Objective To investigate the value of combined use of laparoscopic cholecystectomy(LC)and duodenoscopic procedures in the treatment of gallbladder stones with common bile duct stones.Methods We retrospectively analyzed clinical data of 164 cases of gallbladder stones with common bile duct stones treated with laparoscopic cholecystectomy + endoscopic sphincterotomy(EST)from January 2003 to December 2007.Results All the cases underwent ERCP and endoscopic sphincterotomy(EST)followed by LC.In the 164 cases,196 bile duct stones were extracted from 155cases with a success rate of 94.5%.The procedures were unsuccessful in 9 cases,and among them,4 cases had stricture of bile duct more than 2 cm in length,and 5 cases had impacted stones that precluded passage of the guide wire.After EST,6 of the 155 cases had the complication of mild acute pancreatitis and LC was performed after its treatment.The success rate of LC was 96.5% and the average hospital stay was(11?4)d.Conclusions The combined use of EST and ERCP before LC is effective in treatment of gallbladder stones with common bile duct stones,and has broadened the utilization of minimally invasive treatment for bile duct diseases.

The method for preparation of models of myocardial ischemia in rats have been well described in the literature, are of practical value and have been chosen by many researchers for pharmacological studies of drugs for human diseases.However, there is still lack in some details of their operability and practicability.We re-selected the coronary artery ligation site, simplified the procedures and improved the experimental method for preparation of the models, and made satisfactory result.In this paper we will review the selection of method for preparing myocardial ischemia model in rats, describe some details of the surgical operation, explored the influencing factors and so on, and provide a reference for selecting most appropriate animal model in research.

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.

Objective To survey the resistance profile of clinical isolates to antibiotics across the hospitals in Dongguan,Guangdong Province during 2015.Methods Kirby-Bauer method or automated system was used to test the susceptibility of clinical isolates to selected antimicrobial agents.Results were analyzed according to CLSI 2015 breakpoints.The susceptibility data were analyzed using WHONET 5.6 software.Results A total of 29 665 strains of microorganisms were isolated,of which gram positive cocci accounted for 32.1％ (9 509/29 665) and gram negative bacilli accounted for 67.9％ (20 156/29 665),respectively.The prevalence of methicillinresistant Staphylococcus was 23.3％ (705/3 024) in S.aureus and 43.6％ (1 054/2 419) in coagulase-negative Staphylococcus.No vancomycin-resistant staphylococcal strain was found.ESBLs-producing strains accounted for 36.4％ (2 554/7 020) in E.coli and 24.5％(792/3 227) in Klebsiella isolates.The prevalence of carbapenem-resistant Enterobacteriaceae was 0.2％ (30/13 077).The prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Acinetobacter baumannii (CRAB) was 16.0％ (500/3 116) and 53.9％ (827/1 533),respectively.The prevalence of penicillin-resistant S.pneumoniae (PRSP) strains was 10.1％ (142/1 404).Beta-lactamase was produced in 30.6％ (276/902) of the H.influenzae strains.The prevalence of vancomycin-resistant Enterococcus (VRE) strains was 0.7％ (10/1 441).Conclusions Periodic surveillance of antimicrobial resistance is valuable for rational antimicrobial therapy,formulation of treatment guidelines and infection control and prevention measures,as well as preventing the spread of drug-resistant strains.

