Radical pancreaticoduodenectomy is the most effective method for the treatment of malignant tumor of pancreatic head.Safe and complete resection of the uncinate process of the pancreas is the most difficult and important part in radical pancreaticoduodenectomy.For the past years,we put forward the new idea of prior selective arteriovenous treatment in radical pancreaticoduodenectomy according to whether the portal vein and superior mesenteric vein was invaded by the tumor.Thin slice scan and vessel reconstruction using multidetector spiral CT can accurately evaluate the condition of the blood vessels near the pancreatic tumor and judge whether the tumor was resectable.By exchanging superior mesenteric artery,controlling blood stream of pancreatic uncinate process and using 3 or 4 vascular blocking bands and the integrated radical resection of uncinate process for those patients can be successfully completed.It can reduce the operating bleeding,operating time and the miscut of superior mesenteric vein and (or) superior mesenteric artery,and also avoid postoperative pancreas necrosis,infection and hemorrhage caused by the pancreas uncinate process residues,and theoretically reduces the chance of tumor cells spread.

Pancreaticoduodenectomy is the main treatment method for pancreatic head carcinoma and periampullary cancer,and is also the only possible cure way.With the development of minimally invasive surgery,laparoscopic pancreaticoduodenectomy has been widely carried out,it even has been the routine operation in some pancreatic surgery center.The traditional approach is still the main approach for laparoscopic pancreaticoduodenectomy.In recent years,the procedure of the artery approach with its advantages has been put forward and gradually developed in laparoscopic pancreaticoduodenectomy through the continuous study and exploration.On the basis of the early arterial approach,authors' center established an artery preferential disconnection procedure in laparoscopic pancreaticoduodenectomy,which has been named arterial first approach.In the clinical practices and studies,this procedure also represents its unique advantages.

Objective To investigate the methods and techniques of simplified binding pancreaticojejunostomy for patients with periampullary malignant tumor after radical pancreatoduodenectomy (RPD). Methods From March 2005 to May 2010, 323 patients with periampullary malignant tumor received RPD at the Tongji Hospital of Huazhong University of Science and Technology, and their clinical data were retrospectively analyzed.Simplified binding pancreaticojejunostomy was applied after RPD: the distal end of pancreas was freed for 3-4 cm;a No. 6 or No. 8 silicone urinary catheter was inserted into the pancreatic duct for 4-5 cm, and the remaining urinary catheter (6-8 cm) out of the pancreatic duct was sutured to the pancreatic stump with absorbable sutures.The cutting end of the jejunum (2-3 cm) was everted, and the everted mucosa of the jejunum ( 1 cm) was injured by electrocautery, then the everted jejunum was reverted to its normal position. The cutting end of the mesentery of jejunum and its opposite side, as well as the mid-point of these two parts were sutured symmetrically with the lower and upper edges of the pancreas, and with the capsule of pancreas between them. The everted jejunum was wrapped over the pancreatic stump and sutured it to the pancreas for fixation. The cutting end of the jejunum was bound to the pancreatic stump with 1-0 absorbable suture after confirming the jejunum was completely invaginated into the pancreas. The alimentary tract was reconstructed by using Child's method. Results Simplified binding pancreaticojejunostomy was successfully completed in all patients, Pancreatic fistula was detected in one patient who was complicated with anastomotic bleeding on the third day after secondary laparotomy. The patient was discharged with catheter and spontaneously recovered one month later. Pancreatic fistula was also detected in two patients with distal bile duct carcinoma and two patients with carcinoma in the uncinate process of pancreas at postoperative day 3, 6, 8 and 11, and they were cured by expectant treatment. The incidence of pancreatic fistula was 1.5% (5/323). Conclusion Simplified binding pancreaticojejunostomy is simple, safe and feasible, and it can significantly reduce the incidence of pancreatic fistula.

