From ancient to present,liver has always been a mystery and magical organ.As the largest glandular organ of the body,liver has many vital functions.Its regenerative capabilities and functional reservation allow major resection of up to 80%of its volume.Many diseases,such as liver cancer,cirrhosis and hepatolithiasis Can affect liver,and the mainstay of curative treatment is liver resection.Technological advances play an important role in modern surgery,and a new surgical paradigm characterized by precision has evolved.Recently,we haveadvocated the concept of"precise hepatectomy"on the basis of modem anatomy,physiology,oncology,imaging and surgical techniques,which is characterized by minimal invasion,liversaving and maximally restoration of liver function.Related subjects,including computer sciences,imaging and information are needed to be combined to create a new alliance of treatment.Although,there are still many theoretical and technical problems about liver resection and liver function preservation.With the development of science and technology,precise hepatectomy will further improve the outcomes of liver surgery.

Objective To study the morphological structure and the hemodynamics of peribiliary vascular plexus(PVP) of hepatic portal bile duct in rat in vivo,so as to provide an experimental method and accumulate data for further study on the bile duct complications occuring after liver transplantation,operations for bile duct stenosis and other hepatobiliary diseases.Methods Forty SD rats were randomly and equally divided into 2 groups: the control group and the ink-injection group(n=20),microcirculation laser scan confocal microscopy was used to observe the morphological structure and the hemodynamic features of PVP on rat′s hepatic portal bile duct after the bile duct was stained with indocyanine green and the hepatic artery was perfused with ink.Results Morphologically it was showed that PVP were comprised of three layers: the spatial structure of PVP appeared dentriform from outer layer to intermediate layer,and then transformed into a network from intermediate layer to inner layer.The outer layer vessels seemed to be dendritic and located within the ductal wall at 0-60?m scanning from the adventitia,and the branches appeared sparse and straight.The diameter of artery and vein was very different.The vessels of intermediate layer showed as an intricate network and located within the ductal wall in the depth of 40-80?m,and the ranification was rich and tortuous.Inner layer vessels adjacent to the intima appeared to be a plenus in hexagons with 120? intersect angles and uniform diameter.Hemodynamics showed that the flow rate in the artery was higher than that in the vein of PVP.Conclusion The technique,employing microcirculation laser scan confocalmicroscopy,to observe the morphological structure and the hemodynamic features of PVP,may reveal the morphological structure and hemodynamic features limpidly,both macroscopically and dynamically.It can be used as an important tool for the study of bile duct complications after liver transplantation,bile duct stenosis or other hepatobiliary diseases.

OBJECTIVE To compare different methods of processing of homograft costal cartilage. METHODS Homograft costal cartilage samples were processesd by three methods-irradiation, freezing, and alcohol fixation-before being inserted into the rabbit nasal dorsum. They were taken out 12 weeks later and evaluated for histological responses under a optical microscope. RESULTS The histological responses consisted of inflammatory cell infiltration, necrosis, vasal responses and fibroplasia. The was a significant different in degree of inflammatory cell infiltration and necrosis in all three groups(P

Objective To explore the relationship between the pathologic features of the cancer and postoperative recurrence in patients with early stage gastric carcinoma.Methods 139 patients with early stage gastric carcinoma underwent radical resection in our hospital from 1984 to 1995. All cases were followed up for more than 5 years. ? 2 test was used for statistical analysis.Results 7 cases died of hematogenic metastasis, 3 cases died of lymph node metastasis, and stump carcinoma was found in the other 3 cases. The recurrent rate was significantly higher in submucosal tumors (14.1%) than in mucosal tumors (1.9%), in lymphatic and vascular vessel invasion-positive cases (37.5%) than in negative cases (7.6%), in lymph node positive (31.3%) than in negative (6.5%), in synchronous multiple gastric cancer (33.3%) than in solitary tumors (7.9%)(P

