Objective To evaluate the efficacy of double U-stitch and modified"double U-stitch pancreaticojejunostomy"in pancreaticoduodenectomy.Methods We retrospectively analyzed the clinical information of 150 patients who underwent pancreaticoduodenectomy between January 2022 and September 2023 in Wang Wei's team in department of pancreatic surgery,Fudan University Shanghai Cancer Center.The patients were divided into two groups according to the pancreaticojejunostomy method:the double U-stitch 1.0 group(70 cases before modification)and the double U-stitch 2.0 group(80 cases after modification).The postoperative complications of the two groups were compared.Results The overall postoperative complications were significantly lower in the double U-stitch 2.0 group as compared with the double U-stitch 1.0 group(13.8％vs.38.6％,P=0.001).The incidence of clinically relevant pancreatic fistula was 18.6％in the double U-stitch 1.0 group,while this was significantly decreased in the double U-stitch 2.0 group(6.3％)(P=0.021).Postoperative extraluminal hemorrhage occurred in 5 patients in the double U-stitch 1.0 group,while in the double U-stitch 2.0 group,only one patient experienced postoperative intraluminal hemorrhage,the difference was statistically significant between two groups(P=0.007).The median postoperative length of hospital stay was significantly shorter in the double U-stitch 2.0 group than that in the double U-stitch 1.0 group(11d vs.14 d,P=0.001).Conclusions The modified"double U-stitch pancreaticojejunostomy"can significantly reduce the incidence of clinically relevant pancreatic fistula and other relevant severe complications,which helps improve the safety of the procedure.

Objective: To evaluate the efficacy and reliability of K-L approach combined with screw technique for the treatment of acetabular transverse combined with T shaped fractures. Methods: Data of 17 patients with acetabular fractures who were treated by K-L approach combined with screw technique from April 2015 to April 2018 were retrospectively analyzed. There were 11 males and 6 females, aged 28-69 years (mean, 44 years). Injury mechanism: 11 cases were car accident injuries, 4 cases from fall injuries, and 2 cases from ski injury. Letournel-Judet classification: 11 cases in the front with the posterior transverse, 6 cases in the T-shaped (including 3 cases T-shaped plus the posterior wall). The time from injury to surgery was 3-20 days, with an average of 9.8 days. All cases were treated by single K-L approach open reduction and internal fixation. The hip joint function was evaluated by hip Harris score and the Matta's improved Merle d'Aubigné-Postel scores system. Results: All the 17 patients were followed up for 7-26 months with an average of 14 months. The operation time was 171-310 min, with an average of 220 min. The intraoperative blood loss was 360-1 800 ml with an average of 810 ml. All the patients were healed. The healing time was 2-3 months, with an average of 2.5 months. The Matta's improved Merle d'Aubigné-Postel scores was 10-18 points, with an average of 16.7 points. The results were excellent in 12 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The excellent and good rate was 88.2% (15/17). The Harris score at the latest follow-up was 69-96 points, with an average of 88 points. Among them, 10 cases were excellent, 4 cases good, 2 cases fair, and 1 case was poor. The excellent and good rate was 82.4% (14/17). Four patients had deep venous thrombosis of the lower extremities. The deep venous thrombosis of the lower extremities was found at 1-3 days after operation. The thrombus disappeared after 3 months of anticoagulant therapy with low molecular weight heparin. Sensory motor ability decreased in 8 cases after surgery because of sciatic never injury. After mecobalamin drug therapy, 7 patients recovered within 2-3 months, and 1 patient recovered 6 to 12 months later. Eight patients had heterotopic ossification, according to Brooker classification, there were 5 cases of grade I, 2 of grade II and 1 of grade III. Conclusion K-L approach combined with screw technique for the treatment of complex acetabular fractures has satisfactory clinical results but may potentially increase the risk of sciatic nerve injury.

