Objective To explore therapeutic efficacy of endoscopic biliary stent placement in the management of bile leakage following hepatobiliary surgery.Methods 11 cases of bile leakage following hepatobiliary surgery were reviewed retrospectively from January 2001 to December 2005.New clinical classifications of bile leakage were proposed: type I,leakage from cystic duct;type II,leakage from extrahepatic bile duct(diameter of leakage less than 1/3 diameter of biliary duct was type IIA;more than 1/3 was type IIB);type III,leakage from intrahepatic bile duct(leakage from intrahepatic bile duct cecum was type IIIA;leakage from intrahepatic bile duct under draining hepatic segments was type IIIB;above draining hepatic segments was type IIIC);type IV,leakage from Luschka duct.Results In 11 cases,there were 6 cases of type I,2 cases of type IIA,1 case of type IIIA,and 2 cases of type IIIB.4 cases were placed only stents,and Oddi sphincterotomy combined with stent placement were performed in 7 cases.Stents were taken out at 3 weeks(6 cases),1 month(2 cases),2 weeks(1 case),6 months(1 case) and 9 months(1 case) postoperatively.Abdominal pain was relieved in 11 cases after endoscopic treatment,with disappearance of biliary drainage from abdominal cavity and subsidence of jaundice.1 case was followed up for 6 months,and other 10 cases were followed up for 1-3 years,with no recurrence of abdominal pain,fever,jaundice and seroperitoneum,and hemobilirubin became normal.Conclusions Endoscopic biliary stent placement is one of effective therapeutic procedures in the management of most bile leakage following hepatobiliary surgery.New classification of bile leakage may be taken as a guide to select therapeutic procedures.

Objective To investigate the effects of serum from rats with burn injury on the differentiation of bone marrow mesenchymal stem cells(MSCs). Methods Bone marrow was extracted from sacrificed Wistar rats and MSCs were then incubated in F-12 medium in the presence of fetal calf serum (FCS) (group F),normal rat serum (group N),or serum harvested from rats with burn injury(group B). Cells of the fifth passage were harvested to investigate the expression of CK and FⅧ by immunohistochemistry and flow cytometry. Results With immunohistochemical staining,both CK and FⅧ were positive in MSCs of group B and negative in the cells of the other two groups. The flow cytometry analysis showed that the positive rates of CK and FⅧ staining MSCs of group B were higher than that of the other two groups ( P 0.05). Conclusions The serum obtained from rats with burn injury could induce differentiation of MSCs to both epithelial cells and vascular endothelial cells,implying that serum after barm injury might promote the MSCs to participate in the process of wound repair.

BACKGROUND:Posterior lumbar interbody fusion can thoroughly decompress the central canal, which is the common surgical technique for the central type of lumbar disc herniation with intervertebral instability at low lumbar segment. However, due to the regular traction on dural sac and nerve root in the operation, lower limb radicular pain in the early stage is inevitable. OBJECTIVE:To evaluate the effect of local use of gelatin sponge containing prednisolone acetate around the nerve roots after posterior lumbar interbody fusion on lower limb radicular pain. METHED:Sixty-three cases of lumbar disc herniation with degenerative instability were devided into treatment group (n=21) and control group (n=42) based on the type of implants. Gelatin sponge containing prednisolone acetate was implanted into patients in the treatment group after posterior lumbar interbody fusion, while pure gelatin sponge was implanted into patients in the control group. RESULTS AND CONCLUSION:Compared with the control group, radicular pain in the treatment group was significantly relieved within 1 week after surgery. The visual analog scale score and Oswestry disability index score were similar between the two groups. There were three cases of radicular pain recurrence in the control group, but no incision infection and epidural hematoma after surgery in both two groups. In conclusion, local use of gelatin sponge containing prednisolone acetate around the nerve roots can significantly relieve lower limb radicular pain in the early stage after posterior lumbar interbody fusion in lumbar disc herniation, contributing to early rehabilitation exercise and patient satisfaction outcomes.

【Objective】To assess the indications and therapeutic effect of surgical treatment for lumbar disc herniation(LDH) associated with lumbar degenerative instability(LDI).【Methods】Fifty-eight LDH associated with LDI patients,which were ineffective after strictly conservative treatment or simple decompression with disc excision,received lumbar vertebral plate resection and disc excision from posterior approach,and transpedicular screw fixation combined with posterior lumbar interbody fusion.【Results】A averaged 13-month follow-up was carried out in 54 patients.The therapeutic effect assessed by Japanese Orthopaedics Association(JOA) was as follows: excellent in 37 patients,good in 13,ordinary in 4,and the excellent +good rate was 92.59%.The results of X radiography 3 months after the operation showed that lumbar interbody fusion was successful in 52 patients,the infusion rating being 96.30%.【Conclusion】Lumbar vertebral plate resection and disc excision from posterior approach,and transpedicular screw fixation combined with posterior lumbar interbody fusion are effective for the treatment of LDH associated with LDI.

