Objective To evaluate the preventive effect of different portal vein flush solutions in no heart beating donor harvest on biliary cast syndrome (BCS) after orthotopic liver transplantation (OLT), and the application of choledochoscopy in treating BCS. Methods The incidence of biliary complications in 137 consecutive recipients undergoing OLT in our liver transplant center from May. 2002 to Dec. 2003 was retrospectively analyzed. The incidence and risk factors of BCS were compared in 2 groups with different types of portal vein flush solution in no heart beating donor liver harvest: group 1 (n = 65). University of Wisconsin (UW) solution; and group 2 (n = 72), hypertonic citrate adenine ( HCA) solution combined with UW solution. Therapeutic experience and clinical value of choledochoscopy for BCS were summarized. Results Seventeen out of 137 cases (12.4 %) developed BCS in the first three months after operation. In the group 1, the incidence of BCS was 20. 0 % (13/ 65), while that in the group 2 5. 56 % (4/72) with the difference being significant (P

Objective To improve the technique of pancreatoduodenectomy in order to facilitate the(management) of complications and direct observation on follow up.Methods Pancreatoduodenectomy and Child′s method of digestive tract reconstruction was performed in 42 paltents.A blind loop of jejunum 5 to 6 cm in length was constructed beyond the pancreatojejular anastomosis and it was fixed to the subcutaneous(tissue) of the adjacent abdominal wall.Results Thirty-two cases recovered uneventfully,and 10 cases had complications induding pancreatic and biliary leakage and hemorrhage.These complications were successfully treated under direct vision by choledochoscope passed into the blind jejunal loop.This method of observation was used for long-time follow up in 22 cases,and revealed ercurrent tumor(n=5),bile duct stricture(n=4) and bile duct ascariasis(n=1).Conclusions This operative method did not cause new(complications) and it can be combined with the traditional operation.Postoperatively,direct observation and management of leakage of pancreatojejular anastomosis and biliointestinal anastomosis and hemorrhage can be accomplished,and the anastomoses and pancreatic stump can be directly observed at followup.

Objective To evaluate the effectiveness of scanning with labeled autologous leukocytes for the detection of abdominal inflammation in equivocal patients. Methods From July 1998 to April 2000 sixteen patients with equivocal abdominal inflammation were recruited into this study. ResultsThere were 10 cases with positive scanning. The diagnosis of intraabdominal infection was consequently confirned by laparotomy and or good response to antibiotic therapy.The 6 cases with negative result were eventualy proven to have no intraabdominal infection. The average radioactivity of imaging and paired non imaging district was determined ( P

Objective To discuss the value of choledochoscopy via subcutaneous jejunal blind loop in the diagnosis and treatment of severe complications after pancreatoduodenectomy. Methods A fiber choledochoscope (FCC) was introduced through a subcutaneous jejunal blind loop. Under direct vision, the pancreatojejunal or choledochojejunal anastomotic leakages were coated with biological glue, or the anastomotic bleedings were stopped with hemostatic drugs. Results Five cases of intestinal leakage, 3 cases of biliary leakage and 2 cases of anastomotic bleeding were all cured. Follow-up for 1～3 years in the 10 cases found no recurrence of tumors. Choledochojejunal anastomotic stricture occurred in 1 case 1 year after the surgery and was cured by dilatation under fiber choledochoscope. In the remaining 9 cases, the pancreatic juice and bile fluid were excreted normally. Conclusions Application of FCC through the subcutaneous jejunal blind loop can be employed in the diagnosis and treatment of complications after pancreatoduodenectomy and in the long-term follow-up of pancreatojejunal or choledochojejunal anastomotic stoma under direct vision.

Objective To investigate the clinical correlative factors of malignant cystic pancreatic tumors.Methods The clinical data of 45 patients who received cystic pancreatic tumor resection at the General Hospital of Tianjin Medical University from May 2000 to May 2011 were retrospectively analyzed.All patients were divided into benign tumors + precancerous lesions group (35 patients) and malignant tumor group (10 patients).The clinical symptoms and imaging features of cystic pancreatic tumors were analyzed.All data were analyzed by chisquare test or Logistic regression analysis.Results Abdominal pain,jaundice,emaciation,nausea and vomiting were observed in 23 patients (51％),and 22 (49％) patients had no clinical symptoms.The clinical features of benign pancreatic cyst included pancreatic calcification and pancreatic divisum,while the clinical features of malignant pancreatic cystic tumors were nodules,swelling of lymph nodes,dilation of biliary and pancreatic duct.The results of univariate analysis showed that age ≥ 60 years,presence of symptoms,jaundice,emaciation,dilation of pancreatic duct were the correlative factors of malignant cystic pancreatic tumors ( x2 =4.220,4.294,4.645,7.705,4.645,P ＜ 0.05 ).The results of multiple logistic regression analysis found that age ≥60 years,dilation of pancreatic duct and presence of clinical symptoms were the correlative factors of malignant cystic pancreatic tumors ( OR =1.573,2.674,2.723,P ＜ 0.05).Conclusion Age≥60 years,dilation of pancreatic duct and presence of clinical symptoms are the correlative factors of malignant cystic pancreatic tumors.

