Objective To analyze frequent causes of serious complications of laparoscopic cholecystectomy (LC). Methods A retrospective analysis was made on the diagnosis and treatment of 10 cases of serious complications out of 986 cases of LC. Results The complications included 2 cases of bile leakage caused by the detachment of titanic clips, 1 case of subphrenic Abscess, 3 cases of common bile duct injury, 2 cases of residual stones in the common bile duct, 1 case of duodenal injury, and 1 case of jejunal perforation caused by the Veress needle. No severe outcomes were seen after treatment. Conclusions Causes leading to complications in LC include local adhesion, serious inflammatory edema, serious intraperitoneal adhesion around the umbilicus, anatomic variations of the gallbladder, and lack of experience and proficiency in surgical performance.

Objective:To observe the hemodynamic change and inhibitory effect on stress response of oxycodone during induction, maintenance and resuscitation period of general anesthesia in patients undergoing gastric cancer surgery.Methods:60 patients with general anesthesia undergoing elective gastric cancer from March 2018-March 2019 in No.904 Hospital were selected. According to the random number table method, they were randomly divided into two groups ( n=30): Oxycodone group (group O) and Fentanyl group (group F). The anesthesia was induced by intravenous oxycodone 0.3 mg/kg (group O) or fentanyl 3 μg/kg (group F), propofol 2 mg/kg and cisatracurium 0.25 mg/kg. Oxycodone (group O) or fentanyl (group F) with sevoflurane were used for maintenance of general anesthesia. The mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T 0), immediately intubation (T 1), 1 min (T 2) and 5 min (T 3) after intubation, immediately skin incision (T 4), surgery for 1 h (T 5), the end of operation (T 6) and 1 min (T 7) and 5 min (T 8) after extubation. The concentration of glucose (Glu), cortisol (Cor), epinephrine (E) and norepinephrine (NE) were detected in time T 0,T 2, T 4,T 5 and T 7. The time of extubation and the visual analogue scale (VAS) scores after extubation and 30 min after entering postanesthesia care unit (PACU) were recorded. The incidence of cough during induction, dysphoria during extubation and the adverse effects such as nausea, vomit and respiratory depression during PACU were also observed. Results:There were no significant difference between two groups in MAP and HR at the time point from T 0 to T 8 ( P>0.05); there were no significant difference about concentrations of Glu, Cor, E and NE at the time point of T 0,T 2,T 4,T 5 and T 7 ( P>0.05). Extubation time and VAS scores of 30 min after entering PACU in group O were significantly lower than those of group F ( P<0.05). Meanwhile, the incidences of cough during induction, dysphoria during extubation and respiratory depression in group O were significantly lower than in group F ( P<0.05). There was no significant difference in the incidence of nausea and vomiting ( P>0.05). Conclusions:Oxycodone can be safely and effectively used for induction and maintenance of general anesthesia in gastric cancer surgery, inhibit intraoperative stress response, and improve the quality of recovery period.

ObjectiveTo analyze the differential expression of microRNA (miRNA) and its significance in patients with neonatal necrotizing enterocolitis (NEC).MethodsTwenty-five patients diagnosed with NEC with Bell stage≥Ⅱ, and 25 non-NEC patients as control group admitted to Guangzhou Women and Children's Medical Center between October 2014 and November 2015 were collected. White blood cells were extracted from the peripheral blood. Five samples were selected randomly each from NEC group and control group, and sequenced by second-generation Illumina high-throughput sequencing, screened for differentially expressed miRNA and analyzed for target genes prediction and biological function. The rest samples of the two groups were detected by real-time fluorescent quantitative polymerase chain reaction technology (RT-qPCR), the results were used to validate the results of high-throughput sequencing. Differentially expressed miRNA in the two groups of data was analyzed using DEGseq software.P<0.05 was considered statistically significant.P<0.01,q<0.001 and丨Log2 Ratio丨≥1 were taken as criteria for screening the differential expression. The differential expressions of miRNA in NEC group and control group were analyzed by cluster analysis using MeV4.6 software.ResultsA total of 482 miRNAs were differentially expressed in the two groups, with significant difference (P<0.05). Among them, 126 were known miRNAs with significantly differential expression in the two groups, with 58 being up-regulated and 68 being down-regulated. The results of up-regulated miRNAs (hsa-miR-223-5p,-183-3p,-222-5p) and down-regulated miRNAs (hsa-miR-23b-5p,-150-5p,-146a-3p,-1298-5p) were confirmed to be consistent with the results of sequencing. Bioinformatics analysis showed that the target genes with differential miRNA expression mainly involved Toll-like receptor signal transduction pathway, mitogen-activated protein kinase pathway, JAK-STAT and other signal transduction pathways.ConclusionsThere are significantly differential expressions of miRNAs in peripheral white blood cells of NEC neonates. These miRNs may be involved in the occurrence and development of NEC via adjusting different target genes to regulate the signal pathway.

