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??Expression of PFP and GrB in gastric cancer and their clinical significance HE Chun-hua. Department of General Surgery??Affiliated Hospital of Luzhou Medical College??Luzhou 646000, China
Abstract Objective To study express and clinical significance of PFP and GrB in patient with gastric cancer. Methods The expression of PFP and GrB in stomach incision tissue, peripheral tissue of gastric cancer, cancer tissue and corresponding tissues of lymphoid metastases was detected by immunohistochemical PV staining between 2008 and 2009 in the Department of General Surgery of Affiliated Hospital of Luzhou Medical College. The expression was analyzed combined with clinical and pathological features. Results ??Comparing the expression of GrB??+?? in stomach incision tissue, peripheral tissue of gastric cancer and cancer tissue, there is no significant difference in the adjacent difference two groups (P> 0.05). ??Comparing the expression of GrB in corresponding stomach incision tissue and peripheral tissue of gastric cancer for the the same patient with GrB??+?? and GrB??-?? , there was statistically significant difference (P <0.01). ??Taking the PFP cells as positive control, it showed that the PFP protein showed no expression in the stomach incision tissue, peripheral tissue of gastric cancer and the cytoplasm of adjacent epithelial cells of gastric cancer tissues, whether the GrB??+?? expressed or not. ??Comparing the expression of GrB in gastric cancer and lymph node metastasis, there is no significant difference (P= 0.130). The PFP expressed negative in all lymph node metastasis. ??Analyzing the GrB expression in gastric cancer and the corresponding clinical and pathological features, it showed that the expression of GrB in primary tumor may play an inhibitory effect on lymph node metastasis. Conclusion Non-co-expression between GrB??+?? gastric cancer cells and PFP has not demonstrated that the GrB??+?? gastric cancer cells have lymphoid cells phenotype. GrB may be involved in the whole process of gastric cancer, which is an early event in the formation of gastric cancer.     

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??Expression and significance of interleukin-11(IL-11) and interleukin-11 receptor (IL-11R) in primary hepatic carcinoma SUN Chuan-zheng*, HUANG Fei-zhou, YANG Ming-shi, et al. *Department of General Surgery, Third Affiliated Hospital, Central South University, Changsha 410013, China
Corresponding author: HUANG Fei-zhou, E-mail: zheng-1016@hotmail.com
Abstract Objective To clarify the role of IL-11 and IL-11R in human hepatocellular carcinoma. Methods Thirty primary hepatic carcinoma (PHC) tissues, their pericarcinomatous liver tissues and their clinicopathological factors admitted between December 2006 and March 2007 in the Third Affiliated Hospital, Central South University were obtained in the current study. Expression levers of IL-11 and IL-11R proteins in samples of pericarcinomatous liver and tumor tissue were analyzed by Western blot. The IOD of IL-11, IL-11R and β-actin was analyzed quantitatively by analysis software. The expression level of IL-11 and IL-11R was denoted by the ratio of IOD, which was called value A. Results The expression of IL-11 and IL-11R was upregulated obviously in PHC tissue. The expression of IL-11 was significantly related to Edmondson’s grade, capsule invasion and tumor’s thrombus in portal vein and the expression of IL-11R was correlated with Edmondson’s grad, capsule invasion and tumor’s thrombus in portal vein. Conclusion The finding suggests that IL-11/IL-11R may play important role in the occurrence, differentiation, invasion and transfer of PHC.     

