ObjectiveTo systematically evaluate the therapeutic effect of gastroesophageal devascularization( GD),portasystemic shunt( PSS),devascularization plus portasystemic shunt ( GD + PSS) for the treatment of 4250 cirrhotic portal hypertension cases reported in Chinese literature. MethodsThe literatures about the effect of gastroesophageal devascularization,portasystemic shunt,devascularization plus portasystemic shunt on portal hypertension were collected from Wanfang databases, China National Knowledge Infrastructure(CNKI) from 1980 to 2011.RevMan 4.2 and SPSS 13.0 were used for data analysis. ResultsIn this study 17 reports were enrolled into the meta-analysis.The results of the mta-analysis showed that long term survival rate in the group of GD plus PSS was higher than that in group of GD [OR=1.73,95％CI (1.23,2.44),P ＜0.01].That in group of PSS was similar with the group of GD [ OR =0.87,95 ％ CI (0.63,1.20),P =0.40 ].That of group GD plus PSS was similar with the group of PSS [ OR =1.73,95％ CI (0.95,3.13),P =0.07 ].For recurrent variceal bleeding rate,that in group of PSS was lower than that in the group of GD[ OR =0.46,95％ CI (0.35,0.61 ),P ＜0.01 ].That in the group of GD plus PSS was lower than that in the group of GD [ OR =0.25,95％ CI (0.18,0.35),P ＜ 0.01 ].The group of GD plus PSS was similar to that of group of PSS [ OR =0.72,95％ CI ( 0.40,1.29 ),P =0.27 ].Encephalopathy rate was higher in the group of PSS than the group of GD [ OR =3.57,95％ CI (2.43,5.23 ),P ＜0.01 ].That in group of GD plus PSS was lower than that in the group of PSS[ OR =0.37,95％ CI (0.20,0.69),P ＜0.01 ],while that in GD plus PSS was similar to the group of GD[ OR =1.58,95％ CI (1.02,2.43),P =0.04 ].ConclusionsThe only significant factor influencing the long term result in Chinese patients with portal hypertension is preoperative liver function.The three types of operation have different benefits and disadvantages.

ObjectiveTo evaluate the therapeutic effect of gastroesophageal devasculariztion on cirrhotic portal hypertensive bleeding.MethodsClinical data of 85 cirrhotic patients with portal hypertentsive bleeding undergoing gastroesophageal devascularization were retrospectively analyzed. Results The following-up rate was 78％. The 1-yr,3-yr and 5-yr survival rate was 95％, 88％and 82％respectively.There was significant difference in survival time after devascularization between patients of Child-Pugh A and Child-Pugh B.For the whole group the 1-yr,3-yr and 5-yr recurrent bleeding rate was 6％,16％ and 28％ and postoperative hepatic encephalopathy was 7％.ALT,AST and ALB recovered to pre-operative level on post-operative day 7.ConclusionsGastroesophageal devascularization was an effective therapy in treating portal hypertensive variceal bleeding.Liver function remains a significant factor influencing long term survival.

Objective To summarize clinical experience on the diagnosis and management of pancreatic regional portal hypertension. Methods The clinical manifestations,diagnostic methods and therapeutic modalities of 40 cases of pancreatic regional portal hypertension were analyzed retrospectively.Results Male:female =26: 14.The average age was (40 ± 10)yrs.Among these patients,16 patients (40％) were accompanied by upper gastrointestinal bleeding and 20 patients (50％) by hypersplenism.There were 16 patients (40％) suffering from benign lesions and 6 patients (15％) from malignancy at pancreatic body and tail respectively,and 8 patients(20％ ) from severe necrotic pancreatitis accompanying pseudocyst and 10 patients (25％) from chronic pancreatitis. The average splenic venous pressure was (28.4±4.2) cm H2O(P ＜0.01 ).The average diameter and speed of splenic vein bloodflow by Doppler examination was ( 1.3 ± 0.2 ) cm ( P ＜ 0.01 ) and ( 9.3 ± 0.5 ) cm/s ( P ＜ 0.05 ).The follow-up rate was 100％.Splenectomy was effective for controlling gastrointestinal bleeding. Conclusions It is not difficult to diagnose pancreatic regional portal hypertension based on findings of US,CT and endoscopic examination,together with its clinical features. Therapy should be aimed at both regional portal hypertension and underlying diseases.

