Objective To study a new method for internal drainage and primary suture after laparoscopic choledocholithotomy (LCH). Methods Twenty-five patients with chronic cholecystitis combined with cholecystolithiasis and choledocholithiasis were performed laparoscopic cholecystectomy and choledocholithotomy and extraction of stones with choledoscopy. Results One case of Mirizzi' syndrome converted into laporotomy and 24 cases were successfully performed. Excluding neither internal nor external drainage was carried out with primary closure of common bile duct (CBD) in 1 case and T-tube were placed in 4 cases, the made-self 3mm～5mm diameter silica tubes with one-way hook were placed into the common bile duct for internally drainage in 19 cases. The time of operation was from 90 to 420 minutes with a mean of 145 minutes. 1～5 calculus were removed from CBD. A mean of hospitalized days stay was 7.5 day. Conclusions The operation of internal-tube drainage of LCH frees either the inevitably risk of hyper pressure of biliary duct because of the spasm of Oddi's sphincter or disadvantage of T-tube for drainage after LCH, which is new method both safety and practicality, both simpleness and easiness, and accords with the physiological needs of the human body.

Objective To assess the feasibility of combined laparoscopic multi-organ surgery in clinical appliation. Methods 48 combined laparoscopic multi-organ surgeries performed from August 2000 to November 2001 were analyzed. Results All laparoscopic procedures were successfully completed.No one needed to be converted to laparotomy and had postoperative complications.Postoperative stay was similar to that of patients under laparoscopic mono-organ surgery in the same time. Conclusions Combined laparoscopic multi-organ surgery can be performed conveniently.It offers significant benefits to patients such as decreased postoperative pain,reduced trauma to the abdominal wall and cost-saving.

Objective To evaluate characteristic clinical and imaging findings of pancreatic neuroendocrine tumors (NET) in dual-phase contrast enhancement MSCT.Methods The dual-phase contrast enhancement MSCT images of 23 lesions in 20 patients with histologically confirmed pancreatic NET were studied retrospectively.Their clinical presentations,imaging characters as well as the intensities of lesions and normal pancreas in each phase were measured,and the following indices were calculated.First,the absolute enhancement of lesions,including the increasing of CT value of the maximum enhancement area within a tumor in arterial phase,that was named A1 in short,and that of the minimum enhancement area was labeled as A2.The same ROI measured increasing CT values in portal venous phase was labeled as V1 and V2 respectively.Secondly,the relatively enhancement indices comparing with the normal pancreas in the same patient within the same phase were calculated.This included the differences between the maximum,as well as the minimum,enhancement areas of tumors and the normal pancreas in arterial phase,which was named as AP1 and AP2 respectively,and those differences in portal venous phase,which were labeled as VP1 and VP2 respectively.All of the tumors were graded as G1 to G3 according to the WHO classification in 2010.A Kruskal Wallis test were performed to compare differences of tumor diameters and the enhancement indices.The change trend of enhancement indices varying with pathology grading were described.Fisher exact test was used to find differences of clinical and imaging characters.Results Twenty-three lesions in 20 patients included 13 lesions in grade 1 (G1),8 in G2,and 2 in G3.Among the 10 patients with G1 NET,7 of them had no endocrine symptoms,while the other 3 had endocrine symptoms.Six of them had no abdominal pain,while 4 of them complained of it.All of the 10 patients with G1 NET had no hepatic metastasis.Among 8 patients with G2 NET,4 of them were with endocrine abnormality,and the other 4 were not.Five of them complained of abdominal pain while the other 3 did not.Six of them had no hepatic metastasis,and 2 of them had.Both of the 2 patients with NET in G3 did not have any endocrine abnormality,and one of them complained abdominal pain.Both of them were with hepatic metastasis.There was no difference between groups that whether or not endocrine syndrome and abdominal pain was presented (x2 =2.238,0.713,P =0.318,1.000),while hepatic metastasis was of significant differences (x2 =9.516,P =0.003).Tumor location,distinct outline,necrosis and/or calcification were not significantly different.Tumor enhancement showed a probable trend of decrease in group of higher grade.A1 decreased from (126.4 ± 45.7)HU to (38.7± 8.5)HU (x2 =7.254,P=0.027),A2 decreased from (94.1 ±31.1)HU to (22.8 ± 14.0) HU (x2 =7.323,P =0.026) and AP1 dropped from 80.6 HU(-21.8 — 169.7 HU) to -36.7 HU(-41.6—-31.7 HU) (x2 =6.778,P =0.034).All of the indices mentioned above were of significant difference and the other indices showed no significant difference (P ＞ 0.05).Conclusions Quantitative assessment of their enhancement patterns may provide useful information to preoperative grading of pancreatic NET,and tumors in a higher grade may show poorer enhancement.

