Objective To evaluate imaging diagnosis, differential diagnosis, surgery and interventional therapy of hepatic angiomyolipoma associated with tuberous sclerosis.Methods Clinical features, imaging appearances and interventional therapy for 2 cases of HAML in TS were retrospectrively analyzed. Results The features of HAML in TS are as following:(1) Two cases were female with no history of hepatitis and hepatocirrhosis, liver function test and alpha feto protein were normal. (2) the tumor was shown as a multiple hyperechoic mass with sharp margin on ultrasonography; well defined, fat density and intensity mass on computerized tomography (CT); hypervascular mass with early drainage of hepatic vein and tumor staining on angiography. (3) One case underwent interventional therapy. After 42 month follow up, the tumor was found to be diminished in size. Another case was under monitored with only the enucleating of left renal mass. The hepatic tumor showed no change after 10 months.Conclusions The imaging appearances of HAML in TS are relatively characteristic. Superselective arterial embolization is an effective treatment for HAML in TS.

Objective To understand the situation of oxidative stress among diabetic nephropathy (DN) patients and observe the antioxidative effect of losartan at increasing dose in DN patients. Methods Thirty type 2 DN patients who neither smoked and nor took antioxidants were selected. The study began with an initial 4-6 weeks screening-treatment. Eligible patients then received losartan 50 mg/d daily for 8 weeks followed by losartan 100 mg/day daily for an additional 8 weeks. Blood glucose and blood pressure were closely monitored over the whole study period. All patients were followed up every other weeks, their 24-hour urine samples,fresh urine and venous blood sample were collected to measure urinary protein and creatinine excretion, urinary 8-OHdG, SOD, TAOC and MDA excretion , serum SOD, TAOC , MDA and other blood biochemistry parameters. Urinary 8-OHdG was determined by capillary electrophoresis and liquid phase chromatography. Results The total 24 hours urinary 8-OHdG excretion and the serum MDA concentration were higher than the normal values. The serum and urine SOD concentrations were lower than the normal values. There was an improvement in urinary 8-OHdG,serum and urine SOD, serum and urine MDA levels with losartan therapy. Compared with losartan 50 mg/d, the antioxidative effect of losartan 100 mg/d was more noticeable. Obvious decrease in 24-hour proteinuria on exposure to losartan was found, without severe adverse effect. Conclusions Oxidative stress damage is active in DN patients. Losartan has antioxidative effect on DN patients. Compared with losartan 50 mg/d, the antioxidative effect of losartan 100 mg/d is more marked, without increasing side effect. Losartan's antioxidative effect may be involved in its beneficial mechanisms on DN.

The effect of iodinated contrast on thyroid function and auto-antibodies after a single percutaneous coronary intervention (PCI) was explored.In 96 patients with randomly selected PCI,serum TSH,T3,T4,thyroid peroxidase antibody (TPOAb),thyroglobulin antibody (TgAb) were determined preoperatively as well as by 3-6 months postoperatively.After PCI,the level of TSH,T3,T4,showed no significant changes; TgAb,TPOAb which were positive preoperatively,after 3-6 months were statistically increased(P＜0.05).Iodinated contrast in PCI has no significant influence on thyroid function and auto-antibodies after 3-6 months.

Objective To understand the current status of advanced schistosomiasis in Pukou District,Nanjing City,so as to provide the evidence for its appropriate treatment. Method An epidemiological investigation and medical examinations were carried out based on the national standard for the people who either had been already identified as advanced schistosomiasis or were new suspects. Results There were 55 cases of advanced schistosomiasis in Pukou District,2013. Among them,51 cases (92.73%)were splenomegaly type and 4 cases(7.27%)were ascites type. Fifty-three cases(96.36%)were clinically cured,1 case(1.82%)was in the stable condition and 1 case(1.82%)still needed further treatment. In terms of the age,the youngest was 49 years and the oldest was 86 years. The gender distribution was male accounting for 58.18%(32 cases)and female 41.82%(23 cases). Conclusion The condition of patients with advanced schistosomiasis in Pukou District,Nanjing City is complicated. The investigation and treatment to the patients should be conducted regularly.

