Objective To study the clinical application value of aspirator and electrocautery in dissecting Calot′s triangle in laparoscopic cholecystectomy(LC).Methods All patients underwent LC were divided into group A and group B according the detaching way in the operation.The Calot′s triangle were detached by electrocautery as group A and by aspirator as group B.Operative time,hemorrhage and complication between two groups were compared.Results The mean operative time was(28.5?7.6) minutes in group A and(21.1?4.3) minutes in group B.The mean hemorrhage was(13.9?(4.7)) ml in group A and(8.8?2.5) ml in group B.The complication of bile duct injury occurred in 2 cases in group A.No complication was found during or after surgery in group B.All patients were cured.Conclusion Aspirator and electrocautery are both suitable for skeletonizing the cystic duct and cystic artery in LC.

Objective To evaluate the effects of early tracheotomy and delay tracheotomy on the prognosis of patients with severe craniocerebral injury.Methods Data of randomized controlled test (RCT) of early tracheotomy on the prognosis of the patients with severe craniocerebral injury were retrieved by using Conchrane Library,PubMed,Embase,OVID,CBM,CNKI,Wanfang and VIPdatahase.The retrievaled time was limited from their building to March 2016,and all the index of the obtained references was accessed.Two researchers independently screened the literature in accordance with the established criteria for inclusion or exclusion.The incidence of VAP,mechanical ventilation time and ICU length of hospital stay,mortality were considered as evaluation indexes.The methodology quality of the included references was evaluated,and the Meta-analysis was performed by using Review Manager 5.3 software.Results Finally,4 randomized controlled studies (RCT) were enrolled,including 220 patients.Meta-analysis results showed that:early tracheotomy did not have any effects on VAP incidence rate (P=0.15) and fatality rate (P=0.20) of the patients with severe craniocerebral injury,there was not any statistically difference;but there was a statistically difference between the mechanical ventilation (P =0.01) and ICU hospitalization time (P =0.05).Conclusion Early tracheostomy could not significantly reduce the incidence of VAP and fatality rate of the patients with severe craniocerebral injury,but it can reduce the mechanical ventilation time and ICU hospitalization time.

OBJECTIVE: To observe the effects of Huanglian Jiedu Decoction (HLJDD), a traditional Chinese compound herbal medicine, on p85 mRNA and protein expressions of phosphatidylinositol-3-kinase (PI-3K) in target tissues (skeletal muscular and adipose tissues) in rats with type 2 diabetes mellitus (T2DM) and to investigate the molecular mechanism of HLJDD in treating T2DM. METHODS: The male Wistar rats were injected with streptozotocin (STZ) 30 mg/kg through tail vein, and fed with high-fat and high-caloric diets to induce T2DM. Then the rats were randomly divided into untreated group, aspirin-treated group and HLJDD group, and treated correspondingly. Meanwhile, a group of normal animals without any treatment was set up for normal control group. Ten weeks later, serum fasting blood glucose (FBG), serum fasting insulin (FINS) and oral glucose tolerance test (OGTT) were routinely determined. The expressions of PI-3K p85 mRNA and protein in skeletal muscle and adipose tissue were determined with RT-PCR and Western blotting before and after insulin treatment. RESULTS: Compared with the untreated group, the FBG and OGTT levels in T2DM rats treated with HLJDD decreased significantly (P<0.05). The FINS in HLJDD group was lower than that in the normal control group (P<0.05), but was not significantly different from that in the untreated group. The PI-3K p85 mRNA and protein expressions in HLJDD group obviously increased, as compared with those in the untreated group. CONCLUSION: The effect of HLJDD in treating T2DM was probably associated with its improvement of PI-3K p85 mRNA and protein expressions in skeletal muscle and adipose tissue of the T2DM rats.

