Objective To evaluate the pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy.Methods The clinical data of 455 patients who received pancreaticoduodenectomy at the Xijing Hospital from June 2007 to June 2012 were retrospectively analyzed.For patients with pancreatic duct diameter≥4 mm,duct-to-mucosa pancreaticojejunostomy(DMPJ)was applied(DMPJ group,210 cases).For patients with pancreatic duct diameter ＜ 4 mm,modified Child pancreaticojejunostomy was applied to 140 patients(modified Child group)whose jejunal end was smaller than the pancreatic stump,and binding pancreaticojejunostomy was applied to 105 patients(binding group)whose jejunal end was bigger than or equal to the pancreatic stump.The clinical efficacy and incidence of postoperative complications were compared among the 3 groups.The count data and measurement data were analyzed by chi-square test and t test,respectively.Results The pancreatic duct diameter of the DMPJ group was(4.4 ± 0.7)mm,which was significantly bigger than(2.8 ± 0.6)mm of the modified Child group and(2.3 ± 0.7)mm of the binding group(t =2.25,2.48,P ＜ 0.05).The diameter of the pancreatic stump of the modified Child group was(36 ± 5)mm,which was significantly bigger than(21 ± 6)mm of the binding group(t =21.65,P ＜ 0.05).The overall incidence of pancreatic leakage was 8.4％(38/455).There were no significant differences in the incidences of pancreatic leakage,peritoneal bleeding,abdominal infection,digestive dysfunction rate and the mean duration of hospital stay among the 3 groups(x2 =0.53,0.88,1.63,5.34,F =2.53,P ＞ 0.05).Conclusion Pancreaticojejunostomy procedure selection strategy based on the diameters of pancreatic duct and pancreatic stump could obtain good clinical efficacy and is appropriate.

Objective To evaluate the safety and efficacy of laparoscopic distal pancreatectomy in treatment of insulinoma.Methods Clinical data of 8 cases of insulinoma treated by laparoscopic distal pancreatectomy from Apr.2015 to Apr.2017 were retrospectively reviewed.Results Locations of the insulinoma in distal pancreas were all identified preoperatively by enhanced CT,MRI or somatostatin receptor scintigraphy (SRS).Laparoscopic distal pancreatectomy was applied to 8 cases,including combined splenectomy to 1 case.The operation time,bleeding volume,and postoperative hospital stay was (159±44) min,(125±119) ml and (5.5±1.4) days,respectively.Grade B fistula happened to one patient after surgery.The level of postoperative blood glucoses was normal in all cases.Conclusion Laparoscopic distal panreatectomy is safe,effective,and less invasive in treating insulinoma,with quick recovery and high efficacy in spleen preservation.

Objective Big endothelin-1(big ET-1) is associated with the prognosis of various cardiovascular diseases. This study is to explore the predictive value of plasma big ET-1 level for long-term outcome after mitral valvuloplasty in patients with moderate to severe chronic ischemic mitral insufficiency .Methods A total of 142 consecutive patients with moderate to severe chronic ischemic mitral regurgitation who underwent coronary artery bypass grafting and mitral valvuloplasty were enrolled at our center from January 2009 to December 2015.The clinical baseline data were collected and recorded.All patients were followed up.The mortalities and major adverse cardiovascular and cerebrovascular events during the follow-up period were re-corded.Results A total of 142 patients were enrolled, with mean age of(59.4 ±8.3) years.During(51.9 ±22.6) months follow-up, 19 cases(13.4％) died and 35 cases(24.6％) had major adverse cardiovascular and cerebrovascular events.Uni-variate and multivariate Cox regression analysis showed that big ET-1 was an independent risk factor for all-cause mortality (HR=3.970, 95％CI:1.535-10.268) and major adverse cardiovascular and cerebrovascular events(HR=2.754, 95％CI:1.238-6.129).In addition, left ventricular ejection fraction, pulmonary hypertension and stroke history were independent risk factors for all-cause mortality , while left ventricular ejection fraction , stroke history were independent risk factors for major adverse cardiovascular and cerebrovascular events.Conclusion Long-term outcomes of simultaneous coronary artery bypass grafting and mitral valvuloplasty for moderate to severe ischemic mitral insufficiency are satisfactory and big ET-1 is an inde-pendent risk factor for long-term outcomes of these patients.

