Objective To evaluate the overall survival in patients with locally advanced pancreatic cancer (LAC) treated with irreversible electroporation (IRE) and chemotherapy.Methods A retrospective study on the overall survival of 30 patients with LAC treated with IRE,and 30 patients with LAC treated with chemotherapy from July 2015 to October 2016 in the PLA General Hospital was conducted.Results For the 30 patients with LAC who underwent IRE successfully,there were 21 women and 9 men.The median age was 59 (36 ～81) years.Twenty-four patients had primary pancreatic head cancer and 6 had body cancer.Twelve (40.0％) of these patients had chemotherapy after the IRE ablation.The 90-day mortality in the IRE treated patients was 3 (10.0％).For the 30 patients with LAC who were treated with chemotherapy,the 90-day mortality was 6 (20.0％).In comparison of the IRE treated patients with the chemotherapy treated patients,improvements on disease-free survival (6 months vs.4 months,P ＜ 0.05) and overall survival (11 months vs.5.6 months,P ＜ 0.05) were observed.Conclusion IRE ablation of LAC was safe and could potentially improve overall survival when compared with the standard chemotherapy treatment.

Objective:To evaluate the micro-push-out bond strengths of prefabricated glass fiber posts with poly-dopamine functionalized to root dentin using resin cements, contrasted with silane treatment. Methods:In the study, 30 glass fiber posts were randomly divided into 3 groups ( 10 posts in each group) for different surface treatments. Group 1, treated with poly-dopa; Group 2, treated with silane coupling agent for 60s;Group 3, no surface treatment (Control group). The 30 extracted human, single-rooted teeth were endodontically treated and a 9 mm post space was prepared in each tooth with post drills provided by the manufacturer. Following post cementation, the specimens were stored in distilled water at 37 ℃ for 7 days. The micro-push-out bond strengths were tested using a universal testing machine (0. 5 mm/min), and the failure modes were examined with a stereomicroscope. The data of the three groups were statistically analyzed using the one-way ANOVA test(α= 0. 05). Results:The bond strengths were (7. 909 ± 1. 987) MPa for Group 1, (5. 906 ± 0. 620) MPa for Group 2, and 4. 678 ± 0. 910 MPa for Group 3 . The bond strength of poly-dopamine group was significantly higher than that of the silane group (P<0. 05). Conclusion: Contrasted with silane treatment, surface poly-dopamine functionaliza-tion was confirmed to be a more reliable method for improving the bond strength of resin luting agents to fiber posts.

Objective Nanoknife,also called irreversible electroporation,is a new technique of tissue ablation.Short,microsecond electrical pulses with high voltage are applied to the cell membrane,causing pores to form within the membrane and finally leading to cell death.The current study was to investigate the efficacy and safety of the nanoknife in the ablation of the healthy pig pancreas.Methods Three healthy pigs underwent open pancreatic tissue ablation with nanoknife,and blood leukocytes and amylase were detected before and after treatment.Three pigs were sacrificed and gross specimens were collected on day 5,day 10 and day 15 after the procedure,respectively.HE staining and TUNEL staining were conducted and tissue,cellular and subcellular structures were observed under the ordinary microscope and transmission electron microscopy.Results Three experimental pigs recovered well after the procedure.No significant adhesions were found surrounding the pancreatic tissue,and the ablation zone was slightly harder.Transiently increased leukocyte count and amylase level were observed after the ablation,which decreased to the normal level on day 3 after treatment.Under light microscope,the pancreatic tissues in ablation zone appeared to be significantly different from the normal surrounding regions,with more cell death and more apoptotic cells detected by TUNEL staining.The subcellular structure changes also changed under electron microscope.But the main pancreatic duct and its large branches,together with arteriovenous distributions did not change much.Conclusions Nanoknife pancreatic tissue ablation can induce irreversible damage.In the ablation area,pancreatic duct and vascular structures are kept intact.Within a reasonable voltage range and appropriate electrical pulses setting,nanoknife ablation is safe in vivo experiment.

