Objective To analyze the impact of obesity on short-term prognosis in patients who underwent surgery for cirrhotic portal hypertension with hypersplenism.Methods The clinical data of 310 patients with cirrhotic portal hypertension who underwent splenectomy and portaazygous devascularization between Apr.2002 and Jue.2012 were prospectively analyzed.According to the body mass index (BMI),these patients were divided into the non-obesity group (BMI ＜ 28 kg/m2) and the obesity group (BMI ≥28 kg/m2).There were 78 patients in the obesity group (male:female 56:22; mean age 48.7 ± 8.3years).There were 232 patients in the non-obesity group (male:female 166:66; mean age 46.3 ± 6.9years).The postoperative outcomes in the two groups were analyzed.Results When compared with the nonobesity group,there were significant differences in age (48.7 ± 8.3 in obesity group vs 46.3 ± 6.9 years in non-obesity group),perioperative blood transfusion (400 ± 100 vs 200 ± 100 ml),intraoperative blood loss (370 ± 110 vs 240 ±60 ml),operation time (180 ±40 vs 150 ±35 min),serum albumin level after surgery (28.1 ±2.6 vs 31.2 ±2.3 g/L),drainage volume (280 ±70 vs 230 ±60 ml) and hospital stays (10.5 ±3.0 vs 8.5 ± 2.5 days) in the obesity group (P ＜ 0.05).However,there were no significant differences in gender,preoperative level of liver function,platelet counts (preoperative and postoperative) and postoperative deaths (P ＞ 0.05).Conclusion BMI was a significant independent prognosis risk factor for patients with cirrhotic portal hypertension undergone splenectomy and portaazygous devascularization.

Objective To investigate the effects of preoperative nutrition support on postopreative clinical outcome in patients with nutritional risk with pancreaticoduodenectomy.Methods Forty six patients with pancreaticoduodenectomy complicated with malnutrition from June 2011 to September 2013 in Department of Hepatobiliary and Lapoaroscopic Surgery of People's Hospital of Wuhan University were randomly divided into experimental group (n =23) and control group (n =23) with random number table,patients in experimental group received preoperative nutrition support,but patients in control group did not receive preoperative nutrition support.The preoperative and postoperative nutritional status,the incidence of postoperative complications,the length of hospital stay,and the cost of hospitalization in the two groups of patients was compared.Results In terms of intra-operative blood loss and the operative time,experimental group was significantly lower than those in control group [(340 ±90)min vs (420 ± 104)min,(761 ± 100)ml vs (901 ± 150)ml,P＜0.01],on the 1st day of preoperation,the 1st day,7th day and 14th day of post operation,the levels of serum albumin was significantly higher than those in control group [(30.6 ± 1.8) g/L vs (24.6±2.2) g/L on the,P＜0.05];and on the 1st day of pre-operation,the 1st day,7th day of post operation,the levels of transferrin were significantly higher in experimental group than in control group [(3.23 ± 0.65) g/L vs (2.38 ± 0.49) g/L on the,P ＜ 0.05);the rate of post operative complication were significantly lower in experimental group than that in control group (52.2％ vs 21.7％,P=0.000);the postoperative anal exhaust time was earlier in experimental group than that in control group [(6.4 ± 0.6) d vs (9.5 ± 0.6) d,P =0.000),and the length of hospital stay was shorter in experimental group [(20.1 ± 6.5) d vs (26.7 ± 9.5) d,P =0.014),and the cost in experimental group was lower [(99 ± 13) thousand yuan vs (115 ± 13) thousand yuan,P =0.000),however,the cost of nutrition support between the two groups was not significantly different (P =0.210).Conclusions Preoperative nutrition support is helpful to reduce the incidence of postoperative complications,shorten the length of hospital stay,to save medical costs for patients with pancreaticoduodenectomy.

