Objective To explore the feasibility and clinical value of the trans-umbilical single-port laparoscopic operation with routine apparatus in treatment of hepatobiliary diseases. Methods From Mar 2010 to Sep 2012, 415 patients with hepatobiliary disease, splenic disease, abdominal cavity disease or combine hysteromyoma were performed by trans-umbilical single-port laparoscopic operation with routine apparatus. The clinical data of 415 cases were analyzed respectively.Result All patients except one patients who was added one port for hysterectomy, were performed successfully trans-umbilical single-port laparoscopic operation with routine apparatus without conversion to laparotomy or conventional laparoscopic surgery. Conclusions The trans-umbilical single-port laparoscopic operation with routine apparatus is safe and effective in treatment of hepatobiliary diseases. Limited by the anatomy position, the trans-umbilical single-port laparoscopic operation with routine apparatus can cure most hepatobiliary diseases. So the operator must have the experience both in single-port laparoscopic operation and traditional laparoscopic operation. With the improvement of rotatable equipment, the practical procedure is expected to be generalized in the future.

Objective To summarize our experience in treating high risk carotid stenosis. Methods We retrospectively analyzed the clinical characteristics, treatment, and outcomes of 24 patients with high risk carotid stenosis in our department from January 2001 with emphasis on the application of carotid stents and shunting tubes. Results All patients were successfully treated, with 11 patients undergoing carotid angioplasty and stenting (CAS) and 13 patients receiving carotid endarterectomy (CEA) and shunting. No death, stroke, and ischemic neurological deficit occurred in 30 days postoperatively. Conclusion Selective application of CAS and shunting in CEA can effectively reduce complications and improve therapeutic effects in patients with high risk carotid stenosis.

Objective: To investigate the growth inhibition and apoptosis induction effect of vitamin E succinate (VES) on human colon cancer cells and to analyze the modulation of apoptosis-mediator Fas expression in this process. Methods: Human colon cancer cell line LS174T was treated with VES for 12 h, 24 h and 48 h at the concentrations of 5 mg/L, 10 mg/L and 20mg/L. 1-(4,5-dimethylthiazo-2-yl)-3,5-diphenylformazan (MTT) assay was employed to detect the inhibitory effect of VES on the growth of colon cancer cells. Flow cytometry was then used to analyze the cell cycle of the colon cancer cells after being treated with VES and the apoptotic rate was calculated at the same time. To find out whether the Fas protein expression was modulated in this process, Western blotting assay and flow cytometry were used to detect the Fas protein level in whole cell lystates and on cell surface. Results: VES exhibited a significant inhibitory effect on the growth of human colon cancer cells in a doseand time-dependent manner. After being treated with VES at 5 mg/L, 10 mg/L and 20 mg/L for 48 h, the apoptotic rate of LS174T cells rose from 0.90% to 15.9%, 46.7% and 64.5%, respectively. Fas neutralizing antibody can significantly block VES-induced apoptosis. After the administration of VES, total Fas protein in whole-cell extracts increased in a dose-dependent manner. The flow cytometry showed that the mean fluorescence intensity rose from 5.43 to 9.88, 13.21 and 18.0 after being treated with VES. Conclusion: VES can induce significant growth inhibition and apoptosis in human colon cancer cells. The modulation of Fas expression is one of the mechanisms involved in this process and may be related to the upregulation of Fas molecule on the cancer cell surface.

