Objective To explore the feasibility of hand-assisted laparoscopic splenectomy and azygos-portal disconnection. Methods Hand-assisted laparoscopy was performed in 12 patients with hypersplenia secondary to post-hepatitic hepatocirrhosis and a history of rupture and bleeding of esophago-gastric varicose vein.An ultrasound knife was used to dissect the ligaments of the spleen.The Endo-Cutter was used to cut off the pedicle of the spleen.Then the spleen was removed in a plastic bag.All of the varicose vessels around the fundus and the lower segment of the esophagus(6~8 cm in length) were dissected and disconnected according to the criteria of open surgery.Results The operation was successfully completed in 10 patients,while conversions to open surgery were required in 2 patients because of massive hemorrhage during the operation.The operating time was 2.5~5 h(mean,3.4 h) and the hemorrhagic volume was 100~500 ml(mean,250 ml).Postoperatively,1 patient experienced an intraperitoneal hemorrhage and received open surgery for hemostasis while the remaining patients had an uneventful recovery without complications.A total of 10 patients were followed for 0.5~2 years(mean,1.5 years).Four patients died of liver failure.Six patients presented small volumes of relapsed upper gastrointestinal bleeding around 1 year after operation.Gastroscopy showed portal hypertensive gastropathy in 3 patients,gastric ulcer in 1 patient,and ruptured varicose esophageal veins in 2 patients.All the 6 patients were cured by conservative medical treatment.Conclusions Hand-assisted laparoscopic splenectomy and azygos-portal disconnection is a feasible,effective,and safe surgical procedure.

Objective To explore the clinical effects of unilateral placement of plastic stents by ERCP for nonresectable Bismuth type IV hilar cholangiocarcinoma.Methods A prospective study was conducted in 42 patients with nonresectable Bismuth type IV hilar cholangiocarcinoma,who had unilateral insertion of plastic stents in the recent 4 years,All of the patients had successful insertion of single plastic stent by ERCP manipulation.Early results (less than 30 days) of procedure-related complications,mortality,long-term results (greater than 30 days) and survival were observed.Results All of the 42 patients had successful drainage.Mean total bilirubin value decreased from (332.3?163.4)?mol/L to (30.6?18.5)?mol/L,and complete resolution of jaundice was achieved in 61.9% (26/42)of the patients.Early comlications included papilla bleeding due to EST in 4 of 42 patients (9.5%) and acute cholangitis in 10 of 42 patients (23.8%).No procedure-related death occurred.All of the patients needed to have their stents replaced periodically,and the median duration up to the first stent replacement was 65 d,and without significant differences between the two groups in stent insertion to the left and right hepatic duct.Median duration of stent patency was 5.15 months,and median patient survival was 6.5 months,but also no significant differences were found between the two groups.Conclusions Unilateral plastic stent insertion is safe and feasible,can achieve adequate drainage for relatively long time,and can improve life quality and survival for patients with nonresectable hilar cholangiocarcinoma.

Objective To explore the variations of regeneration hormones after hepatectomy for liver cancer,and evaluate the relationship between the liver regeneration hormones and cancer recurrence.Methods The clinical data of 129 patients with primary hepatic carcinoma in our hospital from Dec 2004 to Dec 2005 were collected.The patients were divided into three groups according to their recurrent times,which were one-month recurrence group,6 months recurrence group and one-year recurrence group.And at the same time,40 cases of liver cancer that received TAE treatment were as contrast group.Serum HGF value was detected before operation and 1,3,7,10 and 14 days after operation.c-met,which is the receptor of HGF,was also detected as c-met mRNA and protein expression in cancer tissue and near-carcinoma liver tissue by semi-quantitative RT-PCR and Western Blot.The differences between the level of expression and the time of recurrence were compared,and the results were also compared with pathological indexes.Results Serum HGF value elevated after hepatectomy,the crest time appeared at about 10 days after the operation,and decreased after 14 days.The elevated values of HGF in large HCC tumors were markedly higher than those in small HCC tumors.The change of c-met mRNA and protein levels,revealed that the earlier the recurrence in both large and small HCC,the higher the c-met levels,and the higher the rate of vascular cancer emboli.Conclusions There is marked elevation of HGF level after hepatectomy in patients with liver carcinoma,and the over expression of c-met of the tumor may be related to its early postoperative recurrence.