Objective To evaluate the therapeutic effectiveness and safety of combining chemoembolization using microspheres with iodized oil in the treatment of patients with hepatocellular cancer.Methods According to the inclusion and exclusion criteria,two reviewers independently completed the whole process of data search,selection,collection and quality assessment.The Medline,Cancer Lit,PUBMED,EMBASE,Cochrane Library,CNKI,CBM,VIP,Wanfang Data and Grey literature were searched for randomized controlled trails (RCTs) on combining chemoembolization using microspheres with iodized oil in the treatment of liver cancer.The search was from January 2005 to December 2012.The software package Rev Man 5.1 (the Cochrane collaboration) was used to conduct the Meta-analysis and to analyze the data.Results Of the 159 trials selected out from January 2005 and December 2012 for review,only five RCT involving 471 patients were finally included into the analysis.When compared with chemoembolization by iodized oil alone,the combination treatment significantly improved the therapeutic effectiveness (CR + PR).However,there was no obvious difference between the two methods of treatment in the incidence of adverse reaction.Conclusions Combining chemoembolization using microspheres with iodized oil for patients with hepatocellular cancer was effective in controlling liver cancer progression.There is still a need to reduce the incidence of adverse reaction in future.

Objective To evaluate the operative treatment of pediatric ureteropelvic junction (UPJ)obstruction. Methods A total of 34 cases of UPJ obstruction in children had double J tubes placed intraoperatively during Anderson Hynes pyeloplasty.Urethral catheterization was maintained for 5～7 days,the double J tube being removed on cystoscopy 4～6 weeks after operation.The outcome was evaluated with ultrasonography or intravenous pelviureterography 3～6 months postoperatively. Results The obstruction was successfully relieved in all the patients and no complications such as urinary infection and leakage of urine were noted on follow up. Conclusions Anderson Hynes pyeloplasty is an effective procedure for the treatment of pediatric UPJ obstruction. The routine use of double J tubes placed intraoperatively can reduce the chance of UPJ restricture and shorten the hospital stay.It is safe and dependable.

Objective To investigate the effects of low carbohydrate diet in treating non-alcoholic fatty liver disease (NAFLD) patients.Methods 58 male NAFLD patients selected in Renmin Hospital of Wuhan University from September 2010 to October 2012 were divided with random number table into low-carbohydrate diet group (L group,n =31) and medium-carbohydrate diet group (M group,n =27).Waistline,weight,serum glucose level,insulin secretion,glutamic-pyruvic transaminase (ALT),aspartate transaminase (AST)、high-density lipoprotein (HDL),low-density lipoprotein (LDL),total cholesterol (TC),and triglyceride (TG) of the patients were measured.Results Six patients were excluded from this research,2 in L group and 4 in M group.After 6-week's dietary intervention,blood glucose level and insulin secretion were significantly lower in L group than in M group [(4.3±1.4) mol/Lvs.(5.0±0.9) mol/L,P=0.004; (6.1 ±1.5) U/mlvs.(8.9 ± 1.4) U/ml,P =0.001].The levels of ALT and AST in L group were significantly lower than those in Mgroup[(30.23±3.34) U/Lvs.(42.33±4.46) U/L,P=0.003; (31.19±4.13) U/Lvs.(45.21±3.73) U/L,P =0.001].The levels of LDL and TG in L group were also significantly lower than those in M group [(1.13±0.22) mmol/Lvs.(2.71±0.67) mmol/L,P=0.001; (0.99±0.74) mmol/Lvs.(1.42±1.06) mmol/L,P =0.001].Conclusion In NAFLD patients,low-carbohydrate diet can improve blood glucose level,insulin secretion,liver function,and lipid metabolism disorders.

Considerable clinical and experimental evidence supports that liver injury in acute pancreatitis (AP) is a sign for the potential progression to systemic inflammatory reaction.The Kupffer cells,various cytokines and macrophage migration inhibitory factor (MIF) play important roles in the pathogenesis of AP associated liver injury.However,the specific molecular mechanism of the liver damage remains uncertain.Therefore,efforts should be made to clarify the regulatory mechanism and related cell signaling disorders of liver injury in AP,which could not only identify novel therapeutic targets,but also provide new insight into improving the clinical treatment.Here our review discusses the recent research progress on the etiology,pathology and diagnosis and treatments of liver injury in AP.

