Objective To explore the prevention and management of biliary tract injury during laparoscopic cholecystectomy(LC) in patients with acute cholecystitis.Methods Between October 1999 and October 2008,368 patients with acute cholecystitis received LC in our hospital,7 of them developed biliary tract injury during the operation,and therefore underwent the biliary repair or Roux-en-Y anastomosis between the common bile duct and jejunum as well as T-tube drainage.Results Among these 7 cases,5 cases was converted to open abdominal operation during the procedure of LC,of which 2 cases(1 with total bile duct transection and 1 with electric burn of bile duct) showed stenosis of the bile duct in 12 and 3 months respectively after the T tube was removed,and then was cured by a second Roux-en-Y anastomosis.Two of the 7 patients received biliary repair because of electric burn;cholangiography showed no stenosis after 3-month T-tube drainage.In one patient who had severe injury to the common bile duct,Roux-en-Y anastomosis was performed,and then the patient was discharged from the hospital in 2 weeks with the T tube;one month later,re-examination by cholangiography showed that the case was cured.In the 7 patients,jaundice was observed in 2 cases in 3 to 5 days after the surgery;ERCP showed biliary stenosis in one of them,and complete biliary atresia in another.Subsequent abdominal exploration on the two cases revealed complete common bile duct occlusion in one and partially occluded common hepatic duct in the other.Roux-en-Y anastomosis between the bile duct and jejunum combined with T-tube drainage was therefore made on the patients.The 7 cases were followed up for 0.5 to 6 years,during the period,none of them showed biliary stenosis,residual stones or other complications.No patient died during the follow-up.Conclusion Biliary tract injury during LC in patients with acute cholecystitis can be avoided as long as we choose the right time for LC as well as for conversion to an open surgery.

Objective To study between serum uric acid and early morning blood pressure of the different degrees of Obstructive sleep apnea syndrome(OSAHS)patients.Methods134 cases of OSAHS were divided into mild,midrange and severe groups according to apnea-hypopnea index(AHI),and 23 healthy people as normal control group.serum uric acid and early morning blood pressure were measured among four groups.ResultsSerum uric acid levels in mild,midrange,severe OSAHS groups and the control group were(392.10?88.22)?mol/L,(460.14?118.86)?mol/L,(537.63?134.11)?mol/L,(304.36?80.12)?mol/L,there were significant differences among four groups.there were significant differences between severe OSAHS and the others in blood pressure,as well as between OSAHS midrange group and the control group.ConclusionSerum uric acid in OSAHS patients increased with increasing degree of AHI,the disorder of serum uric acid possiblly contribute to abnormal blood pressure in OSAHS patients.

Objective: To optimize the extraction conditions of semi-bionic extraction for Gardenia jasminoides Ellis. Methods:The best extraction conditions of the semi-bionic extraction for Gardenia jasminoides Ellis was screened by uniform design with yield of geniposide, total iridoid glycosides and dry extract as the indices. Results:The optimal conditions were as follows:the pH value of wa-ter for the lst, 2nd and 3rd decoction was 2. 0, 6. 5 and 9. 0, respectively, and the extraction time was 2. 0, 1. 0 and 1. 0h according-ly. Conclusion:The optimized extraction conditions by uniform design is scientific and reasonable.

Objective To study the association between serum total IgE level and β2-adrenoreceptor polymorphism (β2-AR) in asthmatic patients. Methods ELISA was used to determine serum total IgE and AS-PCR was used to determine β2-adrenoreceptor polymor- phism in 44 asthmatic patients. Results In β2-AR 16 locus genotype, the distribution frequencies of Arg/Arg, Gly/Gly showed increasing tendency, whereas Arg/Gly showed decreasing tendency, in normal serum total IgE group and increased serum total IgE group. But there was no significant difference between this two groups. In β2- AR 27 locus genotype, the distribution frequency of Gln/Gln genotype accounts for 76.2% and Gln/Glu genotype for 19.0% in increased serum total IgE group, while Gln/Gln genotype accounts for 9.0% and Gln/Glu geno- type for 73.9% in normal serum total IgE group. There was significant difference between two groups ( P<0.01 ). Conclusions Serum total IgE was correlated with β2-AR 27 locus genetic polymorphism, which may contribute to understand the mechanism of asthma in the peo- ple of the Han nationality in GuiZhou.