Objective To investigate the effect of low molecular weight heparin (LMWH) on the expression of endothelial protein C receptor (EPCR) and protease activated receptor 1 (PAR1) in abdominal vascular endothelial cells (VECs) of septic rats. Methods VECs were cultured by tissue-sticking method, and the purity was determined with flow cytometry (FCM). VECs were randomly divided into three groups: control group, septic group (LPS 1 μg/ml) and LMWH group (LPS 1 μg/ml+LMWH 5 μg/ml). The VECs were collected at 1st, 3rd, 5th days after stimulated. The expression of EPCR and PAR1 were assessed by FCM. Results The expression of EPCR and PAR1 of septic group decreased significantly compared with control group at each time point (P＜0.05 or P＜0.01), and the expression decreased most obviously on day 5 (26.53±7.21 vs 39.26±2.62,q＝6.45,P＜0.01;53.21±15.10 vs 86.54±11.34,q＝6.94,P＜0.01). In LMWH group, the levels of EPCR and PAR1 expression were higher than setpic group at each time point (P＜0.05). Compared to control group, the expression of EPCR had a significantly decrease on day 1 (40.86±1.63 vs 45.41±2.82,q＝3.51,P＜0.05), which had no significantly different on day 3 and 5 (41.20±3.32 vs 42.83±2.66,P＞0.05;39.23±3.33 vs 39.26±2.62,P＞0.05), and the expression of PAR1 were not significantly decrease compared with control group at each time point (P＞0.05). Conclusions LMWH could improve the inhibition status and the expression of EPCR and PAR1 on VECs in septic rats.

Objective:Cholangioduodenal reflux is still an unresolved problem in interposed jejunal choledochoduodenostomy (IJC) yet.To settle this problem,we designed IJC with distal suspending (IJCDS).Methods:IJCDS is to insert and suspend the distal end of the 25 cm-ling interposed jejunum to the duodenal cavity,which is about 2.5 cm long.The pressure of the biliary tract and the biochemical composition or the bile were measured during and after the operation and the results were compared.Barium meal and cholangiography through T tube were performed after the operation.Follow-up surveys were also done.Results:The pressure or the biliary tract decreased distinctively after the operation.Barium meals found no cholangioduodenal reflux although the patients had changed many postures.Cholangiography through T tube showed parisaltic or the interposed jejunum and the contrast medium was continuously pushed into the duodenum.Noreflux cholangitis and stone recurrence were found in the follow-up survey in 14 patients.Conclusion:IJCDS has the powerful function on preventing cholangioduodenal reflux.On the other hand,it avods the shortcomings of other reflux-preventing operative pattern.So it had the good prospect to extend its clinical usage.

Objective To summarize the clinical experience in treatment of the Lisfranc joint injury with open reduction and internal fixation at early stage. Methods Twelve patients ( including ten males and two females at average age of 34 years) with early stage Lisfranc joint injury received open reduction and screw/wire fixation from 2005 to 2010. According to the Myerson classification, there were two patients with type A, eight with type B and two with type C. All the patients received open reduction and internal fixation with screw or Kirschner wire within 17 days after injury. The post-operative function was estimated by mid-foot scoring scale of AOFAS. X-ray and CT scan were used in radiography estimation. Results All the patients were followed up for average 33 months ( range, 6-60 months). The mean score of post-operative mid-foot scoring scale of AOFAS was 74.5 points ( range, 53-96 points), with excellent result in eight patients, good in two and fair in two. The anatomical reduction was observed in eight patients and all the patients obtained bony union according to the results of X-ray and CT scan.There was no any complication found.Conclusions Open reduction and internal fixation is a good choice for the treatment of Lisfranc joint injury at early stage. A preoperative comprehensive analysis combined with clinical X-ray and CT scan is necessary.

