Objective To investigate the clinical value of serum apolipoprotein A-1 (Apo A-1) detection in HBV-related liver cancer.Methods Totally 362 cases of patients with chronic HBV infection were enrolled from January 2010 to December 2014 in our hospital,including 88 cases of chronic hepatitis B,94 cases of HBV-related liver cirhosis,18 cases of HBV-related liver cancer (without cirrhosis) and 162 cases of liver cirrhosis merged cancer.At the same time,45 cases of healthy people were selected for normal control.The serum Apo A-1,AFP and other laboratory markers were detected,and the test results were statistically analyzed.Results The difference of Serum Apo A-1 and AFP levels in all groups was statistically significant (F =29.86,x2 =112.53,P =0.000).As the disease progressed,the serum levels of Apo A-1 gradually decreased (P ＜ 0.05).But the difference of Apo A-1 level between normal control and HBV-related liver cancer group (without cirrhosis),chronic hepatitis B and liver cirrhosis merged cancer group,liver cirrhosis and liver cirrhosis merged cancer group was not statistically significant (all P ＞ 0.05).The liver cancer patients with Child-Pugh score A,B,C had different serum Apo A-1 levels (all P ＜ 0.05);The serum Apo A-1 level of liver cancer patients with Child-Pugh score A was significantly higher than that of liver cirrhosis (t =-3.02,P =0.003),but the differences of serum Apo A-1 levels between liver cancer and liver cirrhosis patients with Child-Pugh score B and C were not statistically significant (t =0.52,1.19,P =0.610,0.240).The serum Apo A-1 levels of liver cancer patients with TNM stage Ⅰ and Ⅱ were significantly higher than those with TNM stage Ⅲ and Ⅳ (t =3.85,P ＜ 0.001).Conclusion The serum Apo A-1 levels of HBV-related liver cancer patients are related with cirrhosis,Child-Pugh score and TNM stage,and the liver reserve function,the body's stress response and many other factors may contribute to the expression of serum Apo A-1.

Objective To explore the diagnosis and surgical management for severe injury of the pancreas. Method Fourteen patients with transected or derogated pancreatic trauma from January 1986 to December 1998 were reviewed. Result The mean age was 31 years.Injury was on the body and tail of the pancreas in 5 cases, on the neck in 6,and on the head in 3. Eleven patients suffered from compound injuries of the adjacent organs .Preoperative diagnosis was made in only 4 patients,diagnosis was achieved during first laparotomy in 9 patients ,and in second look in 1 patient.The operative procedure involved distal pancreatectomy in 5,proximal pancreatorrhaphy and distal pancreatojejunostomy in 5,head resection and distal pancreatojejunostomy in 3, and simple external drainage in 1.Fistula developed in 5 cases and perioperative mortality was 3/14.Conclusion Preoperative diagnosis for pancreas injury is difficult,and in most cases diagnosis can only be established during exploration.An appropriate operative procedure reduces the morbidity and mortality of pancreatic injuries.

The plateau personal physiological parameters monitor can be applied to casualty rescue at peacetime and wartime and trainings of troops in the plateau. With the function of telemering, the monitor can give realtime data of O2Sat, pulse and temperature when the subject is in an environment such as the plateau or the one of high and cold.

Objective To build finite-element models of cerebral hemorrhage on which a simulation study of electrical impedance tomography(EIT) is based.Method With a kind of four-layer concentric circle model of head,finite-element method and dynamic NOSER algorithm are performed to reconstruct the images.Result As to the single-focus model of the cerebral hemorrhage,the focus can be clearly imaged,while to the several-focus model,the focuses can be imaged with vaguely adjacent boundaries.Conclusion The dynamic NOSER algorithm is an effective method to image cerebral hemorrhage in EIT.

