Objective To investigate the nosocomial infections among patients undergoing abdominal operation . Method Data in three hundred patients underwent abdominal operation in our department from January 2012 to December 2014 were reviewed. Results Seventeen cases developed nosocomial infection after operation, including 6 cases of respiratory system infection, accounting for 35.29%, 4 cases of urinary infection, accounting for 23.53%. The probability of nosocomial infection from the type Ⅲ operations was higher than that from the typeⅡ operations and that by emergency surgery was higher than that by non-emergency operations(P<0.05). Conclusions Respiratory and urinary infections are the major two types of the nosocomial infections in the abdominal operation. Sufficient preoperative preparation and postoperative nursing can reduce the incidence of nosocomial infections in abdominal surgery.

Dedifferentiated chondrosarcoma(DDCS)comprises approximately 10%of all chondrosarcomas and has the worst outcome with a 5-year survival of 10%.The preferred localizations are the femur,humerus and pelvis.DDCS represents a special form of chondrosarcoma characterized by the presence of well-differentiated cartilaginous component in juxtaposition with malignant mesenchymal tumor of high-malignancy grade.The diagnosis of DDCS is highly complicated,requiring detailed radiological and histopathological evaluation as well as precise bioptic technique.The dedifferentiated component is typically a high-grade sarcoma(usually grade 3 or 4),which can be either an osteosarcoma,a malignant fibrous histiocytoma or an anaplastic spindle cell sarcoma.In approximately one-third of the radiographs,one-third of the MR images,and one-half of the CT scans, the tumors demonskates bimorphic features.Recently,array-based comparative genomic hybridization(array-CGH)studies have been performed on frozen chondrosarcoma(including DDCS)specimens.There is a statistically significant association between high-grade tumor(grade Ⅲ and dedifferent ated)and the recurrent genetic deletions at 5q14.2～q21.3,6q16～q25.3,9p24.2～q12,and 9p21.3.One of the most commonly deleted regions of DDCS involved chromosome 9.Earlier investigations of DDCS showed p53 mutation and p53-LOH in the anaplastic component.It is also accompanied by Rt-LOH.P161NK4 and E-cadherin promotor methylation were observed in the low grade chondroid compartment of DDCS.While p161NK4,FHIT,and E-cadherin were methylated in highly malignant osteosarcomatous compartment of the tumor.Surgical resection of the tumor within wide or radical margins is the most important treatment.The value of neoadjuvant or adjuvant therapy remain uncertain.Several new drug targets have been identified and phase Ⅱ studies are currently ongoing.Current phase Ⅱ trials open for DDCS patients used the following medicine:apomab(proapoptotic selective agonist of Ap02L/TRAIL death receptor),perifosine(serine/threonine kinase Akt inhibitor),dasatinib(multitargeted small-molecule tyrosine kinase inhibitor),and the combination of gemcitabine and docetaxel.More recently,several phase Ⅰ studies have reported incidental responses of DDCS to newer targeted agents,such as histone deacetylase and vascular endothelial growth factor antisense oligodeoxynucleotide.The prognosis for patients with DDCS remains poor. The poor prognosis of the DDCS is determined by nonchondroid high grade component caused by invasive growth and formation of metastases.Therefore,early diagnosis and prompt surgical treatment may improve the outcome.