Objective To verify the expression of long non-coding RNA(LncRNA) TCONS_00023867 in pancreatic cancer tissue and cells,and to explore its effects on cell proliferation,invasion and migration in pancreatic cancer cells.Methods The expression of lncRNA TCONS_00023867 in human pancreatic cancer tissues,adjacent non-cancer tissues,pancreatic cancer cells(Capan-2,AsPC-1,BxPC-3,MIAPaCa-2,PANC-1) and pancreatic normal duct epithelial cell (HPDE6c-7) was detected by quantitative real-time PCR (qRT-PCR).LncRNA TCONS_00023867 over-expression plasmid and its control plasmid PEX-3 were transfected in Capan-2 and PANC-1 cells.Then,the abilities of cell proliferation,invasion and migration were determined by using clone formation assay,CCK-8 assay and Transwell assay,respectively.Furthermore,the expression of p53 protein was examined by Western blot.Results The expression of IncRNA TCONS_00023867 in pancreatic cancer tissues was significantly lower than that in the matched adjacent pancreatic cancer tissue(△Ct value 13.64±0.55vs 8.64± 0.38,P＜0.001).Over-expression of TCONS_00023867,the experimental plate clone count of Capan-2 and PANC-1 cells were respectively lower than that in the empty plasmid vector PEX-3 group (181.3±4.667 vs 227.3± 9.207,P=0.011 2),(86.0±4.933 vs 167.2±2.603,P=0.000 1).The proliferation ability of Capan-2 and PANC-1 was significantly reduced compared with that of the empty plasmid vector PEX-3 group.The migration ability of Capan-2 and PANC-1 was significandy reduces compared with that of the group of empty plasmid vector PEX-3 (57.6±6.809 vs 124.6±8.548,P=0.003),(47.40±7.061 vs 105.2±10.28,P=0.001 7).The invasion ability of Capan-2 and PANC-1 was significantly reduced compared with that of the empty plasmid vector PEX-3 group (46.0± 5.033 vs 120.7±7.055,P=0.001),(64±8.327 vs 118.0±11.53,P=0.019 2).Through western blot experiment,the expression of p53 in Capan-2 and PANC-1 was higher than that in the group of empty plasmid vector PEX-3 (2.192± 0.077 3 vs 1.007±0.018 8,P=0.000 1),(1.816±0.163 vs 0.988±0.012 16,P=0.007 2).Conclusions The level of TCONS_00023867 is decreased in pancreatic cancer tissues and cells.Overexpression of TCONS_00023867 decreases cell proliferation,invasion and migration in pancreatic cancer ceils through increasing the level of p53.

