ObjectiveTo compare liver pathology changes of patients with Budd-Chiari syndrome (BCS) and intrahepatic portal hypertension (IPH) after portosystemic shunt surgery. MethodsFrom January 2010 to December 2011,liverbiopsy was taken during shunt surgery (9 BCS patients,4 IPH patients),and 6-9 months after surgery on follow-up.Collagen type Ⅳ ( Col Ⅳ ),procollagen m (PC Ⅲ ),matrix metalloproteinase (MMP-1),tissue inhibitors of metalloproteinase(TIMP-1) were tested using SABC (immuonohistochemistry) method,and HE staining to observe the morphology of liver tissue.Free portal vein pressure before and after shunt was measured. ResultsIn BCS group,Col Ⅳ,PC 1Ⅲ and TIMP-1expression downregulated after surgery (127 ±15) vs.(137 ±16),t =4.896,P-0.013; (115.2 ± 10.6) vs.(127.3±9.5),t=4.877,P=0.003; (119.2±11.3) vs.(131.2±l9.6),t=2.841,P=0.023.MMP-1expression did not change ( P ＞ 0.05 ),while MMP-1/TIMP-1was not significantly correlated with liver fibrosis (0.95 ±0.16) vs.(0.98 ±0.15),t =-0.710,P =0.504.In IPH group,the expression of Col Ⅳ,PCⅢ,MMP-1,and MMP-1/TIMP-1did not change significantly after surgery (P ＞0.05).Compared with that in IPH group the expression of PC Ⅲ,Col Ⅳ and TIMP-1downregulated significantly in BCSgroup (127±15) vs.(150 ±12),U=3.000,P=0.038; (115.2 ±10.6) vs.(128.1±2.8),U=2.000,P=0.023; (119.2 ± 11.3) vs.(131.4 ±2.5),U=3.000,P =0.038.By HE staining in BCS group there was significant intrahepatic congestion which alleviated after surgery.While in PHT group liver pathology did not change significantly after surgery.FPP in BCS and IPH patients significantly decreased after shunt surgery (25 ±8) vs.(41±8) cmH20,t=17.816,P=0.000;(31±8) vs.(45 ±9) cmH20,t =5.745,P =0.010 ). Drop of FPP of BCS group plays a key role in reversal of liver fibrosis.ConclusionsIn BCS group liver pathology improved after shunt surgery probably by removing the intrahepatic obstruction,but in IPH group liver pathology remained unchanged after shunt.

ObjectiveTo evaluate the safety and effects of pseudomonas aerug PA-MSHA vaccine on cytoimmunity in advanced gastric cancer patients. MethodsSeventy two patients with advanced gastric cancer were randomly divided into experimental group and control group. Tumor bed was treated intraoperatively by pseudomonas vaccine injection in experimental group.The venous bloods were sampled prior to surgery (preoperative) and on days 10,20,and 30 postoperatively.The total lymphocyte count and lymphocyte subpopulations were detected while the postoperative complications and adverse drug reaction were observed,prognosis was evaluated. ResultsThe total lymphocyte count(P =0.042) and the counts ofCD3+ lymphocyte(P =0.027) and NK cell increased (P =0.012) obviously in experimental group.CD8+ lymphocyte decreased(P =0.037),but the counts of CI4+ lymphocyte and CD4+/CD8+ were not significantly different.Complications were not significantly different in the two groups.One year survival rate was longer ( 94.9％ ) in experimental group than that in the control group ( 83.3％ ) ( P =0.022 ).ConclusionsPeritoneal cavity administration with pseudomonas aerug vaccine was safe,and effectively helps regulate cytoimmunity in postoperative patients of advanced gastric carcinoma.

ObjectiveTo evaluate gallbladder conserving gallstone removal and polyps resection using combination laparoscopy,hard gallbladder endoscopy and soft choledochoscopy.MethodsClinical data of 122 patients with cholecystolithiasis or polyps undergoing removal of calculus (polyps) and preservation of gallbladder were analyzed retrospectively.ResultsGallstones in 56 patients and polyps in 24 cases was removed or resected successfully by laparoscopy and hard gallbladder endoscopy; In the remaining 34 cases stones were completely removed by combination soft choledochoscopy; 8 cases were converted to laparoscopic cholecystectomy.Romoved stone was single in 25 cases and multiple in 65 cases,with the number ranging from 1to 52,the diameter of stone ranged from 0.2 cm to 3.2 cm.In the 24 gallbladder polyps,7 cases were single,17 cases were multiple,the diameter of polyp ranged from 0.8cm to 1.2 cm.The operation time was 40-125 (78) min. The mean hospitalization was 4 days. No intraoperative and postoperative complications occurred.All patients were followed up for 1year.Gallstones recurred in 3 cases,and the recurrence rate was 3.06％. ConclusionsLaparoscopy combined with hard gallbladder endoscopy and soft choledochoscopy for removing calculi (polyp) and conserving gallbladder is safe and feasible.

