Search

To detect the variants in the promoter region of the CFTR gene in congenital bilateral absence of vas deferens (CBAVD).A total of 11 CBAVD patients and 50 healthy men as control were enrolled in the study from May 2013 to January 2015. Sanger sequencing was performed in the promoter region of 3.8 kb of the CFTR gene on the PCR products. The genome sequence of the CFTR gene was compared and analyzed with the website of NCBI and Cystic Fibrosis Mutation Database. Also, Transfac and phylogenetic footprinting method was used to investigate the relationship between the promoter region variants and the transcription factors function components.SNP of c.-8GC (n = 1) and c.-966TG (n = 7), as well as one single nucleotide variant of c.-195CA (n = 1) were identified in the promoter region of the CBAVD patients, of which c.-195CA was in the conserved domains of the promoter region.A single nucleotide variant within the conserved region of CFTR promoter is detected in Chinese CBAVD. And further functional study should be performed to explore the relationship between the variants in CFTR promoter and Chinese CBAVD.

To evaluate the safety and efficacy of laparoscopic-assisted distal gastrectomy (LADG) for gastric cancer through a meta-analysis of LADG versus open distal gastrectomy(ODG).Comparative studies of LADG and ODG wer collected from Pubmed, Cochrane library, Web of Science and Biosis Previews Databases between January 1995 and October 2012. The data of operative duration, blood loss volume, number of harvested lymph node, proximal and distal resection margins, time to flatus, time to first oral intake, postoperative hospital stay, postoperative morbidity and 5-year survival rate were analyzed. And statistical analysis was performed with RevMan 5.1 software.A total of 16 articles were analyzed. There were 4 randomized controlled trials and 12 retrospective observational reports. Among a total of 2854 patients with gastric cancer, 1441 LADG and 1413 ODG subjects were included. Compared with ODG, LADG resulted in significantly prolonged operative duration (weighted mean difference (WMD) = 49.09 min, P0.01), less blood loss volume(WMD = -118.99 ml, P0.01), less time to flatus (WMD = -0.58 d, P0.01) and oral intake (WMD = -0.61 d, P0.01), shortened postoperative hospital stay (WMD = -2.48 d, P0.01) and less postoperative morbidity (relative risk (RR) = 0.62, P0.01). Distal resection margin did not differ significantly between LADG and ODG (WMD = -0.01 cm, P = 0.94) while proximal resection margin was significantly shorter in the LADG group (WMD = -0.83 cm, P0.01). The number of harvested lymph node was significantly lesser in the LADG group than that in ODG group (WMD = -2.17, P = 0.05). However, no significant difference existed when only analyzing the papers published over the last 5 years or having over 50 LADG cases (all P0.05). Furthermore, the 5-year survival rate did not differ significantly between two groups (RR = 1.02, P = 0.52).As a safe and practical procedure with less blood loss volume, fewer overall complications and a quicker recovery, LADG may offer satisfactory long-term outcomes comparable to those of conventional open surgery.

To evaluate the necessity of routine nasogastric decompression after radical gastrectomy for gastric cancer with systematic review and Meta-analysis.The literature databases prior to September 2011 were extensively searched to retrieve the randomized controlled trials (RCT) with a relevance of study goal. The inclusion and exclusion criteria were formulated. After quality evaluation, the data were extracted. The Cochrane collaboration RevMan 5.1 version software was used for Meta-analysis.Seven RCT studies fulfilled the inclusion criteria for Meta-analysis. The total sample size of these studies was 871 cases. Those without a nasogastric tube routinely inserted experienced a marginal earlier time to flatus [weighted mean difference (WMD) = 0.10 days, 95% confidence interval (CI) 0.00 - 0.30, P = 0.05], a significant earlier time to oral diet [WMD = 0.43 days, 95%CI 0.25 - 0.61, P0.01], a significant shorter hospital stay [WMD = 0.60 days, 95%CI 0.15 - 1.18, P = 0.01) and a marginal decrease in pulmonary complications [relative risk (RR) = 1.30, 95%CI 1.00 - 1.68, P = 0.05)]. The postoperative rates of anastomotic leakage, morbidity and mortality were similar between two groups.Except for severe vomiting or abdominal distension, nasogastric tubes should not be used routinely in gastric cancer patients undergoing radical surgery.

