Objective To study the reproductive outcome of infertile women suffered from hydrosalpinx treated by laparoscopic salpingostomy or salpingectomy.Methods There were 77 infertile women diagnosed hydrosalpinx by HSG or B ultrasonography and excepted for other infertile factors. Unilateral or bilateral salpingostomy or salpingectomy was performed after hydrosalpinx conifrmed by laparoscopy. Seventy seven patients were followed up for 1 ~ 4 years postoperatively.Results Among 77 cases 39 cases (50.65%) got pregnancy. Thirteen cases (16.88%) conceived spontaneously and 26 cases (33.77%) conceived by IVF-ETin. Thirty ifve cases delivered health babies and 3 cases of pregnancy, 1 cases of early abortion.Conclusion Both laparoscopic surgeries were effective treatment of hydrosalpinx results in infertility. After operation the pregnant rate of those conceived by IVF-ET is higher than spontaneously.

Objective To observe the effect of laser of Q Switch Nd:YAG 1 064nm wave length laser in the treatment of naevus fusco caerulens zygomaticus. Methods Since October 2000, forty nine cases of naevus fusco caerulens zygomaticus had been treated once every three months. Results Thirty two cases had been treated three times, and seventeen cases, four times. The total effective rate was 100 %. The pigmentation of all the cases were darker after the first treatment, later as the treatment progressed, the pigment became lighter. No pigment loss was seen. Conclusion Q switch Nd:YAG 1 064 nm wavelength laser has a good effect in the treatment of naevus fusco caerulens zygomaticus. It is safe and reliable.

Objective To investigate the effects of cold preservation and reperfusion injury on the regen-eration of donor liver and to study the mechanisms. Methods Male SD rats were divided in to sham group (6 rats), UW 1 h group (48 rats) and UW 12 h group (48 rats). Liver tissue specimens were collected at different time points after orthotopic liver transplantation or sham operation. The morphology of liver tissue was observed via light microscope and transmission electron microscope. Proliferation of hepatocytes and sinusoidal endothelial cells (SECs) were assessed by a double immunostaining technique using antibodies against rat endothelial cell antigen-1 and bromodeoxyuridine (BrdU). Expression of vascular endothelial growth factor (VEGF) and its receptors, fins-like tyrosine kinase-1 (flt-1) and fetal liver kinase-1 (flk-1) was evaluated by immunohistochemistry. The mRNA expression of flt-1 was detected by a RT-PCR method. Mean comparison in groups was conducted by one-way ANOVA or t test. Results BrdU labeling indexes of hepatocytes and SECs in UW 12 h group was significantly higher than those in UW 1 h group (F = 61.45,41.4, P < 0.05). The proliferation of hepatocytes peaked at 48 h after operation in both UW 1 h group and UW 12 h group. However, the proliferation of SECs was fallen behind compared to hepatocytes, with a peak appeared at 72 h in UW 1 h group and at 96 h in UW 12 h group, respec-tively. The expression of VEGF was up-regulated in both UW 1 h group and UW 12 h group compared to sham group. Furthermore, expression of flt-1 and flk-1 was found to be mainly limited in SECs, with a peak in expres-sion occurring between 72 h and 96 h, coinciding with the peak in SECs proliferation in UW 1 h group. Conversely, flt-1 was found to be reduced significantly on mRNA level at any time throughout the experiment in UW 12 h group compared to sham group (F = 141.67, P < 0.05). Conclusion Reduced expression of flt-1 results in a retarded regeneration of SECs, and then the recovery of rat donor liver function is delayed after cold-preserved transplantation.

