Objective To investigate the early variations and clinical value of serum delta bilirubin after orthotopic liver transplantation. Methods Orthotopic liver transplantation was performed in 27 cases.Of them,10 cases were uneventful;8 patients suffered from acute rejection.According to the outcome,18 patients (including 10 uneventful cases and 8 cases with acute rejection) survived while other 9 died.Daily determination of serum delta bilirubin was examined in all patients. Results The changing patterns of serum delta bilirubin were different between uneventful patients and those with acute rejection.For those uneventful patients,?B% tended to increase after operation.On the 21st day after transplantation,it reached(37.5?11.2)%.To the contrary,after acute rejection occurred,?B% decreased from basal level(26.4?9.8)% to(20.2?12.7)%(n=8,t=2.12,P=0.07).Serum concentration of total bilirubin (TB) and conjugated bilirubin (CB) significantly increased after acute rejection arose.The difference between peak and basal level of TB and CB was (150.3?113.2)?mol/L(n=8)and(118.5?93.4)?mol/L(n=8)respectively(t=3.75,P=0.007;t=3.59,P=0.009).On the 14th day after operation,?B% in patients with good outcome(n=18) significantly higher than that in patients who died(n=9)(33.4%?12.2% vs 22.0%?10.0%,t=2.42,P=0.02).Conclusions Two weeks after operations,?B% is correlative to the outcome of the patients.But as for the diagnosis of the acute rejection,?B% shows no advantages over serum TB or CB.

Objective To introduce a surgical technique for the cases with the papilla of Vater located in the diverticula. Methods When diverticula was opened, there was a cuff shape edge left in the bottom, which reduced tensility of oversew, and the probability of postoperative leakage was reduced. Fistula Oddi sphincteroplasty was adopted oversewwing when it was splitted,and the length of each time was not more than 3mm,and the total length was not more than 2cm. ResultsNone of 11 cases died in postoperation, 3 of them occured biliary fistula,duodenal fistula,and pancreatic fistula, the rate of fistula was 27.27%. They were all followed-up, and the result was satisfactory.ConclusionAlthough the operation technique is ifficult,and there are many complications,it is a good technique.

Objective To study the vancomycin-resistant genes and the virulence factors genes in vancomycin-resistant Enterococci (VRE),and to analyze the drug-resistance character and epidemic characteristics of VRE strains and provide the basis for clincal selection of drugs and infection control.Methods VRE were screened by agar dilution sieving plate (ADSP) containing 6 μg/ml of vancomycin,drug resistance of VRE to other common antibiotics were detected by VITEK-60 automatic microbial analyzer.The gene types and virulence factor genes of VRE were determined by PCR.And the genetic relationships among VRE were determined by multilocus sequence typing.Results Seven vancomycin-resistant Enterococcus faecium strains were found in 360 enterococcus strains.All the VRE strains exhibited high-level vancomycin resistance ; some of them were medium or senstive to teicoplanin.They all carried vanA gene and esp gene and one of them carried 4 kinds of virulence factor genes.The ST type of the 7 VRE strains were diffused distribution.Conclusion We found vanB phenotype vanA genotype vancomycin-resistant Enterococcus faecium isolates in Wenzhou; these VRE strains were multidrug resistance and carried various virulence factor genes.Linezolid could be used as a recommend drug for treatment of VRE infection.The protection of antibiotics sensitivity should be strengthened.

