Objective To learn and evaluate the present prescriptions from outpatient departments of 21 public hospitals in Songjiang district,and to promote rational drug use.Methods A total of 75,600 outpatient prescriptions from 21 public hospitals in Songjing district were collected monthly from January 2008 to October 2010 and analyzed statistically using indexes for prescription evaluation.Results of the 75,600 prescriptions,the types of drugs in each prescription averaged 2.35,the ratio of antibiotics use and injection agents use were 35.77％ and 17.40％,respectively.The percentage of essential drugs without added profit accounted for 41.91％ of the total drug use,and the average drug cost per prescription was RMB 85.99.Comparison of indexes for prescription evaluation showed that the ratio of antibiotics use and injection agents use as well as the average cost per prescription in secondary hospitals were significantly higher that those in community health centers (P＜0.01),while the percentage of essential drugs without added profit and the average number of drugs in each prescription were statistically smaller than those in community health centers (P＜0.01).Conclusion Drug use in outpatient departments of 21 public hospitals was rational in general,especially noteworthy is the significant improvement made at community health centers in recent three years.

Objective To summarize the experience in surgical management of hilar cholangiocarcinoma.Methods The clinical data of 88 patients with hilar cholangiocarcinoma who received surgical treatment at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.All the patients were diagnosed by imaging examination.According to the severity of jaundice and predictive remnant liver volume,19 patients received percutaneous transhepatic cholangial drainage (PTCD) and 4 received portal vein embolization.The fundamental operation consisted of hilar cholangiocarcinoma resection,skeletonization of hepatoduodenum ligament and Roux-en-Y cholangiojejunostomy,and the transanastomotic stent was placed for 6 months.The count data were analyzed using the chi-square test; the survival rate was analysed using the Kaplan-Meier method; the survival was analyzed using the Log-rank test.Results Of the 88 patients,58 patients (including 11 patients who received PTCD) received hilar cholangiocarcinoma resection.Of the 58 patients,43 (including 4 patients who received portal vein embolization preoperatively) received R0 resection,and 15 received palliative resection.Thirty patients received internal and (or) external drainage.Commitant partial hepatectomy was performed on 22 patients (including 9 received left hemihepatectomy,2 received extended left hemihepatectomy,7 received left hemihepatectomy + caudate lobectomy,4 received right hemihepatectomy).Commitant pancreatico-duodenectomy was performed on 7 patients,commitant hepatic artery resection on 3 patients,and commitant portal vein resection on 2 patients.According to the modified Bismuth-Corlette classification,there were 17 patients with type Ⅰ,19 with type Ⅱ,21 with type Ⅲa,20 with type Ⅲb,and 11 with type Ⅳ.Of the 58 patients who received hilar cholangiocarcinoma resection,19 had postoperative complications,and 2 patients died within 30 days after operation.Seventy-three patients were followed up,and the overall 1-,3-,5-year survival rates were 68.5％,28.8％,11.0％,respectively.The 1-,3-,5-year survival rates of patients who received R0 resection were 94.6％,43.2％,18.9％,respectively,which were significantly higher than 78.6％,35.7％ and 7.1％ of patients who received palliative resection (x2=4.77,P ＜0.05).The 1-,3-,5-year survival rates of patients who received palliative resection were significantly higher than 18.2％,0,0 of patients who received biliary drainage (x2 =13.26,P ＜ 0.05).Conclusions R0 resection is the best choice for patients with hilar cholangiocarcinoma,and biliary drainage with no resection is the last choice.Sufficient preoperative treatment,optimized choice of surgical procedure and exquisite surgical techniques are important for the improvement of the prognosis.

