Objective To estimate the safety,feasibility and generalization of three point single-incision laparoscopic cholecystectomy (SILC).Methods The clinical data of 1 126 patients who underwent three-point SILC at the second department of Hepatobiliary Surgery of Zhu Jiang Hospital,Southern Medical University From January 1,2011 to December 30,2015 was analyzed retrospectively.The patient who were indicated for conventional laparoscopic cholecystectomy were included,but those suspected malignant diseases of gallbladder were excluded.Results Of the 1126 patients,the surgery was performed successfully in 923 patients,and 192 patients need extra ports due to the adhesion and difficulty of exposing the Calots triangle,and 11 were converted to open surgery due to severe adhesion,with the success rate being 81.9％.The operating time was (29.5 ± 12.2) min (from the entrance of laparoscope to the removing of gallbladder),the blood loss was (8.7 ± 7) ml,and the hospital stay time was (1.4 ± 0.7) d (after surgery).There were three cases of bile duct injury:two of them were bile leak of aberrant duct,one of them was bile leak of cystic duct damaged by heat.And there was one case of injury of duodenum,22 cases of umbilicus hematoma,13 cases of hematoma of thorax,and 2 cases of thoracic hemorrhage who required surgery.There were no hernia,aerothorax and so on.Conclusion Three point SILC is a technology that is safe,maneuverable and suitable for being carried out in clinical practice.

OBJECTIVETo investigate the treatment of the displaced neck and subcapital fractures of the fifth metacarpal.

METHODSThirty-one patients with the neck and subcapital fractures of the fifth metacarpal had been operated on with antegrade intramedullary fixation between January and August 2005. There was 11 subcapital fractures (group A), and 20 neck fractures (group B). Following closed reduction of the fracture, a blunt 2.0 mm diameter K-wire, which was pre-bent into 20 degrees at the distal end, was inserted into the medullary canal of the fifth metacarpal and fixed the fractures. Postoperatively, patients in group A were immobilized in a short arm plaster splint for 4 weeks, and the ones in group B were treated with unrestricted mobilization.

RESULTSOperative time was 18 min averagely (range 5 to 30 min). Twenty-nine of 31 patients obtained anatomic reduction, and 2 patients had 2/3 apposition of bone end and no rotational deformity. Follow-up was available for all patients. The average follow-up interval was 4 months, with a range of 3 - 6 months. The head/shaft angle of the fifth metacarpal in group A was 63.4 degrees +/- 14.5 degrees preoperatively, and 15.0 degrees +/- 2.5 degrees postoperatively, and 15.4 degrees +/- 2.6 degrees in 3 months postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 89.5 degrees +/- 4.3 degrees postoperatively, which was not significantly different compared with that of uninjured side. The head/shaft angle in group B was 59.1 degrees +/- 10.0 degrees preoperatively, and 15.9 degrees +/- 2.5 degrees postoperatively, and 15.5 degrees +/- 2.8 degrees in 3 months postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 88.6 degrees +/- 3.6 degrees postoperatively, which was not significantly different compared with that of uninjured side.

CONCLUSIONSThe technique is technically easy to perform, minimally invasive, low-cost, allowing early hand mobilization, with good functional results and low morbidity, and it has been proved to be an ideal method.

Adolescent ; Adult ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpus ; injuries ; Treatment Outcome

OBJECTIVETo investigate the protective effect of electroacupuncture (EA) on injured neurons and the signal transduction mechanism of calmodulin (CaM) in rats with cerebral ischemia-reperfusion injury (CIRI).

METHODSA total of 25 SD rats were randomly divided into a sham-operation group, a model group, an EA. group, a TFP group and an EA+TFP group. The rat model of middle cerebral artery occlusion (MCAO) was established by the modified Longa thread occlusion method. The EA group was treated with EA at "Dazhui" (GV 14) and "Baihui" (GV 20) for 30 minutes. The TFP group was treated with lumbar intrathecal injection of Trinuoperazine (TFP) at a dose of 40 microL/kg, the inhibitor of CaM. The EA + TFP group was treated with EA combined with TFP, and the sham-operation group and the model group without any treatment. The neurology deficit score was evaluated by the Julio's neuroethology score methods in all rats, and the expression of CaM in cerebral hippocampus tissue was detected with immunohistochemical method in different intervention condition.

