Objective To study the early diagnosis and the prognosis of carcinoma of the head of pancreas(CHP) and to determine the sensitivity of various detecting methods. Methods Data of preoperative diagnosis and prognosis in 22 patients with early stage of CHP and 168 patients with advanced CHP treated in our department in recent 15 years were retrospectively analyzed and compared. Results The early stage of CHP revealed no specific symptom. In early stage of CHP,the diagnlstic rate was 88.9%, detecting rate of cancer cells in pancreatic juice with ERCP was 88.4%, The sensitivity of needling cytologic examination during operation was 91.7%,the resection rate was 90.9%, 3years survival rate was 36.4%.Those were significantly higher than those in advanced CHP. Conclusions B mode ultrasonography and CT are the first choice of diagnosis for early stage of CHP. ERCP and selective celiac artery angiography can promote diagnostic rate. Searching carcinoma cells in pancreatic juice collected by ERCP and needling cytologic examination during operation can further improve the early diagnostic rate.In patients with early stage of CHP,the resection rate and post operation cure rate are significantly higher than those in patients with advanced CHP.

The outbreak of the COVID -19 has had a big impact on the implementation of clinical trials of tumor drugs and the prevention and control measures such as traffic control and home isolation has caused clinical trials couldn’t proceed normally, so the protection of tumor subjects in clinical trials faces many new challenges. Based on Western and Chinese policies and guidelines on the management of clinical trials during the COVID -19, this paper expounded the impacts of the COVID -19 on tumor patients and tumor clinical trials, analyzed the challenges faced by the protection of tumor subjects in the prevention and control of the COVID -19, and then protected tumor subjects from aspects of optimizing the allocation of health resources, improving non-face-to-face informed consent procedures, strengthening subject visit management, and enhancing clinical trial safety evaluation. It is hoped that these optimization measures can face the future and continue to protect subjects after the end of the epidemic or in new public health emergencies.

The outbreak of the COVID -19 has had a big impact on the implementation of clinical trials of tumor drugs and the prevention and control measures such as traffic control and home isolation has caused clinical trials couldn’t proceed normally, so the protection of tumor subjects in clinical trials faces many new challenges. Based on Western and Chinese policies and guidelines on the management of clinical trials during the COVID -19, this paper expounded the impacts of the COVID -19 on tumor patients and tumor clinical trials, analyzed the challenges faced by the protection of tumor subjects in the prevention and control of the COVID -19, and then protected tumor subjects from aspects of optimizing the allocation of health resources, improving non-face-to-face informed consent procedures, strengthening subject visit management, and enhancing clinical trial safety evaluation. It is hoped that these optimization measures can face the future and continue to protect subjects after the end of the epidemic or in new public health emergencies.

OBJECTIVETo appraise the clinical efficacy, safety and compliance of the intervention of spleen-restoring decoction combined with dormancy hygiene education and the intervention of spleen-restoring decoction alone on sub-healthy insomnia of deficiency of both the heart and spleen pattern.

METHODStudy design took multi-centers, blind and randomized control trial, 107 participants with sub-healthy insomnia of deficiency of both the heart and spleen pattern were assigned to A group (52 cases) which was treated with the intervention of spleen-restoring decoction combined with dormancy hygiene education and B group (55 cases) which was treated with the intervention of spleen-restoring decoction single, compared by efficacy, PSQI score, CGI score, WHOQOL-BREF score and security.

RESULTThe efficacy of two group was 79.58%. There was no significant different between them. The PSQI scores before treatment was (11.80 +/- 2.08) and which afer treatment was (6.78 +/- 2.84) of A group. The PSQI scores before treatment was (11.61 +/- 2.00) and which afer treatment was (6.73 +/- 2.27) of B group. There was significant difference in PSQI scores both A group and B group after treatment (P < 0.01); the results of CGI score and WHOQOL-BREF score before and after measurement showed the same as PSQI. There were no significant difference between two groups in all scores after treatment and there was no interaction between time pots and treatment factors . Withdrawal reaction analysis: comparing CGI after withdraw 2 weeks and at the end of treatment course, there was no significant difference between two groups. The same result was in comparison among groups.

CONCLUSIONBoth the intervention of spleen-restoring decoction integrating with dormancy hygiene education and spleen-restoring decoction had obvious clinical efficacy on treating subhealthy insomnia of deficiency of both the heart and spleen pattern, and had high compliance and safety. The intervention of spleen-restoring decoction integrating with dormancy hygiene education showed no better clinical efficacy than spleen-restoring decoction did.

Adult ; Female ; Health Education ; Humans ; Hygiene ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; drug therapy ; physiopathology ; Splenic Diseases ; drug therapy

