The diagnosis of nonparasitic hepatic cysts has been significantly improved with the development of imaging techniques,however,the successful differential diagnosis depends on more careful consideration.The differential diagnosis of multiple hepatic cysts and polycystic liver disease depends on the family heredity,number of cysts,combination of polycystic kidney,division and the results of B ultrasound.The differential diagnosis of hepatic cyst and hepatic cystic adenocarcinoma depends on the imaging features and results of histopathological examination.Recently,laparoscopic surgery has been widespread-ly used in the management of hepatic cystic disease,while it still cannot replace open surgery.The individualized and various treatment should be selected according to the condition of the patients.

Objective To evaluate the efficacy and safety of itraconazole injection in treatmeat of invasive fungal infections.Methods The clinical trial was conducted in 16 patients(17 times)with invasive fungal infection from August 2003 to August 2005,including 1 case confirmed,11 cases(12 times)suspected and 4 cases for empiric treatment.They were treated with iv itraconazole injection in a dose of 200 mg twice daily in the first and the second day,from the third day to 14th day they were given iv itraconazole injection in a dose of 200 mg once daily,and then treated with capsule in a dose of 200 mg twice daily for another 28 days.Two cases were treated with iv itraconazole injection in a dose of 200 mg twice daily for 9 days and 14 days;1 case in a dose of 200 mg once daily for 21 days.Results 62 strains were isolated from 16 patients with invasive fungal infection,including 40 strains in urine cultivate,and 21 strains of tropic candida were primacy.In confirmed and suspected patients,the cure rate was 6/13,the effective rate was 11/13 and the eradication rate was 6/13.The incidence of adverse reaction was 3/24.Conclusion Itraconazole injection is effective and safe in treatment of severe invasive fungal infections,especially in severe ill,old patients for long time use.

Objective To investigate the pulmonary microvascular responsiveness of diabetic animals to sepsis and the potential mechanism of NO system.Methods Sixty-four Wistar rats of clean grade were randomly (random number) divided into 4 groups,namely normal control group (group A,n =16),diabetes group (group B,n =16),sepsis group (group C,n =16),diabetes and sepsis group (group D,n =16).Diabetic mellitus model was made in rats with injection of streptozotocin,STZ (65 mg/kg).Successful model was defined as the blood glucose value≥ 16.67 mmol/L 48 hours after injection of STZ.All animals were fed 4 weeks before initiation of next experiment.The sepsis model was established by intravenous injection of LPS (10 mg/kg) in rats.RT-PCR was used to determine the mRNA expression of Tie-2 in rats'blood.The ratio of dry/wet of lung tissue and the extravasation of Evans blue dye into the lung were detected.Quantitation of NO in lung tissue and serum was measured by using Griess method.RT-PCR was also used for determination of iNOS,eNOS,DDAH2 mRNA expressions in lung tissue.Data were analyzed with ANONA and LSD method for comparison between groups,and P ＜ 0.05 was considered statistically significant.Results Compared with septic group.,the diabetic rats with sepsis group demonstrated higher expression of Tie-2 mRNA in blood (19.72 ± 0.70) vs.(3.99 ± 0.92),P =0.00,lower ratio of dry/wet in lung tissue (0.19 ±0.01) vs.(0.22 ±0.01),P =0.000,higher permeability of Evans blue dye into lung tissue (3.76 ± 0.77) vs.(1.74 ± 0.24),P =0.000.Serum NO level was lower in group D than that in group C (123.13 ±4.24) vs.(188.30 ±5.18),P =0.000,however,NO levels in lung tissue of both group D and group C were higher than that in control group (53.62 ± 6.70),(23.63± 3.92) vs.(10.37 ± 1.29),P =0.00,and NO level in group D was higher in 2 times than that in group C (P =0.00).However,there were no differences in eNOS expression among groups A,B and C,but the difference in eNOS expression was present between group D with lower expression and group A,that lower in group D (0.07 ±0.02) vs.(0.38 ±0.05),P=0.017.Compared with group C,the expression of iNOS was higher in group D (80.23 ±2.49),(32.48±5.37) vs.(1.74±0.23),P=0.00),and the expression of DDAH2 was lower in group D (0.49 ±0.13),(7.26 ±0.50) vs.(11.96 ±0.55).Conclusions Diabetic rats with sepsis enhanced endothelial cell damages.Diabetes deteriorates the regulatory activity of NO system,suggesting the potential mechanism of the worsened damages of EC in diabetic sepsis host.

