Pancreaticobiliary maljunction(PBM)is closely related to many surgical diseases in which are commonly seen in clinical practice.However,diagnosis of PBM is difficult and it is easily missed.The lack of knowledge and awareness of PMB has once made PBM “the forgotten corner of abdominal surgery”.This essay summarized the current knowledge on the diagnosis of PBM by medical imaging.

Objective To identify and characterize dietary patterns in a middle-aged Guangzhou population and study associations between these patterns and plasma lipids.Method 555 subjects(98 men and 367 women) were recruited in Guangzhou.Subjects completed a detailed health and lifestyle questionnaire and provided a fasting blood sample for plasma lipids test.Dietary intake was assessed using a food-frequency questionnaire.Dietary patterns were assessed by K-means cluster Analysis.Results Three dietary patterns were identified.In Cluster 1,the subjects took higher intakes of cereals(301.9?97.2) g/d,and the lower intakes of leafy vegetables(275.9?92.7)g/d,non-leafy vegetables(139.4?84.7) g/d,fruits(122.1?73.3) g/d,eggs(18.3?17.3) g/d and milk(50.0?93.2) ml/d.In Cluster 2,they was characterized by significantly higher intakes of dried legumes and legume products(28.5?31.1) g/d,eggs(30.2?18.3) g/d,milk(217.1?152.0) ml/d,nuts(7.0?13.9) g/d,fruits(345.0?151.8) g/d and non-leafy vegetables(280.3?153)g/d,and lower intakes of cereals(269.1?98.0) g/d.In Cluster 3,the people took higher intakes of leafy vegetables(540.6?158.3) g/d and fish(42.9?42.2) g/d,and the lower intakes of dried legumes and legume products(12.7?20.9) g/d,nuts(4.9?14.7) g/d.There were significant differences in LDL between clusters.Conclusion Dietary pattern of Cluster 2 could help to maintain plasma lipids in normal range.

Objective To discuss the clinical significance of nephroscopic surgery for simple renal cysts. Methods A 2~4 cm incision was made below the 12th costal interspace. Through the incision the nephroscopic decortication was performed in 26 patients with simple renal cyst. Results The operation time was 20~80 min (mean, 30 min) and the postoperative hospital stay, 3~)6 days (mean, 4 days). No blood transfusion was required and no severe complications were noted. Follow-up observations for 3~)12 months (mean, 8 months) in the 26 patients found no recurrence. Conclusions Mini-incision nephroscopic decortication for renal cysts is feasible and mini-invasive, with advantages of simplicity of performance and quick postoperative recovery.

Objective To discuss the clinical application of individualized strategy of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of bile duct stenosis after liver transplantation (LT).Methods Fifty-two patients,including 40 men and 12 women,aged 54.3 ± 9.1 years old,who suffered from bile duct stenosis and accepted 88 times of ERCP from June 2014 to May 2016 in our department were investigated.The procedures,clinical features and biochemical criteria were analyzed retrospectively.Results According to the treating occasions and clinical symptoms,single plastic stent,dilatation combined with single plastic stent,and dilatation combined with multiple plastic stents were chosen to use.ERCP in 8 patients out of 52 patients failed technically,and the therapeutic efficacy was 82.7％.The treatment duration was 8.2 ± 2.9 months.The recurrence rate was 4.7％ (2 cases) during the follow-up period.The most common complications were postERCP pancreatitis (2.3％) and cholangitis (3.4％),which would be cured by conservative treatment in most cases.Conclusion ERCP,as an effective and safe method,could be used as the first choice or bridge treatment for bile duct stricture after LT.We recommend individualization strategy,including step by step mode and different combinations of PTC or endoscopic procedures,in order to improve clinical efficacy of all kinds of stricture.