Objective To evaluate the diagnostic performance of multi ? b value DWI to differentiate pancreatic adenocarcinoma from healthy pancreas using the apparent diffusion coefficient (ADC) and parameters derived from the intravoxel incoherent motion (IVIM) theory. Methods Forty?eight patients with histopathologically proven pancreatic adenocarcinoma and fifty patients with healthy pancreas were examined at 3.0 Tesla using a single?shot echo?planar imaging DWI pulse sequence. Eight b?values ranging from 0 to 1 000 s/mm2 were used. ADC, diffusion coefficient (D), perfusion?related diffusion (D*) and perfusion fraction (f) were compared between pancreatic adenocarcinoma and healthy pancreas, t test or Mann?Whitney U test was used to compare the MRI parameters, ROC was used to evaluate the diagnostic efficiency. Results In comparison to healthy pancreatic tissue, a significant reduction of the ADC, D*and f was found in pancreatic adenocarcinoma [healthy pancreatic tissue:(1.68±0.31)×10-3mm2/s, 27.10×10-3mm2/s, (36.92±12.47)%;pancreatic adenocarcinoma:(1.51±0.37)×10-3mm2/s, 13.90×10-3mm2/s, (30.06±19.84)%] (P<0.05). No significant difference in the diffusion coefficient D was observed between the two groups (1.06× 10-3 and 1.26 × 10-3mm2/s; P>0.05). In the ROC?analyses, the area under curve for D* was the largest (0.727), followed by f and ADC in order (0.680 and 0.669). Conclusion Using the IVIM DWI approach, the D*, f and ADC value are useful for differentiating pancreatic adenocarcinoma from healthy pancreatic tissue.

Purpose To explore the three-dimensional display and parameter features of 3.0T MR diffusion tensor imaging (DTI) in the imaging of normal female pelvic floor muscle fiber bundles, and to provide a reference standard for the application of DTI in patients with pelvic organ prolapse. Materials and Methods Fifty cases of females who had not given birth or had given birth by cesarean delivery were divided into four groups:20 to 29 years (15 cases), 30 to 39 years (15 cases), 40 to 49 years (12 cases) and 50 to 54 years (8 cases). First, the conventional sagittal, axial, coronal T2WI and axial T1WI images were acquired with a 3.0T MRI scanner;then a dynamic sagittal fiesta sequence was executed to exclude pelvic organ prolapse; at last, the transverse two-dimensional diffusion-weighted spin echo-echo planar imaging (SE-EPI) pulse sequence was executed to acquire pelvic floor DTI data, through the post-processing of the data, normal female pelvic floor muscle fiber bundle images can be obtained and apparent diffusion coefficient (ADC) value and fractional anisotropy (FA) value were calculated. Results Content three-dimensional muscle fiber bundle images and corresponding ADC and FA values of the pubic visceral muscles in pelvic wall and obturator muscles in pelvic wall were acquired in all subjects;there was no statistically significant difference (P>0.05) for the ADC and FA values between the left and right side of the pubic visceral muscles and obturator muscles within the same age group;and the difference of ADC and FA values of pubic visceral muscles and obturator muscles among different age groups were not statistically significant (P>0.05), either. Conclusion 3.0T MR DTI fiber tracking imaging can be applied for the three-dimensional observation of the complicated muscle fiber bundle structures in female pelvic floor, through the measurement of ADC and FA value changes, functional abnormity can be suggested before the anatomy structure changes of the pelvic muscles occurs, thus provides an important new approach for further study of pelvic organ prolapse.

Objective To investigate the therapeutic effect of frozen-thawed murine islets which were transplanted into diabetic rats after cultured with hyperbaric oxygenated rotary cell culture system (HORCCS). Methods The purified rat islets were divided into two groups: A. In vitro experiment groups (IvEG) : The rat islets in each subgroup were cultured in HORCCS or common medium for 30 days, then evaluated for the intracellular DNA and insulin contents of islets, and the viability and insulin secreting level of islets. B. Islet transplantation experimental groups (TxEG) : The frozen-thawed islets were cultured in HORCCS or common medium for 7 days, and then transplanted into the recipients. We observed the blood glucose level (BGL) and insulin secreting level in the recipients as well as the uhrastructure change of islets in TxEG. Results The viability and insulin secreting level of islets cultured with HORCCS at 14th day were much higher than those cultured with common medium (P <0.05). The blood glucose level in recipients transplanted with islets cultured with HORCCS recovered to normal value at the 2nd week and lasted for 8 weeks. All these recipients maintained the normal glucose tolerance curve. Electronic microscopy found microchannel outlets on the surface of the frozen-thawed islets cultured with HORCCS. Conclusions Frozen-thawed islets cultured with HORCCS could establish nutrient transmission microchannels, which were not only capable of oxygen and nutrients transmission, but also improving cryopreservation solution to diffuse inside the islet cells evenly and uniformly. So this method not only lessens islet damage from cryopreservation, but also improves the effect of transplantation.

