Liver hanging maneuver was firstly introduced by Belghiti et al in 2001,since then,the new technique has aroused widespread interest.The fatal weakness of liver hanging maneuver is bleeding resulting from blind dissection of the anterior plane of the inferior vena cava.In this review,the anatomic basis of retrohepatic tunnel and the surgical techniques were summarized to provide surgeons with suggestions in hepatectomy,liver transplantation or operations for hepatic trauma,so as to reduce the incidence of complications and raise the safety and success rate.

To study the possible etiopathology of senile cataract,the changes in the activity of lens epithelial enzyme in senile cataract and the effects of oxidative damage on the enzymatic activity of the cultured bovine lens epithelial cells. Methods 1. The activities of succinate dehydrogenase ( SDH)、 Lactate dehydrogenase ( LDH)、 Glucose - 6 - phosphate dehydrogenase (G60D) and Adenosine triphosphatase (ATPase) collected from senile cataract and normal lens epithelial cells were observed by enzyme histochemistry methods. 2. An experimental oxidative damage model of cultured bovine lens epithelial cells in vitro was established. Then the activities of SDH、 LDH and G6PD were observed after oxidative damage and then,after VitC treatment. Results 1. The activities of SDH、 LDH、 G6PD and ATPase of senile cataract lens epithelial cells were apparently lower than those of normal transparent lens.2. After oxidative damage, the activities of SDH、 LDH and G6PD of cultured bovine lens epithelial cells dramatically decreased. Vitamin C partly raised the enzyme activities, rather than bring them to normal.Conclusion Activities of enzyme related with energetic metabolism are decreased following oxidative damage, which may be a possible cause of senile cataract.

Objective To evaluate the sensitivity and specificity of histopathologie analysis vs cytomegalovirus (CMV) detection for the diagnosis of CMV-infected hepatitis post liver transplantation. Methods Twenty-five biopsies with CMV infection and twenty-five without CMV infection were collected. Histopathologic observation, immunohistochemical staining and virus detection were performed on both groups to evaluate the sensitivity and specificity of these examinations for the diagnosis of CMV-infected hepatitis. Results The detection rate of microabscess, aggregation of monocyte and rnacrophage, and cytomegalic change in CMV infection group was higher than that in the group without CMV infection (P<0.05), but there was no significant difference in intranuclear inclusion and eosinophilic body between the two groups (P>0.05). The sensitivity and specificity of IHC and PCR for CMV detection were 20% and 100%, 72% and 84%, respectively. Conclosions CMV detection with PCR combined with histological observation is the most effective diagnostic scheme for CMV disease of liver.

Objective To assess the effects of orthotopic liver transplantation (OLT) on the quality of life (QoL) of the patients with end stage liver disease. Methods QoL of OLT recipients was assessed by the GLQI index of the digestive system disease. A total of 43 recipients with benign end stage liver disease without operational complications, who were clearly conscious and had no difficulty in comprehending the investigation table because of their relative good education above the middle school, had been investigated during May 2000 to December 2002. The detecting data were divided into three parts including before OLT, at discharge, and 3 months after discharge. Results At the stage of discharge, QoL of OLT recipients was improved as compared with that before OLT. The physical function, psychological status, symptom of the recipients had been significantly improved than as compared with those before OLT ( P 0.05). And at the stage of 3 months after discharge, QoL of the recipients was improved significantly than that in the hospital ( P

Objective To discuss the value of 16-slice spiral CT urography in clinical diagnosis.Methods To compare the images between CR excretory urography,CT and MPR,which are the results of 26 cases who were examined by both CR and 16-slice spiral CT urography.Results From the comparison,it is found that the spiral CT urography images are better than that of the CR excertory urography,and at the same time,the relationship between the parenchyma of the renal,renal pelvis,ureter,bladder and the urinary organs and adjacent structures can be demonstrated clearly.Conclusion The scanning time of the spiral CT is shorter.The machine can not only reconstruct powerfully but also work out better images,and the result is better than CR excretory urography which can not detect some details in its images.Therefore CR excretory urogaphy can be replaced by 16-slice spiral CT urography regardless of its cost.

