Objective To investigate the clinical efficacy of transumbilical single-incision retrograde laparoscopic cholecystectomy.Me,otis The clinical data of 979 patients with gallbladder diseases who were admitted to the Shengjing Hospital of China Medical University from May 2009 to December 2012 were retrospectively analyzed.The numbers of patients who were admitted in the year of 2009,2010,2011 and 2012 were 51,265,374,289,respectively.The preoperative preparation of transumbilical single-incision retrograde laparoscopic cholecystectomy was similar to that of traditional multi-portal laparoscopic surgery.During the operation,the umbilical incision was selected.After the body and bottom of the gallbladder was dissociated,the cystic duct of gallbladder was dissociated and straightened,which was vertical to the common bile duct.After clipping the proximal part of the cystic duct of gallbladder with 2 hem-o-lock clips,the cystic duct was cut off with the ultrasonic knife,and then the gallbladder was removed.Postoperative nursing was also similar to that of traditional laparoscopic cholecystectomy.Patients were followed up via phone call or out-patient examination till March 2013.The wound infection,incisional hernia,incisional pain,cosmetic benefits were observed.Results No patient was converted to open surgery.Twenty patients were converted to multi-portal laparoscopic cholecystectomy because of severe inflammation (3 patients in 2009,5 in 2010,5 in 2011 and 7 in 2012).The mean operation time and volume of blood loss of the 959 patients were 48.5 minutes and (27 ± 25) mL.The operation time in 2009,2010,2011 and 2012 were 51.8 minutes,49.2 minutes,48.9 minutes and 46.7 minutes.The volumes of blood loss in 2009,2010,2011 and 2012 were 35.0 mL,32.1 mL,33.8 mL and 22.9 mL,respectively.The postoperative pain was slight.Forty-seven patients were administered antalgesics (5 in 2009,12 in 2010,18 in 2011 and 12 in 2012).In the 959 patients,umbilical swelling occurred in 4 patients,and was cured by disinfection treatment.Bile duct injury occurred in 3 patients from 2010 to 2011,timely repair wad done in 2 patients,and 1 was cured by drainage.The mean time of postoperative exhuast time and duration of hospital stay were 2.2 days and 4.2 days.A total of 924 patients were followed up for 1-3 months.The scar was hidden in the navel,and no incisional hernia occurred.Conclusion Transumbilical single-incision retrograde laparoscopic cholecystectomy is safe and effective with cosmetic benefits.

Moyamoya disease (MMD) is a chronic and progressive cerebrovascular disease which is characterized by the bilateral internal carotid artery ends and (or) stenosis or occlusion of anterior cerebral artery and middle cerebral artery initial segments,compensatory proliferation of small blood vessels in the skull base and formation of abnormal vascular network.Its etiology and pathogenesis remains unclear.The present studies speculate that MMD may be a polygenic disease,inflammation,immune response,abnormal cytokine secretion,endothelial progenitor cell change and nitric oxide level change are associated with the occurrence and development of MMD.This article reviews the advances in research on the genetics and pathophysiological mechanism of MMD.

Objective: To observe the effect of double LVIS stent intussusception assisted coils embolization in treatment of intracranial blood blister-like aneurysm (BBA). Methods: Data of 45 patients with BBA and treated by stent-assisted coils embolization were retrospectively analyzed. The patients were divided into double LVIS stent group (DLS group, 18 cases) and non-double LVIS stent group (NDLS group, 27 cases) according to the disparate therapy method. The operation outcomes, perioperative complications and follow-up results were compared between groups. Results: The immediately completely embolization rate in DLS group was 72.22% (13/18), in NDLS group was 55.56% (15/27), and the perioperative complications rate in DLS group was 16.67%(3/18), in NDLS group was 25.93%(7/27) (both P>0.05). No significant difference of the immediately completely embolization rate nor of perioperative complications rate was found between 2 groups (both P>0.05). At the 3- and 6-month follow-up, no significant difference of neurological recovery outcomes post operation was found between 2 groups (both P>0.05). The aneurysm recurrence rate in DLS group was 15.38% (2/13), lower than that in NDLS group (57.89%, 11/19) at 3-month follow-up (P=0.03). No significant difference of aneurysm recurrence rate at 6-month follow-up was found between groups (0 vs 13.33%, P>0.05). Conclusion: Double LVIS stent intussusception assisted coils embolization is safe and effective for treatment of BBA, which can significantly reduce 3-month aneurysm recurrence rate.

