Objective:To evaluate the prediction value of preoperative Fibrinogen(FIB) in combination with neutrophil-lymphocyte ratio(NLR)for the prognosis of operable pancreatic cancer patients.Methods:The clinical data of 124 patients who underwent radical resection for pancreatic cancer in our hospital from Jan 2010 to Dec 2018 were retrospectively analyzed.The patients were divided into three groups according the high and low NLR, FIB value which defined by the receiver operating characteristic curve (ROC). The clinicopathological data and overall median survival time were compared between the three groups.Results:Univarate analysis showed that age, tumor stage, NLR, FIB and F-NLR score were associated with the prognosis( P<0.05), while multivariate analysis showed that high F-NLR score was the independent prognostic factor. The median survival time of patients with F-NLR scores 0, 1 and 2 group was 30.6, 20.3 and 13.9 months( P<0.05). The prognosis of high F-NLR score was significantly worse than that of low F-NLR score( P<0.05). Conclusions:A high preoperative F-NLR score was a promising predictor for the prognosis of pancreatic cancer patients after radical resection.

Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.

BACKGROUND:Sleep deprivation, resulting in a series of physiological and psychological reactions, is a common phenomenon in our modem society. Recently, many physical and medical therapies are on their way to eliminate the negative influence the sleep deprivation exerted on our human beings, and a large number of cigarette smokers believe that cigarette smoke can obviously improve their abnormal behavioral performance and negative emotional fluctuation caused by sleep deprivation in short terms.However, there are few researches but many disputes when it comes to effect of passive smoking on the behavior and emotion of rats on the occasion of acute sleep deprivation.OBJECTIVE: To investigate the effect of passive smoking (PS) on the behavior and emotion of rats with acute sleep deprivation (SD).DESIGN: Completed randomized and controlled study.SETTING: Basic Medicine Experiment Center, School of Basic Medicine;Department of Radiation Medicine, School of Preventive Medicine, Fourth Military Medical University of Chinese PLA.MATERIALS: The experiment was carried out at Experiment Center of Basic Medicine, Fourth Military Medical University of Chinese PLA from April to June 2004. Totally 49 healthy adult male Sprague-Dawley rats,being 3 months old, weighting (180±15) g, were randomly divided into 5groups: sleep deprivation + 24-hour passive smoking group (n=8), 24-hour sleep deprivation group (n=8), sleep deprivation + 54-hour passive smoking group (n=8), 54-hour sleep deprivation group (n=8), and blank control group (n=7).METHODS: ① Rats in sleep deprivation + 24-hour passive smoking group, 24-hour sleep deprivation group, sleep deprivation + 54-hour passive smoking group and 54-hour sleep deprivation group were performed with sleep deprivation with flower pot method for 24 and 54 hours, and rats in sleep deprivation + 24-hour passive smoking group and sleep deprivation + 54-hour passive smoking group were treated with passive smoking at the same time at a frequency of 12 times/day, 120 minute/time, 3cigarettes were lighted at the same time and kept into ashes. ② Broad field test was conducted to determine the behavioral and emotional changes of the rats. We trailed their activities by video recorder for 5 minutes each time. Then we presented the image information to computer process and finally got the total distance and the average distance from the center of the broad field for each rat during the 5-minite test. Meanwhile, we also observed the emotional variety and excitability of the rats. The nearer the average distance from center was, the more the emotional behavior and the greater excitability were; and the longer the total distance was, the greater the excitability was. ③ All the data were expressed with Mean ± SD, the method of non-parametric rank sum test was adopte d for comparing among groups, P ＜ 0.05 was regarded as statistical significance.MAIN OUTCOME MEASURES: Comparisons between DC and TD of rats in each group, and changes of behavior and emotion of rats in each group.RESULTS: Data of all the 49 rats was entered the final data analysis without any loss. ① Observation of emotional stage: Compared with sleep deprivation + 54-hour passive smoking group, rats in sleep deprivation+24-hour passive smoking group appeared more quiet and indifferent, and presented lower excitability, less sensitivity to outside stimulus and less aggressive behaviors towards other rats, and the same as 24-hour sleep deprivation group, compared with 54-hour sleep deprivation group. ② Results from the open field test: DC of 24-hour sleep deprivation group was significantly smaller than that of blank control group and sleep deprivation + 24-hour passive smoking group [(53.93±1.83, 58.21±4.45, 58.11±1.62) cm, (P＜ 0.01-0.05)]. DC of 54-hour sleep deprivation group was significantly bigger than that of 24-hour sleep deprivation group [(61.53±3.02, 58.11±1.62) cm, (P＜ 0.01)]; TD of 24-hour sleep deprivation group was significantly bigger than that of sleep deprivation + 24-hour passive smoking group [(3310.45±1 445.97, 1 818.20±733.25, 2 338.15±694.70) cm, (P ＜ 0.01-0.05)], and that of 54-hour sleep deprivation group was bigger than that of sleep deprivation + 54-hour passive smoking group andsmaller than that of 24-hour sleep deprivation group [(2 410.70t548.64, 1 473.50±945.89, 3 310.45±1 445.97) cm, (P＜0.05)].CONCLUSION: With the prolongation of sleep deprivation time, behavior and emotional reaction of rats are shown from exciting to inhibiting, however, passive smoking can inhibit behavior and emotional state of rats during the whole sleep deprivation.

