Objective To compare the safety and effectiveness of two different flow diverter devices between Tubridge flow diverter(TFD)and Surpass Streamline flow diverter(SFD)in the treatment of unruptured intracranial aneurysms.Methods A retrospective analysis from August 2020 to December 2023 was performed on the clinical data of 62 cases of unruptured aneurysms in the Department of Interventional Radiology(Shinan Branch),the Affiliated Hospital of Qingdao University treated with flow diverter.According to the type of implanted stents,they were divided into TFD group(32 cases)and SFD group(30 cases),general information about patients was collected,including age,sex,and past history(hypertension,diabetes,coronary heart disease),hospitalization time,surgical time(anesthesia start to anesthesia awakening time)and aneurysm location(anterior circulation,posterior circulation),type(giant aneurysm:maximum diameter ≥ 25 mm,large aneurysm:maximum diameter 15-＜25 mm,medium aneurysm:maximum diameter 5-＜15 mm,small aneurysm:maximum diameter＜5 mm),aneurysm morphology(saccular aneurysm,simple fusiform aneurysm,dissecting aneurysm),aneurysm maximum diameter,aneurysm neck,parent artery diameter,aneurysm wall enhancement in preoperative high-resolution MRI scan.Different types of flow diverters were selected according to the results of Surpass intracranial aneurysm embolization system pivotal trial to treat large or giant wide neck aneurysms(SCENT)and intracranial aneurysms managed by parent artery reconstruction using Tubridge flow diverter study(IMPACT).If"ejection sign"was found at the aneurysm neck on angiography immediately after the release of flow diverters,appropriate amount of coils were packed.Tamponade until there is no contrast filling in the aneurysm body on cerebral angiography,at which time the operation is terminated.If there is no"ejection sign"immediately after the release of the flow diverter,the procedure is terminated.Angiography was performed immediately after operation to evaluate the parent artery stenosis(patency[stenosis rate ≤50％],stenosis[stenosis rate＞50％]or occlusion[stenosis rate 100％])degree of aneurysm occlusion.O'Kelly-Marotta(OKM)classification was used to evaluate the degree of aneurysm occlusion.Effectiveness evaluation:DS A follow-up was performed≥1 month after operation,and the final angiographic result was taken as the final follow-up result to evaluate the postoperative aneurysm occlusion(OKM grade D:complete aneurysm occlusion,other grades:incomplete aneurysm occlusion),parent artery stenosis or occlusion.Safety evaluation:the clinical efficacy of patients at the last postoperative follow-up was evaluated by modified Rankin scale(mRS)score(mRS score 0-2:good clinical prognosis,mRS score 3-6:poor clinical prognosis),and perioperative(≤2 weeks after surgery)complications(ischemic complications,bleeding complications and other complications)were counted.The clinical effects and complications of the two groups were compared.Results A total of 62 aneurysms in 62 patients were included in the study.All patients were treated with a single flow diversion device.There were 28 males and 34females,aged 32 years to 76 years,with an average of(57±10)years.There were 39 anterior circulation aneurysms and 23 posterior circulation aneurysms.Among 62 patients,43 patients had saccular aneurysm,4 patients had simple fusiform aneurysm and 15 had dissecting aneurysm.Among them,38 saccular aneurysms were located in the anterior circulation and 5 in the posterior circulation;1 simple fusiform aneurysm was located in the anterior circulation and 3 in the posterior circulation;all dissecting aneurysms were located in the posterior circulation.The maximum diameter of the aneurysm ranged from 2.0 mm to 27.0 mm,with a median of 7.0(5.0,12.0)mm,and the aneurysm neck ranged from 2.0 mm to 18.5 mm,with a median of 5.0(4.0,6.7)mm.(1)There were statistically significant differences in aneurysm location and shape distribution between TFD group and SFD group(both P＜0.05),but there were no statistically significant differences in other general data(all P＞0.05).(2)The incidence of perioperative complications was 6.3％(2/32)in TFD group and 10.0％(3/30)in SFD group,and there was no significant difference between two groups(P=0.940).The good clinical outcome rate of both groups were 100.0％at the last follow-up.(3)All patients were followed up with DS A after operation.The follow-up time ranged from 55 d to 1 150 d,with a median follow-up time of 205.0(108.0,360.0)d.There was no significant difference in OKM classification distribution immediately after operation(P=0.607)and complete occlusion rate at the last follow-up(53.1％[17/32]vs.63.3％[19/30],P=0.416)between two groups.At the last follow-up,no parent artery stenosis or occlusion occurred in either group.Conclusions TFD has comparable efficacy and safety as SFD in the treatment of unruptured intracranial aneurysms.The results of this study need to be further verified by prospective large sample study.

