Objective To introduce a new appointment registration way in the outpatient department.Methods A WeChat appointment registration platform based on HIS was established with smart phone and WeChat public platform,which was gifted with the functions of online registration and payment and etc.The processes including preliminary diagnosis and return visit,cancelling appointment,treatment of appointment breaking,and the limitations during the appointment could be accomplished by the appointment registration.Results The platform realized appointment registration,information feedback and etc.Conclusion The appointment registration based on WeChat public platform contributes to satisfying the patient,enhancing medical service and distributing medical resources rationally.

Objective To summary the experience of living donor liver transplantation (LDLT) in order to improve therapeutic effect of LDLT. Methods We retrospectively analyzed the clinical data of donors and recipients of 22 LDLT cases, evaluating patients' and donors' preoperative assessment, surgical strategies and postoperative complications. Results Donor's grafts harvested included 2 left lateral lobes, 6 left half livers, 1 extended left half liver, 5 right half livers and 8 extended right half livers. Postoperatively all donors recovered without severe post-transplantation complications. Among 13 adult and 9 child receipients, there were 8 recipients suffering from posttransplantation complications, including intra-abdominal severe infection in one case, delayed liver function recovery complicating incisional infection in one case, intra-abdominal hemorrage complicating thrombogenesis of the hepatic artery in one case. All these 3 patients died. One child recipient of hepatic failure died of heart and respiratory failure after operation. Other non-lethal complications were bile leakage in 2 cases, refractory ascites in one and deep venous thrombosis of the lower limb in one. These complications were cured without laparotomy. Finally 18 recipients were fully recovered and discharged. Late post-operative complications included strictures of biliary tract in 3 cases which were treated with PTCD and indwelling stent, the obstructive jaundice due to achalasia of sphincter of Oddi was treated with endoscopic sphincterotomy. These 4 patients' are on stable condition and the liver function is normal. Conclusions Select proper donor and optimal surgical strategy are extremely helpful to secure donors and recipients during the procedure of LDLT.

Objective:To discuss the result of treating valgus or varus knee deformity with fixator assist nailing (FAN)technique and distal femur osteotomy(DFO).Methods:In this retrospective study,14 patients with 17 limbs,12 valgus and 5 varus knee deformity were treated with DFO and FAN.The aver-age age of the patients was 23 (17-44)years .The unilateral external fixator was mounted on the lateral side of femur,the minimal invasive distal femoral osteotomy was performed.After the deformity was cor-rected,the intramedully nail was inserted to fix the femur.None of the patients need bone autograft.The preoperation and postoperation lateral distal femur angle (LDFA ),mechanical axis deviation (MAD ) and range of motion (ROM)were measured and analyzed.Results:All the 14 patients were followed-up for 12 -72 months (average 34 months).The osteotomy site united in 3 -5 months (average 3.5 months)post-operatively.According to Paley’s functional scores,12 patients were excellent,2 patients were good.We achieved desired postoperative MAD (from medial 15 mm to lateral 10 mm)in 15 limbs of 12 patients.The LDFA in 1 1 limbs was corrected to normal (84°-90°).The ROM was not signifi-cantly changed before and after operation in the both groups.No infection or neuro-vascular injury oc-curred.Conclusion:The FAN technique is an effective method to treat valgus knee or varus knee de-formity in young patients with DFO.

ObjectiveTo observe the efficacy of using sorafenib in preventing and treating tumor recurrence after liver transplantation for patients with primary hepatic carcinoma exceeding Milan criteria.MethodsFrom March 2008 to June 2010,30 patients of liver transplantation with primary hepatic carcinoma exceeding Milan criteria were randomized into 2 groups,each group of 15 cases.The experimental group received oral administration of sorafenib (400 mg bid) ; the control group received capecitabine (1500 mg bid) for 14 days every 4 weeks.The patient without recurrence in 18 months after transplantation stoped taking the medication.The recurrent patients maintained the original dose until they were not suitable for the medication.Patients with serious adverse reactions must reduce the dose or stop the medication.ResultsThe 1 year recurrence rate of experimental group was 53.3％,the control group was 86.6％,the difference between 2 groups was statistically significant (x2 =3.968,P＜0.05).The 1 year survival rate of experimental group was 93.3％,the control group was 46.6％,the difference between 2 groups was statistically significant (x2 =7.777,P＜0.05).The mean survival time of experimental group was (28.3±2.5)months (7～36 months),the control group was (17.9±3.5)months (5 ～ 41 months),the experimental group patients' survival time was longer than the control group,the differences was statistically significant (x2=5.702,P＜0.05 ).Most adverse reactions in 2 groups were grade Ⅰ - Ⅱ.The incidence of diarrhea and hand-foot syndrome in experimental group was higher than in control group.ConclusionUsing sorafenib for patients with primary hepatic carcinoma exceeding Milan criteria after liver transplantation probably may reduce or delay the process of carcinoma recurrence,can prolong the survival time of those patients,and side effects can be tolerated.