Objective To explore the clinical features of transbronchial tuberculous mediastinal lymph-adenitis and value of bronchoscopic interventional therapy. Methods The clinical data of 50 patients who had been diagnosed as tuberculous mediastinal lymphadenitis and had received bronchoscopic interventional therapy in our hospital during the period from January 2008 to January 2013 were retrospectively analyzed. The bronchoscopic change , improvement in symptoms , and time to sputum smear and culture conversion were used to assess the therapeutic effect. The patients were followed up for six months. Results The mean age of the patients was (35 ± 15) years and the male to female ratio was 1:1.2. The lesions occurred mostly at the right middle lobe in 24% (12/50) of the patients. The total effectiveness rate was up to 98% (49/50) after chemotherapy and bronchoscopic interventional therapy. The major complication associated with interventional therapy was hemoptysis (8%, 4/50). After follow-up of 6 months , 49 patients with active lesions were stable , with smooth bronchial mucosa and no obvious obstruction by granulation and caseous necrosis tissues. Conclusions The relavent clinical symptoms of transbronchial tuberculous mediastinal lymphadenitis is mainly caused by tuberculosis inflammation which destroys and blocks the airway. The fiber bronchoscopic therapy with forceps clip and drug infusion has a definite effect and fewer complications.

Objective To explore the risk factors for patients with massive hemoptysis in tuberculosis and to provide a strategy for clinical treatment for tuberculosis massive hemoptysis (TMH). Methods Chi-square test and multivariate logistics analysis were applied to analyze the medical data of 241 cases of TMH. Results Chi-squared test showed that eleven factors were found to be significantly correlated with TMH. Longer disease course (≥3 months), lung lesions range ≥ 3 lung fields, pulmonary tuberculosis cavity, a higher smoking index (≥400 cigarettes per year) and clinical treatment were risk factors for TMH. Patients aged 45 years or older accompanied with bronchiectasia, pulmonary fungal infection, diabetes or hepatopathy had higher probabilities of developing massive hemoptysis. Multivariate analysis showed lung lesions range over 3 lung fields (OR = 2.447,P = 0.015), pulmonary tuberculosis cavity (OR = 2.486, P = 0.004), bronchial asthma (OR =3.192,P = 0.002), pulmonary fungal infection (OR = 3.896, P = 0.005) and hepatopathy (OR = 3.101, P =0.006) were final risk factors for TMH. Conclusion Multiple factors contributed to patients with massive hemoptysis in tuberculosis. Lung lesions range over 3 lung fields, pulmonary tuberculous cavities, bronchial asthma, lung fungal infection and hepatopathy might be the independent risk factors for TMH.

