Objective To compare the surgical modes of cholecystectomy in patients with diabetes mellitus. Methods The intraoperative blood loss, operation time, duration of hospital stay and incidence of complications were respectively compared in 46 patients with diabetes receiving either laparoscopic cholecystectomy (LC, n=23) or open cholecystectomy (OC, n=23). Results In the Group LC and the Group OC, the intraoperative blood loss was (80?23) ml and (120?40) ml, respectively ( t = -4.518 , P = 0.000), the operation time was (45?20) min and (69?28) min, respectively ( t =-3.345, P =0.002), and the hospital stay was (6?2) d and (11?3) d, respectively ( t =-6.651, P =0.000). There were no statistical significances between the two groups in the incidence of complications. Conclusions LC can be performed safely in patients with diabetes mellitus. It offers the advantages over OC in less blood loss, shorter operative time and shorter hospital stay.

Objective To explore CT and MRI features of peripheral primitive neuroectodermal tumors (pPNET) .Methods CT and MRI findings were retrospectively analyzed in 9 cases with pPNET confirmed by pathology .Of them ,8 patients underwent CT imaging ,and 5 patients underwent MR imaging .Results The lesions occurred in head and neck in 2 cases ,chest in 3 cases ,scrotum in 1 case ,right scapular region in 1 case ,and lower extremity in 2 cases .The lesions were more solitary (7/9) with round ,lobular or irregular shape .The longest diameter was between 1 .6 cm -13 .8 cm ,and the median diameter was 6 .2 cm .8 cases had blurred boundary .On CT plain scanning ,the lesions were mixed density with predominant isodensity .On MR imaging ,the lesions were slightly T1 hypointensity and heterogeneous T2 hyperintensity .Enhancement patterns were varied ,and the common way was mild‐to‐moderate heterogeneous enhancement .3 cases of them were closely associated with bone ,and showed osteolytic bone destruction . Conclusion The CT and MRI features of pPNET has lack characteristics ,CT and MR imaging have some value for localization diagnosis .

Objective To apply a complete evaluation system for clinical teaching quality and improve the objective and method of the quality control of clinical teaching procedure. Methods Clinical teachers and staff from four clinical medical colleges(Ruijin,the Sixth,the Ninth,and Tongji) were investigated.The data of their cognition about clinical teaching,weakness in teaching procedure,situation,and quantity and quality control of clinical teaching were collected and analyzed. Results The appraisal system for clinical teaching quality was established in all four clinical medical colleges.The improvement was required in evaluation of executive supervision of the present system.The quality control about clinical ability teaching was the key point to perfect the system. Conclusion It is necessary to further discuss consummation of system,establishment of evaluation method and standard so as to perfect the evaluation system of clinical teaching.We should begin with the weakest procedure,and then improve the present condition step by step.

OBJECTIVE: To study the causes of false-positive hyoid fractures and forensic identification. METHODS: Twelve cases of false-positive hyoid fractures were collected and analyzed. RESULTS: Improper dissection technique (4 cases) and congenital separation (8 cases) were the main reasons for false-positive hyoid fractures. CONCLUSION True fractures can be differentiated from false-positive hyoid fractures. False-positive hyoid fracture caused by improper dissection technique can be identified through examination of peripheral muscle, soft tissue hemorrhage, and the characteristics of fracture end.
Autopsy ; Cell Differentiation ; Diagnostic Errors ; Fractures, Bone/diagnosis* ; Humans ; Hyoid Bone/injuries* ; Muscles

Objective To evaluate quantitatively the spasticity of elbow flexor biceps in stroke patients using integrated EMG (IEMG),and to correlate the IEMG with Ashworth scale.Methods The IEMG data was recorded from the biceps while passively stretch the elbow joint of a group of 90 subjects,and was correlated with the varying levels of Ashworth category(20 cases with grade 0,6 cases gradeⅠ,16 cases gradeⅠ~+,20 cases gradeⅡ,and 18 ca- ses gradeⅢ).Results The IEMG data were positively correlated with simultaneous Ashworth scale categories.The range of IEMG value corresponding to the Ashworth category is as follows:1.3～12.1 (6.7?5.4)?V?s vs Ash- worth grade 0;4.6～12.3 (8.5?3.9)?V?s vs Ashworth gradeⅠ.15.3～28.4(21.8?6.6)?V?s vs Ashworth gradeⅠ~+;37.2～68.9 (53.1?15.6)?V?s vs Ashworth gradeⅡ;82.3～144.1 (113.2?30.9)?V?s vs Ash- worth gradeⅢ.Conclusion The IEMG value can be used to quantify the spasticity of elbow flexor in stroke pa- tients.

