Objective To compare the effects of laparoscopic hepatectomy (LH) versus conventional laparotomy hepatectomy (CLH) on cellular immunity. Methods Fifteen ASA Ⅱ-Ⅲ patients aged 34-61 yrs, weighing 48-75 kg undergoing laparoscopic hepatectomy (LH) were studied. Another 15 patients aged 33-64 yrs, weighing 46-73 kg undergoing conventional laparotomy hepatectomy (CLH) served as control. The preoperative liver function was rated as Child classification A in both groups. The patients were premedicated with phenobarbital 0.1 g and atropine 0.5 mg i.m. . Anesthesia was induced with fenlanyl 4 ?g?kg-1, propofol 1.5 mg?kg-1 and succinylcholine 2 mg?kg-1. After tracheal intubation the patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg. Anesthesia was maintained with inhalation of isoflurane (MAC 1.0?0.31) and 60% N2O in O2 and intermittent i.v. boluses of vecuronium. The patients received after operation patient-controlled epidural analgesia (PCEA) with 0.125% ropivacaine and morphine 0.05 ?g?kg-1?min-1. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. Peripheral venous blood samples were taken before operation and on the 1 st and 3rd postoperative day for determination of CD3+ , CD4+ , CD8+ T cells (by flow cytometry) and IL-6, TNF-?concentrations (ELBA) . Results CD3+ , CD4+ and CD8+ counts were significantly decreased while IL-6 and TNF-?levels were significantly increased on the 1st postoperative day compared with the baseline values before operation in both groups but there was no significant difference between the two groups. On the 3rd postoperative day CD3+ , CD4+ and CD8+ counts and IL-6, TNF-?levels returned to preoperative level in group LH while in group CLH CD3+ , CD4+ , CD8+ remained low and IL-6, TNF-?levels remained high.Conclusion The results suggest that LH exerts less effects on immune function than conventional laparotomy technique.

Objective To compare the effects between epidural and general anesthesia for laparoscopic cholecystectomy. Methods A total of 500 cases scheduled for laparoscopic cholecystectomy (LC) were randomly divided into the epidural anesthesia group (Group E, n=250) and the general anesthesia group (Group G, n=250). Results (1) Hemodynamic parameters: in both groups the cardiac output (CO) decreased significantly after CO 2 pneumoperitoneum ( P 0 05), without significant differences between the two groups; the central venous pressure (CVP) was transiently elevated after pneumoperitoneum ( P 0 05), with significant differences between the two groups ( P 0 05), without significant differences between the two groups. (2) Ventilative parameters: the mean airway pressure (P AWM ) and the peak airway pressure (P peak ) were remarkably elevated during the course of pneumoperitoneum in the Group G ( P

Objective To explore the feasibility of laparoscopic cholecystectomy(LC) in patients over 85 years old.Methods Three-port LC was performed in 79 patients aged over 85 years old from October 1996 to October 2006.Patients' co-morbidities were effectively controlled before operation.The operation was conducted under continuous epidural anesthesia,and the CO2 pneumoperitoneum pressure was set at 8～10 mm Hg.Results The LC was successfully completed in 70 patients,while conversions to open surgery were required in 9 patients(11.4%).Causes of conversions included severe intraperitoneal adhesion in 6 patients,uncontrolled bleeding in 1 patient,and suspicion of gallbladder carcinoma in 2 patients.Postoperative complications occurred in 10 patients(12.7%,10/79).Of them,1 patient died of acute myocardial infarction,and the remaining 9 patients were cured(including left heart failure in 1 patient,pulmonary infection in 2 patients,ileus in 1 patient,wound haematoma in 1 patient,fungal enteritis in 1 patient,and effusion in the gallbladder bed in 3 patients).Conclusions Proper peri-operative management,effective control of co-morbidities,and careful surgical performance are essential for a safe LC in patients over the age of 85.

