China is one of the minority countries which have not passed through the law ot brain death in the world. After efforts of decades, the liver transplantation in China have got great achievements, however, owing to unimplementation of the law of brain death, the main source of grafts was the donor of cardiac death which resulted in the bad quality of grafts and poor curative effect after liver transplantation compared with the international advanced level. The implementation of the law of brain death will promote the improvement of liver transplantation level in China greatly.

Medical dispute has become a hot issue in current China. As to the new rules carried out and the importance of medical data in edical disputes litigation,it is necessary that the medical data should reflect the reality of medical behavior comprehensive,authentic and without delay during the writing in order to avoid the occurrence of medical treatment disputes.

Objective To evaluate serum TPSA and F/T ratio in the differential diagnosis of BPH and PCa. Methods Serum TPSA,FPSA and F/T ratio in 177 cases of BPH and 60 cases of PCa were assessed and evaluated both in patients within and outside the "gray zone". Results TPSA and F/T ratio were both significantly discriminating between benign and malignant diseases (0.010.05) whereas F/T ratio could ( P 0.05). Conclusions Serum TPSA is a prostate carcinoma marker,F/T ratio being an adjuvant marker of TPSA of importance on the differential diagnosis in patients within the "gray zone".

Objective[WT5”BZ] To evaluate the method and timing of operation and long term effect of congenital choledochal cysts(CCC) in adults.[WT5”HZ] Methods[WT5”BZ] The mode and timing of operation, effective rate, reoperation rate and incidence of carcinoma after operation for 70 operated patients with CCC in adults during the period from Jan, 1980 to June 1999 were analyzed retrospectively. [WT5”HZ]Results[WT5”BZ] The reoperation rate of external drainage was 86%(6/7); The effective rate of internal drainage was significantly lower than that of resection of the cyst(3/10 vs 45/49,? 2=20 94, P

Objective To study the surgical technique of right hemihepatectomy in adult-to-adult living donor liver transplantation . Methods Eight donors underwent right hemihepatectomy in adult-to-adult living donor liver transplantation . Among these donors operation, there were 5 right hemihepatectomy and 3 extended right hemihepatectomy . If the diameter of the auxiliary right hepatic vein more than 0.8cm, it should be reserved. The dissection line of right hemihepatectomy was at the 0.5cm～1.0cm to the right side of middle hepatic vein, and the dissection line of extended right hemihepatectomy was at 0.5cm～1.0cm to the left side of middle hepatic vein. Intraoperative cholangiogram was performed, and without inflow vascular occlusion was done during the operation.Results The donor average operation time was 448 min (ranged from 353 min to 510 min). The average blood loss of operation was 384 ml (ranged from 170ml to 900ml). The grafts average weight was 669.4g (ranged from 445g to 900g), the right hemihepatic grafts weighted 667.0g averagely and the extended right hemihepatectic grafts weighted 673.3g averagely.The average graft-to-recipient body weight was 1.16% (ranged from 0.76% to 1.50% ). There were 2 donors occurred complications including biliary leak in 1, and dysfunction of liver and kidney in 1, all the 2 complications were cured. There was no donor mortality and all donors well recovered,All the donors were discharged within three weeks after operation.All of the 8 grafts and 8 recipients survived one year. Conclusions The right hemihepatectomy and extended right hemihepatectomy in adult-to-adult living donor liver transplantation can be performed safely,if the liver resection techmqne is proformed exactly and successfully.

Objective To study the effect of S-adenomethionine on early stage recovery of transplanted liver.Methods From January 2010 to October 2012,57 liver transplantation patients were divided into 2 groups beginning the first day:group A,23 patients were treated with routine liver-protecting therapy,including glycyrrhizin,glutathione,albumin; group B,34 patients treated with additional S-adenomethionine (Transmetil).AST,ALT,T-BIL,D-BIL,γ-GT,ALB and ALP were compared between the two groups at pre-operation and post-operation day 1,day 4,day 7 and day 14.Results All patients suffered from preoperative hyperbilirubinemia,decreased ALB and elevated concentration of AST,ALT,γ-GT and ALP.On the first day after transplant,AST,ALT,T-BIL,D-BIL and γ-GT elevated and ALB decreased significantly in all cases compared with that before operation (respectively t =10.493,7.089,6.584,15.134,5.164,10.344,5.289,13.034,3.389,4.366,all P ＜ 0.01).On the contrary,the value of ALB was lower (respectively t =8.239,11.662,all P ＜ 0.05).On the fourth day posttransplant,ALB level was higher and that of other parameters were lower in group B when compared with group A (respectively t =2.536,2.736,2.218,3.318,4.804,2.892,all P ＜ O.05).This tendency of liver function improvement continued till postoperative day 7 in all cases while the differences between the two groups remained significant (respectively t =6.107,3.256,2.929,11.688,8.964,2.857,all P ＜ 0.05)except for γ-GT.On day 14,while T-BIL and D-BIL in group B were lower than that in group A (respectively t =4.413,8.493,all P ＜0.001),differences of liver functions were not significant between the two groups (respectively t =1.916,1.414,1.168,1.035,1.604,all P ＞ 0.05).Conclusions Transmetil promotes the recovery of transplanted liver's function,elevates the concentrantion of ALB and reduces the concentration of AST,ALT,T-BIL,D-BIL,γ-GT and ALP at early stage after liver transplant.

