Objective To study the correlation between serum human cytomegalovirus (HCMV) DNA and peripheral T cell subsets as well as islet function in type 1 diabetic patients.Methods HCMV DNA levels in sera from 20 type 1 diabetic patients and 40 controls were measured by quantitative polymerase chain reaction (PCR),then the comparison and correlation analysis were made between HCMV DNA and T cell subsets,blood glucose (BG),insulin (Ins) and C peptide (C P).Results The positive rate and levels of HCMV DNA in type 1 diabetic patients were significantly higher than those of controls respectively.The percentage of CD 8 and the levels of fasting BG and BG 2 hours after meal in type 1 diabetic patients with positive HCMV DNA were by far higher than those in controls,while the percentage of CD 4,the ratio of CD 4/CD 8,the levels of fasting Ins,Ins and C P 2 hours after meal were significantly lower than those of controls.There existed the linear positive correlation between HCMV DNA and CD 8 or fasting BG,negative correlation between HCMV DNA and CD 4/CD 8,fasting Ins or fasting C P.Differences were not so significant between type 1 diabetic patients with negative HCMV DNA and controls compared with those between patients with positive HCMV DNA and controls.Conclusion HCMV infection is associated with dysfunction of islet and T cell mediated immunity in type 1 diabetic patients.

Objective To evaluate the efficacy and safety of endoscopic sphincterotomy(EST)in treating common bile duct stone or strictive papillitis,and then analyze possible related risk factors for long-term complications after EST.Methods We made a retrospective study of 103 out of 158 patients who had EST from January 2005 to December 2006.Results In the 103 patients,there were 13 cases of long-term complications(≥3 m after EST),the incident rate being 12.6%:recurrent calculus of common bile duct in 8 cases,combined cholangitis in 6;cholangitis in 1;acute calculus cholecystitis in 2;residual calculus in 1 case;chronic pancreatitis in 1 case.Conclusion Endoscopic papillosphincterotomy is an effective and safe way to treat biliary tract obstruction.Preoperative jaundice may be the risk factor inducing long-term complications after EST.

Objective To evaluate the value of video-assisted thoracic surgery(VATS)for penetrating thoracoabdominal injuries.Methods Under general anaesthesia and double-lumen tracheal intubation,VATS was carried out to examine patients with chest injuries.Those who had mild injuries received VATS combined with mini-incision surgery.Electrocoagulation or suturing was employed to control intraoperative bleeding,and then blood clots were removed.Injured diaphragm muscles were repaired,and organs with hemorrhage or ruptures were sutured or resected.The seriously injured cases underwent open surgery and intra-abdominal exploration instead.Results A total of 18 patients received the operations.Among them,15 patients underwent VATS combined with mini-incision surgery(repair of the diaphragm was performed on 15,controlling intercostal arterial bleeding on 8,repair of the lung on 2,wedge resection of the lung on 2,and coagulated hemothorax removal on 2),the other 3 were converted to open surgery for repairing the diaphragm(3),heart(1),or esophagus(1),or lobectomy(2).Abdominal surgery via the thorax were performed on 13 cases,including repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 1,repair of diaphragmatic hernia in 3,and intra-abdominal exploration in 7.Five patients received open surgery(pancreatic neoplasty in 1,repair of the liver in 1,lienectomy in 1,gastrorrhaphy in 2,and repair of the caul and mesenterium in 3).One patient who had multi-organ penetrating injuries died of hemorrhagic shock,circulatory failure,and DIC after open thoracic and abdominal surgeries.The mean operation time in this series was(125?44)minutes(ranged from 45 to 220),and the mean blood loss was(1089?582)ml(500 to 10 000 ml).Twenty-four hours after the operation,the mean volume of chest drainage was(234?75)ml(100 to 350 ml)in the first 24 hours after the operation.The chest drainage tube was withdrawn 2.5(2 to 5)days postoperation.The patients expelled gas in 1 to 4 days(mean,2 days).Totally,12 patients were followed up for 3 to 12 months(mean,6 months),during which none of them had trauma-related complications.Conclusion VATS combined with mini-incision surgery is safe and effective for patients with thoracoabdominal injuries,if the cases were carefully selected.

CdSe/ZnSquantumdots(QDs)werepreparedandcovalentlylinkedtoanti-katacalcinmonoclonal antibodies. After modification, the QDs' maximum emission wavelength was shifted to 625 nm from 620 nm while maintaining the spectral properties. Then the QDs labeled lateral flow strip and corresponding fluorescence measuring instrument were designed and fabricated. To reduce the cost of strip by reducing the amounts of monoclonal antibodies, appropriate amounts of QDs labeled monoclonal antibodies were sprayed on the conjugation pad, with just one test line on the strip but without the control line. Parameters of the strip were optimized by measuring the signal to noise ratio. By using the strip and fluorescence measuring instrument, procalcitonin (PCT) could be detected in 20 min, and the quantitative detection range was 0. 2-100 μg/L with sensitivity of 0. 1 μg/L. A total of 22 blood samples were measured by both our method and the commercial instrument used in the hoptital. The results were consistent for their Pearson correlation coefficient (0. 9995) and Kolmogorov-Smirnov test (Sig=1. 0). The rapid quantitative detection method for PCT is of great importance to quantitative detection of bacterial infection and rational usage of antibiotics clinically.

