Objective To study the feasibility and safety of hand-assisted laparoscopic modified Sugiura procedure for portal hypertension. Methods Ten patients with cirrhotic portal hypertension and splenomegaly underwent hand-assisted laparoscopic modified Sugiura procedure. Results The operation was successful in all 10 patients. Mean surgical time was 189.5 minutes, Mean blood loss was 141 ml. There was no mortality nor serious postoperative complications. The mean postoperative hospital stay was 10. 5 days. Conclusions Hand-assisted laparoscopic modified Sugiura procedure is feasible and safe. It helps to reduce operative difficulty and control intraoperative bleeding for patients with portal hypertension.

BACKGROUND:Animal studies have shown that cauda equina compression can induce apoptosis of lumbosacral spinal cord anterior horn motor neurons.
OBJECTIVE:To explore the pathological change in lumbosacral spinal cord after acute cauda equina compression in dogs.
METHODS:A total of 27 dogs were randomly divided into nine groups, with three dogs in each group. There were one normal control group, seven experimental groups and one sham surgery group. In the experimental group, an empty water sac was implanted above epidural fat below L6 vertebral plate. Compression was given by injecting water at 4, 8, 12, 24, 48, 72 and 168 hours. In the sham surgery group, an empty water sac was implanted, but compression was not given. At the time of compression, the spinal cord sent out by cauda equina nerve and adjacent to the head end was subjected to histopathological examination.
RESULTS AND CONCLUSION:(1) Results of light microscope:at 4-48 hours of compression, spinal cord anterior horn motor neurons did not alter. At 72 hours, motor neurons became smal , cel membrane shrank and separated from surrounding tissues. Cel s were homogenous and darkly stained. At 168 hours, motor neurons disappeared, but spinal cord sections of the adjacent head end did not shown abnormal motor neurons in the spinal cord anterior horn. (2) Results of electron microscope:at 12 hours, spinal cord tissue began to swel , and the swel ing aggravated with prolonged time of compression. The swel ing of glial cel s was apparent. At 168 hours, myelin sheath structure dissolved;axons showed vacuolization;axoplasm spil ed, and exhibited inflammatory injury-like changes. (3) Apoptotic results of spinal cord anterior horn motor neurons:apoptosis appeared at 12 hours of compression, became increased, and showed an increased trend at 168 hours.

Objective To study the integration and expression of HLA-B2704 gene in HLA-B2704 transgenic mice. Methods HLA-B2704 gene was introduced into fertilized eggs of C57BL/6?Kunming and Kunming?Kunming by microinjection. The founder mice were screened by PCR for integration of HLA-B2704 transgene and were then further confirmed by southern blot. RT-PCR and flow cytometry were carried out to detect the expression of HLA-B2704 gene at mRNA and protein level. Results Ten F0 hybrid mice carried HLA-B2704 gene in 101 F0 hybrid mice, 3 of 64 (4.7%) hybrid mice from Kunming?Kunming and 7 of 37 (18.9%) hybrid mice from C57BL/6?Kunming background carried HLA-B2704 gene. Statistical analysis showed that there was significant difference in the integration rate between the two groups (P

Objective To explore the change of serum insulin-like growth factor-2 (IGF-2) and its relationship with clinical characteristics in patients with schizophrenia. Methods Fifty-one schizophrenic patients were recruited in the present study and 50 healthy volunteers served as controls. The serum IGF-2 level was measured using enzyme linked immunosorbent assay (ELISA). Positive and Negative Syndrome Scale (PANSS) was used to evaluate the psychotic symp?toms of patients. Trail Making Test-A (TMTA), Digit-Symbol Coding Test (DSCT), Continuous Performance Test (CPT) and Stroop Color-Word Test (SCWT) were used to evaluate the cognitive function of both groups. Results There were sig?nificant differences in the results of TMTA, DSCT, CPT and SCWT between patient and control groups. The serum levels of IGF-2 were significantly lower in patients than that in controls [(202.7±40.7) ng/mL vs. (365.9±65.5) ng/mL, P<0.01]. The levels of serum IGF-2 were not significantly different between first-episode and recurrent schizophrenic patients (P>0.05). Furthermore, significant correlations were found between the serum IGF-2 level and the negative symptom sub?scale of PANSS (r=-0.397, P=0.004), CPT score (r=0.378, P=0.006), SCWT-word number (r=0.289, P=0.040), SC? WT-color number (r=0.327, P=0.019) and SCWT-word/color number (r=0.386, P=0.005) in schizophrenic patients. Con?clusion The serum IGF-2 levels of patients with schizophrenia are significantly lower than that of healthy controls, and the IGF-2 level is associated with the severity of negative symptoms and cognitive impairments in patients, indicating that serum IGF-2 might be an indicator of the severity of schizophrenia.

