Objective To evaluate the effects of unilateral extralevator abdominal-perineal excision (ELAPE) surgery and the ELAPE surgery on the pelvic floor detected by finite element analysis. Methods Three kinds of finite element mod?el were developed:the intact model, ELAPE model and the unilateral ELAPE model. The maximal stress and stress distribu?tions of each model under the same pressure were analyzed and compared. Results In the unilateral ELAPE model, non-le?vator ani tissue’s maximal stress on the levator ani reserved side was lower than that in ELAPE model, and was similar to that in the intact model. Its maximal stress on the excised side was lower than that in ELAPE model, and which was higher than that of intact model. Its maximal stress on the reserved side was lower than that of on the excised side. Conclusion Compared to the ELAPE surgery, the unilateral ELAPE surgery is able to reduce the stress of non-levator ani tissue on both sides, especially on the levator ani reserved side.

Objective To investigate the selection of the types of anastomosis of bilioenterostomy and evaluate the therapeutic effects.Methods From 1990 to 2000,536 patients with obstructive jaundice underwent bilioenterostomy in our hospital.The patients included 279 cases(52%) of hilar strictures with hepatolithiasis,108 cases(20%) of end stage periampullary tumors,96 cases(17%) of proximal cholangiocarcinoma and 53 cases(12%) of congenital choledochus cyst.The types of anastomosis included extra or hilar hepatic bilioenterostomy in 302 cases(56%),intra hepatic duct anastomosis with different type of hepatectomy in 222 cases(42%),of which 44 cases(8%) were anastomosed by roud ligament approch,27 cases(5%) through gallbladder fossa.Results The short term and 1～9 years long term follow up indicated that the jaundice of different patients can be completed relieved by suitable type of bilioenterostomy.Conclusions The good therapeutic effects of bilioenterostomy come from the correct selection of the anastomosis methods.

Objective To explore the effects of different types of passive and active movements of foot and ankle on the venous return in the lower limb in order to provide evidence for prevention of venous stasis and deep- vein thrombosis(DVT)after joint replacement. Methods Peak and average velocities of the femoral vein were detected and measured by using color ultrasound Doppler on 30 limbs in 15 healthy volunteers under the circumstance of resting and different types of passive and active movements of foot and ankle. Results During the passive movements of the flexion and extension, inversion and eversion, and the circumduction of foot and ankle, the flexion and extension as well as the inversion and eversion only slightly increased the velocities of venous blood flow. The circumduction produced a higher increase in venous blood flow than the former two movements, increasing the peak velocity by 31.3％ and average velocity by 33.9％ . In the same 3 types of the active movements of foot and ankle, the active flexion and extension, inversion and eversion resulted in increases in peak velocity of 41.3％ and 32.9％ and in average velocity of 40.1％ and 32.4％ , respectively. The active circumduction of foot and ankle produced the strongest influence on the promotion of venous blood flow with the peak velocity increased by 69.3％ and average velocity by 69.1％ . Conclusion The active circumduction, flexion and extension, inversion and eversion, and the passive circumduction of foot and ankle can be utilized to prevent DVT after joint replacement. The active circumduction of foot and ankle is the optimal exercise to prevent DVT.

Heart Failure ; Humans ; MicroRNAs

Objective To evaluate the prognostic values of leukocyte count,hemoglobin,biochemical parameters,erythrocyte sedimentation rate and immunoglobulin on mortality in patients aged 80 years and over.Methods Totally 342 patients(aged 85.6±4.0 years)were followed up for (82.0±36.9) months,and the cause and time of death were recorded.Results During the period of follow up,198 patients suffered from death.Compared with the survival group (132 cases),the death group had older age [ (86.5±4.4)years vs.(84.5±3.2)years,t=-4.86,P＜0.01 ],higher white blood cell [ (6.2± 1.7) ＞ 109/L vs.(5.5±1.3) × 109/L,t=-3.93,P＜0.01 ],lower hemoglobin [(134.4±14.4)g/L vs.(140.0± 12.6)g/L,t= 3.65,P＜0.01 ],slightly faster erythrocyte sedimentation rate [ 11 mm/h(15 mm/h) vs.9 mm/h (10 mm/h),U=- 3.31,P＜0.01 ],lower immunoglobulin M [ (0.9±0.5)mg/L vs.(1.1±0.8)mg/L,t =2.55,P＜0.05 ],slightly higher urea nitrogen [ (7.5±2.6) mmol/L vs.(6.8±1.6) mmol/L,t=2.81,P＜0.01]and creatinine [(113.0±32.5) μmol/L vs.(100.5±15.8) μmol/L,t=-4.65,P＜0.01 ].Cox multivariate analysis revealed that older age (RR=1.083,95％CI:1.040 1.127,P＜0.01),white blood cell count (RR=1.134,95％CI:1.021-1.260,P＜0.05),creatinine (RR=1.011,95％CI=1.0021.020,P＜0.05),hemoglobin(RR=0.835,95％CI:0.714-0.975,P＜0.05)andimmunoglobulin M(RR=0.710,95％CI:0.521-0.966,P＜0.03),aorticaneurysm(RR=2.144,95％CI:1.163-3.951,P ＜ 0.05 ) were the independent risk factors for death.Conclusions Aging,increased WBC count,decreased hemoglobin and immunoglobulin M,elevated creatinine and aortic aneurysm are the independent risk factors for death,which are powerful parameters for the prognostic evaluation in the elderly aged 80 years and over.

