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Background/objective: Choledochal cysts are congenital dilations of the biliary tree. The accepted mode of treatment is total excision with hepaticojejunostomy. In this retrospective study, we present our technique and results of laparoscopic choledochal cyst excisions., Methods: We retrospectively studied 45 patients who had undergone laparoscopic choledochal cyst excision in our institutes from September 2006 to August 2009. Data including age, gender, type of cyst, symptoms, surgical technique, conversion rate, morbidity, and mortality were analyzed., Results: There were type Ic (cystic) choledochal cysts in 31 patients (68.9%) and type If (fusiform) in 14 patients (31.1%). An anomalous pancreaticobiliary duct junction union was found in 66.7%. Forty percent (18 out of 45) and 37.8% (17 out of 45) cases had stones within the cysts and gallbladders, respectively. The average size of the cysts was 40.3 +/- 16.9 cm(2). The mean operative time was 307.7 +/- 58.0 min, the estimated operative blood loss was 252.3 +/- 162.5 ml, and the conversion rate was 8.9%. The mean hospital stay was 8.3 +/- 3.2 days. The overall morbidity rate was 17.1%, the reoperation rate was zero, and the mortality rate was also zero., Conclusions: Totally, laparoscopic management of type I choledochal cysts, although technically challenging, is safe and feasible in experienced hands.

Purpose: Mucin-producing intrahepatic biliary papillomatosis (MPIBP) is an uncommon tumor. The purpose of this study was to evaluate the clinical, radiological, and histopathological characteristics of MPIBP, and its prognosis., Methods: A retrospective analysis was conducted of 11 patients who underwent surgery for MPIBP. The clinical features and radiological, pathological, and operative findings were reviewed, and the survival rates were determined., Results: Repeated episodes of fever and epigastric pain with or without jaundice were the common clinical manifestations. Radiologically, all patients showed diffuse bile duct dilatation with cystic change in intrahepatic bile duct. All patients underwent a hepatic resection with or without an extrahepatic bile duct resection. No in-hospital mortality occurred. All patients survived without any signs of recurrence (median 12 +/- 7 months); three patients, including two patients who underwent a palliative resection, had an attack of cholangitis, which was effectively treated with antibiotics., Conclusions: A diagnosis of MPIBP is usually made in patients with biliary dilatation following a radiologic study. Magnetic resonance cholangiopancreatography is more valuable than other modalities in diagnosis. Mucin-producing intrahepatic biliary papillomatosis is a premalignant disease with high malignant potential. The prognosis of MPIBP is excellent if an aggressive resection is performed. A combination of cholangioscopy and frozen sections during the operation is beneficial for a radical successful surgical resection.

During hind limb unloading (HU), the soleus is often in a shortened position and the natural physiological stimulus of muscle spindles is altered, such that muscle spindle activity also changes. Using isolated spindle conditions, the present study investigates the electrophysiological activity and ultrastructure of muscle spindles following HU. Results show that muscle spindle discharges fall into either of two main patterns, single spikes or spike clusters in shortened positions, with a steady frequency of 18-38 spikes/s (mean 29.08 +/- 2.45) in an extended position. Following 14-day HU, afferent discharge activity was significantly altered in soleus muscle spindles. Duration of individual spikes was significantly prolonged, from 0.54 +/- 0.05 ms for control rats to 1.53 +/- 0.25 ms for rats in the HU group. In a shortened position, regular rhythm afferent discharges were obviously depressed, and the majority of muscle spindles became silent, while in an extended position, the discharges remained continuous but with decreased frequency. Results also show that the ultrastructure of muscle spindles experience degenerative changes during HU. Altered muscle spindle afference could possibly modify the activity of motor neurons and further affect the activity of extrafusal fibers.

Background/aim: Optimization of quality of life is an important goal in the management of patients with unresectable peri-ampullary cancer. Herein, we share our two cases to demonstrate the feasibility of scarless transumbilical single-incision laparoscopic cholecystojejunostomy using conventional instruments in the management of unresectable peri-ampullary cancer., Cases and Methods: Two 58-year-old patients (one male) underwent transumbilical single-incision laparoscopic cholecystojejunostomies: The male and female patients were diagnosed with duodenal papillary carcinoma and pancreatic cancer, respectively. The hepatocystic junction was confirmed patent preoperatively in both patients. A 2-cm periumbilical incision was made for the placement of three trocars. Conventional rigid laparoscopic instruments were solely used throughout the procedure, and operative techniques were carried out in the same fashion as for conventional laparoscopic cholecystojejunostomy., Results: The procedures were completed uneventfully in 190 and 155 min, respectively, with no complications, and the blood loss was estimated at 80 and 20 ml, respectively. Postoperative pain scores on postoperative day 1 were 4/10 and 3/10. The patients were discharged from the hospital on postoperative days 3 and 5 with resolving jaundice., Conclusions: Transumbilical single-incision laparoscopic cholecystojejunostomy appears to be a technically feasible alternative to standard laparoscopic procedure and can be performed using conventional laparoscopic instruments.

Objectives: To present our operative and postoperative functional outcomes of sutured compared with endovascular staple ligation of the dorsal venous complex (DVC) during robot-assisted laparoscopic radical prostatectomy (RALP). Ligation of the DVC during RALP with an endovascular stapler has purported advantages of decreased apical positive surgical margin (PSM) rate, blood loss, and operative time when compared with suture ligation., Patients and Methods: In all, 162 patients who underwent RALP between October 2005 and April 2008 by one surgeon (R.B.N.) were assessed. We retrospectively analysed two different treatment groups: group 1 underwent DVC ligation with a single suture, while group 2 underwent endovascular staple ligation., Results: Of the 162 patients evaluated, 67 had suture ligation (group 1) and 95 had staple ligation (group 2) of the DVC. Baseline patient characteristics (age, body mass index, biopsy Gleason score, clinical stage) and tumour characteristics (specimen weight, tumour volume, pathological Gleason score and stage) did not differ between the groups. Estimated blood loss (494 mL vs 288 mL), time to dissect out, ligate and transect the DVC (30 min vs 24 min), apical PSM rate (13.4% vs 2.1%) differed significantly between groups 1 and 2 respectively, favouring staple ligation of the DVC. At 6 months follow-up, there was no difference between the groups for PSA recurrence (3.7% vs 0%), complete continence (63.4% vs 55.7%) and Sexual Health Inventory for Men score (8.4 vs 8.6)., Conclusions: In the present study, staple ligation of the DVC during RALP resulted in improved apical PSM rates, faster operative times and less blood loss.