Objective To observe the effect of neuromuscular electrical stimulation on bone angiogene-sis and osteoporosis induced by denervation in sarcopenia osteoporosis rats,and explore the correlation of the miRNA expression level in circulating extracellular vesicles to bone angiogenesis and osteoporo-sis.Methods Ten-week-old male Sprague-Dawley rats were randomly divided into a sham operation control group(con,n=8),a double leg tibial nerve loss group(DD,n=8)and a double leg tibial nerve loss + right leg electrical stimulation group(D+ES,n=8).The tibial nerve of both legs was re-moved in DD and D+ES groups,and one week later the D+ES group received 8-week neuromuscular electrical stimulation.Samples were taken 24 hours after the last stimulation.Trabecular bone parame-ters were detected using micro-CT and its morphology was observed using hematoxylin and eosin(HE)staining.Immunohistochemical staining was used to identify the vascular markers platelet endothe-lial cell adhesion molecule-1(PECAM-1/CD31)and vascular endothelial growth factor A(VEGFA).Moreover,plasma exosomes were extracted and purified,and the vesicles were identified by electron microscopy,nanoparticle tracking analysis(NTA)and Western blotting.Meanwhile,the real time PCR was used to determine the expression of myogenic miR-1,miR-133a,miR-133b and miR-206 in exo-somes.Results(1)Compared with the CON group,the volume and weight of gastrocnemius and sole-us muscles in the DD group reduced significantly(P＜0.001),and the tibial trabecular bone parameters changed pathologically.After 8-week stimulation,compared with the DD group,the volume and weight of gastrocnemius and soleus muscles in D+ES group increased significantly(P＜0.05),and tibial trabecular bone parameters improved significantly.(2)The immunohistochemical staining results indicat-ed that,compared with CON group,the expression of CD31 and VEGFA in the tibia of DD group re-duced significantly,while that of the D+ES group increased significantly compared with DD group.(3)The results of NTA showed that,compared with CON group,the concentration of circulating extra-cellular vesicles in the DD group decreased significantly(P＜0.001),and the expression of miR-1,miR-133a,miR-133b and miR-206 in exosomes increased significantly(P＜0.05,P＜0.01,P＜0.05,P＜0.05 respectively).Compared with the DD group,the concentration of circulating exosomes in D+ES group increased significantly(P＜0.05),and the expression of the above four miRNAs decreased signifi-cantly(P＜0.05 for all).Conclusion Tibial nerve denervation can successfully establish the model of sar-copenia osteoporosis and neuromuscular electrical stimulation significantly relieves such denervation in-duced changes.Moreover,electrical stimulation also significantly increases the concentration of circulat-ing exosomes,and the expression of myogenic miRNAs carried by them,which suggests that the latter may be related to bone angiogenesis and the progression of osteoporosis.

Monitoring blood glucose level timely and accurately and management of glucose level is crucial for the treatment of diabetes and the prevention of diabetic complications. Glycated albumin is one of the important biomarker to evaluate the fluctuation of blood glucose level, which has been widely used in clinic. To understand the advantages and limitations of the glycated albumin in monitoring glucose level will contribute to its better application in clinic.

OBJECTIVE： To observe the effects of Zhuangtongyin （ZTY） water extract on blood vessels diastolic and systolic function and cardiac function in rats with coronary heart disease （CHD） and its potential mechanism. METHODS： SD rats were randomly divided into control group， sham operation group， model group， positive group （Compound danshen dripping pills， 0.08 g/kg） and ZTY water extract low-dose， medium-dose and high-dose groups （6.8， 13.6， 27.2 g/kg， by weight of water extract）， with 10 rats in each group. Except for control group （no operation） and sham operation group （only open chest without ligation）， CHD model were set up in other groups by ligating the left ventricle cyclotron endings. One week after modeling， control group， sham operation group and model group were given constant volume of water intragastrically， and administration groups were given relevant medicine intragastrically； once a day， for consecutive 4 weeks. Two hours after last administration， cardiac function indexes （LVEDV， LVESV， SV， LVEF） of rats were detected in each group. The levels of inflammatory factors （CRP， IL-1β， IFN-γ and ET-1） in myocardial tissue were determined by ELISA. Histomorphological characteristics of myocardial tissue were determined by HE staining. RESULTS： The structure of myocardial fibers in control group and sham operation group was clear and orderly； there was no statistical significance in difference of each index between 2 groups （P＞0.05）. Compared with control group， myocardial fibers were disorderly arranged in model group， and the phenomena of rupture， dissolution and necrosis were observed， accompanied by infiltration of inflammatory cells. The levels of LVEDV and LVESV as well as the levels of CRP， IL-1β， ET-1 and IFN-γ were increased significantly， while the levels of SV and LVEF were decreased significantly （P＜0.05 or P＜0.01）. Compared with model group， above symptoms of rats in each administration group were improved to different extents； the levels of LVEDV and LVESV as well as the levels of CRP， IL-1β， ET-1 and IFN-γ in positive group， the levels of LVEDV in ZTY water extract medium-dose and high-dose groups， the levels of LVESV and CRP， IL-1β， ET-1， IFN-γ in ZTY water extract groups were decreased significantly. The levels of SV and LVEF in positive group， the levels of SV in ZTY water extract groups as well as the levels of LVEF in ZTY water extract medium-dose and high-dose groups were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： ZTY water extract could reduce the level of ET-1 and improve blood vessels diastolic and systolic function in CHD model rats， then restore blood supply of myocardial tissue and strengthen cardiac function， by acting on inflammation cycle.

