Objective To evaluate the efficacy of laparoscopic-assisted resection of the small bowel for stromal tumors.Methods From January 2003 to May 2007,laparoscopic abdominal exploration was carried out under general anesthesia on 10 patients with space occupying lesion and 5 patients with abdominal pain and hemafecia of unknown origin.After an intestinal lesion was found,a small incision was made at the proper site on the abdominal wall according to the location of the lesion.The diseased intestine was resected outside the abdominal cavity,and then end-to-end anastomosis was performed.Pneumoperitoneum was rebuilt after closing the abdominal cavity in order to observe the blood circulation of the small bowel and intra-abdominal hemorrhage.Results The operation was completed in all the 15 cases.The postoperative pathological examination showed stromal tumors with CD117 positive in 14 cases(93%)and CD34 positive in 9(60%).Three(20%)of the patients were at very low risk,5(33%)at low risk,4(27%)at moderate risk,and 3(20%)at high risk.The mean diameter of the tumors was(2.44?0.63)cm(ranged from 1.5 to 3.6).The operation time was 38 to 72 minutes with a mean of(57.8?10.4),and mean blood loss was(20.1?6.5)ml(10 to 30).The patients were discharged 4 to 7 days after the operation [mean,(5.3?1.1)days],and were followed up for 5 to 36 months [mean,(24.3?8.4)months].No patient had postoperative complications or recurrence in this series.Conclusion Laparoscopy is effective for resection of small bowel stromal tumors.

Objective To evaluate graft regeneration and influencing factors after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-three living recipients were included in this study.We measured graft volume periodically by using MSCT and IQQA-Liver workstation.The liver regenerative ratio (LRR) of different stages of recipients after LDLT was calculated and compared,and stepwise regression analysis was done to set up the regression equation.Result Within 0.5 month after LDLT,graft volume was increased rapidly,and LRR reached maximum [(106.11 + 30.90)％],then decreased slowly.There was significant difference in LRR among 0.5,1 month and 3,6 months after LDLT (P＜0.05).The following factors,including whether the graft containing middle hepatic vein or not,age and sex of recipients,had no significant influence on LRR after LDLT (P＞0.05).The status of liver function of recipients preoperatively had significant influence on LRR 0.5 month after LDLT (P＜0.05).There was significantly negative correlation between the graft volume and LRRs of recipients at different stages after LDLT (P ＜ 0.05).Regression equation could be derived.Conclusion Most evident graft regeneration occurs in early stage after adult LDLT.There are many and different factors influencing graft regeneration at the different stages after LDLT.Graft volumetric measurement by using MSCT is a valid modality to evaluate graft regeneration after LDLT.

Objective To evaluate donor remnant liver regeneration and influencing factors at different stages after right lobe adult living donor liver transplantation (LDLT) using multi-slice spiral computed tomography (MSCT).Methods 68 living donors were included in this study,We did CT volumetric measurement of the liver by using IQQA-Liver workstation.Liver regenerative ratio (LRR) at different stages of donors after LDLT were calculated and compared,correlation coefficient and stepwise regression analysis were calculated.Results The difference between LRRs at different stages after LDLT were significant (F =3.323,P =0.009),there were significant difference between LRR of 7-day and 1-month,3-month (respectively t =-2.065,-2.214,all P ＜ 0.05).The inclusion of middle hepatic vein and donor gender had no influence on LRR (respectively t =0.600,-0.622,1.464,0.926,-1.228,0.624,-0.688,0.131,all P ＞ 0.05).There were negative correlation between the remnant liver volume and LRRs (P ＜ 0.05).Conclusions MSCT is a valid modality to evaluate remnant liver regeneration after LDLT.Most evident remnant liver regeneration occurs in early stage after adult LDLT.

