Objective:To evaluate the short-term and long-term efficacy of Heidelberg triangle dissection in surgical treatment for pancreatic head cancer.Methods:The clinicopathological data of 97 patients with pancreatic head cancer who underwent pancreaticoduodenectomy at Cangzhou Central Hospital from Jan 2017 to Jan 2020 were retrospectively analyzed. After propensity score matching, 33 patients were included into the Heidelberg group and 36 patients in the control group.Results:There were no significant difference between Heidelberg group and control group in preoperative general conditions and postoperative major complications, while there were more cases with safe surgical margin > 1 mm (81.8% vs. 58.3%, P=0.034) and a significantly higher total number of lymph node dissection (11.24±2.35 vs. 9.50±2.76, P=0.006). In the survival analysis, the cumulative recurrence rate at 12 months (0.182±0.067 vs. 0.444±0.083, P=0.023) and 18 months (0.424±0.086 vs. 0.667±0.079, P=0.024) were better off in the Heidelberg group, and the local recurrence rate in the Heidelberg group was significantly lower than that in the control group (15.3 % vs. 36.1 %, P=0.037). However, there was no statistical difference in the overall survival time between the two groups. Conclusion:Dissection of Heidelberg triangle in radical resection of pancreatic head cancer reduces tumor local recurrence ,while fails to provide survival benefit.

Objective:To investigate the characteristics and risk factors of local recurrence in resected pancreatic cancer.Methods:The clinicopathological data of 190 patients in whom recurrent sites can be identified after radical resection of pancreatic cancer from Sep 2013 to Aug 2020 at the Cangzhou Central Hospital were retrospectively analyzed. The survival time and clinicopathological characteristics of local recurrence were compared with those of other recurrence types. Cox risk regression model was used to analyze the risk factors of local recurrence.Results:The recurrence sites were local (49 cases, 25.8%), liver (53 cases, 27.9%), lung (35 cases, 18.4%), peritoneal (25 cases, 13.2%) and multiple sites (28 cases, 14.7%). Patients mRFS and mOS were 17.8 months and 30.9 months respectively. The clinicopathological features of patients with local recurrence were compared with those of other recurrence types [tumor diameter ( P=0.023), preoperative CA199 level ( P=0.021), peripancreatic nerve plexus invasion ( P=0.031), lymphovascular invasion ( P=0.004), surgical margin state ( P<0.001) and postoperative adjuvant chemotherapy ( P=0.038)]. Tumor diameter ( P=0.018), peripancreatic nerve plexus invasion ( P=0.002) and postoperative adjuvant chemotherapy ( P=0.004) were independent factors for local recurrence in resected pancreatic cancer, and only peripancreatic nerve plexus invasion was not associated with other recurrence types. Conclusions:Local recurrence in resected pancreatic cancer has important impact on the prognosis of patients. Peripancreatic nerve plexus invasion is an independent factor affecting local recurrence.

Objective:To investigate the application value of susceptibility-weighted imaging (SWI) in the diagnosis of intracranial dural arteriovenous fistula (DAVF).Methods:Patients with DAVF confirmed by digital subtraction angiography (DSA) in Weihai Municipal Hospital from January 2014 to January 2021 were retrospectively included. All patients underwent conventional T 1-weighted imaging (T 1WI), T 2-weighted imaging (T 2WI) and SWI, and some patients also underwent 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA). Results:A total of 36 patients with DAVF were enrolled, 29 of them received 3D-TOF-MRA. The fistula location of 24 patients (24/36, 66.7%) underwent SWI and 26 patients (26/29, 89.7%) underwent 3D-TOF-MRA were correctly judged, and the difference was statistically significant (Fisher's Exact Test, P=0.039). SWI showed that the proportion of patients with thickened supply arteries (7/36, 19.4%) was significantly lower than that on 3D-TOF-MRA (14/29, 48.3%; χ2=6.105, P=0.013). T 2WI, 3D-TOF-MRA and SWI showed no cerebral venous abnormalities in all 7 patients with DAVF without cortical venous reflux; in 29 patients with DAVF with cortical venous reflux revealed by DSA, SWI and T 2WI showed all patients (100%) and 26 patients (89.7%) had superficial venous dilatation respectively, but there was no significant difference ( χ2=0.693, P=0.405). SWI showed medullary vein dilation in 17 patients (47.2%), and only 2 patients (5.6%) had medullary vein thickening on T 2WI, and the difference was statistically significant ( P<0.001). The proportion of patients with venous cerebral infarction on T 2WI was significantly higher than that on SWI (22.2% vs. 0%; Fisher’s Exact Test P=0.005), and the proportion of patients with intracerebral hemorrhage on SWI was significantly higher than that on T 2WI (61.1% vs. 25.0%; χ2=9.574, P=0.004). Conclusion:SWI is helpful to evaluate the abnormal drainage vein of DAVF and the secondary changes in brain, especially intracerebral hemorrhage.

