Objective To evaluate the outcome of the laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy. Then define the characteristics of the learning curve of this procedure. Methods A prospectively collected database comprising all medical records of the first 79 consecutive patients underwent laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy performed by one surgeon was studied. The patients were divided into seven groups (13 cases in last group) by operative sequence. Data on patients' demographics, clinical and outcome variables including operative duration, conversion to open surgery, complications, and length of hospital stay were analyzed. The learning curve for the laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was established through the moving average and ANOVA methods. Results Comparing the early with the late experiences (33 v. 46 cases), the surgeon-specific outcomes significantly improved in terms of operating times [(292.7 ± 29.8) vs (215.3 ± 10.2) min, P < 0.05], There was four patients converted to open surgery in the early of experiences.the late experiences was five case, it was no statistical significance. significant differences were not shown in the hospitalization period and infectivity complications. Conclusion Operative duration can be reduced with increasing experience of laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy, In this study, the learning curve for a laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy was about thirty-three cases.

The tracheocutaneous fistula after tracheostomy is a complex clinical problem. An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature. We used a turnover skin flap to cover the fistula. All the procedures were completed at bedside under local anesthesia. The fistula was successfully closed and well healed without complications within 7-9 days. It has been proven that this operation is simple, effective, and safe.
Aged ; Aged, 80 and over ; Cutaneous Fistula ; etiology ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; surgery ; Respiratory Tract Fistula ; etiology ; surgery ; Surgical Flaps ; Tracheal Diseases ; etiology ; surgery ; Tracheotomy ; adverse effects

OBJECTIVETo investigate the impact of the ischemic postconditioning on the tumor necrosis factor (TNF)-α/IL-6/signal transducers and activators of transcription (STAT)-3 signal pathway of liver regeneration.

METHODSNinety healthy clean grade male Sprague-Dawley rats weighting 230 to 280 g were selected and assigned into three groups randomly: group I subtotal hepatectomy (SH), group II ischemia reperfusion (IR), group III ischemic postconditioning (IPO). The left and middle liver was resected, and the remnant liver was treated as followed: the blood flow was not blocked in SH group, but blocked 30 minutes in IR group, then reperfused; IPO groups received three cycles of 30 s-30 s intermittent interruptions of blood flow at onset of reperfusion. At 1, 6, 12, 24, 48 h after reperfusion, the serum TNF-α, IL-6 was detected and the mRNA of cyclinD1, Cdk4, STAT-3 was assayed by real-time PCR as well as the protein expression of cyclinD1 and Cdk4 by Western blot.

RESULTSCompared with SH group, the expression of IL-6 declined at each set time point in IR group (t = 5.076 to 8.334, P = 0.000), but the content of TNF-α increased in early stage (1 to 12 h) (t = 2.972 to 7.215, P = 0.000 - 0.014). The expression of STAT-3, cyclinD1 and Cdk4 mRNA and protein of cyclinD1 and Cdk4 at 24 and 48 h after reperfusion were lower in IR group than in SH group (t = 2.857 to 6.684, P = 0.000 to 0.017). However, there was a significant decrease in TNF-α from 1 to 12 h after reperfusion (t = 2.995 to 4.112, P = 0.002 to 0.017), but a significant increase in IL-6 in IPO group than in IR group (t = 2.458 to 3.543, P = 0.005 to 0.034). The expression of STAT-3, cyclinD1, Cdk4 mRNA and protein of cyclinD1 and Cdk4 at 24 and 48 h after reperfusion were all increased in IPO group in comparison with in IR group (t = 2.383 to 6.803, P = 0.000 to 0.038).

CONCLUSIONSThe ischemic postconditioning could promote the remnant liver regeneration after subtotal hepatectomy with ischemia reperfusion injury. Its mechanism relates with the activation of the TNF-α/IL-6/STAT-3 signal pathway of and the cyclinD1-Cdk4 complex which enhances the proliferation of hepatocyte.

Animals ; Cyclin D1 ; metabolism ; Cyclin-Dependent Kinase 4 ; metabolism ; Hepatectomy ; Interleukin-6 ; metabolism ; Ischemic Postconditioning ; Liver ; metabolism ; Liver Regeneration ; Male ; Rats ; Rats, Sprague-Dawley ; STAT3 Transcription Factor ; metabolism ; Signal Transduction ; Tumor Necrosis Factor-alpha ; metabolism

Enuresis ; diagnosis ; pathology ; physiopathology ; Female ; Humans ; Middle Aged ; Polysomnography ; Sleep Apnea, Obstructive ; diagnosis ; pathology ; physiopathology

BACKGROUNDIn China the ginseng root began to be used in medicine over 2000 years ago. Ginsenosides are the most important component isolated from ginseng. The authors investigated the effect of ginsenoside Rg1 on the spectrum of gene expression in the endothelial cells stimulated by TNF-alpha and further explored the potential molecular mechanism of endothelial protection by ginsenoside Rg1.

METHODSNitric oxide (NO) production in the cultured human umbilical vein endothelial cells (HUVECs) was measured by using an NO assay kit. A home-made oligonucleotide microarray containing approximately 400 cardiovascular disease-related genes was constructed. The alteration of the spectrum of gene expression induced by ginsenoside Rg1 in HUVECs which were activated by TNF-alpha were detected by oligonucleotide microarray analysis.

RESULTSNO production in HUVECs was decreased significantly after TNF-alpha treatment, while pretreatment with ginsenoside Rg1 enhanced NO production in TNF-alphastimulated HUVECs. Ginsenoside Rg1 affected the expression levels of genes involved in vascular constriction, cell adherence, coagulation, cell growth and signal transduction in TNF-alphastimulated HUVECs.

