Objective To investigate the changes of NGF mRNA expression and the effect of exogenous interleukin 1?(IL 1?) on it in rats after traumatic brain injury(TBI) and to explore the mechanism of NGF and IL 1? in TBI. Methods A brain trauma model of fluid percussion in rats was established. Changes of NGF mRNA expression and effect of exogenous IL 1? on it were observed by RT PCR, molecular hybridization and immunocytochemical techniques. Results NGF mRNA expression in the brain injury site and tissues adjacent to it began to increase at 12 h after trauma and increased markedly at 24 h and reached the peak value on the 3rd. Then it decreased gradually, but still higher than that of the control. NGF mRNA expression increased at 3 h after trauma in IL 1? treatment group and was significantly higher than that in simple trauma and control groups( P

Objective To explore the application of team-based learning (TBL) and problem-based learning (PBL) method in clinical teaching of laparoscopic surgery in general surgery. Methods 48 students of surgery in our department were selected as the subjects to conduct the clinical teaching study. These students were divided randomly into two groups. The experimental group (24 students) adopted the method that combined TBL and PBL method, while the control group (24 students) adopted the traditional teaching method. We compared the efficacy of two groups in term of theoretical knowledge, surgical practice, com-prehensive surgical grade, and questionnaire survey. Results The score of theoretical knowledge and sur-gical practice on clipping soybean and making suturation and instrumental tie of two groups were obviously higher than that before teaching. After finishing teaching, the score of experimental group on theoretical knowledge, making suturation and instrumental tie and comprehensive surgical grade were higher than that of control group. The score of clipping soybean was similar between two groups. In addition, in term of questionnaire survey on the consciousness of independent study, the depth and width of study, and satisfac-tions to teaching, the TBL and PBL group had a better score than the control group. Conclusion The new teaching method which combines TBL with PBL enhances the teaching effect on theoretical knowledge and laparoscopic surgery practice. It is an effective method to train medical students.

Objective To discuss the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in distinguishing tumor remnants from tumor necrosis of pancreatic carcinoma after cryoablation treatment.Methods Conventional MRI T1WI,T2WI scan,DWI sequence and dynamic enhanced MRI scan were performed in 26 patients with pancreatic carcinoma who were received cryoablation treatment.The changes in MRI signals after cryoablation treatment were recorded.The apparent diffusion coefficient (ADC) values of the normal pancreas,preoperative tumor tissue,postoperative remnants and necrosis tissue were calculated,and the results were compared.The correlation between the ADC values and the size of the tumor was evaluated,and the differences in ADC values among the tumors that had different diameter,location and staging were statistically analyzed.Results Of the 26 patients,complete necrosis of tumor was obtained in 16.The necrotic tumor tissue displayed low-signal on T1WI,high-signal on T2WI and low-signal on DWI,with no enhancement on dynamic enhanced imaging.Active residual tumor tissue was detected in 9 patients,among them the residual tumor diameter ＞5 cm was seen in 7 patients;the residual rate was 34.6％.ADC values of the following tissue,from low to high in order,were preoperative pancreatic tumor tissue (1.022± 0.126)x10-3 mm2/s,postoperative residual tumor tissue (1.130±0.155)x10-3 mm2/s,normal pancreatic tissue (1.924±-0.124)×10-3 mm2/s and postoperative necrosis tissue (2.312-±0.214)×10-3 mm2/s.No statistically significant difference in ADC values existed between preoperative pancreatic tumor tissue and postoperative residual tumor tissue (P=0.452),while statistically significant difference in ADC values existed between normal pancreatic tissue and postoperative necrosis tissue (P＜0.001).The ADC values of pancreatic tumor tissue bore a negative correlation with the tumor size (R=-0.43,P=0.027 2),while the ADC values lacked the relationship to the tumor location as well as to the tumor staging (P=0.738 8 and P=0.089 5 respectively).Conclusion MR-DWI can effectively distinguish the residual tumor tissue from the necrotic tumor tissue of pancreatic carcinoma after cryoablation treatment,which provides reliable basis for further clinical diagnosis and treatment.

Extra-luminal flow hollow fiber membrane oxygenator (ELFHFMO) has been widely applied in cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) or extracorporeal life support (ECLS) because of its advantages over other types of MO. But its low hemocompatibility and durability are the major problems in clinical application that even have limited its wide application. In this paper, we reviewed the recent researches on how to improve the hemocompatibility and durability of ELFHFMO.
Coated Materials, Biocompatible ; Extracorporeal Membrane Oxygenation ; instrumentation ; Heparin ; administration & dosage ; Humans ; Oxygenators, Membrane ; trends

The incidence of metastatic gastric cancer (MGC) is high and the prognosis is poor with 5-year survival rarely exceeding 5%. Systemic chemotherapy is the cornerstone for MGC in current treatment guidelines. Recent studies have revealed both reduction surgery and conversion surgery can improve patient's prognosis, indicating the value of surgical treatment in MGC. Based on the present therapeutic strategy, we discuss the indication, extent and timing of surgery for MGC. Our conclusions are as followings: the treatment of gastric cancer is chemotherapy-based, target-included and surgery-combined multidisciplinary therapy; patients with single non-curable factor are most likely to benefit from surgery-combined multidisciplinary therapy; the optimal timing for surgery depends on the response to chemotherapy; it is worthwhile to explore the conversion therapy combining target therapy and chemotherapy; the resection of metastasis lesion can be managed according to Japanese guideline; in order to establish high-level evidence, it is necessary to unite experts from different disciplines to conduct clinical trial according to the category of metastasis of gastric cancer.

