Liver transplantation,the most effective therapeutic way to the treatment of end-stage hepatopathy,has been widely used in clinical practice,but the complication,ischemic type biliary lesions has been considered the crucial factor influencing the long-term survival and quality of life of patient.In this article,we review the mechanism and the progressions of biliary lesions induced by liver I/R in recent years.

Objective To explore the curative effects of microsurgical clearance for supratentorial hypertensive intracerebral hemorrhage. Methods A retrospective analysis of clinical data of 30 cases of supratentorial hypertensive intracerebral hemorrhage in our hospital from January 2010 to January 2013 was carried out. According to the head CT images, the position of incision was determined. Under orotracheal intubation general anesthesia, a bone flap craniotomy was performed. A cortex fistula 2-3 cm in length was made. Then by using an automatic retraction device, the hematoma was revealed from the shallower to the deeper, and microscopic clearance of hematoma was completed. Results All the 30 cases of operation were successful. Re-examination of head CT scans on the first postoperative day showed hematoma was completely removed in 14 cases, was 90%cleared in 11 cases, and 80%in 5 cases. Four patients died within 4 weeks after operation (13.3%):2 patients died of cerebral hernia caused by brainstem function failure, 1 patient died of lung infection, and 1 patient died of multiple organ failure. The postoperative survival rate was 86.7%.The ADL grade assessment 3 months after operation showed gradeⅠin 7 cases, grade Ⅱin 9 cases, grade Ⅲin 6 cases, grade Ⅳ in 3 cases, and grade Ⅴin 1 case. Conclusion Microscopic hematoma clearance and open haemostatic intervention has advantages of little brain tissue damage, good haemostatic results, and satisfactory efficacy.

BACKGROUND: Dlx gene family is highly expressed in the cranial neural crest cells, and regulates the cranial neural crest cel migration and differentiation. OBJECTIVE: To review the mechanism that the highly-expressed Dlx genes mediate the cranial neural crest cel migration and differentiation. METHODS: An online search of CNKI and Medline databases was performed for articles published before 2013 using keywords of “cranial neural crest cells, migration of cranial neural crest cells, Dlx, Dlx overexpression, Fgf, chodrogenesis, osteogenesis” in Chinese and English, respectively. Relevant articles were summarized from three aspects: the migration of cranial neural crest cells, Dlx over-expression’s impact on the migration of cranial neural crest cells, interaction between the environment and Dlx genes. A total of 63 articles were included. According to inclusion criteria, 43 articles were retained at last. RESULTS AND CONCLUSION: Dlx abnormal-expression wil lead to cel -cel adhesion. Dlx over-expression wil induce most of the cranial neural crest cells aggregate and migrate to a wrong place, and result in skeletal dysmorphology. Dlx over-expression wil also lead to ectopic chondrogenesis, and the interaction between cel factors can be the possible reason for this.

Objective To evaluate the curative effect of endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in the treatment of gallstones complicated with common bile duct stones. Methods A total of 36 cases of gallstones complicated with common bile duct stones were enclosed. First EST was performed to remove the bile duct stones. Then LC was applied to resect the gallbladder. Results EST was successfully performed in 34 cases (94.4%) and failed in 2 cases because of the terminal stricture of the bile duct that was afterwards cured by an open choledochojejunostomy. LC was performed following EST in 34 cases, 32 of which were successful (94.1%) and 2 of which required a conversion to open surgery. Conclusions EST combined with LC is the best way for treating gallstones complicated with common bile duct stones. The biliary stricture mainly accounts for the failure of EST and should be treated by choledochojejunostomy as the first choice.

Objective To explore and analyze the clinical characteristics and treatment strategy of severe complications caused by childrenˊs foreign bodies in esophagus.Methods The clinical data of 71 ca-ses of esophageal foreign bodies in children with ENT admitted to our hospital were analyzed retrospectively from Jan 2009 to Dec 2014.Results Esophageal foreign bodies in children with 71 cases,of whom 42 males and 29 females;aged from 2 months to 14 years old,highest incidence of 1 to 3 years old.Foreign bodies in esophagus lasted 2 h to 15 d.Ingestion of metallic foreign bodies in 43 cases,12 cases of plant-based foreign body,9 cases of animal foreign bodies,7 cases of chemical foreign bodies.Foreign bodies located in the upper esophageal was 51 cases,9 cases of the middle and 7 cases of the under section,3 cases of esophageal en-trance,1 case of falling into the stomach.In children with 71 cases,9 cases had complications,69 cases were cured,improved in two cases,and the cure rate was 97.2%,the average healing time was 4 d.Conclusion Early diagnosis and treatment,avoid esophageal perforation are the key to avoid the emergence of the compli-cations in children with esophageal foreign bodies,timely and accurate treatment of esophageal perforation and other complications are the effective measures to improve the cure rate.

