Pancreatic neuroendocrine neoplasms (pNENs) can be divided into functional and non-functional.Insulinomas,gastrinomas,glucagonomas and VIPomas are the common types of pNENs.Radical resection is the only way for curing pNENs or for a long-time survival of patients.The basic surgical procedures for pNENs are consist of local resection (tumor enucleation) or anatomical resection [pancreatoduodenectomy (standard or pylorus-preserving pancreatoduodenectomy),distal pancreatectomy (combined with splenectomy or spleen-preserving pancreatectomy) and middle segmental pancreatectomy].Liver is the most common site for metastases.Surgical resection is the method of choice for liver metastases.Radiofrequency ablation,transcatheter arterial chemoembolization and liver transplantation could be the adjunctive therapies.

A method was established for the simultaneous determination of the total fatty acid esters of chloropropanols in edible oils by gas chromatography-mass spectrometry combined with isotope dilution technology. The samples were hydrolyzed with sodium methylate-methanol, and then purified by diatomite cartridge. After being derivatized with heptafluorobutyrylimidazole ( HFBI ), the target analytes were determined by GC-MS with the deuteriumchloropropanols esters as the internal standards. An excellent linear correlation in the range of 0. 050-2. 000 mg / L was acquired for 3-monochloropropane-1,2-diol (3-MCPD) esters, 2-MCPD esters, dichloropropan-2-ol (1,3-DCP) esters and 2,3-dichloropropan-1-ol (2,3-DCP) esters, with all the correlation coefficients (r) higher than 0. 9995. The limits of detection (LODs) for 3-MCPD esters, 2-MCPD esters, 1,3-DCP esters and 2,3-DCP esters were 0. 015, 0. 015, 0. 030, and 0. 030 mg / kg, respectively, and the limits of quantitation (LOQ) were 0. 050, 0. 050, 0. 100, and 0. 100 mg / kg, respectively. The average spike recoveries of the four kinds of chloropropanols esters in blank extra virgin olive oil matrix were typically in a range of 87. 0% -110. 5% with the relative standard deviations (RSDs) less than 10. 1% . The detection rates of 3-MCPD esters, 2-MCPD esters, 1,3-DCP esters and 2,3-DCP esters in 74 edible oil samples were 94. 6% , 63. 5% , 5. 4% , and 0% , respectively. The contamination levels of 3-MCPD esters, 2-MCPD esters and 1,3-DCP esters were in the range of not detected (ND) to 10. 646 mg / kg, ND to 3. 617 mg / kg and ND to 0. 089 mg / kg, respectively. This method is accurate and rugged for the simultaneous determination of total fatty acid esters of chloropropanols in edible vegetable oils.

Objective To compare the difficult degree,differences in gastric pouch volume,the complications,and postoperative weight loss effect of two gastric pouch practices in laparoscopic gastric bypass for bariatrics.Methods We retrospectively analyzed laparoscopic gastric bypass surgery in 76 bariatrics cases from May 2010 to May 2012.Two methods were used to create gastric pouch,among which 39 cases were operated with the dissection landmark method (called dissection),and 37 cases with bougie airbags 30 ml (called the bougie).Parameters were compared between the 2 groups including operation time for gastric pouch,the amount of staple cartridges,intraoperative complications,blood loss,and postoperative excess weight loss percentage (EWL ％),the postoperative bleeding,obstruction,fistula and other complications.Results All patients were followed up for more than one month.The dissection group used longer time in creating gastric pouch than that in the bougie group [(58 ± 27) min,(42 ±21) min,P ＜ 0.01].The number of staple cartridges used were significantly different between the two groups [(6.2 ±3.0),(4.3 ± 2.0),P ＜ 0.01].There were 10 cases of complications in the dissection group (26％),and 3 cases in the bougie group (8％) (P ＜0.05).One month after the surgery,one each patient had transient hematochezia.There was no gastric pouch-related complications in the two groups postoperation.There was no difference in excess weight loss (P ＞ 0.05).Conclusions The two methods can achieve the same effect on excess weight loss.The bougie method used less time in creating the gastric pouch,less consumable materials,and less complications occurred in creating gastric pouch.

