Objective To investigate the feasibility of video-assisted thoracoscopic surgery for anterior mediastinal modules. Methods Thoracoscopic surgery was performed with the patients in supine position and the thoracoscope set at 30?. Three trocars were used during the procedure. One of the trocars was inserted through the fifth or sixth intercostal space at the midaxillary line for direct observation. And the other two were placed at the second or third intercostal space at the midclavicular line,and the fifth intercostal space at the anterior axillary line. The nodules were removed directly during the operation. For inseparable nodules,the whole thymus and the fat tissues in the anterior mediastinum were removed all together. Results The procedure was completed under a thoracoscope in all of the 32 cases. Small assistant incision was made in 3 cases because of hemorrhage in the chest cavity. Postoperative pathological examination showed thymus tumor in 14 cases,hyperplasia of the thymus in 3,thymic cyst in 5,bronchial cyst in 3,pericardial cyst in 2,neurilemmoma in 2,lymph node in 2,and angioma in 1. The accordance rate of pre-and post-operative diagnosis was 68.8% (22/32). Postoperative complications were found in two patients,including one case of pericardial effusion,and one case of lung infection. Both the cases were cured afterwards. Conclusions Thoracoscopic surgery is a minimally invasive procedure for the treatment of anterior mediastinal nodules. It is optimal for young patients and cases with low lung function,as it causes less pain,quicker recovery,and satisfying cosmetic outcomes.

Objective To explore the long-term efficacy of endoscopic sphincterotomy (EST) for choledocholithiasis and to evaluate the necessity of cholecystectomy after EST. Methods Two hundred and fifty seven patients who underwent EST for choledocholithiasis in 2006 were followed up for an average period of 34. 8 months (26-48 months). According to the existence of cholecystolithiasis, the patients were divided into group A (combined with cholecystolithiasis, n = 151) and group B (without cholecystolithiasis, n = 106) , and group A was further divided into group A1 as undergoing cholecystectomy after EST (n =56) and group A2 as not having cholecystectomy after EST ( n = 95). Results Of the 257 patients, late complications occurred in 31 patients (12. 1% ) , including recurrent choledocholithiasis in 25 (9.7% ), cholangitis in 27 (10. 1% ) , acute pancreatitis in 2 (0. 8% ) and cholangiocarcinoma in 1 (0.4% ). The rates of late complications and recurrent choledocholithiasis were significantly higher in group A2 than those in group A1 (P<0.05). Conclusion EST is safe and effective for choledocholithiasis. Cholecystectomy after EST is necessary in patients with cholecystolithiasis.

Objective To estimate the long-term efficacy of endoscopic sphincterotomy (EST)in treatment of choledocholithiasis and to analyze the potential risk factors for disease recurrence.Methods A total of 154 patients with choledocholithiasis,who underwent EST between January 2006and December 2006, were enrolled. Multivariate analysis was used to evaluate the association of clinical features and experimental parameters with recurrence of choledocholithiasis. Results Longterm complications developed in 22 patients (14.29%) including recurrent choledocholithiasis (18/154,11.69 % ) and combined cholangitis (16/154). Cholangitis without calculi was found in 1 case (0.65%), acute pancreatitis in 2 cases (1.30%) and cholangiocarcinoma in 1 case (0.65%). High body mass index and serum cholesterol were proved to be risk factors for recurrence of choledocholithiasis. Whereas the incision size (0.5 cm-1.5 cm) of vater's papilla was the protective factor for recurrence of choledocholithiasis. Conclusions Body mass index, serum cholesterol and the incision size of vater's papilla are related to recurrence of choledocholithiasis.

Objective To investigate the factors that related to acute biliary pancreatitis including size and the location of the common bile duct stone. Methods Clinical data from 3497 patients with common bile duct stone admitted to the hospital between Jan. 2002 and Dec. 2008 were retrospective analyzed. All patients were grouped according to the size and the location of the bile duct stones. The incidence of acute pancreatitis was compared among groups. Results In patients with common bile duct stone accompanying the acute pancreatitis,common symptoms were fever, bellyache and jaundice, as well as elevated serum amylase. There was a negative correlation between size of the common bile duct stone and the severity of acute hiliary pancreatitis, which was easily induced by the stone in the Vater's ampullar or distal common bile duct. Conclusion Early endoscopic treatment should be carried out in patients with microlith located in the Vater's ampullar or distal common bile duct in order to prevent the acute biliary pancreatitis.

