The surgical management and the nutritional support in patients with AHNP were reported.We consider that the necrosis of the pancreas complicated with infection should be operated and that parenterally nutritional support could be helpful to patients with AHNP.

Objective To explore the operative technique of endoscopic thyroidectomy and prevent its complications.Methods A retrospective analysis was made on the clinical data of 32 patients with benign thyroid diseases who were treated with endoscopic thyroidectomy between May 2002 and March 2005.Results Thirty-two cases were successfully treated with the mean operation time 130 min(80～180 min).Twelve cases with thyroid adenomas and 20 cases with thyroid tubers were confirmed by histologic examinations.In this group,the postoperative complications included fat liquefaction in 2 cases and transient hoarseness in 1 case who recovered 3 months after operation.No parathyroid injury occurred.The drainage tubes were removed 2~3 days after operation.All of the patients were discharged 2~5 days after operation.Conclusion Endoscopic thyroidectomy is safe and feasible with favorable cosmetic effect.

Mucins(MUC)are secreted by the epithelial cells of polymer ,the height of glycosylation gly-coprotein,widely existing in the respiratory system ,digestive system,urogenital system in the mucosa epithelium and mucus secretion .The resent studies show that sticks are closely associated with tumor protein family .Among them,the sticky protein 1(CA153)and 16 mucins(CA125)has been confirmed that the abnormal expression in the bile duct carcinoma.However,there is unclear relationship between the development ,invasion,metastasis and prognosis of gallbladder .Based on the retrospective literature at home and abroad in recent years , the research progress on the sticky protein 1 and mucins 16 in the gallbladder is summarized in the present review .

Objective To study the influence of intraperitoneal instillation of arsenic trioxide (As_2O_3) on metastasis of hepatoma cell line H_22 under CO_2 pneumoperitoneum in mice. Methods The experiment included 40 Kunming mice (cleaning inbred strain). A 1 mm trocar was punctured through the middle abdomen, by which 1?106 tumor cells were administered. Pneumoperitoneum was established with carbon dioxide at the pressure of 8 mm Hg over 30 min. Afterwards, the mice were randomly divided into four groups with 10 mice in each group, receiving intraperitoneal instillation with one of the following: normal saline (1 ml), As_2O_3 (2 mg/kg, 1 ml), As_2O_3 (4 mg/kg, 1 ml), or As_2O_3 (4 mg/kg) with heparin (10 U/ml) (1 ml totally). Levels of CD_44 and vascular endothelial growth factor (VEGF) were measured on the 3rd and 7th day after pneumoperitoneum, respectively. And the survival condition, abdominal circumference, body weight, and diameter of metastatic tumor were compared among the four groups.Results Compared with control group, significantly lower expressions of CD_44 and VEGF were observed the other three groups on the 3rd and 7th day after pneumoperitoneum (P

Objective To investigate the causes and management of T-tube obstruction after laparoscopic common bile duct exploration.Methods The clinical data of 5 patients who developed T-tube obstruction after laparoscopic common bile duct exploration from Jan.2009 to Oct.2013 were retrospectively analyzed.Results Among the 5 patients with T-tube obstruction,there were 3 patients with residual stones,1 with T-tube kinking at an angle,and 1 with abdominal muscle contraction compressing the T-tube.All of them were cured after treatment.Conclusions There is some risk of T-tube obstruction after laparoscopic common bile duct exploration.The key to resolve this problem is to play detailed attention to the operation.There should be timely discovery of the causes of obstruction followed by treatment.

Objective To explore the relation of donor liver's heme oxygenase-1 level to ische-mia/reperfusion injury and the liver function after liver transplantation. Methods Twenty-eight pa-tients receiving orthotopic liver transplantation (OLT) were divided into two groups according to the donor liver's heme oxygenase level of high HO-1 expression group and low HO-1 expression group.The recipients' serum levels of ALT, AST, bile salt output and the expression of HO-1 mRNA were determined and compared between the 2 groups. Results HO-1 mRNA of low expression group in-creased significantly after the reperfusion. Meanwhile, the HO-1 mRNA of high expression group de-creased. The serum levels of ALT and AST of HO-1 in low expression group were much lower but bile salt concentration higher than those in high expression group. Conclusion HO-1 can be further induced in the liver of HO-1 low expression group during the reperfusion period. The I/R injury in the HO-1 low expression group was less severe than that in high expression group, but the liver function was better. The increase of HO-1 during the transplantation seems better for protecting the liver than the initial HO-1 high expression. Kupffer cells are of the main localization for HO-1 protein in human liver.