Objectives: Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy (LPN) may allow for improved hemostasis without need for renal hilar vessel clamping and elimination of warm ischemia to the kidney. We compare outcomes in patients undergoing radiofrequency ablation-assisted robotic clampless partial nephrectomy (RF-RCPN) and LPN., Methods: Thirty-six patients and 42 patients underwent LPN and RF-RCPN, respectively. In the RF-RCPN group, the Habib 4x RFA device was used to coagulate a margin of normal parenchyma around the renal mass to allow excision of the mass within a bloodless plane. Unlike in the LPN group, renal hilar vascular occlusion was not performed in the RF-RCPN group., Results: Tumors treated in the RF-RCPN group tended to be larger (2.8 vs. 2.0 cm) and more often endophytic (52.6% vs. 16.1%). Collecting system reconstruction occurred more often in the RF-RCPN group (78.6% vs. 30.6%). Operative duration was longer in the RF-RCPN group (373 vs. 250 minutes), but this included time for cystoscopy, ureteral stenting, and repositioning of the patient. Blood loss, transfusion rates, renal function, and complication rates did not differ between the two groups. No patients required renal hilar vessel clamping or nephrectomy to control bleeding in the RF-RCPN group., Conclusions: The use of RFA-assistance during robotic partial nephrectomy allows excision of renal tumors without hilar vascular clamping, thus eliminating renal warm ischemia. Larger and more centrally located tumors were excised with RF-RCPN. No differences in blood loss, complication rate, postoperative bleeding, renal function, or recurrence rate were noted compared with LPN.

Background: This study was designed to review the experience of this department with the treatment of post-common bile duct exploration residual stones using choledochoscopy and to analyze the complications of choledochoscopy and explore effective methods of prevention., Methods: A choledochoscope (PENTAX fibercholedochoscope and electronic choledochoscope PENTAX ECN-1530) was used. A total of 2,882 postoperative percutaneous choledochoscopy (POC) sessions were performed on 986 patients with residual bile duct stones from 1980 to 2008 (408 men, 578 women; ages range, 21-82 years). Forty-five of these had undergone laparoscopic common bile duct exploration (LCBDE); the rest had open bile duct exploration. Seventy-six participants had choledochoscopy examination (for diagnosis only), and in 910 patients it was performed for both diagnosis and therapy (calculi extraction). In 68 cases, plasma shock wave lithotripsy (PSWL) was performed for larger stones before choledochoscopy extraction., Results: The mean duration of choledochoscopy was 25 min (range, 10 min to 2 h), with a mean frequency of 2.85 times (range, 1-11). No mortalities occurred. The procedure was unsuccessful in 28 cases in which stones were not accessible because they were embedded in distal hepatic ducts or because they were in proximal ducts that were severely stenosed. Complications resulted in 13 cases and included perforated sinus, biliary peritonitis, sinus hypoplasia, destruction of the T-tube system leading to obstruction, basket incarceration, bleeding, and intestinal fistular. Choledochoscopic stone clearance was achieved in 95.5% of the cases., Conclusions: Choledochoscopy is an important treatment option for hepatolithus. It has a high efficiency for stone extraction and fewer complications. However, it should be noted that some of its complications are potentially life-threatening.

Aim: To evaluate the efficacy of 6 noninvasive liver fibrosis models and to identify the most valuable model for the prediction of liver fibrosis stage in chronic hepatitis B (CHB) patients., Methods: Seventy-eight CHB patients were consecutively enrolled in this study. Liver biopsy was performed and blood serum was obtained at admission. Histological diagnosis was made according to the METAVIR system. Significant fibrosis was defined as stage score > or = 2, severe fibrosis as stage score > or = 3. The diagnostic accuracy of 6 noninvasive liver fibrosis models, including serum aspartate aminotransferase (AST) to platelet ratio index (APRI), FIB-4, Forn's index, Fibrometer, Hepascore, and Shanghai Liver Fibrosis Group's index (SLFG), was investigated., Results: The APRI, FIB-4 and Forn's index under receiver operating characteristic curve (AUROC) for significant fibrosis were 0.71, 0.75 and 0.79, respectively, with a diagnosis accuracy of 67%, 77% and 80%, respectively, and 0.80, 0.87 and 0.86, respectively, under the AUROC for severe fibrosis. The Hepascore, SLFG, and Fibrometer were 0.80, 0.83 and 0.85, respectively under the AUROC for significant fibrosis (P < 0.01). The diagnosis accuracy of Hepascore and SLFG was 86% and 88%, respectively. The Hepascore, SLFG, and Fibrometer were 0.95, 0.93, and 0.94, respectively, under the AUROC for severe fibrosis (P < 0.01)., Conclusion: The models containing direct serum markers have a better diagnostic value than those not containing direct serum markers.

Objectives: Approximation of the bladder to urethra during robot-assisted laparoscopic prostatectomy (RALP) is a critical step toward achieving long-term continence. To determine the impact on surgical outcomes after RALP, we compare two techniques for constructing the vesicourethral anastomosis., Methods: One hundred fifty-four men underwent RALP by one surgeon between 2005 and 2007. The vesicourethral anastomosis was performed in a standard Van Velthoven fashion for the first 61 patients. The anastomosis in the remaining 93 patients was performed in a running fashion with the sutures under continuous tension applied by the surgical assistant and the third robotic arm. Operative times and surgical outcomes were recorded prospectively., Results: When comparing standard Van Velthoven to continuous tension anastomosis, we demonstrate equivalent oncologic outcomes, continence and time required for the anastomosis. Yet, the frequency of complications related to the anastomotic technique, such as urine leaks, bladder neck contractures and migrated hemo-lock clips, were significantly lower with the continuous tension technique compared to the standard Van Velthoven running anastomosis., Conclusions: Performing the vesicourethral anastomosis under continuous tension demonstrated improved outcomes compared to the Van Velthoven anastomosis by allowing persistent close apposition of the bladder to urethra. Additionally, the learning curve associated with implementation of a new anastomotic technique was negligible.

Introduction: Weck Hem-o-Lok clip migration into the bladder has been reported after robot-assisted laparoscopic radical prostatectomy (RALP). We report a case of Weck clip migration into the rectum presenting as a mass on colonoscopy., Methods: A 61-year-old male with a prostate specific antigen level of 4.84 ng/ml underwent transrectal ultrasound guided biopsy of the prostate revealing a Gleason's 3 + 3 adenocarcinoma of the prostate involving 20% of the sampled tissue for the left apex. He was subsequently treated with a transperitoneal robot-assisted laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy. Weck Hem-o-Lok clips were used to ligate the prostate vascular pedicles. The vesicourethral anastomosis was performed using a double armed running technique., Results: Final pathology demonstrated a Gleason 4 + 3 pT2cN0Mx adenocarcinoma of the prostate with negative margins. Four lymph nodes were negative for malignancy. No intraoperative complications occurred. Postoperatively, patient was found to have a Weck Hem-o-Lok clip that migrated into his rectum. This was found on colonoscopy performed for diverticular disease of the colon. The clip was removed without complication., Conclusions: Judicious use of Weck clips during RALP and communication with physicians participating in patient care for those who have undergone RALP is crucial in minimizing complications and avoiding subsequent procedures.

Background: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases., Methods: An oral radionuclide 99mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases., Results: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (P<0.001). The amylase and trypsin-1 tests also showed consistency in diagnosing pancreaticobiliary reflux (P<0.001). Amylase and lipase levels within gall and ductal bile were strongly correlated (P<0.05). In the common bile duct pigment stone group, the EK and trypsin-1 positive rates were found to be insignificant (P>0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (P<0.05)., Conclusions: Western blotting can accurately reflect duodenal-biliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.