Accurate area assessment of a burn injury and its treatment according to its depth of injury are the foundation of burn treatment due to its complexity, and various techniques and methods have been employed to solve these problems for many years. As the demand of modern medicine calls for individualized and precise therapeutic measures, it is clear that the traditional diagnostic and treatment measures are insufficient. The flourishing development of three-dimensional (3D) technology seems to provide new research approaches and technical opporturities for burn surgery. A series of techniques such as 3D model, 3D scanning, and 3D printing may be promising in advancing burn surgery through basic research to achieve rational clinical applications in the future. In this paper, the applications and achievements of 3D technology in burn surgery in recent years are summarized.
Body Surface Area ; Burns ; diagnosis ; pathology ; therapy ; Humans ; Image Processing, Computer-Assisted ; methods ; Therapy, Computer-Assisted

Objectives:To investigate the effect of early EN on mucosal structure and absorption function of allograft after living-related small bowel transplantation.　Methods:Early enteral nutrition was used.The image analysis,D-xylose absorbtion test and blood culture were used to measure the villus height and area,D-xylose absorption and bacterial translocation in blood.　Results:The morphometric examination showed that villus height and villus area were decreased on the 7th postoperative day,began to increase on the 12th day after transplantation and had been the 80% of normal level.The percentage of D-xylose absorption was gradually increased and reached the normal level on the postoperative 38th day.Postoperative blood cultures were always negative.　Conclusions:Early EN support can improve the mucosal structure and absorption function of small bowel allograft after living-related small bowel transplantation.

0.05).Compared with control group,the GK activity of liver cell,the expression of PEPCK and the expression of GLUT4 in model group decreased signifi cantly(P

Objective To investigate hepatitis B virus (HBV) gene mutations related to entecavir (ETV)-resistance in patients with chronic HBV infections.Methods Serum samples were collected from 44 patients with chronic HBV infections and resistant to ETV treatment who were admitted in Ningbo No.2 Hospital during February 2010 and May 2014.The HBV polymerase regions were amplified by real-time fluorescent quantitative polymerase chain reaction (PCR) method,and the PCR products were analyzed with direct sequencing.SPSS 16.0 was used to assess the frequency of HBV polymerase gene mutations,and its relation to the viral genotype and clinical features.Results The most common HBV polymerase gene mutation was rtS202G/I (52.28％,23/44),followed by rtT184A/G/I/S (36.36％,16/44) and rtM250V/L (11.36％,5/44).Nine mutation patterns were detected,in which rtL180 + rtM204V + rtS202G/I (38.64％,17/44) and rtL180 +rtM204V + rtT184A/G/I/S (27.27％,12/44) were the most frequent ones.The difference in gene mutations between genotype B and C was of statistical significance (x2=12.294,P ＜0.01).Patients carrying rtT184A/G/I/S mutations were associated with worse liver function (x2 =14.499,P ＜ 0.01),and those carrying rtM250V/L mutations were associated with lower HBeAg positive rate (x2 =10.057,P ＜ 0.01).Conclusions rtL180M + rtM204V + rtS202G/I is the most common HBV polymerase gene mutation related to ETV resistance in patients with chronic HBV infections.Different gene mutations may be associated with HBV genotypes,severity of liver damages,and HBeAg positive rate.

Based on the rankings of the best undergraduate/graduate biomedical engineering programs from the USA News & World Report, we have made a comprehensive analysis on the excellent education mode in USA 2002. It is hoped that the results as reference materials will be useful to our biomedical education at home.
Biomedical Engineering ; education ; Education, Graduate ; Humans ; Teaching ; United States

