Laparoscopic surgery in hepatobiliary,splenic and pancreatic diseases is being widely used.However,the incidence of postoperative complications is relatively higher due to the complexity of the operative procedures.Surgeons are expected to have familiarity with normal and variant anatomy,as well as a good command of prevention and management of bleeding.Different separation techniques should be used based on the different characteristics of tissues.Moreover,digestive tract reconstruction is the technical bottleneck in laparoscopic hepatobiliary,splenic and pancreatic surgeries,and depending on the team work.Different anastomotic methods should be applied according to patients' condition.Three-dimensional laparoscopy and Da Vinci robot surgical system have greatly promoted the development of complex laparoscopic surgery in hepatobiliary,splenic and pancreatic surgeries.Comprehensive perioperative management and enhanced recovery after surgery are the guarantee of safe and quick postoperative recovery,which also fully embody the advantages of minimally invasive surgery.

An inductively coupled plasma mass spectrometry ( ICP-MS) was developed for the direct determination of Be, Na, Mg, Al, K, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, Ga, Zr, Mo, Sr, Cd, Ba, Pd, Ag, Sn, Au and Pb in lithium hexafluorophosphate. The sample was dissolved with absolute ethyl alcohol to analyze the above 26 impurity elements in the solution by ICP-MS. The condensation and deposition of high concentrations of carbon in mass cone interface and ion lens, which will decrease the sensitivity of element analysis, can be avoided effectively by introducing O2 to plasma. The mass spectral interferences of polyatomic ions to analytes were corrected by collision reaction cell (CRC). The matrix matching method was used to corrected matrix effect. Satisfactory linearity of each working curve of 26 impurity elements was obtained. The correlation coefficients being over 0. 9995, the detection limits for the investigated elements were in the range of 0. 6-32 ng / L, the relative standard deviation of each element within 2. 5% -7. 3% , and the recovery of each element at 90. 6% -108. 6% . The method had been applied to the determination of trace elements in lithium hexafluorophosphate with satisfactory results.

Objective To investigate the relationship between the number of eosinophil(Eos)and level of eosinophil cationic protein(ECP)in induced sputum and asthma severity and their value of differential diagnosis.Methods From July 2002 to June 2004,59 asthmatic patients were selected in the People Hospital of Wuhan University.The number of eosinophil and level of ECP were measured by Wrights' stain and Immuno-CAP System.The lung function was also evaluated.The same index was measured in 20 patients with COPD and 10 healthy subjects as control.Results The number of eosinophil in induced sputum in asthmatic patients negatively correlated with FEV_1%(r=-0.65,P

Pancreatic cancer is a highly malignancy of the digestive system, with low early diagnosis rate and poor prognosis. Cancer cachexia, muscle and adipose tissue wasting are important factors affecting surgical complications and long-term prognosis of patients with pancreatic cancer. On one hand, the occurrence and development of pancreatic cancer cachexia are associated with the decrease of food intake. On the other hand, the characteristic of tumor hypermetabolism, many inflammatory factors, fat and protein regulatory factors and many neuroendocrine pathways are also involved in pancreatic cancer cachexia. At present, the understanding of cancer cachexia and tissue wasting is not comprehensive, and the diagnostic methods are not unified. The main screening method is based on body mass index, but it is not applicable to obese patients. The detection of serum cytokines and determination of intramuscular fat content based on the abdominal computed tomography scan also play pivotal roles in the diagnosis of pancreatic cancer cachexia. Perioperative inhibition of tissue wasting can not only reduce surgical complications, but also improve the prognosis of pancreatic cancer patients. However, there is no effective method to completely reverse cancer cachexia. Multidisciplinary treatment is the routine therapy. Surgical treatment to remove the tumor is the fundamental measure to impede the development of cachexia. In addition, strengthening nutritional support, reducing inflammation and stress reaction, reducing the muscle wasting are also important in the treatment of cachexia during the perioperative period. Combined with self experience, the authors comprehensively analyze research advances, summarize the etiology, molecular mechanism, diagnosis and treatment of tissue wasting, in order to investigate tissue wasting and perioperative treatment strategies of pancreatic cancer patients.

