Abstract To analyse the mechanism of TECA bio-artificial liver support system(BALSS)to treat acute liver failure (ALF) canines. The blood of partial liver resection-induced ALF canines or RPMI1640 solution were circulated in the inner space of the hollow fibers (blood loop), and porcine hepatocytes were cultured in outer space of the hollow fibers (cell loop). The concentrations of lidocaine, albumine and urine in the RPMI1640 solution were measured. The compositions of proteins in cell loop and blood loop were analysed by polyacrylamide gel electrophoresis (PAGE). The ultrastructure of porcine hepatocytes in BALSS was observed with transmission electronic microscopy. There were not any proteins in RPMI1640 solution before BALSS circulation. After 6 hours of the BALSS circulation, the concentration of lidocaine in RPMI1640 solution decreased significantly,and concentration of albumine and urine nitrogen increased gradually. The ultrastructure of the porcine hepatocyte shown damaged after BALSS 6h. The results suggested that TECA BALSS could replace temporarily the functions of failure liver by the effects of biologic transform and synthesis of porcine hepatocytes.

To evaluate the inhibitory effect of recombinant adenoviruses p16 (Ad p16) combined with Ad p53 on human cholangiocarcinoma cell line QBC939 in vitro. Expression of p16 was low and p53 was negative in QBC939 cells. High level of p16 and p53 expressions were observed in QBC939 cell line transfected with Ad p16 and Ad p53. The growth rates of the Ad p16 infected combined with Ad p53 infected QBC939 cells were inhibited, which was higher than those of the Ad p53 or close to Ad p16 transfection. Colony formation in Ad p16 with Ad p53 transfected cells greatly decreased versus Ad p16 transfected or Ad p53 transfected cells. The Ad p16, Ad p53 and Ad p16 with Ad p53 transfected cells manifested apoptosis and G 1 arrest, which were confirmed by the flow cytometry. The suppression effects mediated by expression of the exogenous p16 with p53 in tumor cell resulted mainly from apoptosis and G 1 arrest, which is higher than exogenous p16 or p53.

Objective To evaluate the impact of laparoscopic cholecystectomy(LC) on the prognosis of unsuspectedgallbladder cancer(GC).Methods A retrospective clinicopathologic study was performed on 21 patients with unsuapective GC,but diagnosed gallbladder cancer postoperatively by pathology.Of which,11patients underwent LC and 10 patients underwent open cholecystectomy(OC),The correlation was evaluatedbetween cumulative survival rates and the following 5 prognostic factors:histopathological grade,pathologic stage,occurrence of bile spillage,type of cholecystectomy(LC or OC),and additional surgical treatments.Results Eight patients(73%) after LC and 7 patients(70%) after OC had cancer recurrence,and the difference was of no statistical significance(P=0.86).There were no recurrences of cancer in the abdominal wall after either LC or OC.Survival rate was statistically correlated to tumor stage(P=0.006),and to the occurrence of bile spillage(P=0.003).Survival rate did not differ according to whether the operation was carried out using LC or OC(P=0.74).Conclusions LC does not worsen the prognosis of unsuspected gallbladder cancer.

Objective A considerable percentage of gallbladder cancers are accompanied by su-perficial cancer spread adjacent to the main tumor. Therefore, cholecystectomy for early gallbladder cancer must be performed carefully to avoid leaving cancer cells at the surgical margins. Methods Thirty-six patients with gallbladder cancer invading no more than perimuscular connective tissue un-derwent surgical resection at our medical center. After operation, the resected specimens were investi-gated macroscopically and microscopically to clarify the clinicopathological features and the risk factors of superficial cancer spread. Results Seventy percent of all cases (25 cases) had superficial cancer spread. Comparison between the cases having superficial cancer spread and the cases without it re-vealed that the macroscopic morphology of the primary tumor and the depth of cancer invasion in the gallbladder wall were significantly different between the two groups. Furthermore, multivariate analy-sis indicated that 'superficial raised type' in macroscopic morphology was an independent predictive factor for having superficial cancer spread. Superficial cancer spread from the main tumor located in the neck of the gallbladder grew predominantly in the direction of the fundus. More advanced gallbladder cases were accompanied by more extensive superficial spread. Conclusion Superficial cancer spread is frequently observed adjacent to the gallbladder cancer, especially in the superficial raised type. A negative margin should be confirmed by intraoperative frozen section while performing cholecystectomy.

