Prevention and surgical treatment of parastomal hernia remain a major challenge to surgeons.The effects of traditional non-operative and surgical treatment would likely be few, but the application of surgical technique which places a prophylactic mesh at the primary operation is bringing down the incidence of parastomal hernia in recent years.Due to a high recurrence rate of parastomal hernia after traditional in or ex situ tissues repair, the short-term outcomes of surgical treatment for parastomal hernia have significantly been improved by using prosthetic mesh, while the long-term outcomes are uncertain and needed for further investigation.

Repair for traumatic abdominal wall defect (TAWD) is a complex subject to be investigated.No consensus in the management of the subject has currently been reached,and the individualized treatment is performed based on TAWD.There are four kinds of type in repair of TAWD according to characteristics of the defect:(1) repair of traumatic full abdominal wall defect,(2) immediate repair of traumatic abdominal wall myofascial defect,(3) delayed repair of TAWD,(4) management of abdominal open following traumatic abdominal compartment syndrome.The concept and practice of treatment for TAWD will be gradually improved and perfect with development of new techniques and materials.

Donation after cardiac death (DCD) means organ harvest and donation cannot be carried on until the requirement of death criteria using cardiopulmonary arrest is reached.Great success has been achieved since DCD was promoted widely in China.However,some problems were encountered during the implementation of DCD and there also exists many ethical controversies.The ethical principles of informed consent and no harm mentioned inDonation after Cardiac Death Work Instructions of China should be strictly adhered to,while justice,fairness and openness must be ensured in organ allocation.Appropriate compensation should be given to DCD donor and his family,and the utilization of DCD should be further improved.All of these ethical principles will help to promote the healthy development of organ donation and transplantation in China.

Gastroesophageal variceal bleeding is one of the major causes of death for patients with portal hypertension.The treatment of portal hypertension has evolved from surgery being the only option to the wide range of options currently available,including endoscopic sclerotherapy of varietals ligation,interventional radiology and surgery.Given the shortage of liver transplantation donors,devascularization would be one of the major treatments for portal hypertension for a considerable time.Based on the clinical experience of the People's Hospital of Peking University,we think that peraesophagogastric devascularization without splenectomy is a better option for the treatment of portal hypertension,with less operation time,less intraoperative blood loss and fewer postoperative complications,and better short-and long-term hemostatic effect.

AIM:To study chromosome aberration due to ethidium bromide (EB), a heterocyclic organic compound and an organic fluorescence dye commonly used in biochemical experiment, and to help further understanding the molecular mechanism of tumor or cancer induced by EB and other heterocyclic organic compounds. METHODS: The toxicity action of EB was evaluated from three aspects including DNA, chromosome and embryo stem cells (ESCs) using atomic force microscopy (AFM), and thereinto, the morphology structural difference of ESCs treated with two EB doses was also valuated. RESULTS: The morphological structures of DNA, chromosome and ESCs were dramatically damaged. The average height of DNA decreased 0.5 nm; chromosomal arms were ruptured from centromere location; molecules of cellular membrane congregated and loop-like structure formed, and ES cell masses were collapsed and became dead after large EB doses treatment and mesh-like morphological structure was discernable. CONCLUSION: The toxicity action of EB is strong and destroys the surface structure of DNA and chromosome. EB induces structural aberration of ES cellular membrane and cell death. The results indicate that the action of EB is externalized at gene level and cell level, which is important to study the carcinogenicity of EB.

The early diagnosis of cholangiocarcinoma is difficult, and the prognosis is poor. The molecular mechanisms underlying the development, growth and metastatic spread of biliary tract cancers are still unclear. The increase in worldwide incidence and mortality of cholangiocarcinoma justifies the impellent need to clarify the intracellular mechanisms triggering the malignant transformation of the biliary epithelium and growth of biliary malignancies. A more complete characterization of the molecular pathology of bile duct cancers could lead to the identification of valid targets for diagnosis and therapy of these devastating malignancies. This review describes the scientific progress made over the past years with regard to the understanding of the molecular processes of cholangiocarcinogenesis.