Objective To discuss the problems of using high pressure injector in the 16-detector-row CT. Methods Reviewed and analyzed the courses of using high pressure injector in the 16-detector-row CT for 799 patients. Results 774 patients obtained successful infusion,contrast medium hydrops were occurred in 20 patients,2 patients were infusion failure and 3 patients were redid for misoperation. Conclusion Master the details of operating high pressure injector can alleviate the pain of patients,and then obtain the satisfactory effect.

Objective:The implementation of a multidisciplinary team (MDT) approach for palliative treatment of patients with multi-ple primary carcinomas (MPCs) was evaluated in Tianjin Medical University Cancer Institute and Hospital. Methods:A total of 40 pa-tients with MPCs who attended the consultation by MDT in our hospital from January 1, 2014 to April 21, 2016 were analyzed retro-spectively. Clinical data of the 40 cancer patients were reviewed. The essential characteristics and results of MDT treatment decisions were summarized and expected outcomes were evaluated. Results:A total of 40 cases with MPCs were included in MDT assessment, accounting for 6.4%of the 629 patients who were handled by the MDT. A total of 39 MDT decisions were followed up successfully. Among these MDT decisions, 26 (65%) were fully implemented, 7 (17.5%) were partially implemented, and 6 (15.0%) were unimple-mented. Expected outcomes were achieved in 25 (96.2%) patients of the fully implemented concordant group, 4 (57.1%) patients of the partially concordant group, and 1 (16.7%) patient from the unimplemented group. Conclusion:MDT specializing on palliative treat-ment can provide recommendations for standardized individualized comprehensive treatment of patients with MPCs. MDT modality should be further improved and widely used for palliative treatment.

OBJECTIVETo explore genetic mutation and clinical treatment for a patient with globozoospermia.

METHODSHistomorphology of the sperms was studied by Wright-Giemsa staining and transmission electron microscopy. Potential mutation of the DPY19L2 gene was detected by PCR amplification and Sanger sequencing.

RESULTSWright-Giemsa staining showed that all spermatozoa from the patient were round-headed and lacked the acrosome, with the nuclei of sperm head stained in dark and full. Transmission electron microscopy revealed large round sperm heads, with an even layer of unit membrane surrounding the nuclei and dispersed cytoplasmic vacuoles but no acrosomal structure. The patient has harbored a homozygous deletion of the DPY19L2 gene. With intracytoplasmic sperm injection (ICSI) treatment, fertilization rate of the oocytes has reached 28.6%, which resulted in a successful pregnancy. A healthy male was born.

CONCLUSIONThe homozygous deletion of DPY19L2 probably underlies the globozoospermia in this case, for which ICSI has provided an effective treatment. However, there is still a risk of low oocyte fertilization rate or fertilization failure. Further studies are required.

Adult ; DNA Mutational Analysis ; Humans ; Infant, Newborn ; Male ; Membrane Proteins ; genetics ; Mutation ; Sperm Injections, Intracytoplasmic ; Teratozoospermia ; genetics

With the increasing understanding of the unique tumor microenvironment in the brain, immunotherapy have emerged as a new and promising treatment for brain metastases. Radiotherapy and immunotherapy have a synergistic effect, and it is of great value to understand its mechanism in the treatment of breast cancer brain metastases. At present, the study of immune checkpoint inhibitors combined with radiotherapy in breast cancer brain metastases is being actively carried out, bringing new hope to patients with breast cancer brain metastases.

