Preoperative Computed Tomography Imaging of the Pancreas Identifying Predictive Factors for the Progression of Grade A, or Biochemical Leak, to Grade B Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy: A Retrospective Study.

BACKGROUND This retrospective study aimed to identify the predictive factors for the progression of grade A, or early biochemical leak, to grade B postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy using preoperative computed tomography (CT) imaging of the pancreas. MATERIAL AND METHODS A total of 156 patients were analyzed retrospectively. Biochemical leakage occurred in 60 patients, who were divided into POPF progression and non-POPF progression groups. Perioperative parameters were collected. Univariate analysis and multivariate logistic regression analysis were done. For the parameters with statistical significance, the area under the curve (AUC) was calculated if possible and the predictive value was assessed. RESULTS Univariate analysis showed that main pancreatic duct diameter, postoperative complications (except POPF), prothrombin time (PT) and serum albumin on postoperative day 3, and pancreatic CT value were risk factors of POPF (P<0.05). Multivariate analysis showed that serum albumin and PT on postoperative day 3 and pancreatic CT value were independent risk factors of POPF (P<0.05). Lower postoperative albumin, lower pancreatic CT value, and longer PT were associated with a higher risk of POPF (P<0.05). The AUC of CT value was 0.808. CT value thresholds of 42.5 Hounsfield units (HU) and 41.5 HU were tied for the highest predictive performance, with Youden indices of 0.486 for both, and sensitivity of 79% and 71%, and specificity of 69% and 78%, respectively. CONCLUSIONS Preoperative laboratory investigations and CT imaging of the pancreas may identify factors associated with early biochemical leakage progressing to grade B POPF following pancreaticoduodenectomy.

[Significance of high sensitivity C-reactive protein level for predicting risk of nonalcoholic fatty liver in type 2 diabetes mellitus patients].

OBJECTIVE: To investigate the significance of high sensitivity C-reactive protein (hsCRP) levels in serum for detecting type 2 diabetes mellitus (T2DM) patients at risk of developing nonalcoholic fatty liver (NAFLD). METHODS: Individuals with T2DM (n = 9489) were recruited from the Kailuan Company between 2006 and 2007 for the first phase of this community-based prospective cohort study. For the second phase of the study, the original cohort was recruited for follow-up (at two years from each subject's original enrollment date (baseline)). The total followed-up subjects (n = 2802; 2344 males, 458 females, 22-88 years old) were categorized into quartiles according to baseline measurements of serum hsCRP levels (less than or equal to 0.30, > 0.30-0.60, > 0.60-1.92 and > 1.92 mg/L) and used to determine the relationship between change in incidence rates of NAFLD and predictive value of baseline serum hsCRP levels by logistic regression analysis. RESULTS: Twenty-nine percent (n = 813) of the followed-up subjects developed NAFLD. The incidence (%) of NAFLD at the two-year follow-up had increased in conjunction with the level of serum hsCRP detected at baseline (quartile 1: 22.5%, 2: 27.3%, 3: 32.1%, and 4: 34.3%; all, P less than 0.01). It was found that the subjects in the highest quartile had an increased risk of NAFLD (odds ratio (OR) = 1.80, 95% confidence interval (CI): 1.42-2.28, P less than 0.01), as compared with those in the lowest quartile. Moreover, when the regression model was adjusted for baseline factors of age, sex, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting serum glucose, and body mass index, the risk of NAFLD remained significantly higher for the highest quartile (vs. the lowest quartile; OR = 1.49, 95% CI: 1.16-1.91, P less than 0.01). CONCLUSION: Serum hsCRP levels may be predictive of development of NAFLD in individuals with type 2 diabetes mellitus. The risk of NAFLD increases in parallel with increasing levels of serum hsCRP.

[Evaluation of the fracture of nickel-titanium rotary Protaper during root canal preparation].

PURPOSE: To assess clinical application of Nickel-titanium(NiTi) rotary instruments Protaper in preparation of curved root canals. METHODS: 281 curved canals from 169 extracted molars were instrumented by Protaper rotary instruments using crown-down technique. An analysis was carried out regarding the relationship between the broken files and canal distribution,degree of curvature of canals, and the relationship between amount of the broken files and the duration was also included. SPSS18.0 software package was used for statistical analysis. RESULTS: A total of 43 kits files were used in the preparation of 281 curved root canals, and broken files often happened in canals with curvature of >30° and very complex canals. CONCLUSIONS: The fracture of NiTi instruments is closely related to the anatomy of the root cana1. With the use of NiTi rotary instruments Protaper, curved root canals can be prepared effectively. Meanwhile, the problem of instrument separation should be prevented.

