Biliary tract carcinoma (BTC) is a common malignancy in human digestive system.The lethality of BTC is essentially attributed to the asymptomatic growth of BTC and the lack of effective diagnostic options.The disease is therefore usually detected at an advanced stage and lost the opportunity of surgical therapy.Conventional chemotherapy and radiation therapy have been notably ineffective against BTC.There is now a real and urgent need to focus on developing novel and potent therapeutic strategies against BTC.Human epidermal growth factor receptor 2/neu (HER2/neu) is a member of the ErbB receptor tyrosine kinase family.HER2/neu is associated with tumor proliferation,invasion,and metastasis that would impact in a significant way on clinical outcome.HER/neu may become a new therapy target of BTC.

Objective To compare the operative results of removing large olfactory groove meningiomas(diameter≥3 cm)using either a unilat?eral or bilateral subfrontal approach ,and to determine whether there is an advantage in the unilateral approach. Methods Sixty?nine cases of large olfactory groove meningioma,treated in our department,by either a unilateral or bilateral subfrontal approach microsurgery were retrospec?tively reviewed. Removal grading,post?operative complications,and other clinical indices were evaluated. Results Total resection(Simpson Ⅰ or Ⅱ)was achieved in all the cases. There were lesser complications with use of the unilateral subfrontal approach. Conclusion Patients with ol?factory groove meningioma have a good prognosis when a unilateral subfrontal approach is used for surgery.

Objective To compare the effects of equivalent dose sufentanil,remifentanil or fentanyl on hemodynamic and cardiac output in the elderly patients during induction of general anesthesia.Methods Ninety elderly patients(ASA Ⅰ ～ Ⅱ) undergoing elective abdominal surgery under general anesthesia were randomly divided into sufentanil group(group S),remifentanil group(group R) and fentanyl group(group F),30 patients in each group.Patients in group S,group R and group F received sufentanil 0.2μg/kg,remifentanil 2μg/kg and fentanyl 2μg/kg Ⅳ,respectively,using an blind method before intubation.SBP,DBP,MAP,HR,CO,CI and SVR were recorded before of anesthesia (T0),immediately after induction (T1),1,3 minutes after tracheal intubation (T2,T3).Changes of SBP and HR during observation were also recorded.Results The MAP and HR in three groups at T1 were significantly lower than those at T0 and decreased significantly in group R than those in group F and S(P ＜0.05).The MAP and HR in group F significantly increased at T1 than T0.The MAP and HR in group R were significantly decreased after tracheal intubation.Compared with the baseline,the MAP and HR in group S at T1,T2,remained unchanged.In group R,there were two patients whose HR were under 50 bpm.In group F,the MAP at T1,T2 were significantly higher than those at T.In group S,there were no significant changes in CO,CI,SVR which were all within normal range (P ＞ 0.05).Conclusion Both sufentanil and remifentanil effectively inhibit the stress response during induction of general anesthesia.At the same time,sufentanil has better hemodynamic stability.

Objective ① To investigate the level of the vitamin D endocrine system in peripheral relationships with bone mineral density (BMD) and the disease activity respectively. Methods The level of the 25-hydroxylate vitamin D3 (25OHD3) and 1,25-dihydroxyvitamin D3 [1,25(OH)D3] in plasma from 43 SLE patients and 44 normal controls were detected by enzyme linked immunosorbent assay. Vitamin D receptor (VDR) gene expression was determinied by real-time PCR in peripheral blood. BMD measurements in the lumbar spine (L1-4) and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry before treatment. The relationship between the vitamin D endocrine system and the bone mass were studied. We also discussed the relationship between the vitamin D endocrine system and the disease activity. Results The levels of 25OHD3 and 1,25 (OH)2D3 were lower in the initial SLE patients than normal controls (P<0.01, P<0.01). The expressions of VDR gene were significantly increased in initial SLE compared with normal controls (P<0.01). The initial SLE patients had significantly lower BMD values, and higher frequency of osteopenia (35%) at both sites of measurement compared with matched healthy controls (P<0.01). The initial SLE patients were divided into two groups by BMD, abnormal group and normal group. There were no differences in 25OHD3, 1,25 (OH)D3 and VDR gene expression (P0.05). There was no correlation between the vitamin D endocrine system and BMD in initial SLE patients. There was no correlation between the vitamin D endocrine system and the disease activity either. Conclusion Vitamin D endocrine system may play an important role in SLE, but the level of VDR gene is not correlated with BMD and disease activity.

