Objective To evaluate the indications of different hepatic blood flow occlusion in hepatectomy of cancer patients. Methods One hundred and fifty-six patients admitted between 1991-2001 underwent hepatectomy with hepatic blood flow occlusion in different ways, among them 48 cases underwent hepatic segmentectomy with segmental portal vein occlusion by a balloon catheter, 71 cases underwent hepatectomy with porta hepatis occlusion by Pringle method, 37 cases treated by hemihepatectomy or partial hepatectomy with hemihepatic occlusion. Results Intraoperative blood loss in patients using balloon catheter was smaller and postoperative liver function recovered faster compared with other ways of blood flow occlusion. Conclusion The preliminary result shows that hepatic segmentectomy with segmental portal vein occlusion by a balloon catheter is safe and useful technique for hepatectomy.

Objective To investigate the clinical features of renal tumor patients with yon Hip-pel-Lindau (VHL) disease. Methods Clinical data of 9 renal tumor cases with VHL disease were analyzed and reviewed. The renal tumor characteristics were compared with data of 46 sporadic renal cell cancer (SRCC) cases during the same period. Results In the 9 renal tumor cases with VHL dis-ease presented, significant statistical differences were found in the aspects of bilateralness (7 vs 0), ipsilateral multicentricity(5 vs 2)and cystic growth pattern(6 vs 1) compared with SRCC (P＜0.01). During the average follow-up period of 54 months, no significant difference was found in the median survival between VHL disease patients and SRCC patients(136 vs 42 months). However, a better tendency of VHL disease over SRCC was found in survival curve study. Conclusions VHL disease should be considered when renal tumors present bilateral, multicentric or with cystic growth pattern. Management should be individualized with close watchful waiting in combination with nephron sparing surgery. Nephrectomy should be avoided when possible.

Objective To explore the effects of renal artery calcification on the renal function in type 2 diabetic ne-phropathy rats .Methods Rats were randomly divided into control group ( CON group ) , diabetic nephropathy group ( DN group) and DN with vascular calcification group ( DN+VC group) .Rats of group DN and DN +VC were fed with high sugar and fat diet and injected with streptozotocin (STZ)into abdominal cavity to induce type 2 diabetes. After diabetic models were made , rats of group DN+VC were treated by vitamin D 3 plus nicotine .The rats were sacrificed at 8 , 12 and16 week respectively and the pathologic change to the renal artery were microscoped by von Kossa staining .The calcium content were detected by calcium assay kit and double immunofluorescence staining and real-time polymerase chain reaction ( RT-qPCR) were applied to detect the protein and gene expression levels of BMP2 in the renal artery.Measure the levels of blood urea nitrogen (BUN),serum creatinine (Scr),cystatin C (Cys C) and 24 hour urinary protein (24-h UA)respectively at the 8th,12th and 16th weeks.Histopathology of kidney was assessed by hematoxylin/eosin staining .Results The deposition of black granules , the calcium content and the protein and gene expression levels of BMP 2 in DN group were significantly higher than those in group CON and lower than DN+VC group at each time points(P<0.05).The BUN, Scr, Cys C and 24-h UA in group DN and group DN+VC were gradually increased in 8th,12th and 16th weeks, and were higher than those in group CON( P<0.05 ) .Compared with the DN group , only the level of Cys C at each time point and the level of 24-h UA in 16th week in DN+VC group were significantly higher ( P<0.05 ) .The pathological damages of the kidney in group DN showed a continual worsening trend and the pathological changes of the kidney in group DN +VC were more serious than group DN .Calcium content was positively correlated with the increased serum BUN , Scr, Cys C, 24-h UA and BMP2 mRNA ( all P<0.01 ) .Conclusions The occurrence and severity of renal artery calcification may participate in and promote the progression of DN .

Objeetive To explore the effects of renal artery calcification on the progression of diabetic nephropathy (DN),the activation and its role of bone morphogenetic protein 2(BMP2) signal pathway in renal artery of rats.Methods Sixty male SD rats were randomly divided into control group(CON group),DN group and DN with vascular calcification group (DN+VDN group).Rats of group DN and DN + VDN were fed with high sugar and fat diet and injected with streptozocin (STZ) into abdominal cavity to induce diabetes.After diabetic models were successfully made,rats of group DN+ VDN were treated by vitamin D3 plus nicotine.The rats were sacrificed at 8th,12th and 16th week respectively and the levels of renal function,blood glucose and 24 h urinary protein (24-h Upro) were measured.The pathologic changes to the renal artery were observed by yon-Kossa staining and the calcium content was detected by calcium assay kit.The pathologic changes to the kidney were observed by HE.Immunohistochemistry was applied to detect the protein expression of BMP2/Smad1/Runx2/ Osterix signal pathway in the renal artery and real-time PCR were applied to detect the mRNA expression levels of BMP2 and Runx2.Results The calcium content and the deposition of black granules in DN group were significantly higher than those in group CON and lower than DN + VDN group at each time point (P ＜ 0.05).The renal function indices in group DN and group DN+VDN were gradually increased in 8th,12th and 16th weeks,and were higher than those in group CON (P ＜ 0.05).Compared with that in DN group,although the level of BUN,Scr,Cys C and 24-h Upro in DN+VDN group rats were higher at different time point,the level of Cys C at each time point and the level of 24-h Upro in the 16th week showed significant differences (P ＜ 0.05).The pathological damages of the kidney in group DN and DN+VDN showed a continual worsening trend and the pathological changes of the kidney in group DN+VDN were more serious than those in group DN.Furthermore,the levels of BMP2/Smad1/Runx2/Osterix signal protein and BMP2,Runx2 mRNA in DN rats were higher than those in CON group,lower than DN+VDN group at each time point (P ＜ 0.05).Correlation analysis demonstrated that calcium content was positively correlated with serum BUN,Scr,Cys C,24-h Upro and the expression of BMP2,Runx2 mRNA (r=0.835,0.705,0.829,0.897,0.641,0.683,P ＜ 0.01,respectively).Conclusion Renal artery calcification may participate in and promote the progression of DN,and the BMP2 signal pathway may be an important regulating factor in DN with renal artery calcification.

