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.

Objective To investigate the diagnosis and treatment of functional pancreatic endocrine tumors (PETs). Methods The clinical data of 45 patients with functional PETs who were admitted to the Southwest Hospital from January 1998 to December 2008 were retrospectively analyzed. Etiologic and localization diagnosis were made preoperatively according to the manifestation and the results of color doppler ultrasound and computed tomography, respectively. Eight patients received resection of the body and tail of the pancreas and spleen, 32 received tumor enucleation, one received resection of the pancreaticobiliary junction and four received pancreaticoduodenectomy. All patients received chemotherapy after the operation. Results Thirty-four cases of the PETs were benign and the rest eleven cases were malignant. Eight cases of the PETs were in the head of the pancreas,26 in the tail of the pancreas, seven in the body of the pancreas and four cases were with multiple PETs. The diameters of the PETs were 0. 3-5.0 cm, and the diameters of the PETs in 19 cases were above 2.0 cm. Eight patients were complicated with pancreatic leakage, two with incision infection and one with abdominal infection. Of the 33 patients with insulinoma, the blood glucose of five patients with multiple PETs was still abnormal after the operation, three patients underwent reoperation and the other two were treated by diazoxide to control the blood glucose in the normal range. The clinical symptoms of the seven patients with gastrinoma disappeared after the operation, and the gastric ulcer was healed, the 12-hour gastric juice volume and the level of the gastric acid were in the normal range after a continuous treatment with proton pump inhibition agents for 6 months. Necrotizing or migratory rash and diabetes of the four patients with glucagonoma were cured three weeks later, and the level of the amino acid was back to normal. Diarrhea and electronic disturbance of one patient with vasoactive intestinal peptide tumor were alleviated after the operation. Thirty-nine patients were followed up for 20-120 months. Of the 32 patients with benign PETs, two patients had tumor recurrence, and three patients died of other diseases. Of the seven patients with malignant PETs, two patients survived, and three patients died of hepatic metastasis or tumor recurrence, two patients died of other diseases. Conclusions Surgical treatment is effective for the treatment of functional PETs. Palliative resection of the tumor also can obviously improve the life quality of patients with fuctional PETs.

Objective To conduct a comprehensive evaluation on safety of Honghua Injection through adopting the method of the evidence-based method;To provide reference for clinical reasonable application of Honghua Injection. Methods Computers were used to retrieve some Chinese databases, such as China Biology Medicine, China National Knowledge Infrastructure, Wangfang Database and VIP database. At the same time, other search methods were employed, up to July 2013, including all research types about Honghua Injection. The adverse reactions in the reports of published literature were analyzed by description and statistical analysis. Results Sixty-nine researches on Honghua Injection were included. The total cases of adverse drug reaction (ADR) were 1111, among which male cases were 568 (51%), and female cases were 543 (49%). Thirty-six (52%) papers described ADR of Honghua Injection in detail, and thirty-three (48%) papers just mentioned ADR or did not describe ADR in detail. Skin, skin accessories damage and pathological changes in circulatory system were main contents of ADR. In terms of original diseases, diseases of circulatory system play an important role. Solvent medium was largely in line with its product specification requirements. Most ADR appeared when the drug was used for the first time, from 5 minutes to 5 days. Conclusion The current published literature data show that severe ADR does not happen after the intervention of Honghua Injection.

Objective To investigate the effects of lovastatin,a widely used antilipemic agent,on cell proliferation,migration and apoptosis in human cholangiocarcinoma cell line QBC939 and explore its possible mechanism.Method After QBC939 cells were either incubated with lovastatin alone or without it as a control,the methylthiazolyl tetrazolium assay (MTT) assay was used to detect cell proliferation at the 24 h,48 h and 72 h mark; flow cytometry (FCM) measured apoptosis at 48 h;scratch assay was used to determine cell migration at 48h; RT-PCR and Western blot detected the expression of inflammatory cytokine interleukin-6 (IL-6),protein kinase (PKB/Akt),vascular endothelial growth factor (VEGF),matrix metalloproteinase-9 (MMP-9) mRNA and Akt protein at 48 h.Results Lovastatin significantly inhibited cell proliferation in a dose and time dependent manner (24 h,48 h and 72 h:F=173.05,159.66,577.87 respectively,all P＜0.01).After lovastatin treatment,apoptosis induction increased (t =15.28,P＜ 0.01 ) as did early apoptosis (t =13.24,P＜0.01),while the average migration velocity was reduced (24 h and 48 h:t=6.21,5.95,respectively,all P＜0.01).The Akt protein expression and mRNA expression of IL-6,Akt,VEGF,and MMP-9 were down-regulated after lovastatin treatment.Conclusions Lovastatin can inhibit cell proliferation,migration and promote apoptosis in human cholangiocarcinoma cell line QBC939.The mechanisms of suppression may be associated with down-regulation of IL-6,Akt,VEGF and MMP-9 expression.

