miRNAs are endogenous short RNA molecules widely distributed in eukaryotic organisms.They are closely related to tumor development. One good example is miR-21. It is overexpressed in a variety of tumor tissues, suggesting that miR-21 may have significant carcinogenic activities and act as a oncogene.Many studies confirm that overexpression of miR-21 has great indication in the development, diagnosis, biological treatment and prognosis of gastrointestinal cancer.

Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.

Background and purpose:It was reported that many microRNAs (miRNAs) have close relation with carcinomas. miR-31 (microRNA-31) shows abnormal change in numerous cancers. China is one of the most high-risk areas of esophageal squamous cell carcinoma (ESCC). The aim of the present study was to investigate the expression of miR-31 in ESCC, and analyze the relationship of its expression with clinicopathological features and prognosis. Methods:The expression of miR-31 in KYSE410, EC1 and EC9706 cell lines, as well as 81 cases of ESCC tissues and adjacent normal esophageal tissues were detected by real-time reverse transcription-polymerase chain reaction (RT-PCR). The result was combined with clinical and follow-up data and statistical analysis was conducted. Results: MiR-31 was up-expression in 3 cell lines and 75.31% of the ESCC tissues. miR-31 up-expression was positively related to severer lymph node metastasis (P=0.043), deeper invasion of tumors (P=0.002) and advanced pathological stage (P=0.027). There was no relationship of miR-31 with other clinicopathological features (P>0.05). Furthermore, high expression of miR-31 was associated with poor progression-free survival (PFS) in 81 ESCC patients by Kaplan-Meier analysis (P=0.014) and by multivariate Cox analysis (P=0.021). Conclusion:Our results identiifed miR-31 may be a new diagnostic criteria and prognostic biomarker for ESCC.

Background and purpose: With the application of laparoscopy in the liver surgery increasingly widely used, the safety and feasibility of laparoscopic liver resection is gaining recognition gradually. This study aimed to explore the laparoscopic liver resection for the tumor and the feasibility of open liver tumor resection and clinical curative effect. Methods: We retrospectively analysed the clinical data from 37 cases of laparoscopic hepatectomy and 74 patients with open liver resection from Mar. 2015 to Mar. 2016. Measurement data by covariance analysis were obtained, and comparison between groups were made using independent sample with Wilcoxon rank test and statistical value of Z. We collected data including operation time, intra-operative blood loss, post-operative recovery time of gastrointestinal tract, surgical drainage tube after extubation time, length of hospital stay, postoperative complications, hospitalization expenses and other clinical data. Laparoscopic group had 20 males and 17 female aged 18 to 76 (median age 55). Open group had 42 males and 32 females aged 26 to 74 (median age 54). The hepatectomy included ultrasonic knife + unipolar electric coagulation, combined with laparoscopic incision suture. Surgery procedures included 13 cases of local excision in laparoscopic group and 24 cases of liver segment or lobe anatomical resection. Open group had 33 cases of local excision and 41 cases of liver segment or lobe anatomical resection. Results: The average duration of laparoscopic hepatectomy was 149 min (40-204 min). The average duration of open hepatectomy was 142 min (45-190 min). The average intra-operative blood loss was 220 mL (30-570 mL) in laparoscopic group and 360 mL (90-970 mL) in open group. The average length of hospital stay was 4.9 d (3-6 d) in laparoscopic group and 6.8 d (5-9 d) in open group. Gastrointestinal average recovery time was 1.1 days in laparoscopic group and 2.3 days in open group. The average hospitalization expenses were 38760 yuan in laparoscopic group and 39145 yuan in open group. Conclusion:Laparoscopic hepatectomy is a safe, effective and minimally invasive surgery, can be safely used in local, liver segment and half liver resection, worthy of promotion.

OBJECTIVETo investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.

METHODSFrom January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.

RESULTSPostoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.

CONCLUSIONSPrimary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.

Adult ; Aged ; Biliary Tract Surgical Procedures ; methods ; Choledocholithiasis ; surgery ; Common Bile Duct ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective:To compare laparoscopic versus laparotomy in the treatment of colorectal cancer liver metastases (CRLM).Methods:The clinical data of 78 consecutive patients with CRLM operated at Department of Hepatic Surgery, Fudan University Shanghai Cancer Center from April 2015 to August 2016 were analyzed retrospectively. There were 52 males and 26 females. The average was (56.8±9.9) years. The patients were divided into the laparoscopic group ( n=26) and laparotomy groups ( n=52). The operation time, intraoperative blood loss, extent of hepatectomy, postoperative liver function and complications were compared between the two groups. The follow-up data was used to compare the long-term survival outcomes. Results:There were no significant differences between the two groups in operation time, intraoperative bleeding volume and extent of hepatectomy ( P>0.05). The percentage of patients who underwent preoperative neoadjuvant chemotherapy in the laparotomy group was significant higher, and the diameter of liver metastasis was significantly larger than that in the laparoscopic group ( P<0.05). On day 1 after operation, the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in the laparoscopic group were (502.2±115.3) U/L and (570.4±132.4) U/L, respectively, which were significantly better than those in the laparotomy group (683.9±150.1) U/L and (739.5±230.2) U/L, respectively ( P<0.05). On day 3 after operation, the ALT and AST levels in the laparoscopic group were (263.3±83.3) U/L, (271.4±87.3) U/L, which were still significantly superior than those in the laparotomy group (410.8±128.4) U/L and (489.1±125.6) U/L ( P<0.05). Complications occurred in 4 patients (15.4%) in the laparoscopic group and 19 patients (36.5%) in the laparotomy group, the difference was significant ( P<0.05). The recurrence and extrahepatic metastasis rates of the laparoscopic group were better than those of the laparotomy group, and the survival outcomes were better than the laparotomy group. Conclusion:Laparoscopic surgery was better than laparotomy surgery in the treatment of CRLM. Laparoscopic surgery should be further promoted.

