With the developments of endoscopic and interventional techniques, the role of surgical treatment in some diseases is gradually replaced by endoscopic or interventional treatment.The word surgery may not preserve only for surgeons, therefore it is redefined.According to different interventional pathways, digestive surgery can be divided into two categories, although both are with similar surgical essentials as resection and repair. Serosa surgery is traditional surgery,characterized for its pathway from skin to visceral serosa and cavity, either by open or laparoscopic platform. Mucosa surgery performs endoscopic operations from natural orifice then mucosa surface.The intercrossing or merging of different disciplines is an inevitable trend for modern medical science, traditional disciplines may be replaced by disease-centered medical model combined with multiple disciplines and techniques.Facing challenges, digestive surgeons should be confidential and inclusive;facing competitions, digestive surgeons should be brave enough for innovation and cooperation, and always regard patients' interest as his first priority.A universal norm for various disciplines should be set up on the practice of evidencebased medicine;surgeons in different specialties should learn from each other, and reinforcing comple-mentary advantages from each other;creating a novel disease-centered multidisciplinary heahhcare model on the basis of fusion of different disciplines is the development direction of digestive surgery.

Objective The aim of this study is to summarize primarily the application range and the clinical effect of the minimally invasive direct cardiac surgery (MIDCS).Methods From April 2010 to August 2011,108 operations had been performed in our centre using MIDCS,among of which 44 males and 64 females,mean age (44.3 ± 16.4 ) years old,mean weight (60.0 ± 12.0 ) kg.These operations included 29 MVR operations (replacement with mechanical valve 19,with tissue valve 10),17 AVR operations( replacement with mechanical valve 11,with tissue valve 6 ),5 MVP operations,6 MVR + AVR operations (replacement with mechanical valve 5,with tissue valve 1 ),12 VSD repair operations and 23 ASD repair operations,9 MIDCAB operations,1 MVR + CABG oparation,2 PECD correction,1 repair of ruptruec chordae tendineae of tricuspid septum and 1 Ebstein deformity correction operation.Concomitant procedures included 19 TVP operations and 11 radiofrequency ablation operations.Except MIDCAB operations,other operations are performed with closed type extracorporeal circulation.Conversion to median sternotomy was necessary in only two patients ( 1.9％ ).Results Mean cardiopulnonary bypass time and aortic eross-clamp time were ( 104.4 ± 59.3 ) minutes and ( 66.7 ± 52.8 ) minutes respectively,74 patients ( 92.5 ％ ) recover to beat automatically after heart ceased operation.Median mechanical ventilation time was ( 14.5 ± 11.9 ) hours,Median intensive care unit stay was ( 18.8 ± 15.3 ) hours,median hospital stay post operative was (6.9 ± 2.9) days.Median incision length was (5.3 ± 1.2 )cm.Median draining volume was( 337.6 ± 240.9 )ml in the first day after operation,No transfusion occurred in 72 patients(66.7％ ).Hospital mortality was 0.No re-exploration for bleeding and sternal wound infection.When leaving hospital,94 being of heart functional class Ⅰ,8 of class Ⅱ,6 of class Ⅲ.Conclusion MIDCS was associated with good operative effect in the near future,superior safety and broad application range.Furthermore MIDCS has minimally invasive,less postoperative bleeding,fewer blood transfusions,good cosmesis,as well as the absence of sternal wound infection.It may be safely performed on selected patients with low postoperative mortality and morbidity.

Objective To summarize the experiences of Nuss procedure with thoracoscope for repairing pectus excavatum.Methods 21 cases of pectus excavatum were treated by Nuss procedure with thoracoscope.In these patients,10 had symmetric pectus excavatum and 11 had asymmetric one.Results The operation in all patients were successful.The mean operating time wag(70.7±9.6)min and the mean intraoperative blood loss was(20.3±10.9)ml.The average hospital length of stay was(5.3±1.1)days,the average durante dolors was(6.9±4.0)days.The exceUent rate was 81.0%(17/21),including 90.0%(9/10)in symmetric pectus excavatum and 72.7%(8/11)in asymmetric pectus cxcavatum.Conclusion Nuss procedure is easy to perform,with minimal invasion,short operating time,and less blood loss.Nuss procedure is suitable for the symmetric pectus excavatum.

Objective To evaluate the diagnostic value of ultrasonography in neonatal necrotizing enterocolitis (NEC)by Meta analysis.Methods PubMed,EMbase,CBM,CNKI,VIP and WanFang databases were retrieved to incorporate studies on the diagnostic value of ultrasound in NEC that met the inclusion criteria.The retrieval time limit was from establishment of the databases to July 24th,2015. QUADAS was used to assess the quality of the literatures and Meta -Disc software (Version 1 .4)was used for Meta analysis.The SROC was drawn and the area under curve (AUC)of SROC was calculated.Results A total of 7 studies were included and 485 patients were involved.The sensitivity of the ultrasonography was 0.65 (95%CI 0.58 ~0.71 )and the specificity was 0.61 (95%CI 0.55 ~0.67).The AUC of the SROC was 0.726.Conclusion The ultrasonography showed no clear advantage for diagnosis of NEC.Combining with clinical manifestations would enhance the diagnostic ability of the ultrasound.

