Objective To study the feasibility of local resection for the tumor of the ampulla of Vater. Methods The result of 14 cases with carcinoma of the ampulla of Vater treated by local resection and 18 cases undergoing Whipple procedure in this hospital between 1988.5～1999.5 was analyzed. Results The postoperative morbidity for local resection was 7% and 39% for Whipple procedure respectively, P 0 05,and 5 year survival rate was 30% and 62% respectively, P

ObjectiveTo evaluate nonoperative management of adult blunt hepatic injury. MethodThe outcome of 132 cases with adult blunt hepatic trauma admitted in this hospital between Oct 1982 and Oct 2002 was analyzed. Thirty-four cases (25.8%) were treated by nonoperative management. Before 1995, only a portion of patients underwent CT scan and after 1995, diagnosis of liver injury was established by CT scan in all cases. ResultThe nonoperative management rate before 1995 was 16.7% (14/84) and after 1995, it was 41.7% (20/48)(P0.05). ConclusionWith the progress of image monitoring and life support system, some patients of blunt hepatic injury could be managed by conservation therapy.

Objective:To discuss the rule of the prescriptions of professor JIANG Wen-zhao in treating the spleen and stomach ailment. Methods:Use the frequency analysis to analyze the 98 pieces of prescriptions of professor JIANG Wen-zhao in treating the spleen and stomach ailment. Results:To understand medicine state of professor JIANG Wen-zhao in treating the spleen and stomach ailment preliminarily,select the main medicine in treating diseases of the spleen and stomach,and make clear the significance of these medicines to the corresponding diseases. Conclusion:The basic rules of professor JIANG Wen-zhao in treating the spleen and stomach disease are regulating qi,removing dampness and reinforcing asthenia. Qi regulating herbs,diuretics for eliminating dampness,tonifying deficiency herbs,dampness-removing herbs,blood-activating and stasis-removing herbs,heat-clearing herbs are the key herbs.

0.05). CONCLUSION The secar of oropharynx can be regarded as a predictive index for OSAHS severity and guideline for operation, but the change of secar after operation can not be used as a predicitive index for therapeutic effectiveness.

Objective To explore the early diagnosis and optimum operative approach of traumatic diaphragma rupture (TDR) . Methods The clinical dada of 23 patients with TDR admitted to our hospital in recent 10 years were retrospectively analyzed. Results The diagnosis of TDR was made before operation in 12 cases1 (52.2%), and intraoperation in 8 (34.8), and misdiagnosed in 3 cases (13.1%). All the 23 patients underwent operation. Of the 23 patients, the operation was performed via thorax approach in 12 patients , via abdominal approach in 8, and via thorax-abdominal approach in 3. Hernation of the abdominal viscera into the thorax was observed in 18 cases, and single TDR in 5 cases.Empyema occurred after operation in 2 patients. 3 cases(13.1%) dead of hypovolemic shock and multiple organs failure. Conclusions The diagnosis of TDR may be difficult. The key of the diagnosis of TDR is to think of it. Once the diagnosis is made or suspected, the operation should be taken as early as possible. The choice of operative approach should be according to the injury mechanism and location; the choice of the operative procedure should be according to the intraoperative findings.

Objective To explore the effect of narrative therapy on family environment and values in adolescents with emotional disorder.Methods 35 adolescents with emotional disorder and their parents from Affiliated Brain Hospital,Nanjing Medical University were enrolled and treated by narrative therapy.Family environment was assessed using Family Environment Scale-Chinese Version (FES-CV)and was compared between pre-and posttherapy.Results 28 adolescents with emotional disorder and their parents completed therapy.The cohesion,independence,intellectual orientation,active-recreation orientation and organization in FES-CV showed higher scores at post-therapy than at pre-therapy ((6.89 ± 2.56) vs.(4.21 ± 3.21) ; (5.54 ± 1.35) vs.(4.68 ± 1.51) ;(4.75±2.07)vs.(3.50±2.12);(4.07±2.65)vs.(2.50±2.32);(3.68±1.77)vs.(2.50±1.62)respectively).The contradict in FES-CV showed lower scores at post-therapy than at pre-therapy ((2.75 ± 2.44) vs (5.25 ± 2.50)).The values of adolescents with emotional disorder and their parents had a positive change after narrative therapy.Conclusion Narrative therapy is effective on the positive change of FES-CV and values of adolescents with emotional disorder and their parents.

