According to the ultrasonic manifestations of the gall bladder before laparoscopic cholecystectomy(LC),including size,morphology,wall thickness,presence or absence of gallstone,congenital anomaly of biliary duct,surrounding adhesion and state of common bile duct,tbe patients Werc dividcd into 4 groups:A.Most suitable for LC,B.Sitable for LC,C.Relatively suitable for LC. D.Not suitable for LC.This provided clinicians the basis for patient selection.Comparing with the sur.gical findings,the coincidence rate of B-mode ultrasonography was 97.8%.Preoperative B-mode ul-trasonography of gall bladder has significant clinical value to relieve the patients from pain,decrease the operative risk and conversion rate of LC.

BACKGROUND: The treatment of upper cervical spine disorders through a posterior pedicle fixation approach have been carried out in some domestic large hospitals, but this surgery is still considered as a difficulty of cervical spine surgery. In order to minimize the risk of surgery, the authors designed a program of individual operations, and combined with self-developed pedicle locating and directing speculum to determine precise intraoperative position of pedicle screws, and no report is found by searching related database in China.OBJECTIVE: To improve the one-time success rate of internal fixation screws, to investigate the biomechanical effect of the implant, to formulate a simple, practical, individual protocol for atiantoaxial pedicle screw-plate system based on related data. METHODS: A total of 31 patients were recruited from Department of Orthopaedics in the 251 Hospital of Chinese PLA, between January 2002 and September 2006. Under the guidance of self-made atlantoaxial locating and directing speculum, the entrance point and angle for screw insertion, as well as screw diameter and length were determined according to the results of X-ray and CT measurement. Atlas pedicle screw was inserted at left (19.93±1.32) mm, and right (19.16±1.3) mm; Atlas pedicle screw insertion angle to inside was left (23.72±2.09)°, and right (23.35±1.91)°; Atlas pedicle screw insertion angle to side of head was (9.00±1.20)°. Axis pedicle screw was inserted at left (13.14±0.82) mm, and right (13.85±0.79) mm; Axis pedicle screw insertion angle to inside was left (24.52±1.26)°, and right (20.42±1.42)°; Axis pedicle screw insertion angle to side of head was (25.00±3.00)°.RESULTS AND CONCLUSION: ①Totally 124 pedicle screws were implanted into 31 patients, and 122 screws were of one-time success. The precision rate was 98.39%. Two screws were secondly inserted because of cutting lateral cortical bone of pedicle for deviation of inward angle. ②Occipital neuralgia was found in 2 cases postoperatively and cured after one month of treatment;screws penetrated atlas left vertebral lateral wall in 2 cases, no spinal or vertebral artery injury was found. ③Radiographs showed that atlas was completely reduced in all patients, and apposition of dentoid process of axis fracture was good. CT films showed the screws a good location to the vertebrarterial spinal cord. ④The follow-up visit was averaged of 10.5 months. Bony fusion was found in all patients. No screw-plate breakage was found. No inflammatory or rejection reactions occurred.⑤By JOA scale, there were 16 cases of excellent, 12 cases of good, 2 cases of fine, and 1 case of poor. The excellent and good rate was 90%. It is suggested that the success rate of atlantoaxial pedicle screw-plate mplantation can be improved through a biomechanical angle.

Objective To explore the clinical effect of the atlanto-axial pedicle screw internal fixation to reconstruct upper cervical spine instability. Methods Using atlanto-axial pedicle screw and internal fixation system combined with autogenous iliac bone graft to treat 21 patients with upper cervical spine instability. Type Ⅱ odontoid process old fracture was 13 patients, odontoid process nonunion was 5 patients, injury of the transverse ligament was 3 patients. They were placed in 84 atlanto-axial pedicle screws, autogenous bones were placed in the posterior arch of atlas and axis to fusion, so that atlanto-axial complex got stabilized. Results The left lateral cortical bone of atlas vertebral pedicle was broken by screws in 2 patients, but the spinal cord and vertebral artery was intact. X-ray film showed the atlas and the fracture of dens of axis was completely replaced in all patients. The position of screw and vertebral artery or spinal cord was good in CT image. According to JOA score standard, 15 cases of all were excellent, 3 cases were good,2 cases were common,1 case was bad, and the rate of excellent and good was 85.71%(18/21).Seventeen cases were followed up for 12-26 (12.83 ± 4.23) months, all patients had acquired bone fusion and found no screw and plate fracture. Conclusions Atlanto-axial pedicle screw combined with screw-plate system fixation to treat upper cervical spine instability, can significantly enhance the biomechanical stability of the atlanto-axial interbody, bone grafting fusion rate is higher, the application value of the atlanto-axialfusion is higher.

