Objective To explore surgical strategy for patients with hilar cholangiocarcinoma (HCC) and study prognostic factors after curative treatment. Methods We retrospectively reviewed medical records of 41 patients with HCC surgically treated in our department during the 9-year period from January 1999 to February 2007. Clinicopathological factors were evaluated for their association with post-operational survival by univariate and multivariate analysis using Cox proportional hazard model. Results All the 41 patients underwent laparotomy following preoperative assessment of extent of disease and 21 patients (resectability rate 51.2%) ultimately underwent resection with curative in-tent. In the resection group, R0 radical resection was possible in 11 patients, while R1 resection in 6and R2 in 4. Different types of hepatectomy were combined to accomplish resection. Meanwhile, por-tal vein wedge resection or reconstruction was needed in two patients. The 1-, 3-and 5-year survival rates were 41.5%, 14.6% and 4.9% in the overall group and 71.3%, 28.6%, 9.5% in the resection group, respectively. In R0-resection, Rl-resection and R2 resection group, the 1-,3-and 5-year sur-vival rates were 81.8% ,45.5% ,18.2% ;66.7% ,16.7% ,0 and 50% ,0,0, respectively. Survival rates after resection were significantly higher than those after palliative drainage and exploratory laparotomy (P<0. 001). Higher survival rates were seen in R0-resected patients when compared with Rl-or R2-resected patients (P<0.001). Multivariate analysis revealed that tumor-free margins, pTNM stage and combined hepatectomy were independent prognostic factors affecting survival. Conclusion Only surgery can provide chance to achieve the possibility of cure and long-term survival. Tumor-free margins, pTNM stage and combined hepatectomy are the most important prognostic factors affecting the survival.

AIM:To observe and analyze the change of visual field and retinal nerve fiber layer thickness of primary open-angle glaucoma ( POAG ) after the Ex-press glaucoma shunt implantation.
●METHODS:A total of 14 patients (24 eyes) with POAG were underwent Ex-press glaucoma shunt implantation. Visual acuity, intraocular pressure ( lOP ) , mean defect ( MD) , pattern standard deviation ( PSD ) , retinal nerve fiber layer thickness ( RNFLT ) , and corneal endothelial cell number were collected preoperatively. Visual acuity and lOP were collected in 1wk, 1 and 3mo postoperatively respectively. Also, MD, PSD, RNFLT, and corneal endothelial cell number were collected preoperatively and 3mo postoperatively respectively. Complication, the additional treatment, success rate were analyzed.
●RESULTS:There was no significant difference (P>0. 05) in visual acuity preoperative and postoperative 1wk, 1, 3mo. Visual acuity did not significantly reduce after operation. Compared with preoperative, there was significant decreased (P<0. 05) in lOP after 1wk, 1, 3mo postoperative, respectively. lOP keep stead in postoperative 3mo. The reduction of RNFLT had significant difference (P<0. 05) between preoperative and postoperative 3mo. Compared with preoperation, MD and PSD had no significant difference ( P > 0. 05 ) after postoperative 3mo. Corneal endothelial cell number decrease had significant difference (Z=-2. 585, P=0. 01) between preoperative and postoperative 3mo. Success rate: complete success: 79. 2% ( 19 eyes ); partial success:8. 3% (2 eyes);failure:12. 5% (3 eyes).
●CONCLUSION: Ex-press glaucoma shunt implantation could efficiently decrease the lOP in POAG patients. Although it results in reduction of RNFLT in short time. The visual acuity and visual field keep stable after operation. lt is a safe and effective device for treating primary open-angle glaucoma.

