Sporadic parathyroid adenomas are the most common cause of primary hyperpamthyroidism,The molecular mechanisms underlying the pathogenesis of sporadic parathyroid adenomas are incompletely understood and early specifical diagnosis is lack.With the development of molecular biological technology,gene research in parathyroid adenoma has made great progress.This article reviewed the changes at the molecular level.

Objective To evaluate the outcomes of umbilical hernia repairing in adults.Methods Forty-nine cases of umbilical hernia admitted between 2003 and 2008 were analyzed retrospectively.Opera-tive techniques included traditional repair (n = 14),Kugel patch (n = 21) and mesh plug-patch (n = 14).Results The operative time of traditional repair was shorter than those for patients who underwent Kugel patch hernioplasty or mesh plug-patch hemiorrhaphy.But the pain was significantly higher.With a follow-up of 1 -6 years,whereas no recurrence was documented for the tension-free hemiorraphy,but a case recurred for traditional repair.Conclusion Tension-free hemiorraphy is a safe,efficacious and lower complications technique for the repair of umbilical hernia.

Objective To investigate the differentially expressed genes in sporadic parathyroid adenomas using genechip and provide basis for further studying the mechanism and diagnosis of sporadic parathyroid adeno-mas. Methods Total RNA was extracted from normal parathyroid tissues and adenomas tissues. The mRNA was used to prepare probes. The mixed probes were hybridized to the cDNA microarray. After washing, the DNA chips were scanned by laser scanner. The acquired image was analyzed. Results Among the 47 000 target genes, 2302 genes were identified in sporadic parathyroid adenomas tissues that had at least two-fold changes compared to normal parathyroid tissues, and 1012 genes up-regulated and 1290 down-regulated were found in this study. Of 10 genes up-regulated and 27 down-regulated, the changes were over five-fold. The function of these changed genes was involved in transport, cell adhesion, signal transduetion, transcription, ion binding and so on. Conclusions Many parathyroid adenomas associated genes have been screened by high-throughout gene chip method, Which may help to identify the mechanism and diagnosis of sporadic parathyroid adenomas.

Objective To investigate the procedures and therapeutic effects of reoperation of papillary thyroid carcinoma with lymph node metastasis.Methods The clinical data of 10 papillary thyroid carcinoma patients with lymph node metastasis received reoperation were retrospectively studied. Results Reoperation was successfully performed in 9 patients except one patient with tumor surrounding common carotid artery and brachial plexus who had partial tumor removed. Three patients had simple lymphectomy,2 had complete thyroidectomy, 2 had complete lobectomy plus ipsilateral cervical lymph node dissection and 2 had tumor resection plus cervical lymph node dissection. There were no new complications. Conclusions Papillary thyroid carcinoma has the characteristic tend to spread to spread to cervical lymph nodes. Rreoperation offers good outcome for recurrent papillary thyroid carcinoma.

Objective To study the impact on the use of branched vascular allografts in the prevention of left regional portal hypertension after pancreatic cancer operations.Methods This retrospective study included 25 patients who underwent pancreaticoduodenectomy for pancreatic head cancer which involved the portal vein,superior mesenteric vein and splenic venous confluence between January 2011 to December 2017 in the Beijing Chao Yang Hospital,Capital Medical University.These patients underwent "en bloc" resection of the spleno-mesenterio-portal (SMS) venous axis with replacement of a branched vascular allografts.They were studied to see whether gastroesophageal varices were found on gastroscopy and whether there were any changes in leukocyte,platelet and splenic volume before and after the operation to determine the incidence of left regional portal hypertension after operation.Results During the follow-up period,all the portal vein,superior mesenteric vein and splenic vein anastomoses were unobstructed and without any thrombosis.No new varices were found on gastroscopy.There were no significant differences in the white blood cell count,platelets count and splenic volume before and after the operations (all P＞0.05).The 25 patients had no left regional portal hypertension.Survival time and one year survival rate of the patients were (20.2±3.7) months and 44.0％.Conclusion Branched vascular allografts effectively prevented the occurrence of left regional portal hypertension after radical pancreaticoduodenectomy with resection of SMP.