Objective: To investigate the differential expression of Sox9 in conventional chondrosarcoma,dedifferentiated chondrosarcoma and normal cartilage. Methods: We reported 12 cases of chondrosarcomas,which were initially diagnosed as chondrosarcomas(6 cases of conventional chondrosarcoma and 6 cases of dedifferentiated chondrosarcoma)at Peking University People's Hospital between January 2003 and January 2007.We used genechip method to identify difierentially expressed genes involved in conventional chondrosarcoma,dedifferentiated chondrosarcoma and in normal cartilage(6 cases)and found thousands of differentially expressed genes after extensive statistical analysis.With Sox9 which played crucial roles in the process of both differentiation and maturation of chondrocyte as a candidate,we used Real-time PCR,Westem blot and immunohistochemistry to confirm the results found by gene chip. Results: DNA microarray results showed that Sox9 was up-regulated about 1.6 times in conventional chondrosarcoma compared with that in normal cartilage.But in dedifferentiated chondrosarcoma,the expression level of Sox9 was significantly down-regulated,0.082 times of that in normal cartilage.Real-time PCR results showed that the expression levels of Sox9 mRNA in conventional chondrosarcomas and dedifferentiated chondrosarcomas were 1.68±0.119 and 0.088±0.017,respectively.Sox9 protein level was significantly higher in humen conventional chondrosarcomas than that in normal cartilage.Sox9 protein level in dedifferentiated chondrosarcomas was significantly lower than that in normal cartilage tissue.All of the 6 cases of conventional chondrosarcomas showed diffuse and strong staining of Sox9.However,Only scattered staining was observed in dedifferentiated chondrosarcomas. Conclusion: Compared with that in normal cartilage,Sox9 expression is up-regulated in conventional chondrosarcomas and down-regulated in dedifferentiated chondrosarcomas.Decrease of Sox9 expression in dedifferentiated chondrosarcoma is correlated with poor survival,indicating that Sox9 may serve as a molecular prognostic marker for chondrosarcomas and disease progression.

Objective:To investigate the clinical value of decompression in the treatment of jaw large cystic lesions.Methods:42 patients with jaw large cystic lesions were treated with decompression.Imaging examination was taken and compared before and after the treatment.The influence of frequency of cyst cavity washing on the effect of decompression was observed.Results:3 moths after de-compression the border of the cyst cavity became ambiguous and the size of the cavity reduced.12 months after decompression the size of cyst cavity was stable,when second surgery was taken to remove the left cyst wall.There was no recurrence of the cystic lesion after 1 ~2 year follow-up.Cyst cavity was washed everyday,but the effect and treatment course were not influenced by the daily washing times.Conclusion:Decompression is effective in the treatment of the jaw large cystic lesions.

Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage (PTCD) combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable Ⅲ and Ⅳ type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors’ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral (both left and right side) bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient’s survival time were followed up. Results One month after the treatment, complete response (CR) was obtained in 15 patients (15/29, 51.7%), and partial remission (PR) in 17 patients (17/29, 58.6%), with the overall efficacy (CR﹢PR) being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% (20/29), 31.0% (9/29) and 6.8% (2/29) respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Conclusion For the treatment of hepatic hilar cholangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective.

Objective To detect the different expression of Runx2 in dedifferentiated chondrosarcoma and conventional chondrosarcoma, and to investigate the role of Runx2 in the occurrence and development of dedifferentiated chondrosarcoma. Methods Dedifferentiated chondrosarcoma cell line NDCS-1 and normal chondrosarcoma cell line SW1353 were cultured, then mRNA and total cellular protein were extracted.RT-PCR Western blotting, and immunocytochemistry were used to detect the expression of Runx2.Immunohistochemistry was used to test Runx2's expression in the dedifferentiated chondrosarcoma specim ens that confirmed by pathology. Results Runx2 was high expression in dedifferentiated chondrosarcoma cell line and high-grade component of dedifferentiated chondrosarcoma tissues. Conclusion The high expression of Runx2 in dedifferentiated chondrosarcoma is involved in the occurrence and development of dedifferentiated chondrosarcoma.

OBJECTIVETo assess the safety and the accuracy of surgical navigation technology in the resection of severe ankylosis of the mandibular condyle with the middle cranial fossa.

METHODSThe CT scan data was transferred to a Windows-based computer workstation, and the patient' s individual anatomy was assessed in multiplanar views at the workstation. In the operation, the patient and the virtual image were matched by individual registration with the reference points which were set on the skull bone surface and the teeth. Then the real time navigation can be performed.

RESULTSThe acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the operative result in three cases. The operations were performed successfully with the guidance of real-time navigation. The application of surgical navigation have enhanced the safety and the accuracy of the surgery for bony ankylosis of temporomandibular joint.

CONCLUSIONSThe application of surgical navigation can improve the accuracy and safety of surgical excision of the ankylosed skull base tissue.