To explore the protective effect of human 14-3-3 γ gene transfer on dopaminergic cells against rotenone-induced injury.Adenovirus vector carrying the gene of 14-3-3 γ (Ad/14-3-3 γ) was employed to transfect PC12 cells. Then the cells were exposed to rotenone as a model of Parkinson's disease. Methyl thiazolyl tetrazolium (MTT) was used to assay the viability of PC12 cells. The 4',6-diamidino-2-phenylindole (DAPI) staining was used to analyze the apoptotic ratio of PC12 cells among the groups of control, Ad/14-3-3 γ, Ad-null and Rotenone. And high performance liquid chromatography (HPLC) was performed to detect the secreting functions of PC12 cells. The aggregates of α-Synuclein protein were detected under confocal microscopy.MTT showed that the cell absorbance A(570) of Ad/14-3-3 γ group (0.46 ± 0.09) was higher than that of Ad-null group (0.19 ± 0.08) and rotenone group (0.16 ± 0.07), but lower than that of normal control (0.63 ± 0.11), (all P0.01); HPLC-ECD showed that the levels of dopamine (189 ± 11) ng/ml and noradrenalin (55 ± 8) ng/ml in the culture fluid of Ad/14-3-3 γ group were higher than those of Ad-null group (79 ± 12, 38 ± 7) ng/ml and rotenone group (81 ± 13, 39 ± 7) ng/ml (all P0.01). DAPI staining showed that cell apoptosis ratio of group Ad/14-3-3 γ (27% ± 64%) was lower than that of group Ad-null (53% ± 10%) and rotenone group (56% ± 12%, P0.01), but higher than that of control group (10% ± 5%, P0.01). Under confocal microscopy, the aggregates of α-synuclein protein in PC12 cells were detected more in Ad-null group and rotenone group than that in Ad/14-3-3 γ group.Gene transfer of Ad/14-3-3 γ has a protective effect on dopaminergic cells against rotenone-induced injury.

To detect the level changes of plasma N-terminal B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) in patients with heart failure (HF) and explore their clinical correlations and prognostic significances.A total of 100 cases of HF patients were selected along with 20 age and gender-matched controls. The levels of NT-proBNP and hs-CRP were tested.The levels of NT-proBNP were significantly higher in HF patients than the controls. And the difference was statistically significant (P0.01). In congestive HF patients, the elevating magnitude of plasma NT-proBNP level showed a significantly positive correlation with that of hs-CRP during the same period.(1) The level of NT-proBNP is significantly higher in HF patients. And it can be used as one of auxiliary diagnostic indicators. (2) The level of NT-proBNP in conjunction with hs-CRP can predict the prognosis of HF patients.

To evaluate the feasibility and clinical efficacy of totally laparoscopic gastrectomy (TLG) for gastric cancer.The investigators retrospectively analyzed 37 cases undergoing TLG for gastric cancer from March 2007 to April 2009 at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University.All 37 cases underwent successful TLG. There was neither transfer to open nor laparoscopic assisted surgery. Twenty-nine cases underwent distal gastrectomy with Billroth II reconstruction, 8 cases total gastrectomy with Roux-en-Y reconstruction, including 5 cases with end-to-side esophageal jejunostomy and 3 cases with side-to-side esophageal jejunostomy. Nineteen cases assisted by intraoperative gastroscopy for tumor locating. The operation duration was 210 - 355 min [mean (284 +/- 43) min]. The blood loss was 80 - 450 ml [mean (175 +/- 62) ml]. The number of dissected lymph nodes was 18 - 55 [mean (31 +/- 9)]. Two cases had post-operative complications, with 1 case of pulmonary infection recovering well after symptomatic treatment and 1 case of temporary delayed gastric emptying recovering well after gastrointestinal decompression for 6 days. No mortality was reported. The hospital stay was 6 - 14 d [mean (9 +/- 2) d]. There was no recurrence during the follow-up period of 2 - 25 months.For surgeons with rich experiences of laparoscopic surgery, TLG for gastric cancer is both safe and feasible. The short-term efficacy of TLG is satisfactory. Furthermore, TLG conforms more to the concept of minimally invasive surgery and the principle of tumor-free technique.