OBJECTIVETo evaluate the effects of primary duct closure and T-tube drainage in laparoscopy choledochotomy to treat the common bile duct stones.

METHODSThe enrollment of the patients was in accordance with 6 criteria. 55 patients with cholecystolithiasis and secondary common bile duct stones from January 2000 to February 2003 were treated with laparoscopic choledochotomy. The patients were randomly divided into two groups: primary duct closure group and T-tube drainage group. Their all data were recorded and studied prospectively,and patients were followed up after discharge.

RESULTSThere were 27 patients and 28 patients in primary duct closure group and T-tube drainage group respectively. The operation time and the results of following up between the two groups had no significant difference. Compared with T-tube drainage group, primary duct closure group had less the total quantity of postoperative transfusion and hospital costs, shorter postoperative hospital stay. The incidence of postoperative complications in primary duct closure group was 11.1% (3/27), and all of them were biliary complications. The incidence of postoperative complications in T-tube drainage group was 28.6% (8/28), and seven of them were biliary complications. The incidence of severe complications that needed reoperations was 10.7% (93/28), and all of them were caused by T-tubes. There was no mortality in two groups.

CONCLUSIONSThe primary duct closure in laparoscopic choledochotomy can avoid the deficiency of T-tube drainage, and it is feasible and safe and lower complications in treating the common bile duct stones, so we advocate it in appropriate cases.

Adolescent ; Adult ; Aged ; Child ; Choledocholithiasis ; surgery ; Choledochostomy ; methods ; Drainage ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Suture Techniques ; Treatment Outcome

OBJECTIVETo evaluate the role of orthotopic liver transplantation (OLT) in treating hepatocellular carcinoma (HCC).

METHODSData of 92 consecutive orthotopic liver transplantations (OLTs) performed during January 1999 and February 2005 at our institution were analyzed.

RESULTSOf the 92 recipients, 8 HCC patients were stage I, 13 were stage II, 12 stage III and 59 stage IV (UICC TNM staging system). Overall 1-, 2-, 3-, 5-year patient survival rates were 65.3%, 27.0%, 20.0%, and 6.9%, respectively. When OLT indications were considered, best recipients survival was obtained in stage I patients (100.0%, 100.0%, 66.7%, and 50.0% at 1, 2, 3, and 5 years, respectively) and stage II patients (85.7%, 66.7%, and 66.7% at 1, 2 and 3 years, respectively). Whereas, 1, 2, 3 and 5-year recipients survival rates were 50.0%, 0, 0, 0 in stage III patients, and 58.1%, 20.0%, 13.0% and 5.0% in stage IV patients.

CONCLUSIONSThe prognosis of different stages of HCC patients who underwent OLT was significantly different. The OLT recipients with HCC should be strictly selected. Long-term recipient survival could be obtained in stage I and stage II patients.

Adult ; Aged ; Carcinoma, Hepatocellular ; surgery ; Female ; Humans ; Liver Neoplasms ; surgery ; Liver Transplantation ; mortality ; Male ; Middle Aged ; Neoplasm Staging ; Survival Rate

Objective To evaluate the efficacy and safety of neoadjuvant arterial interventional chemotherapy(NAIC)and neoadjuvant intravenous chemotherapy(NIVC)for the treatment of locally advanced cervical cancer(LACC).Methods Randomized controlled trials(RCTs)which fit the theme were included by searching PubMed,Web of Science,Embase,CNKI,and Wanfang databases.After study quality assessment and data extraction,statistical analysis was performed using Stata 17.0,and outcome quality was assessed using the GRADE system.Results A total of 14 RCTs were included,with 1 063 LACC patients.The results of the Meta-analysis showed that NAIC and NIVC had a positive effect on the effectiveness indicators:complete response(CR)[RR=1.23,95％CI(0.91,1.67),P=0.174],partial response(PR)[RR=1.10,95％CI(0.86,1.20),P=0.874],total response(TR)[RR=1.10,95％CI(0.95,1.25),P=0.212],no change(NC)[RR=0.62,95％CI(0.33,1.16),P=0.137]and progressive disease(PD)[RR=1.43,95％CI(0.41,4.99),P=0.574]were not statistically significant.Differences in safety indicators:gastrointestinal reactions[RR=0.96,95％CI(0.76,1.23),P=0.755],hepatic and renal impairment[RR=0.71,95％CI(0.41,1.23),P=0.226]were not statistically significant.While in the incidence of myelosuppression[RR=0.62,95％CI(0.45,0.86),P=0.04],NAIC was superior to NIVC.In addition,the GRADE score results showed CR,PR,TR,and NC were high-quality evidence.Conclusion For LACC patients,the incidence of myelosuppression after treatment with NAIV is lower and safer than that with NIVC,and no significant difference was found between the two in terms of other efficacy and safety indicators.Clinicians should choose the appropriate neoadjuvant chemotherapy regimen based on a comprehensive assessment of the patient's actual condition.