Objective To investigate the therapeutic action and molecular mechanisms of Oxalis comiculata L. extracts on rats with alcoholic liver disease. Methods Forty-two male Sprague Dawley(SD)rats were randomly divided into normal control group(n=10),model group(n=8),moderate dose oxalis group(n=8),high dose oxalis group(n=8)and prednisone group(n=8). The model of rat with alcoholic liver disease was established by liquor gavage;after 12 weeks,moderate dose oxalis group,high dose oxalis group and prednisone group were given the total extract of oxalis 3.5 g?kg-1?d-1,7 g?kg-1?d-1 or prednisolone acetate 0.9 mg?kg-1?d-1,respectively,the remaining two groups were given the same amount of normal saline by gavage daily for 6 weeks. Levels of indexes of liver function,superoxide dismutase(SOD),malondialdehyde(MDA),antidiuretic hormone(ADH)and aldehyde dehydrogenase(ALDH)in rats were detected. The pathological changes of liver tissues in rats were observed under light microscope;tumor necrosis factor-α(TNF-α) expression level was detected by immunohistochemical staining. Results Compared with the normal control group, the levels of aspartate aminotransferase (AST), alanine aminotransferase(ALT),alkaline phosphatase(AKP),γ-glutamyl transferase(GGT),MDA were increased significantly,while the levels of SOD,ADH and ALDH were obviously reduced in model group. Compared with the model group,AST,ALT,AKP,GGT and MDA contents were decreased significantly,while the levels of SOD, ADH and ALDH were markedly increased in the drug groups,and the changes of levels of AST,ALT,AKP,GGT, SOD,ADH in high dose oxalis group were the most obvious〔AST(U/L):117.38±22.75 vs. 201.62±17.95,ALT (U/L):33.51±11.64 vs. 59.14±9.52,AKP(U/L):95.19±24.85 vs. 169.39±37.21,GGT(U/L):46.54±14.55 vs. 89.37±12.49,SOD(U/mg):137.03±12.03 vs. 80.64±13.45,ADH(U/L):3.48±0.71 vs. 2.05±0.91,P<0.05 or P<0.01〕,and the most significant changes of MDA and ALDH were in oxalis moderate dose group〔MDA (mmol/mg):2.05±0.64 vs. 3.17±0.61,ALDH(U/L):7.59±1.95 vs. 5.71±1.33,both P<0.05〕. In normal control group,no obvious lesion was seen in the rat liver tissues. In the model group,fatty degeneration of liver cells with formation of bullae was found,while in the moderate and high dose oxalis groups,cells with macrovesicular steatosis were significantly decreased. Immunohistochemical staining showed that the expression of TNF-α in the cytoplasm and part of cell membrane of macrophage was significantly decreased in liver tissues in oxalis moderate and high dose groups. Conclusion These results show that the Oxalis comiculata L. extracts possess certain therapeutic effect on alcoholic liver disease.

Objective To study unfractionated heparin (UFH) effect on the expression of HOXA9 in activation of human umbilical vein endothelial cells (HUVECs) induced by lipopolysaccharide (LPS). Methods HUVECs were cultured and they were randomly divided into four groups (n = 5) for the challenge respectively: ① control group (with an equal volume of phosphate buffer saline); ② LPS group (LPS 10 mg/L); ③UFH group (UFH 10 kU/L);④ UFH+LPS group (10 kU/L UFH 30 minutes + LPS 10 mg/L). After treatment for 3 hours, the expressions of HOXA9, E-selectin and nuclear factor-κB (NK-κB) in endothelial cells were detected by Western Blot. Results Compared with the control group, the expression of HOXA9 in LPS group was significantly decreased, the expressions of E-selectin and NF-κB were significantly increased (HOXA9/β-actin: 0.082±0.009 vs. 0.199±0.067, E-selectin/β-actin:0.113±0.055 vs. 0.047±0.030, NF-κB/β-actin: 0.845±0.025 vs. 0.664±0.092, all P < 0.05). Compared with LPS group, the expression of HOXA9 in UFH+LPS group was significantly increased, the expressions of E-selectin and NF-κB were significantly decreased (HOXA9/β-actin: 0.190±0.096 vs. 0.082±0.009, E-selecin/β-actin: 0.057±0.017 vs. 0.113±0.055, NF-κB/β-actin: 0.544±0.060 vs. 0.845±0.025, all P < 0.05). Each protein expression of UFH group were in accordance with the control group. Conclusions In LPS stimulated endothelial cells, HOXA9 expression is down regulated, E-expression is reduced, and endothelial cell activation is inhibited. UFH can inhibit the activation of endothelial cells by decreasing the degree of HOXA9 reduced expression.