To investigate the relationship between CAVI (Cardio-Ankle vascular Index) and the degree of coronary artery stenosis in elderly patients with type 2 diabetes, the predictive value of CAVI were evaluated using the degree of coronary artery stenosis.Relevant clinical data including CAMI, BMI, blood pressure, smoking, age, Sbp, Dbp, history and blood biochemistry test were collected in 60 years or older patients with coronary artery stenosis diagnosed by coronary angiography, and the 298 cases were divided into two groups, A group (CAVIor = 9), B group (CAVI9), to investigate the correlativity among the level of CAVI and cardiovascular risk factors; at the same time all cases were assigned to group C (diabetes group) and group D (non-diabetic group), to analyse the change of CAVI in coronary artery stenosis patients complicated with diabetes mellitus.A total of 298 eligible patients with coronary artery stenosis were enrolled, including 163 non diabetics and 135 type 2 diabetics. The analysis result shows that there was a positive correlation among CAVI, old age, BMI, LDL-C, multi-vessel lesion, diabetes.The increase of CAVI was most highly related to the coronary artery stenosis. The level of CAVI might be a helpful predictive indexes to the severity of coronary atherosclerosis.

To investigate whether Hepatitis B virus X protein (HBx) regulates the transcription activity of zinc finger transcription factor SNAI1, and to define the main regulation domain.A series of 5' truncated promoters of SNAI1 were amplified and subcloned into the pGL3-Basic vector to construct promoter luciferase report plasmids. The promoter luciferase report plasmids were cotransfected with HBx recombinant adenovirus and pRL-TK plasmid into human hepatocellular cancer cells of the line SMMC7721. Luciferase activity was measured, and relative luciferase activity was calculated.Luciferase reporter plasmids containing 5' flanking deletion of SNAI1 promoter were successfully constructed. HBx obviously upregulated the activity of the SNAI1 promoter (-869 - +59), other than the SNAI1 promoter (-514 - +59) and SNAI1 promoter (-194 - +59).HBx can stimulate the transcription of SNAI1, and the transcription regulation domain is located in the segment from -869 - -514 of the SNAI1 promoter.

To study the correlation between the expression of caveolin-1 in hepatitis B-related hepatocellular carcinoma (HCC) and the relationship thereof with the invasive and metastatic ability of HCC.Real-time PCR and immunohistochemistry were used to detect the expression of caveolin-1 in 123 specimens of HCC tissues obtained during operation. Human HCC cells of the lines MHCC-97L and MHCC-97H were cultured, and Western-blotting was used to detect the caveolin-1 expression in these cells.The expression level of caveolin-1 in the HCC tissues was significantly lower than that of the adjacent noncancerous tissues (P = 0.026). The caveolin-1 mRNA expression in the HBV-related HCC cells was negatively correlated with the tumor size, expression of AFP, major venous invasion, being single or multiple, pTNM staging, and HBx expression level, factors closed to the prognosis of HCC. The caveolin-1 protein expression of the MHCC-97H cells was significantly lower than that of the MHCC-97L cells.Caveolin-1 expression is associated with the invasive and metastatic ability of HCC, low expression of caveolin-1 shows poor prognosis of HCC, and caveolin-1 is probably down-regulated by HBx protein.

To investigate the clinical effect of laparoscopic-assisted radical distal resection of invasive gastric cancer.Forty-seven patients with advanced gastric cancer, 33 males and 14 females, aged 58.2 (36 - 77), underwent laparoscopic-assisted radical resection and then were followed up for 17 months (2 - 33 months).All the 47 patients survived. The operation time was (294 +/- 75) min (200 - 420 min). The blood loss was (150 +/- 65) ml (50 - 500 ml). The number of dissected lymph nodes was (32.4 +/- 22.3) (15 - 48). The gastrointestinal peristalsis recovery time after operation was (2.7 +/- 1.2) d (2 - 6 d). The hospital stay time was (9.0 +/- 3.5) d (5 - 19 d). Post-operational complications were seen in 3 cases: pulmonary infection in 2 cases and incision infection in 1 case, and all the 3 patients recovered well after proper treatment.Laparoscopic-assisted radical resection of invasive gastric cancer is safe and feasible, with the advantages as minimal invasion, less pain, shorter hospital stay, faster bowel function recovery.

