As for the surgeons,surgical treatment of pancreatic cancer promises to be very challenging.The concept of borderline resectable pancreatic cancer has further improved diagnostic and treatment systems of pancreatic cancer recently,but there is no verdict on the controversial problems of borderline resectable pancreatic cancer,such as the significance and indications combined with vascular resection,feasibility combined with artery resection and effect of neoadjuvant treatment.This article will go into in-depth discussions concerning the hot issues of borderline resectable pancreatic cancer in order to further improve the standardized diagnosis and surgical treatment for pancreatic cancer.

Objective To explore the evolution of HBV polymerase gene as a result of adefovir dipivoxil treatment in liver transplant patients with lamivudine resistance. Methods Eight patients with HBV reinfection which was lamivudine resistance received adefovir therapy (10mg/day). Sequential serum samples were obtained from 2 consecutive patients with adefovir failure, and the polymerase gene of HBV was amplified by PCR and TA cloned, and sequencing and analysis were performed in 10 random clones. Results Neither rtN236T nor A181V/T mutation, which were associated with adefovir (ADV) resistance, was found. The rtL180M mutation associated with lamivudine resistance presented before ADV treatment, and several previously unreported amino acid substitutions were observed in the reverse transcriptase domain. Conclusion Possibly, the rtL180M mutation in the B domain of HBV polymerase reduced the susceptibility to ADV. ADV resistance mutation may occur in other sites besides rtN236T and A181V/T amino acid substitutions or do not happen early after treatment.

The majority of the pancreatic cancer was diagnosed at advanced stage.The tumor may invade portal vein and/or superior mesenteric vein.Moore et al.firstly reported pancreaticoduodenectomy combined with portal vein and superior mesenteric vein resection and reconstruction in 1951.This procedure has improved the resection rate of pancreatic cancer.A 72-year-old man suffered from pancreatic cancer was admitted to the Southwest Hospital in September 2011.Because the tumor invaded the confluence of portal vein and superior mesenteric vein,thus the patient underwent a pancreaticoduodenectomy combined with portal vein and superior mesenteric vein resection and reconstruction.The patient recovered smoothly without any complication,and he had a normal liver function and CA19-9 value,and no local and remote metastasis was detected during the follow-up.

Objective To investigate the clinical application value of pancreatoduodenectomy combined with vascular resection and reconstruction for pancreatic head carcinoma.Methods The clinical data of a patient with pancreatic head carcinoma who underwent pancreatoduodenectomy combined with vascular resection and reconstruction at the Southwest Hospital in March 2014 were retrospectively analyzed.Preoperative imaging examination showed no gap between vascular wall of portal vein (PV) and pancreatic head space-occupying lesion,vascular compression and stenosis at intersection of PV,splenic vein (SV) and superior mesenteric vein (SMV),but not excluding adjacent main PV invasion.During the operation,it was difficult to separate pancreatic head carcinoma from PV,indicating vascular wall invasion at intersection of PV,SV and SMV.Therefore,the pancreatic head,bile ducts,duodenum,partial jejunum,invasive vein vessels,lymphatic and nerve tissues were radically resected,then PV,SMV and SV were reconstructed.The patient was followed up by outpatient examination and telephone interview after surgery till April 2015.Results The patient underwent pancreatoduodenectomy combined with vascular resection and reconstruction successfully without blood transfusion.The operation time was 285 minutes and volume of intraoperative blood loss was 300 mL.The patient had a smooth postoperative recovery,resuming diet at postoperative day 5.The abdominal drainage tube and stitches were removed at postoperative day 6 and day 12,and the patient was discharged from hospital at postoperative day 15.Computed tomography reexamination showed clear vascular anastomose.The patient was not complicated with pancreatic fistula,biliary fistula,intra-abdominal hemorrhage and vascular embolism.The postoperative pathological examination confirmed the diagnosis of pancreatic head moderately differentiated adenocarcinoma accompanied by PV invasion and lymph node metastasis,with a negative margin.The patient began a course of single drug common chemotherapy using gemcitabine at postoperative day 40.No cancer recurrence was detected during the one-year follow-up.Conclusion Pancreatoduodenectomy combined with vascular resection and reconstruction is safe and feasible for the treatment of pancreatic head carcinoma with good surgical effects.

