Objective To evaluate the clinical significance of harmonic dissection of the cystic artery in laparoscopic cholecystectomy (LC). Methods Clinical data of 800 cases of LC from July 1999 to December 2000, in which a harmonic scalpel was used to directly coagulate and sever the cystic artery, were retrospectively analyzed. Results The surgery was completed smoothly in all the cases, without intra-or post-operative bleeding at the stump of the cystic artery. Pathological section examinations under microscope showed that high temperatures achieved by harmonic scalpel were great enough to make the arterial walls coagulated and the arterial lumens obstructed. Conclusions Harmonic dissection of the cystic artery in LC is safe and reliable.

Objective To explore the role of nuclear factor-kappa B(NF-?B)in regulating tumor necrosis factor-?(TNF-?)expression in acute pancreatitis (AP)in rats.Methods Sixty-four Wistar rats were randomly divided into two groups:the control group(n=32)and the AP group(n=32).Acute pancreatitis was induced by introperitoneal injection of caerulein,and the animals were killded at 12 hours,24 hours,36 hours,and 72 hours respectively.The activity of NF-?B and expression of TNF-? mRNA in the pancreas were determined by flow cytometry (FCM) method and semi-quantitave RT-PCR analysis,respectively,and the correlation coefficients were analyzed.Results The levels of activated NF-?B protein and TNF-?mRNA were all significantly higher in the AP group than those in the control group at any time point(P

Objective:To explore the influence of psychological factors on temporomandibular disorders(TMD) in school students.Methods:52 school students aged 14-26 years with TMD classified as muscular dysfunction (MD,n =26),temporomandibular displacement(TD,n =14) and MD with TD(MD +TD,n =12),and 53 healthy adolescents as the controls were investigated.All the participants accepted TMD examination and their psychological status were tested by symptom checklist-90 (SCL-90).The patients were divided into acute(case history ≤6 months,n =32) and chronic(case history ＞6 months,n =20) groups.The psychological differences among the related groups were analyzed by SPSS 17.0 statistical software package.Results:The total and the factor scores of the TMD group were higher than those of control(P ＜ 0.05).There was no significant statistically difference between the MD group and the TD group(P ＞ 0.05).MD + TD group got higher SCL-90 total score and factor scores (except depression,phobic anxiety and Psychoticism score) than the other 2 groups (P ＜ 0.05).The acute and chronic group got similar SCL-90 total scores and factor scores (P ＞ 0.05),except somatization score (P ＜ 0.05).There was a positive correlation between the TMD pain level and total score of SCL-90.Conclusion:The psychological status have remarkable influence on the students with TMD.The pain degree of TMD is affected by psychological factors.Therefore,psychological therapy should be applied during the diagnosis and treatment of students with TMD.

Objective:To investigate the use of psychological testing in hospital and its potential existent ethical issues.Methods:Eleven psychometricians from 6 specialized and 5 general hospitals accepted a semi-structural interview.With (10.8 ± 8.8) years of experiences on average in this field,they tested 2 to 30 patients each day.Content analysis was used to investigate the psychometricians' qualification,usage of tests,informed consent,scoring,explanation and preservation.Results:Normally,the number of psychometricians in one hospital varied from 1 to 4.Out of 11 interviewees,2 were unqualified.Three of the interviewees pointed out there were non-standard circumstances when some doctors choosing the tests.Six of them thought that the frequently used tests' norms were obsolete.Eight interviewees considered that comparatively low psychometric fee influenced their devotion of explaining the results.Conclusion:In hospital,it's necessary to strength the ethical awareness of decision-makers and executors in psychological testing.

