Objective:To evaluate the perioperative safety of pancreaticoduodenectomy(PD)in elderly patients.Methods:Clinical data of 152 patients undergoing PD in Beijing Hospital between 2016 and 2019 were retrospectively analyzed.According to the age, patients were divided into the elderly group(age≥65 years)and the non-elderly group(age<65 years). The perioperative and postoperative parameters were compared between the two groups.Results:There was no significant difference in the operative time, intraoperative blood loss and intraoperative urine output between the elderly group and the non-elderly group(352.7±69.5)min vs.(359.0±94.4)min, (708.7±672.7) vs.(662.6±896.7)ml and(875.8±497.3)ml vs.(1010.6±568.2)ml, all P>0.05). The perioperative mortality, postoperative complications(Clavien-Dindo classification ≥ grade Ⅲ)and reoperation rate had no significant difference between elderly group and the non-elderly group(6.1% vs.1.2%, 21.2% vs.19.8%, 10.6% vs.8.1%, respectively, χ2=1.487, 0.048 and 0.272, all P>0.05). The incidences of operation-related complications, cardiovascular or cerebrovascular adverse events in elderly group were comparable to non-elderly group( P>0.05). The postoperative hospital stay had no significant difference between the elderly group and the non-elderly group[(28±19)d vs.(27±18)d, P>0.05]. Conclusions:PD is safe in elderly patients.Age is not a contraindication to pancreaticoduodenectomy.The comprehensive systemic evaluation, intraoperative delicate operation and enhanced perioperative management are necessary in the elderly patients undergoing PD.

Objective: To examine the effect of standardized lymphectomy and sampling of resected lymph nodes (LN) on TNM staging of resectable pancreatic head cancer. Methods: Consecutive patients with resectable pancreatic head cancer who received standard pancreatoduodenctomy at Department of General Surgery in Beijing Hospital from December 2017 to November 2018 were recruited as study group. After operation, the surgeon sampled lymph nodes from the fresh specimen following the Japanese Gastric Cancer Guidelines.Thirty-three cases were recruited in the study group and the mean age was (59.8±15.2) years.Pathologic reports from December 2015 to November 2016 were taken as control group, containing 29 cases with age of (57.0±13.0) years. Number of lymph nodes, standard-reaching ratio and positive nodes ratio were compared between two groups. According to the seventh edition and eighth edition of TNM staging, the changes of N staging and TNM staging were analysed. The quantitative data conforming to normal distribution were tested by independent sample t test, the quantitative data not conforming to normal distribution were tested by rank sum test, and the enumeration data were analysed by χ² test. Results: The basal data of the two groups were comparable (all P>0.05) . The number of lymph nodes sampled in the study group was 23.27±8.87, significantly more than in control group (12.86±5.90, t=0.653, P=0.000) .Ratio of cases with more than 15 nodes was 81.8% (27/33) in the study group and 34.5% (10/29) in the control group with statistical significance (χ²=14.373, P=0.000) . In the study group, the positive lymph node ratios of No. 17a+17b, 14a+14b, 8a+8p LN were 36.4% (12/33) , 30.3% (10/33) and 9.1% (3/33) respectively. The positive lymph node ratio in No.14a+14b LN was higher than in No.8 LN (χ²=4.694, P=0.030) . According to the change in N staging system in the AJCC eighth edition, 2 cases (6.1%, 2/33) changed from ⅠB to ⅡA, 7 cases (21.2%, 7/33) from ⅡA to ⅠB and 5 cases (15.2%, 5/33) changed from ⅡB to Ⅲ (25.0%, 5/20) . Conclusions No.14 LN should be treated as the first station rather than second station because of the anatomic character and higher metastatic ratio. Standardised lymphectomy and sampling may increase the number of LN resected and improve the TNM staging of resectable pancreatic head cancer.

