Recently,there is a gradual increase in the incidence of hyperlipidemic pancreatitis with high serum triglyceride (TG) levels.The treatments include general measures,lipid-lowering drugs,blood purification,low molecular weight heparin and insulin,traditional medicine,improving microcirculation,surgical therapy and gene therapy.The prevention of recurrence of hyperlipidemic pancreatitis is different from other types of pancreatitis.

Bile duct injury is the most common complications of biliary surgery.With the development of tissue engineering,using artificial bile duct to treat the biliary tract disease has become the focus for the treatment of bile duct injury.This article summarizes the applications in clinical work and animal experiment of artificial bile ducts made of biological material,autologous tissue,non-absorbable polymer materials,as well as absorbable polymer materials in the clinical application and animal experiments.The advantageof each material is also discussed here.

Objective To study the expression of HER-3 in breast cancer patients and analyze its relationship with the clinical pathology and prognosis of breast cancer,ER,PR and HER-2.Methods Data of 139 female breast cancer patients undergoing operations at the Second Hospital of Dalian Medical University from Jan.2006 to Oct.2006 were collected.These 139 patients didn't have preoperative chemotherapy or radiation therapy,but had postoperative endocrine therapies.Immunohistochemisty was used to detect the expression of HER-3 in the 139 patients.Data like the expression of ER,PR and HER-2,histological grading,tumor size and lymph node metastasis were obtained from their medical records.The relationship between indicators and breast cancer was analyzed.Results ①The positive expression rate of HER-3,HER-2,ER,and PR was 30.2％ (42/139),42.5％ (59/139),66.9％ (93/139),and 59.7％ (83/139) respectively.(②)The statistical items had no relation with patients' age(P ＞0.05).③HER-3 expression was correlated with tumor sizes,lymph node metastasis,histological grading,5 year survival rate and HER-2 expression(P ＜ 0.05),and had no relation with ER or PR(P ＞0.05).④)The combined expression of HER-3 & HER-2 was correlated with tumor sizes,axillary lymph node metastasis,histological grading,ER and PR.(P ＜ 0.05).Conclusions HER-3 detection is of great significance for the diagnosis and prognosis of breast cancer.The combined examination of HER-3,HER-2,ER,and PR in breast cancer tissues is of clinical significance for early diagnosis/treatment,medication and prognosis of the tumor,as well as for new drug research and development.

Objective To investigate the safety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC) with cirrhosis.Methods The retrospective cohort study was adopted.The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected.The surgical plan was determined according to preoperative liver function and liver functional reserve.The patients underwent portal vein (PV) ligation and liver partition in the first staged surgery.The second staged surgery was performed when growing future live remnant (FLR) came up to the standard of safe section by rescan of computed tomography (CT) at 10,14,18 days after the first staged surgery,and hemihepatectomy and hepatic segmentectomy were applied to patients.(1) The intraoperative situations were observed,including the severity of liver cirrhosis,first staged surgery time,volume of intraoperative blood loss and FLR in the first staged surgery,interval time of surgery,growth rate of liver volume,ratio of FLR and standard liver volume (SLV),time and volume of intraoperative blood loss in the second staged surgery.(2) Pre-and postoperative biochemical indicators in the first and second staged surgeries were detected,including total bilirubin (TBil) and alanine phosphatase (ALT).(3) Postoperative situations were observed,including occurrence of complications,results of pathological examination and duration of hospital stay.(4) The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015.Count data were represented as mean (range).Results (1) Intraoperative situations:of 5 patients,there were 1 patient with F3 of liver cirrhosis and 4 with F4 of liver cirrhosis.One patient was complicated with lots of peritoneal effusion,followed by acute renal failure,and didn't receive the second staged surgery.Four patients underwent successful ALPPS.The first staged surgery of 5 patients:average operation time,volume of intraoperative blood loss,FLR,interval time of surgery,growth rate of liver volume,ratio of FLR and SLV were 282 minutes (range,240-320 minutes),500 mL (range,300-700 mL),457 em3(range,338-697 cm3),15 days (range,14-18 days),58％ (range,46％-67％) and 42％ (range,32％-44％),respectively.Average operation time and volume of intraoperative blood loss in second staged surgery were 220 minutes (range,200-260 minutes) and 412 mL (range,300-600 mL).(2) Pre-and post-operative biochemical indicators:levels of TBil and ALT of 5 patients from pre-operation to postoperative day 12 in the first staged surgery were from 4.9-30.4 μmol/L to 9.8-56.1 μmol/L and from 12.9-156.1 U/L to 46.3-207.3 U/L,respectively.Levels of TBil and ALT of 4 patients from pre-operation to postoperative day 10 in the second staged surgery were from 10.1-21.2μmol/L to 6.9-38.0 μmol/L and from 30.8-55.5 U/L to 19.8-72.8 U/L,respectively.(3) Postoperative situations:there were no perioperative death and postoperative complications of liver failure and intraperitoneal infection.One patient complicated with bile leakage was cured by non-operative treatment for 30 days.Results of pathological examination:5 patients were confirmed as Ⅱ-Ⅲ stage HCC,and 4 tumors had vascular tumor thrombi and negative resection margin with tumor size of 8-13 cm.Duration of hospital stay of 5 patients was 36 days (range,28-48 days).(4) Results of follow-up:4 patients undergoing successful ALPPS were followed up for 4-12 months.One patient was emerged with a new lesion of 2 cm in left half liver at postoperative month 7,level of AFP of which was 512 μg/L before the first staged surgery reduced to normal level at postoperative month 2,and then the patient received transcatheter arterial chemoembolization (TACE) and radio frequency ablation (RFA) treatments without tumor recurrence up to postoperative month 12.No tumor recurrence and new lesions in liver were detected in other 3 patients by abdominal enhanced scan of CT,with a normal level of AFP.Conclusion ALPPS is safe and feasible for HCC with cirrhosis,with a satisfactory short-term outcome.

