Objective To study the significance of dissection and exposure of the recurrent laryngeal nerve(RLN) in thyroid surgery.Methods The clinical data of 1 082 patients who had undergone operations on thyroid were retrospectively reviewed.All cases were routinely operated with dissection and exposure of RLN.Results Six cases had injury of RLN(0.5%),3 cases showed parathyroid insufficiency(0.3%)and 2 cases had injury of the superior laryngeal nerve(0.2%) ofter operation.The incidence of operative complications in thyroid surgery was closely related with if exposure of the RLN.Conclusions Exposure of the recurrent laryngeal nerve is a key measure to decrease injury of parathyroids,superior laryngeal nerve and recurrent laryngeal nerve during thyroid surgery.

Clinical experience of professor YANG Mu-xiang in treating hypertension,hyperplasia of prostate gland,acne and thyroid hyperfunction by brunellae spica were introduced,it was considered that the taste of brunellae spica was bitter and sweet,which was not hurt the spleen and stomach,and its cold nature was not consumption of yang,and it could remove hepatic heat,and have the function of eliminating stagnation.It was used when position of disease was liver,and pathogenesis was stagnation of liver qi or accumulation of heat;the dosage of 10-15g was used when the cooling-relieving heat accumulation therapy,and the dosage of 15-30g was used when eliminating stagnation.

ObjectiveTo investigate the effects of selective splenectomy on modulation of portal vein flow and prevention of small-for-size syndrome (SFSS) in living donor liver transplantation.MethodsTwenty six recipients who received LDLT from September 2007 to March 2008 were reviewed.The data of the portal vein flow of these recipients were collected during the operation.Simultaneous splenectomy was performed in patients with portal blood flow ＞250 ml/(min · 100g).No splenectomy was performed when the portal blood flow was less than 250 ml/(min · 100g).The effect of selective splenectomy on modulation of portal vein flow and whether splenectomy prevented the occurrence of SFSS were analyzed.ResultsThe portal vein flow decreased significantly after splenectomy in 8 patients who received splenectomy (P＜0.01),No SFSS occurred in the patients with or without splenectomy.Actual graft-to-recipient weight ratio (GRWR) of patients with splenectomy was significantly smaller than those with no splenectomy (P=0.044).The portal vein flow of patients with splenectomy was much higher than those with no splenectomy (P＜0.01).ConclusionAccording to the portal blood flow,selective splenectomy in LDLT decreased the portal vein flow and prevented the incidence of SFSS.

Objective To analyze the prognostic indicators in gastric cancer patients underwent radical resection.Methods Clinical data of 257 patients with gastric cancer underwent radical resection from Jan. 2003 to Oct. 2008 in our hospital were analyzed retrospectively. Univariate analysis using Kaplan-Meier analysis and log-rank analysis,multivariate analysis using COX proportion risk model were performed. Results Univariate analysis indicated that tumor site (P <0. 05) .Borrmann type (P <0. 01) .histological type (P <0. 01),depth of infiltration (P < 0. 01 ) , lymph node metastasis rate ( P < 0. 01 ) , tumor size ( P < 0. 01 ) ,complication ( P < 0. 01 ) and accessorial chemotherapy (P<0. 01) influenced the patients' prognosis. Cox regression analysis indicated that lymph node metastasis rate, depth of infiltration, Borrmann type and tumor size were the independent risk factors of prognosis(P<0. 05). The relative risk will increase 3.374 times,2. 337 times,1.657 times and 1.580 times with each additional level of lymph node metastasis, depth of infiltration, Borrmann type and tumor size. Conclusions There are various factors influencing the prognosis of gastric cancer,of which lymph node metastasis rate is the most important prognosis indicator.