Objective To investigate the diagnosis and treatment of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods The clinical data of patients with pathologically verified IPMN who underwent surgical treatment between January 2006 to April 2014 in the First Affiliated Hospital of Harbin Medical University were studied retrospectively.There were 27 males and 21 females.The average age was (57.8 ± 8.8) years old.The average caliber of the main pancreatic duct was (1.1 ± 0.6) cm.The average size of the branch duct IPMN was (4.6 ± 1.5) cm.Results 35 patients underwent pancreaticoduodenectomy.Eight patients underwent distal pancreatectomy.Two patients underwent duodenum-preserving pancreatic head resection.Two patients underwent splenic-preserving distal pancreatectomy and one patient underwent total pancreatectomy.No patient died in perioperative period,and the median length of hospital stay after surgery was 14.3 days.Postoperative pathological examination revealed 5 (10.4％) adenoma,12 (25.0％) moderate-grade dysplasia,14 (29.2％) high-grade dysplasia and 17 (35.4％) invasive carcinoma.The postoperative complication rate was 22.9％.The mean follow up period for the noninvasive tumors was 48.9 months,with no recurrence or deaths.The mean follow up period of the invasive tumors was 43.2 months,with 1 death and no recurrence.Conclusions The indications for resection of IPMN should be based on treatment guidelines and on the patient' s general condition.It is suggested that the diagnosis and treatment of IPMN should be conducted in specialized pancreatic surgery centers.

Objective:Esophageal cancer has high morbidity in China, and surgery is the main treatment for this disease. Postop-erative nutrition is also important for the patients. In this article, we discuss the possibility of retrosternal route gastrostomy feeding (RGF). Methods: The data of 127 esophageal cancer patients between 2011 and 2013 were retrospectively analyzed. RGF was per-formed in all the patients, and post-operation complications were studied. Results: Bowel obstruction, catheter displacement, and wound infection did not occur. Conclusion:RGF is a safe and effective nutrition method for patients who underwent retrosternal recon-struction.

Objective To study the function of early persistent vacuum suction drainage in patients with high risk of pancreatic fistula after pancreaticoduodenectomy (PD).Methods From Jul.2010 to Jun.2013,the clinical data of 286 patients undergoing PD were retrospectively evaluated.87 patients with high risk of pancreatic fistula were screened and then divided into early persistent vacuum suction drainage group (the observation group) and conventional drainage group (the control group) according to postoperative drainage manners.We statistically analyzed the two groups in terms of general information,blood loss,operative time,medical expenses,hospital stay,mortality and morbidity of complications such as pancreatic fistula.Results There were 40 patients screened into the observation group and 47 patients into the control group.No difference was found between the observation group and the control group in basic clinical data or surgical data.There was no statistical difference between the two groups in delayed gastric emptying,bile leakage,bleeding or the incidence of pancreatic fistula and intra-abdominal infection.The incidence of pancreatic fistula with grade B and C in the observation group was statistically lower than that of the control group(12.5％ vs 34.0％,P＜0.05).The incidence of intraabdominal infection in observation group was statistically lower than those in the control group (20.0％ vs 40.4％,P＜0.05).The incidence of total complications in observation group was statistically lower than that in the control group (60.0％ vs 83.0％,P＜0.05),but no difference was found between the observation group and control group in morality.Early persistent vacuum suction drainage could reduce hospital stay((21.93±7.14) days vs (28.70±12.45) days,P＜0.05) and clinical expense ((64.8±12.0) thousands vs (75.2± 14.6) thousands,P＜0.05) in patients with high risk of pancreatic fistula after PD.Conclusions Early persistent vacuum suction drainage can reduce the rate of grade B and C pancreatic fistula in patients with high risk of pancreatic fistula undergoing PD.The manner can also reduce the incidence of intra-abdominal infection,total complications and cost of hospital stay.This manner can accelerate postoperative recovery of patients undergoing PD and is worth of widely used.