Objective To evaluate the effect of three diamension-digital subtraction angiography (3D-DSA) or computed tomography angiography (CTA) on the patients with ruptured multiple intmcranial aneurysm (MIA). Methods A retrospective study on 21 patients with MIA was performed.After scanning with 3D-DSA or 3D-CTA, three-dimensional reconstruction of MIA was carried out by 3D workstation,then the diagnosis was decided and the treatment plan (endovascular treatment or microsurgery) was selected according to stereoscopic image of MIA. Results (1) 3D-DSA or CTA was performed in 21 patients with subarachnoid hemorrhage (SAH),it was revealed these patients carried with 48 aneurysms,including 35 small aneurysms (25 mm).Not only miero-aneurysms and small aneurysms could be precisely showed,also the size of aneurysmal neck,the relationship of the aneurysm and the parent vessel and contiguous branches by stereoscopic image.(2) According to the standard of classification,9 patients with MIA for gradeⅠ(42.9%),10 for gradeⅡ(47.6%),2 for gradeⅢ(9.5%),0 for gradeⅣ.Endovascular treatment was selected prior to microsargery for those high grade patients.In this group,17 patients with 40 aneurysms underwent endovascular embolotherapy with GDC coils.Twenty four anemysms were completely occlusioned,12 beyond 90%,4 were left without treatment because of their small size.In microsurgery group,3 aneurysrus were totally clipped,1 could not be found during operation.No any treatment was accepted in 2 patients with 4 aneurysms. Conclusions 3D-DSA or CTA,which is very useful for the diagnosis and treatment of MIA,could improve the accuracy of diagnosis of MIA and clearly show the stereoscopic image of MIA,also the relation of sac and parent artery.For those patients with high grade MIA,endovascular treatment was selected prior to microsurgery,pro re nata,used to combine with mierosurgery.

OBJECTIVE:To explore the effects of inhaled budesonide on the efficacy and related indexes of patients with acute bronchitis. METHODS:102 patients with acute bronchitis were randomly divided into control group and observation group. Control group was given 100 mg/(kg·d) Cefotaxime sodium injection,adding into 150 ml 0.9% Sodium chloride injection intravenously by 2 times,as well as sedation,oxygen inhalation,rehydration,correcting acid-base balance and other conventional treatment;ob-servation group was additionally given 2 ml Inhaled budesonide suspension,twice a day. The treatment course for both groups was 7 d. Clinical efficacy,erythrocyte immune complex rosette(E-ICR),high-sensitivity C-reactive protein(hs-CRP),peak expiratory flow rate(PEF),forced vital capacity(FVC),1 second forced exhaled volume(FEV1),time of body temperature returned to nor-mal,cough disappearance time,rale disappearance time before and after treatment,and incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,time of body temperature returned to normal, cough disappearance time and rale disappearance time were significantly shorter than control group,the differences were statistically significant(P<0.05). Before treatment,there were no significant differences in the E-ICR and hs-CRP levels,PEF,FVC and FEV1 between 2 groups(P>0.05). After treatment,E-ICR and hs-CRP levels were significant-ly lower than before,and observation group was lower than control group,PEF,FVC and FEV1 were significantly higher than be-fore,and observation group was higher than control group,the differences were statistically significant(P<0.05). And there were no adverse reactions during treatment. CONCLUSIONS:Based on conventional treatment,inhaled budesonide has obvious efficacy in the treatment of acute bronchitis,and it can reduce E-ICR and hs-CRP,improve pulmonary functions,with good safety.