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??Research on expression and its role of regulatory T cells in mammary cancer microenvironment YAN Li*, LI Qing-huai, LI Li, et al. *Department of Gland Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
Corresponding author: CAI Jian-hui,E-mail:jianhuicai2001@163.com
Abstract Objective To investigate the role and mechanism of CD4+ CD25+ Foxp3+ regulatory T cells in immunity tolerance of mammary cancer. Methods There were 40 cases of mammary cancer (20 cases of lymphonodus metastasis, 20 cases without lymphonodus metastasis) and 20 cases of mammary fibroma selected from the Department of Gland Surgery,the Second Hospital of Hebei Medical University. Expression level of CD4+ CD25+ Foxp3+ regulatory T cells, TGF-β and IL-10 in original, peripheral tissue, axilla lymphonodus and mammary fibroma of the above samples were measured respectively by FCM and immunohistochemical method. Results The expression level of CD4+ CD25+ Foxp3+regulatory T cells, TGF-β and IL-10 in orginal tissues of mammary cancer were all higher than that of mammary fibroma (P<0.05), and were higher than that of peripheral tissue and axilla lymphonodus(P<0.05). In the group with lymphonodus metastasis, the expression level of the above three measured index in mammary cancer peripheral tissue was significantly lower than that expressed in axilla lymphonodus(P<0.05). However in the group without lymphonodus metastasis, there was no difference in expression level of the above three measured index between mammary cancer peripheral tissue and axilla lymphonodus (P>0.05). Conclusion The fact that CD4+ CD25+ Foxp3+ regulatory T cells accumulate in mammary cancer microenvironment can probably result in immunity tolerance. With the progress of mammary cancer, there is some synergistic action between CD4+ CD25+ Foxp3+ regulatory T cells and TGF-β, IL-10.     

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近年来 ,随着肿瘤免疫机制及分子生物学研究的深入 ,对抗肿瘤免疫应答、细胞增殖、癌变、转移以及癌基因和抑癌基因之间的作用机制认识的进一步加深 ,许多早期诊断胰腺癌的血清及基因标志物已相继发现 ,同时 ,在胰腺癌的免疫基因治疗上也有了新的进展。1　胰腺癌标志物肿瘤标志物通常是指肿瘤组织自身产生的可反映肿瘤存在与生长的一类分子 ,其临床价值在于早期发现和诊断肿瘤 ,提示肿瘤的原发部位及严重程度 ,监测治疗效果并对预后作出判断。根据被检测物类型可分为血清学肿瘤标志物及基因肿瘤标志物。1 1　胰腺癌血清标志物常用的血清学肿…     

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??Objective:To investigate the security and the operative experiences of laparoscopic ventral incisional herniorrhaphy. Methods:The laparoscopic mesh repair was performed for 79 patients with abdominal ventral incisional hernias from March 2004 to May 2006 in Hua Shan Affiliated Hospital of Fu Dan University. Results:Laparoscopic incisional herniorrhaphy with meshes was successfully performed in 98.7% (78/79) of patients.One case (1.3%) was converted to an open procedure because of extensive adhesion intraperitoneally. The mean operating time was 88 minutes and postoperative hospital stay averaged 4.6 days.Eighteen (22.8%) patients were found to have more than one hernial defect intraoperatively.Postoperative complications included severe pain in operative area temporary (n=58,73.4%),prolonged pain in suture site (n=6,7.6%),seroma (n=14,17.7%),intestinal fistula (n=1,1.3%) and recurrence (n=1,1.3%). Conclusion:Laparoscopic ventral incisional herniorrhaphy with meshes can be performed in most of incisional hernias after complete dissection of adhesions,through the laparoscopy it may find others defects.But the postoperative pain is severe in repair area.If extensive dense adhesion will interfere with the manipulation and lysis,the patients should be converted to open operation.     

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??Clinical application of ultrasound-guided core needle biopsy for breast lesions LI Jin-ping*, LI Juan , WU Li-gang,et al.*Chongqing Medical University, Chongqing 400016, China
Corresponding author ??LIU Qi-lun, E-mail??liuql6311@hotmail.com
Abstract Objective To evaluate the clinical value of ultrasound-guided core needle biopsy (US-CNB) as a preoperative diagnostic modality for breast lesions. Methods Data were collected prospectively from August 2007 to May 2009 for 115 ultrasound-guided core needle biopsy that were followed by excisional breast procedure (EP) within 1 week at our hospital. The histopathological diagnosis on ultrasound-guided core needle biopsy was then compared with the findings of the excisional biopsy. Results Out of the total 115 cases, US-CNB showed 81 as invasive ductal carcinoma, three invasive lobular carcinoma, two ductal carcinoma in situ??two atypical ductal hyperplasia and 26 benign disease. The principle histology identified at CNB was confirmed at EP for 93.9% of the lesions, generating a kappa value of 0.891(P??0.01). The sensitivity for malignancy with CNB was 95.6% and the specificity was 100%. The false negative rate was 4.39% and the false positive rate was 0. Overall, our results indicate moderate agreement between the principal histology identified at USB relative to that identified at EP. Conclusions Ultrasound-guided core breast biopsy is a satisfactory procedure for the histopathological diagnosis of breast lesions. Any unsatisfactory, suspicious or atypical change on US-CNB should be followed by an open biopsy.     

