Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and individualized surgical plans for patients.

Objective To explore the effects of different concentrations of propofol postconditioning against glutamate neurotoxicity to brain slices of neonatal rats.Methods The brain slices of neonatal rats were prepared and cultured in complete medium.They were randomly divided into five groups:the normal control group,glutamate injury group(RI group),1 mg/L propofol postconditioning group(PL1+RI group),3 mg/L propofol postconditioning group(PL3+RI group),5 mg/L propofol postconditioning group(PL5+RI group),12 cases in each group.The RI,PL1+RI,PL3+RI,PL5+RI groups were cultured for 6 days,then the brain slices were moved into the culture medium containing glutamate(1 mmol/L) and incubated for 30 minutes.And then,respectively,the brain slices of RI group were put into another complete culture medium,the PL1+RI group,PL3+RI group and PL5+RI group were put into the medium containing corresponding concentrations of propofol medium and long chain fat emulsion injection.All of the above were cultured for 24 hours in order to establish the injury model.The numbers of the Nissl body,the LDH release rates and the brain tissue damage rates of each brain slice were detected to evaluate the effects of propofol postconditioning on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.Results Compared with the RI group,the numbers of the Nissl body of the PL1+RI group,PL3+RI group and PL5+RI were higher,the LDH release rates and the brain tissue damage rates of the PL1+RI group,PL3+RI group and PL5+RI were lower,the diferences were significant(P<0.05).Among the three PL+RI groups,the LDH release rates and the brain tissue damage rates of the PL3+RI group were lower than those of the other two groups,the diferences were significant(P<0.05),at the same time,the numbers of Nissl body were more than the other two groups,the diferences were significant(P<0.05).Conclusion Propofol postconditioning has protective effects on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.However,the protective effects are not dose-dependent,and 3 μg/mL is the best dose of propofol to keep the glutamate-damaged brain slices from reperfusion injury in this research.

Objective To evaluate MRI in diagnosis and follow-up of Achilles tendon rupture. Methods From April 2003 to May 2005, 24 cases of closed Achilles tendon rupture were examined in our department with MRI. It was performed through sagittal T1WI, T2WI, GE-STIR and axial TME imaging. Four cases were followed up with MRI after 4 to 8 weeks. Results MRI could determinate the severity and exact location of Achilles tendon rupture by demonstrating signal changes of Achilles tendon. In this series, complete rupture of Achilles tendon mostly occurred at the median part, with augmentation and high signal on T2WI. MRI demonstrated high signal on T2WI in partial rupture of Achilles tendon. The signal intensity in the four cases followed up by MRI was shown to decrease. Conclusion MRI is a valuable tool for clinical diagnosis and follow-up of Achilles tendon, because it provides enough information through signal changes at the tendon.

OBJECTIVE To enhance the control of nosocomial infection and improve the quality of medical nursing. METHODS The risk factors and etiological factors of nosocomial infection in sickroom were analyzed. RESULTS In order to control the nosocomial infection we needed to strength the disinfection management in the following aspects: air in the ward,nursing procedures,implements and hands of doctors and nurses. CONCLUSIONS Strict sterilizing procedures and standardized monitoring are the important measures to reduce the nosocomial infection.

Objective To study the protective effect of hyperoxic liquid preconditioning in myocardial ischemia-reperfusion injury. Methods Thirty rabbits were randomly divided into three groups: group A undergoing all procedures except ischemia-reperfusion, group C receiving the routine infusion of hyperoxic liquid 15mL/kg for seven days, and group B receiving the routine treatment infusion of saline instead of hyperoxic liquid 15mL/kg. Seven days later, the myocardial ischemic reperfusion model (I/R) was fabricated, ECG and homodynamic index were monitored simultaneously. Plasma MDA and SOD level was assayed before ligation, 30min after ligation and 1, 2, 3h after reperfusion. Results Hyperoxic liquid preconditioning can lower ST segment and improve index of hemodynamics and significantly reduce myocardial infarction size in group C compared with group B((P

Objective To investigate the changes in gastric intramucosal pH(pHi) and the effect of hyperoxic liquid on intramucosal pH(pHi) after myocardial ischemia-reperfusion injury in rabbits.Methods Twenty healthy male adult rabbits,weighing 2.3-3.0 kg,were randomly divided into two groups: control group(n=10) and hyperoxic liquid group(n=10).Hyperoxic liquid group received the routine infusion of hyperoxic liquidle of 10 mL/kg for seven days,while control group received the routine treatment infusion of saline instead of hyperoxic liquid of 10 mL/kg.Seven days later,the myocardial ischemic reperfusion model(I/R) was established,and ECG and homodynamic indexes were monitored simultaneously.Hemodynamic indexes and pHi were measured before myocardial ischemia,30 min after myocardial ischemia as well as 1 h and 2 h after reperfusion.Results Hyperoxic liquid could lower ST segment and improve hemodynamic indexes.pHi decreased significantly after myocardial ischemia-reperfusion injury in both groups.Compared with that in control group,pHi was significantly higher at 1 h and 2 h after reperfusion in hyperoxic liquid group(P

[Objective] To study the methods of inducing bone mesenchymal stem cells(BMSCs)of rabbits into chondrocytes in vitro and the interaction of transforming growth factor ?1(TGF-?1),insulin-like growth factor-Ⅰ(IGF-Ⅰ)and basic fibroblast growth factor(bFGF).[Methods]BMSCs of rabbits were primarily cultured and subcultured in vitro,and then divided into four groups according to the difference of factors:group A receiving TGF-?1 and bFGF;group B receiving TGF-?1 and IGF-Ⅰ;group C receiving TGF-?1;group D receiving no cell growth factor.After three weeks all the four groups were detected by methyl thiazolyl tetrazolium(MTT)assay,measurement of glycosaminoglycan(GAG)and immunohistochemistry.[Results]Immunohistochemical detection of collagen Ⅱ was positive in groups A,B and C.The results of the MTT assay and the GAG content in groups A and B were obviously higher than those in groups C and D.[Conclusion]Rabbit BMSCs can be induced into chondrocytes under certain conditions.TGF-?1,IGF-Ⅰ and bFGF have synergy effect in the differentiation from BMSCs into chondrocytes.

Age Factors ; Aged, 80 and over ; Female ; Hip Fractures ; surgery ; Humans ; Male ; Orthopedic Fixation Devices

Adult ; Cardiac Catheterization ; Female ; Heart Septal Defects ; therapy ; Humans