Objective:To investigate the influence of preoperative biliary drainage (PBD) on morbidity of severely obstructive jaundice patients after pancreaticoduodenectomy (PD).Methods:A total of 98 severely obstructive jaundice(Serum total bilirubin＞300 μ mool/L) patients underwent PD between February 2010 and October 2015 were enrolled in the study.The patients were divided into two groups based on undergoing PBD or not.The no-PBD group comprised 52 patients and the PBD group comprised another 46 patients.Perioperatives parameters,including operative time,intraoperative blood loss,postoperative mortality and morbidity and postoperative hospital stay were compared between the two groups.Results:The demographics,preoperative examinations and pathological results were similar between the two groups (P＞0.05).Operative time of the no-PBD group was statistically longer than the PBD group (379.44 ± 88.57min vs 346.98 ± 57.17 min,P＜0.05).Besides,intraoperative blood loss of the no-PBD group were much more than the PBD group (365.00 ± 187.07mL vs 297.83 ± 139.57 mL,P＜0.05).There was no statistical difference of mortality rate between the no-PBD group and the PBD group(3.85％ vs 2.17％,P＞0.05).The overall morbidity rate of the 2 groups were similar (53.85％ vs 43.48％,P＞0.05),but the pancreatic fistula rate of no-PBD group was significantly higher than the PBD group (30.77％ vs 13.04％,P＜0.05).Conclusion:PBD could reduce operative time,intraoperative blood loss and pancreatic fistula rate after PD.Meanwhile,the mortality and overall morbidity rates were similar between the two groups.PBD should be considered for severely obstructive jaundice patients.

Background and purpose: Accumulating evidence has revealed that long non-coding RNA (lncRNA) is correlated with carcinogenesis and tumor development. Recent literature suggested that lncRNA promoter of CDKN1A antisense DNA damage activated RNA (PANDAR) was involved in the development of various cancers. However, the functional role of PANDAR in colorectal cancer (CRC) has not been elucidated yet. The present study aimed to explore the functional role of lncRNA PANDAR in promoting CRC metastasis and its mechanism.Methods: The expression of lncRNA PANDAR in CRC cell lines and tissues was detected by real-time fluorescent quantitative polymerase chain reaction (RTFQ-PCR), and the correlation between lncRNA PANDAR expression and CRC clinicopathological characteristics was statistically analyzed. Then, lncRNA PANDAR stably silencing CRC cells (HCT116-shPANDAR), overexpression cells (DLD1-PANDAR) and control vector cells (HCT116-shNC and DLD1-vector) were established using lentiviral vectors. Moreover, Transwell assay and Matrigel assay were performed to investigate the function of lncRNA PANDAR in CRC migration and invasion. Furthermore, the expression of transcriptional factors mediating epithelial-mesenchymal transition of lncRNA PANDAR overexpression cells were monitored by RTFQ-PCR assay, and the function of the target gene in modulating lncRNA PANDAR mediated CRC metastasis was also explored. Results: The expression levels of lncRNA PANDAR in normal colorectal epithelial cells were much lower than in CRC cell. The levels of lncRNA PANDAR in tumor-adjacent tissues were verified to be much lower than in CRC tissues [(171.52±97.80)% vs (100.00±63.18)%, P<0.05]. Moreover, the expression of lncRNA PANDAR was detected to be significantly correlated with CRC TNM stage, lymph node metastasis and distant metastasis (P<0.05). Besides, lncRNA PANDAR deficiency significantly reduced the migration [100.00% vs (42.08±4.77)%, P<0.05] and invasion [100.00% vs (39.14±3.81)%, P<0.05] capabilities in CRC cells, in contrast, the migration [100.00% vs (194.12±9.33)%, P<0.05] and invasion [100.00% vs (204.08±12.27)%, P<0.05] capa-bilities of CRC cells were obviously increased with lncRNA PANDAR overexpression. Furthermore, zinc-finger E-box binding homeobox 1 (ZEB1) expression was detected to be positively correlated with lncRNA PANDAR expression, and ZEB1 silencing could significantly reverse the increased migration and invasion capabilities induced by lncRNA PANDAR in CRC cells. Conclusion: LncRNA PANDAR could promote CRC metastasis by potentially targeting ZEB1. LncRNA PANDAR might be a promising diagnostic marker and therapeutic target for CRC patients.