BACKGROUND: Clinical researches found that portal vein occlusion was beneficial to inhibit growth of hepatocarcinoma, promote compensatory hyperplasia of un-blocking hepatic tissue and decrease metastasis of portal vein occlusion; however, it should be fu~her proved by animal experiments.OBJECTIVE: To investigate models of portal vein occlusion of hepatic VX2 tumor in rabbits and evaluate value of multi-slice CT.DESIGN: Randomized grouping design and animal study.SETTING: Department of Radiology, Xinqiao Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was carried out in the Imaging Department of Xinqiao Hospital of the Third Military Medical University of Chinese PLA from July 2002 to January 2005. Forty New Zealand rabbits were divided according to digital table into 4 groups: immediate group (transplantation of tumor after immediate portal vein occlusion), 3-week group (transplantation of tumor at 3 weeks after portal vein occlusion), negative control group and positive control group, 10 in each group.METHODS: Hepatic VX2 tumor was transplanted with abdominal-embedding innoculation at immediate portal vein occlusion and 3 weeks after portal vein occlusion. Meanwhile, they were divided into negative control group (Left external branch of portal vein was done sham-operative block,and left exite was embedded and inoculated pseudoly) and positive control group (Transplanted tumor did not suffer from portal vein occlusion). All rabbits were scanned with multi-slice CT.MAIN OUTCOME MEASURES: General changes of liver, changes of tumor, metastasis of tumor, vascular-imaging displaying rate of multi-slice CT of hepatic artery and portal vein, blood flow of liver, blood volume,mean transit time, permeability of vascular surface and fraction of hepatic arterial infusion (HAI).RESULTS: All 40 animals were involved in the final analysis. ① Tumor did not grow in both immediate group and 3-week group. In 3-week group,left endite was atrophied and growth of tumor was inhibited. The maximal diameter of tumor was smaller than that in positive control group [(2.55 ±0.46), (3.59±0.37) cm, t=5.57, P ＜ 0.001]. Incidences of metastasis in liver and lung were lower in 3-week group than those in positive control group (10%, 40%; 100%, 90%); however, there was no significant difference. ② Scanning with multi-slice CT, displaying rate of branches hepatic artery was lower in grade Ⅲ than that in grade Ⅰ and Ⅱ (40%, 70%,100%, P ＜ 0.05); but there was no significant difference of displaying rate of portal vein at various grades (P ＞ 0.05). ③ Values of blood flow of liver,blood volume, mean transit time and permeability of vascular surface were lower in immediate group and 3-week group than those in control groups,but values of HAI were increased.CONCLUSION: Ligating left external branch of portal vein is an ideal way to establish models of portal vein occlusion of hepatic VX2 tumor in rabbits; furthermore, multi-slice CT plays a key role in evaluating effect of portal vein occlusion.

Objective To evaluate the role of fetal brainstem-vermis (BV) and brainstem-tentorium (BT) angles in differential diagnosis of fetal cereballar vermis anomalies by three-dimensional ultrasonography. Methods A total of 335 normally developed fetuses at 18-34 gestational weeks were examined prospectively in Prenatal Ultrasound Center of Suzhou Municipal Hospital from July 2013 to July 2014 by three-dimensional ultrasonography scanning. The BV angles and BT angles were measured at the mid-sagittal sections of fetal heads which were obtained by three-dimensional ultrasonography. Sixteen fetuses with abnormal cerebellar vermis were selected. The BV angles and BT angles were measured and compared with the measurements of normal group. Results In normal fetuses, the mean of BV angles was (3.3±1.7)° , ranging from1.0 to 10.0°;the mean BT angle was (31.5±6.9)° , and ranging from 16.6 to 57.8° . In 16 cases of abnormal cerebellar vermis, 4 cases of Dandy-Walker Malformation (DWM) showed significantly upward rotated cerebellar vermises, the BV angles increased significantly (88.9±18.1)° , the cerebellar tentoriums were superior displaced, the BT angles increased remarkably (89.0±12.8) ° ;6 cases of Dandy-Walker variant (DWV) showed upward rotated cerebellar vermises, with increased BV angles (23.7±5.2) ° , and slightly increased BT angles (54.5±12.0)°;6 cases of Blake′s pouch cyst (BPC) showed upward rotated cerebellar vermises were, mildly increased BV angles (16.7±1.8)° , and slightly increased BT angles (50.3±8.2)° . The comparison results showed:BV angles increased with increasing severity of the condition in BPC, DWV and DWM;BT angles increased significantly in DWM. Conclusions The measurements of BV angles and BT angles are valuable in the differential diagnosis of fetal cereballar vermis anomalies. From 19 gestational weeks, a BV angle>60° is strongly suggestive of a Dandy-Walker malformation, while a measurement>10.0° and<20° favors the diagnosis of Blake′s pouch cyst.

