Objective To evaluate the safety,clinical and financial aspects of laparoscopic cholecystectomy(LC).Methods 278 cases undergone LC and 234 cases undergone open cholecystectomy(OC)were compared in retrospective study.Results LC was as safe as OC.In favour of LC,significant differences were observed regarding the time of severe pain,hospitalization and recovery.The total occurences of postoperative complications were low in all the patients undergone LC or OC,and its significantly lower in patients undergone LC than that in those undergone OC.Furthermore,the total charges for LC were significantly lower than that for OC.Conclusions LC is as safe as OC and has clan obvious advantage over OC in clinical,social and financial aspects.

This article introduced professor WANG Shu-chen's experience in picture treating bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation with tougue picture as the key link. Patients with BOS showed deficiency of essence of tongue crack, which should be treated by warming kidney yang, replenishing essence and marrow; fester tongue for qi disorder, inflammation caused by fire, which should be treated by regulating qi, and clearing heat; exfoliative fur accumulation, which should be treated with blood stasis and toxin, removing blood stasis and toxin; thick and greasy fur, which should be treated by warming spleen and activating spleen.

BACKGROUND:The thermosensitive chitosan is a kind of chitosan, its hemostatic effect, tissue compatibility andin vivo absorption need further investigations.
OBJECTIVE:To investigate the hemostasis,in vivo degradation and tissue compatibility of thermosensitive chitosan hemostatic film.
METHODS: A total of 48 Sprague-Dawley rats were randomly divided into four groups, and carried out two
experiments at the same time. (1) The incisions of the liver in three groups were covered with the thermosensitive chitosan hemostatic film, celulose hemostatic cotton and gelatin sponge, respectively. Blank control group
received no treatment. The bleeding time and bleeding amount were recorded. (2) The incisions of the quadriceps femoris muscle of rats in the above three groups were embedded with the same hemostatic materials respectively. Blank control group was not embedded. At 1, 2, 3, 4, 6 weeks, the incision tissues of the liver and the quadriceps femoris muscle were harvested for observation. After 4 weeks, the incisions were observed with hematoxylin-
eosin staining and transmission electron microscopy.
RESULTS AND CONCLUSION: The bleeding time and bleeding amount of thermosensitive chitosan hemostatic film and celulose hemostatic cotton groups were significantly lower than those of gelatin sponge and blank
control groups (P < 0.05). After 6 weeks, the thermosensitive chitosan hemostatic film was absorbed completely. After 3 weeks, the celulose hemostatic cotton was absorbed completely. After 2 weeks, the gelatin sponge was absorbed completely. The liver lobules of thermosensitive chitosan hemostatic film were complete, the liver cellwere normal structure, showing light sweling and little inflammatory cellinfiltration. Under transmission electron
microscopy, the liver cels had integral structure, cellnucleus and organeles remained intact. The muscle fibers showed complete structure and little inflammatory cellinfiltration. Under transmission electron microscopy, the muscle fibers
ranked tidily, with integral cellnucleus and organeles. The thermosensitive chitosan hemostatic film has good hemostasis effect and tissue compatibility.

ObjectiveTo investigate the effects of chitosan/PVA nerve conduits which used for repairing sciatics nerve defect in rats.MethodsTwenty-seven rats were divided into 3 groups randomly,with 9 rats in each group. Firstly, the 15mm defects in the left sciatic nerves were made in the rats and were respectively repaired with chitosan/PVA conduits graft (group A), the silicon conduits graft (group B),and autografts (group C). At 12 weeks after the operations, the left sciatic nerves were taken out, and the comparative evaluation was made on the repairing effects by wet weight of gastrocnemius and soleus muscles, histological examination,computerized imaging analysis and True Blue retrograde tracing. ResultsThe wet weight of gastrocnemius and soleus muscles showed no significant difference between the chitosan/PVA graft and autograft groups (P ＞ 0.05). The wet weight of gastrocnemius and soleus muscles in significant difference between the chitosan/PVA graft and the silicon group at 12 weeks after the operation(P ＜ 0.05). The nerve fiber density showed no statistically significant differences between the chitosan/PVA and autograft groups(P＞ 0.05).The regenerative nerve fiber in group B had normal morphological and structural characters under transmission electron microscope.True Blue-labeled neuron cell bodies were found within both anterior horn of gray matter in the spinal cord and dorsal root ganglions (DRGs) ipsilateral to the operated side of the tested rats on illumination with ultra-violet light 1 week after the injection of True Blue.Conclusion Chitosan/PVA nerve conduit can effectively promote the nerve regeneration and myelinization of rat sciatic nerve, which is expected to substitute for autograft to repair nerve defects succesfully.

