Natural orifice tranluminal endoscopic surgery,NOTES is a noval surgical method whose major ad vantage is the diminishing of surgieal scar,thus is benefical to a subgroup of special patients.The key issues related to the development of NOTES are the invention of instrument satisfing the clinical demand,the setting up of safe method of closing the transluminal acce88 and the training of doctors.

Objective To evaluate the clinical value of 64-slice spiral CT,MRI + magnetic resonance cholangiopancreatography (MRCP) on suspected biliary obstruction.Methods Eighty-five patients with suspected biliary obstruction were examined by 64-slice spiral CT,MRI + MRCP,compared with the pathological results.The accuracy rate of CT,MRI + MRCP,CT + MRI + MRCP in evaluating the sites and nature of obstruction were calculated.Results The accuracy rate of evaluating the site of obstruction in CT was 96.5％ (82/85),MRI + MRCP was 97.6％ (83/85),difference was not statistically significant (P ＞ 0.05).The accuracy rate of evaluating the nature of obstruction in CT was 81.2％ (69/85),MRI + MRCP was 87.1％ (74/85),CT +MRI + MRCP was 94.1％ (80/85),there was no statistically significant difference between MRI + MRCP and CT with CT + MRI + MRCP (P ＞ 0.05),difference was statistically significant between CT and CT + MRI + MRCP (P ＜ 0.05).Conclusion A comprehensive analysis of CT,MRI + MRCP can increase the accuracy of diagnosis biliary obstruction.

Objective To investigate the etiology of iatrogenic bile duct injury and experience in its diagnosis and treatment. Methods A retrospective study was conducted on the clinical data of 86 patients with iatrogenic trauma in the bile duct. Results These 86 cases have received a total of 156 sessions of surgical procedures, including 2 explorations in 66 cases,3 explorations in 6 cases. Lateral bile duct injury in 22 cases was treated by suture repair and T tube stent. Eight cases suffering from iatrogenic transection of the common bile duct were retrieved by cholangiojejunostomy and T tube stent. Nine cases with inadvertent CBD ligature were managed by a lysis and T tube stent. Roux en Y cholangiojejunostomy was adopted in 77 cases. Sixty cases were followed up for 1～10 years, with good result in 90% of the cases. Conclusions Most CBD iatrogenic injury cases were encountered as a result of cholecystectomy.Roux en Y cholangiojejunostomy is the choice of therapy.

Objective To investigate and confirm the value of minimal invasion of separation between specific subcutancous layers of rats.Methods Thirty-two male SD rats were randomized into four groups,group 1:normal incision plus separation beneath superficial fascia; group 2:normal incision plus subdermal separation; group 3:normal incision plus extended separation beneath superficial fascia ; group 4:extended incision plus separation beneath superficial fascia.Blood sampling was taken preopeatively,2 h,12 h,24 h and 48 h postoperatively.The increase of serum IL-6 and neutrophil elastase levels were compared between different groups.Results Compared with each other,the increase of serum IL-6 and NE levels in group 1 vs 3 and group 2 vs 4 was not different significantly (P value was 0.074,0.096 and 0.747,0.897,respectively).However,the increase of serum levels in group 1 vs 2,1 vs 4,3 vs 2 and 3 vs 4 was different significantly (P ＜ 0.01).Conclusion Operation of separating beneath superficial fascia plus small skin incision in rats conduces to relatively minimal invasion.

Objective To study the thin sectional anatomy and CT and MR imaging of ligamentous structures of foramen magnum (FM).Methods Six formalin fixed (10%) specimens including head and neck were selected, and each specimen was imaged with CT and MR. Three specimens were sectioned with frozen section technique, the others were sectioned with plastination. Ligamentous structures of FM on continuous thin sections were observed and compared with the images of CT and MRI.Results Continuous sections of 3.0 mm slice thickness for the axial, coronal, and sagittal planes of FM sectioned with frozen section technique were obtained.Continuous thin sections of 1mm slice thickness for the axial, coronal, and sagittal planes of FM sectioned with plastination were obtained. The resulting sections demonstrated excellent distinction of ligamentous structures of FM (including ligamentum alare, ligamentum transversum, membrana tectoria, anterior obturator membrane of atlas, posterior obturator membrane of atlas, and anterior atlanto-axial ligament). A good overall correlation between sections and images of CT and MR was found.Conclusions In combination with CT and MRI, continuous thin sections of FM offers a better understanding of ligamentous structures of FM.

