Patients undergoing hepatobiliary surgery are very vulnerable to malnutrition while surgeons' knowledge on evidence-based guidelines in surgical nutrition remains poor. Efforts are therefore necessary to implement routine nutritional screening and nutritional support. Rea sonable measures in perioperative nutritional intervention ameliorate pre- and postoperative status of the patient and reduce surgical complications through regulation of immunity,adjustment of glucose concentration and maintenance of tissue and organ functions. Modern surgical achievements using fast- track surgery and minimally invasive surgery provide the opportunity to focus on early intestinal feeding to hepatobiliary surgery patients in the postoperative period.Perioperative nutrition support not only provides nutritional substrates but also modifies the composition of nutritional regimen by adding supernormal doses of specific substrates to improve surgical outcomes. As a consequence,the term “nutrition therapy” instead of “nutrition support” is more acceptable in this era of immunonutrition.

Pancreatic cancer is known as one of the most fatal malignant diseases in digestive system.Approximately 15%-20%of patients are deemed resectable at the time of diagnosis.Neoadjuvant therapy to the borderline resectable pancreatic cancer ( BRPC) has been challenged to achieve down-staging of cancer, to avoid unnecessary major operation if the pancreatic cancer progres-ses and distant metastasis develops during preoperative treatment.However, there are some controversial issues influencing the clinical decision of surgeon in managing BRPC.This manuscript reviews the current controversial issues in managing BRPC in order to enhance proper understanding for the current status and potential role of neoadjuvant therapy in managing BRPC.

Objective To investigate the influence of diabetes on the early complications after pancreaticoduodenectomy in patients with pancreatic cancer,and to provide reference for clinical diagnosis and treatment.Methods A total of 179 patients with pancreatic cancer confirmed by pathology underwent pancreaticoduodenectomy were divided into 81 cases of diabetes group and 98 cases of non-diabetes group according to the level of blood sugar.The fast blood glucose of patients in diabetes group were controlled at 5.6-11.2 mmol/L before surgery,the clinical and pathological data,surgery-related complications and systemic complications of two groups were compared.Results Of 179 patients,5 patients (2.79％) died of severe infection combined with cardiac and respiratory failure.Firm pancreatic texture occurred more in diabetes group than that in non-diabetes group(79.0％ vs 42.9％,x2 =13.62,P＜0.01),but no statistically significant difference in duration of operation,total bleeding,length of stay in hospital,diameter of pancreatic duct,tumor size,pathological pattern,whether reserved pylorus and methods of anastomosis between the two groups (P ＞0.05).There was no statistically significant difference in the incidence of pancreatic fistula,delayed gastric emptying,hemorrhage and infection between diabetes group and non-diabetes group (P ＞ 0.05),but the incidence of respiratory failure (4.9％ (4/81)),cardiac failure (9.9％ (8/81)) and renal failure (1.2％ (1/81)) in diabetes group were significantly higher than that in non-diabetes group (2.0％ (2/98),3.1％ (3/98),0(0/98);P=0.031,0.014,0.007).The incidence of pancreatic fistula was 26.3％ (47/179),and that of patients combined with diabetes (38.3％ (18/47)) and firm pancreatic texture (40.4％ (19/47)) were statistically lower than patients without diabetes and soft pancreatic texture (x2 =8.53,P ＜ 0.05;x2 =11.20,P＜0.01).Conclusion Pancreatic cancer has a big risk in pancreaticoduodenectomy,and those with diabetes would not increase the risk of pancreatic fistula,delayed gastric emptying,hemorrhage and infection when blood glucose is well controlled before surgery,but it has severe impact on systemic complications,so the perioperative blood glucose should be well controlled.

Objective To study the method of promoting spontaneous closure of enterocutaneous fistula with fibrin sealant. Methods In twenty-seven patients with enterocutaneous fistula the selective fibrin sealant occlusion method was applied, and fistulagraphy was used to confirm closure. Results Fistula occlusion was attained within 2 weeks in 25 of the 27 patients, and there had been no sign of recurrence over a follow-up period of 1-15 months (average 5.6 months). Conclusion Selective fibrin sealant occlusion is highly effective for the closure enterocutaneous fistula.