Objective To explore the value of contrast-enhanced ultrasound(CEUS) in diagnosis of placental accrete,placental increta and placental percreta. Methods Twenty suspected patients of placental accrete, placental increta and placental percreta were examined with CEUS after routine ultrasound examination. Sono Vue was injected intravenously as bolus and a real time CEUS was performed to observe the characteristics. Results Comparison of 15 CEUS cases with uterine curettage, 8 cases had a clear relationship between the residual disease of the uterine cavity and uterine wall,7 cases had a thin thickness (2-4 mm) between the residual disease of the uterine cavity and uterine wall. Five of the 20 cases performed cesarean cesion,3 cases of the uterine serosa of placenta affixing part were very thin,incomplete and rough, demonstrating placenta increta and placenta percreta, 1 case of uterine rupture showed non-invasiveness between uterine wall and uterine serosa,and 1 case of placenta increta pathologically proven, initially suspected gestational trophoblastic disease by the CEUS. Conclusions CEUS provides an important diagnostic message for placental accrete, placental increta and placental percreta by showing the different characteristics of the perfusion image.

Objective To assess the disorders of glucose metabolism and insulin resistance in patients with rheumatoid arthritis (RA) and its relationship with disease activity.Methods One hundred and twenty-three RA patients along with 98 age and sex matched controls were studied.Seventy-five g oral glucose tolerance test was performed.The homeostasis model assessment of insulin resistance (HOMA-IR) and beta cell function (HOMA-β) were evaluated.Disease activity score (DAS28) was used to assess disease activity.According to their DAS28 values,patients were divided into high disease activity group and low to moderate disease activity group.Glucose tolerance and HOMA-IR were compared between the two groups.Parameters that reflects disease activity,such as CRP and ESR,as well as disease activity scores were compared between patients with T2DM or prediabetes and patients with normal glucose tolerance.The data was analyzed by t test,Pearson correlation analysis and chi-square test.Results The prevalence of T2DM [20.3％(25/123) vs 5.1％ (5/98),x2=10.774,P＜0.01] and prediabetes [39.0％ (48/123) vs 7.1％ (7/98),x2=29.657,P＜0.01] increased in RA patients compared to controls.RA patients had higher HOMA-IR (2.5±1.5 vs 0.8±0.4; t=5.185,P＜0.01) and lower HOMA-β (83±69 vs 192±85; t=3.768,P＜0.01) compared to controls.ESR [(55±30) mm/1 h vs (37±26) mm/1 h; t=3.159,P＜0.01],CRP [(40±23) mg/L vs (19±10) mg/L; t=3.628,P＜0.01] and DAS28 score (5.6±1.3 vs 4.8±1.2; t=2.923,P＜0.01) were higher in RA patients with T2DM or prediabetes than in RA patients with normal glucose tolerance.In RA patients,the HOMA-IR was significantly positively correlated with DAS28 (r=0.39,P＜0.01),ESR (r=0.54,P＜0.01)and CRP (r=0.20,P＜0.05).The HOMA-IR value and fasting insulin levels were higher in high disease activity patients (DAS28＞ 5.5) than in low-to-moderate disease activity patients (DAS28 ≤5.5) although fasting plasma glucose level did not differ significantly in these two groups.Conclusion The prevalence of T2DM and prediabetes increases in RA patients comparing to controls.RA patients have insulin resistance that is associated with disease activity and systemic inflammation.

10.3969/j.issn.1007-3969.2013.04.003

ABSTRACT:Objective To investigate the clinical features of seronegative rheumatoid arthritis (RA)in western China and its outcomes after one-year treatment with disease modifying anti-rheumatoid drugs (DMARDs) so as to provide evidence for effective therapy.Methods We made a retrospective analysis of 240 RA patients treated in our department from May 2013 to June 2014.We compared the 47 seropositive and 25 seronegative RA patients in clinical features,laboratory parameters and outcomes after one-year DMARDs medication.Results The percentage of seronegative RA was 10.4% (25/240).The number of swollen small joints was significantly smaller in seronegative RA group (P<0 .0 1 ).Compared with those in seropositive RA,the level of hemoglobin was lower,the level of platelets was higher,and the level of alkaline phosphatase was lower in seronegative RA (P<0 .0 5 ).The remission rate was higher in seronegative RA group than in seropositive RA group after one-year DMARDs administration (P<0.05).Conclusion Seronegative RA is not rare in clinic.Even though seronegative RA patients often present fewer swollen small joints, it is difficult to distinguish between seronegative and seropositve RA just based on the clinical features.Besides,hematological damage is more severe in some patients with seronegative RA.Only after one-year treatment with DMARDs,the remission rate is higher in seronegative RA patients than in seropositve RA ones.