Objective To discuss the application of endoscopic techniques in the treatment of calculus of intrahepatic or extrahepatic duct. Methods Laparoscopy in conjunction with duodenoscopy or cholangioscopy was adopted in 96 cases of calculus of intrahepatic or extrahepatic duct, including 72 cases of cholecystolithiasis complicated by choledocholithiasis, 16 cases of simple choledocholithiasis and 8 cases of left intrahepatic duct calculus complicated by choledocholithiasis. The surgical procedures included laparoscopic cholecystectomy (LC) combined with EST (37 cases), LC combined with cholangioscopic exploration (54 cases), and laparoscopic left hepatic lobectomy combined with cholangioscopic exploration (5 cases). Results Postoperative re-examination revealed no residual calculus in 93 out of 96 patients. Small amounts of biliary leakage occurred in 4 patients and healed spontaneously within a mean time of 10 days. No other severe complications took place. A conversion to open surgery was required in 3 patients, 2 of which were high bile duct stricture and 1 of which were severe portal adhesion. Conclusions Endoscopy in the treatment of calculus of intrahepatic or extrahepatic duct is feasible. Proper application of multiple endoscopic techniques is a safe, effective and minimally invasive means for the treatment of cholelithiasis.

Objective To observe the effectiveness of dexamethasone combined with azasetron for the prevention of postoperative nausea and vomiting(PONV) in patients after laparoscopic cholecystectomy(LC).Methods A total of 150 ASA(Ⅰ~Ⅱ) patients undergoing an elective LC were randomly divided into three groups with 50 patients in each group: Group D+A was given intravenous dexamethasone 5mg and azasetron 10mg(2ml) at the end of surgery,Group A received intravenous azasetron 10mg(2ml) at the end of surgery,and Group C received normal saline(NS) 2 ml as the control.Episodes of nausea and vomiting were recorded for 24 h following the surgery.Results The incidence of nausea was 4% in the Group D+A(2/50),which was significantly lower than in the Group A(16%,8/50) and the Group C(34%,17/50)(?~2=4.00 and 14.62;P=0.046 and 0.000).The incidence of vomiting was 2% in the Group D+A(1/50),which was significantly lower than in the Group A (14%,(7/50)) and the Group C(32%,16/50)(?~2=4.89 and 15.95;P=0.027 and 0.000).The incidences of nausea and vomiting were significantly lower in the Group A than in the Group C(?~2=4.32 and 4.57;P=0.038 and 0.033).Conclusions Use of a low dose of dexamethasone in combination with azasetron is more effective than azasetron prophylaxis alone for a successful control of PONV after LC.

Objective: To investigate the effects of DC derived from IL-12-induced erythroleukemia cells on the induction of CTL and protective antituinor immunity. Methods: The cytotoxicity of CTL was assessed by 4h 51 Cr-release assay. HE staining and eleclromicroscopy were used to observe the histological changes after immunized with erythroleukemia-derived DCs. Results: After incubation with naive T cells, the IL-12-induced FBL-3 cells could apparently induce the generation of CTL which exihibit the specific cytotoxicity against wild-type FBL-3 cells in vitro. We further assayed the cytotoxicity of CTL in vivo after immunized with erythroleukemia-derived DCs. CTL cytotoxicity of mice immunized with IL-12-in-duced FBL-3 cells was higher than that of mice immunized with IL-I2-uninduced FBL-3 cells. C57BL/6 mice immunized with IL-12-induced FBL-3 cells could resistant the subsequent rechallenge with the wild-type FBL-3 cells. The tumor growth was efficiently inhibited. Histological observation showed that more inflammatory cells infiltrated into the tumor tissue and necrosis of leukemia cells existed. By transmission electron microscopy, apoptositic phenomena were observed in the tumor of group immunized with IL-12-induced FBL-3 cells. However, these changes were not observed in the group immunized with IL-12-uninduced FBL-3 cells. Conclusion: These data indicate that erythroleukemia cells-derived DCs could induce specific CTL efficiently in vitro and in vivo, and may be used as new vaccine to activate antituinor immune responses.

