Objective To explore more safe and effective method for the treatment of common bile duct stones combined with cavernous transformation of the portal vein (CTPV).Methods We report 2 cases of post-treated patients in this series.In order to avoid severe bleeding caused by dissection of bile duct,we applied different methods to remove common bile duct stones compared with traditional operation.We removed common bile duct stones in one patient through cystic duct approach during operation.Two years later,we performed endoscopic duodenal incision (endoscopic sphincterotomy,EST) for him because of lower common bile duct stenosis with sand like stone.Another patient,on the other hand,we conducted the duodenal papilla incision during operation and removed common bile duct stones with choledochoscope through the bottom of common bile duct.Result Of the two patients,all of the three kinds of operation had good curative effects.Conclusions For the patients with common bile duct stones combined with CTPV,we should select appropriate treatments to avoid dissection of bile duct in front of the dilated and tortuous collateral veins during the operation,which is the key to guarantee the safety and success of the operation.EST is the preferred method of the treatment.Open operation with choledochoscopy via cystic duct approach or duodenal papilla incision through distal common bile duct to perform stone extraction also appears to be effective and safe.

Liver transplantation is one of the main treatments for acute and chronic liver failure currently.In recent years,with the lack of donor liver transplantation and the in creasing number of patients,the major donator of liver transplant is brain dead patients.In brain-dead state,organ functions de cline gradually.Changes in hemodynamics and immunity could lead to inflammation and alter hormone release.Organ survival and patients'prognosis can be unpredictable.The study of the above phenomenal mechanisms is still at an early stage.This article summarized the current liver transplant treatments by explai ning the pathophysiology of donor organ damage and reviewing the prognosis.The aim of this article was to provide a perspective for future study on this topic.

Objective To investigate the feasibility and outcome of resection and reconstruction of hepatic artery in hilar cholangiocacinoma (HCC).Methods The data of 29 patients with HCC with hepatic artery reconstruction carried out from March 2009 to August 2013 in our center were retrospectively analyzed.23 right hepatic arteries and 6 common hepatic arteries were involved.In-situ anastomosis was carried out in 20 patients and a double anastomosis using gastrodoudenal artery grafts was carried out in 9 patients.Results There were no arterial thrombosis or other related complications on prolonged follow-up.Conclusion Hepatic artery resection and reconstruction should be carried out if the artery was invaded by a hilar cholangiocarcinoma to produce a high resection rate and a better outcome.

Objective To analyze the perioperative complications and prognosis of surgical treatment of pancreatic ductal stones.Methods 60 patients diagnosed to have pancreatic ductal stones and were admitted into our hospital from January 2009 and December 2014 were enrolled into this retrospective study.There were 47 males and 13 females.The average age was (44.1 ± 12.0).Results All patients underwent surgical operation and there was no perioperative death.Perioperative complications occurred in 7 patients (11.7％), including pancreatic fistula in 4 patients, delayed gastric emptying in 1 patient, abdominal infection in 1 patient, anastomotic bleeding in 1 patient.Eight patients developed elevated amylase levels.The fasting time was 3.4 ± 1.2 days and the hospital stay was 10.0 ±4.0 days.The follow-up rate was 88.3％ (53/60), at a mean follow-up of 27 months.In 51 patients who presented with abdominal pain, 43 patients (84.3％) had complete pain relief and 7 patients (13.7％) had partial pain relief.In 14 patients with preoperative diabetes mellitus, 1 patient had improvement and 2 patients recovered from diabetes.Two additional patients were diagnosed to have diabetes two years after the operation.Of the 2 patients who were shown to have pancreatic cancer on histopathological study, 1 patient was lost to follow-up while another patient died at 27 months after the operation.The patients diagnosed to have epithelial dysplasia were followed-up and none developed pancreatic cancer.Conclusions The relationship between chronic pancreatitis and pancreatic ductal stones was very close.Chronic pancreatitis also caused exocrine and endocrine dysfunction.Surgical operation plays an important role in symptomatic relief and in delaying pancreatic dysfunction.

