Objective To investigate the anatomic characteristics of hepatopancreatic artery(HPA) by DSA and its significance in preventing pancreatic complications after transcatheter arterial chemoembolization(TACE) in patients with hepatocellular carcinoma.Methods 1 000 cases of hepatic arteriograms have been retrospectively reviewed. The aberrant pancreatic arteries that originate from proper hepatic artery(PHA) and all distal intrahepatic branches to PHA were called hepatopancreatic arteries. The incidence of HPA has been summed up and its anatomic characteristics such as origine, course, branches and distribution have been described. Results Of 1000 cases, HPA were found in 16 cases(1.6%). There were 2 branches of HPA in one case and there was only one branch of HPA in other 15 cases. Altogether 17 branches of HPA were found; of which, 7 branches originated from PHA(41.2%,7/17), 6 branches arose from right hepatic artery(RHA)(35.3%,6/17) and 4 branches came from left hepatic artery(LHA)(23.5%,4/17). Conclusions HPA is a kind of rare variations of pancreatic artery. The importance to avoid embolizing HPA during TACE is preventing pancreatic complications.

Objective To study the anatomic characteristics of hepatogastric artery(HGA) and its significance in preventing gastrointestinal complications in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization(TACE).Methods 1000 cases of hepatic arteriograms were retrospectively reviewed,the aberrant gastrointestinal arteries that originate from proper hepatic artery(PHA)and distal intrahepatic arteries to PHA were named HGA.The frequency,origine,course and distribution of all of HGAs were carefully analyzed.The trial group consists of 34 cases(42 times of TACE)who had HGA and controlled group consists 32 cases(56 times of TACE)who had no HGA.The incidence of gastrointestinal complications after TACE between two groups were compared.Within trial group,superselective catheterization was made and had the tip of catheter away from orifice of the HGA before infusion of embolic agents(Lipiodol)during TACE in 18 times,which was called relative safety group;whereas,the tip of catheter was not laid distal to orifice of HGA when infused Lipiodol through catheter in 24 times,which was called dangerous group.The incidence of complications between this two groups was also compared.Results Of 1000 cases of hepatic arteriography,HGA was found in 740 cases (74%).The incidence of gastrointestinal complication and its grave degree in trial group were more excessive than that in controlled group((?=0.004),similarly,the frequency of gastrointestinal complication and its graveness in dangerous group exceeded significantly that in relative safety group((?=0.000).Conclusion HGA is common vascular variation.That embolic agents (Lipiodol)was perfused carelessly into HGA may induced occurrence of gastrointestinal complications in patients after TACE,and having the tip of catheter away from the orifice of HGA by superselective catheterization during TACE could efficiently prevent happening of this kind of complications after operation.

Objective To study the characteristics of hepatogastric artery (HGA) with DSA and its clinical significance in transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma. Methods One thousand cases of hepatic DSA arteriograms had been retrospectively reviewed. The aberrant gastrointestinal arteries that originated from proper hepatic artery (PHA) or distal intrahepatic arteries to PHA were named HGA. Furthermore, according to their different courses and distributions, HGAs were subdivided into right gastric artery (RGA), aberrant left gastric artery (AbLGA), aberrant gastroduodenal artery (AbGDA), aberrant right gastroepiploic artery (AbRGEA), superior duodenal artery (SDA) and other difficult-to-named HGA. The incidence of each of them had been summed up and their anatomic characteristics such as origin, course, branches, and distribution had been described. Results Of the 1000 cases, at least one branch of HGA was found in 740 cases (74%), and altogether there were 839 branches of HGA in them. The composition of 839 branches of HGA was as follows: 682 branches of RGA (81.29%, 682/839), 84 branches of AbLGA (10.01%, 84/839), 45 branches of SDA (5.36%, 45/839), 21 branches of AbGDA (2.50%, 21/839), 1 branch of AbRGEA (0.12%, 1/839) and 6 branches of difficult-to-named HGA (0.72%, 6/839). Of the 839 branches of HGA, 412 branches originated from PHA (49.11%, 412/839), 314 branches from left hepatic artery (LHA)(37.43%, 314/839), 98 branches from right hepatic artery (RHA)(11.68%, 98/839), and 15 branches from middle hepatic artery (MHA)(1.79%, 15/839). Conclusion HGA is a common gastrointestinal arterial variation and it is very important to be familiar with it so as to prevent the gastrointestinal complications after TACE in patients with hepatocellular carcinoma.

