Objective:To investigate the effect of different additional filters on the image quality and radiation dose in abdominaldigital radiography (DR).Methods:Retrospective analysis was performed on 10 cases of abdominal DR from December 2020 to January 2021 in Fuxing Hospital, and the average mAs was calculated. Using automatic exposure control (AEC) technology, a polymethyl methacrylate (PMMA) slab of the corresponding thickness (18 cm) at the same output of above mAs was confirmed and used as the attenuator to simulate the abdomen. The phantom of CDRAD 2.0 and 17 slices of 10 mm thick PMMA plates (total thickness 18 cm) were placed on the bed. The additional filters were selected as no additional filter, 2 mmAl, 0.1 mmCu+ 1 mmAl, 0.1 mmCu+ 2 mmAl respectively. The AEC levels were selected at -2, -1, 0, 1, and 2 respectively. The images were collected and analyzed by using CDRAD 2.0 software to obtain the image quality factor (IQF inv). The incident air kinetic energy on the surface of the PPMA was measured for each exposure, and PCXMC software was used to estimate the organ dose and effective dose, and a comparative analysis was made. Results:The skin incident doses at no additional filter, 2 mmAl, 0.1 mmCu+ 1 mmAl, 0.1 mmCu+ 2 mm Al were (0.546 1±0.200 8), (0.376 2±0.133 8 ), (0.285 3±0.100 1) and (0.289 9±0.099 2) mGy, respectively. The estimated effective doses were (79.63±29.24)×10 -3, (71.05±25.56)×10 -3, (63.58±22.18)×10 -3 and (67.64±23.11)×10 -3 mSv, respectively. The gonadal doses were (0.058 1±0.020 8), (0.050 0±0.018 0), (0.044 8±0.015 6) and (0.047 7±0.016 3) mGy.The IQF inv values were 4.70±0.61, 4.80±0.84, 4.60±0.55, 4.60±0.60, respectively. There were linear correlations between the effective dose and the skin incident dose under different additional filtration, and the effective doses increased with the increase of the incident doses. The dose was lowest at the addition filtration of 0.1 mmCu+ 1 mmAl. There was no significant difference in the IQF inv between groups( P>0.05). Conclusions:The optimal additional filtration for abdominal DR was 0.1 mmCu+ 1 mmAl with the image quality meeting the requirements of clinical diagnosis, the radiation dose reduced reasonably, and the objective of the optimization of radiographic parameters achieved.

Vascular injury is a severe complication when combined with biliary injuries in laparoscopic cholecystectomy. The most frequent injury is damage to the right branch of the hepatic artery. The incidence ranges between 6. 7% and 61.1%. When bile duct transection is combined with vascular injury, the clinical course is complicated by liver ischaemia or necrosis, biliary stricture, and liver lobar atrophy which sometimes necessitating liver resection or even transplantation. Reconstruction of vascular injury is helpful when the injury is identified early.

To investigate the cause of donor death in living donor liver transplantation(LDLT), we reviewed all published articles in English on LDLT from the Foreign Medical Journal Full-Text Service (FMJS) and searched the literature for donor deaths before 2008. We identified 12 donor deaths. The rate of donor death is 0.2%. Any donor death would be a catastrophe for the donor's family and for the medical team. It is imperative to avoid donor death in LDLT.

Objective To explore the effects of CO2 pneumoperitoneum on pancreatic function in diabetic rabbits. Methods Forty-eight rabbits were divided into 4 groups: control group (the group of N0, n=4), the group of T0 (n=4), the group of T10 (n=20), and the group of T15 (n=20). The animal used in the groups of T0, T10 and T15 was diabetic rabbit, and the pressures of pneumoperitoneum of the three groups were 0 mm Hg, 10 mm Hg and 15 mm Hg respectively.The model of diabetic rabbits were made through intrvenous administration of Allxon. Arterial blood samples were collected before the onset of CO2 pneumoperitoneum, 0, 2, 6, 12 hours after deflation for measuring blood glucose, amylase, insulin and C-peptid. Then the rabbits were sacrificed and their pancreases were removed for measuring SOD activity and MDA content. Results After abdominal deflation, the blood glucose, amylase, insulin, C-peptid, MDA content were significantly increased (P

Objective To investigate the influence of CO_2 pneumoperitoneum on intestinal mucosa permeability in rats with liver cirrhosis.Methods Fifty rats were randomly divided into following groups: control group(n=5),cirrhosis group(n=5) and pneumoperitoneum group(n=40);the pneumoperitoneum group was further divided into 8 mm Hg group(n=20) and 13 mm Hg group(n=20).Four time points were chosen,including 0.5,2,6,and 12 hours after the end of pneumoperitoneum.After rat models with cirrhosis were established successfully,the abdominal cavity was insufflated with CO_2 and maintained under the pressures of 8 mm Hg and 13 mm Hg respectively for two hours.The portal venous blood was collected and the levels of D-lactic acid and endotoxin were measured.Results The levels of endotoxin and D-lactic acid in cirrhosis group were much higher than those of control group(P0.05).Conclusion The intestinal mucosa permeability is increased in rats with liver cirrhosis.It can be further increased under CO_2 pneumoperitoneum with certain pressure and time and in a pressure-dependent manner.The permeability can decrease after removal of pneumoperitoneum.

0.05).Conclusion Under atherosclerosis conditions,CO_2 pneumoperitoneum has an adverse influence on the blood flow of the common carotid arteries which may be associated with increased intra-bdominal pressure,absorbed CO_2 gas.

