Objective To evaluate the significance of laparoscopy in the diagnosis and treatment of unexplained acute right lower abdominal pain in women. Methods Clinical data of 52 women with unexplained acute right lower abdominal pain from April 1999 to April 2004 were retrospectively analyzed. Results Diagnosis was clarified under laparoscope in all the 52 patients, including 28 cases of acute appendicitis, 18 cases of acute pelvic inflammatory disease, 3 cases of ovarian cyst pediculotorsion, 2 cases of right tubal pregnancy, and 1 case of Crohn’s disease with iliac perforation. With exception of a conversion to open surgery in 3 patients, laparoscopic treatment was successfully completed in the remaining 49 patients. No surgical complications occurred. The patients were discharged from the hospital 2~6 days postoperatively. Conclusions Laparoscopy is a timely, safe and effective alternative for the diagnosis and treatment of unexplained acute lower right abdominal pain in women.

Objective To study the characteristics,operative timing,repair methods for iatrogenic bile duct injury caused by laparoscopic cholecystectomy.Methods Clinical data of 30 cases of iatrogenic bile duct injury found during or after laparoscopic cholecystectomy were studied retrospectively.Results There were type Ⅱ 1 bile duct injury in 9 patients,type Ⅱ 2 in 4 patients,type Ⅱ 3 in 2 patients,and type Ⅱ 4 in 15 patient.17 cases underwent immediate repair,13 cases did early repair.All cases followed up from 5 months to 10 years,the follow-up rate was 83.3％.1 case with end-to-end anastomosis and biliary stent underwent Roux-en-Y choledochojejunostomy for biliary stenosis 13 months postoperatively,4 cases underwent secondary Roux-en-Y choledochojejunostomy because of obstructive jaundice and the cicatricial anastomotic orifice stenosis one to one and half years after primary repairs.The remaining cases were doing well up to the end of the follow-up.Conclusion Most iatrogenic bile duct injury after laparoscopic cholecystectomy were high in position,while Roux-en-Y choledochojejunostomy is the mainstay of repair.

Objective To evaluate the therapeutic efficacy of congenital muscular torticollis (CMT) by two different methods. Methods A total of 86 patients with congenital muscular torticollis in recent 7 years were involved in this study, including 69 cases under 12 years old and 17 cases over 12. Two different operation methods, incision of inferior extremity of sternocleidomastoid muscle and incision of amphi-sternocleidomastoid muscle with post-operative traction, were alternatively chosen according to the ages and deformed degrees of the patients. Results 72 patients were followed-up for 1 to 7 years (averaged 4.5 years). Based on the effect of function and cosmetology in the group of 57 cases under 12 years old, there were 52 cases (91.2 %) excellent, 5 cases (8.8 %) good and no case with side-effects. Meanwhile, in the group of 15 cases over 12 years old, there were 11 cases (73.3 %) excellent, 4 cases (26.7 %) good and no case with side-effects. The effect was satisfactory. Conclusion Different patients with congenital muscular torticollis should be treated with different therapeutic methods.

Objective To explore the clinical significance of CP2,CA125,salicylic acid(SA)and carcinoembryonic antigen(CEA)in endometrial carcinoma patients. Methods A retrospective study was carried out on 154 cases of endometrial carcinoma with tumor markers test results who were admitted to our department from Aug 1992 to Nov 2004.Results The patients were followed up for(38±28)months.23.4%,36.8%,19.0%and 30.3%of cases were with abnormal values of CP2,SA,CA125 and CEA.CP2 abnormal level was related with the stage,cell differentiation,adnexa metastasis,positive peritoneal cytology and pelvic lymph node metastasis(P=0.002,P=0.040,P=0.019,P=0.019,P:0.005).SA abnormal level was related with the adnexa metastasis and positive peritoneal eytology(P=0.021,P=0.000). CA125 abnormal level was related with the cell differentiation,cervical metastasis and pelvic lymph node metastasis(P=0.014,P=0.006,P=0.018).The survival was related with CP2,CA125 and CEA (P=0.016,P=0.000,P=0.016),especially CA125. Conclusions Among the commonly used tumor markers,CP2 is related with many clinical pathological parameters.CA125 elevation may strongly suggest worse prognosis.