Objective:To optimize the conditions of semi-bionic extraction for Jinyin Qingre oral liquids. Methods:The best con-ditions of the semi-bionic extraction for Jinyin Qingre oral liquids was optimized by uniform design with the yield of chlorogenic acid, geniposide and total phenolic acid, and the dried extract weight as the indices in a comprehensive evaluation. Results:The optimal pH of water for the three-time decoction was 2. 89, 6. 50 and 8. 43, respectively, and the total extraction time was 2. 0 h. Conclusion:Combined with the actual production, the pH value of water is 3. 0, 6. 5 and 8. 5 with the decoction time of 1. 0, 0. 5 and 0. 5h, re-spectively.

Objective To investigate changes in morning blood pressure surge (MBPS) and blood hemorheology in patients with obstructive sleep apnea-hypoventilation syndrome (OSAHS) of various severity. Methods Total 118 patients with OSHAS diagnosed at the Department of Respiratory Diseases, People's Hospital of Guizhou Province were divided into three groups, i.e. , 31 mild, 40 moderate and 47 severe cases, based on their apnea-hypoventilation index (AHI), and 25 healthy persons were selected as controls. Blood hemorheology, oxygen saturation, morning blood pressure surge of the patients, as well as percentage of the time with oxygen saturation more than 90 percent of the total monitoring time (TS90%) were recorded. Results Early morning blood pressure surge was found in 21 cases (43%) with severe, eight (20%) with moderate and one (3%) with mild OSAHS. All indicators of blood hemarheology and TS90% were significantly higher in the patients with OSAHS than those in controls (P<0.05 ), those in moderate and severe OSAHS were significantly higher than those in controls (P<0.05 ) and those in severe OSAHS was significantly higher than those in moderate and mild OSAHS (P<0.05). All indicators of blood hemorheology were significantly higher in those with early morning blood pressure surge than those without it (P<0.05). Conclusions Blood viscosity, percentage of early morning blood pressure surge and TS90% in the patients with OSAHS are increased with severity of apnea-hypoventilation, and changes in blood hemorheology correlated with early morning blood pressure surge.

Objective To explore the effects and mechanisms of anti-endothelial cell antibody (AECA )in the alveolar cell apoptosis of the emphysema rats induced by smoking,and to discuss the intervention effects of methylprednisolone.Methods 39 male Sprague-Dawley rats were randomly divided into normal control group,model group,and intervention group,with 13 rats in each group.Emphysema models were established in the latter two groups.After exposing to cigarette smoking for one month,methylprednisolone injected intraperitoneally in the intervention group(10 mg/kg,1 time/d),6d/week.On the 90th day,inferiora vena cave blood samples were collected and all rats were sacrificed.The levels of AECA were detected in bronchial alveolar lavage fluid (BALF )and serum,respectively.Pathological changes were observed in lung tissues stained by hematoxylin eosin, quantitative determination of lung average mean linear intercept(MLI)and mean alveolar number(MAN)were preformed. Results Compared with normal group and intervention group,the levels of AECA in BALF and serum,MLI in the model group were higher(P<0.05 ),but the levels of MAN was lower (P<0.05);There is a positive correlation between AECA in BALF and MLI of rats(r=0.821,P<0.05),a negative correlation between AECA in BALF and MAN(r=-0.894,P<0.05.Conclusions ACEA may enroll the pathogenesis of emphysema in rats induced by smoking and related with the severity.Methylprednisolone may inhibit the formation of emphysema by reducing the expression level of AECA in airway.

Objective To study the effects of mirabilite stuck on umbilical region combined with early enteral nutrition (EEN) on gastrointestinal function and serum inflammatory mediators in patients with mechanical ventilation. Methods Sixty-four patients with mechanical ventilation admitted to the Department of Intensive Care Unit of the Second Affiliated Hospital of Zhejiang Traditional Chinese Medical University from January to December 2016 were enrolled, and they were divided into an observation group and a control group by random number table, 32 cases in each group. The control group was treated with routine western medicine+ EEN, and the observation group was treated additionally with mirabilite stuck onto umbilical region on the basis of the treatment of the control group. The clinical effect was observed after 7 days of treatment. The differences in gastrointestinal function scores and the levels of serum inflammatory mediators were compared between the two groups before and after treatment.Results After treatment, gastrointestinal function scores of the diarrhea, bowel sound, abdominal distension and the levels of white blood cell count (WBC), serum procalcitonin (PCT), serum C-reactive protein (CRP) were decreased significantly in both groups compared with those before treatment, and the degrees of decreasing in above index levels after treatment in the observation group were more obvious than those in the control group [diarrhea: 0.72±0.03 vs. 1.59±0.21, bowel sounds: 0.87±0.05 vs. 1.54±0.18, abdominal distension: 0.77±0.04 vs. 1.63±0.09, WBC (×109/L): 9.87±1.25 vs. 12.46±2.04, PCT (μg/L): 5.43±1.02 vs. 9.65±1.63, CRP (mg/L): 56.87±4.52 vs. 89.43±8.24, allP < 0.05].Conclusion Applying mirabilite stuck on umbilical region combined with EEN can effectively promote the recovery of gastrointestinal function and significantly decrease the levels of serum inflammatory mediators in patients with mechanical ventilation.