Objective To explore the mechanism of deep brain stimulation(DBS)therapy to Parkinson's disease(PD).Methods We produced hemi-parkinsonian rat model with stereotaxically injecting 6-OHDA to right medial forebrain bundle(MFB)and stimulated ipsilateral subthalamu nucleus (STN)with platinum electrodes chronically to investigate the influence of DBS to the expression of Calbindin-28,synaptophysin and tyrosine dioxydase(TH)in Striatum by Western blot.In addition,slices of bilateral PD rats after DBS were stained to observe the expression of Calbindin-28 and synaptophysin in substantia nigra by Immunohistochemistry.Results High frequency stimulation impaired the rotational frequency 31% of unilateral PD rats triggered by apomophine;Long-term DBS increased the expression of TH in innocent striatum of unilateral PD rats 78.6%?9.5%,since the ipsilateral striatum(lesion side) was TH depleted by 6-OHDA insults;Calbindin-28 expression in ipsilateral striatum of hemi-PD rats raised up 75.4%?15.0% and long-term DBS reduced the effect by 43.0%?7.1%,meanwhile Calbindin-28 positive neurons in substantia nigra compacta in sham,PD and DBS rats were 74.5?10.2,75.7?15.6, 33.1?7.8.However,Synaptophysin expression in substantia nigra and striatum kept stable even after long- term DBS.Conclusions Consistent to the treatment to PD patients,DBS to STN alleviated the motor disorder of PD rats,the treatment might be based on regulating the expression of Calbindin-28 and TH.

Objective:To explore the risk factors for duodenal papillary adenocarcinoma by comparing the differences in clinical and endoscopic features between patients with duodenal papillary adenomas and adenocarcinomas.Methods:This study retrospectively included patients diagnosed as having duodenal papillary adenocarcinoma and adenoma from January 1st 2018 to June 1st 2023 at Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School. Demographic, clinical manifestations, laboratory tests, imaging, endoscopic and pathological characteristics of patients with adenomas and adenocarcinomas were collected and compared. Multivariable logistic regression analysis was employed to identify high-risk factors for duodenal papillary adenocarcinoma.Results:A total of 119 cases of adenocarcinoma and 171 cases of adenoma were included. There were statistically significant differences between the two groups in terms of patient age, body mass index (BMI), clinical symptoms, family history of malignant tumors, bile duct dilation, pancreatic duct dilation, lesion size, adenoma site classification, stage assessed by EUS, and involvement of the bile and pancreatic ducts ( P<0.05). Univariate logistic regression analysis revealed that non-ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, involvement of the bile and pancreatic ducts assessed by EUS, age ≥60 years, lesion size ≥1.5 cm, clinical symptoms, family history of malignant tumors, bile duct dilation, and pancreatic duct dilation were risk factors for duodenal papillary adenocarcinoma. Multivariate logistic regression analysis showed that non-ampullary lesions ( OR=7.00, 95% CI:1.44-34.15, P=0.016), involvement not limited to the major duodenal papilla assessed by EUS ( OR=13.77, 95% CI: 4.69-40.45, P<0.001), age ≥60 years ( OR=2.52, 95% CI: 1.23-5.18, P=0.011), bile duct dilation ( OR=2.58, 95% CI: 1.12-5.94, P=0.026), and lesion size ≥1.5 cm ( OR=2.76, 95% CI:1.36-5.59, P=0.005) were independent risk factors for duodenal papillary adenocarcinoma. Conclusion:This study shows the independent risk factors for duodenal papillary adenocarcinoma, which include non-ampullary lesions, involvement not limited to the major duodenal papilla assessed by EUS, age ≥60 years, bile duct dilation, and lesion size ≥1.5 cm.

OBJECTIVETo investigate the expression of extracellular matrix metalloproteinase induced (EMMPRIN) in the interface tissue, and explore the role of EMMPRIN in the aseptic loosening of prostheses.

METHODSImmunohistochemistry was performed to characterize the EMMPRIN-expressing cells at sites of interface tissue around aseptic loosened hip prostheses in 16 cases. Reverse transcription-polymerase chain reaction (RT-PCR) was performed to study the existence of EMMPRIN mRNA in interface tissue samples. And it was followed up by computer assisted image analysis in order to detect the A values of their expression. Synovium of hip joint of 8 femoral neck fracture were in control group.

RESULTSStrong immunostaining of EMMPRIN was found in the macrophages and fibroblasts of lining-like layers and vascular endothelium of synovial membrane-like interface tissue around loosened prostheses. Expression of EMMPRIN was significantly higher in interface tissue than the control synovium (z=-3.252, P=0.001). RT-PCR of interface tissue samples disclosed the presence of EMMPRIN mRNA of 14 cases. In interface tissue, the A value of EMMPRIN increased significantly compared to control synovium (P<0.01).