Objective To explore the application value of plastic biliary stent and fully covered self-expandable metallic stent (FCSEMS) in endoscopic retrograde cholangio pancreatography (ERCP) for treatment of benign biliary stricture after liver transplantation.Methods The retrospective cross-sectional study was conducted.The clinical data of 54 patients with benign biliary stricture after liver transplantation undergoing ERCP treatment who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University between January 2010 and August 2016 were collected.Among 54 patients,44 had simple anastomotic stricture and 10 had non-anastomotic stricture.All the patients underwent stent implantation by ERCP.Patients with stricture within 1 month postoperatively initially selected single plastic stent or endoscopic nasobiliary drainage (ENBD),and then changed into multiple plastic stents at the second stent replacement.Patients with stricture after 1 month postoperatively selected multiple plastic stents,multiple plastic stents after balloon dilation or FCSEMS.Observation indicators:ERCP situations,stent implantation,time of stent indwelling,postoperative complications,stent dislocation,treatment outcome and follow-up situations.Patients were followed up by outpatient examination and telephone interview up to November 2016.Clinical symptoms of patients were observed within 1 month postoperatively and liver function and abdominal ultrasound were retested.Liver function and remission degree of biliary stricture were monitored regularly once every 3 months.Measurement data were described as average (range).Results All the patients underwent successful ERCP,of which 53 completed the process of ERCP and 1 rejected treatment due to economic problems.All the 54 patients received 140 times ERCPs with an average of 2.59 times per person,21 times ENBDs,11 times FCSEMSs and 108 times plastic stent implantations (including 35 times single stent implantations,46 times double stents implantations,23 times 3-stents implantations and 4 times 4-stents implantations).All the 54 patients were followed up for 3-143 months,with an average time of 73 months.Of 44 with anastomotic stricture,34 received plastic stent implantation and 98 times ERCPs,with an average number of stent implantation of 2 (range,1-4) and an average time of stent indwelling of 10.7 months (range,9.0-13.0months);the postoperative acute pancreatitis,biliary infection,hyperamylasemia and adverse stent implantation or dislocation were detected in 4 persons every time,7 persons every time,10 persons every time and 3 persons every time,respectively;26 patients were cured and 5 were improved,with an effective rate of 91.2％ (31/34);3 patients with noneffective treatment continued to undergo ERCP and 3 patients had recurrence of anastomotic stricture.Among 10 patients with initial FCSEMS implantation,12 times ERCPs were performed,with an average time of stent indwelling of 7.6 months (range,6.0-12.0 months);postoperative biliary infection,hyperamylasemia and stent dislocation were detected in 1 person every time,1 person every time and 1 person every time,respectively;8 patients were cured,with an effective rate of 8/10;of 2 patients with persistent stricture,1 patient received contrast examination after stent removal,showing a comparative stricture in level 1 branch of intrahepatic duct and considering combined ischaemia,and then underwent the second implantation using multiple plastic stents;the other patient had elevated level of jaundice at 3 months after stents removal and received ERCP,showing anastomotic inflammatory polyp,and then underwent FCSEMS implantation again.Ten patients with non-anastomotic stricture received plastic stent implantation and 30 times ERCPs,with an average number of stent implantation of 3 (range,2-4) and an average time of stent indwelling of 11.3 months (range,10.0-14.0 months);the postoperative acute pancreatitis,biliary infection,hyperamylasemia and adverse stent implantation or dislocation were detected in 2 persons every time,5 persons every time,2 persons every time and 1 person every time,respectively;3 patients were cured and 3 were improved,with an effective rate of 6/10;of 4 patients with noneffective treatment,2 died of gradually deteriorating liver function and 2 underwent the second liver transplantation.Conclusions Stent implantation in ERCP is safe and effective for treatment of benign biliary stricture after liver transplantation,single plastic stent should be used in the early period (within 1 month) and multiple plastic stents should be used in the later period.Although FCSEMS has a higher displacement rate,it should be recommended due to a better clinical effect,lower incidence of complications and simple operation.For patients with non-anastomotic stricture,plastic stent should be used for extrahepatic biliary stricture,with a good clinical effect,and there is worse effect in stent implantation through ERCP for multiple intrahepatic biliary strictures.