Objective To discuss the safety of endoscopic sphincterotomy (EST) in treatment of choledocholithiasis in patients over 80 years.Methods From 2005 to 2007,893 patients with choledocholithiasis were divided into group A (n= 148,aged over 80 years) and group B (n=745,aged below 60 years).The clinical data,complications and EST successful rate were retrospectively reviewed between two groups.Results ① The important chronic concomitant diseases were significantly higher in group A than those in group B ( 29.3 % vs 8.1 % ,P＜0.01).② The EST successful rate in group A and B was 95.6% and 96.5%,respectively ( P＞0.05).③ Sixteen patients in group A had complications including 13 caused by EST itself,3 related with EST and one died of aspiration pneumonia.While in group B,41 complications were caused by EST itself and no EST related complications.There was a statistically difference in EST related complications between two groups (P < 0.01 ).In complications caused by EST itself,there was no difference between two groups (P 0.05 ).④ The average hospital stay was ( 7.2 ± 2.2) days in group A and (5.1 ± 1.4) days in group B with no significant difference (P 0.05),Conclusion The EST is safe and effective in treatment of patients over 80 years.

Objective To investigate the effect of hawthorn leaf flavonoids (HLFs) with the different concentrations in prevention of high blood lipids and fatty liver in quails. Methods Sixty quails were divided into six groups:normal (N),high lipids food model (M),positive control (ZBT),HLF1,HLF2 and HLF3 groups.The animals in the N group were fed with normal food,while the M group was feed with high lipids food to establish the animal model of fatty liver.Besides high-fat diet,HLF1,HLF2 and HLF3 groups were also fed with 1 mL HLFs in the doses of 20 mg/kg,40 mg/kg and 80 mg/kg respectively.The ZBT group was fed with 1 g/kg of ZhiBiTuo and used as the positive control.After the experiments of six months,the serum and liver of the quails were taken and used to evaluate the contents of total cholesterol (TC),triglyceride (TG),high density lipid cholesterol(HDL-C),low density lipid cholesterol (LDL-C),superoxide dismutase (SOD),malondialdehyde (MDA),glutathione (GSH),alanine amino transferase (ALT) and glutamic oxaloacetic transaminase (AST).Meanwhile,the microscopic and electronic microscopic sections were used to observe the pathological changes of the livers of the quails. Results Compared with the M group,HLFs significantly lowered the content of TC,TG,LDL-C,MDA,AST and ALT in the serum and livers of the quails in other groups (P<0.001).However,the levels of HDL-C,SOD and GSH of the other groups were increased markedly (P<0.001).Moreover,the ratios of increase/decrease in the three HLF groups were depended on the concentrations of HLFs.Also,better liver structure and less lipid accumulation were also observed in the HLF groups when compared to the M group. Conclusions These results showed HLFs can lower blood lipid and cholesterol accumulation,improve the antioxidant capacity and protect the physiological function of liver.So,HLFs were effective in preventing and treating high blood lipids and fatty liver induced by high-fat diet.

Objective To investigate the effect of trastuzumab for injection on apoptosis and the expression of related genes in locally advanced breast cancer and related indexes.Methods 166 patients with locally advanced breast cancer were selected and divided into two groups, 83 cases in the control group treated with neoadjuvant chemotherapy before operation, 83 cases in the experimental group received trastuzumab for injection on the basis of the control group, serum tumor marker levels, tumor cell apoptosis index and proliferation activity, Bcl-2, Bax gene expression levels, the clinical effect and incidence of adverse reactions were compared after the treatment.Results The effective rate in the control group(78.32%)was lower than the experimental group(90.36%), with significant difference (P<0.05).Compared with the control group, serum levels of CA153,CA125,CEA,TSGF were lower in the experimental group after chemotherapy, levels of apoptosis index(AI) in tumor tissue was higher, levels of S-phase fraction (SPF), proliferation index ( PI) were lower after treatment, Bcl-2 gene in tumor tissue expression level was lower, Bax gene expression level was higher after treatment, all with significant difference (P<0.05).There was no significant difference in the incidence of adverse reactions between two groups. Conclusion The trastuzumab for injection treatment can significantly improve the total remission rate of patients with locally advanced breast cancer , reduce the levels of serum tumor markers, can down-regulate the expression of apoptosis related gene Bcl-2, up-regulate the expression of Bax gene, promote the apoptosis of tumor cells.

