Objective To assess the mid-term result of laparoscopy in resection of choledoehal cyst,hepaticojejunostomy and discuss the technical improvement.Methods Retrospectively analyzed the data of 31 patients who had undergone laparoscopic choledochal cyst excision from November 2010 to November 2012.Under laparoscopic guidance,intraoperative cholangiogram was performed,Rorx-Y jejunojejunostomy was performed extracorporeally through umbilical incision,then the dilated bile duct were completely excised and a hepaticojejunostomy was carried out intracorporeally.Results Twenty-nine patients successfully underwent laparoscopic choledochal cyst resection,while 2 patients were converted to open surgery because of severe adhesion.The mean operation time was 260 minutes (range from 200 to 460 minutes).A follow-up of 3 to 27 months were achieved in all patients.Three patients developed early complications:one bile leakage,one incision port hemorrhage and one intestinal torsion.The laboratory tests were normal and no dilation of the bile duct was detected in all patients.Conclusions Laparoscopic total cyst excision with Roux-Y hepaticojejunostomy was effective and safe procedure with satisfied results.

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.

Objective The purpose of the present study is to illustrate the effect of olfactory ensheathing cells(OECs) on the survival and neurite outgrowth of GABAergic neurons in vitro. Methods OECs were dissociated from olfactory bulb and neurons from spinal cord of E12 mouse. On the sixth day in vitro,the Millipore cultue blank with OECs was transferred to the neuron culture mediam and continue the co-culture for another 6 days.The cultured neurons were stained with anti-GABA antibody.The neurite of neurons was observed with an image system.The number of GABAergic positive neurons was counted under the microscope. Result The number of GABAergic neurons was 39^7?6^3 in co-culture groups,whereas the number of GABAergic neurons represented only 27^6?2^7 in control groups(CG),(P

Objective To investigate the therapeutic effect of stage treatment of severe complicated injuries in palmar forearm and wrist.Methods From March 2008 to Novemler 2011, eleven cases with skin lost combined with fracture and lost of flexor tendon, ulnar radial arteries, median and ulnar nerves,and some of them had fracture of ulnar and radius were treated in the first stage with vacuum sealing drainage after emergency debridement and tissue repair. Secondary microsurgical repair was performed after the VSD was removed. The lost of median and ulnar nerves was repaired with transplantation of sural nerve,and the wound was repaired with free flaps and complex tissue flaps. Results Eleven cases were treated with vacuum sealing drainage for 7 to 10 days.Infections were under control,wound areas reduced and most wound areas were covered by granulation tissues.Flaps and skin grafts were survived.After postoperative follow-up for 3 to 36 months (average 13 months),three cases was received flexor tendolysis.As result,the blood circulation of hand was good, the sensor of injured nerve was higher than S3, and there was a good functional rehabilitation of hand muscles. Conclusion Using vacuum sealing drainage after emergency debridement and tissue repair, there was a good repairing effect of secondary repair with flaps and skin grafts for severe complicated tissue defect in palmar forearm and wrist,and it is an effective choice of operation.

Objective To evaluate the advantages and disadvantages of various methods for the treatment of aortic dissection involving aortic arch. Methods The clinical data of 56 patients with aortic dissection involving aortic arch were analyzed retrospectively. All the patients were treated with throacic endovascular aortic repair (TEVAR) combined with chimney technique and hybrid operation to reconstruct partial vessels of the aortic arch according to the different morphology sites of aortic disease. Results Among 56 patients, 29 cases received TEVAR combined with chimney technique of left subclavian artery, and 27 cases received TEVAR combined with hybrid operation. Six cases had typeⅠendoleak. Among them, 2 cases improved by compliant balloon dilatation, and 4 cases were not treated. There was no death in perioperative period. The patients were followed up for 3-70 (22 ± 3) months, and all the branches of the artery were unobstructed during middle and long term follow-up. Conclusions Combined endovascular treatment is a safe and effective method for aortic dissection involving the aortic arch. In the meantime, strict preoperative evaluation and suitable operation method is also important.

Standardized rotary residency training is an important part of clinical medical education. Traditional clinical teaching can't meet the rapid development of oncology medicine. In the rotary residency training in oncology department, we put forward the problems encountered in clinical practice, stimulate the interest and initiative of residence, the PBL teaching model is combined with the evidence-based medicine in the teaching process through the relevant training, literature review and discussion. By standardizing the treatment concept the residence's understanding of the basic theory and frontier knowledge of oncology was improved, the thinking innovation and clinical practice ability of the residency doctors were enhanced.

Objective To evaluate the value of three-dimensional ultrasound volume contrast imaging (VCI) and tomo graphy ultrasound imaging (TUI) techniques in observing fetal spinal conus medullaris (CM) position and lumbar enlargement of spinal cord morphologic changes,for assessment of tethered cord (TC).Methods Totally 17 abnormal fetuses of spinal diseases combined with TC (abnormal group) were examined by three dimensional ultrasound VCI and TUI techniques.The position of CM was recorded,and the transverse and anteroposterior diameters of lumbar enlargement of spinal cord were measured and compared with 300 cases of normal fetuses (normal group).Results As the growth of the gestational age (CA),CM terminal position increased.All the ends of CM located at L3 or L3 above level in normal.The transverse and anteroposterior diameters of lumbar enlargement in normal group showed good linear relationship with GA.Transverse diameter (mm) =0.677+0.147 ×GA (R2 =0.836,P＜0.05),anteroposterior diameter (mm)-0.994+ 0.152× GA (R2=0.894,P＜0.05).Compared with the corresponding GA fetuses in normal group,the anteroposterior diameter of lumbar enlargement decreased in abnormal group (P=0.002),while no statistical difference of the transverse diameter was found between the two groups (P=0.082).Conclusion Position of CM and lumbar enlargement measure ment can provide valuable reference information for clinical prenatal diagnosis of fetal spinal TC.

