Objective:To investigate the clinical efficacy of pancreatic cancer surgery with arterial resection.Methods:The clinicopathological and follow-up data of 135 patients undergoing pancreatectomies with arterial resection in Pancreas Center, the First Affiliated Hospital of Nanjing Medical University from Sep 2013 to Dec 2023 were retrospectively analyzed.Results:There were 77 males and 58 females, with age [ M( IQR)] of 63 (14) years old. Among the 135 patients, 122 (90.4%) were distal pancreatectomies, 8 (5.9%) were pancreaticoduodenectomies, 4 (3.0%) were total pancreatectomies and 1 (0.7%) was resection for local recurrence after distal pancreatectomy. There were 120 (88.9%) celiac axis resections, 11 (8.1%) hepatic artery resections, 1 (0.7%) superior mesenteric artery resection and 3 (2.2%) other artery resections. Simultaneous portal vein-superior mesenteric vein or organ resection accounted for 26.7% (36/135) and 29.6% (40/135),respectively. The median blood loss was 300 (300) ml and the median operation time was 275 (105) minutes. The 90-day mortality rate was 7.4% (10/135). The overall morbidity rate was 70.4% (95/135) while the major morbidity rate was 18.5% (25/135). Postoperative hemorrhage occurred in 8.9% (12/135), clinically relevant postoperative pancreatic fistula in 57.0% (77/135), bile leak in 0.74% (1/135), delayed gastric emptying in 9.6% (13/135), liver failure in 3.7% (5/135) and transient liver enzyme elevation in 44.4% (60/135). All of the 135 cases were confirmed as pancreatic cancer histologically, including 54.6% (71/130) moderately differentiated, 45.4% (59/130) poorly differentiated and no for well differentiated. The median tumor size was 4.5 (2.3) cm. The median number of harvested lymph nodes was 14 (13) and the percentage of N0, N1 and N2 according to AJCC 8th staging system was 27.1% (36/133), 52.6% (70/133) and 20.3% (27/133), respectively. The R 0 resection was achieved in 40 of 123 cases (32.5%), whose margins of specimens were assessed circumferentially based on the 1mm rule. The median overall survival time (MST) after surgery was 22.5 months, and the median progress-free survival time was 16.1 months. The overall survival rate at 1-, 2- and 5-year was 71.5%, 45.1% and 11.3%, respectively. The MST of patients who received no adjuvant therapy, chemotherapy after surgery was 8.4 months, 25.3 months, respectively. Conclusions:Pancreatectomy with arterial resection is generally safe and feasible. Survival outcome improves significantly when combined with adjuvant chemotherapy.

Objective:To investigate the clinical efficacy of pancreatic cancer surgery with arterial resection.Methods:The clinicopathological and follow-up data of 135 patients undergoing pancreatectomies with arterial resection in Pancreas Center, the First Affiliated Hospital of Nanjing Medical University from Sep 2013 to Dec 2023 were retrospectively analyzed.Results:There were 77 males and 58 females, with age [ M( IQR)] of 63 (14) years old. Among the 135 patients, 122 (90.4%) were distal pancreatectomies, 8 (5.9%) were pancreaticoduodenectomies, 4 (3.0%) were total pancreatectomies and 1 (0.7%) was resection for local recurrence after distal pancreatectomy. There were 120 (88.9%) celiac axis resections, 11 (8.1%) hepatic artery resections, 1 (0.7%) superior mesenteric artery resection and 3 (2.2%) other artery resections. Simultaneous portal vein-superior mesenteric vein or organ resection accounted for 26.7% (36/135) and 29.6% (40/135),respectively. The median blood loss was 300 (300) ml and the median operation time was 275 (105) minutes. The 90-day mortality rate was 7.4% (10/135). The overall morbidity rate was 70.4% (95/135) while the major morbidity rate was 18.5% (25/135). Postoperative hemorrhage occurred in 8.9% (12/135), clinically relevant postoperative pancreatic fistula in 57.0% (77/135), bile leak in 0.74% (1/135), delayed gastric emptying in 9.6% (13/135), liver failure in 3.7% (5/135) and transient liver enzyme elevation in 44.4% (60/135). All of the 135 cases were confirmed as pancreatic cancer histologically, including 54.6% (71/130) moderately differentiated, 45.4% (59/130) poorly differentiated and no for well differentiated. The median tumor size was 4.5 (2.3) cm. The median number of harvested lymph nodes was 14 (13) and the percentage of N0, N1 and N2 according to AJCC 8th staging system was 27.1% (36/133), 52.6% (70/133) and 20.3% (27/133), respectively. The R 0 resection was achieved in 40 of 123 cases (32.5%), whose margins of specimens were assessed circumferentially based on the 1mm rule. The median overall survival time (MST) after surgery was 22.5 months, and the median progress-free survival time was 16.1 months. The overall survival rate at 1-, 2- and 5-year was 71.5%, 45.1% and 11.3%, respectively. The MST of patients who received no adjuvant therapy, chemotherapy after surgery was 8.4 months, 25.3 months, respectively. Conclusions:Pancreatectomy with arterial resection is generally safe and feasible. Survival outcome improves significantly when combined with adjuvant chemotherapy.

