Objective To evaluate the feasibility and efficacy of Separate stent placement in the palliative treatment of inoperable malignant gastroduodenal obstruction.Methods Thirty four consecutive patients with inoperable malignant gastroduoenal obstruction were treated with peroral placement of Separate stent. Gastroduodenal obstruction was caused by gastric ( n =11), pancreatic ( n =12), matastatic ( n =3), biliary duct ( n =6) or duodenal ( n =2) cancers. Separate outer partial covered stent overlapping with inner bare stent were placed coaxially under fluoroscopic guidance.Results The technical successful rate reached 97% (33 of 34) with no major complication. Symptoms of gastroduodenal obstruction relieved in 33 patients. The average score of food intake capacity improved from 3.8 to 1.2 after Separate stent placment. Stent migration and tumor ingrowth were not detected during the follow up period. Tumor overgrowth was confirmed in one patient and a second stent was placed to solve the problem.Conclusions Peroral placement of Separate stent is a feasible and effective treatment for patients with inoperable malignant gastroduodenal obstruction.

Objective To investigate the effect of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus.Methods Eighty-seven patients with hepatobiliary calculus who underwent hepatectomy from December,1998 to December,2008 were reviewed retrospectively.Forty-six patients underwent the section of common bile duct to remove calculus combined with left lateral segmentectomy and fiber choledochoscope( Group A),41 patients underwent left hepatectomy and section of common bile duct to remove calculus( Group B).The postoperative stone residual rate,complications and long-term outcome were compared between the two groups.Results The postoperative stone residual rate of either group was zero.Intraoperative bleeding ( 401.1 ± 180.4ml) ,operative times ( 202.5 ±36.6 rmin) of group A were significantly lower than those of the group B (515.9 ± 200.6ml and 257.3 ± 42.9min) ( P ＜ 0.001 and 0.01,respectively) .Hospital stays of group A was lower than that of group B,but this is no statistical significance ( P ＞ 0.05 ) .The incidence of postoperative complications were similar in the two groups( 15.2% v.s.24.4% ,P ＞ 0.05 ).The effective rates of the two groups were similar (91.3 % VS 92.7 %,P ＞ 0.05 ).Conclusions The long-term and short-term outcome of left lateral segmentectomy combined with fiber choledochoscope for hepatobiliary calculus is similar to that of left hepatectomy ,and can successfully shorten the hospital stay and reduce the hospital fee.

Objective To investigate the effect of IVIG on pre-existing anti-HLA-A2 Ab levels and graft skin survival.Methods C57BL/6 wild type mice were sensitized to HLA-A2 by intraperitoneal injec-tion (IP) of HLA-A2 TgN mouse spleen cells (C57BL/6-TgN [HLA-2.1]1Enge SC) expressing human HLA-A2 at day 0, week 3 and 4.Sensitized mice were respectively treated with human IVIG , albumin, gly-cine, or PBS for 5 days during week 7.Skin transplantation from TgN mice to C57BL/6 wild type mice was performed at week 10 .Efficacy of IVIG DES was assessed by measuring anti-HLA Ab levels by ELISA pre-/post-Rx and graft skin survival was monitored daily post-Tx.Results Changes of HLA-A2-IgG levels:IgG HLA-A2 class I Ab levels in all groups predictably increased from baseline following spleen cell IP and peaked at week 4 ( P <0.01 ) , indicating sensitization .IVIG-treated mice showed significantly lower IgG Ab levels vs.albumin, glycine and PBS-treated at week 9 post-desensitization ( P <0.01).IgG quickly increased to extremely high levels in all groups following skin transplantation ( P <0.01 ) .Graft skin sur-vival between Rx-groups were similar with all rejecting at about 7 days post-transplantation ( P >0.05 ) . Conclusion However, IVIG alone does not inhibit anti-HLA class I Ab production after skin transplanta-tion or prolong SG survival , indicating combination of IVIG with other immunosuppressant or more optimal protocol for desensitization might show more efficacy and should be under explored .

Objective To understand the infection situation of human T lymphocyte virus(HTLV) among blood donors in Zhongshan area.Methods Blood samples from 40 874 blood donors in Zhongshan from March to December 2016 were screened for HTLV antibody by using,enzyme linked immunosorbent assay(ELISA).The positive samples were reexamined two times,and specimens with positive results of reexamination were detected by using immunohistochemical method(CLIA).Then the positive samples were confirmed by Western blot(WB),and confirmed positive samples were judged as infection.Results Of all 40 874 cases of voluntary blood donors,21 cases were positive with HTLV antibody detected by ELISA,the positive rate of ELISA was 0.05%.Five cases were positive detected by CLIA method.One case was confirmed by WB,and the infection rate was 0.002 4%.Conclusion In order to ensure the safety of blood transfusion and reduce blood transfusion infection of HTLV,it might be necessary to perform HTLV screening in first-time blood donors in Zhongshan area.

