Acute pancreatitis (AP) is a common abdominal acute inflammatory disorder.Clinical manifestations of AP vary from self-limiting local inflammation to multiple organ failure causing significant mortality.At present,AP treatment methods mainly include non-surgical treatment such as fluid resuscitation and somatostatin,and minimally invasive or open surgical debridement treatment.Either treatment programs,nutritional support treatment is an essential part of them.According to the pathophysiological characteristics of AP onset,many scholars have emphasized that strategic nutritional support therapy is the key to limiting local inflammation,preventing and controlling AP-related complications.This article will provide an overview of the latest advances in nutritional support treatment of AP,including enteral and parenteral nutrition strategies in clinical treatment,and nutritional supplements such as glutamine,omega-3 fatty acids,vitamins and probiotics.

Objective: To investigate the relationship of PD-L1 protein expression and gene amplification in gastric cancer and their correlation with clinicopathologic factors. Methods: The cohort included 247 gastric cancer specimens with follow-up data and clinicopathologic data obtained from Shanxi Cancer Hospital in 2011. PD-L1 expression was detected by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Results: PD-L1 protein was expressed in 25.9% (64/247) of the tumor cells and 26.7% (66/247) of the tumor infiltrating immune cells (IC). There was a correlation between the two (P<0.01). The expression of PD-L1 in tumor cells correlated with the degree of differentiation and tumor diameter(P<0.05). The PD-L1 expression in IC correlated with vascular tumor thrombi(P<0.05). The amplification rate of PD-L1 gene detected by FISH was 19.0% (47/247), and was associated with age, large/small curvature of the stomach, tumor location, tumor diameter, and lymph node metastasis(P<0.05). The positive coincidence rate of the two methods was 25.0% (16/64), negative coincidence rate was 83.0% (152/183), and total coincidence rate was 68.0% (168/247), suggesting that the coincidence of IHC and FISH was poor (P=0.157). There was a negative correlation between PD-L1 protein expression on tumor cells and prognosis in gastric cancer. There was no significant correlation between PD-L1 protein expression on IC and PD-L1 gene amplification with prognosis. Vascular tumor thrombi, tumor diameter, depth of invasion, and lymph node metastasis were all poor prognostic factors of gastric cancer(P<0.05). Multivariate Cox regression analysis showed that PD-L1 protein expression, depth of invasion and lymph node metastasis were all independent prognostic risk factors for gastric cancer. Conclusions Concordance between PD-L1 protein expression and gene amplification is poor. PD-L1 protein expression may signify poor prognosis. There is no significant correlation between PD-L1 gene amplification and prognosis of patients with gastric cancer.

Objective To summarize the care points of nursing to patients with maxillary defect repaired by 3D printing individualized titanium mesh. Methods Nursing staff cooperated with doctors to control the disease of the whole body and prevent oral infection by performing psychological nursing, keeping the respiratory tract smooth after operation, preventing bleeding and infection of the wound, conducting oral, eye and pain care, preventing cerebrospinal fluid leakage, intracranial infection and venous blood thrombus of lower extremity and helping the patients with rehabilitation training. Results The hospitalization time of 5 patients was 11～20d with an average of (14.80 ± 3.31) d. 1 case had cerebrospinal fluid leakage during the operation and 1 had postoperative corneal edema. After treatment and nursing, all the patients were discharged from the hospital. Follow-up of 6 months showed no recurrence and good appearance in the maxillofacial region. Conclusion The nursing measures for the patients with to patients with maxillary defect repaired by 3D printing individualized titanium mesh include respiratory tract management, oral cavity, eye and pain nursing, prevention of bleeding and infection of wound, prevention of cerebrospinal fluid leakage, intracranial infection and venous thrombosis of lower extremities, which can promote the recovery of the patients soon.

OBJECTIVETo investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).

METHODSThree hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.

RESULTSNo statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.

CONCLUSIONSGenerally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.

Anastomosis, Surgical ; Humans ; Incidence ; Octreotide ; therapeutic use ; Pancreas ; pathology ; Pancreatectomy ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; drug therapy ; Pancreaticoduodenectomy ; adverse effects ; Perioperative Period ; Prospective Studies

Objective To study the function of early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy (PD).Methods From Jul.2010 to Jun.2013,the clinical data of 286 patients undergoing PD were retrospectively evaluated.87 patients with high risk of pancreatic fistula were screened and then divided into early persistent vacuum suction drainage group (the observation group) and conventional drainage group (the control group) according to postoperative drainage manners.We statistically analyzed the two groups in terms of general information,blood loss,operative time,medical expenses,hospital stay,mortality and morbidity of complications such as pancreatic fistula.Results There were 40 patients screened into the observation group and 47 patients into the control group.No difference was found between the observation group and the control group in basic clinical data or surgical data.There was no statistical difference between the two groups in delayed gastric emptying,bile leakage,bleeding or the incidence of pancreatic fistula and intra-abdominal infection.The incidence of pancreatic fistula with grade B and C in the observation group was statistically lower than that of the control group(12.5％ vs 34.0％,P＜0.05).The incidence of intraabdominal infection in observation group was statistically lower than those in the control group (20.0％ vs 40.4％,P＜0.05).The incidence of total complications in observation group was statistically lower than that in the control group (60.0％ vs 83.0％,P＜0.05),but no difference was found between the observation group and control group in morality.Early persistent vacuum suction drainage could reduce hospital stay((21.93±7.14) days vs (28.70±12.45) days,P＜0.05) and clinical expense ((64.8±12.0) thousands vs (75.2± 14.6) thousands,P＜0.05) in patients with high risk of pancreatic fistula after PD.Conclusions Early persistent vacuum suction drainage can reduce the rate of grade B and C pancreatic fistula in patients with high risk of pancreatic fistula undergoing PD.The manner can also reduce the incidence of intra-abdominal infection,total complications and cost of hospital stay.This manner can accelerate postoperative recovery of patients undergoing PD and is worth of widely used.