Objective To study the impact of blood transfusion on postoperative complications of pancreaticoduodenectomy.Methods The medical data of 356 patients who underwent pancreaticoduodenectomy from January 2005 to December 2011 were retrospectively analyzed.242 patients in the transfusion group received blood transfusion while the remaining patients in the non transfusion group received no blood transfusion.Results The rates of pancreatic fistula and pulmonary infection,mean operative time,intraoperative blood loss,and hospital stay were 17.8％,16.5％,6.4 h,920.0 ml and 29.1 d in the transfusion group compared with 8.8％,6.1％,5.4 h,150.0 ml and 25.9 d in the non-transfusion group,respectively (P＜0.05).However,there were no significant differences between the two groups in the rates of biliary fistula,gastrointestinal and intraabdominal bleeding,delayed gastric emptying and death.Conclusions Patients undergoing pancreaticoduodenectomy in the non-transfusion group had significantly lower rates of pancreatic fistula and pulmonary infection,shorter operative time and hospital stay,and less intraoperative blood loss.This study suggested that a reduction in intraoperative blood loss by advanced instruments and techniques,with operations carried out by experienced pancreatic surgeons in specialized pancreatic center,could result in a significantly lower postoperative complication rate.

Objective To summarize the experience of diagnosis and treatment of traumatic pancreatitis (TP). Methods Clinical data of 13 patients with TP who were admitted to the First Affiliated Hospital of Harbin Medical University between October 2013 and October 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 9 males and 4 females, aged from 28 to 53 years old with a median age of 39 years old. All patients had a definite medical history of trauma, mainly traffic and crush injury. The diagnosis, treatment and complications of the patients were observed. Results The patients were mainly with gradeⅡ and Ⅲ pancreatic damage, incluing 5 cases of pancreatic head injury and 8 of pancreatic neck, body and tail injury. Most patients were diagnosed with TP on 2-5 d after trauma. One case received non-surgical treatment. Twelve cases underwent minimally invasive surgery, including 8 cases treated with percutaneous catheter drainage, 1 with endoscopic pancreatic stent, 4 with endoscopic removal of necrotic tissue. Eight cases underwent laparotomy. Complications were observed in 12 cases. Nine cases developed abdominal or retroperitoneal infection and underwent minimally invasive surgery. Among them, 6 cases were complicated with severe multiple organ injuries and underwent re-operation. Five cases suffered colonic fistula. Among them, colonic fistula of 3 cases were interlinked with abdominal infectious focals, and they underwent fistula proximal intestinal colostomy and two-stage fistula closure. The median length of hospital stay was 57(17-134) d. All patients were recovered and discharged after treatment. Conclusions It is difficult to make an early diagnosis of TP due to the insidious onset and rapid progression. Individualized treatment should be chosen according to the specific conditions of patients.

OBJECTIVETo investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).

METHODSThree hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.

RESULTSNo statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.

CONCLUSIONSGenerally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.

Anastomosis, Surgical ; Humans ; Incidence ; Octreotide ; therapeutic use ; Pancreas ; pathology ; Pancreatectomy ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; drug therapy ; Pancreaticoduodenectomy ; adverse effects ; Perioperative Period ; Prospective Studies

