Predictors of malignancy in chronic calcific pancreatitis with head mass

AIM: To prospectively analyse the clinical, biochemical and radiological characteristics of the mass lesions arising in a background of chronic calcific pancreatitis (CCP). METHODS: Eighty three patients, who presented with chronic pancreatitis (CP) and a mass lesion in the head of pancreas between February 2005 and December 2011, were included in the study. Patients who were identified to have malignancy underwent Whipple' s procedure and patients whose investigations were suggestive of a benign lesion underwent Frey's procedure. Student t-test was used to compare the mean values of imaging findings [common bile duct (CBD), main pancreatic duct (MPD) size] and laboratory data [Serum bilirubin, carbohydrate antigen 19-9 (CA 19-9)] between the groups. Receiver operating characteristic curve (ROC curve) analysis was done to calculate the cutoff valves of serum bilirubin, CA 19-9, MPD and CBD size. The sensitivity, specificity, positive predictive valve (PPV) and negative predictive value (NPV) were calculated using these cut off points. Multivariate analysis was performed using logistic regression model. RESULTS: The study included 56 men (67.5%) and 27 women (32.5%). Sixty (72.3%) patients had tropical calcific pancreatitis and 23 (27.7%) had alcohol related CCP. Histologically, it was confirmed that 55 (66.3%) of the 83 patients had an inflammatory head mass and 28 (33.7%) had a malignant head mass. The mean age of individuals with benign inflammatory mass and those with malignant mass was 38.4 years and 45 years respectively. Significant clinical features that predicted a malignant head mass in CP were presence of a head mass in CCP of tropics, old age, jaundice, sudden worsening abdominal pain, gastric outlet obstruction and significant weight loss (P ≤ 0.05). The ROC curve analysis showed a cut off value of 5.8 mg/dL for serum bilirubin, 127 U/mL for CA 19-9, 11.5 mm for MPD size and 14.5 mm for CBD size. CONCLUSION: Elevated Serum bilirubin and CA 19-9, and dilated MPD and CBD were useful in predicting malignancy in patients with CCP and head mass.

IgG4-Unrelated Type 1 Auto Immune Pancreatitis Manifesting with Pancreatic Head Mass Mimicking Cancer

Auto immune pancreatitis (AIP) is an uncommon form of chronic pancreatitis that has been divided into type 1 and type 2 which have distinct histopathology and clinical features. Type 1 AIP seems to be the pancreatic manifestation of an IgG4-related systemic disease, characterized by elevated IgG4 serum levels, infiltration of IgG4-positive plasma cells and extrapancreatic lesions. When manifesting as a focal disease in the pancreas, it can be challenging to differentiate it from pancreatic cancer (PC). Because AIP is typically responsive to steroid therapy without the need for resection, differentiation between these two diseases is critical. We report the case of a 56-year-old man with initial suspect of PC, and final diagnosis of type 1 AIP according to the International Consensus Diagnostic Criteria (ICDC) without elevated levels of serum IgG4 or need for a histology sample. We take a review of literature in order to improve the diagnostic accuracy of AIP and describe clinical and imaging features to differentiate it from PC and avoid unnecessary surgery due to misdiagnosis.

Method Development and Validation for Determining 1,3-Bu- tadiene in Human Blood by Gas Chromatography-Mass Spec- trometry and Head-Space Gas Chromatography

To develop a simple,validated method for identifying and quantifying 1,3-butadiene(BD) in human blood by gas chromatography-mass spectrometry(GC-MS) and head-space gas chromatography(HS-GC).BD was identified by GC-MS and HS-GC,and quantified by HS-GC.The method showed that BD had a good linearity from 50 to 500μg/mL(r>0.99).The limits of detection and quantification were 10 μg/mL and 50 μg/mL,respectively.Both the intra-day precision and inter-day precision were <6.08%,and the accuracy was 96.98%-103.81%.The method was applied to an actual case,and the concentration of BD in the case was 242 μg/mL in human blood.This simple method is found to be useful for the routine forensic analysis of acute exposure to BD.