Objective Using polysulfon fibers, a new bioartificial liver was developed. This study was to evaluate the efficacy of this bioartificial liver in the support of a disfunctioned liver. Methods Hepatocytes were procured from swine using Seglen′s methods. The bioartificial liver was constructed based on polysulfon bioreactor with a procurement of 10 10 hepatocytes, and was applied in 12 acute liver failure patients for 14 sessions. Each BAL treatment lasted 6 hours. The general conditions of the patients and the biochemical parameters were evaluated. Results After treatment with bioartificial liver, ammonia, prothrombin time and total bilirubin level significantly decreased (all P

Objective To track the migration and incorporation of intravenously injected, magneti?cally labeled endothelial progenitor cells ( EPCs) from mouse bone marrow into the blood vessels in a rapid?ly growing HCC model by microMR (7.0 T). Methods This study was approved by the Institutional Com?mittee on Animal Research. H22 hepatic ascitic cancer cells was directly injected into the left liver lobe of BALB/c nude mice ( n=15) . EPCs derived from bone marrow of C57BL/6 mice were isolated and cultured. The third passage EPCs were collected and labeled with 25 μg/ml superparamagnetic iron oxide ( SPIO) and poly?l?lysine (PLL) complex (SPIO?PLL). MTT assay and flow cytometry were used to evaluate the difference of growth curve and apoptosis between labeled and unlabeled EPCs. EPCs labeled with SPIO?PLL were injected into mice via tail vein in experiment group (on the 3rd day after establishing HCC model) (n=15) and control group (n=6). The signal changes of tumor (the 1st, 3rd and 7th day after transplantation) were observed by microMR. Prussian blue staining and immunohistochemistry staining of CD31 were per?formed. MRI findings were confirmed by histomorphology. Two?sample t test was used to analyze the data. Results Single tumor was showed in the liver of all mice 3 d after establishing models. Labeling with SPIO?PLL at a concentration of 25μg/ml did not alter cell growth curve ( measured by MTT assay;t=0.281, P>0.05) and cell apoptosis (analyzed by flow cytometry). The apoptosis rates of SPIO?PLL labeled and un?labled EPCs were (12.31±1.43)% and (11.57±1.24)% in early stage, and (0.55±0.07)% and (0.49± 0?05)% in late stage. No significant differences were observed between them (t=0.967, 1.060; both P>0?05) . Migration and incorporation of transplanted and labeled cells into tumor were documented with in vivo microMR as low signal intensity at the tumor periphery as early as the 3rd day after EPCs administration in preformed tumors (4/5). Prussian blue staining showed iron?positive cells at the sites corresponding to low signal intensity on MRI. The positive cells expressing CD31 existed in intratumoral and peritumoral vessels. There was no signal change in control group at all time points. Conclusions MRI can demonstrate the in?corporation of magnetic labeled mouse EPCs into the implanted hepatoma. It may be helpful for early diagno?sis and therapy of liver tumor.

