Objective To analyze relevant factors causing pancreatic fistula post pancreaticoduodenectomy with ex-ternal drainage of pancreatic duct. Methods Altogether 133 patients who underwent pancreaticoduodenectomy with exter-nal drainage of pancreatic duct in our hospital from 1999 to 2011 were retrospectively analyzed. Logistic regression analysis was used to analyze the relevance of pancreatic fistula with age, gender, combined diseases, pancreatic duct diameter, patho-logical types, preoperative total bilirubin (TBIL), albumin (ALB) levels, drainage of the bile duct before operation, obstruc-tion of the pancreatic duct drainage and postoperative application of growth somatostatin. Then we also analyzed the relation-ship between those risk factors and the severity of pancreatic fistula. Results Postoperative pancreatic fistula occurred in 24 cases (3 cases were of grade A,13 cases were of grade B and 8 cases were of grade C) among the 133 patients. Logistic re-gression analysis showed that obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula in these patients(OR=4.529,P=0.005). The patients whose pancreatic duct drainage was obstructed had a significantly higher pan-creatic fistula rate than the patients whose drainage was not obstructed (30.8%vs 12.8%, P＜0.05). The occurrence of pan-creatic fistula has no significant correlation with age, gender, combined diseases, pancreatic duct diameter, pathological types, preoperative TBIL, ALB level, preoperative bile duct drainage and postoperative application of somatostatin. What’s more, in those pancreatic fistula patients, the pancreatic fistulas were more severe in the obstructed ones than those in the un-obstructed ones. Conclusion The obstruction of the pancreatic duct drainage is a major risk factor of pancreatic fistula post pancreaticoduodenectomy with external drainage of pancreatic duct. If adequate preventive measures were employed during operation , the incidence of pancreatic fistula and pancreatic fistula severity will be significantly reduced.

Peliosis hepatis is a rare benign hepatic vascular disease.There is the lack of specific clinical features and preoperative diagnosis.A patient with intermittent liver area pain was admitted to the Third Central Hospital of Tianjin in April 2014.The patient with space-occupying lessions of the right lobe of liver was preliminarily diagnosed as with hepatocellular tumor or vasogenic tumor by computed tomography and B ultrasound examinations and then received liver resection combined with cholecystectomy.The result of postoperative pathological examination confirmed peliosis hepatis with adenomatous hyperplasia of liver cells.The patient was followed up till October 20,2014 without recurrence.

Objective To evaluate the expression of Yes-associated protein (YAP) in colorectal carcinoma and analyze its influence on tumor cell proliferation.Methods The expressions of YAP in 94paired colorectal carcinomas and pericancerous normal tissues were detected by using immunohistochemistry method.The expressions of YAP in colorectal carcinoma cell line HCT116 were inhibited with a YAP-spe-cific siRNA.Cell proliferation was then determined by methyl thiazolyl diphenyl-tetrazolium bromide (MTT) assay.Results The positive rate of YAP in colorectal carcinomas was significantly higher than that in pericancerous normal tissues [69.1％ (65/94) vs 22.3 ％ (21/94),P ＜ 0.001].The expression of YAP was associated with tumor Node Metastasis(TNM) stage and lymph node metastasis(P ＜0.05),but not associated with gender,age,tumor location and histological grade(P ＞0.05).After YAP-specific siR-NA was transfected into HCT116 using lipofectamine,the expression of YAP mRNA and protein in the experimental group were reduced by (78.2 ±2.1)％ and (81.7 ± 1.5)％,respectively,with a statistically significant difference (t =67.55,91.601,P ＜0.01).The growth of HCT116 was significantly inhibited and the reduced rate of cell proliferation was (28.1 ± 1.6) ％,(34.7 ± 2.4) ％ and (24.7 ± 1.2) ％ at the time point of 48 h,72 h and 96 h,respectively.Conclusions Expression of YAP was upregulated in colorectal carcinomas and downregulation of YAP expression could inhibit growth of colorectal carcinoma cells.YAP can be used as a new candidate target for diagnosis and treatment of a colorectal carcinoma.

Objective To analyze the relevant factors of portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis. Methods The clinical data of 226 patients with hypertension due to cirrhosis resulting from hepatitis receiving simple splenectomy or splenectomy and portal-azygous devascularization in our hospital from August 2000 to June 2007 were retrospectively analyzed. Effective results were found in 154 of the patients. The 154 cases were divided into the thrombosis group and non-thrombosis group. The relation of portal vein thrombosis to the descendent level of portal vein pressure after operation,the prothrombin ratio (PTR) and fibrinogen(FIB) before operation, platelet count before and 1, 7, 14 days after operation, diameter of main portal vein and bilirubin level before operation and blood loss in operation were determined by logistic regression analysis. Results Portal vein thrombosis occurred in 31 patients. Regression univariate analysis showed that portal vein thrombosis was related to the descendent level of portal vein pressure after operation but not to the PTR and FIB, platelet count, diameter of main portal vein, bilirubin level and blood loss. Multivariate analysis demonstrated the same results. Conclusion The descended level of portal vein pressure is an important factor in portal vein thrombosis in patients after splenectomy for portal hypertension due to cirrhosis resulting from hepatitis.