AIM: Site-specific functional neurons of brains were with different cellular morphology. It has not been fully understood whether the grafted neural stem cells could differentiate into the site-specific neurons. This experiment is to investigate the neuronal differentiation of the neural stem cells derived from a human fetal brain after transplanted into young rats' brains, to study the possibility of cell-replacement therapy for children's brain disorders with neural stem cells. METHODS: Experiments were performed at the Cell Laboratory of Naval General Hospital from April to July 2007. ①Human fetal brain tissues of 16 week gestation were provided by Department of Gynaecology and Obstetrics of Naval Hospital. Pregnant woman and family members signed an informed consent. Experimental intervention was approved by Hospital Ethical Committee. Fourteen clean brood young SD rats aged 10 days, irrespective of gender, were provided by Experimental Animal Center of Medical College of Peking University. Animal intervention met the animal ethical standards. ②The neural stem cell spheres were derived from the fetal brain tissues of 16 week gestation. The differentiation multipotency of the neurosphere was identified when cultured in a child's cerebrospinal fluid (CSF). The neurospheres cultured in vitro for 14 days were injected into the lateral ventricles of young rats of 10 days old. The rats were respectively killed at days 4, 7 and 14 after transplantation. The special immuno-fluorescent assays were performed using anti-human neurofilament (anti-hNF) to show the location and morphology of graft neurons. RESULTS: ①The typical floating neurospheres were obtained, with the potency to differentiate into neurons, astrocytes and oligodendrocytes. ②The neuronal differentiation of grafts was detected with the mixture of three monoclonal antibodies against human neurofilament. Four days after transplantation, the immune response positive cells lied within the granule cell layer of cerebral cortex were shown in the shape of granule cells, or within the pyramid cell layer in the shape of pyramid cells with long processes, and the interneuron-like cells also were seen. The Purkinje cells arranging in a monolayer were detected in the cerebellum. Compared the results at different time points, the location of grafts were the same. The graft cells were less and the processes were longer over time. CONCLUSION: The in vitro cultured neurosphere cells can migrate into brain tissues and differentiate into site-specific neurons in shape after transplanting into the lateral ventricles of young rats. It is suggested that the host brain tissue microenvironment played an important role in guiding the graft differentiation into neurons. The results have an important significance for understanding cell replacement of developing brain disorders.

Objective To detect apoptosis of transplanted lung adenocarcinoma cells in nude mice after 125I brachytherapy by 99Tcm-Annexin V combined with diffusion weighted MRI (MR-DWI).Methods Twenty-five BALB/c-nu nude mice models subcutaneously transplanted with A549 cells were divided into experimental group (EG,n=13) and control group (CG,n=12) by random number table method.One 125I seed with apparent activity of (24.8±6.3) MBq was implanted into each mouse in EG,while CG underwent cold seed implantation.Both of 99Tcm-Annexin V imaging and MR-DWI were performed within 7-10 d after brachytherapy,then all mice were sacrificed and tumor cell apoptosis was detected by terminal oxynucleotidyl transferase mediated dUTP biotin nick end labeling (TUNEL) immunofluorescence,Survivin expression was assayed by SP.Two-sample t test,x2 test and Pearson correlation analysis were used for data analysis.Results Positive rate of cell apoptosis by 99Tcm-Annexin V imaging was 69.2％(9/13) and 8.3％(1/12) respectively in EG and CG (x2 =12.73,P＜0.01).The uptake ratio of 99Tcm-Annexin V,apparent diffusion coefficient(ADC) value and apoptosis index(M) of the tumor in EG were 2.91±0.85,(2.03±0.44)×10-3 mm2/s and (49± 18) ％,respectively,which were significantly higher than those of CG (1.26 ± 0.37,(1.29 ± 0.21) ×10-3 mm2/s and (11±4)％ respectively,t=5.930,5.452,7.606,all P＜0.05).Survivin expression in EG and CG was (46± 13) ％ and (15±7) ％ respectively (t =5.158,P＜0.05).The value of ADC was correlated with AI and uptake ratio(r=0.756,0.788,both P＜0.05).Uptake ratio was correlated with AI (r=0.754,P＜0.05),while Survivin expression was negatively correlated with AI (r =-0.772,P＜0.05).Conclusions Down-regulation of Survivin expression may play an important role in apoptosis induced by 125I brachytherapy.99Tcm-Annexin V combined with MR-DWI could effectively evaluate apoptosis of lung adenocarcinoma cells in a non-invasive way,thus it might be helpful in evaluation of early efficacy of 125I brachytherapy.

