Side-to-side meso-caval shunt is one of the peripheral porto-systemic shunts that can retain a part of the portal blood flow passing through the hepatic vascular bed. It has the advantages of simple operative maneuver and limited operative traumatism. Furthermore it can maintain the continuity of the inferior vena cave.This type of operation was performed on 24 patients with portal hypertension of different causes from 1963 to October, 1980- There was no immediate operative mortality. One case was complicated with chylous ascites postopera-tively. A second operation failed to correct the condition and the patient died of progressive exhaustion about one month later.Among the follow-up cases, four cases developed hepatoencephalopathy four to seven years later respectively; six cases developed recurrent digestive bleeding within 5 years after the shunt operation.The indications of this operation are: ( 1 ) slender body type;(2)no large amount of ascites; ( 3 ) bleeding after splenectomy; (4) no thrombosis or phlebitis of the superior mesenteric vein;(5)no enlargement of the pancreas; (6) a sufficient length of the main trunk of the superior mesenteric vein; ( 7 ) the distance between the superior mesenteric vein and the inferior vena cava is not too long.If there is a recent history of G-I bleeding, the coronary vein of the stomach should be ligated when the patient is being operated on. Whenever the anatomy of the regional veins is not suitable for this kind of operation, an interposing autogenous internal jugular vein graft had better be used.

Objective To evaluate the efficacy of scle rotherapy (EVS) for esophageal variceal bleeding. Methods Retrospective analysis was made in 1 010 patients with es ophageal variceal bleeding who underwent sclerotherapy, among them 850 patie nts were cirrhosis and 160 patients were hepatocellular carcinoma. The total num ber of procedures of sclerotherapy were 3 203, including 602 for emergency scler otherapy and 2 601 for selective sclerotherapy. Supplementary sclerotherapy was performed in 502 cases. Average procedures of sclerotherapy for initial treatme nt were 3.18?1.1 in 710 cirrhotic patients. Follow-up was made in 579 cirrhosi s patients for 3-157 months, with an average follow-up period of (42.47?32.78) months. Results 1. The hemostasis rate in the whole group was 97.0%, the c omplication rate was 13.4%, and the mortality was 1.8%. 2. Rate of complete and nearly complete elimination of esophageal varices in cirrhotic patients was 84 .1 %, and long term rebleeding rate was 23.7%. Survival rates were (95.8?0.8)% 、(86.1?1.6)%、(74.5?2.4)%、(53.6?3.8)% at 1,3,5 and 10 year according to t he Kaplan-Meier analysis. Conclusions EVS is an important method of treatment for esophageal variceal bleeding.

Objective To evaluate the long term results of regular hepatic resection for hepatolithiasis.Methods Five hundred and fourteen patients with hepatolithiasis underwent hepatic resection from Jan. 1975 to Dec. 1998 in Southwest Hospital. The indications included stones confined to one segment or one lobe of the liver, significant atrophy of the portion of the liver harboring the stones from repeated episodes of obstruction and infection, multiple strictures of the ducts in the affected portion of the liver. Resection of S 2 and S 3 was performed in 284 patients, S 2, S 3 and S 4 in 98 patients, S 6 and S 7 in 26 patients, S 5, S 6, S 7 and S 8 in 37 patients; both of the left and right hepatic lobes were partially resected in 23 patients. Additional biliary procedures including choledochojejunostomy and common bile duct exploration were performed in 296 patients.Results The operative mortality was 2 1%, and the morbidity rate was 8 4%. The majority of complications were biliary fistulas (2 9%), subphrenic infection (4 5%), peritoneal abscesses (0 4%) and liver failure (0 6%). Long term follow up on 436 patients at a median of 9 1 years showed that 75 9% were symptom free, 14 5% had occassional mild attacks of cholangitis, 9 6% had severe cholangitis requiring further surgical intervention.Conclusion Anatomic hepatic resection is the most effective treatment and the therapy of choise to eradicate intrahapatic stone foci in cases of hepatolithiasis .

Epidermalgrowthfactorreceptor-tyrosinekinaseinhibitor(EGFR-TKI)resistanceinnon-small cell lung cancer(NSCLC)has become more and more common,which includes primary and secondary resistance.The primary resistance is mainly related with EGFR gene mutation,and the secondary resistant is mainly related with T790M,MET and other genes.