CONCLUSIONOver-expression of EMMPRIN up-regulates the production of matrix metalloproteinase (MMPs) in the interface tissue. And it can promote the bone destruction around prostheses. Thereby it may be one of methods to prevent and treat aseptic loosening of prostheses by repression the biology activity of EMMPRIN.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; Basigin ; genetics ; physiology ; Female ; Hip Prosthesis ; Humans ; Immunohistochemistry ; Male ; Matrix Metalloproteinases ; metabolism ; Middle Aged ; Osteolysis ; physiopathology ; Prosthesis Failure ; RNA, Messenger ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Synovial Membrane ; metabolism

OBJECTIVETo introduce the experience in the treatment of lower eyelid pouches orbital rim.

METHODSAn incision was made along the margin of lower eyelid and dissection was performed under the orbicularis muscle to expose the orbital septum and periosteum of lower orbital rim. The fat released from orbital septum was transposed just below the lower orbital rim and fixed on the periosteum. If lacrimal groove deformity was not corrected completely, the musculocutaneous flap, which may be excised beside the incision, was kept to correct the deformities further with only the muscle portion.

RESULTS72 cases with lower eyelid pouches complicated with lacrimal groove deformities were treated with transposition of orbital fat and orbicularis muscular flaps. Satisfactory results were achieved in all the patients after a follow-up period of 3-6 months.

CONCLUSIONIt is an effective and feasible technique to correct lacrimal groove deformities with transposition of orbital fat and orbicularis muscular flaps.

Adipose Tissue ; transplantation ; Aged ; Blepharoplasty ; methods ; Eyelids ; surgery ; Humans ; Orbit ; Periosteum ; surgery

Objective To explore the effects of aripiprazole on clinical symptoms and neurotrophic factor levels in patients with schizophrenia. Methods Forty patients with schizophrenia and 40 normal controls were included in the study. The clinical symptoms of patients receiving aripiprazole only for 12 weeks were evaluated by using the Positive and Negative Syndrome Scale (PANSS). Stroop Color-Word Test (SCWT), Continuous Performance Test, Digit-Symbol Coding Test and Trail Making Test-A were used to evaluate the cognitive function both in patients and controls. Serum levels of Nerve Growth Factor (NGF), Brain Derived Neurotrophic Factor (BDNF) and Neurotrophin 3 (NT-3) were measured using enzyme linked immunosorbent assay. Results The clinical scores, cognitive function and levels of neurotrophic factors were different before and after treatment (P<0.01). And those were significantly lower in patients than in control group (P<0.05). Before treatment, BDNF was negatively correlated with PANSS negative symptom score (r=-0.362, P=0.022);NGF was related to the total score of PANSS (r=0.332, P=0.037) and positive symptoms (r=0.401, P=0.010); NT-3 was associated with negative symptom scores (r=-0.376, P=0.017) and SCWT-color words (r=0.332, P=0.037) in patient group. After treatment, the increase in BDNF was correlated with the reduction in PANSS total score (r=0.371, P=0.018), negative symptom score (r=0.345, P=0.029) and general pathology score (r=0.342, P=0.031). There was a correlation of the increase of NGF with the decrease of PANSS total scores (r=0.437, P=0.005) and with positive symptom scores (r=0.357, P=0.024). Conclusion Treatment with Aripiprazole can improve the clinical symptoms and cognitive functiona impairments in patients with schizophrenia, which may be related to the increase in serum levels of BDNF, NGF and NT-3.

Objective To study the clinical effect and complications of MRI guided stereotactic radiofrequency lesion in patients with intractable schizophrenia. Methods Thirty-eight cases of intractable schizophrenia underwent MRI guided stereotactic stereotactic radiofrequency lesion for single target or combined target. According to 1990 standards from National Psychosurgery Cooperation, the therapeutic outcome was assessed 6 months after operation. In addition, pre-and post-operative brief psychiatric reacting scale (BPRS) scores were got by psychiatrists for evaluating the curative effect. Results Six months after operation, 8 cases were free from symptoms, 15 cases were significantly improved, 12 improved a little and 3 had no improvement. The effective rate was 92.1%. 15cases had mild transient post-operative complications, and all recovered within 2 weeks. Psychiatric evaluations of BPRS demonstrated that there were significant decreases in total score and factor scores of anxiety-depression, lacking-activity, disturbance, activation and hostile-suspiciousness after operation (P<0.05). Conclusions MRI guided stereotactic radiofrequsency lesion is accurate, safe and effective for intractable schizophrenia.