Objective To explore the extrahepatic bile duct stones after reoperation cause analysis and coun-termeasures.Methods Clinical data of 150 patients with liver surgery gallstone surgery again were retrospectively analyzed,according to the first reason for liver from gallstone surgery will be divided into the three groups:group hepa-tolithiasis ( group A,100 cases) ,gallstones group ( group B,30 patients) ,common bile duct stones group ( group C, 20 cases) .The reasons for reoperation were analyzed.Results In intrahepatic bile duct stones reoperation patients, the recurrence of liver gallstones was 98 cases(65.3%),common bile duct cysts and Caroli disease was 35 cases (23.3%),anastomotic stenosis in 17 cases(11.3%);The postoperative complication rate of group A(44.0%) was significantly higher than that of group B(13.3%) and group C(15.0%)(χ2 =9.32,5.88,all P<0.05);The sec-ondary and post-operative inflammation stone recurrence within 5 years of group A was 32.0%,which was significant-ly higher than 6.7%of group B and 10.0%of group C(χ2 =7.67,3.97,all P<0.05).Conclusion The intrahe-patic bile duct stones are the main types of reoperation after liver gallstones,gallstones and liver recurrence is the main cause of its secondary surgery.It should be make clear the disease cause of preoperation, take a different surgical options for patients with different types of stones,prevention,and avoid the occurrence of postoperative complications, which can effectively reduce the risk of secondary surgery to alleviate the suffering of patients.

Objective To investigate the effects of changes in protein bile sugar chain structure for differen-tiating benign and malignant biliary tract disease .Methods 100 patients with biliary tract diseases who were treated in Department of General Surgery ,Qingdao Haici Medical Group were selected in this study .According to benign or malignant biliary disease ,the patients were divided into control group ( benign biliary tract disease ) and observation group ( cholangiocarcinoma ) ,50 cases in each group .Two groups of patients with bile drops on the nitrocellulose mem-brane,through the comparison of wheat germ agglutinin (WGA),Datura stramonium agglutinin (DSA),lentil lectin (LCA),concanavalin A(CONA) positive rate of test,to explore the relationship between sugar chain of glycoprotein in bile and bile duct benign and malignant diseases .Results In control group,the positive rates of WGA,DSA,LCA, CONA agglutinin test were 22.0%,14.0%,2.0%,76.0%,those in the observation group were 76.0%,66.0%, 76.0%,82.0% respectively.No statistically significant difference between the two groups of CONA agglutinin test positive rate was observed(P>0.05).The WGA,LCA,DSA agglutination test positive rates in observation group were significantly higher than those in the control group ,the differences were statistically significant (χ2 =29.17,28.17, 57.55,all P<0.05).Conclusion Changes in bile glycoprotein chain structure are closely related to benign and ma -lignant biliary tract disease ,positive rates of WGA ,LCA,DSA agglutination test can be used to determine the benign and malignant biliary disease ,it should be popularized in clinical practice .

Objective To evaluate the characteristics of two angiographic manifestation of ocular fundus in choroidal metastatic carcinomas. Methods Fundus fluoresein angiography (FFA) and indocyanine green angiography (ICGA) were performed on 17 patients (24 eyes) with choroidal metastatic carcinomas, and the characteristics of these two kinds of angiograms were analyzed and compared each other. Results According to various clinical features, e.g., locations of metastatic tumor in ocular fundus, disease course, and different kinds of original malignancy, the findings of ocular fundus were divided into (1) Isolation type: FFA showed pinpoint and mottled leaks against hypofluorescence background, increased and confluent fluoresecence in later stage. ICGA showed the similar images as in FFA, except later appearance of leaks and the choroidal vesseles could be seen beneath the thin metastatic tumor mass.(2) Diffusion type: Tumors showed hypofluorescence in early stage and uneven ill defined hyperfluorescence both in FFA and in ICGA. (3) Small metastatic carcinomas: Hypofluorescence in early stage and mild mottled hyperfluorescence were found in FFA as well as in ICGA. Conclusion Both FFA and ICGA are helpful in the diagnosis of choroidal metastatic tumors and ICGA may be conducive if there are some troubles in diagnosing the tumors with FFA.

