Objective To investigate MRI value in diagnosing and differential diagnosing intrahepatic peripheral cholangiocarcinoma(IHPCC).Methods Twelve cases with IHPCC proved by pathology underwent plain MRI,and contrast-enhanced MR imaging including arterial,portal and delayed phase.MRI features were analyzed.Results All of 17 leisons in 12 cases,12 lesions exhibited hyperintensity at edge and hypointensity at center on T2WI,5 appeared as hyperintensity.2 lesions showed no enhancement and 15 lesions were circular enhancement in arterial phase,all of 17 lesions showed gradual fill in the center of lesions.The diagnostic accuracy was 100%.Conclusion MRI plays an important role in detecting and diagnosing IHPCC.

Objective: To study the treatment method of apoplectic joint contracture. Method: Fifty-two cases were treated with acupuncture plus cupping and thirty cases were treated with acupuncture alone as the control group. Result and conclusion: The effective rate of the former and later were 100% and 93.3% respectively,combined treatment of acupuncture and cupping was superior to acupuncture alone (P＜0.05).

Objective To investigate the reasons of complications after ultrasound-guided PTBD and explore measures for their management. Methods The clinical data of 753 patients with obstructive jaundice treated with ultrasound-guided PTBD in our hospital from January 2001 to June 2008were retrospectively analyzed. Results The 753 patients received a total of 791 treatments of PTBD.The occurring rates of severe, common, and long-term complications were 1.14 % (9/791), 11.88 %(94/791 ) and 4.3% (9/791), respectively. Only 1 patient died of manipulation-related complications.Conclusion Ultrasound-guided PTBD is an effective method for treatment of obstructive jaundice.

Objective To explore the thoracic and diaphragmatic complications of treating hepatic malignant tumor using thermal ablation techniques.Methods The patients received thermal ablations were involved as subjects from January 2002 to December 2013.The thoracic and diaphragmatic complications of treating hepatic malignant tumor with percutaneous thermal ablation were retrospectively analyzed.Results A total of 1 520 patients with 2 789 hepatic tumors [average largest diameter of tumor (2.30 ± 1 .03)cm] underwent 2 066 thermal ablation treatments.Five hundred and six radiofrequency ablation (RFA)and 1 560 microwave ablation procedures were performed,respectively.The complete ablation rate was 96.8%(2 701/2 789)at 1 month after treatment.The major thoracic and diaphragmatic complication rates were 0.8%(1 7/2 066 ),meanwhile the minor complication rates were 6.5% (134/2 066 ).Conclusions The thoracic and diaphragmatic complication rate of percutaneous thermal ablation is low in the treatment of hepatic malignant tumors.However,the major complications may cause serious consequences.Therefore, the patients of diaphragm-abutting liver tumors are fully assessed before thermal ablation treatments,and relevant prevention measures are completed.Open or laparoscope is used to assist thermal ablation treatment when necessary.

Background:Intestinal metaplasia(IM)and dysplasia in Barrett’s esophagus(BE)can be detected by endoscopic biopsy combined with pathological examination. Aims:To evaluate the efficacy of acetic acid stain-guided biopsies in detection of IM and dysplasia in BE under standard endoscopy. Methods:One hundred patients found to have columnar-lined esophagus by endoscopy from January 2012 to November 2014 at Shanghai Jing’an District Central Hospital were enrolled. Under standard endoscopy,acetic acid was sprayed and multi-point biopsies were performed in visible abnormal regions. This was followed by four-quadrant biopsies at every 1 to 2 cm of the remaining BE segments. Detection rates of columnar epithelium,IM and dysplasia were compared between acetic acid stain-guided biopsies and four-quadrant biopsies. Results:A total of 96 patients were diagnosed as BE. Detection rates of columnar epithelium by acetic acid stain-guided biopsies and four-quadrant biopsies were 96. 9%(93 / 96)and 90. 6% (87 / 96),respectively,no significant difference was found between the two methods(McNemar test,P = 0. 146),however,consistency of the two methods was poor(κ = 0. 340). A total of 32 patients were diagnosed as BE with IM. Detection rates of IM by acetic acid stain-guided biopsies and four-quadrant biopsies were 84. 4%(27 / 32)and 40. 6%(13 / 32),respectively,difference in detection rate between the two methods was significant(McNemar test,P = 0. 007),and consistency of the two methods was poor(κ =0. 266). Five cases of low-grade dysplasia were detected by acetic acid stain-guided biopsies only. Conclusions:Acetic acid stain-guided biopsies can detect BE with IM and dysplasia better than four-quadrant biopsies.

