Objective To prospectively evaluate changes in serum vascular endothelial growth factor (VEGF) levels in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE), and to investigate the association between serum VEGF levels and characters of imaging features. Methods Serum VEGF levels in 30 patients with HCC were measured on one day before TACE 3-4 days and 28-30 days after TACE, using quatitative sandwich enzyme-linked immunosorbent assay (ELISA R&D system). The occurrence of metastasis was assessed 6 months after TACE by CT (computed tomography) and DSA (digital subtraction angiography). Results (1) Serum VEGF levels had a tendency to increase in patients with the heterogenous uptake of iodine oil and those with portal vein invasion (P

Objective To evaluate the possibility,efficacy and safety of endoscopic balloon dilation(EBD)for the treatment of common bile duct stones.Methods EBD of the sphincter of Oddi and removal of the stones by balloon,basket net and mechanical lithotripsy were performed in 47 patients with common bile duct stones.In order to prevent the possible complicated pancreatitis,Sandostatin,endoscopic nasobiliary drainage(ENBD)and small sphincterotomy were used according to the patients conditions.Results The success rate of EBD for the treatment of common bile duct stones was 91 5%(43/47)in our group.During one EBD session the common bile duct was cleared in 41(87 2%)of 47 cases.Incomplete duct clearance was achieved in 2(4 3 %)cases,both of whom underwent repeated EBD with successful duct clearance without undergoing endoscopic sphincterotomy(EST).Mechanical lithotripsy was required in 27(57 4%)of the 47 cases for stones greater than 1 0cm in diameter.Failure to clear the common bile duct with EBD in 4 cases(8 5%)was primarily related to large stones size (≥2 0cm),in whom EST was required to clear the duct.No perforation or hemorrhage was observed.Temporal hyperamylasemia was observed in 11 patients,only 1 of whom was accompanied by abdominal pain,which was rapidly relieved through conservative treatment.Conclusion EBD for the treatment of common bile duct stones is possible,effective and safe.

objective To evaluate endoscopic surgery for high risk patients over 70 years old with severe acute cholangitis. Methods From October 1991 to October 2003, 84 high risk patients over 70 years old suffering from severe acute cholangitis were included and divided into laparotomy surgery (ST) and endoscopic surgery (ET) group. Results 80 patients were cured. The care rate was 81.2% in ST group and 91.6% in ET group. The mortality rate was lower in ET compared with ST (9.1% vs 18.8%). The rate of complication was reduced from 37.5% in ST group to 13.9% in ET group. The average duration of drainage was reduced from 49.4 days in ST group to 18.6 days in ET group. The total treatment days were shortened from 46.2 days to 22.8 days comparing ST with ET. Conclusions Endoscopic surgery should be the first choice for the senile and high risk patients with severe acute cholangitis. Endoscopic surgery was convenient, with mininal injury, safe and effective, and period of treatment was shortened, especially for elderly or critically ill patients, as well as those with MODS or previous billiary operations.

Objective: To clone human T cell receptor (TCR) ? chain gene and express its encoding protein by baculoviral expression system in insect cells. Methods: TCR ? chain cDNA was cloned from normal human peripheral blood mononuclear cells (PBMC) by RT-PCR and inserted into baculoviral transfer vector. This vector was co-transfected with baculovirus into insect sf 9 cells. The recombinant protein expressed was identified by SDS-PAGE and flow cytometry with mouse anti-human ? chain monoclonal antibody. Results: Human TCR ? chain cDNA cloned and inserted into baculoviral vector specifically expressed protein in the insect sf 9 cells, accounting for about 11% of the total protein yield in the supernatant of cell lysate. The molecular weight of the recombinant protein determined by SDS-PAGE was identical to what we anticipated. The insect cells transfected with recombinant baculovirus were demonstrated by intracellular labeling flow cytometry to express ? chain protein. Conclusion: Human T cell receptor ? chain gene was successfully cloned from human PBMC, and its encoding protein was highly expressed in insect cells. The TCR ? chain protein obtained by bioengineering technique is useful for in depth biological function study.

