Objective To evaluate the results of patients operatively treated transverse plus posterior wall fractures of the acetabulum.Methods Review forty-five patients who had operated for transverse plus posterior wall fractures of the acetabulum 1 retrospectively with fracture displacement,from August 1993 to January 2005 in Department of Orthopaedics,Beijing Shunyi Hospital.The radiographs were graded according to the criteria described by Matta.The functional outcome was evaluated using a modification of the clinical grading system developed by Merle d'Aubigné and Postel.Result Forty-five patients were followed up 16 to 48 months with an average of 34 months.The radiographic result was excellent in seventeen patients,good in eighteen,fair in seven,and poor in four.The clinical outcome at the time of final follow- up was graded as excellent in fourteen patients,good in twenty- two,fair in eight,and poor in two.Conclusion Operative treatment for transverse plus posterior wall fractures of the acetabulum has a satisfying therapeutic effect.The appropriate operation time,reasonable operation approach,anatomic reduction and stable internal fixation is the key to obtain good results.

Objective To evaluate the practical value of ERCP for etiologic diagnosis and treatment of postcholecystectomy syndrome(PCS).Methods A retrospective review of 116 cases of postcholecystectomy syndrome received ERCP in the recent four years in our hospital was undertaken.Of the116 cases,80 cases(68.97 %) had the indications for therapeutic ERCP and were treated by endoscopy.Results The bile duct was visualized in all of the 116 cases(100 %),and the pancreatic duct was visualized in 97 cases(83.62 %).The etiology of PCS was choledocholithiasis in 56 cases(48.28 %),diverticulum adjacent to duodenal papilla or papilla with in the diverticulm in 19 cases(16.37 %),residual of long cystic duct with stones in 15 cases(12.93 %),benign stenosis of terminal commom bile duct in 13 cases(11.20 %),sphincter of oddi dysfuction in 4 cases(3.45 %),tumour of doudenal papilla in 3 cases(2.59 %),stenosis of injured bile duct in 2 cases(1.73 %),sclerosing cholangitis in one case(0.86 %),cholangiocarcinoma in one case(0.86 %),remnant gallbladder with stones in one cases(0.86 %),and chronic pancreatic ductal lithiasis in one case(0.86 %).Fifty-seven cases were treated by EST stone extraction,20 cases by ERBD,23 cases by ENBD,1 case by EMBE,and 1 case by EPS extraction.In the 80 cases treated with endoscopy,75 cases were followed up for 3~12 months,with relief of symptons in 74 cases(98.67 %).Conclusions ERCP is the gold standard for etiologic diagnosis of PCS.PCS is an indication for therapy by ERCP.Therapeutic ERCP is the preferred treatment of PCS cases with an indication for endoscopic treatment.

Objective To explore the efficacy of liver retransplantation for hepatocellular carcinoma (HCC) patients with or without HCC recurrence.Method 131 cases of retransplantation performed between 2003 and 2012 were analyzed retrospectively.Their first and second liver transplantations were both performed in our hospital.Diagnoses of their primary diseases before transplantations were confirmed pathologically after the first transplantation.Patients were divided into two groups in terms of benign causes and HCC.Results Sixty cases were fallen into benign disease group and 65 cases into HCC group.The proportions of main causes of retransplantation were similar between two groups.The graft survival rate of early retransplantation (retransplantation performed within 30 days after the first transplantation) and late retransplantation (retransplantation performed beyond 30 days after the first transplantation) was calculated and compared respectively due a great difference in survival rate between the two phrases.The deaths of HCC patients with HCC recurrence before retransplantation were more than those without HCC recurrence (P＜0.01) and benign disease group.The 5-year cumulated survival rate was close between HCC patients without recurrence before retransplantation (51.0％) and benign disease group (51.8％).Conclusion The retransplantation after HCC recurrence has an unacceptable prognosis.The survival rate was similar between patients without HCC recurrence and patients with benign diseases.HCC patients without recurrence should not be restrained from retransplantation just for the HCC history.

