Objective To investigate the indication an d timing for operation in severe acute pancreatitis. M ethod The clinical data of 213 patients with severe acute pancr eatitis treated in our hospital were analyzed. Resul ts Fifty two cases of severe biliary pancreatitis were treated operatively with survival rate of 92%, in which the death cases had a mean su rvival time of 31 days. 43 cases were treated nonoperatively with survival rate of 88%, in which death cases had a mean survival time of 3 days. Sixty five case s of non-biliary pancreatitis were treated operatively with survival rate of 75 %, in which the death cases had a mean survival time of 56 days. 56 cases were treated nonoperativly with survival rate of 89%, in which the death cases had a mean survival time of 8 days.Conclusion (1)Pancreatitis with biliary obstruction should be treated by urgent surgery, in those with infected necrosis a surgery is also indicated.(2) In no n-biliary pancreatitis, nonoperative therapy should be adopted unless there is a sign o f severe peritonitis. Moreover, patients with rapid deteriorated clinical condit ions should undergo exploration. (3) Localized infected necrosis is indicated fo r operation.

Objective To study the clinical meaning of Transgelin expression in heptacellular carcinoma(HCC) in prognosing recurrence after hepatectomy. Methods The expression of Transgelin in cancerous lesions and tissue adjacent to cancer lesions from 223 operation samples was detected by immunohistochemical staining combined with tissue microarray techniques. The correlation between the level of Transgelin expression and the prognosis was analyzed by means of log- rank test, Kaplan- Meier analysis and multivariate Cox regression analysis. Results Transgelin was higher expressed in tumor tissue than in tissue adjacent to cancer lesions. Transgelin was positively correlated with the presence of tumor size, portal vein invasion, pTNM tumor stages and serum AFP level. Patients with positive expression of Transgelin had worse tumor free survival than those with negative ones (P ＜0. 01). The multivariate Cox regression analysis showed that Transgelin expression level was one of the independent prognostic factors in tumor free survival after surgery. Conclusions The expression of Transgelin in hepatocellular carcinoma was significantly associated with recurrence in patients with HCC after hepatectomy, and this protein could be the biomarker of the prognosis in HCC surgery.

ObjectiveTo discuss the diagnosis and treatment of rupture of spleen in a base-level hospital with limited conditions. MethodsThe clinical data, diagnosis of bleeding by ultrasound, and results of (nonoperative) and operative treatment of 317 patients with rupture of spleen in Vila Central Hospital of the (Republic) of Vanuatu were retrospectively analyzed. ResultsUltrasound diagnosed 30 patients with (subcapsular) hemorrhage and 287 patients with true rupture of spleen. Based on ultrasound results, (conservative) treatment was used for 29 patients and 288 patients underwent operation. Conclusions(Ultrasonography) had a high positive diagnostic rate for rupture of spleen, and the diagnosis of bleeding volume was consistent with the findings at operation. The findings on ultrasonography can be considered in selection of cases with appropriate indications for splenectomy. Ultrasonography is an effective method for use in the (treatment) of rupture of spleen.

Objective To study the feasibility,safety,indications and possible advantages of minimally invasive surgery over traditional open surgery in treating pancreatic body or tail lesions.Methods From December 2009 to December 2014,the clinical data of 71 patients with lesions in pancreatic body or tail who underwent minimally invasive distal pancreatectomy (MIDP) or open distal pancreatectomy (ODP) at the General Surgery of Huadong Hospital were retrospectively analyzed.There were 22 patients in the MIDP group and 49 patients in the ODP group.The operations in 15 patients in the MIDP group were performed by the Da Vinci robot-assisted surgical system and 7 patients by laparoscopic distal pancreatectomy.Results The MIDP group had a shorter time to pass first flatus [(MIDP (2.5 ± 1.0) d vs ODP (3.5 ±1.0)d,P ＜ 0.05],and shorter postoperative hospital stay [(MIDP (15.2 ± 7.9) d vs ODP (23.4 ±21.2) d,P ＜ 0.05] than the ODP group.There were no significant differences on total pancreatic fistula rate [MIDP 45.5％ (10/22) vs ODP 55.1％ (27/49),P ＞ 0.05] and symptomatic postoperative pancreatic fistula rate [MIDP 18.2％ (4/22) vs ODP 18.4％ (9/49),P ＞ 0.05] between the two groups.The MIDP group had a significant longer operative time [MIDP (246.3 ±75.3)min vs ODP (168.1 ±33.7)min,P＜0.05] than the ODP group.Conclusions Minimally invasive surgery is safe and feasible in treatment of lesions in pancreatic body or tail with less trauma and faster recovery.The application of robotic surgery has expanded the treatment options for lesions in pancreatic body or tail.