Diagnostic and surgical challenges of progressive neck and upper back painless masses in Madelung’s disease: A case report and review of literature

BACKGROUND Madelung’s disease(MD)is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head,neck,shoulders,back,trunk,and nerve roots of the upper and lower limbs.It is relatively rare in Asian individuals and is prone to misdiagnosis.Herein,we report a case of a patient with MD who had undergone surgical management at our hospital,and we discuss the pathogenesis,diagnosis,and treatment of MD.CASE SUMMARY We report a case of MD in a 65-year-old man of Han descent.The patient had multiple,painless progressive masses for more than five years in the neck and more than 30 years in the upper back.Because of neck mobility limitations and progressive cosmetic deformities caused by the masses,he was admitted to our hospital.He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years.Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated,subcutaneous fatty deposits.We prepared a staged operation plan.The patient was diagnosed with MD;he was advised to abstain from alcohol and was followed up regularly.After a 3-month follow-up,no recurrence of fat accumulation was found in the surgical areas.CONCLUSION This report presents a case of surgical treatment for MD to improve clinicians'understanding of the disease.

Head and Neck Cancer Early Identification of Malnutrition High Risk Patients and Quality of Life Optimization

Malnutrition in Head and neck cancer (HNC) patients can be present at the moment of diagnosis. The nutritional status is determinant for the treatment success and quality of life of the patients. The nutritional status gradually declines during treatment and the majority of patients undergoing treatment will need nutritional therapy. On the other hand, HNC, like other cancers, can induce a paraneoplastic syndrome that leads to cachexia. This cachexia status is most of the times the cause of death or the cause of treatment failure. So, early identification of malnutrition high risk patients is crucial to start an adequate nutrition support intervention in HNC patients. This study aims to identify HNC patients who present malnutrition or higher risk of malnutrition;to signalize variables that support early identification of high-risk patients of becoming malnourished and to establish a dynamic relationship between malnutrition risk in these patients and Quality of Life (QoL) impacts. For six months consecutive outpatients with HNC admitted at the Head & Neck Unity of Oncology Portuguese Institute—Porto were asked to participate in the research (n = 114). The European Organisation for Research and Treatment of Cancer (EORTC) cancer-specific HRQoL questionnaire-QLQ-C30 and Malnutrition Universal Screening Tool, MUST were used. At the moment of first presentation, 32 patients (28.1%) presented high-risk of malnutrition. HNC patients with oral cavity and oropharynx tumour locations, older, with low literacy or with BMI under 18.5 at the moment of diagnosis, represent a high-risk group. When HNC is considered, a dynamic and bi-directional connection between malnutrition and QoL is observed. A significant (p Emotional and social functional scales and all symptom scales—including pain, presented significant differences between high and medium risk of malnutrition patients. Fatigue, pain, insomnia, appetite loss and financial difficulties were domains directly related to high risk of malnutrition patients. Pain scores were significantly higher (43.23) in the high-risk patients when compared to medium risk patients (11.67). Nutrition support should be considered at any stage of the pathway —especially in high risk group—in order to optimize tumour treatment results, reduction of adverse effects of therapy and improving both QoL and survival.

考虑激励幅值慢变的卷绕头转子系统动力学建模

卷绕头转子系统结构之间的耦合振动和时频变激励使振动问题十分复杂,为了更准确地研究其动力学特性,根据转子动力学理论,使用有限元方法建立了考虑多盘质量慢变的卷绕头非线性转子系统整机动力学模型,运用Newmark-β数值积分方法对其动力学特性求解,得到仅存在初始不平衡量以及卷装不良带来的激励频率、幅值慢变下的非线性动力学行为。通过分析轴心轨迹、时域波形和幅频特性曲线等结果,发现卷绕头转子系统对因卷装不良引起的激励幅值慢变较为敏感,出现新的频率成分。进一步对比分析了不同节点处的振动频谱,其结果可为卷绕头转子系统动力学设计和故障识别提供一定理论支持。

Coupled hydro-mechanical effect of a fractured rock mass under high water pressure

