Medical dispute has become a hot issue in current China. As to the new rules carried out and the importance of medical data in edical disputes litigation,it is necessary that the medical data should reflect the reality of medical behavior comprehensive,authentic and without delay during the writing in order to avoid the occurrence of medical treatment disputes.

China is one of the minority countries which have not passed through the law ot brain death in the world. After efforts of decades, the liver transplantation in China have got great achievements, however, owing to unimplementation of the law of brain death, the main source of grafts was the donor of cardiac death which resulted in the bad quality of grafts and poor curative effect after liver transplantation compared with the international advanced level. The implementation of the law of brain death will promote the improvement of liver transplantation level in China greatly.

Objective[WT5”BZ] To evaluate the method and timing of operation and long term effect of congenital choledochal cysts(CCC) in adults.[WT5”HZ] Methods[WT5”BZ] The mode and timing of operation, effective rate, reoperation rate and incidence of carcinoma after operation for 70 operated patients with CCC in adults during the period from Jan, 1980 to June 1999 were analyzed retrospectively. [WT5”HZ]Results[WT5”BZ] The reoperation rate of external drainage was 86%(6/7); The effective rate of internal drainage was significantly lower than that of resection of the cyst(3/10 vs 45/49,? 2=20 94, P

Objective To investigate the clinical effects of laparoscopic sleeve gastrectomy with duodenaljejunal bypass (LSG + DJB) for the treatment of type 2 diabetes mellitus.Methods The clinical data of 17 patients with type 2 diabetes mellitus who underwent LSG + DJB at the Xijing Hospital of the Fourth Military Medical University from March 2013 to February 2014 were retrospectively analyzed.The fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin (HbA1c) and body mass index (BMI) in 17 patients before operation were (9.2 ± 0.6) mmol/L,(14.4 ± 2.2) mmol/L,8.3％ ± 1.2％ and (29.4 ± 2.2) kg/m2,respectively.All the patients received LSG + DJB and were followed up by outpatient examination up to March 2015.The pre-and post-operative 12-month fasting blood glucose,postprandial 2-hour blood glucose,HbA1 c and BMI in 17 patients were compared.Measurement data with normal distribution were presented as-x ± s and analyzed by the t test.Results All the 17 patients received successful laparoscopic LSG + DJB without conversion to open surgery.The operation time,volume of intraoperative blood loss and recovery time of postoperative gastrointestinal function were (141 ±53)minutes,40 mL and 2.5 days.Of 3 patients with postoperative complications,1 patient with anastomotic leakage at postoperative day 5 received reoperation by laparoscopic Roux-en-Y gastric bypass,1 patient with digestive tract obstruction at postoperative day 10 released obstruction by reoperation and 1 patient with left subphrenic abscess and leakage at the upper of the stomach at postoperative week 2 was cured by the symptomatic treatment.The duration of hospital stay was 5.2 days.All the patients were followed up for a median time of 16 months (range,13-24 months).The postoperative 12-month fasting blood glucose,postprandial 2-hour blood glucose,HbA1c and BMI in 17 patients were (5.5 ± 0.7)mmol/L,(8.8 ± 1.7)mmol/L,5.1％ ± 0.7％ and (24.7 ± 2.3)kg/m2,which were significantly different from preoperative indicators (t =19.96,10.52,12.06,31.99,P ＜ 0.05).During the follow-up,no anastomotic ulcer and stenosis,dumping syndrome and severe malnutrition were occurred.Conclusion LSG + DJB is safe and feasible for the treatment of type 2 diabetes mellitus,with a good short-term hypoglycemic effect.

