Objective To analyze the cost-effectiveness of selective intraoperative laparoscopic cholangiography (LIOC) in the county level hospitals.Methods The medical costs and cost-effectiveness of 60 patients undergoing LIOC (group A) during laparoscopic cholecystectomy (LC) in 2014 and 52 patients undergoing LC (group B) only in 2013 at 3 county level hospitals were analyzed.Results The direct medical care costs of group A were less than that of group B significantly [(9 072 ± 1 282) Yuan vs.(10 941 ± 4 064) Yuan,t =-3.38,P =0.001],there were no significant different in indirect medical care costs between group A and group B[(2 039 ± 1 020) vs.(2 100 ± 1 172) Yuan,t =0.24,P =0.810].The cure rate was 100％ in two groups;however,the cost per patient in group A was less than that in group B [(11 111 ± 2 348)vs.(13 041 ± 5 118)Yuan].The direct medical care cost of the patients who needed additional treatment in group A was significantly less than that in group B [(10 828 ± 1 101)vs.(16 533 ±1 733)Yuan,t =-11.45,P =0.000].There were no significant different in direct operational costs between group A (LIOC + LC) groups and group B (LC) [(8 378 ± 326) vs.(8 225-± 363) Yuan,t =1.96,P =0.054].Conclusions Selective LIOC is a cost-effective procedure and should be recommended in county level hospitals in which magnetic resonance cholangiopancreatography is not available.

Object To study the anti endotoxic effect of syringic acid (SA) which was isolated from Radix Isatidis (Banlangen in Chinese, BLG). Methods SA was extracted and isolated from BLG and made to 1% solution. The content of SA pretreated ET was quantitatively determined using Limulus Test. Then the ability of fever induction of endotoxin (ET) pretreated with SA was measured using endotoxin induced fever test in rabbits. At last, the lipopolysaccharide (LPS) induced death in mice pretreated with and without SA was compared. Results Being pretreated with SA, 83.16% ET was destroyed, the ET induced fever in rabbits relieved markedly and the LPS induced death rate in mice dropped from 68% to 20%. Conclusion SA isolated from BLG has anti endotoxic effects.

Objective To investigate the clinical application value of the laparoscopic intraoperative cholan-giography in laparoscopic cholecystectomy,and summarize the experience.Methods The clinical data of 169 cases of laparoscopic cholecystectomy intraoperative cholangiography were analyzed retrospectively.Results 169 patients were successfully completed,131 cases recovered well and no complications occurred after operation.29 patients showed hyperamylasemia,of which 3 patients had intractable hyperamylasemia,8 patients complicated with secondary acute pancreatitis,with fasting,gastrointestinal decompression,enzyme inhibition(plus somatostatin)and acid,analgesic, anti infection,rehydration treatment after remission.Conclusion Laparoscopic cholecystectomy intraoperative cholan-giography is a safe and reliable diagnostic technique,on the occurrence of biliary residual stones in prevention of post-operative prevention and timely detection of bile duct injury during operation and improves the success rate of repair of bile duct injury has important clinical value;control adaptation of intraoperative cholangiography has important clinical significance of reasonable application license.

OBJECTIVE:To investigate the effect of the active site F 022 of Radix Isatidix antiendotoxin on the LPS-stimulated release of inflammatory cell factors in monocytes of mice.METHODS:Monocytes samples taken from the abdominal cavities of BALB/C mice were divided into6groups,the trial group were divided into1%,0.5%,0.25%and0.125%4groups,which added with Radix Isatidis F 022 sample solution and LPS solution;The positive group were treated with LPS solution;The negative group were added with1%F 022 solution.Thereafter the levels of TNF-?,IL-6and NO of the3kinds of inflammatory cell factors cultured in the clear supernatant liquid were determined.RESULTS:LPS could stimulate monocytes of mice to excessively release inflammatory cell factors including TNF-?,IL-6and NO.Compared with the positive group,the levels of inflammatory cell factors in the trial group reduced and which was dose dependent.CONCLU-SION:The active site F 022 of Radix Isatidix antiendotoxin has inhibitory action on LPS-stimulated excessive release of in-flammatory cell factors of in monocytes of mice.