Objective To investigate the inhibitory effect of vitamin E succinate(VES) combined with ~chemotherapeutic drugs on the proliferation of human breast cancer cells. Methods Bcap-37 human breast cancer cells were treated with VES combined with chemotherapeutic drugs for 24h and 36h. The ~concentrations of VES were 10?g/mL and 20?g/mL and those of 5-florouracil, mitomycin and ~cyclophosphamide were 16.9?g/mL and 33.8?g/mL, 1?g/mL and 3.3?g/mL and 100?g/mL and 300?g/mL respectively. The inhibitory effect was measured with MTT method and the cell cycle and cell ~surface Fas expression were analyzed with flow cytometry assay. Results The combination of VES with ~chemotherapeutic drugs had a significant inhibitory effect on the growth of Bcap-37 human breast cancer cells. Flow cytometry assay of cell cycle showed that the natural apoptptic rate of Bcap-37 cells was 0.7%;after treatment with VES 20?g/mL,the apoptotic rate was 19.2%;after treatment with 5-Fu,mitomycin and ~cyclophosphamide the apoptotic rates were 16.2%,16.7% and 12.3%,respectively;after the combined use of VES and the 3 chemotherapeutic drugs,the apoptotic rates were 40.3%,44.8%,39.6%,~respectively .Fas expression in cancer cells increased after the co-administration of VES and chemotherapy drugs. Conclusions VES combined with chemotherapeutic drugs had significant inhibitory effect on the growth of Bcap-37 human breast cancer cells. The mechanism may be related to Fas upregulation on the surface of cancer cells.

Objective To investigate the inhibitory effect of vitamin E succinate(VES) on experimental breast cancer in nude mice.Methods MCF-7 human breast cancer cells were inoculated subcutaneously in nude mice.VES was administrated at a dosage of 150mg/kg body weight for 5 weeks.Then,the size of the tumor was measured and cell cycle and cell surface Fas/FasL were detected by flow cytometry.Fas/FasL expression in tumor tissue was detected with immunohistochemistry,and apoptosis index was detected by TUNEL method.Results VES showed obviously inhibitory effect on the growth of graft breast cancer tumor in vivo.VES treatment blocked tumor cells in G_0/G_1 phase.Fas/FasL expression was up-regulated accompanied with a rise of apoptotic index in tumor tissue.Conclusions VES had potent inhibitory effect on MCF-7 breast cancer graft in nude mice.The mechanism involved may be related to the up-regulation of Fas/FasL expression and promotion of apoptosis of tumor cells.

Objective To study the effects of tonifying kidney therapy on pathology in chronic hepatitis B virus carriers.MethodsWith the multi-center, randomized, double-blinded and placebo-controlled methods, 600 cases of chronic hepatitis B virus carriers were divided intoBushen Qingtou group,Bushen Jianpi group and control group, 200 cases in each group, and were treated withBushen Qingtou prescription,Bushen Jianpi prescription and placebo prescription respectively for 52 weeks. The pathological changes of the liver biopsy were observed by liver biopsy examination before and after treatment. Inflammatory active degree and fibrosis were scored with Knodell HAI and Ishak.Results The number of decreasing more than 2 points on Knodell HAI inBushen Qingtou group,Bushen Jianpi group and control group was 21, 18, and 6 respectively (P<0.05); the number of increasing more than 2 points on Knodell HAI in three groups was 3, 2, and 8 respectively (P<0.05). The curative effect ofBushen Qingtou prescription,Bushen Jianpi prescription were significantly obviously better than control group, without statistical significnce between the two treatment groups (P>0.05). The number of decreasing more than 1 points on Ishak in Bushen Qingtou group,Bushen Jianpi group, and control group was 13, 12, and 9 respectively (P>0.05); the number of increasing more than 1 points on Ishak inBushen Qingtou group,Bushen Jianpi group and control group was 8, 3, and 11 respectively, with statistical significance betweenBushen Jianpi group and controlled group (P<0.01), without statistical significance betweenBushen Qingtou group and control group (P>0.05), which meantBushenJianpi prescription could prevent the deterioration of liver tissue fibrosis more significantly than placebo prescription did. ConclusionTonifying kidney therapy, includingBushen Qingtou prescription andBushen Jianpi prescription, can inhibit the inflammatory activity and slow down the fibrosis progression of the chronic HBV carriers.

This study reviewed the definition of resilience, evaluation tools, protective factors and its effect on health outcomes of adult patients with chronic diseases, in order to provide theoretical guidance for the intervention of resilience of adult chronic disease patients.

