Objective To study the effect of antivirus therapy of HBV reinfection and YMDD mutation after liver transplantation. Methods Fifteen of 317 patients with HBV-related end-stage liver diseases received lamivudine ( LAM ) monothereapy, others received combination low-dose hepatitis B immune globulin( HBIG) and LAM (or adefovir dipivoxil, ADV) therapy, as prophylaxis against HBV reinfection after OLT. Hepatitis serum markers, HBsAg, HBeAg, HBcAb-IgM, and HBcAg were detected every 2 weeks by immunohistochemistry. Serum HBV DNA was examined by PCR every 2 weeks. HBsAg and HBcAg in the liver specimens were examined by immunohistochemistry. YMDD mutation was detected by PCR in those patients with recurrence of positive HBV DNA posttransplantation. Results In LAM monotherapy group, 4 developed HBV reinfection out of 15 patients with pretreatment positve HBV DNA. Sixteen of 302 patients with combination HBIG and LAM therapy suffered from posttransplant HBV reinfection, the difference between the two groups was significant (26.7% vs. 5. 30% ,P

Objective To investigate whether increased signal intensity (ISI) can help assess the prognosis in patients with cervical spondylotic myelopathy (CSM) by means of measuring the ratio of signal intensity. Methods A retrospective study with two or more years follow-up of 57 patients with CSM underwent posterior cervical decompression were carried out from February 2000 to February 2006. 1.5T MRI was performed in all patients before surgery. T2-weighted images (T2WI) of sagittal ISI on the cervical spinal cord were obtained, For those with ISI, the values of signal intensity of the spinal cord on T2-weighted image (T2Wl) and TI-weighted image (TIWI) of sagittal view were measured at the location where there was ISI on T2WI, and the ratio of signal intensity of T2WI / T1WI (T2/T1 ratio) at the same level of the spinal cord and with similar area was calculated on the computer. Patients with ISI were subdivided into 2 groups according to T2/T1 ratio. Results ISI was not observed in 20 patients (group 1). The range of T2/T1 ratio of other 37 patients was from 1.28 to 2.80 and the median was 1.65. Nineteen patients were divided into group 2 (ratio range, 1.28-1.63), and 18 into group 3 (ratio range, 1.67-2.80). Significant differences were noted in age at surgery, duration of disease, recovery rate, pre and preoperative JOA score among three different groups.Spearman's rank correlation showed that T2/T1 ratio was positively correlated with age at surgery and duration of disease, negatively with pre- and postoperative JOA score and recovery rate. Conclusion Patients with ISI and higher T2/T1 ratio tend to have relatively severe preoperative state of illness and poor prognosis after surgical intervention. Spinal cord signal intensity change on T2-weighted MRI might be a predictor of a poor outcome in terms of functional recovery rate in patients underwent operations for multi-level CSM.

The actual efficacy of acupuncture on cerebral infarction was explored in clinical practice. The retro spective cohort study was adopted to investigate 344 cases via inpatient's medical cases. According to whether acupuncture was received or not, an acupuncture group (207 cases) and a non-acupuncture group (137 cases) were divided. The matching method, regression method and weighting method of propensity score (PS) were adopted, and the efficacy on muscle strength was taken as effect index so that the specific impacts of acupuncture were ex plored on the muscle strength in the patients of cerebral infarction. Before matching, COX regression model and Logistic regression model were used. And PS hierarchical regression, PS inverse probability weighting method (IPTW) and PS standardized mortality weighting method (SMRW) were applied to the analysis on the relationship between the muscle strengthen changes and the total effective rate in the two groups. It was found that the efficacy in the acupuncture group was better than that in the non-acupuncture group, indicating the significant difference (P<0.05). Meanwhile, the rehabilitation therapy also brought the obvious impacts on the efficacy evaluation (OR=2.737, P=0.0055). After PS matching, the Logistic regression model was used to analyze whether acupuncture or rehabilitation therapy impacted the total effective rate of muscle strength. The results showed that the efficacy was impacted apparently with the rehabilitation therapy involved (OR=2.930, P=0.0247). Without the rehabilitation effect considered, the efficacy in the acupuncture group was better potentially than that in the non-acupuncture group, but without significant difference (OR=2. 235, P=0,058 7). All of these indicate that on the basis of routine treatment, without the effect of rehabilitation therapy considered, acupuncture improves in tenden cy of the muscle strength of the patients with cerebral infarction. However, it is expected to increase the study medical cases for further verification.
Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Cerebral Infarction ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Muscle Strength ; Propensity Score ; Retrospective Studies ; Treatment Outcome