AIM: In this study, CD147 antibody was used to carry out targeted modification of nanoparticles for protein kinase Cε (PKCε)-siRNA gene therapy to target lung cancer cells.The inhibitory effects of the nanoparticles on the proliferation and invasion of the lung cancer cells were observed.METHODS: The magnetic nanoparticles targeting CD147 protein were assembled as gene vector.The expression of CD147 in the lung cancer cells was observed under laser scanning confocal microscope.The cells were divided into CP group, CN group and LP group as the experimental groups. Targeted nanoparticles were used as CA group.Non-transfected cells were used as control group.The cell transfection was carried out with 250 ng plasmids/well in 6-well plate.The effect of nanocontrast agent on the cell endocytosis was observed under laser scanning confocal microscope.The mRNA expression of PKCε was detected by RT-qPCR.The protein expres-sion of Ki67, MMP3, PKCε, Wnt1 and GAPDH was determined by Western blot.The cell proliferation ability was detec-ted with colony formation assay.The cell invasion ability was detected by Transwell method.RESULTS: The expression of
CD147 protein in the human lung cancer A549 cells was confirmed by immunofluorescence staining.The endocytosis of siRNA into the A549 cells in CP group was observed with the highest efficiency as compared with CN group and LP group. The relative mRNA expression of PKCε in the A549 cells of CP group, CN group, LP group and CA group were (9.76 ± 0.18)%, (98.51 ±0.32)%, (99.17 ±0.16)% and (99.68 ±0.11)%, respectively.The difference between CP group and control group was statistically significant (P <0.05).No significant difference among CN group, LP group and control group was observed.The protein expression of PKCε, Ki-67, MMP3 and Wnt1 in CP group was significantly reduced, and the protein expression levels among CN group, LP group and control group had no significant difference.The colony number in CP group was significantly smaller than that in control group (P <0.05).The effective colony numbers in CN group, LP group and CA group had no significant difference as compared with control group.The number of the invading cells in CP group was significantly less than that in control group (P <0.05).The numbers of the invading cells in CN group, LP group and CA group had no significant difference as compared with control group.CONCLUSION: Nanogene vector targe-ting CD147 can carry PKCε-siRNA to conduct gene therapy efficiently on the lung cancer cells to achieve effective inhibito-ry effects on the proliferation and invasion of the lung cancer cells.

Objective To evaluate sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia.Methods Seventy ASA Ⅰ children were randomly divided into two groups,35 children in every group.Children in group S were appliedsevoflurane inhalation[the minimum alveolar concentration(MAC)of sevoflurane was 1.0-1.5],children in group PK were applied ketamine inhalation and total venous anesthesia of propofol[80μg/(kg·min)]with ketamine[20μg/(kg·min)].Compared the time of anesthesia induction,tracheal catheter extubation,anesthesia recovery between the two groups.The mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_2)during anesthesia were compared.During 2 days after operation,the adverse effects such as nausea and vomit,lower grade of sleep quality were also compared.Results Compared with group PK,the time of anesthesia induction,tracheal catheter extubation and anesthesia recovery in group S were shorter (P<0.05),the incidence of emergence agitation in group S was higher(20.0%,7/35 vs 2.9%,1/35)(P<0.05).But nausea(17.1%,6/35),vomit(31.4%,11/35)and lower grade of sleep quality(54.3%,19/35)were higher in group PK than those in groups(all 2.9%,1/35)at 1 day after operation(P<0.05).The incidence of lower grade of sleep quality at2 days after operation in group PK(14.3%,5/35)was higher than that in group S(0)(P<0.05).Cardiovascular effects of children,such as MAP and heart rate during the period of tracheal catheter extubation in group S was higher than that in group PK.Conclusion Sevoflurane inhalation and propofol combined with ketamine total venous anesthesia in pediatric laparoscopic surgery of oblique inguinal hernia still has some disadvantages,the anesthesia technology is selected by anesthesia method and medicine combination.

