BACKGROUND: Rat model of orthotopic liver transplantation is a very valuable model for experimental study in liver transplantation including organ preservation, tissue ischemia-reperfusion injury, allograft rejection and immune tolerance mechanism. Stable liver transplantation animal model is the basis of the related experimental studies. However, its experimental operation is long and boring, especially performed by a single operator under direct vision. OBJECTIVE: To investigate the operation techniques to establish a stable rat model of orthotopic liver transplantation by a single operator under direct vision. METHODS: The orthotopic liver transplantation was performed using two-cuff method in 50 pairs of rats. We exposed the abdominal cavity fully, perfused the donor liver through abdominal aorta without flipping donor liver; suprahepatic inferior vena cava was in vivo cut down using one-step method, without diaphragm ring; the suprahepatic inferior vena cava was anastomosed with single-row suture, and the cuff of portal vein was installed by fixing the blood vessel forceps on rubber. Hepatic artery was not reconstructed. Fluid replacement was administered to maintain hemodynamic stability in rats after operation. RESULTS AND CONCLUSION: The donor operative time was (36.2± 2.5) minutes, donor liver trimming time was (12.2± 1.5) minutes, receptor operative time was (45.6 ± 3.5) minutes, suprahepatic inferior vena cava anastomosis time was (10.1 ± 2.1) minutes, portal vein cuff time was (1.5 ±0.9) minutes, infrahepatic inferior vena cave cuff time was (1.1 ± 0.6) minutes, anhepatic phase was (15.1 ± 2.2) minutes. The success ratio of the operation was 100% and the survival rates within 1 week and 1 month were all 100%. It is indicated that the key factors of a successful model were stable anesthesia, good donor liver perfusion, adequate exposure, skilled microsurgical technology and vascular anastomosis technique.

ObjectiveTo compare therapeutic effects of the bone-guided tissue regeneration in combination with a composite bovine-derived xenograft versus flap surgery only on intra-bony defects in elderly patients with periodontal disease. MethodsThirty elderly patients with periodontal disease were randomly divided into two groups. One group was treated by the bone-guided tissue regeneration in combination with a composite bovine-derived xenograft (experimental group). The other group was treated by flap surgery only (control group). Probing depth (PD)and clinical attachment level (AL) were determined before surgery and six months after treatment in two groups. The change of bone amount was also determined before surgery and six months after treatment through computer-assisted densitometric image analysis(CADIA). ResultsThe changes of PD and CADIA were (3.8+1.7)mm, (20. 3+11.1)g/mm2 in experimental group and were (2.5+1.1)mm, (9.4+8. 6)g/mm2 in control group. The differences between two groups were significant (P.＜0. 05). The change of AL was (3.5+ 1.6)mm in experimental group, compared with control group(2. 3 1.7)mm, which showed more obvious regeneration of alveolar bone (P＜ 0. 01). ConclusionsGuided tissue regeneration in combination with a composite bovine-derived xenograft appears to be more effective than flap surgery only for intra-bony defects in elderly patients with periodontal disease.

Objectives To explore the long-term prognosis, treatment (especially dietary treatment) of classic maple syrup urine disease. Methods The complications and dietary treatment were observed by follow-up study of a classic MSUD patient. Results The patient have obvious damage in nervous system. However, reasonable dietary leucine tolerance therapy after the neonatal period can effectively reduce the metabolic crisis and complications. A mutation in BCKDHB gene was detected in the patient by genetic testing. Conclusion It is suggested that dietary restriction and monitoring of branched-chain amino acids are helpful to reduce the development of acute metabolic crisis and complications and improve the quality of life.

AIM:To evaluate the efficacy and safety of the regimen based on platinum compound plus docetaxel in the treatment of advanced esophageal carcinoma as first-line drug,and to further explore prognostic factors of advanced esophageal carcinoma by survival analysis.METHODS:From August 2006 to October 2008,36 patients with advanced esophageal carcinoma were enrolled in the study,and non-randomly assigned to docetaxel 75 mg/m2 in the first day every 3 weeks,combined with cisplatin 25 mg/m2 in the first day to third day or in the first day to forth day(DT,n=27),or with carboplatin AUC=5 on day 1(CT,n=9).RESULTS:The curative and toxic side effects were evaluated to the 36 patients.There were 1 complete respone,17 partial respone,11 no changes and 7 progressive disease in 36 patients with total response rate of 50.00%.The response rates of DT,CT regimen were 59.26% and 22.22%(P=0.121).The major side effects were nausea-vomiting,all side effects were reversible by symptomatic treatment.After a median follow-up of 8.70 months,the overall median survival was 10.50 months(95% CI 7.36 to 13.64 months).The COX univariate regression analysis suggested there was no correlation with sex,age and the hemoglobin of before chemotherapy with existence.But there was statistical significance between the behavior state of chemotherapy and the existence(P=0.036).CONCLUSION:The regimen based on platinum compound plus docetaxel is tolerable and more effective as a first-line treatment for advanced esophageal carcinoma.Patients with good performance status before chemotherapy indicates good prognosis and it is an independent factor affecting survival for advanced esophageal carcinoma.