A method was developed for the determination of four sulfa antibiotics in groundwater, soil and excreta using solid phase micro extraction disks coupled with high performance liquid chromatography. The influence of eluent, different solid phase micro extraction membranes on the recovery of sulfa antibiotics in groundwater was investigated and it was found that when using the mixture of methyl alcohol and 1 . 0% formic acid as eluent, HLB ( divinyl benzene-N-vinyl pyrrolidone polymer ) as extraction membranes, an optimal enrichment effect was obtained. Different pretreatment methods for the 3 kinds of samples abovementioned were also examined. It was found that the signal response values obtained by using mixture of methyl alcohol and 1 . 0% formic acid as base solution of standard or sample solution was higher 8-10 times than that by using methyl alcohol only. Under the optimal conditions, good linear relationships were obtained in the sulfa antibiotics concentrations of 0 . 005-10 . 0 mg/L with the correlation coefficients>0 . 9999;The detection limits of sulfathiazole ( ST ) , sulfadiazine ( SM ) , sulfamethazine ( SM2 ) , sulfamethoxazole ( SMX ) were 1 . 08 , 3. 56, 4. 63 and 1. 84 ng/L(S/N=3), respectively. The enrichment factors for four sulfa antibiotics were 4000 times with solid phase micro extraction disks. The RSD of matrix spiked samples were 0. 1%-0. 4%(n=7). The proposed method was applied to the determination of the four sulfa antibiotics in groundwater, soil and excreta with spiked recoveries of the four sulfa antibiotics in the range of 69 . 80%-117 . 60%.

Objective To summarize the clinical features,diagnosis,treatment and prognosis of hepatolithiasis complicating cholangiocarcinoma. Methods From June 1958 to March 2011,709 cases of hepatolithiasis were admitted to Department of General Surgery,Peking University Third Hospital.The cases concomitant with cholangiocarcinoma were reviewed. Results 20 of 709 (2.8％ ) hepatolithiasis cases developed cholangiocarcinoma.17 cases (85％,17/20) were followed-up for 2 years (0 - 15 years).The hepatolithiasis course before the malignant diagnosis was 15 ± 1 1 years (3 -38 years).14 cases had frequent episodes of cholangitis,15 cases had liver cirrhosis.Preoperative diagnosis was established by CT,MRCP,B-ultrasound and tumor markers in 55％ (11/20) cases.4 cases underwent radical resection,7 received palliative resection,9 cases received conservative treatment.In radical resection,one lost to follow-up,one survived one year,two for 5 years.In palliative resection,2 lost to follow-up,two survived one year,one survived 3 years, one for 5 years. None in conservative group survived more than one year.Conclusions Cholangiocarcinoma developed from hepatolithiasis with a long history,frequent cholangitis,liver cirrhosis,especially in cases with imige showing thickness of bile duct or mass and rising tumor markers (CA19-9,CA125,CEA).The cases undergoing radical resection may have a favorable prognosis.

Objective To explorethe clinical features of adenosquamous carcinoma,squamous cell carcinoma and adenocarcinoma of the gallbladder. Methods A retrospective analysis of 112 patients with gallbladder carcinoma was performed.The clinical features and outcomes of 11 patients with either adenosquamous or squamous cell carcinoma were compared with the other 101 patients of adenocarcinoma.Results The rate of tumor with T3 or T4 stage in adenosquamous/squamous cell carcinoma group and adenocarcinoma groupwere 100%and 53%(X2=7.013,P=0.008).The rate of distant metastasis in adenosquamous/squamous cell carcinoma group and edenocarcinoma at advanced stage(T3 or T4 stage)group were 0 and 35%(X2=3.900,P=0.048).The rate of lymph node invasion were 82% and 87%(X2=0.000,P=1.000).The rate of gastrointestinal tract invasion in adenosquamous/squamous cell carcinoma group and adenocarcinoma at advanced stage(T3 or T4 stage)group were 45% and 15%(X2=3.618,P=0.054).The median survival time for the two groups were 5 months and 4 months respectively(X2=0.359,P=0.549).Condusiom Adenosquamous/squamous cell carcinoma of the gallbladder had high local invasion capacity and usually were diagnosed at an advanced stage.The distant metastasis rate of adenosquamous/squamous cell carcinoma of the gallbladder was lower compared with adenocarcinoma.The lymph node invasion mte of adenosquamous/squamoua cell carcinoma was similar to adenocarcinoma.

