The left triangular ligament of liver and its fibrous appendix(free border) was studied in 42 Chinese adult male cadavers. 37 fibrous appendices were further studied histologically.In order to prove the formation of the fibrous appendix 30 left triangular ligaments of new born cadavers were also studied. The average length of the left triangular ligament of adult cadavers was 13.91cm.,and that of their fibrous appendices was 6.86cm. Almost all of the left triangular ligaments were attached to the superior surface of the left lobe of liver,consequ- ently, the left suprahepatic space could be properly subdivided into anterior and posterior left suprahepatic spaces by the ligament. The forms of the fibrous appendices were classified into 5 types:triangular (23.8％), narrow band(14.3%), triangular-narrow band(50.0％),membranous (7.1%), and bifurcate type(4.8%).The left triangular ligaments of the 30 new born cadavers were devoid of fibrous appendix. Histological observations of the 37 fibrous appendices showed:aberrant bile ducts were found in 89% of the cases, rudimentory liver-cell cord 65％,nerves 78％, and blood vessels 100％.Their size and number diminished gradually from the pro- Kimal (hepatic) end of the fibrous appendix to the distalend. The authors agreed with Toldt and Zuckandl that the fibrous appendix might be the result of the retrogression of the left lobe and suggested that the occurrence of the fibrous appendix was after birth. The clinical importance of the fibrous appen- dix was discussed.

Objective To observe the effects of different posture on hemodynamics and plasma atrial natriuretic polypeptide(ANP) during laparoscopic surgery. Methods Forty patients who scheduled for elective laparoscopic surgery under general anesthesia were allocated into two groups according to their posture during laparoscopic surgery,20 cases for each group. In group A, the patients were arranged in a head-down tilt position, in group B, the patients were arranged in a head-up tilt position systolic blood pressure (SBP),diastolic blood pressure (DBP),central venous pressure (CVP) and electro cardio gram (ECC) were monitored continuously. Blood samples were taken from central venous at four time points of prepneumoperitoneum(T1), 10 minutes after that(T2) and 20 mintues(T3) when the patients were arranged at the different operation-needed position with a stable pneumoperitoneum pressure of 14 mm Hg (1 mm Hg = 0.133 kPa),and at 5 minutes (T4) after deflation of pneumoperitoneum when the patients returned to supine position. The plasma ANP was assessed by radioimmunoassay. Results In group A,the CVP at T2 and T3 [(14.45 ±2.72),(14.20 ±2.46) mm Hg] was significantly higher than that at T1 [(6.05 ±1.76) mm Hg] (P<0.01), in group B,the CVP at T2 and T3 [(8.90±1.27),(9.02 ±0.47) mm Hg] was significantly higher than that at T1[(6.30 ±1.34) mm Hg](P< 0.01) ,with a higher level in group A than those in group B at the same time point during pneumoperitoneum(P< 0.01). The ANP level in group A was higher at T2 than that at T1, and there was significantly higher at T3 than that at T1 (P < 0.05). But the ANP level was significantly higher in group A than that in group B at the same time points of T2 and T3 (P < 0.05). Conclusion The posture may have obvious effect on CVP and plasma ANP level during laparoscopic surgery.

Objective:To evaluate the effect of resection of frontal ethmoid sinus osteomas with nasal endosco-py. Method: Eighteen cases of frontal ethmoid sinus osteoma from 2005 to 2008 were enrolled in our study, including 8 cases of frontal sinus osteomas, 6 cases of ethmoid osteomas and 4 cases of frontal sinus osteomas extending to ethmoid sinus. Seventeen cases were treated by an endoscopic approach alone, and one case treated by a combined endoscopic and an external approach. Result: All cases were resected completely without complications. The preoperative symptoms disappeared without recurrence within the follow-up periods , ranging from 6 months to 3 years. Conclusion: Most frontal ethmoid sinus osteomas can be resected with nasal endoscopy aided by extra nasal incision in some cases.

Objective To evaluate the significance of the expression level of aldo-keto reductase family 1 member C3(AKR1C3) for esophageal carcinoma patients treated with radiotherapy.Methods The clinical data of 28 patients with locally advanced esophageal carcinoma treated with radiotherapy alone was retrospectively analyzed, and the expression level of AKR1C3 was detected by immunohistochemistry.Statistical analysis was performed using SAS 8 statistical software, P<0.05 was considered statistically significant difference.Results The expression level of AKR1C3 was different in esophageal carcinoma patients at different levels of differentiation.The level of AKR1C3 expression was negatively correlated with efficacy of radiotherapy (P=0.031, 95%CI 0.151-0.914).Conclusion AKR1C3 can serve as a promising biomarker of the efficacy of radiotherapy for esophageal cancer.

Rhesus retinal vascular endothelial cell line RF/6A cells were treated with human insulin. Cell proliferation, migration, and lumen formation, as well as the expressions of vascular endothelial growth factor-A ( VEGF-A ), VEGF-A receptors, and phosphorylated receptors were measured. Insulin promoted RF/6A cell proliferation, migration, and lumen formation ( all P＜0. 01 ). Insulin increased the expression of VEGF-A mRNA and improved its protein activity ( all P＜0. 05 ), and promoted the expression of VEGFR2 mRNA and its phosphorylation ( both P＜0. 01 ). There was no significant difference in the expression of VEGFR1 mRNA among the groups ( P＞0. 05 ).