CONCLUSIONSGinsenoside Rg1 could enhance NO production and the expression of eNOS mRNA in TNF-alpha stimulated HUVECs. Ginsenoside Rg1 regulated sets of genes in endothelial cells and protected endothelial cells from TNF-alpha activation. Microarray analysis provided us with valuable insights into the atheroprotective mechanism by gingsenoside Rg1.

Endothelial Cells ; drug effects ; physiology ; Gene Expression ; drug effects ; Ginsenosides ; pharmacology ; Humans ; Nitric Oxide ; biosynthesis ; Nitric Oxide Synthase ; analysis ; Nitric Oxide Synthase Type III ; Oligonucleotide Array Sequence Analysis ; Tumor Necrosis Factor-alpha ; pharmacology

Adult ; Balloon Occlusion ; instrumentation ; Cardiac Catheterization ; methods ; Coronary Angiography ; Coronary Vessel Anomalies ; therapy ; Female ; Humans ; Vascular Fistula ; therapy

OBJECTIVETo investigate the effect of transurethral resection of the prostate (TURP) in the treatment of advanced prostate cancer with bladder outlet obstruction (BOO).

METHODSWe included in this study 43 cases of advanced prostate cancer with BOO treated by TURP, and analyzed their IPSS, maximum urinary flow rate and relevant risk factors pre-operatively and at 3 and 12 months after TURP.

RESULTSCompared with the baseline, IPSS and the maximum urinary flow rate of the patients showed significant differences 3 months after surgery ([19.60 +/- 0.41] score vs. [9.58 +/- 0.33] score, [4.93 +/- 0.68] ml/s vs. [8.96 +/- 0.47] ml/s, P < 0.05), but not at 12 months ([15.73 +/- 0.66] score, [5.67 +/- 0.44] ml/s). In multiple regression analysis, a good outcome was associated with pre-operative acute urinary retention, while poor prognosis with hormone-refractory prostate cancer.

CONCLUSIONIn the treatment of advanced hormone-refractory prostate cancer with BOO, TURP can reduce IPSS and increase the maximum urinary flow rate in the early period after surgery, but its long-term effect is not so desirable. Meanwhile the operation itself may bring about relevant complications and reduce the patient's quality of life.

Aged ; Aged, 80 and over ; Feasibility Studies ; Humans ; Male ; Middle Aged ; Prostatic Neoplasms ; surgery ; Transurethral Resection of Prostate ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; surgery

Adult ; Dextrocardia ; surgery ; Ductus Arteriosus, Patent ; surgery ; Fluoroscopy ; Heart Septal Defects, Ventricular ; surgery ; Humans ; Male ; Surgical Instruments ; Vena Cava, Inferior ; abnormalities

Aptamers are capable of binding a wide range of biomolecular targets with high affinity and specificity. It has been widely developed for diagnostic and therapeutic purposes. Because of unique three dimensional structures and cell-membrane penetration, aptamers inhibit virus infection not only through binding specific target, such as the viral envelope, genomic site, enzyme, or other viral components, but also can be connected to each other or with siRNA jointly achieve antiviral activity. Taking human immunodeficiency virus and hepatitis C virus as examples, this paper reviewed the effects and mechanisms of aptamers on disturbing viral infection and replication steps. It may provide an insight to the development of aptamer-based new antiviral drugs.
Antiviral Agents ; pharmacology ; Aptamers, Nucleotide ; pharmacology ; therapeutic use ; Genome, Viral ; drug effects ; HIV ; drug effects ; HIV Reverse Transcriptase ; metabolism ; Hepacivirus ; drug effects ; genetics ; Humans ; Macular Degeneration ; drug therapy ; Neoplasms ; drug therapy ; Oligodeoxyribonucleotides ; therapeutic use ; RNA, Small Interfering ; pharmacology ; SELEX Aptamer Technique ; Viral Envelope Proteins ; metabolism ; Virus Replication ; drug effects

Objective: This research aimed to explore the therapeutic effect and its mechanism of pirfenidone in liver cirrhosis induced by carbon tetrachloride in mice. Methods: Sixty male C57 BL/6 mice were randomly divided into the control group, model group and different doses of pirfenidone group, twelve rats in each group. Mice were intraperitoneally injected with 20％ CCl4 soybean oil solution ( 5 ml/kg), twice a week for 7 weeks. And these mice were free to drink 20％ ethanol solution in the third week after building the model. The low, medium and high dose groups were respectively given 50, 100 and 200 mg/kg of pirfenidone solution according to the body weights, while the model group and control group were given equal volume of blank solvent after building the model, once a day for 2 weeks. The serum level of ALT and AST, liver index, spleen index, the gene or protein expression level of TGF-β1 and Smad3 were analyzed before and after the treatment of pirfenidone. Results: The serum level of ALT, AST increased significantly in the model group ( P＜0. 05), while decreased significantly in different doses of pirfenidone group ( P＜0. 05). The liver and spleen index in the model group was significantly higher than that in the control group ( P＜0. 05). However, after treating with pirfenidone, the liver and spleen index were significantly lower than that in the model group ( P＜0. 05). The number of TGF-β1 positive cells in the model group was significantly more than that in the control group, but it was significantly decreased in the pirfenidone group. The gene expression level of Smad3 in the model group was significantly higher than that in the control group ( P＜0. 05). The gene expression level of TGF-β1 and Smad3 in different doses of pirfenidone group were significantly lower than that in the model group ( P＜ 0. 05). Meanwhile, the protein level of TGF-β1 and Smad3 were significantly increased in the model group, while decreased in the pirfenidone group. Conclusion: Pirfenidone relieves liver cirrhosis caused by carbon tetrachloride in mice by inhibiting the TGF-β1/Smad3 signaling pathway.