In the current international situation, there is the possibility of nuclear war and nuclear terrorism. The nuclear and radiological emergency in the event of an accident should be enhanced. The World Health Organization (WHO) issued a publication on January 27, 2023, updating the list of drugs recommended for stockpiling in response to radiation and nuclear emergencies, which was the first update since 2007. The list of recommended drug stocks in the publication includes drugs to prevent or reduce the effects of radiation, as well as drugs used to treat injuries after exposure. Based on the list of drugs, this article reviews the emergency response to nuclear and radiological accidents, the general situation of emergency drug stockpiles, drug reserves in some countries, and current considerations, with a view to providing references for emergency medical rescue in nuclear and radiological accidents in China.

Objective:To investigate the clinical efficacy of distal pancreatectomy with celiac axis resection(DP-CAR).Methods:A total of 89 consecutive patients (50 males and 39 females) who were diagnosed with pancreatic body cancer and underwent DP-CAR in Pancreas Center,First Affiliated Hospital of Nanjing Medical University between September 2013 and June 2022 were retrospectively reviewed. There were 50 males and 39 females,with age( M(IQR)) of 63(12) years(range:43 to 81 years). Perioperative parameters,pathology results and follow-up data of these patients were analyzed, χ2 or Fisher′s test for categorical data while the Wilcoxon test for quantitative data. Survival results were estimated by the Kaplan-Meier survival method. Results:Among 89 cases,cases combined with portal vein-superior mesenteric vein or organ resection accounted for 22.5% (20/89) and 42.7% (38/89),respectively. The operative time,blood loss and postoperative hospital stay were 270 (110) minutes,300 (300) ml and 13 (10) days,respectively. The overall morbidity rate was 67.4% (60/89) while the major morbidity was 11.2% (10/89). The increase rate in transient liver enzymes was 42.7% (38/89),3.4% (3/89) for liver failure,53.9% (48/89) for clinically relevant postoperative pancreatic fistula,1.1% (1/89) for bile leak,3.4% (3/89) for chylous leak of grade B and C,11.2% (10/89) for abdominal infection,9.0% (8/89) for postoperative hemorrhage of grade B and C,4.5% (4/89) for delayed gastric emptying,6.7% (6/89) for deep vein thrombosis,3.4% (3/89) for reoperation,4.5% (4/89)for hospital mortality,7.9% (7/89) for 90-day mortality. The pathological type was pancreatic cancer for all 89 cases and pancreatic ductal adenocarcinoma made up 92.1% (82/89). The tumor size was 4.8(2.0) cm, ranging from 1.5 to 12.0 cm. The number of lymph nodes harvested was 14 (13)(range:2 to 33),with a positive lymph node rate of 13.0% (24.0%). The resection R0 rate was 30.0% (24/80) and the R1 (<1 mm) rate was 58.8% (47/80). The median overall survival time was 21.3 months (95% CI: 15.6 to 24.3) and the median disease-free survival time was 19.1 months (95% CI: 11.7 to 25.1). The overall survival at 1-year and 2-year were 69.60% and 39.52%. The median survival time of 58 patients with adjuvant chemotherapy was 24.3 months (95% CI: 17.8 to 32.3) while that of 13 patients without any kind of adjuvant therapy was 8.4 months (95% CI: 7.3 to 22.3). Seven patients accepted neoadjuvant chemotherapy and there was no significant morbidity among them,with a resection rate of R0 of 5/7. Conclusion:DP-CAR is safe and feasible for selective cases,which could be more valuable in improving long-term survival when combined with (neo) adjuvant therapy.

