Objective To investigate the CT-guided percutaneous irreversible electroporation (IRE) in treating locally advanced pancreatic cancer (LAPC) and providing guidance for its prevention and treatment. Methods We retrospectively analyzed the clinical and imaging data of 17 patients (17 lesions) of LAPC treated with CT-guided IRE in our hospital from July 2015 to June 2016. Complications were documented and reviewed at day 7,30 and 90 follow up as well as during the procedure. The Clavien?Dindo was used for classification. The reasons that induced complications were summarized and to further discuss the prevention and treatment approaches. Results Of 17 patients, 2 patients suffered a transient tachycardia during the procedure. Eleven patients (65%) showed complications at day 7, of which gradeⅠcomplications occurred in 6 cases, including abdominal pain, nausea, vomiting, or a few of inflammatory exudations around the pancreas; four patients have grade Ⅱ complications, along with portal vein thrombosis;one patient showed grade Ⅲ a complications for retroperitoneal infection. With 30 days follow up, the grade Ⅰ complications disappeared, gradeⅡcomplications have not getting better, while grade Ⅲ a complications have been improved. With 90 days follow up,patients with grade Ⅲ a complications getting better; two patients with grade Ⅱ complications didn't show any changes;2 cases progressed to grade Ⅴ, and died of digestive tract bleeding at 82 days and 98 days after procedure. Conclusion CT-guided irreversible electroporation for treating LAPC is a safe ablation approach. Strict patient selection before procedure and make a reasonable prevention and treatment measures can reduce the complications.

Objective To investigate the complications caused by CT-guided percutaneous radiofrequency ablations (RFA) for lung cancer and analyze the prevention approach. Methods A total of 125 lung cancer patients (142 RFA treatments) in our hospital were enrolled in this study between July 2015 and June 2017. This retrospective study analyzed the reasons and the strategies for preventing the complications. Results One hundred and twenty?five patients underwent RFA treatment for lung lesions. All the operations were successfully completed. During the treatment, 18 patients showed hemorrhage (3 of CTCAE grade 3 hemorrhage); 16 patients showed pneumothorax, among which, 15 patients have chronic obstructive pulmonary disease; 28 patients showed chest pain (23 cases were located under the pleura); 3 patients showed pneumonia;1 patient showed pulmonary abscess, which located in the subpleural space with a maximum diameter of ＞3 cm; 1 patient showed pulmonary embolism, and 1 patient with scald. Complications were attenuated after symptomatic treatment. Conclusion The main reasons of complications of RFA in treating lung cancer were direct injuries caused by punctures, tumors with abundant blood supplement, tumors adjacent to pleura, low scores of lung function, coagulation disorders, and diabetes. The key points for avoiding and reducing complications are preoperative evaluation of patients' basic situations, exclusion of intraoperative avoidable technical risk factors.

Nanoknife (irreversible electroporation) has demonstrated to be a safe and effective approach to tumor ablation,and plays a prominent role in application of treatment of pancreatic carcinoma,specifically locally advanced pancreatic carcinoma (LAPC).The complicated parameters of Nanoknife comparatively is still difficult.The advantage,optimal selection,adequate parameters regarding Nanoknife were reviewed in this article.

Objective To investigate the safety and efficacy of treatment with CT-guided percutaneous irreversible electroporation (IRE) of locally advanced pancreatic cancer(LAPC). Methods Patients with unresectable radiographic stage ⅢLAPC were prospectively collected. Comprehensive blood and imaging (CT,MRI,PET-CT) baseline examinations were completed and analyzed preoperatively. Operations were performed under general anesthesia and the needles were inserted under the guidance of CT. Ablative parameters were altered depending on the tumor size, anatomical location, and the number of electrodes. Needle withdrawal combined segmental ablation was chosen and the active electrode exposure length was 1 cm. All the imaging and serological follow-up examinations were performed within 1 to 3 days after procedures, at day 7 postoperatively, 1 and 3 months postoperatively to evaluate the safety and efficacy of IRE(according to modified response evaluation criteria in solid tumours of WHO). Results All the procedures were completed successfully. Immediately postoperative CT and/or MRI images showed all the ablation areas were well-defined and presented low-density necrosis without enhancement. The CT scans at day 7 postoperatively showed all the 14 lesions were drastically necrotized and the surrounding tissues were unharmed. CT and/or MRI scans at 1 month postoperatively revealed hypodense or low signal ablation areas without enhancement and the peritumoral and involved vessels and pancreatic duct were undamaged. All the patients had a CA199 transient rising, but it decreased progressively within 3 days and then markedly decreased at 1 weak and 1 month postoperatively. The laboratory carcino-embryonic antigen was almost within normal lists. Peripancreatic exudation was noted in 3 cases immediately after the procedures. One patient developed retroperitoneal infection. Mesenteric(2 of 4)and portal(2 of 4)venous thrombosis were found on MRI images in 4 patients. One patient had a duodenum stenosis and 1 died from serious gastrointestinal bleeding 2.5 months after IRE(unclear etiopathogenisis). The postoperative 3 months dynamic imaging showed that 4 of 13 reached complete response (CR) ,7 of 13 reached partial response (PR) and 2 of 13 had stable disease (SD). Conclusion CT-guided percutaneous IRE is safe and effective in patients with locally advanced pancreatic cancer.

