Twenty-four cases of carcinoma of biliary duct, 6 of carcinoma of gallbladder and 19 of carcinoma of Vater's ampulla are reported. All of those 49 cases were con- firmed by operation and/or pathology.The diagnostic accuracy by endoscopic retragra-de cholangiopancreatography(ERCP)was 85.7%.The radiological appearances of carcinoma of biliary tract under ERCP were described and classified into 3 types, namely obstruction,stricture and polypoid types. The stricture type was further divided into 3 subtypes of occlusive,annular and diffuse stenosis.The obstruction type and occlusive stenosis type were more common. Carcinoma of gallbladder manifested as a constant filling defect with a wide base in the gallbladder, while carcinoma of ampulla as an irregularly bordered space occupying lesion in it, which could obstruct the biliary duct and/or pancreatic duct. The soft rattan-form change in intrahepatic biliary ducts was the characteristic manifestation of malignant tumor of biliary tract.

Abandon of treatment and euthanasia is a hot topic on the medical ethics.The issue includes the ethical significance,the definition of criteria,the ethical disputes,the legislation,the basic procedure and so on.The paper comprehensive analyzes these issues in different respects and make the necessary explanation.

Personalized therapy has became a main method to break through efficacy of chemotherapy in lung cancer. At present, we have got a few progressions in personalized therapy, but which are very limited. This review discourses upon the dilemma and hope of individualized treatment from the following ways:limitation of based on histology type to determine treatment regimens, undecided sequential therapy after failure of TKI as front-line therapy for advanced NSCLC patients with EGFR mutation, clinical study of maintenance therapy and EGFR mutation detection based on peripheral blood being trap or surrogate for tumor tissue to direct personalized TKI therapy.

Objective To explore the diagnostic value of ultrasonography for the residual gallbladder after cholecystectomy.Methods Application of the ultrasound diagnostic apparatus in cholecystectomy patients was to be screened to find the residual gallbladder.Results Ultrasound resuts showed 18 cases of residual gallbladder,which combined stones in 12 cases(66.7％ ),polyps in 1 case(5.6％ ) ;Atrophic cholecystitis,acute cholecystitis,postoperative residual gallbladder probability were high,accounting for 83.0％.Conclusion Ultrasound for the preoperative prevention and postoperative diagnosis of the residual gallbladder has better value,and the cholecystectomy patients should be routinely review the ultrasound.

Ocular surface tissues are vulnerable to various stimuli from the external environment,including microbial invasion,mechanical damage,chemical stimulation,dust,UV light,and allergen stimulation.Conjunctival goblet cells play an important role in maintaining ocular surface self-homeostasis and health.These cells are the only unicellular glands in humans and mammals that are mainly distributed in the epithelium of the digestive tract,respiratory tract,and the ocular surface.Many factors affect goblet cell development and differentiation,especially the newly discovered molecule Spdef,which is a transcription factor found in the ETS family.The main function of conjunctival goblet cells is to secrete mucin to protect and lubricate the ocular surface;however,they also secrete a variety of other bioactive substances.Recent studies have demonstrated that goblet cells are involved in antigen presentation,regulation of dendritic cell phenotype differentiation,and induction of immune tolerance on the mucosa.Many ocular surface diseases,such as dry eye,will alter density and function of conjunctival goblet cells.Therefore,ophthalmologists should be concerned about the biological behavior of conjunctival goblet cells and the relationship between them and ocular surface diseases.

BACKGROUND: There are many reports on the entrance point of adult inferior thoracic spinal latero-anterior screw.Because of the differences in race,districts and the shape of vertebral body are various,and the choice of screw placement position is also varied.OBJECTIVE:To provide an anatomical reference for the implantation of clinical screws for inferior thoracic spinal latero-anterior fixation with the concave rib set as a reference.METHODS:Spinal specimens from 20 adult cadavers were observed,and anatomical data were colected from the concave ribs.One vernier caliper was used for the measurements.RESULTS AND CONCLUSION:The thoracic transverse diameters and the distance between the upper and the inferior edge of the concave rib and upper endplate increased gradualy as the vertebral number increased,whereas the distances between the upper and the inferior edge of the concave rib and inferior endplate and between the anterior edge of the concave rib and anterior edge of the vertebral canal decreased gradualy.Above findings suggested that the anatomical positions of the inferior thoracic concave ribs folowed a set of rules.The concave rib could be used as a simple,constant,and reliable reference point for inferior thoracic spinal latero-anterior fixation screw placement.

Objective To evaluate the assistant medial approach used in the surgical management of intraarticular fractures of calcaneus.Methods From January 2005 to December 2009,33 patients with intraarticular fracture of calcaneus were treated by open reduction and internal fixation through the expanded lateral L-shape approach and the assisted medial approach.They were 27 men and 6 women,aged from 18 to 62 years (average,36 years).There were 15 left sides and 18 right sides.According to Sanders' classification system,there were 27 patients with type Ⅲ displaced calcaneal fracture and 6 with type IV.Four cases were complicated with fracture of lumbar vertebra,one with pilon fracture and one with fracture of acetahulun.Fracture healing was observed and the Bǒhler and Gissane angles were measured.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale system was used to evaluate the functional recovery.Results All patients were followed up postoperatively to assess their functional outcome.The follow-up duration was 6 to 24 months (mean,12 months).All incisions healed primarily and all fractures obtained bony union in an average of 8 weeks (from 6 to 24 months).All the Bǒhler and Gissane angles were corrected and AOFAS scores were improved.There were significant differences between preoperation and pestoperation in all indexes( P ＜ 0.05).Conclusion As the medial approach can be used to assist the expanded lateral L-shape approach in treatment of the intraarticular fractures of the calcaneus,the reduction and insertion of internal implants can be improved to achieve satisfactory functional outcome.