OBJECTIVE: To investigate the feasibility of the treatment of otosclerosis using laser stapedotomy with mini incision in the external auditory meatus. METHOD: Thirteen patients(15 ears) with otosclerosis evidence on clinic history. They were all operated using the laser assisted stapedotomy by mini incision in external auditory meatus because of the wide straight canal. Laser resection the tendo musculistapedius and anterior and postrior arch, breaking the articulatioincudostapedia, removing the stapes superstructure, making a hole of 6mm diameter in the rear of stapes footplate by laser drilling, implanting the corresponding length Piston artificial ossicle. RESULT: All the surgeries were successful and the operation time was about one hour. There was only one patient manifested vertigo and nausea after the operation. But the symptoms improved three days later after the expectant treatment. All the incisions were healed in the externals. There was significant difference between the preoperative and postoperative PTA. The air conduct improved in every frequent and the bone conduct improved in 1 kHz, 2 kHz and 4 kHz. CONCLUSION Laser assisted stapedotomy by mini incision in the external auditory meatus in patients having wide straight canal with otosclerosis can shorten the operation time, minimize the tissue damage, fasten the healing of the incision and reduce the complications postoperatively. In addition, the mini incision is beauty and easy to nurse.
Ear Canal ; surgery ; Humans ; Lasers ; Otosclerosis ; surgery ; Postoperative Complications ; Postoperative Period ; Prostheses and Implants ; Stapes ; Stapes Surgery ; Treatment Outcome

Objective To investigate the feasibility of using optical coherence tomography (OCT)in thy-roid surgery .Methods Surgical specimen including parathyroid gland , lymph nodes , adipose tissue and thyroid tissue from patients receiving thyroid surgery in Tianjin Medical University Cancer Institute and Hospital were col -lected.OCT images were collected and the results were compared with the routine examination .Results Para-thyroid glands , lymph nodes , adipose tissue , and thyroid tissue can be obtained high-resolution OCT images .Dif-ferent tissues and metastatic lymph node can be clearly distinguished .OCT imaging took about 1 minute and fro-zen examination cost about 25 minutes.Conclusions OCT is a time-saving, non-invasive and cross-sectional imaging technique .It can obtain clear structural images of the internal microstructure of bio-tissues.OCT technol-ogy used in thyroid surgery including parathyroid identification and determination of lymph node metastasis is fea -sible.

The purpose and meaning of epidemiology curriculum,the current problems existing in the teaching and teaching reforms for different specialties were discussed.

BACKGROUND:Currently, the morphologic changes of the discoid lateral meniscus (DLM) remain unclear, and morphological indexes used to evaluate the injuries of DLM stil need to be explored. OBJECTIVE:To compare the MR imaging difference between symptomatic and asymptomatic DLM in adults, and to select reliablemorphologicalparametersfor assessing DLM. METHODS:A total of 36 patients (36 knees) with a symptomatic DLM (study group)and 34 patients (34 knees) with an asymptomatic DLM (control group) were included in this study. GE Healthcare Centricity RIS/PACKS System was used to measure the primary morphological parameters of two patients with DLM on coronal MR imaging. Intergroup comparison was performed with the Wilcoxon test. RESULTS AND CONCLUSION:On the coronal MR imaging, the width of the body portion and height of the free edge of the DLM was significantly increased in the study group compared with the control group (P< 0.001), while the height of the peripheral portion which connects with the capsule of the DLM was significantly decreased in the study group compared with the control group (P= 0.002). The heightof the middle of the DLM and the width of the lateral femoral condyle showed no significant differences between the both groups (P> 0.05). The width ratio of the body of the DLM to the lateral femoral condyle and the height ratio of height of the free edge to the middle of the DLM were significantly increased in thestudy group compared with the control group (P< 0.001), while the height ratio of the peripheral portion to the middle for the DLM was significantly decreased compared with the control group (P< 0.001). These findings suggest that compared with asymptomatic discoid lateral meniscus, the width of the body portion and the height of the free edge for the DLM are increased;however,the height of the peripheral portion which connects with the capsule of the DLM is decreased. The width ratio of the body portion of the DLM to the lateral femoral condyle and the height ratio of the free edge to the middle for the DLM may be reliable morphological parameters for the assessment of the DLM in adults.

Objective To analyze the expression of IFIT4,PRKR and investigate the clinical and immunology features of different types of liver involvement in patients with systemic lupus erythematosus (SLE).Methods Clinical data of 62 cases of SLE with liver damage and 62 cases of SLE without liver damage were collected.Peripheral venous blood samples were obtained and total RNA were extracted and transcribed into cDNA.Sybr green dye based real-time quantitative PCR method was used to compare the expression levels of IFIT4,PRKR in patients with SLE.Clinical parameters were analyzed by ANOVA,Chi-square test,Pearson's or Spearman's test.Results ① The increase of γ-GT or ALP was correlated with rash and oral ulcer (x2=5.625,P=0.018),lupus nephritis (x2=5.631,P=0.019),anemia,thrombocytopenia (99±21,P=0.028; 81±45,P=0.004,),CRP (33±43,P=0.004).The positive rate of nRNP (x2=4.862,P=0.027 ) and SSA (x2=8.087,P=0.004) was higher in patients with liver damage than other groups; ② The positive rate of anti-Rib antibody in SLE with liver damage was significantly higher than SLE without liver damage (x2=19.542,P=0.000); ③ There was no difference in the expression of IFIT4 among these groups,but higher expression of PRKR was detected in the group of patients with increased γ-glutamyl transpeptidase (γ-GT) or ALP(F=3.54,P=0.018).Conclusion The different types of liver damage in SLE patients have different clinical and immunology characteristics.The expression of PRKR is higher in patients with increased γ-GT or ALP.