Objective To investigate the replantation of complete severed fingertip when vein can't be repaired and only artery be repaired. Methods All 13 cases complete severed fingertips were replantated with only artery anastomosis but vein cannot be repaired.Low molecular weight heparin was applied to prevent blood clotting postoperation. Blood-letting by nail extraction or latero-incision were done in some cases.The survival fingers were observed. Results After 3-12 months followed-up,12 cases survived with satisfactory appearance and locomotion,2-PD of 2-7 mm,but 1 case was failed. Conclusion The replanted fingertip may survival with only artery anastomosis because of fewer tissue and faster recontruction of venous return.It would raise the survival rate of replanted fingertip by blood-letting by nail extraction or latero-incision according to the traumatic condition.

Objective To evaluate segmental resection of involved portal vein (PV) in the surgical treatment of advanced pancreatic carcinoma (PC). MethodsIn our 22 advanced PC patients involving PV and/or superior mesenteric vein (SMV) extended pancreaticoduodenectomy or distal pancreatectomy plus extensive regional lymph node clearance were performed and cancer involved PV and/or SMV segment were resected enbloc. Results Among 22 cases, 6 underwent wedge resection and repairment of PV or SMV. Eight underwent segmental resection of PV or SMV followed by end-to-end anastomosis in 5,autotransplantation of great saphenous vein in 2, mesocaval shunt in one. The mean operation time was 7 5?h, the average blood transfusion was 600?ml, and there was no mortality in all cases. All 22 patients were followed up with a postoperative survival of 6 mos in one, 12 mos in 3, 18 mos in 6 cases, 24 mos in 8 and 36 mos in 4 cases. ConclusionsIt is rationale to resect the advanced PC en bloc with the cancer involved segment of PV and/or SMV in terms of low morbidity and long postoperative survival.

Objective To investigate the value of spleen stiffness measured by transient elastography (FibroScan,FS) for diagnosing esophageal-gastric varices in liver cirrhosis patients.Methods A total of 259 cirrhotic patients in Tianjin Third Central Hospital from Apr 2011 to Apr 2012,and 30 healthy controls were enrolled.All the patients and controls were evaluated for spleen and liver stiffness by FS and 201 cirrhotic patients also underwent gastroscopy for the diagnosis of esophageal-gastric varices.By using gastroscopy as the gold standard,the receiver operating characteristic (ROC) curves of three parameters including spleen stiffness,liver stiffness and platelet/thickness of spleen were delineated for different disease stage.The areas under curves (AUC) were used to evaluate the value of these parameters in the diagnosis of esophageal-gastric varices.Results The spleen and liver stiffness values in cirrhotic patients were (44.64 ± 22.27) kPa and (24.27 ±18.89) kPa,respectively,while those in healthy controls were (20.94± 14.78) kPa and (6.12±5.77) kPa,respectively,which were both lower than cirrhotic patients (P＜0.05).The stiffness values of liver and spleen both increased with higher Child-Pugh scores.And the liver stiffness values were different among groups (F=0.068,P =0.000),while the spleen stiffness values in patients with Child-Pugh A and B were different from that in patients with Child-Pugh C (P＜0.05).In patients with moderate or serious esophageal-gastric varices,the spleen and liver stiffness values were significantly higher.The ROC curve analysis showed that the AUC of spleen stiffness,liver stiffness and platelet/thickness of spleen in the patients with moderate to serious esophageal-gastric varices were 0.918,0.749 and 0.743,respectively.The corresponding optimal cut-off values were 50.7 kPa,20.1 kPa and 1.65.The AUC,sensitivity and specificity of spleen stiffness were all higher than liver stiffness and platelet/thickness of spleen.Conclusion Spleen stiffness measured by transient elastography is a valuable parameter for non-invasive diagnosis of esophageal-gastric varices in cirrhotic patients.

