Objective To characterize the spectrum of adult choledochal cyst and to determine suitable surgical procedures for this disorder.Methods The medical records of 169 patients who were treated for choledochal cyst from July 1977 to October 2008 in our Department were retrospectively reviewed.The cysts were classified using Todani's classification as type Ⅰ in 110 patients (65.1％),type Ⅱ in one patient (0.6％),and type Ⅳ in 56 patients (33.1％).The choledochal cysts in two patients could not be classified because of the lack of clinical data.163 patients received surgical treatment,which included cystectomy (n=119),cystenterosotmy (n=33),T-tube drainage following bile duct exploration (n=5),surgical exploration/biopsy (n =5),and endoscopic sphincterotomy (n =1).Results There was an increase in the number of patients in the 1980s which became stable at round 30 patients per every four years since the late 1990s.The proportion of patients presenting with a history of biliary surgery decreased and accounted for about 25％ of patients in the past decades.The rate of cyst malignancy dropped from 16.5％ in 1977=1995 to 9.7％ in 1996=2008.Of the 163 patients who received surgical treatment,long-term complications included anastomotic strictures and intrahepatic bile ductal stones presenting with repeated cholangitis.Conclusions The incidence of adult congenital choledochal cysts had become stable following years of rapid increase.The rate of cancer progression had gradually decreased.The use of different surgical treatments based on the condition of the proximal bile duct helped to prevent postoperative stenosis of biliary anastomosis.

Objective To determine the value of preoperative clinical, biochemical, cross-sec-tional imaging features and results of fine-needle aspiration for predicting malignancy in cystic neo-plasms of the pancreas (CNP). Methods The medical records of 69 patients receiving operations for CNP between 1994 and 2008 in our hospital were reviewed retrospectively. The predictive effect of va-rious preoperative factors such as sex, location, clinical manifestation, maximum diameters, tumor marker, pancreatic duct obstruction and calcification on the malignant potential of CNP was evaluated by Single and multi-factor analysis, fine needle aspiration (FNA) and intraoperative frozen-section ex-amination of the pancreatic transection margin was investigated. Results All the 69 patients were con-firmed pathologically. Of the 69 patients, 13 suffered from serous cystic neoplasms, 30 from mucinous cystic neoplasms,7 from intraductal papillary mucinous neoplasms,12 from solid pseudopapillary neo-plasms and 7 from cystic neoplasms. Forty-four lesions were diagnosed as malignant or borderline.Univariate analysis should that jaundice, raised CEA and/or CA19-9, maximum diameters and solid component of cystic neoplasmshad were of statistical significance for the risk of malignancy in CNP.The sensitivity was 34.1% (15/44), 47.7 % (21/44), 88.6%(39/44),72.7%(32/44) and specificity 96% (24/25), 84% (23/25), 68% (17/25),72% (18/25), respectively. The last three were identified as independent predictive factors for malignancy by multivariate analysis. Three cases were accurately diagnosed out of the 9 undergoing FNA preoperatively. One of 7 patients with intraductal papillary mucinous neoplasms (IPMN) undenwent total pancreatetomy for transection margin positivity.Conclusion Most malignant CNP can be accurately diagnosed preoperatively from a typical clinical,biochemical and cross-sectional imaging picture. FNA is only used in the patients who are potential candidates for nonoperative management. Margin analysis is necessary for pancreatic resection.

The isolated working heart of guinea pig perfused with Tyrode's solution could work normally for at least 60 min. It was shown that berbamine ( BA ) could depress the function of isolated working heart of guinea pig in dose-dependent manner. BA 3 mol/L could decrease the left ventricular pressure, aortic pressure, -dP/dtmax, aortic blood flow and coronary blood flow, and increase left ventricular end-diastolic pressure. BA 100 mol/L could result in the ventricular asystole, however, no obvious influence the contraction of atrium.It was also demonstrated that BA could antagonise the arrhythmias induced by the adrenaline in isolated working heart of guinea Pig.

