Objective To investigate the risk factors affecting early mortality in spontaneous rupture in patients with hepatocellular carcinoma (HCC)and explore the effective treatment.Methed A retrospective study of 34 consecutive patients with spontaneous rupture of HCC from January 1998 to January 2008 was conducted.Followup was conducted for more than 3 years.18 clinical ,biochemical and pathological factors influencing 30-day mortality were analyzed.Results 30-day mortality rate was 38% (n=13).Univariate analysis showed that presence of cirrhosis,Child's C status,shock on admission,higher blood transfusion requirement,raised α-fetoprotein (AFP),raised alkaline phosphatase(ALP)and raised aspartate transaminase(AST)were all associated with increased risk early death (P＜0.05).Multivariate analysis displayed that shock was an independent risk factor affecting early death.The median survival time was 14.4 months in 8 patiens receiving emergency curative rescection and 44.4 months in 5 cases underwent delayed curative resection,and the 1-and 3-year survival rate were 63% (5/8)and 13% (1/8)in the former group and 80% (4/5)and 60% (3/5)in the latter group.Conclusion Poor prognosis of spontaneous rupture of HCC is associated with poor liver reservation,advanced disease and large volume of haemorrhage.Shock and blood transfusion requirement are the independent factors affecting early mortality.Curative resection is a definite treatment and delayed curative resection following initial haemostasis has a safer and more effective result.

DNA methylation is a normal modification mode of eukaryon, there is an intimate relationship between aberrant promoter methylation of tumor-related genes and the generation or development of neo- plasms,emerging significantly biological effectiveness. Aberrant promoter methylation of tumor-related genes as the epigenetic markers, maybe play a very important role in the incidence, diagnosis, therapeutic effects, prognosis judgements and other aspects in gallbladder carcinoma.

Objective To investigate the expression of chemokine VCC-1 in hepatocellular carcinoma (HCC).Methods RT-PCR was used to detect the VCC-1 mRNA expressions in 8 HCC cell lines,10 normal liver tissues and 42 HCC tissues.Result In HCC cell lines,the expressions of VCC1 mRNA were high in SUN 398,intermediate in SUN387,SUN449,SUN423,HepG2,PLC5,and low in Hep3B and Huh7.In HCC tissues,the expressions of VCC-1 mRNA could be found in tumor and adjacent tissues.In these 42 tissues,VCC-1 mRNA was highly expressed in 26 specimens of tumor tissues (61％,14.9±7.6 fold) and 16 specimens of adjacent tissues (39％,6.9±5.4 fold).VCC-1 mRNA was up regulated in tumor tissues (P＜0.01).The expression levels of VCC-1 mRNA in 2 specimens were related to tumor differentiation and tumor size (P＜0.05).In the 10 specimens of normal liver tissues,no expression was detected in 8 specimens and light expression in 2 specimens.The expression was lower compared with cell lines,cancer tissues and adjacent tissues (P＜0.01).In 3 cases of recurrence,VCC-1 was highly expressed in cancer tissues (20.1±2.3 fold).In 8 specimenswith tumor thrombosis,5 tissues showed highly expressed VCC-1 (17.3±4.5 fold) while 3 specimens showed low expression.Conclusion VCC-1 plays an important role in HCC,and it may be considered as a potential therapeutic target of HCC.

AIM:To determine four bioactive components in Tongda Granule ( Radix Paeoniae alba,Flos Carthami,Radix Scutellariale,etc. ),namely hydroxy safflower yellow A,peoniflorin,ferulic acid,and baicalin. METHODS:The isolation was performed on an Alltech Apollo C18 (250 mm ? 4. 6 mm,5 ?m) with the mobile phase consisting of methanol-0. 2% (w)phosphoric acid for gradient elution. The flow rate was 1. 0 mL/min and the column temperature was set at 30 ℃. RESULTS:This method was successfully applied to determining four bio-active components in Tongda Granule. The standard curves were linear over the ranges of 5. 20 -104 mg/L for hydroxy safflower yellow A(r =0. 999 1),25. 6 -512 mg/L for peoniflorin (r =0. 999 6),7. 72 -154. 4 mg/L for ferulic acid (r =0. 999 5),32. 5 -650 mg/L for baicalin (r = 0. 999 5),respectively. The average recoveries were 101. 1% ,99. 6% ,98. 9% and 101. 9% ,RSD were 2. 3% ,1. 8% ,2. 6% and 1. 3% ,respectively. CONCLUSION:The method is simple and can be used as a quality control method for Tongda Granule.