Objective:To investigate the clinical efficacy of pancreaticoduodenectomy (PD) for periampullary diseases.Methods:The retrospective cohort study was conducted. The clinico-pathological data of 2 019 patients with periampullary diseases who underwent PD in the First Affiliated Hospital of Nanjing Medical University from January 2016 to December 2020 were collected. There were 1 193 males and 826 females, aged 63(15) years. Observation indicators: (1) surgical situations; (2) postoperative conditions; (3) postoperative pathological examinations; (4) prognosis of patients with periampullary carcinoma. Regular follow-up was conducted by telephone interview and outpatient examination once every 3 months within the postoperative first year and once every 6 months thereafter to detect the survival of patients with periampullary carcinoma. The follow-up was up to December 2021. Measurement data with skewed distribution were represented as M(IQR) or M(range), and comparison between groups was analyzed using the rank sum test. Count data were described as absolute numbers and (or) percentages, and comparison between groups was analyzed by the chi-square test or Fisher exact probability. Kaplan-Meier method was used to draw survival curves and calculate survival rates, and Log-Rank test was used to conduct survival analysis. Results:(1) Surgical situations: of 2 019 patients, 1 116 cases were admitted from 2016-2018 and 903 cases were admitted from 2019-2020. There were 1 866 cases undergoing open PD and 153 cases undergoing laparoscopic or robot-assisted PD. There were 1 049 cases under-going standard PD and 970 cases undergoing pylorus-preserved PD. There were 215 cases combined with portal mesenteric vein resection, 3 cases combined with arterial resection. The operation time of 2 019 patients was 255(104)minutes and the volume of intraoperative blood loss was 250(200)mL. The intraoperative blood transfusion rate was 31.401%(623/1 984), with the blood transfusion data of 35 cases missing. The proportions of pylorus-preservation, combination with portal mesenteric vein resection, intraoperative blood transfusion were 585 cases(52.419%), 97cases(8.692%), 384 cases(34.941%) for patients admitted in 2016-2018, versus 385 cases(42.636%), 118 cases(13.068%), 239 cases(27.006%) for patients admitted in 2019-2020, showing significant differences between them ( χ2=19.14,10.05,14.33, P<0.05). (2) Postoperative conditions: the duration of postoperative hospital stay of 2 019 patients was 13 (10) days. One of 2 019 patients lacked the data of postopera-tive complications. The overall postoperative complication rate was 45.292%(914/2 018), of which the incidence rate of grade B or C pancreatic fistula was 23.439%(473/2 018), the rate of grade B or C hemorrhage was 8.127%(164/2 018), the rate of grade B or C delayed gastric emptying was 15.312%(309/2 018), the rate of biliary fistula was 2.428%(49/2 018) and the rate of abdominal infection was 12.884%(260/2 018). The reoperation rate of 2 019 patients was 1.932%(39/2 019), the in-hospital mortality was 0.644%(13/2 019), the postoperative 30-day mortality was 1.238%(25/2 019), and the postoperative 90-day mortality was 2.675%(54/2 019). There were 541 cases(48.477%) with overall postoperative complications, 109 cases(9.767%) with grade B or C hemorr-hage, 208 cases(18.638%) with grade B or C delayed gastric emptying , 172 cases(15.412%) with abdominal infection, 39 cases(3.495%) with postoperative 90-day mortality of 1 116 patients admitted in 2016-2018. The above indicators were 373 cases(41.353%), 55 cases(6.098%), 101 cases(11.197%), 88 cases(9.756%), 15 cases(1.661%) of 902 patients admitted in 2019-2020, respectively. There were significant differences in the above indicators between them( χ2=10.22, 9.00, 21.30, 14.22, 6.45 , P<0.05). The in-hospital mortality occurred to 11 patients(0.986%) of 1 116 patients admitted in 2016-2018 and to 2 cases(0.221%) of 903 patients admitted in 2019-2020, showing a significant difference between them ( P<0.05). (3) Postoperative pathological examinations. Disease area of 2 019 patients reported in postoperative pathological examinations: there were 1 346 cases(66.667%) with lesions in pancreas, including 1 023 cases