Objective To retrospectively analyze the diagnostic value of a noninvasive score system based on transient elastography (TE),serological test and imaging examination on esophageal variceal bleeding (EVB) in patients with hepatitis B virus (HBV)-related cirrhosis.Methods Between April 2011 and December 2012,172 patients with HBV-related cirrhosis including 120 males and 52 females who visited clinic or hospitalized at the Department of Hepatology,Tianjin Third Central Hospital,were retrospectively enrolled.The mean age was (52.9 ± 10.6) years.Patients underwent upper gastrointestinal endoscopy to evaluate esophageal varices (EV) and were further categorized into three stages of mild,moderate and severe according to the morphology of EV and the risk of bleeding.Liver stiffness and spleen stiffness measurement were performed using Fibroscan.Portal vein width,splenic width and spleen thickness were measured using color Doppler ultrasound.All the patients were tested for white blood cell counts and platelet counts.With endoscopy as the gold standard,receiver operating characteristic (ROC) curves and the areas under curves (AUC) were used to assess the performance of the noninvasive score system in predicting EV by liver stiffness,spleen stiffness,portal vein width,spleen thickness and platelet counts.Student's t-test was performed to determine differences between continuous variables.Pearson's correlation was used to evaluate the association between EVB and these parameters.Results All these 172 patients underwent endoscopy.Among them,41 were EVB patients and 131 with no bleeding of EV.Among 172 EV patients,39 without EV,30 were mild EV,47 were moderate EV and 56 were severe EV.EVB was all positively correlated with liver and spleen stiffness,portal vein width,spleen thickness,splenic vein width (r=0.224,0.771,0.214,0.425 and 0.364,respectively; all P＜0.05).EVB was negatively correlated with platelet counts (r=-0.408,P=0.000).Liver stiffness,spleen stiffness,portal vein width,spleen thickness and splenic vein width in EVB patients were significantly higher than those in EV patients (P＜0.05).In contrast,platelet counts level was lower in EVB patients with difference of statistical significance (P＜0.05).AUC of non-invasive score system for EV and EVB were 0.953 and 0.882,respectively (P＜0.05).The optimal cut-off level of noninvasive score system for prediction of EV and EBV were 7 (sensitivity:96 ％,specificity:85 ％) in EV patients and 10 (sensitivity:78％,specificity:89 ％) in EVB patients.Conclusion Non-invasive score system based on liver stiffness,spleen stiffness,spleen thickness,width of splenic and portal vein and platelet counts is of clinical importance in assessing the presence of EV in patients with HBV-related cirrhosis,which is higher clinically valuable in the diagnosis for EV.

Objective To investigate the effect of hyperthermic intraperitoneal perfusion and cisplatinon apoptosis in human ovarian cancer cells.Methods Two human ovarian cancer cells (OVCAR-3,A2780) were divided into control group,cisplatin group,hyperthermia group and thermo-chemotherapy group;microscopy was used to observe the morphological changes of the four groups;AO/GV stain and flow cytometry(FCM) was used to analyze cell apoptosis;Apoptosis related genes caspase7,caspase8 and Bax in ovarian cancer cells were detected by fluorescence quantitative PCR.Results Inverted microscopy observeed that the ovarian cancer cells retracted and suspended partially in the cisplatin group and hyperthermia group,especially in the thermo-chemotherapy group.After AO/GV staining,the apoptotic cells were increased in the cisplatin group and hyperthermia group compared with the control group,and the thermo-chemotherapy group was more than cisplatin group and hyperthermia group.FCM results indicated that the proportion of cells apoptosis were higher in the cisplatin group and hyperthermiagroup,the thermo-chemotherapy group is the higher than the all other groups(P＜0.05).q-PCR results showed that in the thermo-treatment group the expression of pro-apoptotic genes,including caspase3,caspase6,caspase7,caspase8,caspase9,Bax,Bak and Bid,was significantly higher than other groups,apoptosis inhibitory gennes,such as Bcl-2,Bcl-xL,Mcl-1,c-FLIP,was significantly decreased than the others.Conclusions Cisplatin plus hyperthermia can promote the apoptosis in ovarian cancer cells.

This study aimed at preparing the chemical reference substance of garcinol.A preparative high-speed countercurrent chromatography (HSCCC) was adopted for the isolation of garcinol from the twigs of Garcinia multifiora Champ,G.esculenta Y.H.Li and the fruits of G.xanthochymus Hook.f.ex T.Anders.The crude extracts were separated by HSCCC with two phase solvent systems composed of n-hexane-ethyl acetate-95％ ethanol-water (8∶8∶12∶4,volume ratio) using the upper stationary phase and the lower mobile phase.Under the conditions of a flow rate of 2.0 and 4.0 mL· min-1,and the apparatus rotation at 850 rpm,the column temperature at 25℃ and the detection wavelength at 254 nm,the fraction containing garcinol was purified by the Sephadex LH20 chromatography.The purity test in the extracts was determined by high-performance liquid chromatography.As a result,the contents of garcinol were 45,281 and 4080mg respectively separated from 104.765 g twigs of G.multiflora Champ,105.270 g G.esculenta Y.H.Li and 102.318 g the fruits of G.xanthochymus Hook.f.ex T.with the purity of 98.72％,98.36％ and 98.42％.Compared with the sample pretreatments and separation efficiency of the three plants,it was found that the fat-soluble extracts rapidly and efficiently extracted using n-hexane-ethyl acetate-95％ ethanol-water (5∶5∶5∶5,volume ratio) contained abundant garcinol taking fruits of G.xanthochymus Hook.f.ex T as the raw material with the combination of HSCCC and Sephadex LH-20 chromatography.In conclusion,it was indicated that the combination method is efficient with high operability and large preparation quantity.