Objective:To investigate the clinical efficacy of distal pancreatectomy with celiac axis resection(DP-CAR).Methods:A total of 89 consecutive patients (50 males and 39 females) who were diagnosed with pancreatic body cancer and underwent DP-CAR in Pancreas Center,First Affiliated Hospital of Nanjing Medical University between September 2013 and June 2022 were retrospectively reviewed. There were 50 males and 39 females,with age( M(IQR)) of 63(12) years(range:43 to 81 years). Perioperative parameters,pathology results and follow-up data of these patients were analyzed, χ2 or Fisher′s test for categorical data while the Wilcoxon test for quantitative data. Survival results were estimated by the Kaplan-Meier survival method. Results:Among 89 cases,cases combined with portal vein-superior mesenteric vein or organ resection accounted for 22.5% (20/89) and 42.7% (38/89),respectively. The operative time,blood loss and postoperative hospital stay were 270 (110) minutes,300 (300) ml and 13 (10) days,respectively. The overall morbidity rate was 67.4% (60/89) while the major morbidity was 11.2% (10/89). The increase rate in transient liver enzymes was 42.7% (38/89),3.4% (3/89) for liver failure,53.9% (48/89) for clinically relevant postoperative pancreatic fistula,1.1% (1/89) for bile leak,3.4% (3/89) for chylous leak of grade B and C,11.2% (10/89) for abdominal infection,9.0% (8/89) for postoperative hemorrhage of grade B and C,4.5% (4/89) for delayed gastric emptying,6.7% (6/89) for deep vein thrombosis,3.4% (3/89) for reoperation,4.5% (4/89)for hospital mortality,7.9% (7/89) for 90-day mortality. The pathological type was pancreatic cancer for all 89 cases and pancreatic ductal adenocarcinoma made up 92.1% (82/89). The tumor size was 4.8(2.0) cm, ranging from 1.5 to 12.0 cm. The number of lymph nodes harvested was 14 (13)(range:2 to 33),with a positive lymph node rate of 13.0% (24.0%). The resection R0 rate was 30.0% (24/80) and the R1 (<1 mm) rate was 58.8% (47/80). The median overall survival time was 21.3 months (95% CI: 15.6 to 24.3) and the median disease-free survival time was 19.1 months (95% CI: 11.7 to 25.1). The overall survival at 1-year and 2-year were 69.60% and 39.52%. The median survival time of 58 patients with adjuvant chemotherapy was 24.3 months (95% CI: 17.8 to 32.3) while that of 13 patients without any kind of adjuvant therapy was 8.4 months (95% CI: 7.3 to 22.3). Seven patients accepted neoadjuvant chemotherapy and there was no significant morbidity among them,with a resection rate of R0 of 5/7. Conclusion:DP-CAR is safe and feasible for selective cases,which could be more valuable in improving long-term survival when combined with (neo) adjuvant therapy.

Objective:To summarize the research progress on tissue damage, poisoning mechanism and treatment measures for the injury caused by liquid rocket propellant nitrogen tetroxide (N 2O 4) in China and foreign copuntries. Literature resource and selection The literatures published in the related fields at home and abroad. Literature quotation Fifty-one references were cited. Literature synthesis N 2O 4 is currently a commonly used liquid rocket propellant, which is a colorless gas or liquid and easy decomposition into nitrogen dioxide. It has the characteristics of flammability, explosive, strong oxidation and toxicity. In the process of propellant transportation and usage, poisoning and explosion accidents caused by N 2O 4 leakage occurred from time to time, which seriously threatened the physical and mental health of employees. Early inhalation of N 2O 4 may cause eye and respiratory tract irritation, and severe ones included pulmonary edema and acute respiratory distress syndrome. Long-term exposure may lead to idiopathic pulmonary fibrosis, and the difficulty of treatment N 2O 4 for poisoning patients was increasedwheninjured by the blast of the explosion at the same time. A large number of experimental studies have shown that vitamins E and radix salviaemiltiorrhizae (RSM) can reduce oxidative stress and inflammatory responses induced by N 2O 4. However, due to the lack of specific antidotes in actual treatment, symptomatic treatments such as oxygen administration and correction of pulmonary edema were often used. Conclusions:N 2O 4 poisoning can cause acute respiratory system damage, such as respiratory tract inflammation and pulmonary edema and also lead to chronic diseases, such as fibrosis or other organ damages. Symptomatic and supported treatment is often used in the process of treatment. It indicated that further study of N 2O 4is needed to clarify the molecular mechanism of its action, so as to provide help for clinical treatment.