Tumor recurrence after surgery is the main cause of treatment failure. However, the initial stage of recurrence is not easy to detect, and it is difficult to cure in the late stage. In order to improve the life quality of postoperative patients, an efficient synergistic immunotherapy was developed to achieve early diagnosis and treatment of post-surgical tumor recurrence, simultaneously. In this paper, two kinds of theranostic agents based on gold nanorods (AuNRs) platform were prepared. AuNRs and quantum dots (QDs) in one agent was used for the detection of carcinoembryonic antigen (CEA), using fluorescence resonance energy transfer (FRET) technology to indicate the occurrence of

Objective:To investigate whether the combination of conventional axial and thin-layer sagittal diffusion-weighted imaging (DWI) can improve the detection ability of acute brainstem infarction (ABI).Methods:Patients with ABI diagnosed clinically and admitted to Weihai Municipal Hospital, Shandong University from January 2019 to July 2020 were enrolled retrospectively. All patients underwent conventional axial and thin-layer sagittal DWI examination after admission. Those who could not make a definite diagnosis were confirmed by DWI reexamination before discharge. The numbers of positive and negative cases of brainstem infarction at different sites detected by conventional axial and conventional axial+ thin-layer sagittal DWI were recorded.Results:A total of 65 patients with ABI were included. Conventional axial DWI was positive in 51 patients (78.5%) and was negative in 14 (21.5%); conventional axial+ thin-layer sagittal DWI were positive in 60 patients (92.3%) and was negative in 5 (7.7%). In 8 patients with medullary infarction, only 4 (50.0%) were positive on conventional axial DWI, and 6 (75.0%) were positive on conventional axial+ thin-layer sagittal DWI; in 50 patients with pontine infarction, only 44 (88.0%) were positive on conventional axial DWI, and 48 (96.0%) were positive on conventional axial+ thin-layer sagittal DWI; in 4 patients with midbrain infarction, only 1 (25.0%) was positive on conventional axial DWI, and 3 (75.0%) were positive on conventional axial+ thin-layer sagittal DWI; in 3 patients with pontine+ midbrain infarction, only 2 (66.7%) were positive on conventional axial DWI, and 3 (100.0%) were positive on conventional axial DWI+ thin-layer sagittal DWI. The detection rate of ABI on conventional axial+ thin-layer sagittal DWI was significantly higher than that on conventional axial DWI, and difference was statistically significant (92.3% vs. 78.5%; χ2=4.993, P=0.026). Conclusion:The combination of conventional axial and thin-layer sagittal DWI improved the detection rate of ABI. For ABI patients whose axial DWI did not find lesions or whose diagnosis was not clear, thin-layer sagittal DWI should be added.

Objective:To investigate the short-term outcome of Heidelberg triangle dissection in laparoscopic pancreaticoduodenectomy (LPD) for pancreatic cancer.Methods:The clinical data of 84 patients with pancreatic head cancer who underwent LPD from July 2015 to September 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the Cangzhou Central Hospital were retrospectively analyzed. According to the scope of surgical dissection, the patients were divided into the control group ( n=45) and the Heidelberg group ( n=39). In the control group, routine lymph node dissection was performed, and in the Heidelberg group, all blood vessels, lymphatic tissue and nerve tissue in the Heidelberg triangle area were dissected on the basis of routine lymph node dissection. Operation-related indicators (operation duration, intraoperative blood loss, cases of patients with intraoperative blood transfusion, fasting time and hospitalization duration after operation), postoperative complications (pancreatic fistula, biliary fistula, lymphatic fistula, bleeding and delayed gastric emptying) and postoperative pathological parameters (surgical margin, degree of differentiation, tumor size, cases of nerve invasion, number of dissected lymph nodes, lymph node metastasis and TNM stage) were compared between the two groups. Results:Compared with the control group, the operation time of the Heidelberg group was longer [ (334.85±24.95)min vs (305.09±24.54)min], theincidence of lymphatic fistula was higher (15.4% vs 2.2%), the rate of >1 mm at surgical margin was higher (76.9% vs 53.3%), and the total number of lymph nodes dissection was more [ (11.31±2.46) vs (9.49±2.28)]. All the differences between the two groups were statistically significant ( P<0.05). However, there were no significant differences on the intraoperative blood loss, cases of patients with intraoperative blood transfusion, postoperative hospital stay and fasting time, incidence of pancreatic fistula and biliary fistula, bleeding, delayed gastric emptying, degree of differentiation, tumor size, cases of nerve invasion, lymph node metastasis and TNM stage between the two groups. Conclusions:LPD combined with Heidelberg triangle dissection for pancreatic cancer was feasible and safe, which can increase the R 0 resection rate, remove more lymph nodes, reduce the local recurrence of pancreatic cancer and improve the prognosis of patients.

