Objective To investigate the risk factors of extrahepatie recurrences after curative resection of primary hepatocellular carcinoma (HCC). Methods Clinicopathologic data of 238 curative resected cases of primary HCC were retrospectively reviewed for parameters affecting postoperative extrahepatic recurrences. Results During a median follow-up of 34 months (7 - 78 months), extrahepatic recurrences were observed in 32 out of 238 patients (13.4%). According to univariate analysis, the risk factors for extrahepatic recurrences were preoperative serum a-fetoprotein (AFP) level of > 1000 ng/ml,aspartate aminotransferase level of > 50 IU/L, presence of hepatic vein invasion, neighboring organ invasion, tumor satellites, and lack of tumor capsule formation. Preoperative serum AFP levels of > 1000 ng/ml, hepatic vein invasion, neighboring organ invasion proved to be independent risk factors by multivariate analysis. Conclusions Extrahepatic recurrences after curative resection of HCC was found to be related to preoperative serum AFP level of > 1000 ng/ml, hepatic vein invasion, and neighboring organ invasion.

Objective To explore the clinical value of total hemihepatic vascular exclusion (THHVE) in right hepatectomy for hepatocellular carcinoma (HCC). Methods One hundred and twenty-three consecutive patients who underwent right hepatectomy for HCC between February 2006 and December 2008 were studied retrospectively. THHVE was used in 58 patients (group A) and Pringle maneuver in 65 patients (group B). The patient's demographics,surgical procedure and outcome were collected and compared between the two groups.ResultsThe tumor size was significantly bigger in group A than group B (7.69±3.70 cm vs.6.08±4.07 cm,P＜0.05).The vascular occlusion time in group A was significantly longer than groupB (28.55±8.67 min vs.19.85±6.71 min,P＜0.05). However, intraoperative blood loss in group A was significantly less than group B (304.31±270.36 ml vs.542.62±876.84 ml,P＜0.05),and the elevation of serum alanine aminotransferase (ALT) on day- 1,-3 and- 7 after operation in group A were significantly lower than group B (P＜0.05).The postoperative complication rate in group A was lower than group B (18.97％ vs.38.46％,P＜0.05).ConclusionTHHVE was a safe and efficacious technique in right hepatectomy for HCC.It significantly decreased blood loss,alleviated liver injury and reduced postoperative morbidity and mortality.

Objective To evaluate the techniques and the effects of resection of giant hepatic tumors in the caudate lobe of the liver. Methods The clinical data of 33 patients with primary liver carcinoma or benign tumor (>10 cm) in the caudate lobe of the liver surgically treated in our hospital from January 2000 to January 2007 were retrospectively analyzed. Results The total of 33 huge liver tumors with a median diameter of 12.3 cm (10.2-15.3cm) were successfully resected. The types of the hepatectomies conducted were as follows:isolated total caudate lobectomy in 7cases, partial cau-date lobectomy in 8, caudate lobectomy plus other extended hepatectomy in 18. The median operative time was 218 min (120-360 min) and the median intraoperative blood loss 958 ml (400-7000 ml),with operative mortality and morbidity being 0 and 27%, respectively. The postoperative 1-, 3- and 5-year survival rates for the patients with primary liver cancer were 76 %,52% and 24%, respectively. Con-clusion The hepatic tumors of caudate lobe, when larger than 10 cm in diameter, frequently involves all the hepatic portal,hepatocaval confluence and retrohepatic IVC. Though it is sophisticated in tech-nique, surgical resection of this kind of tumor is safe, effective and of the first choice.

Objective To evaluate the inhibitory effects of sustained-release 5-fluorouracil(5-FU)micmparticles on the growth of HepG2 eels.Methods The inhibitory effects of sustained-releage 5-FU micropartides,5-FU microparticles and poly L-lactic acid on HepG2 cells were detected by MTT assay.The HepG2 cell apoptosis was demonstrated by flow cytomerry after Hoehest staining.Results The survival rate of HepG2 cells in sustained-release 5-FU microparticles group decreased as time passed by.The survival rate of HepG2 cells in 5-FU microparticles group wag the lowest on the first day,and then it increased gradually.The survival rates of HepG2 ceHs in 5-FU microparticles group on day 21 and 28 were hJigher than those in sustained-release 5-FU microparticles group.The survival rate of HepG2 cells in poly L-lactic acid group WSB higher than that in the other two groups.The difference upon survival rate among the 3 groups had statistical significance(F=3163.52,128.47.P＜0.01).Conclusions The sustained-release 5-FU micropartieles could keep on inhibiting tlle growth and inducing apoptosis of HepG2 cells in time-dependant manner.The inhibitory effect of sustained-release 5-FU is better than that of 5-FU microparticles.