Cell therapy has a very promising potential for end-stage liver diseases (ESLD).Fetal liver stem/progenitor cells (FLSPCs) have advantages of safety,high survival and proliferation rates,and a small volume,all which make them ideal for liver disease stem cell therapy.During the early phase of our study,we applied a three-step separation method to enrich FLSPCs and obtained a separation efficiency similar to that of the flow-cell sorting method.Additionally,using a fulminant hepatic failure model in rats,we have demonstrated that FLSPCs can contribute to morphological and functional recovery of the liver.This manuscript will discuss how FLSPCs can be induced to accurately differentiate into hepatocytes and cholangiocytes and how FLSPCs maintain self-renewal.The Notch signaling plays a critical role in regulating the differentiation and self-renewal of many types of stem cells.Our previous findings have shown that the Notch signaling plays an important role in FLSPCs differentiation into hepatocytes.Therefore,the Notch signaling might be involved in the differentiation and self-renewal of FLSPCs.We conducted a study on the regulatory effects and relative molecular mechanisms of the Notch signaling on FLSPCs and found the corresponding interfering target,which might become an index for the clinical application of FLSPCs.

Objective To study the effect of S-adenomethionine on early stage recovery of transplanted liver.Methods From January 2010 to October 2012,57 liver transplantation patients were divided into 2 groups beginning the first day:group A,23 patients were treated with routine liver-protecting therapy,including glycyrrhizin,glutathione,albumin; group B,34 patients treated with additional S-adenomethionine (Transmetil).AST,ALT,T-BIL,D-BIL,γ-GT,ALB and ALP were compared between the two groups at pre-operation and post-operation day 1,day 4,day 7 and day 14.Results All patients suffered from preoperative hyperbilirubinemia,decreased ALB and elevated concentration of AST,ALT,γ-GT and ALP.On the first day after transplant,AST,ALT,T-BIL,D-BIL and γ-GT elevated and ALB decreased significantly in all cases compared with that before operation (respectively t =10.493,7.089,6.584,15.134,5.164,10.344,5.289,13.034,3.389,4.366,all P ＜ 0.01).On the contrary,the value of ALB was lower (respectively t =8.239,11.662,all P ＜ 0.05).On the fourth day posttransplant,ALB level was higher and that of other parameters were lower in group B when compared with group A (respectively t =2.536,2.736,2.218,3.318,4.804,2.892,all P ＜ O.05).This tendency of liver function improvement continued till postoperative day 7 in all cases while the differences between the two groups remained significant (respectively t =6.107,3.256,2.929,11.688,8.964,2.857,all P ＜ 0.05)except for γ-GT.On day 14,while T-BIL and D-BIL in group B were lower than that in group A (respectively t =4.413,8.493,all P ＜0.001),differences of liver functions were not significant between the two groups (respectively t =1.916,1.414,1.168,1.035,1.604,all P ＞ 0.05).Conclusions Transmetil promotes the recovery of transplanted liver's function,elevates the concentrantion of ALB and reduces the concentration of AST,ALT,T-BIL,D-BIL,γ-GT and ALP at early stage after liver transplant.

Objective To evaluate the clinical efficacy of 3D DCE MRA(three dimensional dynamic contrast-enhanced MR angiography)in patients of preoperation of liver transplantion.Methods 8 cases of potential liver transplant recipients suffering from severe liver disease underwent MRI and 3D DCE MRA, accessed the images synthetically. All of them had DUS examination, 4 cases received liver transplantation successfully.Results Satisfactory angiography images were obtained in all cases, the grade Ⅱ～Ⅲ branches of the hepatic artery, the grade Ⅱ～Ⅴ branches of the portal vein and gradeⅡ branches of the hepatic vein could clearly be visualized. Gastric-oesophageal varices were found in 3 cases of cirrhosis, compression and displacment of hepatic artery and portal vein were shown in one case of polycystic liver.Conclusion 3D DCE MRA is an efficiency, noninvasive technique, it offers great help in evaluating pre-operative vasculature of liver transplantation.

