Objective Analyse the causes,diagnosis and treatment for delayed hemorrhage after distal radical gastrectomy.Methods Retrospective study on 45 patients combined with intro-abdominal hemorrhage after distal radical gastrectomy from January 2008 to June 2013.Results Thirteen patients combined with delayed hemorrhage in these 45 patients,all of 13 patients had intro-abdominal hemorrhage in 1week to 4 weeks after operation.And 5 of the 13 patiens were intermittent intro-abdominal hemorrhage 1 week after operation,these patients were demonstrated the blood come from gastroduodenal artery pseudoaneurysm fracture by CT and DSA examine,and they were cured by interventional embolization.Other 8 patients were marginal ulcer hemorrhage diagnosed by gastroscope,and they stoped bleeding with the help of gastroscope.Conclusions The causes of delayed hemorrhage after distal radical gastrectomy were complicated,and CT,DSA and endoscope can use for diagnosis.What was more,interventional embolization and endoscope were helpful for curing the intro-abdominal hemorrhage,avoiding re-operation.

Pheochromocytomas and paragangliomas are rare but therapeutically challenging neuroendocrine tumors in urology. Surgical treatment has been recognized as a definitive treatment. However, traditional surgical methods present certain risks and limitations. The Da Vinci robotic surgery offers a new approach for treating these tumors. This review elucidates the technical features, clinical applications, and treatment outcomes of Da Vinci robotic surgery and the progress in the treatment of pheochromocytomas and paragangliomas. In addition, this review discusses the prospects of combining Da Vinci robotic surgery with other emerging technologies, emphasizing the further research to validate its long-term efficacy and safety.

BACKGROUND: Subsequent to liver transplantation, pulmonary infection and new drug resistant strain frequently appear due to complex pathophysiological changes and abuse of antibiotics.OBJECTIVE: To collect the clinical data of 6 cases who underwent liver transplantation, and analyze the prevention and treatment measures of pulmonary infection after liver transplantation.DESIGN, TIME AND SETTING: Retrospective case analysis, performed in the Department of Hepatobiliary Surgery,First People's Hospital of Guangzhou between January and December 2004.PARTICIPANTS: Six cases that underwent liver transplantation and received treatment in the First People's Hospital of Guangzhou were recruited in the present study. All 6 cases underwent selective homologous whole liver transplantation, 5cases underwent modified orthotopic piggyback liver transplantation, and only 1 underwent classical orthotopic liver transplantation.METHODS: The clinical data of the 6 cases were retrospectively analyzed. After transplantation, basic disinfection,isolation, infection-protection measures should be taken. In addition, etiological information was collected. Chest X-ray was underwent to know the lung at the early stage. Aseptic manipulating was strictly performed during sputum aspiration.Gastrointestinal decompression and non-obstructed drainage were maintained to prevent aspiration. Moreover, preventive anti-infective treatment against the bacteria, fungi, and viruses was performed.MAIN OUTCOME MEASURES: Pulmonary infection and curative effects subsequent to liver transplantation.RESULTS: Of the 6 cases, 5 presented with pulmonary infection, including 1 at 4-11 days after transplantation and 1 at 1day after transplantation. One case died of respiratory failure. The remaining 5 cases were cured after standardized anti-infection, respiratory therapy, sputum aspiration, and nutritional support.CONCLUSION: Application of effective antibiotics, aseptic operation in sputum aspiration, and unobstructed respiratory tract drainage are important measures for treating pulmonary infection subsequent to liver transplantation.

Objective To systematically evaluate the role of laparoscopic living donor hepatectomy in living donor liver transplantation (LDLT).Methods A systematic literature search was conducted on Medline-Pubmed,Embase,Cochrane Library to find studies on laparoscopic living donor hepatectomy for LDLT.All extracted data were analyzed using the RevMan 5 software.Results Ten studies with a total of 1 059 participants were included in this analysis.Laparoscopic donor hepatecomy (LDH) was associated with significantly less intraoperative blood loss [SMD =-0.39,95％ CI (-0.73,-0.05),P ＜ 0.05],lower peak level of postoperative total bilirubin [SMD =-0.24,95％ CI (-0.47,-0.01),P ＜ 0.05]and longer operative time [SMD =0.50,95％ CI (0.04,0.96),P ＜0.05] when compared with those operated with open surgery.On subgroup analyses,hospitalization stay decreased in patients who underwent LDLT with grafts obtained by complete living donor hepatectomy (LDH) and left lateral sectionectomy (both P ＜ 0.05).LDH was comparable to open surgery in donor complication rates and in-hospital cost (P ＞ 0.05).There were no differences on the harvested liver graft size,ischemic time,recipient postoperative liver function and complications between the two groups (P ＞ 0.05).Conclusions Laparoscopic hepatectomy in living donor is a safe procedure for graft-harvesting,which improved the clinical outcomes of the donor,liver graft and recipient in LDLT.It has also the advantages of reduced blood loss,low peak levels of postoperative total bilirubin and short hospitalization stay.

