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??Objective    To investigate the characteristics of indirect injury of periodontal membrane caused by maxillofacial impact injury. Methods    The study was carried out at the laboratory of oral and maxillofacial trauma in Fourth Military Medical University??from November 2013 to January 2014. Totally 18 dogs were divided equally into six groups with random allocation??the right mandible of each dog was impacted by a cylindroid iron cap whose weight was 0.26kg??but teeth were not injured directly??the animals were killed 6 h??24 h??3 d??7 d??2 wk and 4 wk later??respectively??the histopathologic manifestations of periodontal membrane of the fourth premolar of right mandible??the second premolar of right mandible and the second premolar of left mandible were observed. Results    The injury of periodontal membrane of the fourth premolar of right mandible was relatively obvious??but the pathologic changes were reversible??periodontal membrane of the second premolar of right mandible was injured slightly??yet no obvious histopathologic change could be observed in periodontal membrane of the second premolar of left mandible. Conclusion    Maxillofacial impact injury can cause indirect injuries of periodontal membrane of adjacent teeth??but the pathologic changes are reversible??traumatic severity decreases as the distance of the tooth to the wound area increases.     

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??Surgical outcomes after laparoscopic-assisted radial total gastrectomy for Siewert type ?? and type ??adenocarcinoma of the esophagogastric junction CHEN Qi-yue??LÜ Chen-bin??ZHENG Zhao-hui, et al. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail??hcmlr2002@163.com
Abstract Objective To investigate the oncologic efficacy of laparoscopic-assisted radial total gastrectomy ??LATG?? for Siewert type ?? and ?? adenocarcinoma of the esophagogastric junction (AEG). Methods The clinicopathalogical data of 418 patients with Siewert type ?? and ?? AEG who had undergone radical total gastrectomy between December 2008 and June 2013 in Fujian Medical University Union Hospital were analyzed retrospectively. The short and long term outcomes were compared between the LATG (n=342) and opened radial total gastrectomy ??OTG?? (n=76) groups. Results The clinicopathological characteristics between the two groups had no statistical difference. LATG compared with OTG was associated with shorter operative time??less blood loss??shorter time to the resumption of a semi-fluid diet and shorter hospital stay. However, postoperative complication rates between the two groups had no significant difference. The 3-year overall survival rate in the LATG group was significantly higher than that in the OTG group (71.1% versus 61.1%??P=0.033). In stratified analysis according to Siewert classification??the LATG group demonstrated significantly higher 3-year overall survival rate (79.5%versus 69.1%??P=0.010) for Siewert type ?? AEG compared with the OTG group??however??in the Siewert type ?? AEG subgroup??the 3-year overall survival rates were similar (P=0.315). COX proportional hazards regression model indicated that the surgical approach and TNM stage were independent prognostic factors affecting the whole group??P<0.05??. Conclusion LATG is a safe and feasible procedure with better short-term outcomes for Siewert type ?? and ?? AEG. For Siewert type ?? AEG particularly??LATG may yield better long-term survival.     

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??Correlation between lymph node metastasis of colorectal carcinoma and vascular pattern of inferior mesenteric artery by CTA LIU Huan-ran, HU Xiang, ZHANG Jian, et al. No. 1 Department of General Surgery, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
Corresponding author: HU Xiang, E-mail??lhrlhr9050@sina.com
Abstract Objective To study vascular pattern of inferior mesenteric artery (IMA) by CT angiography (CTA) for colorectal operation. Methods Seventy-seven patients with colorectal carcinoma underwent preoperative IMA CTA from January 2011 to April 2013 in the First Affiliated Hospital of Dalian Medical University were selected randomly. IMA and its branches were reconstructed by VR-r AV technique and divided into different categories. Results All the patients’ IMA branched off the abdominal aorta. Four types of branching were confirmed. Type A, where the three arteries branched off from the same point; Type B, where SA branched off from LCA; and Type C, where SA branched off from SRA; Type D, where SA branched off from LCA and SRA respectively. There was no statistical relation between typing and age, gender, invasive depth of tumor, lymph node metastasis, distance from tumor to anus. But lymph node metastasis had significant associated with the distance from tumor to anus (P=0.002). Conclusion Aberrance of IMA is various, metastasis of 242 group lymph nodes was associated with aberrance of SA. Performing preoperative IMA-CTA is helpful to preserve LCA and reduce inadequate lymph node dissection.     