Anatomic Landmarks ; anatomy & histology ; Ankylosis ; surgery ; Humans ; Skull ; diagnostic imaging ; surgery ; Surgery, Computer-Assisted ; methods ; Temporomandibular Joint ; surgery ; Temporomandibular Joint Disorders ; surgery ; Tomography, X-Ray Computed

Objective:To investigate the killing effect of nanoliposome encapsulated cisplatin(NLE-CDDP) on human osteosarcoma cell line Saos-2 and explore the distribution of platinum(Pt) in tumor-bearing mice.Methods: Saos-2 cells were cultured at different concentrations of NLE-CDDP.MTT assay,inverted microscopic observation and flow cytometry assay(FCM)were used to observe the antiproli-ferative effect of NLE-CDDP on the human osteosarcoma cells.Antitumor effect of NLE-CDDP was determined using the xenografts models of human osteosarcoma cell Saos-2 in nude mice.The Pt concentration in the tissues of tumor-transplanted mice was determined by atomic spectrophotometer.Results: When treated at different concentrations of NLE-CDDP for 24-96 hours,the survival rate of Saos-2 cells decreased significantly(P

ObjectiveTo explore the role of fatty acid on endoplasmic reticulum (ER) stress and to detect the influence of tauroursodeoxycholic acid (TUDCA) on the expression of ER related genes in steatosis hepatocytes by establishing different models of hepatic steatosis.MethodsHealthy adult hepatocyte cell line HL-7702 was taken as research object.The model of hepatic steatosis was established with palmitic acid alone or mixed fatty acids.The cell viability was measured and calculated through CCK-8 positive cell proliferation assay.The cell morphology and steatosis was observed.The intracellular triglyceride content was tested with the triglyceride determination kit.With TUDCA intervention,the relative expression of Glucose-regulated protein 78 (GRP78) and CCAAT/Enhancer binding protein homologous protein (CHOP) at mRNA level was determined by real-time PCR.ResultsThe viability of hepatocyte was influenced once the concentration of mixed fatty acid reached 0.5 mmol/L or palmitic acid was 0.125 mmol/L.The effect of palmitic acid alone was stronger than that of mixed fatty acid on hepatocyte injury.The content of intra-hepatocyte triglyceride gradually increased in mixed fatty acid group,which only significantly increased after treated for 12 hours in palmitic acid alone group and then there was no significant change.There was no significant difference in relative expression of GRP78 and CHOP at mRNA level in various concentrations and treated time of mixed fatty acid group.After treated with palmitic acid at 0.5 mmol/L,intra-hepatocyte relative expression of CHOP at mRNA level increased obviously,however there was no effect on GRP78mRNA expression.After treated with palmitic acid at 1.0 mmol/L,both intra-hepatocyte GRP78 and CHOP mRNA relative expression increased.There was no significant difference in GRP78 and CHOP mRNA relative expression before and after ER stress in TUDCA intervented low dose palmitic acid group.There was significant difference in CHOP mRNA relative expression before and after ER stress in TUDCA intervented high dose palmitic acid group (at 12hrs:8.6400 to 5.1032; at 24hrs:13.7948to 6.4928,P=0.042 and 0.017),while no significant difference in GRP78 mRNA expression.ConclusionAt same fatty acid concentration,the larger propotion palmitic acid has,the more severe injury hepatocyte has.The regulation of palmitic acid on intra-hepatic ER stress is a time and dose dependent manner.TUDCA may improve palmitic acid induced ER stress to some degree.

We retrospectively analyzed the clinical data of 17 patients with esophageal perforation and rupture from August 2007 to December 2011.Among them,there were spontaneous esophageal rupture (n =6),esophageal perforation caused by foreign bodies (n =8) and iatrogenic injury (n =3).Family members gave up treatment because of critical illness (n =2),conservative treatment was offered for surgical intolerance (n =1) and all others (n =14) underwent operation (thoractomy,n =13 ; neck incision,n =1).One patient with conservative treatment and another two surgical cases died.The other 12 cases recovered.Therefore individualized treatment is essential for the patients with esophageal perforation and rupture.