ObjectiveTo summarize the experiences in surgical and endovascular treatment for isolated iliac artery aneurysm.MethodsData of 17 cases with isolated iliac artery aneurysm were reviewed and analysed retrospectivel.17 cases were examined with color Doppler ultrasounograpy preoperatively,13 cases underwent computed tomographic angiography (CTA),2 cases did digital subtraction angiography (DSA).Artificial graft interposition were performed in 10 cases with unilateral iliac artery aneurysm,endovascular repair were performed in 6 cases.One case was treated by artificial graft interposition after a failed endovascular repair. ResultsPreoperativaly correct diagnosis was established in all 17 cases,and they were cured after operation.The average operative time was (3.7 ± 1.2) h in group of surgical operation,and ( 1.4 ±0.7) h in group of endovascular treatment (P ＜0.05).The length of hospital stay was ( 16 ± 5 ) d for the group of surgical operation,and ( 9 ± 4 ) d for endovascular treatment ( P ＜ 0.05 ).The percentage of blood transfusion was 72.7％ ( 8/11) in the group of surgical operation,and 16.7％ (1/6) in the group of endovascular treatment.There were a ureteral injury and a ectopic embolism happened during the procedure.There were 2 hip claudication and 2 type Ⅰ endoleaks after operation,which subsided after 3 months.ConclusionsArtificial graft interposition or endovascular repair is effective treatment for isolated iliac artery aneurysm which has the advantage of minimally invasiveness and rapid recovery.

ObjectiveTo explore the effect of endovascular treatment for closed limb artery trauma. MethodsFrom March 2006 to December 2011,the clinical data of 12 cases treated for closed limb artery trauma were analyzed retrospectively.Catheters sheath were placed by antegrade or retrograde puncture.Catheters was send to the proximal end of the lesion.Intraoperatively through angiography the location and extent of arterial lesions were determined.Catheter with the help of guidewire were sent through the lesion to establish treatment “ pathway,at the lesion site suitable stents were placed to repair damaged arteries. ResultsThe procedure was all successful in 12 patients,there was no mortality nor sever compalications.Postoperatively 2 cases suffered from acute renal failure,and were managed and cured by continuous veno-venous hemofiltration (CWH).Osteofascial compartment incision decompression was carried out in 3 cases due to osteofascial compartment syndrome.One case of them suffered from amputation due to sever muscle necrosis and lost of limb function.Eleven patients were followed-up for 1year.All the arteries were patent.There were no stent break,deformation or stenosis.ConclusionsEndovascular techniques for the treatment of closed limb arterial trauma is safe and effective.

ObjectiveTo study the feasibility,safety and effect of laparoscopic splenectomy and selective pericardial devascularization in the treatment of portal hypertension.MethodsThis study included 7 patients diagnosed as posthepatitie cirrhosis and portal hypertension with a history of up GI bleeding receiving laparoscopic splenectomy and selective pericardial devascularization.ResultsThe operation was successful in all 7 patients without conversion to laparotomy.There were no postoperative severe complications.The average operation time was 4.2 h,mean blood loss was 430 ml.All patients recovered well,and were followed-up for 0.5 ～ 2.0 years,and there was no rebleeding in this period.ConclusionsLaparoscopic selective pericardial devascularization is feasible,safe,minimally invasive.The short to mid term result was satisfactory.

ObjectiveTo evaluate interventional therapy for Buddi-Chiari syndrome with occlusive hepatic veins.MethodsIn this study,37 Budd-Chiari syndrome cases with occlusive hepatic vein undergoing abdominal ultrasonography, CT scan, and liver vascular reconstruction before operation.Interventional procedures included recanalization of occlusive hepatic veins through transjugular,transfemoral vein or both. ResultsProcedures were successful in 34 patients (success rate 34/37,92％ ),with 38 hepatic veins opened. After hepatic vein was opened,nine patients were treated with PTA alone.27 stents were placed in 25 patients,with 2 cases receiving stent placement in both the right hepatic vein and accessory hepatic vein.7 home-made Z-stent were placed after the opening of occluded inferior vena cara.After the procedures hepatic vein pressure dropped from ( 36.0 ± 3.4) cm to ( 21.0 ± 2.3 ) cm H20.Recurrence of stenosis or oclusion was found in 4 out of 9 receiving PTA only after a follow-up of (23.0 ± 2.0) months.In the other 23 patients with stent implantation there were 6 eases of restenosis or occlusion (6/23,26％ ). ConclusionsAccording to the hepatic vein and intrahepatic collateral venous occlusion conditions,correct selection of interventional methods can significantly decrease the hepatic and portal vein pressure,improve clinical symptoms.