Objective To explore selection of the procedures in one stage urethroplasty for treatment of the coexistence of urethral strictures in anterior and posterior urethra.Methods Between January 2008 and December 2014, a total of 27 patients with coexist strictures simultaneously in anterior urethra and posterior urethra were treated in our hospital.The mean age was 38 years old (ranging 13-83 years old.Stricture etiology was secondary to lichen sclerosus in 2 patients, iatrogenic in 3 and posttraumatic in 22.The mean length of urethral stricture was 11cm (ranging 6-14cm).Two procedures for treatment of anterior urethral stricture, including augmentation of urethroplasty using penile skin flap was performed in 20 patients and augmentation of urethroplasty using lingual mucosa in 7.Three procedures for treatment of posterior urethral stricture, including non-transecting spongiosum end to end anastomosis of the two urethral ends was performed in 3 patients, end to end anastomosis of the two urethral ends was performed in 17 and substitution urethroplasty using different tissues was performed in reminder 7 patients.Of them, pedicle scrotal skin urethroplasty was performed in 2 patients and lingual mucosal graft urethroplasty in 5 patients.Results The patients were mean followed up 2.6 years (ranging 0.545.0 years) with an overall success rate of 88.9％ (24 of 27 cases).Complications developed in 3 patients (11.1％).Of the 17 patients with end to end anastomosis, urethral stricture developed respectively 4 and 6 months in 2 patients and voiding well after pedicle scrotal skin urethroplasty.Urethral pseudodiverticulum developed 9 months after pedicle penile flap urethroplasty in another patient and voiding well after urethroplasty.Urethrography showed patent urethra with adequate lumen in the remaining patients and mean urinary peak flows was 21.3 ml/s (ranging 14.2-37.9 ml/s).Conclusions Substitution urethroplasty using penile skin or oral mucosa was more good procedure for anterior urethral stricture during the treatment of the coexistence of urethral stricture in the anterior and posterior urethra.The treatment of posterior urethral stricture was based on the length of the stricture, local condition to make a choice between anastomotic urethral reconstruction and substitution urethroplasty using other tissue.

OBJECTIVETo investigate the therapeutic effect of facial artery perforator flap for the soft tissue defects at nose, lip and cheek.

METHODSThe facial artery perforator adjacent to the defect was identified by Doppler ultrasonography. The perforator flap was designed according to the defect location, size and shape. The subcutaneous tissue around the perforator was kept as much as possible to protect the venous drainage.

RESULTSFrom Oct. 2012 to Oct.2013, 26 cases were treated with facial artery perforator flaps, with 9 cases of nasal defects, 10 cases of lip defects and 7 cases of buccal defects. The defects size ranged from 1.5 cm x 2.0 cm to 3.0 cm x 3.0 cm and the flaps size ranged from 2.0 cm x 2.5 cm to 3.5 cm x 3. 5 cm. Superficial necrosis(3mm in width) happened at the end of one flap. All the other 25 flaps survived completely. 16 cases were followed up for 3 months to 2 years with no relapse and satisfactory cosmetic and functional results were achieved.

CONCLUSIONSBoth cosmetic and functional effect can be achieved with facial artery perforator flap for defects at nose, lip and cheek.