OBJECTIVE： To study the chemical constituents in the ethyl acetate extract of Balanophora involucrate， and to provide reference for further enriching chemical constituent of the plant and the development and utilization of B. involucrate. METHODS： The whole plant of B. involucrate was extracted with 75％ ethyl alcohol. The extraction was carried out by petroleum ether， dichloromethane， ethyl acetate and n-butyl alcohol in turn. The chemical compounds from ethyl acetate extract part were isolated and purified by silica gel column， gel column and semi-preparative HPLC. The structures were identified on the basis of spectral spectrum （mass spectrum， hydrogen spectrum and carbon spectrum） data and literature reports. RESULTS： Thirteen compounds were isolated from ethyl acetate extract part of B. involucrate， identified respectively as pyracanthoside （1）， 5，7，3′ ，5′ -tetrahydroxyflavanone （2）， naringenin （3）， homoeriodictyol （4）， hesperetin （5）， sakuranetin （6）， eriodyctiol （7）， aureusidin-6-O-β-D-glucopyranoside （8）， penicillic acid （9）， dihydropenicillic acid （10）， 2-methyl-3-foroic acid （11）， 5-hydroxymaltol （12） and 5， 7-dyhydroxy chromone （13）. Most of them were dihydroflavones. Compounds 2 to 13 are isolated from Balanophora genus for the first time. CONCLUSIONS： The study enriched the chemical constituents of the Balanophora genus and lays foundation for quality evaluation of B. involucrate.

Objective To evaluate the correlation between microvascular invasion(MVI) and prognosis in patients with hepatocellular carcinoma (HCC),and to analyse the influencing factors of MVI in patients with HCC.Methods Total of 81 patients with hepatocellular carcinoma treated in Beijing Hospital from January 2014 to December 2016 were retrospectively studied.There were 65 males and 16 females.The mean age was 59.6± 12.7 years,and the age ranged from 21 to 87 years old.Pathological examination showed presence of MVI in 35 patients.Results Total of seventy-six patients with hepatocellular carcinoma were followed-up.The 1-,2-,3-and 4-year overall survival rates in the 35 patients with microvascular invasion of hepatocellular carcinoma were 78.6％,55.4％,38.3％,and 32.2％,respectively.The 1-,2-,3-,and 4-year overall survival rates of the 41 patients without microvascular invasion were 93.4％,76.5％,68.2％ and 68.2％,respectively.The difference was significant (P＜0.05).Cox multivariate regression analysis showed that microvascular invasion was an independent risk factor of overall survival after surgery (HR=3.071,95％ CI:1.239～7.610,P＜0.05).Sub-group analysis was done on patients with microvascular invasion based on pathological results which included the number of MVI lesions,the call number in the MVI lesion,the distance of the MVI to the primary liver cancer,and the gradings of MVI.There were no significant differences in the overall survival outcomes (P＞0.05).Multivariate logistic regression analysis showed the maximum diameter of tumor ＞ 5 cm (OR =6.340,95％ CI:2.000 ～ 20.096),preoperative total bilirubin (TBil) ＞ 17 μmol/L (OR =5.067,95％CI:1.386 ～ 18.525),and preoperative alpha-fetoprotein (AFP) ＞400 μg/L (OR =6.042,95％ CI:1.435 ～ 25.444) were independent risk factors of microvascular invasion (P＜ 0.05).Conclusion Hepatocellular carcinoma patients with microvascular invasion had poor prognosis.Preoperative AFP,preoperative TBil,and diameter of tumor were independent risk factors of microvascular invasion in patients with hepatocellular carcinoma.

OBJECTIVE: To screen for LDLR gene mutations in 9 patients with familial hypercholesterolemia (FH). METHODS: All exons of the LDLR gene and flanking intronic sequences were amplified by PCR and subjected to automatic DNA sequencing. For patients with homozygous or compound heterozygous mutations, parental DNA sequencing or T cloning sequencing was carried out to determine the parental origin of the mutant alleles. RESULTS: Direct sequencing of PCR products revealed 8 LDLR variants in 7 patients, which included c.259T>G, c.513delC, c.530C>T, c.682G>T, c.763C>T, c.1187-10G>A, c.1948delG, and c.1730G>A, among which c.1948delG was novel. Four patients have carried heterozygous mutations, two carried homozygous mutations, and one carried compound heterozygous mutations. The patients with biallelic mutations presented with a more severe phenotype compared those carrying heterozygous mutations. CONCLUSION LDLR mutations were identified in 7 out of 9 patients with FH. Among the 8 identified LDLR mutations, c.1948delG was firstly reported. Above findings have expanded the mutation spectrum of LDLR gene.
DNA Mutational Analysis ; Genetic Testing ; Humans ; Hyperlipoproteinemia Type II ; genetics ; Mutation ; Phenotype ; Receptors, LDL ; genetics

