Objective To investigate the perioperative management for patients of thyroid crisis complicating acute abdomen.Methods The clinical data of 11 acute abdomen patients combined with hyperthyroidism were analyzed retrospectively.Results In this study,the surgical procedures were appendectomy in 5 patients,perforation repair for duodenal ulcer in 2 patients,distal gastrectomy in 2 patients,choledochotomy in one patient and splenectomy in one patient.Thyroid crisis occurred postoperatively in 7 patients,intraoperatively in 2 patients and preoperatively in 2 patients.Emergency treatment succeeded in 8 patients,and death occurred in 3 patients,with a death rate of 27.3%,including the preoperative thyroid crisis patient complicating duodenal ulcer perforation,who died of heart sufficiency on the first day postoperation.The second patient suffering from intraoperative thyroid crisis during exploration for perforation of the small bowel died of muhiple organ dysfunction syndrome caused by intestinal fistula,intra-abdominal abscess and lung infection,in spite of successful rescue treatment of thyroid crisis.The third patient was of acute appendicitis with perforation who died of coma and multiple organ dysfunction syndrome on the postoperative 5th day because the concomitant thyroid crisis was overlooked.Conclusions The early recognizing thyroid crisis in perioperative surgical abdomen and adequate treatment is the key to rescue succesS,and the diagnosis mainly depends on comprehensive judgment of clinical presentation and laboratory examination.

[ABSTRACT]Pulmonaryarterialhypertensionisdefinedasamultifactorialgroupofpulmonaryvasculardisorders characterized by a progressive increase in the pulmonary vascular resistance , resulting in right heart failure and premature death.The plexiform lesion is the hallmark of severe pulmonary arterial hypertension .This article summarized the recent progress in the plexiform lesion including its occurrence , structure, animal models and molecular mechanism , which tried to predict the tendency of plexiform lesion study .

[Objective]To investigate the effects of mesenchymal stem cells (MSC) feeder layer, culture sere and freeze-thaw lysates on expansion and differentiation of cord blood CD34~+ cells in vitro. [Methods] MSC were isolated from human bone marrow and cultured until the third passage. Sera were obtained from the cultured MSC, and freeze-thaw lysates were obtained by repeated freeze-thaw procedures. Cord blood CD34~+ cells were isolated by magnetic cell separation system, and were co-cultured with the MSC feeder layer, culture sera, freeze-thaw lysates and hematopeietic growth factors (HGFs), respectively. The nucleated cells, CD34~+ cells, CD34~+CD38~- cells, CD41~+ cells and CD3~+ cells in the above culture system were detected by flow cytometry on day 6 and day 12. [Results] ①MSC feeder layer had a strong effect on nucleated cells, CD34~+,CD34~+CD38~- cells expansion. The MSC sera and freeze-thaw lysates had similar effect on cell expansion, but the effect was weaker than that of feeder layer (P<0.05). ② Both MSC sera and feeder layer inhibited cord blood CD34~+ cells differentiation toward CD3~+ cells or CD19~+ cells, and no significant differences were found between these two groups (P>0.05). ③ Both MSC sera and feeder layer promoted cord blood CD34~+ cells differentiation toward CD41~+ cells, and the effect was stronger in the feeder layer than that of the sera (P<0.05). ④ Freeze-thaw lysates had no effect on cell expansion and differentiation, and were similar with that of HGFs (P>0.05). [Conclusions] The MSC sera have positive effects on expansion of cord blood CD34~+ and CD34~+CD38~- cells, moreover they have the ability of promoting cord blood CD34~+ cells differentiation toward CD41~+ cells.

Animal models of pulmonary artery hypertension (PAH),aiming to simulate human characteristics of the disease,have contributed extensively to understanding the pathophysiology of PAH and the investigation of experimental treatments.The classical models include monocrotaline models,chronic hypoxia model and so on,more new models were investigated in recent years.These animal models were not able to perfectly mimic human pathological characteristics of PAH because of the defect in different aspects.In this review,both typical and novel methods of PAH modeling were summarized and evaluated to provide a suitable guidance for the settlement of animal models which can meet human characteristics comprehensively.