Objective To investigate the expression of interleukin-37 (IL-37) in placenta tissue and its relationship with the pathogenesis of severe preeclampsia. Methods All the patients were recruited in Qilu Hospital of Shangdong University from November 2012 to November 2013. Among them, thirty patients with severe preeclampsia were assigned to the preeclampsia group, and thirty-one healthy pregnant women were assigned to the control group. Immunohistochemistry of SP was used to detect the IL-37 protein expression in placenta tissue of the two groups. The expression level of IL-37 in placenta tissue of the two groups was detected by western blot. Besides, reverse transcription(RT)-PCR was used to detect the expression of IL-37 mRNA. The correlation between the expression of IL-37 mRNA and the delivery gestational age, body mass index(BMI)was analyzed. Results (1) IL-37 were detected in the placenta of both the preeclampsia group and the control group, and the expression site mainly located in the syncytiotrophoblast, with a small amount in cytotrophoblast.(2)The expression levels of IL-37 protein in the preeclampsia group and the control group were 0.59 ± 0.39 and 0.88 ± 0.22, respectively. The IL-37 mRNA levels in the preeclampsia group and the control group were 0.55 ± 0.17 and 1.11 ± 0.21, respectively. Both decreased significantly when compared to the control group (P<0.05). (3) Significant correlation between the expression of IL-37 mRNA and the delivery gestational weeks(r=0.209, P>0.05) was seen neither in the preeclampsia group nor in the control group(r=-0.053, P>0.05). In the severe preeclampsia group, the pregnant women′s BMI had no significant correlation with IL-37 mRNA expression of placenta tissue(r=0.102, P>0.05), neither did the control group(r=-0.115, P>0.05). Conclusion IL-37 expression is significantly lower in severe preeclampsia placenta tissue than that in the normal pregnant women, which may play a protective role in the course of severe preeclampsia.

Objective To investigate the expression of growth arrest-specific protein 6 (Gas6) in the placenta and decidua tissues and its relationship with the pathogenesis of preeclampsia. Methods All the patients were recruited in Qilu Hospital of Shangdong University from October 2013 to June 2014. Among them, thirty-two women with early-onset severe preeclampsia who received cesarean section were assigned to the preeclampsia group, and thirty healthy pregnant women who received cesarean section were defined as the control group. Blood glucose, blood lipids, platelet count, D-dimer levels and other clinical indicators of the two groups were detected. Immunohistochemistry of SP was conducted to identify the localization of Gas6 protein in the placenta and decidua tissues. And reverse transcription (RT)-PCR was performed for quantitative analysis of Gas6 RNA expression in placentas. The correlations between placental Gas6 mRNA levels with clinical indicators were analyzed. Results (1) The gestational age at delivery, blood pressure, serum albumin, platelet count and birth weight of fetuses showed statistically significant differences between the two groups(P<0.05). (2) The Gas6 protein expressed in the cytoplasm and nucleus of the syncytiotrophoblasts and decidual cells in the placenta and decidual tissues of the two groups. (3) The Gas6 mRNA expression elevated significantly in the placenta of preeclampsia group (0.60 ± 0.38) when compared to that of the control group (0.34±0.22;P<0.05). (4) The expression of Gas6 mRNA was positively related with body mass index, diastolic blood pressure, systolic blood pressure, free fatty acids and creatinine (P<0.05), while it was negatively associated with serum albumin(P<0.05). Conclusion The high expression of Gas6 in the placenta and decidua tissues may be related to the pathogenesis of severe preeclampsia.