Objective To study the influence of cholangiocarcinoma cells on endothelial cells in a co-culture system. Methods A co-culture system of eholangioeareinoma cell line QBC939> and endothelial cells was established in vitro (co-culture group). Endothelial cells were cultured individually during the same time (control group). The mixed supematant of cholangiecareinoma cells and endothelial cells was in the mixed group. Light microscopy and transmission electron micrescopy were used to observe the morphology of the endothelial cells. Changes in expression of ppI25FAK, MMP-2, MMP-9 and uPA of the endothelial cells were detected by mmunofluorescence, and the activities of MMP-2 and MMP-9 were detected by gelatin zymography. All the data were analyzed by paired t test. Results The intercellular space between endothelial cells in co-cuhure group was wider than in the control group. The expression of pp125FAK, MMP-2, MMP-9 and uPA was 394 ±51,455±82, 377±48,422±55 in control group, and was 1096±128,931±72,815±76,801±56 in the eo-euhure group. The difference between the 2 groups had statistical significance (t = 6.53,4.32, 3.61,3.45, P < 0. 05). The values of gray-scale scanning of MMP-2 and MMP-9 in the mixed group were 240.2±15.2 and 2.4±0.8, respectively. The values of gray-scale scanning of MMP-2 and MMP-9 in the co-culture group were significantly increased, they were 687.4 ± 43.6 and 150.9 ± 13.2, respectively (t = 4.89, 5.43, P < 0.05). Conclusions The intercellular space between endothelial ceils and the expression of the proteolytie enzymes are increased after co-culturing endothelial cells with eholangiocarcinoma cells. Proteolytie enzymes may be involved in the process of degradation of subendothelial matrix, and promotes the metastasis of cholangiocarcinoma.

Objective To investigate the impact of planning parameter settings on plan quality and delivery efficiency of VMAT for nasopharyngeal carcinoma with two treatment planning systems (TPS),as references for clinic plan optimization. Methods 25 patients with nasopharyngeal carcinoma were selected and planned for SIB?VMAT treatment. The same planning aims were used in the two kinds of TPS ( TPS?1 and TPS?2). Multiple planning parameters were set for plan optimization. Dose distribution to the target volumes and organs at risk,monitor unit ( MU) and delivery time were compared. Paired t?test or one?way ANOVA was used for the data which was in accordance to normal distribution;otherwise, nonparametric Wilcoxon signed rank test or nonparametric Friedman test was used. Results More segments lead to better plan quality and less MU but longer delivery time ( Minor impact was observed when segment number was larger than 120) in TPS?1,while it had little impact on both plan quality and delivery efficiency in TPS?2. Comparing to single?arc plans,dual?arc VMAT achieved no significant benefit in plan quality but had more MU and longer delivery time in TPS?1 ( P= 0?000 ) . However, dual?arc VMAT plans had better dose distribution in TPS?2, decreased the maximum and mean dose for spinal cord in 3?9% and 13?7%respectively (P=0?000,0?000).Changing the settings of maximum or minimum dose rate did not affect the plan quality in both of the tested TPSs. Increasing the maximum or minimum dose rate reduced the delivery time but the latter increased the number of MU ( P=0?000,0?000) . Conclusions VMAT plan quality and delivery efficiency is affected significantly and differently by planning parameter settings for two TPSs. Trial test should be conducted for different TPS to determine the optimal parameter settings.

Objective To quantify the amplitudes of lung tumor motion during free-breathing using four dimensional computed tomography (4DCT), and seek the characteristics of tumors with large motion. Methods Respiratory-induced tumor motion was analyzed for 44 tumors from 43 patients. All patients un-derwent 4DCT during free-breathing before treatment. Gross tumor volumes (GTV) on ten respiratory phases were contoured by the same doctor. The eentroids of GTVs were autoplaeed with treatment software (ADAC Pinnacle 7.4f), then the amplitudes of tumor motion were assessed. The various clinical and anatomic fac-tors associated with GTV motion were analyzed. The characteristics of tumors with motion greater than 5 mm in any direction were explored. Results The tumor motion was found to be associated with T stage, GTV size, the superior-inferior (SI) tumor location in the lung, and the attachment to rigid structures such as the chest wall, vertebrae or mediastinum. The motion over 5 mm was observed in ten tumors, which were all lo-cated in the lower or posterior half of the lung, with the greatest motion of 14.4 mm. For 95% of the tumors, the magnitude of motion was less than I 1.8 mm, 4.6 mm and 2.7 mm along the SI, anterior-poste-rior (AP) and lateral directions, respectively. Conclusions Tumor motion due to breathing is associated with tumor location, volume, and T stage. The greatest motion was in the SI direction for unfixed tumor in lower-lobe, followed by tumor in upper-lobe posterior-segment.