Objective To observe the effect of heparin on the cellular morphology and the expressions of nitric oxide (NO) and reactive oxygen species (ROS) in renal microvascular endothelial cells (RMVECs) stimulated by lipopolysaccharide (LPS). Methods The three step gradient screen method was used to primarily culture rat RMVECs, and the 3rd and 4th generation cells with excellent growth were collected. The cells were divided into blank control group, 10 mg/L LPS treatment group and 2.5, 5, 10 kU/L heparin pretreatment groups (the corresponding dose of heparin was given 0.5 hour before LPS stimulation). The morphology of the cells at 24 hours after LPS stimulation was observed by transmission electron microscope, the expression of ROS in RMVECs was determined by immunofluorescence at 5, 15, 30, 45 minutes after LPS stimulation, and the expression of NO in RMVECs was determined by nitrate reductase method. Results ① In blank control group, the RMVECs membrane was intact, and the mitochondria and endoplasmic reticulum in cells were clearly visible. The nuclear membrane was complete, and nucleolus was obvious. Cell bubble deformation was obvious at 24 hours after LPS stimulation, especially in the mitochondria and cell membrane. After 10 kU/L heparin pretreatment, the vacuolar degeneration of organelles was significantly reduced, and the cell membrane morphology was stable. ② The increases in ROS and NO in RMVECs could be detected at 5 minutes after LPS stimulation, showed an increase tendency with time prolongation, ROS expression peaked at 30 minutes, NO expression peaked at 45 minutes, which showed significant differences as compared with those of blank control group [30-minute ROS (mean density): 76.2±5.8 vs. 1.5±0.1, 45-minute NO (μmol/L): 70.3±8.6 vs. 1.8±0.1, both P < 0.01]. The expression of ROS and NO production in RMVECs were significantly reduced by heparin, showed a decrease tendency with heparin dose elevation, and the most obvious effect was 10 kU/L of heparin, with significant difference as compared with those of LPS treatment group [30-minute ROS (mean density): 16.8±1.7 vs. 76.2±5.8, 45-minute NO (μmol/L): 11.8±8.6 vs. 70.3±8.6, both P < 0.01]. Conclusions Unfractionated heparin ameliorates LPS induced expressions of NO and ROS in RMVECs and protects the cell morphology. The effect of 10 kU/L heparin is most obvious.

Objective To compare risk factors and bacterial etiology in patients with early-onset versus late-onset ventilator-associated pneumonia (VAP) in intensive care unit (ICU).Methods This prospective cohort study enrolled mechanically ventilated patients hospitalized for more than 48 hours in the first affiliated hospital,China Medical University from Jan 2012 to Jun 2016.Subjects were classified by ventilator status:early-onset VAP (＜ 5 d ventilation,E-VAP) or late-onset VAP (≥ 5 d ventilation,L-VAP).Potential risk factors and pathogen were evaluated.Results A total of 4 179 patients in adult ICU were screened,3 989 (95.5％) of whom were mechanically ventilated,962 patients with mechanical ventilation time ≥ 48 h.VAP developed in 142 patients.E-VAP and L-VAP had different potential risk factors based on statistical analysis.Independent risk factors for E-VAP included male (OR =1.825,95％ CI 1.006-3.310),chronic obstructive pulmonary disease (COPD;OR =3.746,95％ CI 1.795-7.818),emergency intubation (OR =1.932,95％ CI 1.139-3.276),aspiration (OR =3.324,95％ CI 1.359-8.130).Whereas independent risk factors for L-VAP were coma (OR =2.335,95％ CI 1.300-4.194),renal dysfunction (OR =0.524,95％ CI O.290-O.947),emergency intubation (OR =2.184,95％ CI 1.334-3.574).Mortality in E-VAP and L-VAP group were both higher than the non-VAP group[30.2％(19/63)vs 19.8％ (162/820),P=0.044;29.1％ (23/79) vs 19.8％(162/820),P=0.046].The pathogens isolated from early-onset versus late-onset VAP were not significantly different between groups,which the most common ones were acinetobacter baumannii,pseudomonas aeruginosa and klebsiella pneumoniae.Conclusion E-VAP and L-VAP have different risk factors,however related pathogens are similar.Different specific preventive strategies are suggested based on different onset of VAP.