Objective To summarize the experience in the management of incarcerated umbilical hernia in cirrhotic patients with aseites. Methods The operative methods, perioperative management and fellow-up data of 15 patients diagnosed incarcerated umbilical hernia in the setting of cirrhosis and ascites were studied retrospectively. All the patients underwent emergency operation to remove necrotic umbilical skin and hernial content, including incarcerated greater omentum (6 cases) and strangulated segment of small bowel (5 cases). After debriding the operating field thoroughly, the umbilical hernia was repaired with polypropylene mesh, among those Sublay repair was used in 11 cases with the longest diameter of hernial ring more than 3 cm and Onlay repair in 4 cases with the longest diameter of hernial ring less than 3 cm. During the perioperative period, albumin and fresh frozen plasma transfusion, as well as diuresis and ascites paracentesis, was adopted to treat eirrhosis and ascites. Results All the patients underwent operation successfully. The operative time was 90～185 min, averaging at 122 min. Seroma formation in 2 cases and incision infection in one were cured with conservative therapy. One patient died of multiple organ dysfunction after the operation. During the fellow-up of 1～5 years, 1 patient died of liver function failure and there was no hernia recurrence. Conclusion With appropriate perioperative management and correct operative method, polypropylene mesh could be adopted in the emergency repair operation of incarerated umbilical hernia in the setting of cirrhosis and ascites.

Pancreatic neuroendocrine tumor (pNET)is a rare type of pancreatic tumors.The incidence of pNET shows a gradually increas-ing trend in recent years.The most common organ of distant metastases is the liver.Surgical resection is still the optimal treatment for resect-able,well -differentiated liver metastases with no evidence of extrahepatic spread.For unresectable patients,a combination of multiple mo-dalities,such as transarterial chemoembolization,radiofrequency ablation,systemic chemotherapy,and molecular targeted therapy,can pro-long the survival time of patients.Liver transplantation should be strictly evaluated on an individual basis.

Objective:To prove the feasibility and validity ofXing Nao Jing acupoint-injection (XNJ-AI) at Fengchi (GB 20) for pseudobulbar palsy caused by ischemic stroke (PBP-IS).
Methods:An assessor-blinded, two-parallel-group, randomized controlled trial was conducted, and the patients with PBP-IS were recruited and randomly divided into two groups. Patients in the control group received oral aspirin (100 mg per day for 2 weeks). In addition to oral aspirin; patients in the treatment group received XNJ-AI at Fengchi (GB 20), once a day, for two weeks. The primary outcome was assessed by the water-swallowing test (WST). Thromboxane B2 (TXB2) and 6-keto-prostaglandin F1a (6-keto-PGF1a) in plasma were measured before and after the treatment.
Results:In the treatment group, the percentage of swallowing function no less than grade 3 before and after the treatment was 32% and 88%, respectively; in the control group, it was 28% and 76% before and after the treatment, respectively; the difference after the treatment between the two groups was statistically significant (P<0.05). There were statistical differences between pre- and post-treatment levels of plasma TXB2and 6-keto-PGF1αin the two groups (bothP<0.05). After the treatment, there were significant differences in the levels of plasma TXB2 and 6-keto-PGF1α between the two groups (bothP<0.05).
Conclusion:XNJ-AI at Fengchi (GB 20) can improve the patients’ swallowing function and balance the levels of TXB2 and 6-keto-PGF1α in plasma.

Multidrug resistance-associated protein 1 (MRP1/ABCC1) is the first identified member of ABCC subfamily which belongs to ATP-binding cassette (ABC) transporter superfamily.It is ubiquitously expressed in almost all human tissues and transports a wide spectrum of substrates including drugs,heavy metal anions,toxicants,and conjugates of glutathione,glucuronide and sulfate.With the advance of sequence technology,many MRP1/ABCC1 polymorphisms have been identified.Accumulating evidences show that some polymorphisms are significantly associated with drug resistance and disease susceptibility.In vitro reconstitution studies have also unveiled the mechanism for some polymorphisms.In this review,we present recent advances in understanding the role and mechanism of MRP1/ABCC1 polymorphisms in drug resistance,toxicity,disease susceptibility and severity,prognosis prediction,and methods to select and predict functional polymorphisms.