Objective To investigate the efficacy of double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula.Methods The retrospective cohort study was adopted.The clinical data of 208 patients who underwent pancreaticojejunostomy at the Hunan Provincial People's Hospital from March 2011 to March 2015 were collected.Of 208 patients,106 patients undergoing double-“ U” embedding and pursestring suture and binding pancreaticojejunostomy were allocated into the double-“ U” group and 102 patients undergoing Child pancreaticojejunostomy were allocated into the Child group.Observation indicators included (1) surgical effects:anastomosis time,postoperative pancreatic leakage,duration of hospital stay,(2) follow-up situations.The follow-up using telephone interview and outpatient examination was performed to detect postoperative long-term complications and recovery of patients by abdominal ultrasound or computed tomography (CT) at every 6 months postoperatively up to September 2015.Measurement data with normal distribution were represented as x ± s and comparison between groups was analyzed by t test.Count data were analyzed using the chi-square test.Results (1) Surgical effects:208 patients underwent successful surgery without occurrence of death.The anastomosis time was (13.0 ± 1.5) minutes in the double-“ U” group and (20.0 ± 1.6) minutes in the Child group,with a statistically significant difference between the 2 groups (t =4.713,P ＜ 0.05).Two patients in the double-“ U” group were complicated with grade A of pancreatic leakage,including 1 of 36 patients with normal pancreatic remnant and 1 of 70 patients with fibrotic pancreatic remnant.Nine patients in the Child group were complicated with pancreatic leakage,including 6 in grade A,1 in grade B and 2 in grade C,and there were 6 of 33 patients (4 in grade A,1 in grade B,1 in grade C) with normal pancreatic remnant and 3 of 69 patients (2 in grade A,1 in grade C) with fibrotic pancreatic remnant.There were statistically significant differences in the pancreatic leakage between the 2 groups and among the patients with normal pancreatic remnant in the 2 groups (x2 =2.951,4.994,P ＜ 0.05).The duration of postoperative hospital stay was (13.5 ± 1.2)days in the double-“U” group and (15.7 ± 2.6)days in the Child group,with a statistically significant difference (t =1.011,P ＜ 0.05).No readmission in the 2 groups occurred.(2) Followup situations:91 of 106 patients in the double-“U” group were followed up for 6-54 months with a median time of 30 months.During the follow-up,8 patients were dead,12 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,4 and 4 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Eighty-eight of 102 patients in the Child group were followed up for 6-54 months with a median time of 25 months.During the follow-up,10 patients were dead,11 patients didn't undergo reoperation due to multiple metastases in the liver,lung and greater omentum,6 and 6 patients were respectively complicated with relapsing pancreatitis and refluxing cholangitis,and other patients had good conditions without the occurrence of diabetes,diarrhea,indigestion and hypopancreatism.Conclusion Double“U” embedding and pursestring suture and binding pancreaticojejunostomy for the prevention of pancreatic fistula can reduce the suture time,incidence of pancreatic leakage and duration of postoperative hospital stay,and it is especially suitable for the patients with normal pancreatic remnant.