Objective To investigate the diagnosis and surgical management of adult choledochal cyst.Methods The clinical data of 58 adult patients with congenital choledochal cyst who were admitted to the First Affiliated Hospital of Nanjing Medical University from January 1997 to December 2010 were retrospectively analyzed.All patients were diangosed by the B ultrasonography,computed tomography (CT),Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). Surgical procedures were selected according to the diagnosis and Todani classification.All data were analyzed using the t test or chi-square test.Results The accurate rates of B sonography,CT,MRCP and ERCP were 78％ (45/58),92％ (23/25),9/9 and 5/5,respectively.Forty-one patients underwent complete excision of the cyst + hepaticojejunostomy (2 patients were converted from laparotomy due to abdominal adhesions),2 underwent resection of the cyst and involed hepatic segments + hepaticojejunostomy,8 underwent laparoscopic excision of the cyst + hepaticojejunostomy,1 underwent left hemihepatectomy,3 underwent pancreaticoduodenectomy ( including partial hepatectomy in 1 patient),2 underwent common bile duct exploration + cholecystectomy due to acute obstructive suppurative cholangitis,1 underwent external drainage of choledochal cyst due to advanced malignance.The mean operation time and postoperative duration of hospital stay of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were (235 ± 70) minutes,(320 ± 50) minutes,and ( 10.0 ± 2.3 ) days,( 12.6 ±6.6) days,respectively,with significant differences between the 2 groups (t =3.157,2.162,P ＜ 0.05).The postoperative morbidities of patients who received open and laparoscopic excision of the cyst and hepaticojejunostomy were 18％ (7/39) and 3/8,respectively,with no significant difference (x2 =1.515,P ＞ 0.05 ).Canceration of the choledochal cyst was observed in 6 patients( 10％ ).No perioperative mortality was observed,and the operative complication rate was 24％ (14/58).The duration of the follow up ranged from 1 to 15 years,no severe long-term complications were observed in patients with benign lesions.Four of the 6 patients with malignancy died in 1 year after operation,the other 2 patients survived for 3 years and 5 years,respectively.Conclusions Abdominal B ultrasonography should be the first choice for diagnosing adult congenital choledochal cyst,while MRCP is the gold standard.Surgical intervention should be timely considered once diagnosed. Complete excision of the cyst combined with Roux-en-Y hepaticojejunostomy is the first choice of treatment.

Objective To investigate the clinical features, diagnosis and treatment of malignant pancreatic endocrine tumor. Methods The clinical data of 38 patients with malignant pancreatic endocrine tumor who had been admitted to First Affiliated Hospital of Nanjing Medical University from January 1969 to December 2008 were analyzed retrospectively. Of all patients, 6 were with insulinoma, 23 with pancreatic polypeptide tumor, 4 with glucagonoma and 5 with pancreatic carcinoid. Results All patients except 1 with insulinoma were found with pancreatic lesion by imaging examination. The resection rate was 87% (33/38). Pathological examination found 7 patients with liver metastasis, 5 with lymph node metastasis, 1 with tumor thrombus in vessels and lymphatic vessels, and 28 with local invasion. Twenty-four patients were followed up, and neither recurrence nor metastasis was found except 1 patient with insulinoma who received reoperation for local recurrence and 1 patient with pancreatic carcinoid who received radiofrequency ablation for liver metastasis. Conclusions The diagnosis of pancreatic endocrine tumor mainly depends on imaging examination. The malignancy of pancreatic endocrine tumor is determined after the comprehensive analysis of preoperative imaging findings, intraoperative examination, post-operative pathological examination and the data obtained during follow-up. The malignant pancreatic endocrine tumor should be managed actively by resection because of its relatively low malignancy, high operative resectability and relatively good prognosis.

OBJECTIVETo compare the clinical effects and safety of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of close Pilon fractures of the proximal interphalangeal joint.

METHODSFrom June 2012 to June 2014, totally 41 patients (45 fingers) with close interphalangeal joint Pilon fracture were treated by dynamic external fixtor combined with limited internal fixation or cross K-wires fixation, and all the patients were followed up. In the dynamic external fixtor combined with limited internal fixation group (group A), there were 21 patients with 22 fingers, including 12 males and 9 females, with an average of (30.6±5.6) years old. In the cross K-wires fixation group (group B), there were 20 patients with 23 fingers, including 11 males and 9 females, with an average of (30.1±5.3) years old. Regular re-examination of X-ray was performed to evaluate the active range of joint motion, fracture healing time, infection rate and postoperative joint motion pain.

