Objective To evaluate the application of a new laparoscopic hepatic forceps for laparoscopic liver resection in pigs.Methods A laparoscopic hepatic forceps was designed by using the CAD software,and was manufactured in coordination with the Hangzhou Kangyou Medical Company for pilot tests.An assessment was made on outcomes of the forceps for blocking hepatic blood flow and controlling cut surface hemorrhage in laparoscopic hepatectomy in 12 pigs.Results The experimental group had a significantly lower intraoperative blood loss than control group(47.8 ?6.9 ml vs 86.3?3.9 ml;t=11.898,P=0.000) and a significantly shorter operation time than control(53.2?7.4 vs 97.5?5.8 min;t=11.541,P=0.000).No significant difference was observed in the weight of resected liver between experimental and control groups(34.7?4.2 g vs 35.3?4.2 g;t=0.245,P=0.812).Conclusions This new laparoscopic hepatic forceps can be used for the occlusion of liver blood flow,offering advantages of less blood loss and shorter operation time and facilitating laparoscopic performance in liver resection.

Objective To summarize the clinical experiences and efficacy of laparoscopic total extraperitoneal repair(TEP) for inguinal hernia.Methods From April 2004 to August 2006,294 TEP operations was performed on 269 patients with inguinal hernia by using laparoscopy under epidural or general anesthesia.Among the patients,175 had indirect hernia,40 direct hernias,25 bilateral hernias,and 29 recurrent hernias.Results The operation was completed without converting to open surgeries in all the cases.The mean operation time was(63.1?37.5) min,blood loss(12.3 ?8.2) ml,and hospital stay(3.7 ?1.4) d.Of the patients,24 had peritoneal tearing(8.2%,24/269),4 had groin hematoma(2.4%,4/269),and 2 had foreign body sensation(0.7%,2/269).The patients were followed up for 6-12 months(median,9 months),the recurrence rate was 1.0%(3/294). Conclusion Laparoscopic TEP is safe and effective for patients with inguinal hernia.

Objective:To explore the mechanism for immunomodulatory activity of Astragalus polysaccharide (APS) with peripheral blood mononuclear cells(PBMC)-derived plasmacytoid dendritic cells (pDCs) from healthy volunteers.Methods:Healthy volunteers-derived pDCs were sorted by flow cytometry,then incubated with APS (0m50,100,200 mg/L ).After 24 hours,the concentration of IFN-?,TNF-?,IL-6 was detected using ELISA.After 5 days,the cultured cells were collected and analyzed by flow cytometry,light microscope and electron microscope scanning.Results:APS-treated pDCs secreted higher level of IFN-?,TNF-?,IL-6.APS could promote differentiation of pDCs to dendritic cells (DCs) which displayed more matured morphology and immunophenotypes compared to the untreated-pDCs.Conclusion:APS could increase the immune function of pDCs,promote differentiation and maturation of pDCs.

Objective To explore the mechanism of immunomodulatory activity of triptolide on healthy volunteers peripheral blood mononuclear cells (PBMC)-derived plasmacytoid dendritic cells (pDCs). Methods Healthy volunteers-derived pDCs were sorted by flow cytometry, then incubated with triptolide (0, 5, 10, 30 μg/L). After 24 hours, we detected the concentration of IFN-α, IL-6, TNF-α using ELISA. After 5 days, the cultrural cells were collected and analyzed by flow cytometry, light microscope and electron microscope scanning. Results Triptolide-treated pDCs secreted lower level of IFN-α,IL-6 ,TNF-α, triptolide could inhibit pDCs differentiation to DCs which displayed more immature morphology and immunophenotypes than untreated-pDCs. Conclusion Triptolide could decrease the immune function of pDCs, inhibit differentiation and maturation of pDCs.