OBJECTIVE：To investigate the e ffects of Zhuangtongyin water extract （ZTYWE）on hemorheology and blood lipid level of myocardial ischemia-reperfusion model rats ，and preliminarily explore its molecular biology foundation of reducing arrhythmia after myocardial ischemia-reperfusion. METHODS ：Totally 75 SD rats were divided into control group ，model group and ZTYWE low-dose ，middle-dose and high-dose groups. Myocardial ischemia-reperfusion model was established by ligating the left ventricle cyclotron endings for 30 min then reperfusing for 60 min. Since the first day after surgery ，control group and model group were intraperitoneally administrated with same volume normal saline ；ZTYWE low-dose ，middle-dose and high-dose groups were intraperitoneally administrated with medicine solution （6.8，13.6，27.2 g/kg），once a day ，for continuous 28 d. At the 7th， 14th，21st，28th day after surgery ，the incidence rate of arrhythmia of rats were detected. The hemorheology indicators and serum contents of TC ，TG，LDL-C，HDL-C were determined after the last administration. The morphology of myocardial tissue was observed by HE staining. The protein expressions of apoptosis-related factor FAS and FAS-L were detected by Western blotting assay. RESULTS ：Compared with control group ，the incidence rates of arrhythmia of rats in model group were significantly increased；the whole blood contrast viscosity ，hematocrit（HCT），in vitro forming length and quality of thrombosis ，platelet aggregation rate ，erythrocyte filtration index （IF），as well as the serum contents of TC ，TG and LDL-C were significantly increased；in vivo thrombus formation time as well as the serum content of HDL-C were significantly decreased ；the protein expression of FAS and FAS-L were significantly increased （P＜0.05 or P＜0.01）；obvious pathological changes were observed in myocardial tissue. Compared with model group ， the incidence rates of arrhythmia of rats in ZTYWE groups were in obvious reducing trend ； except for the HCT in 163.com low-dose ZTYWE group without significance ， the blood contrast viscosity ，HCT，in vitro forming length and quality of thrombosis ，platelet aggregation rate ，IF as well as the serum contents of TC ，TG and LDL-C were significantly decreased ；in vivo thrombus formation time as well as the serum contents of HDL-C were significantly increased ；the protein expressions of FAS and FAS-L were significantly decreased （P＜0.05 or P＜ 0.01）；the pathological changes of myocardial tissue were improved. CONCLUSIONS ：Through the promoting blood circulation and removing blood stasis effect ，Zhuangtongyin decoction can improve indexes of hemorheology index of ischemia-reperfusion model rats ，reduce the contents of TC ，TG and LDL-C ，enhace the contents of HDL-C ，down-regulate the protein expression of FAS and FAS-L ，so as to inhibit myocardial cells apoptosis and reduce arrhythmia.