Objective To explore the feasibility and advantages of endoscopic thyroidectomy via breast areola approach.Methods Endoscopic thyroidectomy via breast areola approach was performed in 113 cases between August 2002 and May 2005.Preoperative diagnosis included 46 cases of adenoma,62 cases of nodular goiter,and 5 cases of Graves' disease.Results The operation was successfully completed endoscopically in 112 cases,and was converted to conventional thyroidectomy in 1 case because of bleeding.The tumor was 2.3?1.6 cm in diameter(range,0.8~7.0 cm).The operating time was 136.7?58.0 min(range,50~310 min),the intraoperative blood loss was 42.5?62.7 ml(range,10~200 ml),the postoperative drainage volume was 87.1?78.1 ml(range,15~310 ml),the time to resume normal activities was 2.2?0.9 d(range,1~4 d),and the length of postoperative hospital stay was 5.5?1.9 d(range,2~9 d).Out of the 113 cases,analgesic requirement was necessary in 18 cases (15.9%).Postoperative complications occurred in 6 cases,including 2 cases of recurrent laryngeal nerve injuries,1 case of superior laryngeal nerve injuries,1 case of hemorrhage,1 case of hypocalcemia,and 1 case of recurrence of Graves' disease.Pathological results showed 43 cases of thyroid adenoma,58 cases of nodular goiter,5 cases of Graves' disease,3 cases of thyroid cancer,and 4 cases of Hashimoto's thyroiditis.Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure.It can be employed as the first choice for indicated patients.

Objective To investigate the clinical value of the combined detection of manganese superoxide dismutase (Mn-SOD)genetic polymorphism and lipoprotein phospholipase A2 (Lp-PLA2)in the early diagnosis of coronary heart disease (CHD).Methods 92 cases of coronary heart disease patients and 78 cases of healthy control group were selected.The activ-ity of Lp-PLA2,the activity of Mn-SOD and genotype of Mn-SOD 9 Ala/Val genetic polymorphism were detected in the ser-um of each group via the use of colorimetry,continuous monitoring technique and gene-sequencing method respectively and then the correlation of serum Mn-SOD,Lp-PLA2 and Mn-SOD genetic polymorphism with CHD were analyzed.Results The Lp-PLA2 activity in serum of CHD groups with Mn-SOD 9 VV genotype was statistically significantly higher than that of patients with the AV+AA genotype (P<0.01).The serum Mn-SOD activity in patients with VV genotype was signifi-cantly lower than that of those with AV+AA genotype (P<0.01).Conclusion Combined detection of Mn-SOD 9 Ala/Val genetic polymorphism and Lp-PLA2 activityin the serum can provide an important foundation for the diagnosis and predic-tion of coronary heart disease.

Objective To investigate the relationship between the activity of superoxide dismutase (T-SOD)as well as its manganese superoxide dismutase isozyme (Mn-SOD),concentration levels of hypersensitive c-reactive protein(hs-CRP)and coronary heart disease.Methods The levels of serum T-SOD,Mn-SOD and hs-CRP were measured in 81 patients with coro-nary heart disease and 60 healthy controls,respectively.T-SOD was measured by colorimetricmethod and hs-CRP was meas-ured by latex enhanced immune turbidimetric assay.Results Compered with the control group,activity of T-SOD,Mn-SOD in CHD group were significantly decreased (t=9.41,6.34,all P<0.01).However,hs-CRP in CHD group were significantly increased to those in controls (t=3.09,P<0.05).The activity of T-SOD,Mn-SOD were negatively correlated with hs-CRP (P<0.01).Conclusion The variation of T-SOD,Mn-SOD activity and hs-CRP content were closely related to the occur-rence and development of CHD,they could be the impor tant indicators for riskfactors assessment of CHD.Moreover,con-joint analysis the correlation of T-SOD,Mn-SOD and hs-CRP has certain guiding significance for the clinical treatment and prognosis of coronary heart disease.

Objective To evaluate the effect of combination of surgery and transcatheter hepatic arterial chemotherapic embolism(THACE) with or without placement of drug deliery system(DDS) of portal vein for hepatocellular carcinoma with portal vein tumor thrombus (PVTT). Methods Fifteen cases of advanced HCC with PVTT were treated by hepatectomy, thrombectomy of portal vein with THACE,and 5 of the 15 cases received postoperative chemotherapy via portal vein. Results All patients survived after operation. The survival rate of 6,12,18 months was 15,12 and 9 cases respectively. Conclusions Operation is still an effective method for advanced HCC , postoperative comprehensive treatment can improve the survival rate.