Objective To investigate the effect and mechanism of STAT3 gene silencing on the growth of xenografts in human pancreatic cancer SW1990 cells in nude mice.Methods The expression vector inserted with shRNA targeting at STAT3 gene was constructed and was stably transfected into SW1990 cells (SW1990-RNAi group).SW1990 cells transfected with negative control shRNA expression vector (SW1990-Con group) and parent SW1990 (SW1990 group) were used as controls.STAT3,VEGF,MMP-2 protein expressions in these groups were determined by using Western blot.The subcutaneous xenografts models were established in nude mice,and the growth of xenografts was observed,CD34 expressions were determined by immunohistochemistry and MVD was measured.Results The expression of STAT3 protein was 84.69 ± 9.31,82.00 ± 7.76,7.93 ± 1.24,repectively,in SW1990 group,SW1990-Con group,SW1990-RNAi group,and the expression of VEGF protein was 82.94 ± 8.97,80.86 ± 10.28,39.04 ± 6.23,respectively,and the expression of MMP-2 protein was 40.88 ± 5.09,38.26 ± 5.71,12.54 ± 2.15,respectively.The expression in SW1990-RNAi group was significantly lower than those in other 2 groups (P ＜ 0.05),while the expression of all three proteins between SW1990-Con group and SW1990 group was not significantly different.The weight of the xenografts in SW1990 group,SW1990-Con group,SW1990-RNAi group was (2.2 ± 0.4),(2.2 ± 0.3),(0.5 ± 0.3) g,respectively ; the MVD of the xenografts was (20.35 ± 2.41),(18.79 ± 1.94),(9.62 ± 1.06) per high power field,respectively,and the number in SW1990-RNAi group was significantly lower than those in other 2 groups (P ＜ 0.05 or P ＜ 0.01),while the difference between SW1990-Con group and SW1990 group were not significant.Conclusions Inhibition of STAT3 gene expression can significantly slow the growth of SW1990 xenografts in nude mice,and the mechanism may be related with down-regulation of VEGF and MMP-2 expression and inhibition of the angiogenesis of pancreatic cancer.

Medical curriculum integration mode is the development trend of medical education re-form. The Institute of Basic Science of Guangzhou Medical University has given full consideration to the present situation at home and abroad and its own conditions, modularized the traditional basic medicine ex-periment course according to the similar content, and formed medical human morphology (human anatomy and tissue embryology, pathology), immune and pathogenic biology (microorganisms, parasites, immunology), biological science (cell biology, genetics, biological sciences) three modules, and then gradually established and perfected a scientific and effective comprehensive morphology experiment teaching material, teaching method, examination and evaluation system based on the teaching content of integration. The establishment of this new basic medical morphology course system, which is based on the organs and systems, shows the less content redundancy, good structural and overall coordination of the new curriculum, so as to play its comprehensive advantages and conform to the trend of the development of the medical education.

Objective To study the abdominal CT findings of the penicilliesis marneffei in patients with AIDS.Methods Abdominal CT imaging features of the the penicilliesis mameffei in 35 patients with acquired immunodeficiency syndrome (AIDS) were retrospectively analyzed.Results Abdominal lymph adenopathy was observed in 27 (77.1%) cases.Hepatosplenomegaly was observed in 18 (51.4%) cases.Lesions in the liver and spleen were found in 11 (31.4%) cases which included 3 cases of low density nodules in the liver (8.6%) and 5 cases of low density nodules in the spleen (14.3%).5 cases of diffuse low density in the liver (14.3%) and 5 cases of heterogeneous enhancement in the liver (14.3%) .Thickening of the intestinal wall was observed in 3 cases (8.6%). Ascites was observed in 4 cases (11.4%).Pancreatitis was found in 1 case(2.9%).Conclusions Penicilliosis marneffei in patients with AIDS usually involves multiple organs in the abdomen.Abdominal lymphadenopathy, hepatosplenomegaly and parenchymai lesions in the liver and spleen are the most common CT findings in the abdomen.

