Objective To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) with different approaches in patients with hilar cholangiocarcinoma type Ⅱ-Ⅳ.Methods The short-term clinical effect and longterm survival rate were analyzed retrospectively for a group of 97 patients with hilar cholangiocarcinoma type Ⅱ-Ⅳ receiving PTBD with different approaches,i.e.unilateral and bilateral biliary drainage,each including stent placement and drainage tube implantation.Results No significant difference was found in the decreasing of TBIL and DBIL,the survival rate and survival Curve between unilateral and bilateral biliary drainage.The median survival time was 7.5 months in unilateral and 6.7 months in bilateral biliary drainage,6.0 months in single stent and 6.5 months in single drainage tube,and 4.3 months in bilateral stents,respectively.The post operation complications mainly occurred in single drainage tube.Conclusion Single biliary drainage is able to decrease bilirubin for hilar cholangiocarcinoma type Ⅱ-Ⅳ,while stent implantation should be taken as the first choice.

Objective To explore the reasons of biliary restenosis after interventional treatment for malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma and to discuss its management. Methods During the period from June 2010 to Sep. 2013 at authors’ hospital, a total of 36 patients with high biliary obstruction caused by Bismuth Ⅱ - Ⅳ type of hepatic hilar cholangiocarcinoma received percutaneous transhepatic cholangial stenting (PTCS), and as the patients developed biliary restenosis after PTCS percutaneous transhepatic cholangial drainage (PTCD) had to be carried out. All the patients had complete data. Serum total bilirubin, direct bilirubin, glutamyltranspetidase and alkaline phosphatase levels were determined on the operation day and at five days after PTCS and PTCD. The short - term remission of malignant obstructive jaundice produced by PTCS and PTCD were assessed. The causes of biliary restenosis were analyzed by comparing the CT and/or MRI images as well as the cholangiography and drainage test results which were performed at the first and second admission to hospital. Results The interval time from operation to restenosis was 31 - 468 days, with an average of 132.8 days. The effective rates of PTCS and PTCD for relieving jaundice were 77.8% and 75.0% respectively. The main causes of restenosis included the formation of biliary sludge, acute cholangitis and tumor growth. Conclusion PTCS is an effective means to relieve the malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma, however, the incidence of biliary restenosis after PTCS is higher, which may be mainly due to the tumor growth. Nevertheless, subsequent PTCD can effectively improve the liver function, control biliary infection, remit biliary obstruction and relieve the clinical symptoms.

[Objective]To discuss the operative treatments and evaluate the effects of reconstruction interlocking nail(RIN)in treating femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur.[Method]A retrospective study was done on 37 patients with femoral shaft fractures combined with ipsilateral peritrochanteric fractures treated by RIN from September 2002 to Janurary 2009.This study involved 32 males and 5 females,with an average age of 36 years (range,24 to 69 years).Thirty-three patients had high-energy injury (26 of road accident,7 of falling from height),and 4 low-energy injury.Among them,13 patients had fractures in the upper one-third of the femoral shaft,18 in the middle one-third and 6 in the lower one-third.Six patients had open fractures (Gustilo scale Ⅰ in 1,and Ⅱ in 5).According to Garden classification for femoral neck fractures,there were 19 cases of type Ⅱ,9 cases of type Ⅲ and 2 cases of typ Ⅳ.According to AO classification for femoral intertrochanteric fractures,there were 3 cases of type A1.1,1 case of type A2.1.According to Seinsheimer classification for femoral subtrochanteric fractures,there was 1 case of type Ⅰ,and 2 cases of type ⅡA.The mean duration from injury to surgery was 3.7 days (range,4 hours to 13 days).After operation step-by-step functional rehabilitation was encouraged.[Result]The follow-up periods ranged from 14 to 38 months (average,24 months).Bony union was achieved in all patients.The average bony union time was 13 weeks for fractures of femoral shaft,14 weeks for femoral neck,12.6 weeks for intertrochanteric and 15.5 weeks for subtrochanteric fractures.Femoral head necrosis occurred in one case.No such complications as infection,loosening of nails,coxa vara,or malunion was found.According to Harris Scoring system,32 cases (86.5%)were rated as good or excellent.[Conclusion]The treatment of femoral shaft fractures associated with ipsilateral peritrochanteric fractures of the femur with RIN is a good method because of its advantages of small trauma,stable fixation,high union rate,few complications and good results.It may have fewer internal fixators.Carefully choosing suitable patients,sophisticated operation skills and active functional exercise after operation are keys to success.

