Objective To evaluate the impact of chronic hepatitis B virus (HBV) infection on the outcome following resection for intrahepatic cholangiocarcinoma (ICC) patients.Methods The clinicpathological data of 60 consecutive operated ICC patients were collected.These patients were divided into group A with HBV infection,represented by serum positive hepatitis B surface antigen (HBsAg),group B with hepatitis B surface antibody (HBsAb) positive,and group C with all serum marker of HBV negative.The overall survival rate was evaluated.Results The 1-and 3-year overall survival rate and median survival of three groups were 50％ vs 53％ vs 29％ ; 22％ vs 18％ vs O; and 12.0 m vs 12.0 m vs 6 m,respectively.The difference was statistically significant(P =0.037).Multivariate analyses revealed that the preoperative serum level of TIBL,tumor location,HBV infection or injection of hepatitis B vaccine,hepatolithiasis and adjuvant chemotherapy were related to the prognosis.Conclusions HBV infection or injection of hepatitis B vaccine is favorable independent factor for prognosis of patients with intrahepatic cholangiocarcinoma after resection.

AIM: To study the effect of vascular endothelial growth factor(VEGF) on hematopoietic differentiation from mouse embryonic stem cells(ESC) in vitro.METHODS: ES-D3 was allowed to grow on mouse fetal fibroblast feeder layer,and then was developed into embryoid bodies(EB).EB cells were transferred into medium supplemented with different concentration of VEGF and VEGF+SCF for 1 week.Six groups,including.VEGF 5 ?g/L,VEGF 10 ?g/L,VEGF 20 ?g/L, VEGF 5 ?g/L+SCF,VEGF 10 ?g/L+SCF and VEGF 20 ?g/L+SCF,were designed.The group of spontaneous differentiation without cytokine(s) was used as control.Hematopoietic transcription factor GATA-2 and early hematopoietic differentiation genes(c-kit and ?-H1) were detected by RT-PCR.The content of CD34~+ cells in each group were measured by flow cytometry.The cells derived from ESC were incubated in semisolid methycellulose cultures.The numbers of total colony-forming units in culture(CFU-C) were counted by reverse microscope.RESULTS: ES-D3 grew and formed EB at day 4.VEGF had a stimulatory effect as a single factor on the expression of genes associated with early hematopoietic differentiation(GATA-2,c-kit and ?-H1),the generation of CD34~+ cells and CFU-C in EB.The effects of VEGF+SCF were the most potent in the experimental groups according to the percent of CD34~+ cells and the numbers of hematopoietic colonies.The most highest inducing efficacy was achieved in VEGF 20 ?g/L or VEGF 10 ?g/L combined with SCF.CONCLUSION: VEGF promotes the differentiation of ESC into hematopoietic cells in vitro.The strongest effect was achieved when VEGF was combined with SCF.

Objective To explore the effect of NGAL knockdown by NGAL siRNA encapsulated with urocanic acid-modified chitosan nanoparticles (UAC).MethodsNGAL siRNA encapsulated by UAC and chitosan (CTS) respectively, which were then used to transfect human colon cancer cell lines HT29.The expression level of NGAL protein were detected by Enzyme Linked Immunosorbent Assay(ELISA).ResultsThe ELISA study revealed that the expression level of NGAL protein in UAC group(average 0.583μg/L) was significantly lower than in CTS group (average 0.772μg/L) and control group(average 1.071μg/L) (P<0.05).ConclusionThe NGAL expression of mRNA and protein in HT29 cells could be down-regulated by siRNA encapsulated by UAC.

Objective To evaluate the strategies and effect of surgical treatment for concomitant abdominal aortic aneurysm (AAA) and colorectal cancer (CRC). Methods Literatures on concomitant AAA and CRC published from January 1988 to December 2008 were retrieved from Pubmed, Sciencedirect, Ovid, CBMdisc, CNKI and et al, and correlated indexes were extracted for analysis. Differences among the groups were analyzed using the t test, chi-square test and fisher's exact test. Results A total of 367 cases of concomitant AAA and CRC treated by operation were retrieved. The length of operation delay of patients who received radical resection of CRC first was (115 ± 21 )days, which was significantly longer than (42 ± 8 )days of patients who received open abdominal aortic aneurysm repair (OAAR) first (t = 18. 9, P <0.05). The 30-day complication rate and accumulative length of hospital stay of patients who received one-stage radical resection of CRC + OAAR were 10.5% ( 12/114 )and (23 ±6) days, and 26.0% (47/181) and ( 16 ±4)days of patients who received two-stage radical resection of CRC + OAAR, with a significant difference ( χ2 = 10.42, t = 12. 01, P <0.05 ). The accumulative length of hospital stay of patients who received radical resection of CRC + endovascular aneurysm repair (EVAR) was (12 ±4) days, which was significantly shorter than that of patients who received radical resection of CRC + OAAR [ ( 19 ±5 ) days ] ( t = 9.48, P < 0. 05 ). The 4-year survival rate of patients who received two-stage radical resection of CRC + OAAR was 43.5% (27/62), which was significantly lower than that of patients who received two-stage radical resection of CRC + EVAR [69.2% (18/26) ] or one-stage radical resection of CRC + OAAR [73.7%(14/19) ] (χ2 =4.83, 5.28, P<0.05). Conclusions If the diameter of AAA is under 5 cm, radical resection of CRC should be firstly carried out; but if the diameter of AAA is above 5 cm, OAAR should be firstly carried out to prevent the rapture of tumors. One-stage surgery is better than two-stage surgery if patients could tolerate it.

