BACKGROUND: The application of polymerized 2-hydroxyethyl methacryate (PHEMA) in many organs of living body shows good biocompatibility.OBJECTIVE: To observe the biocompatibility and fibrovascular condition of methl-methacrylate (MMA) modified PHEMA hydrogel orbital implant.DESIGN: Single sample observation.SETTING: Department of Ophthalmology, the General Hospital of Chinese PLA; Institute of Polymer Science,Department of Chemical Engineering, Tinghua university.MATERIALS: Twenty-five New Zealand rabbits of either gender and clean grade, weighing 2.0 to 2.5 kg, were provided by the Animal Experimental Center, General Hospital of Chinese PLA. The animals were observed at postoperative 2, 4,8, 12 and 24 weeks, 5 at each time point. The experiment was permitted by ethics committee. MMA modified PHEMA hydrogel orbital implant was provided by Institute of Polymer Research, Department of Chemical Engineering, Tinghua University. The experiment was permitted by ethics committee.METHODS: This experiment was carried out in the laboratory of Department of Ophthalmology, the General Hospital of Chinese PLA from March to October 2003. The right eye served as operation eye. When the rabbits were anesthetized,their eyelids were open with eyelid retractor. Bulbar conjunctiva was open along the edge of limbus of cornea for isolating fascia. Oculorotatory muscle was isolated and pre-set suture line was made, then muscle was cut off. When optical nerve was cut off, eyeball was completely excised. A MMA modified PHEMA hydrogel orbital implant with the diameter of 14 mm was implanted into the fossa orbitalis of rabbits. Single photon emission computed tomography (SPECT) was performed at postoperative 2, 4, 8, 12 and 24 weeks. The hydrogel orbital implant was taken out at postoperative 2, 4, 8,12 and 24 weeks for light microscope, immunohistochemical and electron microscope examinations.MAIN OUTCOME MEASURES: Vascularization of hydrogel orbital implant was observed in vivo by isotope tracing observation at different time points. Vascularization of hydrogel orbital implant was observed ex vivo by light microscope,immunohistochemical and electron microscope observations.RESULTS: All 25 New Zealand rabbits were involved in the final analysis. ①SPECT examination showed that isotope increased around the implants at week 2, and extended gradually at weeks 4 and 8. The radiotracer accumulated evenly in the implants from surrounding to the center at week 12. ②Light microscopic examination of the prostheses revealed fiber vessels grew from the surrounding to the center. At week 2,fibrovascular tissue grew in the hole of implant. Long or round cells with deeply dyed nucleuses were found in the hole, being fibroblasts. The vascular structure in the hole of the implant was clear, and vascular wall and blood cells were found. The inflammatory cells were mainly neutrophils and lymphocytes, and occasionally large macrophages. ③Scanning electron microscope showed that fibrovascular tissue grew in the hole of the implant, and was dense and intercrossed at week 12. ④ Conjunctiva split appeared postoperatively in 1 of 25 cases, and healed well after two times of operation. Conjunctival congestion lessened and conjunctiva healed within postoperative 7 days in the remaining 24 animals.CONCLUSION: MMA modified PHEMA hydrogel orbital implant has good histocompatibility and fast vascularization process, and is easy to be operated with fewer complications. So, it is a safe and practicable new type orbital implant.

Objective To investigate the clinical efficacy of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries in the treatment of Todani type Ⅰ choledochal cyst.Methods The retrospective cohort study was conducted.The clinical data of 59 patients with Todani type Ⅰ choledochal cyst who were admitted to the People's Hospital of Hunan Province between January 2013 and January 2016 were collected.Thirty patients undergoing 2D laparoscopic surgery between January 2013 and June 2014 were allocated into the 2D group and 29 patients undergoing 3D laparoscopic surgery between July 2014 and January 2016 were allocated into the 3D group.There were the same Trocar placement and surgical procedure in the 2 groups,and surgical procedure completely followed the treatment principle of Todani type Ⅰ choledochal cyst.Observation indicators included (Ⅰ) surgical situations:conversion to open surgery,operation time,volume of intraoperative blood loss,(2) postoperative situations:postoperative complications,(3) follow-up.Patients were followed up by outpatient examination or telephone interview to detect postoperative recovery up to April 30,2016.Measurement data with skewed distribution were presented as M (range) and analyzed using the Mann-Whitney U test.Count data were compared by Fisher exact probability.Results (1) Surgical situations:patients in the 2 groups underwent laparoscopic choledochal cystectomy + Roux-en-Y hepaticojejunostomy.Two patients in the 2D group received conversion to open surgery and patients in the 3D group received the successful surgery without conversion to open surgery.Rate of conversion to open surgery in the 2D and 3D groups were 6.7％ (2/30) and 0,respectively,with no statistically significant difference (P ＞ 0.05).Operation time in the 2D and 3D groups were 285 minutes (range,240-390 minutes) and 190 minutes (range,140-215 minutes),with a statistically significant difference (U =40.0,P ＜ 0.05).Volume of intraoperative blood loss in the 2D and 3D groups were 50 mL (range,10-300mL) and 45 mL (range,20-250 mL),with no statistically significant difference (U =1 018.5,P ＞ 0.05).(2)Postoperative situations:patients in the 2 groups had good recovery,without occurrence of severe complications in Clavien-Dindo≥ Ⅲ stage.Four and 1 patients in the 2D and 3D groups were complicated with bile leakage (in Ⅱ stage of Clavien-Dindo) and 1 and 1 were complicated with upper gastrointestinal hemorrhage (in]][stage of Clavien-Dindo),respectively,with no statistically significant difference (P ＞ 0.05).Overall incidence of complications in the 2D and 3D groups were 16.7％ (5/30) and 10.3％ (3/29),with no statistically significant difference (P ＞ 0.05).All the patients were cured by conservative treatment.(3) Follow-up:59 patients were followed up for 5-36 months,with good recovery and without occurrence of reflux cholangitis,hepatic and intestinal anastomosis stenosis and reoperation.Conclusions 3D and 2D laparoscopic surgeries are safe and effective for Todani type Ⅰ choledochal cyst.Compared with 2D laparoscopic surgery,3D laparoscopic surgery can reduce the operation time and not increase the complications,and it should be discreetly promoted based on the experiences of surgeons.

