Objective To investigate enteral or parenteral nutrition therapy effects in the aspects of patients' postoperative nutrition status,incidence of complications and health economics indicators of pancreatic head carcinoma or periampullary carcinoma patients after pancreaticoduodenectomy.Methods The clinical data of patients underwent PD in the First Affiliated Hospital of Harbin Medical University from January 2010 to August 2015 were collected.According to different postoperative nutrition therapy,patients were divided into parenteral followed enteral nutrition group (treatment group) and parenteral nutrition group (control group).Observed indicators such as postoperative nutrition status,liver and kidney function,incidence of complications,length and total cost of hospitalization were assessed.Results This study enrolled 207 cases in treatment group and 92 cases in control group.There was no significant difference in preoperative NRS scores,surgical procedures,pathology and other preoperative clinical indicators (P ＞ 0.05).Postoperative bilirubin reduction(△TB1.10) in treatment group versus control group had significant difference (P ＜ 0.05).Compared with postoperative Day 1,the prealbumin level of Day 7 and Day 10 in treatment group recovered rapidly than control group(△PA7.1,△PA10-1),however the differernce was not significant (P ＞ 0.05).Postoperative complications (pancreatic fistula,post-pancreatectomy hemorrhage,inna-abdominal infection,delayed gastric emptying) in treatment group and control group had no significant difference (P ＞ 0.05).The average and median hospitalization in treatment group [(28 ± 11) d,26 d] versus control group [(32 ± 18) d,29 d] had significant difference (P ＜ 0.05).The total cost of hospitalization in treatment group and control group were not significantly different(P ＞ 0.05).Conclusions This study indicated that postoperative parenteral followed enteral nutrition therapy could significantly enhance the recovery of liver function,shorten the length of hospitalization in patients after PD.Moreover,parenteral followed enteral nutrition therapy did not significantly increase the postoperative complications.

Objective To investigate the clinical application of pancreatic head resection with the second portion duodenectomy (PHRSPD). MethodsThe clinical data of 4 PHRSPD cases were analyzed retrospectively. ResultsThere were 3 benign and 1 low-grade malignant periampullary tumors. The mean surgical time was 417 min, mean blood transfusion was 533 ml, mean hospital stay was 28.6 days. Delayed gastric emptying was encounted in one case. There was no hospital morality or major surgical complications. All cases were alive in the follow-up ranging from 6 to 36 months. There was no newly developed diabetes mellitus or severe gastroenteral symptoms. No reccurrence was found in the case with low-grade malignant duodenal tumor after 26 months. ConclusionsPHRSPD is an efficient way to treat benign and low-grade periampullary neoplasm and accompanying massive bleeding episodes.

The effect of CYP3A4*18B and CYP3A5*3 on concentration/dosage x body surface area ratios (C/D'), adverse effects and acute rejection of tacrolimus in renal transplant patients were investigated. The CYP3A4*18B genotypes of 227 renal transplant patients were determined by PCR-RFLP method. The differences of C/D' ratios, adverse reactions and acute rejection were compared among all of the genotype groups treated with tacrolimus. The frequencies of CYP3A4*18 and CYP3A5*3 alleles in renal transplant patients were 30.8% and 74.2%, respectively. No significant association was found between the C/D's of tacrolimus and CYP3A4*18B genotypes when they were classified by two CYP3A5 genotypes (P > 0.05). While after the effects of CYP3A4*18B genotype were eliminated, the C/D' ratio of tacrolimus in patients with CYP3A5*1/*1 and *1/*3 genotype group was significantly lower than those with CYP3A5*3/*3 genotype groups (P < 0.01). There is no significant difference in adverse effects and acute rejection among different genotypes (P > 0.05).

Objective To evaluate multiple minimally invasive techniques in the treatment of severe acute pancreatitis (SAP).Methods The clinical data of 93 patients with SAP who received minimally invasive treatment at the First Affiliated Hospital of Harbin Medical University from January 2005 to July 2010 were retrospectively analyzed.Percutaneous catheter drainage (PCD),endoscopic retrograde cholangio-pancreatography (ERCP),endoscopic sphincterotomy (EST),endoscopic nasobiliary drainage (ENBD) and laparoscopy were applied according to the condition of the patients.The efficacies of different treatment methods were evaluated.Results On the basis of comprehensive treatment,32 patients received 1 kind of minimally invasive treatment,41 patients received 2 kinds of minimally invasive treatment,14 patients received 3 kinds of minimally invasive treatment and 6 patients received 4 kinds of minimally invasive treatment.Sixty-nine patients received ultrasoundguided PCD; 28 patients received ERCP,EST and (or) ENBD; 29 patients received laparoscopy; 19 patients received treatments with stepped approach; 4 patients were complicated with abdominal bleeding,and received interventional treatment.The mean time of abdominal pain relief and duration of hospital stay were (37 ± 18)hours and (31 ±21 )days,respectively.The abdominal infection rate,laparotomy transfer rate,curative rate and mortality rate were62％(58/93),4％(4/93),91％ (85/93) and 9％ (8/93),respectively.Conclusion Multiple minimally invasive techniques combined with individualized treatment may significantly improve the curative rate of SAP.