Background and Purpose: Obesity is associated with adverse outcomes with certain urologic procedures and may make patient positioning more difficult. We describe our technique of awake intubation and prone patient self-positioning before percutaneous nephrolithotomy (PCNL), and review the literature regarding prone positioning in obese patients and the impact of obesity on PCNL., Methods: Patient preparation begins with detailed preoperative counseling regarding the procedure. Premedication with a sedative and antisialagogue is followed by airway topicalization to suppress gag reflex and pain. Fiberoptic bronchoscope intubation is then carried out. The patient then positions himself/herself comfortably before induction of general anesthesia., Results: We have successfully performed awake intubation and patient prone self-positioning followed by PCNL, most recently in a 58-year-old (body mass index 51.3 kg/m(2)) man with a history of gastric bypass, diabetes mellitus, and hypertension, without added morbidity. Adverse effect on patient cardiopulmonary dynamics can be minimized in the prone position., Conclusions: The technique of awake intubation with prone patient self-positioning can be helpful for positioning morbidly obese patients before PCNL and has been safe and effective in properly selected patients. Efficacy of PCNL should not be impacted by obesity or prone positioning and morbidity minimized provided that surgical and anesthesia teams understand and safeguard against potential complications.

Objective: To investigate the effect of the exposure to di- (2-ethylhexyl) phthalate (DEHP) during pregnancy on the DNA methylation level of genomes in the testis of the offspring in mice., Methods: Pregnant KM mice were randomly divided into three groups, normal control, corn oil and DEHP-exposed. Corn oil and DEHP (500 mg/[kg x d]) were administrated respectively from gestation day 12.5 (GD 12.5) to postnatal day 3 (PND 3). The testes of the offspring were excised on PND 7, and their genomic DNA was treated with EcoR I /Msp I and EcoR I /Hpa II. The genome-wide DNA methylation patterns of the CCGG sites were detected by methylation-sensitive amplification polymorphism (MSAP). The samples were electrophoresed in the ABI 3730 DNA sequencer and the results analyzed by the Genescan3.1., Results: The average incidence of DNA methylation was (34.03 +/- 3.05)% in the DEHP-exposed mice, obviously higher than (28.37 +/- 2.37)% in the normal control and (28.58 2.45)% in the corn oil group, with statistically significant differences (P < 0.05)., Conclusion: Exposure to DEHP during pregnancy increases the DNA methylation level of the genome in the testis of the offspring and affects the apparent genetic modification of the genome, which may be one of the important toxicological causes of the lesion in the reproductive system.

Objectives: Despite nearly equivalent outcomes between open and robot-assisted laparoscopic prostatectomy (RALP) for organ-confined prostate cancer (PCa), the role of primary treatment with RALP in men with locally advanced (T3 or greater) PCa has not been described in detail. We report our experience with RALP for pathologically advanced disease., Patients and Methods: From October 2005 to November 2008, 220 RALPs were performed by a single surgeon (R.B.N.). Outcomes were assessed prospectively in an institutional review board-approved database., Results: Of 220 RALPs, 35 (15.9%) were performed for pT3 PCa; none of them were identified preoperatively. There was no difference in operative time compared with patients with pT2 disease (271 vs. 295 minutes, p = 0.09). The positive surgical margin (PSM) rate was 20% compared with 4.9% for pT2 (p = 0.004). Sural nerve grafts were performed in 20%, and 57% had bilateral nerve sparing. The use of bilateral or unilateral nerve sparing was not associated with increased PSM (p = 0.85). Biochemical recurrence occurred in 28.6% of men with pT3 disease over an average of 13 months of follow-up time, 30% of which occurred in men with a PSM. At 6 months, an 85% continence rate was achieved, and at 1 year continence was 100% for pT3. Compared with pT2, men with advanced disease had similar recovery after RALP based on postsurgery questionnaires., Conclusions: RALP is a feasible approach to patients with pathologically advanced PCa as 71% were without evidence of disease at 13 months postoperatively. PSM rate (20%) is comparable to previously reported open PSM rates (24-66%).

Introduction and Objective: Specimen morcellation during laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) is controversial. We seek to evaluate the safety and efficacy of specimen morcellation and LRN for treatment of presumed malignant renal lesions., Methods: We retrospectively reviewed all patients who underwent LRN at three academic institutions from 1996 to 2007. One hundred eighty-eight patients underwent specimen morcellation after LRN for enhancing solid or cystic renal masses., Results: LRN was successfully performed on all the patients. Patient age ranged from 36 to 94. One hundred sixty-seven patients were in clinical stage T1, 19 patients T2, and unknown in two. The specimen was manually morcellated within a Cook Lap Sac or Endocatch II bag under laparoscopic or direct observation. On histological review of morcellated specimens, 165 patients were confirmed to have RCC, 17 had an oncocytoma, and 2 had benign cysts. At least 13 patients with RCC were pathologically upgraded to stage T3. Mean operative time was 225 minutes (range 94-650). Mean hospital stay was 2.5 days (range 1-8). In patients with RCC, 11 developed recurrent disease with mean follow-up of 21 months (range 0.3-111). In one patient, a port site recurrence occurred in concert with renal fossa and lymph node metastases., Conclusions: Intracorporeal mechanical morcellation after LRN appears to be safe and effective in clinical stage T1 and T2 RCC. This supports the use of morcellation as an alternative for intact specimen removal in properly selected patients.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) has been shown to induce cleft palate, in which the molecular etiology of the defect is poorly characterized. Recently, transforming growth factor-beta3 (TGF-beta3) has been indicated to play an essential role in the development of palatal shelves. In this developmental toxicity study, we investigated the effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) on the expression of TGF-beta3 in fetal mice. Pregnant C57BL/6 mice were exposed to corn oil or TCDD (32 microg/kg/day 64 microg/kg/day, per os) at embryonic day 10 (ED10), a drastic inhibition of palatal shelves was induced. By using RT-PCR (reverse transcription-polymerase chain reaction) and Western blot, the expressions of TGF-beta3 was investigated. We found that the expression of TGF-beta3 was gradually up-regulated in TCDD-treated group. These results suggest that cleft palate can be induced by TCDD exposure, the modification of TGF-beta3 is related to its pathogenesis.

Objective: To determine Th1/Th2 cytokines and chemokines in patients with allergic diseases and its clinic significance., Methods: Serum levels of IFN-gamma, IL-4, IL-5, IL-13, Eotaxin, RANTES and LTB4 were determined from peripheral blood of 64 allergic patients and 21 healthy controls with ELISA., Results: IL-4, IL-5, IL-13 and Eotaxin, LTB4 were increased significantly in serum of allergic patients compared with those of controls (P<0.05). There were no significant differences in serum levels of IFN-gamma and RANTES between patients and controls (P>0.05). Serum levels of IL-4, IL-5, IL-13 and LTB4 were correlated with each other (P<0.01). Eotaxin, RANTES and IFN-gamma levels were also significantly correlated with each other (P<0.05). LTB4 was correlated with Eotaxin as well (P<0.01)., Conclusion: A wide range of cytokines and chemokines is involved in allergic diseases,which may play their roles in a complex interactive manner.