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??A comparative study of omentum wrapping in pancreaticojejunostomy for reducing postoperative pancreatic fistula XU Jie-ru*??CHEN Chao??SHEN Ning-jia??et al. *Medical College of Soochow University??Suzhou 215000??China
Corresponding author: ZHANG Yong-jie, E-mail: yjoy005@sina.com
Abstract Objective To investigate the efficacy of the omentum wrapping technique in pancreaticojejunostomy on decreasing the incidence of pancreatic fistula after pancreaticoduodenectomy. Methods The clinical data of 225 patients underwent pancreaticoduodenectomy and pancreaticojejunostomy in single operation group from January 2009 to October 2015 in No.2 Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital Affiliated to the Second Military Medical University were analyzed retrospectively. Patients were divided into two groups??including group with omentum wrapping technique (n=125) and control group without it (n=100). After propensity score matching??the rates of pancreatic fistula were compared between the two groups??including group with omentum wrapping technique (n=64) and control group without it (n=64). Results All operations were completed successfully. The overall complication rate of all 225 patients was 62.7%??141/225??. The reoperation rate was 2.7%??6/225??. The mortality is 2.7%??6/225??. The incidence of pancreatic fistula was 46.7%??105/225????including 61 cases of Class A??37 cases of Class B??and 7 cases of Class C. The incidence of bleeding was 11%??25/225??. The incidence of DGE was 24.9%??56/225??. The incidence of abdominal infection was 20.9%??47/225??. Except the incidence of pancreatic fistula??there was no statistical difference between the two groups in the incidence of bleeding??DGE and abdominal infection??P>0.05??. In the omentum wrapping group, no reoperation case occurred??and there were only 2 death cases. In the control group??there were 4 reoperation cases and 4 death cases. There was no significant difference between the two groups in those data??P=0.119, 0.680??. In the PSM model??soft pancreas??pancreatic duct diameter and omentum wrapping were related to the postoperative pancreatic fistula in single factor analysis. In the multiple factors analysis??pancreatic duct diameter <3 mm and no omentum wrapping were independent risk factors for pancreatic fistula. Conclusion The omentum wrapping technique can decrease the rate of pancreatic fistula and it is worth applying in pancreaticojejunostomy.     

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??Surgical and endovascular treatment of thromboangiitisobliterans LIU Bing, HUANG Ren-ping. Department of Vascular Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: HUANG Ren-ping, E-mail: cup521@163.com
Abstract Objective To investigate the outcomes of surgical and endovascular treatment for thromboangiitisobliterans. Methods The clinical data of 202 patients with thromboangiitisobliterans underwent surgical and endovascular treatment in the First Affiliated Hospital of Harbin Medical University from April 2006 to April 2015 were analyzed retrospectively. According to the outcomes of ankle brachial index (ABI) and the Rutherford classification value (R-value), the effectiveness of different operation methods were evaluated. Results The Rutherford classification value evaluation??One month after operation, R-value decreasedin all 4 groups??P<0.05??. Six months after operation, R-value decreased in lumbar sympathectomy group, sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, R-value decreased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??.ABI evaluation??One week after operation,ABI increased in all 4 groups ??P<0.05??. Six months after operation, ABI increased in sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Twelve months after operation, ABI increased in sequential endarterectomy group and sequential endarterectomy combined with lumbar sympathectomy group??P<0.05??. Conclusion Percutaneous transluminal angioplasty (PTA) and lumbar sympathectomy can bring benefit to the patient with TAO in the short term. Sequential endarterectomy combined with or without lumbar sympathectomy are proved to be effective as a surgical method for TAO.     