Objective To isolate and purify Thy 1 low Lin Sca 1 + bone marrow stem subset cells by magnetic activated cell sorting(MACS). Methods Thy 1 low Lin Sca 1 + cells from mouse bone marrow were collected through three processes by MACS.After Lin + cells were removed,Thy 1 low Lin Sca 1 + bone marrow stem cell subsets were harvasted.The purity of the cells was analysed by FACS and the reclaimation rate was counted. Results The purity and reclaimation rate of Thy 1 low Lin Sca 1 + cells were 72.36% and 82.43% respectively, which equaled to the level of isolation and purification of CD34 + cells by MACS. Conclusions It is effective to isolate and purify Thy 1 low Lin Sca 1 + bone marrow stem cell subsets by MACS, and the purity and reclaimation rate of the cells are high.

ovel GCK-E339K mutation might be linked to this MODY2 pedigree.

Objective To investigate the presences of regulatory T cells (Treg) and natural killer T cell (NKT)-like T cells in the peripheral blood of healthy subjects and patients with newly diagnosed cancer. Methods Patients were enrolled into four groups: healthy subjects (Group A), patients without cancer (Group B), patients with newly diagnosed stage Ⅰ~Ⅱ cancer (Group C), and patients with newly diagnosed stage Ⅲ~Ⅳ cancer (Group D). Flow cytometry was performed to detect the percentage of CD4+ CD25high CD127low cells in CD4+ T lymphocytes (Treg) and the percentage of CD3+ CD56+ cells in CD3+ T lymphocytes (NKT-like). Results The percentage of Treg cells in CD4+T lymphocytes was(6.72 ± 3.16)%, (6.49 ± 2.83)%,(6.80 ± 3.07)%and (7.63 3.47)% in Group A, B, C and D, respectively, with no significant differences among these groups (P>0.05). However, the percentage of CD3+CD56+T cells in CD3+T lymphocytes was (3.13 ± 1.66)%, (2.56 ± 1.27)%,(7.22 ± 2.70)% and (7.72 ± 3.10)% in Group A, B, C and D, respectively, with marked increases in Group C and D compared to those in Group A and B (P < 0.05). Conclusion Patients with newly diagnosed cancer demonstrated increasing trends in the percentage of peripheral NKT-like cells.

Objective:To investigate the safety and efficacy of ultrasound-guided transvaginal radiofrequency ablation in the treat ment of symptomatic uterine fibroid.Methods:39 patients with symptomatic uterine fibroid underwent transvaginal radiofrequency ablation therapy were selected Before treatment,the fibroid size and volume were measured using ultrasound.The fibroid-related symptom severity and quality of life were scored using uterine fibroid symptom and quality of life survey.The fibroid volume reduction rate,improvement in clinical symptom and quality of life,and ovarian function of patients were observed before treatment and at three,six,nine and 12 months after treatment.Results:The average operation time of radiofrequency ablation was 25 minutes.There was no clear intraand postoperative complication.Preoperative fibroid volume was 65.2± 49.3cm3,which was reduced to 32.2± 27.6 cm3,21.2± 18.2 cm3,15.3± 12.1 cm3 and 10.3± 9.8 cm3 at 3,6,9 and 12 months after treatment,respectively(P＜0.05).The symptom severity score (SSS) was 60.23± 13.2 before treatment,and gradually decreased to 42.2± 11.4,21.1± 10.2,15.4± 10.3 and 12.2± 9.7 at 3,6,9 and 12 months after treatment(P＜0.05).The quality of life (QOL) score gradually increased from 58.24± 16.24 before treatment to 70.3± 20.3,81.4± 8.6,86.3± 7.6 and 88.2± 9.1 at 3,6,9 and 12 months after treatment (P＜0.05).The levels of follicle stimulating hormone,luteinizing hormone and estradiol at 3,6,9 and 12 months after treatment showed no difference compared with these before treatment (P＞0.05).Conclusions:Ultrasound-guided transvaginal radiofrequency therapy was a minimally invasive,safe,and effective therapy for symptomatic uterine fibroid.