Objective To compare the operation situation of pancreatico duodenectomy (PD) and pylorus‐preserving pancreatico duodenectomy (PPPD) ,and analyze the clinical efficacy of PPPD .Methods Data of 47 patients with periampullary carcinoma and pancreatic head carcinoma underwent pancreatico duodenectomy from January 2010 to December 2013 were retrospectively analyzed and divided into PPPD group (20 cases) and PD group (27 cases) according to different surgery method .Then compare the situa‐tion of intra‐operative and post‐operative situation in two groups of patients .Results The operation time of PPPD group was sig‐nificantly lower than that of PD group (P<0 .05);the incidence of postoperative complication rate of PPPD group was obviously lower than PD group (P< 0 .05);and postoperative infection rate of PPPD group was significantly lower than PD group (P<0 .05);there was no significant difference between two groups in pancreatic leakage ,bile leakage ,gastrointestinal leakage ,post oper‐ative bleeding ,mortality and the incidence of delayed gastric emptying after surgery (P>0 .05) .Conclusion PPPD operation could shorten the operation time ,promote post‐operative recovery ,lower complication rates and shorten hospitalization time ,and could al‐so help to improve the nutritional status of patients ,improve the postoperative quality of life of patients ,thus it should be further promoted .

Objective To observe the effect of somatostatin on liver function in patients after splenectomy combined with de-vascularization.Methods The clinical data of 48 patients with liver cirrhosis,portal hypertension and esophageal varices were retro-spectively analyzed,26 cases (somatostatin group)were used somatostatin after splenectomy combined with devascularization,and the other 22 cases (control group)were not used.The changes of serum albumin (Alb),alanine aminotransferase (ALT),aspartate transaminase (AST),prothrombin activity (PTA)and total bilirubin (TBIL)was observed.Results All patients recovered well af-ter surgery,and no deaths occurred.However,ALT,AST and TBIL of using somatostatin group were significantly reduced than those of control group(P <0.05),Alb and PTA were also improved significantly (P <0.05).Conclusion The combination of som-atostatin can not only reduce postoperative portal pressure,control of bleeding,but also to be significantly promote recovery of liver function.

Objective:To investigate the relationship between T/N take-up value and the clinic feature of breast cancer, and explore the predictive ability of T/N take-up value for breast cancer prognosis.Methods:Breast cancer patients treated at Zhongshan Hospital, Fudan University and undergoing BSGI examination before surgery from Jan 2014 to Nov 2018 were collected. The relationship between T/N take-up value and the clinical features of breast cancer and DFS was analyzed.Results:A total of 419 breast cancer patients were collected. The median follow-up time after operation was 34 months. At the end of the follow-up, 43 cases relapsed and 376 cases did not. The average T/N values of CC position and MLO position before surgery were 2.74 and 2.58. The T/N value of CC is related to tumor stage (χ 2=22.077, P<0.05), lymph node metastasis ( Z=2.138, P<0.05) and degree of invasion ( Z=3.371, P<0.05). The T/N value of MLO is related to tumor stage (χ 2=23.091, P<0.05), lymph node metastasis ( Z=2.531, P<0.05) and degree of invasion ( Z=2.99, P<0.05). The best cut-off values of CC position and MLO position calculated by ROC curve are 2.59 and 2.97. Univariate analysis showed that tumor staging ( HR: 2.039, 95% CI: 1.404-2.962, P=0.001), T/N value at CC position ( HR: 4.349, 95% CI: 2.141-8.883, P<0.001) and T/N value at MLO position ( HR: 2.767, 95% CI: 1.520-5.039, P<0.001) is an independent risk factor for the prognosis of breast cancer. Multivariate COX regression analysis showed that tumor stage ( HR: 1.959, 95% CI: 1.302-2.946, P=0.001) and T/N value at MLO position ( HR: 3.498, 95% CI: 1.531-7.992, P=0.003) are independent risk factor of breast cancer prognosis. Conclusion:The BSGI T/N value has a certain correlation with breast cancer DFS.

Objective To investigate the significance of test of receptor activator of nuclear factor?kappa B(NF?κB)ligand(RANKL)in serum and urine for the diagnosis of osteoporosis. Methods A total of 53 patients with osteoporosis(the experimental group)and 45 healthy controls(the normal control group)were recruited in this study. The expression levels of RANKL in serum and urine was measured and compared by enzyme?linked immunosorbent assay. Results The serum and urine levels of RANKL in the experimental group were significantly higher than those in the normal control group(P<0.01). The areas under receiver operating characteristic(ROC)curve of serum and urine RANKL were 0.898 and 0.734, respectively. The combined detection of serum and urine RANKL and Ca2+reached a high sensitivity of 89.5%and a specificity of 86.1%for diagno?sis of osteoporosis. Conclusion RANKL may be closely associated with the progression of osteoporosis. Serum and urine RANKL test may be help?ful in the diagnosis of osteoporosis.