Objective To compare the safety and effectiveness of two different flow diverter devices between Tubridge flow diverter(TFD)and Surpass Streamline flow diverter(SFD)in the treatment of unruptured intracranial aneurysms.Methods A retrospective analysis from August 2020 to December 2023 was performed on the clinical data of 62 cases of unruptured aneurysms in the Department of Interventional Radiology(Shinan Branch),the Affiliated Hospital of Qingdao University treated with flow diverter.According to the type of implanted stents,they were divided into TFD group(32 cases)and SFD group(30 cases),general information about patients was collected,including age,sex,and past history(hypertension,diabetes,coronary heart disease),hospitalization time,surgical time(anesthesia start to anesthesia awakening time)and aneurysm location(anterior circulation,posterior circulation),type(giant aneurysm:maximum diameter ≥ 25 mm,large aneurysm:maximum diameter 15-＜25 mm,medium aneurysm:maximum diameter 5-＜15 mm,small aneurysm:maximum diameter＜5 mm),aneurysm morphology(saccular aneurysm,simple fusiform aneurysm,dissecting aneurysm),aneurysm maximum diameter,aneurysm neck,parent artery diameter,aneurysm wall enhancement in preoperative high-resolution MRI scan.Different types of flow diverters were selected according to the results of Surpass intracranial aneurysm embolization system pivotal trial to treat large or giant wide neck aneurysms(SCENT)and intracranial aneurysms managed by parent artery reconstruction using Tubridge flow diverter study(IMPACT).If"ejection sign"was found at the aneurysm neck on angiography immediately after the release of flow diverters,appropriate amount of coils were packed.Tamponade until there is no contrast filling in the aneurysm body on cerebral angiography,at which time the operation is terminated.If there is no"ejection sign"immediately after the release of the flow diverter,the procedure is terminated.Angiography was performed immediately after operation to evaluate the parent artery stenosis(patency[stenosis rate ≤50％],stenosis[stenosis rate＞50％]or occlusion[stenosis rate 100％])degree of aneurysm occlusion.O'Kelly-Marotta(OKM)classification was used to evaluate the degree of aneurysm occlusion.Effectiveness evaluation:DS A follow-up was performed≥1 month after operation,and the final angiographic result was taken as the final follow-up result to evaluate the postoperative aneurysm occlusion(OKM grade D:complete aneurysm occlusion,other grades:incomplete aneurysm occlusion),parent artery stenosis or occlusion.Safety evaluation:the clinical efficacy of patients at the last postoperative follow-up was evaluated by modified Rankin scale(mRS)score(mRS score 0-2:good clinical prognosis,mRS score 3-6:poor clinical prognosis),and perioperative(≤2 weeks after surgery)complications(ischemic complications,bleeding complications and other complications)were counted.The clinical effects and complications of the two groups were compared.Results A total of 62 aneurysms in 62 patients were included in the study.All patients were treated with a single flow diversion device.There were 28 males and 34females,aged 32 years to 76 years,with an average of(57±10)years.There were 39 anterior circulation aneurysms and 23 posterior circulation aneurysms.Among 62 patients,43 patients had saccular aneurysm,4 patients had simple fusiform aneurysm and 15 had dissecting aneurysm.Among them,38 saccular aneurysms were located in the anterior circulation and 5 in the posterior circulation;1 simple fusiform aneurysm was located in the anterior circulation and 3 in the posterior circulation;all dissecting aneurysms were located in the posterior circulation.The maximum diameter of the aneurysm ranged from 2.0 mm to 27.0 mm,with a median of 7.0(5.0,12.0)mm,and the aneurysm neck ranged from 2.0 mm to 18.5 mm,with a median of 5.0(4.0,6.7)mm.(1)There were statistically significant differences in aneurysm location and shape distribution between TFD group and SFD group(both P＜0.05),but there were no statistically significant differences in other general data(all P＞0.05).(2)The incidence of perioperative complications was 6.3％(2/32)in TFD group and 10.0％(3/30)in SFD group,and there was no significant difference between two groups(P=0.940).The good clinical outcome rate of both groups were 100.0％at the last follow-up.(3)All patients were followed up with DS A after operation.The follow-up time ranged from 55 d to 1 150 d,with a median follow-up time of 205.0(108.0,360.0)d.There was no significant difference in OKM classification distribution immediately after operation(P=0.607)and complete occlusion rate at the last follow-up(53.1％[17/32]vs.63.3％[19/30],P=0.416)between two groups.At the last follow-up,no parent artery stenosis or occlusion occurred in either group.Conclusions TFD has comparable efficacy and safety as SFD in the treatment of unruptured intracranial aneurysms.The results of this study need to be further verified by prospective large sample study.