AIM:To study the chemical constituents of the leaves of Cyclocarya Paliums(Batal.) Iljinskaja. METHODS: Chemical constituents were separated through chromatographic methods and their structures were elucidated by spectral analysis. RESULTS: Six compounds were isolated from the chloroform fraction through 75% alcohol extraction from the leaves of Cyclocarya Paliums.Their structures were elucidated as ?-Sitosterol(1),Behenic acid(2),3?,20-dihydroxyl-5?-Pregnanes(3),Kaempferol(4),?-amyrin(5),?-amyrone(6). CONCLUSION: Compounds 3?,20-Dihydroxyl-5?-Pregnanes(3),?-amyrin(5) and ?-amyrone(6) are isolated from this plant for the first time.

OBJECTIVEBy observing the adipogenic and angiogenic microenvironment impact on the morphology of newly generated tissue for exploring the key factors which inducing mature adipose tissue regeneration in tissue engineering model.

METHODS24 healthy 6 months' New Zealand rabbits were picked and put into four groups according to different microenvironment. Every group has 6 rabbits and divided as follows: no axial-blood supply fat flap(0 ml), granular fat only(0.6 ml), axial blood vessel only (0.05 ml), axial vascularized fat flap ((0.6 ml). We separated or combined adipogenic and angiogenic environment within these groups. After 8 weeks, samples were harvested for histologic observation including macroscopic observation, volume analysis and HE testing.

RESULTSIn granular fat group, its volume decreased by (0.25 ± 0.10) ml after 8 weeks as the shortage of blood supply and finally it could be enveloped. In axial blood vessel group, its volume increased by (0. 37 ± 0. 04) ml after 8 weeks with fibrous tissue formation as shortage of adipogenic microenvironment. The no axial-blood supply fat flap group grew into(0.12 ± 0.03) ml, which can' t support large volume adipose tissue formation because of lacking independent blood supply. Only axial vascularized fat flap model could generate mature adipose tissue in large volume(3.45 ± 0.48) ml. The number of new capillary in every group was different after 8 weeks. By counting the numbers in every single view, no axial-blood supply fat flap group 15 ± 3.5)and granular fat only group(5 ± 2.5)had a significant difference with axial vascularized fat flap group 22 ± 5) respectively.

CONCLUSIONOnly both adipogenic or angiogenic microenvironment exist could induce mature adipose tissue in large volume in tissue engineering chamber model.

Adipogenesis ; physiology ; Adipose Tissue ; physiology ; Animals ; Neovascularization, Physiologic ; Rabbits ; Regeneration ; physiology ; Surgical Flaps ; blood supply ; transplantation ; Tissue Engineering ; methods

BACKGROUND: Pathological changes of pulmonary emphysema are not reversible according to the existent pathogenesis of pulmonary emphysema. Research over many years report that injury of pulmonary blood capillary may take part in new pathogenesis of pulmonary emphysema based on lung volume reduction operation and bronchial lumen occlusion. Mesenchymal stem cells (MSCs) have multi-directional differentiation potencies, such as the differentiation into vascular endothelial cells. Therefore, MSCs may promote pulmonary vascularization and repair pulmonary tissue.OBJECTIVE: To observe the effect of MSCs transplantation on pathological changes of arterial blood gas and pulmonary tissue in model rats with pulmonary emphysema, and investigate the therapeutic effects on MSCs on pulmonary emphysema and the pathogenesis of pulmonary emphysema.DESIGN: Randomized controlled animal study.SETTING: The Second Hospital of Shanxi Medical University.MATERIALS: Thirty healthy Wistar rats, 6 weeks old, of either gender, weighing 180-200 g. They were provided by Physiological Experiment Animal Center, Shanxi Medical University. All rats were randomly divided into MSCs treatment group, model group and control group with 10 rats each.METHODS: The experiment was carried out in the Physiological Laboratory of Shanxi Medical University from April 2005 to April 2006. Rats in the MSCs treatment group and in the model group were anesthetized and intratracheally perfused with 250 U/kg Porcine pancreatic elastase (PPE) to establish pulmonary emphysema models; while, rats in the control group were perfused with saline. The models were successfully established 4 weeks later. All rats were anesthetized and then femur and tibia were obtained to separate and culture MSCs in vitro. Immunocytochemistry was used to detect the expression of CD71 in order to evaluate MSCs. Bromium azacytidine-labeled MSCs were inserted along caudal vein into rats in the MSCs treatment group; while, rats in the model group and control group were inserted with the same volume of PBS solution.MAIN OUTCOME MEASURES: ① Changes of arterial blood gas in the three groups; ② Pulmonary tissue was used for pathological sections in order to calculate mean alveolar number, mean alveolar area and mean linear intercept; ③Immunocytochemical staining was used to measure numbers of CD34+ cells so as to determine proliferation of alveolar blood capillary.RESULTS: Three rats in all died during the model establishment, while another 3 rats were supplied. Therefore, an overall number of 30 rats were involved in the final analysis. ① Culture and evaluation of MSCs: At 3 days after inoculation, MSCs were generally adherent to walls and fusiformly shaped. In the third generation, the expression of CD71 was observed on the surface of MSCs.② Comparisons of arterial blood gas in the three groups: There were no significant differences in pH value, PO2, PCO2 and SaO2 in the three groups (P ＞ 0.05). ③ Pathological changes of pulmonary tissue: Pathological changes in the MSCs treatment group were milder than those in the model group;meanwhile, mean alveolar number in the MSCs treatment group was more than that in the model group, and there was significant difference between them (F=80.201, P＜ 0.05). While mean alveolar area and mean linear intercept in the MSCs treatment group were smaller than those in the model group, and there were significant differences (F =26.755,26.875, P ＜ 0.05). ④ Comparisons of CD34+ expression in pulmonary tissue: Relative positive area of CD34+ in the MSCs treatment group and model group was smaller than that in the control group (F =20.411, P ＜ 0.05), but that in the MSCs treatment group was larger than that in the model group, and there was significant difference between them (F=20.411, P＜ 0.05).CONCLUSION: MSCs can reverse the pathological changes of pulmonary emphysema; on the other hand, the decrease of the number of pulmonary capillary maybe one of the important pathogeneses of pulmonary emphysema.