In the past,it is always believed that routine drainage after pancreaticoduodenectomy (PD) is one of the most crucial methods to prevent and detect postoperative complications and to reduce mortality.However,in more recent years,with the development of fast track surgery,scholars in pancreatic surgery have investigated the necessity of drainage after PD together with its merits and faults.Therefore,this paper gives a brief review on this topic.

Objective To investigate the correlation between emotional intelligence and self control in adult patients with early depressive disorder .Methods From September 2015 to February 2016 , a total of 61 adult patients with early depressive disorder were selected by convenience sampling and were surveyed by questionnaires of Emotional Intelligence Scale ( EIS) and self control scale of depression .Results Total scores of emotional intelligence in patients with early depressive disorder were (113.61 ±16.60), with the highest score of emotional use , and the lowest of self management .Emotional intelligence had a significantly positive correlation with total score of self control of depression ( r =0.369, P <0.01 ).Dimensions in emotional intelligence , like emotional perception , self management and emotion use , were positively correlated with self control of depression ( P<0.05 ) .Conclusions For adult patients with early depressive disorder , emotional intelligence has a significantly correlation with self control of depression .Nurses in department of psychiatry are thus reminded to take effective educational measures to improve the patients ′emotional intelligence , so as to improve emotional intelligence and self control abilities of patients with depressive disorder .

Objective To summarize the experience of diagnosis and treatment of traumatic pancreatitis (TP). Methods Clinical data of 13 patients with TP who were admitted to the First Affiliated Hospital of Harbin Medical University between October 2013 and October 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 9 males and 4 females, aged from 28 to 53 years old with a median age of 39 years old. All patients had a definite medical history of trauma, mainly traffic and crush injury. The diagnosis, treatment and complications of the patients were observed. Results The patients were mainly with gradeⅡ and Ⅲ pancreatic damage, incluing 5 cases of pancreatic head injury and 8 of pancreatic neck, body and tail injury. Most patients were diagnosed with TP on 2-5 d after trauma. One case received non-surgical treatment. Twelve cases underwent minimally invasive surgery, including 8 cases treated with percutaneous catheter drainage, 1 with endoscopic pancreatic stent, 4 with endoscopic removal of necrotic tissue. Eight cases underwent laparotomy. Complications were observed in 12 cases. Nine cases developed abdominal or retroperitoneal infection and underwent minimally invasive surgery. Among them, 6 cases were complicated with severe multiple organ injuries and underwent re-operation. Five cases suffered colonic fistula. Among them, colonic fistula of 3 cases were interlinked with abdominal infectious focals, and they underwent fistula proximal intestinal colostomy and two-stage fistula closure. The median length of hospital stay was 57(17-134) d. All patients were recovered and discharged after treatment. Conclusions It is difficult to make an early diagnosis of TP due to the insidious onset and rapid progression. Individualized treatment should be chosen according to the specific conditions of patients.

Clinical trials for medical research subjects of protection in China is still the researchers and sub-jects′cognitive biases, informed consent to carry out the difficult and the lack of follow-up tracking examination questions.Based on the experience and the domestic exploration of a hospital, put forward the Suggestions of per-fecting our country′s subjects protection: establish multi-sectoral cooperation of the subjects protection system, improve the legal consciousness and the consciousness of the subjects, the ethics committee should be field trips, build system of compulsory insurance, adverse drug reaction relief system is established.

Objective To investigate the diagnosis and treatment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods The clinical data of patients with pathologically verified IPMN who underwent surgical treatment between January 2006 to April 2014 in the First Affiliated Hospital of Harbin Medical University were studied retrospectively.There were 27 males and 21 females.The average age was (57.8 ± 8.8) years old.The average caliber of the main pancreatic duct was (1.1 ± 0.6) cm.The average size of the branch duct IPMN was (4.6 ± 1.5) cm.Results 35 patients underwent pancreaticoduodenectomy.Eight patients underwent distal pancreatectomy.Two patients underwent duodenum-preserving pancreatic head resection.Two patients underwent splenic-preserving distal pancreatectomy and one patient underwent total pancreatectomy.No patient died in perioperative period,and the median length of hospital stay after surgery was 14.3 days.Postoperative pathological examination revealed 5 (10.4％) adenoma,12 (25.0％) moderate-grade dysplasia,14 (29.2％) high-grade dysplasia and 17 (35.4％) invasive carcinoma.The postoperative complication rate was 22.9％.The mean follow up period for the noninvasive tumors was 48.9 months,with no recurrence or deaths.The mean follow up period of the invasive tumors was 43.2 months,with 1 death and no recurrence.Conclusions The indications for resection of IPMN should be based on treatment guidelines and on the patient' s general condition.It is suggested that the diagnosis and treatment of IPMN should be conducted in specialized pancreatic surgery centers.