Objective To investigate the effects of different doses of remifentanil on learning and memory ability,the expression of hippocampal tissue phosphorylation of cAMP response element binding protein (p-CREB)in developing rats.Methods A total of 72 Sprague-Dawley rats (1 9-23 g) were randomly divided into 4 groups (n =18 each):Group C:normal saline control group;R1,R2, R3 group received continuous intraperitoneal remifentanil 1,5,10 μg·kg-1 ·min-1 for 2 hours re-spectively.Both total volume of remifentanil and saline were 2 ml.The SpO 2 and pulse rates were mo-nitored during the experiment.Step-down test was used to evaluate the learning and memory ability, while Western blot analysis was performed to measure the expression of hippocampal p-CREB protein in 4 h,24 h,1 week when the rats were awake.Results Compared with group C,group R1 and R2, pulse rates of group R3 decreased significantly (P <0.05 ),but the changes of SpO 2 in each group were not statistically significant.At 4 h point:compared with group C and group R1,the error times in step-down test were increased in both group R2 and R3,the latencies were shortened (P <0.05);Compared with group R2,the error times were increased in group R3,latency was shortened (P <0.05).At 24 h point,compared with group C and group R1,the error times were increased in group R2,R3,latencies were shortened (P < 0.05 );Compared with group R2,the error times were in-creased in group R3,latency was shortened (P <0.05 ).The error times and latency of each group had not statistical significance in one week.At 4 h point,the expression of p-CREB protein in hippo-campus of group R3 downregulated compared with group C and group R1,R2,respectively (P <0.05).At 24 h point,the expression of p-CREB protein in hippocampus of group R2,R3 decreased compared with group C and group R1 respectively(P <0.05);The expression of p-CREB protein in each group had no statistical significance in one week.Conclusion 5-10 μg · kg-1 · min-1 dose of remifentanil can result in a decline of learning and memory ability in the developing rats in short-term,and the mechanism may relate to the inhibition of p-CREB protein expression in hippocampus.

Objective To observe the expression of high mobility group A 1(HMGA1)protein in pituitary adenoma(PA)and explore its relationship with the aggressiveness and recurrence of PA .Methods The labeling index(LI)of HMGA1, detected by immunohistochemistry staining , was compared between aggressive and non-ag-gressive PA, recurrent and non-recurrent PA.Results The expression of HMGA1 were observed in all 52 cases of PA and homogenously distributed in nuclear of tumor cells .The LI of HMGA1 showed no significant difference between functioning and nonfunctioning PA (P=0.79), as well as among different immunophenotypical variants of PA(P=0.28).The expression of HMGA1 was significantly higher in the aggressive PA than in the nonaggres-sive PA(0.50 ±0.20 vs 0.24 ±0.17, P=0.000).Patients with a recurrent PA had a higher value of HMGA 1 than patients with a non-recurrent PA(0.60 ±0.20 vs 0.24 ±0.18, P=0.000).The expression of HMGA1 in-creased stepwise with the tumor size, as the highest was present in macro-sized PA(0.52 ±0.20)and the lowest was in micro-sized PA(0.18 ±0.17).A similar trend was found in Hardy's grade I(0.18 ±0.17),II(0.30 ± 0.20)and III-IV(0.50 ±0.20)(P=0.003).The area under the ROC curve was 0.918(>0.90).When the LI reached 49.2%, the predicting specificity was 90.5%and the sensitivity was 71.4%.Conclusions The LI of HMGA1 has a positive correlation with the tumor size , aggressiveness and recurrence of PA and also has a valua-ble predicting efficacy for PA recurrence .The characteristics of HMGA 1 in PA can help pathologists make repro-ducible evaluation on prognosis of PA .

