Objective To explore the causes for the bile duct injury in gallbladder bed and investigate its diagnosis and management. Methods The data of 37 cases of bile duct injury in the gallbladder bed after cholecystectomy between January 1988 and March 1998 were retrospectively analyzed. Results According to the operative records, 17 among the 37 cases had leakage from Luschka bile duct, 4 from the cholecystohepatic duct and 3 from the right lobular hepatic duct and its branches. The sources of the leakage were not identified in other 17 cases. The injured sites were sutured and drained or drained alone in 30 cases. The other 4 cases without drainage were percutaneously under the ultrasonographic guidance because of an intra abdominal bile collection. The remaining 3 cases were surgically treated again for aggravation of the illness in them. Conclusions During performance of cholecystectomy, surgeons should pay close attention to the bile duct in the gallbladder bed for its vulnerable position. Careful inspection of the gallbladder bed should be a routine procedure after the operation. Once the bile leakage was recognized in the gallbladder bed, intraoperative drainage must be performed.

Objective To observe the morphologic change in rats with pulmonary fibrosis induced by bleomycin through antisense-human tissue inhibitor of metalloproteinase-1(hTIMP-1)transfection.Methods Thirty rats were divided into five groups randomly(six rats in each group),namely,hTIMP-1 transfection group,anti-sense hTIMP-1 transfection group,empty retroviral vectors transfection group,pulmonary fibrosis group,and the normal group.On the 1st,3rd,7th,14th,28th,60th,90th day of BLM administration to the hTIMP-1,anti-sense hTIMP-1 and retroviral vectors transfection group,the hTIMP-1 cDNA retroviral vectors containing sense and anti-sense ones and the empty vectors were conducted into the lungs of rats with pulmonary fibrosis,which were sacrificed on the 28th days.The pulmonary fibrosis group was given just BLM for the same period of time.The rats in the normal control groups were sacrificed on the same day.Observe the role of anti-sense hTIMP-1 transfection and the change of hydroxyproline.Results The degree of fibrosis and content of HYP were extenuated by antisense hTIMP-1 transfection on 1st and 3rd day after BLM exposure compared with the same time of fibrosis and transfection by empty retroviral vectors group,morphologically.Conclusion Transfection with antisense-TIMP-1 on the first and third day can suppress the process of pulmonary fibrosis induced by BLM to some extent.

Objective To summarize the complication of clinical characteristics, factors causing misdiagnosis, and diagnosis of large intestine tuberculosis (LIT). Methods The data of twenty cases of LIT misdiagnosed preoperatively in our hospital were analyzed retrospectively. The difficulties of LIT diagnosis and management were studied and analyzed. Results Abdominal pain, mass, and the alteration of stool habit were the most common symptoms. LIT was most commonly confused with malignant tumor, Crohn's disease, and periappendicular abscess. Ten of 17 patients, who were performed exploratory laparotomy, were misdiagnosed as tumor or Crohn's disease. Most of our cases were not definitively diagnosed until the histopathologic examination after surgery. Three cases were diagnosed by other methods. Gastrointestinal X ray series, colonoscopy, endoscopic fine needle aspiration cytology(FNAC) and laparoscopic exploration may improve the diagnosis. Exploratory laparotomy with biopsy was the final procedure for diagnosis. Final diagnosis mainly depends on histology. Conclusions LIT lacks special clinical manifestations and has a high misdiagnosis rate. But if correct diagnosis is established, most patients can be cured and unnecessary exploratory laparotomy can be avoided. Six months antituberculosis treatment is effective for LIT whether the lesion is excised or not.

Objective To investigate the effects of intrathecal different doses of dexmedetomidine hydrochloride in spinal block by ropivacaine hydrochloride . Methods Forty lower limb surgery scheduled for elective under spinal anesthesia, were randomly divided into 2 groups (n = 20 each): the control and the treatment groups.The control and the treatment group were intrathecally injected with 4,12 μg dexmedetomidine hydrochloride respectively.The 0.75% ropivacaine hydrochloride 1.5 mL was injected for spinal anesthesia.SBP,DBP,HR,SpO2 and Ramsay Sedation Score were recorded before the spinal anesthesia conduct and thereafter every five minutes. And the onset and duration of block were recorded,adverse reaction like nausea, vomiting and respiratory depression were also observed. Results Compared with the control group,the onset of sensory block was shorter [(6.9±2.6) min vs (8.7±2.9) min] (P<0.05),and the duration of sensory and motor block was longer in the treatment group[(130.8±30.1) min vs (115.9±23.9) min] (P<0.05) and [(145.9±29.0) min vs (130.0±30.1) min] (P<0.05). Conclusion Intrathecal dexmedetomidine hydrochloride at 12 μg improves anesthesia via shortening the sensory block onset and prolonging sensory and motor block,which maintains hemodynamically stable,and does not generate adverse reactions as nausea,vomiting,bradycardia and respiratory depression.