Objective To investigate the protective effects of α-lipoic acid in rats with acute panereatitis(AP)and its potential mechanism.Methods Wistar rats were randomly divided into four groups according to random number table:sham operation(SO)group,AP group,normal saline(NS)group and α- lipoic acid group with 30 rats in each group.AP model was induced by retrograde iniection of 3.5%sodium taurocholate into the pancreatobiliary duct.Rats in α-lipoic acid group immediately received α-lipoic acid intra- peritoneal injection at the dose of 1 mg/kg.Rats in NS group received sanle amount of normal saline.The rats were sacrificed at 1,3,6,9 and 12 h after AP induction.The serunl levels of amylase.TNF-α and ICAM-1 were measured.Pancreatic histological changes were observed.The activities of pancreatic SOD and MDA were measured. Results In rats of AP group,optical microscopy showed pancreatic edema,adhesion and necrosis. The semm amylase,TNF-α,ICAM-1 and MDA levels in pancreatic tissue 6h after operalion were(2211±547)U/L,(174.8±7.9)ng/ml,(49.3±8.0)ng/ml and(32.2±5.9)U/mg prot,respectively,in AP group;which were significantly increased when compared with those of SO group(P<0.05).Pancreatic SOD activity was(38.5±9.5)U/mg prot,which was signifieandy lower than(56.7±6.7)U/mg pint of SO group (p<0.05).The serum amylase,TNF-α,ICAM-1 and MDA levels in pancreatic tissue 6 h after operation in α-lipoic acid group were(1478±642)U/L,(164.8±6.2)ng/ml,(37.5±3.9)ng/ml and(20.2 ±8.4)U/mg prot,respectively;which were significantly decreased when compared with those of AP group(P<0.05).Pancreatic SOD activity was(66.0±8.6)U/mg prot,which were significantly hisher than(38.5±9.5)U/mg prot of AP group(P<0.05).Condusiors The pathogenesis of AP wag associated with oxiddative stress,and α-lipoic acid as an antioxidant played a role in the treatment of AP.the possiblemechanismsincludedinhibitedproduction of TNF-α and ICAM-1.

BACKGROUND:In recent years,studies have shown the effects of tumor necrosis factor-a(TNF-а)on fibroblasts at different organizations in a tissue-specific and dose-dependent manner.OBJECTIVE:TO investigate the biologic effects of TNF-а and its signal transduction pathway-specific kinase inhibitors on mouse embryonic fibroblasts(NIH3T3).METHODS:NIH3T3 cells were cultured in vitro,and then the cells were assigned into 3 groups.Cells in the control group were cultured in DMEM high-glucose medium with 2%serum;those in the TNF-а group were cultured in 100 μg/L TNF-аmedium;those in the TNF-а+Anti-TNFRSF 1 B group were firstly cultured in medium with 50 μg/L Anti-TNFRSF 1 B for 1 hour,and then placed in the medium with 100 μg/L TNF-а.RT-PCR and Western blot methods were used to evaluate mRNA and protein expressions of type Ⅰ collagen and matrix metalloproteinase 3(MMP3)in each group.RESULTS AND CONCLUSION:In this experiment,NlH3T3 cells cultured with a certain concentration of TNF-а,the specificity kinase signal of transduction pathway presented with phosphorylation or protein activation,and the signal pathway was activated,which promoted MMP3 activation,and significantly reduced the expression of type Ⅰ collagen.The effect of TNF-а was certainly inhibited,but not completely eliminated after adding its signal transduction pathway inhibitor Anti-TNFRSF1 B.This further proves the role of TNF-а on NIH3T3 activation.

Objective To investigate the safety and feasibility of lapraroscopic Heller myotomy combined with Dor fundoplication surgery. Methods Three cases with achalasia have been treated with laproroscopic Heller-Dor surgery since February, 2005. Before surgery, patients were examined for generally esophageal barium meal and esophageal manometry. Results The operation time ranged from 110 and 120 minutes with the bleeding volumes between 40 to 50 ml, and the hospitalized time for patients post operation was 6 to 7 days. During a month after surgery, the patients showed the normal lower esophageal sphincter pressure and remnant pressure, increased the rate of relaxation,disappeared reversed peristalsis and gastroesophageal reflux, and no recurred symptoms. Conclusions In comparison to conventional surgery, Heller-Dor procedure results in smaller wound, less pain, fewer complications, faster recovery, shorter hospitalized days, and better therapeutic effectiveness. The Heller-Dor procedure is safe and feasible.