To explore the variation of permeability and deformation behaviors of a fractured rock mass in high water pressure,a high pressure permeability test（HPPT）,including measuring sensors of pore water pressure and displacement of the rock mass,was designed according to the hydrogeological condition of Heimifeng pumped storage power station.With the assumption of radial water flow pattern in the rock mass during the HPPT,a theoretical formula was presented to estimate the coefficient of permeability of the rock mass using water pressures in injection and measuring boreholes.The variation in permeability of the rock mass with the injected water pressure was studied according to the suggested formula.By fitting the relationship between the coefficient of permeability and the injected water pressure,a mathematical expression was obtained and used in the numerical simulations.For a better understanding of the relationship between the pore water pressure and the displacement of the rock mass,a 3D numerical method based on a coupled hydro-mechanical theory was employed to simulate the response of the rock mass during the test.By comparison of the calculated and measured data of pore water pressure and displacement,the deformation behaviors of the rock mass were analyzed.It is shown that the variation of displacement in the fractured rock mass is caused by water flow passing through it under high water pressure,and the rock deformation during the test could be calculated by using the coupled hydro-mechanical model.

响应面法优化顶空固相微萃取分析茉莉加香颗粒挥发性成分

目的建立顶空固相微萃取(head space-solid phase microextraction,HS-SPME)分析茉莉加香颗粒挥发性成分的检测方法。方法采用HS-SPME和气相色谱-质谱法(gas chromatography-mass spectrometry,GC-MS),以总峰个数为指标,在选定萃取头的基础上,采用单因素实验法分析萃取温度、萃取时间、解吸时间对萃取效果的影响,根据单因素实验结果运用Box-Benhnken中心组合实验设计响应面优化萃取条件,并在最优萃取条件下对茉莉加香颗粒挥发性成分进行分析鉴定。结果50/30μm DVB/CAR/PDMS萃取头对茉莉加香颗粒挥发性成分萃取效果较好;响应面法得到最佳萃取条件为萃取温度62℃,萃取时间26.5 min,解吸时间2.6 min。在最佳条件下茉莉加香颗粒共检测出61种挥发性成分,占流出组分总量的87.97%,其中酯类16种、烯烃类21种、烷烃类7种、醛酮类3种、酚类1种、醇类2种、杂环类1种、其他类10种。结论本研究建立了茉莉加香颗粒挥发性成分的检测方法,此方法快速准确,为加香颗粒挥发性成分的检测研究提供技术支撑。

汉麻花和叶挥发性成分分析

为明确汉麻不同花和叶的挥发性成分,以品种brosom为材料,利用顶空-气相色谱/质谱联用技术对其雌花、雄花、雌株老嫩叶、雄株老嫩叶的挥发性成分进行测定。结果表明,相对含量在0.05%以上的挥发性成分中,雌花检测到36种、雄花23种、雌株老叶32种、雌株嫩叶35种、雄株老叶26种、雄株嫩叶30种;萜烯类是花、叶的主要挥发性成分,其中单萜类是雌/雄花的优势成分,雌花主要成分为β-蒎烯和D-柠檬烯,雄花为α-蒎烯、β-蒎烯和D-柠檬烯;倍半萜类是雌株老/嫩叶优势成分,单萜类是雄株老/嫩叶优势成分;雌株老叶主要成分为β-蒎烯、D-柠檬烯、石竹烯和叶醇,雌株嫩叶为D-柠檬烯、石竹烯和β-金合欢烯,雄株老叶为α-蒎烯、β-蒎烯、石竹烯和叶醇,雄株嫩叶为α-蒎烯和β-蒎烯。挥发性成分相似率分析结果显示,雌花和雄花相似率较高,雌株老/嫩叶及雄株老/嫩叶相似率极高,而不同性别的花、叶间相似率较低。雄株老嫩叶α-蒎烯含量(>44.84%)显著高于雌株老嫩叶(<2.65%),雌株老嫩叶的β-金合欢烯含量(>9.18%)显著高于雄株老嫩叶(<0.33%),故α-蒎烯和β-金合欢烯可作为区分brosom雌/雄株的挥发性成分标识物。α-蒎烯、石竹烯、β-罗勒烯在雌/雄花中的差异表现丰富了汉麻雌/雄花在挥发性成分方面的基础知识。本研究结果为汉麻育种及其综合开发利用提供了理论基础。