Pancreatic leakage is most common among numerous complications after pancreaticoduodenectomy surgery.Predicting at early stage and taking preventive measures in time are of great importance to reducing the incidence of pancreatic leakage as well as its related complications.The article reviewed pancreatic leakage monitoring related reports worldwide in recent 10 years.It was found that some factors were useful for the prediction of pancreatic leakage including the drainage fluid amylase and leukocyte count on postoperative day 1 and 3,C-reactive protein on postoperative day 3,the combined detection of white blood cells and albumin on postoperative day 4,the serum urea nitrogen and the serum albumin on postoperative day 1 and 5-8 days,as well as the ratio of amylase level in abdominal drainage to abdominal drainage volume.

In recent years, 125I radioactive seed implantation has been greatly developed for the treatment of unresectable pancreatic cancer, and clinical practice shows that it has good therapeutic effects in relieving pain, controlling local tumor progression, and prolonging patients′ survival time. This article introduces the physical and biological features of 125I radioactive seeds and the advantages and disadvantages of implantation, as well as the therapeutic method, surgical safety, and clinical effects of 125I radioactive seed implantation in the treatment of unresectable pancreatic cancer. This article points out that it is an effective therapeutic method and should be widely applied in well-equipped hospitals.

Objective:To implement an intervention with community-dwelling middle-aged and elderly people through a new science promotion approach, and to evaluate changes in the level of bone health awareness.Methods:From April 2017 to June 2017, 200 community-dwelling middle-aged and elderly people aged 50 years and over were randomly included.They were divided into the intervention group receiving a new science promotion intervention(n=100, with 50 males and 50 females)and the control group(n=100, with 50 males and 50 females). Baseline and follow-up assessments of bone health awareness were performed before and after the one-year intervention.A questionnaire survey on preferences for different types of science promotion articles in WeChat accounts was conducted.Differences in scores for intervention effects before and after intervention were compared between the two groups.Potential influencing factors for the scale score were examined by a multi-factor analysis.Results:After one year of intervention, scores for intervention effects were higher in the intervention group than in the control group( P<0.001). In the intervention group, scores were higher after intervention than before intervention( P<0.001). In the control group, scores after follow-up were slightly higher than those at baseline(29.4±11.4 vs.27.9±10.1, P<0.001). The increase in scores before and after intervention was greater in the intervention group than in the control group( P<0.001). Baseline score, group designation, history of drinking and diabetes impacted the scores in middle-aged and elderly women, while other factors did not.Most middle-aged and older people preferred texts illustrated with pictures, and older people were more receptive to videos. Conclusions:The new science promotion method is beneficial to bone health management, can improve bone health awareness in middle-aged and elderly people.

Objective To study the phosphorylation of AKT2 protein and autophagy activation in cardiac tissues of mice infected with coxsackievirus B3 (CVB3) for further analyzing the regulatory mecha-nism of PI3K/AKT2/mTOR signaling pathway on autophagy activation in viral myocarditis. Methods Thir-ty BALB/c mice were randomly divided into three groups (n=10): control group, myocarditis group and AKT activator-treated group. Those in the latter two groups were intraperitoneally injected with CVB3 to es-tablish the mouse model of acute viral myocarditis. Daily intraperitoneal injection of 0.04 mg/g of Akt acti-vator (SC79) was given to each mouse in the AKT activator-treated group 24 hours after CVB3 infection for 7 consecutive days,while the mice in the other two groups were given the same dose of normal saline. HE staining was used to observe the infiltration of inflammatory cells and tissue necrosis. Expression of CVB3 and inflammatory cytokines such as IL-1β and IL-6 in cardiac tissues at mRNA level was detected by q-PCR. Brain natriuretic peptide(BNP) and cardiac troponin I(cTnI) were measured by ELISA to evaluate myocardial injury. Changes in the expression of autophagy-related protein LC3 and Beclin1 at protein level as well as PI3K/AKT2/mTOR pathway were analyzed by Western blot assay. Results Compared with the con-trol group,massive inflammatory cell infiltration was observed in cardiac specimens of mice with myocarditis, but no obvious tissue necrosis was detected. Moreover,expression of CVB3 and inflammatory factors in car-diac tissues at mRNA level,levels of BNP and cTnI in blood,LC3Ⅱto LC3Ⅰratio as well as Beclin1 pro-tein level in cardiac tissues were significantly increased after CVB3 infection(P<0.05),whereas the activi-ty of PI3K/AKT2/mTOR signaling pathway was decreased. AKT activator not only down-regulated the LC3Ⅱ to LC3Ⅰratio and the expression of Beclin1 protein, but also enhanced the activation of PI3K/AKT2/mTOR signaling pathway in cardiac tissues of mice with myocarditis (P<0.05). Conclusion Enhanced autophagy and suppressed PI3K/AKT2/mTOR signaling pathway are observed in cardiac tissues of mice with myocarditis,indicating that the activation of autophagy may be regulated by PI3K/AKT2/mTOR signaling pathway.