Objective:To explore the clinical characteristics, diagnosis and treatment of allergic bronchopulmonary aspergillosis(ABPA) with eosinophilic granulomatous with polyvasculitis(EGPA) as a comorbidity.Methods:We collected the clinical data of a patient with EGPA who sought treatment with ABPA as a comorbidity. We summarized the diagnosis and treatment process of the patient, and reviewed the literature. After that, we discussed the relationship between the pathogenesis of ABPA and EGPA and the diagnosis and treatment experience.Results:A 61-year-old male patient suffered from repeated coughing, expectoration, hemoptysis, wheezing. His blood eosinophils count and immunoglobulin (Ig)E level were elevated. He was tested positive for aspergillus fumigatus. His Computer Tomography (CT) showed pulmonary nodules and bronchiectasis. He was diagnosed as ABPA. He also suffered limb numbness, sinusitis, and renal dysfunction and was diagnosed as EGPA. His condition improved after treatment with glucocorticoids, immunosuppressants and antifungal agents. We reviewed the relevant literature and retrieved 10 case reports, of which 5 cases were diagnosed as ABPA first and then EGPA, 3 cases were diagnosed as EGPA first and then ABPA, 2 cases were diagnosed simultaneously. We found that there was a certain correlation between them in the pathogenesis, and the main treatment is glucocorticoids, immunosuppressants and antifungal drugs.Conclusion:ABPA with EGPA as a comorbidity is rarely reported, which reminds us that when diagnosing one of the diseases in clinical work, we should be alert to the coexistence of another disease to avoid misdiagnosis.

OBJECTIVE：To study the effects of methylprednisolone sodium succinate on oxidative stress and anti-endothelial cell antibody （AECA）of autoimmune emphysema model rats. METHODS ：Male SD rats were randomly divided into control group，model group and intervention group ，with 8 rats in each group. Except that control group was given same volume of complete Freund ’s adjuvant intraperitoneally ，model group and intervention group were given the mixture of human umbilical vein endothelial cells and complete Freund ’s adjuvant intraperitoneally to establish the model of autoimmune emphysema. On 2nd day after modeling ，intervention group was intraperitoneally injected with 10 mg/（kg·d）methylprednisolone sodium succinate. Control group and model group were intraperitoneally injected the same volume of normal saline ，once a day ，for consecutive 21 days. After last medication ，the right lung tissue of rats were taken for paraffin section and HE staining in each group ，and the pathological changes of lung tissue were observed. The mean alveolar number （MAN）and mean linear intercept （MLI）were measured. The contents of MDA and GSH ，the activities of SOD and glutathione peroxidase （GSH-Px）in bronchial alveolar lavage fluid（BALF）of left lung were determined ；the contents of AECA in BALF and serum were also determined. The correlation of AECA with MDA ，GSH，SOD and GSH-Px were determined in model group by Pearson analysis. RESULTS ：Compared with control group ，the pathological changes of pulmonary emphysema were obvious in model group ，MAN decreased significantly ，and MLI prolonged significantly （P＜0.01）； GSH content ， GSH-Px and SOD activities in BALF were decreased 1100，1195） significantly，the contents of AECA in BALF and serum were increased significantly （P＜0.01）. Compared with modelgroup，the pathological changes of pulmonary emphysema was improved significantly in the intervention group ， increased significantly ，while MLI shortened significantly （P＜ ·1208；GSH content ，SOD and GSH-Px activities were increased significantly，while the contents of AECA in BALF and serum were decreased significantly （P＜0.01）. AECA in BALF of rats in model group was positively correlated with MDA （r＝0.710， P＜0.05），and the AECA were negatively correlated with GSH ，SOD and GSH-Px （r＝－0.754，－0.781，－0.736，P＜0.05）. CONCLUSIONS：Methylprednisolone sodium succinate may achieve the purpose of the prevention of autoimmune emphysema through reducing oxidative stress and inhibiting the expression of AECA.