基于ROAV法确定雪菜不同发酵条件下的关键挥发性风味物质

采用顶空固相微萃取-气质联用技术(Head Space Solid Phase Microextraction,Gas Chromatography-Mass,HS-SPME-GC-MS)检测不同发酵条件(氧气暴露程度、用盐量)下雪菜成品中的挥发性风味物质,并结合相对气味活度值(Relative Odor Activity Value,ROAV)确定关键风味物质.结果表明:在采用密闭发酵雪菜成品中,不同用盐量对挥发性风味物质总量无显著性影响;而在采用半开放发酵的雪菜成品中,7.0%用盐量的雪菜成品中挥发性风味物质总量显著高于5.5%用盐量的雪菜成品.基于ROAV法确定了6种关键风味物质,分别为2-甲基丁酸乙酯、柠檬醛、大马酮、β-紫罗酮、二甲基三硫醚和2-甲氧基-3-仲丁基吡嗪;4种修饰风味物质,分别为1-辛烯-3-醇、芳樟醇、十一醛和4-乙基-2-甲氧基苯酚.

建筑施工物体打击事故数学模型及数值分析

探究建筑施工物体打击事故的发生机理,对有效防控物体打击事故的发生具有十分重要的意义。通过建立物体打击事故的数学模型,分析人体头部所受冲击力与掉落物体质量和坠落高度之间的关系,并应用Matlab软件进行数值分析。结果表明:人体头部所受到的冲击力与掉落物体的坠落高度和质量有关,掉落物体的坠落高度和质量越大,人体头部所受到的冲击力越大,当坠落高度在一定范围内,对人体头部所受冲击力不断增大,超过一定范围时增大的趋势变缓,并估算出了使头皮挫裂、额部骨折、顶部骨折、颞部骨折和枕部骨折的掉落物体最低高度,为确定安全防护距离、做好易坠物体管理、安全帽选型以及制定安全管理措施,以便更好地防范物体打击事故提出了新的思路。

SPME-气相色谱串联质谱法检测食品中的环氧乙烷及其代谢物2-氯乙醇

建立了顶空固相微萃取(solid phase micro extraction,SPME)-气相色谱串联质谱(GC-MS/MS)法检测食品中的环氧乙烷及其代谢物2-氯乙醇的分析方法。样品采用SPME(萃取纤维头95umC-WR/PDMS)在线提取,使用毛细管色谱柱HP-VOC分离环氧乙烷和2氯乙醇及其他干扰组分,高效电子轰击电离源(HES)离子化,多反应监测(multiple reaction monitoring,MRM)扫描,外标法定量。环氧乙烷及2-氯乙醇在10~200μg/L线性范围内,线性关系良好(r>0.995),以环氧乙烷表示的环氧乙烷和2氯乙醇的总和方法定量限20μg/kg,在1倍、2倍和10倍定量限3个浓度添加水平下,水果、蔬菜、谷物及调味料食品中添加回收率在76.32%~102.05%之间,重复性精密度在1.66%~5.96%之间。该方法灵敏度高、准确度高、重现性好,适用于食品中环氧乙烷及其代谢物2-氯乙醇的检测。

引江济淮船闸闸首施工期开裂风险与防裂分析

与混凝土坝相比,船闸闸首、泵站类薄壁大体积混凝土结构体型相对较小,但结构型式与受力复杂、约束明显且采用泵送高性能混凝土浇筑,早期混凝土放热量较常态混凝土大且发热快,施工期比大坝更易产生温度裂缝,其防裂设计成为施工质量控制的难点之一。结合在建的引江济淮枞阳船闸上闸首工程,采用三维有限元法仿真分析手段,模拟真实环境、材料、结构、温控措施的影响,分析结构施工期温度场、应力场以及开裂风险,并提出针对性的防裂措施。研究表明,输水廊道、墩墙、空箱及启闭机房周边大体积混凝土等功能性部位为高风险开裂部位,实现控温浇筑、通水冷却以及表面保温的多措并举且差异化控制,能够大大降低其开裂风险,可为引江济淮工程薄壁结构防裂设计提供参考。