Objective To evaluate the effect of molecular adsorbent recirculating system(MARS)in treatment of severe pneumonia complicated with multiple organ dysfunction syndrome(MODS).MethodsSeventy-five patients who were diagnosed as severe pneumonia complicated with MODS were randomly divided into MARS group,continuous renal replacement therapy(CRRT)group and routine comprehensive therapy group.Flow dynamics,respiration function,liver function and renal function,coagulation function,inflammatory mediators,and Marshall scores were measured and compared before and after the treatment. The survival curves in 60 days were also compared among three groups.Results With MARS therapy,mean heart rates,peak inspiratory airway pressure,serum TBil,plasma D-dimmer levels and Marshall score were decreased;mean artery pressure,PaO2,oxygenation index,urine output,and platelet counts were increased;the levels of proinflammatory(NO,IL-6,IL-8,TNF-α and LBP)and anti-inflammatory(IL-10 and IL-13)mediator were decreased remarkably.The differences of these indicators between MARS group and other two groups were statistically significant(P＜0.05).And after MARS therapy,respiratory rate and Cr level were decreased,while SaO2 and WBC were increased significantly(P＜0.05).The 60 day-survival rate in MARS group was 80%(20/25),36%(9/25)in routine comprehensive therapy,and 52%(13/ 25)in CRRT group(P＜0.05).Conclusion MARS therapy has better effect on severe pneumonia conplicated with MODS than routine comprehensive therapy and CRRT.

Objective To analyze the clinical factors predicting long-term survival after curative resection of pancreatic head carcinoma. Methods The clinical data of 58 patients with ductal adenocarcinoma of pancreatic head who underwent curative resection of carcinoma of pancreatic head from 1996 to 2004 were collected and were analyzed by SPSS 10.0 with Cox Proportional Hazards Model. Results 58 patients, including 30 male and 28 female patients, were involved in this study. Pancreaticoduodenectomy were performed in 14 cases and extended resections were performed in 44 cases. The overall 1, 3, 5 year survival rates was 46.6%, 29.3% and 8.6%, respeclively. The 1,3, 5 year survival rates of pancreatoduodenectomy with extended regional lymphadenectomy was 43.1%, 22.7% and 6.8%, respectively. UICC staging, peri-pancreatic nerve invasion and blood infusion had significant effects on the prognosis after curative resection. Conclusions The long-term prognosis after curative resection of pancreatoduodenectomy was still dismal. Much importance should be paid to early diagnosis and comprehensive management for pancreatic head cancer.

OBJECTIVE To explore the outcomes of CO2 laser assisted stapedotomy with artificial stapes prostheses in the treatment of advanced otosclerosis. METHODS Between January 2010 and January 2014, 15 patients (16 ears) diagnosed as advanced otosclerosis accepted CO2 laser assisted stapedotomy with artificial stapes implantation in our department. The averaged preoperative air conduction threshold of the speech frequency was 70.21 dB HL, the averaged bone conduction threshold was 38.49 dB HL, the averaged air-bone gap (ABG) was 31.72 dB HL. All cases were followed up for more than 6 months after operation. RESULTS All cases accepted auditory follow up after 6 months postoperatively. The speech frequency average air conduction threshold was 43.7 dB HL, the average bone conduction threshold was 28.95 dB HL, the average ABG was 14.75 dB HL. The ABG≤20 dB was achieved in 9 ears (56.3%) and ABG closure (≤10 dB) was achieved in 6 ears (37.5%). No cases appeared intractable vertigo, sensorineural hearing loss, secondary facial paralysis and other serious complications. CONCLUSION CO2 laser assisted technique reduced the probability of serious complications of stapedotomy, most patients with hearing level improved significantly. It's a safe, practical, relatively economical choice for advanced otosclerosis.

