The anatomy and position of choledocho-pancreatico-duodenal junction are unique,so choledocho-pancreatico-duodenal junction is easily be injured during operation,and thus it needs further investigation.Anatomical,pathological and iatrogenic factors are the 3 main causes of choledocho-pancreatico-duodenal junction injury.The diagnosis of choledocho-pancreatico-duodenal junction injury includes intraoperative and postoperative diagnosis; and the treatment methods include intraoperative repaire and suture,T tube drainage,postoperative debridement and drainage,biliopancreatic shunt,duodenal diverticulum,jejunum stoma,gastrointestinal and biliary reconstruction.Precise operation,T tube cholangiography,choledochoscopy can effectively prevent the choledocho-pancreatico-duodenal junction injury.The principle of early discovery,early management,avoiding over-management,and promoting damage control surgery should be awared to reduce the mortality.

Hepatocellular carcinoma (HCC) in nonimpaired livers are a type of HCCs arising in non-cirrhotic,non-fibrotic livers without viral hepatitis or alcohol abuse.Liver resection is the major form of treatment.Factors considered when developing a prognostis include R0 liver resection,hepatocellular function,recurrence,vascular invasion,transfusion,tumor size,tumor number,tumor capsule,and daughter nodules.So the prognosis can be predicted through the analysis of these factors during preoperative and perioperative period. The curative effects of the operation can be enhanced by optimizing treatment based on the analysis of these prognostic factors.

Objective To investigate the effects of Buyang Huanwu decoction and its decomposed recipes on neurological function and angiogenesis after focal cerebral ischemia in rats and its mechanism. Methods Fifty-two clean grade SD male rats were randomly divided into sham-operation,model,whole prescription,invigorating qi,and promoting blood circulation groups (n = 8 in each group)according to the random number table. In addition to the sham-operation group,the middle cerebral artery occlusion models of the rats in other groups were induced by the suture method. The patients with the first Longa nerve function scores 1 to 3 were used as successful modeling. The whole Buyang Huanwu decoction included dried root of Astragalus membranaceus 120. 0 g,dried root of angelica sinensis 6. 0 g,dried root of Paeonia lactiflora 4. 5 g, dried rhizome Ligusticum chuanxiong 3. 0 g,dried body of Pheretima aspergillum 3. 0 g,dried flowers of Carthamus tinctorius 3. 0 g,and seed of Prunus persica 3. 0 g;the invigorating qi prescription included dried root of Astragalus membranaceus 120. 0 g;the promoting blood circulation prescription included dried root of angelica sinensis 6. 0 g,dried root of Paeonia lactiflora 4. 5 g,dried rhizome Ligusticum chuanxiong 3. 0 g, dried body of Pheretima aspergillum 3. 0 g,dried flowers of Carthamus tinctorius 3. 0 g,and seed of Prunus persica 3.0 g. On the first day after procedure,the rats began to be administered intragastrically. The intragastric doses of the whole prescription group,invigorating qi group,and promoting blood circulation group were 13. 1,10. 8,and 2. 2 g/ kg,respectively. The sham-operation group and the model group were given equal volume of isotonic saline,once a day for 14 days. 5-bromodeoxyuridine (BrdU,50 mg/ kg)were injected intraperitoneally,once a day for 14 days. The modified neurological severity score (mNSS)and the corner test were used to evaluate sensorimotor function at day 1,7 and 14 after procedure. BrdU and rat von Willebrand factor (vWF)double immunofluorescent staining were used to detect the angiogenesis in ischemic peripheral region;Western Blot was used to detect the protein expression of vascular endothelial growth factor (VEGF). Results (1)Compared with the model group,the mNSS score in rats in the whole prescription group was lower at day 7 and 14 after procedure (6. 8 ±1. 0 vs. 8. 5 ±1. 1,6. 1 ± 0. 8 vs. 8. 0 ± 1. 4;all P < 0. 01). The number of turning right in the whole prescription group was reduced (7. 1 ±0. 6 vs. 8. 6 ±1. 2 and 6. 1 ± 0. 8 vs. 7. 9 ±1. 1;all P < 0. 01). The number of turning right in the invigorating qi group was reduced (7. 5 ± 0. 5 vs. 8. 6 ± 1. 2 and 6. 2 ± 1. 0 vs. 7. 9 ± 1. 1;all P < 0. 01). At day 14 after procedure,the number of BrdU / vWF co-labeled immunopositive cells in ischemic peripheral zone of the whole prescription group was increased significantly. There was significant difference between the groups (30 ± 8 / mm2 vs. 24 ± 7 / mm2;P < 0. 01). The VEGF protein expression was increased (0. 33 ±0. 01 vs. 0. 30 ±0. 01;P <0. 01). (2)Compared with the invigorating qi group,the rat mNSS scores of the whole prescription group were lower at day 7 and 14 after procedure (the invigorating qi group 8.2 ±1.3 and 7.5 ±0.9 respectively;all P <0. 05). The number of BrdU/ vWF immunopositive cells in the whole prescription group was increased at day 14 after procedure (26 ±5/ mm2 in the invigorating qi group;P < 0. 05). The VEGF protein expression was increased (0.31 ±0.01 in the invigorating qi group;P <0.01). (3)Compared with the promoting blood circulation group, the mNSS scores of the whole prescription group were lower at day 7 and 14 after procedure (the promoting blood circulation group 8.5 ±0.9 and 7.6 ±0.7 respectively;all P <0. 05). The number of turning right was reduced (8.5 ±0. 8 and 7. 6 ± 0. 9 respectively in the promoting blood circulation group;all P < 0. 05). The number of BrdU/ vWF immunopositive cells in ischemic peripheral zone of the whole prescription group at day 14 after procedure was increased (26 ± 6 / mm2 ,P < 0. 05). The relative expression level of VEGF was increased (0. 31 ±0. 01 in the promoting blood circulation group,P <0. 05). Conclusion Buyang Huanwu decoction can promote angiogenesis and recovery of neurological function after cerebral ischemia. Its mechanism may be associated with the up-regulation of the VEGF protein. The traditional Chinese medicines for invigorating qi and invigorating the circulation of blood in the prescription have synergistic effect.