ObjectiveTo study the potential of using temporal clustering analysis(TCA)technique in localizing an epileptogenic zone.MethodsTwelve patients with epilepsy were examined using resting functional MRI(fMRI). The patients had detectable focal lesions on cranial MRI.TCA was performed to analyze resting fMRI data in order to identify the timing of interictal epileptiform discharges (IEDs).Standard event-related fMRI analysis in SPM99 was used to generate maps of the activation induced by epileptic brain activities.Comparisons were made between TCA Resultsand SPM motion trochoid.ResultsEight of the twelve subiects showed activations in the brain regions that were consistent with those lesions determined on anatomic MRI.The remaining four subiects showed no clear activation in the areas of detectable lesions. In addition, correlation was found between TCA Resultsand motion trochoids.ConclusionsTemporal cluster analysis,an exploratory data-driven technique,may provide the timing information about interictal epileptiforill discharges.However,the Resultsfrom this novel fMRI analytical technique need to be interpreted with caution as it is vulnerable to motion artifact.

Objective To investigate the clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 73 patients who underwent neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer at the First Affiliated Hospital of Zhejiang University between June 2004 and December 2009 were collected.Neoadjuvant chemotherapy regimens included XELOX and FOLFOX.Patients received radical gastrectomy within 2 weeks after the completion of the last cycle of neoadjuvant chemotherapy and then continued to undergo postoperative neoadjuvant chemotherapy.Observation indicators:(1) adverse event of neoadjuvant chemotherapy;(2) surgical and postoperative situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to December 2014.Measurement data with skewed distribution were described as M (range).Overall survival time was from the beginning of treatment to death or end of follow-up (patients with loss to follow-up).Progression-free survival time was from the beginning of treatment to tumor progression,recurrence and metastasis or death.The survival curve was drawn by the Kaplan-Meier method.Results (1) Adverse event of neoadjuvant chemotherapy:of 73 patients,38 received XELOX regimens and 35 received FOLFOX regimens,with a median cycle of 3 (range,1-7 cycles).There were 55 adverse events during neoadjuvant chemotherapy,including 47 with grade 1-2 and 8 with grade 3-4.(2) Surgical and postoperative situations:all the 73 patients underwent successful D2 radical gastrectomy for gastric cancer,including 40 receiving total gastrectomy,31 receiving distal gastrectomy,1 receiving total gastrectomy with transverse colon resection and 1 receiving distal gastrectomy with cholecystectomy.Of 73 patients,10 with postoperative complications were improved by conservative treatment,including 3 with pleural effusion,2 with peritoneal effusion,2 with anastomotic bleeding,2 with cholecystitis and 1 with lympha fistula.No patient received reoperations or died within 30 days postoperatively.Pathological TNM staging:22 patients were detected in stage Ⅰ-Ⅱ,45 in stage Ⅲ,4 in stage Ⅳ and 2 in stage T0N1M0.Three patients (in stage T0N0M0) had complete remission.Forty-three patients underwent postoperative chemotherapy.(3) Followup:all the 73 patients were followed up for 8-125 months,with a median time of 51 months.The median survival time,5-year overall survival rate and 5-year disease-free survival rate of 73 patients were 52 months,41.1％ and 34.2％,respectively.Conclusion XELOX and FOLFOX regimens of neoadjuvant chemotherapy combined with radical gastrectomy for advanced gastric cancer are safe and effective.

