Bone Morphogenetic Proteins ; therapeutic use ; Calcitriol ; analogs & derivatives ; therapeutic use ; Electric Stimulation Therapy ; methods ; Humans ; Osteogenesis ; Osteogenesis, Distraction ; classification ; methods ; Transforming Growth Factor beta ; therapeutic use ; Vitamin D ; analogs & derivatives

Objective To evaluate the effect of omega-3 polyunsaturaed fatty acid on liver function, donor's T lymphocytes and acute rejection following orthotopic liver transplantation in rats. Methods Orthotopie liver transplantation from BN (RT1 n) to Lewis was performed. Normal saline (NS, n = 6), parenteral nutrition (PN, n = 6) or parenteral nutrition and Omega-3 fatty acid (OM, n = 6) was given through internal jugular vein catheter respectively beginning the first day for consecutive 6 days. At 7thday, the liver function and pathological changes of the transplant liver were observed. The percentage of CD4+ , CD8+, CD4+ CD25+ and CD8+ CD28- T lymphocytes were analyzed by flow-cytometry. Results In OM group the CD4+, CD8+ , CD4+ CD25+ and CD8+ CD28- T lymphocytes significantly decreased, compared with NS (t = 4.28, P < 0.01 ; t = 2.63, P < 0.05 ; t = 2.59, P < 0.05 ; t = 8.86, P <0.01)or PN group(t =8.06, P<0.01; t =3.57, P<0.01; t =5.35, P<0.01; t =7.98, P<0.01). The ratio of CD4+ to CD8+ significantly decreased in OM group compared with NS group and PN group(t = 6.25, P<0.01; t=4.92, P<0.01). RAI (rejection activity index) in NS group, PN group and OM group was 7.17 +0.98, 6.17±0.75 and 4.33±0.52, respectively. The rejection grade in OM group was siguificanfly alleviated than that in NS group and PN group(t =6.25, P <0.01;t =4.92, P <0.01). Conclusion Omega-3 fatty acid inhibits T lymphocytes, especially help T lymphocytes, alleviates acute rejection. The suppressor T cell and the regulatory T cell were not responsible for the alleviation of the rejection.

Adult ; Aged ; Bone Transplantation ; Female ; Fibula ; transplantation ; Free Tissue Flaps ; Humans ; Male ; Mandible ; surgery ; Maxilla ; surgery ; Middle Aged ; Muscle, Skeletal ; transplantation ; Reconstructive Surgical Procedures ; methods

Objective:To explore the protective effect of ellagic acid on the acute liver injury induced by carbon tetrachloride (CCl4) of the mice,and to explore its possible mechanism.Methods:A total of 50 mice were randomly divided into normal control group,model group,low,medium and high doses of ellagic acid groups (n=10).The mice in normal control group and model group were treated with 1% sodium carboxymethyl cellulose solvent by intragastic administration,and the mice in ellagic acid groups were treated with 160,320,and 480 mg·kg-1 ellagic acid by intragastic administration,respectively.After 14 d,the mice in model group and different doses of ellagic acid groups were intraperitoneally injected with 10 mL·kg-1 0.1% CCl4,while the mice in normal control group were intraperitoneally injected with 10 mL·kg-1plant oil.16 h later,all the mice were sacrificed and the body weights and the liver indexes of the mice were detected;the serum levels of alanine transaminase(ALT),aspartate transaminase(AST) were detected;the activities of superoxide dismutase(SOD) and levels of GSH-Px,malonalde hyde(MDA) and catalase(CAT) in liver tissue of the mice were detected.Results:There were no significant differences of the body weights of the mice between each group before and after treatment(P>0.05).Compared with normal control group,the liver indexes and the levels of serum ALT and AST of the mice in model group and different doses of ellagic acid groups were significantly increased (P<0.05).Compared with model group,the liver indexes of the mice in different doses of ellagic acid groups were decreased(P<0.05);the serum levels of ALT and AST of the mice in high dose of ellagic acid group were significantly decreased (P<0.05),while the CAT level in liver homogenate was significantly increased (P<0.05);the levels of GSH-Px in liver homogenate of the mice in medium and high doses of ellagic acid groups were significantly increased (P<0.05);the activities of SOD in liver homogenate of the mice in different doses of ellagic acid groups were significantly increased (P<0.05),and the MDA levels were significantly decreased (P<0.05).Conclusion:The ellagic acid has the protective effect on acute chemical liver injury in the mice induced by CCl4 and the most effective dose is 480 mg·kg-1;its mechanism may be related to the anti-oxidation.

Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome.Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females;mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed.The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient.Three male patients had left-sided secondary varicoceles.Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta.The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area,and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became fiat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression.Results Stenting was successfully accomplished in all 12 patients.Mean operative time was 62 min (50-125 min),estimated blood loss was 35 ml(20-100 ml),and the hospital stay after operation was 8 days (6-12 days).Three patients had a transient orthostatic intolerance,and they were cured by conservative treatment.With a mean follow up of 14 months (5-30 months),symptoms of hematuria and flank pain resolved in 7/8 and 1/1,respectively.Varicoceles were cured in all three patients.One case got partial relief because of recurrent hematuria due to excessive exercise.Ultrasonography showed that extravascular stent was in the right place,and the angle between abdominal aorta and superior mesenteric artery became normal.The inner diameter of left renal vein was decreased,and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth.Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome.

Objective Acute type A aortic dissection associated pregnancy severely threatens the lives of both the mother and her ferus.We retrospectively reviewed our clinical experience with this life-threatening condition in six cases.Methods Between January 2007 and February 2012,6 women with acute type A aotic dissection associated pregnancy were treated by our group,with an average of 3 1 years (range 24 -37 weeks)and a mean gestation weeks of 24.5 (range,12 -38 weeks ).The etiology was Marfan syndrome in 4 cases and gestational hypertension in 2.The pathology was the modified Stanford type A3S in I case,A2C in 2 and A3C in 3.- Five patients were treated surgically and 1 medically.Surgical operations were performed under hypothermic cardiopulmonary bypass or deep hypothermic circulatory arrest,including Bentall procedure in 1case,Bentall + Sun's procedure in 2,ascending aortic replacement + Sun's procedure in 2.Results The woman treated medically and her fetus died from aortic rupture 9 days after admission.The cardiopulmonary bypass and cross clamp time and circulatory arrest time averaged 167 rninites(range,75 -210 minites) and 98 minites(range,83 - 145 minites) and 23.5minites(range,19 -27 minutes),respectively.Five patients treaed surgically survived the operation.Three fetuses survived rand two fetuses died.After a mean follow-up of 2.2 years (range,1 - 3.5 years ),5 patients were doing well.CT angiogram detected nonmal aortic and valvular structures,with no signs of distal dilation.Three babies were normal in development and neurocognitive functios.Conclusion Palients with aortic dissection associated with pregnancy should be operated on ugently and medical treatment carries high risks of aortic rupture and maternal and fetal death.Methods of surgical repair,peffusion techniques and delivery should be chosen based on the underlying aortic pathology and gestational age,so as to maximize the safety of the mother and her baby.

Objective To investigate the risk factors for conversion of laparoscopic cholecystectomy (LC) to laparotomy.Methods In 1020 LC patients,36 patients with conversion of LC to laparotomy were chosen as the case group,108 patients with successful LC were chosen as the control group.Univariate analysis and Logistic multivariate regression model were used to analyze the risk factors for conversion of LC to laparotomy.Results Age ＞ 65 years (0R=3.234,95％ CI:0.532-6.853),course of disease ＞ 72h (OR =2.342,95％ CI:0.568 ～ 5.656),history of upper abdominal operation (OR =2.453,95％ CI:0.345-7.453),thickness of gallbladder wall ≥ 6 mm (OR =2.453,95％ CI:0.453-6.343),white bloodcell count ＞ 15.0 × 109/L (OR =4.532,95％ CI:0.535-8.329) were risk factors for conversion of LC to laparotomy.Conclusion Preoperative comprehensive evaluation the risk factors and selecting suitable program have important clinical significant in reducing the rate of conversion LC to laparotomy.