Objective:To investigate the clinical efficacy of modified biliary-intestinal anasto-mosis by pancreaticoduodenectomy and influencing factors of postoperative biliary leakage.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatholo-gical data of 165 patients with benign and malignant diseases around the ampullary who underwent pancreaticoduodenectomy in the Affiliated Hospital of Inner Mongolia Medical University from June 2014 to October 2020 were collected. There were 92 males and 73 females, aged (59±10)years. Of the 165 patients, 44 patients undergoing modified biliary-intestinal anastomosis within pancreatico-duodenectomy were divided into the modified group, and 121 patients undergoing traditional biliary-intestinal anastomosis within pancreaticoduodenectomy were divided into the traditional group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative situations; (3) analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the corresponding statistical methods based on data type. All indicators in univariate analysis were included in multivariate analysis. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 165 patients, 72 cases were successfully matched, including 36 cases in the modified group and 36 cases in the traditional group, respectively. The elimination of jaundice, preoperative reduction of jaundice and hypertension confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. All patients in the two groups underwent surgery successfully. The operation time, postoperative pathological type (lower bile duct cancer, pancreatic head cancer, pancreatic cystic tumor, chronic pancreatitis, duodenal cancer), time of no drainage fluid in the drainage tube around biliary-intestinal anastomosis were 371(270,545)minutes, 6, 12, 1, 2, 15, (12±7)days in patients of the modified group, versus 314(182,483) minutes, 13, 14, 1, 4, 4, (16±8)days in patients of the traditional group, showing significant differences in the above indicators between the two groups ( Z=-3.54, χ2=10.01, t=-2.34, P<0.05). Cases with postoperative grade A biliary leakage was 0 in patients of the modified group, versus 6 in patients of the traditional group, showing a significant difference between the two groups ( P<0.05). Cases with postoperative grade B biliary leakage, cases with postoperative grade B pancreatic fistula, cases with postoperative bleeding, cases with abdominal infection, cases with incision infection, cases with delayed gastric emptying, cases undergoing unplanned readmission were 1, 0, 1, 4, 1, 5, 1 in patients of the modified group, versus 0, 1, 2, 5, 2, 5, 2 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with postoperative grade A pancreatic fistula, cases with overall complications, cases with Clavien-Dindo grade Ⅰ-Ⅱ complications, cases with Clavien-Dindo grade Ⅲ-Ⅳ complications were 6, 12, 6, 6 in patients of the modified group, versus 7, 14, 8, 6 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.09, 0.24, 0.36, 0.00, P>0.05). None of patient in the two groups had postoperative grade C biliary leakage and postoperative grade C pancreatic fistula. (3) Analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Results of multivariate analysis showed that preoperative reduction of jaundice and traditional biliary-intestinal anastomosis were independent risk factors for biliary leakage after pancreaticoduodenectomy ( odds ratio=11.37, 12.27, 95% confidence interval as 1.76-73.35, 1.14-131.23, P<0.05). Conclusions:Compared with traditional biliary-intestinal anastomosis, modified biliary-intestinal anastomosis within pancreaticoduodenectomy is safe and feasible. Preoperative reduction of jaundice and traditional biliary-intestinal anastomosis are independent risk factors for biliary leakage after pancreaticoduodenectomy.