Objective:To investigate the difference between the short-term and long-term survival rates of patients undergoing tricuspid valve replacement with biological and mechanical valves.Methods:273 patients who received tricuspid valve replacement were selected from our Hospital from November 1993 to August 2018. The mean follow-up time was(8.2±5.6) years. The total follow-up rate was 95%. Kaplan-Meier method was used to make survival curves of the two groups and log rank test was used to compare the differences between the two groups. In addition, this study made the comparison of preoperative, intraoperative and postoperative information and long-term survival rate between these two groups.Results:There was no significant difference in demographic characteristics and baseline between mechanical valve group and biological valve group. 16 patients died in the mechanical valve group and 22 in the biological valve group. In the mechanical valve group, 14 cases died of postoperative low cardiac output syndrome and 2 cases died of gastrointestinal hemorrhage. 22 patients were died of low cardiac output syndrome. The auxiliary time in the mechanical valve group was longer than that in the biological valve group[(151.76±70.30)min vs.(131.62±60.25)min, P=0.013)]. There was no significant difference in long-term survival rate between the two groups in Kaplan- Meier survival curve( P=0.234). Conclusion:There is no difference in short-term and long-term survival rate between mechanical valve and biological valve in tricuspid valve replacement.

Objective: To evaluate the effects of continued acceptance and commitment therapy intervention on post-traumatic growth of postoperative patients with breast cancer. Methods: According to the hospitalization time, 120 patients with breast cancer were divided into observation group (62 cases) and control group (58 cases). From January to December 2017, 58 patients were used as control group. Regular health education and discharge follow-up were performed. Intervention with the commitment therapy 3 times; 62 patients from January to December 2018 were selected as the observation group. On the basis of the control group, the patient continued to receive and commit the intervention for 3 to 4 times from February to March after discharge. The post-traumatic growth status of patients before, at the time of discharge (after the intervention), at the hospital for 2 months, at the hospital for 3 months, and at the hospital for 6 months was assessed using the Simplified Chinese version of the Post-Treatment Growth Rating Scale (PTGI). Results: There was no significant difference in the post-traumatic growth scores between the two groups (P>0.05). The post-traumatic growth scores of the two groups were 67.02±14.17, 66.93±14.24, which were better than 51.72±11.65, 51.86±11.67 before the intervention (t= 7.634, 7.725, P<0.05). At 3 months and 6 months after discharge, the post-traumatic growth scores of the observation group were (67.12±14.07) and (68.21±14.48), which were significantly better than the control group (54.17±11.64). 54.02±11.12), the difference was statistically significant (t= 7.957, 7.674, P<0.01). Conclusion Acceptance and commitment therapy intervention during hospitalization can effectively improve post-traumatic growth of postoperative patients with breast cancer. Continued admission and commitment therapy intervention after discharge can provide patients with out-of-hospital continuous care programs to improve post-traumatic growth of postoperative patients with breast cancer. It has a better long-term effect than the control group.

In recent years, the use of fluorescent contrast agents staining to guide surgery has flourished in various fields of surgery under the concept of precision surgery, which is helpful to guide surgery and provide surgeons with actual visible fluorescence imaging.Clinically, fluorescent contrast agent can be used to display tumor’s outline with high recognition degree, guide operation in real time, locate lymph node metastasis, detect small metastases, and identify important anatomical structures during the operation to avoid possible side-injury. Great progress has been made in the study of fluorescent contrast agents that can mediate surgery, including the study and surgical application development of classical fluorescent contrast agents such as indocyanine green and methylene blue, etc, as well as the discovery and clinical application of new targeted fluorescent contrast agents such as folate receptor targeting contrast agents, monoclonal antibody based fluorescent targeting contrast agents and intelligent contrast agents, etc. This paper will review the research and surgical application of fluorescent contrast agents in two aspects: classical fluorescent contrast agents and new targeted fluorescent contrast agents.