Objective To study the results using T-tube and retroperitoneal space drainage to manage perforating injury of the distal common bile duct(PIDC) during common bile duct(CBD) exploration.Methods We retrospectively analyzed the clinical data of 12 patients who were diagnosed to suffer from PIDC during CBD exploration from 2010 to 2012.Result All these 12 patients who received T-tube and retroperitoneal space drainage,gastrointestinal decompression,nutritional support and antibiotics recovered uneventfully.Conclusion Given that the CBD was unobstructed,T-tube and retroperitoneal space drainage was an good treatment for patients with PIDC.

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.

Objective To develop a modified method of adherent culturing NSCs to replace the traditional suspension culturing method.Methods Neural stem cells(NSCs)were isolated from brain of fetal mouse at 15.5-day fetal age.In culture bottle which had been pre-coated with poly-L-ornithine hydrochloride/fibronectin(PO/FN),the cells were adherently cultured and passaged.The cell morphology was observed under inverted microscope.NSCs and their differentiated cells were identified by immunofluorescence.Results NSCs obtained in this study were successfully adherently cultured and expressed specific markers.Conclusion NSCs are successfully adherently cultured in this study.As compared with the traditional suspension culturing method,adherent culturing is simpler and has lower wastage of passage.It is easy to observe cell morphology and differentiation by this method.It is also helpful to culturing and storage of NSCs.

The initiation and operation of the tissue repair program between the broken ends after fracture is very important for fracture healing, which goes through three intertwined and gradual evolution stages: hematoma inflammatory organization stage, primitive callus formation stage and callus remodeling stage. It is completed by a variety of tissues, cells and cytokines in the bone marrow cavity. In the study of the mechanism of fracture healing, it is found that there are many signal pathways and molecules regulating bone repair, including bone formation, bone remodeling and neovascularization. At the cellular level, it regulates osteoblasts, chondrocytes, osteoclasts and endothelial cells. Hippo signaling pathway is a signal pathway that maintains the size of organs and the balance between cell proliferation and apoptosis, and also plays an important role in maintaining bone homeostasis and bone metabolism. In the process of regulating bone development and repair, it regulates the physiological activities of cells in microenvironment through protein kinase cascade reaction and transcriptional coactivator. The upstream and downstream effectors of Hippo signal pathway directly or indirectly regulate the proliferation, differentiation and apoptosis of bone metabolic cells, and the interaction with Wnt signal pathway, Notch signal pathway and other important pathways related to bone repair show that Hippo signal pathway plays an important role in the regulation of fracture healing and may become a new target to promote fracture healing. This article reviews the regulatory mechanism of Hippo signaling pathway and its regulatory role in the process of fracture healing, and looks forward to the research prospect of promoting bone healing by using it as a target.

Objective To investigate the diagnostic significance of synchronous observation on bone marrow biopsy,bone marrow smear and peripheral blood smear in stubborn hematonosis.Methods Thirty-seven patients with difficult and complicated hematologic diseases were detected by peripheral blood smear,bone marrow smear and bone marrow biopsy.Those slides and smears were observed.Results The 37 cases with blood disease was diagnosed of aplastic anemia in 3 cases,5 cases of myelodysplastic syndrome,6 cases of primary myelofibrosis,13 cases of secondary myelofibrosis,7 cases of lymphoma with bone marrow infiltration and 3 cases of metastatic carcinoma of bone marrow.In the diagnosis of aplastic anemia,myelodysplastic syndrome,primary and secondary myelofibrosis,lymphoma and metastatic carcinoma of bone marrow diagnosis,bone marrow biopsy is superior to smear.Conclusion Bone marrow biopsy,bone marrow smear and peripheral blood smear synchronous observation can effectively increase the diagnostic rate,decrease misdiagnosis rate,and correctly identify the stage of the disease.

Background and purpose:Unbalance of apoptosis regulation plays an important role in tumor initiation and progression.Survivin and caspase-3 all take part in the regulation of cell cycle and apoptosis.We investigated the role of survivin and caspase-3 in apoptosis of gastric carcinoma,as well as its relationship with the clinicopathologic features and the prognosis of gastric carcinoma by using tissue microarray.Methods:The gastric cancer tissue microarrays were composed of tissues from 100 cases of carcinoma of the stomach without a history of chemo-radiation therapy and 30 gastric tissues of control subject.The diameter of each specimen on tissue microarrays was 2.0 mm.Expressions of survivin,caspase-3 were investigated immunohistochemically on these tissue microarrays.Tumor cell apoptosis index was also examined by TUNEL method.Of the 100 cases,47 cases were followed-up from 14 months to 13 years,in which the prognosis was analyzed.Results:Two paraffin-embedded gastric carcinoma tissue microarrays were successfully constructed,including 114 and 116 tissue spots,respectively.Immunohistochemical analysis showed that survivin expression was positive in 78 cases(78%) in this series.In contrast,no expression of survivin in control tissues was detected(P

Objective: The impact of parenteral fish oil lipid emulsion on liver function and nutritional status of malignant tumors of the liver and gallbladder patients. Methods: From December 2007 to A-pril 2008, 32 post-operative hepatobiliary cancer patients were randomly divided into control and study groups. Two groups were treated with isocaloric, isonitrogenic parenteral nutrition and the study group was added fish oil lipid emulsion. Comparison of plasma protein, glucose, jaundice index, transaminase, ALP and the rate of infection complications was made betweent the two groups. Results: The blood glucose, transaminase and ALP levels were not significantly different between the two groups. But the plasma proteins and bilirubin levels were improved significantly (P < 0.05) with reduced infection complication in the study group. Conclusion : Fish oil lipid emulsion is conducive to the recovery of post-operative liver and gallbladder cancer patients in live function and nutritional status.