Objective To evaluate the long term results of regular hepatic resection for hepatolithiasis.Methods Five hundred and fourteen patients with hepatolithiasis underwent hepatic resection from Jan. 1975 to Dec. 1998 in Southwest Hospital. The indications included stones confined to one segment or one lobe of the liver, significant atrophy of the portion of the liver harboring the stones from repeated episodes of obstruction and infection, multiple strictures of the ducts in the affected portion of the liver. Resection of S 2 and S 3 was performed in 284 patients, S 2, S 3 and S 4 in 98 patients, S 6 and S 7 in 26 patients, S 5, S 6, S 7 and S 8 in 37 patients; both of the left and right hepatic lobes were partially resected in 23 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were performed in 296 patients.Results The operative mortality was 2 1%, and the morbidity rate was 8 4%. The majority of complications were biliary fistulas (2 9%), subphrenic infection (4 5%), peritoneal abscesses (0 4%) and liver failure (0 6%). Long term follow up on 436 patients at a median of 9 1 years showed that 75 9% were symptom free, 14 5% had occassional mild attacks of cholangitis, 9 6% had severe cholangitis requiring further surgical intervention.Conclusion Anatomic hepatic resection is the most effective treatment and the therapy of choise to eradicate intrahapatic stone foci in cases of hepatolithiasis .

Objective To explore the current status of non-operative management strategy for blunt hepatic trauma. Methods The clinical data of patients with blunt hepatic trauma admitted to our hospital during the past 15 years were retrospectively analyzed, and the new standpoints in the selection of therapeutic strategy for blunt hepatic trauma were elucidated with referance to recent litereture, especially regarding the different opinions in non-operative management in the treatment of blunt hepatic trauma between the developed countries and China. Results The concept in the selection of therapeutic strategy for blunt hepatic trauma in China lagged relatively behind the advanced countries. Compared with that in the developed countries, the percentage of non-operative management was significantly lower in China (10%-30% vs 50%-80%), and the fewer CT scanning was carried out in the patients with stable hemodynamics. Conclusion Non-operative management is becoming one of the most important strategies in the treatment of blunt hepatic trauma nowadays. Non-operative management is widely acknowledged as the first choice for blunt hepatic trauma, especially for those with stable hemodynamics. This new trend should be more emphasized in China. Besides, CT scanning as a diagnostic tool should be carried out as frequently as possible in those patients with stable hemodynamics.

Objective To explore the effects of static wrist on radial nerve palsies. Methods 60 patients with radial nerve palsies were devided into wrist group (n=20), acupuncture group (n=20) and intermediate-frequency (IF) group (n=20), who accepted static wrist wearing, electroacupuncture, and intermediate-frequency electro-stimulation respectively. Results The efficacy was not significantly different among these groups, but the time out of working and the cost for the management were the least in the wrist group. Conclusion Wearing static wrist is not only effective on radial nerve palsies, but also reduce the loss of working time and cost of treatment

Objective To analyze the clinical characteristics and therapeutic effects of cutaneous metastasis from cholangiocarcinoma. Methods From 2006 to 2009, clinical data of 6 patients found with cutaneous metastasis from cholangiocarcinoma were reported. Perineural and vascular invasion were all found in the primary cholangiocarcinoma in these 6 cases with cutaneous metastasis and results were compared with 60 cases of cholangiocarcinoma without cutaneous metastasis. Follow-up to the 6 patients with cutaneous metastases was conducted at an interval of three months. Results One patient with mixed hepatocellular and cholangiocellular carcinoma developed cutaneous metastatic tumor and the pathological diagnosis was cholangiocellular carcinoma. Three patients with hilar cholangiocarcinoma and two patients with distal cholangiocarcinoma presented cutaneous metastases. All six cases of the primary cancers and cutaneous metastases were diagnosed as moderately- poorly differentiated adenocarcinoma. And there was perineural and vascular invasion in the primary tumors. Perineural and vascular invasion of primary cancer was found in 17of 60 patients with cholangiocarcinoma and without cutaneous metastasis. The cutaneous metastasis was positively correlated to the perineural and vascular invasion in the primary tumor (χ2 = 12. 7288, P ＜0. 001 ). Two of 6 cases presenting solitary nodular cutaneous metastasis received skin tumor excision. These two patients survived 8 and 10 months respectively. Among four patients with multiple cutaneous metastases,two cases received chemotherapy and survived 3 and 6 months respectively, the other two cases refusing treatment survived 3 and 4 months respectively. Conclusions Cutaneous metastasis usually occurred at cholangiocarcinoma with lower differentation and perineural and vascular invasion in the primary tumor.Solitary nodular cutaneous metastasis could be excised, multiple cutaneous metastases had poor prognosis.