BACKGROUND: Following trauma caused by seawater, cells often exhibit special pathological changes because of the special physico-chemical properties of seawater.OBJECTIVE: To observe corneal histopathological changes and interleukin-6 level in aqueous humor of a rabbit model of penetrating corneal trauma combined with seawater immersion.METHODS: The rabbit eye models of penetrating corneal trauma caused by firecrackers were established in 16 adult healthy grey rabbits. A 3-mm whole-layer incision was made in the cornea. The right eyes served as experimental sides and the left eyes served as controls. Seawater was injected into the aqueous humor of the right eyes via the corneal incision. The eye surface was flushed with seawater for 30 minutes. Physiological saline was used for the left eyes. RESULTS AND CONCLUSION: Optical microscopy results showed that at 1, 2, 3 days after model establishment, corneal cells on the experimental side exhibited severe necrosis and abscission, obvious swelling of substantia propria layer complicated by cellular infiltration. At 1 and 2 days after model establishment, the pathological changes on the control side were the same as the experimental side, but they were mild, but at 3 and 5 days, they were obviously alleviated. At 1, 2, 3 days after model establishment, interleukin-6 level in aqueous humor was significantly higher on the experimental side than on the control side (P < 0.05). These findings suggest that the degree of injury on the experimental side was more severe than that on the control side, indicating that seawater may be an important causative factor of corneal injury.

Objective　To study the expressions of some apoptosis related to genes in lung tissues and their relationship to the pathogenesis in rats to hypoxic pulmonary hypertension (HPH). Methods　A total of 60 rats were employed and equally divided into 5 groups, i.e. control, HPH, hemin, Tin Protoporphyrin (Snpp) and low concentration CO groups. Of them, the rats from middle 3 groups were treated with hypoxia under normal pressure for 7 h in every day, 3 weeks except Sunday. Hemin and Tin Protoporphyrin (Snpp) were given half an hour before hypoxia while low concentration CO after 2 h of hypoxia. The expression of bcl-2, bax, Fas and Fas ligand (FasL) were detected with immunohistochemical staining, in situ cell death detection, DNA fragment detection, and in situ hybridization. Results　In low concentration CO and hemin group, typical DNA ladder bands and apoptotic cells were found in lung tissues, and the expressions of Fas, FasL, bax, and bcl-2 mRNA were increased in the epithelial cells of alveoli, vascular and bronchial walls. And the expression of bcl-2 mRNA was decreased than in hypoxic group. Conclusion　CO can regulate the expression of bcl-2, bax, Fas and FasL, these apoptotic genes may involve in the regulation of cell apoptosis of lung tissues under HPH and play important roles in the genesis and development of chronic obstructive lung disorders.

Internal drainage of the biliary tract such as choledocho-duodenostomy or Roux-en-y choledocho-jejunostomy is a common operation for the treatment of primary choledocholithiasis and biliary stricture. Though these operations can creat a good drainage, serious reflux cholangitis is frequently resulted. In order to prevent this tiresome complication, the authors have designed a new operative procedure: a loop of jejunum is isolated and an artificial papilla is made on its distal end, then its proximal end is joined to the bile duct and its distal end with the artificial papilla is inserted into the duodenum and the two parts are sutured up.This paper is to report this operative method in detail and our experience with 11 cases. After operation, no reflux of the intestinal content into the interposed jejunal loop was found and barium meal could demonstrate reflux of the contrast medium only in one case out of the 11. Ten cases were followed up from 4 to 18 months and excellent results were observed. It proves that this operative procedure can prevent the reflux of chyme into the biliary tract.Interposed jejunal loop with an artificial papilla is more physiological than Roux-en-y choledochojejunostomy since bile can flow through the interposed jejunum loop into duodenum to mix with the pancreatic fluid and the chyme, which is helpful to better digestion.

Objective To investigate cytotoxicity,biocompatibility and new bone formation traced of Chinese porous tantalum,and provide experimental strategies for further clinical application.Methods The physical properties of the porous tantalum were observed by the SEM.The osteoblasts were isolated from rabbit embryo.The extract fluid from tantalum was made.The cytotoxicity and proliferation of osteoblasts compounded with porous tantalum in vitro were detected by the MTT assay.The osteoblasts were co-cultured with extract of tantalum in vitro and the morphological changes,proliferation and adhesion were observed under SEM.A total of 24 New Zealand rabbits were used to establish the model of femoral condyles with porous tantalum bars implanted.Among which 4 of them was injected with calcein and alizarin on the 5th day and the 19th day and sacrificed at 10 week postoperatively.The specimens were observed with LSCM at 488 nm and 543 nm wavelength respectively.The remained 20 animals were sacrificed successively at 2,4,8,12 weeks of implantation,then were examined by histological observation.Results The SEM showed that the pore of porous tantalum were three-dimensional connected morphology.MTT assay showed that the osteoblasts grew well in extract and no significant difference between experimental and control groups.The osteoblasts grew and spread extensively on porous tantalum.Early on co-culture,the osteoblasts attached to the surface and inner walls of material,in the later stage,the osteoblasts excreted bone matrix over the surface of porous tantalum.The animal model showed that porous tantalum was bonded closely with host bone.Hard slicing showed that new bone and capillary regenerated on tantalum-bone interface at 2,4 weeks postoperatively.The pores were full with bone tissue at 8,12 weeks.The LSCM indicated that the green and red fluorescence-labeled new bone was displayed on tantalum-bone interface,while the red zone located around the green zones.They appeared to be discontinuous at early stage,but connected with each other at the end.Conclusion The Chinese porous tantalum has good biocompatibility and no cytotoxicity.The contact osteogenesis and bone conduction exist in tantalum-bone interface,and in a time-dependent manner.