To find a component with the strongest anti-endotoxin effect from the four components (F021, F022, F023, and F024) of chloroform extract (F02) of Radix Isatidis, the protective effects of the five components on endotoxin-challenged mice and their effects on the production of TNFalpha and IL-6 by macrophages from the endotoxin-challenged mice were compared. It was found that the five components all had protective effects on endotoxin-challenged mice in terms of mortality. The mortalities of the mice challenged by 2.42 mg/kg endotoxin were 30 %, 50 %, 20 %, 50 % and 60 % after treatment with F02, F021, F022, F023, and F024. The 5 components all had inhibitory effects on the production of TNFalpha and IL-6 by macrophages from the mice. At a concentration of LPS of 50 ng/mL, the inhibitory rates of F02 , F021 1, F022, F023, and F024 for the production of TNFalpha and IL-6 were 76.54 %, 30.86 %, 78.60 %, 36.63 %, 2.06 % and 75.85 %, 18.45 %, 77.68 %, 24.41 %, 3.64% and at the dose of 100 ng/mL, the inhibitory rates were 49.65 Y, 16.86 %, 66.97 %, 13.39 %, 7.16 % and 59.78 %, 1.28 %, 61.86 %, 2.08 %, 1.44 %, respectively. It is concluded that the component F022 of Radix Isatidis has the strongest anti-endotoxin effect.

To investigate the effect of the anti-endotoxic part of Radix Isatidis on the expression of moesin mRNA in murine tissues induced by lipopolysaccharide (LPS), the sample solution of F(022) part from Radix Isatidis was intraperitoneally administered to experimental mice, and the lipopoly-saccharide (LPS) were injected into the tail vein, and then the tissues of liver, kidney and spleen were colleted and cut into slices. The mRNA was detected by moesin mRNA hybridization in situ. The staining results were observed under microscope. It was found that moesin mRNA expression was increased in the tissues of liver, kidndy and spleen in mice treated with LPS, while in the mice pre-treated with F(022) part from Radix Isatidis, the LPS-induced moesin mRNA expressions in these tissues were inhibited in a dose-dependant manner. Our study showed that F(022) part from Radix Isatidis can inhibit the LPS-induced expression of moesin mRNA in the tissues of liver, kidney and spleen in mice.

Objective To analysis the risk factors of cardiovascular events during periopemtive period undergoing hand surgery . Methods 197 cases of hand surgery in our hospital from 2009 to 2012 ,aged 21 to 74 years were selected .The general condition ,an-esthesia ,operative time and intraoperative hemodynamics (blood pressure> 20% ) were recorded ,postoperative follow-up and record the occurrence of cardiovascular events ,and factor analysis was carried on .Results In 48 hours ,23 patients were suffered from car-diovascular events ,and the total morbidity rate was 11 .7% ,in which sinus tachycardia was 3 case(1 .52% ) ,atrial fibrillation were 2 cases(1 .02% ) ,premature ventricular contractions were 4 cases(2 .03% ) ,the myocardial ischemia were 11 cases(5 .58% ) ,the angi-na pectoris were 3 cases(1 .52% ) ,the myocardial isehemia was 1case(0 .51% ) .Multiariable Logistic regression analysis showed that ,the influencing factors of perioperative cardiovascular events undergoing hand surgery were were diabetes mellitus (OR=2 .012 ,P=0 .023) ,coronary heart disease (OR=2 .301 ,P=0 .028) ,preoperative ST ischemic changes (OR=2 .942 ,P=0 .031) ,lip-id abnormalities(OR=3 .012 ,P=0 .019) and hemodynamics changes during operation(OR=3 .522 ,P=0 .020) .Conclusion The risk factors of perioperative cardiovascular events independent undergoing hand surgery might be diabetes ,coronary heart disease , preoperative ST ischemic changes ,intraoperative hemodynamic changes .