Objective To investigate the clinical efficacy of bronchoscopic MMC topical spraying for the treatment of tuberculous cicatricial stenosis of the central airway. Methods 45 patients with t tuberculous cicatricial stenosis of the central airway were randomly divided into a control group (14 patients), treatment group 1 (group1, 15 patients), or treatment group 2 (group 2, 16 patients), who received bronchial balloon dilatation alone, bronchial balloon dilatation combined with topical MMC spraying for one time, and for twice, respectively . The clinical efficacy was observed by using the MRC score and measuring airway diameter at the time points before treatment, end of treatment, and 3, 6, and 12 months after treatment, respectively. Results For the MRC scores at different time points, the MRC scores in group 2 (0.06 ± 0.25) and group 1 (0.33 ± 0.617) were significantly lower than those in the control group at 3 months after treatment (P < 0.05 for all comparisons);there were nosignificant differences at the other time points among the three groups. For the airway mean diameters at the different time points, the airway mean diameter was higher in group 2 than in the control group at 3 and 6 months after treatment (P < 0.01), and in group 1 at 3, 6, and 12 months (P < 0.05). No statistical differences were found in the other time points among three groups (P > 0.05). Conclusions Bronchial balloon dilatation combined with topical MMC spraying has certain short-term and long-term efficacy for improving dyspnea and maintaining the airway diameter after dilatation.

Objective To establish an appropriate neonatal rat model with necrotizing enterocolitis (NEC) and to investigate the protective effects of interleukin-1 receptor associated kinase (IRAK) 1/4 inhibitor on intestinal tissue of neonatal rats with NEC.Methods Thirty-six newborn SD rats were randomly divided into normal control group,NEC model group and IRAK1/4 inhibitor group,12 rats in each group.The rats in normal control group were raised by their mother and they did not receive any intervention.The rats of NEC model group were given artificial feeding,under hypoxia and cold stress.The IRAK1/4 inhibitor group were given IRAK1/4 inhibitor intervention,and also given artificial feeding,under hypoxia and cold stress.Three days later,all rats were sacrificed and intestinal tissues were obtained.The histopathological changes in ileocecal tissues were evaluated by pathological score after hematoxylin-eosin staining.The levels of interleukin (IL)-1β,IL-6 and tumor necrosis factor (TNF)-α in intestinal tissues were detected by enzyme-linked immunosorbent assay.Results The rats of NEC model group presented abdominal distention,diarrhea (partly with mucous bloody stool),decreased activity,poor response,lethargy and other symptoms,and the extent was gradually worsened;the rats in IRAK1/4 inhibitor group also had abdominal distention,diarrhea,decreased activity,poor response and other symptoms,but the symptoms emerged later and milder.The histopathological score of intestinal tissues of normal control group was (0.33 ± 0.49) scores,NEC model group was (3.08 ± 0.99) scores,and IRAK1/4 inhibitor group was (1.75 ±0.96) scores.The histopathological scores of NEC model group and IRAK1/4 inhibitors group were significantly higher than those in normal control group (all P ＜ 0.01),and the histopathological scores of IRAK1/4 inhibitor group were significantly lower than those in the NEC model group (P ＜ 0.01).The levels of IL-1β,IL-6 and TNF-α in normal control group separately were (128.76 ± 27.25) ng/L,(0.41 ± 0.10) ng/L,(6.93 ± 1.79) ng/L,respectively;the levels of NEC model group separately were (410.99 ± 44.16) ng/L,(1.79 ± 0.18) ng/L,(44.39 ± 6.00) ng/L;the levels of IRAK1/4 inhibitor group separately were (256.23 ±41.29) ng/L,(1.05 ±0.19) ng/L,(21.45 ± 6.36) ng/L,respectively.The levels of IL-1β,IL-6 and TNF-α of NEC model group had significant differences compared with those of normal control group,respectively (all P ＜0.01);the levels of IL-1β3,IL-6 and TNF-α of IRAK1/4 inhibitor group had significant differences compared with those of normal control group,respectively (all P ＜ 0.01);the levels of IL-1β,IL-6 and TNF-α of IRAK1/4 inhibitor group had significant differences compared with those of NEC model group (all P ＜ 0.01),respectively.Conclusions IRAK1/4 inhibitor has some protective effects on the intestinal tissues of neonatal rats with NEC,which can reduce the damage to the intestinal tissues,and decrease the secretion of inflammatory cytokines like IL-1β,IL-6 and TNF-α.

