BACKGROUND: Biliary complications are a common cause of death in patients after liver transplantation, biliary endoscopic minimally invasive technique is gradually becoming an important tool to solve biliary complications following orthotopic liver transplantation.OBJECTIVE: To analyze the literatures on the biliary tract complications after liver transplantation, and to demonstrate a clear role of bile duct endoscopy in biliary complications.METHODS: Using "orthotopic liver transplantation, biliary complications, biliary tract, endoscope technique" in English for the search term, Pubmed database were searched between January 1980 and October 2008; Using "liver transplantation, biliary complications, bile duct cast, cholangioscopy" in Chinese for the search term, Vip Chinese Periodical Database and CNKI database were searched between 1994 and January 2009. Literature language was limited to English and Chinese. The studies related to bile duct injury-caused biliary complications after liver transplantation were included, while other research unrelated to biliary complications after liver transplantation were excluded.RESULTS AND CONCLUSION: A total of 52 literatures were screened out by the primary computer inspection, according to inclusion and exclusion criteria, 30 ones were involved for analysis. Biliary complications and vascular complications are considered as a common cause of death in patients after liver transplantation, particularly in biliary complications has become the major reason limiting the development of liver transplantation. Because of the difficulties on early recognition and treatment, the importance of the treatment for the complications in liver transplant patients is increasingly attracting more and more attention. Endoscopic operation technology and their subsidiary parts are improving, particularly therapeutic endoscopic retrograde cholangiopancreatography and biliary mirror technology are developing and continuously improving, biliary endoscopic minimally invasive technique is gradually becoming a major approach to solve biliary complications after orthotopic liver transplantation, The minimally invasive endoscopic diagnosis and treatment is an intuitive, reliable and credible means for the biliary complications after liver transplantation, serving as the most preferred method for diagnosing and treating biliary complications after liver transplantation.

BACKGROUND:Bioactive glass has good biocompatibility, which can promote the remineralization effects of demineralized enamel and enhance the resistance of enamel to erosion. OBJECTIVE:To evaluate the effect of bioactive glass toothpaste versus fluoride toothpaste on brushing abrasion of enamel after acid etching. METHODS:Fifty-six enamel specimens were prepared from bovine incisors, and were embedded in acrylic resin with exposed buccal surface. The exposed area was 6 mm×6 mm and two amalgam fil ings were placed into the enamel and polished. Al specimens were divided into seven groups with eight specimens each. In six groups, specimens were brushed with ordinary toothpaste, fluoride toothpaste, bioactive glass toothpaste immediately and 30 minutes after being eroded by the Sprite. The last one group was brushed with ordinary toothpaste without acid etching as control. The treatment course was cycled 60 times. The surface abrasion loss of the specimens between two amalgam fil ings compared with respective amalgam reference surfaces was final y observed and calculated under laser scanning confocal microscope. RESULTS AND CONCLUSION:The abrasion loss amount of teeth with no acid etching was significantly lower than that with acid etching (P<0.05). The abrasion loss amount of teeth brushed with bioactive glass toothpaste was less than that with fluoride toothpaste at the same brushing time (P<0.05). For the same toothpaste, the abrasion loss amount of teeth brushed 30 minutes after eroded was less than that bushed instantly after eroded (P<0.05). Use of bioactive glass toothpaste can effectively reduce enamel loss caused by acid etching and brushing. The loss amount can also be reduced by brushing teeth 30 minutes after acid etching.

Objective To study the long term results of thoracolumbar fractures treatment with AF (atlas fixator) pedicle system. Methods The clinical results of 60 cases of thoracolumbar fractures treated with AF pedicle system from 1996 2000 were analyzed retrospectively. Results The follow ups lasted from 3 to 6 years, averaging 4 years. The neurological function improved by at least 2 ASIA grades in 27 cases and by 1 ASIA grade in 33 cases. The correction of the vertebral body height averaged 95.1%, and the correction loss averaged 19.7%. Degeneration and narrowing of the disc space next to the fractured vertebrae were common, and correction loss was most evident at the upper disc spaces. Conclusions The AF pedicle system can achieve good long term clinical results for the recovery of neurological function and the vertebral body height. But the rates of implant failure and correction loss are still high probably due to deficiency of bone grafting and delayed implant removal.