Objective To evaluate the clinical efficacy of single ilioinguinal approach combined with screwing for treatment of complex acetabular fractures.Methods Twenty-six patients with complex acetabular fracture were treated by single ilioinguinal approach combined with screwing from May 2015 to April 2017 at Department of Orthopaedics,Hospital of Traditional Chinese Medicine,Xinjiang Medical University.They were 17 men and 9 women,aged from 31 to 69 years (average,54 years).By the Judet-Letournel classification,there were 9 anterior + posterior hemitransverse fractures,13 double-column fractures and 4 T-type fractures.They were treated by pilot surgical plan based on preoperative CT reconstruction,disinfection at floating position for the standby posterior approach,single ilioinguinal approach for standard reduction,followed by intraoperative fixation with lag screws,posterior column screws,or acetabular screws.Operation time,intraoperative blood loss and complications were documented.Fracture reduction was assessed postoperatively using the modified Matta system for X-rays.The function of affected hip was evaluated using Harris hip score at the last Follow-ups.Results The 26 patients were followed up for 6 to 24 months (average,11 months).Their operation time averaged 210 min and intraoperative blood loss 600 mL.The postoperative modified Matta scores showed that 14 cases obtained excellent anatomic reduction,9 good anatomic reduction,one poor anatomic reduction,and 2 articular outline reduction.Fracture union was achieved in all after an average time of 2.3 months.Their Harris hip scores at the last Follow-ups ranged from 70 to 86 points,averaging 80 points.The function of affected hip was excellent in 13 cases,good in 6,fair in 4 and poor in 3,giving an excellent to good rate of 73.1％ (19/26).Postoperatively,deep venous thrombosis of lower extremity was found in 3 patients,injury to the lateral femoral cutaneous nerve in 5,and incision complication in one.No re-displacement of the fracture occurred.Conclusion In treatment of complex acetabular fractures,single ilioinguinal approach combined with screwing can lead to a high rate of fine reduction,limited complications,a low displacement risk,and good clinical efficacy.

Pancreatic ductal adenocarcinoma (PDAC) is among the most devastating human malignancies. The poor clinical outcome in PDAC is partly attributed to a growth-permissive tumor microenvironment. In the PDAC microenvironment, the stroma is characterized by the development of extensive fibrosis, with stromal components outnumbering pancreatic cancer cells. Each of the components within the stroma has a distinct role in conferring chemoresistance to PDAC, and intrinsic chemoresistance has further worsened this pessimistic prognosis. The nucleoside analog gemcitabine (GEM) is usually the recommended first-line chemotherapeutic agent for PDAC patients and is given alone or in combination with other agents. The mechanisms of intrinsic resistance to GEM are an active area of ongoing research. This review highlights the important role the complex structure of stroma in PDAC plays in the intrinsic resistance to GEM and discusses whether antistroma therapy improves the efficacy of GEM. The addition of antistroma therapy combined with GEM is expected to be a novel therapeutic strategy with significant survival benefits for PDAC patients.

BACKGROUND:There is no consensus on the choice of elastic stable intramedulary nailing or plate fixation for the treatment of humeral fractures in children.Current research is limited to smal-sample studies,and it is difficult to carry out a large-sample multicenter analysis.OBJECTIVE:To evaluate the efficacy and safety of elastic stable intramedulary nailing and plate fixation for the treatment of humeral fractures in children with meta-analysis.METHODS: The PubMed database,EMbase database,CBM database,CNKI database,VIP database and Wangfang database were searched with computer to colect the controled trials of elastic stable intramedulary nailingversusplate fixation for humerus fractures in children,and related journals were manualy searched.The searching time ranged from the date of database establishment to August 2014.The trails were selected,the data were extracted and the quality was evaluated by two investigators independently.RESULTS AND CONCLUSION: Two randomized controled trials and three retrospective controled trials were included in the meta-analysis.The Meta-analysis results showed that the postoperative functional recovery Constant score of the elastic stable intramedulary nailing group was higher than that of the plate fixation group (P＜0.01).The bone union time,operation time,incision length,intraoperative blood loss and the hospital stay of theelastic stable intramedulary nailing group were less than those of the plate fixation group (P＜0.01).There were no significant differences in incidence rate of complications,nonunion,wound infection and malunion between two groups (P＞0.05).Based on the current evidence,elastic stable intramedulary nailing for the treatment of humeral fractures in children is superior to the plate fixation in the efficacy.There is no significant difference in incidence rate of complications between elastic stable intramedulary nailing and plate fixation.But al the studies were smal-sample,and high-risk original study.Clinical trials with adequate samples,rational design and strict execution shal be carried out to provide more reliable evidence.