Objective To compare the clinical efficiency of endoscopic thyroidectomy by breast approach with conventional open thyroidectomy in patients with benign thyroid tumor. Methods Ninety-one patients of thyroid adenoma or adenomatous goiter underwent endoscopic thyroidectomy (group endoscopy) , Ninety-nine patients underwent conventional open thyroidectomy (group open). Operative time, blood loss, the volum of drainage, time of hospital stay and postoperative stay, postoperative complications and analgesic requirements, time taken to return to normal activity and total fee were compared. Results There were no significant differences in operative time, time of stay and postoperation stay between the two groups. Blood loss was significantly less in group endoscopy (27. 7?17. 4) ml than in group open [ (96. 8?84. 8) ml, P

Objective To explore the feasibility and therapeutic effect of total laparoscopic hepatectomy(LH) for treating hepa‐tolithiasis .Methods 75 consecutive patients with hepatolithiasis operatively treated in our hospital from November 2003 to Novem‐ber 2012 were retrospectively analyzed .Among them ,35 cases underwent laparoscopic hepatectomy(LH group) and 40 cases under‐went open hepatectomies(OH group) .The operative modes in the two groups included the left liver lateral lobe resection ,left hemi‐hepatecomy ,common bile duct incision exploration ,choledochoscopy exploration for calculi extraction ,T tube drainage and cholecys‐tectomy .The clinical indicators including the operation time ,intraoperative blood loss ,analgesic drug use situation ,ambulation time , diet recovery time ,postoperative complication rate ,postoperative hospital stay time ,stone clearance rate and recurrence rate were analyzed and compared between the two groups .Results The operation time of the LH group was longer than that of the OH group[(205 .0 ± 40 .9) min vs .(155 .0 ± 26 .6) min ,P< 0 .01] and the postoperative hospital stay time of the LH group was shorter than that of the OH group[(12 .3 ± 2 .6) d vs .(15 .6 ± 4 .3)d ,P< 0 .01] .The intraoperative blood loss of the LH group was slightly more than that of the OH group[(330 .0 ± 259 .7) mL vs .(151 .5 ± 137 .0) mL ,P< 0 .01] .However ,the blood loss of last 10 cases in the LH group was similar to that of the OH group[(81 .0 ± 19 .70)mL vs .(78 .0 ± 22 .0)mL ,P> 0 .05) .The use rate of analge‐sic drugs in the LH group was lower than that of the OH group (0 vs .62 .5% ) .The ambulation time and the diet recovery time in the LH group were shorter than those in the OH group[(1 .5 ± 0 .5)d vs .(3 .6 ± 0 .7)d ,P< 0 .01 ;(2 .4 ± 0 .5)d vs .(4 .0 ± 0 .7) d , P< 0 .01] .No differences between the two groups were found in the occurrence rate of postoperative complications (2 .9% vs . 16 .0% ) ,stone clearance rate(instant clearance rate 91 .4% vs .90% ;final clearance rate 97 .1% vs .100% ) and the opeartion ex‐cellent rate(97 .1% vs .100% ) .No case of perioperative death occurred in the two groups(P > 0 .05) .Conclusion LH combined with choledochoscopy for treating hepatolithiasis is feasible and safe in the patients conforming to the selected standard with an e‐qual therapeutic effect to that of open hepatectomy .LH has the advanteages of minimally invasive surgery such as small incision , less pain ,fast recovery ,less complications ,etc .