Peroxisome proliferator-activated receptor(PPAR) belongs to the superfamily of nuclear hormone receptor.Three PPAR subtypes have been identified to date(PPAR?,PPAR? and PPAR?)and the relationship between PPAR? and tumor has drawn great attention.Current data showed that PPAR? agonists exert their antineoplastic effect through inhibiting cell growth and angiogenesis,inducing cell apoptosis and differentiation,and reducing tumor invasive ability.PPAR? agonists may be a promising tool for cancer chemotherapy.

Objective To construct a vector containing protein transduction domain (PTD) and cardiotrophin-1 and a vector containing PTD and EGFP, express them in E. coli. and purify them. To detect the distribution of the two fusion proteins in mice. Methods CT-1 and EGFP were cloned to GST-fusion expression vector pGEX-4T3 by PCR and cloning techniques respectively, and then TAT was cloned into the vectors respectively to give pGEX-TAT/CT-1, pGEX-TAT/EGFP. After induced by IPTG the soluble protein GST-TAT/CT-1 and GST-TAT/EGFP was purified by Glutathione Sepharose 4B. The purified fusion proteins were injected into mice through caudal vein and examined in tissue section by immunohistochemical staining. Results CT-1 and EGFP were effectively amplified and the TAT/CT-1 and TAT/EGFP gene sequencing showed the same sequence as scheduled. The fusion proteins was successfully expressed in E. coli. and purified. Conclusion TAT/CT-1 and TAT/EGFP fusion proteins were expressed and purified successfully. The two fusion proteins were all detected positively in mouse brain, spinal cord, heart and liver.

Objective To retrospectively analyze the effect of interventional embolization for hepatocelluar carcinoma (HCC) associated with arteriovenous shunting (AVS), and to discuss the factors influencing the therapeutic results. Methods The clinical data of 62 cases with HCC associated with AVS , who were treated with interventional chemoembolization , were retrospectively analyzed. Based on the type and extent of AVS identified by angiographic manifestations, appropriate obstruction of the shunt and Lipiodol chemoembolization of HCC were conducted. The curative effect of the shunt embolization was assessed by DSA at one or two months after the treatment. The relevant factors influencing the prognosis of embolization were analyzed by using univariate and multivariate Cox regression analysis methods. Results Of the 62 patients, arterioportal shunting (APS) was detected in 44, hepatic arterio-venous shunting (HAVS) in 11, APS together with HAVS in 4, and hepatic artery-pulmonary artery shunting (HAPAS) in 3. Re-examination with DSA was carried out in 53 patients at 1 - 2 months after the treatment , which showed that the shunting disappeared in 18 cases, obvious reduction of the shunt flow was seen in 19 cases, the lesion remained stable in 9 cases and the disease became worse in 7 cases. Univariate analysis indicated that the kind of embolic material and the presence of tumor thrombus could affect the obstructive result of the shunt , while multivariate Cox regression analysis showed that portal tumoral thrombus was an independent risk factor. The embolization effect of polyvinyl alcohol (PVA) particles and Lipiodol-ethanol mixture, used as the embolic agents, was better than that of gelatin sponge particles. Conclusion To ensure a successful interventional chemoembolization for HCC combined with AVS the procedure should be individualized according to the type and extent of the arteriovenous shunting. The type of embolic materials used for embolization can affect the results to a certain degree.

Objective To examine the effects of a peroxisome proliferator-activated receptor γ ligand troglitazone on the proliferation and differentiation of HepG2 cells. Methods After the pretreatment of HepG2 cells with troglitazone, MTT and flow cytometry were used to analyze the proliferation and cell cycle of HepG2 cells, respectively. Immunocytochemistry, bromocresol green dye-binding method and chemiluminessence immunosorbent assay was used to determine E-cadherin, albumin and AFP, respectively. The expression of cyclin D1 and c-myc protein were detected by Western blot. Results Troglitazone inhibited the proliferation of HepG2 cells in a concentration-dependent manner and arrested HepG2 ceils at the G0>/G1> phase. After pretreated with troglitazone, HepG2 cells showed E-cadherin expression, a decreased expression of cyclin D1 and c-myc protein, a reduction of AFP level and a dramatic increase of albumin level. Conclusions Troglitazone inhibits proliferation and induces differentiation of HepG2 cells, the mechanism of which might be attributable to the down-regulation of cyclin D1 and c-myc expression.