Arteries ; Cheek ; surgery ; Graft Survival ; Humans ; Lip ; surgery ; Nose ; surgery ; Perforator Flap ; blood supply ; transplantation ; Rhinoplasty ; methods

Objective To investigate the effect of total glucosides of paeong (TGP) on the liver lipid infiltration and fibrosis in rats with non-alcoholic fatty liver disease (NAFLD) induced by fructose and high-fat diet. Methods Fructose-high-fatty induced NAFLD rat model was established. Metformin ( MET,200 mg · kg-1 ) and TGP (200,100 mg · kg-1 ) was intragastrically given to the rats in the treatment group,TGP high dose and low dose group,respectively. Normal control group and model control group was intragastrically treated with equivalent distilled water (10 mL·kg-1 ). At the fourth week after the treatment,all the rats were sacrificed and the indices such as serum fasting blood glucose(FBG),INS,insulin sensitivity index (ISI),triglycerides(TG),apelin-36,visfatin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),free fatty acid (FFA),collagen Ⅲ(COLⅢ),collagen Ⅳ(COLⅣ) were determined. Hepatic content of TG was determined and the pathological changes in the liver tissues were observed under the microscope. Results As compared with the model control group,TGP effectively decreased FBG,INS,TG in serum and liver tissues,activity of ALT and AST in serum and content of FAA,Apelin, Visfatin,COLⅢ and COLⅣ,with significant differences (P<0. 05 or P<0. 01). TGP alleviated lipid infiltration and fibrosis in rat liver tissues. Conclusion TGP can inhibit effectively lipid infiltration and fibrosis of NAFLD rats,probably through improving glucolipid metabolism and antogonizing insulin resistance.

Objective To compare the effects of two different parenteral nutrition solutions on nutritional status of premature infants,such as the early physical,serum prealbumin,retinol binding protein and albumin.Methods We collected 61 cases of premature infants in neonatal intensive care unit of the Third Military Medical University Xinqiao Hospital,which were divided into 2 groups of traditional parenteral nutrition (TTPN) and early parenteral nutrition (ETPN).Group TTPN geted 6％ paediatric compound amino acid 0.5 g/(kg·d) at24 hours after birth,daily increasing 0.25 ～0.5 g/(kg·d),up to 3.0 g/(kg·d).The 20％ long-chain fat emulsion 0.5 g/(kg ·d) was applied at 3 days after birth,daily increasing 0.25 ～ 0.5 g/(kg·d),up to 3.0 g/(kg·d).Group ETPN get 6％ paediatric compound amino acid 1 g/(kg·d) at 12 ～24 hours after birth,daily increasing 0.5 g/(kg·d),up to 3.0 ～ 0.5 g/(kg· d).The 20％ long-chain fat emulsion 0.5 ～ 1.0 g/(kg·d) was applied after 24 hours after birth,daily increasing 0.5 g/(kg· d),up to 3.0 g/(kg· d).We calculate calorie and amino acid intake of the two groups,and compared the weight,length,head circumference growth,serum prealbumin,retinol-binding protein and albumin levels of the two groups.Results The amino acid and total caloric intake of Group ETPN were significantly higher than those of Group TTPN (P ＜ 0.05).No statistical differences in the albumin,prealbumin,and retinol binding protein level of the two groups at birth (P ＞ 0.05).However,the prealbumin and retinol-binding protein level of group ETPN significantly higher than those of Group TTPN (P ＜ 0.05) at 7 days after birth.Conclusion Early parenteral nutrition in early life can effectively improve physical growth and nutrient metabolism status of premature infants.Prealbumin and retinol-binding protein are sensitive to evaluate the protein nutritional status in premature infants.

