Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.

Remembering medical English terms is the difficult point in learning medical English.Only through learning the rules and characteristics of medical terms can one remember and get command of thousands of medical terms rapidly and effectively.When studying medical English terms,we explored and summarized a series of pithy formula hook memorial method - a pithy formula linked to the affix and etyma was turned into rhyming verse and formed a memory chain after memorizing by hook memory method many times so as to keep the medical terms firmly in the mind rapidly.

Objective To compare the clinical efficacy and radiologic changes between constrained and non-constrained titanium plate in anterior cervical corpectomy and fusion (ACCF) in elderly cervical spondylosis patients.Methods A total of 58 elderly cervical spondylosis patients who underwent ACCF were divided into group 1 (patients treated with constrained titanium plates,n =30) and group 2 (patients treated with non-constrained titanium plates,n=28).The Japanese Orthopedic Association (JOA) score,fusion rate,the loss of segmental height and cervical lordosis were recorded.The clinical efficacy and imaging features were compared between the two groups.Results The improvement rate of JOA score had no significant differences between group 1 and group 2 [(77.7±18.6)％ vs.(75.8±23.2)％,t=0.340,P＞0.05].At 3 months after operation,the fusion rate was higher in group 2 than in group 1 (89.3％ vs.63.3％,x2 =5.327,P＜0.05).At 3,6 and 12 months after operation,there were no significant differences in the loss of segmental cervical height and lordosis between group 1 and group 2 [(2.42±3.05)mm vs.(0.98±2.86)mm,(3.95±3.65)mm vs.(2.34±2.97)mm,(3.60±4.33)mm vs.(2.40±2.96)mm,(1.64±2.33)° vs.(0.66 ± ±2.14)°,(2.13∧±±3.79)° vs.(0.70±2.99)°,(2.39±4.26)° vs.(0.86±3.25)°,respectively,all P ＞0.05].Conclusions The clinical efficacy is similar in ACCF with the two types of titanium plates.The non-constrained titanium plate can increase the fusion rate in early time,but may aggravate the loss of segmental cervical height and lordosis,which should be used with caution in elderly osteoporosis patients.

Objective To investigate the effects of toll-like receptor 9 (TLR9) agonist CpG ODN2216 on the sensitivity of pancreatic cancer cell line PANC1's to gemcitabine.Methods The immunofluorescence staining method and Western blot method were used to examine the expression of TLR9 protein in PANC1 cells.The changes of sensitivity to gemcitabine after CpG ODN2216 treatment were examined by MTT assay.Results The TLR9 protein was highly expressed in PANC1 cells and the median inhibition concentration of gemcitabine against PANC1 cells was reduced from (1.23 ± 0.14) mg/L to (0.28 ± 0.13) mg/L after CpG ODN2216 treatment,and the difference between the two groups was statistically significant (P ＜0.01).After 0.01,0.10,1.00,10.00 mg/L gemcitabine treatment with CpG 0DN2216,the inhibition rates of PANC1 were (34.4 ±1.3)％,(43.5 ± 2.7)％,(76.3 ± 2.5)％,(95.3 ± 2.2)％ ; and without CpG ODN2216,the inhibition rates of PANC1 were (14.5 ± 0.9) ％,(23.5 ± 1.1) ％,(44.8 ± 1.4) ％,(63.6 ± 1.8) ％,and the difference between the two groups was statistically significant (P ＜ 0.01).Conclusions The sensitivity of PANC1 cells to gemcitabine can be enhanced by CpG ODN2216.

BACKGROUND:Thoracolumbar spine as highly concentrated stress, often prone to vertebral fractures. With the further development of the biomechanics and anatomical structure of the spine, posterior open reduction and internal fixation with pedicle screw has been widely accepted by clinicians. OBJECTIVE:To explore the clinical results and safety of percutaneous pedicle screw fixation system (Viper system) used in thoracolumbar compression fractures. METHODS:We retrospectively analyzed 40 patients with thoracolumbar compression fractures from Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital and Nanjing General Hospital of Nanjing Military Area Command of Chinese PLA from January 2013 to February 2014. According to the type of graft, patients were randomly divided into experiment group and control group, with 20 patients in each group. They were respectively subjected to Viper percutaneous pedicle screw fixation system and open reduction and pedicle screw fixation. RESULTS AND CONCLUSION:Al vertebra got bone unions. Operative time and time to bone union were shorter in the experiment group than in the control group. Moreover, intraoperative blood loss was less in the experiment group than in the control group. Cobb’s angle, height percentage of leading edge and wedge angle were similar between the two groups. However, at 12 months after internal fixation, height percentage of leading edge was lower in the experiment group than in the control group. Visual Analogue Scale scores and Oswestry Disability Index were noticeably improved after fixation in both groups. Visual Analogue Scale scores and Oswestry Disability Index were lower in the experiment group than in the control group immediately after fixation. These results suggest that compared with open reduction and pedicle screw fixation, Viper percutaneous pedicle screw fixation system for thoracolumbar compression fractures can stably restore the structure and function of spine, and does not increase perioperative complications.