With the development of laryngeal microsurgery, the requirements for the flexibility and convenience of surgical instruments are increasing. The research on related instruments has important value for the clinical application of laryngeal microsurgery. We have redesigned a gun-type tube-guide device of laser fiber by comparing the shortcomings of existing laser fiber introducers. The innovation of this design lies in its rotating nut device with adjustable laser angle and pre-bent tip. The corresponding
Humans ; Larynx/surgery* ; Laser Therapy/instrumentation* ; Lasers ; Microsurgery/instrumentation* ; Surgical Instruments

With the aging of the society, the number of stroke patients has been increasing year by year. Compared with the traditional rehabilitation therapy, the application of upper limb rehabilitation robot has higher efficiency and better rehabilitation effect, and has become an important development direction in the field of rehabilitation. In view of the current development status and the deficiency of upper limb rehabilitation robot system, combined with the development trend of all kinds of products of the upper limb rehabilitation robot, this paper designed a center-driven upper limb rehabilitation training robot for cable transmission which can help the patients complete 6 degrees of freedom (3 are driven, 3 are underactuated) training. Combined the structure of robot with more joints rehabilitation training, the paper choosed a cubic polynomial trajectory planning method in the joint space planning to design two trajectories of eating and lifting arm. According to the trajectory equation, the movement trajectory of each joint of the robot was drawn in MATLAB. It laid a foundation for scientific and effective rehabilitation training. Finally, the experimental prototype is built, and the mechanical structure and design trajectories are verified.

Objective To investigate if anesthetic sensitivity to propofol will be restored after biliary decompression.Methods Twenty-four adult male SD rats were randomly assigned into 3 groups:sham group (group S),irreversible obstructive jaundice group (group Ⅰ) and reversible obstructive jaundice group (group R).The serum total bilirubin (TBL) and total bile acid (TBA) concentratins were detected in the rat blood samples collected from the caudal vein before and after the operation,3,7,14,21 d respectively.Propofol was administered to measure the time of loss of righting reflex and recovery pre or 7th and 21th day post ligation.Results Serum TBL and TBA in group Ⅰ and serum TBA in group R were significantly higher than that in group S on 3rd,7th,14th,21th day post surgery(P＜0.05).Compared with group S,seum TBL in group R were significantly high on 3rd,7th,14th day post-surgery.Serm TBL and TBA in group R were significantly lower than group Ⅰ on 14th,21th day post-surgery (P＜0.05).Compared with group S,the time to loss of righting reflex in group I and group R were significantly shortened and the time to recovery were significantly increased on 7th day post-surgery (P＜0.05).Conclusion Obstructive jaundice could significantly potentiate the ability of propofol to induce a loss of righting reflex,and the increased anesthesia sensitivity will be restored after biliary decompression.

Objective: To observe the efficacy and safety between Pegfilgrastim (PEG-rhG-CSF) and Recombinant human granulocyte colony stimulating factor (rhG-CSF) in hematological malignancy after allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: 157 patients after allo-HSCT were enrolled in this study from June 2015 to November 2016. Two agents of G-CSF were used to stimulate hematopoietic recovery after transplantation. There were 65 cases in PEG-rhG-CSF and 92 cases in rhG-CSF groups. Patients in PEG-rhG-CSF group were given a single subcutaneous dose of 6 mg on the first day and +8 d, while cases in rhG-CSF group were given in dose of 5 μg·kg^-1·d^-1 by subcutaneous injection from +1 d continuing to neutrophils more than 1.5×10⁹/L, and then the indicators and survival rates in two groups after transplantation were compared. Results: ①There were no significant differences of the neutrophil implantation time[13.5 (8-12) d vs 13 (9-24) d, P=0.393] and platelet implantation time [14 (9-160) d vs 14 (9-92) d, P=0.094] between PEG-rhG-CSF and rhG-CSF groups respectively. There were no significant differences in terms of neutropenia period (P=0.435) , number of cases who got fever during neutropenia (P=0.622) , and the median time of fever in neutropenia period (P=0.460) , respectively between the two groups. There were no significant differences of erythrocyte and platelet transfusions (P=0.074, P=0.059) within 1 month after transplantation. ②There were no significant differences with regard to the incidences of acute GVHD[23.1% (15/65) vs 34.8% (32/92) , P=0.115], chronic GVHD[20.0% (13/65) vs 32.6% (32/92) , P=0.081], Ⅱ-Ⅳdegree of acute GVHD[30.0% (13/65) vs 30.4% (30/92) , P=0.287] and extensive chronic GVHD[9.2% (6/65) vs 20.7% (19/92) , P=0.135] between PEG-rhG-CSF and rhG-CSF groups. ③There were no significant differences in terms of disease free survival (DFS) (62.5% vs 61.4%, P=0.478) and overall survival (OS) (67.4% vs 67.3%, P=0.718) between PEG-rhG-CSF and rhG-CSF groups. ④There was no significant difference of the non-relapse mortality (NRM) between PEG-rhG-CSF and rhG-CSF groups[20.5% (95%CI 11.4%-37.0%) vs 32.6% (95%CI 22.2%-47.9%) , P=0.141]. The relapse rate was not statistically significant[14.9% (95%CI 7.4%-29.8%) vs 10.0% (95%CI 5.0%-20.0%) , P=0.299]. Conclusion Compared with rhG-CSF, PEG-rhG-CSF could reduce the times of injection. There were no differences in terms of hematopoietic recovery, the incidence of GVHD, relapse rate, DFS and OS rates after allo-HSCT between two groups.