Objective To analyze and study the implication of dynamic changes in plasma CD62P among patients with obstructive jaundice and cholecystolithiasis.Methods A total of 58 patients diagnosed with choledocholithiasis and jaundice were included in the obstructive jaundice group,and 50 patients were in the cholecystolithiasis group.Peripheral venous blood was collected on preoperative day 3,on opera-tive day,and on postoperative days 3,6,9,12,15,18,and 21 in two groups,and the concentrations of plasma CD62P were measured by ELISA.Comparison of continuous data between the two groups was made by t test.Results The concentrations of plasma CD62P from preop-erative day 3 to postoperative day 18 were significantly higher in the obstructive jaundice group than in the cholecystolithiasis group (P<0.01 across all time points).In the cholecystolithiasis group,the concentrations of plasma CD62P significantly increased on operative day, and the increase continued and reached the peak on postoperative day 3,then followed by a decrease down to the preoperative level on post-operative day 9.In the obstructive jaundice group,the concentrations of plasma CD62P reached the peak on postoperative day 9,followed by a gradual decrease down to the preoperative level on postoperative day 18 and to an even lower level (preoperative level of patients with cho-lecystolithiasis)on postoperative day 21.Conclusion Extrahepatic biliary obstruction may lead to endothelial cell injury and platelet acti-vation,the condition of which is improved with the relief of obstruction.The surgery for obstructive jaundice may lead to much more endothe-lial cell injury and higher platelet activation than that for cholecystolithiasis.

Objective To investigate the effects of the mouse bone marrow cell mutation induced by vechile exhaust. Methods The mice were divided into two groups. The experimental group exposed to car exhaust, after exposure of given days (15 d, 30 d, 45 d, 60 d), bone marrow micronucleus and SCE rates in the experimental group were compared with the control. Results Significant differences had been seen between the two groups in bone marrow micronucleus and SCE rates except the 15 d group. The rate of the bone marrow cell mutation was positively correlated to the periods of exposure to car exhaust. Conclusion Car exhaust has effect of mutation on mouse cells.

Twenty eight patients with multiple organ dysfunction syndrome (MODS) underwent continuous venovenous hemofiltration (CVVH)in ICU from June 2003 to June 2008, including 13 cases treated with predilution mode and 15 with postdilution mode. The changes of oxygenate index( PaO2/FiO2 )during CVVH were retrospectively analyzed. The total case fatality rate of this group of patients was 46%(13/28). There was a significant increase in PaO2/FiO2 of 28 cases during the first 48 h of CVVH (P ＜0. 05);the levels of PaO2/FiO2 in predilution group had increased significantly within 48 h during CVVH (P＜0. 05), while those in postdilution group had not significantly changed (P ＞ 0. 05). There was a significant increase in Pa02/FiO2 for the survival patients during the first 48h CVVH( P ＜ 0. 05 ), while no significantly change in the fatal cases(P ＞0. 05 ). In summary, oxygenate function and outcome of patients with MODS can be improved by CVVH, and predilution may be a more effective mode.

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Hydatid is a common pathogen found in human and animals,incidence of hepatic echinococcosis is high in the west China.In recent years,operation and chemotherapy are basic treatment.Faced with varieties of operational manner,a proper choice is very important.5 operational manners are compared in this article,furthermore,problems in the selection of operational manner is analysed.

Objective To investigate the factors affecting the recovery of immunological function after bilirubin decreasing interventional therapy in patients with obstructive jaundice.Methods 67 patients with malignant obstructive jaundice were investigated.The patients were randomly divided into the enteral nutrition (EN) group (n =34)and the parenteral nutrition (PN) group (n =33).TBIL,DBIL,TSP,ALB,PA,TF,CD3 +,CD4 +,CD8 +,CD4 +/CD8 + were determined before PTCD and at the 7th day after the procedure.Results Except for 20 patients,the levels of TBIL,DBIL,CD8 + significantly declined,and the levels of TSP,ALB,PA,TF,CD3+,CD4+,CD4+/CD8 + significantly increased in the 2 groups of patients.There was no significant difference in the recovery of liver function and immunological status between the PN and the EN groups.Conclusions The recovery of immunological function was significantly associated with reduction of serum bilirubin in patients with malignant obstructive jaundice.There was no relationship with the ways of nutrition support.

Objective To summarize the effect of supra-arch branches bypass combined with endovascular aortic repair for aortic diseases.Methods From January 2012 to August 2015,120 cases of thoracic aortic diseases (aortic dissection 103,aortic aneurysm 16,penetrating aortic ulcer 1) received hybrid operation in Guangdong Cardiovascular Institute.Vascular bypass was established among the brachiocephalic arteries,followed by endovascular repair through femoral artery either one-stage or two-stage.Patients were followed up for 3-24 months.Results Technical success was achieved among all the patients.Five patients died after the operation(one patient had retrograde aortic dissection,2 patients had pericardial tamponade,one patient had apnea,and one patient had respiratory and cardiac arrest.The death rate is 4.1％),4 patients had stroke,among them,symptoms were relieved in three patients,one patient was not cured.Total 92 patients were followed-up and had no symptoms of up-limb ischemia or dizziness.CT scan showed bypass graft and endovascular stent patency.6 patients had endoleak (type Ⅰ b 2 cases,type Ⅱ 3 cases,and type Ⅲ 1 case),distal aortic dissection occurred in one patient,three patients had mild contrast agent leakage around the distal endovascular stent,type A aortic dissection occurred in one patient,there were no late stage death.Conclusion Supraarch branches bypass combined with endovascular aortic repair for treating aortic disease is minimally invasive,safe,and can reduce the incidence of postoperative complications.

