To evaluate the role of color Doppler flow imaging in the portal vein chemotherapy by ultrasound guided percutaneous transhepatic portal injection, the blood supply of liver tumor and portal hemodynamics were studied in 15 patients with primary hepatic carcinoma and one patient with secondary hepatic carcinoma. The continuous wave in the lesion and forward continuous wave in the portal vein seen by pulsed Doppler in nine cases, were indications for this therapeutic method. The distribution of the drugs in the liver could be observed by color Doppler flow imaging when injection was being done. The therapeutic efficacy of portal vein chemotherapy in liver tumor may be evaluated by color Doppler folw imaging and puncture biopsy.

BACKGROUND:Chinese nourishing kidney herbs can prevent osteoporosis and improve bone metabolism, which has been proved in animal and cel experiments. But there are few reports on the compatibility of Chinese nourishing kidney herbs, and it is difficult to screen the optimal compatibility, as the interaction of active ingredients and drug substance basis are uncertain. OBJECTIVE: To determine the proliferation, differentiation and Smad4 mRNA expression of neonatal Sprague-Dawley rat osteoblasts cultured by Chinese nourishing kidney herbs with different compatibility so as to find out the optimal compatibility of Chinese nourishing kidney herbs. METHODS: Passage 5 osteoblasts were divided into five groups: group A, 1×10-5mol/L icarin; group B, 1×10-5mol/L icarin+1×10-5 mol/L naringin; group C, 1×10-5mol/L icarin+1×10-5 mol/L diosgenin; group D, 1×10-5mol/L icarin+ 1×10-5mol/L catalpol; group E, 10 μL normal saline (control group). There were six wels in each group. RESULTS AND CONCLUSION: Compared with the group E, the proliferative ability of osteoblasts and expression of Smad4 mRNA were increased in the groups B and C; until the 72nd hour, the proliferative ability of osteoblasts in the group B reached the peak. At 48 hours of culture, the activity of alkaline phosphatase in groups B and C was higher than that in group E; at 72 hours of culture, the activity of alkaline phosphatase in groups B and D was higher than that in group E. These findings indicate that the compatibility of Chinese nourishing kidney herbs can influence the activity of osteoblasts, and icarin+naringin has the strongest effect.

Objective To investigate the safety of laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively.Methods Forty patients who received laparoscopic common bile duct exploration and lithotomy at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 2011 to June 2013 were prospectively analyzed.All the patients were randomly divided into 2 groups according to the random number table.Twenty patients in the experimental group did not received drainage tube placement,and the other 20 patients in the control group had subhepatic drainage after operation.The operation time,duration of hospital stay and incidence of postoperative complications were compared between the 2 groups.Patients received computed tomography and B sonography at postoperative month 1 and 3,and then patients were reexamined every 6 months till postoperative year 3.The follow-up was ended on July 31,2013.The measurement data and the count data were analyzed using the independent sample t test and the Fisher exact probability,respectively.Results Patients in the 2 groups were cured after the operation.The operation time and duration of hospital stay were (117 ± 11) minutes and (5.6 ± 0.6) days in the experimental group,and (108 ± 12)minutes and (7.9 ± 0.7)days in the control group,with significant difference between the 2 groups (t =2.453,-ll.388,P ＜ 0.05).No complications including bile leakage,residual stones,obstructive jaundice,abdominal bleeding and subphrenic infection were detected after the operation.Thirty-one patients were followed up for 1 month to 2 years,no bile duct stone recurrence or biliary stricture were detected during the follow-up.Conclusion Laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively is safe and feasible.