ObejectiveTo evaluate the efficacyofacupointthread embedding in easing painafterMilligan-Morgan(M-M)for mixed hemorrhoids.MethodSixty patients undergone M-M for mixed hemorrhoids were randomized into a treatment group of 30 cases and a control group of 30 cases. After M-M, patients in the treatment group received thread embedding at Changqiang (GV1) and bilateral Zhibian (BL54), while the control groupdidn’treceive any intervention. The onset time of post-operative pain, average pain index within a week, and pain index after defecation, electromyogram (EMG), change of anal canal pressure, patients’ satisfaction, and adverse-event rate were observed.ResultThe average pain index and pain index after defecation in the treatment group were significantly lower than that in the control group (P<0.05), and the onset of pain in the treatment group was significantly later than that in the control group (P<0.01); after surgery, the anal canal resting pressure in the treatment group was markedly lower than that in the control group (P<0.05); there wasno significant difference in comparing the squeeze pressure of anal canal between the two groups (P>0.05). According to the motor unit potential (MUP) analysis, there were significant differences in comparing the amplitude (Ampl) and Ar/Am of the restingphase between the two groups (P<0.05), while there were no significant differences in comparingthe Ampl, Area, Ar/Am, and Freq of the contraction phase between the two groups (P>0.05). There were significant differences in comparing the patients’satisfaction, adverse-event rate, and use of analgesics between the two groups (P<0.05). ConclusionAcupoint thread embedding can produce a content analgesic effect, and it’s safe and reliable.

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OBJECTIVETo evaluate the feasibility and characteristics of human engraftment in HLA disparate cord blood transplantation.

METHODSTwo human HLA-haploidentical or HLA-mismatched cord blood units were transplanted into sublethally irradiated severe combined immunodeficiency (SCID) mice. The characteristics of engraftment, hematopoietic and immunological reconstitution between the two groups were compared.

RESULTSTwo mixed cord blood units can engraft in SCID mice with donor-recipient chimerism and reconstitute hematopoiesis and immunological functions. No unfavorable factors had been observed. Only one of the two cord blood units which had higher colony forming ability in vitro could engraft in most SCID mice as shown by HLA-DQB(1) gene detection. Two HLA-haploidentical cord blood units were simultaneously engrafted in 3 SCID mice.

CONCLUSIONDouble HLA-haploidentical or HLA-mismatched cord blood can engraft in SCID mice and reconstitute hematopoietic and immunological functions. HLA disparity has no significant effect on survival and engrafting rate. However, in less HLA disparity group, two cord blood units were prone to engraft simultaneously.

Animals ; Antigens, CD ; immunology ; Cord Blood Stem Cell Transplantation ; methods ; Disease Models, Animal ; Female ; Fetal Blood ; immunology ; metabolism ; Flow Cytometry ; HLA Antigens ; genetics ; immunology ; Hematopoiesis ; Humans ; Mice ; Mice, SCID ; Random Allocation ; Severe Combined Immunodeficiency ; immunology ; physiopathology ; surgery ; Survival Analysis ; Transplantation, Heterologous

OBJECTIVETo assess the efficacy and safety of modified ligation of the intersphincteric fistula tract for simple transsphincteric perianal fistula.

METHODSSeventy patients with simple transsphincteric perianal fistula between October 2012 and January 2014 in our department were prospectively enrolled. According to the random number table, patients were divided into two groups: modified-LIFT group (37 cases, from the external opening close to the fistula, dissect the external sphincter fistula to the intersphincteric groove by tunneling technique, resect the lateral free fistula) and LIFT group (33 cases). Clinical parametres before and after operation were compared, and results of pelvic electromyogram (EMG) and anorectal manometry three months after operation were analyzed to evaluated anal function.