Objective To investigate the efficacy of precise hyperthermic intraperitoneal perfusion chemotherapy (HIPEC) in the treatment of advanced pancreatic cancer.Methods Thirty-six patients with advanced pancreatic cancer were analyzed retrospectively.Eighteen patients who received HIPEC combined with radiotherapy and chemotherapy were assigned as the treatment group and the other 18 patients who received chemotherapy and radiotherapy were assigned as the control group.Recent curative efficacy,Karnofsky Performance Status (KPS) score,postoperative complications and survivals between the two groups were analyzed,respectively.Results Significant differences were found between two groups in total short-term effective rate (P ＜ 0.05).The total short-term effective rate of treatment group and control group were 66.67％ (12/18) and 27.78％ (5/18),respectively.The increment of KPS score of treatment group was significantly higher than that of control group (P ＜ 0.05).There was no significant difference between two groups in postoperative complications (P ＞ 0.05).The median overall survival time (OS) of treatment group was 11 months (7 ～ 31 months),and the median OS of control group was 7 months (4 ～ 18 months).The survival of the treatment group was longer than the control group (P ＜ 0.05).Conclusions HIPEC treatment improved significantly the survival and life quality of advanced pancreatic cancer patients.With acceptable morbidity and mortality rates,HIPEC regime was an effective treatment modality for patients with advanced pancreatic cancer.

Objective To introduce the improvement of the flap from the dorsal site of the index in the application of treatment in the thumb web contracture. Methods Apply improved first dorsal metacarpal flap for 111 cases of patients of the thumb web contracture releasing. The original island or tongue-shaped flaps was modified to be the local flap transfer to the thumb web. Surgical method simplified. Before thumb web contracture was released, the flap was taken from ulnar aspect to radial aspect on the dorsum of the index. The flap was transferred to cover the soft tissue defect on the first web space following the contracture releasing. Flap donor area was closed by split-thickness skin graft. Results One hundred and eleven cases of flaps survived. After the 3-18 months (mean follow-up of 8.5 months), the local appearance, thumb function recovered well for 94.6 percent. Conclusion Improved first dorsal metacarpal flap is effective methods in thumb web contracture releasing.

ObjectiveTo investigate the technique and clinical results of curved osteotomy under the metatarsal head's cartilage for improving reconstructed metacarpophalangeal joint function of fingers with second toe transplantation. MethodsThere were total 21 cases with 21 digits. During second toe transplantation with the metatarsophalangeal joint, the bottom of the second metatarsal head was incised. Then a curved osteotomy were carried out on about 5.0 mm under the metatarsal head's cartilage until the passive range of motion could be 90°.Longitudinal or cross-Kirschner wires were used to fix the joint.Finally,the conventional methods were used to reconstruct the blood supply, movement and nerves. ResultsAll 21 digits of the 21 cases survived uneventfully.The follow-up time was ranged from 6 to 24 months.Their average passive range of motion of the reconstructed metacarpophalangeal joint was 75°,ranging from 65° to 85°.The average active range of motion was 65°, ranging from 45° to 80°. Postoperative X-ray revealed fracture healed well without joint degeneration. ConclusionCurved osteotomy under the metatarsal head's cartilage is an effective way to improve active and passive activities function of the reconstructed metacarpophalangeal joint with second toe transplantation.

BACKGROUND: Traditional scaphotrapeziotrapezoid limited intercarpal arthrodesis contains Kirschner wire, U-shaped nail, AO/ASIF steel plate and so on. Long-term plaster external fixation was needed following surgery. USA-designed arthrodesis apparatus is mainly suitable for European and people from USA, but not fit for Asian.OBJECTIVE: To simulate scaphotrapeziotrapezoid limited intercarpal arthrodesis, and to test the stability of the novel arthrodesis apparatus developed by the group according to anatomic form of dorsal joint fovea of Chinese scaphotrapeziotrapezoid.DESIGN, TIME AND SETTING: The observational study was performed at the Laboratory of Biomechanics of the Department of Orthopaedics, Nantong University from April 2006 to March 2007.MATERIALS: A total of 40 fresh forearm samples of corpses that were not subjected to antiseptic treatment were used for this study. Radiograph verified that these samples did not develop wrist joint affection or abnormal alinement.METHODS: The cadaver models were imitated limited intercarpal instability before scaphotrapeziotrapezoid arthrodesis used circular plate. Then, simulated flexion 50°, extenion 35°, ulnar deviation 30°, radial deviation 10° ultimate activities (50000).CT scan and 3-D reconstruction should be taken before and after motion.MAIN OUTCOME MEASURES: The index of the radial-scapho angle (RSA), radial-scapho distance (RSD), scapho length(SL), trapezium-trapezoid inclination (TTI), trapezium-trapezoid width (TTW) were measured.RESULTS: Prior to motion RSA, RSD, SL, TTW and TTI were (38.725±2.230) °, (18.988±1.216) mm, (1.686±0.191) cm,(27.360±1.571) mm and (114.975±2.293) °. Following motion RSA, RSD, SL, TTW and TTI were (38.800±2.388) °,(19.215±1.443) mm, (1.683±0.209) cm, (27.718±1.910) mm, (115.300±3.023) °. No significant difference in above-described indexes was determined before and after motion (P > 0.05).CONCLUSION: The novel STT limited intercarpal arthrodesis apparatus shows confidential stability. Thus, wrist joint can do exercises in an early stage at the range of 35 dorsal extension, 50 palmar flexion, 10 radial deviation and 30 ulnar deviation.