BACKGROUND:Whether there are breast cancer stem cel microspheres in the breast cancer tissues and whether these microspheres have an impact on isolation and culture of breast cancer stem cel s after different cycles of neoadjuvant chemotherapy are stil unclear. OBJECTIVE:To explore the proliferation and differentiation of breast cancer stem cel s in breast cancer tissues after different cycles of neoadjuvant chemotherapy. METHODS:Breast cancer stem cel microspheres were isolated from the breast cancer tissues after different cycles of neoadjuvant chemotherapy to drawn a cel growth curve. Immunocytochemical method was used to detect ALDH1 expression. RESULTS AND CONCLUSION:Microspheres could be obtained from the specimens of neoadjuvant chemotherapy for two, three and four cycles rather than one cycle. At 3 days prior to culture, there was no difference in the number of cel s isolated after two-and three-cycle neoadjuvant chemotherapy;but after 3 days, the cel s from the three-cycle neoadjuvant chemotherapy proliferated faster than those from the two-cycle neoadjuvant chemotherapy;after 6 days, the cel growth curve of two-cycle neoadjuvant chemotherapy was in the plateau stage, and the proliferation of cel s from the three-cycle neoadjuvant chemotherapy showed a rapid increase trend. The positive expression of ALDH1 in the microspheres from the three-cycle neoadjuvant chemotherapy was higher than that from the two-cycle neoadjuvant chemotherapy. These findings indicate that breast cancer stem cel s from the specimens of two-and three-cycle neoadjuvant chemotherapy both have proliferation and differentiation potentials, and the specimens of three-cycle neoadjuvant chemotherapy or above are preferred.

Objective To investigate the effects of therapeutic hypercapnia on acute pulmonary allograft rejection induced by macrophages in rats.Methods Twenty-four adult male Wistar rats and 12 adult male Sprague-Dawley rats,weighing 250-280 g,were used in this study.The recipient rats were randomly divided into 3 groups using a random number table (n =6 each):syngraft group (group S),allograft group (group A) and therapeutic hypercapnia group (group H).In group S,Wistar rats served as donors and recipients,while in A and H groups,Sprague-Dawley rats served as donors and Wistar rats served as recipients.Orthotopic left lung transplantation was performed using the cuff technique.After transplantation,the rats inhaled 50％ N2-50％ O2 for 90 min during reperfusion in S and A groups,while in group H the rats inhaled N2-O2-CO2 for 90 min during reperfusion and PaCO2 was maintained at 80-100 mm Hg and O2 concentration in inspired air at 48％-50％ by adjusting the concentrations of the three gases.At 7 days after operation,the arterial blood sample was collected for blood gas analysis and for determination of serum concentrations of tumor necrosis factor α (TNF-α) and interferon γ (IFN-γ)by ELISA.The oxygenation index was calculated.Then the rats were sacrificed,and the transplanted lungs were removed for microscopic examination and for detection of infiltration of macrophages (by immunohistochemistry)and cell apoptosis (by using TUNEL) in lung tissues.The rejection was scored and apoptotic index was calculated.Results Compared with group S,PaCO2,serum concentrations of TNF-α and IFN-γ,rejection score,the number of macrophages and apoptotic index were significantly increased,and oxygenation index was decreased in group A (P ＜ 0.05).Compared with group A,pH value and oxygenation index were significantly increased,and serum concentrations of TNF-α and IFN-γ,rejection score,the number of macrophages and apoptotic index were decreased in group H (P ＜ 0.05).Conclusion Therapeutic hypercapnia can reduce macrophage-induced acute pulmonary allograft rejection possibly through inhibiting the inflammatory responses and cell apoptosis.