Acyl-CoA synthetase long chain family member 5 (ACSL5), is a member of the acyl-CoA synthetases (ACSs) family that activates long chain fatty acids by catalyzing the synthesis of fatty acyl-CoAs. The dysregulation of ACSL5 has been reported in some cancers, such as glioma and colon cancers. However, little is known about the role of ACSL5 in acute myeloid leukemia (AML). We found that the expression of ACSL5 was higher in bone marrow cells from AML patients compared with that from healthy donors. ACSL5 level could serve as an independent prognostic predictor of the overall survival of AML patients. In AML cells, the ACSL5 knockdown inhibited cell growth both in vitro and in vivo. Mechanistically, the knockdown of ACSL5 suppressed the activation of the Wnt/β-catenin pathway by suppressing the palmitoylation modification of Wnt3a. Additionally, triacsin c, a pan-ACS family inhibitor, inhibited cell growth and robustly induced cell apoptosis when combined with ABT-199, the FDA approved BCL-2 inhibitor for AML therapy. Our results indicate that ACSL5 is a potential prognosis marker for AML and a promising pharmacological target for the treatment of molecularly stratified AML.
Humans ; Antineoplastic Agents/therapeutic use* ; Apoptosis ; beta Catenin/metabolism* ; Biomarkers, Tumor/metabolism* ; Cell Line, Tumor ; Coenzyme A Ligases/metabolism* ; Leukemia, Myeloid, Acute/metabolism* ; Lipoylation ; Prognosis ; Wnt Signaling Pathway

Objective:To summarize the computed tomography (CT) and magnetic resonance imaging (MRI) features of acinar cell carcinoma of the pancreas (ACCP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 patients with ACCP who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2015 to December 2019 were collected. There were 5 males and 16 females, aged (57±9)years, with a range from 41 to 74 years. Patients underwent CT and MRI examinations. Observation indicators: (1) imaging examination; (2) imaging features on CT; (3) imaging features on MRI; (4) pathological examination and immunohistochemistry staining; (5) treatment and follow-up. Follow-up using outpatient examination and telephone interview was conducted at 1, 3, 6 months after discharge and once every 6 months thereafter to detect survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers. Results:(1) Imaging examination. Of the 21 patients, 7 underwent single CT examination, 11 underwent MRI examination, and 3 underwent both CT and MRI examinations. ① Tumor shape: all the 21 patients had single tumor, including 17 showing round or quasi-round shape, and 4 showing irregular clumps. ② Tumor location: of the 21 patients, 6 had tumor located at pancreatic head, 2 had tumor located at pancreatic head and body, 2 had tumor located at pancreatic body, 4 had tumor located at pancreatic body and tail, 4 had tumor located at pancreatic tail, and 3 had had tumor located at ampulla. ③ The maximum tumor diameter was (43±29)mm, with a range from 11 to 129 mm. ④ Adjacent organ invasion: 10 of the 21 patients had invasion of adjacent organ, including 2 with invasion of stomach, spleen and left adrenal gland invasion, 4 with invasion of duodenum, 3 with invasion of duodenum and common bile duct, 1 with invasion of spleen. ⑤ Vascular invasion: 12 patients had invasion of splenic artery or splenic vein, including 1 combined with invasion of both common hepatic artery and superior mesenteric vein, 1 combined with invasion of celiac root. ⑥ Pancreatic and bile duct invasion: 8 patients had pancreatic and bile duct dilation, including 4 with bile duct and upper pancreatic duct dilation, and 4 with pancreatic duct dilation. ⑦ Lymph node metastasis: 2 patients had perineoplastic lymph node enlargement. ⑧ Other conditions: 7 patients had tumor center with cystic necrosis. Four patients had atrophy pancreatic parenchyma. Two patients had splenic vein tumor thrombosis. Two patients had cysts. One patient had multiple liver metastases. (2) Imaging features on CT. ① The solid part was dominant in the main body of the 10 patients undergoing CT examination, demostrating equal density, of which 3 cases had clear boundaries, 2 cases had pseudocapsule around the lesion, and 5 cases had low-density necrotic area in the center of lesion. ② In arterial phase of CT examination, the solid part of tumor had a lower enhancement compared with the normal pancreatic tissues in 7 patients, while the solid part of tumor had a high enhancement compared with the normal pancreatic tissues in 3 patients. ③ In delayed phase of CT examination, the tumor density was slightly lower than or equal to density of normal