Serum glucose control is an important aspect of perioperative management. For major hepatobilipancreatic surgery, specific pathophysiologic changes can lead to specific problems. This article reviews recent advances in the perioperative serum glucose control for major hepatobilipancreatic surgery.

As no fiber sheath covered,mesopancreas is considered to be different from mesocolon and mesorectum.Though amount of lymphatic,nervous,vascular and fat tissues are consisted in this structure,the margin and range are still controversial in the clinical practice.Only a few clinical reports show a higher R0 resection rate with the procedure of total mesopancreas excision (TMpE),but most of the studies are singlecentered and retrospective,from which we could not assess the outcome improvement for the patients undergoing TMpE.Moreover,the difference between the ranges of TMpE and ever-used extended excision or lymphectomy should be further evaluated.More anatomical and clinical studies are needed to standardize the operation range in order to benefit the patients.

Rational clinical nutrition support may slow down the progress from heart insufficiency to heart failure and improve the quality of life.This article summarizes advances in nutrition support in patients with heart insufficiency in terms of nutrition and metabolic characteristics, nutritional risk screening and nutrition status evaluation, nutrient recommendations, and clinical application of nutrition support.Moreover, nutrition and metabolic support in acute heart failure is also discussed.

Pancreas and islet transplantation is the only treatment that can cure type 1 diabetes mellitus. Less invasive and more targeted surgical and immunosuppressive regimens make islet transplantation a more attractive treatment for type 1 diabetes. Current methods of islet isolation and purification cause hypoxic stress to which β cells are extremely vulnerable. Transplanted islets need to re-establish their vascular system in order to obtain sufficient oxygen and nutrient supply for stable engraftment. However, this process takes at least 7- 14 days to complete. Massive (＞50%) β cells are dead before revascularization due to hypoxia, especially the core of the islets. Therefore, the obvious critical problem is the circulatory deficit to which the islets are susceptible in the immediate post-transplant period.In the current study, we reviewed various hypoxic-related insults to islets before complete engraftment, and feasible strategies to reduce hypoxic-induced apoptosis based on our experimental experiences together with that of others and investigated the possibility of revascularization in islet transplantation.

From August 6 to 8, 2010, the 23 rd "Nutritional risk, malnutrition, nutritional support, outcome, and cost-effective" workshop was held in Beijing. There were 30 participants from Beijing, Tianjin,Chongqing, Chengdu, Kunming, Guiyang, Guangzhou, Songyuan, Weifang, Guilin, Urumqi, Qingdao, Yueyang, and Qinhuangdao. The workshop has 2 sections. Section 1: Learn the published papers from ( 1 ) Jie B,Jiang ZM, Nolan MT, et al. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition, 2010, (9); (2)Braga M, Gianotti L. Preoperative immunonutrition: cost-benefit analysis. JPEN J Parenter Enteral Nutr,2005, 29 ( 1 Suppl): S57-S61; and ( 3 ) Jiang ZM, Wilmore DW, Wang XR, et al. Randomized clinical trial of intravenous soybean oil alone versus soybean oil plus fish oil emulsion after gastrointestinal cancer surgery. Br J Surg, 2010, 97 (6): 804-809. Section 2: Discuss two protocols for cohort study and for randomized clinical trial (RCT). The cohort study is to continue the investigations of the impact of nutritional support for inflammatory bowel disease (IBD) on outcome and cost/effectiveness, and the RCT protocol is to plan a new protocol about the impact of fish oil on postoperative outcome and cost/effectiveness. The second protocol also asked Professor Kondrup to join with as the co-principal investigator. At the pilot period, the fish oil study is an open RCT because the costs of nutrients need to be paid by patients himself (herself). To apply the support for nutrients is on the schedule. The 24th workshop will bo held on December 17-19, 2010 in Beijing.

Objective To systematically evaluate the efficacy and safety of injected hemocoagulase Agkistrodon for intraoperative bleeding.Methods We electronically searched several Chinese database till May 2014 to identify randomized controlled trials (RCTs) about injected hemocoagulase Agkistrodon for operative hemorrhage.The methodological quality of included RCTs was assessed,and the data were extracted by two reviewers independently according to the Cochrane Handbook.The homogeneous RCTs were pooled using RevMan software (Version 5.1.0).Results 2 358 articles were searched initially,and 12 RCTs involving 1 031 patients met the inclusion criteria.The results of Meta-analyses showed that:in the study groups,the average haemostatic time of the wound is shorter [OR =-40.29,95％ CI(-71.13,-9.44),P =0.01],the hemorrhagic volume of the wound [OR =-1.38,95％ CI(-1.90,-0.87),P ＜ 0.000 01],hemorrhagic volume per unit area of the wound [OR =-0.05,95％ CI(-0.06,-0.03),P ＜ 0.00001],introperative hemorrhagic volume and drainage volume on POD1 [OR =-18.52,95％ CI (-25.50,-11.53),P ＜ 0.000 01] are lower than the placebo groups.In all studies,no difference was found in the variation of hemostatic function,liver and renal function and drug-induced adverse events.Conclusions The injection of hemocoagulase Agkistrodon can significantly reduce the average haemostatic time of the wound,the hemorrhagic volume of the wound,overall introperative hemorrhagic volume and drainage volume on POD1,and does not affect the hemostatic function,liver and renal function and not increase the incidence of adverse effects or postoperative complications.

