Objective To compare the safety and effectiveness of duodenum-preserving pancreatic head resection (DPPHR) with pylorus-preserving pancreaticoduodenectomy (PPPD) in the treatment of chronic pancreatitis with a pancreatic head mass.Methods Medline,Biosis,Cochrane Library,Science Citation Index Database,CBM Database,Wan Fang and CNKI were searched systematically.The bias risk of the included trials was assessed according to the assessing tools as suggested by the Cochrane Handbook.Review Manage 5.2 was used to perform the statistical analysis.Results 7 RCTs with 226 patients were included in the meta-analysis which showed that there were no significant differences between PPPD and DPPHR in overall postoperative morbidity,postoperative hospital stay,complete pain relief,pancreatic fistula,exocrine insufficiency,symptom score at 5 to 7-year follow-up,and quality of life score at 14 to 15-year follow-up (P ＞ 0.05).While DPPHR had significant superiorities in operation time,blood replacement,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,quality of life score at 1 to 2-year follow-up,symptom score at 5 to 7-year follow-up,and physical functioning score at 14 to 15-year follow-up.Conclusions DPPHR is more favourable than PPPD in reducing the use of blood replacement,shortening operation time,delayed gastric emptying,occupational rehabilitation after the operations,weight gain,physical functioning,and in improving quality of life of patients.

Objective To study the use of a preoperative predictive scoring system established by the Beth Israel Deaconess Medical Center,Washington University School of Medicine and Hospital of the University of Pennsylvania for patients with clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy.Methods The clinical data of 394 patients who underwent pancreaticoduodenectomy at the Provincial Hospital Affiliated to Anhui Medical University from September 2007 to December 2015 were retrospectively analyzed.The four indexes including the gland texture,pathology,pancreatic duct diameter and intraoperative blood loss were calculated for the predictive score system using the logistic regression test.The factors associated with CR-POPF were analyzed.The sensitivity and specificity of the predictive scoring system were determined by the receiver operating characteristic (ROC) curve analysis.Results Of the 70 patients who were diagnosed to have postoperative pancreatic fistula (POPF),34 were CR-POPF,which included 36 with grade A,23 with grade B and 11 with grade C.Univariate analysis showed that male,preoperative serum total bilirubin level ≥ 170 mmol/L,pancreatitis or pancreatic cancer,portal vein invasion,soft pancreatic texture,main pancreatic duct diameter ≤ 3 mm,and pancreaticojejunostomy were significantly related to POPF after pancreaticoduodenectomy (P ＜ 0.05).Portal vein invasion,pancreatic texture and main pancreatic duct diameter were the risk factors of CR-POPF after pancreaticoduodenectomy (P ＜ 0.05).Multivariate analysis showed the independent risk factors associated with POPF were male,preoperative serum total bilirubin level ≥ 170 mmol/L,soft pancreatic texture and main pancreatic duct diameter ≤3 mm (P ＜ 0.05),while soft pancreatic texture and main pancreatic duct diameter ≤3 mm were the independent risk factors of CR-POPF (P ＜ 0.05).There were significant differences in the clinical relevant postoperative pancreatic fistula rates among the negligible risk,low risk,intermediate risk,and high risk patients with CR-POPF (P ＜ 0.05).The results of ROC curve analysis showed that the sensitivity and specificity of the Fistula Risk Scoring system were 76.5％ and 95.8％,respectively.The nomogram showed the area under the curve was 0.913 (95％ CI:O.858 ～ 0.968).Conclusion The preoperative predictive scoring system accurately predicted the occurrence of CR-POPF.