It has been thirty years since the three-dimensional (3D) laparoscopy was put into clinical use. The advantages of 3D laparoscopy are depth perception, high cost-efficacy, tactile feedback, education for basic procedures in laparoscopy and accurate operation. Currently, high-level of evidence for 3D laparoscopy in gastric cancer is still lacking. The advantage of 3D laparoscopy could be maximized in complicated procedures, like hilar lymphadenectomy and totally laparoscopic reconstruction in gastrectomy. In order to acquire optimal depth perception, optimal standing position and stereoacuity check should be emphasized for surgeons in 3D laparoscopic surgery. In light of the limitation of 3D laparoscopy, glass-free 3D laparoscopy and real-time navigation-assisted 3D laparoscopy may be one of the future directions. The value of 3D laparoscopy in obese patients and comparison with robot surgical system are worth further investigating.

Different proficiency in minimally invasive surgery has great impact on efficacy of minimally invasive surgery. Therefore, great importance should be attached to the standardization of minimally invasive surgery. Accurate preoperative staging plays a prerequisite role which emphasizes multiple diagnostic strategies. Precise intraoperative procedure plays an essential role which should be performed according to the evidence-based expert consensus and guideline. Standardized postoperative management plays a crucial role which includes ex vivo lymph node dissection, registry of complication and follow-up and establishment of medical database. Establishing training system and improving quality standard system will promote standardized utilization of minimally invasive surgery clinically.

Multidisciplinary therapy is considered as an acceptable option for gastric cancer patients with liver metastases currently, while the effectiveness of surgery is still controversial. Although there was no improved survival for cytoreductive surgery, some evidences showed that some selected patients with the combination surgery of gastric cancer and liver metastases could benefit from curative resection. Compared to cytoreductive surgery for gastric cancer patients with liver metastasis, curative resection did not increase the incidence of complications or mortality. Therefore, surgery?based multidisciplinary therapy would be appropriate for some seleted gastric cancer patients with liver metastasis. In highly selected patients with neoadjuvant chemotherapy, curative resection with both primary and metastatic tumor could improve long?term survival benefits. Furthermore, the long?term survival and quality of life should be considered of equal importance in future studies.

Multidisciplinary therapy is considered as an acceptable option for gastric cancer patients with liver metastases currently, while the effectiveness of surgery is still controversial. Although there was no improved survival for cytoreductive surgery, some evidences showed that some selected patients with the combination surgery of gastric cancer and liver metastases could benefit from curative resection. Compared to cytoreductive surgery for gastric cancer patients with liver metastasis, curative resection did not increase the incidence of complications or mortality. Therefore, surgery?based multidisciplinary therapy would be appropriate for some seleted gastric cancer patients with liver metastasis. In highly selected patients with neoadjuvant chemotherapy, curative resection with both primary and metastatic tumor could improve long?term survival benefits. Furthermore, the long?term survival and quality of life should be considered of equal importance in future studies.

Objective To explore the risk factors of complications after laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer (GC).Methods The retrospective case-control study was conducted.The clinicopathological data of 488 GC patients who underwent LADG in the General Hospital of the Chinese People's Liberation Army between January 2010 and May 2016 were collected.Observation indicators:(1)surgical and postoperative situations;(2) risk factors analysis of postoperative complications;(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the post-operative survival of patients up to October,2017.Measurement data with normal distribution were represented as (x)±s,and measurement data with skewed distribution were described as M (interquartile range).The univariate analysis was done using the chi-square test (count data),t test (measurement data with normal distrubution and homogeneity of variance) or t'test (measurement data with normal distribution and heterogeneity of variance) and nonparametric test (measurement data with skewed distrubution).The multivariate analysis was done using the Logistic regression model.Results (1) Surgical and postoperative situations:all the 488 patients underwent successful surgery,including 7 with conversion to open surgery due to intraoperative bleeding and difficult surgery and 481 with LADG.The operation time and volume of intraoperative blood loss of 488 patients were (233±71)minutes and 100 mL (100 mL).The postoperative complications occurred in 99 of 488 patients,some patients merged simultaneously multiple complications.The Clavien-Dindo Ⅰ,Ⅱ,Ⅲa,Ⅲb,Ⅳa,Ⅳb and Ⅴ complications were detected in 39,26,26,6,0,0 and 2 patients,respectively.The top 3 postoperative complications were delayed gastric emptying (18 patients),intestinal obstruction (14 patients) and anastomotic fistula (14 patients).Cases with delayed gastric emptying,intestinal obstruction and anastomotic fistula were respectively 12,12,6 with the Clavien-Dindo classification ＜ Ⅲ a and 6,2,8 with the Clavien-Dindo classification ≥ Ⅲ a.Of 99 patients with postoperative complications,97 were improved by symptomatic treatment and 2 died.Duration of postoperative hospital stay was (13± 12)days.(2) Risk factors analysis of postoperative complications:the results of univariate analysis showed that preoperative concomitant diseases and digestive tract reconstruction were the related factors affecting postoperative complications of patients undergoing LADG;(x2 =11.225,6.581,P＜0.05).The results of multivariate analysis showed that preoperative concomitant diseases and Billroth Ⅱ anastomosis were the independent risk factors affecting postoperative complications of patients undergoing LADG (Odds ratio=2.336,2.630,95％ confidence interval:1.475-3.687,1.369-5.053,P＜0.05).(3) Follow-up and survival situations:of 486 discharged patients,380 were followed up for 2-89 months,with a median time of 42 months.During the follow-up,289,35,48 and 8 patients had respectively tumor-free survival,tumor recurrence and/or metastasis,tumor-related death and non-tumor-related death.Conclusion The anastomotic fistula is one of the common and severe complications after LADG,and preoperative concomitant diseases and Billroth Ⅱ anastomosis are the independent risk factors affecting postoperative complications of patients undergoing LADG.