AIM: This study is to detail its possible mechanisms that homocysteine (Hcy) induces injury of cultured endothelial cells.METHODS: Hcy in sequential concentrations was added into the cultured human umbilial vein endothelial cells for 24 hours in serum-free medium. The lipid peroxidation, release of LDH, cell total protein content, cell apoptosis and necrosis were assessed. RESULTS: Hcy increased the apoptosis of endothelial cells.In high Hcy concentration the cells also showed obvious injurious and necrotic morphological changes. Lipid peroxidation increased, with LDH releasing up and cell total protein content down, and they showed a positive dose-effect relationship with the Hcy concentration. All the above effects of Hcy was strengthened by low density lipoprotein (LDL) which may suggest synergetic effects of Hcy and LDL.CONCLUSION: Our results indicate that Hcy has a strong oxidizing effect, which may be one of its major mechanism for injury of EC.

Objective To evaluate the endoscopic managements of acute cholangitis of severe type (ACST) accompanied with multiple organ dysfunction syndrome (MODS). Methods A total of 122 ACST patients accompanied with MODS from January 2000 to October 2008 underwent endoscopic treatment in two time periods. In critical phase, emergent endoscopic retrograde cholangiopancreatography (ERCP) plus en-doscopic naso-biliary drainage (ENBD) were performed to correct critical situation of the patients. After sta-bilization, endoscopic sphincterotomy (EST) plus stone removal, EST plus stent placement, or laparoscopy was performed according to the causes of ACST. Results Emergent endoscopic managements succeeded in all patients of critical phase. At third day post-operation, a reduction in white blood cell count, serum total bilirubin, body temperature, and rate of patients with shock, mental symptoms and purulent bile juice was a-chieved. Recovery rate of dysfunction organs was 60.2% at one week after emergent procedure, and 82. 6% at 2 weeks post-operation. Selective EST plus stone removal was performed in 36 patients with a success rate n one session at 91.7%. Laparoscopic cholecystectomy was performed in 85 patients with a success rate of 95.3%. Stent was placed in 16 patients with an effective rate of 81.3% at 3 months post the procedure. No severe complication or death occurred during the whole therapeutic course. The 6-month survival rate of 10 cancer cases was 70%. Conclusion Therapeutic ERCP plus ENBD is the first choice for acute severe cholangitis accompanied with MODS, while EST plus biliary lithotomy, or EST plus stent placement, or com-bined laparoscopy are ideal methods for subsequent treatment.

Objective To study the application of pressure regulated volume control ventilation in respiratory support after liver transplantation.Methods Twenty patients underwent liver transplantation were randomly averagely divided into two groups: pressure regulated vlume control ventilation(PRVCV) group and volume control(VC) group.The parameters of respiratory mechanics,hemodynamics and blood gas analysis of patients in two groups were compared,such as oxygen delivery(DO2),oxygen consumption(VO2),oxygen incepation ratio(O2ER),arteriovenous oxygen content difference(C(a-v)O2),cardiac output(CO),mean arterial pressure(mABP),mean pulmonary arterial pressure(mPAP),alveolar-arterial PO2 difference(P(A-a)O2),gas exchange index(PaO2/FiO2),ratio of shunted blood to total perfusion(Qs/Qt),peak inspiratory pressure(PIP) and mean airway pressure(mAP).Results The P(A-a)O2 and Qs/Qt were significantly decreased in PRVCV group than those in VC group(P(A-a)O2:(101.42?28.07) mm Hg vs.(136.76?39.13) mm Hg;Qs/Qt:(1.78?0.86)% vs.(3.28?0.99)%),P