AIM: To explore inductive methods of hematopoietic stem cell (HSC) from embryonic stem cells (ESC) in vitro. METHODS: Using mice E14 line, the first step was the primary differentiation in which the ESC form embryoid bodies (EB) in methylcellulose-based cultures with SCF and VEGF. The second step involved the plating of cells originating from the EB into three different system of cultures containing SCF, VEGF,IL-3, IL-6 and EPO for HSC. And identifying HSC by flow cytometry analysis, colonogenic cells assay and Wright-Giemsa stain were also used. RESULTS: By two-step differentiating, it showed that HSC differentiated slowly in methylcellulose medium, percent age of CD34+/Sca-1+ cells slight increased about(31.5?4.7)% after day 14 induction. However, EBs were induced after 10 days to fast differentiate for HSC with more cells population by coculture on bone marrow stromal cells feeder. Flow cytometry analysis showed that percentages of CD34+/Sca-1+ cells might reached to (47.8?6.3)%. The more optimistic system of differentiation was bone marrow stromal cells feeder (BMSCF) in combination with supernatants of stromal cells from mice fetal liver(SSCFL), it significant supported differentiation of ESC into HSC with higher percent (53.6?7.2)%. Colonogenic cell assay and Wright-Giemsa stain confirmed that it possessed character of hematopoietic progenitors. CONCLUSION: Using methods of two-step differentiation, mice ESC were induced to differentiate into HSC by coculturing with BMSCF and SSCFL in combination of SCF,VEGF,IL-3,IL-6 and EPO.

Objective To investigate the clinical features,diagnosis and treatment of appendix tumor.Methods The clinical data of 58 cases with primary appendiceal tumor were analyzed retrospectively.Results In the 58 cases clinical presentation mimicked acute appendicitis in 22 cases,chronic appendicitis in 15 cases,appendiceal abscess in 12 cases,intra-abdominal mass in 7 cases,and gastrointestinal perforation in 2 cases.Primary appendiceal tumor was diagnosed intraoperatively by intraoperative frozen histopathological examination in 10 cases,and the diagnosis was made by postoperative histopathological examination in the other 48 cases.There was appendiceal carcinoid in 40 cases,adenocarcinoma in 6 cases,mucocele in 2 cases,mucous adenocystoadenoma in 5 cases,pseudomyxoma peritonei in 2 cases,malignant neurilemmoma in 1 case,and malignant lymphoma in 2 cases.Surgical procedures included appendectomy in 6 cases,ileocecal resection in 8 cases,and right hemicolectomy in 44 cases (including right hemicolectomy and intraperitoneal chemotherapy with 5-FU 1 000 mg for pseudomyxoma peritonei in 2 cases).Radical resection was achieved in 55 cases and palliative resection in 3 cases.The 2 cases with pseudomyxoma peritonei died of tumor recurrence at 36 months and 54 months after operation respectively.All the 5 cases of adenocystoadenoma and 2 cases of appendix cyst survived without an evidence of recurrence.7 of 49 cases of malignant appendiceal tumor suffered recurrence postoperatively,the recurrence rate was 14％,which included liver metastasis in 4 cases and intraperitoneal recurrence in 3 cases.The 1,3,5-year survival rates of malignant appendiceal tumors were 100％ (49/49),92％ (35/49) and 80％ (39/49),respectively,which were 100％,98％ and 92％ for carcinoid,and 100％,67％ and 33％ for adenocarcinoma,respectively.Conclusions The preoperative diagnosis of primary appendiceal tumor is very difficult,the intraoperative frozen histopathological examination is helpful for diagnosis,the prognosis of appendiceal carcinoid is fair after resection.

70% were enrolled into the study. Intravascular ultrasound (IVUS) was used before procedure, immediately after the final inflation of balloon and at the time of 3 month follow up. Cross sectional area(CSA) at the site of lesions, proximal and distal reference segment(vessel CSA,lumen CSA, plaque CSA) and remodeling ration were calculated respectively. Percutaneous cutting balloon angioplasty and intravascular irradiation was adopted to treat restenotic lesions during 3 month follow up period. Results Thirty seven of 76 cases had positive remodeling .There was no difference in the age, gender and other clinical parameters between positive and non positive remodeling(39 cases) groups. The remodeling ration in positive group [( 1.40 ? 0.13 )mm 2] was larger than that in the control group [( 0.79 ? 0.11 )mm 2,P

Objective To study the diagnosis and surgical treatment of primary sarcoma of liver in order to obtain a better understanding of this disease and to improve its clinical treatment.Methods The clinical data on the clinicopathological features,surgical treatments and prognosis of 17 patients with primary liver sarcoma who were treated from January 2001 to May 2016 were retrospectively analyzed.Results Of 17 patients with primary sarcoma of liver,elevation of preoperative serum AFP was detected in one patient (5.9％),HBsAg positivity in 3 patients (17.6％),elevation of CEA in 2 patients (11.8％) and abnormal liver function in 3 patients (17.6％).The main clinical symptoms included epigastric pain in 9 patients,epigastric distention in 7 patients,loss of appetite in 5 patients (including in one patient after resection of gastric carcinoma).Twelve of these 17 patients underwent resection (resection rate 64.7％).Five patients underwent laparotomy and biopsy.Among patients who were treated with surgical resection,10 patients had R0 resection and 2 patients had R1 resection.Postoperatively,5 of these patients underwent adjuvant selective hepatic arterial infusion chemotherapy (mitomycin + fluorouracil + epirubicin),and 4 patients were treated with adjuvant systemic chemotherapy (vincristin,cisplatin,cyclophosphamide and Doxorubicin).The postoperative 1,3 and 5-year overall survival rates for all the patients were 58.8％ (10/17),29.4％ (5/17) and 11.7％ (2/17),respectively.In patients with liver resection,the survival rates were 83.3％ (10/12),41.6％ (5/12) and 16.7％ (2/12),and for R0 resection,100.0％ (10/10),50.0％ (5/10) and 20.0％ (2/10),respectively.Condusions The diagnosis of primary sarcoma of liver was difficult before operation.High survival rate could be achieved by radical resection and adjuvant chemotherapy.