ObjectiveTo investigate prospectively the feasibility and clinical value of catheterization via the ipsilateral great saphenous vein in catheter-directed thrombolysis (CDT) for acute iliofemoral deep vein thrombosis (IFVT) by a comparative study.MethodsThe prospective study included 93 cases of IFVT proved by venography.All patients were divided into three groups randomly.In group A,31 patients received CDT via the ipsilateral great saphenous vein.In group B,27 patients received CDT via the ipsilateral popliteal vein.In group C,35 patients received anterograde thrombolysis via an ipsilateral dorsalis pedis vein.Urokinase was adopted as the thrombolytic agent in all cases.The assessment of the curative effect include therapeutic effective rate,rate of edema reduction and venous patency which were observed according to the clinical symptoms and the follow-up venograms obtained 5 days after thrombolysis.The time and comfort scores of procedures was recorded and compared between group A and B using two independent samples t test.The rate of edema reduction and venous patency were assessed using analysis of variance (LSD method).Therapeutic effective rate and complication rate were assessed using Chi-square test.Results The total effective rate of the three groups were 90.3％ (28/31),92.6％ (25/27) and 68.6％ (24/35) respectively.The limbs edema reduction rate were (83.5 ±21.1)％,(82.4 ±20.1)％,and(67.0±23.3)％ respectively(F=6.059,P = 0.003 ).The venous patency rate after thrombolysis were (61.2 ± 20.2) ％,(55.7 ± 20.5 ) ％,and (44.2 ±23.6)％ respectively.There was no significant difference between group A and B in therapeutic effective rate( x2 =0.09,P =0.759),rate of edema reduction( P =0.822 ) and venous patency ( P =0.343 ).There was a significant difference statistically in therapeutic effective rate(x2 =4.65,P =0.031 ),rate of edema reduction (P = 0.002) and venous patency (P = 0.002) between group A and C.Compared with group A and B,the procedure time [group A (8.3 ±3.1) min,group B (16.3 ±3.5) min,t =9.379,P ＜0.05],comfort scores during treatment [ group A (2.2 ± 1.2),group B (5.0 ± 1.4 ),t = 8.129,P ＜ 0.05 ] had statistical significant difference.The CDT-asscciated complications in group A were less than group B significantly(3 cases in group A,11 cases in group B,x2 =7.60 P ＜0.05).ConclusionsCatheterizationvia the great saphenous vein in CDT therapy for acute IFVT is feasible and effective.It is easily operable with less complications.

Objective To investigate the effects of protocadherin 20 (PCDH20) in the spinal cord in the development of bone cancer pain (BCP) in rats.Methods Thirty-six SPF female Sprague-Dawley rats,weighing 180-200 g,were randomly divided into 4 groups (n =9 each):sham operation group (group S),BCP group,lentivirus control group (group LC) and PCDH20 siRNA lentivirus group (group P).Control lentivirus and lentivirus containing PCDH20 siRNA 4 μl were injected into the ipsilateral spinal cord in groups LC and P,respectively.One week later,BCP was induced by injection of Walker 256 breast cancer cells into the upper segment of bone marrow of right tibia.The mechanical paw withdrawal threshold (MWT) was measured at 1 day before injection of lentivirus (T1),1 day before BCP (T2),and 7,14 and 21 days after BCP (T3-5).Three rats in each group were sacrificed after measurement of the MWT at 21 day after BCP and the tibia on the operated side was obtained for examination of invasion of the cancer cells with light microscope.The spinal cord was removed for determination of the expression of PCDH20 and postsynaptic density 95 (PSD95) protein (by Western blot) and mRNA (by RTPCR).Results In groups BCP,LC and P,the cancer cells grew out of the bone and destroyed the cortical bone seriously.Compared with group S,the MWT was significantly decreased at T3-5 in groups BCP,LC and P,the expression of PCDH20 and PSD95 protein and mRNA was up-regulated in groups BCP and LC,and the expression of PCDH20 was up-regulated in group P (P ＜ 0.05).Compared with BCP group,no significant change was found in the MWT and expression of PCDH20 and PSD95 protein and mRNA in group LC (P ＞ 0.05),and the MWT was significantly increased at T4,5 and the expression of PCDH20 and PSD95 protein and mRNA was down-regulated in group P (P ＜ 0.05).Conclusion PCDH20 is involved in the development of BCP through regulating the expression of PSD95 in the spinal cord and adjusting the function of excitatory synapse in rats.

Objective To report effects of microsurgical treatment for tumors in cervical spinal canal. Methods A total of 32 cases of tumors in cervical spinal canal had received microneurosurgery through a posternmedial approach. 22 cases had received reconstruction of cervical spinal canal stability. Results A total tumor resection was performed in 26 cases (81.25%),a subtotal tumor resection was conducted in 6 cases(18.75%). A cemplete recovery was achieved in 23 cases(71.88%), an improvement of symptoms was achieved in 6 cases(18.75%), and no improvement in 3 cases(9.38%), no death was encountered. Follow up observations were carded out in 30 cases for 3 months to 3 years. MRI examinatious 3 months after operation in 26 cases found no residual or recurrent tumor,recurrence was seen in 3cases of astrocytoma, 1 case was invariable. X-ray radiography in 26 cases showed good vertebral stability ,spinal deformation was found in 4 eases. Conclusion Microsurgery in early period play a key role in treatment of cervical spinal tumors. Reconstruction of spinal canal stability is important to patients.

