Objective To study the prevention and management of early post-cholecystectomy jaundice.Methods The dinical data of 43 cases of jaundice occurring within one week after simple open cholecystectomy in 11 226 cases were retrospectively analyzed.Results The incidence of jaundice at one week after operation was 0.38% in simple open cholecystectomy,among them,medical jaundice accounted for 18 cases,and surgical jaundice for 25cases.Ultrasound,ERCP,MRCP,liver enzyme profile and reoperation confirmed the folowing: Extra-hepatic bile duct or the right hepatic duct was ligated in 9 cases,common bile duct residual stone in 6,partial gallbladder or gallbladder duct stone in 4,biliary leak in 4,cholangitic hepatitis in 4,hepatitis B or posthepatitis cirrhosis in 5,icterus after blood transfusion in 2,hemobilia in 2,ligation of right branch of hepatic artery in 2,and icterus of unknown causes in 5 cases.Reoperation was done in 8 cases,with one mortality.Conclusions Detailed case history,adequate examination before operation,and careful operative technique are the essential prerequisites to prevent early post-cholecystectomy jaundice.Early post-cholecystectomy jaundice should be treated according to the different causes.

Objective To present the experience with scarf-liking esophagojejunal anastomosis to decrease the anastomotic leak. Methods An analysis of the clinical outcome of 86 consecutive patients from January 2000 to October 2008 who underwent scarf-liking esophagojejunal anastomosis after total gastrectomy for advanced gastric carcinoma. Results Two of these patients died, the operative mortality rate was 2.3%. Eighty-four survivals were followed up for 2-95(44±3) months. None of the survivals developed anastomotic leak and reflux esophagitis. Anastomotic strictures occurred in 4 patients (4.8%) treated before December 2004, and transgastroscopy dilatation was effective treatment. There was no anastomotic stricture developed after surgical technology improved. Conclusion The new scarf-liking esophagojejunal anastomosis has more advantages to reduce anastomotic complications and total gastrectomy for advanced gastric carcinoma, is safe and effective.

From August 2011 to March 2012,5 241 type 2 diabetic patients with body mass index ≥ 24kg/m2 were enrolled from 60 hospitals in Guangdong Province.According to estimated glomerular filtration rate (eGFR),a total of 2 631 subjects with norml urine microalbumin level (＜30 ng/L) were divided into normal eGRF group and decreased eGRF group.Binary logistic regression was used to analyze the associations between eGFR and its related risk factors.The results showed that age,blood uric acid,blood urea nitrogen,history of hypertension and coronary heart disease,family history of diabetes,and hyperuricemia were positively related to lowering of eGFR (P＜ 0.05 or P＜0.01).HbA1C＜7％,regular glucose monitoring,and regular physical activity were negatively related to eGFR decrease (all P＜ 0.01).These results suggest that urine microalbumin and eGFR should be applied to overweight or obese patients with type 2 diabetes in order to screen diabetic nephropathy.Furthermore,intensive control of blood glucose,uric acid,and blood pressure is beneficial to lowering the risk of diabetic nephropathy.

Objective To investigate the etilolgy of failed pyeloplasty in children and to study the feasibility of redo laparoscopic surgery for recurrent nreterupelvic junction obstruction.Methods The clinical data of 39 patients with recurrent ureteropelvic junction obstruction after the primary pyeloplasty underwent redo laparoscopic surgery were analyzed retrospectively between September 2009 and June 2016 in our institution.There were 31 males and 8 females with a mean age of 66 months,ranged from 4 to 204 months.28 patients had left obstructions and 11 had fight obstructions,who were diagnosed by ultrasonography,MRU,and MAG3 renal scan et a1.Under general anesthesia,we identified that two patients (5.1％) had renal calices strictures,four patients (10.3％) had unsolved disease ureter and anastomotic strictures,two patients (5.1％) had adhesion band and anastomotic strictures,one patient had adhesion band,high ureteropelvic anastomosis and ureter torsion,and 30 (76.9％) patients had anastomotic strictures.Thirty-three patients underwent cdismembered pyeloplasty,five patients underwent onlay appendiculoureteroplasty and one patient underwent ureterocalicostomy.Results All surgeries were successfully completed without conversion.No intraoperative complication was encountered.One patient had persistent,frequent and intolerable flank pain with severe hydronephrosis after surgery,he subsequently underwent nephrectomy.One patient had persistent severe hydronephrosis which was repaired with on-lay appendiculoureteroplasty.One patient had anastomotic adhesion and balloon dilatation was performed with no further obstruction in follow up imaging.The rest of the patients got complete clinical or radiologic resolution.The successive rate was 36 of 39 (92.3％) at a mean follow up of 25 months (ranging 3-60 months).Conclusions Unsolved ureteric pathologies,anastomotic stricture,renal calices stricture,adhesion band,torsion of ureter and high ureteropelvic anastomosis all contribute to recurrent obstruction after the primary pyeloplasty.Laparoscopic redo pyeloplasty is safe and feasible for skilled surgeons.

