significant.Results Hemolytic anemia and thrombocytopenia appeared in all of the patients. Twelve patients (57.2%) had the classical pentad manifestations of TTP (fever, thrombocytopenia,microangiopathic hemolytic anemia,symptoms of nervous system,renal injury),seven patients (33.3%)had tetrad of TTP clinical manifestations (thrombocytopenia,microangiopathic hemolytic anemia,symptoms of nervous system,fever or renal injury),and only two patients showed the triad manifestations of TTP (thrombocytopenia, microangiopathic hemolytic anemia, symptoms of nervous system).In our studies,seven patients accepted plasmapheresis,and five of them (71.4%)achieved remission.Conclusions TTP progresses quickly.Plasmapheresis is still the treatment of choice for TTP patients.Etiological treatment can help to control the conditions of patients with TTP.