Background and purpose:Concurrent chemo-radiotherapy(CCRT) was considered the best treatment plan for advanced nasopharyngeal carcinoma(NPC),but there was no uniform conclusion as to which category of patients and which chemotherapy associated radiotherapy would have the best therapeutic effect. As the standard treatment plan for advanced NPC, DDP concurrent chemo-radiotherapy was recommended by some scholars. DDP can raise the expression of inducible nitric oxide synthase(iNOS) protein and synthesize nitric oxide (NO) with anti-tumor effects, so we considered whether the therapeutic effect could be predicted and the corresponding treatment plan could be selectived to detect the iNOS expression in the pretherapy NPC tissues.The purpose of this study was to investigate the relation between the expression of iNOS protein and the nasopharyngeal tumor with complete response or with residue after DDP concurrent chemo-radiotherapy, so that the most appropriate plan of treatment can be adopted and the complete response rate of nasopharyngeal tumor can be raised. Methods:All patients were poorly differentiated NPC.The expression of iNOS protein was examined in 30 patients of nasopharyngeal tumor with complete response and 30 patients with residual tumor after DDP concurrent chemo-radiotherapy by immunohistochemical staining (SP method).None of the patients had received radiotherapy and chemotherapy.Results:Immunohistochemical examination revealed that iNOS expression in the NPC tissues was located in both the nucleus and cytoplasm of the tumorous tissues. The intensity of iNOS expression was stronger in the nucleus than in the cytoplasm of the tumorous tissues.The positive rates of iNOS protein expressions were 71.67%(43/60) in NPC tissues. It was 86.67% and 53.33% in 30 tumors with complete response and with residual tumor, respectively. The difference was statistically significant.The rate of iNOS strong postive expressions in the group of residual tumors was higher than that of the group with complete response. It was statistically different,but weak and moderate postive expressions did not have statistical difference.Conclusions:According to the difference of iNOS expression, it is a valuable method to select the most appropriate plan of treatment and the complete response rate of nasopharyngeal tumor can be raised.

Background and purpose:Inducible nitric oxide synthase(iNOS) overexpression has been detected in various malignancies.Nitric oxide(NO) produced by iNOS play an important role in the carcinogenesis,growth,invasion,metastasis and angiogenesis of tumors.However,the clinical and biological significance of the expression of iNOS in NPC were rarely reported in the literature.This study was to investigate the expression of iNOS in NPC and its role in the carcinogenesis,development,invasion and metastasis of NPC.Methods:The expression of iNOS was examined in 40 poorly differentiated NPC and 10 normal nasopharyngeal epithelium tissues by immunohistochemical staining(SP method).The results of immunoassaying were observed by two pathologists independently,using double blank scoring method.iNOS expression was categorized on the base of extent and intensity of staining using a semi quantitative method.The immunoreactive score was obtained by multiplying the extent score with the intensity of score.An immunoreactive score of 2 or higher was considered positive expression.Results:① iNOS was expressed in both the nucleus and cytoplasm of the tumor tissues.The intensity of iNOS expression was stronger in the nucleus than in the cytoplasm of the tumor tissues.②iNOS expression were significantly higher in NPC than those of normal nasopharyngeal epithelium.The positive protein expression rates of iNOS were 67.5%(27/40).The positive expressions of iNOS were significantly correlated with clinical stage,invasion and metastasis. There were no significant difference in terms of age and gender.Conclusions:① Immunohistochemical examination revealed that iNOS expression in the NPC tissues was located in both the nucleus and cytoplasm of the tumorous tissues.The intensity of iNOS expression was stronger in the nucleus than in the cytoplasm of the tumorous tissues.②iNOS may play an important role in the carcinogenesis,development,invasion,metastasis of NPC,respectively.The radiotherapeutic response of NPC may be enhanced by using the selective inhibitors of iNOS.