Objective To comparatively study the su rgical stress caused by laparoscopic appendectomy (LA) and open appendectomy(OA ) in children. MethodsSi xty-nine underwent LA and 91 did OA. Serum IL-6 and CRP levels were measured b efore and 12h post-op. Results The operative time was significantly shorter in laparoscopic group(33? 15min vs 45?9min, P

Objective To evaluate the postoperative complications and safety of pancreaticogastrostomy (PG) versus pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD).Methods Medline,EMBASE,Science Direct,Springer link,CBM,Cnki,Wan fang and VIP database were retrieved by computer search between 1st January 2004 and 31st March 2014 to collect all the RCT articles on pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy.The quality of the included trials was studied by assessing the inclusive and exclusive criteria (the PRISMA statement) by 2 researchers independently,then the data were extracted and analyzed using the RevMan 5.2.10 software.Results A total of 6 prospective randomized controlled trials which involved 976 patents were included in the study.There were significant differences between PG and PJ in terms of postoperative pancreatic fistula (RR:0.51 ; 95 ％ CI:0.37-0.70 ; P ＜ 0.0001),intra-abdominal fluid collection (RR:0.55 ; 95 ％ CI:0.34-0.89; P =0.01),and postoperative biliary fistula (RR:0.14; 95％ CI:0.03-0.59; P =0.0008).There was no significant difference in postoperative complications,mortality,delayed gastric emptying,postoperative hemorrhage,reoperation and length of hospital stay (P ＞ 0.05).Conclusions Pancreaticogastrostomy after pancreaticoduodenectomy is superior to pancreaticojejunostomy in safety and practicability.However,large,multicenter prospective randomized controlled trials are still needed to confirm the findings of this meta-anlaysis.

Objective:To study the use of three-dimensional computer reconstruction in diagnosis and treatment of hilar cholangiocarcinoma.Methods:A retrospective analysis of clinical data was conducted on patients with hilar cholangiocarcinoma admitted to the Department of General Surgery, the First Affiliated Hospital of the University of Science and Technology of China from January 1, 2017 to July 31, 2019. The classification of hilar cholangiocarcinoma, vascular invasion and surgical resectability were determined by preoperative three-dimensional reconstruction. These data were then compared with the findings obtained during operations, by comparing with the three-dimensional reconstruction technology findings in classification of hilar cholangiocarcinoma, vascular invasion, and hilar extent of biliary and vasculature involvement.Results:Of 65 patients included in this study, there were 35 males and 30 females, with an age of (60.35±10.70) years. After operation, these 65 patients were classified into type I ( n=7), type II ( n=4), type III ( n=14), and type IV ( n=40) using the Bismuth classification. The accuracy rates of preoperative three-dimensional reconstruction for hilar cholangiocarcinoma classification, portal vein invasion, hepatic artery invasion, and diagnosis of hilar cholangiocarcinoma vasculature involvement were 90.7% (59/65), 90.7% (59/65), 86.1% (56/65) and 80.0% (52/65) respectively. Conclusions:The three-dimensional computer reconstruction technology could visually and accurately display the shape and spatial extent of hilar cholangiocarcinoma. It has an important clinical use in accurately diagnosing hilar cholangiocarcinoma preoperatively.

Investigated the changes of crosslinking index, swelling ratio, degradation rate and cytotoxicity of genipin crosslinked gelatin accompany with crosslinking time. 1% genipin crosslinked gelatin were divided into 7 groups by crosslinking time: 10 min group, 30 min group, 1 h group, 2 h group, 12 h group, 24 h group, 72 h group. The results proved that genipin could crosslink gelatin effectively. Accompany with increasing of crosslinking time, crosslinking index increased, and swelling ratio, degradation rate decreased. In 10 min group, crosslinking index was low(26.7%), swelling ratio was high, (265%), completely degraded within 1 week. This indicated that biomaterials of 10 min group was instable and degraded easily. Compared with 10 min group, biomaterials of 30 min group changed significantly with crosslinking index(45.7%), swelling ratio (206%) and degration rate (completely degraded between 4 weeks and 8 weeks). This indicated that genipin could change the properties of gelatin within 30 min. Biomaterials after 30 min, crosslinking index increased, and swelling ratio, degradation rate decreased gradually accompanied with increasing of crosslinking time. Biomaterials of 72 h, crosslinking index was 73.1%, swelling ratio was 152%, and degradated 18.9% after 12 weeks. RGR (relative cell growth rate) of every group measured by MTT assay changed between 87.9% and 105.4%, indicated that the cytotoxicity of genipin crosslinked gelatin was very low.
Animals ; Biodegradation, Environmental ; Cell Survival ; drug effects ; Cricetinae ; Cricetulus ; Cross-Linking Reagents ; chemistry ; toxicity ; Gelatin ; chemistry ; Iridoid Glycosides ; Iridoids ; chemistry ; toxicity ; Time Factors