Objective To investigate the safety and feasibility of intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice.Methods Clinical data of 17 consecutive patients,from January 2010 to February 2015,diagnosed with pancreatic ductal adenocarcinoma (4 cases of T4 N0 M0 and 13 of T4 N1M0) with obstructive jaundice and received intraluminal brachytherapy using iodine-125 seed strand were collected and analyzed retrospectively.Liver function was evaluated using paired-samples t test.The iodine-125 seed strand radiation doses were calculated using iodine-125 radiation field distribution calculation software (version 0.1,Institute of Radiation Medicine,Fudan University,Shanghai,China) based on the American Association of Physicists in Medicine TG43U1 brachytherapy formula.Obstruction free survival and overall survival were calculated using the Kaplan-Meier method.Complications were assessed according to the CTCAE 4.0 criteria.Results The estimated mean accumulating dose (r =5 mm,240 days) was 167.2Gy,from 164.19Gy to 170.05Gy.The mean and median obstruction free survival time were (9.62 ± 1.47) months (95％CI:6.73-12.50) and (7.26 ± 1.71) months (95 ％CI:3.90-10.62).The mean and median overall survival time were (9.89 ± 1.59) months (95％CI:6.78-13.00) and (7.26 ± 1.71) months (95 ％ CI:3.90-10.62),retrospectively.Total bilirubin and conjugated bilirubin decreased significantly after the therapy.Two patients had adverse event of Grade 3,one of Grade 4.Stent dysfunction occurred in 1/17 (5.9 ％) patients.Conclusions Intraluminal brachytherapy using iodine-125 seed strand might be considered as a safe treatment option for the locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice.

Calbindin 2 ; metabolism ; Colon ; metabolism ; Hirschsprung Disease ; metabolism ; Humans

AIM: To investigate effects of different therapeutic methods and typical recipes on activation of ERK1/2 in Kupffer cells of rats with fatty liver.METHODS: The rat model of fatty liver was established by feeding high fat diet combinated with distillate spirit.Meanwhile Chinese medicines Shugan fang,Jianpi fang,Huoxue fang,Qushi fang,and Zonghe fang were given to treat different groups respectively.12 weeks later,the Kupffer cells were isolated from livers of control group,model group and different treatment groups by sequential in situ perfusion with collagenaseⅣ and pronase E,density gradient centrifugation,selective adherence.The expression of total ERK1/2 and phospho-ERK1/2 in Kupffer cells of control group,model group and different treatment groups were detected by Western blotting.RESULTS: The expressions of total ERK1/2 and phospho-ERK1/2 were higher in Kupffer cells from model group than those in control group(P

Objective To evaluate the safety and efficacy of brachytherapy with 125I seed strand in treating implanted main portal vein tumor thrombus (MPVTT) in experimental rabbits.Methods VX2 tumor cell line was implanted in the main portal vein (MPV) of 32 New Zealand white rabbits to establish MPVTT models.The rabbits were randomly divided into the treatment group (group T,n=16) and the control group (group C,n=16).125I seed strand was implanted in the MPVTT of the rabbits of group T,while blank seed strand was implanted in the MPVTT of the rabbits of group C.After the implantation,the changes in general condition,body weight and laboratory testing results were recorded.Two weeks after the treatment,every 8 rabbits from each group were sacrificed,and the specimens were collected and sent for pathological examination.The remaining rabbits were fed till they died,and then autopsy was conducted.Multi-slice spiral CT manifestations,histopathological findings,Ki-67 labeling index and apoptosis index were used to assess the curative effect,and the results were compared between the two groups.Results At each observation time point after brachytherapy,the weight loss of the experimental rabbits was more obvious in group C than in group T.No statistically significant differences in liver functions and white blood cell count existed between the two groups (P＞0.05).The mean MPVTT volume of group T and group C were (565.40±220.90) mm3 and (2 269.90±437.00) mm3 respectively (P＜0.001);the Ki-67 labeling indexes were (4.14±1.84)％ and (33.82± 6.07)％ respectively (P=0.001);the median survival days were (39.50±2.37) d and (27.38±1.22) d respectively (P=0.001).Conclusion For the treatment of implanted MPVTT in experimental rabbits,brachytherapy with 125I seed strand is safe and effective.

Objective To investigate clinical features of Peutz-Jeghers syndrome(PJS)and genetic change in STK11. Methods Clinical data and genetic change in STK11 gene of four PJS children were retrospectively analyzed.Results Four patients have hyperpigmentation on their lips, buccal mucosa or fingers. Intestinal polyposis was found at different locations of gastrointestinal tract. Polypectomy was performed in four patients and pathological section displayed the muscle fibers of the muscularis mucosae form a dendritic structure. And we found 4 heterozygous mutations (c.582C>A,c.580G>A,c.719C>G and c.879insA)on STK11 gene in these patients.Conclusions The PJS patients have typical clinical features;gene detection is helpful to early diagnosis,and we found a novel mutation(c.879insA) in STK11 gene.

Objective: To evaluate the differential calretinin immunostaining in different segments of total colonic aganglionosis and its utility in the diagnosis. Methods: Nine specimens including ileum and colon segments were obtained from 9 patients with total colonic aganglionosis (TCA), from 2010 to 2016 year, in Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology. Another 9 ganglionic specimens including the same segments from patients with non-Hirschsprung disease (non-HD) patients were collected as control. All cases were immunostained with calretinin. The patterns of calretinin immunostaining were observed, and morphometric analysis of each sample was performed by image analysis program (Image-Pro-Plus). The mean absorbance was evaluated by calculating the areas of the lamina propria occupied by the positively stained area of the calretinin at high power field. Results: The same pattern of calretinin immunostaining was seen in ganglionic ileum and ganglionic colon segments, with staining seen in intrinsic nerves fibers (INF), and in granular aggregates in the lamina propria and muscularis mucosae. There was no significant difference in the numbers of calretinin-positive INF from the ganglionic segments. In contrast, the number of calretinin-positive INF and granular aggregates in aganglionic segments were significantly lower than those in the ganglionic group (P<0.01). In the ileum transitional zone, scattered calretinin staining was observed, and the amount of calretinin-positive INF was significantly lower than those in the proximal segment of ganlionic ileum (P<0.01). Conclusions Since there is significant different expression of calretinin among the different segments from TCA, calretinin immunostaining has potential value in detecting TCA. It could be an important adjunctive method in detecting TCA in the future.