Objective To investigate emergency management strategies and risk factors for mortality of open pelvic fractures associated with anorectal injuries.Methods Between April 2001 to April 2010,25 patients of open pelvic fractures associated with anorectal injuries were admitted to Shandong Provincial Hospital and Laigang Hospital,and early emergency treatments of this injury were retrospectively studied.Of these 25 patients,23 were male and the remaining 2 were female,and the mean age was 30.1±10.9 years (range,16-56 years).Fisher's exact test and multivariate logistic regression analyses were used to determine the risk factors related to mortality caused by this injury.Results Of the 25 patients,19 survived,other 6 patients were dead.The overall mortality was 24%.Fisher's exact test identified that the following risk factors including Tile classification,ISS,GCS and RTS were associated with the injury mortality.Patients with Tile C pelvic fracture ,ISS ≥ 25 points,GCS≤8 points or RTS≤8 points had a high probability of resulting in death.Multivariate logistic regression analysis was performed with the four variables noted above,and the results demonstrated that RTS ≤ 8 points was the only independent risk factor for mortality of patients with this injury.Conclusion Stabilization of hemodynamic condition,aggressive debridement and irrigation of the wound,early diversion of the fecal stream and early stabilization of pelvic fracture are critical strategies for the emergency management of open pelvic fractures associated with anorectal injuries.Furthermore,based on our findings,it can be concluded that RTS≤8 was reliable for predicting the probability of death in patients with this injury.

Objective　To study the effect of portal vein blocking on the permeability of the intestinal mucosa in pigs. Methods　Healthy Rongchang pigs were divided into 3 groups: ① sham operation group(SO), ② portal vein clamping for 45 min group (PVC-45'), ③ portal vein clamping for 60 min group (PVC-60'). Urine lactulose/mannitol(L/M) ratio was measured after portal vein blocking. Results　The L/M ratio was increased significantly (P<0.05) in PVC-45' and 60' groups than in SO group, with that of PVC-60' higher than that of PVC-45' group, but not significantly. Conclusion　The increase of intestinal mucosal permeability after portal vein blocking is an early and important index for the damage of the intestinal mucosa barrier.

Objective To investigate the effect of the teaching modes based on problem-based learning (PBL) and lecture-based learning (LBL) in clinical practice of hepatobiliary surgery.Methods 166 5-year program students were divided into 2 groups:PBL group (n=83)and LBL group (n=83).The performance in interrogation,physical examination,medical records and theoretical tests were analyzed.Results PBL group had better performance in all the above aspects compared to LBL group (P<0.05).Conclusions The teaching mode based on PBL is a good method,which Can inspire the students and improve their ability to solve problems in clinical practice of hepatobiliary surgery.

In the process of the introduction of classical problem based learning,the combination of PBL teaching method and current teaching method was found to be abstract and difficult to operate. PBL gradual teaching was brought forward through qestionnaires and analysis. Improved PBL teaching is more suitable for clinical teaching of hepatobiliary surgery in China and helping the interns to get good learning habits. Thus ,it is an effective PBL teahcing method of hepatobiliary surgery.

Animals ; Antifungal Agents ; chemistry ; pharmacology ; Drug Repositioning ; Hedgehog Proteins ; antagonists & inhibitors ; genetics ; metabolism ; Humans ; Neoplasms ; drug therapy ; metabolism ; pathology ; RNA, Messenger ; genetics ; metabolism ; Signal Transduction ; drug effects

Objective To summarize our experience in performing modified hepatic outflow tract reconstruction in liver transplantation. Methods The clinical data of 142 cases of liver transplantation from Jan 1999 to Aug 2003 were analyzed retrospectively. Results Sixteen patients died postoperatively, mortality rate of this group was 11.27%. No hepatic outflow obstruction developed in this group. Two postoperative recipients have survived for more than four years, five recipients have survived for more than three years, thirty four for more than two years, thirty eight for more than one year. Conclusion This procedure has the advantage of less technique-related complications and time-saving.