Objective To establish and observe the canine model with esophageal stent implantation for further study of the benign stenosis caused by proliferation.Methods According to orthogonal design,different combinations of two stents and six polytetrafluoroethylene (PTFE) patches were confirmed.Stent was designed as cylinder with mushroom shape on both ends.Beagle dogs (weight 10-12 kg) were adopted and cervical segment of esophagus were dissected.After PTFE patch was encircled around the esophagus,stent was delivered under fluoroscopy.The main body of the stent was located in accordance with the patch.Eating condition and position of the stent were followed on week 1,2,4,6 and 8.Gross specimen was harvested at the end point,and the degree of tissue hyperplasia was evaluated.Each animal model was given a mark according to the eating condition and tissue hyperplasia.Results Eight combinations of stent and patch were provided with orthogonal design.Three models failed for the following reasons:unable to eat in one dog,stent disgorged out in another,and the third died from esophageal necrosis between stent and patch.Four models had obvious tissue hyperplasia on the segment of stent,and weight loss or stent dislocation were observed in each model.One model developed appropriate tissue hyperplasia with normal diet,and stent dislocation was not found during the follow-up.Significant difference was confirmed among 8 models (F =14.7000,P =0.031).Conclusion Animal model with appropriate tissue hyperplasia could be established with following elements:beagle dogs weight from 10 kg to 12 kg; stent 50 mm in length,20 mm in diameter,with top mushroom 10 mm in length,30 mm in diameter,and end mushroom 10 mm in length,25 mm in diameter; PTFE patch 60 mm in length,15 mm in width.

ObjectiveTo summarize 20 ABO-incompatible liver transplantation cases in our hospital and explore the treatment strategy. MethodsFrom January 2009 to July 2011,20 cases donorrecipient ABO blood type not-identical liver transplantation was performed at our hospital. 16 cases were ABO-incompatible(ABO-Ⅰ) and 4 were ABO-compatible(ABO-C ).The median follow-up was (13.3 ± 9.2) months.ResultsExcept preoperative MELD score,there were no significant difference in other perioperative data,the incidence of postoperative complications and the cumulative survival rate between ABO-C and ABO-Ⅰ group.There were 5 deaths in 20 cases,2 cases in ABO-C group and 3 cases in ABO-Ⅰ group,survival rate was 75％.The cause of death was perioperative multiple organ failure in 2 cases,liver cancer recurrence in 2 cases and cerebral hemorrhage in 1 case.There were 2 cases of acute rejection,3 cases of biliary complications and 3 cases of portal vein thrombosis developing postoperatively. Eleven patients had increased serum creatinine after operation,preoperative high creatinine existed in 6 cases and it maintained posttransplant high level for more than 7 days,the serum creatinine level in other 7 patients was back to normal level in 7 days.ConclusionsA combination splenectomy before the portal vein reperfusion,the protocol of basiliximab,tacrolimus (TAC)/mycophenolate mofetil (MMF)/steroids immunosuppression treatment,postoperative peripheral vascular dilatation treatment by Alprostadil,help achieve favorable outcome in selected patients who underwent ABO-incompatible liver transplant.

Objective; To clone, sequence and analyze the coding sequences of the Mr 15000 and Mr 9000 active segments of natural granulysin derived from human CTLs activated by allogenic antigen ,in order to establish the basis for further purifying and investigating the immune - impairing mechanism of granulysin. Methods; The coding sequences of the Mr 15000 and Mr 9000 granulysin gene were amplified from the total RNA of activated CTLs of healthy person after reverse transcription by Nested - PCR, inserted into pET32a ( + ) vectors and then transformed into E. Coli TOP10, respectively. The recons were identified by PCR, endonuclease digestion and sequencing. Results: The whole coding sequences of the Mr 15000 and Mr 9000 active segments were successfully cloned as expected. The accurate pET32a - Mr 15000 and pET32a - Mr 9000 recons were obtained through Colony - PCR, endonuclease digestion and sequencing. There lied polymorphism on the 119 th amino acid of the product encoded by GLS gene. Conclusion; The coding sequences of the Mr 15000 and Mr 9000 active segments of human granulysin can be obtained and cloned by the methods mentioned above and can be used for subsequent research.