MicroRNA (miRNA) plays a regulating function in translation stage of gene expression.MiRNA has been found directly involving in the occurrence and development of pancreatic cancer,and its abnormal expression is closely related to early diagnosis of pancreatic cancer and may provide new therapeutic target for pancreatic cancer patients.MiRNA detection will have good application prospect in on the diagnosis and treatment of pancreatic cancer.

BACKGROUND:Valgus-varus constrained polyethylene insert is selected in strict accordance with the principle of“to obtain reliable stability using minimum restriction”. The stability of the prosthesis is elevated, but the restriction is not increased.
OBJECTIVE:To retrospectively analyze the application experience of constrained polyethylene insert in valgus and varus instability of primary total knee arthroplasty for older patients and to summarize the indications and clinical effects of this kind of implements.
METHODS:From March 2010 to March 2012, a total of 70 patients combined valgus and varus malfomation who accepted primary total knee arthroplasty were enrol ed in this study, including 56 varus patients (averagely 15°-30°) and 14 valgus patients (averagely 10°-20°). Constrained polyethylene insert was performed in 23 patients (25 knees) who stil had remaining unilateral valgus or varus<6 mm (18 patients were varus instability and 7 patients were valgus instability) when finished operation of standard osteotomy and soft tissue balancing. The bone cement knee prostheses in 23 cases were purchased from Smith&Nephew. The stem implant was not used in al cases. Cement or autografts were used in 11 valgus knees to fil the bone defects.
RESULTS AND CONCLUSION:Patients were fol owed up for 2 years on average (18-42 mouths). The knee pain symptoms of al cases disappeared. The joint stability was obviously improved. The lower limb power lines were correct. The Knee Society Score scores were improved from an average of 39.4 points preoperation to an average of 88.5 points postoperation. Al cases did not need the protection of knee braces. The maximum degree of flexion was 110°(96°-130°). The satisfaction degree of 36-Item Short Form Health Survey was 98%. No dislocation or infection happened. Results indicated that constrained polyethylene insert could be applied in the cases of less than 6 mm valgus and varus instability when finished operation of standard osteotomy and soft tissue balancing in total knee arthroplasty for older patients. This kind of implements can preserve bone mass, simplify operational process and have good clinical outcome in a short period.

Pancreaticoduodenectomy,which is also known as Whipple surgery,is a complex of high-risk surgery,while the majority of patients have postoperative complications.As a serious complication,pancreatic fistula has been prevented and treated by a variety of methods.Currently,the main methods include improved surgical methods,somatostatin analogues,the use of support tube and medical adhesive,and so on.However,prevention and treatment of pancreatic fistula remains to be controversial.Here,the author will review the research progress of pancreatic fistula.