The treatment strategy for infected acute necrotizing pancreatitis is that enables recovery but at the same time limits the morbidity and mortality.The current gold standard remains open necrosectomy.Recent literature contains scattered reports of percutaneous drainage,endoscopic,and laparoscopic approaches to managing patients with this condition.This review addresses the role of minimally invasive approaches and treatment strategy in patients with infected acute necrotizing pancreatitis.

Objective To study the efficacy and safety magnesium sulfate for the treatment of adult severe tetanus.MethodsTwenty-seven inpatients with adult severe tetanus during April 2005 - October 2010 were retrospectively analysed.ResultsThe total serum magnesium more than 4 mmol/L was found in 2 patients ( 2/27,7.40％ ).The tracheotomy was performed in 25 Patients (25/27,92.6％),22 of which (22/25,88.0％) run mechanical ventilation with the mean mechanical ventilation time (7.5 ± 3.7 ) days,(4 to 16 days).Pulmonary infection occurred in 25 cases (25/27,92.6％).Twenty-three of 27 (23/27,85.2％ ) cases were cured except 4 cases died,and the mean hospital stay was (32.22 ± 18.78) days,(25to 48) days.Conclusions20％ magnesium sulfate is safe for treatment of the patients of adult severe tetanus.It can control not only muscle rigidity and spasms but also autonomic instability efficaciously,and lower the dosage of sedative such as diazepam and chlorpromazine.This method is worth popularizing in clinical practice for its easy operation and low cost.

Procalcitonin is a biomarker to diagnose the extent and severity of systemic bacterial infection.Procalcitonin is applied in diagnosis and treatment of systemic inflammatory response syndrome and severe acute pancreatitis.The article reviews application of procalcitonin in clinical surgery and guides use of anti-bacterial agents.

This article analyzes the characteristics of lymph node metastasis in proximal advanced gastric cancer,in order to guide the extent of stomach resection (proximal or total gastrectomy) and the resection of spleen or splenic preservation. The metastasis of lymph node in proximal advanced gastric cancer has certain characteristics, which can provide a significant guidance for lymphadenectomy. Total gastrectomy plus splenectomy is a feasible radical surgery for proximal advanced gastric cancer, because of the requirement of lymphadenectomy.

Objective To discuss the effect of the interval between neoadjuvant therapy and surgery on downstaging for local advanced rectal cancer.Method s From May 2003 to December 2008 as earlier period,32 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 4 -6 weeks.From January 2009 to December 2010 as later period,21 patients with clinical stage T3 or T4 rectal cancer received neoadjuvant therapy followed by surgery after 8 weeks.Dworak classification,TNM stage and clinical outcome after surgery were compared between two group paitents.Results All patients with local advanced rectal cancer received R0 resection.No surgical complications and mortality were observed in all cases.Pathological results showed that 0 and 2 cases were Dworak classification Ⅳ,5 cases were Dworak classification Ⅲ,3 and 6 cases were Dworak classification Ⅱ and 24 and 8 cases were Dworak classification Ⅰ in earlier period and later period,respectively (x2 = 9.109,P = 0.028).The postoperative staging showed that 6 and 13 cases were ypT1N0M0,22 and 6 cases were ypT2N0M0,1 case was ypT3 N0M0,3 and 1 cases were ypT3N1 M0,respectively (x2 = 10.909,P = 0.012).There were 65.6% or 81.0% cases reserved anus in earlier period and later period,respectively(x2 = 1.468,P = 0.226).Conclusions The neoadjuvant therapy followed by surgery after 8 weeks is associated with a more significant downstaging effect for local advanced rectal cancer.However,the effect of an extended interval between neoadjuvant therapy and surgery on clinical outcome still needs further investigation.

Ionized calcium is a divalent cation involved in many critical cellular processes,such as regulating intracellular enzyme activity,signal transduction,gland secretion,hormone-receptor bind and activating clotting mechanism,but ionized hypocalcaemia is commonly found in critically illness,for instance serious trauma,major operation,sepsis and severe pancreatitis.The article reviews ionized hypocalcaemia with correlation of the prognosis and ill severity of surgical serious patients.