Objective To analyze the influence factors of complications in CT-guided percutaneous pulmonary biopsy,and to explore the optimal methods of operation.Methods Totally 410 patients who underwent CT-guided percutaneous pulmonary biopsy were retrospectively analyzed,and the complications of biopsy were observed.Results Pulmo-related complications occurred in 54 patients (54/410,13.17%) ,including pneumothorax in 18 patients (18/410,4.39%) ,1 of them had pneumothorax and pulmonary bleeding around the needles in 35 patients (35/410,8.54%) ,15 of which with haemoptysis (15/410,3.66%) ,and 1 patient had acute pleura reaction.No severe complications such as infection.excessive bleeding,hemothorax,aeroembolism,needle track implantation metastasis occurred.Conclusion Accurate and skillful CT-guiding techniques and appropriate operation methods are important to improve the success rate and to reduce complications of CT-guided percutaneous pulmonary biopsy.

Objective To analyze the risk factors for perioperative acute cerebral vascular accident (PACVA) and put forward the corresponding preventive measures.Methods The clinical data of elderly patients in our hospital who suffered from PACVA in recent 5 years were retrospectively studied.The correlation between risk factors and the occurrence of PACVA was analyzed.Results One hundred and fifty cases were enrolled in the study.Seventy eight cases of them suffered from PACVA with the average age of 70 years ranging from 60 to 98 years.Fifty six cases(71.8%)were found PACVA in one week after operation.Multiple regression analysis showed that hypertension, history of cerebrovascular disease, unstable blood pressure and obesity were independent risk factors for PACVA.The newly diagnosed perioperative atrial fibrillation and carotid atheroselerosis were the high risk factors for PACVA.Conclusions PACVA is one of the common perioperative complications.Necessary check, monitor and treat measures should be taken in the perioperative period, especially for patients with risk factors.

Objective To investigate the role of oridonin in preventing skin graft rejection.Methods BALB/c mice were transplanted with skin grafts from C57BL/6 mice.Grafted mice were treated daily with oridonin,CsA and PBS,respectively.The survival of grafts was inspected daily and evaluated by histological analysis.On day 7 after transplantation,the percentage of CD4+ CD25+ Foxp3+ cells (Treg) in the spleen was determined by flow cytometry.The effect of oridonin on MLR and apoptosis was examined in vitro.Naive BALB/c mice were intraperitonealy injected with oridonin (15 mg/kg/day).At different time points,the number of T cells and macrophages in peripheral blood mononuclear cells (PBMCs) as well as the spleen was examined.Results The survival of skin grafts in the oridonin group (15.8 ± 1.5 days) was significantly longer than that in the control group (12.3 ± 1.2 days) and the CsA group (13.3 ± 1.1 days).Oridonin reduced inflammatory cell infiltration in grafts.The expression of Tregs was higher in the oridonin group (17.6 ± 3.6％) than in the control group (14.8 ± 2.3％).In vitro oridonin inhibited MLR and induced apoptosis in a dose-dependent manner.The number of T cells in PBMCs was rapidly decreased following oridonin treatment.With the depletion of T cells in PBMCs,high frequency of granulocytes was observed.On day 8,the number of T cells in the spleen was decreased,which was accompanied by increased phagocyte number.Conclusion Oridonin could suppress allograft rejection and prolong survival of skin grafts.The mechanism may be attributed to upregulation of Tregs and clearance of T cells.

Objective To evaluate the effectiveness of transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) and TACE combined with 125I interstitial brachytherapy in the treatment of primary hepatocellular carcinoma(HCC) and to compare the results of the two therapies.Methods Fifty patients with HCC underwent TACE and RFA during laparotomy and 34 patients received TACE and radioactive 125I particle seeding.Four weeks after the procedure,dynamic enhanced CT or MR scanning was performed for a check.If the lipiodol deposit was poor,TACE was repeated.Follow-up check was made at regular intervals to observe the results.Results One month after the treatment,the local control rate of the tumor for TACE +RFA and TACE + 125I particle seeding combination therapy was 98.0% and 97.1%,respectively.No statistically significant difference existed between the two therapies.Conclusions Both TACE combined with RFA or with 125I particle seeding are effective therapies for HCC,which can be regarded as an ideal alternative therapy for patients who have failed to respond to TACE alone.

