Although choledochoscope has been described as an ideal approach for cholelithiasis, larger,impacted or residual biliary duct stones could hardly be taken out. Choledochoscopic laser lithotripsy was used in 1978. At present, however, it has not wildly been applied in the biliary surgery. In this article, we reviewed the domestic and foreign literatures to state the application and prospect of choledochoscope combined with laser lithotripsy in cholelithiasis.

Objective To investigate the expressions of hypoxia-inducible factor-1 alpha (HIF-1?) and its relation with secondary brain damage in perihematomal issue in human intracerebral hemorrhage. Methods Perihematomal brain issue were collected in the course of evacuation of hematoma in 32 patients with hypertensive intracerebral hemorrhage. Expressions of HIF-1? were observed by immunohistochemistry and the neuronal apoptosis were observed by terminal deoxynucleotidyl transterrase mediate dUIP nick end labeling (TUNEL) staining and HE staining. Results HIF-1? protein immunohistochemical staining positive cells ((2.8?0.8)/HP) were identified dispersedly from 4 h after acute hemorrhagic stroke in perihematomal brain issue, and reached the peak at 24—48 h ((12.5?3.9)/HP). The expressions of HIF-1? kept high at 49—72 h ((12.2?1.8)/HP) after acute hemorrhagic stroke. Nervous cells and vascular endothelium cells had been swelled at 4 h after acute hemorrhagic stroke. TUNEL positive cells appeared from 12 h ((11.2?4.1)/HP), increased markedly at 24—48 h ((29.7?8.4)/HP), and reached the peak ((33.2?4.3)/HP) at 49—72 h after acute hemorrhagic stroke. There was a statistically significant correlation between HIF-1? expressions and TUNEL positive cells (r=0.788, t=7.02, P

Objective:To investigate the effect and mechanism of hypoxia-inducible factor-1α (HIF-1α)in perihematomal brain tissue on the early formation of edema in patients with hyper-tensive intracerebral hemorrhage.Methods:The perihematomal brain tissue in 32 patients with hypertensive intracerebral hemorrhage were treated with hematoma evacuation.The expressions of HIF-1α and vascular endothelial growth factor(VEGF)were measured by immunohistochem- istry staining technique.The volume of perihematomal edema was determined on the basis of reoperative head CT scan.The results of staining and the volume of edema were analyzed by using double-blind method.Resets:Neuron and vascular endothelial cell swelling were observed 4 hours after cerebral hemorrhage,and the scattered HIF-1α positive neurons were visible.The expressions of HIF-1α reached the peak(at 24 to 48 hours,and went on high expressions at 49 to 72 hours.There was significant difference as compared with the normal brain tissue(P＜0.01). There were positive correlations between the expressions of HIF-1α and VEGF (r=0.72,t=6.37,P＜0.01)and the volume of brain edema(r=0.64,t=4.56,P＜0.01).Conclusions: The expression of HIF-1α in perihematomal brain tissue of hypertensive cerebral hemorrhage iS associated with the early formation of cerebral edema.HIF-1α may accelerate the formation of brain edema by inducing and regulating the expression of VEGF.

Objective To explore the influencing factors of degenerative lumbar spondylolisthesis (DLS).Methods Sixty-one DLS patients (DLS group) were enrolled in this study.The control group was formed by 61 patients with same gender and age matched.The lesion position was L4 in two groups.The correlation of intervertebral joint angle,degeneration degree,lumbosacral angle and lumbar spondylolisthesis were analyzed.Results The intervertebral joint and sagittal angle in DLS group was less than that in control group[(37.11 ± 7.52)° vs.(42.44 ± 7.61)°] (P ＜ 0.01).The lumbosacral angle between two groups had no significant difference (P ＞ 0.05).The degeneration degree between two groups had significant difference (P ＜ 0.01).Conclusion Intervertebral joint and sagittal angle and intervertebral joint degeneration degree have important roles in DLS.

