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"Rain classroom + " is an online and offline teaching mode developed under the background of "Internet + Education". However, there are still certain shortcomings in online teaching. Based on this situation, we explore the application of a new mixed teaching mode based on "Rain classroom + " in the teaching of Pathophysiology. Centered on three links of pre-class, in-class and post-class, the flipped classroom has been realized through teaching interaction by combining Tencent Meeting and integrating the problem-based learning with the case-based learning (PBL/CBL) in the teaching. "Rain classroom + " mixed teaching mode realizes the "student-centered" teaching concept by optimizing teaching resources, reorganizing teaching content and perfecting teaching design.
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Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been gradually developing and has replaced the percutaneous transhepatic bile duct drainagebecause of its safety and effectiveness, and it has become an effective alternative plan after endoscopic retrograde cholangiopancreatography treatment failure in patients with benign and malignant biliary obstruction. In clinical operation, the surgeons can choose the appropriate surgical method according to the patient's own condition and anatomical characteristics. This paper summarized the clinical application and research progress of EUS-BD technology by collecting relevant literatures published in recent years.
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Presently, nonalcoholic fatty liver disease has become the most common pathogenic factor of chronic liver disease worldwide that can lead to the occurrence of hepatocellular carcinoma (HCC). Lipid metabolism in cancer cells is closely related to tumorgenesis, invasion and metastasis, and thus acts as one of the hallmark of cancer cells. Lipolipomics is an important branch of metabolomics, which has been adapted recently in the study of HCC for analysis of the structure and function of lipid components by chromatography and mass spectrometry. Fatty acids, glycerides, glycerophospholipids, sphingolipids, and sterol are significantly different in HCC tissues or serum. Therefore, it contributes to the diagnosis, determination of prognosis, mechanistic study and targeted therapy of HCC.
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As a new kind of perioperative management strategy and ideas,enhanced recovery after surgery (ERAS) brings a series of traditional perioperative treatment measures for optimization based on evidence-based medicine.Its primary aim is to decrease surgery-related stress,complications,and also to facilitate recovery with multimodal treatments.The ERAS pathway has been widely applied and proved to be efficient in gastrointestinal,colorectal,orthopedic,thoracic and gynecological surgery.Owing to the complexity of surgical procedure,long operation time and high perioperative complication rate in liver transplantation compared with other surgeries.This new concept has not been widely accepted or recommended in liver transplantation,although some previous studies have validated its safety and effectiveness.This paper overviewed the recent literature on the specific procedures,efficacy,safety and development of ERAS applied in liver transplantation.
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In recent years, 125I radioactive seed implantation has been greatly developed for the treatment of unresectable pancreatic cancer, and clinical practice shows that it has good therapeutic effects in relieving pain, controlling local tumor progression, and prolonging patients′ survival time. This article introduces the physical and biological features of 125I radioactive seeds and the advantages and disadvantages of implantation, as well as the therapeutic method, surgical safety, and clinical effects of 125I radioactive seed implantation in the treatment of unresectable pancreatic cancer. This article points out that it is an effective therapeutic method and should be widely applied in well-equipped hospitals.
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Objective To investigate the safety and clinical effect of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of hepatocellular carcinoma (HCC) with cirrhosis.Methods The retrospective cohort study was adopted.The clinical data of 5 patients with primary HCC with cirrhosis who underwent ALPPS at the First Bethune Hospital of Jilin University between October 2014 and August 2015 were collected.The surgical plan was determined according to preoperative liver function and liver functional reserve.The patients underwent portal vein (PV) ligation and liver partition in the first staged surgery.The second staged surgery was performed when growing future live remnant (FLR) came up to the standard of safe section by rescan of computed tomography (CT) at 10,14,18 days after the first staged surgery,and hemihepatectomy and hepatic segmentectomy were applied to patients.(1) The intraoperative situations were observed,including the severity of liver cirrhosis,first staged surgery time,volume of intraoperative blood loss and FLR in the first staged surgery,interval time of surgery,growth rate of liver volume,ratio of FLR and standard liver volume (SLV),time and volume of intraoperative blood loss in the second staged surgery.(2) Pre-and postoperative biochemical indicators in the first and second staged surgeries were detected,including total bilirubin (TBil) and alanine phosphatase (ALT).(3) Postoperative situations were observed,including occurrence of complications,results of pathological examination and duration of hospital stay.