Objective To compare the safety and effectiveness of duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving pancreaticoduodenectomy (PPPD) in the treatment of chronic pancreatitis with a pancreatic head mass.Methods Medline,Biosis,Cochrane Library,Science Citation Index Database,CBM Database,Wan Fang and CNKI were searched systematically.The bias risk of the included trials was assessed according to the assessing tools as suggested by the Cochrane Handbook.Review Manage 5.2 was used to perform the statistical analysis.Results 7 RCTs with 226 patients were included in the meta-analysis which showed that there were no significant differences between PPPD and DPPHR in overall postoperative morbidity,postoperative hospital stay,complete pain relief,pancreatic fistula,exocrine insufficiency,symptom score at 5 to 7-year follow-up,and quality of life score at 14 to 15-year follow-up (P ＞ 0.05).While DPPHR had significant superiorities in operation time,blood replacement,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,quality of life score at 1 to 2-year follow-up,symptom score at 5 to 7-year follow-up,and physical functioning score at 14 to 15-year follow-up.Conclusions DPPHR is more favourable than PPPD in reducing the use of blood replacement,shortening operation time,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,physical functioning,and in improving quality of life of patients.

Objective To investigate the feasibility of construction of tissue engineering nucleus pulposus by com?bining the novel silk fibroin porous scaffold with PKH26 labeled rabbit nucleus pulposus cells. Methods Rabbit nucleus pulposus cells were isolated and cultured, then the passage 1 nucleus pulposus cells were stained with safranin O and typeⅡcollagen immunohistochemical staining. The isolated rabbit nucleus pulposus cells were labeled with PKH26. MTT assay was used for examining the proliferation of the nucleus pulposus cells before and after labeling. Labeled cells were inoculat?ed in the scaffold, cultured for 4 days and then the cell-scaffold complexes were implanted subcutaneously into nude mice. After 12 weeks of in vivo culture, the cell-scaffold complexes were detected by in vivo imaging technology, H&E staining, toluidine blue staining, safranin O staining and collagen typeⅡimmunohistochemical staining. Results Safranin O stain?ing and typeⅡcollagen immunohistochemical staining of the passage 1 nucleus pulposus cells were positive. The fluores?cence intensity of labeled cell was distributed, and the difference of OD value of nucleus pulposus cells was not statistically significant before and after labeling (P>0.05). The in vivo imaging technique showed a strong fluorescencea in porous scaf?fold. H&E staining of cell-scaffold complexes showed that the scaffolds were filled with a large number of nucleus pulposus cells and large amount of extracellular matrix. Toluidine blue staining, safranin O staining and typeⅡcollagen immunohisto?chemical staining were positive, and large amount of extracellular matrix was secreted around the cells. Conclusion The new silk fibroin porous scaffold with rabbit nucleus pulposus cells in vivo culture formed nucleus pulposus like tissue, which can be used for construction of tissue engineering nucleus.

OBJECTIVETo investigate effects of the variation of immune function in high humidity environment in different time, and lay a foundation for further study of the related mechanism.

METHODThirty SD rats were divided into 3 groups (n = 10): 20 day group, 40 day group in 90% relative humidity chamber and control group in normal relative humidity. Peripheral blood and spleens were collected to detect the levels of T lymphocyte subsets by Flow Cytometery.

RESULTSIn peripheral blood of the 20 day group rats, the CD3+ %, CD4+ %, CD8+ % and CD4+/CD8+ were 52.91 +/- 6.27, 37.80 +/- 4.11, 14.85 +/- 3.73 and 2.72 +/- 0.82 separately. Expect CD3+ %, they all had significant differences (P < 0.05). In addition, the data of the 40 day group rats showed no diversity in statistics. In spleen, CD8+ % of the 20 day group rats was 6.23 +/- 2.87 with significant differences (P < 0.05) and IgG, IgA and IgM did not change a lot in blood serum of the high humidity groups except C3 of the 20 days group (P < 0.05).

CONCLUSIONIn high humidity environment, the immune function of the rats increased in the initial stage. As time went on, the immune function gradually went to normal level through the self adjustment.

Objective To evaluate the prognosis in patients with hepatocarcinoma by examining the expression of α-fetoprotein (AFP) and des γ prothrombin (DCP).Methods Retrospectively analyzed the expression of AFP and DCP in 105 patients received curative hepatectomy.Divided the patients into three groups as follow:the tumor markers were both negative pre-and post-operation (Group N) ; the tumor markers decreased to normal after operation (Group D) ; the tumor markers kept positive or decreased but still higher positive after operation (Group P).Then combined the two markers and divided the patients into 4 groups:two markers both negative(AFP + DCP +)(Group A) ; AFP + DCP-(Group B) ; AFP-DCP + (Group C) ; AFP-DCP-(Group D).Results High AFP and DCP levels were significantly associated with poor tumor-free and overall survival.The presence of large size and advanced stage were significantly associated with Group P.Overall survival in the AFP-N group was significantly better than that of other groups and overall survival in DCP-N group were significantly better than that of the P group.After the combination,Group A had the best overall and tumor free survival rate while the D group had the worst.The differences between B and C group were not significant.Conclusions AFP and DCP can be both used solely as tumor markers and the expressions of them are associated with the prognosis.The combination of two markers can be used for better prediction of hepatocarcinoma.

