Along with the increasing quantity of patients with end-stage liver diseases year by year, as an efficacious treatment, the safety and efficacy of liver transplantation are critical issues to be considered. In addition, liver transplant techniques have become a new research hot spot. In recent years, liver transplant techniques are constantly innovating and developing with the unremitting efforts of researchers. Researchers have successively developed multiple liver transplant techniques, such as split liver transplantation, ischemia-free liver transplantation, liver xenotransplantation, domino liver transplantation, delayed total hepatectomy combined with liver resection and segment Ⅱ-Ⅲ liver transplantation, heterotopic auxiliary liver transplantation on splenic fossa and magnetic anastomosis. It has laid a foundation for expanding the donor pool, improving clinical efficacy of liver transplantation and enhancing the quality of life of liver transplant recipients. In this article, the exploration, development, innovation and improvement of liver transplant techniques were reviewed and prospected, aiming to provide reference for clinical application of liver transplantation.

Objective:To compare the biomechanical properties of dynamic hip screw (DHS), traditional cannulated compression screw (CCS) configuration, traditional CCS configuration+medial locking plate and compression buttress screw (CBS) in the treatment of femoral neck fracture by finite element analyses.Methods:A simulation model of Pauwels type Ⅲ femoral neck fracture with discontinuous medial cortex was established by the finite element method. The maximum displacement, maximum principal stress, normal form equivalent stress, hip varus angle and fracture end stress were compared between DHS (group A), traditional CCS configuration (group B), traditional CCS configuration+medial locking plate (group C) and CBS (group D) in the simulation model.Results:In the internal fixation model in groups A, B, C and D, respectively, the maximum displacement of the femur was 0.41 mm, 2.04 mm, 0.94 mm and 0.30 mm; the maximum displacement of internal fixation 0.34 mm, 1.18 mm, 0.84 mm and 0.22 mm; the peak normal form stress of internal fixation 83.6 MPa, 231.4 MPa, 259.8 MPa and 194.8 MPa; the maximum principal stress of internal fixation 52.3 MPa, 216.3 MPa, 151.7 MPa and 74.6 MPa; the maximum normal form stress of the femur 101.1 MPa, 282.3 MPa, 100.5 MPa and 181.2 MPa; the maximum principal stress 99.7 MPa, 201.0 MPa, 60.9 MPa and 56.1 MPa; the axis angle of the femoral neck after loading 179.55°, 176.97°, 179.66° and 179.64°; the normal form equivalent stress at the fracture end ranged from 42.0 to 50.0 MPa, from 258.7 to 282.3 MPa, from 50.8 to 58.1 MPa, and from 45.3 to 60.4 MPa.Conclusion:Considering stability, stress distribution and prevention of hip varus and femoral neck shortening, CBS may be a choice treatment for femoral neck fracture because it is comparable to DHS in mechanical stability.

Hepatocellular carcinoma (HCC) is the fifth most common cancers worldwide, which ranks as the second of cancer-related death. Each year, more than half of the new and death cases occur in China. Vascular invasion is one of the important biological characteristics of HCC. HCC with portal vein tumor thrombus is closely related to the prognosis of patients, but there is no consensus on the best treatment method.Based on domestic and foreign literatures, the authors discuss the current status and progress of treatment for HCC with portal vein tumor thrombus, in order to explore the optimal treatment.