OBJECTIVETo uncover the transmission patterns of the HIV epidemic in Dehong prefecture.

METHODSThe reviewed case reports, data of sentinel surveillance, testing and special survey were analyzed by SAS 8.0 program. The transmission patterns were modeled by utilizing data including sizes of the whole population and the high risk groups, high risk behavior data from 1989 to 2007, and the population index such as sex ratio and fertility rate.

RESULTSIn 2005, case reports showed the proportion of people infected with HIV through sexual contact was 39.1%, and 46.9% in 2006. Among 1636 cases reported between January 1 to September 20, 2007, the proportion of people infected with HIV through sexual contact was 52%. From 1989 to 2007, the proportion of HIV infection among drug users was declining, while HIV infection through sexual contact was rising after standardizing the population tested/surveyed. The Asian Epidemic Model has shown that the proportions of incident HIV infections through sexual transmissions were 50.6%, 52.3% and 52.7% respectively from 2005 to 2007. Correspondingly, the proportions of incident cases by injecting drug user were 48.9%, 47.2% and 46.7% respectively during this period. Moreover, the Workbook method has shown that, among adults living with HIV in 2007, 50.3% were infected through injecting drugs and 48.4% through unsafe sexual activity.

CONCLUSIONThe rapid rise in HIV infections through injecting drug in Dehong prefecture has been initially curbed. HIV epidemic has already witnessed a change from predominantly through drug injecting-related activity to an almost equally fuelled epidemic by sexual and drug-related transmission.

Acquired Immunodeficiency Syndrome ; epidemiology ; transmission ; China ; epidemiology ; Humans ; Models, Statistical ; Risk Factors ; Social Problems

OBJECTIVETo study the incidence rate and risk factors of HIV infection among sero-negative spouses of people living with HIV/AIDS (HIV/AIDS) in Dehong prefecture, Yunnan province.

METHODSA prospective cohort study was conducted from February 2009 to December 2014 in Dehong prefecture, Yunnan province. Questionnaire survey and HIV related tests were carried out once a year.

RESULTSBy the end of December 2014, 2 091 sero-negative spouses had been recruited, of whom 1 692 were followed-up for at least one time. RESULTS showed that 34 new HIV infections were identified within 5 494.52 person years of follow-up, for an overall incidence of 0.62 per 100 person years. HIV incidence rates appeared as 0.79 per 100 person years, 0.62 per 100 person years, 0.47 per 100 person years in 2009-2010, 2011-2012, 2013-2014, respectively. Data from the Cox proportional hazard regression model indicated that risk factors of HIV infection among sero-negative spouses of HIV/AIDS were: non-consistent condom use (HR=4.64, 95%CI: 1.89-11.40,P= 0.001), HIV/AIDS delayed antiviral retrovirus therapy (ART) for more than one year (HR=3.70, 95% CI: 1.44-9.49,P=0.007) after the HIV negative spouses were initially recruited, HIV/AIDS did not receive any ART (HR=3.62, 95% CI: 1.14-11.51,P=0.029).

CONCLUSIONSThe incidence of HIV infection among sero-negative spouses in Dehong prefecture was relatively low. Publicity on consistent condom use program should be emphasized among sero-negative spouses of HIV/AIDS, together with the timely provision of ART to those HIV/AIDS.