Acute skin failure (ASF) is an inevitable damage to the skin and subcutaneous tissue caused by hemodynamic instability and/or low perfusion. At present, there are some understandings and reports about adult ASF at home and abroad, but there are few reports about children's ASF. This article reviewed the definition, pathophysiological changes, risk factors, clinical manifestations, and management of children's ASF, and put forward suggestions in order to provide ideas for clinical diagnosis and treatment of children's ASF, and promote the further study of children's ASF.

During the process of dairy farming,various factors such as physical injury and bacterial infection act upon body tissues or organs,leading to the disruption of skin or mucous tissue integ-rity and subsequent tissue injury and trauma.The healing of these injuries is a complex process that necessitates the coordinated efforts of different cells and involvement of diverse cytokines.A-mong them,the interaction between macrophages and myofibroblasts is indispensable for efficient tissue repair.Nod-like receptor protein 3(NLRP3),a pattern recognition receptor in the innate im-mune system,may play a regulatory role in modulating this intricate process.In this study,cow myofibroblasts and M1 type bone marrow-derived macrophages were cultured in vitro,followed by collection of cell culture supernatant for co-culture analysis.Both cytokine secretion levels in M1 type bone marrow-derived macrophages as well as expression patterns levels of myofibroblast growth factor protein and mRNA were detected.The regulatory mechanism underlying NLRP3 in-volvement in mediating interactions between these two cell types was investigated using NLRP3 inhibitor MCC950.The results showed that an effective method for culturing cow muscle fibroblasts in vitro was successfully established and myofibroblast conditioned medium(MFbCM)could regulate M1 macrophage secretion profiles.Moreover,M1 macrophage conditioned medium(M1?CM)was found to influence myofibroblast growth factor expression levels.Our findings sug-gest that NLRP3 plays a significant regulatory role during crosstalk between myofibroblasts and M1-type pro-inflammatory macrophages.

Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.

Objective:To investigate the value of total laparoscopic simultaneous resection for left-sided colorectal cancer (CRC) and synchronous liver metastases (SLM).Methods:A retrospective analysis of the clinical data of patients with left-sided CRC and SLM who underwent simultaneous resection in the Shanghai Cancer Center, Fudan University from March 2014 to December 2017. The patients were divided into laparoscopy group, open surgery group and hybrid surgery group. The intraoperative information, postoperative short-term outcome and long-term survival were analyzed among the three groups.Results:A total of 96 patients were enrolled. The total laparoscopic group enrolled 29 patients, including 21 males and 8 females, aged (57.8±1.6) years old; the open surgery group enrolled 28 patients, including 18 males and 10 females, aged (57.3±2.0) years old; 39 cases were included in the hybrid surgery group, including 27 males and 12 females, aged (55.3±1.8) years old. The distribution ratio of the two lobes of liver metastases in the open surgery group was higher than that in the total laparoscopic group and hybrid surgery group (all P<0.05), and there was no significant difference in the other clinical baseline characteristics between the three groups (all P>0.05). In laparoscopy group, open surgery group and hybrid surgery group, the mean operative time was (241.5±12.9) min, (209.3±10.7) min and (234.9±12.4) min, respectively. The median intraoperative blood loss was 200.0 ml, 300.0 ml and 200.0 ml, respectively. The median postoperative hospital stay was 8.0 days, 9.0 days and 9.0 days, respectively. There were no statistical differences in these indicators (all P>0.05). The patients in the open surgery group had a longer initial defecation time than those in the other two groups ( P<0.05). The incidence of postoperative complications was 31.0% (9/29), 39.3% (11/28) and 35.9% (14/39), respectively, with no difference among the three groups ( P>0.05). In laparoscopy group, open surgery group and hybrid surgery group, 1-year overall survival were 93.0%, 85.0% and 94.0%; 3-year overall survival were 72.0%, 81.0% and 74.0%, respectively ( P>0.05). One-year disease free survival were 70.0%, 52.0% and 55.0%; 3-year disease free survival were 36.0%, 30.0% and 39.0%, respectively ( P>0.05). Conclusion:Laparoscopic simultaneous resection for left-sided CRC and SLM shows slight advantages in the safety and short-term outcome, and does not affect the long-term survival.