Objective:To examine the effect of the "four-steps" treatment on infectious pancreatic necrosis(IPN).Methods:The data of 207 patients who were diagnosed with IPN from January 2013 to December 2017 at Department of Pancreaticobiliary Surgery, the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among 207 patients, 132(63.8%) were males and 75(36.2%) were females. The median age was 45 years old (range: 19 to 80 years old). One hundred and fifty-eight patients(76.3%) suffered severe acute pancreatitis and 49 patients(23.7%) suffered moderately severe acute pancreatitis. Percutaneous catheter drainage(PCD) was performed on all the patients(Step 1). Patients received "four-steps" minimally invasive treatment strategy in step-up group(173 patients). The following steps after PCD were mini-incision access pancreatic necrosectomy(MIAPN) (Step 2), sinus tract endoscopic debridement and(or) PCD for residual infections(Step 3) and finally conventional open pancreatic necrosectomy(OPN) (Step 4). Patients(34 cases) received conventional open pancreatic necrosectomy after invalided PCD in OPN group. The perioperative parameters and prognosis were compared between Step-up group and OPN group. Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ 2 test or Fisher exact test, respectively. Results:The basic characteristics of the two groups of patients were similar, but the referral rate of patients and the rate of preoperative 3 days organ failure in the OPN group were significantly higher than those of step-up group patients(47.1% vs. 28.9%, χ 2=4.313, P=0.038; 26.5% vs. 9.2%, χ 2=2.819, P=0.011). The frequency of PCD and the number of PCD tube (root) were less than those in the step-up group(1(1) vs. 2(1), Z=-3.373, P=0.018; 2(1) vs. 3(2), Z=-2.208, P=0.027). Compared with the OPN group, the interval time from onset to surgery and the MIAPN operation time were significantly shorter in the step-up group(29(15) days vs. 36(17)days, Z=-0.567, P=0.008; 58(27)minutes vs. 90(56)minutes, Z=-3.908, P<0.01); postoperative mortality was lower(5.8% vs.17.6%, χ 2=4.070, P=0.044); the overall incidence of postoperative complications was reduced(23.1% vs. 55.9%, χ 2=14.960, P<0.01) and the incidence of new-onset organ failure was decreased after operation in the step-up group(37.5% vs.47.4%, χ 2=7.133, P=0.007). The incidence of local abdominal complications (pancreatic fistula, intra-abdominal hemorrhage, gastrointestinal fistula) showed no significant difference between the two groups ( P>0.05). Fewer patients required ICU treatment after operation in the step-up group compared with OPN group(22.0% vs. 44.1%, χ 2=6.204, P=0.013). Patients in the Step-up group has shorter hospital stay than patients in OPN group (46(13) days vs. 52(13)days, Z=-1.993, P=0.046). Conclusions:The clinical effects of "four-steps" exhibited the superiority of minimally invasive treatment of IPN.And MIAPN is a simple, safe and effective procedure to remove pancreatic necrotic tissue and decrease complications.

Objective:To examine the effect of the "four-steps" treatment on infectious pancreatic necrosis(IPN).Methods:The data of 207 patients who were diagnosed with IPN from January 2013 to December 2017 at Department of Pancreaticobiliary Surgery, the First Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among 207 patients, 132(63.8%) were males and 75(36.2%) were females. The median age was 45 years old (range: 19 to 80 years old). One hundred and fifty-eight patients(76.3%) suffered severe acute pancreatitis and 49 patients(23.7%) suffered moderately severe acute pancreatitis. Percutaneous catheter drainage(PCD) was performed on all the patients(Step 1). Patients received "four-steps" minimally invasive treatment strategy in step-up group(173 patients). The following steps after PCD were mini-incision access pancreatic necrosectomy(MIAPN) (Step 2), sinus tract endoscopic debridement and(or) PCD for residual infections(Step 3) and finally conventional open pancreatic necrosectomy(OPN) (Step 4). Patients(34 cases) received conventional open pancreatic necrosectomy after invalided PCD in OPN group. The perioperative parameters and prognosis were compared between Step-up group and OPN group. Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ 2 test or Fisher exact test, respectively. Results:The basic characteristics of the two groups of patients were similar, but the referral rate of patients and the rate of preoperative 3 days organ failure in the OPN group were significantly higher than those of step-up group patients(47.1% vs. 28.9%, χ 2=4.313, P=0.038; 26.5% vs. 9.2%, χ 2=2.819, P=0.011). The frequency of PCD and the number of PCD tube (root) were less than those in the step-up group(1(1) vs. 2(1), Z=-3.373, P=0.018; 2(1) vs. 3(2), Z=-2.208, P=0.027). Compared with the OPN group, the interval time from onset to surgery and the MIAPN operation time were significantly shorter in the step-up group(29(15) days vs. 36(17)days, Z=-0.567, P=0.008; 58(27)minutes vs. 90(56)minutes, Z=-3.908, P<0.01); postoperative mortality was lower(5.8% vs.17.6%, χ 2=4.070, P=0.044); the overall incidence of postoperative complications was reduced(23.1% vs. 55.9%, χ 2=14.960, P<0.01) and the incidence of new-onset organ failure was decreased after operation in the step-up group(37.5% vs.47.4%, χ 2=7.133, P=0.007). The incidence of local abdominal complications (pancreatic fistula, intra-abdominal hemorrhage, gastrointestinal fistula) showed no significant difference between the two groups ( P>0.05). Fewer patients required ICU treatment after operation in the step-up group compared with OPN group(22.0% vs. 44.1%, χ 2=6.204, P=0.013). Patients in the Step-up group has shorter hospital stay than patients in OPN group (46(13) days vs. 52(13)days, Z=-1.993, P=0.046). Conclusions:The clinical effects of "four-steps" exhibited the superiority of minimally invasive treatment of IPN.And MIAPN is a simple, safe and effective procedure to remove pancreatic necrotic tissue and decrease complications.