Objective: To explore the effects of Di (2-ethylhexyl) phthalate (DEHP) on the testis and testicular gubernaculum of fetal KM mice in vivo and to investigate the mechanism of DEHP-induced cryptorchidism., Methods: Thirty healthy pregnant KM mice were randomly and equally divided into a blank control group, a corn oil control group and a DEHP group. The pregnant mice in the latter group were exposed to DEHP by gavage at the dose of 500 mg/kg body weight per day from gestation day 12 (GD12) through gestation day 19 (GD19). The effects of DEHP were observed on the number of fetuses per pregnancy, the ratio of male to female pups, the weight of the testis, the morphology and location of the testis and gubernaculum, the relative testis-bladder neck distance (TBD) and cranial suspensory ligament (CSL) residual. The expressions of the androgen receptor (AR), estrogen receptor (ER) and actin and proliferating cell nuclear antigen (PCNA) in the gubernaculum were detected by immunohistochemistry., Results: DEHP reduced the testis weight and TBD, induced different degrees of testis maldescent, but produced no obvious effect on the body weight, the number of fetuses per pregnancy, the sex ratio and the testis gubernacular morphology. Under the light microscope, hypotrophy was seen in all the testis seminiferous tubules, spermatogenic cells and Sertoli cells, marked Leydig cell hyperplasia was noted, and the positive expression of AR in the gubernaculum was decreased in the DEHP group (P < 0.01)., Conclusion: DEHP could cause dysfunction of the testis gubernaculum via its anti-androgen effect, induce cryptorchidism, and cause dysplasia and dysfunction of Sertoli cells, Leydig cells and spermatogenic cells in fetal mice.

Purpose: Experience and advances in laparoscopic techniques have made laparoscopic subtotal cholecystectomy (LSTC) a feasible option even in complex procedures. We report our experience of performing LSTC in the management of complicated cholecystitis., Methods: Among 1558 patients scheduled to undergo laparoscopic cholecystectomy (LC) in our institute between July 2004 and December 2007, 48 underwent LSTC for complicated cholecystitis. We describe our tailored approach and the techniques we used to accomplish this., Results: All 48 patients underwent retrograde cholecystectomy. Twenty (41.6%) required an additional port (the fourth port) to obtain adequate exposure of the hilum, 39 (81.3%) required suturing of the gallbladder infundibular remnant, and 4 (8.33%) experienced local complications. The mean operative time of LSTC was 61.7 +/- 17.5 min, the estimated operative blood loss was 72.0 +/- 32.8 ml, the time to resume oral intake was 27.8 +/- 14.9 h, and the mean postoperative hospital stay was 4.5 +/- 1.3 days. There was no bile duct injury or mortality in this series., Conclusion: Laparoscopic subtotal cholecystectomy is a safe and feasible alternative to conversion to open surgery during difficult laparoscopic cholecystectomy for patients with complicated cholecystitis. However, we emphasize that only experienced laparoscopic surgeons should perform this procedure when complete removal of the gallbladder is not possible.

Aim: To assess the effects of H(2)-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents on the human Sphincter of Oddi (SO) motility by choledochoscope manometry., Methods: One hundred and seventy-five patients with T tube installed after cholecystectomy and choledochotomy were assessed by choledochoscope manometry. They were randomly assigned into groups of H(2)-receptor blocking pharmacon, protease inhibitor, and gastro kinetic agents. The Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duodenal pressure (DP), and common bile duct pressure (CBDP) were scored and analyzed., Results: SOBP and SOCA were significantly decreased after cimetidine administration, and no statistical difference was seen in the famotidine group. In the gabexate mesilate group, SOBP had decreased significantly. In the ulinastatin group, SOCA decreased when ulinastatin was given at the rate of 2500 U/min; when ulinastatin administration was raised to 5000 U/min, SOBP, SOF and SOCA all experienced a fall. SOBP and SOCA for domperidone and SOCA for mosapride groups all decreased distinctly after administration., Conclusion: The regular dosage of cimetidine showed an inhibitory effect on the motility of SO, while famotidine had no obvious effects otherwise. Gabnexata mesilate, ulinastatin and gastro kinetic agents also showed inhibitory effects on the SO motility.

Phenomenon of the heart rate variability (HRV) during various meditation techniques has been reported. However, most of these techniques emphasized the skill of slow breathing (<0.15 Hz). This paper reports our study on HRV during meditation which emphasizes inward attention. Inward attention has been an important approach for the Zen-meditation practitioners to enter into transcendental consciousness. Two groups of subjects were investigated, 10 experimental subjects with Zen-meditation experience and 10 control subjects without any meditation experience. We analyzed HRV both in time and frequency domains. The results revealed both common and different effects on HRV between inward-attention meditation and normal rest. The major difference of effects between two groups were the decrease of LF/HF ratio and LF norm as well as the increase of HF norm, which suggested the benefit of a sympathovagal balance toward parasympathetic activity. Moreover, we observed regular oscillating rhythms of the heart rate when the LF/HF ratio was small under meditation. According to previous studies, regular oscillations of heart rate signal usually appeared in the low-frequency band of HRV under slow breathing. Our findings showed that such regular oscillations could also appear in the high-frequency band of HRV but with smaller amplitude.

Background: The presence of bacteria in bile is an important factor in the formation of pigment gallstones. The bile of healthy people is sterile and bacteria in the biliary system come from endogenous infection from the gut. Yet, the route of bacterial translocation into the bile duct is still unclear. Theoretically, two routes exist: one is through the intestinal barrier and the other is by direct reflux from the sphincter of Oddi. This study was undertaken to explore the relationship between the effectiveness of intestinal barrier and the formation of pigment gallstones in hamsters., Methods: Thirty-two hamsters were divided into an experimental and a control group, with 16 hamsters in each group. A low protein and high cellulose diet was given for 6 weeks to induce the formation of pigment gallstones in the experimental group (PS) and a normal diet was given to the control group (CON). Morphological changes, changes in the levels of serum endotoxin and diamine oxidase, and changes in the numbers of B lymphocytes, plasma cells and secretory immunoglobin A (sIgA) in the intestinal mucosa were assessed after 6 weeks., Results: Four hamsters died during lithogenesis and body weight decreased in the PS group. Pigment gallstones were found in 11 hamsters at the end of the experiment, giving a lithogenesis rate of 91.67%. The serum endotoxin level before and after gallstone formation in the PS group was 0.2960+/-0.1734 U/ml and 8.2964+/-4.6268 U/ml, respectively (P<0.05). The blood diamine oxidase level before and after gallstone formation in the PS group was 2.6333+/-0.8037 U/ml and 3.3642+/-0.9545 U/ml, respectively (P<0.05). The numbers of B lymphocytes, plasma cells and sIgA in the intestinal mucosa in the PS group were 71.56+/-2.89, 68.65+/-2.09 and 27.56+/-1.07, respectively, and were significantly decreased compared with the corresponding values in the CON group (94.25+/-3.69, 93.47+/-3.98 and 42.57+/-1.96, respectively, P<0.05)., Conclusions: A low protein and high cellulose diet can markedly reduce intestinal barrier function and facilitate the formation of pigment gallstones. The decrease of intestinal barrier function may take part in the formation of pigment gallstones.