Objective:To investigate the influencing of high sodium donor liver transplan-tation from the death of a citizen′s organ donation (DCD) on the prognosis of recipients.Methods:The retrospective cohort study was constructed. The clinicopathological data of 125 pairs of donors and recipients who underwent DCD liver transplantation in Xijing Hospital of Air Force Military Medical University from January 2015 to June 2021 were collected. Of the 125 donors, there were 93 males and 32 females. Of the 125 recipients, there were 92 males and 33 females, aged 48(41,55)years. According to the last time of serum sodium level of donor liver in the 125 recipients, 9 donor livers with serum sodium level ≥170 mmol/L were divided into group 1 (extremely high sodium), 33 donor livers with serum sodium level ≥150 mmol/L and <170 mmol/L were divided into group 2 (moderate high sodium), and 83 donor livers with serum sodium level <150 mmol/L were divided into group 3 (normal sodium), respectively. Observation indicators: (1) postoperative recover situations; (2) follow-up and survival analysis. Measurement data with normal distribution were represented as Mean± SD. Repeated measures were analyzed by repeated measures ANOVA. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Kruskal-Wallis test. Count data were described as absolute numbers, and Pearson chi-square test or Fisher exact probability were used for data test. The Kaplan-Meier method was used to draw survival curves and Log-rank test was used for survival analysis. Results:(1) Postoperative recover situations. The changes of alanine transaminase (AlT), aspartate aminotransferases (AST), total bilirubin (TBil), alkaline phosphatase (ALP), prothrombin time (PT), international normalized ratio (INR), albumin (Alb) and creatinine (Cr) from the first day to the 14th day after operation were (736±972)IU/L to (75±46)IU/L, (1 290±1 651)IU/L to (38±20)IU/L, (102±98)μmol/L to (33±11)μmol/L, (66±34)IU/L to (104±54)IU/L, (19.9±3.3)seconds to (11.3±1.0)seconds, 1.76±0.31 to 1.00±0.08, (34±5)g/L to (38±3)g/L and (91±41)μmol/L to (76±19)μmol/L, respectively, in the recipients of group 1. The above indicators were (505±377)IU/L to (48±46)IU/L, (855±727)IU/L to (24±17)IU/L, (64±42)μmol/L to (32±22)μmol/L, (68±51)IU/L to (91±46)IU/L, (16.8±3.5)seconds to (11.9±1.2)seconds, 1.47±0.30 to 1.04±0.09, (33±4 g/L) to (40±5)g/L and (106±32)μmol/L to (97±27)μmol/L in the recipients of group 2 and (637±525)IU/L to (65±60)IU/L, (929±1 193)IU/L to (33±27)IU/L, (66±48)μmol/L to (33±36)μmol/L, (64±28)IU/L to (125±64)IU/L, (17.2±4.7)seconds to (13.3±12.8)seconds, 1.51±0.42 to 1.05±0.13, (35±6)g/L to (39±4)g/L, (105±44)μmol/L to (94±40)μmol/L in the recipients of groups. Results of overall effect showed there were significant differ-ences in the change trend of TBil (time effect, inter-group effect, interaction effect) in recipients among the three groups after liver transplantation ( Fgroup=5.42, Ftime=22.78, Finteraction=3.85, P<0.05). There were significant differences in the time effect of ALT, AST, ALP, PT, INR, Alb, Cr in recipients among the three groups after liver transplantation ( Ftime=50.17, 36.24, 19.24, 10.55, 59.61, 41.94, 10.82, P<0.05). (2) Follow-up and survival analysis. All recipients were followed up. Cases with early postoperative liver dysfunction, cases with donor liver failure 1 year after operation, cases with biliary complica-tions 1 year after operation, cases with vascular complications 1 year after operation, cases with rejection 1 year after operation were 2, 1, 0, 0, 0 in the recipients of group 1. The above indicators were 2, 1, 3, 0, 1 in the recipients of group 2 and 10, 8,20, 1, 6 in the recipients of group 3. There was no significant difference in the above indicators among the three groups ( χ2=1.58, 0.60, 5.19, 1.62, 0.97, P>0.05). The 1-year and 3-year cumulative survival rates of the donor liver were 100.00% and 100.00% in the recipients of group 1 after liver transplantation. The above indicators were 94.74% and 77.16% in the recipients of group 2 and 91.57% and 89.30% in the recipients of group 3. There was no significant difference in the cumulative survival rate of donor liver among the three groups ( χ2=2.69, P>0.05). The 1-year and 3-year cumulative survival rates were 100.00% and 100.00% in the recipients of group 1 after liver transplantation. The above indicators were 93.74% and 77.16% in the recipients of group 2 and 89.40% and 86.00% in the recipients of group 3. There was no significant difference in the cumulative survival rate among the three groups ( χ2=1.94, P>0.05). Conclusion:Donor livers with high serum sodium level can be used in the DCD liver transplantation.