AIM: To determine the expression of c-kit mRNA and protein in the bladders in guinea pigs with diabetic cystopathy (DCP) and to explore the correlation and mechanisms between c-kit expression and DCP. METHODS: Sixty guinea pigs were divided randomly into control group (n=20) and experimental group (n=40). The guinea pigs in experimental group were injected with streptozotocin (STZ) to induce diabetes mellitus. After fed for 10 weeks, the animals in both groups were tested with urodynamics, and the guinea pigs in experimental group were divided into the subgroups of DCP and the diabetic no-cystopathy (NDCP) group according to the results of urodynamics. mRNA expression of c-kit was detected by reverse transcription polymerase chain reaction (RT-PCR) and protein expression of c-kit was tested and analyzed by laser scanning confocal microscope. RESULTS: Decreased expression of c-kit mRNA was observed in DCP group compared to control and the NDCP group. The ratio of c-kit mRNA and GAPDH was 5.66±0.54 in controls (P<0.05), 5.54±1.28 in NDCP group (P<0.05) and 4.65 ±0.47 in DCP group. c-kit protein expression significantly declined in DCP group. The mean value of fluorescence intensity was 856.52± 53.03 in control group, 844.67± 59.24 in NDCP group and 548.69± 48.51 in DCP (P<0.01).CONCLUSION: The declined expression of c-kit) gene at transcription and translation levels destroys the SCF/c-kit signal pathway, leading to the dysfunction of Cajal-like) cells in DCP guinea pig, so the abnormal expression of c-kit gene is involved in the pathogenesis of DCP.

In 1989, Fitz defined and classified severe acute pancreatitis (SAP) and he thought that surgical treatment of SAP is feasible. Since then, the strategy of treating SAP was a controversial issue over past decades. Currently, relevant literatures reported that medical or minimally invasive treatments are superior to surgical treatment, while it is too early to make the final conclusion because of the complexity of SAP. From 1989 to 2008, 1852 patients with acute pancreatitis were treated at the General Hospital of PLA, and the clinical data of 18 patients who died of SAP were retrospectively analyzed. Based on the analysis, we concluded that medical conservative therapy and surgical operative therapy should not be opposed to each other. Selecting ideal timing and appropriate operation on the basis of pathological changes of retroperitoneum and pancreatitis should be considered seriously, and the new concept of "miniaturization of trauma" should also be introduced in treating SAP.

Objective To discuss the types of ICC and characteristics of spontaneous Ca2+ waves of different types of ICC in the bladder of guinea pig. Methods Frozen-sections were made from the bladder of guinea pig and ICC were cultured in vitro. Cells were stained by indirect immunofluorescent method and detected by Laser scanning confocal microscope. The ICC cultured in vitro were divided randomly into 4 group: dimmer ICC,monomer ICC,dimmer ICC treated with 2-APB group and monomer ICC treated with 2-APB group according to the cell morphology and disrupted with 2-APB.The calcium concentration of ICC cultured in vitro were marked with Fluo-4 AM and disrupted by 2-aminoethoxydipheylbrate (2-APB, 100 μmol/L) in dimmer ICC treated with 2-APB group and monomer ICC treated with 2-APB group. The calcium oscillation function of ICC was observed under Laser scanning confocal microscope. Results For the monomer ICC and dimmer ICC in frozen sections and cultured in vitro,there were increased frequency (P＜0.01) and amplitude (P＜0.05) of spontaneous Ca2+ waves in dimmer ICC compared with the monomer monomer ICC. But after the cells disrupted by 2-APB after 15 min,There were decreased frequency (P＜0.01) and amplitude (P＜0.01) of spontaneous Ca2+ waves in the dimmer ICC treated with 2-ABP group compared with the dimmer ICC. The changes(P＞0.05) of spontaneous Ca2+ waves was not statistical significance in monomer ICC treated with 2-ABP group compared with monomer ICC group. Conclusions The bladder of guinea pig may exist 2 different types of ICC, dimmer ICC and monomer ICC. The excitability of spontaneous Ca2+ waves of dimmer ICC could be higher than in monomer ICC. The special structure of dimmer ICC may contribute to the formation of high spontaneous Ca2+ waves.

Objective To analyze the influence of usual processing steps on insoluble particles in Chinese medicine injection,with Shuanghuanglian injection as an example.Methods Light block method was adopted to analyze the influence of the different conditions of sterilization,ultra filtration and PH value on insoluble particles in Chinese medicine injection.Results Sterilization,ultra filtration and PH value caused the change of insoluble particles in Chinese medicine injection.Conclusion The comprehensive use of sterilization,ultra filtration,PH value can reduce the quantity of insoluble particles and clinical risk.