Objective To evaluate miniature probe endoscopic ultrasonography (mEUS) in diagnosis of submucosal tumor (SMT) of upper digestive tract.Methods We observed 91 patients with SMT,and mEUS was performed to assess the lesions arised from the specific layer of the wall.Results Among all cases,leiomyoma was the most common,57 cases,found in esophagus more than in stomach;14 of cysts,9 of vascular lesions,5 of lipoma,and 2 cases of malignant stromal tumors.Malignant lesions and part of benign lesions were confirmed by histological examination.Conclusion mEUS is a simple,safe and effective method for SMT,and it can be clue to the location and nature of SMT.

Objective To explore the role of choledochofiberscopy in the diagnosis and treatment of biliary complication after orthotopic liver transplantation.Methods The patients with continuous biliary infection and obstructive jaundice in 6 cases subject to orthotopic liver transplantation were treated by choledochofiberscopy through T tube sinus tract. The findings from choledochofiberscope at different periods after operation were recorded.Results Three to five months after operation, there were a lot of flocs in the bile duct cavity under the choledochofiberscopy, and mucous membrane of bile duct was pale or coarse. On the postoperative month 6, 11 and 18, choledochofiberscopy revealed there were funicular, columned and brown biliary stones in bile duct cavity which mostly located in porta hepatis, and there existed stenosis in anastomotic stoma of bile duct to varying degrees; the wall of bile duct was coarse, with congestion of the mucous membrane. The flocs and stones could be extracted conveniently by the choledochofiberscope.Conclusion We can observe the transplanted liver’s bile duct through the T tube sinus tract by the choledochofiberscopy and treat the biliary complications conveniently.

Objective To compare the effects of intraoperative anesthetic management on im-mune function between enhanced recovery after surgery (ERAS)and traditional approach in laparo-scopic rectal surgery.Methods Clinical data of 90 laparoscopic rectal surgery in Shanxi Provincial People’s Hospital from January 2013 to January 201 5 were prospectively analyzed.90 cases (male 5 1 cases,female 39 cases,aged 48-70 years,ASA grade Ⅰ-Ⅲ)were randomly divided into two groups (n = 45 each)using a random number table:ERAS group (group A,n = 45 )and control group (group B,n = 45 ).In group A patients were treated with epidural general anesthesia,maintaining perioperative normothermia,perioperative goal-directed fluid therapy and patient controlled epidural analgesia,while in group B routine anesthetic management and patient controlled intravenous analgesia were used.The levels of blood CRP and IL-6,CD3 + ,CD4 + ,CD8 + ,CD4 +/CD8 + on the first day before operation,the first day and the third day after operation were recorded.Results The blood CRP and IL-6 levels in two groups were increased on the third day after operation(P <0.05), however the increase was more significantly in group A than in group B (P <0.05).Compared with the first day before operation,CD3 + ,CD4 + ,CD8 + and CD4 +/CD8 + levels in two groups were de-creased on the third day after operation(P <0.05),on the third day group A decreased significantly, which was more than that in group B(P <0.05).Conclusion In the relief of operative stress and the protection of immune function through enhanced recovery after surgery in anesthetic management.

Objective To compare the value of ERCP plus EST and laparotomy in the treatment of common bile duct stones.Methods 56 cases of common bile duct stones were treated with ERCP and EST in our hospital from June 2012 to June 2013 (endoscopy group),78 cases were treated with laparotomy and common bile duct exploration (laparotomy group).The two groups were compared on success rate of stone removal,operation time,intraoperative bleeding volume,incidence of infection and pancreatitis and hyperamylasemia,common bile duct stone recurrence rate,hospital stays,hospital costs.Results Operation time,intraoperative bleeding volume and infection rate in endoscopic group was lower than the laparotomy group,the incidence of hyperamylasemia,hospital costs in the endoscopic group was higher than laparotomy group.The success rate of stone removal and the recurrence rate of common bile duct stone in the endoscopic group was lower than the laparotomy group,incidence of pancreatitis in the endoscopic group was higher than the laparotomy group,though the differences were not statistically significant.Conclusions ERCP and EST is a time saving procedure fast relieving the bile duct obstruction,less traumative,spelling lower infection rate,less hospital stays,though causing higher incidence of hyperamylasemia and hospital costs.