Plasma level of N-terminal pro brain natriuretic peptide (NT-proBNP) was measured for 362 elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), including 97 of AECOPD complicated with left-heart failure and 265 of isolated AECOPD.Results indicated that there was significant difference in plasma level of NT-proBNP between the two groups ( P = 0.000).With a cut-off value of 1643.5 ng/L NT-proBNP, its sensitivity, specificity and accuracy for identifying AECOPD complicated with left-heart failure in the elderly were 84.4%, 85.3% and 85.1%, respectively.It is suggested that assay for plasma NT-proBNP may be helpful to identify left-heart failure in elderly patients with AECOPD.

Objective To investigate clinical significance of small airway function and eosinophil (Eos) percentage,levels of eosinophil cationic protein (ECP) and IL-5 in induced sputum among patients with clinically controlled asthma. Methods Sixty-two patients with clinically controlled asthma were selected for the study. Lung function was performed and percentage of Eos, levels of ECP and IL-5 in induced sputum were measured by Wrights' stain, fluorescence immuno-CAP system and ELISA,respectively. Thirty patients of asthma at acute exacerbation period and 20 healthy subjects were selected as controls. Results In 62 patients with clinically controlled asthma, 43 (69. 4% ) showed abnormal small airway function and 19(30. 6% ) normal one. Percentage of Eos [(5. 6 ±2. 9)%], levels of ECP [( 129 ±100) μg/L] and IL-5 [(21± 12) μg/L] in induced sputum were significantly lower in patients with clinically controlled asthma than those of asthma at acute exacerbation period [( 16. 2 ± 9. 7 ) %, ( 362 ±182) μg/L and IL-5(51 ±26) μg/L, respectively] (all P ＜0. 01 ), but significantly higher than those in healthy controls ( all P ＜ 0. 01 ). Percentage of Eos, levels of ECP and IL-5 in induced sputum were significantly higher in patients with clinically controlled asthma with abnormal small airway function than those with normal ane [(6.9±3.1)% vs. (2.0±1.1)%, (148±90) μg/Lvs. (54±29) μg/L and (24 ±12) μg/L vs. ( 13 ± 5 ) μg/L, respectively] ( all P ＜ 0. 01 ). Conclusions Abnormal small airway function and airway inflammation persistently exist in patients with clinically controlled asthma and it may be helpful to guild treatment during clinical control to determine small airway function and inflammatory markers in their induced sputum.

To explore the clinical significance of changes in maximal expiratory flow in 50％ and 25％ vital capacity (Vmax50％ & Vmax25％) before and after bronchodilator reversibility testing in patients with asthma.Forced expiratory volume in one second (FEV1),Vmax50％ and Vmax25％ were measured before and after bronchodilator reversibility testing in 118 patients with asthma and 82 with chronic obstructive pulmonary disease (COPD).The rate of positive reversibility in Vmax50％ was significantly higher than that in FEV1 in 118 asthmatics (x2 =7.995,P =0.007).The rates of positive reversibility in Vmax50％ and Vmax25％ were significantly higher in asthmatics than those in COPD patients (x2 =9.335,P =0.009).

A direct current glow discharge mass spectrometry ( GD-MS) for the determination of Li, Be, Na, Mg, Si, P, K, Ca, Ti, V, Cr, Mn, Co, Ga, Sr, Mo, Ag, Cd, Sn, Sb, W and Pb in nickel-zinc ferrites was developed. Copper powder as the conductive medium was evenly mixed with nickel-zinc ferrites powder for tableting, and then the impurity elements in nickel-zinc ferrites were determined by GD-MS. The influence of sample preparation and the glow discharge conditions including discharge current, discharge voltage, discharge gas flow rate and pre-sputter time on discharge stability and analysis sensitivity were investigated. The mass spectrometry interferences of analytes were investigated, as well as appropriate isotopes were selected. Most of the mass spectrometry interferences were avoided by measuring in medium resolution mode and high resolution mode. Total signal of Fe, Ni, Zn, O and Cu normalization was adopted, and the impurity elements in nickel-zinc ferrites were calculate in subtraction. The results showed that the detection limits for the investigated elements were in the range of 0. 001-0. 29 μg/g, the relative standard deviations of each element were within 3 . 5%-18 . 6%. The analysis results were consistent with those obtained by inductively coupled plasma mass spectrometry.

OBJECTIVETo examine the renal function changes and mechanisms on rats with diabetes through a sleeve gastrectomy operation.