OBJECTIVE: To construct a lentivirus vector of RNA interference (RNAi) of EGFL7 gene and observe its inhibitive role on the invasion of laryngeal cancer cell. METHOD: The effective sequence of siRNA targeting EGFL7 gene was confirmed. Both sense and antisence Oligo DNA of the targeting sequence was designed, synthesized and cloned into the pLV vector,which contained H1 promotor and green fluorescent protein (GFP). The resulting lentivirus vector containing EGFL7 shRNA was called LV-sh EGFL7,and it is confirmed by PCR and sequencing. After that, EGFL7 shRNA was transfected into Hep-2 cells and Western blot was used to test the expression of EGFL7. At last, boyden chamber was used to observe the invasion of the Hep-2 cells. Colony formation assay using a EGFL7 gene silencing on the Hep-2 cell colony forming ability. RESULT: PCR and DNA sequencing demonstrated that the lentivirus RNAi vector of EGFL7 (LV-sh EGFL7) producing EGFL7 shRNA was constructed successfully. The titer of concentrated virus was 5 x 10(8) TU/L. Western blot showed that the expression of EGFL7 was negative in the EGFL7 siRNA Hep-2 cells. And boyden chamber showed the invasive capability of Hep-2 cells transfected EGFL7 siRNA were obviously decreased. EGFL7 gene silencing of cell colony formation rate of cloned Hep-2 cells and compared with empty vector cells, cell cloning and colony formation was significantly reduced. CONCLUSION The lentivirus RNAi vector of EGFL7 was constructed successfully. And EGFL7 silence can inhibit invasion of laryngeal cancer in vitro. After silence EGFL7, Hep-2 cell colony formation was significantly lower, that is, gene expression can be down EGFL7 some extent laryngeal cancer cells inhibited anchorage independent growth capacity.
Cell Line, Tumor ; Endothelial Growth Factors ; genetics ; Gene Expression ; Genetic Vectors ; Humans ; Laryngeal Neoplasms ; genetics ; pathology ; Lentivirus ; genetics ; RNA Interference ; RNA, Small Interfering ; Transfection

Objective To explore the value of preoperative pancreatic fistula scoring system in prediction of the postoperative pancreatic fistula (POPF) of pancreaticoduodenectomy (PD).Methods 491 patients from Jan 2012 to Jan 2017 undergoing PD were retrospectively analyzed,in reference to independent risk factors for POPF.At the same time,the sensitivity,specificity and accuracy of National Cancer Center Hospital score system (NCCH score system) for preoperative pancreatic fistula score system were evaluated prospectively from Jan 2015 to Jan 2017.Results 90 patients were diagnosed as having POPF,including 56 in grade A,26 in grade B and 8 in grade C.The multivariate logistic regression analysis showed that the gender (male),the pancreatic texture (soft),the non-pancreatic cancer and the main pancreatic duct diameter (smaller than 3 mm) were the independent risk factor for POPF.The results of ROC curve analysis showed that the sensitivity and specificity of the NCCH predictive scoring system were 93.1％ and 76.9％,respectively.The area under the curve was 0.910 (95％ CI:0.857-0.962).Conclusions The NCCH score systems can predict the POPF accurately.