Aim To investigate the effect of melatonin (MT) and pentoxifylline (PTX) on hepatic ischemia reperfusion (I/R) in rat. Methods 128 rats were randomly divided into four groups: control group, MT treated group, PTX treated group and PTX+MT group (combined group). Those operation procedures including occlusion the inflow to the liver 35 minutes, hepatectomy and reperfusion, were underwent by the animals. The following items were investigated: liver function, endothelin 1 (ET 1), malondialdehyde (MDA), superoxide dismutase (SOD), and one week survival. Results The following changes were detected after the liver ischemia: ①Liver function: the increased scopes of ALT and LDH were significantly lower in treatment groups, especially in the combined group than that in control one; ②ET 1: the levers of ET 1 were significantly increased in every group, especially the control group; ③MT function: the increased scopes of MDA and SOD were significantly lower in MT groups (including MT treated and combined groups) than that in others; ④PTX function: the increased scopes of TNF ? were significantly lower in PTX groups (including PTX treated and combined groups) with a higher rate of survival than that in others. Conclusion ①MT could reverse the oxidative damage, but cannot affect the rate of survival; ②PTX can decrease the secretion of cytokine and the one week survival; ③Based on the synergistic effects, the application of MT+PTX may have beneficial effects against the I/R injury to increase the survival.

BACKGROUND:At present, spleen tyrosine kinase is the new target of studying and treating rheumatoid arthritis. OBJECTIVE:To study the influence of smal molecule tyrosine kinase inhibitor HL131078 on the inflammatory cel infiltration and cartilage destruction of the knee joint of mice with col agen-induced arthritis. METHODS:Forty DBA/1 mice were randomly and evenly divided into blank, model, positive and experimental groups. Col agen type II (CII) solution and Freund’s complete adjuvant (including mycobacterium tuberculosis) were injected into the mice of the latter three groups through the tail to establish mouse models of col agen-induced arthritis. At 2 weeks after the the first immunization with CII, the mice in the positive group were intragastrical y given R406 (10 mg/kg), once a day, for 28 consecutive days. The mice in the experimental group were intragastrical y given HL131078 (10 mg/kg), once per day, for 28 consecutive days. RESULTS AND CONCLUSION:Compared with the model group, the mean arthritis indexes of mice in the experimental and positive groups started to decline at 29 and 26 days. In the experimental group, the cartilage destruction of mouse knee joint was obviously reduced and the inflammatory cel infiltration in the knee joints was obviously reduced, which was close to that in the positive group. The results demonstrate that the smal molecule tyrosine kinase inhibitor HL131078 can effectively reduce inflammatory cel infiltration and cartilage destruction in the knee joints of mice with col agen-induced arthritis.

Objective To evaluate the clinical effectiveness of laparoscopic (LDP) versus open distal pancreatectomy (ODP) using meta-analysis.Methods Comprehensive literature search was conducted on articles only in English published from 2006 to 2012 on MEDLINE,EMbase,Cochrane Central Registry of Controlled Trials to compare LDP with ODP for Pancreatic disease.Data were extracted and evaluated by two reviewers independently.The quality of the included trials was evaluated.Meta-analyses were conducted using the Cochrane Collaboration's RevMan 5.1 software.Results Fourteen controlled clinical trials (n=1417) were included.The LDP group was significantly longer than the ODP group in operation time,and was significantly larger in the number of patients with spleen preservation [(MD-273.10,95％ CI-354.39-191.081,P＜0.01),(OR 2.42,95％ CI 1.78-3.30,P＜0.01) respectively].The LDP group was significantly less than the ODP group in intraoperative blood loss,time to oral intake,and length of hospital stay [(MD-273.10,95％ CI -354.39-191.81,P＜0.01),(MD-1.78,95％ CI-2.36-1.20,P＜0.01),(MD-3.15,95％ CI-3.97-2.33,P＜0.01) respectively].There were no significant differences in blood transfusion,pancreatic fistula rate,and mortality between the two groups.Conclusions LDP is feasible and safe in treating pancreatic disease.When compared with ODP,LDP has the advantages of having less intraoperative blood loss,quicker recovery and more patients with spleen preservation.