pancreatic parenchyma in 7 patients, showing slightly progressive enhancement, while the tumor density was slightly higher than or equal to density of normal pancreatic parenchyma in 3 patients. (3) Imaging features on MRI. ① MRI plain scan of 14 patients showed that 8 patients demostrated slightly longer T2 and slightly longer T1 signals in lesions, while 6 patients demostrated mixed signals dominated by long T2 and equal T1 signals. The area of cystic necrosis was observed in lesions of 4 patients and was not observed in 10 patients. No antiphase signal reduction was observed in the 14 patients. ② MRI dynamic enhanced scan of 12 patients showed that 11 patients presented mild progressive enhancement in lesions and 1 patient presented obvious confounding enhancement and clearance in the delayed phase. Compared with adjacent normal pancreatic parenchyma, diffused weighted imaging showed high signals in 6 cases, slightly high signals in 6 cases, and high signal halo in 2 cases. The apparent diffusion coefficient in 14 lesions was (1.22±0.14)×10 -3 mm 2/s. (4) Pathological examination and immunohistochemistry staining. Results of pathological examination in the 21 patients: acinic cell carcinoma, mixed ductal-acinic cell carcinoma, acinar-endocrine carcinoma, and atypical hyperplasia inacinus were detected in 14, 5, 1, and 1 patients, respectively. Of the 21 patients, 10 had invasion of adjacent organ, 3 had invasion of bile duct, 2 had invasion of lymph node. Results of immunohistochemistry staining in 17 patients: 17 patients had proliferation index of Ki-67 as 1%-80%; 10 out of 16 patients were positive for synaptophysin; 6 out of 16 patients were positive for CD56 protein; 2 out of 14 patients were positive for Chromogranin A; 12 out of 13 patients were positive for α-antitrypsin; 9 out of 11 patients were positive for cytokeratin; 8 patients were positive for β-catenin; 2 patients were positive for B lymphoma-10 protein. (5) Treatment and follow-up. Of the 21 patients, 10 cases underwent pancreatico-duodenectomy, 6 cases underwent pancreatic body and tail pancreatectomy combined with splenectomy, 2 cases underwent pancreatic body and tail pancreatectomy, 1 case underwent pancreatic tail tumor enucleation, 1 case underwent liver metastasis resection, and 1 case underwent ultrasound-guided pancreatic lesion puncture biopsy. All the 21 patients were followed up for (30±16)years, with a range from 2 to 52 months. There were 13 patient surviving and 8 cases of death. They had survived for (19±13)months, with a range from 2 to 35 months. Conclusions:The CT and MRI enhanced scan of ACCP showed slightly progressive enhancement, with cystic necrosis seen in the center and high signals in diffused weighted imaging. Dilation of bile duct and pancreatic duct is common in patients with pancreatic head tumors, and invasion of splenic artery and vein is common in pancreatic body and tail tumors. Calcification and cyst are rare and lesions of pancreatic head and body cause atrophy in pancreatic tail.

Objective To evaluate the diagnostic value of gray-scale ultrasound combined with contrast-enhanced ultrasound (CEUS) in thyroid imaging and reporting system ( TI-RADS) 3-5 nodules of American College of Radiology ( ACR) . Methods The 208 patients( 216 nodules) who underwent thyroid contrast-enhanced ultrasound examination from April 2014 to December 2016 were retrospectively analyzed . The ACR TI-RADS classification and contrast-enhanced mode of thyroid ultrasound were evaluated . The benign and malignant thyroid lesions were constructed through the analysis of contrast-enhanced mode of thyroid benign and malignant lesions in the past literature and the preliminary study of our group . Prediction model of gray scale combined with contrast-enhanced ultrasound for lesions were established . Besides ,the sensitivity ,specificity and accuracy of gray scale ultrasound combined with contrast-enhanced ultrasound prediction model for differential diagnosis of benign and malignant thyroid lesions were calculated based on the results of puncture biopsy or surgical pathology as the gold standard . Results Compared with pathological results , the positive predictive value , negative predictive value , accuracy , sensitivity and specificity of gray scale combined with contrast-enhanced ultrasound in evaluating thyroid nodules were 90 .8％ ,93 .3％ ,91 .2％ ,98 .8％ and 62 .2％ ,respectively . Conclusions Gray-scale ultrasound combined with contrast-enhanced ultrasound can provide clinical value in differential diagnosis of benign and malignant TI-RADS 3-5 thyroid nodules .