To identify the influence of tumor characteristics on the outcome of liver transplantation (LT) among patients with hepatocellular carcinoma (HCC).A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and February 2006 at our institution. We compared the outcome of the patients classified by different tumor related factors. Survival analysis was performed using Kaplan-Meier and Cox proportional hazards regression methods.Macroscopic vascular invasion, lymph node metastasis, Edmondson pathologic classification, microscopic tumor thrombosis, tumor location, satellite nodules and alpha-fetal protein (AFP) all significantly affected the overall survival and/or recurrence-free survival post-LT (P0.01 or P0.05). Pre-operative treatment and hepatitis background had no effect to the prognosis (P0.05). At multivariate Cox regression analysis, the factors associated with mortality or recurrence were macroscopic vascular invasion, microscopic tumor thrombosis and satellite nodules (P0.01 or P0.05).Edmondson grade III - IV, microscopic tumor thrombosis, left lobar or bilobar tumor, satellite nodules and AFPor = 300 microg/L were predictive factors of poor prognosis. Presence of macroscopic vascular invasion or lymph node metastasis should be contraindicated.

To investigate the incidence, survival, and influential factors of lung cancer in the Shanghai populations.Data of individual cases of lung cancer 2000 - 2004 were obtained from the Shanghai Cancer registry System. The annual prevent change (APC) of incidence of lung cancer from 1972 to 2004 was calculate by crude and standardized rates so as to analyze the time trends. Cox proportional risk model was used to analyze the factors influencing the survival.23,196 new cases of lung cancer were diagnosed 2002 - 2004. The crude incidence rate of lung cancer in the females was 33.73/100,000, and the age-adjusted rate was 30.90/100,000. The crude incidence rate of lung cancer and the age-adjusted rate for the males were 81.65/100,000 and 33.73/100,000 respectively, both higher than those of females. The APC values of crude incidence 2004 for both the males and females increased by 1.723% and 2.036% respectively in comparison with the values 1972 (both P0.01). The age-adjusted APC of standardized incidence rate for the males in the city center was -0.605% (P0.01), showing a tendency to reduce; while the age-adjusted APC of standardized incidence rate for the females in the city center was -0.136 (P0.05). The proportion of stage IV cases in the females was 47.5%, significantly higher than that in the males (40.0%, P0.05). The proportion of adenocarcinoma in the females was 86.1%, significantly higher than that in the males (47.8%, P0.05). The 3-year survival rate and median survival time of adenocarcinoma in the females were 30.38% and 1.48 years respectively, both significantly higher than those in the males (22.66% and 0.98 years, both P0.01). Female gender, being younger, living in urban area, squamous cancer, early stage, visit to higher-grade hospital were the factors beneficial to the prognosis of lung cancer.The age adjusted incidence rate of lung cancer in Shanghai is much closer to that of Western Europe and North America. The beneficial factors for higher survival rate are female, younger age, urban residency, squamous cell lung cancer, earlier stage of diagnosis, and higher grade hospital for treatment. Women have statistically better outcomes than men in different stages of disease.

