Objective To probe the surgical approach and effect on upper abdominal malignant tumor infiltrating pancrea. Methods Thirty patients with upper abdominal malignant tumor infiltrating pancreas or tissue around pancrea were treated by radical resection on primary tumor combined pancreaticoduodenectomy. Results Three patients died in 1 month after operation due to multiple organ failure. The patients with gallbladder cancer and metastatic lymph nodes fixed behind caput pancreatis were followed up averaged 35 months. The patients with gastric antrum carcinoma infiltrating caput pancreatis were followed up averaged 31 months. The patients with recurrent gastric cancer infiltrating caput pancreatis were followed up averaged 13 months. The patients with pancreatic and duodenal invasion by cancer of hepatic flexure of colon were followed up averaged 41 months. The patients with hilar cholangiocarcinoma and metastatic lymph nodes fixed behind caput pancreatis were followed up averaged 11 months. Conclusion The patients with upper abdominal malignant tumor infiltrating pancreas should be operated by radical resection on primary tumor combined pancreaticoduodenectomy, which can increase the rate of tumor resection, and be expected to prolong the survival period.

Objective To compare the serum index after colonoscopy high-frequency electric snare combined with nylon cord ligation and high-frequency electric resection in treating broad pedicle polyps. Methods 70 cases of broad pedicle polyps patients from July 2012 to May 2016 were chosen as research object. The operation methods and laboratory examination results of all the patients were reviewed. All patients were divided into observation group (n = 37) and control group (n = 33). Patients in observation group were treated by colonoscopy high-frequency electric snare combined with nylon loop ligation, while patients in control group were treated by high-frequency electric resection only. The blood loss and related indexes of the two groups were recorded. Before and after operation, stress hormones and acute phase proteins in serum was determined. Results Intraoperative blood loss of observation group was less than that in control group, postoperative hemoglobin levels was higher than that in control group, postoperative early bleeding rate, postoperative delayed bleeding rate of observation group were lower than that in control group (P < 0.05); 1 hour after surgery, Cor, ACTH, AT II, NE, CRP, SAA, AAT in serum were lower than those in control group (P < 0.05). Conclusion Through colonoscopy high-frequency electric snare combined with nylon cord ligation can reduce bleeding during and after surgery, relieve stress and inflammation.

Objective To compare the efficacy of laparoscopic and conventional open total mesorectal excision (TME) in the treatment of rectal cancer, and to explore the considerations of laparoscopic TME. Methods 75 cases of laparoscopic group and 61 cases of open surgery group were analyzed retrospectively, and cohort study was used to compare the perioperative indicators and clinicopathological results in the two groups. Results Between the laparoscopic group and the open surgery group, the operative incision [8.7 cm (8.0-10.0 cm) vs. 13.6 cm (10.0-16.0 cm)], the use of postoperative analgesics (8 cases vs. 23 cases), postoperative time to remove the drainage tube [5 d (5-6 d) vs. 6 d (6-8 d)], postoperative time to get out of bed [3 d (3-7 d) vs. 5 d (4-8 d)] and postoperative hospital stay time [6 d (5-18 d) vs. 8 d (6-25 d)] had statistical difference (all P<0.05). The cost of laparoscopic group was higher than that of open surgery group (each patient in laparoscopic group spent more about 7 000 yuan than ones in open surgery group ). There was a significant difference in the overall complication rate between the laparoscopic group and the open surgery group [6.7 % (5/75) vs. 13.1 % (8/61), P<0.05]. Conclusions The postoperative analgesics, removal of drainage tube time, hospital stay and other indicators in the laparoscopic TME are superior compared with those in the open surgery, but due to the use of high-value consumables, the cost of laparoscopic surgery is higher. Besides, laparoscopic resection of rectal cancer should be careful.

Objective To investigate the relationship between the expression of decay receptor 3 (DcR3) and the eliniealpathological parameters in human gastric carcinoma. Methods The expression of DcR3 was examined by RT-PCR in a series of 41 human primary gastric carcinomas and 41cases of normal tissue adjacent to tumor. Multiple clinical pathological factors were analyzed according to their relation with the expression of DcR3. Results The positive rate of expression of DcR3 was 56 %(23/41) in human gastric carcinoma. The expression of DcR3 in gastric carcinoma was significantly higher than that in normal tissues adjacent tumor. The expression of DcR3 was significantly correlated with different degrees of differentiation, lymph node metastasis and TNM staging (P <0.10), but there was no significant difference in DcR3 and other clinical pathological features such as tumor position and invasion depth (P>0.10). The multiple linear regression equation was Y=0.432-0.208X1+0.098X2+0,086X3. Conclusion DcR3 expression can be highly found in gastric carcinoma. The abnormal expression of DcR3 may promote tumorigenesis and progression. DcR3 may be important in evaluating the tumor differentiation, infiltration depth, lymph node metastasis and TNM staging of human gastric carcinoma.