Objective To explore the correlation of the throid function and malnutrition in maintenance hemodialysis(MHD) patients.Methods Fifty-four MHD patients and 16 normal controls were enrolled as our subjects and named as MHD group and control group.Serum concentrations of total triiodothyronine (TT3),total thyroxine (TT4),free thyroine (FT4),free triiodothyronine (FT3),and thyroid-stimulating hormone (TSH) were measured by enhanced chemiluminescence immunoassay.Their anthropometry,biochemical assays,malnutrition-inflammation score (MlS) and micro-inflammation parameters such as high sensitivity C-reactiveprotein(hs-CRP) were also measured.Results Serum T3,FT3,T4,FT4 concentration in MHD patients were (1.18 ±0.31) nmol/L,(2.61 ±0.62) pmol/L,(100.00 ± 19.96) nmol/L,(8.56 ±0.85) pmol/L respectively,lower than that of control group ((2.95 ± 0.27) nmol/L,(7.12 ± 0.94) pmol/L,(136.25 ± 19.68) nmol/L,(8.89 ± 0.56) pmol/L respectively,P ＜ 0.01).while there was no significant change on TSH (P =0.058).According to albumin nutrient grading standard:the morbidity of malnutrition was 75％ (39/54).The morbidity of malnutrition was 100％ based on the criteria of MIS.Of which,mild malnutrition rate was 29.63％ (16/54),moderate rate for 37.04％ (20/54) and sever rate for 33％ (18/54).The levels of serum creatinine,hemoglobin,serum iron,upper arm circumference,body mass index(BMI),deltoid skinfold,hs-CRP,T3,FT3,T4,FT4,TSH in MHD patients with mild,moderate and serve rate MIS were significant different(P ＜ 0.01).Of 54 MHD patients,32 cases were with micro inflammatory state,accounting for 59.26％ (32/54).There was a positive correlation between FT3 and albumin (P ＜0.01).T3 was related to serum creatinine(P ＜ 0.05).Thyroid function parameters showed a negative correlation with hs-CRP,MIS(P ＜ 0.01).And a negative correlation was seen between nutrition indices and hs-CRP and MIS (P ＜ 0.01).Conclusion Thyroid function can reflect the nutrition status of MHD patients to some degree,and both relate with miro-inflammation.Furthermore,MIS is a useful index for the estimation of malnutrition inflammation status.

Objective To evaluate the effects of blood-lipid report's reformat on outpatients' behavior and knowledge of dyslipidemia therapy.Methods The blood-lipid report was reformatted by adding three tables from the Chinese Guideline on the Prevention and Treatment of Adult Dyslipidemia on its back.The same questionnaire was used twice to evaluate the patients' behavior and knowledge of dyslipidemia therapy before and after reformat.Results Before and after reformat,the rates of correct deterination of their own risk stratification were 26.0％ ( 112/430 ) and 26.3％ ( 115/438 ) respectively.The awareness rates of Different LDL-C goals among different persons wcre 37.0％ (159/430) and 35.8％ (157/438).Only 0.7％ (2/306) and 1.0％ (3/299) of patients knew their blood lipid goals (P =0.557).When the report showed normal blood lipid levels,the percentages of taking lipid-lowering drug were 47.6％ ( 230/483 ) and 46.6％ ( 216/464 ),20.5％ ( 99/483 ) and 19.0％ ( 88/464 ) of patients questioned the prescription.Non-medication rates were 31.9％ ( 154/483 ) and 34.5％ ( 160/464 ) respectively before and after reformat ( P ＞ 0.05 ).For patients requiting lipid-lowering drug therapy by the guideline,treatment rate improved significantly in the low-risk group (13.3％ vs.75.0％,P =0.002).Treatment rate slightly increased in the high-risk and very high-risk groups after reformat (54.0％ vs.56.8％,62.4％ vs.69.0％,P ＞ 0.05 ).Rates of achieving lipid goal showed no change [ 41.5％ ( 102/ 245 ) vs.44.5％ ( 114/256 ),P ＞ 0.05 ] after reformat,especially among the very high-risk patients [17.9％(12/68) vs.21.6％(11/52),P＞0.05].Conclusions The blood-lipid report reformat did not improve the patient behaviors and knowledge of the prevention and treatment of dyslipidemia because of poor treatment rate and medication compliance.The combination of patient education and thorough blood-lipid report reformat may help to increase the attainment rate of dyslipidemia therapy.