Objective To investigate the diagnosis and treatment of traumatic pancreatic injury.Method The clinical data of 35 patients with traumatic pancreatic injury treated between January 1998and July 2010 at the General Hospital of Chinese PLA were retrospectively analyzed.Results There were 9 patients with Grade Ⅰ injury,7 with Grade Ⅱ injury,7 with Grade Ⅲ,7 with Grade Ⅳ,and 5 with Grade V injury,respectively.The diagnostic rate using CT before operation was 75.8％.8 patients with mild traumatic pancreatic injury received nonoperative treatment. 27 patients underwent open operation which included 15 simple external drainage of the pancreas area,2 distal pancreatectomy,5 Roux-en-Y pancraticojejunostomy,3 duodenal diverticulisation procedure,and 2 pancreaticoduodenectomy.After operation,there were 14 patients with pancreatic leakage,9 with intraabdominal infection,and 6 with intrabdominal bleeding.There were 3 patients with Grade Ⅳ and Grade V injuries who died of multiple organ failure or uncontrolled massive intraabdominal bleeding.Conclusions It was difficult to diagnose pancreatic injury before operation.CT was a suitable method to accurately diagnose severe traumatic pancreatic injury.Most minor pancreatic injury could be treated nonoperatively or by external drainage.The appropriate operation should be selected according to the extent and degree of the injuries basing on the principle of damage control in patients with major injuries.Pancreatic fistula,intraabdominal infection and bleeding were conrmon complications after operation.Multiple organ failure and massive bleeding were the main causes for mortality.

Objective To evaluate the perioperative safety and effect of irreversible electroporation (IRE) in the treatment of locally advanced pancreatic carcinoma (LAPC).Methods Twenty patients with imaging and cytohystological diagnosis of unresectable locally advanced pancreatic carcinoma were enrolled to undergo IRE treatment.The perioperative IRE-related complications were primarily analyzed to evaluate the safety of the procedure.The tumor reduction and biological response were analyzed through CT/MRI imaging and serous level of CA19-9.Results All patients were successfully treated with an average tumor size of(4.2 ± 0.6) cm and an average procedure time of (52.0 ± 23.3) minutes.Three intraoperative procedure-related complications were observed (15.0％) including two transient hypertension and one transient superventricular tachycardia.Six postoperative complications were described including two Grade A pancreatic fistula,one infection of incision,one portal vein thrombosis,one gastrointestinal hemorrhage and two functional delayed gastric emptying.The symptom remission rate was 73.7％ and lower serum CA19-9 level was recorded in all patients at discharge.Conclusions IRE is a safe and feasible procedure in the treatment of LAPC, and a reasonable operation strategy of IRE is helpful to consolidate the safety and efficacy.

Objective:Using lasso regression analysis to screen out the blood lipid indexes closely related to coronary heart diseaseMethods:The clinical data of 3 062 patients with coronary heart disease who were hospitalized in the Department of Cardiology, Affiliated Hospital of Jining Medical College from May 2013 to November 2015 were retrospectively analyzed.They were divided into control group ( n=2 427) and coronary angiography group ( n=635). R language was used for statistical analysis.Multiple logistic regression models were established for indicators of blood lipid related to CAD, and their multicollinearity severity was assessed.LASSO regression was used to screen out the representative lipid parameters in the CAD prediction model. Results:A total of 3 062 patients were enrolled, including 2 427 patients in coronary heart disease group and 635 patients in control group.The inclusion of lipid parameters into multiple logistic regression model leads to serious multicollinearity.Stepwise regression can only partially reduce multicollinearity severity, while LASSO regression model significantly reduces multicollinearity severity.Low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) were found to be the representative lipid indexes for predicting coronary heart disease by LASSO regression analysis.Conclusion:LASSO regression has advantages in processing multicollinearity data.LASSO regression showed that LDL-C, HDL-C and non-HDL-C were representative lipid indicators for predicting coronary heart disease..