AIM: To observe the effect of (IFN-?1b) on morphology and the expression of connective tissue growth factor (CTGF) in hepatic stellate cells (HSC). METHODS: HSC were cultured in vitro, and were treated with (IFN-?1b) and TGF-?_1. The changes of HSC on morphology were observed, and the expression of CTGF in HSC was assessed using reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Phenomenon of apoptosis were observed in HSC treated with IFN-?1b. The expression of CTGF in HSC was decreased after treatment with (IFN-?1b) in control and TGF-?1-triggered groups. CONCLUSION: (IFN-?1b) is able to induce the apoptosis and suppress the expression of CTGF in HSC.

Objective　To report the experience in diagnosis and treatment of inferior vena cava stenosis (IVCS) after orthotopic liver transplantation (OLT). Methods　The clnical data of 3 patients with IVCS out of 51 OLT patients were analysed retrospectively. Results　The incidence of IVCS after OLT was 5.8% (3/51) in our hospital. In the 3 cases, IVCS of the posteriorhepatic IVC segment occurred within the first postoperative month. IVCS was identified by color duplex ultrasonography and confirmed by angiography. Percutaenous transluminal angioplasty (PTA) or metallic stent replacement were used in the 3 cases resulting in restoration of normal venous flow and elimination of legs edema. The first patient died of cerebral hemorrhage 14 days after transplantation during anti-coagulative therapy. The other two recovered smoothly with good liver function, abdominal ultrasonography demonstrated patency of the IVC. The 2 cases were alive for 18 and 4 months respectively. Conclusions　The venacavographic balloon angioplasty and metallic stent replacement are safe and useful for post-OLT IVCS. The short-term result is excellent.

Objective To evaluate the diagnosis and treatment of early-stage hepatic artery thrombosis(HAT) after adult liver transplantation.Methods387 consecutive adult patients who underwent liver transplantation from June 2007 to October 2010 by the same surgery team in the Transplant Center,First Affiliated Hospital of Sun Yat-sen University were retrospectively studied.Hepatic arterial blood flow was monitored by color Doppler ultrasound (DUS) daily during the first week after transplantation.Ultrasonic contrast or hepatic artery angiography was performed on recipients with suspected HAT.Results10 patients developed HAT on 7(2-18)d after operation.The incidence of HAT was 2.6％ (10/387).Interventional therapy was performed in 2 patients with one patient who received a stent because of hepatic artery stricture.Three patients underwent emergent hepatic artery revascularization combined with intra-arterial urokinase thrombolysis treatment.One developed a rethrombosis and died.The remaining 2 patients received re-transplantation.Three patients died of liver failure and severe infection.The mortality rate was 40％ (10/387).ConclusionsIt is essential to diagnoses HAT by monitoring the artery flow by Doppler ultrasound screening in the early period after operation.Interventional therapy,emergent hepatic artery revascularization and re-transplantation are effective rescue treatments.Prevention of HAT is most important.

Objective To investigate the effects of ischemic preconditioning on the cholesterol content and the activity of Na+-K+-ATPase of hepatocytes following cold preservation in rats.Methods Twenty-five rats were randomly divided into five groups,including control group (C),cold preservation group (Ⅰ),ischemic preconditioning group (ⅠP),atorvastatin (30 μmol/L) treatment group (A30),and atorvastatin (100 μmol/L) treatment group (A100).The cholesterol content and the activity of Na+ -K+ -ATPase were assessed.Results The cholesterol contents on the rat liver tissue cell membrane in the C group,Ⅰ group,ⅠP group,A30 group and A100 group were (310.4 ± 27.5),(187.7±13.1),(394.3±25.9),(201.8±14.6) and (122.6±7.7) nmol/mg protein,and activity of the Na+ -K+ -ATP enzyme was (46.55 ± 3.20),(27.4 ± 2.81),(52.71 ± 3.02),(30.67 ±2.78) and (19.64 ± 2.11) μmol Pi/hr mg protein,respectively (P＜0.05).There was no significant difference in the plasma membrane phospholipid content among the five groups (P＞0.05).Conclusion Reduction of cholesterol content and Na+ K+ -ATPase activity on the liver cytoplasmic membrane is one of the factors causing donor liver cold preservation injury,but ischemic preconditioning can significantly improve cell membrane Na+ -K+ -ATPase activity and increase cytoplasmic membrane cholesterol content. Use of atorvastatin statins can reduce cytoplasmic membrane cholesterol synthesis,and significantly decrease Na+ -K+ -ATPase activity,thereby alleviating the donor liver cold preservation injury.

Objective To evaluate permissive hypocaloric intake in postoperative patients by a prospective, randomized, controlled trial. MethodsForty-two postoperative patients were randomly assigned to receive 117kJ?kg~ -1?d~ -1in control group, and 75kJ?kg~ -1?d~ -1in experimental group intravenously. Blood routine, liver and renal functions were measured one day before and day 1, 3, 5 post operation. Blood glucose level, insulin intervention, infectious complications, hospital stay, and relevant cost were also evaluated. ResultsHypocaloric intake in the experimental group post-operatively did not influence the hemoglobin level, liver function, and other indicators in the serum. The fasting blood glucose and glucose levels after infusion, as well as the volume of insulin intervention were significantly higher in the control group during 4 days of parenteral nutrition. Experimental group had lower relevant hospital cost, while two groups had similar duration of hospital stay. ConclusionPermissive hypocaloric intake shortly after surgery does not influence the patient nutritional status, besides it avoids to some extent the hyperglycemia, reduces the need for insulin intervention .