Aim To investigate the brain targeting of ginkgolide B prodrug (PGB ) and its mechanism. Methods The liquid chromatography tandem mass spectrometry (LC-MS /MS)method was applied to in-vestigate the pharmacokinetics of PGB in rat brain tis-sue after intravenous injection of PGB.Also the brain targeting was evaluated on the basis of the pharmacoki-netic parameter of PGB.The incomplete cerebral is-chemia model was induced in mouse,the effect of PGB on cerebral capillary permeability was observed by Ev-ans blue method.High performance liquid chromatog-raphy (HPLC)was used to determine the partition co-efficients (logP)of PGB in octanol-water system.PGB and P-glycoprotein (P-gp)was docked by using Mole-gro Virtual Docker (MVD)software to predict its bind-ing abilities with P-gp.The interaction of PGB with ATPase activity of human P-gp membrane was esti-mated by measuring inorganic phosphate liberation. Results The brain targeting of PGB was evaluated by treatment effective (TA ) and drug targeting index (DTI),the calculated value were 6.87 and 4.1 4 re-spectively.Preventive medication of PGB could signifi-cantly decrease cerebral capillary permeability (P <0.05).The lipo-hydropartition coefficient of PGB was higher than that of GB,their logP data were 1 .03 and 0.61 respectively.PGB displayed the stronger binding affinity with P-gp than GB according to the molecular docking calculations,their MolDock Score toward P-gp were -1 43.36 and -1 1 6.40KJ·mol -1 respectively. ATP-hydrolisis showed that PGB increased ATPase activity with a Km of approximately 237.75 μmol · L -1 ,however GB with a Km of approximately 841 .24μmol·L -1 .PGB might interact with P-gp with a high-er affinity and exhibit more effect than GB.Conclu-sion PGB is characterized by its brain targeting. Higher liposolubility of PGB results in good blood-brain permeability,which is advantageous to its brain targe-ting.Besides,PGB can effectively inhibit the efflux effect of P-gp to GB because of its increased P-gp AT-Pase activity.