鲁西黑头羊早期生长发育规律及出栏标准研究

[目的]探究鲁西黑头羊早期生长发育规律,分析育肥最佳出栏时间和体质量,提高鲁西黑头羊养殖综合效益。[方法]选择1日龄鲁西黑头羊羔羊100只,全舍饲饲养条件下测量不同生长发育阶段体尺、体质量等生产性能指标,并结合育种资料进行统计学分析。[结果]鲁西黑头羊公、母羊初生至周岁前各阶段体质量差异显著,周岁至成年体质量差异极显著。初生体质量与3月龄、成年体质量;3月龄与周岁体质量;6月龄与周岁、成年体质量;周岁与成年体质量都呈极显著正相关。鲁西黑头羊公、母羊出生至6月龄体质量呈直线上升趋势,平均日增质量达274 g以上,6月龄平均体质量达45 kg以上,8月龄开始生长速度有所减缓。[结论]鲁西黑头羊早期生长发育速度快,具备专门化肉羊品种的特点,育肥期6~7月龄,体质量49 kg左右出栏,可实现育肥效益最大化。

天山乌鲁木齐河源1号冰川物质平衡对气候变化的敏感性研究

应用度日物质平衡模式对天山乌鲁木齐河源１号冰川物质平衡及平衡线高度对气候变化的敏感性进行了研究．结果表明，位于大陆性气候区且具有暖季补给特征的乌鲁木齐河源１号冰川物质平衡对气候变化的敏感性要小于海洋性冰川，升温１℃或增加２０％的降水可引起平衡线上升８１ｍ或下降３１ｍ．此外，气温与降水在物质平衡形成过程中的作用是不同的，气温引起物质平衡剖面以旋转方式变化，而降水可导致其平移方式的响应．若未来升温２℃时，即使降水增加３０％，１号冰川向负平衡变化仍然不能得到遏制．

创伤后脑内血肿、局部水肿的CT和临床表现的动态研究(英文)

目的 了解外伤后局部脑血肿、水肿发生发展的动态变化及其与临床表现的关系。方法 选择湘雅医院 1998～ 2 0 0 2年进行过多次头部CT扫描的脑外伤病人 12 0例 ,记录每次CT扫描多项影像学及相关临床指标 ,并对这些指标进行统计分析。结果 96 .7% (116 / 12 0 )的病人CT上存在局部水肿。血肿体积于伤后 1d(中位数 )达到高峰 ,水肿体积伤后 9d达到高峰。最大水肿体积与最大占位体积呈高度相关r =0 .95 9(P <0 .0 1) ,而最低GCS评分在血肿达最大体积时出现 (z =- 1.6 7P >0 .0 5 )。结论 外伤后局灶性脑水肿普遍存在 ,但与血肿相比 ,水肿对临床表现的影响相对较小 ;脑外伤病人当CT扫描示中线移位不明显 ,且病情稳定时应慎用脱水剂。

胰头部肿块术中组织芯活检临床价值

目的评价胰头部肿块术中组织芯活检的定性诊断价值。方法对11年间行胰头部肿块术中组织芯活检245例患者的结果,结合手术后病理切片,进行比较和分析。结果全组患者术中组织芯活检诊断结果示:胰头腺癌188例(76.7%),慢性胰腺炎39例(15.9%)、胰腺不典型增生8例(3.3%)、胰腺神经内分泌肿瘤10例(4.1%)。有3例(1.2%)假阴性的患者,无假阳性病例。穿刺活检敏感性(与术后病理诊断符合率)高达98.8%,特异性为100%。2例(0.8%)发生并发症,其中1例活检过程中因损伤血管导致胆总管出血,病理提示为腺癌,遂行胰十二指肠切除术;另1例慢性胰腺炎行胆肠内引流术,穿刺后引发急性胰腺炎,经非手术治疗后痊愈。结论胰头部肿块术中组织芯活检是判断胰头部肿块性质较为安全、有效而准确的方法,与术后病理切片诊断符合率极高,可以为手术决策提供可靠依据。

顶空-气相色谱-质谱法测定水中痕量丁基黄原酸

建立了顶空-气相色谱-质谱联用测定水中丁基黄原酸的方法。丁基黄原酸在酸性条件下分解成易挥发的二硫化碳,可用顶空-气相色谱分离、质谱定量测定。与传统的分光光度法相比,该法简便、快捷,在0.010～1.00 mg/L范围内线性良好,准确度高,加标回收率为95.1%～100.6%,精密度好,相对标准偏差为3.1%～6.5%,方法检出限为0.002 mg/L,适用于水中丁基黄原酸的监测。