Objective To investigate the advantage of the technique of static compression screws with medial support using one ordinary cannulated compression screw (OCCS) and 2 headless cannulated compression screws (HCCSs) in reducing complications in the treatment of vertical femoral neck fractures.Methods From December 2014 to July 2017,79 patients were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai for vertical femoral neck fractures.They were 51 men and 28 women,aged from 20 to 65 years (average,49.1 years).Their injury involved 45 left sides and 34 right sides.Of them,37 were treated with one OCCS at the top and 2 HCCSs at the bottom of a triangle arrangement for fixation of the vertical femoral neck fracture (the experimental group);the other 42 were treated with 3OCCSs at a triangle arrangement for fixation of the vertical femoral neck fracture (the control group).Their fracture healing and complications were followed up at postoperative 6 weeks,3,6 12,18,24 months and any time of discomfort by anteroposterior and lateral X-ray films of the knee joint.Results The 2 groups were compatible due to insignificant differences between their preoperative general data (P ＞ 0.05).This cohort was followed up for 9 to 24 months (average,17.5 months).Of them,52 achieved fracture union.Of the 27 patients who failed,8 were in the experimental group (21.6％) and 19 in the control group (45.2％),showing a significant difference in the rate of failure between the 2 groups (P ＜ 0.05).In the experimental group,the rate of nonunion was 8.1％ (3/37),the rate of implant failure 18.9％ (7/37),and the rate of fermoral neck varus 8.1％ (3/37),all significantly lower than those in the control group [26.2％ (11/42),40.5％ (17/42) and 23.8％ (13/42),respectively] (P ＜0.05).Conclusion For treatment of vertical femoral neck fractures,the technique of static compression screws with medial support is not only easy but also leads to a lower rate of complications.

Objective:To investigate the significance of periodontal treatment on the levels of MMP-3 and IFN-γin the serum of patients with oral lichen planus(OLP) and chronic periodontitis(CP) before and after treatment.Methods:60 patients with erosion OLP and CP were divided into 2 groups randomly (n =30).The patients in experimental group received basic periodontal treatment combined with drug therapy,those in control group received drug therapy only.Before and after treatment the periodontal indexes of PD,AL,BI and PLI were measured in the experimental group,the levels of MMP-3 and IFN-γ in serum were tested by ELISA in the 2 groups,the differences of the data between 2 groups were statistically analysed.Results:After treatment the periodontol indexes were decreased in the experimental group(P ＜ 0.05),the serum MMP-3 and IFN-γ levels were lower than those before treatment in 2 groups(P＜0.05),and the decline of MMP-3 and IFN-γ in experimental group was more obvious than those in the control group (P＜0.05).Conclusion:Periodontal initial therapy has positive influence on the treatment of OLP and can reduce the level of inflammation.