Microtwins and stacking faults in plastically deformed aluminum single crystal were successfully observed by high-resolution transmission electron microscope. The occurrence of these microtwins and stacking faults is directly related to the specially designed crystallographic orientation, because they were not observed in pure aluminum single crystal or polycrystal before. Based on the new finding above, we propose a universal dislocation-based model to judge the preference or not for the nucleation of deformation twins and stacking faults in various face-centered-cubic metals in terms of the critical stress for dislocation glide or twinning by considering the intrinsic factors, such as stacking fault energy, crystallographic orientation, and grain size. The new finding of deformation induced microtwins and stacking faults in aluminum single crystal and the proposed model should be of interest to a broad community.

Aim: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides., Methods: Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed., Results: Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t=5.254, 3.438 and 3.527, P<0.001). SOD of the reflux group was shorter than the control group (t=2.049, P<0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t= -2.230 and -2.235, P<0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP., Conclusion: About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.

Objective: To investigate the relationship between the intestinal barrier function and pigment gallstone formation., Methods: Ninety Guinea pigs were divided randomly into 3 groups: normal control (CON) group receiving normal forage, pigment gallstone (PS) group receiving pigment gallstone-forming forage, and intestinal mucosa protection group receiving pigment gallstone-forming forage with supplemental glutamine intestinal (GLN), a mucosa protector. The guinea pigs were observed for 8 weeks, the gallstone-forming rate, plasma diamine oxidase ( DAO), serum endotoxin, proportionality of urine lactulose/mannitol, and biliary beta-glucuronidase were detected. PCR was used to detect the bacteria in abdominal lymph node taking 16SrRNA as the target gene common in most bacteria. 32 gallstone patients, 16 with cholesterol gallstone and 16 with pigmental gallstone, and 27 patients with non-gastroenterological diseases, as controls, underwent detection of the plasma DAO and serum endotoxin. Another 109 gallstone patients, 31 with cholesterol gallstone and 78 with pigmental gallstone, and 21 patients with nongastroenterological diseases, as controls, underwent detection of urine technetium-labeled diethylenetriamine-pentaacetate (99mTc-DTPA)., Results: The gallstone-forming rate of the guinea pigs of the GLN group was 44.4% was, significantly lower than that of the PS group (73.9%, P < 0.05). The plasma DAO, serum endotoxin levels, proportionality of urine lactulose/mannitol, and activity of biliary beta-glucuronidase of the PS group were all significantly higher than those of the CON group (P < 0.05 or P < 0.01). The plasma endotoxin level of the pigmental GLN group was significantly lower than that of the PS group (P < 0.01). The positive rate of bacteria in abdominal lymph node of the PS group was 80%, significantly higher than those of the CON and GLN groups (30% and 45% respectively, P < 0.01 and P < 0.05). The level of plasma DAO and endotoxin of the pigmental gallstone patients were significantly higher than those of the controls (P < 0.05 and P < 0.01). The urine 99mTc-DTPA excretion rate of gallstone patients was 11.4%, significantly higher than that of the controls (4.7%, P < 0.01)., Conclusion: Intestinal barrier function is correlated with pigment gallstone forming. Intestinal barrier function disorder may promote pigment gallstone formation through bacteria translocation, endotoxemia, and increase of biliary beta-glucuronidase.

Background: Toll-like receptors (TLRs) are a family of type 1 transmembrane receptors, which can recognize different pathogen-associated molecular patterns. Among them, TLR-4 is specific to lipopolysaccharide. It transfers the infection signal into the cell and promotes the translocation of nuclear factor kappa B (NF-kappaB) to the nucleus and the subsequent transcriptional activation of genes encoding pro- and anti-inflammatory cytokines and chemokines. Acute cholangitis (AC) is a common biliary tract infection in oriental countries, and often leads to liver injury. The activation of TLR-4 and its significance in liver injury in rats with AC remain unclear., Methods: Rat models of AC (biliary tract obstruction+E. coli injection, n=36) and control models (biliary tract obstruction+saline, n=18) were made. Liver tissue injury was investigated by pathological examination. The levels of serum TNF-alpha and IL-10 were measured by enzyme-linked immunosorbent assay, and the expressions of TLR-4, NF-kappaB mRNAs and proteins in the liver were detected by RT-PCR, immunohistochemical staining and Western blotting, respectively., Results: Severe liver tissue injury in rats with AC was evident as shown by pathological examination. TLR-4 and NF-kappaB were strongly expressed in the cytoplasm of hepatocytes in the AC group. They were negative or slightly positive in the control group. TLR-4 mRNA and protein in the liver of rats with AC increased 1 hour after biliary tract ligation and E. coli injection, and peaked at 6 hours after surgery. Twenty-four hours later, they began to decrease. The expression of TLR-4 was paralleled by that of NF-kappaB in the liver and TNF-alpha in serum., Conclusion: The higher expression of TLR-4 in the liver of rats with AC may be involved in liver injury through the activation of NF-kappaB and release of cytokines such as TNF-alpha.

Background: The disorders of gallbladder motility may play an important role in the formation of gallstones. Many neural and hormonal factors and their interactions regulate gallbladder motility and bile flow into the duodenum. Further study in these factors may help to reveal the etiology of gallbladder diseases. This study was undertaken to assess the relationship of the levels of motilin, vasoactive intestinal peptide (VIP) and gastrin in blood and gallbladder tissues with the formation of cholelithiasis., Methods: The levels of motilin, gastrin and VIP in blood and gallbladder tissues of 36 patients with gallbladder stones, 14 patients with gallbladder polyps, 10 healthy volunteers and 10 patients with common bile duct stones were measured by radioimmunoassay., Results: The level of motilin in plasma and gallbladder tissues of the gallbladder stone group was higher than that of the control and gallbladder polyp groups (P<0.05). The levels of plasma VIP and serum gastrin were much higher than those of the other three groups (P<0.01). The level of VIP in gallbladder tissues was higher than that of the control and gallbladder polyp groups (P<0.01)., Conclusions: The abnormal excretion of hormonal factors is closely related to gallstone formation. The high level of VIP in gallbladder tissues may be an important cause of gallbladder hypomotility. The abnormal level of serum gastrin may be related to the gastrointestinal symptoms of patients with gallstones.

Background: Most reports on the prognosis of cholecystectomy have been short-term studied, and few long-term reports have suggested variable incidences of common bile duct stones after cholecystectomy. We retrospectively reviewed the data to find the possible association between cholecystectomy and the subsequent occurrence of primary common bile duct stones., Methods: The data were reviewed retrospectively of 478 patients with primary common bile duct stones diagnosed and treated by endoscopic sphincterotomy at our hospitals between January 1994 and December 2003., Results: Sixty-one (14.1%) of the 432 patients had a history of cholecystectomy, with an incidence rate markedly higher than that in the general population. The mean interval between cholecystectomy and the occurrence of primary common bile duct stones was 8.23 years, with the longest being 28 years and the shortest 2 years. Compared with the patients who had not undergone a prior cholecystectomy, those who had had a prior cholecystectomy more often accompanied with acute cholangiolitis (chi(2)=8.259, P<0.01), and multiple stones or sand-like stones were frequently found (chi(2)=9.030, P<0.01)., Conclusions: These results suggest a possible relationship between cholecystectomy and the subsequent occurrence of primary common bile duct stones. Perhaps patients with primary common bile duct stones who have had a prior cholecystectomy have a higher probability of infection of the biliary system. The infection may be one of the causes of occurrence of primary common bile duct stones after cholecystectomy.