Objective To investigate the immunoregulatory effects of bone marrow-derived mesenehy-real stem ceils (BMSCs) combined with leflunomide (LEF) on mice T-lymphocytes in vitro. Methods BMSCs from BALB/c mice were isolated and expanded. The purity of BMSCs was identified by flow cytometry (FCM). The BALB/c mice's spleen lymphocytes were isolated by using EZ-Sep<'TM> Mouse 1X. Under ConA stimulation, spleen lymphocytes were pretreated with LEF, then washed and co-cuhured with BMSCs. We set up four groups to investigate in this study: group A, spleen lymphocytes alone; group B, spleen lymphocytes with BM- SCs; group C, LEF-pretreated spleen lymphocytes alone and the group D, LEF-pretreated spleen lymphocytes with BMSCs. T-lymphocytes proliferation was assessed by MTT. FCM was used to analysis T-lymphocytes apoptosis and surface markers of CD69 and CD28. The mRNA expression of interleukin (IL)-2, IL-10 were detected by real-time RT-PCR. Results In vitro, the T-lymphocytes'values of A570 nm were significantly lower in group B and group C, compared with group A (group B vs group C vs group A, 0.578±0.042 vs 0.502± 0.040 vs 0.778±0.035, P<0.01), while the value of A<,570 nm>in group D was 0.218±0.033, which was also obviously lower than that in group B and group C (P<0.01). There were no suppressing effects on T-lympho-cytes'activation and expression of IL-2 had been observed. The proportion of apoptotic T-lymphocytes in group B and group D were (2.29±0.32)％ and (4.22±0.98)％, which was significandy lower than that in group A (8.08±1.20) (P<0.01). The expression of IL-10 in group B and C were also lower than that in group A (group B vs group C vs group A, 0.098±0.039 vs 0.054±0.022 vs 1.000, P<0.01 ). Either, the expression of IL-10 in group D was 0.023±0.015, which was obviously lower than that in group B and group C (P<0.01). Conclusion BMSCs combined with LEF show synergistic immunoregulatary effects on mice's T-lymphoeytes.

Objective To analyse our clinical experience in pediatric living donor liver transplantation (PLDLT).Methods The clinical data of 45 patients who underwent PLDLT in our hospital from April 2005 to April 2014 were retrospectively studied and their preoperative,intraoperative and postoperative data were analyzed.Results All donors recovered well.The graft to recipient weight ratio (GRWR) ranged from 1.0％ ～ 6.4％ (2.5％ ± 1.2％).Size reduction of graft were performed in 2 patients.An interposition venous conduit from the confluence of the native right and left portal vein (PV) to the graft PV was carried out in 1 patient,venous grafts for revascularization of the tributaries of the middle hepatic vein from segment Ⅴ and Ⅷ were used in 3 patients,and a venous patch for revascularization of the left hepatic vein was used in 2 patients.Hepatic artery re-reconstruction was performed in 3 patients after hypoperfusion was detected on intraoperative Doppler ultrasound.The postoperative complications included acute rejection (n =2),vascular complications (n =7),biliary complications (n =11),and infectious complications (n =27).The 1-,2-and 5-year survival rates were all 84.4％.Seven of 45 recipients died within one year post transplantation,with 3 patients who died of vascular complications,and 4 patients who died of infection.The differences in age [(50.8 ± 49.8) months vs (12.6 ± 14.9) months],body weight [(16.2 ± 10.5) kg vs (7.3 ± 1.7) kg],serum total bilirubin [(177.0 ± 126.5) μmol/L vs (301.9 ± 110.6)μmol/L],Pediatric end-stage liver disease (PELD) score (16.1 ± 12.1 vs 26.2 ± 11.3) and GRWR (2.2％ ± 0.8％ vs 4.2％ ± 1.6％) between the survival and the dead groups were significant (P ＜ 0.05).Conclusions PLDLT is an effective method to treat children with end-stage liver disease.Using a multidisciplinary approach in the preoperative management,excellent surgical techniques,and proper postoperative management are extremely helpful to improve postoperative survival rate.

Objective To investigate the characteristics of infection and risk factors after pediatric living donor liver transplantation (PLDLT).Method Form April 2005 to April 2014 the clinical data of 45 cases of PLDLT in General Hospital of Chinese People's Armed Police Forces were retrospectively investigated,and the difference between the patients after PLDLT with infection and those without infection was analyzed.Result Eighty-four infections occurred in 27 (60.0％) of 45 patients,including 25 cases of bacterial infections,14 cases of viral infections,and 3 cases of candida albicans infections.Most infections occurring within 3 months after PLDLT have been found to be caused by bacteria,viruses and fungi.The trough level of tacrolimus (Tac) was in target therapeutic window in 16/20 infected patients and more than 10 ng/mL in 4/20 infected patients within 3 months after PLDLT,and there were 12/16 infected patients with the trough level of Tac of more than 10 ng/mL 3 months post-PLDLT,with the difference being significant (P＜0.05).Multivariate analysis revealed that post-transplant infection was significantly related with the factors as weight＜10 kg,age ＜12 months,biliary intestinal anastomosis,pediatric end-stage liver disease (PELD) score,ChildPugh score,total bilirubin,blood loss per kg body weight and graft to recipient weight ratio (GRWR).Logistic regression analysis suggested that PELD score was independent risk factor of infection after PLDLT.Conclusion The infection after PLDLT has their special characteristics.The proper irnmunosuppressive protocol and control of above risk factors are helpful to decrease the incidence of infection after PLDLT.

OBJECTIVE: To observe the protective effects of Yanggan Lidan Granules (YGLDG) on carbon tetrachloride (CCl(4))-induced liver damage in mice and to find out its mechanism. METHODS: A model of chronic liver damage was established in mice by intraperitoneal injection of CCl(4). After three weeks, those model mice were treated with low-, medium-, high-dose YGLDG, Danning Tablets and bifendate respectively for four weeks. Then the levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as the contents of superoxide dismutase (SOD) and malondialdehyde (MDA) in liver tissues were detected. RESULTS: YGLDG could significantly reduce the levels of serum ALT and AST in model mice, and the content of MDA was obviously decreased while the content of SOD was increased in liver tissue. CONCLUSION: The therapeutic effect of YGLDG on mice with CCl(4)-induced liver damage is to relieve the seriousness of liver damage, and its mechanism may relate to reducing peroxidation activity in liver tissue.