Objective To study the incidence of osteopenia in patients with initial systemic lupus erythematosus(SLE). Investigate the levels of the vitamin D (VitD) endocrine system in peripheral blood of SLE patients and its relation to bone mineral density (BMD). Analyse the relationship between the estrogen receptor (ER) and BMD and evaluate the role of ER in the pathogenesis osteopenia. Methods Serum levels of 25-OH VitD_3 and 1,25-(OH)_2 VitD_3 were detected by enzyme linked immunosorbent assay. The gene expression levels of VitD receptor (VDR) and ER were determined by real-time PCR. BMD measurements in the lumbar spine (L1-L4) and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry before treatment. Results The initial SLE patients had significantly lower BMD values, and higher frequency of bone loss at both sites of measurement compared with normal controls (P < 0. 05). The levels of 25-OH VitD_3 and 1,25-(OH)_2 VitD3 were lower in the initial SLE patients than normal controls(P<0.01 both). There is no difference in the levels of 25-OH VitD_3 and 1,25-(OH)_2 VitD_3 between the osteopenia SLE group and the normal BMD SLE group (P > 0. 05, P > 0. 05). There are no correlations between the Vitd and BMD in initial SLE patients (P>0.05 both). The expressions of VDR gene were significantly increased in the initial SLE patients compared with the normal controls(P<0.01). There was no difference in VDR gene expression between osteopenia SLE group and normal BMD SLE group (P>0.05). The VDR gene expression does not correlate with the bone mass (P>0.05). The levels of ER-β gene expression are higher in the initial SLE group than the normal controls (P<0.01).Conclusions The incipient SLE patients may have lower BMD than expected. SLE patients present abnormal VitD endocrine system and higher ER-β mRNA expression than those in normal controls, but these weren't concerned with osteopenia.

Objective To discuss the risk factors for coagulopathy in acute isolated traumatic brain injury (TBI).Methods A retrospective study was performed on 191 patients with acute isolated TBI hospitalized from July 2012 to June 2015.There were 70 patients with coagulopathy (coagulopathy group) and 121 patients without coagulopathy (control group).Age,gender,injury type,midline shift on CT and injury severity (Glasgow Coma Scale,GCS) were analyzed to identify the independent risk factors for coagulopathy using the logistic regression analysis.Correlation between the independent risk factors and coagulation indices was analyzed.Results Injury severity,acute subdural hematoma,intraventricular bleeding and midline shift on CT were identified as the independent risk factors for coagulopathy(P ＜ 0.05,OR ＞ 1).Furthermore,injury severity and acute subdural hematoma were respectively associated with abnormalities of international normalized ratio (INR) and fibrinogen (Fg) (P ＜0.05 or P ＜ 0.01),intraventricular bleeding with abnormalities of prothrombin time (PT) and platelet count (PC) (P ＜ 0.01),and midline shift on CT with abnormalities of Fg and PC (P ＜ 0.05).Conclusions Injury severity,acute subdural hematoma,intraventricular bleeding and midline shift on CT are independent risk factors for coagulopathy in patients with acute isolated TBI,and correlate with abnormalities of several coagulation indices.Changes in coagulation indices should be monitored accurately after TBI,and timely treatment of coagulopathy can improve the prognosis.

Objective To explore the correlation between the glucose variability and the severity of acute isolated traumatic brain injury(TBI). Method According to the inclusion/exclusion criteria,a total of 125 cases of acute isolated TBI admitted in Department of Neurosurgery of China Medical University from July 2012 to June 2015 were included. According to Glasgow coma scale(GSC),the patients were divided into five groups including control(GCS 15),mild(GCS 13?14),moderate(GCS 9?12),severe(GCS 6?8),and extra?severe(GCS 3?5)groups. Blood glucose control(including relief of the stress and the application of insulin)were carried out immediately. The average,standard deviation,and variation co?efficient of blood glucose of all groups were recorded at admission,48 hours and 3?7 days after hospitalization. The clinical records and glycemic in?dex were compared among different groups and during different periods,so as to analyze the relationship of the variability of glucose and the duration of hyperglycemia with the severity of TBI and the effects of glycemic intensive care management. Results The results of Kruskal Wallis test and Mann?Whitney Utest showed that the average,standard deviation,and variation coefficient of glucose in the extra?severe group and the severe group were statistically higher than those in the control group(P<0.05)during the same period. Meanwhile,the average,standard deviation,and variation coefficient of glucose at admission,48 hours and 3?7 days after hospitalization were also different among each group(P<0.05). The duration of hy?perglycemia and conscious disturbance in both the extra?severe group and the severe group were longer than those in the control(P<0.05). The analyses using rank correlation indicated that glucose variability,the level and duration of hyperglycemia were positively correlated with the severity of TBI(r>1). Conclusion The glucose variability in acute isolated TBI patients could be considered as the index of the severity of TBI.