Objective To assess the safety and feasibility of CT-guided percutaneous argon-helium cryoablation in the treatment of adrenal tumors.Methods 1 7 patients with adrenal tumors were treated with CT-guided percutaneous argon-helium cryoablation. Three of these patients were retreated second cryoablation three months later due to the lager tumor diameters.Percutaneous tran-scatheter arterial embolization was performed in four patients because of rich blood supply before cryoablation.Continuous arterial blood pressure monitoring was performed in eight pheochromocytoma patients.Results Technical success was achieved in all pa-tients.There were no serious complications.Eight pheochromocytoma patients experienced a significant increase in systolic blood pressure and diastolic pressure when compared with the basic values (P <0.05).There were no enhancement on enhanced CT and/or up-take on FDG PET-CT in the ablated zones during the follow-up period (3-24months).Conclusion It is safety and efficacy of CT-guided percutaneous argon-helium cryoablation for adrenal tumor.It might be initial treatment of choice for the patients who were not suitable for resection.

OBJECTIVETo investigate the role of angiotensin converting enzyme inhibitor (ACEI) in the treatment of acute respiratory distress syndrome (ARDS).

METHODSChanges in physiological and biochemical indexes, and circulating endothelial cells (CEC) were observed in rats of oleic acid-induced ARDS with ACEI-Captopril (Cap) therapy and controls, respectively.

RESULTSUnder the normal systemic blood pressure, Captopril therapy showed good effect on ARDS in rats. Two hours after administration of Captopril, their pulmonary arterial pressure reduced to (14.43 +/- 1.51) mm Hg (1 mm Hg = 0.133 kPa), approximating to normal level, from (23.50 +/- 5.79) mm Hg. The number of CEC, which reflected injuries in pulmonary capillaries, decreased to (4.25 +/- 0.20)/0.9 micro l from (6.88 +/- 1.90)/0.9 micro l. Value of oxygen pressure in arterial blood (PaO(2)) increased to (70.48 +/- 9.54) mm Hg from (35.08 +/- 4.59) mm Hg. In the mean time, ratio of wet to dry lung weight was returned to nearly normal. So, it indicated that high-dose of oleic acid could only induce mild lung injury, and the development of ARDS was obviously inhibited by ACEI.

CONCLUSIONSACEI may effectively depress pulmonary arterial hypertension, block the development of ARDS, and have certain good protective effect on pulmonary capillary endothelia.

Acute Disease ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Animals ; Captopril ; therapeutic use ; Disease Models, Animal ; Endothelium, Vascular ; drug effects ; physiopathology ; Hypertension, Pulmonary ; complications ; drug therapy ; Male ; Oleic Acid ; Rats ; Rats, Wistar ; Respiratory Distress Syndrome, Adult ; chemically induced ; etiology ; prevention & control

Objective To detect the expression of NRP‐1 in gastric cancer tissue ,to analyze its relationship with clinicopath‐ological features ,and to explore its value in judging the prognosis of gastric cancer .Methods The clinical pathologic data and prog‐nosis situation in 168 cases of gastric cancer were retrospectively analyzed .The expression of NRP‐1 in gastric cancer tissue and normal tissue was detected by the immunohistochemical method .The relationship between the expression of NRP‐1 with the clinico‐pathological features and prognosis was investigated .Whether NRP‐1 serving as a reference indicator for judging the prognosis of gastric cancer was evaluated .Results (1) In 168 cases ,the NRP‐1 expression in gastric cancer tissue was higher than that in nor‐mal tissue (66 .7% vs .8 .33% ,P<0 .05) .(2) The NRP‐1 expression was related with the tumor size ,differentiation degree ,infil‐trative depth ,lymph node metastasis and TNM stage(P<0 .05) .(3)The median survival time in the patients with high NRP‐1 ex‐pression was shorter than that in the patients with low NRP‐1 expression (P<0 .05) .(4) The multiple factor analysis by COX pro‐portional hazard model showed that the NRP‐1 expression was an independent risk factor for the prognosis of gastric cancer(P<0 .05) .Conclusion (1)NRP‐1 plays an important role in the incidence and development process of gastric cancer and its expression is closely related with the malignant biological behavior of gastric cancer .(2)The high NRP‐1 expression prompts poor prognosis .(3) NRP‐1 may be expected to be regarded as one of the indexes for judging the biologic behaviors and prognosis of gastric cancer .

