Objective:To evaluate the preoperative localization value of endoscopic ultrasound guided fine needle tattooing (EUS-FNT) for laparoscopic distal pancreatectomy in pancreatic lesions with a maximum diameter ≤3 cm.Methods:From November 2017 to October 2022, at the Second Affiliated Hospital of Soochow University, the data of patients with pancreatic lesions ≤3 cm who underwent laparoscopic distal pancreatectomy were retrospectively analyzed. Eight patients who underwent EUS-FNT assisted laparoscopic distal pancreatectomy were included in the fine needle tattooing (FNT) combined laparoscopic group. And 14 patients who underwent simple laparoscopic distal pancreatectomy were taken as the simple laparoscopic group. The success rate and complications of EUS-FNT were observed. The differences in operation time, surgery-related complications and complete resection rate of lesions between the two groups were compared. Mann-Whitney U test and descriptive analysis were used for statistical analysis. Results:In the FNT combined laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 4 cases in the pancreatic tail. In the simple laparoscopic group, the lesions of 4 cases were located in the pancreatic body and 10 cases in the pancreatic tail. There was a significant difference in lesion size between the two groups (14.5 mm (10.8 mm, 16.5 mm) vs. 27.0 mm (23.5 mm, 30.0 mm), Z=-3.09, P=0.001). In the FNT combined laparoscopic group, EUS-FNT was successfully performed in all 8 patients. The average time of laparoscopy after EUS-FNT was (98.4±8.8) min. The marks were clearly visible under the laparoscopic field of view, and no complications such as abdominal hemorrhage and hematoma were observed. Laparoscopic pancreaticocaudectomy was performed in 5 cases and pancreaticocaudectomy plus splenectomy in 3 cases. The median operation time was 192.5 min (176.3 min, 203.8 min). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. The lesions were one-time completely resected in all 8 patients. The postoperative pathology were 6 cases of pancreatic neuroendocrine neoplasm, 1 case of intraductal papillary mucinous neoplasm (IPMN), and 1 case of solid pseudopapilloma. In the simple laparoscopic group, laparoscopic pancreaticocaudectomy was performed in 2 cases and pancreaticocaudectomy plus splenectomy in 12 cases. The median operation time was 202.5 min (192.8 min, 235.0 min), which was longer than that of FNT combined laparoscopic group, but the difference was not statistically significant ( P>0.05). The amount of intraoperative bleeding was large in 2 patients and blood transfusion was needed. In 1 patient with pancreatic body lesions, no lesion was found in the specimen examination after the first pancreatectomy, and the lesions were completely resected after the second partial pancreatectomy. Active abdominal hemorrhage occurred in 1 patient on the second day after operation, and underwent interventional embolization for hemostasis. Two weeks after surgery, 1 patient was found to have a encapsulated fluid with a long diameter of 6 cm around the pancreas by computed tomography re-examination 2 weeks after surgery. The postoperative pathology were 5 cases of pancreatic neuroendocrine neoplasm, 2 cases of IPMN, 1 case of solid pseudopapilloma, 1 case of pancreatic cyst with glandular low-grade intraepithelial neoplasia, 1 case of ectopic spleen, and 4 cases of pancreatic ductal adenocarcinoma. Conclusion:EUS-FNT can effectively localize small pancreatic lesions before laparoscopic distal pancreatectomy, shorten the operation time and improve the complete resection rate under laparoscopy.

Background and Objectives: p21, an important member of the Cip/Kip family, is involved in inhibitory effects of RUNX1b overexpression during the early stage of human hematopoiesis. Methods: and Results: We established a human embryonic stem cell (hESC) line with inducible expression of p21 (p21/hESCs). Overexpression of p21 did not influence either mesoderm induction or emergence of CD34＋ cells, but it significantly decreased the production of CD43＋ cells and changed the expression profile of hematopoiesis-related factors, leading to the negative effects of p21 on hematopoiesis. Conclusions In RUNX1b/hESC co-cultures when RUNX1b was induced from D0, perturbation of the cell cycle caused by upregulation of p21 probably prevented the appearance of CD43＋ cells, but not CD34＋ cells. The mechanisms via which CD34＋ cells are blocked by RUNX1b overexpression remain to be elucidated.

Pyoderma gangrenosum is a reactive inflammatory skin disease characterized by destructive skin ulcers accompanied by intense pain.The cause of the disease is unknown.According to the clinical identification of pyoderma gangrenosum wound treatment in this paper,analyze the difficulty of the wound treatment,the wound care according to the international guidelines recommends the"TIME"principle,we will review the status of wound care of pyoderma gangrenosum.