Objective To evaluate the results of computer-aid customized acetabular cages for patients with severe defects.Methods Twenty-three patients (8 males and 15 females) with a massive acetabular defects were involved in the present study from January 2005 to September 2014.The average age was 64.2 years (range,46-79 years).According to the American Academy of Orthopaedic Surgeons (AAOS) classification,20 had AAOS type Ⅲ defects and three had AAOS type Ⅳ defects.The customized cages were individualized to each patient's bone defects based on the rapid prototype three-dimensional printed models.The mean follow-up duration was 66.3 months (range,24-120 months).The clinical and radiographic outcomes of all patients were assessed at 6 and 12 weeks after surgery and at once yearly thereafter.Harris hip scores were assessed before surgery and at each follow-up.Postoperative radiographs were evaluated for cage position,migration,and graft incorporation.Complications and reoperations were assessed by chart review.Results The mean Harris hip score improved from 36.2±7.9 (range,20-49) to 81.8± 8.4 (range,60-96),and there is a significant difference between pre-and post-operation (t=23.23,P＜0.001).Individualized custom cages resulted in generally reliable restoration of the hip center.The difference of horizontal distance (between the center of each hip and pubic symphysis) between bilateral sides was-3.0±6.4 mm (range,-19-8 mm).The difference of vertical distance (between the center of each hip and the line connecting the inferior border of the bilateral tear drop) between bilateral sides was 0.4±2.8 mm (range,-4.5-5 mm).No re-revisions had been conducted.None of the cups showed radiographic migration,while one cage was suspected to be loose based on a circumferential 2-mm radiolucent line.Cancellous allografts appeared to be incorporated in 22 of 23 patients.One deep infection and one superficial infection were observed and were treated with irrigation,debridement,and vacuum sealing drainage.One dislocation and one suspected injury of the superior gluteal nerve also were observed and were treated conservatively.Conclusion Individualized customized cages appears to provide stable fixation and improve hip scores at short or mid-term follow-up.

Objective To assess the functional restoration in patients with developmental dysplasia of the hip (DDH) who underwent hip resurfacing arthroplasty and to determine whether greater abduction angle of the acetabular component is relat?ed to larger diameter of femoral head component. Methods We reviewed 34 DDH cases (9 hips of 8 males and 25 hips of 24 fe?males, mean age 44.6±11.85 years at the time of surgery) on whom we performed hip resurfacing arthroplasty (HRA) from October 2006 to September 2009. The total hip Arthroplasty (THA) group was consisted of 35 DDH cases (8 hips of 8 males and 27 hips of 25 females, mean age 43.7±10.4 years at the time of surgery). All operations were performed by the same doctor over the same peri?od. Assessment of the functional hip scores was conducted by Harris Hip Scores. A radiographic study was also performed to evalu?ate the implants stability and abduction angle of the acetabular components. All the data was analyzed with Kolmogorov?Smirnov method. Results The mean follow?up was 6.2 years in the HRA group. The Harris Hip Score improved from 54.9±13.2 to 97.3± 6.2 after the surgery. The mean abduction angle of the acetabular component was 51.6° ± 5.33°, hip flexion was 127° ± 6.9° and mean diameter of femoral head was 46.5±1.5 mm. The mean follow?up was 5.9 years in the THA group. The Harris Hip Score im?proved from 51.6±19.7 to 95.6±7.9 after the surgery. The mean abduction angle of the acetabular component was 43.9°±4.90°, hip flexion was 117°±4.2°. There was no failure of the prosthesis, peri?prosthetic fracture and infection in either group. There was sig?nificant difference in the abduction angle of the acetabular component (P<0.05) and flexion of the hip between the two groups (P<0.05). Conclusion Patients in the HRA group had a better functional restoration and larger range of motion. Furthermore, a larger diameter of femoral head component could be achieved by placing the acetabular component in a greater abduction angle, which may contribute to a better long?term stability.

Liver fibrosis can progress to liver cirrhosis and end-stage liver disease, which may lead to poor prognosis. In addition to pathological angiogenesis and hepatic sinusoid remodeling, hepatic lymphangiogenesis also plays an important role in the progression of liver fibrosis. This article briefly describes lymphatic vessel markers and their expression in the liver, introduces the role of lymphangiogenesis in liver fibrosis, and reviews the role of liver macrophages (Kupffer cells) and lymphatic endothelial cells in lymphangiogenesis. It is pointed out lymphangiogenesis may become a potential target for the intervention of liver fibrosis, which plays an important role in the early treatment and reversal of liver fibrosis and the prevention of liver cirrhosis and end-stage liver disease.