Carcinoma ; Combined Modality Therapy ; Humans ; Nasopharyngeal Neoplasms ; radiotherapy ; therapy

ObjectiveTo investigate the effects of chitosan/PVA nerve conduits which used for repairing sciatics nerve defect in rats.MethodsTwenty-seven rats were divided into 3 groups randomly,with 9 rats in each group. Firstly, the 15mm defects in the left sciatic nerves were made in the rats and were respectively repaired with chitosan/PVA conduits graft (group A), the silicon conduits graft (group B),and autografts (group C). At 12 weeks after the operations, the left sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by wet weight of gastrocnemius and soleus muscles, histological examination,computerized imaging analysis and True Blue retrograde tracing. ResultsThe wet weight of gastrocnemius and soleus muscles showed no significant difference between the chitosan/PVA graft and autograft groups (P ＞ 0.05). The wet weight of gastrocnemius and soleus muscles in significant difference between the chitosan/PVA graft and the silicon group at 12 weeks after the operation(P ＜ 0.05). The nerve fiber density showed no statistically significant differences between the chitosan/PVA and autograft groups(P＞ 0.05).The regenerative nerve fiber in group B had normal morphological and structural characters under transmission electron microscope.True Blue-labeled neuron cell bodies were found within both anterior horn of gray matter in the spinal cord and dorsal root ganglions (DRGs) ipsilateral to the operated side of the tested rats on illumination with ultra-violet light 1 week after the injection of True Blue.Conclusion Chitosan/PVA nerve conduit can effectively promote the nerve regeneration and myelinization of rat sciatic nerve, which is expected to substitute for autograft to repair nerve defects succesfully.

Aim To study the interfering effects of picrosideⅡ on the expressions of nuclear transcription factor kappaB(NF-κB)and inhibitor of NF-κB(I-κB)after cerebral ischemic reperfusion in rats.Methods Intraluminal thread methods were applied to establish the middle cerebral artery occlusion reperfusion models in rats.PicrosideⅡ(10 mg·kg~(-1))and salvianic acid A sodium(10 mg·kg~(-1))were injected from the tail vein for treatment.TUNEL positive cells were counted by immunofluorescence assay.The expressions of NF-κB and I-κB were determined by immunohistochemical assay,and the concentration of NF-κB and I-κB in brain tissue was determined by ELISA.Results The exprssions of NF-κB and I-κB were weakly and the apoptotic cells were scattering at cortex,striatum and hippocampus in the sham operative group.In the negative control group,the number of TUNEL positive cells and the expressions of NF-κB and I-κB increased,the absorption(A)values and the concentration were significantly higher than those in the sham operative group(P<0.05).While in the positive control and picroside groups,the expressions(A values)and concentration of NF-κB and I-κB and the number of TUNEL positive cells were significantly lower than those in the negative control group(P<0.05).There was no significant difference between the positive control group and picroside group(P>0.05).Conclusion Picroside Ⅱ might downregulate the expressions of NF-κB and I-κB to inhibit neuronal apoptosis induced by inflammation after cerebral ischemia reperfusion injury in rats.

OBJECTIVETo compare clinical effects between percutaneous compressing plating (PCCP) and proximal femoral nail antirotation (PFNA) for the treatment of patients with intertrochanteric fracture with risk external wall.

METHODSFrom September 2007 to June 2010, 43 patients with intertrochanteric fracture with risk external wall were treated by PCCP or PFNA according to different kinds of internal fixations. There were 22 cases in PCCP, including 9 males and 13 females with an average age of 68.4 (ranged, 60 to 86) years old, and 13 cases with type A2.2 and 9 cases with type A2.3; while 21 cases in PFNA, including 7 males and 14 females with an average age of 67.7 (ranged, 57 to 93) years old, and 10 cases with type A2.2 and 11 cases with type A2.3. Blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up were observed and compared.

RESULTSAll patients were followed up for 12 to 22 (means 18.4) months, and all patients were obtained fracture healing, and recovered walking ability as before injury. There were no significant differences in blood loss, operation time, hospital stay, fracture healing time, complications and Harris score after 1 years' following-up (P>0.05). One case occurred displacement on the top of greater trochanter, and 1 case injuried weakness of hip abduction. One case occurred screw breakage in PCCP, while 1 case occurred hip joint pain in PFNA.