Objective To investigate the ground glass appearance of solitary nodules of bronchioloalveolar carcinoma of the CT imaging features.Methods A retrospective analysis of 20 cases with pathologically proved with a ground glass appearance of solitary nodules of bronchioloalveolar carcinoma of the clinical and imaging data of CT.Results 20 cases of solitary nodules of bronchioloalveolar carcinoma without obvious clinical symptoms ;location:the upper lobe of the left lung in 10 cases,right upper lobectomy in 5 cases,3 cases of the right middle lobe,lower lobe of the left lung in 2 cases; all lesions were located at the lung periphery,both ground glass opacity nodules,14 of them patients with lesions of the peripheral see spiculation in 5 cases,vacuole sign,8 cases with air bronchogram,16 cases with pleural indentation,10 cases of vascular convergence sign etc..In 20 cases the lesion enhancement scan after the lesion showed no enhancement.In all cases,through the CT dynamic observation,no obvious change in lesion size,lesion slightly higher density,finally performed lobectomy pathologically diagnosed non mucoid alveolar cell carcinoma.Conclusion the ground glass appearance of solitary nodules of bronchioloalveolar carcinoma progress is slow,dynamic imaging observation helps to confirm the diagnosis.

Objective To investigate the drug resistance of side population cells in human gallbladder cancer cell line GBC-SD and explore its mechanism. Methods Drug sensitivity assays of 5chemotherapeutic agents were performed on side population cells (SP) and non-SP cells of GBC-SD.GBC-SD was cultured and then treated with the chemotherapeutic agent gemcitabine. The frequency of SP by FACS was measured. RT-PCR and Western blotting were used to detect the expression of AB-CG2 in both the SP and the corresponding non-SP subsets. Results After 1 d treatment with 4 chemotherapeutic agents (gemcitabine, cisplatin, 5-fluorouracil and mitoxantrone) in IC50 concentration to GBC-SD cell line, the reproductive ability of SP was higher than that of non-SP (P<0.05). However, statistical significance was not achieved when compared with epirubicin (P>0.05). The percentage of SP in GBC-SD treated with chemotherapeutic agent gemcitabine after 3 weeks was sharply elevated by FACS (8.02% ±0.13% vs 0.62% ±0.08%, P<0.05), and the expression of ABCG2mRNA and protein were increased in SP as compared with non-SP. Conclusion SP from human gallbladder cancer cell line GBC-SD, like stem cell, showed a heighten resistance to drugs. Increased expression of ABCG2 was largely responsible for the multi-drug resistance.

Objective To evaluate a modified technique for digestive tract reconstruction after pancreaticoduodenectomy(PD).Methods 171 admitted patients were enrolled from January 2012 to January 2014 at our department.According to the preoperative CT scan and intraoperative exploration,pancreaticogastrostomy was performed in cases of soft pancreas texture,while pancreaticojejunostomy was performed in fibrotic pancreas after PD.Bypassed biliary-pancreatic reconstruction were applied on all cases.Results For the digestive tract reconstruction after PD,92 patients underwent pancreaticogastrostomy,79 patients underwent pancreaticojejunostomy.The median time for the surgery was 240.0 minutes (ranging from 186 to 414 min).Operative mortality was zero,and morbidity was 18.1％ (n =31),including hemorrhage (n =4),biliary fistula (n =3),pulmonary infection (n =2),adipose liquefaction and operative incision infection (n =0),delayed gastric emptying (DGE) (n =6),abdominal abscess (n =4).Fout patients developed a pancreatic fistula (type A in 2,type B in 2).Conclusions Modified pancreaticogastrostomy,pancreaticojejunostomy and biliary-pancreatic bypass is safe for digestive tract reconstruction after pancreaticoduodenectomy.

Postoperative pancreatic leakage remains a persistent problem after pancreaticoduodenectomy.For patients with a soft and nonfibrotic pancreas,double binding continuous hemstitch suture is an optimal method for anastomosis.From January 2011 to June 2012,92 cases of periampullary carcinoma with a soft pancreas underwent pancreaticoduodenectomy,and then a modified technique of pancreaticogastrostomy was performed with 2 continuous hemstitch sutures placed in the mucosal and seromuscular layers of the posterior gastric wall,respectively.The median time for pancreaticogastrostomy was 12 minutes,and only 15 patients had postoperative complications.Two patients developed pancreatic leakage(1 grade A and 1 grade B)postoperatively.Pancreaticogastrostomy with double binding continuous hemstitch sutures is a simple and safe reconstruction procedure for patients with a soft and fragile pancreas who received pancreaticoduodenectomy.

