Repair for traumatic abdominal wall defect (TAWD) is a complex subject to be investigated.No consensus in the management of the subject has currently been reached,and the individualized treatment is performed based on TAWD.There are four kinds of type in repair of TAWD according to characteristics of the defect:(1) repair of traumatic full abdominal wall defect,(2) immediate repair of traumatic abdominal wall myofascial defect,(3) delayed repair of TAWD,(4) management of abdominal open following traumatic abdominal compartment syndrome.The concept and practice of treatment for TAWD will be gradually improved and perfect with development of new techniques and materials.

Prevention and surgical treatment of parastomal hernia remain a major challenge to surgeons.The effects of traditional non-operative and surgical treatment would likely be few, but the application of surgical technique which places a prophylactic mesh at the primary operation is bringing down the incidence of parastomal hernia in recent years.Due to a high recurrence rate of parastomal hernia after traditional in or ex situ tissues repair, the short-term outcomes of surgical treatment for parastomal hernia have significantly been improved by using prosthetic mesh, while the long-term outcomes are uncertain and needed for further investigation.

The early diagnosis of cholangiocarcinoma is difficult, and the prognosis is poor. The molecular mechanisms underlying the development, growth and metastatic spread of biliary tract cancers are still unclear. The increase in worldwide incidence and mortality of cholangiocarcinoma justifies the impellent need to clarify the intracellular mechanisms triggering the malignant transformation of the biliary epithelium and growth of biliary malignancies. A more complete characterization of the molecular pathology of bile duct cancers could lead to the identification of valid targets for diagnosis and therapy of these devastating malignancies. This review describes the scientific progress made over the past years with regard to the understanding of the molecular processes of cholangiocarcinogenesis.

Pancreatic neuroendocrine tumor (pNET)is a rare type of pancreatic tumors.The incidence of pNET shows a gradually increas-ing trend in recent years.The most common organ of distant metastases is the liver.Surgical resection is still the optimal treatment for resect-able,well -differentiated liver metastases with no evidence of extrahepatic spread.For unresectable patients,a combination of multiple mo-dalities,such as transarterial chemoembolization,radiofrequency ablation,systemic chemotherapy,and molecular targeted therapy,can pro-long the survival time of patients.Liver transplantation should be strictly evaluated on an individual basis.

Objective To summarize the experience in the management of incarcerated umbilical hernia in cirrhotic patients with aseites. Methods The operative methods, perioperative management and fellow-up data of 15 patients diagnosed incarcerated umbilical hernia in the setting of cirrhosis and ascites were studied retrospectively. All the patients underwent emergency operation to remove necrotic umbilical skin and hernial content, including incarcerated greater omentum (6 cases) and strangulated segment of small bowel (5 cases). After debriding the operating field thoroughly, the umbilical hernia was repaired with polypropylene mesh, among those Sublay repair was used in 11 cases with the longest diameter of hernial ring more than 3 cm and Onlay repair in 4 cases with the longest diameter of hernial ring less than 3 cm. During the perioperative period, albumin and fresh frozen plasma transfusion, as well as diuresis and ascites paracentesis, was adopted to treat eirrhosis and ascites. Results All the patients underwent operation successfully. The operative time was 90～185 min, averaging at 122 min. Seroma formation in 2 cases and incision infection in one were cured with conservative therapy. One patient died of multiple organ dysfunction after the operation. During the fellow-up of 1～5 years, 1 patient died of liver function failure and there was no hernia recurrence. Conclusion With appropriate perioperative management and correct operative method, polypropylene mesh could be adopted in the emergency repair operation of incarerated umbilical hernia in the setting of cirrhosis and ascites.

Objective To investigate and summarize preliminarily the clinical experiences of laparoscopic incisional hernia repair with intraperitoneal patch placement for the patients over 70 years old.Methods From July 2005 to July 2008,laparoscopic incisional hernia repair with intraperitoneal onlay meshes were applied in 8 patients,and whose clinical data were studied retrospectively.Results The procedures were performed successfully in all patients except one converted to open because of severe adhesion.The mean operative time was 105 min(ranged from 50 min to 180 min).One postoperative hypercapnia was resolved through mechanic ventilation for 24 h.One seroma and 1 prolonged postoperative pain over 1 month occurred,which were cured with conservative therapy.Mean postoperative hospital stay was 9.5 d(ranged from 7 d to 14 d).There was no recurrence or local discomfort during 12-36 months(average 26.5 months)follow-up.Conclusions Laparoscopic incisional hernia repair with intraperitoneal onlay mesh for the patients over 70 years old is safe and feasible,which has some advantages such as less trauma and rapid recovery.The perioperative management and operative technique are very important for the success of operation.