Objective: The purpose of this study is to investigate the effect of quantitative exercise on the patients with arteriosclerosis obliterans of the lower extremities over the age of 70 years. Methods: A total of 80 cases elderly patients over 70 years oldfrom the department of vascular surgery were randomly divided into 2 groups, 40 cases in each group, the control group was given conventional nursing, the experimental group was given quantitative exercise with nursing. The pain score, ankle brachial index, quality of life and satisfaction of patients between two groups were compared before and after intervention. Results: The pain score, ankle brachial index, physiological function, bodily pain, social function, mental health and patient satisfaction in the experimental group were 2.13 ± 0.75, 0.89 ± 0.07, 83.25± 8.66, 72.63 ± 13.24, 74.18 ± 10.19, 79.65±8.47, 100% (40/40), and 4.53 ± 1.13, 0.77 ± 0.08, 67.63 ± 5.42, 50.53 ± 8.40, 60.02 ± 10.01, 66.45 ± 7.85, 95%(38/40) in the control group respectively, there was significant difference between 2 groups (t=-9.665-7.664, P< 0.01 or 0.05). Conclusions In elderly patients over 70 years old, the application of quantitative exercise can reduce the pain of patients, improve their quality of life and increase their satisfaction with nursing work, which is worthy of clinical promotion.

Objective To investigate the progression of mild cognitive impairment (MCI) to Alzheimer's disease (AD) and the factors influencing the related changes in cognitive ability.Methods Seventy-five subjects with mild cognitive impairment (the MCI group),32 with Alzheimer's disease (the AD group) and 17 others with normal cognition (the NC group) were recruited.The Montreal Cognitive Assessment (MOCA) and the Mini-mental State Examination (MMSE) were used to assess their cognitive ability.At the same time,relevant clinical information such as their general condition and past history of disease were recorded.The subjects were followed up for 20 months on average to evaluate their annual rates of progression (APRs),and logistic regression was used to highlight any influencing factors.Results By the end of the follow-up,9 of the 75 MCI subjects had progressed to AD,with an APR of 5.25％.Thirteen cases had recovered normal cognitive functioning (97.6 per 1,000 person-years).Also,2 cases in the NC group (11.76％) developed MCI (69.1 per 1,000 person-years),but none of them had yet progressed to AD.Both hyperlipidemia and a body mass index (BMI) lower than 24 kg/m2 significantly predicted the deterioration of cognitive functioning.Heart disease was significantly correlated with cognitive improvement,and selfmanagement of cognitive function was also a significant protective factor.Conclusions Patients with MCI are at greater risk of developing AD than normal persons.Prevention and early treatment of hyperlipidemia as well as maintaining a normal BMI may delay the deterioration of cognitive functioning.Self-management of cognitive function can improve cognition.

Objective:To investigate frequency and position characteristics of the vestibular dysfunction in vestublar neuritis patients. Method:Colaric test (CT), head impulse test (HIT), cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) were applied in 43 vestublar neuritis patients to assess their vestublar dysfunction. Superior vestublar nerve (S-VN), inferior vestibular nerve (I-VN), total vestibular nerve (T-VN) and each vestibular end organ incidence rate were calculated and statistically analyzed. Result:CT incidence rate (93.0%) was statistically higher than that of HIT (72.1%) (P<0.01). Total frequency incidence rate (72.1%) was statistically higher than that of low frequency (20.9%) (P<0.01). No high frequency only case was observed. The incidence rate of S-VN only, I-VN only and T-VN was 44.2%, 4.7% and 51.2% respectively. Among them, the incidence rate of I-VN was significantly lower than the others (P<0.01). The incidence rate of vestibular end organs was 17.4% (S-SCC), 44.2% (H-SCC), 20.9% (P-SCC), 39.5% (utricule) and 26.7% (saccule) respectively. The incidence rate of H-SCC was remarkably higher than the other semicircular canals (P<0.01). The difference between utricule and saccule was not statistically significant. Conclusion:The semicricular canal dysfunction in vestibular neuritis patients mainly involves total frequency of vestibular function, low frequency is more common than high frequency. Total vestibular nerve and single S-VN are mostly involved in vestibular neuritis.

Objective:To explore the clinical value of vestibular autorotation test (VAT) in the treatment for otogenic vertigo patients. Method:One hundred and twenty-nine definite otogenic vertigo patients were included. All patients underwent the VAT and caloric test (CT). The results were analyzed statistically. Result:In VAT examination, 89 (69.0%) cases were abnormal. In CT examination, 56 (43.4%) cases were abnormal. In the contrast test of VAT and CT, VAT results were abnormal in 47 (36.4%) patients and CT results were abnormal in 14 (10.9%) patients. The number of patients whose both VAT and CT results were abnormal was 42 (32.6%). The total number of patients with various abnormal results was 103 (79.8%). According to statistical analysis, the abnormal result rate of VAT was higher than that of CT. The abnormal result rate of both VAT and CT was higher than that of each single test. There was statistic significance in the difference (χ²=1.670, P<0.05). Conclusion:For otogenic vertigo patients, their abnormal result rate of VAT is higher than that of CT. VAT and CT can be mutually complementary. The combination of VAT and CT can help to understand the function of semicircular canal in the general and provide reference for the treatment of otogenic vertigo diseases.