Objective: To systematically evaluate the clinical efficacy of immunonutrition support in perioperative period of hepatectomy. Methods: Literatures were researched using CNKI，CBM，Wanfang database，VIP databases，PubMed (Medline)，Embase，Web of science，Science Direct，Cochrane Center from January 1996 to March 2018 with the key words including "肝切除术，免疫营养，hepatectomy，hepatic resection，immunonutrition，immunoenhanced nutrition" . The randomized controlled trials (RCTs) on comparison of efficacy of immunonutrition support versus routine nutritional support in perioperative period of hepatectomy. Patients in the immunonutrition group received immunonutrition support in perioperative period of hepatectomy，and patients in the routine nutrition group received routine nutritional support in perioperative period of hepatectomy. Outcome measures：overall incidence of postoperative complications，incidence of postoperative infectious complications，incidence of postoperative liver failure，perioperative mortality，hospital stay，and hospitalization expenses. Literatures screening，data extraction and quality assessment of methodology were conducted by two researchers separately. Count data were represented as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) or weighted mean difference (WMD) and 95%CI. Heterogeneity of the included studies was analyzed with I². Funnel plot was used to test potential publication bias if the number of studies included ≥ 10，and funnel plot was used to test potential publication bias for the outcome measures with the maximum number of studies if the number of studies included <10. Results: (1) Document retrival: 12 RCTs were enrolled in the Meta analysis, and the total sample size was 1 136 patients, including 568 patients in the immunonutrition group and in the routine nutrition group, respectively. (2) Results of Meta-analysis: the that immunonutrition group had lower overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and hospital stay (RR=0.57, 0.49, 0.30, MD=-3.28, 95%CI: 0.46-0.71, 0.37-0.65, 0.12-0.74, -4.45 to -2.11, P<0.05), and higher hospital expenses (MD=11.86, 95%CI: 10.96-12.77, P<0.05) compared with the routine nutrition group. There was no significant difference in the perioperative mortality between the two groups (RR=0.26, 95%CI: 0.07-1.05, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies comparing incidence of postoperative infectious complications between the immunonutrition group and routine nutrition group, suggesting that publication bias had little influence on results of Meta-analysis. Conclusions Perioperative immunonutrition support for hepatectomy is safe and feasible. Compared with routine nutritional support, immunonutrition support can significantly reduce overall incidence of postoperative complications, incidence of postoperative infectious complications, incidence of postoperative liver failure, and shorten the hospital stay without increasing postoperative mortality.

OBJECTIVETo evaluate the clinical value of a preoperative predictive scoring system which was established by the National Cancer Center Hospital (NCCH) for the postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.

METHODSThe clinical data of 269 patients who underwent pancreaticoduodenectomy at the Affiliated Provincial Hospital of Anhui Medical University from February 2008 to February 2014 were studied retroprospectively. The five indexes which including gender, portal invasion, pancreatic cancer, main pancreatic duct index and intra abdominal fat thickness were calculated in the NCCH predictive score system. Patients with a score over 4 were defined as high risk of POPF, and those with score less than 4 were defined as low risk of POPF. Then the factors associated with POPF were analyzed by Logistic regression test. The enumeration data and measurement data were compared with χ2 test and t test. Risk factors for postoperative pancreatic fistula were analyzed through single factor and multiple factors Logistic regression analysis. The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis.

RESULTSA total of 33 patients were diagnosed as POPF, including 15 in grade A, 11 in grade B and 7 in grade C. The univariate analysis showed that the factors associated with POPF are gender, total serum bilirubin level, pancreatic cancer, portal invasion, the pancreatic texture, main pancreatic duct diameter and the pancreaticojejunostomy. The multivariate analysis showed that gender, pancreatic texture, portal invasion and main pancreatic duct diameter were the independent risk factor of POPF. The rate of pancreatic fistula of high risk group was 53.8% (14/26), and the rate of pancreatic fistula of the low risk group was 7.8% (19/243). There were significant differences in the pancreatic fistula rate between the high risk and low risk of POPF (χ2=46.231, P<0.01). The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 87.9% and 94.1%, respectively. The area under the curve was 0.946 (95% CI: 0.895-0.997).

CONCLUSIONSThe NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF. While large, multicenter prospective randomized controlled trials is still needed to further confirm it.

Humans ; Intestines ; Logistic Models ; Multivariate Analysis ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; ROC Curve ; Risk Factors ; Sensitivity and Specificity