BACKGROUND:A large number of studies have reported that endoscopic radiofrequency ablation surgeries were better than traditional open surgeries for gluteal muscle contracture, but there is no meta-analysis on the clinical outcomes of endoscopic surgeries versus traditional open surgeries.
OBJECTIVE:To evaluate the effects of endoscopic radiofrequency ablation surgeries versus traditional open surgeries in the treatment of gluteal muscle contracture.
METHODS:Eligible studies were identified from electronic databases including EMbase, Medline, PubMed, OVID, Cochrane Library, Springerlink, CNKI, WanFang, and VIP between January 1970 and May 2014. The literatures about the clinical efficacy of endoscopic radiofrequency ablation surgeries versus traditional open surgeries in the treatment of gluteal muscle contracture were retrieved. We screened the retrieved literature according to the inclusion and exclusion criteria and performed a Meta analysis with the software RevMan 5.2 after identification of the relevant data.
RESULTS AND CONCLUSION:A total of 830 patients from 14 studies were included for the analysis, including 394 patients who underwent endoscopic surgeries and 436 patients who underwent traditional open surgeries. Among the main outcomes measured, the incidence of postoperative pain (relative risk=0.33, 95%confidence interval (CI):0.27-0.42, P<0.001) and postoperative complications (odds ratio=0.40, 95%CI:0.23-0.70, P=0.001) in the endoscopic surgery group were significantly lower than that in the traditional open surgery group. The curative effects showed no significant difference between the two groups (odds ratio=1.09, 95%CI:0.52-2.26, P=0.82). Among the secondary outcomes measured, the incision length, postoperative off-bed activity time and postoperative hospitalization in the endoscopic surgery group were significantly better than that in the traditional open surgery group (P<0.05). There was no significant difference in the surgery duration and recurrence rate (P>0.05) between the two groups. Endoscopic radiofrequency ablation surgeries are similar to traditional open surgeries in the curative effects, recurrence rate and surgery duration, and are better than traditional open surgeries in the incisional length, postoperative pain, postoperative off-bed activity time, postoperative hospitalization and postoperative complication.

Aim To study the differentiation of human bone marrow-derived mesenchymal stem cells ( HM-SCs) into retinal cells in vitro. Methods HMSCs were isolated from human bone marrow after Ficoll den-sity gradient centrifugation. The adherent cells after at least 5 passages were used for study. Immunopheno-type of the cells was analysed by flow cytometer, and cellular differentiation was identified by immunofluores-cence labeling technique. Results The target cells derived from human bone marrow adhered to the plate with fibroblastic-like morphology, whose surface mark-ers were similar to mesenchymal stem cells. Major cells
were positive for CD90 , CD44 , CD147 , while they were all negative for CD34, CD45, HLA-DR. In the differentiation study, HMSCs cultured in induced me-dium can differentiate into nestin ( neural stem cell ) -positive cell, GFAP ( glial fibrillary acidic protein ) -positive glial cells and retina-specific neurons express-ing Rhodopsin with CD90 ( mesenchymal stem cells )-negative. Conclusion HMSCs have the ability to dif-ferentiate into retinal neural cells in vitro.

BACKGROUND:Colagen hydrogel provides good matrix support for hepatocyte growth and tissue reconstruction, and the colagen-based engineered tissue is easy to merge the growth and form integrated tissue. OBJECTIVE:To improve the thickness of engineered hepatic tissue by dissociating hepatocytes/colagen hydrogel composite into smal hepatic units that accumulate in the subcutaneous cavity. METHODS:Freshly isolated hepatocytes from rats were mixed with colagen hydrogel to establish hepatocytes/colagen hydrogel composite. The hepatocytes/colagen hydrogel composite was dissociated into smal hepatic units after being cured. The undissociated hepatocytes/colagen hydrogel composite was taken as a control. Six Spraque-Dawley rats were enroled. Three of them were subjected to a two-thirds partial hepatectomy to induce liver regeneration. Dissociated and undissociated hepatocytes/colagen hydrogel composites were implanted into the bilateral inguinal subcutaneous cavity. Dissociated and undissociated hepatocytes/colagen hydrogel composites were implanted into the bilateral inguinal subcutaneous cavity of the other three rats. At the 7th day after transplantation, engineered hepatic tissue formation was evaluated using hematoxylin-eosin staining, immunohistochemical staining and India ink perfusion methods. RESULTS AND CONCLUSION:The grafts in these two groups al formed vascular engineered hepatic tissue in the subcutaneous cavity, but after the smal hepatic units merged, a large piece of vascular engineered hepatic tissue formed. The hepatic tissue thickness was up to 4 mm. The whole piece of implanted liver grafts only formed smal pieces of hepatic tissues, with only several layers of cels. Immunohistochemistry staining confirmed that the hepatocytes in vascular engineered hepatic tissue had the characteristics and functions of natural hepatocytes. Partial hepatectomy experiment showed that engineered hepatic tissue had the ability to respond to regenerative stimulus of partial hepatectomy. These results show that dissociating the hepatocytes/colagen hydrogel grafts into smal units that accumlate in the subcutaneous cavity can increase the thickness of the engineered hepatic tissue.