Objective:To explore the clinical value of T 1 mapping/indexed extracellular volume fraction (iECV) quantified with cardiac MR (CMR) parameters, and its correlation with traditional indicators of myocardial dysfunction in aortic insufficiency (AI) patients. Methods:A total of 36 patients clinically and radiologically diagnosed with chronic AI in our hospital between May 2012 and February 2016 were retrospectively selected. All AI patients underwent conventional CMR protocol, native and post T 1 mapping. CMR parameters, such as aortic regurgitant fraction (RF), late gadolinium enhancement (LGE) mass fraction, myocardial extracellular volume fraction (ECV) and iECV. Based on the values of aortic RF, AI patients were divided into mild AI group (9 cases), moderate AI group (14 cases) and severe AI group (13 cases). The clinical characteristics were teased from the patients′ electronic medical records. Univariate analysis of variance was used to compare the measurement data of native T 1 mapping, post-contrast T 1 mapping, ECV, and iECV. LSD test was used for pair wise comparison between the mild AI, moderate AI and severe AI groups. Data about cardiovascular history, New York Heart Association (NYHA) heart function classification, and LGE were compared by chi-square test or Fisher exact test. The correlation between left ventricle ejection fraction (LVEF) and iECV was evaluated by Spearman correlation analysis. Results:There was no difference in age, sex, cardiovascular history among the three groups. Comparison of patients with different severity of AI in the three groups: (1) There was statistically significant difference in the LGE positive rate among the three groups ( P=0.023), while the myocardial replacement of fibrosis increased with the grade of aortic regurgitation. (2) There was no statistically significant difference in the measurement data of native T 1 mapping, post-contrast T 1 mapping, ECV among the three groups ( H=1.815, 0.929, 2.496, all P values>0.05), while the diffuse myocardial fibrosis tended to increase with the degree of aortic regurgitation. There was statistically significant difference in iECV among the three groups ( H=16.725, P<0.001). The measurement data of iECV in the severe AI group was significantly higher than those in the other two groups ( P<0.05). LVEF value was inversely correlated with iECV ( r=-0.649, P<0.001). Conclusions:Quantitative T 1 mapping/iECV can serve as a parameter to noninvasively identify diffuse myocardial fibrosis in AI patients of different severities. It changes with LVEF and can manifest the reversible stage of left ventricular decompensation.

BACKGROUND:Breast cancer stem cells not only lead to theoccurrence of breast cancer, but also may cause breast cancer metastasis and recurrence. The relationship between stem cells and cell resistance is also gaining increasing attentions, and the focus on the stem cell treatment may result in unexpected results.OBJECTIVE:To explore the reversal effect of psoralen on glutathione-S-transferase π (GST-π) in human breast cancer MCF-7/ADR cells and its mechanism.METHODS:MCF-7/ADR cells were cultured and enriched in serum-free medium to obtain breast cancer stem cells.RT-PCR and western blot were used to detect the expression of GST-π at the levels of gene and protein in the MCF-7/ADR cells after treatment with 0, 4, 8, 12, 16 mg/L psoralen. To observe the activation of nuclear factor-κB,western blot was used. The expression of GST-π was detected by RT-PCR in 18 μmol/L SN50 group and 8 mg/L psoralen group. Cell counting kit-8 assay was used to detect the effect of doxorubicin on cell proliferation.RESULTS AND CONCLUSION:Compared with the control group, psoralen reduced the expression of GST-π at the mRNA and protein levels, and significantly inhibited the activation of nuclear factor-κB. It was suggested that psoralen could reverse the multidrug resistance of human breast cancer MCF-7/ADR stem cells by decreasing the expression level of GST-π. The mechanism may be achieved by inhibiting the nuclear factor-κB signal pathway.

Objective To explore the effect of psoralen on topoisomerase IIα(TopoIIα) expression of breast cancer stem cells.Methods CD44+CD24-/low breast cancer stem cells were sorted from MCF-7/ADR by magnetic-activated cell sorting(MACS).We observed the growth characteristics of these stem cells through optical microscope and detected the growth-inhibitory effects of psoralen on breast cancer stem cells by CCK-8 assay and IC50 of adriamycin and adriamycin combined with psoralen to calculate the reversal index.The mRNA and protein expressions of Topo IIα were detected using RT-PCR and Western blot, respectively.Results Under the optical microscope, breast cancer stem cells presented spheres.IC10 and IC20 of psoralen on breast cancer stem cells were (6.77±0.23)μg/mL and (10.36±0.21)μg/mL.IC50 of adriamycin and adriamycin combined with psoralen on breast cancer stem cells was (90.03±3.56)μg/mL and (21.47±0.82)μg/mL, the reversal index was 4.19.Psoralen significantly raised the expressions of Topo Ⅱα at mRNA and protein levels.Conclusion Psoralen reversed the resistance of adriamycin by increasing the gene and protein expressions of breast cancer stem cells Topo Ⅱα and the drug targets.