AIM: To study the effect of vascular endothelial growth factor(VEGF) on hematopoietic differentiation from mouse embryonic stem cells(ESC) in vitro.METHODS: ES-D3 was allowed to grow on mouse fetal fibroblast feeder layer,and then was developed into embryoid bodies(EB).EB cells were transferred into medium supplemented with different concentration of VEGF and VEGF+SCF for 1 week.Six groups,including.VEGF 5 ?g/L,VEGF 10 ?g/L,VEGF 20 ?g/L, VEGF 5 ?g/L+SCF,VEGF 10 ?g/L+SCF and VEGF 20 ?g/L+SCF,were designed.The group of spontaneous differentiation without cytokine(s) was used as control.Hematopoietic transcription factor GATA-2 and early hematopoietic differentiation genes(c-kit and ?-H1) were detected by RT-PCR.The content of CD34~+ cells in each group were measured by flow cytometry.The cells derived from ESC were incubated in semisolid methycellulose cultures.The numbers of total colony-forming units in culture(CFU-C) were counted by reverse microscope.RESULTS: ES-D3 grew and formed EB at day 4.VEGF had a stimulatory effect as a single factor on the expression of genes associated with early hematopoietic differentiation(GATA-2,c-kit and ?-H1),the generation of CD34~+ cells and CFU-C in EB.The effects of VEGF+SCF were the most potent in the experimental groups according to the percent of CD34~+ cells and the numbers of hematopoietic colonies.The most highest inducing efficacy was achieved in VEGF 20 ?g/L or VEGF 10 ?g/L combined with SCF.CONCLUSION: VEGF promotes the differentiation of ESC into hematopoietic cells in vitro.The strongest effect was achieved when VEGF was combined with SCF.

Objective The expression of chemokine C-X-C motif ligand 13 (CXCL13) within liver in primary biliary cholangitis (PBC) patients is significantly increased, but its origin and mechanism is not clear yet.The study aimed to investigate the expression of CXCL13 in the liver of mice through establishing a mouse model of PBC.Methods C57BL/6 mice were randomly divided into experiment group (n=20) control group(n=10).The mice in the experimental group were intraperitoneally injected with polyriboinosinic polyribocytidylic acid (Poly I:C) while the mice in control group were injected with PBS of the same volume.The level of serum AMA was quantified by ELISA and intrahepatic inflammatory cells were assessed by HE staining.Kupffer cells, liver sinusoidal endothelial cells, and infiltrating lymphocytes in the liver of mice were collected by in situ perfusion enzyme digestion and magnetic bead separation methods.The transcriptional level of intrahepatic CXCL13 in liver tissues and cell subpopulations were detected by qPCR.Results The serum AMA titers of the mice in experiment group increased gradually with the prolonging of modeling time and the positive rates at the 4th, 8th, and 12th week after the first injection of Poly I:C were 5.9%, 52.9% and 76.5% respectively.While the serum AMA titers of the mice in control group were at a lower level through the modeling process, with only 2 mice presenting a little higher level above positive cutoff value at the 12th week.The results of HE staining in liver tissues of both groups showed that there were a great amount of intensely infiltrating inflammatory cells in the mice of experimental group while no inflammatory cell infiltration were found in the mice of control group.The separation purity of Kupffer cells and liver sinusoidal endothelial cells in the mice of experiment group tested by flow cytometry were 76%-80%, 68%-72% respectively.Compared with the CXCL13 mRNA level in Kupffer cells [2.34(0.22-8.64)], the expression levels in liver sinusoidal endothelial cells and infiltrating lymphocytes declined[0.27(0.03-1.64), 0.05(0-0.22), P<0.05].Conclusion The chemokine CXCL13 is predominantly produced by Kupffer cells in the liver of PBC mice established by Poly I:C injection.

