Risk factors for post-pancreaticoduodenectomy hemorrhage / 中华普通外科杂志

Objective:To investigate the independent risk factors of post-pancreaticoduodenectomy hemorrhage (PPH).Methods:The clinical data of 350 patients who underwent pancreaticoduodenectomy at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Chongqing Medical University from Jul 2014 to Oct 2018 were retrospectively analyzed, the chi-square test and Logistic regression were used for univariate and multivariate analysis.Results:Of the 350 cases, PPH occurred in 35, including intra-abdominal hemorrhage in 20 cases, gastrointestinal hemorrhage in 15 cases, the incidence of PPH was 10.0%. Seven of the 35 PPH cases died. Univariate analysis showed that preoperative bilirubin (χ 2=4.162, P=0.041), pancreatic fistula (χ 2=37.451, P=0.000), biliary fistula (χ 2=7.945, P=0.005), and intro-abdominal infection (χ 2=34.577, P=0.000) infection were significantly associated with PPH; multivariate analysis results indicated that pancreatic fistula ( P=0.000, OR=10.426, 95% CI=3.512-30.955), biliary fistula ( P=0.000, OR=15.754, 95% CI=3.500-70.902), and intro-abdominal infection ( P=0.003, OR=4.530, 95% CI=1.644-12.483) were independent risk factors of PPH. Conclusions:Pancreatic fistula, biliary fistula, and intro-abdominal infection are independent risk factors for PPH.

Prognostic relationship between ratio of peritumoral hepatic stellate cells to γ4δ T cells and prognosis of patients with hepatocellular carcinoma after curative resection / 中华肝胆外科杂志

Objective To study the association between ratio of peritumoral hepatic stellate cells to γδ T cells ratio (SGR) and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection.Methods From January 2011 to December 2013,the clinical data of 320 patients with HCC who underwent curative resection at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively.Immunohistochemistry was used to calculate the SGR in adjacent cancer tissues.Survival was estimated by Kaplan-Meier method.Prognosis of HCC patients was analyzed by univariate and multivariate analyses.Results Multivariate analysis revealed multiple tumors (HR =1.895,95％ CI:1.155-3.108),microvascular invasion (HR =1.665,95％ CI:1.104-2.512),tumor size ＞ 5 cm (HR =2.400,95％ CI:1.603-3.594) and peritumoral SGR ＞ 18 (HR =1.880,95％ CI:1.257-2.810) were independent risk factors of the overall survival rate in HCC patients.Preoperative AFP ＞ 20 μg/L (HR =1.631,95％ CI:1.151-2.311),microvascular invasion (HR =2.145,95％ CI:1.536-2.994),tumor size ＞ 5 cm (HR =1.866,95％ CI:1.342-2.592) and peritumoral SGR ＞ 18 (HR =1.517,95％ CI:1.084-2.122) were independent risk factors of the tumor-free survival rate in HCC patients.Patients were then divided into the low SGR (ratio≤ 18,n =222) and high SGR groups (ratio ＞ 18,n =98) using SGR in adjacent cancer tissues.The overall survival and tumor-free survival rates of the low SGR group were significantly better than the high SGR group (P ＜ 0.05).Conclusion Peritumoral SGR was an independent prognostic factor of patients with HCC following radical resection.The prognosis of patients with low SGR was better.

Prevention and treatment of rethrombosis with an implantable pump of the portal vein after liver transplantation / 中华肝胆外科杂志

Objective To study the feasibility and efficacy of prevention and treatment of rethrombosis with an implantable pump of the portal veinafter liver transplantation.Methods The clinical data of adult patients who underwent orthotopic liver transplantation from Feb.1999 to Dec.2007 were analyzed retrospectively.Results The 404 orthotopic liver transplantation (LT) patients were divided into three groups:PVT patients with an implantable pump (PVT + implantable pump,n =28),PVT patients without an implantable pump (PVT,n =20),and patients without pre-existing PVT (non-PVT,n =356).The following parameters in the 3 groups of patients were compared:(1) pre-operative parameters including baseline data of the donors,recipients,and duration of graft ischemia;(2) intra-operative and postoperative parameters including operative time,red blood cell and plasma transfusion,platelet concentrate transfusion,amount of bleeding,primary graft malfunction,and durations of hospitalization and intensive care unit (ICU) stay;and (3) follow-up data on patency of portal vein,rethrombosis rate,stenosis and reoperation (relaparotomy or retransplantation),in-hospital mortality,and actuarial one-year survival rate.Results among the 3 groups of recipients,there were no significant differences detected in the pre-operative and intra-operative parameters.However,when compared to PVT patients without an implantable pump,PVT patients with an implantable pump showed a remarkable reduction (P ＜ 0.05) in post-operative hospital stay [(21.7 ±8.9) vs.(26.5 ± 6.1)],rethrombosis rate (7.14％ vs.30％),reoperation rate (0 vs.25％),and in-hospital mortality (3.57％ vs.25％).Conclusions Patients with pre-existing PVT had a higher risk of rethrombosis following liver transplantation which was significantly prevented and/or treated with an implantable pump.Implantable pump placement should be considered for PVT patients undergoing liver transplantation.

