Objective To investigate the diagnosis and treatment of Mirizzi syndrome.Methods 6 cases of Mirizzi syndrome were analyzed with review of the latest literatures on its diagnosis and treatment.Results None of the 6 cases were definitely diagnosed by ultrasonography and CT.All of them underwent operations,five of them were cured and one died.Conclusions Ultrasonography and CT can give a hand to diagnosis.Definite diagnosis depends on ERCP and PTC.The specific conditions of the patients and the experience of surgeon decide the selection of treatment.Subtotal cholecystectomy and hepaticojejunostomy are the basic choices.

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45-80 kg, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective abdominal surgery, were randomly assigned into 2 groups (n =40 each) using a random number table: control group (group C) and dexmedetomidine group (group D).After routine induction of anesthesia, all the patients were tracheally intubated, and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45-60.After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery in group D.Group C received normal saline instead.Heart rate (HR) and mean arterial pressure (MAP) were recorded at the end of surgery, and at 1 min before and after extubation.The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded.Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D.Conclusion Dexmedetomidine infused in a dose of 1 μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.

Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT3D-TEE) in non-valvular atrial fibrillation with left atrial appendage(LAA) stunning after catheter ablation.Methods Clinical and echocardiographic variables were analyzed by univariate regression in order to investigate the relationship between the group of LAA stunning and others in 28 patients after catheter ablation.Results Univariate analysis revealed difference in persisting time of atrial fibrillation[(16.4 ± 11.6)weeks vs (21.3 ± 18.6) weeks,P ＜0.05],left atrial diameter[(43.4 ± 8.3) mm vs (47.6 ± 5.9) mm,P ＜0.05 ],left atrial emptying fraction (0.38 ± 0.04 vs 0.30 ± 0.09,P ＜0.05).LAA emptying fraction based on three-dimensional volume measurements had significant difference (0.20 ± 0.03 vs 0.12 ± 0.02,P ＜ 0.001) between the group of LAA stunning and other cases.Conclusions LAA ejection fraction calculation by RT3D-TEE is feasible and more accurate than by clinical and other echocardiographic in LAA stunning after ablaton of atrial fibrillation.

BACKGROUND: Diabetic cardiomyopathy, a serious complication of diabetes, is an important factor of increased mortality in patients with diabetes. Therefore, providing an effective experimental animal model is particularly important for studying the pathogenesis and treatment methods of diabetic cardiomyopathy. OBJECTIVE:To explore the method of establishing Wistar rat models of diabetic cardiomyopathy. METHODS:Forty rats were randomly divided into the control group (n=10) and diabetic cardiomyopathy group (n=30). The rats in the diabetic cardiomyopathy group were intraperitonealy injected with 60 mg/kg streptozotocin at a time to establish rat models of diabetic cardiomyopathy. The rats in the control group were given the same dosage of citric acid buffer by the same way. The rats in these two groups were al fed with non-fat high-sugar normal diet. RESULTS AND CONCLUSION:Compared with the control group, after 3 weeks of injection with streptozotocinin in rat models of diabetic cardiomyopathy, blood glucose level was significantly increased, myocardial cels arranged in disorder, the nuclei were of different sizes, colagen content in the myocardial tissue was significantly increased, and colagen fibers were thick and disordered. In addition, the mRNA and protein levels of transforming growth factorβ1 and type I colagen, two indices reflecting myocardial fibrosis, were markedly increased. These results indicate that intraperitonealy injecting large doses of streptozotocin (60 mg/kg) at a time and feeding with non-fat high-sugar normal diet could establish a stable rat model of type 1 diabetic cardiomyopathy. This method is safe and effective with high feasibility.

AIM:To explore the effects of transforming growth factor-α( TGF-α) in the monoclonal formation , proliferation, migration and adhesiveness of human endothelial progenitor cells ( EPCs).METHODS: The isolated and cultured EPCs were treated with various concentrations of TGF-α(final concentrations of 1, 5, 10μg/L, respectively).At the same time, the PBS control and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) group (10μg/L TGF-αplus 1∶1 000 EGFR-TKI) were set.The effects of TGF-αon monoclonal formation , proliferation, migration and adhesiveness of EPCs were determined by clone formation experiment , thiazolyl blue tetrazolium bromide (MTT), EdU, Transwell and adhesion assays , respectively.The expression of epithelial growth receptor (EGFR) and vascular endothelial growth factor ( VEGF) were measured by Western blotting .RESULTS:Different concentrations of TGF-αall significantly induced the monoclonal formation , proliferation, migration and adhesiveness of EPCs (P<0.01), which were inhibited by EGFR-TKI.The results of Western blotting showed that TGF-αalso induced the expression of EGFR and VEGF with a cer-tain concentration effect ( P<0.01) .CONCLUSION:By combining with EGFR induced the expression of VEGF , TGF-αsignificantly promotes the related cell function of monoclonal formation , proliferation, migration, adhesiveness in EPCs.