Background and purpose: There have been no reports on the clinical and biological significance of the co-expression of inducible nitric oxide synthase (iNOS) and β-catenin (β-cat) in has.pharyngeal carcinoma(NPC). This study was aimed to investigate the expression of iNOS and β-cat in NPC, to analyze their interrelation, and to explore their roles in the carcinogenesis, development, invasion, and metastasis of NPC. Methods: The expression of iNOS and β-cat was examined in 50 poorly differentiated NPC and 15 normal nasopharyngeal epithelium tissue by immunohistochemical staining (SP method). None of the patients had received radiotherapy and chemotherapy. The results of immunostaining were observed by two pathologists independently, using double blind scoring method. iNOS and β-cat expression were categorized by the extent and intensity of staining using a semiquantitative method. Results: No iNOS expression was observed in 15 normal nasopharyngeal epithelium, but β-cat expression was located in cytomembrane in normal samples. The positive rate of iNOS protein expression was 74.0% (37/50) in NPC tissues. The expression of iNOS was statistically different among the NPC group and normal nasopharyngeal epithelium group, T_(1-2) group and T_(3-4) group, metastatic lymph nodes group and no metastatic lymph nodes group. There was a great quantity of β-cat expression in cytoplasm, little or no β-cat expression in cytomembrane and nucleus in NPC tumorous tissues. Statistical analysis indicated that strong positive expression of β-cat in cytoplasm was significantly higher in NPC than those of normal nasopharyngeal epithelium. The positive expression of β-cat was significantly correlated with clinical stage, invasion and lymph gland metastasis. Neither iNOS nor β-cat was significantly different between different ages and genders. There was a positive relationship between iNOS and β-cat expression in NPC tissues (r=0.394, P=0.005). Conclusion: The positive expressions of iNOS and β-cat in cytoplasm were significantly correlated with clinical stage, invasion and metastasis, and were not significantly different in terms of ages and genders of the patients. There was a positive relationship between the expression of iNOS and β-cat in NPC tissues. Co-overexpression of iNOS and β-cat may play an important role in carcinogenesis, development, invasion, and metastasis of NPC.

Objective:To study the value of metastatic positivety in lymph nodes group 8a in deciding on extended lymph node dissection in pancreaticoduodenectomy(PD) for pancreatic head cancer.Methods:A retrospective study on 165 patients with pancreatic head cancer treated with PD at the Department of Pancreas and Spleen Surgery, Hepatobiliary Hospital of Hunan Provincial People's Hospital between January 2014 to June 2019 was performed. There were 101 males and 64 females with ages ranging from 38 to 75 (median 57) years. Patients who underwent standard lymph node dissection were included in the standard group ( n=88), and extended lymph node dissection in the extended group ( n=77). These patients were further divided into 4 subgroup. Subgroup A (standard PD in patients with negative nodes in group 8a, n=61), Subgroup B (extended PD in patients with negative nodes in group 8a, n=47), Subgroup C (standard PD in patients with positive nodes in group 8a, n=27), and Subgroup D (extended PD in patients with positive nodes in group 8a, n=30). The operation time, intraoperative blood loss, postoperative survival rates, complications were compared among the groups and subgroups. Results:The operation time and intraoperative blood loss of the standard group were (456.8±30.4) min and (264.28±101.14) ml, respectively, which were significantly lower than the extended group of (507.1±45.7) min and (388.9±155.3) ml (all P<0.05). The incidence of postoperative complications in the extended group (31.2%, 24/77) was significantly higher than that in the standard group (14.8%, 13/88) ( P<0.05). When compared with subgroup B, the cumulative survival rate of patients in subgroup A was not significantly different ( P>0.05). However, the cumulative survival rate of patients in subgroup C was significantly lower than that in subgroup D ( P<0.05). The cumulative survival rate of subgroup A was also significantly better than that of subgroup C ( P<0.05). There was no significant difference in the cumulative survival rates between group B and group D ( P>0.05). Conclusions:PD with extended lymph node dissection improved the survival rates in patients with cancer of the head of the pancreas with positive lymph nodes in group 8a. For these patients, extended lymph node dissection is recommended. With negative lymph nodes in group 8a, standard lymph node dissection is recommended.

Objective To investigate the differential expression of P57kip2 and CDK5 in neural tube defects t(NTD) from the normal ,and provide the clue for the research of the molecular mechanism of the normal neurula formation .Methods A cDNA mi-croarray containing 1 100 known genes was used to compare differences in P57kip2 and CDK5 gene expression between the normal control group and the retinoic acid(RA)-induced NTD group on embryonic(E) day 9 .5 and 10 .5 .Two differentially expressed genes were randomly selected from the two groups for Northern blotting to verify the results of the cDNA microarray .Results Compared the differences of between P57kip2 and CDK5 in normal and E9 .5 d ,E10 .5 d ,E9 .5 d-NTD ,E10 .5 d-NTD ,P57kip2 and CDK5 expression was significantly up-regulated in the before and after the formation of the normal neurulation ,but them showed a downward trend in retinoic acid (RA)-induced NTD(including two phase E9 .5 d and E10 .5 d) .Conclusion P57kip2 and CDK5 in-volved in the physiological process of NTD ,and provide the useful clue for the research of the molecular mechanism of the normal neurula formation .