RESULTSAccording to the evaluation criteria of upper extremity function issued by the Hand Surgery Society of Chinese Medical Association, the excellent and good cases of group A was up to 19 and 13 for group B. The evaluation results has significant differences (Z=2.558, P=0.011). The excellent and good rate of group A was obviously higher than that of group B. The average bone union time of group A was (7.9±2.1) weeks, and (8.1±2.3) weeks for group B. There was no significant difference on the mean healing time (t=-0.304, P=0.762). The infection fingers of group A was 5, and 1 for group B. The difference between the results was statistically significant (χ2=3.287, P<0.05). The infection rate of group A was higher than that of group B. The postoperative joint motion pain was evaluated by VAS score, the mean score was 0.18±0.50 in group A, and 0.65±0.88 in group B. The difference between the results was statistically significant (t=-2.207, P<0.05). The postoperative joint motion pain was lower than that of group B.

CONCLUSIONDynamic external fixtor combined with limited internal fixation is a reliable and effective method to treat Pilon fractures of the proximal interphalangeal joint. It allows early postoperative functional rehabilitation and restores the joint function.

Adolescent ; Adult ; Bone Wires ; Case-Control Studies ; External Fixators ; Female ; Finger Joint ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

Objective To evaluate the safety and feasibility of simple ligation and resection of the tumor involved inferior vena cava (IVC) without reconstruction during the resection of huge intraabdominal tumors.Methods From 2008 to 2011,4 cases of giant tumor encroaching on inferior vena cava underwent resection without IVC reconstruction.After resection,renal vein was not obstructed in patient 1 and 2.Tumor invaded the third patient's retrohepatic inferior vena cava,anastomosis was performed between the left hepatic vein and the opening of atrium dextrum with artificial vascular graft.The forth patient had right trisegmentectomy of the liver with retrohepatic inferior vena cava resection,anastomosis was performed between the left hepatic vein and the remaining inferior vena cava.Results All 4 patients had a successful operation without intraoperative massive bleeding and death.The postoperative complications included edema in one patient whose collateral circulation was damaged and bile leak in one.Ewin sarcoma patient died of tumor recurrence after a year,but there was no sign of poor renal function and other complications.Ligament fibroma patient had lower limb edema for a long time after the surgery,and tumor relapse for the fourth time in two years following resection.Conclusions When a giant tumor involving and invading IVC,undergoing resection,under the condition that the collateral circulations around IVC established completely,resection and ligation of the inferior vena cava along with huge tumor without IVC reconstruction is safe.This method saves operation time,increases the safety of surgery.

Objective:To compare the clinical efficacy of the Simultaneous three scopes combined surgery [laparoscopic cholecystectomy(LC)+ choledochoscopy exploration + choledochectomy and removal of the common bile duct + primary suture of the common bile duct + endoscopic guided nasobiliary duct placement] and staged two scopes surgery[endoscopic retrograde cholangiopancreatography (ERCP) combined with LC] in the treatment of choledocholithiasis and cholecystolithiasis.Methods:From January 2018 to June 2020, we retrospectively analyzed the clinical data of 83 patients with choledocholithiasis and choledocholithiasis, who underwent minimally invasive treatment in our center. According to the different surgical procedures, the patients were divided into three-mirror group ( n=42) and two-mirror group ( n=41). All patients in the three-mirror group underwent three-scopy combined surgery. The patients in two-mirror group received endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC). In this study we compared the relevant clinical indicators of the two groups, in terms of the operation time, intraoperative blood loss, one-time stone clearance rate, postoperative exhaust time, postoperative defecation time, total hospitalization cost, incidence of postoperative acute pancreatitis, postoperative stone recurrence rate, incidence of postoperative cholangitis, and incidence of postoperative biliary fistula, total hospitalization time, postoperative bile duct stricture rate. Use SPSS 26.0 software to statistically analyze various indexes such as intraoperative, postoperative, follow-up, etc. Normally distributed measurement data were described by the mean±standard deviation ( Mean± SD), the comparison between groups was by t test, and measurement data with skewed distribution were destribed as M( P25, P75), Pairwise comparisons were analyzed using nonparametric test. The comparison of count data between groups was by the chi-square test. Results:No death was observed in both two groups. The operation time, intraoperative blood loss, one-time stone clearance rate, postoperative exhaust time, and postoperative defecation time of the three-mirror groupwere (167.98±47.37) min, 50(50, 100) mL, 100%(42/42), (2.10±0.76) days, 3(3, 4) days, the two-mirror group were (143.80±34.47) min, 50(50, 50) mL, 85.4%(35/41), (1.53±0.99) days and 2(1, 3) days. Compared with the two groups, the three-mirror group was higher than the two-mirror group, and the difference was statistically significant ( P<0.05). The total hospitalization expenses, postoperative acute pancreatitis incidence, and postoperative calculus recurrence rate in the three-mirror group were (3.46±0.77) ten thousand yuan, 0(0/42), 2.38%(1/42), the two-mirror group were (4.22±1.50) ten thousand yuan, 9.8%(4/41), 19.5%(8/41). Compared with the two groups, the three-mirror group was lower than the two-mirror group, and the difference was statistically significant ( P<0.05). No postoperative cholangitis or biliary fistula occurred in the two groups. There was no statistically significant difference in the total hospital stay and incidence of postoperative bile duct stenosis between the two groups ( P>0.05). Conclusions:For choledocholithiasis combined with cholecystolithiasis patients, simultaneous three-scopes combined surgery and elective LC after ERCP are safe and effective, and each has its own advantages. It should be selected reasonably according to the patient′s condition and combined with the technical advantages of the treatment team.