The study of nomogram based on Ishak inflammation score for recurrence of hepatocellular carcinoma after curative resection / 中华外科杂志

Objective@#To investigate the correlation between Ishak inflammation score and the clinicopathological characteristics and recurrence of patients with hepatocellular carcinoma (HCC) after curative resection, and then set up a recurrence nomogram for HCC.@*Methods@#A total of 326 patients with HCC after curative resection from January 2006 to December 2009 were studied retrospectively as training cohort and 110 HCC patients after surgery from January 2010 to December 2012 were used as validation cohort.Clinical follow-up data and peritumoral Ishak inflammation score in training cohort were used to set up a nomogram predicting recurrence of HCC, which was verified by validation cohort. Kaplan-Meier and Cox proportional hazard regression model were used to analyzed accuracy of model prediction.@*Results@#According to Ishak inflammation score, patients were divided into four subgroups: Grade Ⅰ(1-4 scores), Grade Ⅱ(5-8 scores), Grade Ⅲ (9-12 scores) and Grade Ⅳ(13-18 scores). Ishak inflammation score were associated with aspartate transaminase(median 36.0 U/L, P=0.011), γ-glutamyl transpeptidase(median 54.5 U/L, P=0.005), HBV-DNA load(20.5%>106 copies/ml, P=0.015) and microvascular invasion(26.7% positive, P=0.021). Multivariate analysis showed that Ishak inflammation score(P=0.007), HBV-DNA load(P<0.01), tumor size(P=0.001) and microvascular invasion(P=0.001) were related with the recurrence of HCC patients.These four risk factors were incorporated into the nomogram.Calibration curves of the nomogram had good agreement between prediction and observation in the probability of recurrence.Both C-indexes and receiver operating characteristic curve analyses revealed that this nomogram had better predictive abilities than those of the AJCC and Barcelona Clinic Liver Cancer (BCLC) stage systems.These results were verified by the validation cohort.@*Conclusion@#A nomogram based on Ishak inflammation score could accurately predict the recurrence of HCC and contribute to HCC relapse surveillance after curative hepatectomy.

Clinical efficacy of ABO-incompatible living donor liver transplantation: a Meta analysis / 器官移植

Objective To systematically evaluate the clinical efficacy of ABO-incompatible living donor liver transplantation (ABO-I LDLT) and compare with ABO-compatible LDLT (ABO-C LDLT). Methods A systematic search of multiple databases at home and abroad was conducted to retrieve the literatures related to the statistical comparison of clinical efficacy between ABO-I LDLT and ABO-C LDLT. The literature screening was conducted, the quality of literatures was evaluated and data extraction was performed. Using Rev Man 5.3 software, a Meta-analysis was performed by random effect model or fixed effect model. Results A total of 432 articles were searched, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis demonstrated that there was no significant difference in the postoperative 1-, 3- and 5-year survival rate of the recipients and grafts and the incidence of rejection responses between the ABO-I LDLT and ABO-C LDLT groups (all P≥0.05). The incidence of postoperative biliary complications and hepatic artery embolization in the ABO-I LDLT group was significantly higher than that in the ABO-C LDLT group [odds ratio (OR)=2.08, 95% confidence interval (CI) 1.25-3.45, P=0.005; OR=2.24, 95%CI 1.03-4.89, P=0.04]. Conclusions Compared with the ABO-C LDLT, ABO-I LDLT yields lower clinical efficacy, whereas it is still an effective method for the treatment of end-stage liver disease.

