Objective To isolate and identify the chemical constituents of 95% alcohol extract in the fruits of Ailanthus altissima. Methods The compounds were prepared by repurification and their structures were identified by physicochemical properties and spectral analyses. Results Nine compounds were isolated and identified as ailanthone A [11?, 20-epoxy-1?, 2?, 12?-pentahydroxypicrasa-3, 13(21)-dien-16-one, Ⅰ], olean-9(11), 12-dien-3?-ol (Ⅱ), D-friedoolean-14-en-3-one (Ⅲ), ?-amyin (Ⅳ), cycloart-25-ene-3?,24?-diol (Ⅴ), hopane-3-one-22-ol (Ⅵ), n-tetratriacontane (Ⅶ), L-evonymitol (Ⅷ), D-mannitol (Ⅸ). Conclusion Among them Ⅱ- Ⅸ are isolated from the plants of Ailanthus Desf. nom. Conserv. for the first time.

Objective To evaluate the embolization efficiency,short term clinical effect and adverse reactions of trisacryl gelatin microspheres in interventional treatment of hepatic carcinoma. Methods Twenty three cases of hepatic carcinoma (34 foci)were given 0.5-6 ml of microspheres mixed with some contrast medium via catheter after injection of chemodrugs and lipiodol 3-5 ml; and simultaneously observing the appearance of slow down of blood flow and vascular cast formation to stop the procedure. Enhanced CT or MR and AFP were performed every 1 month after the first procedure. Treatment needed to be repeated whenever the foci or new ones were enhanced in CT scans or increase of AFP value. The clinical effect and adverse reactions were also observed. Results The positive response rate was 39.1% (CR+PR). There were 9 cases of PR,13 cases of NC and 1 of PD; but no case of CR. Residual enhancement was observed in 17 foci after first procedure,10 of which received repeated therapy and 3 were embolized completely. The other 11 foci were completely embolized,among them 4 had new residual enhancement during 4-9 mo follow up and 2 were re-embolized completely. Eighteen cases with positive AFP showed obvious decrease in 11,no change in 6 and increase in one. Eighteen cases of pyrexia,11 cases of pain in hepatic region and 6 cases of nausea occurred 5-14 d after the procedure together with vomiting. We also found increase of ALT in 2 cases,BIL of 1 case,and no change of WBC in all cases. Conclusion Trisacryl gelatin microspheres is an excellent embolization agent with better clinical effect and less adverse reaction in the treatment of hepatic carcinoma.

Objectiye To investigate the value of liver transplantation for the treatment of end-stage hepatic alveolar echinococcosis(HAE).Methods The clinical data of 8 patients with end-stage HAE who received liver transplantation at the First Affiliated Hospital of Xinjiang Medical University from December 2000 to August 2010 were retrospectively analyzed.The operation time,anhepatic phase,infusion of suspension of red blood cells and postoperative complications were observed.Results The median operation time,anhepatic phase and infusion of suspension of red blood cells were 635 minutes(range,490-760 minutes),66 minutes(range,44-240 minutes)and 20 U(range,4-40 U).Liver transplantation was successfully carried out on 7 patients except for 1 patient who received emergent liver transplantation died of severe hepatic encephalopathy,renal failure and coagulation disorder on postoperative day 1.The median follow-up time was 6 months(range,3-29 months).One patient died of septicopyemia in postoperative month 3,1 died of incurable infection of bile duct in postoperative month 5,and 1 died of acute rejection in postoperative month 6.One patient was complicated with stricture of the bile duct anastomosis,and was cured by choledochojejunostomy.The size of the metastatic lesion in the left lung of 1 patient was reduced.One patient who underwent liver autotransplantation had no signs of residual liver disease with good liver function.Conclusion End-stage HAE is an indication for liver transplantation.A minimum dose of immunosuppressive agent and systemic administration of anti-HAE drugs are necessary to prevent the recurrence of HAE and ensure a long-term survival.Liver autotransplantation is the optimal method for the treatment of end-stage HAE,because no immunosuppressive agent is needed after operation.