Objective To investigate the effects of extract from couple medicinals of strengthening healthy qi and eliminating pathogenic qi, i.e.Huangqi(Radix Astragali, astragalus root) and Ezhu (Rhizoma Curcumae, curcumae rhizome), and oxaliplatin(L-OHP)on inhibiting metastasis of CT26 wild-type(CT26.WT)cells, and regulating CXCR3, CCR6 mRNA, and protein expression in rats with colon cancer.Methods Orthotopic transplantation model of BALB/c colon carcinoma was built in mice.L-OHP or L-OHP combined with extract from huangqi and ezhu were given to the mice model.Effects of those medicines on liver metastasis were observed.CXCR3 and CCR6 mRNA expression were measured by using RT-PCR, and CXCR3, CCR6 protein expression was detected with Western Blot.Results L-OHP group and L-OHP combined with Chinese medicinal groups exhibited inhibitive effects on orthotropic tumor growth, and best effect was observed in positive expression (P<0.01).L-OHP combined with TCM can decrease the incidence of liver metastasis (P<0.05).Compared with the control group, mRNA expressions of CXCR3 and CCR6 decreased in the model group and low-dose group (P<0.01).Effects of L-OHP combined with low-dose Chinese medicine were more effective than other groups(P<0.01).Compared with the control group, CXCR3 and CCR6 protein expressions decreased sinificantly in all groups(P<0.05 or P<0.01).Conclusion Mechanism of huangqi, ezhu and oxaliplatin(L-OHP) to inhibit tumor metastasis may relate to downregulation of CXCR3, CCR6 mRNA and protein expression.

OBJECTIVE:To study the effect of Xuchangqing-ermiaosan-santeng formula on the contents of tumor necrosis fac-tor α(TNF-α)and ossification-related factor DKK-1 in serum of model mice with arthritis,and reveal its mechanism in the treat-ment of arthritis. METHODS:60 BALB/c mice were randomly divided into normal group,model group,sulfasalazine group(posi-tive control,9 mg/kg) and Xuchangqing-ermiaosan-santeng formula low-dose,medium-dose,high-dose groups (calculated by crude drug as 11.25,22.5,45 g/kg),10 in each group. Except for normal group,other 50 mice were intraperitoneallly injected complete Freund's adjuvant + proteoglycans to induce model with arthritis. After modeling,mice in each administration group were intragastrically administrated relevant medicines,mice in normal group and model group were intragastrically administrated equal volume of normal saline,once a day,for 20 d. After administration,enzyme-linked immunosorbent assay was used to detect the contents of TNF-αand DKK-1 in serum of mice in each group,and ultrastructural changes of sacroiliac joint synovial cells were ob-served by transmission electron microscopy. RESULTS:Compared with normal group,TNF-α content in serum in model group was obviously increased,DKK-1 content was obviously decreased (P<0.05);sacroiliac joint synovial cells showed hyperplasia, organellar deformation,mitochondrial swelling and other pathologic damage. Compared with model group,TNF-α contents in se-rum in each administration group were obviously decreased(P<0.05 or P<0.01);except for sulfasalazine group,the DKK-1 con-tent of mice in other administration groups were obviously increased (P<0.05). Pathologic damages of sacroiliac joint synovial cells in each administration group were reduced to varying degrees,and improvement degree in Xuchangqing-ermiaosan-santeng for-mula groups was higher than sulfasalazine group. CONCLUSIONS:Xuchangqing-ermiaosan-santeng formula may inhibit the sacroil-iac arthritis and pathological ossification of model mice with arthritis by decreasing TNF-α content and increasing DKK-1 content in serum.