Objective To explore the clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients who underwent PD in the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected.There were 26 males and 13 females,aged (60±7)years,with a range of 41-75 years.All the 39 patients underwent PD,using Child method to reconstruct digestive tract.Of 39 patients,19 undergoing modified invagination for pancreaticojejunostomy and 20 undergoing mucosa-to-mucosa end-to-side pancreaticojejunostomy were allocated to innovative group and traditional group,respectively.Observation indicators:(1)surgical situations;(2) postoperative complications;(3) follow-up.Follow-up was performed by outpatient examination and telephone interview to detect postoperative tumor recurrence,main pancreatic duct dilatation,survival,and discomfort (abdominal pain,bloating,indigestion,etc.) of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as M (P25,P75) or M (range),and comparison between groups was analyzed by Mann Whitney U test.Count data were expressed as absolute numbers,and comparison between groups was analyzed by chi-square test or Fisher exact probability.Results (1) Surgical situations:operation time,volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay of the innovative group were (342±47) minutes,400 mL (300 mL,400 mL),10,9,3.1 cm (2.9 cm,3.4 cm),37 days (32 days,63 days),17,18 days (15 days,22 days),respectively,versus (392±95)minutes,400 mL (300 mL,525 mL),6,14,3.6 cm (2.6 cm,4.2 cm),43 days (34 days,49 days),18,and 24 days (15 days,27days) of the traditional group;there was no significant difference in the volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay between the two groups (Z=-0.775,x2 =2.063,Z=-1.155,Z=-0.295,x2 =0.003,Z=-1.286,P＞0.05);but a significant difference in operation time between the two groups (t =-2.114,P＜0.05).(2) Postoperative complications:6 patients in the innovative group had complications,including 1 of delayed gastric emptying,1 of wound infection,1 of pulmonary infection,1 of acute respiratory failure,1 of perihepatic effusion,and 3 of grade A pancreatic leakage;11 patients in the traditional group had postoperative complications,including 1 of bile leakage,2 of delayed gastric emptying,4 of abdominal infection,4 of wound infection,2 of pulmonary infection,1 of ascites,1 of abdominal hemorrhage,1 of pleural effusion,2 of grade A pancreatic leakage,5 of grade B and C pancreatic leakage;the same patient had multiple complications.There was no significant difference in postoperative complications between the two groups (x2=2.174,P＞0.05),but there was a significant difference in postoperative grade B and C pancreatic leakage between the two groups (P＜O.05).Patients with postoperative complications were improved after symptomatic support treatment,and no patient died during the perioperative period.(3) Follow-up:of the 39 patients,33 (18 in the innovation group and 15 in the traditional group) were followed up for 3-57 months,with a median follow-up time of 17 months.Of the 18 patients receiving follow-up in the innovative group,5 died of tumor recurrence and metastasis,with a survival time of 5-24 months,1 had tumor recurrence at 34 months after operation,1 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,5 had indigestion,1 had back pain,and 5 had good recovery.Of 15 patients receiving follow-up in the traditional group,10 died of tumor recurrence and metastasis,with a survival time of 3-57 months,2 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,2 had indigestion,1 had good recovery.Conclusion Compared with the traditional mucosa-to-mucosa end-to-side pancreaticojejunostomy,modified invagination for pancreaticojejunostomy in the PD is safe and feasible,which can simplify the operation,reduce the requirements for the operator's operation skills,shorten the operation time,and reduce incidence of postoperative grade B and C pancreatic leakage.