Objective To investigate the relationship between EphA2, EphrinAl and E-cadherin expressions and tumor stage and prognosis in pancreatic cancer. Method EphA2, EphrinAl and Ecadherin expressions were detected by immunohistochemistry in the tumor tissue and normal tissue specimens from 48 patients with primary pancreatic cancer. Results The expressions of EphA2 and EphrinAl were higher in the pancreatic carcinoma tissues than in the normal pancreatic tissues (P<0. 05). The E-cadherin expression was lower in the pancreatic cancer tissues than in the normal pancreatic tissues (P<0. 05). With decreasing histological differentiation, the expressions of EphA2 and EphrinAl in carcinoma tissues increased significantly (P<0. 05), while the E-cadherin expression decreased significantly (P<0. 05). The positive expressions of EphA2 and EphrinAl in the primary tumor significantly increased in stageⅢ and Ⅳ than in stage Ⅰ and Ⅱ (47. 9%vs 6. 25% , P<0. 05;47. 9% vs 8. 3%, P<0. 05), while the negative expression of E-cadherin was reversely correlated with these tumor stages (14. 6% vs 64. 6%, P<0. 05). Cox multivariate analysis showed that the clinical stage, EphA2 positive expression and E-cadherin negative expression were significantly associated with survival. Conclusion Abnormal expressions of EphA2, EphrinAl and E-cadherin were involved in the progression of pancreatic cancer and they were useful in predicting prognosis.

Objective To investigate the prognostic value of vascular endothelial growth factor C (VEGF-C) and clinicopathologic indexes in predicting recurrence following curative resection of pancreatic cancer. Methods The expressions of VEGF-C of 47 patients who underwent curative resection for curative pancreatic cancer resection were detected by Envision immunohistochemical methods. The effects of VEGF-C and clinicopathologic indexes on recurrence were assessed by the Kaplan-Meier and Cox proportional hazards model. Results The positive rates of VEGF-C were 61. 7% in = 29) and 14. 9%(n = 7), respectively, in pancreatic cancer and normal pancreatic tissues. The positive expression of VEGF-C in pancreatic carcinoma was obviously higher than the normal pancreatic tissues (P = 0. 018). The median disease-free survival time was 11. 9 months, the average disease-free survival time was 18. 4 + 2. 4 months, and the cumulative 1-year, 2-year and 3-year actuarial recurrence free survival rates were 46. 8%, 23. 4%, 14. 4%, respectively. There was a significant correlation between the VEGF-C expression and lymph node metastasis in pancreatic cancer (P = 0. 036). On Kaplan-Meier analysis, VEGF-C (P = 0. 020), tumor diameter (P = 0. 013), age (P = 0. 057) and adjuvant chemotherapy (P=0. 017) were associated with disease-free survival time. Multivariate analysis showed VEGF-C (P = 0. 009), tumor diameter (P = 0. 010) and adjuvant chemotherapy (P = 0. 017)were independent prognostic factors of disease-free survival after surgery for pancreatic cancer.Conclusion The expression of VEGF-C was higher in pancreatic cancer, and VEGF-C was correlated with lymph node metastasis. VEGF-C was the biomarker that independently predicted disease-free survival after surgery for pancreatic cancer.

Objective To study the effect of intra-tumor injection of slow-release 5-FU on pancreatic carcinoma cells in nude mice,and on changes in serum tumor markers and cellular immunity of patients with pancreatic carcinoma.Methods (1) In vitro experiments, the releasing action and anti-tumor effect of slow-release 5-FU were studied. Measurement of the concentration of effused fluid,calculation of amount of drug released,and observation of the inhibitory effects of effused fluid on PC3 strains of pancreatic cancer cellswere perfomed.(2) Human pancreatic carcinoma strain PC-3 cells were cultured and inoculated into 60 nude mice,and were randomly divided into 5 groups according to various treatments received: NS injection as control group(A group), 5-FU (10 mg/kg)IV injection group(B group), stroma implant group(C group), intra-tumor injection of high dose slow-release 5-FU (4mg/kg) group(D group) and intra-tumor injection of low dose slow-release 5-FU (1mg/kg) group(E group). Tumor size were measured before and 14 days after treatment. On week 2, histological changes of the tumors were examined. The apoptotic index (AI) of the tumor cells was detected by terminal-deoxynucleotide transferase mediated d-UTP nick end labeling(TUNEL) and expression of bcl-2 and Bax by immunohistochemistry.(3) 69 cases of unresectable pancreatic carcinoma were divided into 3 groups randomly:intra-tumor injection of slow-release 5-FU treated group(treatment group), intra-venous injection of 5-FU group( chemotherapy group), and control group. The serum values of CD3+, CD4+, CD8+, CD4+/ CD8+, NK cells, CEA, CA50, CA19-9, CA125 and CA242 were measured in all patients 1 day before and 14 days after operation. Results (1) There was 0.85 mg 5-FU released in the 1st day and 0.45 mg 5-FU released in the 3rd day. The release remained constant at 0.25 mg and continued for about 14 days. (2) The tumor growth suppression rate on the 1st day by effusion fluid of slow-release 5-FU was 60.27% and on the 3rd day was 34.25%. Later, it remained at about 25.00%. The tumor growth rate was slower in D and E group than in other groups (P