Objective To investigate the effect of esketamine on perioperative pain and depression in patients with thoracoscopic pulmonary nodule resection.Methods A total of 120 patients with selec-tive thoracoscopic pulmonary nodule resection were randomly divided into low-dose esketamine group(group L),high-dose esketamine group(group H)and saline control group(group C),with 40 cases in each group.Before skin incisionafter anesthetic induction,0.25 mg/kgesketamine,0.50 mg/kg esketamine and the equivalent amount of saline were separately administered for patients in the three groups.Visual Analogue Scale(VAS)score for pain and the Self-rating Depression Scale(SDS)score were compared among the three groups at the time points of one day before surgery(T0),one day after surgery(T1),three days after surgery(T2),and the day of discharge(T3),and postopera-tive analgesia within 24 h and perioperative adverse reactions were also recorded.Results The VAS scores for rest and coughing at T1 were significantly lower in group L and group H than group C(P＜0.05);compared with group C,the total press number of analgesic pump with in 24 h and effec-tive press number were significantly decreased in group L and group H,and the dosage of sufentanil was also significantly decreased(P＜0.05).There were no significant differences in depression scores at different time points among the three groups(P＞0.05).There were no significant differences in the incidence rates of nausea,vomiting,dizziness,hallucinations,and nightmares among the three groups(P＞0.05).Conclusion Esketamine can effectively alleviate pain on the first day after oper-ation and reduce the dosage of opioid analgesics without increasing the incidence of adverse reactions in patients with thoracoscopic pulmonary nodule resection;compared with 0.25 mg/kg esketamine,0.50 mg/kg esketamine doesn't demonstrate better postoperative analgesia or improvement in periop-erative depression.

Objective The purpose of this study was to explore the early experience of elderly patients who had the Percutaneous Coronary Intervention (PCI) for the second time due to coronary restenosis, so as to provide targeted nursing interventions. Methods Nine elderly male patients underwent the second-time PCI were interviewed by using qualitative research method. Results The main experiences of these patients were as follows: obvious emotional disorder, rational intellectual curiosity, purposeful behavior modification and eager to obtain support from the family and society. Conclusions Nursing care for elderly male patients after the second-time PCI should involve mental care, knowledge, behavior, and family and social support.

Objective To investigate the effect of esketamine on perioperative pain and depression in patients with thoracoscopic pulmonary nodule resection.Methods A total of 120 patients with selec-tive thoracoscopic pulmonary nodule resection were randomly divided into low-dose esketamine group(group L),high-dose esketamine group(group H)and saline control group(group C),with 40 cases in each group.Before skin incisionafter anesthetic induction,0.25 mg/kgesketamine,0.50 mg/kg esketamine and the equivalent amount of saline were separately administered for patients in the three groups.Visual Analogue Scale(VAS)score for pain and the Self-rating Depression Scale(SDS)score were compared among the three groups at the time points of one day before surgery(T0),one day after surgery(T1),three days after surgery(T2),and the day of discharge(T3),and postopera-tive analgesia within 24 h and perioperative adverse reactions were also recorded.Results The VAS scores for rest and coughing at T1 were significantly lower in group L and group H than group C(P＜0.05);compared with group C,the total press number of analgesic pump with in 24 h and effec-tive press number were significantly decreased in group L and group H,and the dosage of sufentanil was also significantly decreased(P＜0.05).There were no significant differences in depression scores at different time points among the three groups(P＞0.05).There were no significant differences in the incidence rates of nausea,vomiting,dizziness,hallucinations,and nightmares among the three groups(P＞0.05).Conclusion Esketamine can effectively alleviate pain on the first day after oper-ation and reduce the dosage of opioid analgesics without increasing the incidence of adverse reactions in patients with thoracoscopic pulmonary nodule resection;compared with 0.25 mg/kg esketamine,0.50 mg/kg esketamine doesn't demonstrate better postoperative analgesia or improvement in periop-erative depression.

Depressive disorder ranks as a major bur-den of disease worldwide,yet the current antidepressant medications are limited by frequent non-responsiveness and significant side effects.The lateral septum(LS)is thought to control of depression,however,the cellular and circuit substrates are largely unknown.Here,we identified a subpopulation of LS GABAergic adenosine A2A receptors(A2AR)-positive neurons mediating depres-sive symptoms via direct projects to the lateral habenula(LHb)and the dorsomedial hypothalamus(DMH).Activa-tion of A2AR in the LS augmented the spiking frequency of A2AR-positive neurons leading to a decreased activation of surrounding neurons and the bi-directional manipula-tion of LS-A2AR activity demonstrated that LS-A2ARs are necessary and sufficient to trigger depressive pheno-types.Thus,the optogenetic modulation(stimulation or inhibition)of LS-A2AR-positive neuronal activity or LS-A2AR-positive neurons projection terminals to the LHb or DMH,phenocopied depressive behaviors.Moreover,A2AR are upregulated in the LS in two male mouse mod-els of repeated stress-induced depression.This identifica-tion that aberrantly increased A2AR signaling in the LS is a critical upstream regulator of repeated stress-induced depressive-like behaviors provides a neurophysiological and circuit-based justification of the antidepressant poten-tial of A2AR antagonists,prompting their clinical transla-tion.

The advancement of medicine and biotechnology is based on biomedical research. The rights and safety protection of subjects in biomedical research is one of the core issues of research ethics,and the protection of vulnerable subjects should be the top priority importantly,research ethics should provide special protection for vulnerable subjects. Chinese laws and regulations have not yet given a clear definition of the concept of vulnerability,and the content and regulations related to vulnerability are relatively rough and not perfect. By drawing on the main international and foreign research ethics policies and guidelines,introducing the definition of vulnerability,clarifying the source of vulnerability,and applying vulnerability to the process of biomedical research in China. When applying vulnerabilities,one should avoid using the label approach to include people with common characteristics into vulnerable groups,but mainly analyze the types and sources of vulnerability,and includes as many vulnerable subjects of different types as possible to provide them with more comprehensive and adequate protection in biomedical research.