(4) The follow-up using telephone reservation and outpatient examination was performed to detect tumors recurrence and metastasis and survival of patients by imaging examination and tumor marker test up to November 2015.Count data were represented as mean (range).Results (1) Intraoperative situations:of 5 patients,there were 1 patient with F3 of liver cirrhosis and 4 with F4 of liver cirrhosis.One patient was complicated with lots of peritoneal effusion,followed by acute renal failure,and didn't receive the second staged surgery.Four patients underwent successful ALPPS.The first staged surgery of 5 patients:average operation time,volume of intraoperative blood loss,FLR,interval time of surgery,growth rate of liver volume,ratio of FLR and SLV were 282 minutes (range,240-320 minutes),500 mL (range,300-700 mL),457 em3(range,338-697 cm3),15 days (range,14-18 days),58％ (range,46％-67％) and 42％ (range,32％-44％),respectively.Average operation time and volume of intraoperative blood loss in second staged surgery were 220 minutes (range,200-260 minutes) and 412 mL (range,300-600 mL).(2) Pre-and post-operative biochemical indicators:levels of TBil and ALT of 5 patients from pre-operation to postoperative day 12 in the first staged surgery were from 4.9-30.4 μmol/L to 9.8-56.1 μmol/L and from 12.9-156.1 U/L to 46.3-207.3 U/L,respectively.Levels of TBil and ALT of 4 patients from pre-operation to postoperative day 10 in the second staged surgery were from 10.1-21.2μmol/L to 6.9-38.0 μmol/L and from 30.8-55.5 U/L to 19.8-72.8 U/L,respectively.(3) Postoperative situations:there were no perioperative death and postoperative complications of liver failure and intraperitoneal infection.One patient complicated with bile leakage was cured by non-operative treatment for 30 days.Results of pathological examination:5 patients were confirmed as Ⅱ-Ⅲ stage HCC,and 4 tumors had vascular tumor thrombi and negative resection margin with tumor size of 8-13 cm.Duration of hospital stay of 5 patients was 36 days (range,28-48 days).(4) Results of follow-up:4 patients undergoing successful ALPPS were followed up for 4-12 months.One patient was emerged with a new lesion of 2 cm in left half liver at postoperative month 7,level of AFP of which was 512 μg/L before the first staged surgery reduced to normal level at postoperative month 2,and then the patient received transcatheter arterial chemoembolization (TACE) and radio frequency ablation (RFA) treatments without tumor recurrence up to postoperative month 12.No tumor recurrence and new lesions in liver were detected in other 3 patients by abdominal enhanced scan of CT,with a normal level of AFP.Conclusion ALPPS is safe and feasible for HCC with cirrhosis,with a satisfactory short-term outcome.
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ObjectiveTo investigate postoperative application of multidisciplinary treatment (MDT) in hepatobiliary and pancreatic malignancies based on the pathological results. MethodsThe clinical data of patients who were diagnosed as hepatobiliary and pancreatic malignancies who were diagnosed and treated with postoperative MDT in our hospital from Apirl 2014 to March 2015 were analyzed. MDT was performed by consultation for four to six patients once every other week. The postoperative comprehensive treatment strategy for each patient was discussed and determined by all experts in the consultation. The effect of postoperative treatment and prognosis was summarized . Results25 postoperative MDT consultations on hepatobiliary and pancreatic malignancies were held for 131 patients, including 53 patients with hepatocellular carcinoma, 7 patients with intrahepatic cholangiocarcinoma, one patient with mixed-type liver cancer, 3 patients with metastatic liver cancer, 2 patients with liver sarcoma, 29 patients with extrahepatic cholangiocarcinoma, 22 patients with pancreatic cancer, 5 patients with gallbladder cancer, and 9 patients with periampullary cancer. After surgery, 38 patients received interventional treatment, 19 systemic chemotherapy, 15 radiotherapy, 17 cell biotherapy, and 5 molecularly targeted therapy. The case fatality rate was 2.29%（3/131）. ConclusionPostoperative MDT provides scientific and rational personalized comprehensive treatment for patients with hepatobiliary and pancreatic malignancies, and improves medication compliance in patients, which holds promise for wide application.
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Bile duct injury is the most common complications of biliary surgery.With the development of tissue engineering,using artificial bile duct to treat the biliary tract disease has become the focus for the treatment of bile duct injury.This article summarizes the applications in clinical work and animal experiment of artificial bile ducts made of biological material,autologous tissue,non-absorbable polymer materials,as well as absorbable polymer materials in the clinical application and animal experiments.The advantageof each material is also discussed here.
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Pancreatic leakage is most common among numerous complications after pancreaticoduodenectomy surgery.Predicting at early stage and taking preventive measures in time are of great importance to reducing the incidence of pancreatic leakage as well as its related complications.The article reviewed pancreatic leakage monitoring related reports worldwide in recent 10 years.It was found that some factors were useful for the prediction of pancreatic leakage including the drainage fluid amylase and leukocyte count on postoperative day 1 and 3,C-reactive protein on postoperative day 3,the combined detection of white blood cells and albumin on postoperative day 4,the serum urea nitrogen and the serum albumin on postoperative day 1 and 5-8 days,as well as the ratio of amylase level in abdominal drainage to abdominal drainage volume.
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Recently,there is a gradual increase in the incidence of hyperlipidemic pancreatitis with high serum triglyceride (TG) levels.The treatments include general measures,lipid-lowering drugs,blood purification,low molecular weight heparin and insulin,traditional medicine,improving microcirculation,surgical therapy and gene therapy.The prevention of recurrence of hyperlipidemic pancreatitis is different from other types of pancreatitis.