Objective To investigate the value of three dimensional (3D) laparoscopic anatomical hepatectomy for liver tumors. Methods Clinical data of 10 patients with liver tumors who underwent 3D laparoscopic anatomical hepatectomy in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from September to November 2013 were analyzed retrospectively. There were 7 males and 3 females with age ranging from 36 to 62 years old and the median age of 49 years old. The primary disease were primary liver cancer (n=8), hepatic hemangioma(n=2). The informed consents of all patients were obstained and the ethical committee approval was received. All the patients underwent 3D laparoscopic anatomical hepatectomy through endotracheal general anesthesia. The operators and assistants wore special 3D glasses. After the 3D laparoscope was inserted through the navel incision, operation channels were established by putting 3 to 4 trocars (5 mm or 10 mm) at different positions of upper abdomen respectively, and then anatomical hepatectomy was performed according to the diseased region. The operaton procedures, intraoperative blood loss, length of hospital stay and postoperative complications of patients were observed. Results All the 10 patients underwent anatomical hepatectomy through 3D laparoscope, and no case converted to open surgery during the operation. Three cases received right hemihepatectomy, 3 cases received segment Ⅴ+Ⅵ hepatectomy, 2 cases received hepatic left lateral lobectomy, 1 case received mesohepatectomy, and 1 case received segment Ⅴ hepatectomy. The average operation duration of patients who underwent right hemihepatectomy was (270±26)min, segment Ⅴ+Ⅵ hepatectomy was (122±8)min, hepatic left lateral lobectomy was (90±7)min, mesohepatectomy was 245 min, and segment Ⅴ hepatectomy was 95 min. The intraoperative blood loss was (483±104), (233±29), (125±35), 450, 180 ml, and the length of hospital stay was (17±5), (11±1), (9±1), 13, 10 d accordingly. Liver disfunction was observed in 1 case out of the patients after right hemihepatectomy. Right lower lung infection was observed in the patient after mesohepatectomy. No complication was observed in the other 8 patients after operations. Conclusions The 3D laparoscope has a certain advantage in dissecting the intrahepatic ductal structures precisely, and can help to control the intraoperative blood loss. It is applicable to anatomical hepatectomy for liver tumors, especially to hemihepatectomy.

In recent years,psoriatic arthritis has become a major problem in the medical field,with cases gradually increasing in China,and it is still incurable.Here,we summarize the pathogenesis and clinical characteristics of currently available animal models of psoriatic arthritis based on Chinese and Western medical evidence.Literature in line with this topic was collated and summarized.The etiology and pathogenesis according to Chinese and Western medicine of existing psoriatic arthritis models were given agreement scores;the diagnostic criteria of Chinese and Western medicine were compared;and the models'characteristics and degree of agreement with clinical observations were assessed.This study found that the human leukocyte antigen transgenic mouse model,the multiple hybridization transgenic mouse model,and the mannan-induced mouse model had the highest agreement scores.As psoriatic arthritis is more common in Europe,methods for the preparation of animal models have been mostly imported from abroad,and very few animal models have the characteristics of Chinese medicine;therefore,the model fitness scores of Western diagnoses were higher than those of Chinese diagnoses as a whole.We hope to leverage the unique diagnosis and treatment method of Chinese medicine further to improve the types of psoriatic arthritis animal models available.This study provides a basis for the construction of improved animal models of psoriatic arthritis with combined traditional Chinese and Western medicine characteristics.

Anatomic resection aims to improve the surgical efficacy of hepatocellular carcinoma by systematic resection of portal territory. However, due to its deviation of traditional theory and practice, the oncology effect is questionable. Anatomic resection based on portal territory(PT-AR) is planned by the analysis of real portal vein territory, and performed complete resection of tumor-bearing portal territory by fluorescent guidance, while exposing typical inter-territory hepatic vein, so as to ensure the complete function of future liver remnant. PT-AR is based on the core theory of classical anatomic resection, which will correct the deviation of traditional theory and practice from the technical level, so as to lead a better surgical oncology outcomes for hepatocellular carcinoma.