[Objective]To explore the intracellular antimicrobial activities of erythromycin,ciprofloxacin,levofloxacin,moxifloxacin against Legionella pneumophila.[Methods]The minimum inhibition concentration(MIC)of each antibiotic was evaluated by E-test method and microdilution method respectively.The minimal extracellular concentration inhibiting intracellular multiplication(MIEC)of each antibiotic was evaluated by the MTT colorimetric assay system.[Results]The MIC concentration for each drug by E-test method were:erythromycin,0.047 μg/mL;ciprofloxacin,0.38 μg/mL;levofloxacin,0.125 μg/mL;moxifloxacin,0.125 μg/mL,the MIC concentrations for each drug by microdilution method were:erythromycin,0.125 μg/mL;ciprofloxacin,0.03 μg/mL;levofloxacin,0.016 μg/mL;moxifloxacin,0.016 μg/mL.The MIEC concentration for each drug were:erythromycin,0.25 μg/mL;ciprofloxacin,0.016 μg/mL;levofloxacin,0.016 μg/mL;moxifloxacin,0.004 μg/mL.[Conclusions]Fluoroquinolones have superior activity than erythromycin in U937 cells infected with L.pneumophila.Moxifloxacin is the most potent drug among the four tested antimicrobials.Our results indicated that the MTT assay system allows comparative and quantitative evaluations of the intracellular activities of antibiotics against L,pneumophila and efficient processing of a large number of samples.

Objective To compare the toxicity of outer membrane vesicles ( OMVs) secreted by Acinetobacter baumannii strains with different drug-resistance spectrums.Methods Four Acinetobacter baumannii strains with different drug-resistance spectrums were collected (strain 33, 3237, B29 and 10), and OMVs produced by these strains were extracted and purified.BCA assay was used to determine the protein concentrations, and RAW264.7 cells were incubated with different concentrations of OMVs for 24 h. Cell viability was measured with CCK-8 assay, and gene expression of tumor necrosis factor-alpha ( TNF-α) , interleukin-6 ( IL-6) , interleukin-1 beta ( IL-1β) , keratinocyte-derived chemokine ( KC) and macrophage inflammatory protein 2 (MIP-2) was assessed by quantitative real-time PCR.One-way ANOVA was used for data analysis.Results According to the result of drug susceptibility test, strain 10 was extensively drug-resistant Acinetobacter baumannii ( XDRAB ) strain, strain B29 was multi-drug resistance Acinetobacter baumannii (MDRAB) strain, while strain 33 and 3237 were non-MDRAB strains.After incubated with different concentrations of OMVs for 24 h, cell viability of RAW264.7 declined with the increase of OMVs concentrations.OMVs released from strain10, B29 and 3237 significantly lowered the cell viability at the concentration of 5 μg/mL, while the cytotoxicity of OMVs released from strain 33 was much weaker, and no remarkable decrease in cell viability was observed even at the concentration of 25 μg/mL.OMVs of all strains induced the release of TNF-α, IL-6, IL-1β, KC and MIP-2 in RAW264.7 cells, and the levels of theses cytokines were increased with the concentration of OMVs.Inflammatory response in cells incubated with OMVs from strain 33 was the weakest, while OMVs from strain 10 induced strongest inflammatory response.KC and MIP-2 levels were significantly higher in RAW264.7 cells incubated with OMVs from strain 10 with a concentration of 5 μg/mL than that incubated with OMVs from other strains ( F=19.094 and 19.032,P<0.05 or <0.01).Conclusions OMVs from Acinetobacter baumannii strains with different drug-resistance spectrums are of different toxicity.OMVs from XDRAB and MDRAB strains have higher toxicities and may induce stronger inflammatory response.

Objective To determine the risk factors and prognostic survival of patients with para-aortic lymph node metastasis of advanced esophagogastric junction malignancy by comparing their general clinicopathological characteristics and regional lymph node metastasis status with those of patients with negative para-aortic lymph node metastasis. Methods This single-center retrospective case study collected the clinical and pathological data of 224 patients with esophagogastric junction malignant tumors undergoing radical resection. Single factor affecting lymph node metastasis in group 16 was analyzed by chi square test, and multiple factors were examined using logistic regression. Kaplan-Meier method was used for survival analysis, and Log rank test was used for survival rate comparison. Results Among the 224 patients with advanced esophagogastric junction malignant tumors, (1) Univariate analysis showed that Siewert classification, tumor diameter, pathological stage, T stage, and N stage were associated with positive para-aortic lymph node metastasis (P<0.05). Meanwhile, multivariate logistic analysis showed that Siewert type and tumor diameter were independent risk factors for positive metastasis (P<0.05); (2) Among the 17 groups of regional lymph nodes with para-aortic lymph node metastasis, univariate analysis revealed that No.5, No.6, No.111, and No.112 lymph nodes were not correlated with positive para-aortic lymph node metastasis (P>0.05). The remaining 13 groups of regional lymph nodes were all associated with para-aortic lymph node metastasis. Meanwhile, multivariate logistic analysis revealed that No.7, No.11p, and No.110 lymph nodes were independent risk factors for metastasis (P<0.05). When the regional lymph node metastasis in these three groups was negative, the positive rate of para-aortic lymph node metastasis was only 4.7%. When at least one of these groups had regional lymph node metastasis, the positive metastasis rate was up to 47.4%; (3) The 1- and 3-year cumulative survival rates of the patients with positive para-aortic lymph node metastasis after surgery were 76.5% and 8.1%, respectively, and those in negative patients were 98.3% and 76.8%, respectively. Log rank test showed a significant difference in overall survival rate between the patients with positive and negative para-aortic lymph node metastasis (P<0.001). Conclusion (1) Preoperative examination of patients with advanced esophagogastric junction malignant tumors should clarify the tumor type and maximum diameter. Patients with Siewert type Ⅱ and Ⅲ and maximum tumor diameter of >6 cm are recommended to undergo para-aortic lymph node dissection. (2) Frozen biopsy of lymph nodes of No.7 and No.11p is performed during the operation, and the para-aortic lymph nodes should be dissected if the metastasis is found to be positive, which is helpful for the clinical surgeon to judge the dissection of the para-aortic lymph nodes.