Adolescent ; Adult ; China ; epidemiology ; Female ; HIV Infections ; epidemiology ; transmission ; HIV Seronegativity ; Humans ; Incidence ; Male ; Mass Screening ; Middle Aged ; Prospective Studies ; Risk Factors ; Sexual Behavior ; Spouses ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo establish HEK293 cell lines with stable expression of human parathyroid hormone (PTH) receptors.

METHODSThe purified gene fragments of PTH-related peptide receptor (PTHR) and its mutant form (DSEL) were cloned separately into pcDNA3.1(+) vector after digestion with EcoR I and Not I, and the resulted pcDNA3.1(+)-PTHR and pcDNA3.1(+)-DSEL plasmids were verified by restriction enzyme digestion and DNA sequencing. HEK293 cells were transfected with these plasmids and the expression of PTHR and DSEL in the cells were examined by RT-PCR and ELSIA.

RESULTSSequencing and restriction enzyme digestion analysis showed that PTHR and DSEL cDNAs were correctly cloned into pcDNA3.1(+)vector. After a 48-h transfection of HEK293 cells with the recombinant plasmids and G418 selection, the positive cell clones stably expressing the constructs were obtained, which showed expressions of PTHR and DSEL mRNAs detected by RT-PCR. These positive cells showed high levels of PLC and aAMP production in response to PTH stimulation.

CONCLUSIONThe HEK293 cell lines with stable expression of PTH1R or DSEL gene established in this study provide useful cell models for studying the physiological functions of PTH peptides.

Gene Expression ; Genetic Vectors ; HEK293 Cells ; Humans ; Plasmids ; Receptors, Parathyroid Hormone ; genetics ; metabolism ; Sequence Analysis, DNA ; Signal Transduction ; genetics ; Transfection

OBJECTIVETo investigate the effect of parathyroid hormone (1-34) (PTH) on tumor growth in a mouse model of lung cancer with bone metastasis.

METHODSMouse models of proximal tibial bone metastasis of lung cancer were established in 30 female BALB%c mice. The mouse models were randomly divided into 3 groups and received injections with 40 mg%kg PTH (1-34), equal amount of solvent (blank control), or cyclophosphamide (positive control). Body weight of the mice was measured every 2 days and the right hind limb tumor growth was observed. The mice were sacrificed after 28 days for X-ray and CT examinations to observe the tumor shape, size, tibial bone density, and tumor volume. HE staining and immunohistochemistry were performed to observe the tumor morphology and pathological type, and serum concentration of serum alkaline phosphatase (ALP) was detected.

RESULTSThe body weight change curves did not show significant difference between PTH (1-34) group and the blank control group (P>0.05). In both PTH (1-34) group and the blank control group, X-ray and micro-CT revealed significant bone defects, and in cyclophosphamide group the bone cortex was basically intact with only mild bone destruction. The tumor volume was similar between PTH (1-34) group and the blank control group (P>0.05), but significantly smaller in cyclophosphamide group (P<0.05). The bone density in PTH (1-34) group was significantly greater than that in the blank control group, but lower than that in cyclophosphamide group (P<0.05). Pathological examination revealed mainly osteolytic lesions mixed with bone destruction, which was severer in PTH (1-34) group and blank control group with obvious tumor cell filling of the defects; immunohistochemistry identified the tumors as adenomas. ALP activity was higher in PTH (1-34) group than in the other two group and differed significantly between the 3 groups (P<0.05).

CONCLUSIONIntermittent small-dose injections of parathyroid hormone PTH (1-34) does not promote bone metastatic tumor growth in mice and increases the bone quantity around the metastatic lesions.

Animals ; Bone Density ; Bone Neoplasms ; secondary ; Disease Models, Animal ; Female ; Lung Neoplasms ; pathology ; Mice ; Mice, Inbred BALB C ; Parathyroid Hormone ; pharmacology ; Tibia ; pathology

