Objective To compare efficacy and complications of endoscopic sphincterotomy(EST) and limited endoscopic sphincterotomy plus endoscopic papillary balloon dilation (ESBD) for choledocholithiasis.Methods A total of 120 choledocholithiasis patients (stone diameter ≤ 2 cm)underwent endoscopic treatment,including 60 cases of EST,60 ESBD.The stone-free rate,complication rate of postERCP pancreatitis,hemorrhage,perforation and recurrence rate of stones were compared between two groups.Results Success rates of one-time removal were 90.0％ (54 cases) and 93.3％ (56 cases) in group EST and ESBD (x2 =0.436,P =0.743).Eleven case (18.3％) and 4 case (6.7％) underwent mechanical lithotripsy(x2=3.733,P =0.053).There were 4 cases of hemorrhage,6 post-ERCP pancreatitis and 1 perforation in EST group,while in ESBD group,there was 1 case of hemorrhage,4 pancreatitis and no perforation.The total rates of early complications were 18.3％ (11/60) and 8.3％ (5/60) in two groups (x2 =3.322,P =1.422) and recurrence rate of stones were 21.7％ (13/60) and 6.7％ (4/60) respectively (x2=5.551,P =0.034).Conclusion There are no significant differences between EST group and ESBD group in treatment of choledocholithiasis,in success rate of one-time removal and the occurrence of early complications,but the recurrence rate of late complications in ESBD group is lower than that in EST group.ESBD shows high efficacy and safety for younger patient of choledocholithiasis.

The high mobility group A2 (HMGA2) is a non-histone chromatin protein. It has no transcriptional activity of itself but could alter chromatin structure to regulate the transcription of other genes. HMGA2 gene is weakly expressed or does not express in normal tissues. The expression of HMGA2 is up-regulated during embryogenesis and malignant neoplasias. In several malignant tumors, HMGA2 is used as a diagnostic molecular marker or an independent prognostic indicator. Furthermore, HMGA2 not only elicits epithelial-mesenchymal transition but also maintains the differentiation potential and self-regeneration capability of stem cells. It plays an important role in initiation, proliferation, and metastasis of malignant neoplasias.

Background and purpose:PTEN mutation has been found in 20%-40% of malignant gliomas.The common mutant epidermal growth factor receptor(EGFR vⅢ)was reported to coexpress in PTEN-deficient EGFR-expressing tumor.PTEN has been shown to interact directly with FAK and reduce its tyrosine phosphorylation levels to inhibit cell invasion.The invasion of glioma cells with EGFRvⅢ expression and PTEN deficiency is increased.This study was to observe whether PTEN inhibits glioma cell invasion even in the presence of strong pro-invasive signals provided by constitutive EGFR activity.Methods:U87?EGFR cells were transfected with pcDNA3.1 constructs encoding PTEN and the cells invasion levels were detected by transwell invasion assay.The expression of FAK was detected by immunoblotting.FAK expression vector was transfected into U87?EGFR-wtPTEN cells and the change of cells invasion was documented.Results:PTEN and PTEN(G129E)could inhibit cell invasion induced by EGFRvⅢ.PTEN and PTEN(G129E)could decrease the FAK phosphorylation at Tyr397.Over expression of FAK in U87?EGFR-PTEN abrogated PTEN-induced down-regulation of the phosphorylation status of FAK and rescued cell invasion.Conclusions:PTEN could inhibit cell invasion induced by EGFRvⅢ by dephosphorylating FAK.

Objective To investigate the clinical value and relating problems in treating complex fractures of proximal humerus by using replacement of humeral head prosthesis. Methods There were 23 cases (10 males and 13 females, age range 43-76 years, mean 58.6 years) with complex fractures of proximal humerus. According to Neer classification, 4 cases had three-part fracture, 17 four-part fracture, 2 cleavage fracture of humeral head, 18 fresh fracture (within 2 weeks after injury) and 5 old fracture, which were all treated with replacement of humeral head prosthesis. Results Follow-up study for a mean period of 15.6 months was conducted in all the cases. No flexible prosthesis, prosthesis dislocation, infection, nerve damage or periprosthesis fractures occurred. According to scoring system modification for hemiarthroplasty (SSMH) of UCLA (Los.Angeles, California, USA), the average score was 26.3. Score was above 27 (excellent) in 3 cases and 24-27 (good) in 18 with an excellence rate of 91.3%, score was 18-24 (moderate) in 2 but no one had score less than 18. Average score was 9.5 in pain, 8.6 in function and 8.2 in muscle power and motion in 23 cases. Conclusions Replacement of humeral head prosthesis is a preferable method for treating the complex fractures of proximal humerus, with significant effect in relieving the pain in the shoulder joint posterior to trauma. It is key to a satisfactory curative effect to correctly select the indication, clearly master the local anatomy, grasp the operation technique and give early and reasonable postoperative rehabilitation treatment.