METHODSThirty-six rats were induced diabetes through injection of streptozotocin (STZ), and 30 of these diabetic rats that blood glucose levels at the midrange (blood sugar 17.88-23.65 mmol/L, mean: 20.32 mmol/L) were randomly assigned to the sleeve gastrectomy group, Sham-operation group and control group. The serum creatinine, lipid parameters were measured postoperatively. The 24 h urine volume obtained and urine albumin excretion rate (UAER) was calculated. Serum and urinary creatinine were examined and glomerular filtration rate (GFR) was counted. Kidney sections were stained with periodic acid-Schiff, and then the index of mesangial expansion was determined. The expression of synaptopodin for podocytes was also performed through the immunohistochemical procedure. A one-way ANOVA and t-test were performed to evaluate differences between groups and each other.

RESULTSOnly one rat of SG group died after operation. The GFR ((8.44 ± 2.10) ml · g⁻¹ · d⁻¹), 24 h UAER ((36.04 ± 11.10) mg/d), plasma lipids level (total cholesterol (1.66 ± 0.23) mmol/L, triglycerides (1.25 ± 0.17) mmol/L), kidney weight ((1.61 ± 0.06) g), the index of mesangial expansion ((6.14 ± 1.50)%) and synaptopodin expression ((20.44 ± 2.99)%) were improved in the SG group compared with the sham-operation group ((15.05 ± 3.01) ml · g⁻¹ · d⁻¹, (57.01 ± 11.34) mg/d, (2.15 ± 0.29) mmol/L, (1.65 ± 0.23) mmol/L, (1.93 ± 0.07) g, (11.32 ± 2.09)%, (10.34 ± 1.43)%) and control group ((14.79 ± 2.38) ml · g⁻¹ · d⁻¹, (62.71 ± 16.46) mg/d, (2.23 ± 0.21) mmol/L, (1.59 ± 0.20) mmol/L, (1.91 ± 0.06) g, (10.82 ± 1.79)%, (11.13 ± 2.43)%) (t = 0.781-5.025, all P < 0.05).

CONCLUSIONThe sleeve gastrectomy procedure can improve the renal function in a diabetes rat model may be through protecting the podocytes function and preventing the mesangial expansion of glomeruli.

Animals ; Blood Glucose ; Creatinine ; blood ; urine ; Diabetes Mellitus, Experimental ; physiopathology ; Diabetic Nephropathies ; physiopathology ; surgery ; Gastrectomy ; Glomerular Filtration Rate ; Kidney ; physiopathology ; Kidney Function Tests ; Random Allocation ; Rats