Objective To investigate the effects and value of enhance recovery after surgery (ERAS) application in patients with hepatocellular carcinoma underwent liver resection.Methods One hundred and seventy-two patients with hepatocellular carcinoma underwent liver resection in the first affiliated hospital of Harbin medical university from June 2013 to June 2015,ERAS group (92 cases) and control group (80 cases) were retrospectively studied.Laboratory indicators (ALT,AST,TBIL,ALB,PA,lymphocyte count),postoperative complications,postoperative hospitalization days and total hospitalization expenses were compared between two groups.Results For postoperative liver functional indicators (ALT,AST,TBIL),ERAS group Day 1 and Day 7 were respectively (216.3±141.7) U/Land (70.1 ±29.4) U/L,(184.0±155.8) U/Land (39.1 ±17.5) U/L,(22.4± 8.7) μmol/L and (20.0 ± 7.5) μmol/L,control group were respectively (304.5 ± 226.2) U/L and (83.9 ± 48.5) U/L,(294.1 273.0) U/L and (49.2 ±33.8) U/L,(26.9 ±15.6) μmol/L and (24.6 ± 10.8) μmol/L,the difference between two groups was statistically significant (F =9.33,9.84,9.26,P ＜ 0.05).For postoperative nutritional indicators (ALB,PA),ERAS group Day 7 were respectively (35.3 ± 4.4) g/Land (136.3 ±34.1) mg/L,control group were respectively (33.6 ±4.2) g/L and (108.0 ± 32.5) mg/L,the difference was statistically significant (F =4.97,4.54,P ＜ 0.05).For postoperative immune indicators (lymphocyte count),ERAS group Day 1 and Day 7 were respectively (0.9 ±0.3) × 109/L and (1.5 ± O.5) × 109/L,control group were respectively (0.7 ± 0.3) × 109/L and (1.3 ± 0.5) × 109/L,the difference was statistically significant (F =7.37,P ＜ 0.05).For postoperative complications (hemorrhage,bile fistula,hepatic dysfunction,infection) were no statistically significant differences (P ＞ 0.05),however,ascites had statistically significant difference (x2 =7.609,P ＜ 0.05).Off bed time,postoperative exhaust time,postoperative hospitalization time and total hospitalization expense of ERAS group were respectively (1.7 ± 0.5) days,(2.3 ± 0.6) days,(9.8 ± 2.3) days,(4.6 ± O.9) × 104 RMB,control group were respectively (3.0 ± 0.7) days,(3.4 ± 0.8) days,(17.6 ± 5.8) days,(6.3 ± 2.1) × 104 RMB,the difference was statistically significant (t =13.032,10.937,11.371,7.118,P ＜ 0.05).Conclusions Application of ERAS in patients with HCC underwent liver resection is safe and effective.ERAS effectively reduce stress reaction of patients,promote the recovery of liver function,improve the postoperative immune and nutrition status,shorter postoperative hospitalization time,and reduce the total cost of hospitalization.

Objective To study the delayed gastric emptying for patients underwent pylorus-preserving pancreaticoduodenectomy and standard Whipple procedure.Methods Clinical data of 401 consecutive patients who underwent standard Whipple procedure/pylorus-preserving pancreaticoduodenectomy between January 2012 and July 2016 in the First Affiliated Hospital of Harbin Medical University were retrospectively collected and analyzed.Using the independent-samples t test,x2 test or Fisher's exact test,Mann-Whitney test and other statistical methods to compare the postoperative complications between pylorus-preserving pancreaticoduodenectomy and standard Whipple procedure group.Results Compare with standard Whipple procedure group,delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy occurred in 8 of 35 patients (22.9％),obviously higher than it after standard Whipple procedure occurred in 40 of 366 patients (10.9％) (P =0.038).Other postoperative complications were not significantly different (P ≥ 0.05).Each level of delayed gastric emptying after pyloruspreserving pancreaticoduodenectomy and standard Whipple procedure were not significantly different (P ≥ 0.05),but the average recovery time of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy (12.13 ± 3.09) d was obviously shorter than it after standard Whipple procedure (17.28 ± 9.63) d (P =0.009).Conclusions Pylorus-preserving pancreaticoduodenectomy increases the risk of delayed gastric emptying,but it does not increase severity delayed gastric emnptying by each level.The recovery time of delayed gastric after pyloruspreserving pancreaticoduodenectomy is shorter.

AIM: To investigate the variation and distribution of abnormaly methylated p15 INK4B in myelodysplastic syndrome (MDS) and its subgroups. METHODS: The abnormal methylation of p15 INK4B in 32 cases with MDS was studied using methylation-specific PCR (MSP). RESULTS: The positive rate of abnormal methylation of p15 INK4B was about 50% in MDS. The ratios in subtypes were: 0% (0/6) in RA,20% (1/5) in RA-S,57.1% (4/7) in RAEB,74.1% (5/7) in CMML,85.7% (6/7) in RAEB-t, respectively.It was worth noticing that 4 cases represented abnormal methylation of p15INK4B during their transformation and progression into AML. CONCLUSION: The abnormal methylation in p15 INK4B might be one of the causes of MDS, which was related to pathologial process of MDS.Every subtype was not solitary classification completely. Abnormal methylation of p15 INK4B was apt to occur accompanying the progression and transformation of the subtypes.