Objective Clinicians are very cautious on operationsof laparoscopic cholecystectomy(LC) in patients with cirrhosis because of its high risk.And few researches were carried out on this situation.This article aimed to summarize the LC in cirrhotic patients with cholecystolithiasis and cholecystitis, observe the clinical therapeutic effect and analyze the feasibility of this treatment.Methods The clinical data of 112 operation cases of cholecystolithiasis and cholecystitiswith cirrhosis were retrospectively analyzed from January 2012 to December 2015 in Department of General Surgery, Changzhou Third People's Hospital.According to different surgical methods, all patients were divided into laparoscopic cholecystectomy group (n=56) and open cholecystectomy group (n=56).Peroperative period indicators including operation time, intraoperative blood loss, Postoperative exhaust time, postoperative hospital stay and complications were recorded, data were analyzed to evaluate the clinical effect.Results Compared with open cholecystectomy group, laparoscopic cholecystectomy group had shorter operative time[(54.28±15.34)min vs (91.63±20.09)min,P=0.000];less intraoperative blood loss[(73.42±4.28)mL vs (98.54±7.16)mL,P=0.000], shorter Postoperative exhaust time and postoperative hospital stay(P=0.000).The complication incidence in laparoscopic cholecystectomy group were lower than that in open cholecystectomy group(7.14% vs 21.43%, P<0.05).Conclusion Operation of laparoscopic cholecystectomy on cirrhotic patients has a high clinical efficacy.It is safe and feasible to carry out such an operation on the basis of strict indication and reasonable risk assessment.

Objective To summarize the experience during early stage of postoperative monitoring and treatment for the patients follwing lung transplantation in surgical intensive care unit,and to improve the patient's outcome of lung transplantation.Methods A retrospective analysis of 9 cases of orthotopic lung transplantation admitted to surgical intensive care unit (SICU) of Beijing Anzhen Hospital from May 2005 to May 2011 was made.Results There 5 male patients and 4 female patients with the age 21 -67 (46.1 ± 14.1 ) years old in present group,and among them 6 patients survived (survival rate:66.7％ ).The etiological indication of admission were idiopathic pulmonary fibrosis (n =4),pulmonary lymphangioleiomyomatosis ( n =3 ),and bronehiectasis ( n =2).Bilateral sequential lung transplantation ( n =5 ),single left lung transplantation ( n =1 ) and single rigbt lung transplantation ( n =3) were performed.The postoperative duration of mechanical ventilation,stay duration in SICU and in hospital were 2 -32 d,3 -42 d,and 3 -60 d respeetively.Postoperative complication taking place after surgery were acute rejection in 2 cases and pneumonia 4 cases (3 cases were treated with extracorporeal membrane oxygenator).Postoperative in hospital death was 3 cases of 9 resulting from severe intection (n =2) and cireulation failure ( n =1 ).Conclusion Well-planned postoperative management stroategy in SICU plays an important role in outcome control after lung transplantation,including monitor and respiratory and cardiacvascular management,reasonable implementation of vasoactive medications and diuretics,protective mechanical ventilation strategy,reducing the time of ventilation.

Purpose To construct expression vector of Fas extracellular region gene(eFas) ,to express and purify recombination protein and to prepare polyclonal antibody, which have laid a foundation of studying its function. Methods The eFas gene encoding sequence was acquired through overlapping PCR, and pET-22b ( + )/eFas expression vector was constructed. Then this vector was transformed into E. coli Rosetta-gami. Re-combinant protein was expression being induced by IPTG,and was purified using Ni-NTA matrix of affinity chromatograph. The purity of recombination protein was identified by SDS-PAGE. Hereafter, the purified eFas recombinant protein was immunized to New Zealand white rabbit in order to prepare polyclonal antibody. The titer of polyclonal antibody was determined by ELISA. Results The encoding sequence and expression vector of eFas was obtained while the interest protein was mainly expressed in the inclusion body. The eFas fusion protein's expression quantity accounts for more than 30% proportion of total E. coli protein. The eFas protein we obtained was provided with the purity of at least 95 % . Conclusion The successful constrution, expression and purification of FasL fusion protein and preparation of polyclonal antibody will provide some material for further studies of Fas.