OBJECTIVE: To explore the curative effect of pediatric chronic sinusitis and analyze its relative factors, so that the best treatment plan and operation time can be choose. METHOD: Two hundred and twenty cases of pediatric chronic sinusitis were divided into 4 groups: group A with only simple chronic sinusitis, group B accompanied adenoid hypertrophy. Among group B, group B1 with no nasal cavity structural abnormalities but group B2 on the contrary. Group C accompanied only nasal cavity structural abnormalities. According to the documents, all patients were administered with standard and systematical three-stage treatment. The curative effect of each group was calculated and analyzed in each treated stage. RESULT: After the first stage treated in 220 pediatric chronic sinusitis, a statistical significance of curative effect could be observed between group A and B, A and B1, A and B2, A and C (P < 0.01), but none between group B and C, B1 and B2, B1 and C, B2 and C (P > 0.01). Ninety-four patients in group B were accepted the second stage treated: adenoidectomy after first treatment failed. There was a statistical significance of curative effect between group B1 and B2 (P < 0.01). Once the above management both failed, endoscopic sinus surgery (FESS) was carried out. The total effective rate of FESS was 89.65%. CONCLUSION The systemic, disciplinary medical management has some referred value in the treatment for children with chronic sinusitis. Adenoid hypertrophy and nasal cavity structural abnormalities are two relative factors of the curative effect in pediatric chronic sinusitis. The time and cost of therapy can be saved if adenoidectomy and FESS are done for cases with adenoid hypertrophy or (and) nasal cavity structural abnormalities with the systemic, disciplinary medical management simultaneously.
Adenoidectomy ; methods ; Adolescent ; Child ; Child, Preschool ; Chronic Disease ; Endoscopy ; Female ; Humans ; Male ; Patient Care Planning ; Sinusitis ; surgery ; Treatment Outcome

OBJECTIVE: To investigate the effect of hyperbaric oxygen therapy to different degrees of hearing loss and different types of threshold curve in sudden deafness patients, and establish a personalized therapy, so as to promote clinical effect to sudden deafness. METHOD: One hundred and twenty cases were divided into two groups respectively (each group 60 cases). Drug treatment had been used in group A for two weeks. The patients in group B received drug treatment combined with hyperbaric oxygen therapy for two weeks. According to the different degrees of hearing loss and the types of audiogram in two groups, the statistical analysis to the difference of hyperbaric oxygen therapeutic effect was done. RESULT: The effective rates was statistically different (chi2 = 8.044, P < 0.01) between group A (60.00%, 36/60) and group B (83.33%, 50/60). There was no statistical difference between two treatment program in mild and the profound deafness patients. The statistical difference could been found between moderate and the severe deafness, the value of chi2 and p were 4.969, 5.560 and 0.040, 0.035, respectively. In group A, the statistical difference could only been found between mild and the profound deafness patients (chi2 = 6.739, P < 0.05). In group B, the statistical difference could been found in mild and the profound deafness, the moderate and the profound deafness, the severe and the profound deafness patients. The value of chi2 were 11.500, 15.058,10.221 and P < 0.01 respectively. The effective rates was no statistical difference in two treatment programs in the upsloping audiogram and the profound deafness. The statistical difference could been found between the downsloping and the flat audiogram, with the value of chi2 and p were 5.144 and 5.969, P < 0.05, respectively. In group A, the statistical difference could been found between the ascending and descending audiogram, the ascending and the flat audiogram,the ascending type and the profound deafness. The value of chi2 were 6.188, 7.247, 8.082 and P < 0.05, respectively. No statistical difference could been found among the other types of audiogram. In group B, no statistical difference could been found among all types of audiogram. CONCLUSION The effect of hyperbaric oxygen therapy varies with degree of hearing loss and audiogram type. Drug treatment combined with HBOT can promote clinical effect for patients in moderate deafness and severe deafness, the descending and flat type of audiogram.
