Objective:To investigate the kinetic metrics of 68Ga-fibroblast activation protein inhibitor (FAPI)-04 in pancreatic cancers and normal organs by using total-body PET dynamic imaging. Methods:From December 2020 to December 2021, 68Ga-FAPI-04 total-body PET/CT dynamic imaging were performed on 6 pancreatic cancer patients (3 males, 3 females, median age 55.5 years) in Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University. Images were respectively analyzed. Manual delineations of volume of interests (VOIs) on multiple normal organs and pathological lesions were performed and time-to-activity curves (TACs) were generated. A reversible two-tissue compartment model (2TCM) was fitted for each tissue TAC. Rate constants including K1, k2, k3 and k4, and the total volume of distribution ( Vt) were obtained and compared by tissue types. Wilcoxon rank sum test and Spearman correlation analysis were used for data analysis. Results:Kinetic metrics varied significantly among normal organs and pancreatic cancer lesions ( z values: 2.00-1 240.00, all P<0.05). The highest K1 among lesions was observed in primary tumor (0.30 min -1), which was observed in the spleen (1.42 min -1) among normal organs. The highest k2 among lesions was observed in peritoneal metastases (0.24 min -1), which was observed in the spleen (2.59 min -1) among normal organs. Primary tumor showed the highest k3 of 0.17 min -1 among lesions, and the pancreas had the highest k3 of 0.16 min -1 among normal organs. Primary tumor had the highest k4 of 0.03 min -1 among lesions, and the heart, lungs, parotid glands had high k4(0.06 min -1) among normal organs. Vt were higher in pathological lesions compared to normal organs, with the highest in primary tumor (13.78 ml/cm 3). There were correlations between Vt in lesions and SUV mean( rs=0.86, P<0.001) or SUV max ( rs=0.77, P<0.001). Conclusion:The rate constants including K1, k2, k3 and k4, and Vt of 68Ga-FAPI-04 vary among normal organs and lesions.

Objective    To evaluate whether long frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection. Methods    From 2018 to 2019, 172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital. They were divided into two groups according to the length of FET: patients treated with stents of 100 mm in length were enrolled into a short FET group, and those with stents of 150 mm in length into a long FET group. There were 124 patients in the short FET group, including 108 (87.1%) males and 16 (12.9%) females with a mean age of 51.8±7.9 years. There were 48 patients in the long FET group, including 44 (91.7%) males and 4 (8.3%) females with a mean age of 50.6±9.7 years. The clinical data and prognosis of the patients were analyzed. Results    The mean distal stent graft was at the level of T 8.5±0.7 in the long FET group, and at the level of T 6.8±0.6 in the short FET group (P=0.001). Sixteen patients died after operation in the two groups, including 13 (10.5%) in the short FET group and 3 (6.2%) in the long FET group (P=0.561). There were 7 patients of spinal cord injury in the two groups, including 6 (4.8%) in the short FET group and 1 (2.2%) in the long FET group (P=0.675). There was no statistical difference in other complications between the two groups. The follow-up time was 16.7 (1-30) months. During the follow-up, 2 patients died in the long FET group and 5 died in the short FET group. No new spinal cord injury or distal reintervention occurred during the follow-up. Conclusion    Long FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.

Objective: To elucidate the anti-inflammatory mechanism of Reduning Injection (RDN) by analyzing the potential biomarkers and metabolic pathways of the carrageenan-induced inflammatory model from the overall metabolic level. Methods: Rat inflammatory model was established by carrageenan. UPLC-Q-TOF/MS was used to detect and analyze changes of endogenous metabolites in the serum and urine of carrageenan-induced inflammatory rats. Combined with multivariate analysis and databases analysis, inflammatory-related potential biomarkers were screened and identified to analyze possible metabolic pathways. The reliability and biological significance of these biomarkers was verified by metabolic network analysis and correlation analysis with pharmacodynamic indicators. Results: A total of 16 potential biomarkers were screened and identified by multivariate analysis and metabolite databases, among which 13 species could be adjusted by RDN. The metabolism pathway analysis revealed that histidine metabolism, sphingolipid metabolism, and tyrosine metabolism were greatly disturbed. Their biomarkers involved urocanic acid, sphingosine, and norepinephrine, all of which showed a callback trend after RDN treatment. The three biomarkers had a certain correlation with some known inflammatory-related small molecules (histamine, arachidonic acid, Leukotriene B4, and PGE