Objective To investigate the rates of undernutrition and nutritional risks of surgical pa-tients with pancreatic tumors .Methods Totally 121 surgical patients with pancreatic tumors from Depart-ment of Surgery Beijing Hospital were enrolled in a prospective study during January 2014 to December 2015 . Patients were divided into two groups:the pancreatic cancer group ( n=90 ) and other pancreatic tumor group ( n=31 ) .Nutritional Risk Screening 2002 was used to assess the nutritional status .Other data including an-thropometric measure, body composition, blood biochemistry and clinical outcome were collected and ana-lyzed.Results Among 121 patients, the mean age was ( 61.9 ±13.6 ) years, the mean body mass index was ( 23.20 ±2.95) kg/m2 , the mean mid-upper circumference was ( 28.8 ±3.5 ) cm, the mean muscle weight was (44.6 ±7.4) kg, and the mean fat mass was (16.8 ±7.6) kg .There was no significantly differ-ence in anthropometric measurement results and body compositions between two groups ( all P>0.05 ) .In the pancreatic cancer group, albumin [ (39.0 ±4.7) g/L vs. (42.3 ±2.9) g/L, P<0.001], total protein [ (62.8 ±6.2) g/L vs.(66.3 ±2.9) g/L, P<0.001], and prealbumin [ (136.1 ±85.4) mg/L vs. (197.8 ±112.6 ) mg/L, P=0.011 ] were significantly lower than those in the other pancreatic tumor group and a higher fasting blood-glucose [ (6.45 ±2.47) mmol/L vs.(4.95 ±0.79) mmol/L, P<0.011] was found.Among all patients , the rates of undernutrition and nutritional risk were 4.1% and 78.5%, and the pancreatic cancer group had a higher rate of nutritional risk (91.1% vs.38.7%,χ2 =36.525, P<0.001). Conclusion In this prospective study , surgical patients with pancreatic cancer have a high incidence of nutri -tional risk, with low protein level and abnormal glucose metabolism .

Objective To investigate the nutritional status,body composition,and energy metabolism of hepatocarcinoma patients undergoing surgical treatment and explore the relationships of the nutritional status with body composition and energy metabolism.Methods Totally 112 hospitalized hepatocarcinoma patients undergoing surgical treatment met the inclusion and exclusion criteria were enrolled as the intervention group,and another 100 patients with cholelithiasis during the the same period were enrolled as the control group.Their general clinical data including body mass index(BMI),arm circumference,grip,albumin,prealbumin,energy expenditure,and body composition were collected.The nutritional status was assessed by the scored patient-generated subjective global assessment(PG-SGA).The relationships of the nutritional status with body composition and between energy metabolism were analyzed.All the data were analysed by SPSS 16.0 software package.Results The arm circumference [(23.9±3.6)cm vs.(25.3±4.5)cm,t=2.57,P=0.014],hand grip[(31.7±6.0)kg vs.(39.2±7.6)kg,t=8.19,P<0.001],serum albumin[(32.5±4.7)g/L vs.(36.5±7.2)g/L,t=4.92,P=0.007] and prealbumin[(0.172±0.052)g/L vs.(0.263±0.077)g/L,t=10.3,P=0.004] of the intervention group were significantly lower than the control group.The total malnutrition rate of the intervention group was 37.5％(42 cases at levels B and C),and that of the control group was 14.4％(14 cases at levels B and C)(X2=19.73,P<0.001).The extracellular water significantly increased in the intervention group compared with that of the control group[(15.35±2.21)L vs.(13.51±2.73)L,t=5.54,P<0.001];however,the somatic cell mass [(27.54±4.42)kg vs.(29.03±4.38)kg,t=2.53,P=0.012],fat mass[(13.44±4.23)kg vs.(17.36±5.21)kg,t=6.18,P<0.001],and muscle mass[(43.11±6.27)kg vs.(48.17±7.13)kg,t=5.63,P<0.001] had significantly decreased compared with the control group.The measured value of rest energy expenditure(mREE)[(6 581.62±1 201.70)kJ/d vs.(6 290.73±1 071.68)kJ/d,t=1.98,P=0.042] of the intervention group was significantly higher than the control group(P=0.042),and the respiratory quotient(RQ)was also significantly higher(0.87±0.10 vs.0.85±0.06,t=2.72,P=0.027).The extracellular fluid(PG-SGA A vs.B P=0.035;A vs.C P<0.001;B vs.C P=0.042)were significantly increased,and the number of somatic cells(A vs.B P=0.015;A vs.C P=0.001;B vs.C P=0.022),fat(A vs.B P=0.026;A vs.C P=0.003;B vs.C P=0.022)and muscle mass(A vs.B P=0.029;A vs.C P=0.011;B vs.C P=0.036)were decreased with the deterioration of nutritional status,resting energy expenditure(A vs.B P=0.023;A vs.C P=0.002;B vs.C P=0.032),and RQ(A vs.C P=0.004;B vs.C P=0.012)were also increased with the deterioration of nutritional status,and there was significant difference among three groups.Conclusions The incidence of malnutrition is high in hepatocarcinoma patients undergoing surgical treatment.The patients can have lower lean body mass,more water retention,and higher energy metabolism,which may worsen along with the deterioration of nutritional status.