Objective To investigate the features of computed tomography (CT) and magnetic resonance imaging (MRI) of regional portal hypertension (RPH).Methods The retrospective cohort study was conducted.The clinicopathological data of 31 patients with PHR in the RPH group and 31 patients with liver cirrhotic portal hypertension (CPH) in the CPH group who were admitted to the Affiliated Hospital of Inner Mongolia Medical University between February 2014 and February 2018 were collected.Etiologies of patients in the RPH group included 21 of chronic pancreatitis complicated with pancreatic pseudocyst,5 of carcinoma of pancreatic body and tail,1 of solid pseudopapillary tumor of the pancreas,1 of pancreatic serotls cystoadenoma,1 of gastric stromal tumor,1 of retroperitoneal metastatic tumor and 1 of left renal carcinoma.Etiologies of patients in the CPH group included 27 of liver cirrhosis after viral hepatitis type B (4 complicated with liver metastasis),3 of alcoholic cirrhosis and 1 of cholestatic cirrhosis.All the patients underwent CT and MRI examinations.Patients in the RPH group were mainly treated the primary diseases and patients in the CPH group were decreased portal vein pressure.Observation indicators:(1) imaging features of patients in the two groups;(2) treatment and follow-up situations.Follow-up using outpatient examination and telephone interview were performed to detect management of portal hypertension after treatment up to February 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed by the t test.Measurement data were represented as M (range) and comparison between groups was analyzed by the Mann-Whitney rank sum test.Count data were compared with chi-square test.Results (1) Imaging features of patients in the two groups:of 31 patients in the RPH group,12 underwent CT examination,2 underwent MRI examination,and 17 underwent CT combine with MRI examination.Of 31 patients in the CPH group,12 underwent CT examination and 19 underwent CT combined with MRI examination.The number of patients with varices in the gastric fundus,the number of patients with combined esophageal varices,the number of perigastric varices,diameter of main portal vein,diameter of splenic vein,liver volume,splenic volume,hepatosplenic volume ratio were 11,1,49,(13.9±2.9) mm,(12.0±2.8) mm,1 383 cm3 (range,1 005-1 637 cm3),271 cm3(range,199-311 cm3) and 5.5±2.0 in the RHP group and 24,21,33,(16.3±1.7)mm,(10.5±3.2)mm,1 087 cm3(range,916-1 536 cm3),603 cm3(range,415-869 cm3) and 2.2±0.9 in the CHP group,with statistically significant differences in the number of patients with varices in the gastric fundus,the number of patients with combined esophageal varices,the number of perigastric varices,diameter of main portal vein,splenic volume,hepatosplenic volume ratio between the two groups (x2=11.088,28.182,8.940,t=4.430,Z=6.205,t=8.544,P＜0.05) and with no statistically significant differences in the diameter of splenic vein and liver volume between the two groups (t=1.974,Z=1.162,P＜0.05).Of 31 patients in the RPH group,2 with pancreatic pseudocyst were misdiagnosed as pancreatic cancer and 29 were diagnosed accurately by imaging examinations.Of 31 patients in the CPH group,3 with liver metastasis were undetected by CT examination and the other 28 were diagnosed accurately by imaging examinations.Splenic vein occlusion,severe splenic vein stenosis,moderate splenic vein stenosis and mild splenic vein stenosis were detected in 2,17,10 and 2 of 31 patients in the RHP group.All the 31 patients in the CHP group mainly had dilation in splenic veins,with no clear stenosis.(2) Treatment and follow-up situations:patients in the two groups were followed up for 6-48 months,with a median time of 21 months.Of 21 patients with chronic pancreatitis complicated with pancreatic pseudocyst in the RPH group,7 underwent pancreatic pseudocyst puncture and drainage,6 of them had poor control on portal hypertension and 1 had moderate control;4 underwent pancreaticoenteric drainage,1 of them underwent pancreaticojejunostomy 4 years later and 3 of them had good control on portal hypertension;3 undergoing splenectomy combined with perigastrectomy had good control on portal hypertension;7 undergoing conservative treatment had good control on portal hypertension.Of 5 patients with carcinoma of pancreatic body and tail in the RHP group,2 undergoing distal pancreatectomy combined with splenectomy had good control on portal hypertension and 3 undergoing non-operative combined therapy died of primary disease one year later.One,1 and 1 patient with solid pseudopapillary tumor of the pancreas,pancreatic serotls cystoadenoma and gastric stromal tumor respectively in the RHP group underwent relative surgical treatments and had good control on portal hypertension.One and 1 patient with retroperitoneal metastatic tumor and left renal carcinoma respectively in the RHP group underwent non-operative combined therapy and had good control on portal hypertension.All the 31 patients in the CHP group were mainly treated with protection of liver function,8 of them were encounted with medusa head,7 with upper gastrointestinal rehemorrhage within one year,5 with subcutaneous varicose vein of abdominal wall,3 with continuing increase of spleen volume and 8 had good control on portal hypertension.Conclusions RHP are existed in pancreatic,splenic or peritoneal diseases,especially the pancreatic primary diseases.The main imaging features of RHP include isolated gastric varices,perigastric varices and splenic vein occlusion without normal main portal vein and liver function.Surgical resection of primary tumor and reasonable splenectomy are effective therapy.