Tumor cells supernatant promotes the healing of diabetic foot ulcers in mice through increasing the expression of VEGF-A, α-SMA and Vimentin / 中华内分泌外科杂志

Objective To investigate the effect of tumor cells supernatant on treatment of diabetic foot ulcer in mice and on the expression of VEGF-A,α-SMA and Vimentin.Methods A total of 45 male BALB/c mice were randomly divided into three groups:normal control group (group A),tumor cell supernatant treated group (group B),and diabetic control group (group C).Mouse models of type 2 diabetic foot ulcers were established in group B and group C.After the first day of modeling,group B were treated with tumor cells supernatant and the other two groups were injected with equal volume of medium.At the 1st,3rd and 7th day following model established,mouse ulcer area was observed in each group.The ulcer infection rate and mortality of mice were compared between each group.The ulcer tissue of each group was HE-stained and the expression of VEGF-A,α-SMA and Vimentin in each group was detected by immunohistochemistry (IHC).ELISA assay was used to detect the relative protein levels and stability in tumor cells supernatant.Results The healing degree in group A (66.7％) and group B(80.0％) was better than that in group C(33.3％) and the infection rate (group A=0,group B=7.1％) and mortality (group A=0,group B=6.7％) were significantly lower than those of group C (40.0％,33.3％),and the difference was statistically significant(P＜0.05).Compared with group C,HE staining showed that the healing time of group A and B was shorter than group C,and the epidermal coverage was more obvious.The expression levels of VEGF-A,α-SMA and Vimentin detected by IHC in group A and B were significantly higher than those in group C.ELISA results showed high-level and stable TGF-β expression in the tumor cells supernatant.Conclusion The tumor cells supernatant can effectively promote the healing of diabetic foot ulcers in mice and TGF-β,VEGF-A,α-SMA and Vimentin play a very important role in ulcers healing process.

Relationship between preoperative FIB-4 and hepatocellular carcinoma prognosis after curative resection / 中国肿瘤临床

Objective: To investigate the correlation between FIB-4 and the clinicopathological characteristics and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection. Methods: From January 2009 to December 2012, the clinicopathological and follow-up data of 245 patients with HCC after curative resection were retrospectively studied. Their survival was calculated using the Kaplan-Meier method. The Cox proportional hazard regression model was used for the multivariate analysis. Results: According to FIB-4 index, patients were divided into two subgroups: FIB-4Ⅰ(≤3.25) and FIB-4Ⅱ(>3.25). FIB-4 could predict liver cirrhosis severity (Ishak grade, Grade 1-5 vs. Grad 6, r=0.681, P<0.001). It was associated with liver function such as:aspartate transaminase (P<0.001)、total bilirubin (P=0.009)、albumin (P=0.001) and platelet count (P<0.001) other than tumor clinicopathologic features. Both univariate and multivariate analysis showed FIB-4 could predict the prognosis of HCC patients (Overall survival: P=0.037 and 0.011; Recurrencefree survival: P=0.027 and P=0.043, respectively). Conclusion: The preoperative FIB-4 index could be used as a prognostic marker for the prognosis of HCC after curative hepatectomy.

Diagnosis and treatment of early portal vein thrombosis after liver transplantation and research progress / 中国综合临床

Early portal vein thrombosis is a rare but serious complication after liver transplantation,also is one of the main causes which lead to graft loss and receptor death. We collected domestic and foreign relevant data,and summarized and discussed the causes, clinical manifestation, imaging diagnosis of early portal vein thrombosis after liver transplantation. Early portal vein thrombosis after liver transplantation caused by multiple risk factors synergy. It was reported incidence of 1% to 2%. Clinical manifestations were concealment and lacked of specificity. Abdominal ultrasound and computed tomography angiography ( CTA) imaging methods of combi?ning could help early clinical findings,When necessary magnetic resonance angiography( MRA) . If each check negative,portal vein angiography could make a definitive diagnosis. Intravascular interventional therapy with small trauma, less complications and high success rate for advantages gradually became first?line treat?ments. Surgical treatment is not only as traditional effective treatments,but also an effective remedial measures after interventional treatment failure.

Research advances in diagnosis and treatment of adult hepatoblastoma / 临床肝胆病杂志

Adult hepatoblastoma is extremely rare in clinical practice, and its pathogenesis is unknown. At present, there is a lack of understanding of this disease, and therefore clinical misdiagnosis is common. This review introduces the pathogenesis, clinical manifestations, and radiological and pathological characteristics of hepatoblastoma, focuses on the choice of treatment for adult hepatoblastoma, and explains briefly the latest research progress in biological therapy. Comparison of different treatments suggests that comprehensive treatment based on radical resection is still the best choice. However, the curative effect is poor since the disease is highly malignant and its treatment experience is insufficient. The newly reported target for biological therapy may represent a breakthrough for the treatment of the disease, but its clinical efficacy remains to be evaluated. The pathogenesis of the disease in adults and children has not been confirmed as the same, and the review indicates that further clinical research is still needed.

