The clinical data of 97 patients who underwent laparoscopic hepatectomy from July 2007 to November 2014 in the First Affiliated Hospital of Wenzhou Medical University was collected.Of the 97 patients,46 cases were diagnosed with hepatolithiasis,20 with primary liver cancer,26 with benign liver tumor,1 with liver abscess,and 4 with metastatic liver cancer.The surgical approaches included laparoscopic left hepatectomy (n =16),left lateral lobectomy (n =35),right hepatectomy (n =2),right posterior lobectomy (n =1),hepatic wedge resection (n =42),and left lateral lobectomy with segment Ⅶ resection (n =1),and 4 cases underwent multi-visceral resection.88 patients underwent laparoscopic hepatectomy and 9 patients were transferred to open hepatectomy.Postoperative complications included bile leakage (n =9),abdominal cavity infection (n =7),ascites (n =1),wound infection (n =1),pleural effusion (n =3) and pulmonary infection (n =1).There was no perioperative death.Taken together,laparoscopic hepatectomy is feasible and efficient for treating liver diseases and it has the advantages of minimal invasion and rapid recovery.

Objective To explore the clinical significance of the precision evaluation of computed tomography angiography and color Doppler image formation technology to the condition of the vascular system in the donor site.Methods From January,2014 to December,2014,CTA and color Doppler were used to examine conditions of the first dorsal metatarsal artery's courser and the size of original caliber in 25 patients with thumb or finger defected.Also the distance between skin and the first dorsal metatarsal artery.The accurate positions and adjacent relations of vessels in donor site were precisely marked and then the vessel original caliber was measured.Results All the first dorsal metatarsal arteries of 25 cases can be appeared clearly in CTA and color Doppler.Blood vessels line and filling results were completely consistent in intraoperative findings.The difference of the vessel original average caliber was statistically significant (P ＜ 0.05) (1.20 ± 0.25 mm,1.41 ± 0.15 mm and 1.3 ±0.2 mm in Doppler,CTA and operation,respectively) while the distance was not significant (P ＞ 0.05)(9.20 ±3.06 mm,10.32 ± 2.76 mm and 0.2 ± 2.6 mm in Doppler,CTA and operation,respectively) All the 25 transplanted toes were survived.Conclusion CTA combined color Doppler image formation technology in thumb or finger reconstruction can objectively reflect the real situation of the vessels in donor sites,and the structural characteristics and classification of anatomy for individualized,and has important clinical value in preoperative foot blood supply assessment.

Objective To observe the effect of combined treatment with rhTRAIL(recombinant human TNF-related apoptosis inducing ligand) and selective Cox-2 inhibitor Celecoxib on gallbladder carcinoma in vitro and to explore the possible mechanism of the effect. Methods Western blot analysis was used to detect the expression of c-FLIP and death receptors after treatment by Celecoxib. Apoptosis of gallbladder cell line SGC-996 after the combined treatment with Celecoxib and rhTRAIL was detected in three ways: (1) phase microscopy of the cells, (2) detection of effector caspase-3 and caspase-7 activity, and (3) determination of the proportion of apoptotic cells labeled by Annexin V-PI flow cytometric analysis using CELLQUEST software. Results Celecoxib down-regulated the expression of c-FLIPs and up-regulated the expression of DR5 in a dose- and time-dependent mode on cell line SGC-996. Apoptotic levels in the combined treatment group in cell line SGC-996 were significantly higher than those in the single drug treatment group and control group. Conclusion Celecoxib markedly sensitized rhTRAIL-induced apoptosis through the down-regulation of c-FLIPs and up-regulation of DR5 in gallbladder carcinoma cell line SGC-996.

Aim To establish an allogenetic mouse skin trans-plant model,in order to provide a research model for immunosup-pressive drugs. Methods Skins from the ears of C57BL/6 mice were transplanted to the back of BALB/c mice and skin isografts ( BALB/c mice to BALB/c mice) were used as control. Cyclos-porin A( CsA) was used as a model compound to test the imm-nosuppresive effect on allogenetic graft rejection. Following the transplation and CsA treatment, the graft rejection score and graft skin survival rate were quantified. Four and nine days after transplantation,serum IL-4,IL-12 and IFN-γ levels were meas-ured using ELISA kits. Twelve days after transplantation, mice were sacrificed. The weight of spleen and thymus was obtained, and CD4 + and CD8 + population of spleenic T cells were ana-lyzed using flow cytometer. Histological features were assessed by hematoxylin-eosin( HE) staining of formalin-fixed, paraffin-em-bedded graft skins. Results After transplantion, the graft rejec-tion score increased and graft skin survival rate decreased gradu-allly. Serum IL-12 and IFN-γ levels of allograft mice increased markedly. Compared with those of isograft mice, mice with skin allograft displayed a significant increase in the percentage of the CD8 + T cell subpopulation. Remarkable inflammation, such as edema, inflammatory cell infiltration were observed in allograft mice. Compared with saline treated mice, CsA significantly re-duced the graft rejection score and improved survival rate of skin grafts. And also, CsA treated mice had smaller spleen and thy-mus. Mice that received high doses of CsA had significantly less CD8 + T cells than those treated with saline. Moreover, allograft skins in mice that received CsA had less inflammation. Conclu-sions Allogenetic mouse skin transplantation exhibits acute graft rejection. CsA can inhibit the rejection in a dose dependent manner.

