Objective To evaluate the feasibility and efficacy of subfascial endoscopic perforator surgery in treating varicose ulcer after great saphenous vein stripping.Methods Between July 2008 and July 2013,152 limbs of venous ulceration after great saphenous vein stripping were divided into two groups (conservative therapy and subfascial endoscopic perforator surgery therapy) and followed up at least for 2 years,respectively compared symptoms and signs improvement,ulcer healing time,ulcer healing and ulcer recurrence rate after healing for 6,12,24 months.Results No patient underwent the surgery occured pulmonary embolism or death,2 limbs appeared hematoma.Conservative and subfascial endoscopic perforator surgery group's symptoms and signs improvement rates were 81.9％ (59/72) and 86.3％ (69/80) (not significant,P =0.528),while the ulcer healing time,ulcer healing and ulcer recurrence rate respectively were 65.3％ (47/72) and 78.8％ (63/80),(73 ±15.7) d and (41 ± 12.6) d,34.0％ (16/47) and 14.3 ％ (9/63) (significantly different,P ＜ 0.05).According to the three time-points' (6,12,24 months) follow-up,the non-recurrence rate were 89.4％ (42/47) and 96.8％ (61/63),P=0.135;72.3％ (34/47) and 92.1％ (58/63),P=0.006;66.0％ (31/47) and 85.7％ (54/63),P =0.014.Conclusions Subfascial endoscopic perforator surgery is a reliable,safe and minimally invasive surgery,and has a long-term effect in treating varicose ulcer after great saphenous vein stripping.

Objective A new method for detecting K-ras mutations based liquid chip was used to evaluate K-ras mutations associated with non-small cell lung cancer (NSCLC) patients,to direct the personalized treatment and prognosis evaluation.Methods Take the diagnosis technology research methods,the sensitivity and repeatability of the liquid chip K-ras gene mutation detection method were assessed.A total of 100 NSCLC patients from Nov 2011 to Feb 2012 in Shanghai Chest hospital were included in this study,the fresh tumor tissues were collected for DNA extraction.The 2nd exon 12 and 13 codons,containing 8 K-ras mutations occuring in high frequency were amplified by polymerase chain reaction (PCR),followed by ligation of the PCR products to a series of special probes using ligase detection reaction (LDR),then the PCR-LDR products were analyzed by liquid chip platform.Direct sequencing was applied to compare with the detection results.Results The sensitivity of liquid chip technology detection was 10％-20％,higher than the traditional sequencing method by 1％.Average CV value was 4％-15％ and showed good repeatability.5 K-ras mutations in 100 patients (5％) were detected using multiplex PCR-LDR combined fluid chip methods,including 3 Glyl2Val and 2 Gly12Asp mutations in exon 2.The 5 K-ras mutations were verified accurately by direct sequencing.Conclusions The novel detection method of K-ras mutations based PCRLDR and fluid chip shows high throughput,high sensitivity,good repeatability and the results are reliable and accurate.This method can be used to accurately identified K-ras mutations for NSCLC patients prior to their targeted therapy with TKIs.

Objective To discuss the surgical procedures and treatment after combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends in one case.Methods A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.With the techniques of en bloc,the liver and intestinal grafts were harvested from cadaveric donor.The intestinal graft,200 cm long,was implanted with portal venous drainage and aortic inflow,and enterostomy of both ends was performed instead of intestinal anastomosis.The liver graft was placed in a piggyback fashion with end to end anastomosis of the bile ducts without T tube. Inmunosuppression protocol was administrated with campath-1H and tacrolimus.Endoscopic biopsy of intestinal graft was performed regularly,and clinical observation was done to monitor the acute rejection.Results In the first month after operation,abdominal infection was controlled by intraperitoneal drainage with open surgery.One suspect acute rejection was treated with methylprednisolone.Until sixth month,the functions of liver and intestine were progressively restored.However,the patient lost weight and could not be free from intravenous nutrition because of diarrhea.Conclusion Combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends is a simple surgical procedure with lower risk of surgical complications.This method is propitious to monitoring rejection and function improvement of the grafts.Diarrhea and loss of digestive juice are the main reasons of low body weight and malnutrition.