Objective To study the surgical technique of right hemihepatectomy in adult-to-adult living donor liver transplantation . Methods Eight donors underwent right hemihepatectomy in adult-to-adult living donor liver transplantation . Among these donors operation, there were 5 right hemihepatectomy and 3 extended right hemihepatectomy . If the diameter of the auxiliary right hepatic vein more than 0.8cm, it should be reserved. The dissection line of right hemihepatectomy was at the 0.5cm～1.0cm to the right side of middle hepatic vein, and the dissection line of extended right hemihepatectomy was at 0.5cm～1.0cm to the left side of middle hepatic vein. Intraoperative cholangiogram was performed, and without inflow vascular occlusion was done during the operation.Results The donor average operation time was 448 min (ranged from 353 min to 510 min). The average blood loss of operation was 384 ml (ranged from 170ml to 900ml). The grafts average weight was 669.4g (ranged from 445g to 900g), the right hemihepatic grafts weighted 667.0g averagely and the extended right hemihepatectic grafts weighted 673.3g averagely.The average graft-to-recipient body weight was 1.16% (ranged from 0.76% to 1.50% ). There were 2 donors occurred complications including biliary leak in 1, and dysfunction of liver and kidney in 1, all the 2 complications were cured. There was no donor mortality and all donors well recovered,All the donors were discharged within three weeks after operation.All of the 8 grafts and 8 recipients survived one year. Conclusions The right hemihepatectomy and extended right hemihepatectomy in adult-to-adult living donor liver transplantation can be performed safely,if the liver resection techmqne is proformed exactly and successfully.

Objective Proliferation and apoptosis play a major role in the development of tumor cells,and the intranuclear transcriptional factor c-fos is significantly up-regulated in the primary hepatocellular carcinoma and involved in early carcinogenesis.The purpose of the present study is to investigate the apoptotic effect of c-fos antisense oligodeoxynucleotide(ASO) on human hepatocellular carcinoma HepG2 cells and the participation of Caspase3 in this process.Methods Cell culture,Hoechst 33258 staining,real-time PCR and Western blotting were used in present study.Cultured HepG2 cells were divided into 3 groups: 1) control group: cultured with 10?l saline;2) sense oligodeoxynucleotide(SO,used as a negative control) treated group: co-cultured with 10?l SO(5?g/?l);3) ASO treated group: co-cultured with ASO 10?l(5?g/?l).The subsequent experiments were performed 1h after cultivation for each group.Hoechst 33258 staining was performed to detect the apoptosis by observing the staining of nuclear chromatin.Real-time PCR and Western blotting were used respectively to detect the expression of Caspase 3 at mRNA and protein levels after different treatments.Results Hoechst 33258 staining revealed that the nuclei of HepG2 cells showed diffuse and adqulis fluorescence in control and SO-treated groups,while dense and dark fluorescence was observed in ASO-treated group,which indicated that c-fos ASO had significantly induced apoptosis of HepG2 cells.The expression of Caspase 3 in ASO group was enhanced both at mRNA and protein levels compared to that in control groups.Conclusions C-fos ASO significantly induces apoptosis in human hepatocellular carcinoma HepG2 cells,as shown by Hoechst 33258 staining and higher expression of Caspase 3 mRNA and protein.Moreover,Caspase 3 activation is involved and probably plays an important role in c-fos ASO-induced apoptosis of HepG2 cells.

Objective　To investigate the relationship between canceration and primary operation mode for congenital choledochal cysts(CCC). Methods　The clinical data of 21 patients with CCC treated in the last 30 years were analysed retrospectively. Results　In this series, the incidence of carcinoma was 14.8%; the canceration rate after internal drainage operation was significantly higher than that after resection of the cyst(P<0.001); the age of canceration after internal drainage was younger than that of resection of the cyst(P<0.01) and patients without operation(P<0.01); the interval time of canceration after internal drainage operation was significantly less than that of resection of the cyst(P<0.01); the age of carcinoma would be 15.4 years younger in internal drainage operation patients than that in patients without operation. Conclusions　Internal drainage, which could accelerate the occurrence of canceration of CCC, should be abandoned; resection of the cyst is recommended as the therapy of the first choice.