Objective To explore the characteristics of intestinal Microbiota in T2DM patients by two molecular fingerprint technologies,and investigate the correlation of intestinal microbiota and T2DM,and evaluate the application value of two fin-gerprint technologies.Methods Fecal samples of 8 healthy groups and 7 diabetes patients were collected.Then the total DNA of gut microbiota was extracted.Through the analysis of products by two molecular fingerprints of ERIC-PCR and DGGE-PCR,ecological characteristics of diversity and similarity of gut microbiota were obtained in healthy groups and dia-betes patients.Results Compared to healthy groups,the number of bands and Shannon-Wiener index of gut microbiota in di-abetes patients was decreased but no statistical significance.The similarity in patients group was declining(P <0.05),and the construction of gut microbiota was inclined to differ.Two fingerprint technologies of ERIC and DGGE could directly re-flect the diversity of gut microbiota and were the modern molecular biological techniques without depending on cultivation. ERIC was simple and convenient,had a better reflection of microbial diversity,but gel band cutting and regarded asa proper approach with higher diffraction efficiency and excellent repetition to studysequencing couldn’t be performed since there were more influencing factors on the experiment.DGGE could better reflect the ecological characteristics such as microbial diversity and similarity,and selecting bands,gel band cutting and sequencing could be done.Conclusion The composition and construction of gut microbiota in diabetes patients were changed,which suggests the occurrence of the disease had the correlation with gut microbiota.ERIC and DGGE is regarded as a proper approach with higher diffraction efficiency and ex-cellent repetition to study intestinal microbiota,but also gel band cutting,sequencing,bacteria identification can be performed by DGGE,both can be used in combination.

ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.

Objective: To study the feasibility of using a double purse-string bridging pancreaticojejunostomy in total laparoscopic pancreaticoduodenectomy (TLPD). Methods: A database of 35 patients who underwent TLPD using a double purse-string bridging pancreaticojejunostomy from January 2016 to January 2019 in Jinhua Hospital of Zhejiang University was retrospectively reviewed. The perioperative outcomes were analyzed. Results: All the 35 patients underwent TLPD successfully. The surgery time was (370.2±33.5) min, and the time of constructing the pancreaticojejunostomy was (28.4±12.6) min. The hospital stay after surgery was (14.2±6.9) days. Five patients developed postoperative complications, including pancreatic fistula in 3 patients, bile leakage in 1 patient, gastroparesis (complicated with abdominal infection) in 1 patient, and abdominal infection in 3 patients (2 patients with pancreatic fistula, and 1 patient with gastroparesis). All the patients with complications responded well to conservative treatment. Conclusions A double purse-string bridging pancreaticojejunostomy was simple and widely applicable. It is safe and feasible in total laparoscopic pancreaticoduodenectomy and should be promoted in clinical practice.