Ex-vivo liver resection and liver autotransplantation offers a chance to cure extensive regional liver diseases which are otherwise deemed untreatable in selected cases. A 33-year-old male patient with advanced alveolar echinococcosis (AE) which invaded the right lobes and adjacent retrohepatic inferior vena cava, while the left lobes were free from lesion and had proliferated to over 1200 ml in size except for a 1 cm × 1 cm solid lesion in the segment Ⅳ. No extrahepatic metastases were found in this patient. A lesion with a size of 4300 ml and other small lesions in the right lobes were removed extracorporeally,and the retrohepatic vena cava was repaired, then the remaining AE-free left lobes (more than 700 ml in size) and the retrohepatic inferior vena cava were re-implanted in situ. A temporary end-to-end cavo-caval shunt with interposition of a blood vessel prosthesis and end-to-side portocaval shunt were established to keep the blood flow during the four-hour anhepatic phase. The patient was followed up for six months, and he had no signs of residual liver disease with good hepatic function.

Objective To evaluate the clinical applications and surgical methods of combined laparoscopic common bile duct (CBD) exploration with choledochoscopy. Methods From 2006 to 2009,clinical data of 42 patients with choledocholithiasis undergoing laparoscopic common bile duct exploration were retrospectively analyzed. We applied a step-by-step electric coagulating incision technique on the CBD,the step-by-step suturing technique, and the step-by-step clamping technique with alligator forceps, and soft tube irrigating technique with suctioning by selecting the proper exploration route, improving the common bile duct incision technique and calculus removing techniques. Results Procedures were successful in all the cases. There was no conversions to open surgery, no postoperative bleeding and no operative mortality. The mean operating time was 120 minutes (ranging, 90 to 150 minutes) with minimal intraoperative blood loss ( ranging, 20 to 40 ml). Ductal stone clearance was successful in 41 out of 42 patients ( 93% ). The largest number of the common bile duct stones was 16. With the diameter of stones larger than 15 mm in 18 cases in which the biggest was 30 mm. Bile leak developed in 1 patient, retained stones found in 3 patients,including intrahepatic cholelithiasis in one case. As a result, 38 out of 42 patients underwent common bile duct exploration. 35 patients were placed on T-tubes. Four patients underwent cystic duct exploration in which 3 had primary suture of the cystic duct and 1 had drainage. There was no infection and stenosis of biliary tract in the 42 followed-up cases. Conclusions Laparoscopic common bile duct exploration with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. Improving the way of operation and selecting suitable exploration can result in better clinical outcomes.

Objective To establish a simple,rapid and sensitive nucleotide polymorphisms genotyping method in order to conduct the routine clinical detections under the simple laboratory condition by this method.Methods Based on the ligase-agarose gel electrophoresis,the oligonucleotide detection probes of mutational sites was designed.The detection underwent the detection probe connecting,purification and universal amplification,finally the mutation genotypes of detection sites were judged by the ap-peared bands in the agarose gel electrophoresis(AGE).With the 3 SNP sites EGFR,c.2573T>G(L858R),EGFR,c.2582T> A (L861Q)and EGFR,c.2155 G>T(G719C)in epidermal growth factor receptor(EGFR)gene as the detection objects,the plasmid template and plasma circulating DNA sample in lung cancer were performed the detection.Results The established method was easy to operate with higher specificity and sensitivity.After 20-30 cycles of PCR amplification,the genotype of detection sites was clearly estimated according to the amplification band.When detecting the mixed alleles in the heterogeneous sample,minimal 2.5%mutation alleles could be detected out.This method and the direct sequencing method could respectively detect 6 cases and 2 cases of heterozygotes mutation in the SNP site of L858R among 62 samples of lung cancer.Conclusion The established detection method for SNP genotyping is suitable to the routine mutation detection on the heterogeneous samples under the simple laboratory condi-tion.