BACKGROUND: Application of traditional osteoarthritis animal models was limited by long duplicated time, poor stability, different successful rate, and rough analysis of osteoarthritis.OBJECTIVE: To observe clinical and pathological features of osteoarthritis by modified Hulth modeling way and to determine the stages of ostecarthritis.METHODS: A 2-cm medial longitudinal incision was resected to expose knee joint. Anterior and posterior cruciate ligament and medial collateral ligament were cut off, and medial meniscus was fully cut to reserve articular cartilage., The injured limb was not fixed postoperatively. Animals were allowed to move freely. At one week after surgery, 800 000 U penicillin was used to avoid from infection, 30 mind, twice per day, for 12 successive weeks. The normal group was treated without any treatments. Pathological features were observed using Mankin scores under electron and optic microscope at 4, 6, 8, 10, and 12 weeks postoperatively.RESULTS AND CONCLUSION: Changes of osteoarthritis were observed in the model group at 4 and 6 weeks after operation,showing synovial hyperemia and hyperplasia, increased synovial fluid effusion, cartilage surface roughness, matrix stained tinge,and Mankin score of 3.5-3.8. Intermediate stage changes of osteoarthdUs were found in the model group at 8 weeks after operation, showing synovial hyperplasia, less synovial fluid, flssuration reaching cartilage surface, cartilage cells with tangled and uneven staining matrix, Mankins score of 8-9. Advanced osteoarthritis changes were observed in the model group at 12 weeks after operation, showing severe nodular synovial hyperplasia, less and turbid synovial fluid, osteophyte formation of serious exposure of subchondral bone, cartilage calls reducing the majority of loss of matrix staining, and Mankin score of 12-14. Electron microscopy indicated a coincidence with the histological observation of cell mutation. The rabbit model by Hulth suggested that early change of osteoarthritis occurred at 6 weeks after operation, intermediate stage at 8 weeks, and advanced stage at 12 weeks.This model could be more comprehensive response to osteoarthdtis cartilage degeneration from early compensatory hypertrophy to decompensation after the cartilage cells and matrix reduction, cartilage softened to endarterectomy missing characterized the late changes in the entire process.

BACKGROUND:Clinical work shows that there are a large proportion of patients suffering from osteoerthritis(OA)and osteoporosis(OP),therefore establishing OA+OP models to simulate the clinical disease in postmenopausal women addreasing the basic characteristics of lesions,will offer better prevention and treatment of OA+OP in clinical practice.OBJECTIVE:To attempt to create OA+OP animal model.DESlGN,TIME AND SETTING:Randomized controlled animal expedment in terms of call pathology was perforrned between August 2008 and January 2009 in the Scientific Research Center and Traditional Chinese MediciRe Hospital of Xinjiang Medical University.MATERIALS:Forty 4-month-old female SD rats,weighing(210±10)g,were randomly divided into normal control group,OA group,OP group,OA+OP group.METHODS:In the OA+OP group,rats underwent abdominal incision 1.5 cm longitudinal on both sides of lumbar spine on back,followed by bilateral ovarian resection and ovarian artery ligation,to establish OP models.One month after the skin incision,left knee skin,subcutaneous tissue and fascia were cut,then joint capsule was given a vertical incision.Anterior cruciata ligament was cut off in orthophoria,meniscus was removed,followed by subcutaneous tissue and skin suture,OA model was prepared and placed under warm environment.antibiotic subcutaneous injection for 3 days,and the displacement of one month.OA group and OP group were produced in accordance with the above method of OA.OP model.Normal control rats received no treatment.MAIN OUTCOME MEASURES:When the rats were 6 months old,the left knee femoral condyle articular cartilage were examined by light microscopy and electron microscopy,left femur was used to measure proximal femoral bone mineral density.RESULTS:In three groups of model rats,articular cartilage become thinning and degeneration.In the OP model group and OA+OP model group,trabecular was sparse and arranged in disorder.In the OA model group and OA+OP model group,the incision layer was chiefly deleted,transferring layer was greatly injured,call hypertrophy and colony were observed,a large amount of blood capillary invaded into cartilage and calcification layer,even break through tidal line;in OP model group,incision layer of articular cartilage became thinning and appeared bilateral tidal line.In the OA model group and OA+OP model group,knee condylar number of special-shaped cartilage cells increased,manifested as irregular nuclei,reduced cell organelle,nuclear shnnkage,chromatin uneven distdbution,mitochondrial swelling,rough expansion of endoplasmic raticutum,accumutation of cytoplasmic microfilaments,showing lipid droplets and glycogen granules,gliel fibdllary fracture,disorder arrangement,a large number of cartilage calls were apoptotic.Three groups of model rats exhibited a dramatically decreased bone mineral density compared with control rats(P＜0.05).CONCLUSION:The animal modal of OA+OP was successfully established.