CONCLUSIONBoth of PCCP and PFNA in treating patients with intertrochanteric fracture with risk external wall can receive good clinical effects, while the effects and therapy strategy for displacement of bone on the top of lateral wall should further study.

Aged ; Aged, 80 and over ; Bone Nails ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Intramedullary ; Fracture Healing ; Hip Fractures ; physiopathology ; surgery ; Humans ; Male ; Middle Aged

Adult ; Diagnosis, Differential ; Female ; Gastrectomy ; methods ; Gastrointestinal Stromal Tumors ; metabolism ; pathology ; Humans ; Ki-1 Antigen ; metabolism ; Leukocyte Common Antigens ; metabolism ; Leukosialin ; metabolism ; Lymphoma, Large-Cell, Anaplastic ; metabolism ; pathology ; surgery ; Melanoma ; metabolism ; pathology ; Mucin-1 ; metabolism ; Receptor Protein-Tyrosine Kinases ; metabolism ; Stomach Neoplasms ; metabolism ; pathology ; surgery

Antibodies, Monoclonal, Murine-Derived ; metabolism ; Brain Neoplasms ; metabolism ; pathology ; Child ; Choriocarcinoma ; metabolism ; pathology ; Chorionic Gonadotropin, beta Subunit, Human ; metabolism ; Diagnosis, Differential ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal ; metabolism ; pathology ; Pineal Gland ; pathology

Purpose To establish rabbit VX2 tumor model and to explore the relation between perfusion parameters and the expression of the VEGF in the portal vein VX2 implanting tumor emboli. Materials and Methods VX2 tumor was implanted in the portal vein of eight experimental rabbits. Multi-slice CT (MSCT) perfusion scan was performed after tumor formation to measure and compare portal vein tumor thrombus, hepatic blood lfow (HBF) near tumor foci and far away from tumor foci, hepatic blood volume (HBV), probability of surface area product (PS) and mean transit time (MTT). The VX2 tumor emboli were then resected to analyze the relationship between the liver perfusion parameters and VEGF expression using immunohistochemical method. Results MSCT liver perfusion parameters were not statistically signiifcant between foci close to or far away from the tumor (P>0.05). The HBF, HBV and PS within the tumor emboli were higher than that in hepatic parenchyma (P<0.05) and the MTT was higher (P<0.05). There was positive correlation (r=0.711, 0.646 and 0.626, P<0.05) between the HBF, HBV and PS of portal vein VX2 tumor emboli and VEGF expression, and there was negative correlation between MTT and VEGF expression (r=-0.565, P<0.05). Conclusion MSCT perfusion parameters in the portal vein VX2 implanting tumor emboli and the expression of VEGF are positively related. MSCT can evaluate the angiogenesis of portal vein VX2 implanting tumor emboli.

Objective To evaluate the Chinese decoction prescriptions combined with incision drainage operation in treatment of perianal abscess after leukemia chemotherapy.Methods One hundred cases of perianal abscess after leukemia chemotherapy were randomly divided into two groups,treatment group (Chinese decoction prescriptions combined with incision drainage operation) and control group (potassium permanganate combined with incision drainage operation).Observe and record the efficacy and ache alleviated after treatments,recurrences were followed up in and 3 years.Results After the treatments,the total effective rate was 90.0％ in the treatment group,significantly more than control group(72.0％),the difference was significant(x2 =10.52,P ＜ 0.05).And treatment after a week the VAS score in the treatment group and control group were(2.2 ± 0.4) and(4.7 ± 1.2),(t =14.62,P ＜0.05).The healing time were(13.4 ±9.3) d and(19.8 ±11.6) d,(t =4.95,P ＜ 0.05).After 3 years follow-up the recurrence rate and fistula formation rate in the treatment group and control group were 2.0％ and 2.0％,22.0％ and 26.0％,(x2 =18.93 and 23.92,P ＜ 0.01).Conclusion Chinese decoction prescriptions could collaborative incision drainage operation treatment of perianal abscess after leukemia chemotherapy,effective and safe,suitable for extensive application and promotion.