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??Establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis FANG Chi-hua, FANG Zhao-shan, CAI Wei, et al. The First Department of Hapatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou510282,China
Corresponding author:FANG Chi-hua,E-mail: fangch_dr@126.com
Abstract Objective To study the establishment and value of three-dimensional visualization diagnosis platform in the treatment of hepatolithiasis. Methods The clinical data of 112 consecutive patients with hepatolithiasis between January 2008 and April 2015 in the First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University were analyzed. (1) In order to acquire submillimeter CT data, each patient underwent the spiral CT epigastric enhancement scanning. Medical image three-dimensional visualization system (MI-3DVS) was used to establish three-dimensional visualization image model. (2) The three-dimensional visualization analysis covered the vascular classification, the classification of clinical diagnosis, liver segments, virtual hepatectomy and liver volume calculation with three-dimensional visualization technology. (3) Preoperative evaluation and surgical planning were performed to select a reasonable plan. (4) The 3D printing of liver might be performed when necessary, which help to perform the precise surgery. (5) Therapeutic effect was evaluated. Results All the patients had a real reconstruction of three-dimensional visualization image model based on CT images. The position and distribution of calculus, location and degree of biliary stricture, vascular anatomic relationships were shown in the three-dimensional visualization image model clearly. The category of hepatic artery, hepatic vein and portal vein were made. The three-dimensional visualization diagnostic classification of hepatolithiasis and liver segments was also performed. The relationships between lesions and vasculature were shown in the 3D printing model of liver. The three-dimensional visualization preoperative evaluation and 3D printing model were in tune with actual operation. The stone residue rate, incidence rate of complications and calculus recurrence rate was less than 3.0%, 5.6% and 2.4% respectively. Conclusion The establishment of three-dimensional visualization diagnosis platform for hepatolithiasis could help to improve the clearance of calculus and decrease postoperative complications. It could provide safe, precise, minimally invasive and efficient therapeutic measures for hepatolithiasis and has a good clinical prospect.     

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??Clinical control study of laparoscopic procedures vs open mesh repair for ventral hernias LI Jian-wen, XIE Yi-sheng, QIU Ming-yuan, et al. Department of General Surgery, Ruijin Hospital of Shanghai Jiao Tong University, Shanghai Minimally Invasive Surgery Centre, Shanghai 200025, China. Correspongding anthor: MAO Zhi-hai, E-mail:zhihaimao@163.com Abstract Objective To estimate the laparoscopic ventral hernia repair(LVHR), focusing on the safety and efficiency of the operations. Methods The clinical data of 68 patients with ventral hernias (defect≤20cm) performed hernia reparing between January 2007 and August 2008 at Ruijin Hospital of Shanghai Jiao Tong University were analyzed retrospectively. Results Thirty-one patients underwent laparoscopic repair (LVHR), and 37 patients underwent open mesh repair (OVHR). The clinical outcome was determined by a median follow-up of 11 months(1~21 months) for the two groups. No significant differences were noticed between the two groups in age, sex, body mass index (BMI), and hernia size. The mean operative time was (60.5±17.7)min for LVHR patients and (75.5±30.3)min for OVHR patients (P??0.017). The mean postoperative hospital stay was (6.2±2.5)d for LVHR patients and (9.6±8.0)d for OVHR patients (P??0.026). 96.8% of patients (30/31) were able to return to usual activity in 2 weeks for LVHR and 78.4% of patients (29/37) for OVHR (P=0.026). LVHR patients felt less pain in the first day after operation (P??0.018), and there were no significant differences in visual-analogue pain scores between the two groups afterward. Complications occurred in 19.4 % of LVHR patients and 24.3 % of OVHR patients (P =0.623) with a recurrence rate of 3.2% in LVHR and 5.6% in OVHR patients (P =1.000). The mean cost was (18334±5336) yuan RMB for LVHR patients and (9508±9222) yuan RMB for OVHR patients (P=0.000). Conclusion The short-term results indicate that laparoscopic technique is safe and effective for ventral hernia repairing with hernia defect less than 20cm.     