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??Objective:To evaluate the clinical merit of contrast??enhanced ultrasound (CEUS) in the diagnosis of Small hepatocellular carcinoma (HCC) in patients with posthepatitic cirrhosis. Methods:Small hepatocellular carcinoma were examined and observed by CEUS between March 2004 and October 2005,using ultrasound contrast agent??Sonovue.Contrast enhanced CT and or MRI were performed in all cases. Results:The accuracy of diagnosing Small HCC by CEUS were 88.2% (60/68),according to the hypo??enhancement in arterial phase,iso??enhancement or hyo??enhancement in portal phase,hypo??enhancement in delayed phase.The accuracy and false positive rate of diagnosing Small HCC by CEUS were 97.1% (66/68) and 2.9%(2/68) according to the hypo??enhancement in delayed phase. Conclusion:CEUS might increase the diagnosis of small HCC.     

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??Transumbilical single port access laparoscopic cholecystectomy:a clinical report of 12 cases and review of the literaturesHAN Wei,ZHANG Zhong??tao,LI Jian??she,et al.Department of General Surgery,Beijing Friendship Hospital Affiliated to Capital University of Medical Science,Beijing 100050,China Corresponding author:ZHANG Zhong??tao,E??mail??zhangzht@medmail.com.cn AbstractObjectiveTo evaluate the clinical feasibility of the transumbilical single port access (SPA) laparoscopic cholecystectomy.MethodsThe methods and clinical effects of 12 cases of transumbilical single port access laparoscopic cholecystectomy performed between May and August 2008 at Beijing Friendship Hospital Affiliated to Capital University of Medical Science were reported.ResultsThe operations of 12 cases were completed successfully without conversion to routine laparoscopic or open surgery.No post??operation complications occurred.ConclusionThe transumbilical laparoscopic cholecystectomy by single port access is a difficult procedure,but the technique results in superior cosmesis.The feasibility of the clinical research is determined by the ability of the center,and patients should be selected carefully.     

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??Objective??To detect the level of fecal primary and secondary bile acids in infants with infantile cholestatic hepatopathy??ICH??and analyze its clinical value. Methods??Thirty infants with ICH were enrolled in this study??who were diagnosed with infantile cholestatic hepatopathy. Thirty infants with good health condition were enrolled as the healthy control group. The fecal samples were collected respectively in the preparatory treatment phase and treatment phase from infants with ICH and from the healthy infants. Bile acids were extracted from infants’ feces and were quantitatively analyzed by liquid chromatography-mass spectroscopy. Results??Among the fecal primary bile acids??the level of cholic acid??chenodeoxycholic and glycochenodeoxycholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group??P??0.016??.The level of fecal cholic acid and chenodeoxycholic acid of ICH treatment group was higher than in the ICH preparatory treatment group??P??0.016??. Among the fecal secondary bile acids??the level of lithocholic acid both in the ICH preparatory treatment group and ICH treatment group was significantly lower than that in the healthy control group??P??0.016????and the level of ursodeoxycholic acid in the ICH preparatory treatment group was lower than that in the ICH treatment group and healthy control group??P??0.016??. Conclusion??In infants with ICH, the changes of fecal primary bile acids and fecal secondary bile acids have their own characteristics at the early stage of treatment, which may be caused by the short-term treatment, the prognosis of the disease itself and the changes of intestinal function, including intestinal bacteria. Clinical attention should be paid to these changes.     

Scheduling of parathyroidectomy for refractory secondary hyperparathyroidism.

??Abstract??Secondary hyperparathyroidism (SHPT) has been the most common complication in patients with chronic kidney disease.A large population of patients progressed to refractory SHPT??a disease characterized of osteodynia??bone fracture or deformities??blood vessels??organs metastatic calcification and heart valve calcification??owing to their insufficient awareness.Timely and effective Parathyroidectomy??when underwent in a timely manner??may be effective to improve the quality of life and halt the progression to multiple organ injury.     

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??Robot-assisted resection of choledochal cysts and Roux-en-Y bilioenterostomy??A report of 2 patients PENG Cheng-hong, LIU Fei. Department of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai200025,China
Corresponding author: PENG Cheng-hong, E-mail: chhpeng@188.com
Abstract Objective To investigate the feasibility and security of robot surgical system in resection of choledochal cysts and Roux-en-Y bilioenterostomy. Methods The clinical data of 2 patients who underwent choledochal cysts resection and Roux-en-Y bilioenterostomy with robotic system from July 2012 to July 2013 in Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. Results All the operations by robot were performed successfully and none was converted to laparotomy. The operation time was range 140 to 170 mins. The intraoperative blood loss was 50 ml. No transfusion was needed during and after the operation. The follow up of 23 months and 14 months were done postoperatively. Conclusion Robot-assisted resection of choledochal cysts and Roux-en-Y bilioenterostomy are secure, feasible and mini-invasive. The superiority remains to be confirmed by more cases and long-term follow-up.