Morphea complicated by Hashimoto's thyroiditis is reported in two sisters.Case 1:a 64-year-old female presented with skin rashes on the anterior neck,trunk and bilateral anterior shins for 5 years,itching skin rashes on the perineum for 4 years,and Hashimoto's thyroiditis for 9 years.Physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema.Dermatological examination showed pink patches on the neck and breast,sclerosis and atrophy of skin over the back,porcelain-white patches on the perineum.Histopathological findings suggested the diagnosis of morphea on the breast and lichen sclerosus et atrophicus on the perineum.Case 2:a 55-year-old female,who was the younger sister of case 1,suffered from gradual sclerosis and atrophy of skin in the left inframammary region and abdominal region for 4 years,as well as Hashimoto's thyroiditis for 3 years.Similarly,physical examination revealed grade 1 enlargement of firm thyroid gland without exophthalmos or pretibial myxedema.Hypopigmentation,sclerosis and atrophy of skin were observed in the left inframammary region,abdominal region and central back region.Histopathological examination suggested a diagnosis of morphea.According to the clinical and histopathological manifestations,periodic acid-Schiff staining and thyroid gland function test results,the 2 cases were both diagnosed as morphea complicated by Hashimoto's thyroiditis.

Objective Mongolian gerbil can make themself urine concentration for saving water and adapt to the harsh desert environment, due to their very unique moisture control system in the body.Methods Mongolian gerbil is resistant to drought on account of their special kidney. Histology of the kidney, ureter and bladder in Meriones Unguiculataus were observed by light microscopy using HE staining.Results The results showed that compared with rats and mice, the Mongolian gerbils have more developed distal tubules, and well developed inner renal medulla.Conclusions We hope that the findings of this study enrich our understanding of the histology of urinary system in Mongolian gerbils and provide support for the laboratory animalization of this animal.

Objective To explore factors influencing the prognosis of hepatocellular carcinoma (HCC) patients after hepatectomy. Methods From May 1994 to January 1998, 189 patients who underwent hepatectomy for HCC were enrolled for reviewing their clinical characteristics, treatment and prognosis. Twenty-two parameters contributing to long-term survival rate (SR) and disease-free SR were analysed. Results The 3,5-year cumulative SR of the whole group was 63%,45%, respectively. The 3,5-year SR and disease-free SR in the curative resection (CR) group ( n =162) were 67%,47% and 45%,26% respectively. Results showed that the way by which a tumor was found, tumor size, portal tumor thrombi, satellite nodule, TNM stage, cirrhosis type, recurrent and treatment, blood transfusion, differentiation grade,and CR were risk factors by individual variable analysis( P =0.0000～0.0034); A multivariable analysis showed that CR, tumor size, tumor finding mode and reoperation were significant factors associating with prognosis( P =0.0000～0.0024). Blood transfusion and type of cirrhosis were closely correlated with tumor-free survival ( P =0.0001). Conclusions Curative resection, tumor size, reoperation for recurrence were important factors for recurrence by multivariate analysis. The severity of concomittant liver cirrhosis and perioperative blood transfusion were closely correlated with postoperative tumor free survival.

BACKGROUND:The molecular mechanism of periprosthesis osteolysis is not yet completely clear. Periprosthetic osteolysis and absorption is the pathological and physiological process typical of artificial joint loosening. Interleukin-1 can affect bone resorption process through a mitogen-activated protein kinases (MAPK) signaling pathway.
OBJECTIVE:To explore the effects of siRNA-induced interleukin-1 receptor-associated kinase-4 gene (IRAK-4) silence on MAPK expression in MG63 cells, which may provide experimental basis for treatment and prevention of periprosthesis osteolysis.
METHODS:The siRNA sequences of the target gene, IRAK-4, were constructed and transferred into MG63 cells using Lipofectamine 2000. There were three groups:blank group=MG63 cells, control group=MG63 cells transfected with scrambled IRAK-4siRNA, and silence group=MG63 cells transfected with specific IRAK-4 siRNA. The protein level of extracellular regulated kinase (ERK), c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinases (p38MAPK) were detected by western blot assay.
RESULTS AND CONCLUSION:The expression of IRAK-4 mRNA and protein in the silence group was significantly decreased compared with the control group. Compared with the blank and control groups, 48 hours after the transfection, IRAK-4 gene silencing in MG63 cells decreased protein expression of p-JNK1/2P46, p-ERK1/2 and p-p38MAPK (P<0.05). IRAK-4 silencing inhibited ERK, JNK and p38MAPK expression in osteoblast-like cells.