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??Clinical research of anorectal manometry in unrelaxed pelvic floor syndromeHUA Yang*??MA Xiu??kun??QIAO Li,et al.*Department of General Surgery,the Second Hospital of Tianjin Medical University,Tianjin 300211,China Corresponding author:HUA Yang,E??mail:superbuyeree@yahoo.com.cn AbstractObjectiveTo explore the changes of anorectal manometry in unrelaxed pelvic floor syndrome (UPFS).MethodsAnorectal pressure,rectal evacuation were measured in 57 UPFS patients (UPFS group) and 30 healthy volunteers (control group) between January 2006 and August 2007 at the People’s Hospital of Tianjin City.ResultsThe anal resting pressure in UPFS group had no significant difference with that in control group (P>0??05).The anal maximum contractive pressure in UPFS group was higher than that in control group (P<0??01).The rectal anal pressure difference when straining to defecate in UPFS group was negative and lower than that in control group (P<0??01).The minimum rectal volumes to first sensation and desire to defecate in UPFS group were higher than those in control group (P<0??01) .ConclusionThere are decreased rectal sensation and pelvic floor muscle dysfunction in patients with UPFS.     

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目的：前瞻性地研究癌性恶液病人的机体组成成分变化。方法：将54例恶性肿瘤病人依体重指数（BMI）分为两组：BMI≤18为A组，BMI＞18为B组，利用机体组成分析仪（InBody 3.0,Biospace Co.)对两种病人进行测定，并以节段多频生物电阻抗法自动分析受检者的各项机体组成成分。结果：A组肿瘤病人各项机体组成成分与理想体重的比值皆明显低于B组，两组间的差异有极显著意义（P＜0．01）。结论：癌性恶液质病人的机体组成变化不但有显著的脂肪群丢失，还有大量瘦肉群与体细胞群的丢失。癌性恶液质病瘦肉群的丢失，可能会导致病人生活质量下降、机体功能障碍及生存时间缩短。因此，尽早地监测肿瘤病人营养状况变化、及时予以营养支持干预，都将有效地将改善肿瘤病人的预后。     

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??Clinical application of self-expending metallic stent in the management of acute colorectal malignant obstruction ZHAO Xiao-mu??WANG Jin??JIN Lan??et al. Department of General Surgery??Beijing Friendship Hospital??Capital Medical University??Key Laboratory of Cancer Invision and Metastasis Research & National Clinical Research Center for Digestive Disease??Beijing 100050??China
Corresponding author: ZHANG Zhong-tao??E-mail??zhangzht@ccmu.edu.cn
Abstract Objective To explore the short and long term efficacy of bridge to surgery (BTS) in the treatment of acute malignant colorectal cancer obstruction ( AMCO ). Methods The clinical data of 128 patients with AMCO treated by BTS or acute resection (ES) between January 2007 and December 2016 in Department of General Surgery??Beijing Friendship Hospital??Capital Medical University were analyzed retrospectively. Fifty-two patients and senventy-six patients performed BTS and ES??respectively. The surgical safety??radical tumor??permanent intestinal stoma ratio and survival rate of two groups were compared and analyzed. Results Compared with the ES group??BTS gruop had no difference in the operative approach and time. The incidence of total perioperative complications (21.2% vs. 39.5%??P=0.029) was lower in the BTS one??but there were no significant difference in the incidence of class ??/?? complications (11.5 % vs. 14.5 %??P=0.631) and mortality ( 0 vs 2.6 % ) between two groups. The total number of lymph node harvest was more (18.2±6.7 vs. 16.0±9.9??P=0.022)??the number of lymph node harvest ≥ 12 was higher (86.5 % vs. 55.3 %??P =0.001) and the permanent stoma rate was lower (23.1 % vs. 59.2 %??P=0.000). There was no significant difference between the two groups in the three-year overall survival rate (71.6% vs. 67.8%??P=0.215??and disease-free survival rate ??77.0% vs. 64.7%??P=0.703??. Conclusion Bridge to surgery can significantly improve the perioperative safety of patients with AMCO??reduce the proportion of permanent stoma??improve the proportion of tumor radical operation. Meanwhile??the long-term survival is not affected.     