胰头肿块型胰腺炎治疗策略的选择及预后分析

目的探讨胰头肿块型胰腺炎患者治疗策略的选择及预后。方法回顾性分析我科2001年1月~2011年12月收治的胰头肿块型胰腺炎患者的临床资料,并对患者治疗策略的选择及预后情况进行总结。结果共纳入50例胰头肿块型胰腺炎患者,其中76%（38/50）的胰头肿块为实质性,24%（12/50）为囊性肿块。在38例胰头实质性肿块患者中,有26例行手术治疗,12例行非手术治疗,在手术治疗的26例患者中,12例行胰十二指肠切除术,7例行保留十二指肠的胰头次全切除术,4例行胆管空肠Y型吻合,3例行胰管空肠Y型吻合。在12例囊性肿块患者中,有8例患者行手术治疗,其中假性囊肿外引流术3例,空肠囊肿吻合术3例,囊肿局部切除术2例。胰头实质性肿块患者术后病理确诊为慢性胰腺炎仅5例（26.3%,5/19）,胰腺癌9例（47.4%,9/19）,黏液状乳头状腺瘤3例（15.8%,3/19）,神经内分泌肿瘤和胰腺不典型增生各1例（5.3%,1/19）。未接受手术治疗的12例胰头实质性肿块患者中,有7例（58.3%）发生肝转移临床诊断为胰腺癌。接受手术治疗的26例胰头实质性肿块患者中,3例患者术后出现胆瘘,1例术后出现胰瘘,2例术后出现胃瘫;9例病理确诊为胰腺癌的患者在随访过程中有2例（22.2%）发生肝转移。对于胰头实质性肿块患者,手术治疗和非手术治疗患者的5年存活率差异有统计学意义（92.3%vs 41.7%,P〈0.05）。结论对胰头实质肿块型胰腺炎患者,应适当放宽手术指证以提高患者预后,提倡以手术切除胰头肿块为宜。

基于TMT技术的激素性股骨头坏死硬化带修复模式探索及临床验证

背景:股骨头内硬化带是激素性股骨头坏死疾病发展过程中重要的影像学特征并与预后相关。过氧化物酶体增殖物活化受体γ协同刺激因子1α(peroxisome proliferator-activated receptor gamma coactivator 1α,PGC-1α)被证明具有成骨、促血管形成、抗线粒体凋亡等生物活性,与激素性股骨头坏死的骨修复可能存在紧密关联。目的:筛选激素性股骨头坏死硬化带区与正常区的差异蛋白,筛选出硬化带的关键蛋白,并验证关键蛋白在激素性股骨头坏死股骨头标本中的差异表达;探索激素性股骨头坏死硬化带修复模式。方法:取激素性股骨头坏死行人工全髋关节置换术取出的股骨头标本,通过串联质谱标签技术筛选硬化带区与正常区的差异表达基因,并进行GO与KEGG信号通路分析,构建关键靶点的蛋白互作网络、筛选关键基因。观察关键蛋白在激素性股骨头坏死硬化带中的表达,通过Western blotting、免疫组化验证关键蛋白在硬化带中的表达。结果与结论:①通过串联质谱标签定量蛋白质谱检测发现:相比于正常区骨组织,股骨头硬化带骨组织中具有显著差异表达(Log_(2)FC>1.20、Log_(2)FC<0.84和P<0.05)的蛋白质有609个,其中发生上调的蛋白质290个,发生下调的蛋白质319个;②通过GO与KEGG通路富集分析,发现在前10位的富集通路中,Wnt信号通路与生命周期调控通路与骨修复关系密切;在生命周期调控通道中,PGC-1α是重要的蛋白之一;③与激素性股骨头坏死标本正常区相比,Western blotting验证了PGC-1α、NRF-1在硬化带中低表达,Cleaved Caspase-3在硬化带中高表达;④光镜下免疫组化结果显示,股骨头组织标本中硬化区及正常区的PGC-1α、NRF1及Cleaved Caspase-3阳性染色分布,可以发现骨小梁、成骨细胞和骨髓均有表达存在;硬化带区Cleaved Caspase-3表达更为明显;⑤结论:激素性股骨头坏死硬化带中存在包含Wnt等成骨相关通路活跃、以PGC-1α低表达为特征的氧化凋亡活跃等生物学行为;PGC-1α在激素性股骨头坏死硬化带中低表达可能与氧化凋亡活跃相关。