Objective: The Notch signaling pathway is closely related to biliary fibrosis. Previous studies have shown that Astragaloside (AS) can prevent the progression of cholestatic liver fibrosis. The purpose of this study is to observe the effect of AS on the regulation of Notch signaling pathway in biliary fibrosis. Methods: Cholestatic liver fibrosis was established by common bile duct ligation (BDL) in rats. Two weeks after BDL, the rats were randomly divided into a model group (i.e., BDL), an Astragalosides group (AS), and a sorafenib (SORA) positive control group and treated for 3 weeks. Bile duct proliferation and liver fibrosis were determined by tissue staining. Protein and gene expression were determined by immunostaining, immunoblotting and RT-PCR, respectively. Activation of the Notch signaling pathway was evaluated by analyzing expressions of Notch-1, -2, -3, -4, Jagged (JAG)1, Delta like (DLL)-1, -3, -4, Hes1, Numb and RBP-Jκ. Statistical analysis of variance analysis, q test, P < 0.05 showed that the difference was statistically significant. Results: (1) AS significantly reduced the deposition of collagen and the Hyp content of liver tissue (500.15 ± 86.10 vs. 625.72 ± 105.62, P = 0.031), and inhibited the activation of hepatic stellate cells. (2) AS significantly decreased the protein and mRNA expressions of transforming growth factor (TGF)-β1 (1.02±0.15 vs. 1.89±0.36, P = 0.007; 1.17±0.18 vs. 1.68±0.29, P = 0.013, respectively) and α-smooth muscle actin (α-SMA, 0.41±0.11 vs. 0.72±0.16, P = 0.003; 1.71±0.57 vs. 2.68±0.46, P = 0.008, respectively) compared with BDL group. In contrast, AS significantly enhanced expression of the Smad 7 protein compared with the BDL group (0.72±0.008 vs. 0.33±0.001, P = 0.005). AS also reduced biliary epithelial cell proliferation. AS reduced the mRNA levels of CK7, CK8 and CK18 (1.31±0.39 vs. 2.63±0.82, P = 0.009; 0.71±0.09 vs. 0.87±0.08, P = 0.031; 2.56±0.32 vs. 3.41±0.39, P = 0.010, respectively) and reduced the positive areas of CK19 and OV6 (62 337.17±21 873.38 vs. 22 5472.67±26 933.63, P = 0.000; 92 237.43±15 894.11 vs. 171 298.13±61 761.37, P = 0.000, respectively). (3) The mRNA expression of Notch-2, -3, -4 and JAG1 were significantly reduced in the AS group compared to the BDL group (1.07±0.19 vs. 1.51±0.28, P = 0.044; 0.99±0.24 vs. 1.18±0.10, P = 0.043; 1.36±0.42 vs. 3.40±0.44, P = 0.048; 2.62±0.43 vs. 3.73±0.83, P = 0.046, respectively). In contrast, the mRNA level of Numb was clearly enhanced after AS treatment (0.90±0.05 vs. 0.75±0.11, P = 0.019). In addition, consistent with the mRNA levels, the protein expressions of Notch-2, -3, -4 and JAG1 were reduced significantly (1.27±0.18 vs. 1.71±0.26, P = 0.004; 0.99±0.11 vs. 4.38±0.60, P = 0.001; 1.76±0.32 vs. 4.01±0.74, P = 0.002; 1.62±0.33 vs. 2.74±0.63, P = 0.002) and the Numb protein level was increased significantly (1.50±0.15 vs. 0.85±0.11, P = 0.001) in AS group compared with BDL group. Conclusion AS may prevent cholestatic liver fibrosis via inhibition of the Notch signaling pathway, thereby inhibiting the abnormal proliferation of biliary epithelial cells. Results indicate that AS may be a potential treatment for cholestatic liver disease.

OBJECTIVE： Te analyze the problems of clinical use in pediatric drug in China， and to put forward related countermeasures and suggestions. METHODS： Using “children” and “pediatrics” as retrieval words， registered drug information were retrieved from the website of China Food and Drug Administration； the data of pediatric drug use prescription was retrieved from hospital prescription system of 9 hospitals； all drug information were retrieved from national drug data management system； off-label drug use investigation and the literatures of pediatric drug use in medical institutions （5 representative third grade general medical institutions） were retrieved from CNKI and Wanfang database. General information and problems of pediatric drug use in China were investigated. RESULTS： A total of 170 009 items of registered drug information were retrieved， including 2 784 drug information items labeled with ”children” or ”pediatrics”， accounting for 1.64％；320 000 drug prescriptions from hospital prescription system of 9 hospitals covered 22 treatment areas involving 1 186 drugs and 51 dosage forms. Only 10％ suitable for children. The retrieval results of database showed that the incidence of children off-label drug use in outpatients prescriptions of 5 hospitals was in high level， mainly manifesting as without the information of pediatric drug use， hyper-indication drug use， hyper-dosage drug use. There were many problems in clinical pediatric drug use in China， such as less variety for children， single dosage form and specification， widespread off-label drug use， lack of scientific reference for drug use， difficulty in developing pediatric drug clinical trials， etc. CONCLUSIONS： Although the policies to protect children’s clinical drug use have been introduced in China， the problems facing children’s clinical drug use in China are still very serious. While further implementing relevant policies， it is necessary to establish a linkage management system led by government departments， with the full participation and mutual cooperation of society， enterprises， medical institutions and patients so as to guaratee the safety of pediatric drug use in clinic.