Objective To study the effect of Guizhi Fuling Wan(GFW) on tumor apoptosis and apply the experimenting basis of GFW's development and utilization.Methods The S180 mice sarcoma model was used to detect the inhibitory effects of GFW,observe the ultrastructural change by electron microscopy,and the flow cytometer was used for apoptosis determination.The protein expression of P21waf/cip and the mRNA expression of Survivin were evaluated by immunohistochemistry and in situ hybridization.Results For S180 sarcoma,the inhibition ratio of GFW was 38.93%.The apoptosis was 17.79% by the flow cytometer.Some typical apoptotic cells and apoptotic bodies were observed through electron microscope.Chromatin gathered at the side of cell,the nucleus turned into the nucleus band and nucleus projected.Survivin mRNA markedly declined in the GFW group when compared with that in the model group(P

0.05) and hospital mortality(both 3.1%) between the two groups.All the pancreatic fistula patients were cured by non-surgical treatment.Conclusion: The comparative study of the two reconstructive techniques revealed no difference in the incidence of pancreatic fistulas following pancreaticoduodenectomy.

Objective To investigate the clinical efficacy of postoperative three-dimensional conformal radiotherapy concurrent with paclitaxel +TS-1 chemotherapy in the treatment of advanced gastric carcinoma.Methods A total of 60 patients with advanced gastric carcinoma were randomly divided into treatment group and control group.In treatment group,30 patients received simultaneous three-dimensional conformal radiations therapy combined with paclitaxel +TS-1 chemotherapy.In control group,30 patients received paclitaxel +TS-1 chemotherapy.The long term survival rate,local recurrence rate and side reactions were observed in two groups.Results The 1,2-year survival rate in treatment group [93.1％ (27/29),75.9 ％ (22/29)] and control group [72.4 ％ (21/29),48.3 ％ (14/29)] had significant difference (P ＜ 0.05).The 1,2-year local recurrence rate in treatment group [6.9％ (2/29),13.8％ (4/29)] and control group [31.0％ (9/29),44.8 ％ (13/29)] had significant difference (P ＜ 0.05 or ＜ 0.01).The side reactions in two groups were mainly manifested as leukopenia,thrombocytopenia,anemia,nausea,vomiting,liver function damage and oral mucositis.The incidence rate of nausea,vomiting in treatment group was significantly higher than that in control group [83.3％ (25/30) vs.53.3％ (16/30)] (P =0.012).Conclusions Postoperative threedimensional conformal radiotherapy concurrent with paclitaxel +TS-1 chemotherapy in the treatment of advanced gastric carcinoma may improve the long-term survival rate,lower local recurrence rate.But the adverse reactions are increased.

Aim To observe the anti-hepatitis B virus effect of total phenolics acid extracted from Oenanthe Javanica(OJTPA) with in vitro experiments.Methods HePG2 2.2.15 cells were treated with OJTPA,which were diluted into 500 mg?L-1,250 mg?L-1 and 125 mg?L-1 groups.The test set up positive control group(entecavir,3 mg?L-1) and normal control group.The cells of the 4 th,8 th and 4 th day ceasing treatment were collected.The content of HBV-DNA and cccDNA was determined with Quantitative Real-Time PCR method,and the inhibition rates were calculated.Results OJTPA could obviously inhibit HBV-DNA and cccDNA under the dosages used in the experiment,and showed a dose-dependent relationship.The inbhibitory rates reached the peak of 62.3% and 62.7% for HBV-DNA and cccDNA respectively,and a high inhibitory rate was retained within 3 days of OJTPA withdrawal.Conclusion OJTPA has significant inhibition on HBV-DNA and cccDNA and there is no significant rebound phenomenon.

Objective To establish the quality standard for Jinyin Lidan Oral Liquid. Methods Artemisiae Scopariae Herba, Taraxaci Herba, Aurantii Fructus and Schisandrae Chinensis Fructus in Jinyin Lidan Oral Liquid were identified by TLC. The contents of naringin and neohesperidin were determined by HPLC. The HPLC separation was performed on Phenomenex C18 column (4.6 mm × 250 mm, 5 μm) with the mobile phase of methanol-0.1% phsophonic acid solution and gradient elution. The UV detection wavelength was 254 nm;flow rate was 1.0 mL/min;column temperature was 25 ℃. Results The results of TLC showed that relevant spots were clear, with strong specificity, without interference of negative sample. The calibration curves for naringin and neohesperidin were in good linearity in the range of 0.56-5.60μg (r=0.999 9) and 0.38-3.80μg (r=0.999 8), respectively. The average recoveries were 99.86%and 98.95%with RSD of 2.04%and 2.45%, respectively. Conclusion The qualitative and quantitative determination method is simple, accurate and reliable, with good stability and reproducibility, and can be used for the quality control of Jinyin Lidan Oral Liquid.