ObjectiveTo evaluate the role of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) in the diagnosis of invasive pulmonary aspergillosis (IPA) in elderly patients with lung diseases.MethodsThe elderly patients with lung diseases and suspected of having IPA were enrolled. BALF for culture and GM detection, and serum samples for GM detection were obtained from all participants.According to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) with host factors, clinical criteria, mycological evidence and histological or cytopathological evidence, all patients were categorized into the proven, probable,possible and no IPA patients. The IPA patients were considered as IPA group while no IPA was considered as control group. ResultsAmong 76 enrolled elderly patients, 18 cases were diagnosed with IPA (1 proven, 11 probable and 6 possible), the remained 58 patients were as control group.Based on a GM index cutoff value of ≥0. 5, the sensitivity, specificity, positive predictive value and negative predictive value for BALF were 83.3％, 82. 8％, 60.0％ and 94.1％, respectively; these variables in serum were 55.60％ , 91.4 ％, 66.7 ％ and 86.9％ , respectively. Using a GM index cutoff value of ≥1.0, the specificity and positive predictive value of both BALF GM and serum GM reached 100％, but the sensitivity and negative predictive value of BALF GM were higher than serum GM (66.7％ vs. 22.2％, 90.60％ vs. 80.60％, respectively). Receiver operating characteristic curve analysis yielded a sensitivity of 83.4％ and a specificity of 96.6％ at a BALF GM index cutoff value of ≥0.725. ConclusionsGM detection in BALF seems to be a useful tool in the diagnosis of IPA in elderly patients with lung diseases,and could be widely used in future.

Objective To establish a canine model with pulmonary thromboembolism(PTE) of selective lobar pulmonary artery embolization mimicking chronic thromboembolism, to assess the effects of an inhaled nitric oxide (NO) 20 ppm on vital signs, blood gas, hemodynamic parameters and neutrophils in the alveolar of the canine model. Methods Twenty canines were divided into four groups: group 1: sham group (n=5); group 2; ischemic lung group (PTE group without embolectomy, n=5); group 3; reperfusion lung group (PTE group with embolectomy, n=5); group 4: reperfusion lung group with inhaled NO (PTE group inhaled 20 ppm NO after embolectomy, n=5). And central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP) and carbon monoxide (CO) were recorded, pulmonary vascular resistance (PVR) was also calculated. Vital signs, blood gases were measured before embolectomy and at 2, 4, 6 hours after the operation. Albumin in bronchoalveolar lavage fluid (BALF) was measured by chromatometry of Coomassie brilliant blue. Lung wet to dry weight ratio(W/D) was also measured. Lung tissue pathology and alveolar PMN in the left lower lobar were observed by optical microscopy. Results MPAP increased significantly at 2 hours after reperfusion [(3. 20±0.53)kPa vs. (2. 27±0. 67)kPa,F=63,P=0.02]; At 6 hours after reperfusion as compared with baseline,HR increased significantly [(175±8) beats/min vs. (155±5) beats/min, F=38.72, P=0.01],PaO_2/FiO_2 also decreased significantly (41.70±8.04 vs. 54.71±3.78,F=48.36,P=0.03). MPAP decreased significantly in group 4 as compared with group 3 at 2 hours after reperfusion [(2.53±0.4)kPa vs. (3. 20±0. 53)kPa,F=55,P=0.04]. At 4 hours after reperfusion,PaO_2/FiO_2 raised in group 4,but there was no significant difference as compared with group 3 (49.17±7.37 vs. 39.71±7.31, F=2.36, P=0. 11). The quantities of alveolar PMN infiltration in group 4 decreased significantly as compared with group 3 (19±6/10 HPF vs. 31±11/10 HPF, F=98, P=0.01).Conclusions Lung ischemia-reperfusion injury can be induced by embolectomy from lower pulmonary artery in the PTE model embolized for one week. An inhaled NO 20 ppm can decrease the elevated pulmonary artery pressure induced by ischemia-reperfusion injury and may alleviate the injury by reducing the PMN immigration into the alveoli.

Objective To characterize the regular and the dynamic contrast enhancement MR imaging in choroidal hemangioma.Methods MR imaging findings of 30 cases (31eyes, 32 lesions) with choroidal hemangioma confirmed by follow-up results were retrospectively analyzed.Among them, postcontrasted T1-weighted imaging was performed in 30 patients and dynamic contrast enhancement scanning was performed in 26 cases.MRI findings and the time-intensity curve of dynamic contrast enhancement were analyzed.Results Among the 32 choroidal hemangiomas, 26 of them were at the temporal side of optic disc and 28 lesions were fusiform.Before enhancement, 23 lesions showed isointense T1-weighted signal and 31 lesions were isointense on T2-weighted imaging.All the lesions showed strong enhancement on postcontrast T1-weighted imaging, including 31 homogenously enhanced lesions and one heterogeneously enhanced lesion.Retinal detachments were found in 18 eyes.Fill-in sign were observed in 12 lesions during dynamic contrast enhancement.The time-intensity curve of dynamic contrast enhancement in 28 lesions suggested a pattern with rapid enhancement and slow washout, time to peak (91.00±25.27) s, slope ratio 3.03±1.13, the median of washout ratio 17.06%, enhancement ratio 2.87±0.79.Conclusion MRI showed a few features of the location, shape, signal characteristics, and enhancement pattern in choroidal hemangioma, which may contribut to diagnosis and treatment plan of this disease.