Obstructive sleep apnea (OSA) may induce chronic intermittent hypoxia, which may lead to the disorders of multiple systems and organs and even sudden cardiac death in severe cases. Besides respiratory, cardiovascular, endocrine, and metabolic diseases, OSA is also closely associated with nonalcoholic fatty liver disease (NAFLD). This article briefly describes the current status of OSA and NAFLD, introduces the impact of OSA on NAFLD, and reviews the mechanisms of OSA in NAFLD. It is pointed out that clarifying the mechanisms of OSA in affecting NAFLD and discovering potential prevention and treatment targets for NAFLD from the aspect of OSA are of great significance in delaying and even blocking the progression of NAFLD.

Objective:To investigate the analgesic effect of nalbuphine combined with sufentanil on elderly patients with colorectal cancer after laparoscopic surgery.Methods:From January 2017 to December 2019, 106 elderly patients with colorectal cancer underwent laparoscopic surgery in Jiangshan People's Hospital were divided into observation group (53 cases) and control group (53 cases) according to the random digital table method.The control group was given sufentanil analgesia, and the observation group was given nalbuphine analgesia on the basis of the control group.The recovery time and catheter extubation time, pain visual analogue score (VAS) scores at 3, 12 and 24 hours after operation, changes of stress response before and 24h after operation, and adverse reactions were compared between the two groups.Results:The recovery time [(9.87±1.42)min] and catheter extubation time [(13.24±3.51)min] in the observation group were shorter than those in the control group [(17.34±2.98)min and (21.83±5.62)min] ( t=16.474, 9.438, all P<0.05). The postoperative 12h VAS score[(1.63±0.19)points] and 24h VAS score[(1.06±0.13)points] in the observation group were lower than those in the control group [(2.37±0.27)points and (1.83±0.32)points] ( t=16.318, 16.230, all P<0.05). The serum levels of Cor [(234.18±19.98)μg/L] and NE [(1.59±0.21)mmol/L] in the observation group were lower than those in the control group [(287.24±14.26)μg/L and (1.97±0.16)mmol/L] ( t=15.737, 10.479, all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups ( P>0.05). Conclusion:Nalbuphine combined with sufentanil has good analgesic effect on elderly patients with colorectal cancer after laparoscopic surgery, and can reduce the postoperative stress response.

Objective:To evaluate the effects of human umbilical cord mesenchymal stem cells-derived exosomes (hUCMSCs-ex) injection on cardiac function and myocardial fibrosis in dilated cardiomyopathy (DCM) rats induced by Adriamycin(ADR).Methods:One hundred male SD rats were randomly divided into the normal group (20 rats) and the DCM group (80 rats). The rats in DCM group were treated with ADR by intravenous injection to induce DCM.DCM rats were randomly divided equally into DCM group, low-dose group, medium-dose group and high-dose group which were received intravenous injection 1 mL/kg Dulbecco′s modified eagle medium(DMEM), 20 μg/kg, 100 μg/kg and 250 μg/kg exosomes.After modeling, 10 rats in normal group and 30 rats in DCM group were randomly selected to receive echocardiography to evaluate the cardiac function.After exosomes treatment, 10 rats were randomly selected form each group for echocardiography to evaluate the cardiac function.The morphological changes in myocardial cells were observed by using Masson staining in each group; Western blot detection between groups of rats was used to analyze the expression of myocardial collagen Ⅰ type(COLⅠ), Smad2 and alpha smooth muscle actin (α-SMA).Results:Left ventricular ejection fraction(LVEF) and left ventricular fraction shortening (LVFS)in the DCM group [(64.30±3.51)% and (38.70±2.85)%] were significantly lower than those of the normal group [(78.80±1.52)% and (50.60±1.50)%], and the differences were statistically significant ( t=20.518, 22.311, all P<0.01). The left ventricular end-diastolic diameter(LVEDD) and left ventricular end-systolic diameter (LVESD) [(4.62±0.13) mm and (3.40±0.12) mm] of the DCM group were significantly higher than those of the normal group[(3.29±0.24) mm and (3.16±0.33) mm], and the differences were statistically significant( t=2.854, 3.800, all P<0.01). After exosomes treatment, LVEF[(84.3±2.6)% and (83.4±3.2)%] in the medium-dose and high-dose groups were significantly higher than that in the DCM group [(79.2±2.4)%], and the diffe-rences were statistically significant(all P<0.01). Masson staining found that collagen fibers were less in exosomes treating group than those in the DCM group; Western blot test showed that high-dose exosomes can reduce the expression of α-SMA and Smad2, high-dose and low-dose exosomes can both significantly reduce the expression of COLⅠ. Conclusions:It suggests that exosomes intravenous injection from hUCMSCs-ex can significantly improve myocardial fibrosis in DCM rats induced by ADR and cardiac function.