Objective To discuss the curative effects of alfacalcidol combined with losartan potassium tablets in the treatment of early diabetic nephropathy (EDN).Methods 90 EDN patients in our hospital were chosen and randomly divided into the observation group and control group (45 cases in each group).The control group was given losartan potassium tablets treatment,while the observation group was given alfacalcidol combiend with telmisartan treatment.All the two groups were treated for 3 months.Before and after treatment,the fasting blood glucose (FBG), 24h urine trace albumin quantitative (UAER),24h urine protein (24h pro),serum creatinine (SCr),25 -hydroxyl vitamin D [2 5 (OH )D ],blood calcium (Ca2+),potassium (K+),glycosylated hemoglobin (HbA 1 C )and serum inflammatory factors[C-reactive protein (CRP),tumor necrosis factor alpha (TNF-α),interleukin-6 (IL-6 )] were observed,and the correlation between 25 (OH)D and UAER,24h pro was analyzed.At the same time,the clinical curative effects and adverse reactions during treatment were evaluated.Results In the observation group,the total effective rate was 93.3%,which was significantly higher than 71.1% in the control group (χ2 =7.601,P<0.05).In the two groups after treatment,the FBG,HbA1c,blood Ca2+and K+had no significant changes (all P>0.05).After treatment,Scr,24h pro and UAER in the two groups were all significantly reduced compared with before treatment (P<0.05),and 24h pro and UAER in the observation group were significantly lower than those in the control group (t=6.296,11.530,all P<0.05),but Scr had no statistically significant difference between two groups (t=0.331,P>0.331).After treatment,25(OH)D in the observation group decreased significantly compared with before treatment (t=12.000,P<0.05),which was significantly higher than that in the control group after treatment (t=11.278,P<0.05).Compared with before treatment,25(OH)D in the control group had no significant change after treatment (t=0.436,P>0.436).Pearson correlation analysis showed that 25 (OH)D level was negatively correlated with 24h pro and UAER (r=0.483,0.778,all P<0.05 ).In the two groups after treatment,the CRP, TNF-αand IL-6 levels significantly reduced (P<0.05 ),which in the observation group decreased more obviously (all P<0.05).In the two groups,no serious adverse events were found,the difference was not statistically significant (χ2 =0.212,P >0.151 ).Conclusion Alfacalcidol combined with losartan potassium tablets can significantly reduce the proteinuria levels of EDN patients and inflammation,which has better clinical curative effects and higher safety.

BACKGROUND:The position of median and radial nerves corresponding to elbow is usual y estimated by macroscopical measurements, but there are big data errors when the elbow is bent. OBJECTIVE:To measure and analyze the impacts of elbows in different positions on median and radial nerves under X-ray. METHODS:Ten fresh frozen upper limb specimens were selected. The distance of median and radial nerves to the osseous marks inside the elbow was measured when the elbow was in extension, extension-half pronation, bent at flexion 90 degrees and bent at 90 degrees with the injection of normal saline into the joint capsule, respectively. RESULTS AND CONCLUSION:The positions of median and radial nerves were not influenced when the elbow was in extension or in extension-half pronation (P>0.05). The distance of median and radial nerves to the osseous mark of the elbow was significantly lengthened when the elbow was moved from from extension to was bent at 90 degrees (P<0.05). The intra-articular injection of normal saline when the elbow flexion 90 degrees significantly elongated the distance of median and radial nerves to the osseous mark of elbow (P<0.05). These results suggest that the elbow in different positions can induce the displacement of median and radial nerves. In addition, the distance between median, radial nerves and the osseous marks of the elbow is obviously lengthened when the elbow is in flexion with intra-articular injection of normal saline.

Objective To investigate the status of self-care ability and cognition among disabled elderly,and to analyze the relationship between self-care ability and cognition,then analyze their influencing factors.Methods A total of 813 disabled elderly accepted long-term care at community or facility were recruited by stratified sampling method and investigated by socio-demographic questionnaire,activities of daily living and short portable mental status questionnaire.Results The total scores of self-care ability of the long-term care disabled was 32.01±11.59,and the total points of cognition was 3.77±3.24.Disabled elderly with severe disorders of self-care ability had a higher obstacle rate in every cognition ability than those with mild disabilities (P＜0.001).There were differences in orientation and memory function with different persistent disabled time (x2 =11.875,14.758,P＜0.01).Disabled elderly with cognition obstacles have a higher obstacle rate in every self-care aspect than those with normal cognition (P＜0.01).The multiple regression analysis showed that the educational level (β=-0.067),arital status (β=-0.071),disabled persistence time (β=0.121),orientation ability (β=0.403),the amount of cognition obstacles (β=0.443) were the influence factors of Basic Activities of Daily Living(BADL) among disabled elderly ; and disabled persistence time (β=0.116),orientation ability (β=0.417),recalled ability (β=0.275),memorial ability (β=0.189),calculative ability (β=0.257),the amount of cognition obstacles (β=0.358) were the important factors influence Instrumental Activities of Daily Living(IADL).Conclusion The self-care ability and cognition of the long-term care elderly were declining sharply,and influencing each other.It is advisable to offer them direct long-term care service combined with the laws and characteristics of cognition and self-care ability.

