Post-operative pancreatic fistula(POPF)is the most common and severe complication after pancreaticoduodenectomy,which may have significant impacts on curative effects and prognosis.It has been shown that POPF is not only closely associated with texture of pancreatic parenchyma,diameter of pancreatic duct and tumor site,but also affected by surgeon's experience and surgical techniques.Double layer pancreaticojejunostomy and external pancreatic duct stent may be beneficial to decrease POPF.

Thioredoxin (Trx) is a class of small redox proteins which is widely found in all organisms.It acts as antioxidant by facilitating the reduction of other proteins by cysteine thiol-disulfide exchange.Recently,thioredoxin is found to be over-expressed in many kinds of tumor,which is closely associated with tumor cell proliferation,apoptosis and cell cycle control.Trx is also found to promote the synthesis and stabilization of the HIF-1α protein.It is also related to the control of reactive oxygen species and chemoresistance of tumor cells.Trx has been proved to play an important role in promoting the metastasis of cancer,and may become a potential target for anti-metastasis of cancer.

Objective To investigate the clinical value of a preoperative predictive scoring system established by National Cancer Center Hospital (NCCH) for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).Methods The clinical data of 100 patients with periampullary tumor who underwent PD in the Cancer Hospital of Tianjin Medical University from October 2008 to January 2012 were retrospectively analyzed.Five indexes including gender,pancreatic cancer,main pancreatic duct index,portal invasion and intra-abdominal fat thickness were in the NCCH preoperative predictive scoring system.Patients with score ＞ 4 were defined as with high risk of POPF,and those with score≤4 were defined as with low risk of POPF.Factors associated with POPF were analyzed using the Pearson chi-square test.The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis.Results Of the 100 patients,20 had POPF,including 9 in grade A,6 in grade B and 5 in grade C.Gender,pancreatic cancer,portal invasion,texture of pancreas and method of pancreaticojejunostomy were closely correlated with POPF (x2=5.613,4.785,15.479,7.145,7.050,P ＜ 0.05).The incidence of POPF was 86.4％ (19/22) for patients with high risk of POPF,and 1.3％ (1/78) for patients with low risk of POPF,with significant difference (x2=77.637,P ＜ 0.05).The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 95.0％ and 96.3％,respectively.The nomogram showed an area under the curve of 99.0％ (P ＜ 0.05).Conclusion The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF.

Objective To discuss the manifestations of MRI of enlarged iliopsoas bursa.Methods MRI features of enlarged iliopsoas buras were studied retrospectively proved by aspiration of synovial fluid under ultrasound guidance or surgical operation-pathology or clinical followed up and with typical MRI findings in 13 cases were analysed retrospectively.Results 13 enlarged iliopsoas bursas all located at the level of or part of the acetabulum sections in only one side(right side in 5 and left side in 8).The largest cyst was 7.0 cm in diameter.All of them appeared as round,oval,upside-down water drop-like or irregular multilocular cystic shadow and located posterolateral to the external iliac blood vessels and or femoral blood vessels,medial to iliopsoas muscle(tendon),and anterior to hip joint capsule.The cysts were hypo-or iso-intensity on T1WI and water-like high signal intensity on T2WI and markedly higher signal intensity on STIR,it was difficult to identify the cystic wall on plain scans.5 cases underwent contrast-enhanced MR scan,the cystic wall had linear slight to moderate homogeneous enhancement in 3,no enhancement in one and irregular multilocular enhancement in one who was with simple purulent synovitis.2 cases were simple synovitis,11 cases accompanied by hip joint disease.Conclusion MRI is of important value in diagnosing the enlarged iliopsoas bursa.

Objective:To observe the effects of Dyad Flow self-adhering flowable composite in the minimal invasive treatment of decid-uous molar caries.Methods:31 7 deciduous molars caries of 206 patients were randomly divided into 3 groups and treated by minimal invasive method,the cavities of the molars were filled with Dyad Flow self-adhering flowable composite(group A,n =1 07),traditional flowable composite and self-etching adhesive(group B,n =1 04)and glass ion(group C,n =1 06)respectively.The children were fol-lowed up for 1 and 2 years after treatment.Results:1 year after treatment the success rate(%)of group A,B and C was 95.3,96.77 and 91 .84(P >0.05);2 years after treatment 89.1 9,90.67 and 79.45(P >0.05),respectively.Conclusion:Dyad Flow self-adhe-ring flowable composite is effective in the treatment of deciduous molar caries.

Objective To study the changes in expression of osteoglycin (OGN) in the lung tissue in a rat acute pulmonary embolism (PE) model and its effects on the metabolism of collagen. Methods A rat acute PE model was reproduced by injecting 3-4 emboli into the left jugular vein. The lung tissue samples were collected at different time points as following: 1h, 8h, 24h and 48h, then the total RNA and total proteins of the lung tissue were extracted. Normal rats were used as control. The changes in mRNA level in OGN were assayed by semi-quantitative RT-PCR, and the changes in protein level were determined by Western blot method. The immunohistochemical method was employed to study the distribution and expression changes in OGN in the lung tissue after PE. Masson staining was employed to observe the deposition of collagen in the lung tissue 4 weeks after acute PE. Results t different time points, the mRNA levels and the protein levels of OGN were lowered gradually in the lung tissue in rat acute PE models. The immunohistochemical study indicated that OGN was distributed beneath the bronchial epithelium, and in the periphery of cartilaginous tissue and the lung alveoli. It also could be observed beneath the arterial endothelium and in the adventitia of pulmonary arteries. In pulmonary veins, OGN accumulated in the adventitia, media, and intima. The deposition of collagen in the lung tissue increased obviously 4 weeks after acute PE. Conclusion The expression of OGN is down-regulated after acute PE. It facilitates the deposition of collagen in the lung tissue.