To evaluate the protective effect of adenovirus mediated vascular endothelial growth factor 165 (VEGF165) gene transfer on dopaminergic neurons in Parkinson disease (PD).Adenovirus vector coding VEGF165 (Ad-VEGF165) was injected into the striate bodies of 16 SD rats, and adenovirus Ad-LacZ was injected into 25 rats and phosphate-buffered saline (PBS) was injected into 16 rats as controls. Then 6-hydroxydopamine (6-OHDA) was injected to establish PD model. X-gal staining was used to detect the expression of the report gene LacZ in the brain of the Ad-LacZ group 3 d, 2 w, and 6 w after injection, 3 rats in each time point. RT-PCR was used to detect the VEGF165 mRNA expression in the striate body of the rats of the 3 groups 2 weeks after injection, 3 rats for each group. Western blotting was performed to check the protein expression of VEGF165 in the striate bodies of the rats of the 3 groups 2 weeks after injection, 3 rats for each group. A certain numbers of rats in each group underwent rotational behavior analysis 1, 2, and 6 weeks after the 6-OHDA injection. Immunohistochemistry was used to examine the number of tyrosine hydroxylase (TH) positive neuron, density of TH-positive fiber in striate body and black substance, laminin-positive vessel density, and glial fibrillary acidic protein (GFAP) positive glial cells. High performance liquid chromatography-electric-chemical discharge (HPLC-ECD) was performed to detect the contents of dopamine (DA) and its metabolites, dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in the striatum.Beta-gal was expressed in the striate bodies of all Ad-LacZ transfected rats, showing the successful transfection of LacZ gene. The mRNA expression and protein expression of VEGF165 in the striate body were significantly higher in the Ad-VEGF165 group than in the other 2 groups. The apomorphine-induced rotation number in the Ad-VEGF165 group was 8.3 turns/min +/- 8.7 turns/min 1 week after the transfection, then gradually decreased, and became 5.0 turns/min +/- 4.4 turns/min 6 weeks after. The rotation numbers of the Ad-LacZ and PBS group were 14.7 turns/min +/- 11.2 turns/min and 13.9 turns/min +/- 8.3 turns/min respectively 1 week after the injection, then increased gradually, and became 20.2 turns/min +/- 13.6 turns/min and 21.8 turns/min +/- 11.8 turns/min respectively 6 weeks later, all significantly higher than those of the Ad-LacZ group (all P0.01). The ratios of TH-positive cells in the black substance in the transfected side was 0.42 +/- 0.11, and the density of fibers in the striate body of the transfected side to that of the contralateral side was 0.56 +/- 0.10 in the Ad-VEGF165 group, both significantly higher than those of the Ad-LacZ group (0.20 +/- 0.10 and 0.28 +/- 0.09) and PBS group (0.22 +/- 0.13 and 0.24 +/- 0.08), (all P0.01). The ratio of laminin-positive vessel density of the transfected side to that of the contralateral side in the Ad-VEGF165 group was 2.09 +/- 0.42, and the ratio of GFAP-positive glial cells of the striate body of the transfected side to that of the contralateral side was 2.77 +/- 1.21 in the Ad-VEGF165 group, both significantly higher than those in the Ad-LacZ group (1.01 +/- 0.16 and 1.64 +/- 0.28) and the PBS group (1.04 +/- 0.09 and 1.56 +/- 0.62) (P0.01 and 0.05). HPLC-ECD showed that the contents of DA, HAV, and DOPAC of the striate body at the destroyed side in the Ad-VEGF165 group were all significantly higher than those in the other 2 groups (all P0.01). The ratios to the DA, DOPAC, and HVA of the destroyed side striate body to those of the contralateral side in the Ad-VEGF165 group was 0.35 +/- 0.11, 0.46 +/- 0.09, and 0.38 +/- 0.09 respectively, all significantly higher than those in the Ad-LacZ group (0.17 +/- 0.15, 0.21 +/- 0.07, and 0.16 +/- 0.05) and PBS group (0.19 +/- 0.06, 0.20 +/- 0.09, 0.14 +/- 0.03) (all P0.01).Gene transfer of Ad-VEGF165 has a protective effect on the dopaminergic neurons of PD. The proliferation of vessels and glial cells induced by VEGF may involve in the process of neuroprotection to the dopaminergic neurons of PD.