Objective To investigate the trend in incidence, causative drugs, clinical types and treatment of drug eruption. Methods Clinical data were collected from 922 inpatients with drug eruption in Huashan Hospital, Fudan University from January 2009 to December 2013, and analyzed retrospectively. Results From 2009 to 2013, the percentage of inpatients with drug eruption among all inpatients in the Department of Dermatology in a given year varied from 9.45% to 10.01%, and the percentage of inpatients with severe drug eruption among inpatients with drug eruption from 17.45% to 28.24%. Of the 922 cases, 371 (40.2%)were caused by single drugs, and 551 (59.8%)by multiple drugs. Among the 371 cases of drug eruption caused by single drugs, the top five causative drugs were traditional Chinese medicine(72 cases), cephalosporins(38 cases), amoxicillin(27 cases), antipyretic analgesics(26 cases)and tetanus antitoxin (24 cases)in 278 cases of non-severe drug eruption, antiepileptic agents (33 cases), allopurinol (28 cases), antipyretic analgesics (7 cases), cephalosporins (6 cases)and traditional Chinese medicine (6 cases)in 93 cases of severe drug eruption. Of the 922 patients, 422 (45.8%)presented with maculopapular eruption, 259 (28.1%)with urticaria, 135(14.6%)with Stevens-Johnson syndrome, 49(5.3%)with toxic epidermal necrolysis, 33(3.6%)with drug reaction with eosinophilia and systemic symptoms (DRESS), and 7 (0.8%)with acute generalized exanthematous pustulosis (AGEP). A total of 791 (85.8%)patients with drug eruption received glucocorticoid treatment. The dose of glucocorticoids was(47.61 ± 12.07)mg prednisone equivalent per day in 550 patients with non-severe drug eruption, and (73.10 ± 18.23)mg prednisone equivalent per day in 221 patients with severe drug eruption. Totally, 110 (11.0%) patients with drug eruption were treated with combined intravenous immunoglobulin (IVIG)because of poor response to glucocorticoids alone. Of 224 patients with severe drug eruption, only 2 (0.9%)died. Conclusions Carbamazepine and allopurinol are the main causative drugs for severe drug eruption, while traditional Chinese medicine is the first causative drug for non-severe drug eruption. From 2009 to 2013, the annual mortality of severe drug eruption decreased considerably.

BACKGROUND: The formation mechanism of biliary cast syndrome following liver transplantation has not been thoroughly illuminated, and it is unclear that whether some proteins correlated to the formation mechanism of biliary cast or prewarning to the formation of biliary cast.OBJECTIVE: To investigate the holoprotein expression in biliary cast syndrome patients following liver transplantation. METHODS: Four patients underwent liver transplantation at Liver Transplantation Institute, General Hospital of Chinese People's Armed Police Force. Three months later, 10 g biliary cast was harvested. Four kinds of biliary cast specimens at different colors and textures were preserved at deep hypothermia, followed by protein abstraction and restriction enzyme digestion, the total protein abstraction solution of biliary cast were analyzed by high definition mass spectrometry and query on MASCOT database. All protein name of biliary cast were list, the conjunct protein was found by comparing 4 specimens. RESULTS AND CONCLUSION: There were totally 208 proteins in 4 biliary cast specimens, 82, 44, 56 and 65, respectively. By comparison, 5 proteins were found to overlay in 2 biliary cast specimens, 7 proteins in 3 specimens and 13 proteins in 4 specimens. Among the latter 13 proteins, 5 unnamed-proteins, as well as 8 named-proteins (termed alpha-fibrinogen precursor, beta-fibrinogen precursor, fibrinogen gamma chain, proapolipoprotein, Chain A of Human Cathepsin G, S100 calcium-binding protein A9, lactoferrin) were included. The proteins exists in biliary cast, the common proteins of 4 biliary cast specimens imply a correlation between the formation of biliary cast and the exudative inflammation following the damage of biliary tract epithelium; Some proteins might be considered as a marker of prewarning the presence of biliary cast syndrome, judging the inflammation severity following the damage of biliary tract epithelium and the prognosis of biliary cast syndrome.

Objective To explore the main anatomical factors for relapse in patients underwent radical mas-toidectomy and discuss the preventive measures .Methods A retrospective study was carried out 36 patients who had underwent radical mastoidectomy and 100 patients (100 ears) who had been cured underwent radical mastoidectomy during July 2011 toSeptember 2013 .The patients underwent axial and coronal temporal Computed Tomography (CT) .The incidence of low -lying middle cranial fossa ,high jugular bulb ,anterior locati(36 ears)on of sigmoid si-nus ,dehiscent tympani tegmen ,dehiscent of the facial nerve canal ,large sinus tympani ,low -lying horizontal facial nerve were recorded .Results The incidence of low -lying middle cranial fossa(36 .1% ) ,anterior location of sig-moid sinus(41 .7% ) ,dehiscent tegmen tympani (30 .6% ) ,dehiscent of the facial nerve canal (41 .7% ) ,large sinus tympani(25 .0% ) ,low -lying horizontal facial nerve(22 .2% ) were higher than those of in the normal group .There was no significant difference in high jugular bulb .Conclusion The main anatomical factors for relapse in patients un-derwent radical mastoidectomy were low -lying middle cranial fossa ,anterior location of sigmoid sinus ,dehiscent tegmen tympani ,dehiscent of the facial nerve canal ,large sinus tympani ,low -lying horizontal facial nerve .