Objective To investigate the difference of hepatic microvessel density, neovasculariza-tion of regenerating liver tissue after ablation of two ways of irreversible electroporation and radiofrequency ablation in rats. Methods 90 male Sprague-Dawley rats were randomly divided into 3 groups, including the control group ( n =30), the irreversible electroporation group ( n =30 ) and the radiofrequency ablation group (n=30). 3,7 and 10 days were executed after the operation and draw material, expression of vascu-lar endothelial growth factor(VEGF) and CD34 in tissue was studied by immunohistochemistry, and the mi-crovascular density of tissue and VEGF positive cells were measured. Results The microvascular density of 3, 7 and 10 days in the control group was 50. 3 ± 12. 5, 54. 6 ± 11. 9 and 58. 2 ± 14. 7, the microvascular density of the radiofrequency ablation group was 18. 4 ± 4. 7, 17. 3 ± 5. 1 and 18. 1 ± 5. 9, respectively. The microvascular density of the irreversible electroporation group was 42. 8 ± 10. 4, 45. 6 ± 10. 2 and 49. 2 ± 13. 8, respectively. The positive cells of VEGF in control group was 50, 56 and 57 at 3, 7 and 10 days, and 32, 30 and 33 at 3, 7 and 10 days in radiofrequency ablation group, 44, 43 and 45 at 3, 7 and 10 days in irreversible electroporation group; expression of VEGF and CD34 in 3, 7, 10 d and the microvascular density of ablation area in radiofrequency ablation group was significantly lower than those in control group after irreversible electroporation and radiofrequency ablation. No significant differences were found between irreversible electroporation group and control group. Conclusion The irreversible electroporation can effectively protect the microvessels in the ablation area, ensure the tissue’s blood supply after the ablation, and provide a guarantee for the repair and regeneration of the tissue.

Objective:To determine the predictive value of atherogenic index of plasma (AIP) on the long-term prognosis of patients with coronary artery disease (CAD).Methods:A total of 2 500 patients with coronary heart disease who underwent coronary angiography in Affiliated Hospital of Jining Medical University from May 2013 to November 2015 were retrospectively analyzed. According to the AIP value, the subjects were divided into low AIP group (AIP<0.06) and high AIP group (AIP≥0.06). The incidence of major adverse cardiovascular events (MACE) was compared between the two groups. Kaplan-meier method was used to evaluate the MACE-free survival rate, and multivariate Cox survival analysis was used to evaluate the independent predictors of MACE.Results:A total of 2 427 patients were followed up, with a follow-up rate of 97.08% and a median follow-up time of 4.29 years. There were 1 123 cases in the low AIP group and 1 304 cases in the high AIP group, among which 624 patients (25.7%) had MACE. The total incidence of MACE in the high AIP group was higher than that in the low AIP group ( HR=1.43, 95% CI: 1.22-1.68, P<0.01). Kaplan-meier curves showed that the MACE-free survival rate was significantly lower in the high AIP group ( P<0.01). After adjusting for multiple confounding factors, AIP was still associated with the prognosis of CHD patients. Increased AIP (≥0.06) was an independent predictor of MACE in CHD patients within 4 years ( HR=1.34, 95% CI: 1.14-1.58, P<0.01). Conclusions:AIP (≥0.06) was an independent predictor of MACE occurrence in patients with CAD within 4 years. AIP has a certain value in the long-term prognosis of patients with CAD.

Objective To estimate the incidence of drop out of treatment in patients with access to methadone maintenance treatment and explore the correlation and interaction between insufficient methadone dosage and morphine positive urine on the drop out in Guangxi Zhuang Autonomous Region.Methods Face to face interview was conducted in 1 031 patients at 3 methadone maintenance treatment clinics in Guangxi.Results The study included 1 031 participants,40.6％ of them (419/1 031) had stopped treatment.The drop out rates in urine morphine positive group and methadone dosage ＜ 100 mg/d group were 57.6％ (99/172) and 37.4％ (347/929) respectively,higher than those in urine morphine negative group and methadone dosage ≥ 100 mg/d group (42.3％,363/ 859,and 26.5％,27/102).Orderly logistic regression analysis results showed that after adjusted factors,such as gender,age,marital status,ethnic group,patients who received a dosage less than 1 00 mg/day (OR=3.05,95％CI:1.84-5.06) and had morphine positive urine (OR=2.25,95％CI:1.59-3.19) were more likely to drop out of the treatment.Interaction analysis showed that dosage less than 100 mg/d and morphine positive urine during treatment had additive interaction (RERI=256.46,AP=0.87,S=8.05) and multiplication interaction (OR=2.45,95％CI:1.71-3.49).Conclusion Insufficient dosage and morphine positive urine were significantly correlated with drop out of treatment in patients with access to methadone maintenance treatment.