OBJECTIVE:To establish a HPLC method for determining cefixime in human plasma.METHODS:Analytical column was Discovery C 18 (4.6mm?250mm,5?m),the mobile phase consisted of methanol-acetate buffer-triethylaming(28∶72∶0.5V/V),the flow rate was1.0ml/min.The detection was performed at UV286nm.Plasma concentrations of cefixime and internal standard(Cephradine)were determined by HPLC.RESULTS:The calibration curve was linear in the concentrations ranging from0.1to5.0?g/ml(r=0.9995).The detection limit was0.1?g/ml.The recovery was(96.63?3.17)%.The within-day RSD was less than6.10%and between-day RSD was less than6.69%.CONCLUSION:The method is simple,sensitive,accurate and suitable for determination of cefixime in human plasma and pharmacokinetic study.

OBJECTIVE:To evaluate the pharmacoeconomic(PE) efficacies of three therapeutic schemes in the treatment of community acquired pneumonia.METHODS:By applying the principle of decision tree analysis in pharmacoeconomics,a retrospective analysis and evaluation was performed on the following 3 therapeutic schemes:sequential therapy of levofloxacin hydrochloride injection,cefuroxime sodium for injection by iv gtt,and azithromycin for injection by iv gtt.RESULTS:The total costs of the three schemes were 4 327.56 yuan,5 327.32 yuan,and 5 074.14 yuan,respectively,and the total effective rates were 89.80%,88.80%,and 85.29%,respectively.The anticipant costs for each cured case of community acquired pneumonia were 3 886.15yuan,4 730.66yuan,and 4 327.73yuan,respectively.CONCLUSION:The sequential therapy of levofloxacin hydrochloride injection is the optimal one among the 3 schemes.

Objective To investigate the morphological change of intratumoral microvessels after administration of thalidomide in the murine hepatic metastases. Methods Among 20 mice with hepatic metastases created by injection of colon-26 tumor cells into the spleen, 10 were treated with thalidomide (200 mg/kg) by intraperitoneal injection daily, the other 10 were treated with saline only by intraperitoneal injection daily. Fifteen days after inoculation of tumor cell, the intratumoral mierovessel of hepatic metastases with similar size in both groups were studied with in vivo microscopy (26 and 27 neoplasms in experimental group and control group respectively ) and immunohistochemistry for CD34 (52 and 55 neoplasms in experimental group and control group respectively). Two-tailed student t test was used to determine differences in intratumoral microvessel density (MVD), intratumoral branch density (BD) and CD34 positive intratumoral microvessel density (MVD-CD34) between the small ( < 400 μm in diameter) and large metastases in both groups, and that between thalidomide treated group and control group. Results For the control group, although the MVD and MVD-CD34 of larger metastases was more than that of small metastases respectively [(18.1±3.5)% vs (13.0±3.2) %, t =2.840,P<0.01;(22.9±2.8)vs ( 12. 8±2. 5) vessels per field, t = 9. 860, P < 0. 01 ], the BD was similar to that of small metastases [(110.0±20.5)vs(99.7±17.3) branches/rnm2, t = 1.040,P >0.05]. For the thalidomide treated group, despite the MVD-CD34 of larger metastases was more than that of small metastases [ ( 17.4±2. 3)vs (11.5±2. 5 ) vessels per field, t = 8. 770, P < 0. 01], the MVD and BD was similar to that of small metastases respectively [(14.7±3.5)% vs(13.2±3.3) %, t =0.826,P >0.05; (95.3±18.3)vs (97. 1±21. 0)branches/mm2,t=0. 347,P>0. 05]. The MVD, BD and MVD-CD34 of small metastases were similar to each other between two groups ( t = 0. 098, 0. 392,1. 190; P > 0. 05 ), however, that of large metastases were significantly lower in thalidomide treated group than in control group ( t = 3. 140,2. 870, 9. 850;P < 0. 01 ). Conclusions Thalidomide exerts antiangiogenic effect on the hepatic metastases with angiogenesis only, and the different vascular components in the tumor vasculature demonstrate variousresponses to antiangiogenic therapy.