Objective To compare the prognosis of sentinel node-positive breast cancer patients forgoing axillary lymph node dissection.Methods A systematic literature search (Medline,Embase,Cochrane Library)ended in April 2014 was performed to identify all eligible articles.Two reviewers independently screened and extracted data.RevMan5 was used for statistical analysis.Results A total of 1026 abstracts were retrieved and 18 clinical controlled studies finally included,the total number of patients were 47 894,7389 had micrometastases in sentinel lymph node,35 217 had macrometastases in sentinel lymph node and 5288 had positive sentinel lymph node regardless of micrometastases or macrometastases.For patients with MIC,the 5-year axillary recurrence rate,5-year disease free survival and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.78;95％ CI:0.72-4.39,P=0.21),(OR =0.76,95％CI:0.56-1.04,P=0.08),(OR=0.77,95％CI:0.43-1.40,P=0.39).For patients with MAC,the 5-year axillary recurrence rate had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.21;95％ CI:O.76-1.91,P =0.42).For patients with positive sentinel lymph node regardless of micrometastases or macrometastases,the 5-year axillary recurrence rate and 5-year overall survival had no significant difference between patients who only received sentinel lymph node biopsy and patients who received further axillary lymph node dissection,(OR =1.29;95％ CI:0.92-1.80,P =0.14),(OR =0.96,95％ CI:0.64-1.45,P =0.84).Conclusions Among patients with limited positive SLN of breast cancer,patients forgoing ALND compared with ALND did not have obvious affect on long-term survival.

Neurogenic bladder caused by herpes zoster is not common.An 86 years old male patient with 6 months of dysuria and urinary retention caused by herpes zoster underwent sacral neuromodulation (SNM) operation. The symptoms of dysuria and fecal incontinence were improved significantly after operation.

AIM: To study the inhibitory effects of nm23-H1 gene on proliferation and invasion of human lung adenocarcinoma A549 cell line. METHODS: Recombinant eukaryotic expression vector pcDNA3.1-nm23-H1 containing full length of human nm23-H1 cDNA was constructed and transfected into a human lung adenocarcinoma A549 cell line by lipofectamine. Cell strain that expressed nm23-H1 stably was screened out by G418 and named pcDNA-nm23-A549. Expression of nm23-H1 was identified by RT-PCR and immunohistochemistry. Growth curves were drawn to detect the inhibitory effects on cell proliferation. Cell cycle of pcDNA-nm23-A549 was examined by flow cytometry. Atomic force microscopy was used to observe the filopodia on the surface of the cells. RESULTS: Introduction of nm23-H1 obviously inhibited the proliferation of A549. Expression of nm23-H1 did not induce apotosis in A549 cells but increased the percentage of phase G_1 cells and decreased phase S cells. Meanwhile, phase G_1 to phase S transition was restrained. Filopodia in the cell surface was much fewer and its structure changed in cells transformed. CONCLUSION: nm23-H1 is capable of inhibiting A549 proliferation and decreasing its metastatic ability, probably by interfering with cell cycle and cell surface structure.

Objective To assay the serum adiponectin levels in normal subjects and patients with insulin resistance syndrome, and to explore the correlation between adiponectin and insulin sensitivity, blood glucose, insulin, lipids etc. Methods Insulin sensitivity index (SI) was assessed by the reduced sample number of Bergman's minimal model method with intravenous glucose tolerance test in subjects of normal controls, obesity, impaired glucose tolerance (ICT) and type 2 diabetes mellitus (DM). Meanwhile the anthropometrical parameters such as body mass index (BMI) and waist hip ratio (WHR) were evaluated and the serum lipids, fasting and postprandial 2 h plasma glucose and insulin levels were also measured. Results Compared with normal control group, the SI in obesity, IGT and type 2 DM groups was significantly decreased (P