Medical virtual simulation experimental teaching platform has the characteristics of high openness and sharing, overcoming resource constraints, diversified teaching methods and so on. Applying the virtual simulation platform to general surgery teaching, students can break through the constraints of the textbooks, and perform immersive practical operations on the network by watching experimental videos, and simulating virtual instrument, and experimental materials online, so as to improve their hands-on skills and increase their interest in learning.

OBJECTIVETo study the antitumor effects of Chansu injection on transplanting- tumor of S(180 ) in mice and human colon cancer HT-29 in nude mice.

METHODSUsing transplanting- tumor models of S(180 ) in mice and human colon cancer HT-29 in nude mice,the tumor inhibitive ratio(IR) of Chansu injection was determined and apoptosis was microscopically observed.

RESULTSCompared with tumor-negative control groups, IR at different dosage of Chansu in models of S(180) and HT-29 was 19.1% - 38.2% and 9.5% - 15.8% respectively,there was a dose-dependent relationship in models of S ( 180) (P< 0.05) and HT- 29 (P> 0.05). The tumor growth was markedly inhibited by cyclophosphamide (CTX) in model of S( 180) with IR of 70.7% and in model of HT-29 with IR of 67.1%, compared with control groups, both P< 0.01; apoptosis induced by CTX was markedly observed by in microscope examination. No significant side effects were shown in the study group.

CONCLUSIONSChansu injection can significantly inhibit tumor growth in model of S(180), but not in model of HT- 29. Different type of tumor has different drug-sensitivity.

Animals ; Bufanolides ; pharmacology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; HT29 Cells ; Humans ; Male ; Mice ; Mice, Inbred BALB C ; Mice, Inbred Strains ; Mice, Nude ; Sarcoma 180 ; drug therapy ; Xenograft Model Antitumor Assays

Objective:To explore whether a longitudinal integrated clerkship (LIC) model is more conducive to medical students' post competency and satisfaction with clerkships compared with the traditional block rotation clerkship.Methods:We selected 72 students who participated in graduating clerkships at The First Affiliated Hospital of Harbin Medical University from June 2018 to June 2019. They were equally divided into experimental group and control group to adopt LIC and traditional block rotation clerkship models, respectively. After completing the clerkships, the two groups were evaluated for post competency through objective testing of theoretical medical knowledge and basic clinical skills and rating of the other five competence items by the students themselves and their teachers. At the same time, a questionnaire was delivered to both groups for the degree of satisfaction with clerkships. The t-test and chi-squared test were performed using SPSS 23.0. Results:The objective tests and students' self-evaluation showed that the experimental group had significantly higher scores of theoretical medical knowledge [(8.02±1.11) vs. (7.50±0.97)], basic clinical skills [(7.63±0.90) vs. (6.93±0.73)], medical professional responsibility [(7.74±0.56) vs. (7.31±0.78)], clinical communication [(8.10±1.06) vs. (7.22±0.60)], team work [(7.84±0.62) vs. (7.11±0.69)], literature searching [(6.25±0.60) vs. (4.78±0.84)], and scientific research ability [(4.26±0.88) vs. (2.46±1.20)] compared with the control group (all P<0.05). The experimental group had significantly higher teacher-rated scores of medical professional responsibility [(8.03±0.74) vs. (6.59±0.70)], clinical communication [(7.95±0.73) vs. (6.87±0.67)], team work [(7.96±0.75) vs. (6.95±0.69)], literature searching [(4.84±0.84) vs. (3.30±0.69)], and scientific research ability [(4.53±1.03) vs. (2.70±1.05)] than the control group (all P<0.01). The scores of satisfaction were all higher in the experimental group than in the control group in terms of course arrangement satisfaction [(7.17±0.91) vs. 6.56±0.84)], teacher-student interaction satisfaction [(7.08±0.69) vs. (6.28±0.82)], self-improvement satisfaction [(7.28±0.45) vs. (6.36±0.49)], and clinical work smoothness [(7.72±0.82) vs. (6.81±0.71); all P<0.01]. Conclusion:Compared with the traditional block rotation model, the LIC model is more helpful for improving the post competency of medical students. LIC is a new clinical clerkship model that can potentially replace the traditional block rotation clerkship.