Objective Common bile duct stones are common in elderly patients.The laparoscopic transcystic approach with micro-incision of the cystic duct confluence in common bile duct exploration (LTM-CBDE) is a modified laparoscopic transcystic approach.This study evaluated the safety and efficacy of LTM-CBDE in the elderly (≥65 years) patients with choledocholithiasis and compared the results in the elderly with those in younger patients.Methods In this retrospective analysis,128 patients underwent LTM-CBDE from March 2007 to December 2013.The patients were divided into two groups:aged ≥65 years (n=50,the elderly group) versus aged ＜65 years (n=78,the younger group).The preoperative morbidity rate,American Society of Anesthesiologists (ASA) score,previous abdominal operations,operation time,postoperative hospital stay,open conversion rate,postoperative complication rate,residual stone rate,recurrence rate and mortality rate were compared between the both groups.Results The preoperative morbidity (41 vs.28) and ASA score (2.5± 0.7 vs.1.8±0.6) were higher in the elderly group than in he younger group (x2=26.063,t=-6.030,P =0.000,in both).No significant differences in previous abdominal operations,operation time,postoperative hospital stay,open conversion rate,postoperative complication rate,residual stone rate,recurrence rate and mortality rate (P＞0.05) were found between the two groups from March 2007 to December 2013.Conclusions LTM-CBDE is a safe and effective treatment procedure for elderly patients with choledocholithiasis.For LTM-CBDE-suitable patients,we recommend LTM-CBDE as the treatment of choice.

Objective To analyse the experience and treatment of early phase severe acute pancreatitis (SAP) in intensive care units (ICU).Methods A multicenter retrospective study was done on patients with SAP treated in three major teaching hospitals (Beijing Hospital,Peking University First Hospital and Peking University Shenzhen Hospital) in China from Jan.2001 to Dec.2011.Results There were 188 patients who were enrolled in the study,including 121 males and 67 females.The age ranged from 19 to 104 (51.0±18.2) years.The mean APACHE Ⅱ score was (22.2±4.6).84.0％ of patients survived,the mortality was 10.1％ in the early phase and 5.9％ in the late phase.The most common systemic complications were acute renal injury (46.3 ％),acute respiratory distress syndrome (35.6％),and septic shock (17.6％).The local complication rate was 47.3％,which included acute peripancreatic fluid collections (32.8％),acute necrotic collection and walled-off necrosis (48.4 ％) and pseudocyst (18.8 ％).The conservative treatments included intensive care,fluid resuscitation,mechanical ventilation,continuous renal replacement therapy,antibiotics,glucose control,inhibition of pancreatic enzyme activity and secretion,and nutritional support.Surgical intervention included endoscopic retrospective cholangio-pancreatography and endoscopic sphincterectomy,B ultrasound or CT guided puncture and drainage,and surgical drainage and debridement of necrosis.Conclusions The early phase of SAP was characterized by systemic inflammatory response syndrome and multiple organ dysfunction syndrome which accounted for the first peak in mortality.Intensive care therapy and multi disciplinary comprehensive combined strategy were very important for these patients with systemic and local complications.ICU treatment in the early phase was preferred for patients with SAP.

ObjectiveTo study the feasibility and technique in liver transplantation (LT) in an adult with situs inversus (SI) and reviewed the medical literature on this subject.MethodsA 45-year-old male with complete SI,suffered from progressive hepatic failure secondary to hepatolithiasis,obstructive jaundice,portal hypertension and liver cirrhosis.He underwent liver transplantation in July 2004.His anatomy was studied by preoperative CT scan and three-dimensional liver reconstruction imaging and angiography.LT was performed using the modified piggyback technique.The donor right liver was rotated 45 degree to the left,making the donor left liver pointing to the left paracolic sulcus and the donor right liver was in the recipient hepatic fossa.The donor suprahepatic vena cava was anastomosed end-to-side to the recipient vena cava,and the infrahepatic vena cava was closed by oversewing.ResultThe patient recovered uneventfully.His liver function was stable during a follow-up of 75 months.ConclusionLT in patients with SI is safe and feasible.Exact determination of the anatomy,comprehensive preoperative planning,and good technique in liver transplantation play important roles in LT for patients with SI.