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.

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.

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.

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.

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 .

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.

BACKGROUND: The neurotoxicity and cardiotoxicity of bupivacaine have been reported frequently. However, the studies on bupivacaine-induced muscle toxicity are few.
OBJECTIVE: To establish and evaluate local intramuscular injection of bupivacaine on the changes in histomorphology and ultrastructure of rat multifidus muscle at various time points.
METHODS: A total of 54 male Sprague-Dawley rats weighing 280-320 g were randomly divided into black group (n=18), model group (n=18) and model control group (n=18). Each group was then equal y subdivided into three subgroups according to time points (4, 7 and 14 days) (n=6). Both sides of multifidus muscle of the rats (L4 and L5) were injected with 0.5% bupivacaine. The morphological and ultrastructural changes of multifidus muscle were observed and analyzed with light microscope and transmission electron microscope at 4, 7 and 14 days after model establishment.
RESULTS AND CONCLUSION: (1) A single intramuscular injection of 0.5% bupivacaine induced muscular damage. (2) Hematoxylin-eosin staining results showed fiber necrosis, inflammatory cel infiltration, and a smal amount of macrophages in local skeletal muscle. (3) Under the transmission electron microscope, the structure of myofibrils was destroyed or disintegrated; kinds of bands and lines were indistinct, disrupted or disappeared; the structure of mitochondria was abnormal, the mitochondrial cristae were reduced or disappeared. In the 7- and 14-day groups, multifidus muscle proliferated and repaired. (4) Ultrastructural change scores in skeletal muscle were significantly higher in the model group than in the blank and model control groups (P < 0.05). Above scores were significantly greater in the 4-day group than in the 7- and 14-day groups (P < 0.05), and higher in the 7-day group than in the 14-day group (P < 0.05). (5) Results suggest that a single intramuscular injection of 0.5% bupivacaine can result in pathological changes of skeletal muscle from morphology and ultrastructure. This method can establish a suitable model of skeletal muscle injury.

Objective To evaluate the clinical characteristics,diagnosis and treatment method of pancreatic sinistral portal hypertension caused by tumors in the body and tail of the pancreas.Methods A retrospective review of 40 patients diagnosed with pancreatic sinistral portal hypertension at Peking Union Medical College Hospital from January 2007 to December 2012 was performed.Results The Initial symptoms were epigastric pain and discomfort (n =12),emaciation (n =5),low-back pain (n =4),splenomegaly (n =2),hematemesis and melena (n =4),hypoglycemic coma (n =1).All 40 patients had splenomegaly and varices in the gastric fundus with normal liver function.8 had combined esophageal varices.24 had hypersplenism and 26 had elevated serum CA19-9 level.25 patients received surgical intervention and 15 were treated conservatively.Pathology confirmed malignancy in 29 patients and benign lesions in 11.Thirty-five patients (35/40,88％) were followed up for 12 to 72 months.For patients undergoing surgery,hypersplenism and varices in the gastric fundus were all relieved.There was no upper gastrointestinal bleeding occurred during follow-up.For patients treated conservatively,hypersplenism remained stable and among them 4 patients had upper gastrointestinal bleeding,and successfully treated by medication,therapeutic endoscopy and interventional therapy.Conclusions Patients with pancreatic sinistral portal hypertension caused by tumor in the body and tail of the pancreas can be cured successfully by surgery.In those patients portal hypertension can present as initial clinical manifestation.