Objective To investigate the clinical value of endoscopic biliary stent drainage for obstructive jaundice due to hepatic portal metastatic carcinoma. Methods Patients with obstructive jaundice arising from hepatic portal metastatic carcinoma were selected and treated with consent by plastic endoscopic bile duct stents since 2006. Success rate and survival were evaluated. A total of 38 patients with obstructive jaundice were treated and analyzed. Hepatic portal metastatic carcinoma included 13 cases of liver cancer, 3gallbladder carcinoma, 14 gastric carcinoma, 2 esophageal carcinoma, 1 ileum adenocarcinoma and 5 pancreatic carcinoma. Results Stents were successfully placed in all patients and jaundice rapidly subsided after the endoscopic procedure. Follow-up life span was 92-521 days, mean 264. 42 ± 104. 41 days. During follow-up, biliary stents were replaced in 5 patients in 3-14 months ( mean 8. 6 ± 4. 1 months) because of stent displacment in 1 case, biliary stone obstruction in 2 cases and carcinomatous obstruction in 2 others.Conclusion For patients with obstructive jaundice arising from hepatic portal metastatic carcinoma, endoscopic biliary stent drainage is effective and can prolong life span to some degree.

Objective To assess the curative effect of endoscopic resection for patients with duode-nal bulb carcinoid.Methods Data of 17 patients with duodenal bulb submucosal tumor who underwent en-doscopic dissection in our department and confirmed as duodenal bulb carcinoid by postoperative pathology from Jun 2009 to Jun 2012 were retrospectively analyzed.Seventeen patients included 1 1 men and 6 women with the mean age of 36. 3 ±8. 4.Results All patients underwent preoperative diagnosis of endoscopic ultrasonography(EUS).Four cases were diagnosed as heterotopic pancreas and 13 cases carcinoid.The size of tumor was from 4 to 10 millimeter.Cap-assisted endoscopic mucosal resection (EMR-C)were used in all patients successfully.No complications were found during or after the operation.Postoperative pathology con-firmed 6 cases of duodenal bulb carcinoid.The accuracy of EUS preoperative diagnosis was 76. 5%.The average follow-up time was 20. 5 ±12. 4 months.Metastases and recurrence had not been found.Conclusion EUS can confirm the invasive depth of duodenal submucosal tumors and estimate the indication of endo-scopic excision.EUS can not give a preoperative qualitative diagnosis of duodenal submucosal tumors.Endo-scopic hyaline cap excision is a safe and sufficient method for duodenal bulb carcinoid.

Objective To observe the clinical effects of external application of Chinese medicine ion introduction through acupiont in the prevention and treatment of hyperamylasemia and pancreatitis following endoscopic retrograde cholangio pancreatography (ERCP). Methods Three hundred subjects were divided into treatment group and control group randomly, and treated with routine therapy after surgery, moreover, treatment group was treated with external application of Chinese medicine ion introduction through acupiont. The incidence of hyperamylasemia and pancreatitis, the time of serum amylase returned to normal in patients with hyperamylasemia and pancreatitis was observed, and the abdominal pain after ERCP was scored. Results Excluding 17 cases according to the exclusion criteria, the treatment group included 142 cases and the control group included 141 cases. The hyperamylasemia and pancreatitis happened less frequently in the treatment group than in control group, but there was no significant difference (P>0.05). The time of serum amylase returned to normal in patients with pancreatitis was (4.25±0.95)d in treatment group and (5.28±1.11)d in control group, with no significant difference (P>0.05). The time of serum amylase returned to normal in patients with hyperamylasemia was (2.88 ± 0.78)d in treatment group and (3.81±1.62)d in control group, showed a significant difference (P<0.05). The score of abdominal pain was 0.95±1.04 in treatment group and 1.21±1.12 in control group, showed a significant difference (P<0.05). Conclusion External application of Chinese medicine ion introduction through acupoint can promote the recovery of the patients postoperative ERCP combined with hyperamylasemia or pancreatitis, and can better alleviate abdominal pain.