RESULTSThe operative time, pain score, hospital stay, and healing time were not significantly different between the two groups (all P>0.05). During the median follow-up of 12 months (3-20 months), the healing rate in modified-LIFT group was 83.8% (31/37), which was significantly higher than 60% (20/33) in LIFT group (P=0.029). After operation, 4 patients had persistent unhealed wound, 2 recurred in modified-LIFT group, while 8 patients had persistent unhealed wound, and 5 recurred in LIFT group. No patients developed anal incontinence. By the pelvic EMG and anorectal manometry 3 months after operation, the duration of motor unit potential, occurrence of simple phase, mean resting pressure and maximun squeeze pressure were not significantly different.

CONCLUSIONModified-LIFT procedure for the management of simple transsphincteric perianal fistulas is a simple and effective operation with higher healing rate and similar anal function as LIFT.

Anus Diseases ; surgery ; Humans ; Ligation ; Operative Time ; Pelvis ; Pressure ; Rectal Fistula ; surgery ; Recurrence ; Treatment Outcome ; Wound Healing

Objective:To investigate the effects of total minimally invasive surgery (TMA) and mixed minimally invasive/open surgery (HMOA) on perioperative conditions and long-term efficacy of patients with rectal cancer.Methods:The clinical data of 240 patients with rectal cancer treated with minimally invasive surgery from January 2014 to August 2018 in Hangzhou Third People′s Hospital were retrospectively analyzed. Among them, 110 patients were treated with TMA (TMA group) and 130 patients were treated with HMOA (HMOA group). The relevant indexes of patients before and after surgery were collected and analyzed.Results:The operation time in TMA group was significantly longer than that in HMOA group: (312.5 ± 20.3) min vs. (210.8 ± 15.2) min, the length of hospital stay was significantly shorter than that in HMOA group: (4.0 ± 0.5) d vs. (6.8 ± 1.0) d, and there were statistical differences ( P<0.01); there were no statistical differences in low anterior resection and surgical procedures, ileostomy, open surgery, postoperative complications, reoperation, morphine dosage at 3 d after surgery and readmission between 2 groups ( P>0.05). Multivariate Cox analysis result showed that BMI ≥ 30 kg/m 2 ( OR=4.11, 95% CI 1.68 to 9.72, P<0.01), TMA ( OR=0.13, 95% CI 0.06 to 0.42, P<0.01), delayed bowel obstruction ( OR=13.6, 95% CI 1.59 to 110.56, P<0.05) and reoperation ( OR=15.32, 95% CI 5.52 to 42.56, P<0.01) were independent risk factors of prolonged hospital stay in patients with rectal cancer. The patients were followed up for 15 to 42 (29.5 ± 0.2) months, and there were no statistical differences in 3-year overall survival (OS) rate and 3-year disease-free survival (DFS) rate between HMOA group and TMA group (92.5% vs. 92.8% and 79.6% vs. 85.5%, HR=1.20 and 0.75, 95% CI 0.35 to 3.14 and 0.28 to 1.34, P=0.98 and 0.25). Conclusions:Patients with rectal cancer treated with TMA have the advantages of shorter hospital stay and shorter short-term effects compared with those treated with HMOA. However, the long-term effects of the two minimally invasive procedures are similar.

Objective:To evaluate the safety and efficacy of Delorme procedure for adults with full-thickness rectal prolapse.Methods:Clinical data of 17 adult patients suffering from full-thickness rectal prolapse undergoing Delorme procedure from June 2014 to May 2018 in Hangzhou Third Hospital were retrospectively analyzed. Patient characteristics, operative data, postoperative complications, recurrence of rectal prolapse, continence state and constipation state were evaluated.Results:Eleven patients were female, 6 patients were male with a mean age of (68 ± 9) years. Operations were successfully performed in these 17 cases. The operation time was (88 ± 16) minutes. The estimated blood loss during operation was (23 ± 9) ml. The postoperative time of hospital stay was (8 ± 1) d. Two complications in two patients were observed. There was no treatment related death. One recurrent case was observed during (16 ± 2) months follow-up. The preoperative and postoperative mean constipation score of five patients with fecal constipation were (23 ± 2) and (11 ± 3) respectively ( t = 9.51, P<0.01). The mean fecal incontinence score of six patients with fecal incontinence, before and after Delorme procedure, were (14 ± 2) and (6 ± 2) respectively ( t = 9.09, P<0.01). Conclusions:The Delorme procedure for adults with full-thickness rectal prolapse is a safe and effective surgery with less complications and low recurrence rate. The Delorme procedure may be one of the preferred option of perineal approach for adults with full-thickness rectal prolapse, but the long-term outcome of Delormer procedure and its effect on postoperative anal function need to be further studied.