AIM To speculate the hypoglycemic mechanism for rats with type 2 diabetes by exploring the therapeutic effects of leaf aqueous extract from Cyclocarya paliurus on liver insulin receptor (InsR) and insulin receptor substrate 2 (IRS-2).METHODS The diabetic rat model was established through intraperitoneal injection of streptozotocin and fed with high-fat diet.The moleled rats were equally assigned into the control group and leaf aqueous extract from Cyclocarya paliurus group (extract group).After the test extract was orally administrated for four weeks,body weight,urine output,food intake,water intake and fasting blood-glucose (FBG) were measured,and the levels of serum insulin,InsR and IRS-2 mRNA in liver tissue were investigated in rats.RESULTS Compared with the control group,the extract group showed a reduction in urine output,food intake,water intake,FBG and insulin levels.Meanwhile,the rats' body weights in extract group were presented a trend to increase.The gene expressions of InsR and IRS-2 in liver tissue were up-regulated.Moreover,the insulin sensitivity was improved.CONCLUSION The leaf aqueous extract from Cyclocarya paliurus can reduce FBS,improve insulin sensitivity,which may be associated with the increase of InsR and IRS-2 gene expression in liver tissue.

Objective:To investigate the application value of three-dimensional (3D) printing technology assisted laparoscopic anatomic liver resection of segment 8 (Lap-S8).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 8 liver cancer patients including 7 cases with hepatocellular carcinoma and 1 case with intrahepatic cholangio-carcinoma who underwent 3D printing technology assisted Lap-S8 in the Hunan Provincial People′s Hospital from January 2019 to December 2020 were collected. There were 7 males and 1 female, aged from 49.0 to 80.0 years, with a median age of 56.5 years. Of the 8 patients, 6 cases underwent laparoscopic anatomic liver resection of the entire segment 8, 1 case underwent laparoscopic anatomic liver resection of ventral subsegmental of the segment 8 and 1 case underwent laparoscopic anatomic liver resection of dorsal subsegmental of the segment 8. 3D printing technology was used to assist preoperative evaluation and intraoperative navigation for all 8 patients. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination, internet or telephone interview to detect survival and tumor recurrence of patients after operation up to March 2021. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations: all the 8 patients underwent 3D printing technology assisted Lap-S8 successfully, without conversion to open surgery. The operation time, hepatic portal occlusion time and volume of intraoperative blood loss of the 8 patients were (216±41)minutes, (56±11)minutes and 75 mL(range, 50 to 300 mL), respectively. There was no intraoperative blood transfusion in 8 patients, and the surgical margin of the 8 patients was negative. (2) Postoperative situations: the duration of postoperative hospital stay of the 8 patients were (9±3)days. There was no complication such as postoperative hemorrhage, biliary fistula, liver abscess or abdominal infection occurred. (3) Follow-up: all the 8 patients were followed up for 3.0?24.0 months, with a median follow-up time of 12.5 months. During the follow-up, 1 of 8 patients with preoperative diagnosis of recurrent hepatocellular carcinoma developed tumor recurrence at 5 months after operation. The patient underwent laparoscopic surgery followed with the transcatheter arterial chemoembolization and target therapy, and survived with tumor. There was no tumor recurrence in the other 7 patients.Conclusion:3D printing technology assisted Lap-S8 is safe and feasible.

Nowadays,surgery is a comprehensive approach for the treatment of hepatic carcinoma as the first choice,but there are still many limitations in surgical therapy,such as the location,boundary and metastasis of hepatic carcinoma.Currently,the indocyanine green fluorescence imaging-guided hepatectomy is widely used at home and abroad as a new progress and hotspot in hepatobiliary surgery,which makes hepatobiliary surgery more convenient and makes up for some deficiencies in hepatectomy.Thus,we summarized the experience of indocyanine green fluorescence imaging-guided hepatectomy in the People's Hospital of Hunan Province and discussed its value of application.

Objective To evaluate a new prenatal diagnosis model of chromosomal abnormalities and nine microdeletion syndromes by using both traditional karyotyping and a newly-developed rapid prenatal diagnosis technology, BACs-on-Beads (BoBs) technique. Methods From June 2012 to December 2014, 807 pregnant women with high risk after screening or with other indicators, were performed amniocentesis. Traditional karyotyping and BoBs were employed simultaneously for prenatal diagnosis. Results Thirty-two cases with chromosome aneupoidies were successfully detected both by BoBs and karyotyping, including 18 cases of trisomy 21, 6 cases of trisomy 18, 1 case of trisomy 13, and 7 cases with sex chromosome abnormality. All 8 fetuses with chromosome structural abnormalities detected by karyotyping were missed by BoBs;while BoBs contributed more in detection of five microdeletion syndrome cases, including 3 cases of DiGeorge syndromes (two with microduplication and one with microdeletion), one case of Miller-Dieker syndrome, and one case of Wolf-Hirschhorn syndrome. Conclusion Combined use of traditional karyotyping and BoBs, is a rapid and effective prenatal diagnosis model that may enlarge our horizon on chromosomal diseases and should be widely used in future clinical service.