Objective To observe clinical significance、anatomy and variation of normal internal cerebral veins and their tributa-ries.Methods The studies included 284 sides in 142 patients.The patients were performed with 320-detector Row CT One-stop Scanning.Then,the anatomical features of internal cerebral veins and their tributaries were evaluated.Results The detection rate of internal cerebral veins(ICA)、thalamostriate veins(TSV)、septal veins(SV)、anterior caudate nucleus veins、posterior caudate nucleus veins and lateral direct veins was 100%、100%、98.9%、95.4%、93.7%、48.6%.Type of IA was seen frequently in four types of ICA,the parts of ICV and their tributaries were mirror symmetry,the majorities of ICA were located the same plane.Anterior cau-date nucleus veins were classified four types on basis of these different draining patterns,they were drained to TSV commonly.There was no significant difference between venous angle or false venous angle and type of their draining(P>0.05).There was significant difference between detection rate of lateral direct veins and development of posterior caudate nucleus veins(P<0.05).Conclusion 320-detector Row CT One-stop Scanning was an important method that internal cerebral veins were detected effectively and non-inva-sively,observed anatomy,course and morphological change of ICV.

Objective To study the value of diffusion weighted imaging (DWI)in Marchiafava-Bignami disease.Methods (1)12 cases of Marchiafava-Bignami disease (MBD)patients with 6 month follow-up and 12 hedthy adults were clone MRI DWI;(2)MR imaging characteristics of 12 patients were observed on the corpus callosum and the other gray-white matters;(3)The ADC values of the central part and marginal area of the corpus callosum and the other gray-white matters were measured,data analysis were carried out completely by random design.Results Hyperintensity on the corpus callosum were showed in 12 patients on DWI,typical“sandwich sign”was seen on the sagittal T2 WI in 1 1 cases,and gray-white matters beside the corpus callosum were involved other in 6 cases;The ADC values of central and marginal area of the corpus callosum and the other gray-white matters had significant differ-ence between the improved clinical symptom group and,unimproved clinical symptom group and the control group (P < 0.05 ). There were no significant differences in the ADC values for the other white matters.Conclusion DWI can be used to reflect the change of MBD.Low ADC values in the corpus callosum and cortex are associated with a poor prognosis.

Objective To evaluate the value of 64-slice spiral computed tomography angiography(CTA) in diagnosis of acute severe chest pain caused by vascular diseases.Methods 34 cases with acute severe chest pain caused by vascular lesions confirmed clinically underwent CTA examinations.The images were processed with multi-planar reconstruction,maximal intensity projection,curved planar reconstruction and volume rendering,then the imaging features were analysed.Results CTA showed acute aortic dissection in 13 cases,acute pulmonary embolism in 9 cases and acute coronary syndrome in 12 cases,all cases were confirmed by clinic.Conclusion 64-slice CTA has very important practical value in diagnosis of acute severe chest pain.

Objective To study the value of the application of 320-row detector dynamic volume CT in diagnosis of complicated congenital heart diseases(CCHD).Methods Datas of 43 cases with CCHD,who examined by ECC-gated 320-row CT angiography (CTA)as preoperative examinations were collected.All the CT data were processed by combined application of multi-imaging post-processing technique to show the anatomic malformation based on segmental analysis,and were compared with the transthoracic ech-ocardiography (TTE )and surgical results .Results 1 97 various malformations were found in 43 cases and proved by operation, among which there were 87 intracardiac malformations,the diagnostic accuracy with CTA and TTE were 86.2%,89.7%,and there was no obvious difference between them(P >0.05 ).1 10 extracardiac malformations (including connection malformations between heart and vessels,extracardiovascular malformation,bronchial or other nonvascular structure malformation)were found ,the accura-cy with CTA and TTE were 91.8% and 76.4%,the former was superior to latter (P <0.05)Conclusion 320-row detector dynamic volume CT in diagnosis of CCHD has very important meaning and practical application value,should be used as the significant choice for clinical diagnosis of CCHD.

