0.05).But age had distinct influence on symptom survey(P

Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.

Objective To study the morphological changes of the cyctic duct in bile duct stones secondary to choledocholithiasis.Methods The results of imaging examinations before cholecystectomy and biliary exploration with laparoscopy and cholechodoscopy were respectively analyzed in 108 patients.Meanwhile, the cystic duct morphology, diameter and dilatation during the operation were determined to investigate the features of changes in its morphology.Results Gallstones were confirmed in all of the 108 cases by B-model ultrasonography preoperatively.The gallstone was positive in common bile duct in 76 cases.Common bile duct dilatation was seen in 75 cases and cystic duct dilatation in 21.Common bile duct dilatation was found in 81 cases by MRCP and in 45 by CT.Cystic duct dilatation was found in 36 cases by MRCP and in 19 by CT.Cystic duct variety was found in 9 cases by MRCP.Laparoscopic transcyctic common bile duct exploration(LTCBDE)was performed in those patients with short and wide cystic duct.Conclusion MRCP is the effective method for considering the outlooks of the cystic duct in bile duct stones secondary to choledocholithiasis.

Objective To observe the iffectiveness of comprehensive rehabilitationinterventions on stroke patients with unilateral spatial neglect (USN). Methods A total of 245 cases if strijd were examined to diagnose USN. Of the 245 patients,86 cases were diagnosed as being with USN, and divided into a control group(n=43 cases) and a treatment group (n=43 cases) randomly. The control group was treated with Bobath and Rood techniques in addition to routine clinical medical interventions, while the treatment group was treated with a comprehensive rehabilitation protocol for USN in addition to the same interventions for the control group. Both groups were assessed with regard to motor, balance function, walking performance, and USN severity as well as the activities of daily living (ADL) performance. Results After 8 weeks of treatment,both groups improved, but there showed a significantly statistical difference between the 2 groups in terms of Fugl-Meyer motor function scores (P＜0.01), balance function scores (P＜0.01) Holden walding function classifications (P＜0.01), Barthel index(P＜0.001) and USN severity scores(P＜0.01). Conclusion Comprehensive USN rehabilitation intervention could improve motor, balance, walking functions and ADL performance and alleviate the USN severity in stroke patients with USN.

Objective]To evaluate the reliability and validity of Chinese version of the Pediatric Quality of Life Inventory PedsQL multidimensional fatigue scale among short stature.[Methods]The Cross-sectional surveys was made using this Chinese scale. A total of 570 children and adolescents and their parents were investigated. 522 valid questionnaires were collected,of which 138 were short stature and 384 with normal height ,Analysis feasibility ,reliability and validity of this Chinese version scale.[Results]Cronbach alpha coefficients of the parent-proxy report was 0.89,the dimensions ranged from 0.75 to 0.87,Cronbach alpha coefficients of the child self-report was 0.86,the dimensions ranged from 0.70 to 0.80;Test retest reliability was satisfied for intra-class correlation coefficient(ICC)exceeded 0.9 in all dimensions. Correlation coefficients between items and their belong dimensions higher than those with other dimensions;The result of confirmatory factor analysis indicated the main indexes χ2/df = 2.62,CFI =0.93,TLI=0.92,NFI=0.89,RFI=0.87,IFI=0.93,RMSEA=0.056 of self-report andχ2/df=3.12,CFI=0.94,TLI=0.92, NFI=0.91,RFI=0.89,IFI=0.94,RMSEA=0.064 of proxy-report all met the criteria of psychometrics.[Conclusion]The Chinese version of PedsQL Multidimensional Fatigue Scale has good feasibility ,reliability and validity ,and can be used to evaluate the fatigue of short stature in children and adolescents in Chinese cultural background.