Objective:To investigate the efficacy of mFOLFOX7 regimen systemic chemo-therapy combined with camrelizumab and apatinib for hepatocellular carcinoma (HCC) with Vp4 portal vain tumor thrombus (PVTT).Methods:The single-arm, open, exploratory clinical study was conducted. The clinicopathological data of 15 HCC patients with Vp4 PVTT who were admitted to the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from April 2021 to October 2023 were collected. There were 14 males and 1 female, aged 48(range, 33-67)years. All patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib. Observa-tion indicators: (1) clinical efficacy; (2) survival of patients. Measurement data with skewed distribution were represented as M(rang), and count data were described as absolute numbers or percentages. Results:(1) Clinical efficacy. All 15 patients underwent treatment with mFOLFOX7 regimen combined with camrelizumab and apatinib. According to the response evaluation criteria in solid tumors version 1.1, the ratio of objective response, ratio of complete response, ratio of partial response, ratio of disease control, median progression free survival time and median total survival time of the 15 patients were 10/15, 1/15, 9/15, 15/15, not reached and not reached. The median progression free survival time and median total survival time were both >9 months. According to the modified response evaluation criteria in solid tumors, the ratio of objective response, ratio of complete response, ratio of partial response, ratio of disease control, median progression free survival time and median total survival time of the 15 patients were 12/15, 6/15, 6/15, 15/15, not reached and not reached. The median progression free survival time and median total survival time were both >9 months. Of the 15 patients, 7 cases were successfully treated with conversion therapy with the surgical conversion rate as 7/15, and all of them achieved R 0 resection. The other 6 cases were failed in conversion therapy, and there were 2 cases still undergoing conversion therapy. Of the 7 patients with successful conver-sion therapy, 5 cases achieved complete pathological remission, 1 case achieved major pathological remission with 90% of tumor tissue necrosis, and 1 case achieved complete remission through imaging examination, but new liver lesions appeared in multiple locations during further observation which were surgically removed. Results of histopathology examination on the patient confirmed multiple liver metastases. The proportion of treatment-associated adverse reactions in 15 patients was 13/15, with 7/15 having ≥grade 3 adverse reactions, including diarrhea (3/15), neutropenia (2/15), thrombo-cytopenia (2/15), and elevated aspartate aminotransferase (2/15). One patient may experience ≥1 adverse reaction. All patients were improved after symptomatic treatment. (2) Survival of patients. All 15 patients were followed up for 13.0(range, 2.0-31.0)months. During the follow-up period, 3 patients died. One case died of upper gastrointestinal bleeding after achieving partial remission, with a survival time of 7.5 months. One case died of multiple liver metastases of tumor, with tumors accounting for over 70% volume of liver and a survival time of 9.5 months. One case with multiple liver tumors and bilateral lung metastasis died due to disease progression after achieving partial remission, with a survival time of 13.5 months. The postoperative follow-up time for 7 patients undergoing surgical treatment was 14.0(range, 2.0-25.0)months. Of the 7 patients, 1 case experien-ced tumor recurrence 20.0 months after surgery, and 6 cases had no recurrence at last time of the follow-up (3 cases completed treatment and entered follow-up observation). The longest survival time was 31.0 months. Conclusion:The mFOLFOX7 regimen systemic chemotherapy combined with camrelizumab and apatinib for HCC with Vp4 PVTT is safe and feasible.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.

Objective:To combine and improve two kinds of classical transvaginal cervical cerclage,and to provide a new reference for the clinical treatment of patients with cervical insufficiency(CIC).Methods:Retro-spective analysis was performed on the clinical data of 117 patients who underwent transvaginal cervical cerclage due to CIC from January 1,2018 to August 31,2023 in the Second Affiliated Hospital of Kunming Medical Univer-sity.According to different surgical methods,the patients were divided into the modified cerclage group(40 ca-ses),the McDonald cerclage group(40 cases)and the Shirodkar cerclage group(37 cases).Intraoperative and postoperative conditions and pregnancy outcomes were compared.Univariate and multivariate Logistic regression analysis was performed to analyze the related factors of preterm birth after modified cervical cerclage and the oth-er two groups of classical cervical cerclage.Results:①Compared with the McDonald cerclage group,the modified cerclage group had longer effective cervical length,longer delivery and gestational weeks,higher term delivery rate,and shorter post-operative contraction inhibitor time,with statistical significance(P＜0.05).Compared with the Shirodkar cerclage group,the operation time of patients in the modified cerclage was significantly shortened,the amount of intraoperative blood loss was reduced,the use time of postoperative contraction inhibitors was shortened,and the rate of postoperative wire-cutting was decreased,with statistical significance(P＜0.05).②Multivariate Logistic regression analysis of preterm birth showed that the longer the length of the cervix and the later gestational age when the modified cervical cerclage was performed with reference to McDonald's cerclage,the longer the length of the cervix after surgery,the later the gestational age when the suture was removed.The risk of preterm birth was reduced(OR＜1,P＜0.05),while preoperative BMI≥24 kg/m2 was associated with an increased risk of preterm birth(OR＞1,P＜0.05).Using Shirodkar's cerclage as reference,the risk of preterm delivery was consistent between the two types of cervix(P＞0.05).Longer cervical length and later gestational age after suture removal reduced the risk of preterm delivery(OR＜1,P＜0.05).Conclusions:The modified transvaginal cervical cerclage is simple and safe in clinical application,it has certain advantages in improving ad-verse pregnancy outcomes of pregnant women,which provides a new reference for the treatment of pregnant women with CIC.Due to the small number of cases included in the study,comprehensive evaluation by clinicians is still needed for clinical application.