Objective To investigate the roles of glutamate signaling pathway in the activation of human peripheral blood lymphocytes(PBLs) and pathogenesis of vitiligo.Methods Peripheral blood lymphocytes (PBLs) isolated from 5 patients with generalized vitiligo and 5 healthy controls were cultured in vitro.Flow cytometry was performed to quantify the expression of CD25 and interferon-γ on PBLs derived from healthy controls and treated with MK801 (a non-competitive antagonist of N-methyl-D-aspartic acid receptor,NMDAR) at 100 μmol/L or phosphate buffered saline (PBS) for 48 hours,as well as the level of reactive oxygen species (ROS) in the controlderived PBLs treated with MK801 at 100 μmol/L,NMDA (an agonist of N-methyl-D-aspartic acid receptor) at 0.5 mmol/L or PBS for 48 hours.The protein and mRNA expressions of NMDAR1 and NMDAR2A were measured by flow cytometry and real-time PCR,respectively,in PBLs from the healthy controls and vitiligo patients.Immunohistochemistry was used to observe the expressions of NMDAR1 and NMDAR2A in tissue specimens from depigmented and postinflammatory hyperpigmentation lesions of the patients with vitiligo and from normal skin of the healthy controls.Results Compared with the PBS-treated PBLs from the healthy controls,the MK801-treated PBLs showed a downregulated expression of CD25 (7.28％ ± 0.18％ vs.16.02％ ± 0.42％,P ＜ 0.01),but an upregulated proportion of CD25+IFN-γ+ lymphocytes (1.79％ ± 0.09％ vs.0.78％ ± 0.06％,P ＜ 0.01),and the NMDA-treated PBLs displayed a higher ROS level (101.1 ± 3.50 vs.69.80 ± 2.08,P＜ 0.01 ).The protein expression of NMDAR1 in PBLs was significantly higher in vitiligo patients than in the healthy controls (3.85 ± 2.17 vs.0.97 ±0.55,P ＜ 0.05).Conclusion Glutamate signaling pathway may be involved in the immunopathogenesis of vitiligo via affecting the secretion of interferon-γ by,and ROS level in,activated lymphocytes.

Objective To explore the clinicopathological characteristics in atypical endometrial hyperplasia patients. Methods A retrospective study was carry out on 79 cases with atypical endometrial hyperplasia patients admitted to Department of Gynecology, Peking University People's Hospital from Mar.2007 to Jul. 2010. All patients were divided into two groups, hyperplasia group (merely atypical endometrial hyperplasia, 49 cases, 62%) and cancerization group (atypical endometrial hyperplasia accompanying endometrial carcinoma, 30 cases, 38%). Results The mean age of 79 cases were (50 ± 11) years old ,while they were (50 ± 10) and (51 ± 11) years old for hyperplasia group and cancerization group, there were not difference (P = 0.994). The gravidity and delivery frequencies were also not differently between two groups. The rates of complicated other diseases were 47% (23/49) and 43% (13/30), which was not significantly different (P = 0.755). The body mass index (BMI) of cancerization group was higher than that of hyperplasia group [(27.9 ± 5.4) vs. (25.2 ± 2.9) kg/m2, P = 0.024]. There were 50% (15/30) and 31% (15/49) menopause cases in two groups, respectively. Among them there were 13/15 and 8/15 cases showed vaginal bleeding. Among premenopausal patients, there were 12/15 and 68% (23/34) showed abnormal vaginal bleeding, but there were not significantly different between two groups (all P ＞ 0.05). The uterine cavity mass found by ultrasonography in the cancerization group patients was more than that in hyperplasia group [73% (22/30) vs. 51% (25/49), P = 0.050]. There were 23 cases (29%), 44 cases (56%) and 12 cases (15%) were diagnosed by dilatation and curettage (D&G), hysteroscopy and hysterectomy, respectively. The rates of diagnosing atypical endometrial hyperplasia by D&G and hysteroscopy were 87 % (21/23) and 93 % (41/44), respectively. The rate of diagnosis of canceration were 6/12 and 12/16, respectively. While, the rate of missed diagnosis of canceration in the atypical endometrial hyperplasia patients by D&G and hysteroscopy were 6/13 and 19% (4/21) ,respectively. Which all did not shown significantly different (P ＞ 0.05). Conclusion Hysteroseopy or D&G should be chosen on those peri-menopausal patients with abnormal bleeding, while those atypical endometrial hyperplasia patients with high BMI and uterine cavity mass diagnosed with D&G and ultrasonography should consider the possibility of canceration.