Objective To investigate the influence of body configuration on the therapeutic effects of totally laparoscopic and laparoscopy-assisted radical total gastrectomies.Methods The retrospective cohort study was conducted.The clinicopathological data of 677 patients with gastric cancer who underwent laparoscopic radical total gastrectomies in the 11 clinical centers [100 patients in the First Affiliated Hospital of Army Medical University (Third Military Medical University),98 in the First Affiliated Hospital of Nanjing Medical University,94 in the First Affiliated Hospital of Nanchang University,89 in the First Affiliated Hospital of Xiamen University,81 in the Affiliated Hospital of Qinghai University,81 in the First Affiliated Hospital of Xinjiang Medical University,42 in the First Affiliated Hospital of Xi'an Jiaotong University,39 in the Traditional Chinese Medicine Hospital of Guangdong Province,26 in the First People's Hospital of Hangzhou City,17 in the Second Affiliated Hospital of Jilin University and 10 in the Xijing Hospital of Air Force Medical University (Fourth Military Medical University)] from January 2015 to June 2017 were collected.Among 677 patients,305 [89 patients in the First Affiliated Hospital of Army Medical University (Third Military Medical University),28 in the First Affiliated Hospital of Nanjing Medical University,14 in the First Affiliated Hospital of Nanchang University,26 in the First Affiliated Hospital of Xiamen University,75 in the Affiliated Hospital of Qinghai University,14 in the First Affiliated Hospital of Xinjiang Medical University,10 in the First Affiliated Hospital of Xi'an Jiaotong University,10 in the Traditional Chinese Medicine Hospital of Guangdong Province,19 in the First People's Hospital of Hangzhou City,13 in the Second Affiliated Hospital of Jilin University and 7 in the Xijing Hospital of Air Force Medical University (Fourth Military Medical University)] undergoing totally laparoscopic total gastrectomy were allocated into the totally laparoscopic group,and 372 [11 in the First Affiliated Hospital of Army Medical University (Third Military Medical University),70 in the First Affiliated Hospital of Nanjing Medical University,80 in the First Affiliated Hospital of Nanchang University,63 in the First Affiliated Hospital of Xiamen University,6 in the Affiliated Hospital of Qinghai University,67 in the First Affiliated Hospital of Xinjiang Medical University,32 in the First Affiliated Hospital of Xi'an Jiaotong University,29 in the Traditional Chinese Medicine Hospital of Guangdong Province,7 in the First People's Hospital of Hangzhou City,4 in the Second Affiliated Hospital of Jilin University and 3 in the Xijing Hospital of Air Force Medical University (Fourth Military Medical University)] undergoing laparoscopy-assisted total gastrectomy were allocated into the laparoscopy-assisted group.All patients received laparoscopic radical total gastrectomy and D2 lymphadenectomy using routine five-port method.Roux-en-Y anastomosis was applied for digestive tract reconstruction,and digestive tract reconstruction was performed under laparoscopy in the totally laparoscopic group and via upper abdominal median incision in the laparoscopy assisted group.Observation indicators:(1) surgical and postoperative situations;(2) stratified analysis:surgical and postoperative situations of obese patients [body mass index (BMI) ＞ 25.0 kg/m2,the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the xiphoid bone (X-APD) ＞ an average value of 22.7 cm and X-APD/the maximum horizontal distance of a plane at a right angle to X-APD (X-TD) ＞an average value of 0.8] between groups;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative overall survival and tumor recurrence or metastasis up to July 2017.