Objective To investigate the risk factors associated with gastroparesis syndrome after laparoscopic pancreatoduodenectomy which provide reference for clinical prevention.Methods Ninety cases of laparoscopic pancreatoduodenectomy admitted from August 2013 to December 2016 in Traditional Chinese Medicine Hospital of Guangdong Province were studied retrospectively,57 were male(63.3%),the average age was 54.6 years old.Twenty cases were diagnosed postoparative gastroparesis syndrome(22.2%).To screen out the risk factors,31 independent variables were analyzed by univariate analysis and logistic regression.Results Univariate analysis showed that malnutrition,hypoproteinemia,anemia,pylorus-preserving,extensive lymph nodes dissection,anxiety,high blood sugar before operation,delay of enteral nutrition,abdominal infection and postoperative high blood sugar were associated with postoperative gastroparesis(The value of OR were 3.143,3.587,2.852,2.889,3.231,7.071,2.889,5.359,6.000,6.263,P<0.05).Multivariate Logistic regression analysis showed that extensive lymph nodes dissection,anxiety,pylorus-preserving,abdominal infection,delay of enteral nutrition,hypoproteinemia,postoperative high blood sugar were risk factors of postoperative gastroparesis(The value of OR were 17.574,8.931,6.637,6.461,6.446,5.414,5.200;P<0.05).Conclusion Multiple risk factors can lead to gastroparesis after laparoscopic pancreatoduodenectomy,measures should be taken aimed at these risk factors during perioperative period.

ObjectiveTo compare orthotopic liver transplantation (OLT)and combined liverkidney transplantation (CLKT) in the treatment of severe hepatitis B.MethodsIn this study 52 patients of severe hepatitis B were allocated to OLT (40 cases) or CLKT( 12 cases) at our department from Jan.2001 to Sep.2005.The perioperative complications and the result of follow-up were analyzed.ResultsThe preoperative renal functions in CLKT cases were severer than that in OLT cases.Postoperative severe infection was more common in CLKT cases than that in OLT cases.In OLT group 28 patients (70％)suffered from early posttransplant renal dysfunction,among them 11 patients needed dialysis,whilst there were 2 (16.7％ ) patients who needed dialysis in CLKT group (P ＜0.01 ).The posttransplant mortality in OLT group was 40％ ( n =16),significantly higher than that in CLKT ( 16.7％,n =2) ( P ＜ 0.01 ).In OLT group,9 cases developed severe renal failure and died.No one died of renal failure in CLKT group.ConclusionsThe prognosis is more favorable to perform CLKT in patients who suffered from severe hepatitis B with chronic renal dysfunction before transplantation.

Objective To summarize the experience of rapid liver and kidney graft harvesting. Methods From Jan 2001 to Sep 2003,a quick procedure for combined liver and kidney procurement were used in 138 cases. The procedure includes in situ perfusion through aorta and superior mesenteric vein(SMV) plus drainage through inferior vena cava. Liver,pancreas,spleen and kidney were harvested en bloc. Results The warm ischemia time averaged at 2 to 6 minutes for kidneys and 3 to 8 minutes for livers. The total procurement time averaged at 20 to 30 minutes. All aberrant arteries were preserved. After transplantation there was no primary non-function in all 131 liver grafts,and the peak sALT level during the first 3 post-operative days was (581?392) U/L. Acute tubular necrosis rate was 3.3%(9/274) in renal grafts. Conclusion[WT5”BZ] This rapid procurement protects the quality of liver and kidney simultaneously. It is a simple,effective,safe and reasonably standardized procedure.

Objective To summarize the clinical technique and experience of one stage combination of renopancreatic transplantation(SKPT) with portal venous drinage of pancreatic endocrine and enteric drainage of exocrine(PE).Methods Five patients with insulin-dependent diabetes mellitus and end-stage renal disease underwent SKPT with PE drainage.The clinical data,operative techbuque,and the prevention of non-technical complications were summarized.Results This procedure was successfully applied in the 5 patients.Three patients recovered excellently;but 2 died perioperatively,one died of sepsis due to pancreatic leakage,and one of FK506 toxicity.On postoperative day 3,in the 3 survivors,blood creatinine and urea nitrogen levels returned to normal;insulin administration was discontinued on 7d postoperatively,and the endogenous and exogenous secretory functions of the graft were normal.Conclusions SKPT with PE is a resonable procedure,because of its potential physiologic,metabolic,and immunologic advantages.PE drainage may become the prefer technique of pancreas transplantation.Intensive perioperative managements are effective methods to prevent complications and to improve the therapeutic effects.

OBJECTIVETo summarize the therapeutic effect of 5 kinds of flaps for the treatment of skin and soft tissue defect in the hallex.

METHODSFrom Jan. 2008 to Jun. 2013, 24 cases with skin and soft tissue defects in the hallex were treated with 5 kinds of reversed flaps, including medial foot dorsal neurocutaneous flaps, medial foot neurocutaneous flaps, lateral tarsal flaps, anterior malleous flaps, medial cross leg and saphenous nerve flaps. The defects size ranged from 3 cm x 2 cm to 5 cm x 3 cm, with the flap size from 3. 5 cm x 2. 5 cm to 5. 5 cm x 4. 0 cm.

