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.

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

Alu Elements ; physiology ; Chromosome Aberrations ; DNA Topoisomerases, Type II ; metabolism ; DNA, Neoplasm ; metabolism ; DNA-Binding Proteins ; genetics ; metabolism ; Humans ; Sarcoma ; genetics ; metabolism ; Soft Tissue Neoplasms ; genetics ; metabolism ; Translocation, Genetic

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Chronic Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Pterygopalatine Fossa ; innervation ; Rhinitis ; physiopathology ; therapy ; Smell ; Treatment Outcome ; Young Adult

Objective To explore the effect of eletroacupuncture (EA) on angiogenesis after cerebral ischemia and reperfusion through observing the number of peripheral blood endothelial progenitor cells (EPCs) and the expression of vascular endothelial growth factor (VEGF) in the hippocampus.Methods Among 50 male Sprague-Dawley (SD) rats,10 were randomly selected as a control group (CG).Qi deficiency and blood stasis were induced in the other 40 rats by intragastric administration of dahuang daily for 7 days.A model of focal cerebral ischemia and reperfusion injury was then created by thread-occlusion of the middle cerebral artery,except in 10 rats selected for the sham operation group (SOG) who received the same operation without tightening the thread.The successfully modeled rats were divided into a model group (MG,n =10) and an electroacupuncture group (EAG,n =10).The rats in EAG started acupuncture treatment the next day after modeling,while no treatment was given to those in the other groups.On day 1,3 and 7 after the modeling,the neurological functioning of the 4 groups was assessed using Basso-Beattie-Bresnahan locomotion scoring and the number of EPCs in the peripheral circulation was detected by flow cytometry.On the 8th day,all the rats were decapitated and the VEGF expression was detected immunohistochemically.Results The average BBB locomotion score of the EAG rose significantly from (4.50 ± 1.05) on day 1,to (13.67 ± 1.21) on day 3,and then further to (20.00 ±0.89) by day 7,significantly higher than that of MG at the same time points,but still significantly lower than that of the control group.The average number of EPCs in the peripheral circulation in the MG also increased from (26.83 ± 6.05) on day 1 to (33.67 ± 5.39) on day 3,and decreased to (32.83 ± 5.04) on day 7 after modeling,significantly lower than that of the CG [(45.50 ±9.40),(42.17 ±4.62) and (41.33 ±5.50)],the SOG [(58.00 ±8.05),(59.67±4.84) and (53.83 ±5.38)[and the EAG [(66.17 ±4.36),(127.50 ±73.75) and (55.00 ±35.15)] at each time point.After occlusion,the average expression of VEGF-positive cells in the hippocampus of the EAG [(27.80 ± 2.39)％] was significantly higher than that of the MG,and both were significantly higher than that of the CG.Conclusions Eletroacupuncture can up-regulate VEGF expression and EPCs in the peripheral blood in rats after cerebral ischemia-reperfusion,which can promote angiogenesis and neural functional recovery.

Persistent infection of hepatitis C virus (HCV) remains as a worldwide threat to public health,which involves a complex interaction between virus- and host related factors.HCV is classified as six genotypes and many subtypes according to the sequence heterogenecity.HCV genotype should be determined prior to treatment initiation since it plays a key role in selection of therapeutic regimen for chronic hepatitis C.Development of the antiviral treatment with protease inhibitor in combination with pegylated IFN-α and ribavirin requires the accurate determination of subtypes,e.g. 1a and 1b,as well.Genotyping methods based onsequenceanalysis, reversehybridizationorreal-timePCRhavebeendevelopedand evaluated.Some issues,however,should be settled to standardize the utility and result interpretation of these methods.More recently,host genotypes of IL28B have been found to be closely associated with HCV spontaneous clearance and the response to antiviral therapy.Moreover,polymorphisms in inosine triphosphate pyrophosphatase gene affect ribavirin-induced anemia.Therefore, host genotyping will be beneficial in predicting the outcome of chronic hepatitis C and monitoring the drug-induced adverse events.

Objective To analyze the clinical feature, treatment and prognosis of ventricular septal rupture after myocardial infarction Methods Clinical data of 16 patients with ventricular septum repture after acute myocardial infarction were who were hospitalized between January 1990 and July 2004 were analyzed retrospectively Results Among 2?057 patients with acute ST segement elevation myocardial infarction, 16(0 7%) patients (8 males and 8 females) were found to have ventricular septal rupture The average age was 59 4?11 6 years 7 (43 8%) patients had hypertension, 5(31 3%) patients had diabetes and 5 (31 3%) patients smoked 15(93 8%) patients were diagnosed as acute anterior infarction and among them, 6 patients also had posterior infarction 1 patient were diagnosed as inferior infarction 11 patients received coronary arteriography and ventriculography, and in 10 cases, the infarct related arteries (IRA) were found to be LAD (90 9%) Total occlusion was found in 9 cases out of the 11 patients (81 8%) Cardiogenic shock was found in 3(18 8%) patients 12 cases (75%) of ventricular septal rupture occurred within the first seven days after the onset of symptoms The defect on rentricular septumn and its size were confirmed by means of ectocardiography The size of the rupture varied from 0 68 cm to 2 5 cm Surgery was performed in 10 (62 5%) patients, and 3 of them survired All the 6 patients who only received medical therapy died within 30 days Conclusion Ventricular septal rupture after AMI was relatively rare which mostly happened in patients with acute anterior infarction Mortality rate was righ in patients who only received conservative medical treatment Surgical therapy could improve the survival rate

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.