Objective:To investigate the clinical efficacy of ex vivo liver resection and autotransplantation (ELRA) for liver complex space-occupying lesions.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 50 patients with liver complex space-occupying lesions who underwent ELRA in the First Hospital Affiliated to Army Medical University between June 2009 and May 2017 were collected. There were 36 males and 14 females, aged from 13 to 69 years, with a median age of 51 years. All patients underwent ELRA. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination or telephone interview. Patients were followed up according to the individual follow-up plan in the first 6 months after discharge, and then once every 3 to 6 months to detect tumor recurrence and survival up to May 2019. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M (range). Count data were expressed as absolute numbers or percentages. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Results:(1) Surgical situations: all the 50 patients underwent ELRA successfully, and postoperative pathological examination showed the R 0 resection rate was 100%(50/50). The operation time of the 50 patients were (630±186)minutes, of which 9 patients with liver benign occupation had the operation time of (684±168)minutes and 41 patients with liver malignant tumor had the operation time of (618±190)minutes. The operation time of temporary reconstruction of inferior vena cava and portacaval shunt, time of anhepatic phase, volume of intraoperative blood loss of the 50 patients were (35±9)minutes, (256±71)minutes, 2 000 mL(range, 400-10 000 mL), respectively. The remnant liver mass to standard liver mass ratio of the 50 patients was 65%±16%, of which 9 patients with liver benign occupation had the remnant liver mass to standard liver mass ratio of 63%±14% and 41 patients with liver malignant tumor had the remnant liver mass to standard liver mass ratio of 65%±17%. Of the 50 patients, 35 had vascular invasion (7 cases with liver benign occupation, 28 cases with liver malignant tumor), of which 24 (6 cases with liver benign occupation, 18 cases with liver malignant tumor) underwent in vitro vascular reconstruction, 12 (5 cases with liver benign occupation, 7 cases with liver malignant tumor) had bile duct invasion and underwent choledochojejunostomy due to the inability of the common bile duct to anastomose the ends. Two cases with liver metastasis of gastric cancer, one case with liver metastasis of colon cancer and one case with liver metastasis of pancreatic cancer underwent radical gastrectomy, radical resection of colon cancer, and pancreaticoduodenectomy, respectively. (2) Postoperative situations: the duration of postoperative hospital stay of the 50 patients were 25 days (range, 11-169 days). Of the 50 patients, 12 had pleural effusion who were treated with pleural puncture drainage, 10 had bile leakage who were treated with abdominal puncture drainage, 3 had bile duct anastomotic leakage who were treated with endoscopic nasobiliary drainage or biliary stent implantation, 6 underwent reoperation among which 4 underwent exploratory laparotomy due to abdominal hemorrhage, 1 underwent portal vein reconstruction due to abdominal hemorrhage combined with portal vein thrombosis, and 1 underwent salvage liver transplantation due to liver failure. Nine of the 50 patients died within 90 days after surgery, all of whom had liver malignant tumor. Among them, 3 died of multi-organ dysfunction syndrome caused by severe infection, 3 died of acute liver failure, 2 died of abdominal hemorrhage and 1 died pulmonary embolism. (3) Follow-up: all the 50 patients were followed up for 1 to 119 months. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 50 patients after operation were 17 months (range, 1-119 months), 68.0%, 45.9%, 41.1% and 41.9%, 33.4%, 30.8%, respectively. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 9 patients who with liver benign occupation after operation were 68 months (range, 10-114 months), 88.9%, 88.9%, 88.9% and 88.9%, 88.9%, 88.9%, respectively. The overall survival time, 1-, 3-, 5-year overall and tumor-free survival rates of the 41 patients who with liver malignant tumor after operation were 15 months (range, 1-119 months), 63.4%, 36.6%, 31.0% and 31.5%, 21.0%, 18.0%, respectively. There were significant differences in the overall and tumor-free survival rates between patients who with liver benign occupation and patients who with liver malignant tumor ( χ2=7.626, 11.766, P<0.05). Conclusions:ELRA can be applied in the treatment of liver complex space-occupying lesions. The selection criteria of patients with liver malignant tumor should be more rigorous to reduce perioperative mortality.