Objective To analyze the clinical characteristics of eosinophilic gastroenteritis (EG) so as to provide evidence for early diagnosis and treatment of EG. Methods The clinical data of 17 patients with EG, who were admitted to Changzheng Hospital of Second Military Medical University from Jul. 2009 to Jan. 2017, were retrospectively analyzed. Results Male patients had a higher prevalence of EG and occurrence ratio of male and female was 2.4∶1. Nine (52.9%) of the 17 patients had a history of allergy. The most common symptoms were abdominal pain (13/17, 76.5%), followed by abdominal distension (7/17, 41.2%). Peripheral eosinophil count elevated in the 17 patients. Endoscopic examination showed that the lesions were mainly located in the gastric antrum, gastric body and descendant duodenum, and the most common finding were mucosal erythema. Biopsy of 13 cases and/or ascites examination of 5 cases showed eosinophil infiltration in the lesions. Abdominal CT scanning of 8 cases showed stomach or partial small bowel wall thickening with edema and thickened mesenterium. Glucocorticoid therapy was the main treatment for EG, and it could effectively relieve the symptoms. Seven of 13 cases who were followed up had relapse, with the recurrence rate being 53.8% (7/13), and were improved after administration of glucocorticoid again. Conclusion The clinical manifestation of EG is non-specific, and the endoscopic multi-point biopsy is the key to diagnose EG. Glucocorticoid can effectively relieve symptoms of EG and reduce peripheral eosinophils count.

Covert hepatic encephalopathy (CHE) is defined as presence of neuropsychological and/or neurophysiological abnormalities in cirrhotic patients without disorientation or asterixis. The West-Haven criteria are most often used to grade hepatic encephalopathy (HE), with scores ranging from 0 to 4. In 2011, the minimal (grade 0) and grade 1 hepatic encephalopathy were collectively referred to as CHE by SONIC classification. It is difficult for clinicians to diagnose CHE because its clinical manifestation is not obvious. So far, there is no consensus on CHE treatment. Here we have reviewed the articles regarding the diagnoses and treatment of CHE, hoping to provide guidance for the clinicians in clinical practice.

Objective To explore a modified method of cerebellar tonsillectomy combined with posterior fossa decompression via small-size craniotomy for Chiari- malformation associated with syringomyelia and to evaluate its clinical efficacy. Methods The clinical data of 29 Chiari- malformation patients associated with syringomyelia, who underwent modified cerebellar tonsillectomy combined with posterior fossa decompression via small-size craniotomy from January 2012 to January 2014, were analyzed retrospectively.Patients were prone with head and neck in the coaxial position and received surgical intervention including posterior fossa decompression via small-size craniotomy, opening the rear atlas arch, resection of the inner part of cervical canal of the cerebellar tonsil herniation while keeping the integrity of soft meninges, adhesiolysis of median aperture of the fourth ventricle, dissection of the suture of arachnoid and dural edge to avoid latrogenic dead space, and suture of the dura with autologous fascia. The cerebrospinal fluid release rate of the whole process was controlled. Results A total of 24 patients were followed up after operation while 5 patients were lost in follow-up. The clinical symptom of 23 patients was improved within one year after operation. The repression of medulla oblongata and posterior upper part of cervical cord was removed in MRI examination 6 months after operation. The lower edge of cerebellar tonsillar was up to the plane above the foramen magnum and the herniation was resolved. The syringomyelia was shortened or disappeared. Conclusion Modified cerebellar tonsillectomy combined with posterior fossa decompression via small-size craniotomy, as a microscopy neurosurgery, is an effective method for the treatment of Chiari- malformation associated with syringomyelia.

Objective To observe the effect of Rheb, a regulating protein in the upper stream of mTOR signaling pathway, on adipocyte differentiation. Methods (1) The recombinant plasmid pCAG-Insulator-Rheb was constructed and injected into the embryo of B6 mouse to produce transgenic mouse over-expressing Rheb. (2) The mouse embryonic fibroblast cells (MEFs) were collected from Rheb transgenic mice on pregnancy day 13. 5, and they were induced to differentiate into adipocytes after identified by PCR. (3) On differentiation day 12, the MEFs were subjected to Oil Red O staining and the contents of triglyceride in the MEFs were determined; moreover, the expression of special transcription factor PPARy and C/ EBPa was examined by real-time PCR, and all of the above parameters were used to assess the role of Rheb in the differentiation of adipocytes. Results We successfully constructed the transgenic mouse model over-expressing Rheb. We found that mouse over-expressing Rheb promoted adipogenesis in MEFs and increased the content of triglyceride in MEFs; moreover, the overexpression also greatly changed the results of Oil Red O staining and greatly promoted the expression of adipocyte specific transcript factor PPARy and C/EBPα. Conclusion Over-expression of Rheb can promote the differentiation of MEFs into adipocytes.