Objective To perform a preclinical test of a delineation software based on atlas-based auto-segmentation (ABAS),to evaluate its accuracy in the delineation of organs at risk (OARs) in radiotherapy planning for nasopharyngeal carcinoma (NPC),and to provide a basis for its clinical application.Methods Using OARs manually contoured by physicians on planning-CT images of 22 patients with NPC as the standard,the automatic delineation using two different algorithms (general and head/neck) of the ABAS software were applied to the following tests:(1) to evaluate the restoration of the atlas by the software,automatic delineation was performed on copied images from each patient using the contours of OARs manually delineated on the original images as atlases;(2) to evaluate the accuracy of automatic delineation on images from various patients using a single atlas,the contours manually delineated on images from one patients were used as atlases for automatic delineation of OARs on images from other patients.Dice similarity coefficient (DSC),volume difference (Vdiff),correlation between the DSC and the volume of OARs,and efficiency difference between manual delineation and automatic delineation plus manual modification were used as indices for evaluation.Wilcoxon signed rank test and Spearman correlation analysis were used.Results The head/neck algorithm had superior restoration of the atlas over the general algorithm.The DSC was positively correlated with the volume of OARs and was higher than 0.8 for OARs larger than 1 cc in volume in the restoration test.For automatic delineation with the head/neck algorithm using a single atlas,the mean DSC and Vdiff were 0.81-0.90 and 2.73％-16.02％,respectively,for the brain stem,temporal lobes,parotids,and mandible,while the mean DSC was 0.45-0.49 for the temporomandibular joint and optic chiasm.Compared with manual delineation,automatic delineation plus manual modification saved 68％ of the time.Conclusions A preclinical test is able to determine the accuracy and conditions of the ABAS software in specific clinical application.The tested software can help to improve the efficiency of OAR delineation in radiotherapy planning for NPC.However,it is not suitable for delineation of OAR with a relatively small volume.