To investigate the effects of rapamycin (RPM) in inhibiting the growth and metastasis of hepatocellular carcinoma (HCC).Human HCC cells of the line MHCC97H with a high potential of metastasis were divided into 3 groups to be cultured with cyclosporine A (CsA) 100 ng/ml, RPM 10 ng/ml, or CsA + RPM for 48 hours. Flow cytometry was used to examine the apoptosis and cell cycle MTT method was used to examine the effect of RMP on the proliferation of the MHCC97H cells. RT-PCR was used to detect the mRNA expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), hypoxia-inducible factor-1alpha (HIF-1alpha), and transforming growth factor b (TGFb). Another MHCC97H cells were cultured in complete medium without RPM for 48 hours, then the protein expression of VEGF in the supernatant was detected by ELISA. Twenty-eight nude LCI-D20 mice were inoculated with human HCC cells and then divided into 4 groups to be fed with CsA (25 mg/kg), RPM (2 mg/kg), CsA + RPM, and normal saline (0.2 ml, as control group) for 35 days. Then the mice were killed to take the weight of inoculated tumor, measure the blood drug concentration, calculate the lung metastasis rate and number of metastatic foci, and observe pathology of the lung.CsA showed no effect on the cycle of the MHCC97H cells. The MHCC97H cells of the RPM and CsA + RPM groups arrested at the stage G(0)/G(1) (both P = 0.000). MMT method also showed that the proliferation of the MHCC97H cells in the RPM and CsA + RPM groups were blocked (P = 0.003 and P = 0.002). However, CsA did not influence the proliferation of the MHCC97H cells. Flow cytometry showed that RPM did not promote the apoptosis of the MHCC97H cells. RT-PCR showed that RPM down-regulated the mRNA expression of VEGF and HIF-1alpha (both P0.05), however, did not influence the mRNA expression of bFGF, TGFb, and TGFb. The VEGF protein level in the supernatant of the culture fluid of MHCC97H cells of the RPM group was (890.3 +/- 25.1) pg/ml, significantly lower than that of the control group, (1583.7 +/- 17.3) pg/ml (P = 0.000). The tumor inhibiting rate of the RPM group was 63.7%, not significantly different from that of the RPM + CsA group (80.9%, P = 1.000). The metastatic rate of the CsA and control groups were both 100% with a higher number of metastatic tumors in the CsA group (P = 0.046).RPM significantly inhibits the growth and metastasis of HCC. RPM-based immunosuppressive regimen may be of value in HCC patients receiving liver transplantation.

To evaluate the effects of different selection criteria on the prognosis of hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) and to explore the new criteria adapted for Chinese National Situation.A retrospective analysis was performed on 251 consecutive patients with HCC who underwent LT between April 2001 and January 2006 at our institution. We compared the outcome of the patients meeting different criteria such as milan, UCSF and the Pittsburgh modified TNM criteria. Survival rates were calculated using the Kaplan-Meier method, and differences between the curves were assessed by log-rank test.There was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates between milan criteria (n = 93; 86%, 77%, 77% and 91%, 86%, 86%) and UCSF criteria (n = 131; 90%, 83%, 83% and 92%, 89%, 89%). According to Pittsburgh criteria (n = 207), the 1, 2, 3-year survival rates and recurrence-free survival rates were 84%, 74%, 67% and 85%, 83%, 73%, respectively. For advanced tumors (over all the criteria), the survival rates and recurrence-free survival rates decreased significantly (n = 44; 65%, 43%, 43% and 47%, 43%, 43% respectively). When criteria (named as Shanghai Fudan Criteria) were expanded to HCC patients with solitary lesionsor = 9 cm in diameter, or no more than 3 lesions, the largestor = 5 cm, with a total tumor diameteror = 9 cm, there was no significant difference in 1, 2, 3-year survival rates and recurrence-free survival rates (n = 151; 88%, 80%, 80% and 90%, 88%, 88%, respectively) as compared with milan criteria, but more patients using Shanghai Fudan Criteria could undergo liver transplantation.Shanghai Fudan Criteria, which expanded the tumor size limits, does not adversely impact survival of HCC patients after LT.

To analyze the risk factors influencing the prognosis of orthotopic liver transplantation for hepatocellular carcinoma (HCC) and sum up the relevant clinical experience in diagnosis and treatment of HCC.The clinical data of 198 HCC patients, 177 males and 21 females, aged 49 (24-83), were analyzed.The 0.5-, 1-, and 2-year survival rates were 89%, 78%, and 65 respectively. The rates of disease-free survival (DFS) were 85%, 73, and 67% respectively. Univariate analysis revealed that tumor size, presence of vascular invasion, Edmondson grade, TNM classification, and preoperative alpha-fetoprotein (AFP) were significantly related to DFS, and the 4 foregoing factors were also related to the survival rate. Cox regression analysis suggested that presence of vascular invasion was an independent prognostic factor of survival rate and DFS.Vascular invasion plays a leading role in evaluating the prognosis of orthotopic liver transplantation for HCC. It is important to discover the micro-metastasis and explore more effective approaches to prevent recurrence after transplantation.