OBJECTIVE To evaluate the efficacy and safety of immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy in the treatment of early-stage triple-negative breast cancer （TNBC）. METHODS A systematic search was conducted in PubMed， Embase， Cochrane Library， CNKI， and Wanfang Data to collect randomized controlled trials （RCT） on the use of immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy （experimental group） versus neoadjuvant chemotherapy and adjuvant chemotherapy （control group） in the treatment of TNBC. After literature screening， data extraction and literature quality evaluation， meta-analysis was performed using Stata 17.0. RESULTS A total of 5 RCT involving 1 498 patients were included. The meta-analysis results showed that the pathological complete response rate （pCR） [RR＝1.34， 95%CI （1.09， 1.63）， P＝0.03]， pCR in patients with positive programmed death-1 （PD-1） and its ligand （PD-L1） [RR＝1.33， 95%CI （1.16， 1.51）， P＝0.01]， pCR in patients with positive lymph nodes [RR＝ 1.56， 95%CI （1.27， 1.93）， P＝0.01]， the incidence of grade 3-4 adverse events （AEs） [RR＝1.07， 95%CI （1.01， 1.14）， P＝ 0.04]， the incidence of serious AEs [RR＝1.57， 95%CI （1.31， 1.87）， P＝0.03]， and the incidence of treatment discontinuation due to AEs [RR＝1.45， 95%CI （1.19， 1.76）， P＝0.01] were significantly higher in the experimental group than control group. There were no statistically significant difference in pCR in patients with negative PD-1/PD-L1[RR＝ E-mail：biejun23@126.com 1.26， 95%CI （0.98， 1.62）， P＝0.08] and pCR in patients with negative lymph nodes [RR＝1.14， 95%CI （0.97， 1.33）， P＝0.17] between the two groups. CONCLUSIONS Immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy demonstrates significant efficacy in early-stage TNBC patients， with more pronounced benefits observed in those who are PD-1/PD-L1 positive and lymph node- positive. However， the incidence of AEs is relatively high.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective    To summarize our experience of surgical resection of multiple ground-glass opacity (GGO) in recent years. Methods    Clinical data of patients who underwent one-stage resections of multiple GGO from November 2015 to May 2019 in our hospital were collected, including 13 males and 52 females at an average age of 56.0±9.4 years. The clinical effects and pathological types of GGO were evaluated. Results    Time interval from first discovery to surgery was 8-1 447 (236.5±362.4) days. There were 48 patients with unilateral surgery and 17 patients with bilateral surgery during the same period. Except for 2 patients who underwent open thoracotomy due to total thoracic adhesions, other patients underwent video-assisted thoracoscopic surgery (VATS). The mean postoperative hospital stay was 12.2±4.3 days. No severe perioperative complication or death occurred. A total of 156 GGO lesions were resected, 80 lesions were pure GGO, including 58 (72.5%) malignant lesions and 22 (27.5%) benign lesions, with an average diameter of 7.7±3.3 mm and 5.5±2.6 mm, respectively. Another 76 lesions were mixed GGO, including 69 (90.8%) malignant lesions and 7 (9.2%) benign lesions, with an average diameter of 13.6±6.6 mm and 7.7±3.5 mm, respectively. Conclusion    Patients with multiple GGO should be treated with anti-inflammatory therapy firstly. When conservative treatment is ineffective and no benign outcomes are observed, surgical treatment should be considered. And when lung function is sufficient for patients to underwent surgeries, the simultaneous unilateral or bilateral thoracoscopic resection is suggested, and the sublobar resection or lobectomy methods can be adopted flexibly according to the clinical features of the lesion and the rapid pathological results, which will not increase the risk of postoperative complications. Otherwise, surgical resection should be given priority for pure GGO lesions with a diameter > 7.7 mm and mixed GGO lesions.