Objective To evaluate the impact of donor age on graft short-term outcome after right lobe adult living donor liver transplantation (LDLT).Method Thirty living recipients were divided into 2 groups according to donor age:older donor group (O group,donor age ＞50,n =5) and younger donor group (Y group,donor age ＜30,n =25).Alanine transarninase (ALT),aspartate transaminase (AST),total bilirubin (TB),prothrombin time (PT) on the postoperative day 1 to 5 and graft liver regenerative ratio (LRR) on the postoperative month 0.5,1,3,and 6 between 2 groups were determined and compared.Result TB on postoperative day 1,2,3,4 and 5 was significantly higher in O group than in Y group there were significant differences between two groups (P＜0.01).There was no significant difference of other liver function parameters 2 groups (P ＞ 0.05).There was no significant difference in LRRs on the postoperative month 0.5,1,3 and 6 months postoperatively between 2 groups after LDLT (P＞0.05).Conclusion Although allografts from older donors in LDLT have prolonged jaundice than those of their younger counterparts,after strictly preoperative evaluation,donor age has little effect on short-term outcomes of graft after LDLT.

Objective To evaluate the impact of donor age on early remnant liver function and regeneration after right lobe adult living donor liver transplantation (LDLT) donation.Methods 43 living donors were divided into 2 groups:donor age ＞ 50,n =8,and donor age ＜ 30,n =35.Alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TB) and liver regenerative ratio (LRR) of donors between the 2 groups were compared.Results There were no significantly different in ALT,AST and TB on days 1,2,3,5 after LDLT between the 2 groups (respectively t =0.147,1.030,-0.903,0.013,0.043,1.362,0.817,0.003,1.121,0.241,1.061 and 0.943,all P＞0.05).There was significant difference between LRR on day 7 (t =-0.965,P =0.042),but the difference was not statistically significant in LRR when evaluated on day 15 after LDLT (t =0.585,P =0.385).Conclusions Remnant liver regeneration on the first week is reversely affected by donor's age after hepatectomy,while the influence of age decreases significantly after 2 weeks.

Objective To evaluate and compare liver regeneration between normal donors and recipients at the different stages after right lobe adult living donor liver transplantation (LDLT) using MSCT.Method Sixty-eight living donors and 63 recipients without complications were included in this study.We did CT volumetric measurement of the liver by using IQQA-Liver workstation.The relationship between graft volume measured by preoperative MSCT and intraoperative actual graft volume was evaluated.The liver regenerative ratio at different stages of donors and recipients after LDLT was calculated and compared.Result Preoperative measurement of total liver and grafts resulted in a mean volume of (1366.99 ± 234.75) cm3 (standard deviation) and (862.73 175.94) cm3 (VCT-right),respectively.Intraoperative volume of the grafts was (654.46 ± 151.23) ml (Vintraop).Corresponding pre-and intraoperative data were correlated significantly each other (r =0.795,P=0.000).Vintraop can be calculated with the equation:Vintraop =64.949 + 0.683 VCT-right.There was significantly difference in LRR between donors and recipients at 0.5,1,3 and 6 months after LDLT (P＜ 0.05).Conclusion The patterns of normal liver regeneration between donors and recipients after LDLT are different.The liver of donors regenerates more significantly and quickly than recipients.Liver volumetric measurement by using MSCT is a valid modality to evaluate liver regeneration after LDLT.