Objective:To evaluate the efficacy of splenic artery ligation on liver function recovery and hypersplenism in liver transplant patients with end-stage liver disease complicating portal hypertension and hypersplenism.Methods:From Jan 2016 to Jan 2019, the clinical data of patients undergoing liver transplantation at our hospital were analyzed retrospectively, among which 53 patients were enrolled in the study with end-stage liver disease complicated with portal hypertension and hypersplenism. Patients were divided into ligation group( n=23) and no ligation group( n=30). The serum liver function and white blood cells, platelets and postoperative complications were compared. Results:20 pairs of patients were successfully matched by PSM method. All patients were followed up for over 6 months.There was no statistically significant difference between the two groups in all the observation points within 2 weeks after operation; Within 6 months, there was no statistically significant difference in WBC, platelet and Hgb.Statistically significant differences in postoperative complications such as infection, gastrointestinal bleeding, and splenic artery stealing syndrome were also not found between these two groups.Conclusions:Splenic artery ligation during liver transplantation does not accelerate liver function recovery nor ameliorate hypersplenism.

Hepatocellular carcinoma is one of the most common malignancies of liver cancer.Partial hepatectomy and liver transplantation are potentially curative treatments in patients with hepatocellular carcinoma.However,the postoperative tumor recurrence rate is high with poor long-term survival outcome.Studies have shown that the presence of microvascular invasion is an independent risk factor of post-resection prognosis.Therefore it draws attention that whether postoperative TACE can prevent the recurrence of liver cancer.This article reviews the research progress postoperative TACE effect on hepatocellular carcinoma patients with microvascular invasion,in order to provide the reference for selection of further treatment.

Objective To study the safety,feasibility and efficacy of trans-diaphragm thoracoscopic hepatectomy for liver carcinoma.Methods Thoracoscopic hepatectomy was performed in 5 cases with single liver neoplasm from Jan 2016 to Aug 2018,including hepatocellular carcinoma (HCC) in 4 cases and metastatic liver cancer in 1 case.During the operation,the diaphragm just above the tumor was opened.Then we completely removed the tumor.After meticulous hemostasis of cut surface,the diaphragm was closed.A thoracic drain was placed.Results Thoracoscopic hepatectomy was performed successfully in all 5 cases,the median total operating time was 140 min (120-230 min),and the median blood loss was 300 ml (200-500 ml),Patients recovered quickly.One patient had pleural effusion and recovered after chest drainage.There were not other major post-operative complications.During 6 to 31 months' follow-up,one patient was lost to follow-up,two patients were survival with tumor recurrence,two patients were recurrence free.Conclusions Thoracoscopic hepatectomy is a safe and feasible operation in selected liver cancer patients and has advantages in post-operative recovery.

Objective To compare the clinical results of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and open spleen-preserving distal pancreatectomy (OSPDP).Methods From Jan 2014 to Aug 2017,the clinical results of 30 patients undergoing LSPDP were compared with those of 20 OSPDP patients.The postoperative pancreatic fistula rate was the main observation index.Results There was significant difference in operation time [(140.33 ±55.93) min vs.(182.71 ±43.51)min],blood loss [(175.61 ± 180.78) ml vs.(253.51 ± 176.06) ml],postoperative hospital stay [(6.16 ± 7.22) d vs.(8.85 ± 9.36) d],postoperative exhaust [(2.17 ± 1.43) d vs.(3.10 ± 1.89) d],and postoperative feeding time [(2.26 ± 1.78)d vs.(3.42 ±2.01)d] between LSPDP and OSPDP.LSPDP group was better than OSPDP group (all P ＜ 0.05).The rate of postoperative pancreatic fistula (66.7％ vs.70.0％) and overall complications (80％ vs.90.0％) were not statistically different between the two groups.Pancreatic leakage occurred in 20 cases,lung infection in 1 case,peritoneal infection in 1 case and chylous leakage in one case in LSPDP group,while pancreatic leakage in 14 cases,lung infection in 2 cases,and peritoneal infection in 2 cases in OSPDP group,all were cured by conservative therapy.Conclusions LSPDP is a safe,effective,less traumatic and more economic surgical approach for benign cystic tumors located at the body or tail of the pancreas.