Objective To investigate the alterations and phenotypes of dendritic cells, inflamma-tory monocytes and macrophages in immunocompetent mice during Pneumocystis murina ( P.murina) infec-tion for further analysis of the function of these cells during P.murina infection.Methods Wild type male C57BL/6 mice at age 6-8 weeks were randomly divided into two groups including the group with P.murina infection and the group receiving sham surgery.The mice without any intervention were used to set up the blank control group.The loads of P.murina strains in lung tissues of each mouse were quantified by TaqMan real-time fluorescence polymerase chain reaction after the infection.Histopathological examination was per-formed to evaluate the degree of inflammation in lung tissues.The numbers of dendritic cells, inflammatory monocytes and macrophages in lung tissues, peripheral blood and bone marrow samples, and the changes of inflammatory monocytes in spleen tissues were measured by flow cytometry analysis.The expression of major histocompatability complexⅡ(MHCⅡ), CX3C chemokine receptor 1 (CX3CR1) and CC chemokine re-ceptor 2 ( CCR2 ) by dendritic cells, inflammatory monocytes and macrophages in lung tissues during P.murina infection were analyzed by flow cytometry analysis.All of the data were collected one, two, three and four weeks after the corresponding treatments.Results The loads of P.murina strains in P.murina in-fected mice were elevated after two and three weeks infection, but decline at week 4 (P>0.05).Significant pathological changes including the alveolar destruction, inflammatory cell infiltration and thickened alveolar septum in mice with P.murina infection were observed under a microscope at week 3 and week 4.Compared to the sham surgery treatment group, the number of CD11c+CD11b+dendritic cells were increased in lung tissues, but decreased in blood samples during P.murina infection ( P<0.05) .The levels of inflammatory monocytes in blood samples fell at week 3 and then rose at week 4 during P.murina infection (P<0.05). No significant difference with the change of macrophages in mice was observed during P.murina infection ( P>0.05).The CD11c+CD11b+dendritic cells in lung tissues of mice with P.murina infection expressed high levels of MHCⅡand CX3CR1, and low levels of CCR2.The inflammatory monocytes in lung tissues of mice expressed high levels of CCR2, moderate levels of MHCⅡand low levels of CX3CR1 during P.murina in-fection.High levels of CX3CR1 and low levels of MHCⅡ and CCR2 were observed in macrophages from lung tissues of mice with P.murina infection.Conclusion Highly expressed CD11c+CD11b+dendritic cells and MHCⅡwere detected in lung tissues of mice during P.murina infection, indicating that CD11c+CD11b+dendritic cells were involved in the host defense against P.murina infection.

Objective To investigate the effect of radiofrequency ablation (RFA) of ventricular outflow tract septum on the left ventricular structure and function in experimental canine.Methods Healthy experimental dogs were used for this study.RFA of the myocardium at ventricular outflow tract septum was performed.Before RFA,thoracic ultrasound examination was used to determine the width of left ventricular outflow tract,the systolic interventricular septum thickness,left ventricular ejection fraction,etc.The ultrasound examination was performed immediately after RFA to check the above indexes.Ultrasound examination was employed one and 3 months after RFA to record the above indexes of the survived dogs,and pathological examination was made.Results Among the 10 experimental dogs,successful RFA was achieved in 9,and one dog died of ventricular fibrillation.In one dog RFA was successfully accomplished,but it died of respiratory inhibition due to over-deep anesthesia.Immediate success rate of surgery was 80％,eight dogs survived to the scheduled follow-up time point.The width of left ventricular outflow tract and the systolic interventricular septum thickness determined immediately after RFA as well as one and three months after RFA in the survived dogs were significantly different from the preoperative data (P＜0.05).Histopathologically,striking microscopic changes could be observed.No obvious changes in ECG and blood pressure were seen.Conclusion The results of this study indicate that RFA of ventricular outflow tract septum in experimental dogs is safe and effective,which provides useful parameters and experimental basis for further animal experiments and clinical trials.