To investigate the measures to further improve the therapeutic efficacy of liver transplantation.The clinical data of 203 consecutive cases of orthotopic liver transplantation (OLT) performed in Zhongshan Hospital, Fudan University April 2001 to October 2004, with the indications for considering OLT of hepatocellular carcinoma (HCC) (142 cases), liver cirrhosis (36 cases), fulminant hepatic failure (7 cases), Wilson's disease (6 cases), and other end-stage liver diseases (12 cases), including 199 cases of cadaveric OLT, inclusive of 2 cases of reduced-size and 1 case of splitting liver transplantation, and 4 cases of living-donor liver transplantation, were retrospectively analyzed. Multivariate analysis using Cox proportional hazards regression model was applied to determine the risk factors predicting liver transplantation prognosis for HCC.For the whole group of the 201 patients, the 1-year and 2-year cumulative survival rates were 85.0% and 82.4% respectively and the rejection rate was 12.3%. In the HCC group the 1- and 2-year cumulative survival rates were 80.2% and 78.4%, and the 1- and 2-year disease-free survival (DFS) rates were 85.3% and 80.3% respectively. HCC recurrence was observed in 20 patients after OLT with a recurrence rate of 14.1%. Multivariate analysis revealed that the tumor size and portal vein tumor thrombus were the most independent and statistically significant factors affecting the DFS.OLT may be the most effective treatment option for patients with end-stage liver diseases and may also provide the opportunity of curative treatment or survival improvement for selected patients with hepatic malignancies.

To explore the diagnosis and management of early hepatic artery thrombosis (HAT) after liver transplantation.Routine examination of Color Doppler Imagine (CDI) was used to detect hepatic artery flow after liver transplantation in 220 cases from April 2001 to November 2004. Suspected patients were further confirmed by immediate hepatic artery angiography, and continuous infusion of urokinase through hepatic artery with catheter was performed to the patients with HAT.HAT was identified in 6 patients (2.7%), occurring 5.5 days (2 - 19 days) after liver transplantation. Hepatic artery recanalization was obtained in 6 cases. One patient died from lung infection 2 months after liver transplantation. One patient underwent the second liver transplantation because of the recurrence of HAT 6 months after the first transplantation, but died from multiple system organ failure 2 months after the operation. The other 4 cases have been surviving well disease-freely.CDI is useful for the diagnosis of early HAT after liver transplantation. Contributes to recovery of the hepatic artery flow, continuous infusion of urokinase through hepatic artery with catheter may be the first choice of the therapy for early HAT.

To summarize the experience in laparoscopic resection of true pancreatic cyst.Five patients with true pancreatic cyst, including 1 case of pancreatic head cyst and 4 cases of distal pancreatic cyst, underwent laparoscopic resection. Among them one case with pancreatic head cyst and 4 cases of distal pancreatic cyst underwent simple laparoscopic cyst resection and one case of distal pancreatic cyst underwent laparoscopic distal pancreatectomy with resection of the spleen. The curative effects were evaluated. A follow-up lasting 2 approximately 33 months was conducted.All operations were successful with intraoperative blood loss of 50 to 150 ml. The patients could get up and move about 6 hours after the operation and were recovered and discharged 4 to 6 days later. Follow-up showed that all symptoms disappeared and no recurrence of cyst occurred.Laparoscopic resection of true pancreatic cyst is feasible with the advantages of reduced injury and earlier recovery.