RESULTSPartial superficial necroisis happened at the distal end of one foot dorsal medial neurocutaneous flap. One third flap necrosis occurred in 1 foot medial neurocutaneous flap due to too tight suture at flap pedicle and resulted thrombosis. All the other 23 flaps survived completely. 15 cases were followed up for 3-36 months with normal walking function and satisfactory appearance. Among the 8 cases with nerve anastomosis, 4 cases were followed up with 2-point discrimination distance of 8-11 mm. the flaps without nerve anastomosis also had protective sense due to nerve ingrowth.

CONCLUSIONSSkin and soft tissue defects in the hallex can be treated with different appropriate flaps. The hallex length can be reserved with satisfactory function and appearance.

Foot Injuries ; surgery ; Graft Survival ; Hallux ; injuries ; surgery ; Humans ; Necrosis ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; pathology ; transplantation

Objective To evaluate the efficacy and safety of ureteral stenting after transurethral resection ( TUR) of bladder tumors involving the ureteral orifice.Methods From March 2009 to November 2015,34 cases of non-muscle invasive bladder tumor including 28 male and 6 female aged from 26 to 79 years( mean 51 years) were treated by TUR.14 cases had single tumor and 20 had multiple tumors,and 29 were primary and 5 were recurrent.All the patients had tumors involving the ureteral orifice without preoperative hydronephrosis revealed by IVU or CTU examination.The tumors were resected into the deep muscle layer and the involved ureteral orifices were resected during the procedure,and after that a double-J ureteral stent was placed in 18 cases.All patients received one immediate intravesical instillation of 50mg epirubicin after TUR, and further scheme of adjuvant intravesical chemotherapy instillations were made according to the pathological diagnosis.Ureteral stents were removed 10-12 weeks after TUR,and cystoscopy and urinary tract ultrasound examinations were performed every 3 months for 1-2 years postoperatively. Results The operations were successful without complications.No serious adverse reaction occurred in immediate and further adjuvant intravesical chemotherapy.During the follow-up period of 3-71 months, no ureteral stricture, hydronephrosis or tumor recurrence in the upper urinary tract occurred in all the 18 patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine.Hydronephrosis was observed in 3 of 16 patients without ureteral stent including 2 cases of nontumoral stenosis at the ureterovesical junction requiring ureteral reimplantation and 1 case of lower ureteral tumor on the involved side requiring nephroureterectomy and bladder cuff excision.No patient complained of symptoms secondary to vesicoureteral reflux or continuous unrelievable lower urinary tract symptoms.2 cases of bladder tumor recurred out of the resected area.Conclusions Ureteral stenting after TUR of bladder tumors involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract.The existence of a double-J ureteral stent does not increase complications of adjuvant intravesical chemotherapy, and also won't cause intolerable lower urinary tract symptoms.

Objective:To investigate the methods and complications of ultrasound-guided percutaneous nephrostomy (PCN) for treat-ing cancer-related hydronephrosis. Methods:From June 2003 to December 2015, 289 patients (342 kidneys) with cancer-related hy-dronephrosis were treated by ultrasound-guided PCN in Fujian Provincial Hospital. Among the 97 cases of renal insufficiency, 4 pa-tients were treated with hemodialysis before PCN. Except for the anterior mid calyx of nine kidneys in nine patients, the posterior mid or lower pole calyx of all other kidneys was punctured with ultrasound guidance. With the one-step PCN technique, 8F pigtail nephros-tomy tubes were placed into six kidneys in six patients;with the Seldinger PCN technique, 14F balloon and Malecot catheters were placed into 25 kidneys in 25 patients and 311 kidneys in 258 patients, respectively. Results:No severe bleeding and injury in the intes-tine, liver, spleen, pleura, or lung occurred. Two pigtail tubes were blocked one week after PCN. Seven balloon catheters failed to drain well because of the tip and balloon of the catheters located in the proximal part of the dilated ureters. Four balloons slipped out of the collection system of the kidney because of the auto-deflation of three balloons and one case of meager renal parenchyma failing to hold the balloon after a severe hydronephrosis was emptied. All, except 1, Malecot catheter drained well, and 8/9 PCNs through anteri-or mid calyx were successful. Serum creatinine levels were significantly decreased in all the 97 patients with renal insufficiency, of which 81 cases returned to normal, and no one needed persistent hemodialysis. Conclusion:Ultrasound-guided PCN is safe and effec-tive for treating cancer-related hydronephrosis. For appropriately selected patients, puncturing the anterior mid calyx may be an op-tion without additional complications. One-step pigtail nephrostomy tubes are recommended for patients with poor systemic condi-tions. For patients with long life expectancy or suspected complicated urinary infection, large sized Malecot catheters should be consid-ered.