Objective To provide information and assistance for research of bile duct injury in OLT through endoscopic observation and treatment of biliary complications after liver transplantation.Methods After OLT, all the cases in normal group, bile duct injury group and hepatic artery injury group were observed, diagnosed and recorded respectively. Meanwhile, the biopsy was performed through the endoscopy for pathological examination. For those cases without T tube, the biopsy was conducted by choledochoscopy in combination with duodenoscopy. Results The exterior and interior bile duct anatomy of the 9 cases in the normal group was normal. They had no bile duct stenosis and scar, their bile duct mucous membrane looked good and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Fibrous tissue and small vascular proliferation happened under epithelium scattered with plasmocyte and lymphocyte. Various kinds of bile duct stones-simple, multiple and casting mould type, were found in 12 cases with bile duct injury. Bile duet mucous membrane injured in different degrees was repaired after stone removed and obstruction relieved by endoscope. Bile duct tree becoming normal was seen by pacification examination. Three cases in the hepatic injury group had bile duct ischemic necrosis, losing of normal structure without bile duct wall and mucous membrane. Conclusion Bile ducts are injured in different degrees in OLT. The choledochofibroscopy is of the first choice for diagnosis and treatment of complications after OLT.

BACKGROUND: Complications, caused by bile duct injury after liver transplantation, are difficult for diagnosis and treatmerit and the bottlenecks for the development of liver transplantation. OBJECTIVE: To observe and record bile duct injury and do biopsy in parallel with treating biliary complications following liver transplantation successfully with choledochoscope, and to analyze the relationships between various bile duct injuries, histopathological types and biliary complications following liver transplantation. DESIGN, TIME AND SETTING: Case analysis was carried out at Dalian Institute of Hepatobiliary Surgery, Department of Hepatobiliary Surgery. Dalian Friendship Hospital between July 2001 and October 2005. PARTICIPANTS: Nineteen patients after liver transplantation were divided into three groups according to the occurrence of biliary complications: four cases for normal group, twelve cases for bile duct injury group, three cases for hepatic artery miury group. METHODS: They were observed. diagnosed and recorded respectively and take biopsy for pathological analysis through the choledochoscope. With regard to the cases without T-tube. Choledochoscope combined duodenoscope were used to take biopsies. MAIN OUTCOME MEASURES: Choledochoscope was used to observe T-tube cholangiography, the appearances and pathological changes of intemal and external bile duct mucous membrane. healing of the donor-receptor bile duct stoma. Patients in the bile duct injury group were done examinations described above after endoscopic stone extraction and stenosis expansion. RESULTS: The intemal and extemal bile duct anatomy of the patients in the normal group were normal, without bile ductstenosis and scar, their bile duct mucous membrane lookcd good, and the anastomosis of the donor-receptor bile duct healed well. Restored mucous tissue coating with intact epithelium was found by pathological examination. Various kinds of bile duct stones, simple, multiple and casting mould stones, were found in patients of the bile duct injury group. Bile duct mucous membranes were injured at different degrees and repaired after removing stones and relieving obstruction by endoscope. Contrast examination demonstrated that bile duct tree regained normal. In hepatic artery injury group, patients had bile duct wall ischemic necrosis and lost bile duct normal structure, congestion was obvious, biliary sludge and stones completely filled in the bile duct tree. Interrupted bile duct structure were found in Ⅲ grade bile ducts.Pathological examination revealed extensive bile duct wall necrosis,indistinct strcture,more bile infiltration,proliferative granulation tissue and suppuration focus.CONCLUSION:Bile ducts are injured at different degrees in orthotopic liver transplantation;cold preservation/repeffusion injury is the most important initiating agent leading to bile duct tree injuries;the vessel plexus damage and microcirculatory disturbance surrounding the bile ducts maybe one of the mechanisms of the bile duct injury.

Objective To investigate the curative effects of selected proprioceptive neuromuscular facilitation (PNF) patterns and techniques on shoulder subluxation soon after strokd. Methods Forty-one stroke patients with shoulder subluxation were randomly divided into a treatment group(n=22) and a control group (n=19). The patients in the treatment group receiveed the selected PNF techniques daily for 4 weeks, while the patients in the control group were treated with their previous therapeutic protocol. The shortest distance from the lower border of the acromion to the nearest point of the humeral head(AHH) was measured. Brunnstron grading was used to evaluate motor function in the affected upper linb, and a visual analogue scale (VAS) to assess subLuxation. Shoulder pain before and after treatment was also assessd. Results There was no significant difference in general condition between the patients in the two groups before treatment. In the treatment group, a significant improvement in AHH distance of the affected shoulder was observed after 4 weeks. Shoulder subluxation waw cured in 13 patients, with AHH distance ＜0.75 cm after 4 weeks of treatment. Conclusion The PNF technique applied was effective for the early treatment of subluxation after stroke. Motor function in the affected upper limb could be improved significantly and pain alleviated.