of carcinoma (76.003%) and 323 cases(23.997%) of benign diseases or low potential malignancy. There were 250 cases(12.382%) with lesions in duodenal papilla, including 225 cases of carcinoma (90.000%) and 25 cases(10.000%) of benign diseases or low potential malignancy. There were 174 cases(8.618%) with lesions in bile duct, including 156 cases of carcinoma (89.655%) and 18 cases(10.345%) of benign diseases or low potential malignancy. There were 140 cases(6.934%) with lesions in ampulla, including 134 cases of carcinoma (95.714%) and 6 cases(4.286%) of benign diseases or low potential malignancy. There were 91 cases(4.507%) with lesions in duodenum, including 52 cases of carcinoma (57.143%) and 39 cases(42.857%) of benign diseases or low potential malignancy. There were 18 cases(0.892%) with carcinoma in other sites. Postoperative pathological examination showed carcinoma in 1 608 cases(79.643%), benign diseases or low potential malignancy in 411 cases(20.357%). The histological types of 1 608 patients with carcinoma included adenocarcinoma in 1 447 cases (89.988%), intra-ductal papillary mucinous carcinoma in 37 cases(2.301%), adenosquamous carcinoma in 35 cases(2.177%), adenocarcinoma with other cancerous components in 29 cases(1.803%), neuroendocrine carcinoma in 18 cases(1.119%), squamous carcinoma in 1 case (0.062%), and other histological malignancies in 41 cases(2.550%). The histological types of 411 patients with benign or low poten-tial malignancy included intraductal papillary mucinous neoplasm in 107 cases (26.034%), chronic or autoimmune inflammatory disease in 62 cases(15.085%), neuroendocrine tumor in 58 cases(14.112%), pancreatic serous cystadenoma in 52 cases(12.652%), pancreatic solid pseudopapillary tumor in 36 cases(8.759%), gastrointestinal stromal tumor in 29 cases(7.056%), villous ductal adenoma in 20 cases(4.866%), pancreatic mucinous cystadenoma in 2 cases(0.487%), pancreatic or duodenal trauma in 2 cases(0.487%) and other histological types in 43 cases(10.462%). (4) Prognosis of patients with periampullary carcinoma. Results of survival analysis of 1 590 patients with main locations of periampullary carcinoma showed that of 1 023 patients with pancreatic cancer, 969 cases were followed up for 3.0-69.6 months, with a median follow-up time of 30.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates of pancreatic cancer patients were 19.5 months [95% confidence interval ( CI) as 18.0-21.2 months], 74.28%, 29.22% and 17.92%. Of 225 patients with duodenal papillary cancer, 185 cases were followed up for 3.0-68.9 months, with a median follow-up time of 36.7 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were unreached, 94.92%, 78.87% and 66.94%. Of 156 patients with distal bile duct cancer, 110 cases were followed up for 3.0-69.5 months, with a median follow-up time of 25.9 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 50.6 months (95% CI as 31.4 to not reached), 90.37%, 56.11% and 48.84%. Of 134 patients with ampullary cancer, 100 cases were followed up for 3.0-67.8 months, with a median follow-up time of 28.1 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 62.4 months (95% CI as 37.8 months to not reached), 90.57%, 64.98% and 62.22%. Of 52 patients with duodenal cancer, 38 cases were followed up for 3.0-69.5 months, with a median follow-up time of 26.2 months. The median overall survival time, 1-year, 3-year and 5-year survival rates were 52.0 months (95% CI as 30.6 months to not reached), 93.75%, 62.24% and 40.01%.There was a significant difference in overall survival after PD between patients with different locations of periampullary malignancies ( χ2=163.76, P<0.05). Conclusions:PD is safe and feasible in a high-volume pancreas center, but the incidence of overall postoperative complications remains high. With the increase of PD volume, the incidence of overall postoperative complications has significantly decreased. There is a significant difference in overall survival time after PD among patients with different locations of periampullary malignancies. The 5-year survival rate after PD for duodenal papillary cancer, ampullary cancer, duodenal cancer and distal bile duct cancer is relatively high, whereas for pancreatic cancer is low.