Objective To compare oral with intravenous Prednisolone after hepatoportoenterostomy in improving biliary drainage and survival with the native liver.Methods Forty-nine cases of biliary atresia were conducted from January to December in 2012.Participants were randomized to receive oral Prednisolone (group A) or intravenous Prednisolone (group B) on the fifth day of posthepatoportoenterostomy (the other treatments were same,including intravenous injection of Cefoperazone for 2 weeks, choleretic treatment, etc.).The initial dose was 4 mg/(kg · d), and it was reduced by half per 3 days, until 1 mg/(kg · d).Then Prednisolone was administered orally with 1 mg/(kg · d)for 3 months.The primary end points were the total bilirubin level(TBIL) and the percentage of cholangitis in 6 months of posthepatoportoenterostomy.Secondary outcome was survival with native liver in 24 months after hepatoportoenterostomy.Results The ages of group A and group B were(98 ±33) d and(105 ±36) d,TBIL of them were (158.36 ± 55.22) μmol/L and (160.11 ±43.12) μmol/L,and there were no statistical differences between the 2 groups before surgery (t =-0.663,-0.123, all P ＞ 0.05).In the first 2 months after operation, the mean TBIL value of group A was higher than that of group B (in the first month after surgery ,the TBIL quartiles P25 ,P50 ,P75 of group A were 105 μmol/L, 152 μmol/L, 236 μmol/L, and the quartiles of group B were 40 μmol/L, 74 μmol/L, 99 μmol/L.In the second month after surgery,the TBIL quartiles of group A were 67 μmol/L, 103 μmol/L, 144 μmol/L,and the quartiles of group B were 39 μmol/L,64 μmol/L, 196 μmol/L) (all P ＜ 0.05).The morbidity of cholangitis which occurred in group A(56.0％ ,60.0％) was higher than that in group B (25.0％, 29.2％) (x2 =4.871,4.705, all P ＜ 0.05).However,from the 3rd to 6th months,there was no statistical difference between group A and group B(all P ＞ 0.05).Transplant-free survival was 44.0％ in group A and 47.7％ in group B 24 months after operation, and there was no statistical difference(x2 =1.007 ,P ＞ 0.05).Conclusions Therapy of intravenous Prednisolone following portoenterostomy may be more beneficial in bile drainage than oral method,but it's of no use to improve survival.

Objective To compare the difference of the effects and safety of endoscopic submucosal dissection (ESD) and surgery for early gastric cancer. Methods We searched the Pubmed, CBM, Embase, Cochrane Library, CNKI, CQVIP and WanFang data from January 1990 to June 2016 studies comparing endoscopic resection with gastrectomy for treatment of early gastric cancer. We selected the eligible studies according the including and excluding criteria. The quality of the included studies was assess using the Newcastle-Ottawa Scale (NOS), then using Revman 5.3 to make the Meta analysis. Result The meta-analysis enrolled 12 studies with 4331 patients, all of the studies were retrospectively analyzed. The result of the meta-analysis showed that there were no significant difference regarding the recurrence rate [(22/2586, 0.85%) vs (6/1134, 0.53%), P = 0.370] and five-year survival rate [(852/909, 93.72%) vs (707/746, 94.77%), P = 0.340] between endoscopic resection and gastrectomy. Gastrectomy was associated with higher en bloc resection rate, which were 100.00% and 92.23% respectively. However, gastrectomy was also related to longer operative time (SMD = -3.04, 95%CI: -3.64 ~ -2.45, P = 0.000) and hospital stay (SMD = -2.53, 95%CI: -3.73 ~ -1.32, P = 0.000). The postoperative complication was also higher than endoscopic, which were (45/816, 5.50%) vs (101/686, 14.72%) respectively. Conclusion There were no significant difference regarding recurrence rate and five-year survival rate between endoscopic and gastrectomy. While the en bloc resection rate was lower than gastrectomy, endoscopic offers a shorter hospital stay, shorter operative time with minimal invasive and fewer operating and postoperative complications than gastrectomy. Endoscopic should be recommended as a standard treatment for early gastric cancer with indications.

Objective To investigate the effect of progressive decompression elasticity socks therapy on life quality of the lower extremity deep vein thrombosis patients.Methods 50 qualified patients were divided into 2 groups receiving respectively compression therapy or not.Analysis and comparison were made based on results of SF36 questionnaire.Results There were no demographic differences between the two groups.Average follow-up time was (5.6 ± 2.4) months,the cronbach α coefficient was 0.8652 in compression therapy group,there was significant improvement on every evaluated stage and in every dimension after standard treatments (P ＜ 0.01),while in control group,only 4 dimensions (PF,RP,RE,BP) improved (P ＜ 0.05),there were statistical differences on every dimension between the two groups (P ＜ 0.01).Conclusions Progressive decompression elasticity socks therapy helps make the recovery of patients of acute deep vein thrombosis of the lower extremities.