Objective To explore the clinical effect of anteromedial thigh perforator flap for repairing soft tissue defect in lower extremity.Methods From January 2009 to December 2012,12 patients with soft tissue defect of lower extremity were treated with free anteromedial thigh perforator flap.Among them,there were 5 cases of wound in front of tibia,4 cases of dorsal foot wound,3 cases of heel wound;the wound size was 3.0 cm ×3.5 cm-7.0 cm × 9.5 cm;3 cases were repaired with free perforator flap of descending genicular artery,2 cases with free anteromedial thigh perforator flap,and 7 cases with medial vastus muscle perforator flap.Results All the transplants survived.Among them,1 case of anteromedial thigh perforator flap and 1 case of descending genicular artery perforator flap appeared vascular crisis postoperative.After anticoagulation and antispasmodic treatment aggressively,the flaps survived.One case of descending genicular artery perforator flap necrosis in edge,and then were cured by changing dressing.Twelve cases were followed up 6-12 months after operation (average 8.6 months),and the texture of flaps were good,the appearance appropriate ;7 sensation of 5 free flaps after nerve anastomosis came back to S; the donor sites in all cases were sutured directly and healed,leaving only the linear scar,and no effect on function.Conclusion The anatomy of anteromedial thigh perforator flap is constant,and the operation is convenient.The clinical result of repairing soft tissue defect of lower extremity is satisfying.

Objective To investigate the common complications of thermal ablations of liver cancer using both radiofrequency ablation (RFA) and microwave ablation (MWA) techniques,and compare the safety between these two procedures.Methods A total of 879 patients with hepatic tumors underwent thermal ablation.There were 323 cases having the RFA procedures and 556 cases having MWA procedures.The complications of thermal ablations of liver cancer were compared using both RFA and MWA techniques.Results A total of 1030 thermal ablation sessions was performed in 879 patients with a total of 1652 tumors.There were 323 patients with 562 tumors received a total of 376 RFA.The other 556 patients with 1090 tumors received a total of 654 MWA.The mortality rates were 0.31 ％ (1/323) and 0.36％ (2/556) in RFA and MWA group.In RFA and MWA group,the major complication rates were 3.5％ (13/376)and 3.1％ (20/654),meanwhile the minor complication rates were 5.9％ (22/376) and 5.7％ (37/654).There was no statistical significant difference for the mortality rates,the major complications,the minor complications between the RFA and MWA groups (P ＞0.05).Conclusions Thermal ablation therapy in the treatment of liver cancers is relatively safe with low mortality and low incidence of serious complications.The types and incidences of complications caused by RFA and MWA are similar and comparable for safety consideration in clinical settings.

