Objective To approach the treatment value of endoscopic sphincterotomy for the dysfunction of Oddi sphincter in postcholecystectomy syndrome.Methods Endoscopic sphincterotomy was undergone in 28 cases with ultimate diagnosis of Oddi sphincter dysfunction after BUS, ERCP , basal sphincter pressure examination and ruled out the patients with retained or recurrent stones,stricture or carcinoma in the bile duct having postcholecystectomy syndrome.Results Symptoms disappeared completely after the treatment in 18 cases,alleviated apparently in 5 cases and other 2 cases after the second treatment,without alleviation in 3 cases,the effective rate is 89.3%(25/28).No severe complication happened.Conclusion It is assumed that endoscopic sphincterotomy is a micro-traumatic,safe and effective treatment for the dysfuction of Oddi sphincter in postcholecystectomy syndrome.

Objective To find out a new treatment method for advanced pancreatic carcinoma. Methods Twenty-nine patients with advanced pancreatic carcinoma and liver metastases were randomly divided into 2 groups.Group A (n=11) underwent bilio-enterostomy and/or gastro-enterostomy combined with systemic chemotherapy after operation;Group B(n=18) underwent bilio-enterostomy and/or gastro-enterostomy combined with peripancreatic arterial ligation and arterial infusion regional chemotherapy.The alleviation of clinical symptom,the change of carcinoma volume by BUS and CT scan,survival period and serum CEA were observed in two groups. Results The symptoms were alleviated apparently in most cases in Group B;BUS and CT scan showed that the tumor volume decreased apparently in Group B;The response rate was 67.7% in Group B,and 18.2% in Group A,respectively(P＜0.01);the mean survival period was (4.8±0.6) months in Group A,and (12.5±1.2) months in Group B,respectively(P＜0.01),there was significant difference between the two groups.The decrease of serum CEA was 54% in Group A and 60% in Group B,but the difference was not significant(P＞0.05). Conclusion Peripancreatic arterial ligation combined with arterial infusion regional chmotherapy is believed to be effective against both pancreatic carcinoma and liver metastases,and it can alleviate the clinical symptoms,postpone the growth speed of tumor,and prolong the survival period.

Objective To investigate the effectiveness and safety of anterior vitrectomy combined with capsular retractor and Cionni modified capsular tension ring (MCTR) in traumatic lens subluxation surgery with anterior vitreous prolapse.Methods This study comprised 16 patients (16 eyes) of traumatic lens subluxation with anterior vitreous prolapse,in which iridodialysis was in 3 eyes,express implantation in 1 eye and Ahmed glaucoma valve implantation in 1 eye.According to the severity of lens subluxation,the patients were divided into three levels,including 90°-120° (7 eyes),120°-180° (5 eyes) and 180°-270° (4 eyes).Considering the anterior vitreous prolapse,anterior vitrectomy or/and pars plan vitrectomy was conducted with assistance of triamcinolone acetonide.After continuous curvilinear capsulorhexis,two to four capsular retractors were placed in the capsulorhexis to support and center the capsule.MCTR was inserted with scleral suture fixation after phacoemulsification.At last,the foldable IOL was implanted to capsular bag.Postoperative visual acuity,intra-and post-operative complications,anterior capsular opening,IOL positions and intraocular pressure (IOP) were assessed during 3 months' follow up.Results All patients had successfully undergone phacoemulsification,MCTR insertion and IOL implantation.Seven eyes were inserted with 2-eyelet MCTR and nine eyes were inserted with 1-eyelet MCTR.The postoperative visual acuity was better than 0.5 in 9 eyes,between 0.3 and 0.5 in 4 eyes,between 0.1 and 0.3 in 2 eyes,and less than 0.1 in 1 eye.Compared with pre-operation,the difference in the visual acuity was statistically significant (x2 =17.503,P =0.000).The scheimpflug images obtained from the Pentacam,which demonstrated that the IOL was well centered,and no MCTR and IOL decentration occurred.The common intraand post-operative complications were residual cortex,aqueous misdirection syndrome,anterior capsular tears,anterior capsular phimosis and posterior capsular opacification.Conclusion The effective application of anterior vitrectomy is the key point to reduce surgical complications.Anterior vitrectomy combined with insertion of capsular retractor and MCTR is an ideal surgical option for patients of traumatic lens subluxation with anterior vitreous prolapse.