Objective To evaluate the embolization efficiency,short term clinical effect and adverse reactions of trisacryl gelatin microspheres in interventional treatment of hepatic carcinoma. Methods Twenty three cases of hepatic carcinoma (34 foci)were given 0.5-6 ml of microspheres mixed with some contrast medium via catheter after injection of chemodrugs and lipiodol 3-5 ml; and simultaneously observing the appearance of slow down of blood flow and vascular cast formation to stop the procedure. Enhanced CT or MR and AFP were performed every 1 month after the first procedure. Treatment needed to be repeated whenever the foci or new ones were enhanced in CT scans or increase of AFP value. The clinical effect and adverse reactions were also observed. Results The positive response rate was 39.1% (CR+PR). There were 9 cases of PR,13 cases of NC and 1 of PD; but no case of CR. Residual enhancement was observed in 17 foci after first procedure,10 of which received repeated therapy and 3 were embolized completely. The other 11 foci were completely embolized,among them 4 had new residual enhancement during 4-9 mo follow up and 2 were re-embolized completely. Eighteen cases with positive AFP showed obvious decrease in 11,no change in 6 and increase in one. Eighteen cases of pyrexia,11 cases of pain in hepatic region and 6 cases of nausea occurred 5-14 d after the procedure together with vomiting. We also found increase of ALT in 2 cases,BIL of 1 case,and no change of WBC in all cases. Conclusion Trisacryl gelatin microspheres is an excellent embolization agent with better clinical effect and less adverse reaction in the treatment of hepatic carcinoma.

Thirty-two male Sprague-Dawley rats were divided into control group (n =16) and fructose group (n =16) fed with 10％ fructose solution.After 4 weeks,the rats of two groups were treated with saline and 50 nmol/kg ghrelin for 6 weeks,respectively (each group n =8).Fasting plasma glucose,insulin,and blood lipid profile were measured.Insulin receptor (Ins-R) mRNA expression in muscle was detected by RT-PCR.The phosphorylation of insulin receptor substrate-1 (IRS-1) was measured by Western blot.The results showed that insulin level and homeostasis model assessment for insulin resistance index (HOMA-IR) in fructose group were higher than those in control group [(13.1±3.6 vs 9.0 ± 1.5) μU/ml,P＜0.05 ;2.78 ± 0.14 vs 1.81± 0.13,P ＜0.01)].After ghrelin treatment,plasma insulin concentration [(9.6 ± 2.5) μU/mL,P＜0.05] and HOMA-IR (1.96 ± 0.12,P＜0.01)significantly decreased,along with increased Ins-R mRNA and IRS-1 phosphorylation in skeletal muscle (P ＜0.01).These results suggest that ghrelin can ameliorate insulin resistance in fructose-fed rats by restoring Ins-R function.

