Hilar cholangiocarcinoma always presents with a mass, thickness of the bile duct wall or nodules in the bile duct. Computed tomography (CT) can demonstrate the above findings with high partial resolution as well as dilation of the intrahepatic bile duct. CT can show the field and the involvement of adjacent vessels on 3D reconstruction images for hilar cholangiocarcinoma spreading along the lumen of the bile duct. CT images can also demonstrate vessel involvement when evaluating the resectability. When combined with 3D reconstruc-tion, the sensitivity and specificity of CT imaging can reach 90.5% and 91.7% , respectively, for detecting vessel involve-ment.

Objective To observe the clinical effect of tigecycline combined with cefoperazone sulbactam for the treatment of pneumonia caused by muitidrug-resistant acinetobacter baumannii pneumonia. Methods 68 patients with muitidrug-resistant acinetobacter baumannii pneumonia were randomly divided into two groups, control group and observation group, with 34 patients in each group. The control group was treated with cefoperazone sulbactam, and the observation group was treated with tigecycline combined with cefoperazone sulbactam. The level of PCT, CRP, WBC and clinical cure rates, as well as microbiological eradication and side effect, before and after treatment were collected and compared. Results After treatment, the level of PCT, WBC and CRP in two groups was decreased, and the observation group was more significant than the control group(P < 0.05). The side effect rate in two groups were 14.7% and 17.6% respectively (P > 0.05), while the clinical cure rates and microbiological eradication in observation group were significantly higher than the control group (P<0.05). Conclusion With a higher rate of clinical efficacy and a lower rate of side effect, the combination treatment with tigecycline and cefoperazone sulbactam would be a promising alternative for the treatment of muitidrug-resistant acinetobacter baumannii pneumonia infection.

Objective To evaluate the effect of pantoprazole and norepinephrine injection on serum levels of inflammatory factors and hemostasis in the treatment of patients with peptic ulcer bleeding .Methods 102 cases of patients with peptic ulcer bleeding from September 2014 to September 2016 in our hospital were selected and randomly divided into observation group ( n =51 ) and control group ( n =51 ) .Observation group were received pantoprazole and norepinephrine injection combination therapy, the control group received only pantoprazole therapy.The treatment lasted 3 days.The efficacy, bleeding time, hospitalization and blood transfusion, serum IL-6 and IL-10 levels, the incidence of rebleeding and incidence of adverse reactions were compared between two groups.Results The overall response rate ( 98.02%) was significantly higher ( 82.35%) ( P<0.05 );observation group bleeding time was significantly faster than the control group ( P<0.05 ) , length of hospital stay was significantly shorter than the control group (P<0.05), blood transfusion was significantly less than the control group (P<0.05); levels of serum IL-6, IL-10 after treatment were lower than those before treatment (P<0.05); the serum levels of IL-6, IL-10 after treatment were significantly lower than those in control group (P<0.05); rebleeding rate in observation group was significantly lower than that in control group (P<0.05);there was no significant difference in adverse reactions between two groups.Conclusion Pantoprazole and norepinephrine injection in the treatment of digestive bleeding ulcer bleeding has the obvious effect, can reduce serum levels of inflammatory factors, while also reduce the incidence of rebleeding, safe and reliable.

Objective To investigate the changes of immune state and the impact on immunological rejection elicited by abdominal cavity bacterial infection after DA-Lewis rat liver transplantation.Methods Orthotopic liver transplant model was established by modified Kamada two-cuff technique.The animals were divided randomly into Group 1,isotonic Na chloride injected into abdominal cavity 3 days after operation;Group 2,mixed Bacillus coli liquid injected instead of saline;Group 3,immunosuppressive drug CsA administered routinely after operation(3 mg?kg-1?d-1).All the animals were sacrificed 7 days after infection.The blood and graft samples were collected for cell-subpopulation,mixed lymphocyte culture,IL-4,IFN-? mRNA detection and histological evaluation.Results Seven days after infection,the lympholeukocyte population,CD4/CD8(G1=1.753?0.181,G2=1.384?0.073,G3=0.997?0.025)and lympholeukocyte function(SI:G1=67.59?3.40,G2=37.14?0.90,G3=15.87?0.51)declined in Group 2 as compared with other groups and cellular differentiation drifted to Th2.There was significant difference between Group 2 and Group 1 or 3.Conclusion Abdominal cavity bacterial infection after rat liver transplantation will promote the differentiation of T cells into Th2,down-regulate CD4/CD8 ratio and immune function of lymphocytes and accordingly alleviate partly the acute rejection following liver transplantation.