Objective To investigate the molecular mechanisms of protective effects of thioredoxin (Trx) on human vascular endothelial cells in atherosclerosis.Methods The cell models of Trx-overexpressing cells (Ad Trx) and the control cells (Ad-con) were established by adenovirus vector gene transfer technology in human umbilical vein endothelial cells (HUVECs).The oxidized low density lipoprotein,a risk factor of atherosclerosis,was used as a stimulator.Western blot and indirect immunofluorescence were used to detect the protein expression levels and the cellular localization of Trx,adhesion molecules (ICAM-1,VCAM-1) and the upstream signal pathways.Trx activity was detected by insulin disulfide reduction assay,and cellular reactive oxygen species (ROS)production was detected by fluorescent probe DCFH-DA.Results As compared with control group,Trx protein expression level was enhanced in Ad-trx group and the Trx activity in Ad-Trx group was upregulated by (26.2 ±3.3)％.The result of ROS detection showed that overexpression of Trx significantly inhibited the cellular ROS generation.As compared with control group,overexpression of Trx obviously inhibited the adhesion molecules expression but markedly promoted the phosphorylation of Smad3 in endothelial cells with or without oxLDL stimulation (P＜0.05).Pretreatment of cells with SIS3,a specific inhibitor of Smad3 phosphorylation,reversed Trx-induced inhibition of adhesion molecules expression.Further studies showed that pretreatment of cells with SIS3 enhanced oxLDL-induced AP-1 subunit c-fos nuclear expression.Conclusions The enhancement of Smad3 phosphorylation and c-Fos nuclear expression are mainly responsible for the Trx-induced downregulation of adhesion molecules.

Objective To investigate the accuracy and utility of preoperative CTA in the anterolateral thigh perforator flap (ALTPF) transplantation.MethodsPreoperative CTA was performed in 15 consecutive patients,who underwent the ALTPF transplantation. The suitable perforators were found through measuring and estimating the perforator parameters including size,course and origin location by reviewing preoperative angiogram.These parameters were compared with the actual intraoperative findings.ResultsOne patient was transferred to abdominal flap transplantation,because no perforator could be found by both CTA and intraoperative observation.In 14 patients,the sizes and origin locations ( perpendicular and horizontal length from the origin of the perforator to both patella and lateral of thigh) of all selected perforators on CTA were no significantly different from the operative findings( P ＞ 0.05 ),and the types were consistent with the operative findings.The rate of septocutaneous perforator was 28.6％ (4/14),and the rate of musculocutaneous perforator was 71.4％ (10/14).The utilization rate of perforator flap was 93.3％ ( 14/15),and the accuracy of preoperative CTA was 100％.All of these ALTP flaps survived,and there was no donor site morbidity. Conclusions Preoperative mapping using CTA provides fairly accurate information about the size,type (course) and location of the perforators.Preoperative CTA in the ALTPF transplantation is an accurate and useful method and leads to safer and successful operation with optimal outcome.

Objective To evaluate ascending venography in the diagnosis of iliac vein compression syndrome.Methods From April 2011 to April 2013,we have had 556 patients with varicose veins suspected of Cockett syndrome.The degree of varicose veins by the International Union of Venous Clinical Classification (CEAP classification) was as following[1]:shallow varicose veins of lower limb (C2) in 190;varicose veins with limb swelling (C3) in 149 cases ; with body skin changes,such as pigmentation,eczema or lipid hard skin disease (C4) in 130; with healed ulcers (C5) in 17; with active ulcer(C6) in 70.Deep vein anterograde contrast and femoral venous cannula angiography were performed on 760 times.Results Iliac vein compression syndrome (Cockett) was detected by ascending venography in 154 patients,the diagnosis was established by following femoral venous cannula angiography.In the other 48 patients in whom Cockett syndrome was suspected by ascending venography,final diagnosis was reached by femoral venous cannula angiography.Altogether there were 202 iliac vein compression syndrome cases,with a positive rate 38.19％ (202/529).The narrowness was larger than 50％ in 173 cases.In 145 cases there were visible collateral vessels.Conclusions Deep vein ascending angiography is a useful screening method in the diagnosis and treatment of Cockett syndrome.

AIM: To construct the replicative defecient adenovirus Ad-Runx3 expressing Runx3, and to express it in U251 malignant glioblastoma cells. METHODS: The runx3 gene with a flag tag was amplified by PCR using pCMV5-AML2 as a template, and was confirmed by DNA sequencing. The adenovirus shuttle vector pShuttle-CMVRunx3 was constructed by introducing runx3 DNA fragment into the sites of Kpn Ⅰ and Xho Ⅰ of pShuttle-CMV vector. This recombinant plasmid was linearized by Pmel and electronically transfected into BJ5183 cells to get the recombinant adenovirus vector Ad-Runx3. The recombinant adenovirus expressing Runx3 was infected into U251 malignant glioblastoma cells. The expression of exogenous Runx3 was observed by immonoblotting and its localization was detected by immunostaining using anti-Flag tag antibody. RESULTS: The recombinant adenovirus expressing Runx3 with a Flag tag was constructed and infected into U251 glioblastoma cells. The exogenous Runx3 protein was detected only in the nuclei. CONCLUSION: The recombinant adenovirus expressing Runx3 with a Flag tag is constructed successfully, and the Runx3 protein expressed in the nuclei of infected cells. The study laid a foundation for further research of the function of Runx3 in gliocarcinogenesis.