[Connection of trigeminal nerve and facial nerve branches and its clinical significance].

In recent years, many anatomical researches have showed that there are common and extensive connections between the trigeminal nerve and the facial nerve.They are briefly outlined as follows: (1) The infraorbital nerve communicates with buccal branch of the facial nerve. (2) The auriculotemporal nerve of the trigeminal nerve communicates with the buccal, zygomatic,temporal branches and the upper divisions of the facial nerve. (3) The supraorbital nerve communicates with the zygomatic and temporal branches of the facial nerve. (4) The mental nerve communicates with the marginal mandibular branch of the facial nerve. (5) The buccinator nerve communicates with the zygomatic, buccal and marginal mandibular branches. These communications between the trigeminal nerve and facial nerve are probably related to several clinical signs, for example,some trigeminal neuralgia patients are complicated by facial spasm, some patients appeared spontaneous partial functional recovery of mimetic muscles following surgical resection of a considerable segment of the facial nerve (including a portion of its main trunk and the peripheral plexus), etc. The purpose of this article was to review the anatomical features and clinical significance of the communications between the trigeminal nerve and the facial nerve.

Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension.

AIM: To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension. METHODS: From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnection (LSD) were performed on 28 patients with cirrhosis, bleeding due to portal hypertension, and secondary hypersplenism. Success was achieved in 26 patients. Demographic, intraoperative, and postoperative variables of the patients were compared. RESULTS: Success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but two patients (7.14%) who required open splenectomy and azygoportal devascularization (OSD). The operation time was significantly longer in patients undergoing LSD than in those undergoing OSD (235 +/- 36 min vs 178 +/- 47 min, P < 0.05). The estimated intraoperative blood loss was much more in patients receiving OSD than in those receiving LSD (420 +/- 50 mL vs 200 +/- 30 mL, P < 0.01). The proportion of patients undergoing laparoscopic and open splenectomy and azygoportal disconnection who received transfusion of packed red blood cells during or after the operation was 23.08% and 38.46%, respectively (P < 0.05). The time of first oral intake was faster in patients after LSD than in those after OSD (1.5 +/- 0.7 d vs 3.5 +/- 1.6 d, P < 0.05). The hospital stay of patients after LSD was shorter than that of patients after OSD (6.5 +/- 2.3 d vs 11.7 +/- 4.5 d, P < 0.05). The pain requiring medication was less severe in patients after LSD than in those after OSD (7.69% vs 73.08%, P < 0.001). The overall complication rate was lower in patients after LSD than in those after OSD (19.23% vs 42.31%, P < 0.05). CONCLUSION: Laparoscopic splenectomy and azygoportal disconnection are the feasible, effective, and safe surgical procedure, and are advantageous over minimally invasive surgery for bleeding portal hypertension and hypersplenism.

[The neuromuscular toxicity and clinical application of adriamycin].

Adriamycin (doxorubicin) is commonly used in the treatment of malignant tumours. In recent years,retrograde adriamycin sensory ganglionectomy has been used in treatment of trigeminal neuralgia and has obtained good therapeutic effect. The mechanism of action, particularly, of the toxic effects with different medication methods and choice of doses for muscle cells and nerve cells is still unclear. This article reviewed the mechanism and feature of the toxicity of adriamycin effects on these cells and its advance in experimental study. The damage of adriamycin was highly selective and self-limited. The different effects of adriamycin with different administration routes and doses is also described. Adriamycin shows great potentiality in treatment of trigeminal neuralgia, facial spasm and some other neuromuscular diseases.

[Changes in voltage-gated potassium currents in the trigeminal neurons after a chronic constriction of infraorbital nerve.].