Objective To investigate the risk factors resulting in the perioperative liver failure and death for the HBV-associated hepatocellular carcinoma (HCC) patients with or without cirrhosis.Methods The method of retrospective case-control study was performed.The clinicopathological data of 1 083 HCC patients with positive HBsAg who received curative liver resection at the Southwest Hospital from January 2008 to December 2012 were collected.According to the absence or presence of cirrhosis,the HCC patients with positive HBsAg were divided into the 2 groups,including the cirrhosis group (633 patients) and the non-cirrhosis group (450patients).The intraoperative conditions (operation time,volume of intraoperative blood loss,rate of blood transfusion,rate of pringle maneuver) and postoperative conditions (incidence of perioperative complications,duration of postoperative hospital stay,perioperative mortality) of HCC patients were observed.The gender,age,alanine transaminase (ALT),aspartate transaminase (AST),albumin (Alb),total bilirubin (TBil),platelet (PLT),Child-Pugh classification,operation time,volume of intraoperative blood loss,blood transfusion,pringle maneuver,extent of liver resection,number of tumors,tumor diameter,tumor thrombus and liver cirrhosis were enrolled and prognostic factors resulting in perioperative liver failure and death for the HCC patients were explored.Measurement data with skewed distribution were presented as M (range) and comparison between the 2 groups was analyzed using Mann-Whitney U test.Count data were presented as counts (percentage) and comparison between the 2 groups was analyzed using chi-square test or Fisher exact probability.Univariate analysis was performed by chi-square test and multivariate analysis was performed by Logistic regression model (forward).Results (1) The intraoperative conditions:the volume of intraoperative blood loss were 500 mL (range,30-7 000 mL) in the cirrhosis group and 400 mL (range,50-8 000 mL) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (Z =-2.209,P ＜ 0.05).The operation time,rate of blood transfusion and rate of pringle maneuver were 250 minutes (range,82-715 minutes),29.86％ (189/633),62.24％ (394/633) in the cirrhosis group and 242 minutes (range,85-738 minutes),27.11％ (122/450),66.67％ (300/450) in the non-cirrhosis group,respectively,with no statistical differences between the 2 groups (Z =-1.212,x2 =0.969,2.236,P ＞0.05).(2) The postoperative conditions:the incidence of perioperative complications was 30.49％(193/633) in the cirrhosis group and 21.11％ (95/450) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (x2 =11.851,P ＜ 0.05).The incidence of lung infection,abdominal infection and liver failure were 6.48％ (41/633),2.69％ (17/633),5.53％ (35/633) in the cirrhosis group and 3.56％ (16/450),0.89％ (4/450),1.33％ (6/450) in the non-cirrhosis group,respectively,with statistically significant differences between the 2 groups (x2 =4.502,4.465,12.713,P ＜ 0.05).The duration of postoperative hospital stay was 15 days (range,0-70 days) in the cirrhosis group and 14 days (range,0-71 days) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (Z =-3.448,P ＜ 0.05).The perioperative mortality was 5.85％ (37/633) in the cirrhosis group and 2.44％ (11/450) in the non-cirrhosis group,with a statistically significant difference between the 2 groups (x2=7.181,P ＜ 0.05).(3)Results of risk factors affecting perioperative liver failure:①results of univariate analysis showed that age,AST,Alb,Child-Pugh classification,operation time,volume of intraoperative blood loss,blood transfusion,extent of liver resection,tumor diameter,liver cirrhosis with positive HBsAg were associated with perioperative liver failure in HCC patients (x2=5.013,7.979,8.855,16.968,14.148,9.764,18.511,11.749,5.534,12.713,P＜0.05);age,AST,Alb,Child-Pugh classification,operation time,blood transfusion,extent of liver resection and tumor diameter were associated with perioperative liver failure in the cirrhosis group (x2=5.877,5.380,11.087,13.672,8.849,13.170,12.418,5.805,P ＜ 0.05);volume of intraoperative blood loss was associated with perioperative liver failure in the non-cirrhosis group (P ＜ 0.05).②Results of multivariate analysis showed that age≥60 years,Child-Pugh class B,operation time ＞ 360 minutes,blood transfusion,extent of liver resection ≥3 segments and liver cirrhosis were independent risk factors affecting perioperative liver failure in HCC patients with positive HBsAg [OR =2.285,2.716,2.315,2.159,2.459,4.322;95％ confidence interval (CI):1.081-4.831,1.100-6.706,1.064-5.038,1.068-4.362,1.264-9.786,1.763-10.598,P＜0.05];Alb ＜38 g/L,Child-Pugh class B,blood transfusion and extent of liver resection ≥ 3 segments were independent risk factors affecting perioperative liver failure in the cirrhosis group (OR =2.231,2.857,2.186,2.927,95％ CI:1.038-4.795,1.095-7.451,1.045-4.576,1.426-6.008,P ＜ 0.05);volume of intraoperative blood loss ＞ 1 200 mL was an independent risk factor affecting perioperative liver failure in the non-cirrhosis group (OR =15.077,95％CI:2.695-84.353,P ＜ 0.05).(4) Risk factors affecting perioperative death:①results of univariate analysis showed that gender,Alb,TBil,Child-Pugh classification,blood transfusion,extent of liver resection,tumor diameter,tumor thrombus and liver cirrhosis were associated with perioperative death in HCC patients with positive H BsAg (x2=4.462,8.783,4.212,4.869,7.189,11.745,6.837,4.323,7.181,P ＜0.05);Alb,extent of liver resection and tumor diameter were associated with perioperative death in the cirrhosis group (x2=12.173,12.793,10.981,P ＜ 0.05);blood transfusion and tumor thrombus were associated with perioperative death in the non-cirrhosis group (x2 =5.836,6.417,P ＜ 0.05).② Results of multivariate analysis showed that Alb ＜38 g/L,extent of liver resection ≥ 3 segments and liver cirrhosis were independent risk factors affecting perioperative death in HCC patients with positive HBsAg (OR =2.560,2.657,2.567,95％ CI:1.382-4.742,1.471-4.800,1.283-5.134,P ＜ 0.05);Alb ＜ 38 g/L,extent of liver resection ≥ 3 segments and tumor diameter≥5 cm were independent risk factors affecting perioperative death in the cirrhosis group (OR =3.003,2.533,3.060,95％ CI:1.495-6.034,1.251-5.128,1.135-8.251,P＜0.05);blood transfusion and tumor thrombus were independent risk factors affecting perioperative death in the non-cirrhosis group (OR =3.755,4.036,95％ CI:1.047-13.467,1.126-14.469,P ＜ 0.05).Conclusions Liver cirrhosis is an independent risk factor for perioperative liver failure and death in HCC patients with positive HBsAg.The risk of perioperative liver failure and death in HCC patients with cirrhosis is significantly higher than that in HCC patients without cirrhosis,and there is a difference in the risk factors for perioperative liver failure and death.