Objective To study the correlation between thyroid autoantibodies anti‐thyroid peroxidase antibody (TPOAb) with recurrent miscarriage to seek the objective data indicator for clinical diagnosis of recurrent miscarriage .Methods A total of 1 016 pregnant women of physical examination and normal thyroid function in the obstetric and gynecologic clinic of our hospital from March 2012 to May 2014 were selected as the research subjects .Among them ,90 cases of abortion were screened out and di‐vided into the primary abortion group(60 cases) and the recurrent abortion group(30 cases) .90 healthy childbearing age women of physical examination were selected as the control group .The positive TPOAb cases were performed statistics and compared among various groups ,the ratio was calculated;the TPOAb level was recorded in each group .At the same time the correlation between TPOAb with recurrent abortion was analyzed .Results The TPOAb positive rate in the recurrent abortion group was 46 .67% , which was significantly higher than 25 .00% in the primary abortion group and 4 .44% in the control group;at the same time the TPOAb positive rate of primary abortion group was also significantly higher than that of the control group ,the difference had sta‐tistical significance (P<0 .05) .The TPOAb concentration level in the recurrent abortion group was significantly higher than that in the primary abortion group and the control group;the TPOAb concentration level in the primary abortion group was also signifi‐cantly higher than that in the control group ,the differences were statistically significant (P< 0 .05) .In the follow‐up of adverse pregnancy occurrence with recurrent abortion as the adverse pregnancy event ,and according to the method of Spearman correlation analysis ,with the increase of TPOAb level ,the occurrence rate of recurrent miscarriage was higher ,which showed the positive cor‐relation(r=0 .764 ,P=0 .000) .Conclusion Monitoring the patient′s TPOAb level can better show the symptoms of recurrent abor‐tion .

BACKGROUND:Cirrhosis is a long-term consequence of chronic hepatic injury, which has no effective therapy. Mesenchymal stem cels have been shown to play a potential role in the treatment of liver fibrosis/cirrhosis. OBJECTIVE:To investigate the therapeutic effect and mechanism of human umbilical cord-derived mesenchymal stem cels on CCl4 induced liver fibrosis/cirrhosis in rats. METHODS:A CCl4-induced liver fibrotic/cirrhotic rat model was used, and human umbilical cord-derived mesenchymal stem cels were injectedvia the tail vein after modeling. Liver biochemical profile was measured by Beckman Coulter analyzer. Histopathological changes were assessed by Sirius red staining. The expressions of colagen type I, colagen type III, matrix metaloproteinases-2 and tissue inhibitor of matrix metaloproteinases-2 protein and mRNA in liver tissues were observed by immunohistochemistry, western blot and real-time PCR, respectively. RESULTS AND CONCLUSION:Liver biochemical profile indicated the transplantation of human umbilical cord-derived mesenchymal stem cels could improve the liver function of rats with liver fibrosis and cirrhosis. After cel transplantation, except 1-week cel transplantation group, the expressions of the matrix metaloproteinases-2 mRNA and protein were significantly increased, while the expressions of colagen type I, colagen type III and tissue inhibitor of matrix metaloproteinases-2 mRNA and protein significantly decreased, compared with the corresponding model groups. Human umbilical cord-derived mesenchymal stem cels play a role in the treatment of liver fibrosis and cirrhosis through upregulating the expression of matrix metaloproteinases-2 and lowering the expression of inhibitor of matrix metaloproteinases-2. With the continued presence of pathogenic factors, human umbilical cord-derived mesenchymal stem cel transplantation cannot reverse liver fibrosis or cirrhosis, and only delay the process of liver fibrosis or cirrhosis.

Objective:To explore the present situation of medical students' professionalism cognition and provide reference for medical personnel training and medical education.Methods:A cross-sectional survey was conducted on medical students among 2 affiliated hospitals of a medical university in H province by cluster sampling. Exploratory factor analysis and reliability and validity test were carried out and a descriptive analysis of the present situation of professionalism was conducted by SPSS 20.0. Amos21.0 software was used for a confirmatory factor analysis on the samples.Results:The measurement scale had good reliability and validity, and the Cronbach alpha coefficient of the scale was 0.901. The average professionalism score of the medical students was about 80 points. The score of "physical and mental status and self-development ability" was the highest (83.65 points), and the lowest score was "academic ability" (72.21 points). There was a little difference in the professionalism cognition between the two hospitals, with significant differences between the dimension "respect and care" and "responsibility".Conclusion:This study has initially formed a medical professionalism measurement scale with good reliability and validity. The professionalism of medical students in the 2 affiliated hospitals of a medical school in Province H is in good condition as a whole. In the future, medical education should pay more attention to the combination of basic professional knowledge and clinical practice of medical students, and change the training model of medical students in order to improve the academic ability of medical students and medical students' overall cognition of professionalism.