Object To evaluate the effects of ginsenosides (GSS) in stem and leaves of ginseng on glucocorticoid receptor (GR) in the hemorrhagic shock rats, and study the mechanism. Methods Rats were divided into hemorrhagic shock group and control group. The rats in hemorrhagic shock groups were ig 200, 100, 50 mg/kg/d GSS, model group and control group were ig distilled water 2 mL for 10 days. The Rs of GR in brain and hepatic cytosol of rats were measured by radioligand binding assay, using [ 3H] dexamethasone as the ligand. The level of GR mRNA expression in hepatic cytosol were determined by RT-PCR. Plasma adrenocorticotrophic hormone (ACTH) and glucocorticoid (GC) concentrations were determined by the radioimmunoassay. Results Rs of GR in brain and hepatic cytosol were higher in hemorrhagic shock+GSS groups than those in hemorrhagic shock group, and the Rs of GR was the highest in hemorrhagic shock+10 mg/mL GSS group (P

Objective To evaluate CT features of pulmonary tuberculosis in the patients with HIV infection and AIDS(HIV/AIDS).Methods CT findings of pulmonary tuberculosis were retrospectively analyzed in 48 patients with HIV/AIDS.Results The CT features of pulmonary tuberculosis in HIV/AIDS included: secondary pulmonary tuberculosis in 19 cases(39.6%), mostly showing patchings shadows,10 cases with large confluent consolidation; hematogenous pulmonary tuberculosis in 17 cases(35.4%), including 7 cases of acute miliary tuberculosis(showing miliary lesions evenly distributed in both lungs), and 10 cases of sub-acute disseminated tuberculosis(showing nodular patterns diffusely distributed in both lungs, asymmetrical in size and distribution); complex lesions in 10 cases(20.8%, showing patchy, nodular and miliary lesions). Among all the patients, 36 (75.0%) showed enlarged mediastinal lymphnodes, 13(27.1%) pleural effussion, 10(20.8%) pericardial effusion.Conclusion The characteristics of pulmonary tuberculosis in the patients with HIV/AIDS were mostly diffuse distribution.

Objective To investigate the correlation between carotid intima-media thickness (CIMT) and glucose fluctuation in patients with type 2 diabetes mellitus (T2DM).Methods Sixty-eight T2DM patients admitted to Beijing Military General Hospital from March to August 2012 were enrolled in the study,including 32 cases with CIMT thickening (CIMT ≥ 0.9 mm) and 32 cases with normal CIMT (CIMT ＜0.9 mm).The 72 h continuous blood glucose levels were monitored from the day of admission.Results There were no significant differences in the gender,age,body mass index (BMI),systolic and diastolic blood pressure,HDL-C,LDL-C,CHO,TG,glycosylate hemoglobin (HbA1c),fasting blood glucose(FBG) and postprandial average blood glucose (MPBG) between two groups (P ＞ 0.05).The atherosclerosis (AS) score and mean amplitude of glycemic excursion (MAGE),glucose standard deviation,frequency of glycemic excursion (FGE) and absolute mean of daily differences (MODD) in patients with thickening CIMT were (11 ± 7) years,(6.9 ± 3.0) mmol/L,(2.8 ± 1.2) mmol/L,(3.4 ± 1.5) times/d,(2.8 ± 1.3) mmol/L,(4.5 ± 1.0) score,respectively ; while those in patients with normal CIMT were (8 ±6) years,(4.2 ± 1.1) mmol/L,(1.6 ± 0.5) mmol/L,(2.2 ± 0.8) times/d,(2.0 ± 1.0) mmol/L,(3.3 ±0.6) score,respectively.There were significant differences between two groups (all P ＜ 0.05).Pearson correlation showed that CIMT was positively correlated with MAGE,FGE,MODD,course of disease,diastolic blood pressure,LDL-C,MPBG and AS score (P ＜ 0.05).Multiple stepwise regression analysis showed that MAGE,MBPG were the influencing factors of CIMT.Conclusions The CIMT of patients with T2DM is closely correlated with glucose fluctuation,indicating that reduction of blood glucose fluctuation and MAGE,MPBG levels may delay the occurrence of diabetic macroangiopathy.