ObjectiveTo explore the tumor igenic property of side population cells (SP) from human gallbladder carcinoma cell line GBC-SD. Methods SP and non-SP cells were isolated from GBC-SD staining with Hoechst33342 dye by fluorescence-activated cell sorting (FACS). The soft agar clonal assay and xenograft assay were performed to characterize tumorigenic property of side population cells in vitro and in vivo, respectively. The percentage of SP cells was analyzed by FACS in 5 hu man gallbladder carcinoma specimens. ResultsThe percentage of SP cells accounted for approximately 0.87 ％ of GBC-SD cells. The clone-formed rates of SP was more frequent than that of non-SP cells (14.74％ ± 3.53％ vs 5.17％ ± 1.05％), there was statistically significant difference (t =2.75,P＜0. 05). SP cells could generate tumors with as few as 5 × 103 cells (four of seven animals), whereas at least 1 × 105 non-SP cells were needed to form a tumor (one of seven animals). Re-analysis of SPderived tumors by FACS showed that SP cells under in vivo conditions also have the capacity to regenerate the SP and non-SP fractions. Besides, analysis of Hoechst33342 revealed s small fraction of SP cells, ranging from 0. 27％ to 2.3％ in gallbladder carcinoma specimens. ConclusionSP cells from GBC-SD are highly tumorigenic similar as the cancer stem cells.

Objective To summarize the experiences with early treatment of the wounded associated with 4 · 20 Lushan earthquake in army hospitals.Methods Emergency response programs were started and tent hospitals were set up.According to the basic principle of wartime wound treatment regulation,emergency triage,emergency medical care,transferring,specialized treatment and evacuation were performed for the wounded in this earthquake.Results After the earthquake,the emergency rescue programs were started in the hospital.Twenty minutes later,emergence medical team with full equipment were set out for the epicenter and the tent hospitals were set up.A total of 181 earthquake cases were admitted within two weeks,of which 68 (37.6％) were transferred from the scene of earthquake and 113 (62.4％) were transferred after the primary treatment (including cases evacuating from other hospitals).Forty-nine surgeries had been done,including 30 emergence ones.Thirty-four cases (including 14 severe wounded) were evacuated to superior hospitals as their vital signs turned stable.There was no death or surgical wound infection.Conclusions Peacetime complete emergence programs and materials reserves,unified and well-organized command as well as normative grading treatment system in army hospitals assure the standardized medical care with high efficiency and high quality for earthquake victims.However,more researches are needed over diagnosis methods and standards for wound severity,equipment improvement and standards for casualty evacuation.

Mounting evidence has shown that side population (SP) cells are enriched for cancer stem cells (CSCs) responsible for cancer malignancy. In this study, SP technology was used to isolate a small subpopulation of SP cells in human gallbladder cancer cell line GBC-SD, and SP cells which had superior potential for proliferation in vitro and tumorigenesis in vivo were identified. Importantly, the abundance of GBC-SD SP cells was increased by a transforming growth factor-β (TGF-β)-induced epithelial-mesenchymal transition (EMT), and this effect was accompanied with a strong up-regulation of ABCG2 mRNA expression, and a decreased sensitivity to mitoxantrone. SP cells were restored upon the removal of TGF-β and the reversion of the cells to an epithelial phenotype, and smad3-specific siRNA reduced SP abundance in response to TGF-β. In conclusion, TGF-β-induced EMT by smad-dependent signaling pathway promotes cancer development and anti-cancer drug resistant phenotype by augmenting the abundance of GBC-SD SP cells, and a better understanding of mechanisms involved in TGF-β-induced EMT may provide a novel strategy for preventing cancer progression.