Gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. It is an unusual and rare occurrence with a predilection for women in their sixth or eighth decades of life. Only about 400 cases have been reported in the literature. The etiology of gallbladder volvulus remains speculative; however, the presence of a redundant mesentery is a prerequisite for torsion. Clinical symptoms are non-specific. Some form of right upper quadrant abdominal pain is nearly always present. Although recent advances in radiographic studies have aided in the diagnosis of many diseases,radiographic studies remain nonspecific in diagnosing gallbladder torsion. Laboratory evaluations are often nonspecific. An elevated white blood cell count is a frequent finding.Liver function tests are commonly normal. Gallbladder volvulus leads to gangrene or perforation because of occlusive obstruction of biliary drainage and blood flow. With early diagnosis and surgical intervention, the disease maintains a low mortality. Here, we present a review of the literature about gallbladder volvulus in order to enhance recognition of gallbladder volvulus.

To discuss the status quo of gallbladder cancer in China,88 articles published in China were collected and the clinical data of 7882 patients who were suffering from gallbladder cancer was analyzed.The requirements for the literature were:domestic articles published from 1980.1 to 2008.6,the gallbladder cancer cases must exceed 50,the cases must come from the same domestic hospital,and if the cases were reduplicative,the maximum were selected.Analysis of the data showed that primary carcinoma of the gallbladder was the most common malignant tumor in the biliary tract,with a higher incidence in females than males.The cancer's pathologic characteristics of undiscoverable growth and poor differentiation led to its clinical significance of difficult early stage diagnosis,high degree of malignancy,poor prognosis,and adenocarcinoma formation.Although the technique of surgical operation has constantly progressed over time,gallbladder cancer surgery possesses a lower rate of radical resection.Every biliary surgeon should brainstorm and deliberate about how to face the status quo of gallbladder cancer in China.This article participates in that discussion by identifying several noticeable problems in the diagnosis and treatment of gallbladder cancer.

Objective To investigate the protective effects of felodipine on mRNA levels of endothelial nitricoxide synthase (eNOS) and inducible nitricoxide synthase (iNOS) as well as the level of nitrogen monoxidum (NO) from human umbilical vein endothelial cells (HUVECs) injuryed by oxidized low density lipoprotein (ox-LDL). Methods Isolated HUVECs were divided into blank control group,ox-LDL injury group treated with ox-LDL of different concentrations (6,12.5 and 25 mg/L),and intervention group of felodipine (0.1,1.0 and 10 ?mol/L)+ox-LDL (25 mg/L). Then eNOS and iNOS expressions were measured by real time-polymerase chain reaction and the level of NO in the supernatants of the cultures was assayed by nitrate reductase method. Results The mRNA expressions of eNOS and iNOS in HUVECs and NO level in the supernatants during treatment with different ox-LDL concentrations were higher than those in control group. However,felodipine significantly down-regulated the expression of iNOS in HUVECs injured by ox-LDL and inceased NO generation. Conclusion Felodipine has protective effects on endothelial cells. The mechanism may be related to its lowering the mRNA expression of iNOS induced by low ox-LDL concentration and increasing NO production.

Objective To investigate the protective effect of felodipine on reactive oxygen species (ROS) generation,mRNA level of inflammatory factors such as intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1),in human umbilical vein endothelial cells (HUVECs) injured by oxidized low-density lipoprotein (ox-LDL) so as to explore felodipine's anti-atherosclerosis mechanism independent of its anti-hypertensive effect. Methods Isolated HUVECs were treated with ox-LDL at different concentrations (6,12.5 and 25 mg/L) for 24 hours so that the optimal concentration and time of ox-LDL treatment were selected. Then the cells were incubated with ox-LDL and treated with felodipine at different concentrations (0.1,1 and 10 ?mol/L). Intracellular ROS level was determined by flow cytometry (FCM). Expressions of inflammatory factors ICAM-1 and VCAM-1 were measured by real time-polymerase chain reaction (real time-PCR). Results ROS generation was increased in HUVECs after treatment with different concentrations (6,12.5 and 25 mg/L) of ox-LDL for 24 hours and there was a significant difference at 25 mg/L ox-LDL (P