Background: The effect of "intestinal transit" has become a new field of interest in the study of the pathogenesis of cholesterol gallstones. This study was undertaken to further test this notion and ascertain the relationship between impaired intestinal transit function and cholesterol gallstones., Methods: A total of 64 hamsters were divided into 2 groups, experimental and control. Each was subdivided into 4 subgroups for sacrifice at different time. A high-cholesterol diet and a standard diet were fed to each group. The geometric center, which represents the intestinal transit function was calculated., Results: The growth of all hamsters was normal. Cholesterol gallstones were found in 2 hamsters at the end of the 4th week. The geometric center values for the experimental and control groups were 2.3891+/-0.3923 vs. 2.7730+/-0.5283, at the end of week 3; 1.8148+/-0.4312 vs. 3.2294+/-1.1613 at week 4; 1.8451+/-0.3700 vs. 2.9075+/-0.3756 at week 5; and 1.8025+/-0.3413 vs. 3.0920+/-0.5622 at week 6., Conclusion: A high cholesterol diet can significantly reduce the intestinal transit function and facilitate the formation of cholesterol gallstones.

Purpose: Before the early 1990s total urethrectomy at radical cystectomy for bladder cancer in women was considered the standard of care. As our understanding of the natural history of urethral urothelial carcinoma in women has improved, neobladders have been increasingly created in carefully selected women with bladder cancer. We reviewed the literature regarding the incidence of urethral involvement, the risk factors for urethral involvement and the incidence of urethral recurrence in women undergoing orthotopic urinary diversion for bladder cancer., Materials and Methods: A comprehensive literature review was performed regarding the natural history of urethral tumor involvement by urothelial carcinoma, risk factors and the incidence of urethral recurrence following radical cystectomy and orthotopic diversion in women with bladder cancer., Results: Urethral tumor involvement occurs in approximately 12% of female patients with bladder cancer undergoing radical cystectomy for high grade, invasive urothelial carcinoma. Preoperative involvement of the bladder neck or anterior vaginal wall with urothelial carcinoma is an important risk factor for urethral tumor involvement. Intraoperative frozen section analysis of the proximal urethra is an appropriate and reliable method of identifying female candidates for orthotopic diversion. The rate of secondary tumor recurrence in the retained urethra of women following radical cystectomy and orthotopic urinary diversion is low but the condition requires long-term followup., Conclusions: Orthotopic urinary diversion can be performed safely in appropriately selected women with bladder cancer. Excellent oncological outcomes can be expected with a minimal risk of urethral recurrence. Preoperative bladder neck involvement is an important risk factor for urethral involvement but not an absolute contraindication to orthotopic diversion should intraoperative frozen section of the proximal urethra be without evidence of malignancy.

Background: Cholelithiasis is a common entity in China, but its etiology and pathogenesis have not been fully elucidated. Pigment stones of the intrahepatic and extrahepatic bile duct still form a high proportion in China, while they are rare in Europeans. To date, reports on fatty acids in stones remain few. We analyzed the quantity of fatty acids in different stones from Chinese and Japanese cases and discussed the role and mechanism of fatty acids in the formation of pigment stones., Methods: Clinical data from 18 Chinese and 37 Japanese patients with different types of stones were analyzed using the procedure for extracting fatty acids from gallstones and high performance liquid chromatography., Results: The total fatty acid and free fatty acid contents of pigment stones were markedly higher than those in black or cholesterol stones. The ratio of free saturated to free unsaturated fatty acids was highest in intrahepatic and less in extrahepatic pigment stones, which were significantly different from the other two kinds of stones., Conclusions: This indicates that phospholipase participates in the course of pigment stone formation. The action of phospholipase A1 is more important than phospholipase A2.

Background: The presence of intraduodenal peri-ampullary diverticulum is often observed during upper digestive tract barium meal studies and endoscopic retrograde cholangiopancreatography (ERCP). A few papers in China and overseas reported that the diverticulum had something to do with the incidence of cholelithiasis. This study was undertaken to further test this notion and ascertain the relationship between intraduodenal peri-ampullary diverticulum and biliary disease, especially the formation of bile duct pigment stones., Methods: A total of 178 patients who had undergone ERCP or endoscopic sphincterotomy (EST) were studied retrospectively. They were divided into 6 groups according to the category of biliary disease, and the incidence rates of intraduodenal peri-ampullary diverticulum were calculated., Results: There were 44 patients with intraduodenal peri-ampullary diverticulum in 81 patients with primary bile duct pigment stones (54.32%), 4 in 8 patients with bile duct stones and gallbladder stones (50%), 7 in 33 patients with bile duct stones secondary to gallbladder stones (21.21%), 3 in 21 patients with inflammation and stricture of the end of the bile duct and papilla (14.29%), 1 in 22 patients with carcinoma of the end of the bile duct and papilla (4.54%), and 5 in 13 patients with post-cholecystectomy syndrome or sphincter of Oddi dysfunction (38.46%)., Conclusions: The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones is higher than that in patients with bile duct stones secondary to gallbladder stones, patients with inflammation and stricture of the end of the bile duct and papilla, and patients with carcinoma of the end of the bile duct and papilla. These findings indicate that the anatomical abnormalities and malfunction of the sphincter of Oddi play an important role in the formation of bile duct pigment stones.

Objective: To investigate the intestinal permeability of patients with cholelithiasis of different types., Methods: Technetium-99m-diethylenetriaminepentaacetatic acid (99mTc-DTPA) at the dose of 185 MBq (5 mCi) was administered orally to 56 patients of cholelithiasis, 15 cases of cholesterol stone (CS group) and 41 cases of pigment stone (PS group) based on the cross section of the stone during operation, and 17 healthy controls. A 24 h urine collection was obtained after the ingestion of the tracer to calculate the urinary excretion of DTPA., Results: The mean percentage of the total ingested dose of 99mTc-DTPA excreted in a 24 h urinary excretion was 5.0%+/-3.6% in the CS group, not significantly different from that in the control group (4.5%+/-3.4%. F=2.18, P>0.05), and the mean percentage of the total ingested dose of 99mTc-DTPA excreted in a 24 h urinary excretion of the PS group was 10.5%+/-6.9%, significantly higher than that in the control group (F=7.62, P<0.05), showing a significantly increase of intestinal permeability (P<0.05)., Conclusion: The intestinal permeability of the patients of pigment stone is higher than that of the healthy subjects. Hyperpermeability may be a factor of the pathogenesis of pigment stone.

This research was aimed to develop the first level blood information centralized database and real time communication network at a province area in China. Multiple technology like local area network database separate operation, real time data concentration and distribution mechanism, allopatric backup, and optical fiber virtual private network (VPN) were used. As a result, the blood information centralized database and management system were successfully constructed, which covers all the Zhejiang province, and the real time exchange of blood data was realised. In conclusion, its implementation promote volunteer blood donation and ensure the blood safety in Zhejiang, especially strengthen the quick response to public health emergency. This project lays the first stone of centralized test and allotment among blood banks in Zhejiang, and can serve as a reference of contemporary blood bank information systems in China.