Objective To investigate the effect of donor specific immature dendritic cells infusion in combination with CsA on differentiation of liver recipient′s Th1/Th2 cell in rats. Methods Allograft models of orthotopic rat liver transplantation were established, 88 LEW rats (recipient) and SD rats (donor) were randomly divided into three groups: (1) in control group no immunosuppresive drug was used after liver transplantation. (2) in CsA group 1 mg/100 g body weight of CsA was injected intraperitoneally every the other day for 3 times beginning the 2nd day after liver transplantation. (3) in CsA+DC group additional 1? 10 6 immature DC from donor bone marrow was injected through penile vein at the 8th day after operation, in combination with CsA as in CsA group. Rats were sacrificed for immunopathological examination and detection of INF ?mRNA, IL 6 mRNA of celiac lymph node on 5th, 10th, 15th, and 25th day after transplantation. Results The average recipient survival time in the CsA+DC group was (27 0?1 0) days, significantly longer than that in control and CsA group (all P

[Objective] By means of study of related literature records about Neiguan points in Great Compendium of Acupuncture and Moxibustion, it is intended to provide a theoretical foundation for the application of Neiguan points in modern clinical acupuncture and moxibustion. [Method] Collect articles with regard to Neiguan points inGreat Compendium of Acupuncture and Moxibustion , and systematically analyze its location, needling and moxibustion techniques, as well as clinical application law. To investigate the clinical application of differences between ancient and modern Neiguan. [Results] InGreat Compendium of Acupuncture and Moxibustion, Neiguan points are located at 2-inch above palm strips. Needle can be penetrated into 3/10 inch, 1/2 inch, and 1.2inch between two tendons. Neiguan point is a collateral-connecting acupoint for pericardium meridian, and mainly treats cardiothoracic excess and deficiency related diseases. If matching with yangchi point, it can be called Yuan-primary point and collateral-connecting point combination that can treat triple energizer meridian related diseases. The Neiguan point is also regarded as the eight confluence point connecting Yinwei meridian that can treat mental diseases, Yinwei vessel is associated three yin meridians of foot diseases, conception vessel diseases and Yangming Channel penetration diseases. [Conclusion] It is concluded the location, needling therapy and clinical application law of Neiguan points in Great Compendium of Acupuncture and Moxibustion, which is of reference significance to the application of Neiguan points in modern clinical acupuncture and moxibustion.

Objective To evaluate the treatment effect of Lobaplatin combined with Aidi Injection on patients with advanced NSCLC, and observe the influence on the level of serum VEGF by the treatment. Methods 60 patients, with advanced NSCLC and malignant pleural effusion, were divided into two groups (observation group and control group) randomly, with 30 cases in each group. All patients were treated with thoracentesis and inserted central venous catheter for the drainage of pleural effusion. After exhaustion of pleural effusion, the control group was treated with Lobaplatin by pleural perfusion, and the observation group was treated with Aidi Injection in addition to the treatment on control group. The treatment, side effects and quality of life and the level of serum VEGF were compared. Results After treatment, it is significant that clinical effects, side effect and KPS score of living quality of the observation group was better than that of the control group (P<0.05). The level of serum VEGF was significant lower than that before treatment in both groups (P<0.05). The decrease of VEGF serum level in the observation group was significantly lower than the decrease in the control group (P <0.05). Conclusion Lobaplatin combined with Aidi Injection was one of the effective method for the treatment of NSCLS with malignant pleural effusion, and was worthy of clinical application.