Objective To study the diagnosis and surgical treatment of Mirizzi syndrome (MS).Method The clinical data of patients with Mirizzi syndrome treated in our center from July 2001 to July 2011 were retrospectively studied and the diagnostic methods,operative strategies and outcomes of surgical treatment were analyzed.Results Mirizzi syndrome (MS) was identified in 56 out of 13800patients who received cholecystectomy (0.4％). MS was diagnosed preoperatively in 30 patients (53.6％).There were 29 patients with Mirizzi syndrome type Ⅰ,17 patients with type Ⅱ,9 patients with type Ⅲ,and 1 patient with type Ⅳ using the Csendes's classification.In two patients (3.6％) coincidental gallbladder carcinoma was detected.An initial laparoscopic approach was attempted in 33patients,and 16 were converted to open surgery.The remaining 23 patients underwent open operation.Surgical procedures included cholecystectomy,choledochotomy and T-tube insertion,simple closure and drainage (via T tube) of the biliary fistula,Roux-en-Y hepaticojejunostomy,radical resection of gallbladder and hepaticojejunostomy.Inadvertent bile duct injury occurred in 2 patients who had an initial laparoscopic approach for a preoperative undiagnosed MS. Postoperative morbidities included biliary leak (n =4) and residual common bile duct stone (n=2).All patients recovered completely and there was no hospital mortality.Conclusions Preoperative diagnosis of Mirizzi syndrome is still challenging despite the availability of multiple imaging modalities.Open surgery remains the standard of care,although laparoscopic treatment may be used in selected patients,especially for type Ⅰ Mirizzi syndrome.Patients with Mirizzi syndrome should be managed differently,basing on intraoperative findings and the type of Mirizzi syndrome.

Recently clinical MR contrast media consists mainly of gadolinium based small molecule complexes,such as Gd-dTPA,Gd dOTA,etc,but small molecule complexes are defective in the relaxation and early diagnosis.With the development of nanotechnology,molecular nanoprobes not only have the advantages of small particle size,good biocompatibility,enhanced penetration and retention (EPR) effect and long half-life,but also their relaxation rates are higher than that of common gadolinium contrast media.The application of current MR molecular probe,such as liposomes,dendrimers,mesoporous silica,polymer micelles,carbon nanotubes,nano-gold and paramagnetic nanoparticles were mainly introduced in this paper.

OBJECTIVETo analyze the impact of platelet count on the prognosis of stage II-III colorectal cancer receiving adjuvant chemotherapy.

METHODSClinical and follow-up data of 286 patients with stage II-III colorectal cancer receiving adjuvant FOLFOX chemotherapy from March 2003 to October 2011 were analyzed retrospectively. Associations of baseline blood platelet count before chemotherapy and nadir blood platelet count during chemotherapy with relapse and death after adjuvant chemotherapy were analyzed by ROC curve and the optimal cutoff was selected. The association of the blood platelet count and the prognosis was analyzed by Kaplan-Meier and Cox regression model.

RESULTSROC curve showed the baseline blood platelet count was associated with recurrence (AUC=0.588, P=0.034). The optimal cutoff affecting recurrence was 276×10(9)/L. Kaplan-Meier showed those with baseline platelet count >276×10(9)/L receiving adjuvant chemotherapy had worse disease free survival (DFS) than those with baseline platelet count ≤276×10(9)/L, whose 5-year disease free survival(DFS) was 66% and 80% respectively (P=0.013). Cox regression analysis revealed baseline platelet count >276×10(9)/L was an independent unfavorable factor for DFS of adjuvant chemotherapy in colorectal cancer (HR=1.865, 95% CI: 1.108-3.141, P=0.019).

CONCLUSIONColorectal cancer patients receiving adjuvant chemotherapy with baseline platelet count >276×10(9)/L have worse prognosis.

Antineoplastic Combined Chemotherapy Protocols ; Chemotherapy, Adjuvant ; Colonic Neoplasms ; Colorectal Neoplasms ; Disease-Free Survival ; Fluorouracil ; Humans ; Leucovorin ; Neoplasm Staging ; Organoplatinum Compounds ; Platelet Count ; Prognosis ; Recurrence ; Retrospective Studies