Objective: To investigate the relationship between anatomic abnormalities and malfunction of Oddi sphincter with formation of bile duct pigment gallstone., Methods: One hundred and twenty-three patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group by measuring the amounts of radioactivity of (99m)Tc-DTPA in the bile. Among them 53 were selected randomly to undergo choledochoscopic manometry. Basal pressure of Oddi's sphincter (SOBP), amplitude of Oddi's sphincter (SOCA), frequency of contraction (SOF), duration of contraction (SOD), duodenal pressure (DP), common bile duct pressure (CBDP) were scored and analyzed. The level of plasma motilin and serum gastrin of 45 patients and 12 healthy volunteers were measured by radioimmunoassay. The incidence rates of duodenal descending part diverticulum in patients with bile duct pigment stones, patients without alimentary tract diseases, patients with gallbladder polyps, patients with gallbladder stones were studied by means of barium meal examination. The incidence rates of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stones, patients with bile duct stone and gallbladder stones, patients with bile duct stones originating from the gallbladder, patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla, patients with post-cholecystectomy syndrome were detected by duodenoscope., Results: Of the patients, 44 were detected with duodenal-biliary reflux (35.8%). SOBP, SOCA and CBDP in the reflux group were much lower than those in control group (P < 0.001). The level of serum gastrin and plasma motilin of the reflux group were much lower than those of control group (P < 0.01). Positive correlation was found between level of motilin and SOBP while level of gastrin was positively correlated with SOBP and CBDP. The incidence of duodenal diverticulum in patients with bile duct pigment stone was 36.62%, which was higher than that of the other 3 groups. The incidence rate of intraduodenal peri-ampullary diverticulum in patients with primary bile duct pigment stone was higher than that of patients with inflammation and stricture of the extremity of bile duct and papilla, patients with cancer of the extremity of bile duct and papilla and patients with bile duct stones originating from the gallbladder., Conclusions: The patients with bile duct pigment stone have apparent duodenal-biliary reflux and infection of the bile duct. The state of structure and function of Oddi's sphincter is correlated significantly with bile duct pigment stone. The anatomic abnormalities and malfunction of Oddi's sphincter played an important role in the formation of bile duct pigment stone.

Objective: To investigate the prevention of hepatolithiasis and biliary stricture post choledochojejunostomy using choledochoscopy technique and evaluate feasibility and efficacy of choledochojejunostomy and artificial valve of efferent loop in preventing reflux., Methods: To analyze the data of 47 patients with hepatolithiasis who had been operated with Roux-en-Y cholangiojejunostomy and artificial valve of efferent loop to prevent bilio-intestinal regurgitation. Of the patients, 19 were marked with silver nip at the jejunum export of bilio-intestinal anastomosis. The regurgitation, recurrence, anastomotic stricture and their managements after the surgery were investigated., Results: The bilio-intestinal regurgitation were found in 32 cases (32/47, 68.1%), it suggested that artificial valve could not prevent bilio-intestinal regurgitation efficiently. Two cases of hepatolithiasis recurred and were cured by sinus tract placement with the aid of silver nip mark under choledochoscope instead of re-operation. Of the 6 cases with anastomotic stricture, 5 cases were treated successfully with stone extraction, biliary stent dilatation under the percutaneous transhepatic cholangioscopy (PTCS) and the other one case died., Conclusions: Silver nip mark provides safe and simple path for the cholangioscopy, it made the treatment of the recurrent biliary stricture and stone safe and brief, made the cholangioscopy play more important role in the hepatolithiasis, residual stone and biliary stricture. PTCS is mini-invasive, safe, simple and effective.

Background: The function of the intestinal barrier has drawn more and more attention from researchers in recent years for its important role in many diseases such as burns, wounds, and pancreatitis. In our experimental studies on pigment gallstone, we found potential relationships between the function of the intestinal barrier and pigment gallstone formation. This study was undertaken to investigate the possible action and mechanism of the function of the intestinal barrier in the pathogenesis of pigment gallstone., Methods: Eighty guinea pigs were divided into a normal group (CON), a pigment gallstone group (PS) and an intestinal mucosa protection group (GLN). Normal forage, pigment gallstone-forming forage and pigment gallstone-forming forage with supplemental intestinal mucosa protector (glutamine) were given to each group. In the gallstone-forming rate, morphology of intestinal mucosa, intestinal permeability, serum endotoxin and biliary beta-glucuronidase were assessed after 8 weeks., Results: The rate of gallstone-formation was 73.9% in the PS group. Damage of intestinal mucosa, endotoxemia (from 77+/-43 X 10(-6) EU/L to 1,367+/-525 X 10(-6) EU/L, P<0.01) and increased activity of biliary beta-glucuronidase (endogenous beta-glucuronidase from 122.1+/-39.5 to 209.8+/-47.5 Fishman Unit, P<0.01, and exogenous beta-glucuronidase from 573.5+/-476.9 to 2,206.6+/-983.9 Fishman Unit, P<0.01) were observed in the PS group compared with the CON group. The rate gallstone-formation decreased significantly to 44.4% and the other indices except beta-glucuronidase were lower in the GLN group than in the PS group., Conclusions: The function of the intestinal barrier is correlated with pigment gallstone formation. Dysfunction of the intestinal barrier function may promote pigment gallstone formation through bacterial translocation, endotoxemia, and biliary beta-glucuronidase.

The effect of the refractive index of the substrate together with the incident polarization on the optimization of sawtooth surface-relief gratings (SRGs) is investigated. The global optimum diffraction efficiencies of the -1st forward-diffracted order of sawtooth SRGs are 63.3% occurring at n2=1.47 for TE polarization and 73.8% occurring at n2=2.88 for TM polarization. Incident TE polarization has higher optimum diffraction efficiency than TM polarization for all n2<1.85. In contrast, TM polarization has higher optimum diffraction efficiency than TE polarization for all n2>1.85. A polymer (n2=1.5) optimum sawtooth SRG exhibits 62.6% efficiency for TE polarization. A silicon (n2=3.475) optimum sawtooth SRG exhibits 68.6% efficiency for TM polarization. These sawtooth SRGs are compared to right-angle-face trapezoidal SRGs. It is found that the optimum profiles of right-angle-face trapezoidal SRGs have only very slightly increased efficiencies over sawtooth SRGs (0.04% for TE and 0.55% for TM).

A rapid revised phase high-performance liquid chromatographic (RP-HPLC) method for the determination of six organic acids in Bayer liquors is reported. Oxalic, tartaric, acetic, succinic, glutaric and butene dicarboxylic acid were separated and quantified in 10 min. First time repeatability, reproducibility and recoveries were determined out for these acids in Bayer liquors. The organic acids were removed from Bayer liquor by using a solid-phase extraction procedure with anion-exchange cartridges. The chromatographic separation was achieved with only one Kromasil RP-C18 column thermo stated at 25 degrees C. Organic acids were detected with a UV-vis detector (215 nm). The precision results showed that the relative standard deviations of the repeatability and reproducibility were < 2.80% and < 3.74%, respectively. The accuracy of the method was confirmed with an average recovery ranging between 85.2 and 107.3%. Under optimum conditions the detection limits ranged from 50 to 1000 mg/L.