OBJECTIVETo evaluate the role of laparoscopic ultrasonography(LUS) in prevention of bile duct injury(BDI) and residual common bile duct (CBD) calculi during complicated laparoscopic cholecystectomy (LC).

METHODSOne hundred and four cases of LC were defined complicated because of anatomic aberrance of the extrahepatic biliary system, unconfirmed exposed cystic duct, suspected CBD calculi or BDI, adhesion or inflammation in the Calot's triangle, acute cholecystitis, and atrophic gallbladder. LUS was performed to scan the extrahepatic bile duct. LC was carried out with assistance of the LUS.

RESULTSAssisted with the LUS demonstrated anatomic relationship between the extrahepatic bile duct and cystic infundibulum or cystic duct, 85 cases of LC were accomplished successfully. 19 were converted to open cholecystectomy because of LUS-indicated potential risk of BDI, CBD calculi, and suspected BDI.

CONCLUSIONSWith the extrahepatic bile duct visualized by LUS and contrast of the cystic infundibulum and cystic duct, operators can precisely identify the anatomic relationships between the cystic infundibulum, cystic duct and extrahepatic bile duct. Preoperatively unpredicted choledocholithiasis may be recognized.

Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Extrahepatic ; diagnostic imaging ; Cholecystectomy, Laparoscopic ; adverse effects ; methods ; Cystic Duct ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Ultrasonography

Objective　To investigate the way of closed establishment of pneumoperitoneum(CEPP) in patients with peritoneal cvity adhesion in laparoscopy cholecystectomy(LC). Methods　CEPP experiences of 1046 patients in 6600 cases LC in our hospital from September 1991 to September 1999 were retrospectively analysed. The difficulty in establishing pneumoperitoneum was divided into two kinds: real establishment pneumoperitoneal difficulty(REPPD) and false establishment pneumoperitoneal difficulty(FEPPD). REPPD was due to Veress needle penetrating into visceral or extensive adhesion in peritoneal cavity resulting in CO2 flowing into difficulty. FEPPD was due to Veress needle pentrating in the fat out of peritoneum, in round hepatic ligament or in greater omentum. The formal situation needed to open laparotomy as a change, and the latter situation could establish pneumoperitoneum successfully by regulating the Veress needle penetrating direction or depth in the second penetration. Results　Of the 1046 patients, 1028 cases had been establishedpneumoperitoneum successfully though CEPP; 6 cases of REPPD and 18 of FEPPD were required opening laparotomy as a change. The successful rate of CEPP was 98.3%. Conclusions　CEPP is a safe and feasible method in patients with peritoneal adhesion in LC. It is the main reason for CEPP failure regarding REPPED as FEPPD made by the deficiency in LC experience and loss confidence in laparoscopist.

Purpose: To explore the autocrinism of vascular endothelial growth factor ( VEGF) in human hepatocellular carcinoma cell and its significance. Methods: The expression of VEGF receptors was analyzed by reverse transcription-polymerase chain reaction (RT-PCR) in human hepatocellular carcinoma cell lines SMMC7721, HHCC and HepG2 in vitro. The expression of VEGF in human hepatocellular carcinoma cells was inhibited by synthetic antisense oligodeoxynucleotide (ODN). Phenotypic alterations in human hepatocellular carcinoma cells by antisense reduction of VEGF expression were observed. And the alterations for expression of VEGF receptors in human hepatocellular carcinoma cell membranes were analyzed by flow cytometry. Results: Flt-1 was expressed faintly in SMMC-7721 cell whereas KDR was expressed in HHCC cell and HepG2 cell in vitro. Compared to control, antisense ODN against VEGF inhibited HHCC cell proliferation in vitro in a dose-dependent manner and had no effects on SMMC-7721 cell and L929 cell. When the concentration of antisense ODN was 2.5 ?mol/L,5 ?mol/L and 10 ?mol/L, the proliferation of HHCC cell was inhibited by 26%, 41 % , and 50% respectively. Compared with control, flow cytometry analysis showed a decrease in cell number in S phase and a pre-apoptosis peak in HHCC cell treated by antisense ODN. There was no alteration of cell cycle in SMMC-7721 cell. The positive rate of KDR expression in HHCC cell membrane was 19. 2%, 29. 8% and 31. 2% in the antisense ODN, sense ODN and control groups, respectively. The expression of KDR in HHCC cell membrane was markedly inhibited by antisense ODN against VEGF compared with the control group, as measured by flow cytometry. There was no alteration for expression of Flt-1 in SMMC-7721 cell membrane. Conclusions: VEGF produced by human hepatocellular carcinoma cells acts directly upon human hepatocellular carcinoma in an autocrinal manner and may promote the proliferation and differentiation of human hepatocellular carcinoma cells via the activation of the KDR-dependent signaling pathway.

Objective To investigate the reasons for the changes of serum ALT, AST after laparoscopic cholecystectomy. Methods 69 patients admitted in Oct, 1999 were randomly divided into two groups. The gallbladder was resected with monopolar cautery laparoscopically and cystic bed was routinely coagulated in 35 patients, group a. The gallbladder was removed with microscissors and the cystic artery was clipped with titanium clip in 34 patients, group B. Hepatic tissue in bulk of 1cm X 1cm and close to the gallbladder bed was sampled for histological study for all patients in the two groups. The serum ALT and AST levels were measured on the 1st, 5th ,postoperative day. Results Comparing with group B, the serum ALT and AST levels in group A were significantly higher on the 1th postoperative day ( P