Objective:To observe the application effect of formative evaluation of embedded standard patient (SP) on internal medicine practice teaching.Methods:In this study, 110 students from our school in Batch 2014 who were interned in the internal medicine of the same affiliated hospital were selected as the research objects, and they were randomized into the experimental group and the control group, with 55 students in each group. The control group was trained with traditional clinical practice teaching methods. The experimental group used SP combined mini-clinical evaluation exercise (Mini-CEX) to participate in the evaluation during the clinical practice teaching of internal medicine. After the internal medical practice, the two groups of students were evaluated by Mini-CEX, and the teaching effect of both groups was evaluated through questionnaires.Results:There was no significant difference in the degree of difficulty in the examinations ( P>0.05), but the test scores of the experimental group were significantly higher than those of the control group. The results of Mini-CEX used in inquiry skills, physical examination, humanistic care, and organizational effectiveness were significantly higher in the experimental group than in the control group. The experimental group was highly satisfied with the formative evaluation of SP participation in improving the effect of internal medicine practice, with statistical significance ( P<0.05). Conclusion:The formative evaluation with SP participation in this study can improve the clinical practice teaching effect of medical students to a certain extent.

Secondary hyperparathyroidism (SHPT) is a common and serious complication in long-term dialysis patients, who often experience multiple symptoms and a poor quality of life. Parathyroidectomy (PTX) is the best choice for severe SHPT patients with poor drug treatment. At present, the follow-up after PTX has not received sufficient attention, and the assessment of patients' clinical symptoms and quality of life is not yet adequate. In view of this, we systematically combed the changes and influencing factors of patients' quality of life and related symptoms after surgery, in order to provide reference for the practice and research of symptom management of such patients in the future.

ObjectiveTo evaluate the safety, feasibility and efficacy of transplantation of purified peripheral blood CD34+ cells in treatment of critical ischemia of the lower extremities.MethodsFrom May 2009 to March 2010, seven cases of critical ischemia of the lower extremities received purified peripheral blood CD34+ cells transplantation, among those 6 were caused by thromboangiitis obliterans and 1 by thrombosis coexistent with nodular erythema. Mean age was ( 39 ± 11 ) years ( range 23 - 54 ), and all patients were not suitable for surgical or endovascular revascularization. G-CSF was subcutaneously injected for 5 days before apheresis for peripheral blood mononuclear cells. Then CliniMACS system was used to isolate the CD34+ cells. If the number of CD34+ cells was between 105/kg and 106/kg , they were all intramuscular injected into patients' calf and foot. ResultsTechnical success and limb salvage were achieved in all cases. The mean number of transplanted cells was (7. 1 ±2.3) × 105/kg [ range(4.6 ×105 -1 × 106 )/kg]. All cases were followed-up, ranging from 6 - 14 months (mean 8 ± 3 months). One month after transplantation, the rest pain was obviously relieved in all cases, and the Wong-Baker FACES pain rating scale score significantly decreased from 7. 1 ±2. 0(4 - 10)to 1. 1 ± 1.1 (0 -2) ,P =0. 0000. The pain-free walking distance was significantly improved from (4 ± 4) min (range 1 -10 min)to (12 ± 7 ) min (range 5 - 21min , P =0.04) at 3 months and(20.4 ± 12.5) min(range 6 -40 min, P = 0.02) at 6 months, respectively. The ankle-brachial index increased from 0. 54 ± 0. 18 ( range 0. 41 - 0. 87 ) to 0.66 ±0. 13(range 0. 52-0. 86 , P=0. 17)at 3 months and 0.72 ±0. 13(range 0.56 -0.91, P=0. 07)at 6 months, respectively. Of 6 cases with the toe ulcer, the ulcer was healed in 3 and apparently shrank in 3. Transcutaneous partial oxygen pressure rose from (29 ± 14)mm Hg(range 10 -52 mm Hg)to 46 ±14 mm Hg ( range 27 - 63 mm Hg, P = 0. 04) at 3 months and (57 ± 10) mm Hg( range 41 - 66 mm Hg, P =0.001) at 6 months,respectively.No serious complications were found either perioperatively or postoperatively.ConclusionsTransplantation of purified peripheral blood CD34+ cells is safe, feasible and effective in the treatment of critical ischemia of the lower extremities.