Objective To systematically review the safety and efficacy of enhanced recovery after surgery (ERAS) in perioperative management of pancreaticoduodenectomy.Methods A search was performed in databases (including PubMed,EMASE,Cochrane library,Sinomed,Wangfang,VIP,and CNKI) for randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) up to September 2016 on use of ERAS in patients undergoing pancreaticoduodenectomy.After quality evaluation and data extraction,meta-analysis was performed using RevMan 5.3.Results Four RCTs and Twelve NRCTs involving a total of 2 828 patients were included.1 401 patients were in the ERAS group,and 1 427 in the control group.Meta-analysis results showed that compared with the control group,the ERAS group had shorter length of hospital stay (SMD =-0.36,95 ％ CI =-0.44--0.28,P＜ 0.05) and lower incidence of delayed gastric emptying (RR =0.61,95％ CI=0.51-0.73,P＜0.05).However,no significant differences were observed in pancreatic fistula rate,bile fistula rate,readmission rate,reoperation rate,and overall mortality morbidity rate between the two groups (all P＞0.05).Conclusion It is reasonably safe and efficacious to adopt ERAS in periopetative management of patients undergoing pancreaticoduodenectomy.

Objective To investigate the clinical efficacy of total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts for pancreatic cancer with vascular invasion.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 9 patients with pancreatic cancer who underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts in the Beijing Chao Yang Hospital of Capital Medical University from January 2014 to September 2016 were collected.There were 4 males and 5 females,aged from 53 to 78 years,with a median age of 60 years.Involvement of portal vein (PV) and (or) superior mesenteric vein (SMV),splenic vein or convergence was detected in patients by preoperative evaluation,which indicated borderline resectable pancreatic cancer.Patients underwent complete surgical resection of tumor and involved portal veins,and then underwent vascular and digestive tract reconstruction.Observation indicators:(1) intraoperative situations;(2) postoperative situations;(3) follow-up.Patients were followed up by telephone interview and outpatient examination to detect survival of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,measurement data with skewed distribution were expressed as M (range),and count data were expressed as absolute number.Results (1) Intraoperative situations:9 patients underwent total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts successfully,including 1 undergoing total pancreaticoduodenectomy due to positive margin of pancreatic neck during pancreatico-duodenectomy for pancreatic head carcinoma,3 of pancreatic head carcinoma with portal vein involvement and atrophy of pancreatic body and tail,and 5 of carcinoma of pancreatic neck and body with portal vein involvement.The operation time,portal vein occlusion time,and volume of intraoperative blood loss were (573± 19) minutes,(21 ±4) minutes,and (717±33) mL.(2) Postoperative situations:4 of 9 patients had postoperative complications,including 2 with grade Ⅰ complication and 2 with grade Ⅱ complication.There was no grade Ⅲ or above complication.No anastomotic stenosis or thrombus formation after reconstruction for portal vein.The perioperative complications were cured after conservative treatment.Duration of postoperative hospital stay was 17 days (range,10-25 days).Nine patients underwent subcutaneous injection of insulin to control blood glucose during the period fasting for solids and liquids.After resuming the semi-liquid diet of diabetes,patients received subcutaneous injection of rapid acting insulin before meals combined with subcutaneous injection of long-acting insulin before bedtime,with a insulin need of 24-36 U/d.Patients had postprandial blood sugar level of 8-11 mmol/L,without unmanageable hyperglycemia orlong-term application of insulin pump.Patients received oral trypsin pancreatin instead of trypsin,with no gastrointestinal symptoms such as bloating and steatorrhea,no malnutrition.Of 9 patients,2 had well-differentiated adenocarcinoma,4 had moderately differentiated adenocarcinoma,and 3 had poor-differentiated adenocarcinoma.There were 3 patients with no vascular invasion,1 with endangidic invasion,5 with tumor infiltration of tunica adventitia vasorum.One of 9 patients was in IIA stage of TNM staging,3 were in the II B stage,and 5 were in IIIB stage.The negative rate of pathological sections for excised specimen margin was 8/9.(3) Follow-up:9 patients were followed up for 7-37 months,with a median follow-up time of 15 months.Four patients survived,4 died of tumor recurrence and metastasis,and 1 died of cerebrovascular accident.Conclusion Total pancreaticoduodenectomy combined with portal vein resection and allograft vascular grafts is safe and feasible for pancreatic cancer involving portal vein,splenic vein or junction.