Objective To investigate the effect of at-RA in macrophage accumulation in tubulointerstitium of rats with renal tubulointerstitial fibrosis.Methods Unilateral ureteral obstructive(UUO) rat animal models were used for the study.40 SD rats were randomly divided into 5 groups: sham group,UUO group,benazepril group,low-dose at-RA groups and high-dose at-RA groups.The rats were under intragastric administration by benazepril(10mg/(kg?d)) in benazepril group,and by(at-RA)(10mg/(kg?d)) in low-dose at-RA group and 20mg/(kg?d) in high-dose at-RA group and by sodium chloride in tales doses in sham group and UUO group from the day before the operation to 14 day after operation.Immunohistochemistry staining of CD68 and Col Ⅲ was used to define the macrophage accumulation and expression of interstitial Col Ⅲ.The degree of tubulointerstitial damage was scored by HE and Masson staining.Results Tubulointerstitial macrophage infiltration were all significantly reduced by(at-RA) or benazepril treatment.They also improved the histological changes of UUO rats and inhibited interstitial colⅢ deposition.Conclusion Reduction of interstitial macrophage infiltration may be an important event by which(at-RA) or benazepril prevents renal injury caused by UUO.

AIM: To investigate the significance and function of IFN-γ on the changes of peripheral blood platelet count during tumor-rejection induced by a low dose of melphalan in C57BL/6 mice. METHODS: Mouse tumor rejection model induced by a single dose of melphalan was used in this experiment. Different gene-type tumor-bearing mice (IFN-γ~(+/-) and IFN-γ~(-/-)), which had the same genetic background of C57BL/6, were treated intraperitoneally with melphalan (7.5 mg/kg). Tumor size was observed and recorded every one to three days in these different gene-type mice subsequently. Blood samples were obtained from orbital venous sinus on different days before and after melphalan treatment, and then complete blood counts were performed. The function of IFN-γ on the efficacy of chemotherapy and the changes of blood platelet count in IFN-γ~(+/-) and IFN-γ~(-/-) mice after melphalan treatment was analyzed. RESULTS: There was no significant difference in tumor sizes and blood platelet count between IFN-γ~(-/-) and IFN-γ~(+/-) mice (P>0.05). On the first day after melphalan (7.5 mg/kg) treatment, there were no significant changes in tumor sizes between mice in these two groups (P>0.05). Tumors shrank a little in IFN-γ~(-/-) mice and then grew gradually. Tumors relapsed in 2 w after melphalan injection in all IFN-γ~(-/-) mice, while tumor volumes decreased progressively and tumor cured at last in IFN-γ~(+/-) mice. The number of blood PLT in IFN-γ~(+/-) mice increased to (1935±378)×10~9/L 6 h after melphalan treatment, significantly higher than before (P<0.01); While in IFN-γ~(-/-) mice it was (1183±186)×10~9/L 6 h after melphalan treatment, no obvious increase than before. There was significant difference in blood PLT 6 h after melphalan treatment between IFN-γ~(+/-) and IFN-γ~(-/-) mice (P<0.01). Later, the numbers of blood PLT in IFN-γ~(+/-) mice decreased gradually and it dropped to normal (1158±270)×10~9/L on 11th day after melphalan treatment (P>0.05); While it sustained in normal range in IFN-γ~(-/-) mice. There was no significant difference in blood platelet count between IFN-γ~(-/-) and IFN-γ~(+/-) mice. CONCLUSION: Peripheral blood platelet count increased on the first day after melphalan treatment and tumors cured in IFN-γ~(+/-) mice; While tumors relapsed and there is no increase in blood platelet count on the first day after melphalan treatment in IFN-γ~(-/-)mice. These data indicated that the increase of blood PLT count was related to the function of IFN-γ in tumor-bearing mice in vivo during tumor rejection induced by a low dose of melphalan.