Ohjective To observe the inhibition effect of total glucosides of Picrorhiza on hepatitis B virus covalently closed circular DNA (HBV cccDNA) in HepG 2.2.15 cell line. Methods HepG 2.2.15 cells were incubated with culture medium containing 50 mg/L of picrosides or 5 mg/L of adefovir dipivoxil for 2 or 5 days. HBV DNA in the supernatant, intracellular cccDNA, relaxed circular DNA (rcDNA) and pregenomic RNA (pgRNA) were quantified by specific real-time polymerase chain reaction (RT-PCR) and inhibition rates were calculated. The means were compared by t test. Results After treated with picrosides for 2 and 5 days, the inhibition rates of HBV DNA in thesupernatant were 49. 74% (t=4.723, P<0.05) and 79.48% (t = 7.512, P<0.05), respectively. The inhibition rates of intracellular cccDNA were 43.55% (t = 5.216, P<0.05) and 56.43% (t=7.262, P<0.05), respectively, while those of intracellular rcDNA were 43.39% (t=4.137, P<0.05) and 63.86% (t=7.861, P<0.05), respectively, and those of intracellular pgRNA were 54.72% (t=4.532, P<0.05) and 56.08% (t=4.833, P<0.05), respectively. Comparatively, after treatment with adefovir dipivoxil for 2 and 5 days, the inhibition rates of HBV DNA in the supernatant were 25.56% (t=2.874, P<0.05) and 92.44% (t =10.276, P<0.05), respectively. Those of cccDNA were 18.54% (t=2.736, P<0.05) and 47.19% (t=6.852, P<0.05), respectively. Those of rcDNA were 21. 20% (t=3.206, P<0.05) and 71.47% (t=8.332, P<0.05), respectively, pgRNA were 11.14% (t=1.761, P>0.05) and 37.61%(t=3.632, P<0.05) respectively in HepG2.2.15 cells. Conclusions Pierosides may inhibit the replication cycle of HBV, including the formation of cccDNA in HepG 2.2.15 cells. The mechanism of pierosides on cccDNA may differ from adefovir dipivoxil's due to its earlier inhibition time phase.

Objective To evaluate the value of interventional therapy in treatment of iliac compression syndrome (ICS) and subsequent venous thrombosis. Methods Examined by DSA, 125 cases were diagnosed of iliac vein compression and subsequent thrombosis. In 39 cases of ICS ( group 1 ), left: right = 4.6: 1. In 86 cases of ICS complicated with subsequent thrombosis (group 2), left: right = 4.7: 1. The patients of iliac vein compression and compression-related iliac vein stenosis or occlusion without fresh thrombus were treated by percutaneous transluminal angioplasty (PTA) and self-expandable stenting. In those cases with fresh thrombosis the inferior vena cava filter were inserted before thrombosis suction, mechanical thrombus ablation, PTA, stenting and transcatheter thrombolysis. The Chi-square test for comparison of proportions was used to test statistical significance. Results In 39 cases of ICS, 38 cases were treated by PTA and stenting. In 86 cases of deep vein thrombosis complicated with ICS, 83 cases were treated by various interventional therapy. There was no significant difference in the efficiency of intraluminal treatment between the two groups at discharge (97.4% and 96.5%, X2 =0.000,P >0.05) and at 6 months follow-up(96.3% and 90.2%, X2 = 0.266, P > 0.05 ), the difference in excellent-good rate of the two groups was significant at discharge (94.9% and 79.1%, X2=3.879, P <0.05) and at 6 months follow-up (92.6% and 68.6% ,X2 =4.441,P <0.05). Conclusions Interventioual treatment for ICS and secondary thrombosis is safe and effective.

Objective To detect the different expressions of Drosha between endometrial cancer (EC) tissue and other tissues and to explore correlation between Drosha mRNA transcription level and protein expression level with clinicopatho?logical characteristics of EC. Methods The mRNA transcription and protein expression levels of Drosha were examinaned by q-PCR and Western blot respectively in normal endometrial tissues (25 cases), atypical hyperplasia of endometrial tis?sues (20 cases) and endometrial cancer tissues (40 cases). Correlations between Drosha mRNA transcription and protein ex?pression with clinicopathological characteristics of EC were analyzed. Results The levels of Drosha mRNA and protein lev?els in EC were obviously lower than those in endometrial atypical hyperplasia and normal endometrium (P<0.05). But there is no significant difference of Drosha expression between endometrial atypical hyperplasia and normal endometrium tissues (P>0.05). The protein expression levels of Drosha were consistent with transcription of mRNA transcription levels. Drosha mRNA expression does not differ significantly with differentiation, histological type, myometrial invasion, lymphatic metasta?sis and FIGO stages of EC (P>0.05). Conclusion The expression levels of Drosha in EC tissues were down-regulated, therefore the reduction of Drosha may contributed to tumorigenesis of EC.