Objective To study the use of a preoperative predictive scoring system established by the Beth Israel Deaconess Medical Center,Washington University School of Medicine and Hospital of the University of Pennsylvania for patients with clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy.Methods The clinical data of 394 patients who underwent pancreaticoduodenectomy at the Provincial Hospital Affiliated to Anhui Medical University from September 2007 to December 2015 were retrospectively analyzed.The four indexes including the gland texture,pathology,pancreatic duct diameter and intraoperative blood loss were calculated for the predictive score system using the logistic regression test.The factors associated with CR-POPF were analyzed.The sensitivity and specificity of the predictive scoring system were determined by the receiver operating characteristic (ROC) curve analysis.Results Of the 70 patients who were diagnosed to have postoperative pancreatic fistula (POPF),34 were CR-POPF,which included 36 with grade A,23 with grade B and 11 with grade C.Univariate analysis showed that male,preoperative serum total bilirubin level ≥ 170 mmol/L,pancreatitis or pancreatic cancer,portal vein invasion,soft pancreatic texture,main pancreatic duct diameter ≤ 3 mm,and pancreaticojejunostomy were significantly related to POPF after pancreaticoduodenectomy (P ＜ 0.05).Portal vein invasion,pancreatic texture and main pancreatic duct diameter were the risk factors of CR-POPF after pancreaticoduodenectomy (P ＜ 0.05).Multivariate analysis showed the independent risk factors associated with POPF were male,preoperative serum total bilirubin level ≥ 170 mmol/L,soft pancreatic texture and main pancreatic duct diameter ≤3 mm (P ＜ 0.05),while soft pancreatic texture and main pancreatic duct diameter ≤3 mm were the independent risk factors of CR-POPF (P ＜ 0.05).There were significant differences in the clinical relevant postoperative pancreatic fistula rates among the negligible risk,low risk,intermediate risk,and high risk patients with CR-POPF (P ＜ 0.05).The results of ROC curve analysis showed that the sensitivity and specificity of the Fistula Risk Scoring system were 76.5％ and 95.8％,respectively.The nomogram showed the area under the curve was 0.913 (95％ CI:O.858 ～ 0.968).Conclusion The preoperative predictive scoring system accurately predicted the occurrence of CR-POPF.

Objective To explore the mechanism of preventive effect of Chinese medicine with Replenishing kidney and invigorating Qi on osteoarthritis. Methods 72 male Long-eared white rabbits aged 4 months were randomly divided into six groups, A group (blank control group), B group (model group), C group (traditional Chinese medicine high-dose prevention group), D group (Chinese herbal medicine with medium-dose prevention group), E group (Chinese herbal medicine with low-dose prevention group), F group (glucose-amino acid hydrochloride capsules prevention group).All the animals apart from A group were established osteoarthritis model by immobilizing knee joint with plaster cast for 6 weeks. In the same time of immobilization, traditional Chinese medicine and glucose-amino acid hydrochloride capsules were given to C, D, E and F group for 4 weeks. Physiological saline was given to B group. After 6 weeks of modeling, synovial fluid was extracted and the changes of TNF-α in it were analyzed by ELISA. Results Articular cartilage degeneration of B group was most obviously compared with C, D, E and F group. There was a significant difference of TNF-α level in comparison of A and B group (P＜0.05), B and C, D, E and F group (P＜0.05), and among C, D and E group. Conclusion Chinese medicine with replenishing kidney and invigorating Qi can prevent osteoarthritis by reducing TNF-α level in synovial fluid, enhancing cartilage cell metabolism, and slowing down cartilage degradation.

Objective To analyze the clinical features of patients with traumatic brain injury in the Ya' an earthquake and discuss the treatment experiences.Methods Medical records of 69 patients admitted from April 2013 to May 2013 because of traumatic brain injury in the Ya' an earthquake were collected.Retrospective review was performed for age,gender,causes of injury,time from injury to hospitalization,types of injury,associated injury,treatment methods and outcomes.Results There were 47 males and 22 females.Forty-two patients (61％) were injured from falling objects.Fifty-eight patients (84％) were sent to the West China Hospital within 72 hours postinjury.Twenty-two cases (32％) sustained associated injuries.Twenty-nine patients (42％) were critically injured.Twenty-four patients underwent operation at the local hospital and twelve patients had operation at our hospital.Outcome measure using GOS one month after treatment showed 55 favorable recovery,5 moderate disability,4 severe disability,and 5 coma.Conclusions Main cause of injury is hit by falling objects during the Ya' an earthquake.Majority of the patients obtained effective treatment in the time window.GCS in combination with patients' general condition used in casualty triage and critical patients charged by neurosurgeons and treated with the cooperation of multiple disciplinary teams are helpful to successful treatment.