Objective To explore the anatomical characteristic of the third palmar interosseous mus- cle as well its dominate nerve,and to investigate the anatomical basis of difficult recovery of digitus minimus adduction.Methods Twenty aduh fresh hands without deformity and trauma were obtained.Dissect and observe the third palmar interosseous muscle and its dominate nerve and adjacent structure under surgical mi- croseope,measure the size of the third pahnar interosseous muscle and its dominate nerve,the data were pro- cessed by stastistics method.Results Among palmar interosseous muscles and its dominate nerves,the third palmar interosseous muscle and its dominate nerve is the smallest.There are conspicuous tendon bundle on the surface of the third palmar interosseous muscle partly,which have a potential compression on the third palmar interosseous muscle dominting nerve.Conclusion The third palmar interosseous muscle is the smal- lest among palmar interusseous muscles and it is the only digitus minimus adduction muscle.The sominating nerve of the third palmar interosseous muscle is small anti the tendon bundle of the third palmar interosseous muscle have a potential compression.All these can cast light on diffcult recovery of digitus minimus adduction.

Renal angiomyolipomas are uncommon benign neoplasms composed of mature fat tissue, thick-walled blood vessels and smooth muscle in varying proportions, which art often associated with tuberous sclerosis. During the last 5 years, 7 patients of renal angiomyolipoma were managed at Hanyang University Medical College. All cases were unilateral and were not associated with tuberous sclerosis. One patient was managed by radical nephrectomy because we could not distinguish from renal cell carcinoma. In 6 patients preoperative diagnosis were possible and one of them was managed by nephrectomy due to spontaneous rupture with severe bleeding and 5 patients were managed by conservative treatment. One patient was managed by enucleation of angiomyolipoma, and 2 patients were successfully managed with selective renal angioinfarct. Another 2 patients were incidentally found, small sized asymptomatic cases, so they were managed byobservation. All 7 patients were free of recurrence for follow up.
Angiomyolipoma* ; Blood Vessels ; Carcinoma, Renal Cell ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Muscle, Smooth ; Nephrectomy ; Recurrence ; Rupture, Spontaneous ; Tuberous Sclerosis

OBJECTIVETo analyses the genetic diversity and relationship of Salmonella typhi strains isolated from different years and districts in Guizhou province.

METHODSRibotyping with 16s rDNA probe was used to describe the diversity of the 209 strains which were isolated in 26 counties of Guizhou province, from 1959 to 1999. The antibiotics resistance was also studied.

RESULTSTwenty-six ribotypes were found in all 209 strains, with two dominant types. The strains isolated from local typhoid epidemics belonged to the unique Ribotypes. The major ribotypes of the resistant strains were RT7 and RT1.

CONCLUSIONThe Salmonella typhi isolates from Guizhou diverged obviously. The abundant clones and multi-resistance of the strains might serve the major reasons of the high morbidity of typhoid in Guizhou.

Blotting, Southern ; China ; DNA, Bacterial ; genetics ; DNA, Ribosomal ; genetics ; Phylogeny ; RNA, Ribosomal, 16S ; genetics ; Ribotyping ; Salmonella typhi ; classification ; genetics ; isolation & purification

Objective To discuss the feasibility and effectiveness of transcatheter implantation of double-ring aortic valve stent through puncturing the tip of the heart under thoracotomy.Methods A novel double-ring aortic valve stent was independently designed by the authors.Three healthy goats were selected for this study.A small incision on the left anterolateral thoracic wall was made to expose the cardiac apex,than the puncturing of the left ventricular apex was performed to establish the working pathway.Guided by fluoroscopy,along a hard guide wire a double-ring aortic valve stent was inserted through a 22-French sheath to the site above the aortic valve.By utilizing the opened outer ring of the stent,the double-ring aortic valve stent was accurately placed at the bottom of the aortic valve sinus.Then,the balloon was inflated and the stent was released to substitute the original aortic valve of the experimental goat.The experiment results were evaluated immediately after the procedure.Results Transcatheter aortic valve implantation (TAVI) was successfully accomplished in all the three experimental goats.DSA was performed immediately after the procedure and anatomy evaluation indicated that the position of the implanted artificial aortic valve was satisfactory,which could replace the work of original valve.Conclusion It is technically feasible and clinically effective to use this novel double-ring aortic valve stent to perform TAVI through transapical route by puncturing the left ventricular apex.