Objective To prepare transferring and R8 co-modified liposome (TF/R8-LP)for forhepatoma targeting.Methods The co-modified liposome were prepared by film-ultrasonic method.The appearance,particle size,Zeta potential were evaluated.The cellular uptake by HepG2 cell in vitro was used to evaluate the targeting efficiency and in vivo imaging were used to evaluate the targeting efficiency. Results The particle diameter of the co-modified liposome was(108.5 ±12.6)nm and the Zeta potential was(24.15 ±4.78)mV.The liposome kept stable in 50% FBS at 24 h.The result demonstrated that the co-modified liposome uptaken by HepG2 were 2.4,2.6 times higher than that of R8-LP and TF-LP,respectively(P<0.05).The evaluation of tumor spheroid penetration and in vivo imaging results showed the co-modified liposome had the strongest fluorescence intensity. Conclusion The co-modified liposome might serve as a promising hepatoma delivery system of antitumor drugs.

This paper was aimed to study the dynamic changes of San-Ao(SA) decoction in different compatibility of ephedrine hydrochloride,pseudoephedrine hydrochloride,amygdalin and glycyrrhizic acid.HPLC was used to simultaneously determinate the transfer rate of SA decoction of ephedrine hydrochloride,pseudoephedrine hydrochloride,amygdalin and glycyrrhizic acid.Kromasil C18 (4.6 mm×250 mm,5μm) column was selected with methanol and 0.1% phosphoric acid as a mobile phase to gradient.The flow rate was 1 mL·min-1.The column temperature was 30℃.The injection volume was 10μL.Ephedrine hydrochloride,pseudoephedrine hydrochloride and amygdalin were detected at the wavelength of 208 nm.The glycyrrhizic acid was detected at the wavelength of 250 nm.The results showed that the transfer rate of ephedrine hydrochloride in decoction was more than that of the single preparation.The transfer rate of pseudoephedrine hydrochloride was the highest in the combination of ephedra and bitter almond.The transfer rate of amygdalin was the highest in the combination of ephedra and bitter almond.The transfer rate of glycyrrhizic acid in decoction was more than that of the single preparation.It was concluded that there were dynamic changes in the boiling process during herbal decoction preparation.The effectiveness and stability of Chinese medicine should be improved according to these changes.

Objective To study the education of medical mycology for undergraduates of medical laboratory specialty and provide a basis for teaching reformation.Method Setting of mycology related courses of medical mycology for undergraduates in 5 medical schools and 85 inspection and technical personnel's detection of fungi in 81 hospitals were investigated through consultation and questionnaire survey.Results More than 140 class hours for medical mycology were arranged in 5 schools,but as to medical mycology,22 class hours in 1 school and less than 10 class hours in 4 schools,the minimum class hours were 5.Although various numbers of Candida and filamentous fungi could be isolated in hospitals investigated,more than half laboratory workers could not identify penicillium,thermally dimorphic fungi,Zygomycetes and Dematiaceous fungi.Conclusion Education on medical mycology for medical laboratory specialty undergraduates is insufficient and the corresponding teaching lacks such content as medically important pathogenic fungi detection methods and identification characteristics.The hospital technical personnel's fungal identification ability cannot meet the situation of increasing fungal infection involved in clinical medicine,so it is necessary to carry out teaching reformation of medical mycology for undergraduates in laboratory medicine,including adding class hours,increasing course contents and so on.

OBJECTIVE:To observe the effects of dexmedetomidine hydrochloride on extubation stress response in elderly pa-tients during general anesthesia recovery period. METHODS:80 patients underwent general anesthesia of abdominal surgery were randomly divided into observation group and control group,with 40 cases in each group. Both groups received routine anesthesia before surgery and during surgery. 10 min before the end of surgery,observation group was given intravenous pump of dexmedeto-midine hydrochloride diluted to 10 ml 0.5 μg/kg,and control group was given constant volume of 10 ml 0.9% Sodium chloride so-lution. HR,MAP and SaO2 levels of 2 groups were compared before the induction of anesthesia (T0),at the moment of intrave-nous injection of dexmedetomidine hydrochloride or 0.9%Sodium chloride solution(T1),at the moment immediately before extuba-tion(T2),at the moment of extubation(T3),1 min after extubation(T4),5 min after extubation(T5)and 10 min after extubation (T6). Ramsay sedation score of 2 groups were compared at T0,T2,T4,T5 and T6;cough score,restlessness score,awake time(t1) and extubation time(t2)were also compared between 2 groups. RESULTS:Compared with at T0,the fluctuation of HR and MAR in 2 groups decreased significantly and became stable gradually at T4,T5 and T6,and HR and MAP of observation group at T1-T6 were significartly lower than those of control group,with statistical significance(P<0.05);but there was no statistical significance in SaO2 (P>0.05). There was statistical significance in Ramsay sedation score between 2 groups at T2,T4,T5 and T6 (P<0.05). The cough score and restlessness score of observation group were significantly lower than those of control group,and t1 and t2 were significantly shorter than those of control group,with statistical significance(P<0.05). CONCLUSIONS:Dexmedetomidine hydro-chloride can relieve extubation stress reaction in elderly patients during general anesthesia recovery period with good safety.