Objective To compare the clinical efficacies of totally laparoscopic and laparoscopy-assisted radical total gastrectomies.Methods The retrospective cohort study was conducted.The clinicopathological data of 373 patients with gastric cancer who underwent totally laparoscopic or laparoscopy-assisted radical total gastrectomies from the 7 medical centers in China (82 patients in the Affiliated Hospital of Qinghai University,80 in the Traditional Chinese Medicine Hospital of Guangdong Province,60 in the First Affiliated Hospital of Xiamen University,51 in the Hangzhou First People's Hospital,46 in the First Affiliated Hospital of Xi'an Jiaotong University,30 in the Second Affiliated Hospital of Jilin University and 24 in the Xijing Hospital of the Fouth Military Medical University) between January 2015 and December 2016 were collected.Of 373 patients,the 183 and 190 patients were respectively divided into the totally laparoscopic group (undergoing totally laparoscopic radical total gastrectomy) and laparoscopy-assisted group (undergoing laparoscopy-assisted radical total gastrectomy),including 63 and 19 in the Affiliated Hospital of Qinghai University,36 and 44 in the Traditional Chinese Medicine Hospital of Guangdong Province,25 and 35 in the First Affiliated Hospital of Xiamen University,20 and 31 in the Hangzhou First People's Hospital,10 and 36 in the First Affiliated Hospital of Xi'an Jiaotong University,17 and 13 in the Second Affiliated Hospital of Jilin University,12 and 12 in the Xijing Hospital of the Fouth Military Medical University.Routine five-port method was applied for laparoscopic radical total gastrectomy and D2 lymphadenectomy.Roux-en-Y anastomosis was applied for digestive tract reconstruction,and digestive tract reconstruction was performed under laparoscopy in the totally laparoscopic group and via upper abdominal median incision in the laparoscopy-assisted group.Observation indicators:(1) operation and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative overall survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as x±s.Comparison between the groups was analyzed by the t test.Measurement data with skewed distribution were represented as M (range).Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Results (1)Operation and postoperative situations:all the patients in the 2 groups underwent successful operations,without perioperative death.Esophagojejunostomy methods of 183 patients in totally laparoscopic group:conventional circular stapler method were performed in 28 patients,anti-puncture circular staplar method in 6 patients,OrVilTM method in 5 patients,functional end-to-end esophagojejunostomy method in 65 patients and peristalsis side-to-side esophagojejunostomy method in 79 patients.Conventional circular stapler method was applied to 190 patients in the laparoscopy-assisted group.Operation time,time of esophagojejunostomy,length of assisted incision,using time of analgesics and expenses of digestive tract reconstruction were (238± 55)minutes,(29±9)minutes,(5.1 ± 1.1)cm,(2.2±l.0)days,(18 332±2 141)yuan in the totally laparoscopic group and (217±39)minutes,(26±7)minutes,(7.8 ±2.0)cm,(2.7± 0.9)days,(16 237 ± 1 923)yuan in the laparoscopy-assisted group,respectively,with statistically significant differences between the 2 groups (t =4.324,3.455,-16.835,-5.561,9.949,P＜0.05).The cases with postoperative overall complications,anastomosis leakage,anastomosis stricture,anastomosis bleeding and expenses of esophagojejunostomy were respectively 24,9,7,5,(9 668±2 814)yuan in the totally laparoscopic group and 24,8,9,6,(9 331 ±2 067)yuan in the laparoscopy-assisted group,with no statistically significant difference between the 2 groups (x2 =0.036,0.107,0.189,0.059,t=1.322,P＞0.05).All the patients with postoperative complications were cured by symptomatic treatment.(2) Follow-up and survival situations:of 373 patients,336 were followed up for 4-26 months,with a median time of 13 months,including 166 in the totally laparoscopic group and 170 in the laparoscopy-assisted group.During the follow-up,cases with overall survival,tumor recurrence and tunor metastasis were respectively 150,10,16 in the totally laparoscopic group and 154,9,16 in the laparoscopy-assisted group (10 and 9 patients in the totally laparoscopic and laparoscopy-assisted groups with simutaneous tumor recurrence and metastasis),showing no statistically significant difference between the 2 groups (x2 =0.075,0.010,P＞0.05).Conclusions Total laparoscopic and laparoscopyassisted radical total gastrectomies are safe and feasible,with equivalent overall outcomes and effects of esophagojejunostomy.Compared with laparoscopy-assisted radical total gastrectomy,the postoperative pain time of patients in total laparoscopic radical total gastrectomy is less,but there are longer time of esophagojejunostomy and higher expenses of digestive tract reconstruction.

Adult ; Delivery of Health Care ; Female ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Occupational Health