Objective To assess hepatitis B virus(HBV)and hepatitis C virus(HCV)infections in different anatomic location of cholangiocarcinoma(CC)and relationship with abnormal p53 expression.Methods A total of 411 CC samples including intrahepatic cholangiocarcinoma(ICC 312 cases);perihilar cholangiocarcinoma(PHC,73 cases)and distal cholangiocarcinoma(DC,26 cases)underwent serologic test for HBsAg and anti-HCV using microparticle enzyme immunoassay.Abnormal p53 expression was detected in formalin-fixed.paraffin-embedded CC tissues by immunohistochemistry.Results Seropositivity for HBsAg and anti-HCV were found in 48.4%(151/312)and 2.9%(9/312)of ICC cases,and in 10.9%(8/73)and zero of PHC,and in 7.7%(2/26)and zero of DC,respectively.Abnormal p53 expression was detected in 30.1%(94/312)of ICC cases.23.3%(17/73)of PHC cases and 19.2%(5/26)of DC cases.There was no correlation between seropositivity of HBsAg and anti-HCV and p53 overexpression among three groups of CC. Conclusions HBV but not HCV infection may be associated with the development of ICC.p53 abnormality may not play a significant role in HBV-associated carcinogenesis of ICC.

Objective To explore a safe and effective posterior surgical operation for correction of the horacolumbar kyphotic deformity. Methods The study involved 16 patients with thoracolumbar kyphotic deformity treated with the modified posterior transpedicular-intervertebral disc wedge resection osteotomy and screws-rods internal fixation apparatus.There were 11 males and 5 females at an average age of 26.5 years(13-53 years).The kyphosis deformity was caused by ankylosing spondylit in four patients,old lumbothoracic fracture in nine,vertebral dysplasia in two and vertebral body in one.The preoperative kyphosis Cobb angle was 58.1(45°-85°),with the kyphosis deformity at T10 in two patients,at Thin two,at T12in six,at L1 in three and at L2 in three.The main clinical manifestations were different degrees of lower back pain and progressive aggravation of the deformity,influencing the work and living.The course of disease was 8.5 years(4-17 years).All patients underwent pesteriortotal vertebral osteotomy on the apex vertebra,trails-pedicular fixation combined with correction and fusion,after which the patients stayed in bed for four weeks and received orthosis fixation for three months after operation. Resuits The operation lasted for average 190 minutes(125-240 minutes),with average blood loss of 750 ml(450-1 900 m1).All patients were with single segment cut bone,with no spinal cord injury,neurological injury or hardware failure.The post-operative vertical plane facial deformity was corrected for average 55(44°-76°),wit average correction rate of 83%.The follow-up for 10-24 months showed firm internal fixation on the X-ray film and good fusion ofthe vertebral column,with no pseudoarticulation formation,loosening internal fixation or loss of correction.All the patients obtained obvious improvement in appearance of the deformity,with disappearance of the lower back pain and improvement of the quality of life. Conclusion One stage posterior transpedicular-interverte-bral disc wedge resection osteotomy is all effect and safe surgical technique for correction of horacolumbar kyphotic deformity.

Objective To evaluate the feasibility and safety of percutaneous posterior pedicle screw fixation in treatment of traumatic thoracolumbar fracture without neurologie deficits. Methods From January 2007 through December 2007, there were 15 patients with traumatic fracture of the thoracic or lumbar spine without neurologie deficits treated within 10 days after injury. There were 10 males and 5 females at age range of 31-65 years (average 45.6 years). The fracture was located at T11 in 1, T12 in 4,L1 in 7, L2 in 2 and L3 in 1. Preoperative anteroposterior and lateral radiographs of the fractured spine as well as CT and MRI were done to evaluate injury severity of the vertebral body, spinal canal and diseolig-amentary structures. According to Magerl classification criteria, there were 10 patients with type A3 frac-ture, 3 with type A2 fracture and 2 with type A1 fracture, which were treated with pereutaneous posterior pediele screw fixation. Operative time and intraoperative blood loss were recorded to observe clinical re-suits. Results The average operation time was 82 minutes (65-110 minutes), with a mean intraopera-five blood loss of 35 ml (20-50 ml ). There were no conversions to open surgery, new neurological deficits or other surgery-related complications. All patients were followed up for 3-11 months (average 7.6 months), which showed that Cobb angle was corrected from preoperative (15.7±6.3)° to postoperative (3.5±1.2)°. Postoperative CT showed sound reduction of posterior bone displacement in all patients compared to preoperative CT results. Conclusions Percutaneous posterior pedicle screw fixation is fea-sible and safe surgical procedure with fine short-term outcome in treating traumatic thoracolumbar fracture without neurologic deficits. This technique offers serveral potential advantages over open approaches inclu-ding less tissue trauma and blood loss as well as quicker recovery.