Objective:To explore the clinical value of three-dimensional visualization combined with 3D laparoscopy in the resection of middle segment pancreatectomy.Methods:The clinical data of 11 patients who underwent middle segment pancreatectomy by 3D laparoscopy admitted in the Department of General Surgery of Jinhua Hospital affiliated with Zhejiang University from December 2016 to March 2020 were retrospectively analyzed. The 3D visualization software was used to reconstruct the image data collected from 2D CT images of the patients before operation, showing the three-dimensional location of the tumor, the extent of pancreatic tumor involvement, the relationship between tumor and surrounding vessels and the status of peripheral enlarged lymph nodes; according to the reconstructed figure, the specific surgical approach and procedures were determined. All the middle segment pancreatectomy was performed under 3D laparoscopy.Results:Three-dimensional visualization clearly displayed the middle pancreatic tumor and the adjacent organs, especially showing the distinct relationship between the tumor and the artery, vein and common bile duct. All the surgery had been successfully completed because of the good depth of field and sterescopic image of 3D laparoscopy, and no patient was transferred to open surgery and Roux-Y pancreaticojejunostomy was performed in all the patients. The average operation time was (264±98)min, and the intraoperative blood loss was (105±82)ml. The average hospital stay ranged from 6 to 17 days after operation. There were 3 cases of grade B pancreatic fistula after operation, which were cured by active drainage and conservative treatment. All the patients recovered and discharged without death.Conclusions:Three-dimensional visualization can accurately evaluate the pancreatic tumor before operation, and it combined with 3D laparoscopic middle segment pancreatectomy was safe and feasible.

Objective To investigate the level of coagulation factor Ⅺ(FⅪ)in patients with venous thrombosis of lower limbs and its correlation with recurrence risk.Methods A total of 220 pa-tients with deep vein thrombosis(DVT)admitted in our hospital from February 2018 to February 2019 were enrolled as the study group,and another 50 healthy individuals taking physical exami-nation during same period served as the control group.After a 3 years followed,the study group ultimately included 197 cases,according to the results of restricted cubic spline(RCS),the study group was divided into low(FⅪ＜10.3 U/L,94 cases),medium-(10.3-12.1 U/L,52 cases)and high-level groups(＞12.1 U/L,51 cases).The plasma level of FⅪ was detected in the study group 1 month after the end of anticoagulant therapy,and the results were compared with those of the control group during physical examination.Cox model was used to analyze the influence of FⅪ on the recurrence of DVT,and RCS was employed to analyze the relationship between DVT recur-rence and FⅪ level.Kaplan-Meier curve was plotted to analyze the recurrence risk of DVT with different FⅪ levels.The patients from the study group were followed up for 3 years.Results The FⅪ level was significantly higher in the study group than the control group(P＜0.05).During fol-low-up period,33 patients(16.75％)had DVT recurrence.The Cox model analysis after adjust-ment of sex and age showed that FⅪ level was a risk factor for DVT recurrence(P＜0.05).When the FⅪ level was set into tertile and the risk ratio was calculated after adjustment,FⅪ＜10.3 U/L,and the average FⅪ level at this stage was 9.2 U/L,the risk ratio was 0.82(95％CI:0.673-0.984);Patients with FⅪ between 10.3 and 12.1 U/L,and the average FⅪ at this stage was 11.4 U/L,the risk ratio of 1.04(95％CI:0.813-1.432).The those with FⅪ＞12.1 U/L,and the average FⅪ at this stage was 13.8 U/L,hazard ratio of 1.38(95％CI:0.921-1.563).Kaplan-Meier curve analysis showed that the recurrence risk was 28.62％(95％CI:25.633-31.609),30.10％(95％CI:27.594-32.606)and 38.06％(95％CI:34.306-41.371),respectively for the low-,medium-,and high-level groups,with significant correlation among the three groups(x2=6.631,P=0.036).Conclusion Compared with healthy individuals,plasma FⅪ level is at a high level in the DVT patients.With the increment of FⅪ level,the risk of DVT recurrence increases.Two FⅪ levels,10.3 U/L and 12.1 U/L,can be used as reference points for the obvious increase of DVT recur-rence rate.

Objective:To investigate the effect of smart air cell mattresses on sleep quality.Methods:Twenty healthy young people were enrolled as subjects, and each subject underwent a four-night polysomnographic monitoring experiment, including two nights each on a smart air cell mattress and a general mattress. The differences in sleep quality were compared by self-assessment of sleep quality, objective sleep indicators, and electroencephalogram (EEG) spectral analysis.Results:In the comparison between the smart air cell mattress and the general mattress, the differences in self-assessment of sleep quality and objective sleep indicators were not statistically significant (all P > 0.05), but the smart air cell mattress had a slight overall advantage. The relative power of EEG in the low-frequency band and the relative power of EEG in the high-frequency band were higher in the subjects with the smart air cell mattress. Conclusions:For the healthy young population, the smart air cell mattress can positively influence sleep quality to some extent, and the change in EEG relative power indicates an increase in sleep depth.

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.