Objective To summarize the experience of surgical repair for Stanford type A aortic dissection after cardiac surgery.Methods From February 2009 to December 2011,11 patients who underwent previous cardiac surgery accepted the aortic surgery for Stanford type A aortic dissection.There were 8 males and 3 females.The range of age was from 29 to 64 years,the mean age was(52.27±9.90) years.In these patients,one patient had underwent ventrical septal defect,one patient atrial septal defect,nine patients aortic valve replacement.The interval between the two operations was 1-26 years.The types of aortic dissection was A1S(4 patients),A1C(1 patient),A2S(1 patient),A2C(4 patients),A3C(1 patient).All the patients underwent aortic surgery for aortic dissection.Results The time of cardiopulmonary bypass was 75-409 minutes,the mean value was(185.36± 99.67) minutes.Aortic cross clamp time was 37-203 minutes,the mean value was (84.09± 48.36) minutes.Total six patients needed deep hypothermia and selective cerebral perfusion time was 8-32 minutes.The mean value was(17.71 ± 9.48) minutes.One patient dead in the hospital and the mortality was 9％.The morbidity was 27％.Ten patients followed up 16-45 months.No aortic rupture,paraplegia and death were observed in follow-up time.Conclusion The delayed Stanford type A aortic dissection after cardiac surgery should be attached great importance and always need emergency surgery to save patients' life.The technique is demanding and risk is great for surgeons and patients.For the patients who suffered aortic valve disease combined with dilation of ascending aorta larger than 4.5 cm,the ascending aorta also should be repaired while aortic valve replacement is performed,which could avoid delayed aortic dissection in the future.

Objective To summarize the clinical results of the surgical treatment for Stanford B aortic dissection patients with proximal aortic aneurysm(including aortic root,ascending,arch) by enblock technique.Methods From Jun.2011 to Oct.2015,20 patients with Stanford type B aortic dissection and proximal aortic aneurysm underwent open surgery by enbloc technique in our center.Among them,there were 15 male and 5 female.Average age of patients was(40.65 ± 13.55) years (range:22-65 years).The comorbidities of proximal aortic diseases are ascending aortic aneurysm in 10,aortic root aneurysm in 8,and aortic arch aneurysm in 2.All the surgeries were accomplished by hypothermic cardiopulmonary bypass assist.The combined surgery includes:extra-anatomy bypass grafting in 16,Bentall procedure in 15,ascending aortic repair in 5.Before surgery and discharged from hospital computed tomography angiography(CTA) was performed in each patient.All patients except 2 were followed.During the follow-up,CTA was performed and recorded.Results The average operation time,cardiopulmonary bypass time,aortic clamping time and selective cerebral perfusion (SCP) time are (6.47 ± 1.01)h (4.5-9 h),(173.60 ± 43.39) min (109-303 min),(91.25 ± 28.63) min (51-165 min),(27.25 ± 6.80) min (17-43 min),respectively.The mean nasopharyngeal temperature during SCP is(23.77 ± 1.27)℃ (21.6-26℃).There were no operative deaths.The mean follow-up time is (32.44 ± 17.27)months (range:8-60 months).Two patients underwent aortic re-intervention during follow-up.And 2 patients were lost follow-up(The follow-up rate is 90％).One late death was found.The patient succumbed to sudden distal aortic rupture.Other patients are survived without any complications.Conclusion Enblock technique is a relatively simple procedure in total aortic arch repair surgery.And it can be a safely surgical treatment for type B aortic dissection patients with proximal aortic aneurysm.The indications of enblock technique for Stanford B aortic dissection patients are those who combined with proximal aortic aneurysm.

ObjectiveTo study the feasibility and technique in liver transplantation (LT) in an adult with situs inversus (SI) and reviewed the medical literature on this subject.MethodsA 45-year-old male with complete SI,suffered from progressive hepatic failure secondary to hepatolithiasis,obstructive jaundice,portal hypertension and liver cirrhosis.He underwent liver transplantation in July 2004.His anatomy was studied by preoperative CT scan and three-dimensional liver reconstruction imaging and angiography.LT was performed using the modified piggyback technique.The donor right liver was rotated 45 degree to the left,making the donor left liver pointing to the left paracolic sulcus and the donor right liver was in the recipient hepatic fossa.The donor suprahepatic vena cava was anastomosed end-to-side to the recipient vena cava,and the infrahepatic vena cava was closed by oversewing.ResultThe patient recovered uneventfully.His liver function was stable during a follow-up of 75 months.ConclusionLT in patients with SI is safe and feasible.Exact determination of the anatomy,comprehensive preoperative planning,and good technique in liver transplantation play important roles in LT for patients with SI.