Purpose To investigate the relationship between Epstein-Barr virus (EBV) and lymphoepithelioma-like carcinoma (LELC) of the parotid gland and detect the gene expression products of EBV harbouring in LELC cells. Methods Thirty-two parotid LELCs were collected from the Departments of Pathology, Sun Yat-sen University of Medical Sciences, Guangzhou, China during the period of January 1986 and December 1995. All the 32 formalin-fixed paraffin-embedded blocks had been consecutively re-sectioned again. Immunohistochemical and in situ nucleic acid hybridization methods for detection of EBV gene encoded products were performed. Results (1) 32 LELCs were found out of 125 parotid gland carcinomas, the frequency was 25.6% (32/125). (2) All of the 32 specimens contained a variable number of EBNA-1 and EBERs positive neoplastic cells. (3) Twenty-seven out of 32 specimens (27/32, 84.4%) had a portion of carcinoma cells expressing LMP-1. (4) No ZEBRA positive cell could be found. (5) EA-D, VCA and MA positivity rates for these 32 parotid LELCs reached to 71.9%(23/32), 68.8%(22/32), and 12.5%(4/32), respectively. Conclusions (1) The parotid gland LELC is frequently to be seen in Guangzhou locale of China, where is a high-incidence area of nasopharyngeal carcinoma (NPC). The parotid gland LELC and NPC are co-prevalent in Guangzhou locale. (2) This disease is also consistently associated with EBV infection. (3) The EBV infection of the parotid gland LELCs is essentially the type of latency Ⅱ, expressing EBNA-1, EBERs and LMP-1. (4) The latent infected EBV harbouring in LELC cells could in part be switched over to lytic cycle, producing EA-D, VCA or/and MA.

Objective To compare the long-term effectiveness of anti-interleukin-2 receptor antibodies vs.rabbit antithymocyte globulin as induction therapy in kidney transplantation.Methods Between 2006 and 2010,371 recipients of kidney transplants were treated with calcineurin inhibitors (CNI),mycophenolate mofetil and prednisone.261 patients of them received induction therapy with anti-interleukin-2 receptor antibodies (IL2Ra group),and 88 patients received rabbit antithymocyte globulin (rATG group).All the patients received ganciclovir against cytomegalovirus and SMZ against pneumocystis carinii.The data of delayed graft function (DGF),the rate of acute rejectin (AR) and infection in the first year and patient/allograft long survival rate in two groups were retrospectively analyzed during a follow-up period of 1 to 5 years postoperatively.Results There was no significant difference in the sex,age and causes of end-stage renal disease between the two groups.The rATG group had more kidney transplants from deceased donors (P＜0.01 ) and the cold ischemia time was longer than that of the IL2Ra group (P＜0.01 ).The IL2Ra group and the rATG group had similar incidence of DGF (3.1％ vs.1.8％,P＞0.05).One year after operation,the incidence of AR in IL2Ra group and rATG group was 10.7％ and 2.7％ respectively (P＜0.05),and the incidence of infection in IL2Ra group and rATG group was 14.9％ and 21.8％ respectively (P＞0.05).One-,two- and three-year patient survival rate in IL2Ra group was 98.9％,98.9％ and 98.5％ respectively,and that in rATG group was all 98.2％ (P＞0.05).The one-,two- and three-year allograft survival rate in IL2Ra group was 98.5％,98.1％ and 97.7％ respectively,and that in rATG group was all 97.3％ (P＞0.05).Conclusion rATG is more effective than IL2Ra preventing from acute rejection and does not increase the risk of infection for induction in kidney transplant recipients.

Objective To determine the value of liver analysis application in liver segmentation and planning of surgery.Methods Thirty patients suspected having hepatic disease were recruited in this study.Contrast-enhanced CT examinations were performed with Philips Brilliance 64-slice CT,and multi-phase images were obtained.The patients were divided into group B(with focal hepatic lesion,15 patients),and group A(without hepatic lesion,15 patients).We use the portal-venous(60-70 s)images to analysis.Liver volume and vessel recognition were edited manually if necessary,then liver segmentation proceeded automatically.All data were analyzed by the t test,chi-square test,Mann-Whitney U analysis,with SPSS 15.0 software.Results There was no significant difference of post-processing procedure between the two groups(P =0.361).The liver volume was(1374.61 ±444.05)cm3 in the group B and(1225.70±272.07)cm3 in the group A(P=0.108).The accuracy of vessel recognition was no significant difference between the two groups(P=0.87).21 vessels were recognized incorrectly include 18 hepatic veins.Conclusion The liver analysis application provides a 3D reconstruction allow vivid observation of liver segmentation and accurate estimation of the liver volume.It has broad prospect in diagnosing and surgical planning of the liver disease.