Objective To study the activation induced cell death (AICD) of CD4+ T cells in primary biliary cirrhosis(PBC)murine model induced by poly I∶C. Methods Thirty female C57BL/6 mice were divided into model and control group randomly, and the former were injected with 5 mg/kg of poly I∶C, the later with PBS. PBC mice were detected 16 weeks after injection. CD4+ T cells isolated from spleen were stimulated in vitro by Con A and anti-CD3, and the apoptosis were determined by Annexin-V and PI staining. The expression of Fas, FasL and TRAIL were assayed by relative quantitative real-time PCR. Bcl-2 was detected by Western blot. Results Compared with control group, the portal areas of mice in model group were infiltrated with mononuclear cells obviously. The positive rate of serum antimitochondrial antibody(AMA) and the level of alkali phosphatase (ALP) were higher than that in control group (P<0.001). AICD of splenic CD4+ T cells in model group was lower than that of control group (P<0.001). The mRNA of FasL and TRAIL in model mice was down-regulated. Simultaneously, the anti-apoptosis protein Bcl-2 was up-regulated in model group. Conclusion These observations suggest that a defect in AICD of auto-reactive TH1 cells may contribute to the pathogenesis of PBC model. Furthermore, this defect in AICD may results from the change of Fas/FasL, TRAIL pathway and the up-regulation of Bcl-2.

Objective To investigate the cell phenotype for T cells in polyI: C induced primary biliary cirrhosis (PBC)animal model.Methods 20 female C57BI/6 mice,8 weeks old,were divided into model group and control group randomly. Mice in model group and control group were injected with polyI:C at a dose of 5 ms/ks and PBS,respectively.All mice were acrificed after 16 weeks after injection, and the sections of liver specimen were subjected to hematoxylin and eosin(H.E) staining.Serum AMA and ALP were detected.CD4+,CDs8+ and NKT cells in peripheral blood were determined by flow cytometry.The level of serum IL-4 and IFN-γ were assayed by EUSA.Results PBC mouse model was developed 16 weeks fter polyI: C injection. Infiltration of lymphocytes in portal area,positive serum AMA and high level of serum ALP were observed.The ratios of CD4+ T cells in model group and control group were(25.45±11.12)% and (26.72±0.63)%,respectively(t=0.314,P>0.05).The ratios of CDs+T cells in two groups were (18.3±0.91)% and (17.8±0.58)%,espectively(t=0.226,P>0.05).No significant change Was found for CD;and CDs+T cells in mice of both groups.However,NKT cells in peripheral blood of two groups were(11.56±5.09)% and (1.26±0.53)%,respectively(t=9.504,P<0.01).The number of NKT cells in model group was more than that of control group significantly.Simultaneously,serum L-4 and IFN·γ in mice of model group were also higher than that of control group.IL4 in senlm of two groups were (22.19±2.31)pg/ml and(8.72±0.87)pg/ml,respectively(t=58.06,P<0.01).IFN-γ in serum of two groups were(3.34±0.76)ng/ml and(1.14±0.21)ng/ml,respectively(t=23.31,P<0.01).Conclusions NKT cells increase greatly in eripheral blood of polyI:C induced PBC mouse model.NKT cells may play a critical role in the pathogenesis of PBC.

Objective:To predict and identify HLA-A * 0201 restricted CD8+ CTL epitopes in Mycobacterium tuberculosis (Mtb) antigen Ag85C, so as to provide evidence for epitope-based study for tuberculosis (TB) vaccine. Methods: The online database SYFPEITHI was applied to predict the potential HLA-A * 0201 restricted epitopes from Ag85C, an antigen of Mycobacterium tuberculosis. T2 cell line was used to assay the affinity between the predicted peptides and HLA-A * 0201 molecules. The specific CTL lines were induced from peripheral blood mononuclear cells (PBMCs) of HLA-A * 0201 positive TB patients and PPD+ healthy donors by peptides with high binding affinity to HLA-A * 0201 molecules. IFN-?production, in vitro proliferation and cytotoxicity of peptide-induced CTL were determined to screen HLA-A * 0201 restricted CD8+ CTL epitopes from those candidates. Results: Fourteen potential epitopes were identified from the SYFPEITHI database. After binding affinity assay, 3 of the 14 peptides (170-178 aa, 317-325 aa, and 144-153 aa) were found to have high binding affinity to HLA-A* 0201 molecules. However, only one peptide (144-153 aa) stimulated its specific CTL to release IFN-y, proliferate in vitro and produce specific cytotoxicity. Conclusion: We have successfully identified a HLA-A * 0201 restricted CD8+ CTL epitope of Mtb Ag85C-FLTREMPAWL( 144-153 aa) , which might be a candidate epitope for TB vaccine designing. Our findings provides a basis for developing novel and effective anti-TB vaccine.