ObjectiveTo evaluate the efficacy of biapenem in percutaneous nephrolithotripsy for the prevention and control infections.MethodsA retrospective study was accomplished.The clinical data of 68 patients with PCNL which used biapenem for prevention and control infection from Aug 2009 to Feb 2011 in the hospital of Hubei Provincial Corps of CAPF were collected,the treatment effect of biapenem in percutaneous nephrolithotripsy was evaluated.Results57 cases use the injection biapenem each 0.3g,2 times a day intravenously 7 to 14 days could effectively prevent postoperative infections in perioperative period;11 cases of urinary infection and systemic inflammatory response syndrome after pereutaneous nephrolithotripsy use injection biapenem each 0.3g,every 8-hour intravenously 7 to 14 days,were effective treatment of postoperative infections.ConclusionBiapenem was effective in the prevention of infection in percutaneous nephrolithotripsy.

Objective To explore the surgical treatment of urethral recurrence after neobladder reconstruction in patients with bladder cancer. Methods In 89 consecutive patients with radical cystectomy, 5 patients (5.6%) presented with a noninvasive urethral recurrence at a median of 18 months (range 9 to 32 months). All 5 patients were treated by transurethral resection and intraurethral instillation with hydroxycamptothecin used as initial therapy. Mean follow-up was 37 months (24 - 52 months). Results All the 5 patients survived after the treatment. There was no one showed recurrence or distant metastasis. All the 5 cases achieved continence. Conclusion Urethral preservation at initial therapy for incipient noninvasive urethral recurrence would be a good choice and could maintain the quality of life.

Objective To explore the curative effect and security of transurethral holmium laser resection for adult ureterocele.Methods 22 cases with adult ureterocele were retrospectively studied.Eight adult ureterocele cases were male and 14 cases were female.The mean age was 36.5 years (ranged from 20 to 67years).All of the patients were unilateral onset,15 cases on the left side and 7 cases on the right side.The mean course of the disease was 31 months (ranged from 15d to 12 years).The clinical presentations were varied.All 22 cases were treated by tran-surethral holmium laser resection.About one -third of cyst wall were left in order to avoid vesicoureteral reflux and hydronephrosis.Results All 22 cases succeeded uneventfully.The pathologic study confirmed that 22 cases were ure-terocele.The mean hospital stay was 8days (ranged from 6 to 12days).Mean follow -up time was 17 months (12 -26 months),while 2 cases were lost.All 20 cases urine alalysis was normal.Five patients showed no hydronephrosis, while 10 cases showed less hydronephrosis.Cystoscopy showed all 20 cases ureteral healing was smooth,and none showed recurrence of ureterocele.Voiding cystourethrography showed none of vesicoureteral reflux.Conclusion Transurethral holmium laser resection would be a good choice for adult ureterocele,because the treatment has the advantages of simple operation,low requirement of equipment,safety and reliability.Especially for the primary level hospital,transurethral holmium laser resection is worth further clinical promotion.

Objective: To observe an abnormal expression of humoral immune response induced by memory B cells in tonsils and peripheral blood of patients with IgA nephropathy ( IgAN) , the variation of memory B cells after tonsillectomy , and to discover the role of tonsillectomy in IgAN .Methods: In the study , 28 patients were diagnosed as IgAN via renal biopsy , and 27 patients suffering from chronic ton-sillitis without nephritis and 10 normal human beings were selected as controls .The expression of memory B cells in the tonsils and peripheral blood was tested by flow cytometry , and the same method was used to test the variation of the expression of memory B cells in peripheral blood of patients with IgAN after tonsil -lectomy.Results:In this study , higher percentages of memory B cells were observed in tonsil and pe-ripheral blood of IgAN patients, which were 5.72%±5.26%, 4.92%±5.10%.After tonsillectomy, the percentage of memory B cells was 1 .10%±0 .65%, lower than that before tonsillectomy ( P <0.05).Meanwhile, in tonsils and peripheral blood , the percentage of memory B cells varied with the variation of the urinary findings of the IgAN patients .Conclusion:The percentage of memory B cell in tonsils and peripheral blood could predict disease progression of IgAN to a certain extent .