Objective To investigate the value of individualized thyroid stimulating hormone (TSH) inhibition therapy in postoperative patients with differentiated thyroid carcinoma.Methods The medical record and follow-up data of the 556 patients with differentiated thyroid carcinoma after total or neartotal thyroidectomy were retrospectively reviewed.Patients were divided into two groups:Group A (304 cases) received TSH suppression therapy without risk assessment.Group B (252 cases) were given TSH suppression therapy in accord with risk assessment of both differentiated thyroid cancer recurrence risk stratification condition and the side effects of TSH suppression therapy risk stratification.Results The 3-year non-recurrence and (or) non-metastasis rate in group B was 99.2％ which was higher than 96.8％ in group A (P =0.044).The hospitalization rate caused by postoperative cardiovascular events or other morbidities in group B decreased 89％ than that in group A.Conclusions Individualized TSH suppression therapy can significantly decrease the recurrence and metastasis rate as well as concurrent morbidities caused by unnecessary TSH inhibition.

ObjectiveTo compare the efficacy of laparoscopic and open left lobectomy.MethodsThe clinical data of 92 patients who received left lobectomy at the First Affiliated Hospital of Harbin Medical University from May 2010 to June 2011 were retrospectively analyzed.Of the 92 patients,42 received laparoscopic left lobectomy (laparoscopic group ) and 50 received open left lobectomy (open group ). The advantages and disadvantages between laparoscopic and open left lobectomy were compared. All data were analyzed using the t test,chi-square test or by calculating the Fisher exact probability.ResultsTwenty-nine patients received left lateral lobectomy and 13 patients received left hemihepatectomy in the laparoscopic group. One patient was converted to the open group becaused of the injury of the middle hepatic vein.Thirty-three patients nnderwent left lateral lobectomy and 17 underwent left hemihepatectomy in the open group.The tumor-free resection margin of the laparoscopic group was ( 1.6 ± 0.6 ) cm,which was significantly longer than ( 1.2 ± 0.4 ) cm of the open group (t=3.81,P＜0.05).The volume of operative blood loss of the laparoscopic group was (158 ±89)ml,which was significantly smaller than (292 ± 172)ml of the open group (t =4.56,P ＜ 0.05 ).The time of postoperative pain control,time to bowel function recovery and duration of hospital stay were ( 1.2 ± 0.3 )days,(23 ± 4)hours,( 7.5 ± 2.8 ) days in the laparoscopic group,which were significantly shorter than ( 2.0 ± 1.1 ) days,(4.9 ± 7 ) hours,( 11.3 ± 4.2 ) days in the open group,respectively ( t =4.57,21.31,5.00,P ＜ 0.05 ).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 1 were increased,while the increase of AST and ALT in the open group were greater than that in the laparoscopic group (t =6.73,5.03,P ＜0.05).The postoperative prothrombin time in the open group was significantly longer than that before operation (t =2.32,P ＜ 0.05 ).The incidence of postoperative complications and total hospital costs were 7％ (3/41) and (2.5 ±0.7) ×104 yuan in the laparoscopic group,which were lower than 8％ (4/50) and (2.6 ±0.6) × 104 yuan in the open group,but no significant difference was observed (t =0.74,P ＞0.05).One patient in the open group died of multi-organ dysfunction syndrome caused by acute hepatic failure.ConclusionLaparoscopic left lobectomy is safe and effective,and it has the advantages of small trauma,quick recovery of patients and significant overall efficacy when compared with open left lobectomy.

Objective To investigate the effect of antisense oligonucleofide(PCNA ASON)and vascuiar endothelial growth factor (VEGF) gene traneduction on restenosis after balloon angiopasty.Memods chinese rabbits were randomly divided into control group(I),PCNA ASON(II),VEGF only (Ⅲ),PCNA ASON+VEGF(Ⅳ)groups.Each group included 7 rabbits.Restenosis wasevaluated by pathology immunohistochemistry and Western-blotting for the expression of PCNA,and the depth and area oftunica media and tunicca intima were measured. Results All rabbits experienced restenosis on different severities,especially in control group.Lesions were less severe in PCNA ASON and VEGF groups than in controls.The proliferation of smooth muscle and intima significantly ameliorated in PCNA ASON and VEGF combination group that in PCNA ASON or VEGF groups(P<0.01).But the difference between the PCNA ASON and VEGF group was not significant(P>0.7). Conclusion PCNA ASON and VEGF gene transductionn are effective in preventing restenosis after balloon angioplasty caused vessel injury in rabbits.