Objective:To observe changes of serum uric acid (UA)level and red cell distribution Width (RDW)in se-nile men With chronic heart failure (CHF),and explore their correlation With cardiac function.Methods:A total of 60 senile male CHF patients Were enrolled,including 28 cases of NYHA cardiac function class Ⅱ and 32 cases of NYHA class Ⅲ-Ⅳ.Another 30 cases With normal cardiac functionWere regarded as normal control group.Levels of UA,RDW and high sensitive C reactive protein (hsCRP)Were measured,and patients received color-coded Doppler echocardiography,change of every index Was compared among patients With different cardiac function class.Results:Compared With normal control group,there Were significant rise in serum levels of UA [(318.2± 54.3)μmol/L vs.(434.7±72.7)μmol/L],RDW [(13.84±0.60)% vs.(15.79±0.74)%]and hsCRP [(2.23 ±0.56)mg/L vs.(6.35±2.34)mg/L]in CHF group,and they significantly rose alongWith cardiac function class aggravated,P <0.01 all;there Were significant decrease in transmitral early diastolic peak floW velocity/transmitral late diastolic peak floWvelocity [E/A,(1.02±0.36)vs.(0.75±0.13)]and left ventricular ejection fraction [LVEF,(59±9)% vs.(49±9)%]in CHF group,and they significantly reduced along With cardiac function aggravated, P <0.01 both;in CHF group;UA,RDW and hsCRPWere negatively correlatedWith E/A and LVEF (r =-0.391~-0.731,P <0.05 all);RDW Was positively correlated With hsCRP (r =0.491,P <0.05).Conclusion: Serum uric acid and red cell distributionWidth are correlated to cardiac function in senile male patients,Which can help to judge the severity of heart failure and guide clinical treatment.

Objective To investigate the role of nurses in civil cardiac death organ donation work.Methods Cooperating,propagating and promoting in civil cardiac death organ donation; building a bridge between the families of organ donation,donor coordinators,physicians and hospital ethics committees; participating in organ donation medical ethics assessment work; cooperating with the doctors do intend to maintain organ donation,access and preservation; protecting donors remains.Results During the time of July 2011 to November 2013,we successfully completed 52 cases of civil cardiac death organ donation cooperating with doctors,and got 41 liver,which entered the national organ allocation system for distribution.Conclusions The nurses will play a more and more important role in work of civil cardiac death organ donation cooperating with doctors.

Objective: To explore the correlation among serum prealbumin (PAB) level, red cell distribution width (RDW) and cardiac function in advanced aged male patients with chronic heart failure (CHF). Methods: Research objects included 60 patients with heart failure（28 cases with NYHA class Ⅱ and 32 cases with NYHA class Ⅲ-Ⅳ, heart failure group）and 30 cases with normal cardiac function admitted in the same period（normal control group）. Serum PAB, hemoglobin (Hb) concentration and RDW, red blood cell (RBC) count were measured. Patients all received echocardiography examination. Changes of all indexes were compared among patients with different cardiac function class. Results: ① Compared with normal control group, there was significant decrease in serum PAB level [(252±49) mg/L vs. (185±36) mg/L] and significant increase in RDW [(13.84±0.60) % vs. (15.79±1.33) %] in heart failure group, and compared with class Ⅱ group, there was significant decrease in serum level of PAB and significant increase in RDW in class Ⅲ-Ⅳ group, P<0.01 all; ② Compared with normal control group, there were significant decrease in E/A [(1.02±0.36) vs. (0.75±0.18)] and left ventricular ejection fraction [LVEF, (59±9) % vs. (49±11) %] in heart failure group, and the worse cardiac function was, the lower these two indexes were, P<0.01 all; ③ Pearson linear correlation regression analysis indicated that PAB was positively correlated with E/A and LVEF (r=0.451, P<0.05; r=0.596, P<0.05), and RDW was negatively correlated with E/A and LVEF (r=-0.391, P<0.05; r=-0.574, P<0.05) in heart failure group. Conclusion: Prealbumin and red cell distribution width are closely correlated to cardiac function class in advanced aged male patients. Both of them can indirectly reflect cardiac function in advanced aged patients with chronic heart failure.