plus stented elephant trunk implantation (Bentall+Sun′s surgery), aortic root replacement (Bentall surgery), stent implantation, thoracic and abdominal aorta replacement. The aortic operation time of the 19 patients were 5 gestational weeks to 1 month after delivery. The relation between aortic operation and the termination of pregnancy: 4 patients underwent aorta surgery after termination of pregnancy, 9 patients had cesarean section and aorta surgery at the same time, 6 patients underwent aorta surgery before cesarean section. ②5 patients did not receive arota surgery, 2 patients of type A dissection and 1 patient of type B dissection died before the surgery;2 cases of type B dissection underwent conservative treatment. The termination time of pregnancy was 6-37 gestational weeks, with the average of (26 ± 10) weeks. (3)Maternal and fetal outcomes:20 patients survived after treatment (83%,20/24) and 4 patients died (17%,4/24). 10 cases were live births, including 4 full-term infants and 6 preterm premature infants. The birth weight of the neonates was 1 080-3 800 g, with the average of (2 302±764) g. Three of them were very low birth weight infants and 1 was low birth weight infant;3 neonates had mild asphyxia. The neonates were followed up for 0.5 to 10 years, with the average time of (1.4 ± 1.7) years. So far the infants′ development was good.Conclusions Pregnancy with aortic dissection is pernicious. Early identification, prompt diagnosis and prompt interventing of the vascular surgery are necessary to the safety of mother and fetus.

BACKGROUND:Currently, the treatment of proximal humeral fractures mainly contains joint preservation (conservative treatment, open reduction and internal fixation) and arthroplasty, but how to choose the treatment is stil controversial. OBJECTIVE:To evaluate and compare the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced 3-or 4-part humeral fractures in randomized control ed trials using meta-analysis. METHODS:Medline (January 1966 to December 2013), PubMed (January 1980 to December 2013), Embase (January 1990 to December 2013), Science (January 1990 to December 2013), Springer (January 1990 to December 2013), China National Knowledge Infrastructure (1994 to 2013), and Wanfang database (1982 to 2013) were searched for randomized control ed trials addressing joint preservation and arthroplasty for 3-or 4-part proximal humeral fractures. Articles meeting the inclusion criteria were included. The related data were extracted and loaded onto Comprehensive Meta-Analysis Software for meta-analysis. RESULTS AND CONCLUSION:Seven articles with 320 patients (165 patients undergoing joint preservation and 155 patients receiving arthroplasty) were accepted in this mete-analysis and al of them were high-quality English researches by modified Jadad Scale. Meta-analysis results displayed that the random-effects mean Constant score across al types was 55.9 (95%CI:50.7-61.1;P<0.001). Constant score was higher in the joint preservation group than in the arthroplasty group (P<0.01). The study displayed significant heterogeneity (I2 0.001). In the meta-analysis, Constant scores were decreased with increasing rate of male to female and rate of tuberosity resorption. These results suggested that 3-or 4-part proximal humeral fractures demonstrate improved Constant scores when treated with joint-preserving options compared with arthroplasty. Moreover, age, fracture pattern, gender ratio and complication rate are significant predictors of the Constant score. Given the observed heterogeneity and variance in treatment techniques in the included studies, more randomized control ed trial studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for treatment of 3-or 4-part proximal humeral fractures.=88%, Q statistic=107.6, Q=13;P<0.001). In the meta-analysis, Constant scores were decreased with increasing rate of male to female and rate of tuberosity resorption. These results suggested that 3-or 4-part proximal humeral fractures demonstrate improved Constant scores when treated with joint-preserving options compared with arthroplasty. Moreover, age, fracture pattern, gender ratio and complication rate are significant predictors of the Constant score. Given the observed heterogeneity and variance in treatment techniques in the included studies, more randomized controlled trial studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for treatment of 3- or 4-part proximal humeral fractures.

Objective To analyze the correlations of clinical characteristics,CT and pathology features of peripheral primitive neuroectrodermal tumors (pPNET)in abdomen-pelvis region,and to improve the understanding of the disease.Methods The clinical information,CT and pathological features of 23 confirmed pPNET patients in abdomen-pelvis region were analyzed retrospectively.Results (1)All patients had preoperative clinical and imaging data integrallty.(2)23 cases showed soft tissue masses with fuzzy boundary and the average diameter were 10.72 cm.Among all,9 cases showed with varying degrees of sac necrosis,while 2 cases showed with platelet hemorrhage and 4 cases with speckled calcifications.Most showed slight-to-moderate heterogeneous enhancement and the necrosis and cystic are-as showed more obvious.12 cases showed with different degree of recurrence,invasion or distant metastasis.5 cases combined with tumor emboli and 4 cases with tumor feeding vessels.(3)Immunohistochemical examination showed CD99 expressed in 1 9 patients, CD56 in 11,vimentin(Vim)in 12,synaptophysin(Syn)in 11,neuron specific enolase(NSE)in 4,FLI-1 in 4 and epithelial membrane antigen (EMA)in 4 patients.Conclusion pPNET is common among young patients with a high degree of malignancy.CT features include large mass with invasive growth,commonly combined heterogenous density,necrosis and cystic changes.Persistent enhancement is observed during nephrographic phase.