Progress of radiotherapy for hilar cholangiocarcinoma / 国际肿瘤学杂志

The rate of complete surgical resection is still low in hilar cholangiocarcinoma,which greatly affects the curative effect.Radiotherapy,one kind of treatment for tumors,has not been widely adopted in the past years.In recent years,with the development of radiotherapy technology,research of treating hilar cholangiocarcinoma through radiotherapy has become a spot.Many studies have shown that radiotherapy,as an adjuvant therapy for surgery and non-surgical treatment,can be the major means for treatment,and it could bring benefit for patients' survival extension and improvement of life quality.

Diagnosis and treatment of complex retroperitoneal ganglioneuroma / 中华消化外科杂志

Retmperitoneal ganglioneuroma is a rare neurogenic benign tumor.The prognosis of patients was good when the tumor was completely resected,while the surgical procedure is complicated.In March of 2013,a male patient with complex retroperitoneal ganglioneuroma was treated at the First Affiliated Hospital of Chongqing Medical University.A hypoechoic solid lesion (size,6.5 cm ×4.5 cm) adjacent to the head of the pancreas was detected by color Doppler ultra-sonography 9 months ago,and no any other clinical symptoms were detected.Perioperative abdominal computed tomography and the surgery confirmed that the tumor (size,8.5 cm × 7.5 cm × 4.5 cm) was located beneath the pancreas,encompassing thc ccliac artery,hepatic artery,splenic artery and superior mesenteric artery,surrounding the head and uncinate process of the pancreas,making it impossible to be separated.The tumor was closely connected with the portal vein,superior mesenteric vein,splenic vein and left renal vein.The tumor was separated from the major blood vessels,the body and tail of the pancreas,while the tumor could not be resected from the pancreatic head,and thus tumor resection and pancreaticoduodenectomy were performed.The surgery was extremely diffcult,but the complete removal of tumor was successfully achieved without excision of the major blood vessels and the patient recovered well.

Effect of different warm ischemic time on islet isolation and function in pigs / 中华内分泌外科杂志

Objective To study the effect of different warm-ischemia time on islet structure, yield and function. Methods Adult pigs were studied, and according to warm ischemic time (WIT, 0, 10, 20, 30, 45 min), the porcine pancreata were divided into 5 groups (A, B, C, D, and E group). The isolation of adult porcine pancreas was carried out by injection of Hanks into pancreatic duct and digestion with collagenase Ⅴ and Ⅰ. A discontinuous Ficoll 400 solution was applied for purifying islets. The structure, purity and viability of islets were determined by dithizone staining and AO/PI staining, and the function of islets was evaluated by the glucose stimulating insulin release test. Results There were little islets debris in group A, B and C. But it was very difficult to obtain integrate islets in group E. There was no significant difference between the groups of 0, 10 and 20 min in islet number before and after islet purification ( P ＞ 0.05 ), while the difference was significant when warm ischemic time was prolonged to 30 min and 45 min ( P ＜ 0. 01 ). In respect of islet function, the similar results were found in different groups. Conclusions When WIT is within 20 min, there is no deleterious effects on islet morphology and yield as well as function. However, when WIT is prolonged to 30 min, the loss in islet yield is severe, and the islet function is significantly impacted.

Multidisciplinary treatment for renal cell carcinoma involving inferior vena cava / 中华泌尿外科杂志

Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.

Early risk predict markers of prognosis in sever acute pancreatitis / 中华内分泌外科杂志

Objective Analysis of early risk predict markers within 24h after admission of prognosis in severe acute pancreatitis (SAP). Methods Medical records of 127 patients with sever acute pancreatitis admitted to our hospital within 72h after onset from February 2006 to July 2009 were retrospectively analyzed. These inpatients were grouped into survival group (102 cases) and death group (25 cases). The clinical and laboratory data within 24h after admission were compared between two groups. Results Compared with survival group, patients in death group had significantly difference in heart rate, respiratory, PaO2, pH value, serum calcium, serum kalium, serum creatine, BUN, BE, LDH, serum albumin and APCHE Ⅱscores (P<0.05). Higher APCHE Ⅱ scores after admission was an independent early high risk predicator of death. Conclusions Death group was characterized as severe multiple organ dysfunction and severe internal disturbance. Heart rate, respiratory, PaO2, pH value, serum calcium, serum potassium, serum creatine, BUN, BE, LDH, serum albumin and APCHE Ⅱ scores were early risk predict markers of death in patients with sever acute pancreatitis.