Objective To explore the functions of phospholipase C (PLC)-independent protein kinase C signaling pathway (PTH/nonPLC/PKC) of parathyroid hormone (PTH) and its role in bone metabolism. Methods Osteoblasts isolated from the calvaria of 2-or 3-day-old C57BL mice, identified by alkaline phosphatase staining and Alizarin red staining, were treated for 4 h with 100 nmol/L[Gly1, Arg19]hPTH(1-28) plus 10 nmol/L RP-cAMP, 10 nmol/L[Gly1, Arg19]hPTH(1-34) plus 10 nmol/L RP-cAMP , 10 nmol/L PTH(1-34), or and 0.1% trifluoroacetic acid (TFA). The total RNA was then isolated for screening differentially expressed genes related to PTH/nonPLC/PKC pathway using Affymetrix mouse 12x135K gene expression profile microarray, and the identified genes were confirmed by real-time quantitative PCR. MC3T3-E1 cells treated with[Gly1, Arg19]hPTH(1-28)+RP-cAMP,[Gly1, Arg19]hPTH(1-34)+RP-cAMP,[Gly1, Arg19]hPTH(1-34)+RP-cAMP+100 nmol/L Go6983, or 0.1%TFA were also examined for GR(1-28)-or GR(1-34)-mediated gene expression changes using real-time quantitative PCR. Results Alizarin red staining visualized red mineralized nodules in the osteoblasts at 28 days of culture. According to the genechip results, we selected 56 target genes related to PTH/nonPLC/PKC pathway, among which CITED1 showed higher expressions in[Gly1, Arg19]hPTH(1-34)+RP-cAMP group than in both the control group and[Gly1, Arg19]hPTH(1-28)+RP-cAMP group (P<0.05), and its expression was the highest in PTH(1-34) group (P<0.05). RT-PCR of MC3T3-E1 cells yielded consist results with those in the primary osteoblasts, and the cells treated with Go6983 (a PKC inhibitor) did not show GR(1-28)- or GR(1-34)-mediated differential expression of CITED1. Conclusion The activation of PLC-independent protein kinase C signaling pathway of PTH enhances the expression of CITED1 in mouse osteoblasts to mediate the effect of PTH on bone metabolism, and this pathway is not dependent on the activation of PLC or PKA signaling.

Objective To explore the functions of phospholipase C (PLC)-independent protein kinase C signaling pathway (PTH/nonPLC/PKC) of parathyroid hormone (PTH) and its role in bone metabolism. Methods Osteoblasts isolated from the calvaria of 2-or 3-day-old C57BL mice, identified by alkaline phosphatase staining and Alizarin red staining, were treated for 4 h with 100 nmol/L[Gly1, Arg19]hPTH(1-28) plus 10 nmol/L RP-cAMP, 10 nmol/L[Gly1, Arg19]hPTH(1-34) plus 10 nmol/L RP-cAMP , 10 nmol/L PTH(1-34), or and 0.1% trifluoroacetic acid (TFA). The total RNA was then isolated for screening differentially expressed genes related to PTH/nonPLC/PKC pathway using Affymetrix mouse 12x135K gene expression profile microarray, and the identified genes were confirmed by real-time quantitative PCR. MC3T3-E1 cells treated with[Gly1, Arg19]hPTH(1-28)+RP-cAMP,[Gly1, Arg19]hPTH(1-34)+RP-cAMP,[Gly1, Arg19]hPTH(1-34)+RP-cAMP+100 nmol/L Go6983, or 0.1%TFA were also examined for GR(1-28)-or GR(1-34)-mediated gene expression changes using real-time quantitative PCR. Results Alizarin red staining visualized red mineralized nodules in the osteoblasts at 28 days of culture. According to the genechip results, we selected 56 target genes related to PTH/nonPLC/PKC pathway, among which CITED1 showed higher expressions in[Gly1, Arg19]hPTH(1-34)+RP-cAMP group than in both the control group and[Gly1, Arg19]hPTH(1-28)+RP-cAMP group (P<0.05), and its expression was the highest in PTH(1-34) group (P<0.05). RT-PCR of MC3T3-E1 cells yielded consist results with those in the primary osteoblasts, and the cells treated with Go6983 (a PKC inhibitor) did not show GR(1-28)- or GR(1-34)-mediated differential expression of CITED1. Conclusion The activation of PLC-independent protein kinase C signaling pathway of PTH enhances the expression of CITED1 in mouse osteoblasts to mediate the effect of PTH on bone metabolism, and this pathway is not dependent on the activation of PLC or PKA signaling.