Objective To investigate the relationship between the genetic polymorphisms of glutathione S-Transferase M1,T1 and the susceptibility to sporadic colorectal adenocarcinoma(SCRAC) and smoking and alcohol consumption in Chinese Hans.Methods Multiplex polymerase chain reaction (M-PCR) was used in the study of genetic polymorphisms of GSTM 1,T1 gene.Logistic analysis was performed to elucidate the roles of GSTM1,GST1,smoking and alcohol.Results The null GSTM1,T1 genotypes could increase the susceptibility to SCRAC(OR=1.711,95% CI:1.043～2.805;OR=1.734,95% CI:1.057～2.843),but smoking and alcohol consumption made no significant effect on SCRAC(OR=0.584,95% CI:0.356～0.958;OR=0.378.95% CI:0.217～0.657).Further stratification of the SCRAC patients by chnical features showed that there were no relationship between the GST M1,T1 genotype and the age of the SCRAC patients.But the frequency of null GSTM1 genotype was significantly associated with distal colon adenocarcinoma (P=0.021),colorectal adenocarcinoma of Dukes C classification (P=0.003) and poor difierentiation (P=0.020),respectively.The frequency of null GSTF1 genotype was only higher in colorectal adenocarcinoma of Dukes C classification(P=0.041).No relationship was found between the location,the degree of differentiation and the frequency of null GSTF1 genotype(P＞0.05).Furthermore,the frequencies of homozygous deletion in GSTM1,T1 genes were found to be significantly increased in SCRAC patients than those in healthy controls(38.9%VS25.7%.P=0.023).Conclusion The GST genotype is strongly correlated with SCRAC incidence in Chinese Hans.The null GSTM1,T1 genotypes can enhance the genetic susceptibility to SCRAC.while smoking and alcohol consumption have no significant effect on the susceptibility to SCRAC.

OBJECTIVE To discuss the clinic presentation,imaging characteristics and surgical management of the external auditory canal cholesteatoma (EACC) with invasion of the tympaniccavity and the mastoid. METHODS This was a retrospective study including the clinical data of 14 cases of EACC invading tympanic cavity and mastoid from 1998 to 2003 . RESULTS All 14 cases showed different bone erosion in the four walls of external auditory canal with extention to the mastoid . Pars flaccida perforation were found in 4 cases with invasion of the cholesteatoma into the tympanic cavity, the ossicular chains were compressed or destroyed. The bony mastoid segment of facial canal was destroyed in 3 cases . Cerebral plate destruction and congenital stenosis of external auditory canal were found in one case respectively. According to the extent of disease, modified radical mastoidectomy was performed in 8 cases and radical mastoidectomy in 5 cases , meatoplasty in one case. The post-operative hearing of 10 cases with intact ossicula chains were normal.One case with compression,shift of ossicules also got normal audition after the operation. The hearing threshold of the air condition in 3 cases with ossicular disruptions got 15 to 20dB of improvement among the language frequency after reconstruction of ossicular chain. The 14 cases were followed-up from 18 months to 5 years and no recurrences were found. CONCLUSION The exact etiology of EACC still remains unclear. There is some difficulty in diagnosing external auditory canal cholesteatoma (EACC) invading the tympanic cavity and the mastoid because of its untypical clinic presentation . High-resolution temporal bone CT scan could help to find out the primary lesion and determine the range of the pathological changes, and choose the proper surgical approach.

Objective To evaluate the safety and feasibility of hepatic resection for huge primary liver carcinoma (PLC). Methods 216 cases of huge PLCs(mean diameter of 14.2cm) were resected. The hepatectomies were performed under intermittent occlusion of hepatic inflow. Results All 216 cases were successfully resected. The mean time of occlusion of hepatic inflow was 19min, the mean blood loss was 743 ml. No serious complications occurred, and only seven patients died of hepatic failure and upper gastrointestinal haemorrhage postoperatively in this series. Conclusions Although resection of huge PLC is quite difficult, but if suitable surgical techique and perioperative management are adopted ,it is safe and feasible .