Objective To evaluate the effect of endoprostheses for short and long term management of common bile duct stones in elderly patients(70 89 years). Methods Fifty two patients over 70 years with common bile duct stones undergone endoscopic biliary stenting(Group S, 28 cases) or common bile duct exploration (Group D, 24 cases) were followed up for 14 85 months. The two groups were similar to each other in clinical manifestations. Results One patient (4 2%) died because of breath and circulation exhausting on the 3rd day postoperation in Group D. Early complications were 14 4% and 33 3% respectively ( P

Objective To investigate the protective effects of sulforaphen (SFN) on focal cerebral ischemia/reperfusion injuy (IRI) in rats in order to explore the mechanisms.Methods Twenty-four male SD rats were randomly (random number) divided into Sham-operated group (A group,n =8),IRI group (B group,n =12),sulforaphen group (C group,n =8).SD rats were made to be transient focal cerebral IRI models.SFN 5 mg/kg was injected intraperitoneally to rats 15 minutes after IRI in C group,and rats of group A and group B received equal volume PBS instead.Infarct volume was measured by TTC staining and morphologic changes were observed with HE staining.Neuronal cell apoptosis index was detected by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) assay.Rats were sacrificed at 24 h after IRI.The protein levels of NF-κB p65 and iNOS were detected by using western bloting and the mRNA expressions of NF-κB p65 and iNOS were detected by using RT-PCR.Results Compared with the group B,infarct volume was significantly smaller in group C,the number of neuronal cell apoptosis in brain tissue were decreased significantly in group C [(96.34 ±3.72) vs.(124.65 ±3.85),P ＜ 0.01],the levels of NF-κB and iNOS in brain tissue of rats were decreased in the SFN group (P ＜ 0.01).SFN reduced neuronal cell apoptosis,injury,and infarct volume [(0.26 ± 0.018) vs.(0.43 ±0.031),P ＜0.01].The mRNA expression and protein level of NF-κBp65 were decreased in the group C.And the mRNA expression and protein level of induced nitric oxide synthase (iNOS) in IRI affected brain tissue were decreased in the group C [(0.67 ± 0.042) vs.(0.56 ± 0.032),P ＜ 0.01].Conclusions SFN might decrease the neuronal cell apoptosis caused by ischemia/repeffusion injury,and this protective effect is mediated by decreasing the level of NF-κB and iNOS.

Case based learning/problem-based learning ( CBL/PBL ) is a new teaching method based on traditional medical education methods.In order to conquer the deficiency of traditional education methods in autonomous study motivation and ability of knowledge integration, CBL/PBL has been introduced into vascular surgery teaching procedure since 2006.The quality and effort of CBL/PBL compared with lecture-based learning ( LBL ) were evaluated and scored. The outcome of this teaching innovation shows CBL can arouse students' desire in autonomous study and enhance their ability in clinical analysis.But, its superiority is difficult to develop in the current medical education system.

Obiective To expand the functions of the original data integration platform combined business process to achieve cross-system integration in hospital, Methods On the basis of efficient data interaction for every medical information system in hospital, more related function modules for the DIP were added. Results The new function modules can satisfy DIP multiple needs in the hospital daily work and make the DIP more powerful. Conclusion The applicability and rationality of DIP are improved by extended function.

Objective To investigate the prognostic factors of gastrointestinal stromal tumors.Methods From Nov.1999 to Dec.2006,a total of 85 patients were diagnosed by postoperative pathology as gastrointestinal stromal tumors.The relationship between the prognosis of GIST and demographic factors、tumor location、operation style、preoperative metastasis、lymphadenectomy、grading of Fletcher were analyzed retrospectively.Results The 1 year、3 year and 5 year survival rate of these 85 patients were 94%,60%,57%respectively,Univariate analysis indicated that tumor location、operation style、grading of Fletcher and preoperative metastasis were significant predictors of survival(P<0.05),while demographics and lymphadenectomy were not statistically related with prognosis.Multivariate analysis showed that preoperative metastasis was the independent factor predicting the prognosis(P=0.020,β=4.226).Conclusion Radical surgical excision is still the therapy of choice for primary gastrointestinal stromal tumors.Preoperative metastasis is the independent factor predicting poor prognosis,therefore early diagnosis and treatment are very important for GIST.Fletcher grading is also a simple recalls to predict the prognosis of GIST.

To study and compare the protective effects of Cordyceps sinensis from different habitats on acute injury of hepatic tissue induced by carbon tetrachloride ( CCl4 ) . Methods:The rat model of acute injury of hepatic tissue induced by CCl4 was established. The biochemical indicators of alanine aminotranferease ( ALT) and aspartate aminotransferease ( AST) in the serum and superoxide dismutase ( SOD) and L-glutathione( GSH) in the liver tissue were detected, and the liver tissue HE staining was used for the histopathology determination. Results:Compared with those in the model group, the levels of AST and ALT in the serum were sig-nificantly reduced, the levels of SOD and GSH in the liver tissue were notably increased, and the necrosis of liver cells was improved in Cordyceps sinensis groups at low, medium and high dose from different habitats (P<0. 05), however, the differences between the two different habitats were not significant (P>0. 05). Conclusion: Cordyceps sinensis from Qinghai and Tibet shows some positive differences in the protective effect on the acute chemical liver injury induced by CCl4 in rats,however, the differences are not remarka-ble.