Objective To enhance therapeutic effects of hepatolithiasis by improving surgical procedures. Methods Forty eight patients suffering from hepatolithiasis with bile duct stricture were treated in this study, in whom 27% (13/48) of the stone was located in the left lobe, 19% (9/48) in the right, and 54% (26/48) in bilateral lobe. Stone coexisted with stricture in 71% (34/48). Hepatic duct and stricture were opened, making a basin at the porta, and repaired by one end of a segment of jejunum. The other end was set subcutaneously. At the same time, a portion of the liver habouring stone was resected. Results Forty four out of 48 patients were followed up (92%) with an average of 5 years. The rate of recurrent stone was 20% (9/44), the rate of cholangitis was 16% (7/44), and 84% of cases fared very well. Postoperatively, 7 cases underwent lithotomy by choledochoscope through the subcutaneous blind loop. Conclusion This procedure decreases the relapsing cholangitis effectively.

Objective To explore the relationship between surgical procedure and prognosis of gallbladder carcinama invading the whole layer without extension beyond serosa. Methods A retrospective analysis on 24 patients with pathologic stage T2 gallbladder carcinoma invading the whole layer without extension beyond serosa was performed. Kaplan-Meier method was used to analyze the survival rate and disease-free survival rate between the patients undergoing radical resection ( n = 14) and the patients undergoing simple cholecystectomy (re = 10). Results The 1,3 and 5-year survival rates for patients undergoing radical resection were 100%、71% and 54% respectively, whereas the rates that for patients undergoing simple cholecystectomy were 70%、30% and 20% respectively. There was significant difference between the survival time of these two groups ( X2 =4. 659, P = 0. 031). The median clinical tumor-free survival time in radical resection group and simple cholecystectomy group were 45 months and 13.5 months respectively. There was significant difference between the clinical tumor-free survival time of these two groups ( X2 = 3. 854, P = 0. 049 ). Conclusions A radical resection is indicated for patients with pathologic stage T2 gallbladder carcinoma. Radical resection is an effective method to improve the survival rate for pathologic stage T2 gallbladder carcinoma.

Objective To explore the medium effect of social support in process of attachment styles and coping styles on criminal juveniles and adolescents with mood disorders.Methods The survey used in the research included Experiences of Close Relationships Inventory (ECR),Social Support Revalued Scale(SSRS) and Coping Style Questionnaire(CSQ) conducted by three groups:177 criminal juveniles,80 adolescents with mood disorders and 163 normal teenagers.Results Firstly,there were significant differences in the avoidant attachment,attachment anxiety,objective support,subjective support,utilization of support,solving problem,rationalization,self-accusation and retreat among three groups (F=7.902,8.047,59.009,19.248,5.304,7.596,10.652,6.699,11.009;P＜0.05).Secondly,attachment avoidance had significant negative correlation with both utilization of support and help seeking behaviors in the group of mood disorders (r =-0.470,-0.350; P＜ 0.01).Similarly,avoidant attachment had significant negative correlation with both subjective support and utilization of support respectively (r=-0.232,-0.235 ; P＜0.01) in the group of criminal juveniles.The subjective support had significant positive correlation with solving problem (r=0.272,P＜0.01) and as well as the utilization of support with both solving problem and help seeking behaviors (r=0.258,0.424; P＜ 0.01).Attachment anxiety had significant negative correlation with objective support and had significant positive correlation with self-accusation respectively (r=-0.253,0.300;P＜0.01).Finally,utilization of support as a medium completely effect on the process of avoidant attachment and help seeking behaviors in the group of mood disorder and criminal juveniles.Moreover,subjective support and utilization of support as medium both affected a part in the process of avoidant attachment and solving problem for the group of criminal juveniles.Conclusion First,both adolescents with mood disorders and criminal juveniles have unsafe attachment mode,which are lacked social support and easy to take negative coping styles.Yet,the level of attachment avoidance and subjective support of criminal juveniles was found different compared to teenagers with mood disorder.Second,the attachment styles for both adolescents with mood disorders and criminal juveniles have impact on coping styles by the means of social support,but there were slightly different way.