Clinical analysis of real -time ultrasound-guided percutaneous radiofrequency ablation and surgical resection for adult hepatic haemangioma / 中国现代普通外科进展

Objectives: To investigate the feasibility, safety, indication, and clinical effect of real-time ultrasound-guided percutaneous radiofrequency ablation and surgical resection for adult hepatic haemangioma. Methods: The clinical data of real-time ultrasound- guided percutaneous radiofrequency ablation and partial hepatectomy for 79 patients with adult hepatic haemangioma between July, 2005 and June 2008 were retrospectively analyzed. Results: The real-time ultra-sound-guided percutaneous radiofrequency ablation was safely carried out in 18 lesions of 11 patients with hepatic haemangioma. The Surgical resections were done for 68 patients. The surgical procedures were safely carried out in all 79 cases of adult hepatic haemangioma. No one died after operations. The average operation time were(67.2?23.2)min and(108.4?26.3)min in percutaneous radiofrequency ablation group(PRFA)and surgical resection group(SR)respectively(P

Analysis on early diagnosis and treatment of 276 cases with acute appendicitis in elderly / 中国基层医药

Objective To investigate early diagnosis, clinical effect of surgical treatment and prognosis of a-cute appendicitis in elderly. Methods The clinical data of acute appendicitis in elderly undergoing surgical therapy between January 1994 and November 2008 was analyzed retrospectively, and predisposing factors, diagnostic meth-ods, therapeutic effect of operation and prognosis were studied. Results Acute appendicitis in elderly was diagnosed in 276 cases(114 female/162 male). There were 7 cases of deaths. MoRality was 2.5% (7/276). Stitches were taken out from 6 to 8 days after operation. Average stay was 8 days. 196 cases(71.0%) of wound healing at grade A, 43 cases(15.6%) at grade B ,37 cases(13.4%) at grade C. 86 cases(31.2%) with perforated acute appendici-tis, and 7 cases(2.5%) with periappendiceal abscess were confirmed after operation. 76 cases auompanied with con-comitant diseases, 87 cases auompanied with postoperative early complications, and 39 cases(14.1%) with postop-erative wound or intra-abdominal septic complications. Conclusion Key point of improvement of operative therapeu-tic effect and prognosis of acute appendicitis in elderly are early diagnosis, operation in time, and effective treatment of associated diseases and complications.

The Analysis about Etiopathogenisis, Diagnosis and Treatment of The Aged with Bowel Obstruction / 中国基层医药

Objective To analyze etiopathogenisis, diagnosis and treatment of the aged with bowel obstruction. Methods The clinical data of 168 cases with bowel obstruction, whose age were more than 60 years,in our hospital from 1998 to 2007 were reviewed retrospectivly. Results In all the cases,32 patients' original disease were abdomenal hernia,6 patients were mesenteric vascular thrombus,75 patients were bowel tumor, 12 patients were feces,18 patients were false colonic obstruction and 25 patients were ankylenteron. 114 cases (67.68%) received operation,43 patients (25.59%) received expectant treatment and 11cases received colonofiberscope therapy. 138 cases (81.55%) were cured without any complication. 25 cases(14. 88%) had this or that kind of complication. 5 cases (2. 98%) were dead. Conclusion Firstly, the regular original disease of the aged with bowel obstruction were bowel tumor. Secondly,most elderly patients with bowie obstruct should be cured after operations. Thirdly,the aged with bowel obstruction would have higher complication rate,which should attract our enough attention.

Cytokeratin 19 and pancreas stem cells / 中国组织工程研究

BACKGROUND: To synthetically analyze the correlation between cytokeratin 19 and pancreas stem cells.DATA SOURCES:References about the correlation between cytokeratin 19 and pancreas stem cells were retrieved in Medline and Ovid database with the key words of "cytokeratin, pancreas, stem cells, marker, differentiation" in English from January 2000 to May 2006.STUDY SELECTION:Literatures about the correlation between cytokeratin 19 and pancreas stem cells were retrieved and those characterized by strong pertinency, published in the near future and selected from authoritative journals were selected in this paper.DATA EXTRACTION: Among 86 articles, 35 of them met the inclusion criteria and 51 were excluded.DATA SYNTHESIS:Pancreas stem cells are characterized by multi-directional differentiation.Cytokeratin 19 has a positive expression in pancreas stem cells and a molecular sign of pancreas stem cells. This provides a new way to further understand bionomics of pancreas stem cells,study separation,purification,transconformation and direction differentiation to islet cells, and treat diabetes mellitus with transplantation of pancreas stem cells.CONCLUSION: Expression of cytokeratin 19 is observed during the differentiation of pancreas stem cells and cytokeratin19 is a sign of pancreas stem cells.