BACKGROUND:In mass spectrometry analysis, the same protein in different samples labeled with isobaric tags for relative and absolute quantitation presents the same mass-to-charge ratio, while in the tandem mass spectrometry analysis, the ion signal shows different mass-to-charge ratio (114-121). Thus the quantitative information of the related proteins can be obtained. OBJECTIVE:To establish the protein spectrum of spinal cord tissue differences proteins after acute spinal cord injury, and to explore the spinal differential protein expression on the molecular level using isobaric tags for relative and absolute quantitation combined with LC-MS/MS mass spectrometry technique. METHODS:Eight Sprague Dawley rats were selected to establish the acute spinal cord injury models using Al en’s method. The rats were randomly divided into 0 hour spinal cord injury group and 8 hours spinal cord injury group, four rats in each group. The spinal cord tissues were col ected after injury, and the spinal cord tissue differences proteins were analyzed with isobaric tags for relative and absolute quantitation technique after acute spinal cord injury. RESULTS AND CONCLUSION:Total y 220 differential y expressed proteins were identified in this research, the number of up-regulation proteins was 116 and the number of down-regulation proteins was 104. There were 12 differential proteins related to neural regeneration, and among the 12 proteins, there were seven up-regulation proteins and five down-regulation proteins. The various identified differential proteins and significantly expressed nerve growth factors in this experiment can be used as the biomarkers of acute spinal cord injury or used as the strong evidence for the clinical management and monitoring of the injury process and target therapy of acute spinal cord injury, as wel as the effect evaluation.

Objective To summarize the successful experience of three cases of heart-lung transplantations performed in our institute.Methods From July 2003 to August 2012,three patients,with diagnosis of end-stage heart-lung diseases,received heart-lung transplantation in our institute.One case was diagnosed as congenital atrial septal defect,Eisenmanger syndrome,NYHA class Ⅳ; one was dilated cardiomyopathy with moderate/severe pulmonary arterial hypertension,NYHA class Ⅲ-Ⅳ,one was diagnosed as double outlet left ventricle (DOLV) with ventricle septal defect and stenosis of pulmonary artery and its left and right branches,NYHA class Ⅲ-Ⅳ.Donor hearts were preserved with UW solution,donor lungs were preserved with Euro-Collin solution in case one and with low potassium dextran containing prostaglandin E1 in the others.Extensive disinfection and strict scrutiny were implemented postoperatively.Immunosuppressive therapy included administration of zenapax or basiliximab preoperatively,methylprednisolone during the operation,and cyclosporine a/tacrolimus + prednisone + mycophenolate postoperatively.Surgical hemostasis is of great importance,as the total pleural effusion reaches 14 640 ml within 31 days postoperatively in case two.Strict postoperative disinfection and isolation were implemented,and management of the respiratory tract was intensified.Therapeutic bronchoscopy was performed frequently for sputum suction.In case two,bronchoscopy was used thirteen times within 40 days after transplantation.Broad-spectrum antibiotics and antifungal antibiotics were used for infection control.Results All three patients were discharged after recovery from operation.Case one died of obstructive bronchitis and lung failure caused by chronic rejection four years and ten months postoperatively.Case two died of sudden cerebrovascular accident 68 days after operation.Case three survives more than one year postoperatively so far and is still alive.Conclusion Proper preservation of the donor heart and lung,perfect surgical hemostasis,strict infection control,frequent application of bronchoscopy and appropriate immunosuppressive management are critical to the success of heart-lung transplantation.

Objective To explore the clinical value of intraoperative ultrasound (IOUS) in liver resection with radiofrequency-assisted technique.Methods Thirty-two patients underwent hepatic resection with radiofrequency-assisted technique by IOUS-guidance.The use of IOUS before,during and after resection were analyzed.Results All patients were completed hepatic resection by IOUS-guidance successfully.All lesions were resected drastically,and the reserved blood vessel and biliary duct were not injured.The mean transaction time was (53.6 ± 28.4) minutes and the mean blood loss during resection was (115.3 ± 118.5)ml.No patient needed blood transfusion.Nine patients developed postoperative complications including 3 bile leaks,1 lymph leak and 6 pleural effusions.There were no cases of postoperative haemorrhage,liver failure or wound infection.The mean postoperative stay was (20.5 ± 16.8) days.Conclusions The hepatectomy with radiofrequency-assisted technique can be guided by IOUS accurately.As IOUS-guidance,the lesions are resected drastically and liver tissue is reserved farthest,and the injury of blood vessel and biliary duct is avoided.IOUS is significant value in liver resection with radiofrequency-assisted technique.