Objective To investigate the effect of salmeterol/fluticasone (SM/FP) on serum inflammatory factors in the treatment of bronchial asthma in children.Methods 80 children with bronchial asthma from January 2015 to October 2015 in department of pediatrics of first affiliated hospital of Zhejiang Chinese medicine university were selected and randomly divided into two groups.The control group were given routine clinical treatment, the experimental group were treated on the basis of the control group with salmeterol/fluticasone (SM/FP), for 4 weeks.The serum IL-2, IL-4, IFN-α, T-lymphocyte subsets and clinical efficacy between the two groups were compared.Results Compared with control group, the serum levels of IL-2 and IFN-γin experimental group were higher, IL-4 in experimental group was lower ( P <0.05 ); the serum CD3 +T, CD4 +T and CD4 +T /CD8 +T levels in experimental group were higher, the serum CD8 +T was lower than those in control group (P<0.05); the total efficiency of the experimental group (92.5%) was significantly higher than that of control group (75.0%) (P<0.05).Conclusion The salmeterol/fluticasone (SM/FP) has the good efficacy in the treatment of bronchial asthma in children, which could effectively regulate T lymphocyte subsets proportion and the level of cytokines.

Objective To analyze the clinical diagnosis and treatment strategies of liver-localized posttransplantation lymphoproliferative disease (LL-PTLD).Methods Six cases of LL-PTLD from more than 3000 cases of liver transplant recipients from July 2003 to July 2011 were retrospectively analyzed.Other six cases of LL-PTLD were retrieved through Pubmed and Wanfang.The diagnosis and treatment of 12 cases of LL-PTLD were summarized and analyzed.Results All patients with LL-PTLD were diagnosed pathologically.The incidence of LL-PTLD was 0.2％ (6/3000).Among 12 patients,immunosuppressant and anti-EB virus treatment was reduced or withdrawn in the vast majority of patients,and treatment response was satisfactory.Systemic chemotherapy was given in 6 cases,and three of them died.Local radiation therapy was given in 4 cases,the tumor was significantly controled,and patients survived.Secondary liver transplantation was performed on 3 cases: 1 case died of recurrent lymphoma,and one case received partial hepatectomy and no lymphoma recurred.Conclusion For cases with obstructive symptoms of fever and chills associated with jaundice without reasonable explanation,LL-PTLD is suspected and diagnosed by liver biopsy.Basic treatments such as adjustment of immunosuppressive agents and anti-viral therapy are recommended as early as possible.Local radiation therapy is a treatment method of LL-PTLD,which can obtain a satisfactory therapeutic effect.

Objective Small-for-size syndrome (SFSS) is a common and serious problem after living donor liver transplantation (LDLT) of small grafts.To prevent SFSS by selecting large enough graft,enlarging outflow tract,and controlling the portal vein pressure and flow during LDLT.Methods 113 adult LDLT recipients were reviewed from Dec.1,2007 to Nov.30,2009.Enlarging the portal outflow tract by the incision of the anterior rim of the orifice of the right hepatic vein (RHV),modificating graft inflow,and selecting large enough graft were done to prevent SFSS.The relationship between the patients' GRWR,portal vein flow,portal vein pressure and the occurrence of SFSS was analyzed.Results All patients received the outflow orifice modification.The portal vein pressure and the portal vein flow were decreased after spleen artery ligation.No SFSS ocurred.Conclusion Selecting large enough liver graft,and enlarging portal vein inflow and outflow were safe for the LDLT recipients,and can effectively prevent SFSS.

Objective To investigate the clinicopathological characteristics of retransplantation for intrahepatic recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT).Methods In a center hospital of organ transplantation setting,9 patients after primary liver transplantation had intrahepatic recurrence and received retransplantation,and 12 patients in control group were not subjected to LT over the same period.The follow-up period was 10 to 58 months.Results As compared the pathological characteristics of secondary transplanted liver with primary thansplanted liver,there was significant difference in tumor differentiation (grade Ⅱ,Ⅲ and Ⅳ)between primary group (33％,67％ and 0) and secondary group (22％,22％ and 56％) (P＜0.01).After primary liver transplantation,median of tumor free survival was 15.0 months.After secondary liver transplantation,median of survival was 5.8 months,and median of tumor free survival was 2.5 months.In control group,median of tumor free survival was 13.0 months,and total survival survival was 17.6 months.In transplantation group and control group,1-,2-,and 3-year cumulative survival rate was 89％,44％,33％ and 91％,45％,9％ respectively,with the difference being not statistically significant (P ＞ 0.05).Conclusion It is high risk of vascular invasion for tumor recurrence.The differentiation grade of recurrent tumor is lower.The sign of intrahepatic recurrence of HCC after liver transplantation may be early and local clinical characteristics of tumor cell disseminating and metastasis before and during operation,and it is not recommended to perform retransplantation.