To study the technique and effect of transcervical resection of myoma (TCRM) in treatment of hysteromyoma.962 women suffering type 0 hysteromyoma (n = 281), 316 type 1 hysteromyoma (n = 316), type 2 hysteromyoma (n = 282), submucous and intramural myoma (n = 34), cervical myoma (n = 11), prolapse myoma (n = 23), and adenomyoma (n = 15) underwent TCRM with "five-step technique", monitored by B-ultrasound or laparoscopy, Follow-up lasted more than 6 months.The primary operation successful rate was 99.77%. The mean size and depth of uterus were 7.44 +/- 1.3 gestation weeks and (8.31 +/- 1.43) cm, the diameter of the biggest myoma was 7.2 cm. The mean weight of the resected tissues was (22.63 +/- 31.41) g, and the mean operation time and blood loss during the operation were 32.50 +/- 172.72 minutes and (7.75 +/- 19.49) ml. No transfusion was needed. The complications included postoperative fever (3 cases), uterine bleeding (1 case), uterine perforation (1 case), and TURP syndrome (2 cases). Postoperative scanty menstrual rate was 100% in the type 0 hysteromyoma group, 99.1% in the type I hysteromyoma group, 94.02% in the type II hysteromyoma group, 100% in the cervical myoma and prolapse myoma group, 84% in the multiple myoma and intramural myoma group, and 87% in the adenomyoma group respectively. The alleviation rates of dysmenorrhea and anemia were 78% and 82.95% respectively. Those who have severe complications of internal medicine showed obvious improvement. The residual myoma of 2 cases were resected during the secondary operation 9 days and 3 months after the primary operation. 455 cases (52.17%) resumed their work in 1 month postoperatively. 32 living infants were delivered.Safe and highly effective, TCRM can be the first choice in treatment of submucous and intramural hysteromyoma.

To evaluate the superiority of binding pancreaticojejunostomy (BPJ) and the appropriate degree of tightness of binding from the view of tolerance pressure of the anastomotic stoma.The clinical data of 24 patients with diseases of head of pancreas and duodenum who underwent binding pancreaticojejunostomy were analyzed. The tolerance pressure at the anastomotic stoma was measured before and after the binding.The pre-binding tolerance pressure at the anastomotic stoma ranged from 28 cm H2O to 65 cm H2O, with a median of 44 cm H2O. The post-binding tolerance pressure at the anastomotic stoma ranged from 75 cm H2O to 90 cm H2O, with a mean of 85 cm H2O, significantly higher than those before binding (P0.01).Binding greatly increases the tolerance pressure at the anastomotic stoma. The tolerance pressure adopted is appropriate.

Analyze the variation of T cell receptor(beta) (TCRbeta) CDR3 gene expressing repertoire in systemic lupus erythematosus (SLE) patients before and after autologous peripheral blood hematopoietic stem cell transplantation (APBSCT), to search the pathogenesis of SLE and characteristics of T cell reconstitute immune after APBSCT.Reverse transcriptase - polymerase chain reaction (RT-PCR) amplified 25 subfamily genes of TCRbeta prom peripheral blood lymphocytes (PBLs) of SLE patient with APBSCT and run denaturation polyacrylamide sequencing gel electrophoresis, set up a map of TCRbetaCDR3 gene expressing repertoire. The bands of TCRbeta gene repertoire in the electrophoresis gel can be used to analyze the variety of T cell clones which expanded and disappeared in cases of SLE. Cut the bands and sequencing. Compare sequences of TCRbetagenes in normal and abnormal T cell clones to understand the relationship between TCRbeta gene and autoimmune diseases.In the normal control group, TCRbeta gene repertoires show more than 10 bands in each of 25 TCRbetaV families, characterized as Gaussian distribution. TCRbeta gene repertoire in the 8 patients with SLE were abnormally. Four patients expressed TCRbetaV13.1 gene preferentially. Three patients had TCRbetaV8, TCRbetaV9 and TCRbetaV18 genes over expressed. These over expressive genes represented the oligoclonal expansion of T cell populations. After APBSCT the TCRbeta gene repertoires regained CDR3 polymorphism in 5 patients, some of them recovered to normal completely. The sequencing analyse show dense and strong band in map of TCRbeta gene repertoires were T cell monoclonal or oligoclonal expansion frequently. In a case of SLE an amino acid sequence of TCRbetaV8 CDR3 was same to a sequence of disease correlative T cell clone with ankylosing spondylitis that had been reported in a literature before.SLE patients have oligoclonal expansion of T cell that related with the pathogenesis of autoimmune disease. After APBSCT, T cell clones recover to normal distribution. T cell clones that related with disease have been suppressed during immunological reconstitution. It may be a main reason the SLE get remission after transplantation.