With continuous research of the formation mechanism of chronic pancreatitis with mass in the head of the pancreas and its relation with pancreatic cancer,and steady improvement of the operation safety,the number of operation for the chronic pancreatitis with mass in the head of the pancreas is increasing.On the other hand,with the improvement of the accuracy of preoperative diagnosis,Tru-cut intraoperative biopsy is increasingly applied to patients with negative results of preoperative ultrasonography biopsy,which is important for the surgical procedure selection.With the premise of effective treatment,continous improvement of treatment strategies to the chronic pancreatitis with mass in the head of the pancreas can maximize the benefit of patients.

Objective To discuss the value of tension-free hernia repair for umbilical hernia in adults.Methods Fourty-five adult patients with umbilical hernia were treated with tension-free hernia repair,including mesh plug-patch in 29 cases and prolene hernia system in 16 cases.The operative procedure,postoperative pain,patient's ability recovery time,and complication and recurrence rate were studied.Results All cases were operated successfully.The mean operation time was 60 min.The only postoperative complications were 4 cases of subcutaneous seroma.The follow-up period ranged from 6 to 48 months and no recurrence was observed.Conclusions Tension-free hernia repair is a better surgical operation for umbilical hernia in adults,and it has many advantages,such as safety,rapid recovery,good early therapeutic effect and lower recurrence rate.

Pancreatic cancer is one of the most malignant cancer of all neoplasm.85% cases are not suitable for surgery when at first counsultation to doctors.The effects of chemotherapy and radiotherapy are not satisfactory either.With the advancement of the study of molecular biology,the research of the molecular targeted drugs such as EGFR inhibitor and VEGF inhibitor,become one of the hot spots.This article reviews progress in the research of molecule-targeted therapy.

The special anatomy around the head of pancreas leads to difficulties in arriving at a definitive diagnosis for a pancreatic head mass,the management of which has recently become a hot topic and a challenge for clinicians.Despite recent advances in tumor markers,ultrasound,CT,PET/CT and MRI,some of these pancreatic head masses cannot be diagnosed with certainty.A fine needle aspiration biopsy can be used before operation; however,false negative results not infrequently happen.Based on the reports from domestic and foreign medical literatures published recently,this paper reviewed and discussed the proper treatment strategies when biopsy results from a pancreatic head mass turn out negative.

ObjectiveTo explore the resilience and mental health of recruits during training,and to investigate mutual prediction of resilience between mental health and psychological stress to provide the scientific evidence for the mental health training and psychological selection of recruits.MethodsConnor-Davidson resilience questionnaire ( CD-RISC),symptom checklist ( SCL-90 ),psychological stress self-evaluation test ( PSET),satisfaction with life scale (SWLS),positive and negative affect scale (PANAS) were applied to 650 recruits in 2011 before starting training and after two months of training.Results ① Chinese recruits had good resilience,and the CD scores of pre-and post-test were (61.60 ± 14.36) and (61.41 ± 14.55 ) respectively.②Mental health (SCL-90) of two tests were good in recruits.③ Correlation analysis showed that the same premise of phase correlation,resilience (pre-test) could significantly predict mental health (post-test) ( β =0.070,P ＜ 0.05 ),mental health ( pretest) could not predict resilience (post-test) (β =0.015,P ＞ 0.05 ).Resilience (pre-test) could significantly predict psychological stress (post-test) ( β =0.075,P ＜ 0.05 ),psychological stress (pre-test) could not predict resilience (post-test) (β =0.017,P ＞ 0.05 ).④ Compared with high resilience group,low-resilience group of recruits had higher total score of SCL-90 and psychological stress and less positive emotion,more negative emotion and lower life satisfaction.ConclusionThe recruits training have good resilience.Resilience of recruits have predictive ability to mental health,psychological stress during training.

OBJECTIVETo observe the intervention effect of electroacupuncture (EA) at "Weizhong" (BL 40) on rats with bupivacaine-induced multifidus muscle injury, so as to explore the action mechanism.

METHODSA total of 72 rats were randomly divided into a control group, a model group, a Weizhong group and a Shenshu group, 18 rats in each group. Each group was again randomly divided into a 4-day subgroup, a 7-day subgroup and a 14-day subgroup, 6 rats in each subgroup. Rats in the model group, Weizhong group and Shenshu group were treated with intramuscular injection of 0.5% bupivacaine (BPVC) to establish the model of multifidus muscle injury. Rats in the Weizhong group and Shenshu group were treated with EA at "Weizhong" (BL 40) and "Shenshu" (BL 23), 20 min per treatment, once a day. Each subgroup was treated for 4 days, 7 days and 14 days respectively. Rats in the control group and model group were treated with immobilization. The morphology and cross sectional area (CSA) changes of multifidus with HE and Masson staining at different time points were observed; the expression of insulin like growth factor 1 (IGF-1) and myogenic differentiation antigen (MyoD) was measured by immunohistochemical method.