Objective To observe the efficacy of Sorafenib in preventing and treating tumor recurrence after liver transplantation for patients with primary hepatic carcinoma beyond Milan criteria.Methods From March 2008 to June 2010,30 patients of liver transplantation with primary hepatic carcinoma exceeding Milan criteria were randomized into 2 groups,each group of 15 cases.Beginning one month posttransplantatoin patients in the experimental group received oral administration of Sorafenib (400 mg bid),while those in the control group received Capecitabine ( 1500 mg bid) for 14 days every 4 weeks.Drug was withdrawn in patients without recurrence in 18 months after transplantation,recurrent patients maintained the original dose until they were not suitable for the medication.Results The 1 year recurrence rate in experimental group was 53.3％,that in control group was 86.6％ ( x2 =3.968,P ＜ 0.05).The 1 year survival rate in experimental group was 93.3％,that in the control group was 46.6％( x2 =7.777,P ＜ 0.05 ).The mean survival time of patients in experimental group was (24.6 ± 1.7 ) months (7 - 28 months),that in the control group was ( 16.4 ± 2.7 ) months ( 5 - 34 months ) ( x2 =7.154,P ＜ 0.05).Most adverse reactions in both groups were of grade Ⅰ - Ⅱ.The incidence of diarrhea and handfoot syndrome in experimental group is higher than that in control group.Conclusions Using Sorafenib for patients with primary hepatic carcinoma exceeding Milan criteria after liver transplantation may reduce carcinoma recurrence rate,and prolong patients' survival time.

Hepatic fibrosis models were induced by CCl4 in rats. To explore vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGFβ1) mRNA expression and bcl-2, Bax protein expression levels of intervention and explore the mechanism of the Aralia chinesis anti-hepatic fibrosis. Sixty male Sprague-Dawlley (SD) rats were randomly divided into six groups: nomal group, model group, high-dose (10 mL x kg(-1)), medium-dose (7.5 mL x kg(-1)), low-dose (5.0 mL x kg(-1)) of A. chinesis treated group and colchicine treated group. The change of liver histopathology was observed by HE and Masson staining. The mRNA of VEGF, TGF-β1 were detected by RT-PCR. The protein of Bcl-2 and Bax were detected by Western blot. In the model group liver cell obvious degeneration, necrosis, a large number of collagen fibers of the cable hyperplasia, part visible pseudolobule formation. A. chinesis large, medium, low-dose group and colchicine group liver cell degeneration and necrosis reduced A. chinesis small, medium, and high-dose group was gradually reduced trend and A. chinesis large, middle dose group degree of reduction is particularly significant. Compared with model group, A. chinesis of large, medium and small dose group and colchicine group VEGF mRNA expression, A. chinesis of large, medium-dose group TGF-β1 mRNA expression reduce (P < 0.05); compared with colchicine group, A. chinesis of large, middle dose group of VEGF mRNA expression decreased (P < 0.05); A. chinesis of large, middle dose group of TGF-β1 mRNA expression decreased (P < 0.01), and compared with colchicine group, large dose group of of TGF-β1 mRNA expression decreased (P < 0.05). Compared with model group, A. chinesis of large, medium and small dose group and colchicine group Bcl-2 protein expression reduce (all is P < 0.05). But A. chinesis of large, medium and small dose group and colchicine group of Bax protein expression were increased (P < 0.05). A. chinesis regulation of VEGF, TGF-β1 may prevent the activation of hepatic stellate cells, liver tissue by up regulating the anti-apoptotic protein Bax and down pro-apoptotic protein Bcl-2 expression, thereby to improve the degree of liver fibrosis.
Animals ; Apoptosis ; drug effects ; Aralia ; chemistry ; Drugs, Chinese Herbal ; administration & dosage ; Hepatic Stellate Cells ; drug effects ; metabolism ; Humans ; Liver Cirrhosis ; drug therapy ; genetics ; metabolism ; Male ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; metabolism ; Rats ; Rats, Sprague-Dawley ; Transforming Growth Factor beta1 ; genetics ; metabolism ; Vascular Endothelial Growth Factor A ; genetics ; metabolism ; bcl-2-Associated X Protein ; genetics ; metabolism

Objective To study clinical characteristics of postoperative recurrence of liver malignant tumor after liver transplantation,the postoperative standard evaluation,and treatment for recurrent tumor. Methods We retrospectively analyzed the data of 81 recurrent cases among 215 patients undergoing liver transplantation for malignant liver tumors,focusing on the recurrent time and location and the result oftreatment.Results The follow-up time ranged from 6 to 108 months of all the 81 patients after liver transplantation.The time of tumor recurrence ranged from 3 to 20 months after transplantation.and lung,abdominal cavity,new liver and bone were among the most common places of recurrence.Local therapy was the mainstay of therapy,including liver lobectomy in 6 cases and gamma knife treatment for pulmonary metastasis in 74 cases;Resection for abdominal mass Was performed in 10 cases.Gamma knife treatment for abdominal lymph node metastasis in 8 eases,resection of hepatic metastatic tumor in 6 cases,ablation therapy in 5 cases,gamma knife treatment in 15 cases,33 cases underwent repeated TACE and 3 cases received re-transplantation for liver metastasis;For bone metastasis 15 cages underwent resection,16 cases did gamma knife treatment and 3 cases underwent internal fixation for bone fracture caused by bone metastasis;For intracranial metastasis 4 cnses received gamma knife treatment.3 cases were cured,6 cases were still alive with recurrent tumor for 21～56 months respectively and the mean survival time was 39 months;72 cnses died with a mean survival time of 15 months.Conclusion The regular and standard close follow-up for liver transplantation recipients suffering from primary liver malignant tumors and aggressive therapy for the recurrent tumors help prolong patient's survival.