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed by the t test.Measurement data with skewed distribution were described as M(Q),and comparison between groups was analyzed by Mann-Whithey test.Comparisons of count data were analyzed using the chi-square test.Results (1) Surgical and postoperative situations:all the patients in the 2 groups underwent successful operations,without perioperative death.Esophagojejunostomy methods of 305 patients in totally laparoscopic group:conventional circular stapler method were performed in 107 patients,antipuncture circular staplar method in 6 patients,OrVilTM method in 5 patients,functional end-to-end esophagojejunostomy method in 76 patients,peristalsis side-to-side esophagojejunostomy method in 106 patients and π esophagojejunostomy method in 5 patients.Three hundred and seventy-two patients in the totally laparoscopic group received conventional circular stapler method,including 361 with end-to-side esophagojejunostomy method and 11 with half end-to-end esophagojejunostomy method.Total operation time,time of esophagojejunostomy,length of assisted incision and using time of analgesics were respectively (235± 72)minutes,(33 ± 15)minutes,(5.6± 1.4) cm,(2.0 ± 1.2) days in the totally laparoscopic group and (223± 63) minutes,(29 ± 10) minutes,(8.0 ± 2.6) cm,(2.3 ± 1.6) days in the laparoscopy-assisted group,with statistically significant differences between groups (t =2.383,3.289,-15.236,-2.780,P ＜ 0.05).The eases with postoperative overall complications,anastomosis bleeding,anastomosis stricture,anastomosis leakage were respectively 38,6,11,11 in the totally laparoscopic group and 35,7,10,13 in the laparoscopy-assisted group,with no statistically significant difference between groups (x2 =1.621,0.007,0.470,0.006,P＞0.05).All the patients with postoperative complications were cured by symptomatic treatment.(2) Stratified analysis:length of assisted incision,using time of analgesics,time to postoperative anal exsufflation,time for initial fluid diet intake,time for initial semi-fluid diet intake,time of postoperative drainage-tube removal and duration of postoperative hospital stay in obese patients with BMI＞25.0 kg/m2,X-APD＞22.7 cm and X-APD/X-TD＞0.8 were respectively (5.9±1.3)cm,(5.7±1.4)cm,(5.6±1.4)cn,(2.0±1.2) days,(2.2±1.1)days,(2.1±1.1)days,(3.4±0.9) days,(3.3±0.9)days,(3.3±0.8)days,(4.7±1.1)days,(4.1±2.0)days,(4.0±1.6)days,(6.6±1.5)days,(6.4±2.3)days,(6.3±1.9)days,(7.8±2.3)days,(7.8±2.7)days,(7.6±2.9)days,(9±4)days,(10±5)days,(10±5) days in the totally laparoscopic group and (8.7±3.1)cm,(8.9±3.0)cm,(8.8±2.8)cm,(2.4±1.3)days,(2.5±1.5)days,(2.5±1.6)days,(3.7±1.0)days,(3.8±1.1)days,(3.7±1.3)days,(5.3±1.7)days,(4.8±1.7)days,(5.0±1.9)days,(7.4±2.3)days,(7.8±2.0)days,(7.0±2.2)days,(8.7±2.4)days,(8.4±1.9)days,(8.1±1.5)days,(1 1±8)days,(11±5)days,(1 1±5)days in the laparoscopy-assisted group,with statistically significant differences between groups (t =-7.950,-2.246,-2.222,-2.500,-2.771,-2.404,-2.251,P＜0.05).There were statistically significant differences in above indicators of patients with X-APD＞22.7 cm between groups (t =-12.089,-2.064,-3.732,-3.220,-5.297,-2.074,-2.208,P＜0.05),and in above indicators of patients with X-APD/X-TD＞0.8 between groups (t =-13.451,-2.736,-3.354,-4.961,-3.280,-2.137,-2.127,P＜0.05).(3) Follow-up and survival situations:of 677 patients,645 were followed up for 1-31 months,with a median time of 12 months,including 283 in the totally laparoscopic group and 362 in the laparoscopy-assisted group.During the follow-up,cases with overall survival,tumor recurrence and tumor metastasis were respectively 255,18 and 21 in the totally laparoscopic group and 327,25 and 20 in the laparoscopy-assisted group (11 and 10 patients in the totally laparoscopic and laparoscopy-assisted groups with simutaneous tumor recurrence and metastasis),showing no statistically significant difference between groups (x2 =0.009,0.076,0.959,P ＞ 0.05).Conclusions Totally laparoscopic and laparoscopy-assisted radical total gastrectomies are safe and feasible in obese patients,with the equivalent time of esophagojejunostomy.Totally laparoscopic radical total gastrectomy is of benefit to short-term recovery of patients.