Objective:To summarize the research progress on tissue damage, poisoning mechanism and treatment measures for the injury caused by liquid rocket propellant nitrogen tetroxide (N 2O 4) in China and foreign copuntries. Literature resource and selection The literatures published in the related fields at home and abroad. Literature quotation Fifty-one references were cited. Literature synthesis N 2O 4 is currently a commonly used liquid rocket propellant, which is a colorless gas or liquid and easy decomposition into nitrogen dioxide. It has the characteristics of flammability, explosive, strong oxidation and toxicity. In the process of propellant transportation and usage, poisoning and explosion accidents caused by N 2O 4 leakage occurred from time to time, which seriously threatened the physical and mental health of employees. Early inhalation of N 2O 4 may cause eye and respiratory tract irritation, and severe ones included pulmonary edema and acute respiratory distress syndrome. Long-term exposure may lead to idiopathic pulmonary fibrosis, and the difficulty of treatment N 2O 4 for poisoning patients was increasedwheninjured by the blast of the explosion at the same time. A large number of experimental studies have shown that vitamins E and radix salviaemiltiorrhizae (RSM) can reduce oxidative stress and inflammatory responses induced by N 2O 4. However, due to the lack of specific antidotes in actual treatment, symptomatic treatments such as oxygen administration and correction of pulmonary edema were often used. Conclusions:N 2O 4 poisoning can cause acute respiratory system damage, such as respiratory tract inflammation and pulmonary edema and also lead to chronic diseases, such as fibrosis or other organ damages. Symptomatic and supported treatment is often used in the process of treatment. It indicated that further study of N 2O 4is needed to clarify the molecular mechanism of its action, so as to provide help for clinical treatment.

Objective To observe the effects of T-lymphocyte function subsets,IL-4 and IFN-γ cell factor in different dose and stage after irradiation.Methoda The C57BL/6j mice were divided into shammed irradiation group and model groups.The radiation hurt model was induced by 60Co gamma rays(0.7,1.4,2.8 and 5.6 Gy).The changes of T-lymphocyte subsets CD3,CD4,CD8,IL-4 and IFN-γ in spleen cells were analyzed by flow cytometry in acute injury stage and recovery stage after irradiation.Results The lymphocyte subsets CD3 +,CD4+ and CD8 + decreased after irradiation,which were related to the irradiation dose.At 1 day after irradiation,the decreasing level of IFN-γ was higher than that of IL-4.When irradiation dose was over 2.8 Gy,IL-4 / IFN-γ showed a markedly increased compared with control group.At 25 days after irradiation,CD3 +,CD4+,CD8 +,CD4 +/CD8 +,IL-4 and IFN-γ recovered obviously,but they did not recover to the normal level of shammed irradiation group.Conclusions The depression of mouse immune function induced by γ-irradiation might be caused by changes of CD3,CD4,CD8 and CD4/CD8 ratio,especially the imbalance of IL4 and IFN-γ.

Objective To study the bystander effects and associated mechanisms through irradiated conditioned medium(1CM). Methods Natural kilhr(NK) cells were obtained from peripheral blood samples. ICM irradiated with different doses of 60Coγ-rays was used for culturing K562 cell strain. The degree of injury of K562cells by activated NK cells was observed, as well as the apoptosis frequency of K562 cell was investigated. Results Severe injury was induced in K562 cells cultured in ICM than the control (sham-irradiated) as shown by increased sensitivity to NK cells (P < 0.05). The apoptosis frequency of K562 cell was increased significantly compared with the control cells (P < 0.05). Conclusions The bystander effect induced by irradiation is existent. ICM can trigger the bystander effect on K562 cell strains.

Objective To compare the changes in nitric oxide (NO), total ability of anti-oxidize antioxidase, superoxide dismutase (SOD), glutathion peroxidase (GSH-PX), catalase (CAT) and maleic dialdehyde(MDA) in rats after single and accumulative 60Co γ-irradiation . Methods 48 rats were randomly divided into two groups of single and accumulative irradiation. Each group was irradiated by 60Co gamma-rays. The total irradiation doses were 0.4, 0.8, 1.6, 3.2 and 6.4 Gy, respectively in each group. The NO, total ability of anti-oxidize antioxidaze, SOD, GSH-PX, CAT and MDA in serum were measured at day 1 after last irradiation. Results Compared with the single irradiation group, the NO (52.6-117.9 μmol/ml), total ability of anti-oxidize antioxidaze (3.3-26.2 U/ml), the antioxidase activity of the SOD (26.3-167.5 U/ml), GSH-PX (740.8-2462.4 U/ml), CAT (3.3-29.4 U/ml) and the content of MDA(29.3-155.1 nmol/ml) of mt serum in accumulative irradiation group were increased after irradiation, which was related with the accumulative irradiation dose. For instance, total ability of anti-oxidize antioxidase (26.2 U/ml), antioxidase activity of the SOD (167.5 U/ml) and CAT (29.4 U/ml) in 0.4 Gy group of accumulative irradiation were significandy increased when compared with those of control group. However, the content of MDA in accumulative irradiation group was obviously higher than that in single radiation group when the irradiation doses delivered over 3.2 Gy, which might be correlated with higher antioxidase activity. Conclusions Low dose of accumulative gamma-rays irradiation can induce the stimulative effect of antioxidase activity. However, higher dose of accumulative gamma-rays irradiation can damage the activity of antioxidase.