Objective To explore the feasibility of reducing radiation dose and iodine contrast medium in 70 kVp abdominal CTA imaging in low-body mass index (BMI;≤22 kg/m2) patients.Methods The 48 patients with suspected abdominal vascular diseases and low BMI (≤22 kg/m2) underwent abdominal CTA.All patients were divided into two groups according to tube voltage and contrast intake randomly.The parameters of group A (n=27) were contrast intake 300 mgI/kg,70 kVp,the conditions of group B (n=21) were contrast intake 500 mgI/kg,120 kVp,and the other conditions were the same in both groups.The image quality of right renal arterial images was evaluated by two observers simultaneously (5-scale).The consistency and difference between the two observers were analyzed.The CT values of abdominal aorta,celiac trunk,superior mesenteric artery,common hepatic artery,pancreatic artery and erector spinae,SD values of erector spinae on the level of right renal hilus were measured respectively in both groups.The CT values of abdominal aorta and its main branches,the CNR of abdominal aorta,the volume CT dose index (CTDIvol),dose-length product (DLP) and overall iodine intake in each group were compared.Results The scoring of right renal arterial images in both groups were 5.00 (1.00),the results showed a good consistency (Kappa=0.932,0.911).The CT values of abdominal aorta,superior mesenteric artery,common hepatic artery and pancreatic artery in group A were all more than those of in group B (all P＜0.05).The CNR of group A was higher than that of group B (P＜0.05).The CTDIvoland DLP in group A decreased by 73.36％ and 74.41％ compared with group B.The overall iodine intakes in group A and group B were (46.33±6.43)ml and (84.31±10.71)rnl,respectively.The overall iodine intake of group A decreased by 45.05％ compared with group B.Conclusion For patients with low BMI (≤22 kg/m2),a 70 kVp tube current abdominal CTA scanning can significantly increase the contrast of images of abdominal artery and its branches.Meanwhile,the radiation dose and overall iodine intake can obviously decrease.

Objective To perform a risk factor analysis of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO),and compare the difference in risk factors between CRVO and BRVO.Methods Retrospective observational casecontrol study included 46 CRVO patients,33 BRVO patients and 79 control subjects with senile cataract or refractive error,the risk factors and blood lipid spectrum analysis were performed and compared.Results Multivariate linear regression analysis showed that higher serum levels of homocysteine (P ＜ 0.000 1),total cholesterol (P =0.003 0),lipoprotein (a) (P =0.027 0),hypertension (P =0.022 0) and shorter axial length (P ＜0.000 1) were significantly correlated with CRVO.BRVO was associated with higher serum levels of homocysteine (P ＜0.000 1),total cholesterol (P =0.008 0),hypertension (P =0.002 0),body mass index (P =0.004 0) and shorter axial length (P =0.001 0).There was no significant difference in risk factors between CRVO and BRVO patients on multivariate analysis.Conclusion Multiple systemic (hyperlipidemia,hypertension and hyperhomocystinemia) and ocular (shorter axial length) risk factors are associated with both CRVO and BRVO,but these risk factors are not different between CRVO and BRVO.

Objective To observe the correlation of MRI findings with treatment outcome of percutaneous kyphoplasty (PKP) in the acute phase of osteoporotic vertebral compression fracture (OVCF).Methods A total of 101 patients with single-segment OVCF undergone PKP in the acute phase were included in the study.There were 19 males and 82 females, at age range of 61 to 89 years (mean, 69.3 years).According to the T2WI signal intensity, the patients were divided into low signal group (Group A), low-medium signal group (Group B), medium signal group (Group C), and mediumhigh signal group (Group D).visual analogue scale (VAS) was used to evaluating the pain relief.Correlations of MRI signal with vertebral height, vertebral compression ratio, Cobb's angle change in each group were determined.Results All MRI images were shown as low signal in T1WI and high signal in FS-T2WI.On the T2WI images, the signal was medium-high in 14 vertebrae, medium in 18 vertebrae, low-medium in 31 vertebrae, and low in 38 vertebrae.Among four groups, the VAS score, vertebral body height, vertebral compression ratio and Cobb's angle changes before operation showed no statistical difference compared with those after operation (P ＜ 0.05).Conclusions MRI findings are primarily low or medium signal on T2WI images in the acute phase of OVCF, which shows insignificant correlation with effect of PKP.However, PKP is effective in the treatment of OVCF.

Objective To compare the diagnostic value of high frequency ultrasound,mammography and breast blood-oxygen function imaging system in diagnosis of breast masses.Methods The images of 89 breast masses by high frequency ultrasound,mammography and breast blood-oxygen function imaging system were reviewed.The study compared the sensibilities and specificities of the three methods in the masses and analyzed their cause of missed diagnosis.Results The sensitivity of the diagnosis of breast cancer by high frequency ultrasound,mammography and breast blood-oxygen function imaging system were 80.00％,70.00％ and 50.00％,respectively.The specificity of the diagnosis of breast cancer by them were 94.94％,98.73％ and 97.47％,respectively.There were sigmfiacant differences in diagnosis of breast benign lesion among the high frequency ultrasound,mammography and breast blood-oxygen function imaging system.The sensitivity of high frequency ultrasound in detecting fibroadenoma of breast was 98.11％ higher than the other methods.Mammography was insensitive to the benign breast lesions,but its specificity was high.Conclusions High frequency ultrasound,mammography and breast blood-oxygen function imaging system are the highly effective diagnostic tool for breast cancer,but the diagnostic value of mammography and breast blood-oxygen in breast fibroadenoma and in cystic disease of breast aren' t high.Breast blood-oxygen function imaging system can enhance the accuracy of the diagnosis of mammary inflammation.