The expression and changes of local cytokines network were detected in heart transplantation in rats, so as to determine the role of cytokines in the acute rejection of rats of heart transplantation. Allografts were divided into 4 groups (n=12 in each group): group A (control), group B (IL-2 monoclonal antibody-treated), group C (CsA-treated) and group D (IL-2 monoclonal antibody+CsA-treated). Hearts from DA rats were transplanted into a cervical location in Wistar recipients. The local expression of IL-1beta, IL-2, CD25, IL-4, IL-5, IL-6, 1L-10, TNFalpha and INFgamma was detected at day 1, 3, 5, 7, 9, 11 and 14 by reverse transcription polymerase chain reaction. The results showed that the survival time of allografts was 8.3+/-1.7, 29.2+/-7.1 (P<0.05), 26.4+/-5.7 (P<0.05) and 55.0+/-10.6 (P<0.01) days respectively in groups A, B, C and D. The expression of IL-1beta, IL-4, IL-10 and IFNgamma was up-regulated, and that of IL-2, CD25, IL-5, IL-6 and TNFalpha was significantly inhibited in group A; The expression of IL-10, IL-5, IL-6, IL-10 and IFNgamma was up-regulated, and that of IL-2, L-4 and TNFalpha was significantly down-regulated in group B; The expression of IL-1beta, IL-2, CD25, IL-5, TNFalpha and IFNgamma was up-regulated, and that of IL-4, IL-6 and IL-10 was significantly down-regulated in group C; The expression of IL-14, 11-5, IL-6 and 11-10 was up-regulated, and that of IL-10, IL-2, CD25, TNFalpha and IFNgamma was significantly down-regulated in group D. In conclusion, cytokines play an important role in the development of acute transplantation rejection. Different cytokines play different roles in different local environments.

Objective To establish a rat model of peritoneal bacterial infection after liver transplantation.Methods To construct a dark Agouti rat-to-Lewis(DA-to-LEW) rat model of liver transplantation.Peritoneal bacterial infection in the rats was induced by intraperitoneal injection of bacterial suspension.The liver function,blood gas,blood cell count and other indicators of the rat models were detected.Results There was a high mortality rate in rats with bacterial injection at day 5 after liver transplantation,therefore unfavorable for the following study.It waft better to inject the bacteria in an amount of 5×10~5 cfu/mL at day 3 after liver transplantation.The cumulative 7-day survival rate of those rats after infection reached up to 37.5%.The infection became increasingly severe,the general conditions were worsening,the rectal temperature was rising,the WBC count was increased,the pH was decreased,liver dysfunction was progressively increased,and metabolic acidosis occurred in the rats.Liver parenchymal damage was more pronounced than that of bile ductal injuries,and the rats died one after another at about 5 days after infection.Pathological examination of multiple organs showed that the main cause of death of the rats was liver damage,without accompanying lung and kidney damages.Conclusion The results of this study suggest that it is a successful method to establish a rat model of peritoneal bacterial infection after liver transplantation,and this model can be used in related experimental researches.

Objective To investigate the predictive value of the baseline ,week 1 and week 2 model for end‐stage liver disease (MELD) scores ,MELD‐Na scores and MELDNa scores for 3‐month mortality in hepatitis B virus (HBV) related acute‐on‐chronic liver failure (ACLF) patients .Methods Fifty‐three eligible HBV‐related ACLF patients who received initial treatment in People′s Hospital of Deyang City , Sichuan Province from January 2014 to January 2015 were enrolled in this retrospective clinical follow‐up study .Patients were divided into death group and survival group according to the prognosis after 3 months of treatment .Biochemical data and complications were collected .t test was used to compare the means between two groups and χ2 test was used to compare categorical data .Accuracy of scoring models in predicting mortality within 3 months was performed by area under receiver operating characteristic curve (AUC) .Results Of the fifty‐three patients ,twenty‐one HBV‐related ACLF patients died in 3‐month , while thirty‐two patients survived .The AUC of MELD scores ,MELD‐Na scores and MELDNa scores at the baseline in predicting 3‐month mortality were 0 .548 (95% CI:0 .406 -0 .685 , P= 0 .555) ,0 .502 (95% CI:0 .362-0 .643 ,P=0 .978) and 0 .523 (95% CI:0 .381-0 .662 ,P=0 .778) ,respectively .The AUC increased gradually at the first and the second week .At the second week ,the AUC of MELD scores ,MELD‐Na scores and MELDNa scores were 0 .881 (95% CI:0 .762 -0 .953 ,P<0 .01) ,0 .878 (95% CI:0 .759-0 .951 ,P<0 .01) and 0 .897 (95% CI:0 .783 -0 .963 ,P<0 .01) ,respectively .The AUC of the second week was higher than those of the baseline and the first week (both P<0 .05) .The sensitivity ,specificity ,positive predictive value (PPV) ,and accuracy at the second week were best when the cut off was 26 for MELD ,29 for MELD‐Na and 29 for MELDNa , and were higher than the corresponding values of the baseline and the first week .Conclusions The predictive values of MELD scores ,MELD‐Na scores and MELDNa scores at the second week are superior to the baseline and the first week for 3‐month mortality in HBV‐related ACLF patients ,while the predictive values at the baseline could be poor .