OBJECTIVE To examine the reversal effect of desipramine (DMI) on resistance to temozolomide(TMZ) in U251/TR cells and explore its mechanism. METHODS U251/TR cells were exposed to DMI (20-80μmol · L-1) or TMZ (0.5-10 mmol · L-1) for 24 h, cell viability was determined by cell counting kit-8 assay with IC50 calculated. The cytotoxicity of U251/TR cells treated with TMZ (1 or 2 mmol·L-1) in combination with DMI (20, 30 or 40 μmol · L-1) for 24 h was detected using CCK-8 assay. Synergism between DMI and TMZ was analyzed by the JIN Zheng-jun method. Apoptosis of U251/TR cells induced by TMZ 1 mmol · L-1, DMI 30 μmol · L-1,or their combination was examined by Hoechst33258 stains and caspase 3 activity was detected by luminescence analysis. Expression of C/EBP homologous protein (CHOP) was measured using quantitative real-time PCR and Western blotting. The survival rate of U251/TR cells treated with TMZ 1 mmol·L-1 and/or DMI 30μmol·L-1 was also assessed after silencing CHOP expression by small interference RNA (siRNA). RESULTS DMI or TMZ alone inhibited the growth of U251/TR cells significantly in a concentration-dependent manner (r 2=0.983,0.982,P<0.05), with the IC50 (33.6 ± 0.5)μmol · L-1 and (2.5 ± 0.6)mmol · L-1, respectively. The cell viability inhibitory rate of U251/TR cells by TMZ (1 or 2 mmol · L-1) combined with DMI (20, 30, or 40μmol · L-1) was greater than that by TMZ or DMI alone (P<0.05). The JIN Zheng-jun analysis revealed that combination of DMI and TMZ produced synergistic cytotoxicity (Q>1.15), ie, compared with TMZ alone, TMZ (1 mmol·L-1) com?bined with DMI (30 μmol · L-1) produced significant nuclear fragmentation and condensation (P< 0.05). In addition, DMI and TMZ in combination activated caspase 3 activity in U251/TR cells (P<0.05). Knock?down of CHOP by specific siRNA attenuated the synergistic effect of DMI in the presence of TMZ, the survival rate of the combined drug group raised from 51.8%to 62.2%(P<0.05). CONCLUSION The results suggest that DMI reverse resistance of U251/TR cells to TMZ through activation of the CHOP-depend?ently apoptosis pathway.

Objective To investigate the risk factors of perineal incision complications after abdominoperineal resection (APR) for rectal cancer, and to establish a nomogram model to predict the complications of perineal incision. Methods A case?control study was conducted to retrospectively collect the medical records of 213 patients with colorectal cancer who underwent APR at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2016. The complications of perineal incision after APR were classified according to the modified Clavien?Dindo classification of surgical complications (Version 2019), and the complications of grade II and above were defined as"clinically significant complications".Twenty?two factors related to complication of perineal incision, such as gender, age, surgical procedure, surgical approach, perineal repair, placement of drainage tube, skin position of drainage tube, operation time, intraoperative blood loss, preoperative radiotherapy and chemotherapy, intraoperative local perfusion chemotherapy, tumor classification, pathological grade, tumor T stage, tumor TNM stage and so on, were analyzed by chi?square test for univariate risk factor of complication in all variables, and variables with P<0.2 in univariate analysis were further included in multivariate analysis. Logistic regression analysis was used to screen out independent risk factors. R software (R 3.3.2) was introduced. The rms software package was used to construct a nomogram prediction model. The C?index was calculated (higher meaning better consistency with actual risk) to evaluate the discriminant degree of the model. The Bootstrap method was used to repeat the sampling for internal verification. A total of 42 patients with colorectal cancer who underwent APR from January 2017 to December 2017 at the First Affiliated Hospital of Nanjing Medical University were externally validated, and the corrected C?index was calculated. The model conformity was determined by comparing the C?index calibration difference between the predicted and actual risks. Results Of the 213 patients with colorectal cancer, 131 were male and 82 were female, with mean age of (59.6 ± 11.6) years. The incidence of postoperative perineal incision complications was 20.2% (43/213), including 27 cases of Clavien?Dindo II and above complications. Univariate analysis showed that the Eastern Cancer Cooperative Group (ECOG) score, preoperative albumin, skin position of drainage tube, intraoperative blood loss, preoperative radiotherapy and chemotherapy were associated with complications of postoperative perineal incision (All P<0.05). Multivariate analysis showed that preoperative albumin levels ≤38 g/L (OR=105.261, 95% CI: 7.781 to 1423.998, P<0.001), perinead drainage (OR=11.493, 95% CI: 1.379 to 95.767, P=0.024), intraoperative blood loss>110 ml (OR=6.476, 95% CI: 1.505 to 27.863, P=0.012) and preoperative radiotherapy and chemotherapy (OR=7.479, 95% CI: 1.887 to 29.640, P=0.004) were postoperative clinically significant independent risk factors for perineal incision complications. The nomogram model was established. Preoperative albumin level <38 g/L was for 100 points, the preoperative chemoradiotherapy was for 52.5 points, the intraoperative blood loss>110 ml was for 28.5 points, and the perineal drainage was for 17.5 points. Adding all the points was the total score, and the complication rate corresponding to the total score was the predicted rate of the model. The model had a C?index of 0.863. After internal verification, the C?index dropped by 0.005. External verification showed a C?index of 0.841. Conclusions Preoperative nutritional status, skin position of drainage tube, intraoperative blood loss and preoperative radiotherapy and chemotherapy may affect the occurrence of perineal wound complications after APR for rectal cancer. The nomogram model constructed in this study is helpful for predicting the probability of clinically significant complications after APR.