BACKGROUND:Cataract is not the necessary symptom for myotonic dystrophy(DM).But it may be the early and even only clinical symptom of DM.Molecular diagnosis can provide the important evidence for the diagnosis of DM.OBJECTIVE:To explore the characteristics of cataract in 26 patients with myotonic dystrophy of 3 pedigrees from Shanghai Songjiang area.DESIGN:Analysis on the Genealogy of Pedigree.SETTING:Department of Neurology,Shanghai Changhai Hospital.PARTICIPANTS:Twenty-six patients of 3 pedigrees,aged 7 to 71 years old,which were preliminarily diagnosed as DM patients or were suspicious DM patients,admitted to Department of Neurology,Shanghai Changhai Hospital between May 2001 and August 2003,were recruited in this study.Among the involved patients,13 corresponded to the clinical diagnosis standard from Practical Neurology,and the other 13 patients have adverse symptoms and (or) body signs of partial or mild DM,suspecting with DM patients.METHODS:①Peripheral blood of 1 mL was taken and genome DNA was extracted.By using a thermocycler,a polymerase chain reaction (PCR) was carried out to examine the CTG repeats according to criteria of molecular diagnosis (CTG repeats from 80-3350).②In addition,slit-lamp examination for specific lens opacity was carried out and the association between DM and cataract was analyzed.MAIN OUTCOME MEASURES:①CTG trinucleotide repeat numbers.②Association between DM and cataract.RESULTS:Of the 26 patients,25 participated in the final analysis except 1 who suffered from sterility clinically.①25 patients were consistent with the molecular diagnostic criteria of DM (CTG repeats from 80-3 350).The remaining 1 with CTG repeats of 13 was clinically sterility and therefore belonged to the normal individual.The (CTG)n triplet repeats of 17 patients with cataract were 2380±80,while 8 patients with cataract were 2298±105(P＞0.05).②Cataract was characterized as iridescent lens opacity or blue posterior cortical lens opacity in 17 patients.Among the 17 patients,cataract in 8 patients was the only early clinical sign whose(CTG) n triplet repeats were higher than the normal ones.CONCLUSION:In the pedigrees with DM patients,characteristic cataract,as a main and even only early clinical sign,will provide important clinical evidence for the early diagnosis of DM.

PURPOSE: This study was conducted to investigate the small double-stranded RNA (dsRNA) mediated anti-tumor effects of p21(WAF1/ClP1) (p21) transcriptional activation in vitro in the human glioma SHG-44 cell line. MATERIALS AND METHODS: Human glioma SHG-44 cells were transfected with dsRNA using LipofectAMINE 2000 transfection reagent. Real-time PCR and Western blot analysis were conducted to detect p21 and survivin mRNA and protein levels, respectively. Cell proliferation was examined by MTT assay. Cell cycle distribution and apoptosis were detected by flow-cytometric analysis. RESULTS: We found that dsRNA targeting p21 promoter (dsP21) significantly induced the expression of p21 at transcription and protein levels, and reduced the expression of survivin. AS well, dsP21 transcription significantly inhibited human glioma SHG-44 cell proliferation. Analysis of cell cycle distribution revealed that dsP21 transfection increased accumulation of cells in the G0/G1 phase and reduced accumulation of cells in the S phase. Further analysis revealed that dsP21 transcription led to an increase in both early and late stages of apoptosis in human glioma SHG-44 cells. CONCLUSION: In the present study, P21 activation by RNA-induced gene activation (RNAa) induced anti-tumor activity in vitro in a human glioma SHG-44 cell line. The results suggested that RNAa could be used for human glioma treatment by targeted activation of tumor suppressor genes.
Apoptosis ; Blotting, Western ; Cell Cycle ; Cell Line* ; Cell Proliferation ; Genes, Tumor Suppressor ; Glioma* ; Humans* ; Methods ; Real-Time Polymerase Chain Reaction ; RNA, Double-Stranded* ; RNA, Messenger ; S Phase ; Transcriptional Activation* ; Transfection