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.

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.

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 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.

Objective To summarize clinical experiences for the management of upper cervical fracture associated with mild to moderate craniocerebral injury in order to improve the outcome of patients with craniocervical injury.Methods Twenty-two cases (13 males and 9 females) of non-nerve damage treated surgically from June 2008 to June 2012 were enrolled.Mean age was 41 years (range,23-68 years).Mechanisms of injury were traffic accidents in 12 cases,high falls in 7 cases and violence or others in 3 cases.Dens fractures were noted in 7 cases,Jefferson fractures in 5 cases and axial vertebral arch fractures in 4 cases,and combined atlas and axis fractures in 6 cases.Admission Glasgow Coma Score (GCS) was 12-14 points in 10 cases and 9-11 points in 12 cases.All cases suffered some degree of brain damage including brain contusion and laceration,and epidural,subdural or intracerebral hematoma.Three cases of cervical fractures were misdiagnosed in the early stage.Twelve cases required emergent craniotomy due to the primary craniocerebral injury and had elective upper cervical spine surgery until the medical condition was stabilized.Another 10 cases underwent conservation treatment of craniocerebral injury and had cervical spine surgery within 1 week due to the severe dislocation of the upper cervical spine.Operation time,blood loss,hospital stay,hospitalization cost and perioperative complications were analyzed.Outcome was evaluated with Glasgow Outcome Scale (GOS) at discharge.Fracture union,bone fusion and cervical stability were assayed with X-rays and CT films.Results All were followed up for a mean period of 18 months (range,12-36 months).Among the 12 cases of primary craniocerebral injury,operation time was (115 ± 22) min,blood loss was (280 ± 72) ml,hospitalization period was (23 ±7)d and overall cost was 88,000 yuan;one case sustained wound infection cured two weeks after debridement and dressing and two cases sustained pulmonary infection cured after antibiotic treatment;discharge GOS was grade Ⅳ in 2 cases and grade Ⅴ in 10 cases.Among the 10 cases of primary cervical injury,operation time was (125 ± 38) min,blood loss was (330 ± 90) ml,hospitalization period was (17 ± 6)d and overall cost was 61,000 yuan;no perioperative complications occurred;discharge GOS was grade Ⅳ in 1 case and grade Ⅴ in 9 cases.Pain radiating to occipital region,limited neck mobility and other clinical symptoms were alleviated at discharge.X-rays verified good healing of the bone and no malposition of the screws.Conclusion For cervical fracture associated with craniocerebral injury,cervical examination and protection are important.Once medical condition becomes stable,early surgery can be performed for upper cervical fracture.

Objective To measure the expression of protein kinase D1 (PKD1),tyr463-phosphorylaed PKD1 (pPKD1-tyr463) and ser916-phos-phorylaed PKD1 (pPKD1-ser916) in squamous cell carcinoma (SCC),Bowen's disease (BD) and actinic keratosis (AK),and to explore their significance.Methods Fresh tissue samples were resected from lesions of patients with SCC (SCC group),BD (BD group) and AK (AK group),as well as from normal skin of healthy human controls (control group),and each group had a sample size of 10.Real-time RT-PCR was performed to measure the mRNA expression of protein kinase D1 gene (PRKD1),and Western blot analysis to determine the protein expression of PKD1,pPKD1-tyr463 and pPKD1-ser916.In addition,immunohistochemical study was conducted to determine the expression of PKD1,pPKD1-tyr463 and pPKD1-ser916 in another 50 paraffin-embedded skin samples of SCC,20 samples of BD,20 samples of AK and 10 normal skin samples.Results PRKD1 mRNA expression significantly differed among the control group (0.64 ± 0.09),SCC group (5.37 ± 1.06),BD group (2.69 ± 0.72) and AK group (2.43 ± 0.46) (F =21.37,P ＜ 0.05),and was significantly higher in the SCC,BD and AK groups than that in the control group (P ＜ 0.05),as well as in the SCC group than that in the AK and BD groups (both P ＜ 0.05).However,no significant difference in the PRKD1 mRNA expression was observed between the BD group and AK group (P ＞ 0.05).Immunohistochemical study showed that the total PKD1 protein and pPKD1-tyr463 in the SCC and BD groups were mainly expressed in the cytoplasm and cell membrane of spinous layer cells and atypical cells,and their expression rates were significantly higher than those in the AK group and control group (all P ＜ 0.01).The pPKD1-ser916 was only slightly expressed in some cancer nests of well-differentiated SCC tissues,but not in poorly-differentiated SCC,AK,BD tissues and normal skin tissues.In the SCC group,the expression rate of PKD1 increased with the increase of the pathological grade of SCC,and the PKD1 expression was positively correlated with pPKD1-tyr463 expression (rcc =0.479,P ＜ 0.05).Western blot results were consistent with immunohistochemical findings.Conclusion PKD1 and pPKD1-tyr463 may be involved in the development and differentiation of skin tumors derived from stratified squamous epithelium,and PKD1 may exert promotive effects on the formation of cutaneous SCC by activating the Tyr463 phosphorylation site.

One hundred and thirty patients with esophageal carcinoma were randomly asigned into two groups:62 cases received thoracoscopic esophagectomy (TE group) and 68 cases received open thoracic esophagectomy group (OE group).All patients underwent lymph nodes dissection along bilateral recurrent laryngeal nerve.Compared with OE group,TE group had a less blood loss during the lymph nodes dissection (P ＜ 0.05) and a lower incidence of pulmonary infection (P ＜ 0.05).There were no significant differences in the number of dissected lymph nodes,dissection time,incidence of temporary hoarseness,permanent hoarseness and mechanical ventilation for respiratory failure between two groups (P ＞ 0.05).The study suggests that lymph nodes dissection along bilateral recurrent laryngeal nerve can be succesfully completed by thoracoscopic esophagestomy,and it has the advantage of less intraoperative blood loss and lower incidence of pulmonary infection,compared to open thoracic surgery.

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.