Objective: To investigate Fuzhengzhiqiu Granules' effect on ICAM-1(Intercellular adhesion molecule-1) and VCAM-1(Vascular cell adhesion molecule-1) expression in nasal mucosa of experimental allergic rhinitis. Methods: SD rats (n=64) were immunized by intraperitoneal injection of 200?g Ovalbumin (OVA) (1ml OVA-Al[OH] 3-saline suspension) on 1st, 2ed and eleven day. Normal control group rats A (n=16) were treated with the same methods except injecting OVA. 19th day, 0.1 ml of saline containing 10 mg of OVA was instilled into nasal cavity for 7 consecutive days. Normal control group followed by intranasal administration only with saline. The rats challenged into allergic rhinitis (n=64) were randomly divided into four groups: allergic rhinitis model group B (n=16); Fu zhengzhiqiu Granules treated group C (n=16); Fu zhengzhiqiu Granules treated group D (n=16, three times dosage used in group C); Xinqin Granules treated group E (n=16). All animals were treated for 15 days. The nasal mucosa of them were studied by immunohistochemical staining to observe the ICAM-1 and VCAM-1 expression. Results: Animal model of allergic rhinitis was established by using ovalbumin intraperitoneal immunization and nasal challenge. The number of positive immunoreactive cells (ICAM-1 and VCAM-1) was increased significantly in all the groups compared with normal controls. VCAM-1 expression was inhibited by giving with Fuzhengzhiqiu Granules (especially in group D) and Xinqin Granules (P0.05). Conclusion: Fuzhengzhiqiu Granules can decrease the expression of VCAM-1 in nasal mucosa of experimental allergic rhinitis, but no effect on ICAM-1.

Objective To explore the clinical value and safety of early enteral nutrition support in patients after liver transplantation.Methods We retrospectively analyzed the clinical data of 86 cases who used early enteral nutrition support therapy after liver transplantation between January 2008and October 2011.All of patients were uproot the gastric tube at the first day after the operation,and gradual to the normal diet.The patients who used parenteral nutrition support therapy were as the control group(n＝112).Then we compared the data of patients in the two groups.Results The early enteral nutrition is more useful to the patients after liver transplantation than intravenous nutrition [In the seventh day after the operation,the control group's ALT was (45.2 ± 12.9) U/L,AST was (40.2±9.4) U/L,ALBwas (35.6±2.5) g/L,P＜0.05].The early enteral nutrition also can decrease hospital stay and hospital costs [(14.2±3.4) d,P＜0.05].Conclusion The early enteral nutrition is useful and safe to the patients after liver transplantation.

BACKGROUND: Researches on the hand allograft have been transited from laboratory aspects to clinical application.OBJECTIVE: To evaluate the clinical significance of serial monitoring of co-stimulating signals in double hand transplantation.DESIGN: Case controlled observation.SETTING: Department of Traumatic Orthopaedics, Nanfang Hospital,Southern Medical University.PARTICIPANTS: From September 2001 to December 2001, a patient who was proposed to have double hand transplantation in the Department of Traumatic Orthopaedics, Nanfang Hospital Affiliated to Southern Medical University was taken as the subject of the experiment, meanwhile 15healthy adult man were enrolled as controls.METHODS: Before operation, blood sample was collected from the patient once before given immunodepressant and twice after given immunodepressant; blood sample was also collected before arteriovenous connection during operation, as well as once a day during the first week after operation, once every other day on the second week, twice a week on the third and fourth week, followed by once a week for total two month. The first week after operation was taken as inducing period with the remainder as maintaining period. 2 mL peripheral venous blood was collected from healthy adult and anti-coagulated by EDTA of mass scores of 20 g/L.Flowcytometry was used to carry out a serial monitoring of T cell surface co-stimulating moleculars (CD28, CD54, CD11a).MAIN OUTCOME MEASURES: The change of co-stimulatingmolecules on the surface of T lymphocyte before and after transplantation.RESULTS:The changes of the three co-stimulating molecules were consistent with each other after double hand transplantation (CD28,CD54,CD11a),displaying decrement during inducing period comparing to pre-operation [(9.84±5.28)%, (55.50±3.62)%; (71.03±5.33)%, (95.10±1.26)%;(9.40±9.17)%, (29.70±3.23)%] and keeping at lower level at maintaining period [ (22.54±6.56) %, (91.28±8.12 ) %, ( 11.22±4.08 ) %].CONCLUSION:The serial monitoring of the co-stimulating signals in the peripheral blood of patients with linb allograft is beneficial to the observation of the posopertaive immunologic reaction, providing important guidance for the application of immunosuppression medicine, as well as the prediction and diagnosis of postoperative immune rejection. Meanwhile, costimulating signal induced immunological tolerance is proved promising for the application of hand transplantation.