Objective:To explore the feasibility of ultrasound screening and diagnosis of fetal cleft palate in early pregnancy, analyze and summarize the imaging technology and image characteristics of two-dimensional and three-dimensional ultrasound in normal fetus and cleft palate fetus.Methods:A total of 10 519 pregnant women participated in the early pregnancy were included from January 2016 to June 2020 in Shenzhen Hospital, University of Chinese Academy of Sciences. The palatal line on the standard section of fetal nuchal translucency (NT) measurement was used as a screening marker for routine observation. For fetuses with abnormal palatine line, posterior nasal triangle of coronal plane and axial plane of maxillary alveolar arch of two-dimensional ultrasound were added as the diagnostic sections, and three-dimensional volume data of fetal face were collected, and three dimensional multimodal imaging technology was used to analyze the volume data off-line to determine or exclude fetal severe cleft palate. All fetuses were followed up during the second trimester for deformity scanning and post natal (or induced labor) assessment.Results:Of the 10 519 fetuses, the standard NT plane was obtained and the palatal line was observed in 10 204 cases(97.01%), with normal palatal line in 10 169 cases.In 35 suspected cases, 13 cases were confirmed cleft lip and palate by two and three dimensions ultrasound, and were confirmed by induced labor. There were 7 cases in unilateral side, 3 cases in bilateral, 2 cases in median cleft lip and palate, 1 cases in irregular cleft lip and palate, and no false positive results were reported. Twenty-two suspicious cases were excluded by increasing the two-dimensional sectional and three-dimensional volumetric off-line analysis, and screening after the second trimester and after birth. There was 1 case of missed diagnosis of simple cleft palate.Conclusions:Palatal line is a good screening marker for fetal cleft palate in early pregnancy. For fetuses with abnormal palatine line, the adding of posterior nasal triangle and the axial plane of maxillary alveolar arch, and combining three-dimensional volume data for off-line analysis can determine or exclude severe cleft palate. This study is of great significance for early screening and diagnosis of severe fetal cleft palate, prenatal genetic counseling and prevention birth defect.

Objective To study the BC047440 mRNA expression in human hepatocellular carcinoma tissues, and the role of BC047440 gene in the carcinogenesis and development of human hepatocellular carcinoma.Methods Specimens from 36 cases of hepatocellular carcinoma and their corresponding adjacent non-cancerous tissues were examined for BC047440 mRNA expression by polymerase chain reaction after reverse transcription(RT-PCR).Results(1)the BC047440 mRNA expression in specimens of 36 cases of hepatocellular carcinoma was higher than that in their adjacent non-cancerous tissues(0.2594?0.0928 and 0.0942?0.0443,respectively,P

Objective To evaluate the safety and efficacy of transumbilical single port laparoscopic cholecystectomy. Methods The clinical data of 16 patients who received transumbilical single port laparoscopic cholecystectomy at Xinqiao Hospital from January 2008 to May 2010 were retrospectively analysed. An incision with a length of 1.5 cm was made adjacent to the umbilicus, and then two 5 mm trocars and one 10 mm trocar were installed. After the establishment of pneumoperitoneum, a laparoscopic camera was placed via the 10 mm trocar,and laparoscopic instruments and a 5 mm ultrasonic scalpel were placed via the two 5 mm trocars, respectively.Cholecystectomy was performed in the same manner as for the conventional laparoscopic procedure. Results All the operations were successfully carried out. The operation time was 50-150 minutes. No drainage tube was inserted,and no complications such as bleeding or bile leakage were observed after the operation. Patients recovered well,and no scarring was observed around the umbilicus. Conclusions Transumbilical single-port laparoscopic cholecystectomy is safe and feasible, but it is more difficult than laparoscopic cholecystectomy in terms of manipulation.Transumbilical single-port laparoscopic cholecystectomy has the potential to replace laparoscopic cholecystectomy if the operative instruments are improved.

Objective To approach the surgical timing for the conjoined twins, location of the separation line for the joined liver, and the separation method.Methods The common bile ducts of the conjoined twins were considered as two vertical lines, and a vertical line running parallel to the two lines was set as the separation line for the joined liver.Local blood flow blocking method was then used to separate the joined liver.Results Among all the three cases of the conjoined twins, one case was with sternoxiphopagus and the other two with thoracoabdominalpagus.All the three cases of con-joined twins shared the common livers, but each case had respectively separated gallbladders and bile ducts.They underwent the surgical separation at the age of 28 d and 96 d and 89 d successfully.Their liver sections bled rarely by blocking the local blood flow.The liver function recovered successfully af-ter the operation.All the 6 sick children recovered and were discharged from our hospital.Conclusion Porvided the conjoined twins shared the joined liver with respectively separated common bile ducts, in most cases, the injuries of the important liver vascular as well as bile ducts could be avoided when the separation line for the joined liver was selected with the common bile ducts of the conjoined twins as the longitudinal coordinate.The local blood flow blocking method only blocked the local blood flow, in-terfering to the liver blood flow in the non-operating areas rarely, which was instrumental in the recovery of the liver function and increase of the survival rate of the conjoined twins after the operation.