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??Evaluation of the value of non-enhanced multi-contrast high-resolution magnetic resonance plaque imaging before carotid stenting ZHAO Ge-fei, FU Wei-guo, TANG Xiao, et al. Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032??China
Corresponding author??GUO Da-qiao??E-mail??guo.daqiao@zs-hospital.sh.cn
Abstract Objective To analyze the application value of non-enhanced multi-contrast high-resolution magnetic resonance imaging in preoperative evaluation of CAS. Methods The clinical medical records of patients with carotid stenosis treated at Zhongshan Hospital,Fudan University from January 2017 to March 2018 were analyzed retrospectively.The relationship between carotid plaque characteristics and cerebral infarction lesions after CAS were confirmed by univariate and multivariate logistic regression analysis. Results A total of 181 CAS patients were enrolled in the study. Among them??63 ??34.8%?? had asymptomatic new DWI lesions and 2 ??1.1%?? had symptomatic cerebral infarction. Logistic regression analysis showed carotid plaque hemorrhage ??IPH?? [subacute phase IPH vs. no IPH??OR??9.393??95% confidence interval ??4.431??19.911??] was an independent risk factor for predicting asymptomatic DWI lesions after CAS. Conclusion Preoperative application of non-enhanced multi-contrast high-resolution magnetic resonance imaging to evaluate plaque components can detect plaque instability and has important potential value for indication of CAS.     

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??Preliminary study on a predict model for patients with cholecystolithiasis combined with common bile duct stones WU Zong-yang, ZHENG Xin ,ZAN Xian-feng,LIU Qing-guang. Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University ??Xi'an 710061??China
Corresponding author: LIU Qing-guang, E-mail??liuqingguang@vip.sina.com
Abstract Objective To develop a predictive equation with the factors previously identified by multivariate Logistic regression that were predictive for cholecystolithiasis combined with common bile duct stones ,Evaluate the diagnostic value of predictive equation,ultrasound and MRCP.Methods Make database with the index of 626 patients and select the variables that considered statistically significant for the Logistic equation.The sensitivity??specificity and accuracy of Logistic regression equation, ultrasound and MRCP are compared by χ2 test.Results P=1/1+EXP??-(-5.092 +3.101X1+1.754X2+1.647X3+1.306X4+1.175X5+ 0.963X6)??,The equation has a sensitivity of 69.5% , specificity of 97.1% , and accuracy of 92.5%.The sensitivity and accuracy of MRCP and Logistic regression equation are superior than ultrasound (P<0.05), The sensitivity of MRCP are superior than Logistic regression equation (P<0.05). The accuracy of MRCP and Logistic regression equation have no difference(P>0.05).The specificity of three methods have no difference(P>0.05).Conclusion The specificity and accuracy of Logistic regression equation is superior than ultrasound, it could provide reference for clinical diagnosis and treatment decision making for doctors.     

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??The compliance of implementing sepsis bundles and their effects on mortality of patients with severe sepsis or septic shock WU Jian-feng, CHEN Juan, OU Yang-bin, et al. Department of Surgical Intensive Care Unit, the First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China Corresponding author: GUAN Xiang-dong, E-mail: carlg@163.net Abstract Objective To evaluate the compliance of implementing sepsis bundles in the ICU and their effect on outcomes of patients with severe sepsis or septic shock. Methods In the prospective observational study, it took to applying sepsis bundle interventions for 6h, 24h in 122 consecutive patients with severe sepsis or septic shock admitted from January 2007 to December 2008 at the First Affiliated Hospital of Sun Yat-sen University. The compliance of performing sepsis bundles, ICU and 28-day mortality were recorded. Results The compliance rate of controlling glucose and EGDT was low (both??70%) because both had defects and difficulty in implementation. Compliance with the 6-hour bundle was obtained in 75 (61.5%) of 122 patients; those patients had a lower 28-day mortality rate (22.7% vs 44.7%, P??0.05) and lower ICU mortality rate (18.7% vs 38.3%, P??0.05) than other patients. Compliance with the 24-hour bundle was obtained in 71 (60.7%) of 117 eligible patients. Patients complied with the 24-hour sepsis bundle had a lower 28-day and ICU mortality rate than those who were noncompliant (19.7% vs 41.3%, 15.5% vs34.8%, both P??0.05). Conclusion Correct application of the sepsis bundles was associated with reduced mortality and length of ICU stay.     