Objective:To assess the effects of intranasal cortisteroids application on IL-5 expression in nasal polyps.Methods:Nasal polyps from topical nasal steroid treated patients (n=16) and untreated patients (n=16) were investigated.The specimens were stained by ABC immunohistochemical approach.Results:Most of the IL-5 positive cells were eosinophils,and there was a significant correlation of the mean IL-5 positive cell numbers with total (chromotrope 2R-positive) eosinophil numbers (y=14.782+2.002x,r=0.648,P＜0.01).Compared with untreated polyps,the steroid-treated polyps contained a slightly lower tissue density of IL-5 positive cells,and the difference was not statistically significant.Conclusions:Eosinophils are one of the origins of IL-5 synthesis.The treatment used here was insufficient to affect IL-5 expression in nasal polyps.

Objectives:Dose-response effect of nicorandil cardioplegia at various concentrations was studied to optimize its myocardial protective effect.Methods:Forty-eight isolated working rat hearts were divided into 6 groups randomly.They were group A:control (depolarized cardiac arrest with St.Thomas solution No.2),group B,C,E,F and G:hyperpolarized cardiac arrest (nicorandil concentration were 25,50,100,125 and 150μmol/L respectively).The hearts underwent a 120-minute hypothermic arrest (15±1)℃ with cardioplegia (40 ml/kg) and reinfused with cardioplegia (40 ml/kg) at interval of 30 minutes.Mechanical arrest time,cardiac functional recoveries,myocardial content of malondialdehyde (MDA) and ultrastructure were measured.Results:The protective effect of nicorandil cardioplegia was dose-related.Conclusions:The optimal concentration of nicorandil in cardiplegia may be 100μmol/L for myocardial protection.

OBJECTIVE Evaluation of imaging navigation system during endoscopic sinus surgury and compared endoscopic sinus surgery with and without image guidance, analyzing a number of parameters that can impact on efficacy. METHODS Retrospective review of 76 imaging-navigated endoscopic sinus surgery with image-guidance systems at our department between Jan 2000 and May 2003, including 20 consecutive pituitary adenoma patients and 10 nasal-sinus ossifying fibroma. The control group consisted of 10 nasal-sinus ossifying fibroma patients between Jan 1997 and May 2003 and 20 consecutive pituitary adenoma patients between Jan 1999 and May 2003 who underwent ESS without image guidance. The main outcomes measured were analysis of the using times of different diseases, the user's satisfication in different diseases, and compared pituitary adenoma/ossifying fibroma ESS with and without image guidance. RESULTS The using times of different diseases are different, the user feel satisfication in all cases but the degree is different with diseases. The patient's characterisitics of the two groups of pituitary adenoma/ossifying fibroma were similar in age and gendle. There are no statistically significant differences in estimated blood loss, operative time, anesthesia time. CONCLUSION Imaging navigation systems in different nasal-sinus diseases are all useful. Our experience illustrates the importance of the learning curve, we believe that the problems we had with those systems were largely operator-dependent and that these can be overcome with proper experience and training. For small group patients, it's no evidence to show in ESS can make more complete resection of nasal-sinus ossifying fibroma, but has evidence to show no more cost.

OBJECTIVE To present the modified intranasal endoscopic dacryocystorhinostomy (MIEDCR) and the clinical results. To discuss the modified operative technique and its purpose. METHODS A total of 31 cases (35 eyes) with chronic dacryocystitis who underwent MIEDCR were included in this study. There were 27 female and 4 male. The age was ranged from 9 to 70 years (mean 31 years). The preoperative dacryocystography was taken in all cases. The follow up time was 6 to 20 months. RESULTS Among the 31 cases with chronic dacyocystitis, 4 patients suffered bilateral chronic dacyocystitis. Dacryocystitis related to nasal endoscopic surgery was found in 2 cases (2 eyes). Four cases (5 eyes) had prior laser lacrimal duct surgery. Two patients had external dacrypcystorhinotomy experience. 34 MIEDCR procedures (97.1 %) were successful. Twenty eight patients (32 eyes) were free of their symptoms and kept stoma patency. The shift of mucosal flap was found in one case when Merocel was removed. The rhinostomy of another 2 cases were closed due to mucosal scar and one of them received revision surgery. There were no operative complications. CONCLUSION The preserved nasal mucosal flap which was replaced over the denuded bone would avoid scar formation and hyperostosis and is benefit to gain a satisfied and good clinical effects of dacryocystorhinostomy.

OBJECTIVE To recognize the frontal recess cells and analyze their distributional characteristics during image navigation assisted endoscopic sinus surgery. METHODS 20 cases(39 sides)of chronic sinusitis with nasal polyps were observed in this study. The fontal recess cells and frontal sinus were opened under the endoscope and the distributional characteristics were observed and recorded, and then confirmed by the image navigation system. RESULTS Centred on frontal sinus ostium, frontal recess cells were divided into three areas: the agger nasi cell(ANC)and frontal cells(FC)are located in front of frontal sinus ostium(FS); frontal septum cells(IFSSC)and terminal cells(RT)are located at the same plane of FS; supra-ethmoidal bulla recess(SBR), frontal bulla cell(FBC)and super-obital cells(SOEC)are in the posterior area. The coincidence of identification for ANC, FCI and II, SBR, FBC and IFSSC under endoscope and image navigation is 100%, the coincidence of identification for FS is 89.7%, SOEC 80%, RT 71.4% and FC III and IV 60%. CONCLUSION The distribution of the frontal recess cells around the frontal ostium showed a fixed pattern.It would well benefit the orientation of frontal ostium and the opening of frontal sinus. Furthermore, it is significant for the orientation and opening of the frontal recess cells.