RESULTS(1) In comparison with the model group of 6.90 +/- 1.66, the neuroethology score in the EA group of 14.50 +/- 1.08, the TFP group of 11.70 +/- 1.06 and the EA + TFP group of 14.30 +/- 1.06 were all significantly increased (all P < 0.01), while those still were all lower than the sham group of 17.60 +/- 0.52 (all P < 0.01), and the EA group was better than the TFP group (P < 0.01). (2) In comparison with the sham group of 0.080 +/- 0.045, the immune positive expression score of CaM protein in hippocampus in the model group of 1.680 +/- 0.268 was sig nificantly increased (P < 0.01). In comparison with the model group, the expression score of CaM protein in the EA group of 0.880 +/- 0.179, the TFP group of 0.720 +/- 0.179 and the EA + TFP group of 0.420 +/- 0.249 were all significantly reduced (all P < 0.01), and the expression score of CaM in the EA + TFP group was lower than that in the TFP group (P < 0.05).

CONCLUSIONEA can reduce the injury of cerebral neurons induced by CIRI in rats and promote the recovery, which may be related to its effect in regulating CaM signaling pathway after the ischemia-reperfusion injury.

Animals ; Brain Ischemia ; genetics ; metabolism ; therapy ; Calmodulin ; genetics ; metabolism ; Disease Models, Animal ; Electroacupuncture ; Gene Expression ; Hippocampus ; metabolism ; Humans ; Male ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; genetics ; metabolism ; therapy

OBJECTIVETo discuss the technical improvement of the conventional thrombectomy for portal vein thrombosis (PVT) on liver transplantation.

METHODSThe clinical data of 198 cases of liver transplantation with PVT who admitted in Tianjin First Central Hospital were analyzed retrospectively. According to the different treatments for PVT, these cases were divided into group A and group B. The conventional eversion embolectomy were performed in group A (n = 43) and the improved eversion embolectomy were performed in group B (n = 155). The general conditions, blood loss volumes, the achievement ratio of embolectomy, PVT recurrence rate and survival rate between the two groups were compared.

RESULTSNo statistical significance on operation time between two groups (P > 0.05); the achievement ratio of embolectomy for Yerdel I-II were 100% in two groups, however, the achievement ratio of embolectomy for Yerdel III in group B was higher than that of group A (100% vs. 45.45%; chi(2) = 12.38, P < 0.01). Blood loss volumes in group B was significantly lower than that of group A [(4315.4 +/- 630.5) ml vs. (3509.2 +/- 862.7) ml, P < 0.05]. No statistical significance on Yerdel I and II PVT recurrence rate between two groups (P > 0.05). While thrombosis recurrent rate of Yerdel III PVT in group B was lower than that of group A(5.6% vs. 2/5; chi(2) = 4.09, P < 0.05). Perioperative mortality of Yerdel I-III patients were both 0 in two groups. 1-year survival rate of Yerdel I-III patients was similar in two groups (86.5% vs. 89.0%, P > 0.05).

CONCLUSIONSImproved eversion embolectomy can simplify the operation procedures, reduce blood loss, expand application range, increase the embolectomy success rate, decrease the PVT relapse rate.

Adult ; Aged ; Embolectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Portal Vein ; surgery ; Retrospective Studies ; Treatment Outcome ; Venous Thrombosis ; surgery

OBJECTIVETo study mechanism of the apoptosis of rat pancreas islet β cell strain (INS-1 cells) induced by sodium arsenite.

METHODSINS-1 cells were exposed to sodium arsenite at the different concentrations. MTT assay was used to detect the viability of INS-1 cells. The potentials on mitochondrial membrane and lysosome membrane of INS-1 cells were determined with the fluorescence spectrophotometer. The apoptotic levels of INS-1 cells exposed to sodium arsenite were observed by a fluorescence microscope and flow cytometry.