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

Objective To evaluate regional blood flow occlusion (RBFO) in hepatectomy for liver neoplasms. Methods In this study, hepatic tumors were resected under RBFO in 28 cases (RBFO group), and under Springle's technique (control group) in 24 cases. The Child-Pugh classifications of liver function were grade A in all patients. The ligature ribbon was put in liver parenchyma around tumor to block the blood supply before resecting the tumor under guiding of B sounography in RBFO group. Anesthesia time, blood loss and transfusion, hospitalization, change of liver function and complications were compared between the two groups. Results Blood loss, anesthesia time and postoperative hospital stay were (340±92) ml, (98.4±25.0) min, ( 10.2±2.3 ) d in RBFO group and (620±124) ml, ( 135.8±47.5 ) min, (16.5±5.1 ) d, respectively, in control group, differences were all significant between the two groups (P <0.01, t = 9.222,9.328 and 5.875, respectively). On post-op day 2, ALT (U/L) was (378.4±35.2) vs. (539.2±115.4) (t=7.012, P<0.01), TBIL (37.5±11.2) vs. (51.8±29) mmol/L(t=8.818, P<0.01),PT (17.4±2.4) vs. (20.4±2.8) see(t =4.16, P<0.01) in RBFO group and control group, respectively. ALT was (57.1±15.5) vs. (98.1±21.2) U/L(t =8.039),TBIL (25.4±4) vs. (46.3±13) mmol/L(t=8.085),PT (13.2±4.2) vs. (15.7±2.2) see (t=2.621)on post-op day 7 respectively, again the differences were all significant between the two groups (all P<0.01). Conclusion Regional blood flow occlusion is an effective technique to control blood loss during hepatectomy for liver neoplasms.

Objective To study the application of cyctic duct dilatiion in bile duct exploration through the cystic duct by laparoscope combined with choledochoscope.Methods LC + laparoscopic transcyctic common bile duct exploration were performed in gallstones combined choledocholithiasis in 70 cases.The dilation of cyctic duct was performed by gas-baloon or metal dilator in 39 cases.The dilation of cyctic duct was not performed in 31 cases.Results There was one case of bile leakage and one case of cystic duct damaging in cystic duct dilation group.One case was found bleeding in abdomen postoperation in non-dilation group.Abdominal drainage was(60 ±11)mL and(55 ±8)mL in dilation group and non-dilation group,respectively.Conclusions The dilation of cyctic duct is simple and safe to create the tunnel for common bile duct exploration through the cystic duct by choledochoscope.

Objective To evaluate the efficacy and safety of radiotherapy combined with concurrent and then adjuvant temozolomide in the patient with glioblastoma.Methods The databases of PubMed,Cochrane library,Medline and OVID were retrieved according to the Cochrane systematical assessment method.The included literatures were performed the quality evaluation and the meta analysis was performed after extracting the data.Results The summary of comparison between temozolomide group and radiotherapy group in the included studies showed that the 12-month overall survival rate[RR 1.22,95 ％ CI(1.01,1.47),P=0.04]and 24-month overall survival rate[RR 2.65,95 ％ CI(1.53,4.40),P＜0.01]had statistically significant differences;the 12-month pregrossion free survival rate[RR 2.59,95 ％CI(1.53,4.40),P=0.000 4] and 24-month pregrossion free survival rate[RR 6.77,95 ％ CI (2.82,16.26),P＜ 0.01] also showed statistically significant difference.The results of adverse reaction events revealed that the hematological toxic reactions in the temozolomide group had statistical difference between the concurrent therapy period and radiotherapy period [RR 3.21,95％CI(1.89,5.46),P＜0.01];which in the temozolomide group had statistical difference between the concurrent period and adjuvant period [RR 0.48,95 ％ CI(0.36,0.65),P＜0.01);but the non-hematological toxic reaction had no statistical difference[RR 1.11,95％CI(0.72,1.70),P=0.64].Conclusion Radiotherapy combined with concurrent and then adjuvant temozolomide therapy improves the overall and progression free survival period in the patient with glioblastoma,the higher occurrence rate of hematologic toxic reactions is correlated with temozolomide treatment drugs.

Objective To establish chronic cerebral infarction animal model in nonhuman primate. Methods 10 adult male rhesus monkeyswere embolized the middle cerebral artery (MCA) in contra-lateral of handedness, and divided into M1 segment embolism group (n=3), upper trunk embolism group (n=5), and lower trunk embolism group (n=2). Acute neurological deficit was evaluated with standard neurologicalscale, and the motor function in chronic stage was assessed with a task of retrieving food pill in wells. Results Animals in M1 segmentembolism group all died 38~62 h after surgery. Upper trunk embolism group survived, and MRI showed front parietal cortex infarctioncontra-lateral paralyzed side. All of them paralyzed one side in acute stage, and 4 of them persisted dysfunction in chronic stage, that couldnot finish the task of retrieving food pill in wells; only one completed the task. The lower trunk embolism group paralyzed one side in acutestage, but recovered quickly and completely, that finished the task within 7 d. Conclusion Embolism of MCA upper trunk can cause infarctionof precise and proper size with one side limb dysfunction in the acute stage and long-term dysfunction in most animals, which is feasiblefor treatment and neural plasticity research in recovery.