OBJECTIVETo develop a new treatment for advanced pancreatic carcinoma.

METHODSTwenty-nine patients with advanced pancreatic carcinoma (12 patients with liver metastasis at the same time) were randomly divided into two groups. In group A (n = 11), patients underwent bilio-enterostomy and/or gastro-enterostomy combined with systemic chemotherapy after surgery. In group B (n = 18), patients underwent bilio-enterostomy and/or gastro-enterostomy combined with peripancreatic arterial ligation and arterial infusion regional chemotherapy. Twenty-four patients were followed up for 3 - 18 months. The palliation of clinical symptoms, changes in carcinoma size by B ultrasound (BUS) and CT scan, survival period and serum carcinoembryonic antigen (CEA) were observed and compared between the two groups.

RESULTSSymptoms were alleviated in most patients in group B, and BUS and CT scan showed that tumor volume decreased in group B. The response rate was 66.7% in group B and 18.2% in group A (P < 0.01). The mean survival period was 4.8 +/- 0.6 months in group A and 12.5 +/- 1.2 months in group B (P < 0.01); there were significant differences between the two groups. The decrease in serum CEA was 54% in group A and 60% in group B; the difference was not significant (P > 0.05).

CONCLUSIONPeripancreatic arterial ligation combined with arterial infusion regional chemotherapy is effective against both pancreatic carcinoma and with liver metastases. It can alleviate clinical symptoms, postpone the growth rate of tumor and prolong the survival period.

Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; Arteries ; Female ; Fluorouracil ; administration & dosage ; Humans ; Infusions, Intra-Arterial ; Ligation ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Pancreas ; blood supply ; Pancreatic Neoplasms ; blood supply ; mortality ; therapy

Objective To explore the empowerment education application effect on the healthy education for patients with hepatitis B cirrhosis. Methods A total of 100 cases of hepatitis B cirrhosis decompensation were selected from January to May 2017 in a ClassⅢ Grade A infectious disease specialist hospital in Nantong with convenience sampling method. All the research subjects were divided into observation group and control group by random number table method, with 50 cases in each group. Routine health guidance of clinical pathway was conducted for the control group, and empowerment education based on routine education was carried out for the observation group. Before and after the intervention, self-management behaviors, the incidence rate of cirrhosis complications and nursing job satisfaction in the two groups were compared respectively. Results There were 1 death case in the observation group and 2 cases discharged after 3 days in the control group during the intervention. Finally, there were 49 cases in the observation group and 48 cases in the control group. The evaluation scores of self-management behaviors which includes diet management, daily life management, medication administration, disease monitoring management were higher than those in the control group. The differences were statistically significant(t=-4.047, -3.635, -3.437, -3.831; P＜0.05). Satisfaction with nursing service which includes service attitude, communication ability, humanistic care and theoretical guidance in the observation group was significantly higher than that in the control group. The differences were statistically significant (χ2=7.789, 6.804, 6.557, 6.239; P＜ 0.05). The incidence rate of cirrhosis complications which includes hepatic encephalopathy and electrolyte disorder was lower than that in the control group, and the differences were statistically significant (χ2=4.549, 4.401; P＜ 0.05). Conclusions Empowerment education can improve self-management behavior of patients with hepatitis B cirrhosis and satisfaction, and reduce the incidence rate of complications.