Objective:To assess the safety and feasibility of Bi's intestinal loop binding treatment of esophageal jejunal anastomotic leak after total gastrectomy.Methods:Bi's Intestinal loop binding are suitable for patients who underwent radical total gastrectomy+Roux-en-Y anastomosis and were confirmed by upper gastrointestinal angiography to have esophageal jejunal anastomotic leakage and whose conservative or endoscopic treatment was ineffective. The operation procedure is as follows: take the original central incision of the upper abdomen, remove the abscess around the anastomoses after ventral incision, and place drainage tube inside the abscess, which is convenient to rinse and drain after operation. A double 1-0 VICRYL is applied to the loop of gastrointestinal surrogate 10-15 cm proximal to the jejuno-jejunal anastomosis. The knot tension is tight to prevent regurgitation of digestive juices, but too much force should be avoided to cut the intestinal tract. Nutritional jejunostomy fistula was performed at 10?15 cm distal to the jejuno-jejunal anastomosis and gastric tube was retained during the operation. The preoperative and postoperative data from 12 patients with jejunal esophageal anastomotic leak after total radical gastrectomy and Roux-en-Y anastomosis were retrospectively analyzed from October 2016 to January 2023 in gastrointestinal surgery and pancreas surgery at Shanxi People's Hospital, and observed the curative effect.Results:12 patients were managed with Bi's Intestinal loop binding, operative time (60.0±20.8) minutes, median bleeding (50±10.8) ml, median hospital stay 20(12~28) days, and median reviewing upper and mid Gastrointestinal Contrast time postoperatively 61(52~74) days. The results showed that the anastomoses healed well, all the small intestine showed good imaging, the binding wire fell off by itself, and two patients had incision infection.Conclusions:It is safe and feasible for patients with esophageal jejunostomy fistulae after total gastrectomy to use the method of Bi's Intestinal loop binding.

Objective:To assess the safety and feasibility of Bi's intestinal loop binding treatment of esophageal jejunal anastomotic leak after total gastrectomy.Methods:Bi's Intestinal loop binding are suitable for patients who underwent radical total gastrectomy+Roux-en-Y anastomosis and were confirmed by upper gastrointestinal angiography to have esophageal jejunal anastomotic leakage and whose conservative or endoscopic treatment was ineffective. The operation procedure is as follows: take the original central incision of the upper abdomen, remove the abscess around the anastomoses after ventral incision, and place drainage tube inside the abscess, which is convenient to rinse and drain after operation. A double 1-0 VICRYL is applied to the loop of gastrointestinal surrogate 10-15 cm proximal to the jejuno-jejunal anastomosis. The knot tension is tight to prevent regurgitation of digestive juices, but too much force should be avoided to cut the intestinal tract. Nutritional jejunostomy fistula was performed at 10?15 cm distal to the jejuno-jejunal anastomosis and gastric tube was retained during the operation. The preoperative and postoperative data from 12 patients with jejunal esophageal anastomotic leak after total radical gastrectomy and Roux-en-Y anastomosis were retrospectively analyzed from October 2016 to January 2023 in gastrointestinal surgery and pancreas surgery at Shanxi People's Hospital, and observed the curative effect.Results:12 patients were managed with Bi's Intestinal loop binding, operative time (60.0±20.8) minutes, median bleeding (50±10.8) ml, median hospital stay 20(12~28) days, and median reviewing upper and mid Gastrointestinal Contrast time postoperatively 61(52~74) days. The results showed that the anastomoses healed well, all the small intestine showed good imaging, the binding wire fell off by itself, and two patients had incision infection.Conclusions:It is safe and feasible for patients with esophageal jejunostomy fistulae after total gastrectomy to use the method of Bi's Intestinal loop binding.