Objective To investigate the change and clinical significance of blood D-dimer level during perioperative period in ad-vanced age hip fracture.Methods The blood D-dimer level in 60 patients aged over 80 years old with hip fracture was detected be-fore operation and after operation,which including at admission(T1 ),immediately preoperation(T2 ),immediately postoperation (T3 )and on postoperative 1 d (T4 ).Results The positive rates of D-dimer at T1 ,T2 ,T3 and T4 were 6.67%,16.45%,41.67%and 80.00% respectively;there were statistically significant differences between T3 ,T4 and T1 ,T2 ,between T3 and T4 (P <0.05);there was no statistically significant difference between T1 and T2 (P >0.05).Conclusion The level of D-dimer in advanced age hip fracture has significant change before and after operation.The change of the D-dimer positive rate is an effective index for preven-ting lower limbs deep venous thrombosis and has the important clinical significance to dynamically monitor the D-dimer level during perioperative period in advanced age hip fracture.

Objective To explore the relationship between the expression of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) in gestational trophoblastie diseases and its invasiveness.Methods The expression and distribution of MMP-7,MMP-9,TIMP-1 and TIMP-2 were determined by immunohistochemistry PV-6000 in 49 cases of hydatidiform mole (eight of them with malignant transformation),six cases of invasive hydatidiform mole,two cases of choriocarcinoma and 18 cases with normal villi in early pregnancy.Results The expression of MMP-7,MMP-9,TIMP-2 and MMP- 9/TIMP-1 was significantly higher in choriocareinoma,invasive mole and malignant transformed mole than that in normal villi in early pregnancy and non-malignant transformed mole (F=10.950,7.760,7.304, 3.442;P

Objective: To prepare an adenovirus, Ad-CD, expressing bacterial cytosine deaminase(CD),and use it for tumor suicide gene therapy. Methods: We constructed a recomb ined adenoviral vector carrying CD or LacZ. 293 packaging cell was trans fected by the newly-constructed plasmid and generated the infectious virus. The n the adenovirus was used to infect C26 cell in vitro. Results: The growth of Ad-CD-infected cell was obviously surpressed after admini stration of 5-FC. Conclusion: CD gene carried by adenoviral vec tor is effective for tumor cell suicide gene therapy in vitro.

ObjectiveTo evaluate the expression of interleukin-1 β ( IL-1β) ; interlenkin-8 ( IL-8 ) ; tumor necrosis factor-α,(TNF-α) in induced sputum in different stages of stable chronic obstructive pulmonary disease (COPD) and heath smoking controls.Methods90 healthy smoking controls and 100 stable COPD patients were enrolled.The levels of IL-1β,IL-8 and TNF-α in induced sputum were detected by radioimmunoassay.ResultsThe levels of IL-1β,IL-8 and TNF-α in stable COPD patients were much higher than those in healthy smoking controls (P =0.000).There are an inverse correlation between FEV1 and levels of IL-1 β,IL-8 and TNF-α in induced sputum (r=-0.678,-0.752,-0.615,all P＜0.05).ConclusionIL-1β,IL-8 and TNF-α may play important roles in the mechanism of airway inflammation in stable COPD.The levels of IL-1 β,IL-8 and TNF-α in induced sputum may be a marke of severity of airway inflammation in stable COPD.

Objective To study the efficacy of minimally invasive treatment for lower extremities venous ulcers.Methods A total of 48 patients with lower extremities venous ulcers(56 hmbs)wereexamined with venography to identify the primary lesion that resulted ulcer. According to the type and degree of hemedynamie abnormality,high ligation of the great saphenous vein combined with endovenous laser treatment,subfascial endoscopic perforator surgery,and external banding valvuloplasty of the superficial femoral vein were done in 8 eases(8 limbs),high ligafion of the great saphenous vein combined with endovenous laser treatment and subfascial endoscopic perforator surgery were carried out in 24 cases(28 limbs),and high figation of the great saphenous vein combined with endovenous laser treatment was performed on 16 cases(20 linbs).In all cases,the ulcers were eircumferentially ligated at the same time.Results After the operations,superficial varicosis,pigmentations,and eczematous relieved remarkably in the 56 limbs.In 51 limbs,heavy feeling,ache,and edema disappeared 14-18 days after operation.The ulcers of the 56 limbs healed l6-48 days after operation.During 4 to 46 months follow up,ulcers recurred in 4 limbs(7.1%).Conclusions It is effective to correct the incompetence of the superficial,perforating,and deep veins and manage the surface of ulcers for lower extremities venous ulcers.Endovenous Iaser treatment and subfascial endoscopic perforator surgery are easily performing,minimally invasive,and safe operations.The recurrence of leg ulcers can be reduced by external banding valvuloplasty of the superficial femoral vein.