Radiomics, as an emerging technique of omics, shows the pathophysiological information of images via extracting innumerable quantitative features from digital medical images. In recent years, it has been an exponential increase in the number of radiomics studies. The applications of radiomics in hepatobiliary diseases at present include: assessment of liver fibrosis, discrimination of malignant from benign tumors, prediction of biological behavior, assessment of therapeutic response, and prognosis. Integrating radiomics analysis with machine learning algorithms has emerged as a non-invasive method for predicting liver fibrosis stages, microvascular invasion and post-resection recurrence in liver cancers, lymph node metastasis in biliary tract cancers as well as treatment response in colorectal liver metastasis, with high performance. Although the challenges remain in the clinical transformation of this technique, radiomics will have a broad application prospect in promoting the precision diagnosis and treatment of hepatobiliary diseases, backed by multi-center study with large sample size or multi-omics study.

Objective:To compare the performance of multiple machine learning algorithms in predicting recurrence after resection of early-stage hepatocellular carcinoma(HCC).Methods:Clinical data of 882 early-stage HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from May 2009 to December 2019 and treated with curative surgical resection were retrospectively collected. There were 701 males and 181 females,with an age of (57.3±10.5)years(range:21 to 86 years). All patients were randomly assigned in a 2∶1 ratio, the training dataset consisted of 588 patients and the test dataset consisted of 294 patients. The construction of machine learning-based prediction models included random survival forest(RSF),gradient boosting machine,elastic net regression and Cox regression model. The prediction accuracy of the model was measured by the concordance index(C-index). The prediction error of the model was measured by the integrated Brier score. Model fit was assessed by the calibration plot. The performance of machine learning models with that of rival model and HCC staging systems was compared. All models were validated in the independent test dataset.Results:Median recurrence-free survival was 61.7 months in the training dataset while median recurrence-free survival was 61.9 months in the validation dataset, there was no significant difference between two datasets in terms of recurrence-free survival( χ2=0.029, P=0.865). The RSF model consisted of 5 commonly used clinicopathological characteristics, including albumin-bilirubin grade,serum alpha fetoprotein,tumor number,type of hepatectomy and microvascular invasion. In both training and test datasets,the RSF model provided the best prediction accuracy,with respective C-index of 0.758(95% CI:0.725 to 0.791) and 0.749(95% CI:0.700 to 0.797),and the lowest prediction error,with respective integrated Brier score of 0.171 and 0.151. The prediction accuracy of RSF model for recurrence after resection of early-stage HCC was superior to that of other machine learning models,rival model(ERASL model) as well as HCC staging systems(BCLC,CNLC and TNM staging),with statistically significant difference( P<0.01). Calibration curves demonstrated good agreement between RSF model-predicted probabilities and observed outcomes.All patients could be stratified into low-risk,intermediate-risk or high-risk group based on RSF model;statistically significant differences among three risk groups were observed in both training and test datasets(all P<0.01). The risk stratification of RSF model was superior to that of TNM staging. Conclusion:The proposed RSF model assembled with 5 commonly used clinicopathological characteristics in this study can predict the recurrence risk with favorable accuracy that may facilitate clinical decision-support for patients with early-stage HCC.

Radiomics, as an emerging technique of omics, shows the pathophysiological information of images via extracting innumerable quantitative features from digital medical images. In recent years, it has been an exponential increase in the number of radiomics studies. The applications of radiomics in hepatobiliary diseases at present include: assessment of liver fibrosis, discrimination of malignant from benign tumors, prediction of biological behavior, assessment of therapeutic response, and prognosis. Integrating radiomics analysis with machine learning algorithms has emerged as a non-invasive method for predicting liver fibrosis stages, microvascular invasion and post-resection recurrence in liver cancers, lymph node metastasis in biliary tract cancers as well as treatment response in colorectal liver metastasis, with high performance. Although the challenges remain in the clinical transformation of this technique, radiomics will have a broad application prospect in promoting the precision diagnosis and treatment of hepatobiliary diseases, backed by multi-center study with large sample size or multi-omics study.