Objective To investigate the risk factors of postoperative infection in patients with liver transplantation.Methods Clinical data and laboratory findings of 1 1 3 patients undergoing liver transplantation admitted in Beijing Chaoyang Hospital,Capital Medical University during January 201 1 and December 201 4 were retrospectively analyzed.Among 1 1 3 patients,postoperative infection occurred in 35 patients,multivariate Logistic regression analysis was performed to identify the risk factors of postoperative infection.Results Univariate analysis showed that length of hospital stay,model for end-stage liver disease (MELD)score,preoperative use of antibiotics,duration of postoperative respirator use,length of ICU stay, dosage of albumin,days of parenteral nutrition,intra-abdominal hemorrhage,fasting blood glucose,blood concentration of immunosuppressant (FK506 ),the duration of prophylactic use of antibiotics and pleural effusion were associated with postoperative infection (t =2.56,3.1 9,2.71 and 5.05;χ2 =3.87,5.75,4.66 and 5.46;Z =4.88,3.69,5.86 and 3.90;P <0.05 or <0.01 ).Multivariable logistic regression analysis showed that preoperative use of antibiotics (OR =35.03,95% CI:6.48 -94.64,P <0.01 ),duration of postoperative respirator use (OR =1 .02,95%CI:1 .01 -1 .04,P <0.01 ),days of parenteral nutrition (OR =1 .20,95%CI:1 .07 -1 .35,P <0.01 ),postoperative fasting plasma glucose(OR =1 .46,95%CI:1 .1 0 -2.1 6,P <0.05),the duration of prophylactic antibiotics use (OR =1 .1 0,95%CI:1 .33 -1 .86, P <0.05),and pleural effusion(OR =5.70,95%CI:1 .02 -31 .84,P <0.05 )were independent risk factors of postoperative infection.Conclusion Taken account of possible risk factors,effective prevention and control measures should be taken to prevent postoperative infection after liver transplantation.

Objective To review the clinical data and visual outcomes after treatment of patients with dysthyroid op-tic neuropathy ( DON) .Methods We retrospectively examined the clinic data of the 38 patients (67 eyes) suffer-ing from DON and analysed the effect of glucocorticoids , radiation and orbital decompression .Results The study included 14 men and 24 women.32 patients ( 84.2%) received multiple treatment modalities .LogMAR vision acuity changed from (0.60 ±0.59) before treatment to (0.18 ±0.09) after treatment(P<0.01) .There were 59 eyes (88.1%) in the treatment effective group , 8 eyes (11.9%) in the ineffective group .38 eyes underwent ini-tial treatment with intravenous steroid pulse therapy and 35 eyes ( 92.1%) were effective .29 eyes were treated with other modalities and 24 eyes(82.8%) were effective(P<0.01).There were 3 eyes (5.1%) suffering from fixed eyeball movement in the effective group , while 4 eyes ( 50%) in the ineffective group ( P <0.05 ) .The thickness of the supraocular muscle group in the effective group was (7.63 ±1.19 ) mm, (8.81 ±0.83 ) mm in the ineffective group (P<0.05).Mean defect of the visual field was (2.41 ±2.82) in the effective group and (11.98 ± 7.07 ) in the ineffective group ( P<0.05 ) .Conclusions Treatment with multiple modalities effectively improved visual outcomes in cases of DON .Intravenous pulse steroid therapy was recommended as the initial modality .