Objective To explore the outcome of modified bladder neck reconstruction in treating the urinary incontinence due to the sphincter dysfunction.Methods Between January 2010 and December 2014,a total of 23 patients,including 16 male and 7 female cases,with incontinence due to sphincter dysfunction had undergone a procedure of modified bladder neck reconstruction.The mean age was 36 years (range 17-61 years).Etiology of incontinence was secondary to pelvic fracture and urethral rupture procedure in 19 patients and other failure procedures in 4 cases.The mean duration of incontinence was 2 years (range 1-5 years).Urodynamic examination was performed in all patients and the mean maximum urethral pressure was 34 cmH2O (range 21-43 cmH2O).The modified bladder neck reconstruction was performed in 23 patients.Under the general anesthesia and vertical bladder incision,triangular mucosal strips,from the bladder neck to ureteral office,were denuded and leaving the central urethral plate,which was 2.0-2.5 cm in width.In order to form a neourethra and bladder neck,the multilayer triangular muscles were sutured interruptedly over a 14-16 F catheter using 2-0 or 3-0 polyglactin.And the anterior wall of the bladder was then closed over the new bladder neck using continuous sutured.Results The 23 patients were followed up for 6 months to 3 years,mean 1.4 years.Continence achieved in 5 patients.Of them,2 patients had difficulty in voiding but corrected by indwelling the catheter for another 2 weeks.Social continence was achieved in 7 patients.Incontinence status was improved in 7 cases and failed in 2 cases.Urodynamic examination was performed in 4 patients and the mean maximum urethral pressure was 64 cmH2O (range 52-72 cmH2O).Conclusions Our study suggested that the modified bladder neck reconstruction was a good procedure for the treatment of urinary incontinence due to sphincter dysfunction,particularly for the incontinence secondary to the traumatic urethral stricture or other operation.

Objective To investigate the influence of FOXP 3 expression in pancreatic carcinoma cells (PCCs) on the maturation and immunologic function of dendritic cells (DCs).Methods The siRNA sequences targeting FOXP3 gene (siRNA-FOXP3) and negative control siRNA (siRNA-NC) were specifically designed and transfected into PCCs , then the level of IL-10 and TGF-β1 of culture supernatant were detected by ELISA.The supernatants of pancreatic carcinoma cell transfected by FOXP 3-siRNA were collected , then it was mixed with GM-CSF and IL-4 to induce the differentiation of DCs .Flow cytometric analysis were used to measure the expression of surface markers CD 86 , CD80 , HLA DR on DCs which were treated with supernatants . The levels of IL-12p70, IFN-γin supernatants were detected by ELISA .The DCs were co-cultured with T lymphocytes, and then the lymphocytes proliferation and cytoxicity were analyzed by CCK -8 assays.Results Compared with PANC1 with siRNA-NC transfection, PANC1 with siRNA-FOXP3 transfection had a decreased expression of IL-10, TGF-β1 [(8.93 ±3.06)ng/L vs (26.60 ±5.57)ng/L;(2 544 ±78)ng/L vs (2 856 ± 92)ng/L], the positive expression rate of CD86, HLA DR in DCs cultured in the medium containing the supernatants of the pancreatic carcinoma cell transfected by siRNA-FOXP3 was significantly increased [(28.10 ±3.11)%vs (13.90 ±0.42)%;(66.15 ±4.17)%vs (43.15 ±3.32)%], the expression of IL-12p70, IFN-γwas significantly increased [(52.75 ±7.89)ng/L vs (26.14 ±4.50)ng/L, (898.43 ±88.82) ng/L vs (412.76 ±24.68) ng/L], after co-culture with lymphocytes at ratios of 1:5, 1:10, 1:20, the proliferation was significantly increased [(95.27 ±3.80)% vs (71.77 ±5.70)%, (78.97 ±5.73)% vs (52.30 ±8.72)%, (57.60 ±4.36)% vs (43.73 ±6.01)%], and the cytoxicity of CTL to PANC1 cells with 1:20, 1:40 co-culture was significantly increased [(28.44 ±5.20)% vs (8.82 ±2.29)%, (40.85 ± 5.15)% vs (17.38 ±4.86)%], and the difference between the two groups was statistically significant (P<0.05).Conclusions FOXP3 expression in PCCs can inhibit the maturation and immunologic function of DCs.