Objective To construct a adenovirus vector containing human NRP-1 gene and 3Flag gene to interaction between tumor and interstitial cell.Methods Plasmid containing NRP-1 gene was digested by AgeⅠand NheⅠ restriction endonuclease.Then the DNA was ligated into linearized pDC315-3Flag vector.After having been constructed,the pDC3 1 5-NRP-1-3 Flag plasmid was co-transfected with framework plasmid pBHGlox△E1 , 3Cre into HEK 293 cells to obtain the homologous recombinant adenovirus,which was then amplified and purified its titer tested.Expression of NRP-1 protein was detected using Western blot.Results Polymerase chain reaction and sequencing analysis confirmed that the shuttle plasmid pDC3 1 5-NRP-1-3 Flag and design were consistent. Cytopathic effect was observed by inverted phase contrast after transfecting HEK2 9 3 cells with shuttle plasmid pDC315-NRP-1-3Flag.95-130 ku was detected by Western lot after transfecting HEK293 cells with shuttle plasmid pDC315-NRP-1-3Flag and recombinant adenovirus,the size being consistent with the NRP-1-3Flag fusion protein (104 ku),with a titer of 2.00E+11PFU/mL.Conclusion The recombinant adenovirus vector for human NRP-1 gene was successfully constructed expressed in HEK 2 9 3 cells.

Objectives To analyze the relationship between the multi-organ hypoxia damage and the death of acute high altitude sickness severe case. Methods 3220 cases from 1956. 06 to 2005.06 in the hospital were reviewed by questionnaire and the cases in MODS or death were screened out. The cause of death and feature were analyzed by the data as clinical symptom, physical signs and auxiliary examination. Results 281 cases complicated by MODS (include 35 dead cases) were found out by review. The incidence with MODS is 8.73% , and the death rate was 1.09%. The masculine incidence rate of the clinical symptom, physical signs and auxiliary examination in death were 2. 86% ~65. 71% , 2. 86% ~ 100% and 14. 29% ~ 100% , respectively. The MODS incidence in dead cases was 100%. Compared with the curing group, the MODS number, cardiac functional disturbance, brain disorder and renal functional disturbance in the death group had a significantly high incidence rate in all the 281 cases with MODS( P <0.05). With dependability analysis, there were a significantly direct correlation relationship between the death in the severe cases with acute high altitude sickness and the number of MODS ( r = 0. 3473, P < 0.001). Conclusion Hypoxia to the damage of multi-organ function play an important role in death of the severe cases with acute high altitude sickness in high attitude area, and the functional disturbance of important organs as heart, brain and kidney is the most important cause to death.

Objective To investigate the clinical characteristics, diagnosis and treatment of primary splenic tumors.Methods The clinical data of 47 patients with spleen tumors treated in the First Affiliated Hospital of Medical College, Xi'an Jiaotong University from January 2008 to October 2014 were retrospectively analyzed.Results 28 patients had no symptoms and only on physical examination was a mass found in some patients.There were 12 patients who manifested with upper abdominal discomfort or pain, 2 patients with an epigastric mass, l patient manifested with fever and 2 patients manifested with nausea and vomiting.Preoperative examination showed anemia in 7 patients.Three patients manifested with hypersplenism.Preoperative ultrasonic examination was performed on 39 patients with a diagnostic rate of 89.7％.43 patients underwent CT examination which had a diagnostic rate of 90.7％, MRI was performed in 4 patients and the diagnoses were all correct.Of the 47 patients with splenic tumor, 38 patients had a benign tumor.34 patients were treated by surgery, including 22 patients who underwent open splenectomy, 9 patients laparoscopic splenectomy, 3 patients laparoscopic fenestration of splenic cyst.Malignant tumors were found in 9 patients.Four patients underwent splenectomy, 2 patients were treated by laparoscopic splenectomy.Preoperative examination and postoperative pathological examination showed a benign tumor in 38 patients, including 1 1 patients with a splenic cyst, 6 patients with a cavernous hemangioma, 5 patients with an inflammatory pseudo tumor of spleen (accounting for 57.3％ of all the benign tumor).Malignant tumors included 5 patients with malignant lymphoma, 1 patient with splenic angiosarcoma, 1 patient with gastric carcinoma which metastasizes to the spleen, 1 patient with cervical carcinoma metastasizing to the spleen and 1 patient with liver carcinoma metastasizing to the spleen.Adjuvant chemotherapy and (or) radiotherapy after surgery were performed for patients with malignant lymphoma of the spleen.For 2 patients who were diagnosed early, surgery combined with radiotherapy or chemotherapy and immunotherapy were alive for more than 18 months.Conclusions The clinical manifestations of splenic tumors lack specificity.The diagnosis mainly depends on ultrasonic examination, CT and MRI.Early diagnosis, radical operation and comprehensive treatment are important to improve the prognosis of patients with malignant tumors of the spleen.