Objective:To compare the performance of multiple machine learning algorithms in predicting recurrence after resection of early-stage hepatocellular carcinoma(HCC).Methods:Clinical data of 882 early-stage HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from May 2009 to December 2019 and treated with curative surgical resection were retrospectively collected. There were 701 males and 181 females,with an age of (57.3±10.5)years(range:21 to 86 years). All patients were randomly assigned in a 2∶1 ratio, the training dataset consisted of 588 patients and the test dataset consisted of 294 patients. The construction of machine learning-based prediction models included random survival forest(RSF),gradient boosting machine,elastic net regression and Cox regression model. The prediction accuracy of the model was measured by the concordance index(C-index). The prediction error of the model was measured by the integrated Brier score. Model fit was assessed by the calibration plot. The performance of machine learning models with that of rival model and HCC staging systems was compared. All models were validated in the independent test dataset.Results:Median recurrence-free survival was 61.7 months in the training dataset while median recurrence-free survival was 61.9 months in the validation dataset, there was no significant difference between two datasets in terms of recurrence-free survival( χ2=0.029, P=0.865). The RSF model consisted of 5 commonly used clinicopathological characteristics, including albumin-bilirubin grade,serum alpha fetoprotein,tumor number,type of hepatectomy and microvascular invasion. In both training and test datasets,the RSF model provided the best prediction accuracy,with respective C-index of 0.758(95% CI:0.725 to 0.791) and 0.749(95% CI:0.700 to 0.797),and the lowest prediction error,with respective integrated Brier score of 0.171 and 0.151. The prediction accuracy of RSF model for recurrence after resection of early-stage HCC was superior to that of other machine learning models,rival model(ERASL model) as well as HCC staging systems(BCLC,CNLC and TNM staging),with statistically significant difference( P<0.01). Calibration curves demonstrated good agreement between RSF model-predicted probabilities and observed outcomes.All patients could be stratified into low-risk,intermediate-risk or high-risk group based on RSF model;statistically significant differences among three risk groups were observed in both training and test datasets(all P<0.01). The risk stratification of RSF model was superior to that of TNM staging. Conclusion:The proposed RSF model assembled with 5 commonly used clinicopathological characteristics in this study can predict the recurrence risk with favorable accuracy that may facilitate clinical decision-support for patients with early-stage HCC.

Objective:To compair the outcomes of repairing soft tissue defects of hand between a biodegrad- able repair patch—porcine small intestinal submucosa (SIS) and skin grafting.Methods:From December, 2017 to December, 2018, 36 cases of hand soft tissue defect were treated and analyzed retrospectively. According to the defect area and treatment methods, 36 cases were divided into 2 groups: SIS group (21 cases) and grafting group(15 cases). In SIS group, the area of soft tissue defects was 2.0 cm×1.5 cm-9.0 cm×3.5 cm with an average of 5.3 cm×2.1 cm, treat- ed with SIS; In grafting group, the area of soft tissue defects was 9.0 cm×4.0 cm-16.0 cm×9.0 cm with an average of 12.0 cm×8.5 cm, treated with autologous skin grafting after wet dressing. Wound healing was evaluated at 14, 21 and 28 days, and 3 months after the surgery according to the appearance of colour, elasticity, sensory recovery and prog- noses of partial tendon exposure.Results:All patients were followed-up for 3 to 10 months, with an average of 5 months. All wounds in both groups were completely healed; the appearance was normal, and the skin elasticity and sensation had recovered. Sensation recovery in SIS group: 14 cases were good (66.6%), 5 cases were fine (23.8%), and 2 cases were bad (9.6%); in grafting group: 9 cases were good (60.0%), 4 cases were fine (26.0%), and 2 cases were bad (14.0% ). Wound healing effect in SIS group: 14 cases were good, 5 cases were fine, and 2 cases were bad; in grafting group: 9 cases were good, 4 cases were fine, and 2 cases were bad.Conclusion:The SIS patch can be used in the reconstruction of soft tissue defects in hand. There was no significant difference in colour compared to the sur- rounding skin and left no scar. The patch is an ideal repair material for superficial skin defects.