Objective To investigate the clinical features and treatment of solid pseudopapillary neoplasm (SPN) of the pancreas.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 69 patients with SPN of the pancreas who were admitted to the Qilu Hospital of Shandong University from January 2012 to July 2017 were collected.Serum tumor markers detection,enhanced computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen were carried out preoperatively for all the patients,and a part of the patients received endoscopic ultrasonography (EUS).Surgery plans were formulated after completion of examinations.Observation indicators:(1) clinical features;(2) treatment situation;(3) results of pathological examination;(4)follow-up.All the patients were followed up via outpatient examination and telephone interview to detect the survival and tumor recurrence and metastasis till July 2017.Measurement data with normal distribution were presented by (x)±s and were compared by Student's t test.Count data were compared by chi-square test.Results (1) Clinical features:① epidemiologic features:the ratio of male to female was 1∶5.9;patients were aged between 9 and 65 years,including 40 under 30 years and 29 above or equal to 30 years.The onset age was (34± 15)years for male patients and (28 ± 11)years for female patients,respectively,with no statistically significant difference (t=1.364,P＞0.05).Of 69 patients,SPN was located at pancreatic uncinate process in 25 patients,at neck of pancreas in 12 patients,body and tail of pancreas in 32 patients.② Medical history:history of acute or chronic pancreatitis and abdominal trauma were denied by all the 69 patients.③ Clinical manifestation:26 patients had no obvious symptoms and were detected by physical examination;31 patients had discomfort in upper abdomen,nausea and vomiting;other patients were admitted to the hospital because of upper abdominal mass (10 patients),jaundice (1 patient) or nausea,constipation (1 patient).④ Laboratory examination:the levels of preoperative carcinoembryonic antigen (CEA) and CA19-9 were normal.⑤ Imaging examination:plane scan of the CT examination showed round or round-like low-density shadows in the 69 patients,including 51 of cystic solid lesion,13 of solid lesion and 5 of cystic lesion.Complete capsules were observed in 64 patients,blurred boundary between pancreas and adjacent viscera in 5 patients,calcified foci in the pancreatic parenchyma and capsules in 14 patients.Ten patients received MRI examination,and the T1-weighted images showed equal or slightly lower signal,T2-weighted images showed slightly higher signal in the plane scan,and T1-weighted and T2-weighted images of the tumor capsule showed continuous or non-continuous ring-like signal.The results of enhanced scan showed slightly heterogeneous enhancement of the capsule and the parenchyma of the pancreas in the arterial phase,and progressive enhancement in the venous and delayed phase,while the enhancement degree was lower than that of the normal pancreas parenchyma.The parenchyma was cloud-,papillaor mural nodule-like enhanced.Obvious enhancement was observed in capsule while not in the cystic components.The boundaries of the tumors in 5 patients were clear under EUS.Hypo-,iso-and hyperechoic regions were found in the masses,and the masses were confirmed as cyst-solidary type.Obvious calcified foci were found in 1 patient.(2) Treatment outcome:twenty-seven patients received laparoscopic surgery,including tumor expiration in 13 patients,distal pancreatectomy with preservation of spleen in 8 patients,distal pancreatectomy combined with splenectomy in 2 patients,middle pancreatectomy in 2 patients,pancreaticoduodenectomy with preservation of pylorus in 1 patient,pancreatic head resection with preservation of duodenum under the assistance of laparoscopy in 1 patient.Forty-two patients received open surgery,including tumor expiration in 12 patients,distal pancreateetomy with preservation of spleen in 10 patients,distal pancreatectomy combined with spleneetomy in 6 patients,middle pancreatectomy in 5 patients,pancreaticoduodenectomy in 7 patients (with preservation of pylorus in 2 patients) and pancreatic head resection combined with preservation of duodenum in 1 patient.One patient with SPN + hepatic metastasis received distal pancreatectomy+ metastatic foci resection in the lesser omental bursa,and then followed by radiofrequency ablation in the hepatic metastatic foci.Postoperative complications:21 of 69patients had postoperative complications,including 17 intestinal fistulas,2 abdominal bleedings,1 incomplete obstruction,1 pleural effusion + atelectasis,and all of them were cured by symptomatic treatment.(3)Pathological examination:the resection margins of 69 patients were negative.The mean diameter of the tumor was (7±4) cm (21 patients with tumor diameter ＜ 5 cm,and 48 with tumor diameter ≥5 cm).The tumor diameters of 4 in 10 male patients were above or equal to 5 cm,and the number was 44 in 59 female patients,with statistically significant difference (x2 =4.828,P＜0.05).The tumor diameters of 32 in 40 patients who aged under 30 years were above or equal to 5 cm,and the number was 16 in 29 patients who were aged above or equal to 30 years,with statistically significant difference (x2=4.895,P＜0.05).Solid,pseudo-papillary and cystic regions in the SPN tissues were seen under the light microscope.Tumor cells were surrounded the blood vessels and were arranged in the nest or sheet shape in the solid region;blood vessels were surrounded by one or multiple layers of tumor cells in the axis or pseudopapillary shape in the pseudopapillary region;large amount of mucus and clusters of blood cells were seen in the cystic regions.The result of immunohistochemistry showed that the positive rates of α1-antitrypsin,vimentin,β-catenin,progesterone receptor,CD10,synaptophysin and chromogranin A were 100.0％ (39/39),96.6％ (28/29),95.7％ (45/47),94.4％ (51/54),92.5％ (49/53),72.9％ (35/48) and 5.6％ (3/54),respectively.(4) Follow-up:63 of 69 patients were followed up for 1-68 months,with median time of 29 months.No SPN recurrence or metastasis was detected.One patient died of lung cancer at postoperative month 35 and other patients survived well.Conclusions SPN of pancreas is mostly detected in young female patients,and it could be solid or cystic.Abdominal enhanced CT or MRI examination could clarify the diagnosis.EUS-fine needle aspiration examination could provide pathological evidence for definitive diagnosis.Typical cellular morphology and pseudopapillary regions may provide hints for the diagnosis of SPN,and the diagnosis could be clarified when combined with the detection of vimentin,α 1-antitrypsin or other indexes.Complete resection of SPN and ensure negative resection margin are fundamental principles of treatment.