Objective To explore the effect of intrahepatic injection of liposome-mediated VEGF plasmid on ischemia-reper-fusion liver injury and its mechanism. Methods Rabbits were randomly divided into normal group, ischemia-reperfusion group and recombinant VEGF therapy group( liposome-mediated transfer of VEGF plasmid into liver via portal vein 20 min before ischemia of liver). The model of liver ischemia-reperfusion injury was established. Liver function and the activity of SOD.XO in blood were determined at the 0,2nd,6th,12th,and 24th h after operation. RT-PCR technique was applied to detect the expression level of Fas mRNA in liver tissues of every group,and flow cytometry was used to measure cell apoptosis rate at the 6th h after operation. At the 24th h after operation,all rabbits were killed and liver tissues of ischemia were taken to make pathological sections for observing the morphology and microstructure under the light microscopy and electron microscopy. ResuJts The level of ALT in recombinant VEGF therapy group was markedly reduced as compared with ischemia-reperfusion group at the 6th,12th,and 24th h after operation( P<0. 05). The activity of SOD in recombinant VEGF therapy group was significantly higher than in ischemia-reperfusion group at the 6th, 12th,and 24th h after operation. The activity of XO in recombinant VEGF therapy group was significantly lower than that in ischemia-reperfusion group at the 6th,12th,and 24th h after operation(P< 0. 05 or P<0. 01). In addition,there was significant difference in the expression of Fas mRNA and cell apoptosis rate between recombinant VEGF therapy group and ischemia-reperfusion group(P<0. 01). The injury of hepatocytes in recombinant VEGF therapy group was significantly alleviated as compared with that in ischemia-reperfusion group under the light microscopy and e-lectron microscopy. Conclusion Liposome-mediated transfer of VEGF plasmid into liver before ischemia of liver can obviously protect hepatocytes by increasing anti-oxidative ability, decreasing the expression of Fas mRNA, and finally inhibiting hepato-cyte apoptosis.

OBJECTIVEThis study evaluates piezosurgery for surgically assisted rapid maxillary expansion (SARME) under local anesthesia.

METHODSSARME was performed on adults with maxillary transverse deficiency under local anesthesia with a piezosurgical device. Fourteen patients (six males and eight females) underwent lateral maxillary osteotomies, midpalatal osteotomies, and bilateral pterygomaxillary disjunction. The feelings of patients during the operation were determined through questionnaires.

RESULTSAll patients underwent SARME in the out-patient operating room. The surgical procedures were completed under local anesthesia. All patients exhibited satisfactory tolerance. Ultrasonic bone-cutting surgery was recently introduced as a feasible alternative to the conventional tools of cranio-maxillofacial surgery for its technical characteristics of precision and safety. The device used was unique in that cutting action occurred when the tool was employed on mineralized tissues, but stoped on soft tissues. The results of the questionnaires showed that eight (57.14%) patients felt a mild sensation of ultrasonic vibration, tweleve (85.7 1%) felt mild tolerable pain and tooth soreness during surgery, and eleven (78.57%) felt little fear and hardly heard the ultrasonic sound. Preoperative and postoperative six months later measurements showed an evident effect of expansion.

CONCLUSIONPiezosurgery enabled patients to undergo all the steps of SARME under local anesthesia, but more cases and longer follow-up are needed to verif ' the results.

Hepatolithiasis is a kind of mixed stone disease which mainly depends on pigment stone.However,the etiology is not clear and the pathogenesis is very complex.A lot of studies confirmed that helicobacter pylori played an important role in the occurrence and development of disease.This paper mainly expounds the problems concerning the characteristic of helicobacter pylori and its connection with hepatolithiasis, its state in the formation of hepatolithiasis.

Phenylketonuria (PKU) is a severe autosomal recessive disease which can cause irreversible damage to patients' neural system and results in severe mental retardation.Although the institution of a lowphenylalanine (Phe) diet has been a remarkable success in preventing the devastating damage associated with untreated PKU,there are always small but consistent gap in intelligence quotient (IQ) scores and executive functioning when compared to siblings or healthy age-related control groups.During the past few years,several types of new treatment strategies,such as genetic engineering,enzyme replacement,tetrahydrobiopterin (BH4),large neutral amino acids (LNAA),low-Phe diet and liver or liver cell transplantation therapies,have been studied and improved.This paper aims to introduce the research advances in pathogenesis of PKU,the treatment methods and the related molecular mechanism.

Objective To investigate the prognostic related factors in the patients with ruptured intracranial aneurysm treated by surgical treatment and their clinical significance .Methods The medical record data in 218 cases of ruptured aneurysm treated by operative treatment were performed the retrospective analysis ,including th egeneral data ,Hunt‐Hess grade on admission ,surgical procedure ,etc .The patient′s prognosis situation adopted the Glasgow outcome scale(GOS) as the evaluation standard when dis‐charge from hospital .Firstly the possible factors were performed the single factor analysis ,then the factors with statistic signifi‐cance in the single factor analysis were performed the multiple factors logistic regression analysis .Results The single factor analy‐sis indicated that the age ,Hunt‐Hess grade on admission ,hypertension ,operation mode ,CT Fisher grading and symptomatic vaso‐spasm were significantly correlated with the prognosis ( P < 0 .05) .The multiple factors analysis indicated that age ,Hunt‐Hess grade on admission ,symptomatic vasospasm ,CT Fisher grading were the independent risk factors affecting the prognosis of patients (P< 0 .05) .Conclusion The patients′ age ,Hunt‐Hess grade on admission ,symptomatic vasospasm and CT Fisher grading can sig‐nificantly affect the prognosis of the patients with ruptured intracranial aneurysm after surgical treatment .Paying attention to the predictive value of these predictors has important clinical significance to reduce the postoperative mortality rate and disability rate in the patients with ruptured intracranial aneurysm .