To observe the effect of IL-2 gene modification on the character of biology and function in dendritic cells( DC) and to investigate the immune mechanism of specific anti-tumor of IL-2 gene modification in DC. Methods: DCs were prepared from mouse bone marrow and genetically modified by IL-2 adenovirus. Then observe the changes of DC morphology by scanning electro-microscopy, analyzed molecules on DC by FACS, examined the expression of IFN-? mRNA in DC by RT-PCR.The stimulatory capacity of DC to T cells detected by MLR their capacity of antigen present were measured by 3H-TdR mix into assay. Results: After IL-2 gene modification, the morphology of DC was changed, its pseudopod was more and longer. The expression of Ia, B7-1, B7-2 and CD40 molecules was more on DC surface. The IFN-7 mRNA was expressed in the DC-EL-2 and DC-rhIL-2.DC-IL-2 could stimulate allogeneic T cells more potently and IL-2 gene-modified DC could induce more potent antigen-specific autogeneic CTL. Cooclusioo: IL-2 genetic modification can promote DC growth and up regulate their expression of membrane immune molecules that are relevant for antigen presentation of DC,and enhanced the biologic activity of the DC.

Objective To observe the influence of emotional intervention on alcohol-induced mental disor-ders patients and provide guidance for health intervention.Methods 118 patients with alcohol -induced mental disorders were divided into emotional intervention group and conventional intervention group.After 4 weeks,the effect was evaluated by anxiety,depression,SDSS,BPRS,SCL-90.Results After 4 weeks intervention,the lost rate of follow up in the emotional intervention group was 3.57%,which in the conventional intervention group was 8.06%.In the emotional intervention group, the differential values before and after intervention of anxiety, depression, BPRS, SDSS,somatization,compulsion,interpersonal relationship sensitivity,depression dimension,anxiety dimension,rivalry, consternation,crankiness and spirit were (19.90 ±3.18),(23.02 ±4.26),(15.46 ±3.29),(1.89 ±0.91), (0.48 ±0.24),(0.29 ±0.22),(0.30 ±0.24),(0.26 ±0.24),(0.31 ±0.19),(0.16 ±0.17),(0.32 ±0.20), (0.36 ±0.29),(0.35 ±0.25) respectively.Compared with the conventional intervention group,the differential values were higher than conventional intervention group [(8.27 ±1.72),(12.31 ±2.64),(11.69 ±4.17), (1.52 ±0.84),(0.25 ±0.17),(0.12 ±0.14),(0.19 ±0.18),(0.18 ±0.16),(0.15 ±0.13),(0.09 ±0.07), (0.11 ±0.12),(0.17 ±0.14),(0.16 ±0.15)].There were significant differences between the two groups (anxiety:t=4.159,P=0.000;depression:t=16.013,P=0.000;BPRS:t=5.269,P=0.000;SDSS:t=2.227,P=0.028;somatization:t=5.851,P=0.000;compulsion:t=4.883,P=0.000;interpersonal relationship sensitivity:t=2.741,P=0.001;depression:t=2.076,P=0.004;anxiety:t=5.202,P=0.000;rivalry:t=2.864,P=0.005;consternation:t=6.749,P=0.000;crankiness:t=4.432,P=0.000;spirit:t =4.885,P=0.000).Conclusion Emotional intervention has positive effect on emotional states,somatic symptoms and quality of life,it is worthy of clin-ical promotion.

OBJECTIVE:To evaluate the effect of Stronger Neo-Mioniphagen C(SNMC)on liver function of the patients with hepatocarcinoma associated with cirrhosis.METHODS:55patients with hepatocarcinoma associated with cirrhosis were allocated to2groups randomly,group A:before operation SNMC(1ml/kg)was dripped intravenously to the patients,group B:before surgery NS(1ml/kg)was administered.On the1st、3rd、6th postoperative day,the index of liver function of the perive?nous blood were analyzed statistically.RESULTS:On the1st、3rd postoperative day,all the value of liver function in both group is higher than the basic,and the value in group A is lower than that in group B(P

Objective To compare the effects of three different training patterns of MOTOmed training on the somatosensory evoked potentials (SEPs) of healthy youths. Methods Ten healthy young volunteers received training in patterned sequences of passive movement, active movement with no resistance and active movement with resistance. Each pattern lasted for 30 minutes and SEPs were examined before and after 90 minutes of training. The amplitude and latency of N9 and P40 were recorded. Results All three training patterns heightened SEP amplitude and lengthened SEP latency, but active training had the most obvious effect on amplitude. The rates of change of am-plitude after each training pattern had significant differences, which was most obvious after training the resistance training pattern. Conclusions MOTOmed motor training can excite the cerebral cortex and up-regulate SEP ampli-tude. Active movement with resistance is the most effective among the three patterns tested.