Objective To study the imaging characters and pathological diagnosis for space occupying lesions of the liver with atypical clinical and laboratory features.Methods We retrospectively analyzed the clinical data and treatment of 40 patients with space occupying lesions of the liver in which preoperative correct diagnosis was difficult,the imageological appearances and the final pathological diagnosis of these 40 space occupying lesions were compared,the specificity of B-ultrasonotomography、dynamic contrast-enhanced CT and MR scanning in identifying lesions was evaluated.Results All lesions were surgically resected.On pathology there were 22 hepatocellular carcinomas,7 macroregenerative nodules,2 focal nodular hyperplasias,2 cholangiocellular carcinomas,2 hemangiomas,2 regenerative nodules and 1 hepatocellular adenoma,1 hepatic peliosis,1 antixenic nodule.The specificity of the Bultrasonotomography for all lesions was only 20%;dynamic contrast-enhanced CT has low specificity in differential diagnosis of liver carcinoma and macroregenerative nodule and the overall specificity was 42.5%;dynamic contrast-enhanced MR scanning has excellent capability in differential diagnosing of all lesions and its specificity was 92.5%.Conclusion The preoperative diagnosis for some space occupying lesions of the liver is difficult,the differential diagnosis of these lesions should be emphasized,the dynamic contrastenhanced MR scanning for space occupying lesions of the liver has high specificity.

Objective To evaluate the effect of fixator-assisted nailing (FAN) technique for the treatment of femoral deformity,nonunion of femoral shaft fracture with deformity and malunion.Methods The data of 8 patients with nonunion of femoral shaft fracture with deformity,3 patients with femoral deformity caused by Rickets disease and 2 patients with femoral fracture malunion who received treatment FAN technique was retrospectively analyzed.There were 11 males and 2 females,with an average age of 33 years (range,16-50 years).One-stage operation was used in 10 patients:after the fracture was distracted and reduced with external fixator,an intramedullary nail was used for final fixation.Two-stage strategy was used in 3 patients.Unilateral external fixator was used in 12 patients,ring fixator was used in 1 patient.Femoral intramedullary nailing was used in 8 patients,retro-femoral intramedullary nailing was used in 5 patients; autograft from callus of fracture site was used in 1 patient.Results The 12 patients were followed up for 12-48months with an average of 21 months.The fractures of 7 patients united 3-6 months (average,3.9 months)later after the operation.The osteotomy site of 5 patients united 3-5 months (average,3.5 months) later after the operation.The results were evaluated according to the Paley classification of functional results.There were 9 cases rated as excellent,2 as good and 1 as fair.The lower leg discrepancy (LLD) before and after operation was (48.2±23.0) mm and (27.3±24.6) mm,individually; the length of limb increased 4.6-41.0 mm (average,23.3 mm).The pre-and post-operative MAD was (27.5±24.4) mm and (6.3±8.3) mm.There was no neurovascular injury or infection occurred in any of the patients.All the patients were satisfied with the result of treatment.Conclusion FAN technique combines the accuracy,minimal invasiveness and safety of external fixation together with patient compliance of IM nail.It is an effective method to manage nonunion of femoral shaft fracture with deformity,malunion of femur,and femoral deformity cause by rickets.

Objective To investigate the clinical application value of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney.Methods Fifty-four cases of retroperitoneal laparoscopic nephrectomy for nonfunctioning kidney were reviewed,including 9 cases with nonfunctioning tuberculosis pyonephrosis,18 cases with infection nonfunctioning pyonephrosis and 27 cases of nonfunctioning hydronephrosis.Fifty-four cases were received retroperitoneal laparoscopic nephrectomy,tuberculous and infection pyonephrosis underwent laparoscopic resection surrounding adipose capsule,nonfunctioning hydronephrosis underwent laparoscopic resection by pumping water to increase the peritoneal space.Results The operation of 54 cases were perfomed successfully.None of the patient required conversion to open surgery.During the surgery,1 case showed mild extravasation of cheese-like pus induced by laceration of the kidney capsule;2 cases had injuried on the peritoneum.The mean operation time was 125 (95-230) min,the mean blood loss was 84 (50-420) ml.All patients showed primary healing of the wound,the patients were discharged from the hospital in 6 to 11 d (mean 7.5 d).After followed up for 5-27 months,none of them had long-term complication.Conclusions Retroperitoneal laparscopic nephrectomy for nonfunctioning kidney has advantages of minimal invasion,less blood loss and quicker recovery,so it is a fairly safe and effective procedure for nonfunctioning kidney.