Objective To summarize twenty year experience in the surgical treatment of hilar cholangiocarcinoma(H CC) and explore the effective measuers for increase in resectional rate and reducing operative morbidity and mortality of H CC. Methods Clinicopathological data of 201 patients with H CC treated surgically in our center between 1978 and 1997 were analysed retrospectively. The resection rate, operative morbidity and mortality of the patients before and after December 1990 were compared. Results Of the 201 patients, 97 underwent resection(redical resection in 51; palliative in 46), 84 subjected to internal or external drainage and 20 only laparotomy. In 75 followed up patients, the 1,3,5 year survival rate was 95.45%, 40.91%, 13.64% in radical resection group, and 55%, 10%, 0% in palliative resection group respectively; whereas in unresectional internal and external drainage group, 1 year survival rate was 36%, noone survived for more than 3 years. All the patients with only laparotomy died within 3 months after operation. Comparation of the two stages revealed that the resection rate had been increased from 34.95% before December 1990 to 62.24% after December 1990, and the radical resection rate from 15.53% to 35.71%, meanwhile the operative morbidity and mortality decreased from 39.80% and 17.84% to 18.37% and 6.12% respectively. Conclusions Radical resection plays an important role for improving long term survival rate in patients with H CC. Appropriately perioperative care can reduce the operative morbidity and mortality.

Objective: Investigate the pulmonary surfactant autotransfusion effect on the recovery of respiratory function in patients with whole lung lavage, to provide theoretical basis for the clinical application. Methods: We taken 30 patients of pneumoconiosis treated by whole lung lavage as the subjects. We extracted the pulmonary surfactant from lavage fluid, after single postoperative lung lavage for the first time; after one weeks when the second times of lung lavage were performed to the other side of the lung of patients, we put PS into the right side. We taken the patients the second times of lung lavage who were put PS into the right side as returning group, the first times of lung lavage who were not put PS into as on returning group. We observed indi-cators, such as expiratory resistance, respiratory work, lung compliance, airway pressure, PO₂, the pulmonary function recovery time and other indicators, comparing with the changes of pulmonary function before lung la-vage for the first time and at 0、60、90、120 min after the pulmonary surfactant autotransfusion. Results: Com-pared with the no returning group, the expiratory resistance of the returning group decreased significantly at 90 min、120 min after the pulmonary surfactant autotransfusion; the respiratory work and airway pressure of the re-turning group decreased significantly at 60、90、120 min after the pulmonary surfactant autotransfusion, there was statistically significant in the difference between different groups (P<0.05, P<0.01). Compared with the no returning group, the lung compliance and the PO₂ of the returning group increased significantly at 60 min、90 min、120 min after the pulmonary surfactant autotransfusion, there was statistically significant in the difference between different groups (P<0.05, P<0.01). The lung function recovery time of returning group was (155.7 ± 35.2) min, the lung function recovery time of no returning group was (183.71±41.81) min, there was statistical-ly significant in the difference between different groups (P<0.05). Compared with the no returning, there were not statistically significant in the difference of the Heart rate、the systolic blood pressure and the diastolic blood pressure about the returning at 60、90、120 min after the pulmonary surfactant autotransfusion.There was no ad-verse reactions such as pulmonary infection, pulmonary infection and so on. Conclusion The pulmonary surfac-tant autotransfusion may reduce expiratory resistance, work of breathing, airway pressure; improve lung compliance, alveolar ventilation function; increase oxygen partial pressure and decrease the surgery recovery time in patients with pneumoconiosis.