RESULTSAfter exposure to sodium arsenite, the viability of INS-1 cells significantly decreased with the doses of sodium arsenite. At 24 h after exposure, the OD values of the mitochondrial membrane potentials declined observably with the doses of sodium arsenite (P < 0.01). At 48 h after exposure, the OD values of the lysosome membrane potentials significantly increased with the doses of sodium arsenite (P < 0.01). At 72 h after exposure, the apoptotic cells were observed under a fluorescence microscope and enhanced with the doses of sodium arsenite. The apoptosis cells with light blue, karyopyknosis, karyorrhexis, apoptotic body and chromatin concentration appeared. The results detected with flow cytometry indicated that after exposure, the apoptotic INS-1E cells significantly increased with the doses of sodium arsenite.

CONCLUSIONSThe sodium arsenite can induce the apoptosis of INS-1 cells through the mitochondria-lysosome pathway.

Animals ; Apoptosis ; drug effects ; Arsenites ; toxicity ; Cells, Cultured ; Insulin-Secreting Cells ; drug effects ; Lysosomes ; metabolism ; Membrane Potentials ; drug effects ; Mitochondria ; metabolism ; Rats ; Sodium Compounds ; toxicity

0.05)in the former part of the surgery that was before the beginning of the surgery via anterior route.But in group B,only propofol for sedation was used for the patients during the latter part of the surgery via the anterior route or while the nerve plexus was blocked; during this time in group A,the addition of fentanyl and vecuronium were still intermittently necessary to maintain the general anesthesia.The duration between the completion of surgery and the recovery of spontaneous breathing,times for initial conscious reaction such as opening the eyes following an order, extubation and from extubation to complete recovery were significantly shorter in group B than those in group A(all P

OBJECTIVETo summarize the clinical feature of splenic artery aneurysms (SAA) in OLT recipient, and review the experience in diagnosis and management.

METHODSThe clinical data, results of four-phase CT scanning and CT angiography of 450 recipients, who underwent OLT from December 2001 to December 2003 were analyzed statistically.

RESULTSTwenty of 450 recipients were diagnosed as SAA, the incidence was about 4.4%. Nineteen of them were diagnosed by four-phase CT scanning. Fifteen patients did not receive any treatment for SAA during OLT, but two of them suffered SAA rupture after OLT, among which one died of hemorrhagic shock although emergency operations were performed. The five patients, who were performed splenectomy with SAA resection during transplantation, recovered successfully after OLT, and their grafts' function was satisfactory.

CONCLUSIONSMorbidity of SAA is higher in patients of liver cirrhosis. Four-phase CT scanning can diagnose SAA exactly. In the early period post-OLT, SAA rupture happens frequently, so SAA resection should be performed during transplantation.

Adolescent ; Adult ; Aged ; Aneurysm ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Rupture, Spontaneous ; surgery ; Splenic Artery ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the effects of the three-period treatment theory of bone fracture in TCM (Traditional Chinese Medicine) on VEGF and VEGF mRNA expression in the issues of outer periosteum, endosteum and bone marrow of rabbits, and to explore the rationality of phasing method in TCM in treating fracture.

METHODS3 mm bone defection were made at lower one third part of both radius in 140 male healthy rabbits. The rabbits were randomly divided into four groups, including three-period treatment group (TTG), one-period treatment group(OTG), positive medicine treatment group(PTG) and model control group (MCG). The rabbits in TG were treated with three-period treatment, rabbits in OTG were treated with one-period treatment, rabbits in PTG were fed by Guzhe-Cuoshangsan (a Chinese patent medicine which was used to treat bone fracture), rabbits in model control group were given no prescription or drug but distilled water as same dose as that of other groups. At day 3, 6, 9, 14, 28, 42 and 56, five rabbits from every group were randomly selected and were killed by aeroembolism. The left radiuses were taken out as the research object. Immunohistochemistry stain and in situ hybridization stain were performed to examinate the VEGF and VEGF mRNA expression in the outer periosteum, endosteum and bone marrow.

RESULTSThe VEGF and VEGF mRNA expression of all TCM treatment groups were enhanced in the outer periosteum, endosteum and bone marrow at different time points in fracture healing. The VEGF and VEGF mRNA expression in the three tissues of TTG had the tendency of higher than that of the other groups at the most time points after operation.