Objective To investigate the MRI features of pleomorphic xanthoastrocytoma (PXA).Methods 1 5 pathologically confirmed PXA cases were analyzed retrospectively.Clinical history and imaging features including location,size,shape,signal intensi-ty,enhancement and surrounding changes of those lesions were analyzed.Results All 1 5 cases were supratentorial and solitary le-sions,of which 9 lesions located in temporal lobe(60%).14 lesions contacted with the leptomeninges,and 1 lesion contacted with lat-eral ventricle wall.All lesions were solid-cystic,with different proportion of solid/cystic components.8 large lesions were predomi-nantly cystic(53.3%),3 small lesions were predominantly solid(20%),and 4 lesions had roughly equal cystic and solid proportions (26.7%).Solid components showed iso-intense or mild hypo-intense on T1 WI,iso-intense or mild hyper-intense on T2 WI,and signif-icant enhancement with contrast.Cyst fluid showed slightly hyper-intense in some cases.Cyst wall or septa enhancement was seen in 7 cases,and leptomeningeal enhancement was seen in 8 cases.Conclusion The MRI features of PXA are the characteristic of suprat-entorial solid-cystic lesions commonly seen in temporal lobe and contacting with leptomeninges.The typical features include “cyst with mural nodule”and “multiple cysts with irregular eccentric nodule”with significant enhancement of solid component and some cyst wall.MRI features of PXA is valuable in diagnosis and differential diagnosis of PXA.

Objective To investigate the expression of fragile histidine triad(FHIT),fibronectin (FN) and phosphatase and tensin homology deleted on chromosome ten( PTEN )in human hepatocellular carcinomas (HCC) and their relationship with pathological characteristics and prognosis of HCC.Methods Immunohistochemistry was used to detect expression of FHIT,FN and PTEN in cancerous tissues from 138 HCC patients.The correlation between their expression and clinicpathological features and prognosis were analyzed.Results FHIT,FN,PTEN protein expressed differently between HCC and adjacent mucosa ( respectively x2 =5.968,7.380,4.962,all P ＜ 0.05 ),and the expression level was different with tumor size,tumor number,grades and tumor lymph node metastasis( P ＜ 0.05 ).In FHIT and FN positive group,the recurrence free survival rates were lower than those in negative groups( respectively x2 =4.443,9.867,all P ＜0.05),while in PTEN positive group patients' recurrence free survival rates were higher than those with PTEN negative expression ( x2 =4.199,P ＜ 0.05 ).Conclusions FHIT,FN,PTEN were abnormally expressed in HCC.Positive expression of FHIT and FN predicts poor prognosis,while positive PTEN indicates fair prognosis.

Objective To investigate the predictive values of P-selectin (P-sel),thrombus precursor protein (TpP) and D-dimer (D-D) in the early diagnosis of portal vein thrombosis (PVT) in patients submitted to splenectomy (or to devascularization).Methods The clinical data of 48 patients with portal hypertension (the PVT group,n=26; and the non-PVT group,n=22) who received operation in our hospital from 2009 to 2011 were retrospectively analyzed.Detecting the P-sel,TpP and D-D levels in the two groups of patients were done on preoperative day 1 and postoperative day 1,3,5,7,14.The SPSS software was used for statistic analysis.Results There were no significant differences on the preoperative day 1 levels of P-sel,TpP and D-D in the two groups (P＞0.05).The postoperative day1 levels of the three indicators in the PVT group were significantly higher than the non-PVT group (P＜0.05).Receiver operating characteristic (ROC) curves showed the area under curve (AUC) of P-sel was largest (0.893),followed by D-D,and TpP.The combined detection of the 3 indicators was highest,with the AUC up to 0.977.Conclusions Combined detection of P-sel,D-D and TpP levels were useful in the early diagnosis of PVT after splenectomy in patients with portal hypertension.