AIM:To explore the supportive and expansive effects of aorta-gonad-mesonephros(AGM) region derived stromal cells on hematopoietic stem cells(HSC) in vitro.METHODS:The murine stromal cells were separated and cultured from AGM region of a 11 day postcoitum(dpc) mouse embryo and 6 week mouse.After identification by Wright's staining and flow cytometry,the stromal cells were co-cultured with the embryonic stem cell(ESC)-derived,cytokine-induced HSCs,and the maintenance and expansion of HSCs were evaluated by detecting CD34+,CD34+Sca-1+cells with flow cytometry.Blast colony-forming cell(BL-CFC) and high proliferative potential colony-forming cells(HPP-CFC) were determined by semi-solid medium clonal culture.RESULTS:AGM-derived and bone marrow(BM)-derived stromal cells were similar in morphology and phenotype,and had common character of stromal cells.Supported by AGM stromal cells or by BM stromal cells,more primitive progenitor cells HPP-CFC were expanded,but BL-CFC expansion was only detected in AGM-derived stromal cells.In the supporting of BM stromal cells CD34+ hematopoietic stem/progenitor cells were expanded 3-4 times,but no significant expansion in CD34+Sca-1+ cells was observed.While in the supporting of AGM stromal cells,both CD34+ hematopoietic stem/progenitor cells and CD34+Sca-1+ cells were expanded significantly from 4 to 5 times,respectively(P

BACKGROUND: Hemorrhagic cystitis (HC) is one of common complications in patients undergoing hematopoietic stem cell transplantation (HSCT). It is of great value for improvement in the HSCT outcome to describe the clinical characteristics of HC and risk factors. OBJECTIVE: To investigate the incidence of HC in children after HSCT, and to analyze its clinical characteristics and risk factors.DESIGN: Case analysis SETTING: Center of Hematopoietic Stem Cell Transplantation, Department of Pediatrics, Second Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS: Experiments were performed at the Center of Hematopoietic Stem Cell Transplantation, Department of Pediatrics of Second Affiliated Hospital of Sun Yat-sen University from October 1998 to June 2004. Eighty-eight patients receiving umbilical cord blood transplantation (UCBT) and peripheral blood stem cell transplantation (PBSCT) were enrolled; 49 were males and 39 were females. The age ranged from 2 to 18 years with an average of 8.0 years. Guardians of child patients signed informed consents. The experimental procedures were approved by Medical Ethics Committee.METHODS: ①Conditioning regimens included combination of cyclophosphamide (CY, 120-200 mg/kg) with busulphan (BU, 14-20 mg/kg)-based chemotherapy and combination of CY with total body irradiation (TBI, 2-8 Gy) or total lymphoid irradiation (TLI, 2-8 Gy)-based radiotherapy. ②HC was defined according to the criteria proposed by references 7 and 8. The incidence, clinical characteristics, laboratory examination, treatment and outcome for HC were described. The association of various clinical factors including age, gender, human leucocyte antigen (HLA) typing, diseases for transplant, the type of stem cell, the type of transplantation, the occurrence of acute graft-versus-host disease (aGVHD) and cytomegalovirus (CMV) infection with the development of HC were examined.MAIN OUTCOME MEASURES: ①Incidence of HC, ②HC patient characteristics and laboratory examination, ③HC treatment and outcome, and ④risk factors analysis. RESULTS: All 88 patients were included in the final analysis. ①The incidence of HC: 16 patients (18.2%, 16/88) developed HC post-transplant with the severity graded as mild in 11 cases (68.7%) and severe in 5 cases (31.3%). ②HC patient characteristics and laboratory examination: All had hematuria and 8 cases (50.0%) had typical pollakisuria, urinary urgency, odynuria and gross hematuria; 10 cases (62.5%) had gross hematuria and 11 had proteinuria (+ to +++); Leucocytes were detected in 7 cases. ③Treatment and outcome: All patients recovered at a median of 13.5 days (range 2-53 days). ④Risk factors analysis: The incidence of HC was significantly higher in the group of ≥ 6 years old, presence of aGVHD and development of cytomegalo-virus (CMV) infection (P < 0.05-0.01). CONCLUSION: ①HC has its own clinical characteristics following HSCT in children but with good prognosis. ②The risk factors for HC are ≥ 6 years old, presence of aGVHD and CMV infection.