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目的 对两种类型的捆绑式胰肠吻合术进行对比。方法 同期施行捆绑式胰吻合术Ⅰ型（同时施行空肠粘膜和胰腺缝合以及空肠断端与胰腺缝合等三项防漏步骤）35例（A组），与只行捆绑吻合的Ⅱ型手术49例（B组）进行对照观察。结果 两组都没有发生胰吻合口漏，没有手术死亡。术后随访，两组均无胰管扩张或胰腺外分泌功能不足的表现。完成吻合时间A组平均27min，B组平均16min。结论 捆绑式胰肠吻合术，相比之下Ⅱ型更加简单、省时，而且能够在吻合口完成后立即对它进行检测，可以避免捆绑过紧，从而无须插入胰管导管作为支撑。两种类型的捆绑式胰肠吻合术均可掌声用于胰十二指肠切除术，但是Ⅱ型应当成为首选方法。     

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??The special attention the study of diagnosis and treatment of benign and precancerous lesions of breast JIANG Jun. Breast Disease Center, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China Abstract Pathogenic mechanism leading to breast hyperplasia is still unclear, the standard of clinical diagnosis and treatment have not come to a consensus, the clinical characteristic and process of carcinogenesis from hyperplastic diseases of breast is unclear and there is short of effective clinical methods for monitoring the disease progression. In surgical management of breast fibroadenoma, how to obtain ideal cosmetic results needs to search for the principles of management and micro-invasive operation for micro-fibroadenoma. Difficulties still exist in prevention and treatment of breast fibroadenomas. The development and treatment of acute mastitis during lactation relating to polyacrylamide gel injection for breast augmentation have their specificities. And there is a lack of consensus on the treatment of plasma cell mastitis. Further and deeper study is still required for clinical detection and diagnosis of precancerous lesion and breast cancer in situ. The key of raising the therapeutic effect in treating benign breast lesions is to make efforts to explore methods solving these problems.     

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??Cost-effectiveness of open versus endovascular repair of abdominal aortic aneurysms??A systematic review HU Ming??YANG Han??QIN Xiao. Department of Vascular Surgery??the First Affiliated Hospital of Guangxi Medical University??Nanning 530021??China
Corresponding author??QIN Xiao??E-mail??dr_qinxiao@163.com
Abstract Objective To evaluate therapeutic effectiveness of OR and EVAR of AAA and the difference of the cost effectiveness. Methods The Cochrane Central Register of Controlled Trials ??the Cochrane Library??,Ovid MEDLINE?? EMBASE?? ACP ??American College of Physicians?? Journal Club?? CNKI?? CBMdisc?? Chinese Science and Technology Periodical Full Text Database ??VIP??were retrieved. According to the inclusion and exclusion criteria?? randomized controlled clinical trials and non randomized controlled experiment about endovascular treatment and traditional open surgical treatment of AAA which have been completed??ongoing or published before 2016 April were studied. Results A total of 251 papers were found; 4 published randomized controlled trials and 12 non randomized controlled trials about the effectiveness and cost of AAA repair were pooled in the end. Conclusion The costs of the implant ??stent or graft???? direct costs?? medical / surgical supplies of endovascular treatment group are significantly higher than those of the conventional surgery group??the difference of the costs of following-up?? consultation fees?? operating room cost?? preoperative cost and operation cost between two groups are not obvious?? and in ICU and Ward costs?? staff costs??costs of drugs and blood?? endovascular treatment group was significantly lower than those of the conventional surgery group.