Objective To explore the effect of early rehabilitation on function recovery in stroke patients.Methods 70 patients were divided into two groups, rehabilitation group (38 cases) and control group (32 cases). Rehabilitation group was given clinical treatment and early rehabilitatio therapy, while control group was given clinical treatment and unguided self-training, and the evaluation was done in pre-treatment and eight weeks after the treatment respectively. Motor function of limbs was assessed in Brunnstrom grade and Fugl-Meyer Assessment (FMA), Neurological Function would be assessed with the scale of Clinical Neurological Function Defects (CNFD), and Activities of Daily Living was assessed in Modified Barthel Index(MBI). Results All scores in the rehabilitation group were superior to that in the control group (P< 0.05). Conclusion Early rehabilitation training on stroke patients may obviously improve motor function, promote neurological function and increasing the activities of daily living.

ObjectiveTo observe the therapeutic effect of proprioception strengthening training on knee osteoarthritis.MethodsBased on clinical diagnostic criteria, 80 patients with knee osteoarthritis were randomly divided into a treatment group(41 cases) and a control group(39 cases). The patients in the treatment group were administered proprioception strengthening training, muscle strengthening exercise and treatment with sodium hyaluronate injection of knee joint, while the patients in the control group were administered muscle strengthening exercise and treatment with sodium hyaluronate injection of knee joint. Before and after the treatment, knee function were assessed with Lysholm Assessment Standard on knee function.ResultsThe patients in both groups scored significantly higher on Lysholm on knee function than the patients before the treatment (P<0.01). The patients in the treatment group are better than the patients in the control group(P<0.01).ConclusionProprioception strengthening training can improve the knee function and it is a valid method to treat knee osteoarthritis.

Objective Present study aimed to characterize the alteration of cortical thickness in first-episode, never-medicated, adult patients with major depressive disorder (MDD), and explore whether such deficits were related with their disease duration and clinical symptom severity. Methods Thirty-seven adult MDD patients were recruited from March 2013 to August 2015 as patient group, and 41 healthy volunteers were as control group. All the patients underwent three-dimensional spoiled gradient recalled (3D-SPGR) sequences, and the images were acquired. Constructions of the cortical surface were developed from 3D-SPGR images using FreeSurfer software, and the thickness of the entire cortex was measured according to the automated surface reconstruction, transformation, and high-resolution inter-subject alignment procedures. Finally, cortical thickness was compared between the two groups, and the relativity between clinical symptom severity, disease progression and clinical scores were analyzed using the General Linear Model (GLM). Results Our results revealed a significant increase in cortical thickness(P<0.05, false discovery rate corrected) in the left anterior and middle cingulate cortex, bilateral precentral cortex, left paracentral cortex, bilateral superior parietal cortex, left temporal pole, and right lateral occipital cortex (cortical thickness 1.89-2.87 mm, cortical volume 34-384 mm2, P<0.05) in MDD patients compared to healthy controls, while no reversed alternation was found. In addition, clinical symptom severity and disease progression showed no correlation with the cortical thickness abnormalities in MDD group(P>0.05). Conclusion Excluding the impact of treatment, our study showed that the cortical thickness change was mainly located in the prefrontal-limbic system in the in early course of MDD.

The first case of acquired syphilitic skull osteitis accompanied by syphilitic meningitis in China is reported.A 55-year-old female presented with a persistent distending pain of the frontal and occipital regions of the skull for two months.T1 weighted magnetic resonance imaging(MR1) showed muhiple lesions in the skull and linear enhancement of the meninge near the lesions.The serum and cerebrospinal fluid (CSF) were positive for Treponema pallidum particle agglutination assay (TPPA) and rapid plasma reagin circle card test(at the dilutions of 1∶32 and 1∶4 respectively).The levels of leukocyte and protein were 10 ×106/L and 0.82 g/L respectively in CSF.TP DNA was detected in the calvarial periosteum.Histopathological examination of the frontal bone showed focally destructive osteolytic lesions with obscure texture of the bone,hyperemia around the destructive bone tissue and in dura mater-like tissues,proliferation of interstitial fibrous tissue,swelling of endothelial cells and inflammatory infiltration predominantly composed of abundant plasma cells.After managed with routine treatment regimen for neurosyphilis,her headache was relieved 3 days later,nearly disappeared 15 days later,completely disappeared 30 days later.No similar headache recurred.A 5year follow up demonstrated a satisfactory long-term and short-term outcome.She was finally diagnosed with syphilitic skull osteitis complicated by syphilitic meningitis.