Objective To evaluate the dissection and hemostasis effects of harmonic scalpel in laparoscopic surgery. Methods The effect in patients underwent laparoscopic surgery with harmonic scalpel or with high frequency electricity scalpel was compared. Results All the operations were done by laparoscopy.No complications or massive blood loss occurred during and after operation.The average operation time ,blood loss of operation with harmonic scalpel were less than that with high frequency electricity scalpel. Conclusions Harmonic scalpel has precise cutting , controlled coagulation, and less tissue injury,it can increase the safety and microsurgery techinque of laparoscopic surgery.It is a very important equipmeat and useful for laparoscopic surgery .

BACKGROUND:The growth of mesenchymal stem cells in vitro in different conditioned media is different evidently. So it is necessary to choose a more suitable medium. OBJECTIVE:To contrast and observe the proliferation of human umbilical cord mesenchymal stem cells in three kinds of media and to check the immunophenotype and differentiation ability of mesenchymal stem cells. METHODS:Human umbilical cord mesenchymal stem cells were col ected by explant method in sterile conditions. After subculturing by T75 incubation bottles, the third generation of mesenchymal stem cells were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 medium containing 5%fetal bovine serum, Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum and Mesen PRO RSTM medium. After 1, 3, 5, 7 days of culture, the cells were counted to draw a growth curve. Immunophenotype of the third generation of umbilical cord mesenchymal stem cells were determined by flow cytometry and the ability of osteogenic and adipogenic differentiation was also detected. RESULTS AND CONCLUSION:The third generation of cells cultured highly expressed CD44, CD73, CD90, CD105, but did not express CD29, CD31, CD34, HLA-DR. The oil red O staining showed a lot of little red lipid drops after adipogenic induction;alizarin red staining showed osteoblast-like cells after osteogenic induction, indicating umbilical cord mesenchymal stem cells in vitro have the potential of multi-directional differentiation. After observation and counting, the colony and shape of cells cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum were superior to those cultured in the other two media. Therefore, it is concluded that Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 containing 10%fetal bovine serum is preferred for cellsubculture.

Objective To review the important points in the preoperative assessment and the surgical technique in precise hepatic pedicle dissection in anatomical hepatic segmentectomy.Methods 104 patients who underwent anatomical hepatic segmentectomy were divided into two groups according to the different surgical approaches adopted in a prospective and non-randomized manner:the precise hepatic pedicle dissection group (the precise group,n=44) and the conventional hepatectomy group (the conventional group,n=60).The perioperative and follow-up data were analyzed.Patients who had primary liver cancer,including hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma,were analyzed separately.Results (1) There was no perioperative death in the two groups.There was no significant differences in blood loss and transfusion between the 2 groups of patients (P=0.069,0.208; t=1.844,1.266).There was a significantly higher rate of vascular inflow occlusion (P=0.001).There were significantly longer periods of vascular inflow occlusion and operative time (P=0.001,0.001; t=3.849,3.574) in the precise group.There was no significant difference in postoperative complications (P=0.988) and the duration of postoperative hospital stay (P=0.509;t=0.662) between the two groups.(2) In patients with primary liver cancer,there were no significant differences between the precise group (n=29) and the conventional group (n=41) in tumor margin positivity,vascular invasion and pathological staging (P=0.985,0.630,0.769).(3) All patients were followed up for two years.When compared with the conventional group,the disease-free survival (P=0.012),overall survival (P =0.006),and median survival (16.5 ± 4.5mo vs.7.8 ± 3.8mo)were significantly longer in the precise group.Conclusion Precise hepatic pedicle dissection had the same safety and efficacy as conventional method in partial hepatectomy.For primary liver cancer,precise hepatic pedicle dissection had better survival compared to the conventional method when the surgical margin was negative.

Objective To investigate the diagnostic significance of argyrophilic nuclear organizer regions(AgNORs) of peripheral T lymphocytes in elderly cancer patients. Methods AgNORs was examined using KL tumor image analysis system in 45 cases of health control,36 cases of elderly inflammatory patients,97 cases of elderly cancer patients and 30 cases of elderly tumor-cured patients. CD3,CD4,CD8,CD4/8 and NK were detected by flow cytometer in cancer patients. Results Compared with normal controls,inflammation and tumor-cured patients,AgNORs was decreased extremely in elderly patients with cancer. Moreover,AgNORs was decreased in tumor metastasis status. Conclusions In analyzed elderly cancer patient cases,the expression of AgNORs is significantly decreased. The AgNORs may serve as a marker for judgment of clinical treatment and supervisor.