The impulsive electroencephalograph (EEG) noises in evoked potential (EP) signals is very strong, usually with a heavy tail and infinite variance characteristics like the acceleration noise impact, hypoxia and etc., as shown in other special tests. The noises can be described by a stable distribution model. In this paper, Wigner-Ville distribution (WVD) and pseudo Wigner-Ville distribution (PWVD) time-frequency distribution based on the fractional lower order moment are presented to be improved. We got fractional lower order WVD (FLO-WVD) and fractional lower order PWVD (FLO-PWVD) time-frequency distribution which could be suitable for a stable distribution process. We also proposed the fractional lower order spatial time-frequency distribution matrix (FLO-STFM) concept. Therefore, combining with time-frequency underdetermined blind source separation (TF-UBSS), we proposed a new fractional lower order spatial time-frequency underdetermined blind source separation (FLO-TF-UBSS) which can work in a stable distribution environment. We used the FLO-TF-UBSS algorithm to extract EPs. Simulations showed that the proposed method could effectively extract EPs in EEG noises, and the separated EPs and EEG signals based on FLO-TF-UBSS were almost the same as the original signal, but blind separation based on TF-UBSS had certain deviation. The correlation coefficient of the FLO-TF-UBSS algorithm was higher than the TF-UBSS algorithm when generalized signal-to-noise ratio (GSNR) changed from 10 dB to 30 dB and a varied from 1. 06 to 1. 94, and was approximately e- qual to 1. Hence, the proposed FLO-TF-UBSS method might be better than the TF-UBSS algorithm based on second order for extracting EP signal under an EEG noise environment.
Algorithms ; Electroencephalography ; Evoked Potentials ; Humans ; Models, Theoretical ; Signal Processing, Computer-Assisted

Objective To compare the posterior midline approach and the combined lateral and medial approach usually used in elbow arthrolysis. Methods From January to December in 2009, 41 cases of elbow stiffness were treated and fully followed up by the same team in our hospital. The posterior midline approach was used in 21 cases, 15 males and 6 females, with an average age of 35.8 years (16 to 70 years). In this group, the total flexion-extension arc was ＜ 30° in 12 cases, 31° to 60° in 7 cases, and 61° to 90° in 2 cases. Eight cases had ulnar symptoms. The combined lateral and medial approach was applied in 20 cases, 8 males and 12 females, with an average age of 38. 8 years (16 to 51 years). In this group, the total flexion-extension arc was ＜ 30° in 11 cases, 31° to 60° in 7 cases, and 61° to 90° in 2 cases. Five cases had ulnar symptoms. Results The 41 cases were followed up for 4 to 15 months (average, 7.9 months). In the posterior approach group, the mean preoperative flexion-extension ROM (27.6°± 25.7°) was improved to the postoperative 111.4°± 25.6°, the mean preoperative rotation ROM ( 152.9°± 46. 9°) to the postoperative 168.1°± 19. 1°, and the mean preoperative MEPS score (65.5 ± 11.5) to the postoperative 95.7 ±6.4. In the combined approach group, the mean flexion-extension ROM was improved from 35.5°± 25.0° preoperatively to 116. 5°± 19.1° postoperatively, the mean rotation ROM from 138.0°±55.7° preoperatively to 148.5°± 45.6° postoperatively, and the mean MEPS score from 66. 3 ± 13.0 preoperatively to 97.3 ± 7.0 postoperatively. The differences were statistically significant between preoperation and postoperation in both groups ( P ＜ 0. 05), but not statistically different between the 2 groups in the preoperative or postoperative values ( P ＞ 0. 05). In the posterior approach group, 5 patients had huge hematoma, 3 had wound dehiscence at the posterior elbow, and the others all had mild hematoma. But in the combined approach group, no wound complications were noted. Conclusion The combined lateral and medial approach should be used as far as possible in the elbow arthrolysis to avoid the likely complications when the posterior midline approach is used.

Clinicians monitor the gastric residual volume(GRV) of critical ill patients to minimize or prevent side effect of EN.Nevertheless,recommendations about the threshold GRV in critically ill patients treated with EN are not uniform.Many recent clinical studies had demonstrated that increasing the limit of GRV was associated with the increase in the diet volume ratio of ICU patients receiving EN,and it was not associated with adverse effects in gastrointestinal complications.This review summarizes the influence factors of GRV monitoring to evaluate the feasibility and necessity of increasing the threshold of GRV.

Objective To investigate the effect of netropsin on migration and invasion ability of gastric cancer cells and its mechanisms.Methods To determine if netropsin inhibits migration and invasion of gastric cancer cells, Transwell migration and invasion assay was performed.Then Western blot was performed to detect expression of E-cadherin and vimentin in gastric cancer cells with or without presence in medium netropsin.Finally, immunofluorescence was performed to detect changes in the cellular localization of β-catenin to validate whether Wnt/β-catenin pathway was suppressed or not.Results Netropsin with the concentration of 25 μmol/L had minimal inhibition effect on cell proliferation and was able to suppress ability of migration and invasion by inhibiting EMT in gastric cancer cells(P<0.05).Meanwhile netropsin was able to down-regulate the expression of epithelial markers E-cadherin and up-regulate the expression of mesenchymal marker vimentin.Finally,immunofluorescence showed that netropsin was able to block translocation of β-catenin from cytoplasm to nuclear.Conclusions Netropsin can inhibit EMT thereby suppressing migration and invasion of gastric cancer cells.The mechanism is that netropsin can compete with HMGA2 for transcription factor binding site thereby suppressing the Wnt/β-catenin pathway.

Protein arginine methyltransferases ( PRMTs) play crucial roles in the methylation of a series pro-tein substrates.PRMT5 is a type Ⅱ methyltransferase that symmetrically methylates arginine residues of histone and non-histone substrates, thereby regulating a variety of cellular processes through epigenetic control of target gene expression or post-translational modification of signaling molecules.Recently, accumulated evidence has suggested that PRMT5 may function as an oncogene.This review is aimed to summarize the oncogenic role of PRMT5 and its regulatory mechanisms in tumors.