Objective To investigate the expression of resistin and inflammatory cytokines in pancreatic cancer and explore the association with clinicopathological features.Methods The enzyme-linked immunosorbent assay (ELISA) technique was used to examine the serum resistin level in 38 patients with pancreatic cancer and 32 healthy controls.The real-time PCR technique was used to detect the mRNA expression level of resistin and inflammatory cytokines TNF-α,IL-2 and IL-8 in surgically resected specimens of pancreatic cancer patients.Results The serum resistin level in patients with pancreatic cancer was significantly higher than that in healthy controls (P ＜ 0.05).The serum resistin level was positively associated with TNM stage and lymph node metastasis,respectively (P ＜ 0.05).There was no significant correlation between serum resistin level and age,gender,BMI,preoperative blood glucose levels,tumor location,tumor size,nerve invasion and differentiation grade (P ＞ 0.05).The expression level of resistin mRNA in pancreatic cancer tissues was 3.8 times more than that in normal pancreatic tissues (P ＜ 0.05).The mRNA expressiou level of proinflammatory cytokines as TNF-α and IL-8 in pancreatic cancer tissues were 2.1 and 1.9 times higher than those in normal pancreatic tissues (P ＜ 0.05).The mRNA expression level of anti-inflammatory cytokines IL-2 accounted for 20％ of that in normal pancreatic tissues (P ＜ 0.05).Conlusions The serum resistin level in patients with pancreatic cancer was significantly higher than that of healthy controls,and positively associated with TNM stage and lymph node metastasis.The expression level of resistin and proinflammatory cytokines IL-8 and TNF-α of pancreatic cancer tissues were significantly higher than those of normal pancreatic tissues.The expression level of anti-inflammatory cytokine IL-2 was less than that in normal pancreatic tissues.It's suggested that resistin may take part in the development and progression of pancreatic cancer by mediating inflammatory reaction.

ObjectiveTo describe the characteristics of treatment outcomes of multidrug-resistant tuberculosis （MDR-TB） patients enrolled in second-line treatment in Shanghai from 2017 to 2018， and to analyze the influencing factors of treatment outcomes. MethodsTotally 182 MDR-TB patients were analyzed by using data collected from the China tuberculosis management information system， the hospital's electronic medical record information system， whole genome sequencing results and a questionnaire survey， and logistic regression analysis was used to analyze the factors affecting the success of treatment. ResultsIn 182 MDR-TB patients， the success rate of treatment was 65.4%， the loss to follow-up rate was 8.2%， the mortality rate was 4.9%， the unassessable rate was 13.7%， and the drug withdrawal rate was 7.7%. The factors affecting the success of treatment in MDR-TB patients included age （35‒ years old， OR=5.28， 95%CI： 1.58‒17.59， P=0.007； 55‒ years old， OR=16.30， 95%CI： 4.36‒60.92， P<0.001） and compliance to medication （OR=0.55， 95%CI： 0.42‒0.72， P<0.001）. ConclusionThe treatment success rate of MDR-TB patients in Shanghai from 2017 to 2018 is significantly higher than the average level in China. Older patients and patients with less compliant are at higher risk of adverse treatment outcomes.

OBJECTIVE: To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS: A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, =33) and inverse ventilation group (group R, =33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T), OLV30 min (T), OLV60 min (T), and 15 min after recovery of TLV (T). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS: Sixty-three infants were finally included in this study. At T and T, Cdyn, PaO and OI in group R were significantly higher ( < 0.05) and Ppeak, PaCO and PA-aO were significantly lower than those in group N ( < 0.05). There was no significant difference in HR or MAP between the two groups at T and T ( > 0.05). The level of RAGE significantly increased after the surgery in both groups ( < 0.05), and was significantly lower in R group than in N group ( < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
Cystadenoma ; surgery ; Humans ; Infant ; Lung ; surgery ; One-Lung Ventilation ; Positive-Pressure Respiration ; Thoracoscopy ; Treatment Outcome