ObjectiveTo investigate prophylaxis and treatment of bile leakage from hepatic duct anomalies after liver transplantation.MethodsWe retrospectively analyzed 3 patients with bile leakage from hepatic duct anomalies after liver transplantation in our institute.The graft procurements were combined liver-kidney harvesting.The reconstruction of the bile ducts was end-to-end anastomoses.ResultsIn the first patient with a right accessory duct joining the cystic duct,leakage of bile came from the stump of the cystic duct after anastomosis of the bile ducts.The original anastomosis was taken down,and reanastomosis was performed after plasty of the bile ducts.The patient recovered uneventfully.In the second patient with a Luschka bile duct,the biliary fistula closed spontaneously after percutaneous drainage.However,re-transplantation was performed for severe infection 7 month after the primary transplantation.In the third patient with an accessory hepatic duct from the right posterior sector joining the common bile duct,the bile duct stump which we missed leaked bile.Re-transplantation was performed because of severe complications.Conclusion Understanding the anatomy of intra- and extra-hepatic bile ducts and their common anomalies identifying the structures in the porta hepatis during preparation of the liver grafts,and looking for possible accessory hepatic ducts and aberrant bile ducts are important steps to prevent bile leakage in liver transplantation.

Objective To investigate the effect of different duration skeletal muscle denervation on acetylcholine receptor activity in rats.Methods Fourteen Balb/c mice weighing 18-22 g were used in this study.The denervation model was established by excising sciatic nerve.Two rats were chosen before(T0 ) and at days 1,4,7,14,21 and 28 after excising sciatic nerve (T1～6),and flexor digitorum brevis of the hindfoot was acutely isolated Skeletal muscle cells were isolated ( five cells in each rat),the acetylcholine currents were recorded using whole-cell patch-clamo technique.Extracellular fluid containing 30 μmol/L acetylcholine was first applied to skeletal muscle cells for 10 s,acetylcholine currents (11)were recorded,then the ceils were washed out using extracellularfluid.Skeletal muscle cells were balanced using extracellular fluid containing 0,0.1,1,10,30,100,1000,3000,or 10 000 nmol/L atracurium for 3 min respectively,then perfused using extracellular fluid containing 30 μmol/L acetylcholine and differents concentrations of atracurium mentioned above for 10 s respectively,and acetylcholine currents were recorded,then the cells were washed out,and 30 μmol/L acetylcholine was perfused again and currents(I2 ) were recorded.The mean value of I1 and I2 was taken as control current,and inhibitory percentage of control current was calculated,and the inhibition concentrations for the half-maximal response (IC50) of atracurium were determined by nonlinear regression analysis.Results Compared with T0,IC50 significantly increased at T1～6 ( P ＜ 0.05).IC50 was increased gradually at T1～3 ( P ＜ 0.05).Compared with T3,IC50 was decreased at T4～6 ( P ＜ 0.05).IC50 was decreased gradually at T4～6 ( P ＜ 0.05 ).Conclusion Skeletal muscle denervation can inhibite acetylcholine receptor activity,which is relate to the denervation time.

Background and purpose: Breast cancer is a group of heterogeneous diseases which has racial disparities. Our study was to elucidate the clinicopathologic features of breast carcinoma in Shanghai Han and Xinjiang Uygur women and to analyze the racial differences. Methods: In this study, 125 cases of breast invasive ductal carcinoma of Shanghai Han women and 85 cases of Xinjiang Uygur women were collected. The clinical stage was analyzed. Histological grading was observed. Immunohistochemical staining of ER, PR, HER-2, CK5/6, CK14, EGFR, Ki-67 was performed. Molecular subtypes were studied. Results:The average age of onset of breast cancer in Xinjiang Uygur women was younger than in Shanghai Han women (P<0.05), and Xinjiang Uygur women were more likely to be diagnosed at less than 35 years old (P<0.01). The proportion of stageⅠwas higher in Shanghai Han women (20.0%vs 8.2%), while the proportion of stageⅢwas higher in Xinjiang Uygur women (50.6%vs 27.2%) (P<0.01). The proportion of grade 2 was higher in Shanghai Han women (67.2% vs 43.5%), while the proportion of grade 3 was higher in Xinjiang Uygur women (47.1%vs 31.2%) (P<0.01). The proportion of luminal A subtype was higher in Shanghai Han women (36.8%vs 18.3%), while the proportion of basal-like subtype was higher in Xinjiang Uygur women (29.6%vs 12.0%) (P<0.01). The molecular subtype was associated with race and histological grade (P<0.05).Conclusion:There are racial differences in clinicopathologic features of breast carcinoma between Shanghai Han and Xinjiang Uygur women.