Objective To investigate the risk factors of perineal incision complications after abdominoperineal resection (APR) for rectal cancer, and to establish a nomogram model to predict the complications of perineal incision. Methods A case?control study was conducted to retrospectively collect the medical records of 213 patients with colorectal cancer who underwent APR at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2016. The complications of perineal incision after APR were classified according to the modified Clavien?Dindo classification of surgical complications (Version 2019), and the complications of grade II and above were defined as"clinically significant complications".Twenty?two factors related to complication of perineal incision, such as gender, age, surgical procedure, surgical approach, perineal repair, placement of drainage tube, skin position of drainage tube, operation time, intraoperative blood loss, preoperative radiotherapy and chemotherapy, intraoperative local perfusion chemotherapy, tumor classification, pathological grade, tumor T stage, tumor TNM stage and so on, were analyzed by chi?square test for univariate risk factor of complication in all variables, and variables with P<0.2 in univariate analysis were further included in multivariate analysis. Logistic regression analysis was used to screen out independent risk factors. R software (R 3.3.2) was introduced. The rms software package was used to construct a nomogram prediction model. The C?index was calculated (higher meaning better consistency with actual risk) to evaluate the discriminant degree of the model. The Bootstrap method was used to repeat the sampling for internal verification. A total of 42 patients with colorectal cancer who underwent APR from January 2017 to December 2017 at the First Affiliated Hospital of Nanjing Medical University were externally validated, and the corrected C?index was calculated. The model conformity was determined by comparing the C?index calibration difference between the predicted and actual risks. Results Of the 213 patients with colorectal cancer, 131 were male and 82 were female, with mean age of (59.6 ± 11.6) years. The incidence of postoperative perineal incision complications was 20.2% (43/213), including 27 cases of Clavien?Dindo II and above complications. Univariate analysis showed that the Eastern Cancer Cooperative Group (ECOG) score, preoperative albumin, skin position of drainage tube, intraoperative blood loss, preoperative radiotherapy and chemotherapy were associated with complications of postoperative perineal incision (All P<0.05). Multivariate analysis showed that preoperative albumin levels ≤38 g/L (OR=105.261, 95% CI: 7.781 to 1423.998, P<0.001), perinead drainage (OR=11.493, 95% CI: 1.379 to 95.767, P=0.024), intraoperative blood loss>110 ml (OR=6.476, 95% CI: 1.505 to 27.863, P=0.012) and preoperative radiotherapy and chemotherapy (OR=7.479, 95% CI: 1.887 to 29.640, P=0.004) were postoperative clinically significant independent risk factors for perineal incision complications. The nomogram model was established. Preoperative albumin level <38 g/L was for 100 points, the preoperative chemoradiotherapy was for 52.5 points, the intraoperative blood loss>110 ml was for 28.5 points, and the perineal drainage was for 17.5 points. Adding all the points was the total score, and the complication rate corresponding to the total score was the predicted rate of the model. The model had a C?index of 0.863. After internal verification, the C?index dropped by 0.005. External verification showed a C?index of 0.841. Conclusions Preoperative nutritional status, skin position of drainage tube, intraoperative blood loss and preoperative radiotherapy and chemotherapy may affect the occurrence of perineal wound complications after APR for rectal cancer. The nomogram model constructed in this study is helpful for predicting the probability of clinically significant complications after APR.