Objective:To investigate the efficacy of osteochondral fragment fixation using bioabsorbable pins for Hepple Ⅱ osteochondral lesions of the talus (OLT) in adolescents.Methods:Retrospective case analysis was used. The clinical data and follow-up results of 13 adolescent patients (13 feet) with Hepple Ⅱ OLT were all treated with osteochondral fragment fixation using bioabsorbable pins admitted to Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to December 2021 were retrospectively analyzed. There were 7 males and 6 females, with 13 right feet. The age was (14.85±2.23) years old, ranged from 12 to 18 years old. According to the American orthopedic foot and ankle society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) and SF-36 score before operation and at the last follow-up were used to evaluate the efficacy and function of the patients. Measurement data with normal distribution were represented as mean ± standard deviation( ± s), and the comparison between groups was conducted using the t-test; The mearsurement data with skewness distribution were expressed by M( Q1, Q3), and rank-sum test was used for inter-group comparison. Results:Thirteen adolescent patients (13 feet) with Hepple Ⅱ OLT underwent surgery successfully and were followed up for (25.54±9.95) months. All wounds healed by first intention, and no complications such as wound infection and delayed healing occurred. Preoperative AOFAS ankle-posterior foot score, VAS and SF-36 score were 58.62±3.55, 7.00 (6.50, 8.00) and 68.38±4.81, respectively. At the last follow-up, the scores were 97.38±2.73, 1.00 (0.00, 1.00), 91.15±4.28, respectively, and the results were significantly improved at the last follow-up, with the difference between the two groups statistically significant( P<0.05). Conclusion:Osteochondral fragment fixation using bioabsorbable pins which can promote cartilage repair, significantly improve symptoms, and achieve better clinical satisfaction with fewer complications, is a safe and effective surgical treatment option for Hepple Ⅱ OLT in adolescents with satisfactory short-term clinical outcomes.

OBJECTIVETo explore the association between urinary microalbumin-to-creatinine ratio (ACR) and brachial-ankle pulse wave velocity (baPWV) in hypertensive patients.

METHODSA total of 877 primary hypertension patients were enrolled in this trial from September 2009 to December 2012, and were randomly recruited and patients were divided into normal ACR group (ACR < 30 mg/g, n = 723), micro-albuminuria group (30 mg/g ≤ ACR < 300 mg/g, n = 136) and macro-albuminuria group (ACR ≥ 300 mg/g, n = 18). baPWV was measure by automatic pulse wave velocity measuring system.

RESULTSThe baPWV values in patients of micro-albuminuria group and macro-albuminuria group were significantly higher than in the normal ACR group (all P < 0.05). The baPWV value of macro-albuminuria group was significantly higher than in the micro-albuminuria group (P < 0.05). Linear correlation analysis revealed that ACR was positively correlated with baPWV (r = 0.413, P < 0.01). Multiple linear regression analysis showed that ACR independently correlated with baPWV in patients with primary hypertension (β = 0.29, R(2) = 0.112, P < 0.01) after adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, blood glucose, total cholesterol, low density lipoprotein, high density lipoprotein and triglyceride. Using ACR < 30 mg/g and ACR ≥ 30 mg/g as dichotomous variable, binary logistic regression analysis showed that ACR ≥ 30 mg/g was also a risk factor of the ascending baPWV in primary hypertension patients (OR: 1.73, 95% CI: 1.62-2.98) after adjusting the traditional cardiovascular risk factors.

CONCLUSIONACR is positively correlated to baPWV in primary hypertension patients, and the ascending baPWV is a risk factor of early renal dysfunction in primary hypertension patients.

Albuminuria ; Ankle ; Ankle Brachial Index ; Blood Flow Velocity ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Creatinine ; urine ; Essential Hypertension ; Humans ; Hypertension ; physiopathology ; urine ; Pulsatile Flow ; Pulse Wave Analysis ; Regression Analysis ; Risk Factors