0.05),but was correlated with ?-GT(r=-0.295,P

With the rapid advancement of minimally invasive new technology, laparoscopic surgery and robotic surgery are now regarded as the main direction in surgical treatment for stomach cancers. Recent evidence has confirmed the safety and feasibility of laparoscopic surgery for early gastric cancer and advanced gastric cancer. However, gastrointestinal surgeons should pay more attention to complications after laparoscopic gastrectomy because of rich blood supply, complex tissue layers and lymph node metastasis. Common complications related to laparoscopic surgery are associated with laparoscopic instruments and operating, intra-abdominal bleeding, anastomotic leakage, anastomotic bleeding, pancreatic leakage, duodenal stump leakage, lymphatic leakage and so on. This article mainly focuses on the causes, prevention and treatment of the complications after laparoscopic gastrectomy.
Anastomotic Leak ; Duodenal Diseases ; Female ; Gastrectomy ; adverse effects ; instrumentation ; methods ; Humans ; Laparoscopy ; adverse effects ; instrumentation ; methods ; Lymphatic Metastasis ; Male ; Postoperative Complications ; etiology ; prevention & control ; therapy ; Robotic Surgical Procedures ; adverse effects ; instrumentation ; methods ; Stomach Neoplasms ; complications ; surgery

Objective To discuss the cause of relapse after the first surgery of varicose veins of lower limb,and corresponding prevention and treatment methods.Methods The data of 81 cases of recurrence varicose veins of lower limb in Department of Vascular Surgery,Yanzhou First People's Hospital from September 2010 to October 2016 were analyzed retrospectively,all patients receded ascending phlebography for deep veins Postoperative follow-up of 6 to 48 months was followed by the combination of outpatient and telephone follow-up,with the symptoms,signs and blood vessels of the lower extremities as the follow-up.Results Remnant of the main trunk or tributaries of great saphenous vein in 19 cases,31 limbs of deep venous incompetent,incompetent perforator veins 25 limbs,the residual of small saphenous vein were 3 cases,crockett's syndrome 10 cases,sequelae of deep venous thrombosis belongs to the residual 5 limbs,Klippel-Trenaunay syndrome 1 limbs.There were some patients who suffered from 2 reasons or more than two reasons simultaneously.After surgery again,the cure vate was 100％ and no serious complications such as deep vein throm-bosis.During the follow-up,12 patients showed different degrees of subcutaneous stasis,oral drug observation,and later regression.Local subcutaneous hematoma was 5 cases,2 cases of pure syringe were treated with pressure after suction,3 routine local incision was removed to remove stitches,drainage change and delayed healing.Six patients showed the sensory impairment of skin numbness in the leg boot area,and oral related neurotrophic drugs improved within 1 to 6 months after surgery.The remaining patients recovered well after operation.Conclusions Various causes can lead to the varicose vein of lower limb,a varicose vein of lower limb is a common clinical symptoms of many different diseases.Preoperative comprehensive examination to clarify the cause,this will help to reduce the probability of recurrence of lower extremity varicose veins.

Objective To investigate the clinical value of high-resolution magnetic resonance imaging(HR-MRI)combined with nomogram model in predicting the risk factors of positive circumferential resection margin(CMR)in rectal cancer surgery.Methods A retrospective analysis was conducted on preoperative data from 107 rectal cancer patients who underwent surgery and were confirmed by pathology.SPSS 2 5.0 software was used for univariate statistical analysis of potential risk factors for positive CRM,and after independent risk factors were selected,multivariate logistic regression analysis was performed to classify the risk factor categories.R software(4.2.0 version)was used to establish the nomogram model,and a curve was drawn to evaluate the model.The receiver operating characteristic(ROC)curve was used to show specificity and sensitivity,the area under the curve(AUC)was used to evaluate discriminative ability,the calibration curve was used to evaluate calibration,the decision curve analysis(DCA)was used to evaluate clinical benefit,and the model was internally validated using the Bootstrap method.Results Tumor located in the lower rectum[P=0.01,odds ratio(OR)=8.71],maximum diameter of tumor perpendicular to the intestinal tube(≥18.86 mm±5.32 mm)(P=0.01,OR=1.24),extramural vascular invasion(EMVI)(P＜0.01,OR=0.03),and mesorectal lymph node metastasis(P=0.01,OR=0.15)were independent risk factors for positive CRM in rectal cancer.The nomogram model established based on these factors had a training set AUC of 0.921(sensitivity 0.83,specificity 0.93),a validation set AUC of 0.912(sensitivity 0.87,specificity 0.82),a Bootstrap internal validation corrected AUC of 0.92,and a consistency index(C-index)of 0.92,indicating good discriminative ability,calibration,and clinical benefit value.Conclusion HR-MRI combined with nomogram model predicted that tumor located in the lower rectum,maximum diameter of tumor perpendicular to the intestinal tube ≥(18.86±5.32)mm,EMVI,and mesorectal lymph node metastasis are closely related to positive CRM in rectal cancer.