Objective To analyze the current status of bacterial spectrum and drug resistance in community-acquired biliary tract infection to provide a basis for clinical medication .Methods The patients with community-acquired biliary tract infection (ex-periment group) and the patients with biliary tract diseases without biliary tract infection (control group) derived from the native ar-ea treated in this hospital from September 2014 to January 2016 were selected .The bile juice was intraoperatively extracted for con-ducting the bacterial culture and drug susceptibility test .Results Thirteen specieses (60 strains) of bacteria were isolated in the ex-periment group .The top 3 specieses were Escherichia coli (35 .0% ) ,Klebsiella pneumonia (21 .7% ) and Enterobacter cloacae (10 .0% ) .Eight specieses (13 strains) of bacteria were isolated in the control group .The top 3 specieses were Escherichia coli (30 .8% ) ,Klebsiella pneumonia(15 .4% ) and Lactococcus garvieae (15 .4% ) .The proportions of drug resistant strains in the two groups were 95 .0% and 84 .6% respectively (P>0 .05) .The proportions of multiple drug resistant strains in the two groups were 30 .0% and 7 .7% respectively(P>0 .05) .The occurrence rates of multiple drug resistance in the top 3 specieses of bacteria in the experiment group were 61 .9% ,7 .7% and 16 .7% respectively .Conclusion The bacterial spectra of community-acquired acute bili-ary tract infection in the native area are dominated by Gram negative bacteria .The total bacterial drug resistance is serious ,but the drug resistance situation in different bacteria pathogens is different .

Objective:To investigate the clinical effect of thin superficial inferior epigastric artery flaps in repairing soft tissue defects after buccal cancer surgery.Methods:From January 2018 to October 2019, 6 patients with buccal cancer who underwent surgery were constructed with thin superficial inferior epigastric artery flaps, including 2 males and 4 females, aged 43 to 68 years, with an average of 61.5 years. Doppler ultrasound was utilized of all patients to design flap preoperatively . According to the size of the affected area defect, according to the shape and direction of the blood vessels, a thin superficial inferior epigastric artery flap was elevated above the Scarpas fascia layer and transferred to repair soft tissue defects after buccal cancer surgery. The survival and functional recovery of the flap were observed.Results:All 6 flaps survived. The superficial inferior epigastric artery flaps ranged from 5.0 cm×7.0 cm to 7.0 cm×9.0 cm. The thickness of the flaps ranged from 0.5 cm to 1.3 cm, and the average thickness was 0.8 cm. The pedicle length is 6.0-9.0 cm.Four of them anastomosed to the superficial inferior epigastric veins and companion vein, 2 cases only anastomized superficial inferior epigastric veins . The follow-up period ranged from 3 to 12 months, with an average of 10 months. The cheek shape was good, the mouth opening was normal, there was no obvious bloating, and no secondary surgery was required. Linear scars were left on the donor site, with concealed location and no impairment of abdominal wall function.Conclusions:The donor site of the thin superficial inferior epigastric artery flap is small, the scar is concealed, the cheek is not bloated, and the opening degree of mouth is satisfactory. It is a good choice for reconstructing postoperative defect of cheek cancer.

Objective:To investigate the clinical effect of thin superficial inferior epigastric artery flaps in repairing soft tissue defects after buccal cancer surgery.Methods:From January 2018 to October 2019, 6 patients with buccal cancer who underwent surgery were constructed with thin superficial inferior epigastric artery flaps, including 2 males and 4 females, aged 43 to 68 years, with an average of 61.5 years. Doppler ultrasound was utilized of all patients to design flap preoperatively . According to the size of the affected area defect, according to the shape and direction of the blood vessels, a thin superficial inferior epigastric artery flap was elevated above the Scarpas fascia layer and transferred to repair soft tissue defects after buccal cancer surgery. The survival and functional recovery of the flap were observed.Results:All 6 flaps survived. The superficial inferior epigastric artery flaps ranged from 5.0 cm×7.0 cm to 7.0 cm×9.0 cm. The thickness of the flaps ranged from 0.5 cm to 1.3 cm, and the average thickness was 0.8 cm. The pedicle length is 6.0-9.0 cm.Four of them anastomosed to the superficial inferior epigastric veins and companion vein, 2 cases only anastomized superficial inferior epigastric veins . The follow-up period ranged from 3 to 12 months, with an average of 10 months. The cheek shape was good, the mouth opening was normal, there was no obvious bloating, and no secondary surgery was required. Linear scars were left on the donor site, with concealed location and no impairment of abdominal wall function.Conclusions:The donor site of the thin superficial inferior epigastric artery flap is small, the scar is concealed, the cheek is not bloated, and the opening degree of mouth is satisfactory. It is a good choice for reconstructing postoperative defect of cheek cancer.