BACKGROUND:There are a variety of surgical approaches for minimally invasive total hip replacement,such as anterolateral,posterolateral and two-incision.However,it is unknown which one is more in line with the concept of minimally invasive and easy to carry out.OBJECTIVE:To observe the clinical application effect of total hip replacement using anterlateral modified Watson-Jones approach.METHODS:From January 2005 to December 2006,35 patients were performed total hip replacement with the new anterlateral approach at the Department of Orthopaedics,the First Affiliated Hospital of Soochow University,including 16 males and 19 females,aged 52-78 years,mean aged 65.9 years;the average body mass index was 24.4 kg/m~2 (19.3-30.1 kg/m~2).The length of incision,operative duration,transfusion,complications,postoperative movement,postoperative hospital stay,prosthesis position and Harris score after operation were observed.RESULTS AND CONCLUSION:The patients were followed up 6-24 months,with an average of 17.3 months.The average length of incision was 8.3 cm (7-12 cm).The mean operative duration was 92.1 minutes (70-120 minutes).The average blood transfusion was 300 mL (0-800 mL).All the patients were practice their limb muscles immediately after the operation and they were activity the day after operation under the guidance of doctor.The average postoperative hospital stay was 7.9 days (5-15days).Eleven hip pains occurred at 3 months,9 cases at 6 months and 5 cases at 12 months,the Harris scores were (79.5±4.4)points,(84.0±3.6) points,and (85.4±3.0) points,respectively.No infection,dislocation,vessel or nerve injury happened.From the follow up,all of the patients had good prosthesis position and rang of hip motion.The results revealed that the new anterolateral approach is minimally invasive total hip replacement,and the patients can recover faster via some proper exercise.

Objective To compare the outcome of proximal femoral nail antirotation (PFNA)and third generation of Gamma nail (TGN) in the treatment of femoral intertrochanteric fracture in the elderly. Methods From January 2007 to June 2008, the patients with intertrochanteric fractures were divided into PFNA group ( n = 55 ) and TGN group ( n = 52 ) randomly. The two treatment groups were comparable in aspect of general data. The clinical data of surgical trauma, complications and postoperative function of the two groups were compared in our study. Results The mean operation time was (66.6 ± 15.4) min in PFNA group and (73. 1 ± 20.8 ) min in TGN group (P ＞ 0. 05 ). The mean intraoperative blood loss differed significantly, (219.5 ± 107.5 ) ml in PFNA group compared with (269.0 ±123.9) ml in TGN group ( P ＜ 0. 05 ). The mean fluoroscopy time was ( 2.97 ± 1.14 ) min in PFNA group and (3.43 ± 1.18) min in TGN group (P＜0.05). Unilateral femoral shaft splits at the distal end of the nail was observed intra-operatively in four patients of the PFNA group and in one of the TGN group,with no statistical difference between two groups. Of all, 91 patients ( n =46 in the PFNA group and n =45 in the TGN group) were followed up for a duration of ( 17.5 ±3.69) months. There was one re-fracture and one implant failure during the follow up period in PFNA group, which was not found in TGN group. Fiftyone patients recovered to normal activity status, including 27 in the PFNA group and 24 in the TGN group,with no statistical differences. Conclusions Intertrochanteric fracture can be treated successfully with PFNA and TGN. There is no significant difference in complications and functional outcome between the two groups. However, PFNA takes advantages of less blood loss, less operative time and less fluoroscopy time over TGN.

Objective To investigate the effects of lipoxygenase inhibitor NDGA on expression of 5-LOX and its apoptosis related genes in HepG2 cell line.Methods The expression of 5-LOX and apoptosis related genes hTERT,bcl-2 and bax mRNA was determined by reverse transcriptasepolymerase chain reaction (RT-PCR).Results After 25,50,100,200 μmol/L NDGA treatment for24,48 h,the expression of 5-LOX of HepG2 cell decreased,but the expression of bax was up-regulated and the expressions of bcl-2 and hTERT mRNA were down-regulated,(P＜0.05 compared with the control group).The decrease in the expression of 5-LOX,hTERT and bcl-2 in HepG2 cell was negtively correlated with the dose duration of action of NDGA.Conclusion In vitro,5-LOX is expressed highly in HepG2 cell.Overexpression of 5-LOX may be related to the progression of hepatocellular carcinoma,NDGA can significantly decrease the expression of 5-LOX,up-regulate of bax and downregulation of bcl-2 and telomerse.Lipoxygenase might be a novel therapeutic target for the hepatocellular carinoma.