Forensic Medicine ; Formaldehyde

Objective To investigate the effect of the serum of patients with hepatopulmonary syndrome on the myogenic differentiation,proliferation and migration of human lung fibroblasts.Methods The human lung fibroblasts were seeded in plates or flasks and randomly divided into 2 groups (n =31each) using a random number table:serum of patients with hepato-pulmonary syndrome group and serum of healthy volunteer group.The human lung fibroblasts were incubated in the DMEM culture medium containing 10％ serum of patients with hepatopulmonary syndrome or in the DMEM culture medium containing 10％ serum of healthy volunteers.At 24,48 and 72 h of incubation (T1-T3),the expression of smooth muscle-α-actin (SM-α-actin) and smooth muscle myosin heavy chain (SM-MHC) in human lung fibroblasts was determined by Western blot,the proliferation of the human lung fibroblasts was determined using 3H-TDR incorporation assay,and the migration of the human lung fibroblasts was determined by Transwell chamber assay.Results Compared with serum of healthy volunteer group,the expression of SM-α-actin and SM-MHC in human lung fibroblasts was significantly up-regulated at each time point,and the proliferation and migration of the cells were significantly enhanced at T2,3 in serum of patients with hepatopulmonary syndrome group (P＜0.05).Compared with the value at T1,the expression of SM-α-actin and SM-MHC in human lung fibroblasts was significantly up-regulated,and the proliferation and migration of the cells were significantly enhanced at T2,3in serum of patients with hepatopulmonary syndrome group (P＜0.05).Compared with the value at T2,the expression of SM-α-actin and SM-MHC in human lung fibroblasts was significantly up-regulated,and the proliferation and migration of the cells were significantly enhanced at T3 in serum of patients with hepatopulmonary syndrome group (P＜0.05).Conclusion The serum of patients with hepatopulmonary syndrome can promote the myogenic differentiation,proliferation and migration of human lung fibroblasts.

Objective To observe the analgesia effects of ropivacaine with sufentanil or dezocine on continuous femoral nerve block (FNB)after total knee arthroplasty (TKA).Methods Sixty un-dergoing selective unilateral TKA patients,received postoperative analgesia with continuous FNB for 48 hours,were randomly divided into three groups according to the drug formulations:0.225% ropiv-acaine (group R),0.1 5% ropivacaine mixed dezocine 10 mg (group D),and 0.1 5% ropivacaine mixed sufentanil 1 μg/kg (group S);the visual analogue scale (VAS)in resting state (RVAS), active functional exercise state (AVAS),passive functional exercise state (PVAS)were recorded at 1,3,7 d after surgery.The other analgesics dosage and the incidence of nausea and vomiting and other complications were recorded.Results Compared with preoperative state,the RVAS scores in three groups were significantly lower at 1,3,7 d after surgery,the PVAS scores were significantly lower at 7 d after surgery (P <0.05).Compared with group R,the RVAS scores were significantly higher ei-ther in groups S or D at the 3 d postoperatively (P <0.05).There were no significantly difference in adverse reaction among three groups.Conclusion Ropivacaine combined with sufentanil or dezocine through continuous FNB can provide a effectual postoperative analgesia in TKA patients without an increase in adverse events.But compared to 0.225% ropivacaine,0.1 5% ropivacaine with sufentanil or dezocine may not keep a longer analgesia duration,this is more obvious observed in dezocine group.

Objective To explore the influence of Akt inhibitor MK2206 in the proliferation and apoptosis of tongue squamous cell carcinoma TCA-8113 cells,and to clarify the possible mechanism.Methods The tongue squamous carcinoma TCA-8113 cells at the logarithmic phase were randomly divided into control group and 1,5,25,125, 250 nmol·L-1 MK2206 groups.The inhibitory rate of proliferation of TCA-8113 cells was detected with MTT method,and the apoptotic rate of TCA-8113 cells was determined with flow cytometry(FCM),and the expressions of caspase-9,Bad,GSK-3β,p-Akt and T-Akt proteins in the TCA-8113 cells were detected with Western blotting method.Results The IC50 of tongue squamous cell carcinoma TCA-8113 cells after treated with MK2206 for 12, 24,and 36 h were (112.54±1.67),(79.67±2.01),and (33.33±1.98)nmol·L-1 .The FCM results showed that the apoptotic rates of TCA-8113 cells after treated with 1,5,25,125,and 250 nmol·L-1 MK2206 for 12 h were (14.2±0.74)%,(19.3±0.45)%,(35.1±0.45)%,(39.6±0.48)% and (52.1±0.19)%;there were significant differences compared with control group(P<0.01).The Western blotting method results showed that the expressions of p-Akt, Bad and GSK-3βwere decreased with the increasing of dose and time of MK2206;compared with theβ-actin in control group,the bands got darken;the expression level of caspase-9 was increased, compared with theβ-actin in control group, the bands got darken;the T-Akt protein expression did not change significantly;compared with the β-actin in control group, the color of bands had no significant difference.Conclusion Akt inhibitor MK2206 can inhibit the proliferation of tongue squamous cell carcinoma TCA-8113 cells and induce apoptosis.