Objective To investigate the related factors of early liver cancer recurrence associated with elevated fasting glucose levels after radical resection of liver cancer.Methods The retrospective cohort study was adopted.The clinical data of 145 patients with liver cancer who were admitted to the Nanfang Hospital of Southern Medical University from October 2009 to June 2013 werc collected.After radical resection of liver cancer, 111 patients with average level of fasting blood glucose (FBG) ＜ 6.1 mmol/L and 34 patients with level of FBG ≥ 6.1 mmol/L were divided into the normal group and the hyperglycemic group, respectively.The blood glucose levels of patients during the period of hospital stay and follow-up were observed.The status of early recurrence and risk factors affecting recurrence in the 2 groups were analyzed.Follow-up of outpatient examination was applied to patients up to July 1, 2015 with the first recurrence as the end point.Patients had reexaminations once every month within postoperative month 6 and once every 3 months after 6 months.The general information [gender, age, FBG, underlying hepatopathy, preoperative AFP, alanine transaminase (ALT), aspartate aminotransferase (AST), Child-Pugh stage, Barcelona Clinic Liver Cancer (BCLC) stage, history of alcohol drinking], surgical data (surgical method, operation time, number of blood transfusion, volume of intraoperative blood loss), pathological data (histopathological differentiation, number of tumor nodules, diameter of maximal tumor, liver cirrhosis) and follow-up data (postoperative AFP, imaging findings, recurrence time, preventive chemotherapy) were collected.Measurement data with normal distribution were presented as-x ± s and analyzed by the t test.Measurement data with skewed distribution were presented as M (range) and analyzed by the non-parametric test.Count data were analyzed using the chi-square test.With the first recurrence as the end point, the tumor-free survival rate was drawn using the Kaplan-Meier method, and the comparison was analyzed by the logrank test.The risk factors affecting recurrence were analyzed using the Kaplan-Meier method for proportional hazards assumption test firstly, and then eligible factors were done using Log-rank test in the univariate analysis.The multivariate analysis was done using the COX model.Results The postoperative 1-, 2-year overall recurrence rates of liver cancer were 28.3％ (41/145) and 45.5％ (66/145).And 1-, 2-year recurrence rates of liver cancer were 21.6％ (24/111) and 36.9％ (41/111) in the normal group and 50.0％ (17/34) and 73.5％ (25/34) in the hyperglycemic group, respectively, showing significant differences between the 2 groups (x2=10.335, 14.053, P ＜ 0.05).The univariate analysis showed that FBG, Child-Pugh stage, volume of intraoperative blood transfusion and postoperative AFP were risk factors affecting tumor-free survival rate after radical resection of liver cancer (x2 =17.591,6.492, 10.690,12.820, P ＜ 0.05).The tumor-free survival rates at postoperative month 24 in the normal group and hyperglycemic group were 63.1％ and 26.5％ respectively, showing significant difference between the 2 groups (x2=17.591, P ＜ 0.05).The results of multivariate analysis showed that level of FBG ≥6.1 mmol/L, volume of intraoperative blood transfusion ＞ 200 mL and postoperative level of AFP ＞ 8.1 pg/L were independent risk factors affecting tumor-free survival rate after radical resection of liver cancer (RR =2.542, 2.028, 2.724, 95 ％ condifence interval : 1.529-4.225,1.183-3.479,1.635-4.538, P ＜ 0.05).Conclusions Elevated FBG level has a stimulative effect on early recurrence of tumor after radical resection of liver cancer.As a result, monitoring and controlling of blood glucose after operation is helpful in decreasing the early recurrence rate of patients with liver cancer.

Objeetive To analyze the causes and to explore prevention and management of bile leakage after laparoscopic common bile duct exploration with choledochoscopy followed by primary suturing of choledochal incision.Methods The clinical data of 52 patients with bile leakage after laparoscopic common bile duct exploration choledochoscopy and primary suturing of choledochal incision carried out for choledocholithiasis between June 2011 to June 2013 were retrospectively studied.Results All the 52 patients successfully underwent the laparoscopic surgery and left hospital.The operation time was (101 ± 26) minutes (range 55～ 145 minutes).The intraoperative blood loss was (36±28) ml (range 10～ 100 ml).All the patients were ambulatory after the first postoperative day.The recovery time of postoperative gastrointestinal function was (49.8 ± 12.5) hours (range 37 ～ 74 h).The total hospitalization time was (10.8 ± 2.5) days (range 7 ～ 15 days).The average hospitalization days after surgery was (5.7 ± 1.7) days.The average hospitalization cost was (24 827 ± 3 776) yuan.There were two patients who developed intraoperative bile leakage which was treated with further suturing.Five patients developed postoperative bile leakage and they were cured after unobstructed drainage for 5 days through conservative treatment.After a follow-up of 1 ～ 2years,there was no recurrent lithiasis.The stone clearance rate was 100％.There was no bile duct stricture or other complications.Conclusion In expert hands and with proper selection of patients,laparoscopic common bile duct exploration,choledochoscopy and primary suturing of choledochal incision were safe,effective and feasible for choledocholithiasis.

Objective To observe whether rabbit blood leptin can leak into the brain after craniocerebral trauma (CCT),and to dynamically detect serum levels of leptin,growth hormone (GH),and insulinlike growth factor-1 (IGF-1),and leptin level in cerebrospinal fluid (CSF) after CCT.Methods The FITC labeled leptin was injected into blood vessels of 15 adult male rabbits after anesthesia.Then 9 rabbits underwent unilateral fluid percussive impact,while 6 rabbits underwent sham operation.Thirty minutes postoperatively,brain tissue was taken to make frozen sections which were used to observe fluorescence labeled leptin range.Thirty three adult male rabbits were randomly divided into serum group,serum-control group,CSF group and CSF-control group.Rabbits in serum group and CSF group received fluid percussive impact,while rabbits in serum-control group and CSF-control group were drilled a 7 mm window in skull.Rabbits in serum group and serum-control group were phlebotomized 2 ml at 1 d,3 d,7 d and 14 d after operation,and rabbits in CSF group and CSF-control group were extracted CSF 0.5 ml at the same time points.Then serum levels of leptin,GH,and IGF-1,and leptin level in CSF were tested by ELISA.Results The fluorescence imaging could be seen in the injured brain tissue of rabbits with CCT,which was more than those in brain tissue of rabbits receiving sham operation.Serum leptin levels of rabbits in serum group at each time point were higher than those in serum-control group.Serum levels of GH and IGF-1 and leptin level in CSF were higher in rabbits with CCT than those in rabbits without CCT at 1 d,3 d and 7 d after operation.Conclusion The blood leptin can leak into the brain after CCT,which can cause increase of blood GH and IGF-1.And the latter may be the endocrine factors promoting fracture healing after CCT.