BACKGROUND: Platelet-rich plasma containing various high-concentration growth factors can promote new bone formation and accelerate bone healing. But its effects on distraction osteogenesis remain unclear. OBJECTIVE: To observe the effects of autologous platelet-dch plasma on premaxillary distraction osteogeaesis in rabbits. DESIGN, TIME AND SETTING: A randomized controlled animal experiment was performed at the Laboratory of Physiology, North Campus,Sun Yat-sen University between July and August 2007. MATERIALS: Sixteen healthy rabbits, the same number for male and female, aged 3-5 months,weighing 1. 4-1.7 kg,were randomly and evenly divided into an experimental group and a control group. Premaxillary incisor band,outside front distraction mask, and distraction rubber band were self-made.Coagulant was prepared by dissolving 1000 u bovine thrombin in 1 mL of 10% calcium chloride.METHODS: Titanium nails (1.5 mm in diameter) were separately inserted on two sides of left premaxillary suture in rabbits. A self-made distraction device was used. Gelatum-like substance [Vplatelet-rich plasma: V coagulant=9:1] was injected into the left premaxillary suture of experimental group rabbits immediately prior to distraction.In each group, one-week sustained distraction was performed in 4 rabbits,and three-week sustained distraction was performed in another rabbits. MAIN OUTCOME MEASURES: The increase of nail-nail distance on the two sides and histological results following distraction osteogenesis.RESULLTS: Rabbit premaxillary bone moved anterior in the two groups. The experimental group showed greater increase of nail-nail distance, faster bone formation and mineralization, more blood vessels, and thicker and more mature bone trabecula in the distraction interspace in comparison with the control group. CONCLUSION: Platelet-rich plasma will help bone tissue regeneration and promote premaxillary distraction osteogenesis.

CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy (HAART) and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count (TLC) and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties (Shangcai, Queshan, Shenqiu and Weishi) were included in the study. Pearson correlation and receiver operating characteristic (ROC) were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART (P<0.01). An overall positive correlation was noted between TLC and CD4 count (pre-HAART, r=0.73, P=0.0001; follow-up HAART, r=0.56, P=0.0001). The ROC curve between TLC and CD4 count showed that TLC ≤ 1200 cells/mm(3) could predict CD4 < 200 cells/mm(3) with a sensitivity of 71.12%, specificity of 66.35% at pre-HAART. After 12-month HAART, the optimum prediction for CD4 count < 200 cells/mm3 was a TLC ≤ 1300 cells/mm(3), with a sensitivity of 63.27%, and a specificity of 74.84%. Further finding indicated that TLC change was positively correlated to CD4 change (r=0.77, P=0.0001) at the time point of 12-month treatment, and the best prediction point of TLC change for CD4 increasing was 135 cells/mm(3). TLC and its change can be used as a surrogate marker for CD4 count and its change of HIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.

Nowadays the role of genetic findings in determining the diagnosis, therapy and prognosis of acute myeloid leukemia (AML) has become more valuable. To improve and validate the detection of clonal chromosomal aberrations in leukemia, we designed a combined application of karyotyping with multiplex reverse transcription-polymerase chain reaction (RT-PCR) and fluorescence in situ hybridization (FISH), and addressed the expression and distribution of fusion genes among the subtypes of Chinese adult patients with de novo AML. Multiplex RT-PCR assays were performed on 477 samples from newly diagnosed AML patients, and cytogenetic data were obtained from 373 of them by R or G banding techniques and those in some cases were confirmed by FISH. The PCR products in some suspected cases were tested by two-directional sequencing. The results showed that except unqualified samples, fusion genes were detected by multiplex RT-PCR in 211 of 474 patients (44.51%), including AML1-ETO, CBFβ-MYH11, PML-RARα, PLZF-RARα, NPM-RARα, MLL rearrangements, BCR-ABL, DEK-CAN, SET-CAN, TEL-PDGFR, TLS-ERG, AML1-MDS1 (EVI-1). In 373 patients, who took both multiplex RT-PCR and karyotype analysis, the detection rate of chromosomal aberrations by using multiplex RT-PCR and karyotyping was 160/373 (42.89%) and 179/373 (47.98%) respectively, and the combination could optimize the detection rate of clonal genetic abnormalities to 216/373 (57.90%). The PCR results from 11 cases "normal" in karyotyping but abnormal in RT-PCR for MLL rearrangements were confirmed by two-directional sequencing. It is concluded that karyotype studies remain the cornerstone for genetic testing; conventional cytogenetics and molecular-based methods are complementary tests for the detection of clonal genetic aberrations in AML, especially for the cryptic or submicroscopic aberrations. Once a genetic marker has been identified by combined analysis, it could be used to monitor residual disease during/after chemotherapy, by quantitative RT-PCR and/or FISH.