Objective To investigate the clinic manifestations of intestinal involvement of Beh(c)et's disease (BD).Methods Medical data of patients with intestinal involvement of BD admitted to Peking Union Medical College Hospital (PUMCH) from January 1994 to August 2013 were retrospectively reviewed.Clinic manifestations,laboratory tests and endoscopic characteristics were analyzed,and the influence of sex on the clinic manifestations was investigated.Numerical data and categorical data comparisons were analyzed using t-test,x2 test respectively.Results Sixty-four patients with intestinal involvement accounted for 10.5 percent (64/611) of total hospitalized BD patients during the same period.Among these 64 patients,31 were male and 33 were female.The median age at the onset of intestinal involvement was 34 years old.Gastrointestinal symptoms were presented after other systemic symptoms of BD in 91％ patients (58/64).Abdominal pain (88％,56/64) was the most common clinical manifestations of intestinal involvement,and severe complications such as gastrointestinal bleeding (31％,20/64),intestinal obstruction (22％,14/64),intestinal perforation (11％,7/64) and intestinal fistula (16％,10/64) could also occur in some patients.Lesions usually located at ileocecum portion of the gastrointestinal tract.The common endoscopic manifestation was deep ulcers.Female sex was associated with higher C reactive protein level and lower serum albumin level [(52±46) vs (27±36) mg/L,t=2.287,P=0.026; Serum albumin:(34±6) vs (37±5) mg/L,t=2.237,P=0.029].After treated with glucocorticoid,im-munosuppressant and TNF-α blockers,62 patients achieved clinical remission while 21 cases were operated.Conclusion Most of intestinal involvement of BD patients are young adults,and the gastrointestinal symp-toms usually present after the presence of other systemic symptoms.Abdominal pain is the most common manifestations,while severe complications such as gastrointestinal bleeding and intestinal obstruction can also occur.The most common endoscopic findings are deep ulcers,which often located in the ileocecal region.Female patients are more likely to have severe clinical course.Glucocorticoid,immunosup-pressant and TNF-α antagonist therapy are effective,but some patients still need surgical intervention.

Objective To investigate the effects and mechanisms of sorafenib on hepatic stellate cell viability and activation in the microenvironment of liver tumor.Methods The effects of LX2 cells on HepG2 cell proliferation were observed by coculture of LX2 and HepG2 cells.MTT assay was used to observe the effects of sorafenib on LX2 proliferation,and expression of α-smooth muscle actin (α-SMA) was measured immunocytochemically in LX2 cells treated with different concentrations of sorafenib.Changes in PDGF-BB and TGF-β1 concentrations were detected in LX2 supernatant using ELISA.Expression of ERK1,ERK2,and AKT signaling pathways were measured using Western blot.Furthermore,LX2 cells were cocultured with HepG2 cells for 24 hours to observe their effects on the invasive ability of HepG2 cells.Result After coculture of LX2 and HepG2 cells,HepG2 cells increased in the experimental group more than those of in the control group.After treatment with various concentrations of sorafenib for 12,24,36 or 48 hours,the viability of treated LX2 cells was lower than the controls in a concentration-and time-dependent manner.As sorafenib concentration and time of exposure increased,α-SMA expression became weaker in treated cells.PDGF-BB and TGF-β1 concentrations decreased with higher sorafenib concentrations and with longer exposure under the same concentration.ERK1,ERK2 and Akt expression was identical between treated and control groups,but their phosphorylated expression decreased with increased concentrations of sorafenib.The invasive ability of HepG2 cells induced by LX2 gradually decreased as sorafenib concentrations increased.Conclusions Sorafenib suppressed α-SMA expression,inhibited PDGF-dependent signaling pathways in HSCs,downregulated PDGF-BB and TGF β1 expression in the supernatant of HSCs,and restrained the viability and activation of HSCs.Sorafenib treatment therefore resulted in suppressed proliferation and invasion of HepG2 cells.

Electrolyte disturbance was prominent in patients with severe acute mountain sickness. In these patients hypoxia caused water and salt retension together with vasoactive substances and excessive free radicals might play important roles in the development of multiple organ dysfunction syndrome (MODS). More attention should be given to electrolyte monitoring in dealing with these severe mountain sickness in field.