Expression of cytokeratin-19 as a stem cell marker in different-purity islet samples of rats / 中国组织工程研究

BACKGROUND: Pancreatic stem cells can be differentiated into endocrine functioning cells under a suitable cultivation condition, suggesting that pancreatic stem cells can be used as a new source of islet in treating diabetes mellitus.OBJECTIVE: To discuss the expression of stem cell in different purities of pancreatic islets.DESING: A controlled observation based on cells.SETTING: Third People's Hospital of Mianyang City.MATERIALS: The experiment was conducted in the Center Laboratory (Key Laboratory of Chongqing City), the First Affiliated Hospital of Chongqing Medical University from March 2005 to March 2006. Thirty healthy male SD rats, of clean grade, aged 50 days were used in this study. During the experiment, the disposal of animals corresponded to Animal Ethical Standard. Cytokeratin (CK)-19 and β-actin were designed by Shanghai Invitrogen Biological Co., Ltd.Brdu reagent, mouse anti-rat Brdu monoclonal antibody, rabbit anti-mouse (RAM) CK-19 polyclonal antibody and Brdu immunohistochemical kit were from Boster Co., Ltd. (Wuhan); HistostainTM -DS double immunohistochemical staining kit was purchased from Beijing Zhongshan Company.METHODS: Rats were intraperitoneally injected with Brdu for labeling, and subjected to perfusion with Ⅴ-type collagenase via pancreatic ducts, with pancreas being excised, ripped, beaten up, digested and centrifuged to obtain pancreatic islet sediments. After being precipitated, the sediments were divided into 3 groups. Group A: The isolated sediments of islets were not purified; Group B: The sediments were added slowly with 25% Ficoll-400 and Hanks solution for purification; Group C: The sediments were slowly added with 25% Ficoll-400, 11% Ficoll-400 for purification in order.MAIN OUTCOME MEASURES: Expressions of Brdu and CK-19-positive cells in the islet samples were detected by immunohistochemical method, and mRNA expression of CK-19 in the different purities of islets was detected by reverse transcription-polymerase chain reaction.RESULTS: ① The purity of islets in the group A was the lowest. The purity of islets obtained by different purification techniques showed significances among the three groups (F =89.42, P ＜ 0.05). ②Positive expressions of Brdu and CK-19 in the group A were significantly higher than those in the group B and group C (F =18.64, 22.12, 38.61. P ＜0.01). ③Expression of CK-19 mRNA in the group A was significantly higher than that in other groups, with group C showing the lowest.CONCLUSION: Expressions of Brdu and CK-19-positive cells exist in different purities of islets, suggesting the existence of more stem cells in the low purify of islets.

Laparoscopic splenectomy by dissecting in situ secondary braches of splenic pedicle for idiopathic thrombocytopenic purpura:report of 41 patients / 第三军医大学学报

Objective To evaluate the feasibility and clinical efficacy of amputation in situ secondary braches of splenic pedicle for laparoscopic splenectomy(LS)in patients of idiopathic thrombocytopenic purpura(ITP).Methods LS was performed in 41 ITP patients hospitalized in our department from January 2007 to November 2008 by dissecting secondary braches of splenic pedicle.The serosa on the spleen pedicle was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from downward to upward,and then double ligated with the Hem-O-lok clips.The ligated section was cut off with the harmonic scalpe1,and then the spleen was resected.Results LS was successfully completed with no conversion to open surgery in all the 41 cases.The operative time was 75 to 180 min,and the estimated intra-operative blood loss was 50 to 800 ml.There were 3 cases of vice spleen and the vice spleen removed.Two cases were converted to traditional LS with Endo-GIA.The period of hospitalization was 4 to 9 d after operation.There was no severe postoperative complication.Platelet counts began to increase significantly after operation,reached to the peak in 5 to 7 d after operation.During the follow-up of 3 to 20 months to all 41 ITP patients,the total effective rate was 85.4%(35/41,including 22 cases of complete response and 13 cases of partial response).Conclusion LS with amputation in situ secondary braches of splenic pedicle is a safe,effective,minimally invasive and low complication in treatment of ITP.It is worth be recommended because of its lower costs in comparison with common LS.