Objective To detect the expression of kisspeptin-1 (KISS-1),matrix metallopmteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) in the tissue of colon cancer,and analyze the relativity between KISS-1,MMP-2,VEGF and pathological characteristics of colon cancer.Methods A total of 60 colon cancer patients and 60 patients with benign colorectal disease who received surgical treatment in our hospital from January 2009 to June 2010 were selected as observation group and control group respectively.The cancer tissue samples and excision samples collected from them were used to detect KISS-1,MMP-2 and VEGF with immunohistochemistry.Results The positive rates of KISS-l,MMP-2 and VEGF were 31.7％,58.3％ and 78.3％ in observation group,and 73.3％,16.7％ and 33.3％ in control group.The positive rate of KISS-1 in observation group was lower than that in control group (x2=23.489,P＜0.001),and the positive rates of MMP-2 and VEGF in observation group were higher than those in control group (x2=27.469,P＜ 0.001;x2=25.817,P＜0.001).The expressions of KISS-1,MMP-2 and VEGF were significantly related with the histological grade and TNM stage of colon cancer (x2=8.997,P=0.011;x2=6.163,P=0.013;x2=8.519,P=0.014;x2=9.160,P=0.002;x2=16.577,P＜0.001;x2=10.523,P=0.001).Conclusion It is helpful to understand the differentiation and clinical stage of colon cancer and provide evidence for clinical diagnosis and prognosis prediction by detecting KISS-1,MMP-2 and VEGE

Objective Pressure Ulcer Scale for Healing ( PUSH) was published in 1998 by National Pressure Ulcer Advisory Panel ( NPUAP) as a tool to evaluate the effects of pressure ulcer care.This study aimed to verify the reliability and validity of the Chi-nese version of PUSH in order to provide an efficient and reliable tool for evaluating the effects of pressure ulcer care. Methods Using the Brislin translation model, we translated the English version of PUSH into Chinese and finalized the Chinese version through modifica-tion by an advisory panel, pretests, and verification of its reliability and validity in the care of 126 cases of stage-Ⅱ-Ⅳpressure ulcers. We analyzed the reliability and validity of the scale based on its item scores, content validity, construct validity, Cronbach′s αcoeffi-cient, and test-retest reliability. Results The correlation coefficient value of the total and individual item scores was 0.616-0.963 (P<0.01).Each individual item score was significantly higher in the 27%high-score group (n=35) than in the 27%low-score group (n=36).The total content validity coefficient was 0.965, the correlation coefficient of construct validity between the total and individual item scores was 0.750-0.954 (P<0.01), and that between individual items was 0.666-0.826 (P<0.01), with statistically signifi-cant differences between the total and individual item scores at 7 and 21 days after treatment (P<0.01).The Cronbach′s αreliability coefficient value of the total score was 0.823 and those of individual item scores were 0.770, 0.791, and 0.868, respectively.The inter-rater reliability coefficients were all >0.85 and the test-retest reliabili-ty coefficients of individual items were 0.826, 0.885, and 0.958, re-spectively ( P<0.01) . Conclusion The Chinese version of PUSH, with its high validity and reliability, can be used to evaluate interven-tion effectiveness of Chinese patients with pressure ulcers.

Objective To investigate the expression of excision repair cross-complementation group 1 (ERCC1) and ribonucleotide reductase subunit M1 (RRM1) in patients with esophageal squamous cell carcinoma,and the relationship between the expression of ERCC1 and RRM1 genes and chemotherapy sensitivity.Methods A total of 77 patients with esophageal squamous cell carcinoma admitted in hospital from Jan.2008 to Dec.2012 were recruited.ERCC1 and RRM1 mRNA levels in the cancerous tissue were detected by real-time fluorescent quantitative RT PCR.The relationship between short-term effects of chemotherapy and ERCC1 and RRM1 mRNA levels was analyzed.Results Levels of mRNA in stages Ⅰ a,Ⅰ b,Ⅱ a,and Ⅱ b were (0.578±0.081),(0.560±0.084),(0.521±0.080),(0.464±0.091) for ERCC1 and(0.511±0.089),(0.539± 0.086),(0.584±0.092),(0.637±0.101)for RRM1,respectively.As the clinical stage advanced,the ERCC1 mRNA level declined and the RRM1 mRNA level increased (t=2.679 and 2.952,P =0.034 and 0.025,respectively).Levels of mRNA in patients with complete remission,partial remission,stable disease and progressive disease were (0.487 ± 0.097,0.511 ± 0.095,0.552 ± 0.086,0.568 ± 0.088) for ERCC1 and(0.504±0.091,0.544±0.095,0.595±0.093,0.616±0.097) for RRM1,respectively.The clinical effect of chemotherapy was negatively correlated with mRNA expression of ERCC1 and RRM1 (r=0.567,P=0.032).Conclusions Levels of ERCC1 and RRM1 mRNA expression are correlated with the staging of esophageal squamous cell carcinoma and chemotherapy sensitivity,and can be used as a predictive parameter for chemotherapy sensitivity in patients with esophageal squamous cell carcinoma.