Objective:To detect the expression of miR-106b~25 cluster in glioma cell line and tissues. Methods:Real-time PCR was performed to determine the expression of miR-106b~25 cluster members (miR-106b, miR-93, and miR-25) in different human glio-blastoma cell lines. Different pathological grade glioma specimens were surgically removed. In-situ hybridization was performed to de-tect the expression of miR-106b~25 cluster members in different pathological levels of glioma tissues. Results:In the expression of the benchmark on normal brain tissues, three kinds of miRNAs in all test cell lines have a tendency to increase. Based on the expression of the pathological level I average rate in 43 cases of glioma specimens collected after neurosurgical operations, the real-time PCR results showed that the average expression quantity of the three kinds of miRNAs in each group gradually increase. The increase in tumor path-ological levels results in statistically significant expression differences of miR-106b and miR-93 between the groups (F=4.479, P=0.018 and F=3.493, P=0.040, respectively). However, miR-25 expression differences between the groups have no statistically signifi-cant differences (F=2.766, P=0.075). In situ hybridization results show that the expressions of three miRNAs in high grade gliomas are significantly higher than that in the low-level tumor. Spearman rank correlation analysis results indicate that the expression of these miRNAs signal-intensity distribution is positively correlated with glioma, in accordance with WHO pathology classification. The corre-lation coefficient for miR-106b, miR-93, and miR-25 are 0.617, 0.438, and 0.463, respectively (P<0.001). Conclusion:The expression of miR-106b~25 cluster members is up-regulated in the glioma and is positively correlated with tumor grade.

Objective To study the clincial effectiveness and safety of endoscopic sphincteropapillotomy combined with balloon dilation for decompensated cirrhosis accompanied with choledocholithiasis.Methods Data of 79 cases of decompensated cirrhosis patients with choledocholithiasis who underwent limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD,the ESBD group) and 42 cases who underwent endoscopic papillary balloon dilation(EPBD,the EPBD group)were retrospectively analysed and compared for complete stone clearance rate,one-time stone clearance rate and complications.Results The rate of complete stone clearance and one-time stone clearance were 94.9％ (75/79) and 77.2％ (61/79)in ESBD group,and those were 88.1％ (37/42) and 59.5％ (25/42) in EPBD group respectively.The rate of complete stone clearance was a little higher in ESBD group than that in EPBD group.In ESBD group,ERCP-related bleeding occurred in 3 patients (3.8％),post-ERCP hyperamylasemia in 3 (3.8％)and post-ERCP pancreatitis in 2 (2.5％) ; while in EPBD group,post-ERCP hyperamylasemia occurred in 8 patients(19.0％),post-ERCP pancreatitis in 6(14.3％) and ERCP-related bleeding did not occur.There were no significant difference in ERCP-related bleeding between ESBD group and EPBD group (P =0.551).However,the rates of post-ERCP pancreatitis and hyperamylasemia in ESBD group were significantly lower than those in EPBD group(P ＜ 0.05).Conclusion ESBD is a safe and effective procedure for choledocholithiasis accompanied by decompensated cirrhosis,with several advantages over EPBD in terms of higher one-time stone clearance rate,reduced risk of post-ERCP pancreatitis and hyperamylasemia,and without noticeable increase in the risk of bleeding related to ERCP.

Objective To explore the expressions and correlation of RWD containing sumoylation enhancer (RSUME),small ubiquitin-like modifier (SUMO-1),hypoxia inducible factor-1α(HIF-1α)and vascular endothelial growth factor (VEGF)in gliomas of different pathologic grade.Methods We investigated the expression levels of RSUME mRNA,HIF-1α mRNA and VEGF mRNA with reverse transcription-polymerase chain reaction (RT-PCR),and investigated the immunohistochemical staining to determine the expressions of SUMO-1,HIF-1α and VEGF in 63 cases of human gliomas of different pathologic grade and 9 cases of normal brain tissues.We studied its correlation with the pathologic grade and the relationship between the expression of RSUME promoter sumoylation and HIF-1α/VEGF pathway in gliomas.Results There were significant differences (P <0.01)in the expressions of RSUME mRNA,HIF-1αmRNA and VEGF mRNA in glioma tissues.With the increasing degree of pathologic grade in tumor specimens,the expression levels of RSUME mRNA,HIF-1α mRNA and VEGF mRNA increased markedly (P <0.01 ).There was a positive correlation of the expression levels of RSUME mRNA with HIF-1αmRNA and VEGF mRNA.There were significant differences (P <0.01 )in the expressions of SUMO-1,HIF-1αand VEGF in glioma tissues by immunohistochemical staining.With the ascending of pathologic grade of tumor specimens,the expression levels of SUMO-1,HIF-1α and VEGF increased markedly (P < 0.01 ).There was a positive correlation between the expression level of SUMO-1 and HIF-1α(r =0.857,P <0.01).The Kaplan-Meier analysis and Log-rank test showed significant differences in progress free survival (PFS)between the RSUME high-expression and low-expression groups (χ2 =36.032,P <0.01).Conclusion RSUME may enhance HIF-1α/VEGF pathway through sumoylation in gliomas.It implicates that RSUME is related to angiogenesis in gliomas and can promote tumor invasion and progression,indicating that RSUME can be a novel target in gliomas treatment.