Objective To discuss the pathogenesis of the statin-induced rhabdomyolysis in renal transplant recipients.Methods We presented two renal transplant recipients who developed rhabdomyolysis in 2012 in our hospital.The clinical presentation,laboratory results,diagnosis and treatment of the two patients were analyzed retrospectively.The basic immunosuppressive agent of two patients was cyclosporine A.The recipients developed rhabdomyolysis following simvastatin lipidlowering therapy,and one patient suffered acute renal failure simultaneously.Acute tubular injury was confirmed by renal biopsy.Finally,the symptoms of the two patients were relieved completely,creatine kinase (CK) returned to normal after the satins discontinued and saline,sodium bicarbonate and diuretics were given.The renal failure patient underwent plasma exchange and CRRT,and the renal function returned to normal.Results The level of cyclosporine A should be monitored when the renal transplant patient was given statins,especially whose basic immunosuppressive agent was cyclosporine A.At the same time we should pay more attention to the symptoms of the myotoxic side effects and avoid using the drug which was also metabolized by CYP3A4.Conclusion Physicians should be aware of the potential risks of combined therapy of statins which are metabolized by P450CYP3A4 and cyclosporine A in transplant patients.If using it is advisable to begin with small dosage and monitor the CK level.

Objective To assess the safety and efficacy of extended liver resection using preoperative PTCD (percutaneous transhepatic cholangial drainage) and PVE (portal vein embolization) to treat patients with locally advanced hilar cholangiocarcinoma.Methods We collected and analyzed the clinical data of 27 patients with Bismuth types Ⅲ and Ⅳ hilar cholangiocarcinoma who underwent extended hepatecomy using preoperative PTCD and PVE in our hospital.Results There were 21 patients with R0 resection and 6 patients with R1 resection.The mortality rate was 0％.Eight patients died of cancer recurrence.Conclusion Preoperative PTCD and PVE combined with extended hepatectomy were safe and efficacious in treating patients with locally advanced hilar cholangiocarcinoma,which resulted in potential cure.

Objective To observe Hedgehog signaling pathways of liver cancer cell growth and the influence of the metastatic potential targeted inhibit Hedgehog.Methods Construction of Smo shRNA plasmid,The stable and low-expressed Smo-expressing HCC QGY-7701 cell line was screened after lipofection.The stable and low-expressed Smo-expressing HCC QGY-7701 cell line was screened,The cell cycle,apoptosis,invasion and metastasis of QGY-7701 cells were detected by Western blot,flow cytometry,CCK8 and transwell assay.Subcutaneous implantation of hepatocarcinoma cells in nude mice.Study on the growth and metastasis of hepatocarcinoma cells with low expression of Smo in.The ultrastructural changes of hepatoma cells with low expression of Smo were observed under electron microscope.Results RT-PCR and Western blot showed stable shR-Smo cell line was successfully constructed.Cell cycle test showed that compared with the control group,G0/G1 cells increased in shR-Smo,cells in S phase decreased;apoptosis,CCK8 and Transwell tests showed that Smo-gene silencing could significantly increase the apoptosis percentage of the hepatic cancer cells to (5.46％ ± 1.46％),proliferation activity decreasedand and the migration rates reduced to (7.82％ ±2.14)％;nude mice model showed that Smo-gene silencing could inhibit the growth of hepatocellular carcinoma cells in vivo,electron microscopy revealed that lysosomes increased significantly in Smo-gene silence cells.Conclusions Blocking Hh signaling pathways,liver cancer cells in vitro malignant degree of decline.Hedgehog in treating liver cancer have hidden meaning.

Women undergoing in vitro fertilization-embryo transfer (IVF-ET) may experience repeated implantation failure (RIF). Under the guidance of "Yu Pei Qi Sun" theory, Traditional Chinese Medicine (TCM) compounds can improve the quality of sperm and eggs of both husband and wife by anti-oxidative stress, improving mitochondrial function and reducing excessive apoptosis before IVF-ET to obtain high-quality embryos; TCM compounds can also promote angiogenesis, anti-oxidative stress, regulation of estrogen and progesterone receptor content, regulate immunity to improve female endometrial receptivity to facilitate embryo implantation; it can also invigorate the spleen and kidney after transplantation and caring for the fetus to help implantation, as well as alleviate the anxiety of patients during transplantation.