Objective To explore the mechanism of immunomodulatory activity of triptolide on systemic lupus erythematosus(SLE) patients peripheral blood mononuclear cells( PBMC)-derived dendritic cells (DCs).Methods SLE -derived DCs were sorted by flow cytometry from peripheral blood mononuclear cells,then incubated with triptolide (0,5,10,30 μg/L ).After 24 h,we collected the supernatants and then detected the concentration of IFN-α,IL-6,TNF-α using ELISA.After 5 d,the cultrural cells were collected and CD11c,CD80,CD86 expression of DCs were analyzed by flow cytometry,we observed the morphology of DC by light microscope and electron microscope scanning.Results Triptolide -treated DCs from SLE patients with active and stable disease secreted lower level of IFN-α,IL-6,TNF-α,triptolide could inhibit DCs differentiation,which displayed more immature morphology and immunophenotypes than untreatedDCs.Conclusion Triptolide could decrease the immune function of DCs from SLE,inhibit differentiation and maturation of DCs.

Objective To sudy the changes in mTOR signaling pathway in childhood aplastic anemia(AA) by detecting the expression levels of the molecules of mTOR signaling pathway in T cells,and to explore immunologoical pathogenesis of AA in children from T cell intracellular signal transduction pathway.Methods Peripheral blood samples were collected from 16 newly diagnosed severe AA(SAA) patients and 8 patiens treated with effective immunosuppressive therapy,and the findings were compared with those of 17 healthy children (normal controls) and CEM cells (positive controls).The expressions of p-Akt,p-TSC2,p-mTORC1,p-4EBP1,p-p70S6K in CD3 + T cells in peripheral blood were detected by flow cytometry(FCM).Results 1.The expressions of p-Akt,p-TSC2,p-mTORC1,p-4EBP1,pp70S6K of the newly diagnosed SAA group were higher than those of the normal control group (P ＜ 0.05),but were lower than the postive control group (CEM group) (P ＜ 0.05).The mean fluorescence intensity (MFI) of p-Akt of three groups was 8.04 ± 3.78,2.59 ± 1.01 and 20.23 ± 8.98 respectively ;p-TSC2 was 49.73 ± 19.49,16.10 ± 8.04 and 101.05 ± 29.78 respectively ; p-mTOR was 13.90 ± 9.32,2.92 ± 1.09 and 34.3 ± 19.03 ;p-4EBP1 was 142.69 ± 53.36,26.91 ± 13.70,256.01 ± 53.79 ; p-p70S6 K were 17.67 ± 10.48,3.69 ± 2.22,31.73 ± 12.85 respectively.2.The expressions of p-Akt,p-TSC2,p-mTORC1,p-4EBP1,p-p70S6K of the effective treatment groups were lower than those of the newly diagnosed SAA group (P ＜ 0.05) ; the expressions of p-Akt,p-TSC2,p-mTORC1,p-p70S6K were similar to those of the normal control group(P ＞ 0.05),but the expressions of p-4EBP1 were higher(P ＜ 0.05).The MFI was followed by 3.28 ± 1.27,16.50 ± 10.91,3.54 ± 1.66,74.89 ± 49.69 and 4.21 ± 1.69.Conclusions 1.The expressions of p-Akt,p-TSC2,p-mTORC1,p-4EBP1,p-p70S6K were increased in the newly diagnosed SAA patients,the mTOR signaling pathway was activated in SAA patients.2.The expressions of p-Akt,p-TSC2,p-mTORC1,p4EBP1,p-p70S6K were lower than those of the newly diagnosed SAA patients.The degree of activation of mTOR signaling pathway was associated with disease status.The signaling pathways may be involved in the T cells of AA of the immune abnormalities.

176.2,P0.05).Conclusions The tight adherence around catheter is formed in 5 days after PTCD.

Objective To investigate the feasibility and clinical efficacy of laparoscopic disc hand assisted laparoscopic splenectomy(LDHALS) for patients with ruptured spleen.Methods LDHALS was performed in 14 patients with ruptured spleen,and among them,8 cases were combined with other visceral trauma.Results All cases were performed successfully by using LDHALS.The median operation time was 70 min(45～100 min).The average hospital stay was 7 days in 6 cases with only spleen trauma and 13.5 days in 8 cases combined with other injuries.No major operative complications and mortality occurred.Conclusion The LDHALS is safe,effective,simple and flexible performed for patients with ruptured spleen.