Objective To investigate the treatment efficacy,feasibility and safety of laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm.Methods The clinical data of 31 patients who underwent laparoscopic resection of large gastric GISTs between Jan 2010 and Jun 2017 at Sir Run Run Shaw Hospital and People's Hospital of Zhejiang Province were retrospectively analyzed.Results All operations were successful.Two patients were converted to open surgery.The mean tumor size was (7.2 ±0.5) cm.The mean operation time was (127 ± 12) min,intraoperative blood loss was (83 ±25) ml.The first flatus time was (2.2 ±0.8) days,the first diet resumption time was (2.4 ± 1.2) days,and the median postoperative hospital stay was (5.5 ± 1.5) days.The median follow-up time was 25 months.One patient developing liver metastasis 41 months after primary resection received oral mesylate imatinib therapy for 24 months and was still alive at the last follow-up.One patient died of lung cancer 33 months after primary operation without recurrence of gastric GIST.Conclusions Laparoscopic surgery for gastric GIST larger than 5 cm on laparoscopicaly accessible location is feasible and safe.

Objective To observe the effects of associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) on liver regeneration of the unligated lobe with cirrhosis.Methods 60 liver cirrhosis SD rats were randomly divided into three groups:C-ALPPS group (n =20,liver cirrhosis + ALPPS),C-PVL group (n =20,liver cirrhosis + PVL) and C-Sham group (n =20,liver cirrhosis + sham operation).60 normal SD rats were randomly divided into three groups:N-ALPPS group (n =20,normal liver + PVL),N-PVL group (n =20,normal liver + PVL) and N-Sham group (n =20,normal liver + sham operation).The weight ratio of unligated lobes/total liver,proliferating cell nuclear antigen (Ki-67) and liver function were compared before operation and 2,4 and 7 days after operation.Results Except for sham operation group,liver weight ratios of unligated livers on the 4th and 7th days after operation were lower than those in the normal group (P ＜ 0.05).The weight ratios of unligated lobes/total liver in C-ALPSS group and N-ALPPS group on 4th and 7th day postoperation were (54.3 ± 3.1)％ vs.(61.2 ± 2.1)％,(65.0 ± 4.1) ％ vs.(79.2 ± 1.1) ％.The weight ratio unligated lobes/total liver in group C-PVL and group N-PVL at 4th and 7th day postoperation were (52.4 ± 1.8) ％ vs.(56.6 ± 2.0) ％,(63.8 ± 3.1) ％ vs.(70.0 ± 2.5) ％.There was no significant difference on weight ratio of unligated lobes/total liver between C-ALPPS group and C-PVL group at each time point (P ＜ 0.05).There was significant difference on the alanine transaminase (ALT),aspartate aminotransferase (AST) and albumin (ALB) levels between cirrhosis group and normal group at 4 and 7 days after operation (P ＜ 0.05).The expression level of Ki-67 in cirrhosis group was significantly lower than that in normal group at each time point (P ＜ 0.05).The expression level of Ki-67 in group C-ALPSS and group N-ALPPS at 2nd,4th and 7th day after operation were (19.4 ± 4.8)％ vs.(84.1 ±8.9)％,(33.6±3.5)％ vs.(70.2±7.2)％,(20.2±2.5)％ vs.(50.7±4.4) ％,and the expression level of Ki-67 in group C-PVL and group N-PVL at 2nd,4th and 7th day postoperationwere (21.1±4.0)％ vs.(52.1 ±7.3)％,(32.4 ±5.9)％ vs.(35.6 ±5.3)％,(15.5± 4.6) ％ vs.(12.2 ±4.9) ％.There was no significant difference of Ki-67 levels between C-PVL group and C-ALPPS group at 2 and 4 days after operation (P ＜ 0.05).Conclusions In normal rats,the liver regeneration rate after ALPPS was significantly higher than that after PVL.The liver regeneration rate after ALPPS in cirrhotic rats was significantly lower than that in normal rats after ALPPS.There was no significant difference of the liver regeneration rate between ALPPS and PVL in cirrhotic rats.

Objective: To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma. Methods: Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017. Results: All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis. Conclusion Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.