Objective To observe and discuss the effect of the traditional Chinese drug complex prescription ShensuⅡfrom Xintong Changluo therapeutic principle on renal interstitial fibrosis (RIF) and transforming growth factor-β1 (TGF-β1) expresssion in focal segmental glomerulosclerosis (FSGS) model rats. Methods Forty-eight healthy male SD rats were randomly divided into control group (n=12) and modeling group (n=36). Rats of modeling group were injected by doxorubicin hydrochoride for FSGS model. Rats of modeling group were sub-divided into model group, benazepril group and TCM group randomly. In 12 weeks, TCM group was given by intragastric administration of ShensuⅡ(3.5 g/100 g), benazepril group was given by intragastric administration of benazepril suspension (0.33 mg/100 g), control group and model group were given by intragastric administration of same volume of saline. HE/Masson staining was used to observe changes of tubulointerstitial pathomorphology. The degree of injury and fibrosis was measured. The expressions of fibronectin (FN) and TGF-β1 were detected by immunohistochemical SP method. Results The process of renal interstitial fibrosis was slower in FSGS rats of TCM group. Renal interstitial pathological index was 1.51 ± 0.80 in TCM group, which was lower than that of model group (2.18 ± 0.38) and benazepril group (1.79 ± 0.24). The index of renal interstitial fibrosis was 2.39 ± 0.13 in TCM group, which was lower than that of model group (3.11 ± 0.25) and benazepril group (2.80 ± 0.41). The relative expression of FN in renal interstitial was 14.19 ± 3.06 in TCM group, which was lower than that of model group (21.25 ± 3.31) and benazepril group (18.51±2.29). The relative expression of TGF-β1 in renal interstitial was 2.64±0.21 in TCM group, which was lower than that of model group (6.02 ± 0.12) and benazepril group (3.79 ± 0.46). All the differences were statistically significant (P<0.05). Conclusion Xintong Changluo complex prescription ShensuⅡcan reduce the process of renal interstitial fibrosis in FSGS model rats, which may be related with the inhibiting expression of TGF-β1.

(0.05)).There had significant difference((25.47)?(8.27) vs(32.40)?(5.86)) between them at the seventh day(P

Objective To investigate the clinical effects of laparoscopic sleeve gastrectomy with duodenaljejunal bypass (LSG + DJB) for the treatment of type 2 diabetes mellitus.Methods The clinical data of 17 patients with type 2 diabetes mellitus who underwent LSG + DJB at the Xijing Hospital of the Fourth Military Medical University from March 2013 to February 2014 were retrospectively analyzed.The fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin (HbA1c) and body mass index (BMI) in 17 patients before operation were (9.2 ± 0.6) mmol/L,(14.4 ± 2.2) mmol/L,8.3％ ± 1.2％ and (29.4 ± 2.2) kg/m2,respectively.All the patients received LSG + DJB and were followed up by outpatient examination up to March 2015.The pre-and post-operative 12-month fasting blood glucose,postprandial 2-hour blood glucose,HbA1 c and BMI in 17 patients were compared.Measurement data with normal distribution were presented as-x ± s and analyzed by the t test.Results All the 17 patients received successful laparoscopic LSG + DJB without conversion to open surgery.The operation time,volume of intraoperative blood loss and recovery time of postoperative gastrointestinal function were (141 ±53)minutes,40 mL and 2.5 days.Of 3 patients with postoperative complications,1 patient with anastomotic leakage at postoperative day 5 received reoperation by laparoscopic Roux-en-Y gastric bypass,1 patient with digestive tract obstruction at postoperative day 10 released obstruction by reoperation and 1 patient with left subphrenic abscess and leakage at the upper of the stomach at postoperative week 2 was cured by the symptomatic treatment.The duration of hospital stay was 5.2 days.All the patients were followed up for a median time of 16 months (range,13-24 months).The postoperative 12-month fasting blood glucose,postprandial 2-hour blood glucose,HbA1c and BMI in 17 patients were (5.5 ± 0.7)mmol/L,(8.8 ± 1.7)mmol/L,5.1％ ± 0.7％ and (24.7 ± 2.3)kg/m2,which were significantly different from preoperative indicators (t =19.96,10.52,12.06,31.99,P ＜ 0.05).During the follow-up,no anastomotic ulcer and stenosis,dumping syndrome and severe malnutrition were occurred.Conclusion LSG + DJB is safe and feasible for the treatment of type 2 diabetes mellitus,with a good short-term hypoglycemic effect.

AIM To determine whether botulinum toxin A (BTXa) is an effective and safe treatment for lower limb spasticity and improve walking ability after stroke or traumatic brain injury. METHODS 27 cases with stroke or traumatic brain injury affecting the muscles of lower extremity were selected to receive local intramuscular injection. The injected dose is between 50～100 U?(muscle) -1. All patients received rehabilitation therapy that focused on walking training. Patients were assessed at entry, and 2, 4 weeks post-treatment. The muscle tone was assessed by the modified Ashworth Scale, the changes of time-distance parameters was measured by footprint gait analysis. The correlation relationship between muscles tone and gait parameters was analysed. RESULTS Compared to pretreatment values, the total muscles spasticity, walking distance, and speed were significantly improved in all groups respectively, decrease in the modified Ashworth Score (P