Objective To detect the expression and activity of AMP-activated protein kinase α subunit (AMPKα) and peroxisome proliferator-activated receptor-α (PPARα) in liver of high-fat fed rats treated with metformin, and to investigate the mechanisms underlying metformin decreasing the total cholesterol (TC) and triglyceride (TG) contents of the liver. Methods Total 30 male Wistar rats were randomly divided into control group (group C), high-fat diet fed group (group HF) and high-fat diet feeding plus metformin treatment group (group Met,metformin was administered orally at the last month of high-fat diet feeding). After feeding for 5 months, TC and TG in liver and sera were determined, respectively. The mRNA and protein levels and activity of AMPKα and PPARα in the liver were determined by real-time PCR and Western blotting. The activity of PPARα transcriptor binding to DNA was detected by ELISA. Results Five months of high-fat diet feeding induced a significant decrease in AMPKα and phosphorylated-AMPKα protein expression as well as AMPKα2 and PPARα mRNA levels in the liver of rats (all P＜0.05), while it did not alter PPARα protein expresssion and the PPARα activity binding to DNA as well as AMPKα1 mRNA levels. The TC and TG contents in the liver (P＜0.05) and serum (P＜0.05) were sharply increased in group HF than those in group C. Treatment with metformin for 1 month led to a marked increase of AMPKα2 mRNA level, AMPKα and phosphorylated-AMPKα protein expression as well as the PPARα activity in group Met compared with group HF(all P＜0.05), while the PPARα protein expression and the PPARα mRNA level did not show significant change. Consistent with these findings, the TC and TG contents in rat liver as well as sera were strikingly decreased (all P＜0.05). Conclusion The activations of AMPKα and PPARα induced by metformin may contribute to the decrease of TC and TG content in liver and sera of the high-fat fed rats.

In four patients with chronic pancreatitis from two hereditary pancreatitis (HP) families and 63 normal controls, five exons of cationic trypsinogen gene (PRSS1) were amplified by PCR and it's products were analyzed by sequencing, related clinical data were also collected. All the four patients were found mutations in the PRSS1 gene but their clinical feature is absolutely different. Six patients with diabetes mellitus were found in pedigree No. 1, it's members show pancreatitis symptom later, at about 29, the tumor markers (CA19-9, CA72-4) is obviously higher than the patients in pedigree No. 2, two patients with chronic pancreatitis in pedigree No. 2, show symptom earlier without diabetes mellitus, their clinical characterization are different too. The number of CD4+T cell/CD8+T is very low in Ⅲ 8, but Ⅲ 7 is normal, and the level of anti-HBs of Ⅲ 8 is variable in the course of pancreatitis, but the phenomenon was not found in Ⅲ 7. In their PRSS1 gene two guanosine (G) to adenosine (A) mutations were found in PRSS1 exon 3 of pedigree No. 1, one was detected at 336 basyl, the other mutation occurs at 361 basyl. The results of the mutations were Lys →Lys and Ala →Thr. While thymine (T) to adenosine (A) and (guanosine) G→(adenosine) A mutation in PRSS1 exon 3 was detected in the other patient of pedigree No. 2 (Ⅲ 8). One was 361 basyl, the other at 415 basyl. While c.415 T→A was not found in the proband of pedigree No. 2 PRSS1 gene (Ⅲ 7). All of the mutations were heterozygous mutation, that is to say all of the trypsinogen were wild type and mutant type concomitance, the normal and abnormal pathway of active trypsinogen exist partially. At the same time, the mutations of SPINK1 were not observed. Compared with the documents and registration of NCBI, it can be concluded that PRSS1 gene had many kinds of mutations in hereditary pancreatitis, the heterozygous mutations (c.336 G→A, c.415 T→A) were the novel mutations and related with clinical phenotype. What's more, it's the first time that the multisite heterozygous mutations of PRSS1 gene were reported. The presence of the mutations in four patients with chronic pancreatitis, it's absence in their relatives and the strong evolutionary conservation of the mutation, all indicate that the trypsinogen mutation is associated with hereditary pancreatitis and for the first time raises the question whether a gain or a loss of trypsin function participates in the onset of Chinese pancreatitis.