Objective:The present study discussed the clinical diagnosis and treatment of pancreatic body and tail carcinoma. Methods:The data of 52 patients with pancreatic body and tail carcinoma treated in Tianjin Medical University Cancer Institute and Hospital from January 2008 to December 2012 were reviewed retrospectively. The data included historical materials of perioperative examination and therapy. The data of 49 cases were reviewed retrospectively, and the median survival was calculated by the Kaplan-Meier method. The effects of the clinicopathologic parameters on the prognosis of patients with pancreatic body and tail carcinoma were examined by the log rank test. Results:Thirty-eight patients underwent exploratory surgery among which 24 had surgical resection, and the standard procedure was distal pancreatectomy plus splenectomy. The tumor staging was stage I in five patients (13.16%), stage II in nineteen patients (50%), stage III in five patients (13.16%), and stage IV in nine patients (23.67%). The median survival time was 18.0 ± 1.23 months for patients who received radical resection and 10.0 ± 2.71 months for patients who underwent nonspecific treatment or palliative therapy. The radical resection was associated with a longer survival period than the nonspecific treatment or palliative therapy (P<0.01). Conclusion:Early diagnosis is the key to achieving long-term survival. The radical resection plays an important role in improving the surgical treatment.

Obesity is rapidly becoming a pandemic and is associated with increased carcinogenesis,especially hepatocellular carcinoma (HCC).Adipose tissue has been considered as an endocrine organ because of its capacity to secrete a wide variety of adipokines,such as leptin,adiponectin and resistin.Recently,adipokines have been demonstrated to be associated with many kinds of chronic liver diseases,liver fibrosis and cirrhosis,and carcinogenesis.Direct evidence supporting the inhibitory and/or activating role of adipokines in the process of carcinogenesis and progression of human HCC has been rapidly accumulating. This review aims to provide important insights into the potential mechanisms of adipokines in the development of HCC.Further investigations will shed light on a new therapeutic target in HCC.

Obturator hernia is a rare condition that may present in an acute or subacute setting in correlation with the degree of small-bowel obstruction. Pre-operative diagnosis is difficult, as symptoms are often non-specific. A high index of suspicion should be maintained for emaciated elderly women with small-bowel obstruction without a previous abdominal operation and a positive Howship–Romberg sign. When diagnosis is in doubt, computed tomography scan of the abdomen and the pelvis (if available) or laparotomy should be performed immediately, as high mortality rate is related to the perforation of gangrenous bowels. We present 2 cases of strangulated obturator hernia, managed differently with both open and laparoscopic approaches. The diagnostic accuracy of computed tomography scan is highlighted followed by a brief literature review with an emphasis placed on surgical management.

Objective To investigate the effect of high-frequency oscillatory ventilation (HFOV) on inflammatory responses in lung tissues of dogs with severe acute respiratory distress syndrome (ARDS).Methods Healthy mongrel dogs of both sexes,weighing 13.7-16.2 kg,in which severe ARDS was induced by intravenous infusion of the mixture of oleic acid 0.2 ml/kg and autologous blood (equal to the volume of oleic acid).Twenty-four dogs with severe ARDS were randomly divided into 4 groups (n=6 each) using a random number table:conventional mechanical ventilation with low tidal volume group (group CMV),HFOV-9 Hz group,HFOV-12 Hz group and HFOV-15 Hz group.In HFOV-9 Hz,HFOV-12 Hz and HFOV-15 Hz groups,the frequency was 9,12,and 15 Hz,respectively,mean airway pressure 20 cmH2O,oscillation pressure 70 cmH2O,and inspired oxygen fraction ratio 1.0.In group CMV,the animals were mechanically ventilated in volume-controlled mode,with positive end-expiratory pressure 5 cmH2O,tidal volume 6 ml/kg,respiratory rate 30 breaths/min,inspiratory/expiratory ratio 1:2,and inspired oxygen fraction ratio 1.0.At 4 h of ventilation,the animals were sacrificed,and lungs were removed for determination of wet/dry weight (W/D) ratio,contents of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-10 (by enzyme-linked immunosorbent assay),and expression of vascular endothelial (VE)-Cadherin (by Western blot) and for microscopic examination.Lung injury scores were assessed.Results Compared with group CMV,the lung injury scores,W/D ratio,and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in the other three groups (P＜0.05).Compared with group HFOV-9Hz,the lung injury scores,W/D ratio and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in group HFOV-15 Hz,and the content of IL-6 was significantly decreased in group HFOV-12 Hz (P＜0.05).Conclusion HFOV can significantly inhibit inflammatory responses in lung tissues of dogs with severe ARDS as compared with mechanical ventilation with low tidal volume,which may be involved in the mechanism of lung-protective ventilation effect.