Adolescent ; Adult ; Female ; Hearing Loss ; classification ; therapy ; Hearing Tests ; Humans ; Hyperbaric Oxygenation ; Male ; Middle Aged ; Oxygen ; therapeutic use ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the best time of intratympanic dexamethasone injection to treat sudden sensorineural hearing loss (SSNHL) as salvage therapy so that to improve the curative efficacy on sudden deafness at the utmost. METHOD: A total of 192 patients with SSNHL were included in this study, among whom 63 cases received the systemic steroid therapy throughout the study, while the other ones were treated with systemic steroid as initial treatment and were given intratympanic steroid administration as salvage treatment starting at different time point. The salvage treatment started on the 3rd day after the beginning of the initial treatment for 29 cases, on the 7th day for 38 cases, on the 14th day for 43 cases, and 1 month later for 19 cases. All the patients were followed up for 2 months. RESULT: The recovery rates and total effective rates showed no statistically significant difference between the patients received only systemic steroid therapy and the ones received intratympanic steroid administration on the 3rd, 7th day and 1 month later after the initial treatment. The recovery rate and total effective rate exhibited statistically significant difference between the patients received intratympanic steroid administration since the 14th day after the initial treatment and the ones received only systemic steroid therapy, with the numerical value of P 0. 037 and 0. 034, respectively. CONCLUSION (1) As an initial management plan, the curative effects. between the intratympanic steroid administration and the systemic steroid therapy were not significantly different. (2) As a salvage treatment, intratympanic steroid was a better choice for patients who have not completely recover from ISSNHL after failure of initial management with systemic steroid only. (3) The best time point of salvage treatment with intratympanic steroid was about 2 weeks after initial management with systemic steroid.
Hearing Loss, Sensorineural ; drug therapy ; Hearing Loss, Sudden ; drug therapy ; Humans ; Injection, Intratympanic ; Salvage Therapy ; Steroids ; therapeutic use ; Treatment Outcome ; Tympanic Membrane

OBJECTIVE: To investigate the relation between the expression of COX-2 protein and the effect of radiotherapy, estimate the value of COX-2 in predicting the effect of radiotherapy in patients with nasopharyngeal carcinoma,provide theoretical basement for establishing characteristic project of treatment and raising curative effect and life quantity. METHOD: The expression of COX-2 protein was examined in 30 radiosensitive and 30 radioresistant poorly differentiated NPC by immunohistochemical staining (SP method) before radiotherapy. The relation between the expression of COX-2 and the effect of radiotherapy was analyzed. RESULT: The positive rate of COX-2 protein expression was 61. 67% in NPC tissues, there was statistical difference( P <0. 01) of the positive rate between the 86. 67 % of 30 radioresistant and 36. 67 % of radiosensitive NPC tissues. The intensity of COX-2 protein expressions showed statistical difference( P <0. 05),too. Based on the expression of COX-2, the effect of radiotherapy, sensitivity, specificity, accuracy, positive predictive value, negative predictive value, false positive and false negative were predicted as follows: 86. 67Y, 63. 33% ,75. 00%, 70. 27% ,82. 61% ,36. 67% and 13. 33 , respectively. CONCLUSION COX-2 expression may serve as a marker in predicting the response to radiotherapy in NPC. According to the expression of COX-2, the sound treatment scheme can be selected.
Adolescent ; Adult ; Aged ; Cyclooxygenase 2 ; metabolism ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; radiotherapy ; Neoplasm Staging ; Predictive Value of Tests ; Prognosis ; Sensitivity and Specificity ; Young Adult