OBJECTIVETo explore the methylation status in promoter region of norepinephrine transporter gene (NET, SLC6A2) in heart failure ( HF) patients and its correlation with qi deficiency/blood stasis syndrome (QDS/BSS).

METHODSThirty-six patients with heart failure (NYHA classification III to IV) were recruited in the study (as the heart failure group) and their scores of QDS/BSS were evaluated. Besides, a healthy elderly group (30 cases) and a healthy youth group (30 cases) were also set up. They were recruited from Physical Examination Center of Fujian Provincial Hospital. Pyrosequencing was applied to detect the methylation in promoter region of SLC6A2 gene, and the total methylation index (MTI) of CpG island was calculated. The correlation between the methylation status in promoter region of SLC6A2 and scores of QDS/BSS was assessed using Pearson and Partial analyses. Risk factors were screened and adjusted using Logistic regression.

RESULTSBy one-factor analysis of variance, the total MTI in the HF group (219.72% ± 54.03%) was obviously higher than that in the healthy elderly group (194.47% ± 34.92%) and the healthy youth group (161.60% ± 41.11%) (all P < 0.05). Meanwhile, the total MTI was higher in the healthy elderly group than in the healthy youth group (P < 0.01). By covariance analysis , after controlling age and BMI, the total MTI was higher in the HF group than in the healthy elderly group (P = 0.041), while it was higher in the healthy elderly group than in the healthy youth group (P = 0.016). Age was found to play an essential role in affecting MTI of SLC6A2 gene promoter region among the 3 groups (F = 16.447, P = 0.01). The total MTI was quite lower in the healthy youth group. Results of Partial correlation analysis showed MTI was positively correlated with scores of qi deficiency and blood stasis respectively (r = 0.494 and 0.419 respectively, both P < 0.05). Logistic regression analysis showed after adjusting confounding factors, the relative risk (OR value) of total MTI of SLC6A2 gene in promoter region was 1.038 (95% CI, 1.006 to 1.071, P = 0.020).

CONCLUSIONSAbnormally elevated methylation of the promoter region of SLC6A2 gene is one of risk factors for HF. In addition, the degree of methylation of the promoter region of SLC6A2 gene was positively correlated with the severity of QDS/BSS.

Adolescent ; Aged ; DNA Methylation ; Heart Failure ; genetics ; physiopathology ; Humans ; Logistic Models ; Medicine, Chinese Traditional ; Norepinephrine Plasma Membrane Transport Proteins ; genetics ; Promoter Regions, Genetic ; Qi

Objective: To assess the risk of public health emergencies in Zhejiang Province, March 2021. Methods: An expert counsel was conducted to assess the risk of coronavirus disease 2019 ( COVID-19 ) , enteritis due to norovirus, chicken pox and influenza by professionals in Zhejiang CDC, based on the information from infectious disease and public health emergency surveillance in Zhejiang Province, domestic health administrative departments, World Health Organization, and European CDC. Results: In March 2021, the risk of imported COVID-19 epidemic will be high in Zhejiang Province, and the possibility of local spread could not be ruled out. The possibility of a large-scale outbreak of enteritis due to norovirus and a small-scale outbreak of chickenpox in schools and kindergartens could not be ruled out after the new term begins. An increased risk of influenza epidemic is predicted in collective units such as schools and kindergartens, yet the risk of a large-scale one will be low. Conclusion High attention should be paid to COVID-19 and enteritis due to norovirus, and general attention should be paid to chicken pox and influenza outbreak.