Objective To explore the expression of acid seining ion channels-3 (ASIC3) in lung tissue in rats with acute lung injury (ALI). Method Twenty four male Sprague-Dawley (SD) rats were randomly divided into four groups: LPS groups (LPS 2 h, LPS 4 h, LPS 6 h group, n=6), stimulated by LPS for 2, 4, 6 hours, respectively; normal control group, injected with saline (NS group, n=6). The ALI models were produced through venous injection of LPS, and the criteria was the characteristic pathological changes in the lung tissue. Ar-terial blood gas analysis was observed, lung wet and dry weight ratio (W/D), lung histopathology and ASIC3 ex-pression were detected. Data were expressed as mean±standard deviation. Independent Sample T test and One-way ANOVA and Kendall's tau_b were used for comparison in SPSS 13.0, and changes were considered as statistieal-ly significant if P value was less than 0.05. Results The partial pressure of oxygen (PaO2) in LPS 2 h, LPS 4 h, LPS 6 h group was (67.47±6.01), (59.17±7.18), (52.54±7.62) , respecively, and was significantly lower than that in eontrol group (98.15±1.06) (P<0.01). Compare with control group, pH was significantly lower in LPS4 h group (7.28±0.04), LPS6 h group (7.24±0.03) (P<0.01). Inflammation cells gradually increased, alveolar septum was widened, edema existed in interstitial spaces, and pulmonary structures gradually destroyed in LPS groups.The expression of ASIC3 in LPS4 h, LPS 6 h group was (205.91±10.12), (196.51± 18.60), respectively, and was significantly lower thanthat in control group (220.23±10.11) (P<0.05). The W/D in LPS 6 h group was (5.18±0.21), and was significantly higher than that in the control group (4.45± 0.18) (P<0.05). Conclusions ASIC3 is expressed in alveolar epithelial cells and bronchial epithehal cells in LPS-induced ALI rats.

Objective To investigate whether metabolic pathway-related gene polymorphisms are associated with arterial plaque stability and their gene-gene interactions increase the risk of cerebral infarctions.Methods Totally 294 patients with atherothrombosis stroke admitted to the Department of Neurology, the Third Affiliated Hospital of Wenzhou Medical University from September 2010 to December 2012 were divided into a carotid vulnerable plaque group ( n=69 ) and a stable plaque group ( n=225 ) according to the results of carotid B-mode ultrasonography.A total of 282 healthy volunteers excluded carotid plaque and stroke were enrolled as well.Genetic polymorphisms of ALOX5AP and CYP3A5, CYP2C9*2, CYP2C9*3 and EPHX2 were genotyped using polymerase chain reaction and mass spectrometry analysis.The SPSS16.0 software was used to compare genotype frequencies and the generalized multifactor dimensionality reduction ( GMDR ) method was applied for gene-gene interaction analyses.Results The results showed that EPHX2 GG genotype might protect against stroke ( OR =0.520, 95% CI 0.288 -0.940, P=0.030).The distribution of CYP3A5 genotypes showed statistically significant differences (χ2 =7.284, P=0.026) between the vulnerable plaque ( AA: 5 cases, AG: 36 cases, GG: 28 cases) and stable plaque ( AA: 26 cases, AG: 77 cases, GG: 122 cases ) groups.Multivariate Logistic regression analysis showed that the GG genotype of CYP3A5 was protective factor for unstable plaques ( OR=0.405, 95%CI 0.178 -0.920, P =0.031 ).Differences in other SNPs did not reach statistical significance between the two groups.The GMDR analysis showed a significant gene-gene interaction between SG13S114 and A6986G, with scores of 10 for cross-validation consistency and 9 for the sign test (P=0.011).The best model for ischemic stroke was found to be SG13S114 AA and A6986G AA.Adjusting for age, hypertension and diabetes, the certain gene-gene interaction predicted a significantly higher risk of cerebral infarction (OR=1.804, 95%CI 1.180-2.759, P=0.006).Conclusions The EPHX2 G860A gene might be linked with the incidence of cerebral infarctions.Only a CYP3A5 gene polymorphism might be associated with carotid plaque instability in patients with stroke.The gene-gene interaction predicts a significantly higher risk of cerebral infarction.There is a 1.804-fold increased risk for ischemic stroke in individuals with these combined genetic factors.