Objective To study the effect and mechanism of intensive insulin therapy on stress hyperglycemia in rabbits with sepsis. Methods Rabbits were subjected to cecal ligation plus puncture (CLP) to reproduce sepsis. Sixty rabbits were randomly divided into three groups, control group (n=12), CLP group, and intensive insulin therapy group (n=24). The following parameters were measured with the method indicated in parentheses: blood glucose (blood sugar meter), glucose transporter 4 (GluT4) mRNA expression (RT-PCR), GluT4 protein level (Western blot). Results Compare with the control group, the level of blood glucose was significantly increased at 2h after CLP and reached its peak 12h after CLP (P

Objective To determine the kinetic changes of plasma D-lactate and endotoxin levels in patients after intraperitoneal operations. Methods Blood samples of 63 patients undergoing selective laparotomy were collected 0, 2, 24 and 48h after surgery. According to various criteria, the patients were divided into two groups respectively, i.e. extensive operation or medium sized operation,involvement of gastrointestinal (GI) tract or non-involvement GI tract, and development of symptoms of SIRS or no SIRS after operation. Plasma levels of D-lactate and endotoxin in systemic circulation were determined. Results The analytical data showed that the plasma levels of D-lactate and endotoxin were elevated significantly at 2, 24 and 48h post laparotomy in SIRS patients and major surgery group, and there was also a significant correlation between the plasma levels of D-lactate and endotoxin(?=0.91,P

Objective To investigate the role of recombinant adenovirus Ad-PD-L1 on immunotolerance induction in mouse pancreatic islet transplantation. Methods Full-length mouse PD-L1 cDNA linked with an internal ribosome entry site (IRES)-GFP cassette was subcloned into pShuttle-GFP-CMV( - ) shuttle plasmid. The product was cut by certain restriction endonuclease and ligate with pAdxsi vector. The adenovirus bone plasmid was transformed into DH5α competent bacteria. The positive clone was identified by restriction endonuclease digestion and further confirmed by sequencing. After linearization, the recombined adenovirus DNA was transfected into 293 cells by liposome for package and amplification, which was purified by CsC1 density gradient centrifugation. Streptozocin was injected i.p. into C57BL/6 (H-2b) mouse to induce diabetic model recipient. Recipients were randomly divided into three groups, Group A was the control. Group B and group C were injected of Ad-EGFP and Ad-PD-L1 through tail vein respectively 1 day before islet transplantation. 300 to 400 islets of DBA/2 (H-2d) were transplanted into the renal subcapsular space of the diabetic model recipient. The level of blood sugar and the graft survival time were monitored. Results Recombinant adenovirns Ad-PD-L1 have high efficiency expression of PD-L1 in recipient mouse. The survival time of grafts of Ad-PD-L1 group (27.63 ± 3. 51 ) d was significantly longer than that of the control ( 7. 85 ± 0. 33 ) d and Ad-EGFP group ( 7. 67 ± 0. 59 ) d ( P < 0. 01 ). Mixed lymphocyte response showed a specific decrease reaction of recipient lymphocyte toward donor lymphocytes. Conclusion Recombinant adenovirus Ad-PD-L1 was successfully constructed. In mouse pancreatic islet transplantation, it can suppresses the activation of recipient T lymphocyte through PD-1/PD-L1 co-stimulatory pathway, and significantly prolong the survival time of grafts.

Objective This study was to detect protein expression of ERK 1,ERK 2,JNK 1,p38 and MEK 1 ,MEK 2 in human hepatocellular carcinoma and adjacent non neoplastic liver tissues.Method Western blot was used to detect the expression of ERK 1,ERK 2, JNK 1,p38 and MEK 1,MEK 2 in the surgically resected hepatocellular carcinoma and para carcinoma tissues in 16 HCC patients.[WT5”HZ] Result The expression of ERK 1,ERK 2,p38 expressed by integral optic density (IOD) in hepatocellular carcinoma was significantly higher than that in para carcinoma respectively: as for ERK 1 it was 300?98 in carcinoma and 98?48 in para carcinoma tissues ( P