A scientific appointment-driven outpatient service proves vital for the medical quality improvement initiative, and a key part of public hospital reform as well. The authors introduced the approaches taken by Northern Jiangsu People′s Hospital as follows. The hospital-wide appointment-drive service was coordinated in terms of top-level design, appointment items, appointment channels, supporting services, and monitoring regulations. This service could optimize the allocation of medical resources, enrich the connotation of appointment for registration, examination, bed, examination, operation and treatment. These efforts were expected to provide references for the implementation of overall management of the appointment-driven service of the hospital.

OBJECTIVETo investigate the effect of carvacrol pretreatment on myocardial ischemia-reperfusion (I/R) injury and its underlying mechanisms.

METHODSWild-type male C57 BL/6 mice were randomized into 5 groups (n=13), namely the sham-operated group, vehicle (DMSO in saline)+ I/R group, carvacrol (20 mg/kg) + I/R group, carvacrol (40 mg/kg) + I/R group, and carvacrol (60 mg/kg) + I/R group. The mouse models of myocardial I/R injury were established by a 45-min occlusion of the left anterior descending coronary artery (LAD) followed by reperfusion for 2 h. Carvacrol or vehicle was administered intravenously 15 min before LAD occlusion. After reperfusion, the mice were examined for myocardial oxidative stress level and apoptosis rate.

RESULTSCompared with the vehicle group, the 3 carvacrol-pretreated groups showed significantly reduced myocardial infarct size, oxidative stress level and cardiac myocyte apoptosis rate (P<0.01).

CONCLUSIONCarvacrol can protect against myocardial I/R injury by inhibiting myocardial oxidative stress and apoptosis in mice.

Animals ; Antioxidants ; pharmacology ; Apoptosis ; drug effects ; Cardiotonic Agents ; pharmacology ; Male ; Mice ; Mice, Inbred C57BL ; Monoterpenes ; pharmacology ; Myocardial Infarction ; pathology ; Myocardial Reperfusion Injury ; metabolism ; pathology ; Myocytes, Cardiac ; cytology ; drug effects ; Oxidative Stress ; drug effects ; Random Allocation

Objective To investigate the possible electroencephalograph network connectivity mech-anism of working memory disorder in patients with frontal lobe epilepsy ( FLE). Methods Seventeen adult FLE patients were enrolled as the case group and 22 normal adults were selected as the control group. The behavioral data and 34-channel electroencephalographs were recorded in the working memory behavioral par-adigm. The directed transfer function was used to construct the causal connectivity brain network of theta band of working memory delay period. Two-sample t-test or tˊ-test was used to analyze the differences in be-havioral and frontal causal connectivity between the two groups. Results (1) Compared with control group, working memory behavioral data of FLE group showed significantly lower correct rate ((92. 778±4. 399)%, (96. 258±2. 470)%,tˊ=-2. 925,P<0. 01),and significantly longer reaction time ((978. 586± 65. 161) ms,(798. 671±196. 207)ms,tˊ=4. 023,P<0. 001). (2) Compared with control group,causal connectivity of FLE group showed significantly reduced whole brain ( tˊ=-6. 008, P<0. 001), Fz channel ( tˊ=-7. 703,P<0. 001),frontal region (tˊ=-14. 667,P<0. 001),frontal-temporal interval ( t=-14. 467,P<0. 001),and frontal-central interval (t=-3. 501,P<0. 001). The causal connectivity of frontal-occipital in-terval had no significant difference( t=1. 056,P=0. 281). Conclusions Working memory disorders were found in FLE patients. The abnormal causal connectivity of frontal brain network in theta band may be one of its potential neurophysiological mechanisms.