ObjectiveTo study the effect on humoral immunity with combination of CsA and IL-2 fusion protein. MethodsForty C57/B6 mice were evenly divided into four groups,after receiving skin graft from DBA mouse.Mice in the experimental group was given CsA(30 mg/kg,ip) plus IL-2/Fc (1μg,ip) while the control group was only given CsA,each group was given HBV vaccine after skin graft surgery (2 μg,im),while blank group was only given vaccine after skin transplantation.The fourth group were left intact.Fourteen days later,the level of HBSAb,IL-4,IL-10,IFN-γ,IL-2 were measured with ELISA and IL-21and FoxP3 expression level and Tfh percentage of mixed lymphocytes detected. ResultsThe HBSAb level in experimental group is significantly higher than that in the control group and the survival time of skin graft is longer than that in the control group ( F =29.886,P =0.010 ; F =29.772,P =0.011).IL-2,IFN-γ are significantly higher than that in the control group( F =18.156,P =0.0020;F =90.042,P =0.003 ),but the Th2 cytokines such as IL-4,IL-10 are lower ( F =42.102,P =0.009 ; F =23.734,P =0.015 ).The expression level of both IL-21and FoxP3 are significantly higher than control group( F =9.784,P =0.048 ;F =27.883,P =0.012). ConclusionsCombination of CsA and IL-2 fusion protein can significantly enhance the immunogenicity of HBV vaccine and prolong graft survival time.It may be related to the higher expression level of IL-21and FoxP3.

ObjectiveTo study the biologic distribution of 131I-Herceptin in BALB/c-neu nude mice bearing HER-2 positive SK-BR-3 human breast cancer xenografts and the radioimmunoimaging characteristics of nude mouse bearing human SK-BR-3 breast cancer xenografts. MethodSK-BR-3 breast cancer cells were implanted subcutaneously to athymic mice to establish animal model.Tumor bearing mice were continuously imaged with SPECT. The radiocounting per minute (cpm) of different organ on a γ-arithmometer was measured at 4,12,24,48 h postinjection of 131I-Herceptin or 131I-mlgG,and the T/NT ratios and the uptake percentages per gram of the injection dose (％ ID/g) was gained. ResultsModel was established in 96％ nude mouse.Compared with the control group,there was a significantly stronger contrast enhancement of tumor imaging,bigger T/NT and ％ ID/g in experimental group ( P ＜ 0.0l ).Conclusions 131I-Herceptin concentrates obviously in implanting tumor tissues of nude mouse,hence it is a good radiopharmaceutical agent targeting SK-BR-3 xenografts.

ObjectiveTo explore the influencing factors in neoadjuvant chemotherapy on pathological complete response (pCR),by analyzing the effect of 6 cycles epirubicine combined with docetaxel(ET) regimen in breast cancer patients. MethodsFrom June 2009 to September 2011,clinical date of 52 Ⅱ,Ⅲ stage breast cancer patients treated with ET regimen for neoadjuvant chemotherapy for 6 cycles were retrospectively analyzed.The curative effect was evaluated by palpation and ultrasonography,and finally compared with postoperative pathological results. ResultsIn these 52 patients,the total pCR rate was 42.3％ after 6 cycles chemotherapy.After the first circle of chemotherapy,pCR rate was higher in patients with tumor size reducing ＞ 30％ than those ＜ 30％ as measured by ultrasonography(60.9％ vs.27.6％,P ＜0.05 ).Higher pCR rate was obtained in patients with tumor size ≤3 cm than those in which the initial tumor size ＞ 3 cm(52.9％ vs.22.2％,P ＜0.05) after 6 cycles ET neoadjuvant chemotherapy.PCR rate was higher in patients with positive HER-2 or triple negative breast cancer after 6 cycles than those with luminal type 1breast cancer ( 77.8％,75.0％ and 25.7％,respectively,P ＜ 0.05 ).Logistic regression analysis showed that tumor size and its early response to neoadjuvant chemotherapy evaluated by ultrasonography were the significant predictive factors. ConclusionsHigher pCR rate can be achieved after 6 cycles ET regimen neoadjuvant chemotherapy in stage ]Ⅱ,Ⅲ breast cancer patients.Tumor's early response to chemotherapy as evaluated by ultrasonography could forecast the pCR.Tumor size and molecular type are important influencing factors on pCR in breast cancer patients.