objective To observe whether the killing effect on HCC SMMC-7721 cell of the antihepatocellular carcinoma scFv reconstructed by pharmacy was enhanced or not.Methods Prokarycytic expression vector containing PET32a-RC-RNase was induced to express by IPTG.The inclusion body purified and Western-blotting was used.PC.CHOL and CHS was added in chloroform.Dry membrane was formed after chloroform was removed.RC-RNase protein solution was added to dissolute the membrane.Then pass the solution over a Sephadex G-50 column after ultrasound and filtrated to detect the encapsulation efficiency of the liposome.The solution reacted in EDC.SSNHS and MES for 30 minutes.Then add hdscFv to the solution in 4 ℃ over night.MTT method was used to detect the killing effect on HCC cell of immunoliposome RC-RNase,immunotoxin RC-RNase and liposome RC-RNase in vitro.Resuits The killing effect on HCC cell of immunoliposome RC-RNase is the best.but that of Iiposome RC-RNase is the worst.The respective JC50 are:3.28μg/ml,22.44μg/ml and 98.26μg/ml.Conclusion The anti-hepatocellular carcinoma scFv relomtructed by pharmacy can promote the killing effect on HCC cell and may have potential in the treatment of hepatocarcinoma.

AIM: To investigate whether viable apoptotic cells and phagocytosis of them affect the activation of T lymphocytes. METHODS: Ultraviolet irradiation was used to induce apoptotic cells in vitro and the model of phagocytosis of these cells was established. Cytokine TGF ?1 was detected by ELISA. The rate of apoptotic cells and phagocytosis of them were assessed by flow cytometry. Furthermore, flow cytometry was also employed to examine the expression of activation signs, such as CD69, CD25, CD71, of T lymphocytes under the intervention of apoptotic cells and macrophage which ingested apoptotic cells, to reflect whether the apoptotic cells and the phagocytosis of these cells could influence the activation of lymphocytes stimulated by Con A. RESULTS: Ingestion of apoptotic cells increased TGF ?1 secretion. Only the macrophages that had ingested apoptotic cells could suppress the activation of lymphocytes. The expression of the markers of lymphocytes activation such as CD69, CD25, CD71 had been restrained. These inhibition effects were abolished by monoclonal anti-TGF ?1 antibody. CONCLUSION: The macrophages that have ingested apoptotic cells inhibit expression of CD69, CD25 and CD71 of T lymphocytes stimulated by ConA. This effect is dependent on the increase in TGF ?1 secretion in local site. [

Objective To investigate the clinical features and the management of primary pigmented nodular adrenocortical disease PPNAD) and to evaluate its relationship with Carney complex. Methods One case of PPNAD reported. The patient was a 52 years oldmale. He was hospitalized because of hypertension for one year. The patient had a Cushing's face with elevated plasma and urine cortisone levels which could not be suppressed by both low dose and high dose dexamethasone tests. Ultrasonography howed normal bilateral adrenal glands. CT scan found a 1.6 cm × 2.0 cm mass in the left adrenal gland and normal on tralateral adrenal gland. Results The patient had accepted left laparoscopic adrenalectomy. The pathological examination onfirmed the diagnosis of PPNAD. Micro scopic study showed that there were black-gray spots in the center of the specimen. Hyperplasia was found in all the three adrenal zones. Lipofuscin was observed in the cytoplasm of reticular zone cells. The patient's blood pressure had returned to normal level after the surgery. Conclusions PPNAD is a rare type of ypercortisolism. As there is no specific feature in clinical manifestation and radiological examination of this disease, it is very easy to make a misdiagnosis in clinical practice. PPNAD itself can be the comorbidity of Carney complex, careful differentiation is needed.