CONCLUSIONTreating fracture in stages has more predominant effect on the expression of VEGF and VEGF mRNA in the outer periosteum, endosteum and bone marrow than that of treating fracture with single prescription or drug.

Animals ; Bone Marrow ; metabolism ; Fractures, Bone ; metabolism ; therapy ; Male ; Medicine, Chinese Traditional ; Periosteum ; metabolism ; RNA, Messenger ; analysis ; Rabbits ; Vascular Endothelial Growth Factors ; analysis ; genetics

OBJECTIVETo observe the effects of the three-period treatment theory of bone fracture in traditional Chinese medicine (TCM) on VEGF and VEGF mRNA expression in the issues of callus of rabbits. And to explore the rationality of phasing method in TCM in treating fracture.

METHODone hundred and forty male and healthy rabbits were made 3 mm wide bone defection at lower one third part of both radius as fracture healing model. Then those rabbits were divided into four groups randomly, which are three-period treatment group (TTG), one-period treatment group (OTG), positive medicine treatment group (PTG) and model control group (MCG). Those rabbits in TTG were treated with three-period treatment. Those in OTG were treated with one-period treatment. Those in PTG were feed by guzhecuoshangsan, a Chinese patent medicine which is used to treat bone fracture. Those in model control group were given no prescription or drug but distilled water as same dose as that of other groups. At day 3, 6, 9, 14, 28, 42 and 56, five rabbits were selected from every group randomly and were killed by aeroembolism respectively. Their radius were taken out and the left one was taken as the research object. Immunohistochemistry stain and in situ hybridization stain were performed to examinate the VEGF and VEGF mRNA expression in the haematoma, fibrous callus and soft callus.

RESULTAll TCM treatment groups can enhance the VEGF and VEGF mRNA expression in the haematoma, fibrous callus and soft callus at different time points in fracture healing. The VEGF and VEGF mRNA expression in the three issues of TTG had the tendency of higher than that of the other groups at the most time points after operation.

CONCLUSIONTCM can promote the VEGF and VEGF mRNA expression in the haematoma, fibrous callus and soft callus. Different Chinese medicines play various roles on VEGF and VEGF mRNA expression at different stage of fracture healing. Treating fracture in three-period treatment has more predominant effect on the expression of VEGF and VEGF mRNA in the haematoma, fibrous callus and soft callus than that of treating fracture with single prescription or drug. It is necessary to treat fracture in stages.

Animals ; Bony Callus ; metabolism ; Drugs, Chinese Herbal ; therapeutic use ; Fractures, Bone ; drug therapy ; metabolism ; Male ; Medicine, Chinese Traditional ; Phytotherapy ; methods ; RNA, Messenger ; metabolism ; Rabbits ; Vascular Endothelial Growth Factor A ; biosynthesis ; genetics

In order to fabricate the HLA-DQA1 genotyping chip and develop an integrated, parallel technical platform to type HLA system, a pair of primers and a set of probes were designed according to the sequences of HLA-DQA1 exon 2, where the polymorphism is concentrated. The oligonucleotide chip was made with the methods developed in our laboratory. The target DNA was asymmetrically amplified with the labeled sense primer. The signals were scanned and analyzed after the hybridization between microarray and PCR product. The allele types of the samples were identified. The result was verified by the standard DNA and DNA sequencing. The results showed that the genotyping was successfully carried out in 50 standard DNA samples and 50 clinical samples. Among them, results of the 50 standard DNA samples matched their templates. In the other 50 samples, results of the randomly selected 10 matched their sequencing results except that two of them got the incompletely result. In reproducible tests, the signal reappear rate was 95%. It is concluded that HLA-DQA1 genotyping by using our array system is simple and convenient with satisfied accuracy and reproducibility.
Genotype ; HLA-DQ Antigens ; genetics ; immunology ; HLA-DQ alpha-Chains ; Humans ; Oligonucleotide Array Sequence Analysis ; Oligonucleotide Probes ; Reverse Transcriptase Polymerase Chain Reaction