Objective To study the relationship between the leukoaraiosis (LA) and obstructive sleep apnea/hypopnea syndrome(OSAHS)in the elderly. Methods 169 cases of OSAHS diagnosed by polysomnogram (PSG) underwent brain MRI to evaluate the incidence and degree of LA and to explore the relationship between LA and OSAHS in the elderly. Results LA was found in 145 (85.80%) of 169 OSAHS cases, and rdmong them, mild LA in 27 cases (15.98%), moderate in 65 (38.46%) and severe in 53 (31.36%). There was a significant correlation of LA with age, oxygen desaturation index,MSaO2 sleep time spent when SaO2＜90%,apnea hyponea index(AHI)(P＜0.05).By multivariate regression analyses, age and oxygen desaturation index were the most vital effective factors for LA. Conclusions With the increase of patients'age and oxygen desaturation index,LA becomes more common and aggravated. Appropriate interventive treatment for OSAHS will be able to ameliorate the LA-induced cognitive dysfunction.

Objective To investigate the clinical efficacy of finger reconstruction in child with second toe transplantation,and evaluate the postoperative appearance and function regarding the reconstructed donor feet.Methods From June 2002 to May 2011,sixteen cases were reconstructed in sub-emergency with second toe transplantation.Two thumbs,eight index fingers,and 6 middle fingers were reconstructed.All patients were followed-up from 12 to 24 months.The functions of reconstructed fingers were analysed.Results All the reconstructed fingers survived.Vascular crisis occurred in 1 patient,and survived after re-anastomosis.Necrosis of skin grafts at the domon site with exposed tedons was seen in 1 ease,and healed after changing dressings.All the reconstructed fingers showed good in growth and development,and performed good functions as grabbing,grasping and nipping.Two-point discrimination was between 6 mm and 10 mm.The donor site of the foot had normal gait,without obvious influence on walking.Also,no pain was complained.Conclusion The method of transplanting the second toe can reconstruct the appearance and function of the finger defects in child,and has little effect on the appearance and motion of feet.It is an effective treatment method.

To evaluate the use of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for treatment of acute and chronic leukemia, from March 1997 to January 2003, 21 adult patients with malignant hematopoietic diseases underwent allo-PBSCT from HLA-identical siblings (19 patients) and haplo-identical mother (one) and one B point site mismatched sibling (one). All donors were mobilized with G-CSF for 4 days and peripheral blood stem cells were collected by CS-3000 separator. The conditioning regimen included the high dose combination chemotherapy and TBI. Cyclosporine-A (CsA) plus a short course of MTX was used for GVHD prophylaxis in all patients. The results showed that after trans plantation, median time for the recovery of granuocyte > or = 0.5 x 10(9)/L and platelets > or = 20 x 10(9)/L were 12 (10 - 20) and 15 (11 - 35) days, respectively. Acute GVHD was observed in 8/17 patients (47%), of which one transplanted from HLA-haploidentical mother. Chronic GVHD occurred in 12/17 patients (70%). All of four female survivals did not show acute and chronic GVHD. Day 100 transplantation-related mortality was 14% (3/21). Relapse occurred in two patients (9.5%) who underwent allo-PBSCT in stage of non-remission at one and six months. After follow-up of 40 (15 - 70) months, 11 patients (52.4%) are still disease-free survival. These results suggested that peripheral blood stem cells produce a faster hematopoietic recovery and a lower relapse of leukemia. The rate of aGVHD is not increased when using the peripheral blood as source of stem cells; however, cGVHD continues to be a significant problem. Donors tolerated the procurement procedure without complications.
Adolescent ; Adult ; Female ; Graft vs Host Disease ; etiology ; Humans ; Leukemia ; therapy ; Male ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Transplantation, Homologous ; Treatment Outcome

OBJECTIVETo study the application of three-dimensional visualization technology for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.

METHODSSix cases of cystic carcinoma in the pancreatic body and tail treated between Nov, 2009 and Mar, 2011 were retrospectively analyzed. The original image data of 64-slice spiral CT were collected and using adaptive region growing algorithm, the serial CT images were segmented and automatically extracted to obtain the 3-dimensional reconstruction images with customized image manipulation software. The specific surgical approach (the trocar position) and surgical procedure were planned based on the reconstructed mode.

RESULTSThe reconstructed 3-dimensional model clearly displayed cystic carcinoma in the pancreatic body and tail and the adjacent organs, showing distinct relationship between the cystoma and the splenic artery and vein. All the patients successfully underwent laparoscopic resection of the pancreatic body and tail without perioperative death. The spleen was preserved in 5 cases and removed in 1 case due to mucinous cystadenocarcinoma. The overall rate of pancreatic fistulae was 33.3% without incidences of postoperative hemorrhage. The average hospital stay of the patients was 12 days.

CONCLUSIONThree-dimensional reconstruction based on pancreatic CT data provides valuable assistance for laparoscopic resection of cystic carcinoma in the pancreatic body and tail.

Adult ; Aged ; Computer Simulation ; Cystadenocarcinoma, Mucinous ; diagnostic imaging ; surgery ; Cystadenoma, Mucinous ; diagnostic imaging ; surgery ; Cystadenoma, Serous ; diagnostic imaging ; surgery ; Female ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Male ; Middle Aged ; Pancreas ; diagnostic imaging ; surgery ; Pancreatectomy ; adverse effects ; methods ; Pancreatic Fistula ; etiology ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Retrospective Studies ; Spleen ; surgery ; Tomography, Spiral Computed