The purpose of this study was to establish a model of trigeminal neuralgia (TN) through an approach from lower edge of cheekbone and to observe the functional changes in the voltage-gated potassium currents in the cultured trigeminal ganglion (TG) neurons. Thirty Sprague-Dawley male rats were divided into two groups, the sham-operated (sham) group and the operated group. The TN model was carried out by using a chronic constriction injury of the infraorbital nerve (ION-CCI) from lower edge of cheekbone. Peripheral pain threshold test and whole-cell patch clamp recording were used to determine the difference between sham and ION-CCI rats. The withdrawal threshold of whisker pad in operated side of ION-CCI rat was decreased significantly from 6 d after operation and then maintained until 21 d, with the lowest on the 15th day. The threshold of whisker pad in non-operated side of operated rats was also decreased significantly compared with that in the sham group. Delayed rectifier potassium current (I(K)) in cultured ION-CCI TG neurons was decreased significantly compared with that in the sham group. Transient outward potassium currents (I(A)) in both operated and non-operated sides of TG neurons from ION-CCI rats were also reduced significantly compared with that in the sham group. The present study provided a new method of ION-CCI. In this model, the decrease of I(A) and I(K) might contribute, at least in part, to the decrease in mechanical pain threshold of whisker pad and the subsequent hyperalgia.

[The expression and significance of osteopontin and its receptor CD44v6 in oral squamous carcinoma].

OBJECTIVE: To study the clinical significance of osteopontin (OPN) and its receptor CD44v6 expression in oral squamous cell carcinoma (OSCC). METHODS: OPN and CD44v6 expression were examined in OSCC (n=59) and normal oral mucosa (n=12) by EnVision method, the staining-grade were quantitatively studied by multiple functional image analyzer. Their expression grade of different clinical and pathological index were statistically studied. RESULTS: OPN expression grade was significantly higher in OSCC than that in normal oral mucosa (P<0.05). Significant deviation of OPN expression grade was found between different clinical stages, as well as between the groups with or without cervical lymph node metastasis. The group with cervical lymphnode metastasis had higher expression than that of the group without lymph node metastasis (P<0.05). However, there was no significant deviation between the expression grade in well-differentiated group and moderate or poorly differentiated group. The expression of CD44v6 showed no correlation with that of OPN, nor any difference between OSCC and normal oral mucosa. CONCLUSION: OPN over expression was found in OSCC, and the expression level has correlation with the clinical staging and with cervical lymph node metastasis status. CD44v6 expression showed no difference between OSCC and normal oral mucosa nor any correlation with that of OPN.

[Local drug injection for the treatment of trigeminal neuralgia].

Trigeminal neuralgia is the most common facial pain syndrome,which remains a difficult condition to manage due to lack of knowledge on pathophysiological mechanisms. Local drug injection is a minimally invasive and useful technique to manage trigeminal neuralgia, with a high success rate and low incidence of morbidity. Although a large number of drugs have been used to treat trigeminal neuralgia, there still remains a great challenge to reduce the recurrent rates and complications both intra- or post- injections.

[Evaluation of living donor liver transplantation for patients with hepatocellular carcinoma].

OBJECTIVE: To evaluate the donor risks and potential recipient benefits of living donor liver transplantation (LDLT) for adult patients with hepatocellular carcinoma (HCC). METHODS: From January 2002 to December 2006, a total of 27 LDLT for HCC patients were performed in our center, of which 25 received right lobe grafts and 2 received dual grafts. The clinical and follow-up data of these 27 recipients and 29 donors were analyzed retrospectively. RESULTS: Of the 29 donors, the overall complication rate was 17.24% (5 cases). Two cases (6.90%) experienced major complications (one with intra-abdominal bleeding and one with portal vein thrombosis) and three cases (10.34%) experienced minor ones (fat necrosis and infection of the surgical skin wound in one, pleural effusion in another and transient chyle leakage in the third). All donors were fully recovered and returned to their previous work. No recipients developed small-for-size syndrome. The overall HCC patients survival rate at 1- and 3-years was 84.01% and 71.40%, respectively, similar to that of patients undergoing LDLT for various nonmalignant diseases during the same period (P > 0.05). CONCLUSION: Although further study is needed to fully assess the risks and benefits of LDLT for the HCC patients and donors, our present results preliminarily suggest that LDLT offers an acceptable chance and duration of survival in patients with HCC, and it is a relatively safe procedure.

Donor safety in adult living donor liver transplantation using the right lobe: single center experience in China.

AIM: To evaluate the safety of donors in adult living donor liver transplantation (LDLT) using the right lobe in a single liver transplantation center in China. METHODS: We investigated retrospectively 52 living donor liver resections performed from October 2003 to July 2006. All patients were evaluated by blood tests and abdominal CT. The mean donor age was 28.2 +/- 7.4 years. Residual liver volume was 42.1% +/- 4.7%. Mean operative time was 420 +/- 76.2 min; mean ICU stay, less than 36 h; mean hospital stay, 16.4 +/- 8.6 d; and mean follow-up period, 6 mo. RESULTS: There was no mortality. The overall complication rate was 40% (21 donors). Major complications included biliary leak in two, and pneumonia in 2 donors. Minor complications included mild pleural effusion in 12 donors, transient ascites in 6, mild depression in 4, intra-abdominal collections in 2, and wound infections in 1 donor. Residual liver volume did not affect the complication rate. None required re-operation. Return to pre-donation activity occurred within 5-8 wk. CONCLUSION: Right hemi-hepatectomy can be performed safely with minimal risk in cases of careful donor selection. Major complications occurred in only 7.7% of our series.