Objective To compare the efficacies of early intensive and moderate insulin therapy on the prognosis of patients with severe acute pancreatitis (SAP).Methods The clinical data of 78 patients with SAP complicated by hyperglycemia who were admitted to the Second Hospital of Lanzhou University from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into the intensive insulin therapy (IIT)group (31 patients) and moderate insulin therapy (MIT) group (47 patients).The target levels of blood glucose were 0.80-1.10 g/L(4.4-6.1 mmol/L) in the IIT group and 1.44-1.80 g/L(8.0-10.0 mmol/L) in the MIT group,respectively.The effects of the 2 therapies on the prognosis of the patients were compared.All data were analyzed by the t test or chi-square test.Results The daily intravenous insulin dosage,fasting glucose level and incidence of severe hypoglycemia were ( 35 ± 11 ) u,( 1.02 ± 0.13 ) g/L[ (5.7 ± 0.7 ) mmol/L] and 10％ (3/31 )in the IIT group,and ( 24 ± 15 ) u,( 1.58 ± 0.21 ) g/L[ ( 8.8 ± 1.2 ) mmol/L] and 2％ ( 1/47 ) in the MIT group.A significant difference was detected in the daily intravenous insulin dosage between the 2 groups( t =12.76,P ＜=0.05),but no significant difference was detected in the incidence of severe hypoglycemia between the 2 groups (x2 =0.91,P ＞ 0.05 ).The levels of albumin and prealbumin on the 14th day were ( 34 ± 6) g/L and (231 ± 31 ) mg/L in the IIT group,and (35 ± 5)g/L and (241 ± 29)mg/L in the MIT group,respectively,with no significant difference between the 2 groups( t =-1.94,-1.68,P ＞ 0.05).The incidences of abdominal infection,circulatory dysfunction,respiratory dysfunction and acquired kidney injury were 23％ (7/31),32％ (10/31),26％ (8/31)and 13％ (4/31) in the lIT group,and 26％ (12/47),36％ ( 17/47),30％ (14/47) and 23％ (11/47) in the MIT group,with no significant difference between the 2 groups(x2 =0.09,0.13,0.15,1.33,P ＞ 0.05).The scores of APPACHE Ⅱ on the 14th day were 9 ± 4 in the IIT group and 9 ± 3 in the MIT group,respectively,with no significant difference between the 2 groups ( t =- 0.60,P ＞ 0.05 ).There were 4 ( 13％ ) patients in the IIT group and 7( 15％ ) patients in the MIT group died of multi-organ dysfunction syndrome,including 2 patients in the IIT group and 6 patients in the MIT group complicated with sepsis.There was no significant difference in the mortality between the 2 groups ( x2 =0,P ＞ 0.05 ).Conclusions Compared with MIT,early IIT could not improve the prognosis of the patients with SAP.MIT is appropriate for SAP patients complicated with hyperglycemia.

Objective To investigate the effect of escitalopram combined neuro-linguistic programming treatment(NLP) on cognitive function in patients with somatoform disorders.Methods 120 cases with somatoform disorders were randomly divided into the escitalopram monotherapy group and escitalopram with NLP combined group,with 60 cases in each group for six weeks.At baseline and after six weeks for treatment,it was respectively assessed that the efficacy using Symptom Checklist 90 and Global Assessment Function,and cognitive function using the Raven Standard Progressive Matrices Test,digit span and digit symbol tests in Adult Wechsler Intelligence Test,while event related potentials P300 were detected.60 cases normal healthy adults as controls.Results Compared with the control group,the Raven scores,digit span,digit symbol scores were lower (P ＜0.01),N1,P3 latent periods were longer (P ＜ 0.01 or ＜ 0.05),N1N2,N2P2,P2P3 amplitudes were less(P =0.00) in patients with somatoform disorders.After treatment,Raven scores(91.25 ± 14.87,95.60 ± 19.95),digit span scores (11.98 ± 1.89,10.90 ± 2.76),digit symbol scores (11.71 ± 2.89,11.92 ± 2.90),N2P2 amplitudes ((11.32 ± 6.67) μV,(13.39 ± 9.31) μV),P2P3 amplitudes ((9.04 ± 6.14) μV,(9.51 ± 7.17) μV) increased,N2 latent periods ((240.60 ± 41.41) ms,(238.31 ± 41.47) ms) prolonged,N1 latent periods shortened (P ＜ 0.05 or 0.01) in the monotherapy group and the combined group.The digit span,P2 latent periods,N1N2,N2P2,P2P3 amplitudes had statistically significant differences between monotherapy group and combined group after treatment(P ＜ 0.05 or 0.01).Conclusion Both escitalopram monotherapy and escitalopram combined NLP have improved cognitive function in patients with somatoform disorders,but combined therapy has more prominent advantage.

Some locally advanced tumors involving multiple abdominal organs without distal metastasis may cause digestive tract obstruction.Some of these patients can achieve long-term survival after Ro resection,others can obtain digestive tract obstruction relief,pain anesis and survival prolongation after R1 resection combined with postoperative comprehensive treatment.In this review,the efficacy of complex pancreaticoduodenectomy combined with organs resection was introduced based on reviewing the literatures.After the surgery,some patients achieved R0 resection and long-term survival,and the quality of life was significantly improved in some patients.