Objective:To evaluate the role of nuclear receptor subfamily 1, group D, member 1/brain and muscle Arnt-like 1(Rev-erbα/Bmal1) signaling pathway in myocardial ischemia-reperfusion (I/R) injury in diabetic rats and its relationship with autophagy.Methods:SPF-grade adult male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-220 g, were used in this study.Type I diabetes mellitus was induced by intraperitoneal streptozotocin 60 mg/kg.The rats were continuously fed for 8 weeks after successful establishment of the model.Thirty rats with type 1 diabetes mellitus were divided into 3 groups by a random number table method: diabetic sham operation group (DS group, n=6), diabetic myocardial I/R group (DI/R group, n=12) and diabetic myocardial I/R plus Rev-erbα antagonist SR-8278 group (DI/R+ SR group, n=12). Eighteen non-diabetic rats were divided into 2 groups by a random number table method: non-diabetic sham operation group (NS group, n=6) and non-diabetic myocardial I/R group (NI/R group, n=12). The myocardial I/R model was established by ligation of the left anterior descending coronary artery for 30 min followed by 120-min reperfusion in anesthetized rats.SR-8278 2 mg/kg was intravenously injected via the femoral vein at 1 h before ischemia in group DI/R+ SR.Blood samples were collected from the carotid artery immediately after the end of reperfusion for determination of serum troponin I (cTnI), creatine kinase-MB (CK-MB) and lactic dehydrogenase (LDH) levels (by enzyme-linked immunosorbent assay). Then the rats were sacrificed, and myocardial tissues were obtained for determination of myocardial infarct size (by TTC method), expression of Rev-erbα and Bmal1 mRNA (by real-time polymerase chain reaction) and expression of Rev-erbα, Bmal1, microtubule-associated protein 1 light chain (LC3) Ⅱ and LC3Ⅰ (by Western blot) and for calculation of the ratio of LC3 Ⅱ/LC3Ⅰand the number of autophagosomes (with a transmission electron microscope). Results:Compared with group NS, the percentage of myocardial infarct size, serum levels of cTnI, CK-MB and LDH and the number of autophagosomes were significantly increased, the expression of Rev-erbα and its mRNA in myocardial tissues was up-regulated, the expression of Bmall and its mRNA was down-regulated, and the ratio of LC3 Ⅱ/LC3Ⅰwas increased in group NI/R, and serum levels of cTnI, CK-MB and LDH were increased, the number of autophagosomes was decreased, the expression of Rev-erbα and its mRNA in myocardial tissues was up-regulated, the expression of Bmall and its mRNA was down-regulated and the ratio of LC3 Ⅱ/LC3Ⅰwas decreased in group DS ( P<0.05). Compared with group NI/R, the percentage of myocardial infarct size and serum levels of cTnI, CK-MB and LDH were significantly increased, the number of autophagosomes was decreased, the expression of Rev-erbα and its mRNA in myocardial tissues was up-regulated, the expression of Bmall and its mRNA was down-regulated, and the ratio of LC3 Ⅱ/LC3Ⅰwas decreased in group DI/R ( P<0.05). Compared with group DS, the percentage of myocardial infarct size, serum levels of cTnI, CK-MB and LDH and the number of autophagosomes were were significantly increased, the expression of Rev-erbα and its mRNA in myocardial tissues was up-regulated, the expression of Bmall and its mRNA was down-regulated, and the ratio of LC3 Ⅱ/LC3Ⅰwas increased in group DI/R ( P<0.05). Compared with group DI/R, the percentage of myocardial infarct size, serum levels of cTnI, CK-MB and LDH and the number of autophagosomes were significantly decreased, the expression of Rev-erbα and its mRNA in myocardial tissues was down-regulated, the expression of Bmall and its mRNA was up-regulated, and the ratio of LC3 Ⅱ/LC3Ⅰwas increased in group DI/R+ SR ( P<0.05). Conclusion:Rev-erbα/BMAL1 signaling pathway is involved in the process of myocardial I/R injury by regulating cell autophagy in diabetic rats.

Induced pluripotent stem cells (iPSCs) can be propagated indefinitely, while maintaining the capacity to differentiate into all cell types in the body except for the extra-embryonic tissues. This iPSC technology not only represents a new way to use individual-specific stem cells for regenerative medicine but also constitutes a novel method to obtain large numbers of disease-specific cells for biomedical research. However, the low efficiency of reprogramming and genomic integration of oncogenes and viral vectors limit the potential application of iPSCs. Chemical-induced reprogramming offers a novel approach to generating iPSCs. In this study, a new combination of small-molecule compounds (SMs) (sodium butyrate, A-83-01, CHIR99021, Y-27632) under conditions of transient folate deprivation was used to generate iPSC. It was found that transient folate deprivation combined with SMs was sufficient to permit reprogramming from mouse embryonic fibroblasts (MEFs) in the presence of transcription factors, Oct4 and Klf4, within 25 days, replacing Sox2 and c-Myc, and accelerated the generation of mouse iPSCs. The resulting cell lines resembled mouse embryonic stem (ES) cells with respect to proliferation rate, morphology, pluripotency-associated markers and gene expressions. Deprivation of folic acid, combined with treating MEFs with SMs, can improve the inducing efficiency of iPSCs and reduce their carcinogenicity and the use of exogenous reprogramming factors.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Hypothalamic Neoplasms ; pathology ; radiotherapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms ; pathology ; radiotherapy

Background and objective Heparanase has been thought to be a good molecular marker of tumor, and the heparanase expression level was correlated closely with tumor metastasis. In this study, we investigate the effects of heparanase on angiogenesis and lymphangiogenesis of lung cancer and the relationship between heparanase expression and vascular endothelial growth factor (VEGF), vascular endothelial growth factor-C (VEGF-C).Methods Immunohistochemistry was used to detect the expression of heparanase, VEGF, VEGF-C protein and microvascular density (MVD), lymphatic vessel density (LVD) in 115 cases of non-small cell lung cancer (NSCLC) and 45 cases of adjacent normal tissue samples.Results Our results showed that heparanase expression was significantly increased in 91 (79.13%) of the 115 cases and correlated with lymph node metastasis (node positive rate 87.0%; node negative rate 36.8%; P=0.003). Heparanase positive expression cases have significantly higher concentration of microvascular density (MVD) and lymphatic vessd density (LVD) as compared with heparanase negative expression cases (P<0.01, P<0.01, respectively), heparanase expression was significantly correlated with VEGF, VEGF-C expression in NSCLC.Conclusion Heparanase overexpression was associated with angiogenesis and lymphangiogenesis of lung cancer, targeting ofheparanase may represent a significant therapeutic potential for lung cancer.