OBJECTIVETo investigate the effect of perioperative application of intestinal probiotics to substitute oral intestinal antimicrobial agents on intestinal flora and immune function in surgical patients with colorectal cancer.

METHODSSixty patients with colorectal cancer undergoing elective laparoscopic radical surgery were randomized to receive preoperative bowel preparation using oral intestinal antimicrobial agents (n=20) or using oral intestinal probiotics (Jinshuangqi Tablets, 2.0 g, 3 times daily) since the fifth day before the operation and at 24 h after the operation for 7 consecutive days. Upon admission and 7 days after the operation, fecal samples and fasting peripheral venous blood were collected from the patients to examine the intestinal flora and serum levels of interleukin-2 (IL-2), IgA, IgG, and IgM, NK cell activity, T lymphocytes subsets CD3(+), CD4(+), CD8(+) and CD4(+)/CD8(+) ratio.

RESULTSAt 7 days after the operation, the patients receiving probiotics showed significantly increased counts of intestinal Bifidobacterium, Lactobacillus, and Enterococcus (P<0.05) and significantly lowered counts of Escherichia coli and Staphylococcus aureus (P<0.05). The serum levels of IL-2, IgA, IgG and IgM as well as CD4(+) cell percentage all increased significantly in probiotics group compared with those in patients with conventional intestinal preparation (P<0.05).

CONCLUSIONSPerioperative application of intestinal probiotics to replace preoperative oral intestinal antimicrobial agents can effectively correct intestinal flora imbalance and improve the immune function of surgical patients with colorectal cancer.

Aged ; Bifidobacterium ; Colorectal Neoplasms ; immunology ; microbiology ; Female ; Humans ; Intestines ; microbiology ; Intraoperative Period ; Male ; Middle Aged ; Premedication ; Probiotics ; therapeutic use ; Prospective Studies ; Single-Blind Method

Objective:To investigate clinicopathological characteristics of misdiagnosed pediatric extraskeletal Ewing′s sarcoma in children, its diagnosis and differential diagnosis, and the reasons of misdiagnosis by pathologists.Methods:The clinical data of 34 cases of pediatric extraskeletal Ewing′s sarcoma diagnosed by the Department of Pathology, Xi′an Children′ Hospital and Xijing Hospital Fourth Military Medical University from January 2011 to July 2019 were retrospectively analyzed.Hematoxylin-eosin staining, immunohistochemical staining and EWSR1 fusion gene detection by fluorescence in situ hybridization (FISH) were performed on 6 primarily misdiagnosed cases.The clinical features, histological morphology, immunophenotype and molecular genetics of these 6 patients were studied. Results:The median age of 6 cases was 7 years old.There were 5 cases with slowly-growing, painless and localized masses.Four masses were located in the superficial subcutaneous fascia, and 1 was a rapidly growing soft tissue mass.Tumor cells were lobular and nest-like under low power microscopy.At high power microscopy, 2 cases were composed of small blue round cells, and 4 cases had morphological changes, including an increase in cell volume and enriched cytoplasm.Among the 4 cases with tumor morphological changes, tumor cells of 1 case had fine and smooth chromatin, tumor cells of 1 case had clear nuclei and prominent nucleoli, tumor cells of 1 case were composed of epithelioid cells, and tumor cells of 1 case were mixed spindle and epithelioid cells in large round and oval cells.The positive rates of CD 99, friend leukaemia integration-1(FLI1) and ERG were 5/6 cases, 5/6 cases and 2/6 cases, respectively.Rearrangements of EWSR1 gene were detected in all 6 cases. Conclusions:Biological characteristics including young onset age, superficial position and primary benign tumor, histological diversity and atypical immunohistochemical markers are 3 important factors contributing the misdiagnosis of extraskeletal Ewing′s sarcoma in children.The diagnosis should be made by combining the clinical features, morphology, immunohistochemical staining and EWSR1 gene detection.