Type, mode of affiliating, mechanism of action of entrainer in Supercritical CO2 on extraction of Chinese traditional and herbal drugs were briefly reviewed. Application of entrainer in Supercritical CO2 on extraction of flavones, terpenes, sterols, and saponins in Chinese traditional and herbal drugs were recommended in particular. Some problems and directions in research of entrainer in Supercritical CO2 on extraction of Chinese traditional and herbal drugs were shown in this paper.
Carbon Dioxide ; chemistry ; Chromatography, Supercritical Fluid ; methods ; Drugs, Chinese Herbal ; chemistry

To find a new preventive strategy for the infection of Schistosoma japonica, plasmid pIRES-Sj97-Sj14-Sj26 that contains fatty binding protein (Sj14), GST (Sj26) and paramyocin (Sj97) that are expressed on the membrane, was constructed. RT-PCR was used to detect the expression of Sj14 mRNA, Sj26 mRNA and Sj97 mRNA in the Hela cells, the indirect immunofluorescent test was employed for the detection of the expression of trans-membrane Sj26 after the plasmid was trans-fected into Hela cells. Fifty BALB/c mice were randomly divided into 5 groups and pIRES-Sj97-Sj14-Sj26 plasmid DNA, pIRES-Sj14-Sj26 plasmid DNA, plRES-Sj26 plasmid DNA,plRES blank vector and normal saline were respectively injected into the quadriceps muscles of thigh.Eight weeks after the immunization the mice were killed and significantly higher level of IgG was detected in the pIRES-Sj97-Sj14-Sj26 group as compared with the plRES blank vector, normal saline and pIRES-Sj26 groups (P<0.01) and the pIRES-Sj14-Sj26(P<0.05). Single splenocyte suspension was prepared to detected the level of IFN-γ by ELISA and the lymphocyte stimulating index (SI) by MTT SI was significantly higher of in the pIRES-Sj97-Sj14-Sj26 group than in other groups (P<0.01), while the IFN-γ, level was significantly higher the pIRES-Sj97-Sj14-Sj26 group than in pIRES blank vector and normal saline groups (P<0.01), but no significant differences were found when compared with pIRES-Sj14-Sj26 and pIRES-Sj26 groups. Flow cytometery showed that the percent-ages of CD4+ and CD8+ T cells were much higher in the pIRES-Sj97-Sj14-Sj26 group (P<0.01,P<0.05). It was concluded that pIRES-Sj97-Sj14-Sj26 vaccine may induce stronger immune response in BALB/c mice.

Objective To evaluate the adjuvant activities of cyclic guanosine monophosphate-adenosine monophosphate ( cGAMP) in enhancing humoral and cellular responses against Helicobacter pylori ( H. pylori) . Methods BALB/c mice were immunized with the protein antigens including UreA, UreB and NapA of H. pylori in combination with cGAMP as the adjuvant on 0 d and 14 d by subcutaneous administra-tion. Then, the serum-specific antibody responses were evaluated by ELISA. Flow cytometry ( FCM) and enzyme-linked immunospot assay ( ELISpot) were used to detect the cellular immune responses occurred in spleen and mesenteric lymph nodes (MLN). Results Subcutaneous administration of protein antigens of H. pylori together with cGAMP induced strong humoral and cellular immune responses in BALB/c mice. The levels of serum-specific IgG antibodies induced by adding cGAMP as the adjuvant were significantly higher than those by immunizing with antigens alone. The levels of splenic IFN-γ-producing lymphocytes in re-sponse to H. pylori antigens and cGAMP immunization were significantly higher than those in the correspond-ing groups without using cGAMP. Conclusion By using cGAMP as an adjuvant, H. pylori antigens could elicit significantly stronger humoral and cellular immune responses in mice than those induced by the anti-gens only. As a stable small molecular compound with strong adjuvant activity, cGAMP has the potential to be used for the development of H. pylori vaccine.