Objective To detect the dynamic changes of the level of serum Clara cell protein(CC16)and surfactant protein-D(SP-D)in rats with pulmonary fibrosis induced by bleomycin and to evaluate their value in early diagnosis of pulmonary fibrosis. Methods Sixty Wistar rats were randomly divided into two groups, the control group and bleocin-induced pulmonary fibrotic group,with 30 rats in each group. The rats were killed at 1,3,7,14 and 28 days of treatment Pathology changes of lung tissue were observed by HE,Masson stain,alkaline hydrolysis to assess the hydroxyproline concentration of lung tissue, enzyme-linked immunosorbent assay (ELISA) was used to measure the levels of serum CC16 and SP-D. Results The hydroxyproline concentration of lung tissue in the pulmonary fibrotic group ((913. 1 ±69. 3) μg/g) were higher than those of the control group ((790. 5 ± 36. 8) μg/g) from the seventh day(P <0. 05). The levels of serum CC16 of the pulmonary fibrotic group((27. 34 ± 0. 32) μg/L) were lower than those of the control group((27. 85 ±0. 32)μg/L) since the third day(P<0. 05) ,and tended to decrease with the development of the disease. However,the levels of SP-D of the former group were always higher(P <0. 05), and tended to increase with the development of the disease. Conclusions The levels of serum CC16 and SP-D changed considerably in early-stage of pulmonary fibrosis, thus might be used as biomarker for early diagnosis and have some value for pathogenesis of pulmonary fibrosis.

Objective To investigate the feasibility, safety and technical superiority of mechanical thrombectomy using a direct aspiration first-pass thrombectomy (ADAPT) in treatment of patients with acute cerebral artery occlusion. Methods A retrospective study was conducted on all patients with acute ischemic stroke treated with mechanical thrombectomy in our institution from January 2013 to August 2016.Patients using ADAPT or stent retriever as a first-line endovascular procedure were compared for clinical characteristics, procedural variables and clinical outcomes. The technical superiority of ADAPT was analyzed in depth. Results During observation period, a total of 91 cases were performed endovascular treatment with mechanical thrombectomy. ADAPT was designed in 46 cases as a first-line endovascular procedure and was utilized in 38 cases (82.6%;ADAPT group), while primary stent retriever thrombectomy was performed in 21 patients(stent group). There was no significant difference in baseline clinical or radiographic factors between ADAPT and stent groups. Although rates of good neurological outcome (modified Rankin Scale(mRS) score≤2) at 90 days were similar between the ADAPT and stent groups (61%(23/38) vs 48%(10/21), P=0.247), National Institute of Health Stroke Scale (NIHSS) score at seven days (6.0(2.0, 9.3) vs 9.0(5.5, 18.5),Z=-2.031,P=0.021) and full recovery rate of neurological outcome (mRS score=0, 37%(14/38) vs 10%(2/21), P=0.022) were significantly better in the ADAPT group than in the stent group. There were no significant differences in rates of embolus to new territory (21%(8/38) vs 29%(6/21), P=0.365), Thrombolysis In Cerebral Infarction (TICI) 2b/3 grade revascularization (84%(32/38) vs 81%(17/21), P=0.507) and symptomatic intracerebral hemorrhage (0%(0/38) vs 10%(2/21), P=0.123) between the ADAPT and the stent groups, but the figures were better in the ADAPT group. Conclusions Mechanical thrombectomy using ADAPT is feasible and safe compared with stent retriever, with higher full recovery rate of neurological outcome and better NIHSS score.It is a method worthy of further exploration for endovascular mechanical recanalization.

ObjectiveTo discuss new treatment of posterior urethral disruption complicated pelvic fracture.To discuss new treatment of posterior urethral disruption complicated pelvic fracture.MethodsIn 15 cases of posterior urethral disruption complicated pelvic fracture,3～4 weeks after realignment of the urethra with traction,3 silicone catheters 8～10F in diameter and 1 ureteral catheter 4F were laid in the urethra for 3 months.ResultsThe cured rate and the improved rate were 60%(9/15) and 33.3%(5/15) respectively.ConclusionThe stated approach for the treatment of posterior urethral disruption was safe,simple and highly effective.