[ ABSTRACT] AIM:To observe the effect of oleanolic acid ( OA) on the expression of Tumor necrosis factor-α( TNF-α) and collagen in silicotic rats in vivo and its possible mechanism.METHODS:Male Wistar rats were divided in-to 4 groups according to the randomized block design:control group, model group, OA group and solvent control group (20 rats in each group) .Except control group, the rats in other groups were induced by intratracheal instillation of silicon di-oxide (SiO2;250 mg/kg).The rats in OA group were intragastrically administered with OA (60 mg/kg) from the second day of giving SiO2 .The rats in solvent control group were gavaged daily with 0.6%sodium carboxymethyl cellulose solution (10 mL/kg).The rats in control group were given normal saline under the same condition for 56 consecutive days.All rats were killed at the 7th, 14th, 28th and 56th days.The lung coefficient was detected and the morphological changes were ob-served.The serum contents of TNF-αwere detected by ELISA.The content of total collagen in the lung tissue was meas-ured.The protein level of nuclear factor-κB ( NF-κB) in the lung tissue was determined by immunohistochemical method. RESULTS:(1) According to the morphological changes, the silicosis model was successfully established.Compared with control group, the lung coefficient and total collagen increased obviously in model group and solvent control group.The lung coefficient and total collagen content in OA group at each time point reduced compared with those in model group and sol-
vent group, and increased compared with those in control group at the corresponding time points.(2) The serum contents of TNF-αin model group and solvent control group significantly increased, peaking at the 14th day, slightly decreasing af-terward, and showing statistically significant difference at each time point compared with those in control group.No signifi-cant difference between model group and solvent group at different time points was observed.OA had inhibitory effect on the contents of TNF-αcompared with model group and solvent group at the corresponding time points.(3) NF-κB in model group and solvent control group significantly increased, peaking at the 28th day, and showing statistically significant differ-ence at each time point compared with those in control group.The NF-κB expression in OA group was similar to model group, but significantly decreased compared with control group at each time point.CONCLUSION: OA inhibits the ex-pression of TNF-αand collagen and attenuates the silicosis fibrosis, which may be related to the NF-κB pathway.

Objective To investigate the characteristics of pathogenic bacteria/the drug resistance/the correlated risk fators/the prophylaxis control strategy of the severe craniocerebral injury patients combined with intracranial infection .Methods The clinical data of 35 craniocerebral injury patients with intracranial infection were retrospectively analyzed .Results 35 patients′cerebrospinal fluid were separated and 54 pathogenic bacterium had been cultured ,including G+ bacterium(61 .11% ) ,the G - bacteria(33 .33% ) , fungi(5 .56% ) .The pathogenic bacteria showed a higher resistance .The single factor analysis found that the wound itself exists in-fection factors ,the postoperative drainage of incision ,liquorrhoea ,with other basic diseases ,surgery lasted for a long time (>4 h) reoperative ,surgery is placed foreign body is severe craniocerebral trauma combined with intracranial infection were the main rele-vant factors .The total effective rate was 62 .86% ,and the mortality was 11 .43% by the positive therapy .Conclusion G+ bacteria were the main pathogenic bacterium in the severe craniocerebral injury patients combined with intracranial infection .The iatrogenic factors leaded to the increase of the proportion of intracranial infection and the resistance increased year after year .The clinical in-travenous antibiotics combined intrathecal injections were beneficial to control intracranial infection ,shorten the course of treatment and enhance the curative effect .