Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and individualized surgical plans for patients.

Objective: To investigate the root canal configuration and the incidence and location of the isthmus in extracted maxillary second premolar with single root. Methods: 60 maxillary second premolars were included in the study. 1 mm root was cut from the apical end of root. The transverse section was stained with methylene blue dye and viewed with a surgical operating microscope. 1 mm increment sections were made and stained and observed by the same way from apex to 6 mm. The number of canals as well as the type of canal isthmuses were recorded. Results: 41.67% maxillary second premolar with single root had two canals. Canal isthmus happened more frequently in the apical 4 mm levels. Conclusion: The incidence of isthmus in the maxillary second premolar was highest in the apical 3-to 5-mm level. Canal morphology in the apical 1-to 6-mm is complicated.

Objective To understand the gene distribution and drug resistance rate of integron gene of extended spectrumβ‐lac‐tamases(ESBLs) producing Klebsiella pneumonia infection in ICU elderly patients in order to provide the basis for rational use of antimicrobial agents .Methods The BioMerieux VITEK‐2 Automated Microbes Identification System was adopted to conduct the bacteria identification and drug susceptibility test on various clinical specimens of ICU elderly patients in our hospital from January 2013 to December 2015 .The integron gene in 167 strains of ESBLs‐producing Klebsiella pneumoniae was analyzed by PCR ,and the gene was identified by sequencing .Results Among 386 strains of Klebsiella pneumoniae ,the detection rate of ESBLs‐producing strains was 43 .26% ;the positive rate of integron was 50 .89% ,the detected integron was class Ⅰ integron;aadA2 ,aadA1 ,aada16 , dfra27 and arr‐3 genes were amplified from integron variable region;the drug resistance rate of ESBLs‐producing integron gene pos‐itive strains was significantly higher than that of integron gene negative strains .Conclusion the ICU elderly patients with ESBLs‐producing Klebsiella pneumoniae infection is closely related to the integron gene and integron plays an important role in bacterial drug resistance .

Evidence-Based Practice ; Humans ; Practice Guidelines as Topic

Evidence-Based Medicine ; Evidence-Based Practice ; Humans ; Practice Guidelines as Topic

Evidence-Based Practice ; Practice Guidelines as Topic

Adrenocorticotropic Hormone ; therapeutic use ; Brain-Derived Neurotrophic Factor ; physiology ; Child, Preschool ; Female ; Humans ; Methyl-CpG-Binding Protein 2 ; genetics ; Mutation ; Rett Syndrome ; drug therapy ; genetics

Zymonomas mobilis was transformed with a polyhydroxybutyrate synthesis operon phbCAB equipped with a pdc promoter from Z. mobilis. For the first time,PHB was produced in recombinant Z.mobilis. Shake flask studies indicated that accumulation of PHB in Zymomonas mobilis increased approximately 10% ethanol productivity for the first 48h of anaerobic fermentation. After that,the PHB effect was observed as insignificant probably due to the exhaustion of the sugar.

A combination vaccine which consists of ≥2 immunogens is intended to provide protection against two or more diseases or against multiple serotypes of a single disease. The use of combination vaccines decrease the number of vaccine injections in the regular immunization schedules. However,the development of combination vaccines is more complicated than monovalent vaccines,preservatives and adjuvants used with one component may alter the potency of other components. Physical,chemical,and biological interactions between the components of combination vaccines must be considered to avoid detrimental effects on safety or efficacy. Therefore combination vaccines present unique challenges for product evaluation. This paper presents a review of research application status,the evaluation of effectiveness and safety,as well as development prospects on combination vaccines.

Objective To investigate the effects of Naoluoxintong which is representative prescription of supplementing Qi and activating blood therapy(Yiqihuoxue),the prescription of supplementing Qi therapy(Yiqi) and the prescription of activating blood therapy(Huoxue) on local cerebral ischemia-reperfusion injury rats.To observe the changes of neural stem cells(NSCs) and correlated SVZ factors.Methods Models of local cerebral ischemia-reperfusion were established by thread-occluding the MCA.The time points were observed at 1,3,7 d after reperfusion following 2 h of MCAO respectively.The expression levels of Nestin were measured by immunohistochemical staining.Results The expression of Nestin of treatment groups increased significantly compared with model group at 7 d(P