[A study of interleukin-10 gene polymorphism in irritable bowel syndrome].

OBJECTIVE: To investigate whether three diallelic polymorphisms at the position -1082, -819 and -592 in the promoter region of the IL-10 gene were associated with diarrhea-predominant irritable bowel syndrome (D-IBS). METHODS: The IL-10 gene -1082, -819 and -592 position polymorphisms were genotyped by amplification refractory mutation systems-polymerase chain reaction (ARMS-PCR) methods in 43 patients with D-IBS and 41 healthy subjects (HS). RESULTS: Compared with HS, D-IBS patients had a greater frequency of T/T genotype at IL-10 gene promoter -819 position (67.4% vs 39.0%, P < 0.05), the frequencies of -819 C/T and C/C genotype were not significantly different (23.3% vs 43.9% and 9.3% vs 17.1%, P > 0.05). D-IBS patients also had a greater frequency of -592 A/A genotype compared with HS (67.4% vs 39.0%, P < 0.05), the frequencies of -592 C/A and C/C genotype were not significantly different (23.3% vs 43.9% and 9.3% vs 17.1%, P > 0.05). No significant difference was found in genotype at IL-10 gene promoter -1082 position. The -819 T allele frequency in D-IBS was significantly higher than that in control (79.1% vs 61.0%, P < 0.05), whereas -819 C allele frequency in D-IBS was lower (20.9% vs 39.0%, P < 0.05). D-IBS patients also had a greater frequency of -592 A allele compared with HS (79.1% vs 61.0%, P < 0.05), -592 C allele frequency in D-IBS was lower (20.9% vs 39.0%, P < 0.05). No significant difference was found in -1082 G or A allele frequency. CONCLUSIONS: The presence of -819 T/T and -592 A/A genotype may be related to development of D-IBS.

[Microvessel density and expression of vascular endothelial growth factor in adenoid cystic carcinoma of salivary gland].

OBJECTIVE: To discern whether the microvessel density (MVD) and the expression of vascular endothelial growth factor (VEGF) could be prognostic indicators for the metastasis and survival of patients with SACC after radical surgery. METHODS: After the follow-up of 31 primary patients with SACC treated with radical surgeries for at least 60 months, the paraffin-bedded sections of the those patients were stained immunohistochemically with anti-CD34-McAb and anti-VEGF-McAb, respectively. Subsequently, two pathologists double-blindly evaluated the sections stained with anti-CD34-McAb to determine the MVD values individually, as well as, measured the sections stained with the ani-VEGF-McAb to determine the OD values. Consequently the data were analyzed with the statistic software package detailed. RESULTS: The univariate statistical analysis showed that the pathological types of SACC, the TNM stages, MVD and OD values were all statistically significant variables for the survival of the patients with SACC (P = 0.047, 0.000, 0.000, 0.024). Furthermore, among those reliable variables, only MVD was more significant in the Cox proportional hazard model for the multivariate analyses (P = 0.000). The MVD values were statistically significantly higher, in the group with either death, or metastasis, or tumor-relapse, or worse pathological types, or advanced TNM stages, than their counterparts respectively(P = 0.029, 0.045, 0.019, 0.031, 0.00). On the other hand, the OD values were also statistically significantly higher, in the group with either death, or worse pathological types, or advanced TNM stages, than their counterparts respectively(P = 0.037, 0.013, 0.014). The results of Fisher exact test showed that the incidence of distant metastasis differed statistically significantly between the subgroups divided with the median of the MVD values (P = 0.032). The stepwise linear regression equation showed that the MVD value correlated positively with the OD value (P = 0.029). CONCLUSIONS: The MVD value and the expression level of VEGF all have statistically significant correlations with the survival of the patients with SACC, moreover, the MVD value is more significant as a prognostic indicator. The MVD value could also be a prognostic indicator for the incidence of the distant metastasis of patients with SACC. The over-expression of VEGF in SACC might contribute to the MVD values increasing.