RESULTSAfter the modeling, there were significant morphology changes of multifidus at different time points, which was not fully recovered after 14 days. The morphological observation in the Weizhong group and Shenshu group was superior to that in the model group. At 7th day, the CSA in the Weizhong group was higher than that in the model group (P < 0.05); at 14th day, the CSA in the Weizhong group and Shenshu group was higher than that in the model group (P < 0.01, P < 0.05). At 4th day and 7th day, the expression of IGF-1 in the model group was higher than that in the control group (both P < 0.01); at 4th day, that in the Weizhong group was higher than that in the model group (P < 0.01), and that in the Weizhong group was higher than that in the Shenshu group (P < 0.05), and that in the Shenshu group was as higher than that in the model group (P < 0.05); at 14th day, that in the Shenshu group was higher than that in the model and Weizhong group (P < 0.01). At 4th day, the expression of MyoD in the Weizhong group and Shenshu group was higher than that in the model group (P < 0.01), which was more significant in the Weizhong group (P < 0.01).

CONCLUSIONElectroacupuncture at "Weizhong" (BL 40) and "Shenshu" (BL 23) can both promote the regeneration of multifidus muscle injury. EA at "Weizhong" (BL 40) has a better effect at early phase, which may be related to the up-regulation of IGF-1 and MyoD and the completion of the proliferation of myoblast in advance.

Acupuncture Points ; Anesthetics, Local ; adverse effects ; Animals ; Bupivacaine ; adverse effects ; Electroacupuncture ; Humans ; Male ; Muscles ; injuries ; physiopathology ; Muscular Diseases ; chemically induced ; physiopathology ; therapy ; Rats ; Rats, Sprague-Dawley ; Regeneration

Objective To investigated the potential influences of poly(lactic-co-glycolicacid)(PLGA)scaffold as a platform on the differentiation of mouse bone-marrow stem cells to islet-like cells.Methods Mouse bonemarrow stem cells were grown and differentiated in culture with or without PLGA scaffold,and cell morphology and functions were compared within these groups.Results The PLGA scaffold showed fine biological compatibility.Differentiated islet-like cells were dithizone (DTZ) positive,insulin and C-peptide double positive,glucagon positive and somatostatin positive in both groups.Under electron microscope there were ultrastructures similar to that of islet β cells in cells of both groups.Cells with PLGA scaffold secreted more insulin under high level glucose stimulation (P＜0.01).Conclusions PLGA scaffold was biologically compatible and improved function of the differentiated islet-like cells.

In recent years,the epidemiology of Candida infection has changed.Although Candida albicans is still the main pathogens causing invasive candidiasis,non-albicans Candida species are increasingly encountered.Different Candida species show distinct sensitivity of different drugs.The emergence of drug resistance has become the main problem of Candida in-fection treatment.Antifungal resistance of clinical Candida infections often lead to treatment failure.The review of resistance mechanisms and the effect on clinical treatment is very significant to improve the prognosis of patients and strengthen the control of infection.This text reviews the present state of the detection of mechanisms of resistance in Candida spp .

Objective To evaluate clinical features of three different gallbladder projective lesions. Methods Statistic analysis was performed for clinical data obtained from 325 cases of gallbladder projective lesions. Results There were 308 patients of benign lesions, including cholesterol polyps in 278 cases, other polyps in 5 cases, and adenomas of 25 cases. Malignant lesions was found in 17 cases, including 2 adenomas with malignant changes and 15 adenocarcinomas. 36. 0% and 32. 0% patients with benign polyps and adenomas were over 50 years of age, while 82.4% patients with adenocarcinomas were over 50 years. Average size of benign polyps, adenomas and adenocarcinomas were 8. 5 mm, 11.7 mm and 31.1 mm in diameter. 1.5% of benign polyps, 0% of adenomas and 52. 9% of adenocarcinomas were of low echo. 42.9% of benign polyps, 68.0% of adenomas and 100% of adenocarcinomas were single polyp. Conclusion The nature of gallbladder projective lesions can be suggested by patient age, size, number, and intensity of gallbladder projective lesions under B-ultrasound.

Objective To evaluate the clinical features and the key points in the diagnosis and management of splenic hemangioma.Methods The clinical presentations,laboratory tests,imaging and pathological results,treatment,and prognosis of 21 cases of splenic hemangioma admitted in Peking Union Medical College Hospital from April,1989 to July 2007 were retrospectively analyzed.Results The clinical presentations of splenic hemangiom are not specific which include left upper quadrant mass or discomfort,abdominal pain,etc.The diagnosis of imaging includes Doppler ultrasound,CT,MRI,DSA,etc.Splencetomy is recommended for all splenic hemangioma with severe symptoms or rupture.Conclusion Asymptomatic patients with small splenic hemangioma(＜4 cm)can be managed conservatively.Symptomatic large hamangioma may need a sp]enectomy.