Objective To present the distinction on clinical features,laboratory features,treatment schemes between the patients with and without brucellar epididymo-orchitis,and to provide a theoretical basis for clinical diagnosis and treatment.Methods A retrospective analysis of 223 male patients with brucellosis in the First Hospital of Jilin University from June 2010 to November 2016 was carried out.A comparative analysis of the clinical and laboratory features of 22 patients with epididymo-orchitis and 201 cases without epididymo-orchitis was done.The SPSS 23.0 software was used to analyze the statistical results,P ＜ 0.05 was defined as statistically significant.Results Epididymo-orchitis occurred in 9.87％ (22/223) of all male patients with brucellosis.The median ages of patients with and without epididymo-orchitis were 35.5 and 42.0 years old,respectively,the difference was not statistically significant (Z =1.323,P ＞ 0.05).Cases with and without epididymo-orchitis of brucellosis with fever [90.9％ (20/22) vs 69.2％ (139/201)],chills [54.4％ (12/22) vs 28.9％ (58/201)],hepatomegaly [22.7％ (5/22) vs 3.5％ (7/201)],abdominal symptoms [59.1％ (13/22) vs 17.4％ (35/201)],and urinary tract infection symptoms [31.8％ (7/22) vs 3.5％ (7/201)],the differences were statistically significant (x2 =4.586,6.076,14.424,20.392,27.059,all P ＜ 0.05).The medians of white blood cell (WBC) count (7.9 × 109/L),erythrocyte sedimentation value (ESR,38.0 mm/h),and aspartate aminotransferase (AST,110.0 U/L) in brucellosis with epididymo-orchitis were higher than those without epididymo-orchitis (5.1 × 109/L, 30.0 mm/h,73.8 U/L),the differences were statistically significant (Z =2.239,2.064,2.762,all P ＜ 0.05).All brucellosis patients with epididymis-orchitis were treated with antibiotics for 8 weeks.The defervescence time was 4.5 days,the time of pain relief was 3.9 days,21 patients were cured,and only Ⅰ patient relapsed.Conclusions Epididymo-orchitis is a common complication of brucellosis.Brucellar epididymo-orchitis is usually characterized with a severe acute clinical presentation,which needs timely diagnosis.Combination of antibiotics treatment for 8 weeks in brucellosis patients with epididymis-orchitis is effective.

Objective To obtain alpaca single domain antibody targeting Her2.Methods An alpaca was immunized with human recombination Her2 protein mixed with Freund's adjuvant.Total RNA was extracted from the alpaca's blood and was used to synthesize first strand cDNA.Single domain antibody variable region (VHH) gene of the alpaca was amplified by PCR and cloned into pMES4 vector for library construction.After screening, E.coli BL21 (DE3) was transformed with selected clones and was induced with IPTG for the expression of recombinant proteins.The nanobody was purified by nickel ion affinity chromatography column.The affinity of the nanobodies to Her2 was tested.Results After the second round of screening, two antibody clones were selected, H3 and H5.The affinity of H5 was 8.106×10-10mol/L.Histochemistry results showed that H5 could recognize Her2 antigen in breast tumor tissue.Conclusion An Her2 specific nanobody derived from alpaca is obtained through phage display library screening, which can recognize human Her2 antibody in human breast tumor tissue.

Background and purpose: Thyroid carcinoma cells spread mainly through lymph node metastasis, and lymphangiogenesis plays an important role during the lymph node metastasis, but it is not very clear to understand the formation mechanism. This study was to investigate the correlative expressions of HPSE, VEGF-C, D2-40 and lymphangiogenesis in thyroid carcinoma. Methods: Immunohistochemistry SP method was used to detect the expressions of HPSE, VEGF-C and D2-40 in 77 patients with thyroid carcinoma including papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC),medullary thyroid carcinoma (MTC), 32 of them with lymph node metastasis was enrolled into the study, D2-40 stained the lymphatic vessels, and lymphatic vessel density (LVD) was scanned under the light-microscope, and the correlation among the above indexes in different thyroid carcinoma types were analyzed respectively. Results: The expressions of HPSE, VEGF-C and D2-40 were observed to have a different degree in thyroid carcinoma, and the highest expression of the protein could be seen in the patients with papillary carcinoma (P<0.05),The expression ratios of HPSE,VEGF-C and D2-40 in different carcinoma types were 54.9%, 68.6%, 12.8±5.7 for PTC, 37.5%, 50%, 8.6±1.7 for FTC, 20% and 20%, 4.9±0.8 for MTC, respectively. There were significant different expressions of HPSE, VEGF-C and D2-40 between the patients with lymph node-positive group and node-negative group (P=0.014, P=0.048, respectively). In addition, the expressions of them were positively correlated (P<0.001, r=0.616). Conclusion: HPSE, VEGF-C and D2-40 have a close relationship with lymph node metastasis, HPSE and VEGF-C are related to the lymphangiogenesis.

Objective To investigate the clinical features and risk factors of primary Sjogren's syndrome (pSS) patients with malignancies.Methods The clinical features of 29 pSS patients with malignancies from January 1985 to March 2008 were retrospectively analyzed.Results The ratio of pSS with malignancies to all hospitalized pSS patients from January 1985 to March 2008 was 2.2%.In these patients,8 were lymphoma,4 were breast cancers,2 were myeloma,2 were thymoma,2 were lung cancer,2 were gastric carcinoma,2 were hepatoma,2 were colon carcinoma and 2 were tongue cancer.Uterine cervix cancer,renal carcinoma,thyroid carcinoma and carcinoma of parotid gland each were fund in this series of patients.Conclusion The most common malignancy in pSS is lymphoma and the major of pathological type is B cell non-Hodgkin's lymphoma.