Aim: To study the effects of inosine on myosin heavy chain (MHC) activity in rats soleus muscle after tail-suspension., Methods: Weightlessness was simulated by tail-suspension of rats. Using immunohistochemistry technique, changes of expression of MHC in intrafusal and extrafusal fibers in soleus muscle were detected., Results: Expression of fast MHC in intrafusal and extrafusal fibers in soleus muscle increased after 14 d of simulated weightlessness, whereas in tail-suspended rats given inosine, the expression of fast MHC was not detected., Conclusion: Inosine could counteract the changes in expression of MHC in intrafusal and extrafusal fibers of rats soleus under simulated weightless situation.

Background: Primary intrahepatic cholelithiasis is usually combined with biliary tract infection. This research was undertaken to investigate the relationship between intrahepatic stones and biliary tract infection., Methods: Thirty-five bile samples and 30 stones specimens were cultured for bacteria and 12 stones specimens were examined with a scan electron microscope (SEM) or a transmission electron microscope (TEM)., Result: 94.2% bile samples and 96.7% stones specimens were positive in bacteria culture. Bacteria were found in stones under SEM and TEM., Conclusion: Bacteria in stones are associated with the infection of the biliary tract.

Aim: To detect the expression of pituitary adenylate cyclase-activating polypeptide receptor 1 (VPCAP1-R)and VPCAP2-R mRNA in gallbladder tissues of patients with gallstone or gallbladder polyps., Methods: The expression of VPCAP1-R and VPCAP2-R mRNA in gallbladder tissues was detected in 25 patients with gallstone,8 patients with gallbladder polyps and 7 donors of liver transplantation by reverse transcription polymerase chain reaction (RT-PCR)., Results: The VPCAP2-R mRNA expression level in the control group (1.09+/-0.58) was lower than that in the gallbladder polyp group (1.64+/-0.56) and the gallstone group (1.55+/-0.45) (P<0.05) while the VPCAP1-R mRNA expression level in the control group (1.15+/-0.23) was not apparently different from that in the gallbladder polyp group (1.28+/-0.56) and the gallstone group (1.27+/-0.38)., Conclusion: The abnormal expression of VPCAP2-R mRNA in gallbladder tissue may play a role in the formation of gallbladder stone and gallbladder polyps.

Orthotopic lower urinary tract reconstruction to the native intact urethra following radical cystectomy for bladder cancer was slower to gain clinical acceptance for women than for men. Until the 1990s, little was known about the natural history of urethral involvement by urothelial carcinoma in women with primary bladder cancer. The increasing availability of pathologic data to define the incidence of and risks for urethral involvement in women sparked an increasing interest in orthotopic diversion in female patients. Pathologic guidelines have been suggested to identify women suitable for orthotopic diversion. Preoperative involvement of the bladder neck is a significant risk factor for secondary tumor of the urethra, but is not an absolute contraindication, as long as full-thickness, intraoperative frozen-section analysis demonstrates no tumor involvement of the proximal urethra. Although less common, anterior vaginal wall tumor involvement may be a significant risk factor for urethral tumor involvement. Other pathologic parameters, including tumor multifocality, carcinoma in situ of the bladder, and tumor grade and stage, do not seem to be absolute contraindications. Long-term follow-up is critical for all patients. Women undergoing orthotopic reconstruction, if appropriately selected, should be assured of an oncologically sound operation and good function with their neobladder.

Aim: To examine the expression of p53 and vascular endothelial growth factor (VEGF) as well as microvessel count (MVC) and to investigate the role of VEGF as an angiogenic marker and the possible role of p53 in the regulation of angiogenesis in human gallbladder carcinoma., Methods: Surgically resected specimens of 49 gallbladder carcinomas were studied by immunohistochemical staining for p53 protein, VEGF, and factor VIII-related antigen. VEGF expression and mutant p53 expression were then correlated with Nevin stage, differentiation grade, MVC, and lymph node metastasis., Results: Positive p53 protein and VEGF expressions were found in 61.2% and 63.3% of tumors, respectively. p53 and VEGF staining status was identical in 55.1% of tumors. The Nevin staging of p53- or VEGF-positive tumors was significantly later than that of negative tumors. The MVC in p53- or VEGF-positive tumors was significantly higher than that in negative tumors, and MVC in both p53- and VEGF-negative tumors was significantly lower than that in the other subgroups., Conclusion: Our findings suggest that p53-VEGF pathway can regulate tumor angiogenesis in human gallbladder carcinoma. Combined analysis of p53 and VEGF expression might be useful for predicting the tumor vascularity of gallbladder cancer.

The optimum profiles of right-angle-face anisotropically etched silicon surface-relief gratings illuminated at normal incidence for substrate-mode optical interconnects are determined for TE, TM, and random linear (RL) polarizations. A simulated annealing algorithm in conjunction with the rigorous coupled-wave analysis is used. The optimum diffraction efficiencies of the -1 forward-diffracted order are 37.3%, 67.1%, and 51.2% for TE-, TM-, and RL-polarization-optimized profiles, respectively. Also, the sensitivities to grating thickness, slant angle, and incident angle of the optimized profiles are presented.

Warming yang, which is one of the treatment principles of traditional Chinese Medicine, is very important in treating chronic heart failure, especially late-stage heart failure. It has been proved in many experiments and clinical trials that warming yang can improve the hemodynamic parameters. The treatment strategy for heart failure has changed from short-term correction of hemodynamic parameters to long-term rehabilitation approaches. We discussed the possible negative-effects of warming yang on neuroendocrine responses and myocardial remodeling. The potential beneficial effects of treatment for nourishing yin or nourishing yin combined with warming yang on heart failure were also explored.

Background: The high choledocholithiasis recurrence rate after choledocholithotomy plus T-tube drainage is related to biliary bacterial infection. These bacteria are from the intestine, either via the major duodenal papilla, or the penetrating intestinal mucosa. It is therefore possible that duodenobiliary reflux and increased intestinal permeability exist in patients who have undergone choledocholithotomy. This study was undertaken to find the evidence of duodenobiliary reflux and to assess intestinal permeability in these patients., Methods: Twenty-one patients who underwent choledocholithotomy plus T-tube drainage 2 months ago, and 11 healthy volunteers (controls) took orally 185MBq of (99m)Tc-DTPA. The patients' bile was collected in the next 2 hours via a T-tube and the (99m)Tc-DTPA radioactivity in the bile was counted. Intestinal permeability was evaluated by measuring the 24-hour urinary excretion rate of ingested (99m)Tc-DTPA in both patients and controls., Results: In 6 of the 21 patients, radioactivity in the bile was detected. The intestinal permeability was significantly higher in patients (11.45%+/-6.16%) than that in controls (3.61%+/-1.63%, t=3.28, P<0.05)., Conclusions: Duodenobiliary reflux exists in patients who have undergone choledocholithotomy plus T-tube drainage. The intestinal permeability is higher in these patients than in healthy subjects. Duodenobiliary reflux and increased intestinal permeability may be factors of cholelithiasis recurrence.