Objective To investigate the clinical efficacy of radiofrequency ablation for the treatment of metastatic hepatic carcinoma.Methods The clinical data of 87 patients with metastasis hepatic carcinoma who received radiofrequency ablation (RFA) at the Southwest Hospital from January 2004 to December 2008 were retrospectively analyzed.Of the 87 patients,34 were with liver metastasis from colonic cancer,33 with liver metastasis from rectal cancer,12 with liver metastasis from pancreatic cancer,and 8 with liver metastasis from gastric cancer.The survival of the patients was analyzed by life score and kamofsky performance status (KPS)scale.Patients were followed up via phone call and out-patient examination.Ultrasonography,computed tomography,liver function and tumor markers test were done every month within postoperative 6 months,and every 2 months at 6 months later.The follow-up was ended in Novermber 2013.All data were analyzed using chi-square test or rank sum test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was compared using the Log-rank test.Results Of the 87 patients,84 were successfully treated by RFA,and 3 patients gave up RFA because of unbearable pain (2 patients with colonic cancer and 1 with gastric cancer).A total of 129 metastatic lesions were detected in the 84 patients,and 107 metastatic lesions were ablated after single RFA,with the success rate of 82.95％ (107/129).The other 22 lesions were ablated after a second RFA.The mean duration of hospital stay was (10.7 ± 2.3) days (range,4-29 days).Before operation,the life quality was excellent in 60.7％ (51/84) of patients,good in 22.6％ (19/84) of patients,fair in 10.7％ (9/84) of patients,and poor in 6.0％ (5/84) of patients.The candition of 63.1％ (53/84) of patients was improved,29.8％ (25/84) of patients was stable,and 7.1％ (6/84) of patients was deteriorated.At postoperative month 6,the life quality was excellent in 78.2％ (54/69) of patients,good in 11.6％ (8/69) of patients,fair in 5.8％ (4/69) of patients,and poor in 4.4％ (3/69) of patients.The condition of 73.9％ (51/69) of patients was improved,21.7％ (15/69) of patients was stable,and 4.4％ (3/69) of patients was deteriorated.There were significant differences in the life score and KPS scale between patients before and after operation (x2 =29.760,17.140,P ＜ 0.05).All patients were followed up for 6-60 months.The 1-,3-,5-year survival rates of patients with liver metastasis from colonic cancer after RFA treatment were 68.8％,21.9％ and 6.3％,and the median survival time was 21.5 months.The 1,3,5-year survival rates of patients with liver metastasis from rectal cancer after RFA were 66.7％,27.3％,12.1％,and the median survival time was 19.5 months.The 1-,3-,5-year survival rates of patients with liver metastasis from pancreatic cancer after RFA treatment were 41.7％,0 and 0,and the median survival time was 8.5 months.The 1-,3-,5-year survival rates of patients with liver metastasis from gastric cancer after RFA treatment were 71.4％,14.3％ and 0,and the median survival time was 16.5 months.The survival rates of patients with liver metastasis from pancreatic cancer and gastric cancer were significantly lower than those with liver metastasis from colorectal cancer after RFA (x2 =9.169,P ＜ 0.05).Conclusion The efficacy of RFA for selected patients with liver metastasis from digestive tract tumors is satisfactory.

Objective To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer by systematic review and meta-analysis.Methods The literature database before February,2012 was extensively searched to retrieve the comparative studies of LATG and open total gastrectomy(OTG) with a relevance of study goal.The inclusion and exclusion criteria were formulated.Aftera quality evaluation,the data was extracted.The Cochrane collaboration RevMan 5.1 version software was used for meta-analysis.Results There are ten studies meeting the inclusion criteria for meta-analysis.The total sample size of these studies was 942 cases.Compared to OTG,LATG experienced longer operation time [weighted mean difference(WMD) =41.12 min,95％ confidence interval(CI):20.62-61.63,P ＜0.01)],less blood loss(WMD =-198.36 ml,95％ CI:-300.94--95.78,P ＜ 0.01),earlier time to flatus(WMD =-0.80 days,95％ CI:-1.17--0.42,P＜0.01),shorter hospital stay(WMD =-4.02days,95％ CI:-6.03--2.01,P ＜ 0.01) and decrease in overall complications [relative risk (RR) =0.55,95％ CI:0.40-0.76,P ＜ 0.01)].The number of dissected lymph nodes,proximal or distal resection margin and mortality were similar between the two groups.Conclusions Laparoscopy-assisted total gastrectomy is a safe and feasible procedure with less blood loss,less overall complications and quick recovery.