Objective To summarize the clinical experience of hepatic artery bypass reconstruction using gastroduodenal artery in radical resection of hilar cholangiocarcinoma,and to provide assistance for surgeons applying artery reconstruction technique correctly in radical operation of hilar cholangiocarcinoma.Methods 9 cases of hilar cholangiocarcinoma with hepatic artery invasion wcrc subjected to radical resection combined with tumor invaded hepatic artery resection and reconstruction.Hepatic artery bypass reconstruction was performed by end-to end anastomosis,using the gastroduodenal artery interposition graft.The clinical data of these patients were reviewed retrospectively.Results All tumors of these cases with hilar cholangiocarcinoma were involved right hepatic artery,and the in volvement length was not less than 2 cm.The artery reconstruction was one-time successfully per formed in all cases.The median time required for anastomosis was (23.0±3.1) min.No postoperative complications,the dysfunction of gastrointestinal peristalsis or abnormal gastric drainage volume for example,related to the gastro-duodenal artery resection was observed.None of the patients devel oped any complications related to the arterial bypass reconstruction in the follow-up period,which was confirmed by abdominal CT scan.Conclusion Hepatic bypass reconstruction using gastro duodenal artery graft decreases the morbidity related to artery reconstruction and has little effect on gastrointes tinal function,which is the optimal choice for arterial reconstruction in radical operation for hilar cholangiocarcinoma.

Objective To investigate the genetic effects of radio-frequency radiation (RF-radiation) on mammalian somatic cells. Methods A meta-analysis of reported data (1991-2009) was conducted to obtain a quantitative estimate of genotoxicity ( including single-and double-strand breaks in the DNA, incidence of chromosome aberration, micronuclei, and sister chromatid exchanges) in RF-radiationexposed cells compared with sham-exposed cells or unexposed control cells. Results After RF-radiation exposure, the weighted mean difference and its 95% confidence interval was 1.03(0. 74, 1.31 )for comet tail length in radiation group, and was 0. 10 (0. 04, 0. 16) for comet tail moment compared with control group. Relative risk and its 95% confidence interval for chromosome aberration was 1.21 (0. 68, 2. 13 )for lower than 2000 MHz RF-radiation exposure group, and 1.76( 1.05, 2.97 ) for more than 2000 MHz RF-radiation exposure group. The combined relative risk and its 95% confidence interval for micronuclei formation was 1.39(1.18-1.64). The combined WMD and its 95% confidence interval for sister chromatid exchanges in radiation group was 0. 40 ( - 0. 33,1.14 ) compared with control group. Conclusions On certain RF radiation exposure conditions, it can increase in the DNA damages and micronuclei formation.There might be an increase of chromosomal aberration occurrence for RF-radiation exposure above 2000 MHz, while no significant differences for those lower than 2000 MHz RF-radiation exposure. For the incidence of sister chromatid exchanges in mammalian somatic cells, RF-radiation exposure had no significant influence.

Objective To investigate the feasibility and realistic significance of different teaching methods in professional and scientific degree graduate students.Methods Twenty six graduate students (scientific 12,professional 14) were randomly selected as research object from Sep.2014 to Apr.2017,and the relationship between clinical or research outcome and type of degree,clinical or experiment time were analyzed.Results The experiment time of scientific degree graduate students was significantly longer than that of professional degree graduate students [(21.0 ± 1.6) vs.(11.0 ± 3.5) months],and professional degree graduate students paid more attention to clinical work,there was statistic difference between the two groups [(20.0 ±2.1) vs.(12.0 ±2.4) months,both P＜0.05].The qualification rate of basic clinical manipulation in the professional group was higher than that in the scientific group (85.7％ vs.75.0％,P ＜ 0.05).Conclusion Different type of teaching methods based on the type of student degree were feasible and proper for graduate students in surgery,and the terminal object of our teaching should be focus on the resolution of clinical problems.