Objective: To establish a RP-HPLC method for the determination of icariin in Bushenning Capsules. Methods: The sample was prepared by water extraction-purfication through polyamide column. The determination was carried out on C 18 ODS column with mobile phase of acetonirile-water (23∶77), and detection wavelength at 270nm according to the external standard method.Results: The icariin sample size showed a good linear relationship at the range of 0.12-1.91ug and correlation coefficient was 0.9999. The average recovery of the added sample was 99.21%(n=5) and RSD was 1.79%. The RSD in a duplicate test was 2.18%.Conclusion: The method is simple, accurate, reproducibe and can be used for content determination of icariin of icariin of Bushenning Capsules.

Objective To compare the benefits of the combined nutrition support with enteral nutrition (EN)and parenteral nutrition(PN)versus sole PN for elder patients after pancreaticoduodenectomy.Methods The clinical data of 48 consecutive elderly patients who underwent Whipple operations in Beijing Hospital were retrospectively analyzed.Patients were divided into PN+EN group(n=25)and sole PN group(n=23)according to the nutrition support modes.Demographic data as well as data on liver function,endotoxin levels,and post-operative complications were recorded.Mortality,length of hospital stay,and total costs of post-operative management were compared between two groups.Results Endotoxin level increased on the 1stpost-operative day(POD 1) in two groups,but there is not significant difference,and then gradually decreased in beth two groups;however,the decrease rate(compared with the POD 1 level)was significantly higher in PN+EN group than in PN group on POD 7 and 14(P<0.01).The levels of alanine transaminase,aspartate aminotransferase,total bilirubin,and direct bilirubin increased on POD 1 in both groups,but there is not significant difference,and then gradually decreased;however,the decrease rates(compared with the levels on POD 1)were also significantly higher in PN+EN group than in PN group(P<0.05)on POD 14.Infective complication rate in group PN+EN(2/25,8.0%)was significantly lower than that in group PN(6/23,26.0%)(P<0.05).Total complication rate,post-operative hospital stay,and total costs were similar between these both groups.Conclusions PN+EN can effectively reduce endotoxemia and post-operative infective complications and improve liver function without increasing costs.Therefore,it is feasible for elderly patients after pancreaticoduodenectomy.

ObjectiveTo investigate the current situation of postoperative fluid therapy in general surgery department of grade Ⅲ-A general hospitals in Beijing and Tianjin. Methods Postoperative patients in general surgery department who were fasting for 3 days were retrospectively investigated, and 600 cases were recruited without considering age, gender, denomination of disease and operation type.The general information of patients, laboratory examination before and after operation, postoperative fluid therapy for 3 days, postoperative complications and infusion reaction were collected.Results In total 588 valid cases, the volume of average fluids supplement was (3030±638)ml per day, With the prescribed glucose (142+67)g per day, potassium chloride (59.9±23.9) mmol per day and sodium chloride (179.5±66.7) mmol per day. 85.2 % of total patients received nutrition support and the ratio of parenteral nutrition/enteral nutrition (PN/EN) was 28/1.There were 549 patients with BMI>18.5 before operation, and among them, 470 cases (85.6%)received parenteral and enteral nutrition treatment. There were 39 patients with BMI < 18.5 and 27 cases (69.2%) received parenteral nutrition support without enteral nutrition treatment. During the 3 days after operation, there were 36 cases with fluid therapy without potassium chloride supplement.ConclusionsThe proportions of receiving nutrition support and parenteral nutrition treatment are relatively high in grade Ⅲ-A general hospitals in Beijing and Tianjin. Ready-to-use preparation canreduce mistake and will be benefit to patients.

Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index(BMI),arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment(PG-SGA).The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [(23.9±3.6)cm vs.(25.3±4.5)cm,t=2.57,P=0.014],hand grip[(31.7±6.0)kg vs.(39.2±7.6)kg,t=8.19,P<0.001],serum albumin[(32.5±4.7)g/L vs.(36.5±7.2)g/L,t=4.92,P=0.007] and prealbumin[(0.172±0.052)g/L vs.(0.263±0.077)g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5％(42 cases at levels B and C),and that of the control group was 14.4％(14 cases at levels B and C)(X2=19.73,P<0.001).The extracellular water significantly increased in the intervention group compared with that of the control group[(15.35±2.21)L vs.(13.51±2.73)L,t=5.54,P<0.001];however,the somatic cell mass [(27.54±4.42)kg vs.(29.03±4.38)kg,t=2.53,P=0.012],fat mass[(13.44±4.23)kg vs.(17.36±5.21)kg,t=6.18,P<0.001],and muscle mass[(43.11±6.27)kg vs.(48.17±7.13)kg,t=5.63,P<0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure(mREE)[(6 581.62±1 201.70)kJ/d vs.(6 290.73±1 071.68)kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group(P=0.042),and the respiratory quotient(RQ)was also significantly higher(0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027).The extracellular fluid(PG-SGA A vs.B P=0.035;A vs.C P<0.001;B vs.C P=0.042)were significantly increased,and the number of somatic cells(A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022),fat(A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022)and muscle mass(A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036)were decreased with the deterioration of nutritional status,resting energy expenditure(A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032),and RQ(A vs.C P=0.004;B vs.C P=0.012)were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.