Objective To compare the clinical effectivness of the treatment by open surgery and by therapeutic endoscopy for common bile duct(CBD) stones.Methods The randomised controlled trails on the open surgery or therapeutic endoscopy for CBD stones were identified by electronic-searching and hand-searching,meta-analysis was conducted using the methods recommended by the Cochrane Collaboration.Data of 407 patients included in 6 high-quality randomized controlled trials were meta-analyzed using in fixed effect model.Results Compared with endoscopic stone extraction technique,open surgery had retained stones after primary intervention rate(OR 0.39,95% CI 0.25 to 0.75,P=0.003) and additional procedures rate(OR 0.33,95% CI 0.19 to 0.60,P=0.0002) with statistical significance.But open surgery made no significant difference in postoperative complication rate(Peto OR 1.10,95% CI 0.69 to 1.76,P=0.67).Conclusion Current evidence suggests that there is no significant difference between open surgery and therapeutic endoscopy in preoperative complications,but open surgery is superior to therapeutic endoscopy in stone clearence rate.

BACKGROUND:Ful-thickness articular cartilage injury is notoriously difficult to be treated in the fields of orthopedics and sports medicine. Al ogeneic bone and cartilage transplantation can offer a transparent cartilage with biological activity and biomechanical properties to repair ful-thickness articular cartilage defects. Al ogeneic osteochondral grafts from osteochondral tissue bank are adequate, and have a good prospect in the treatment of articular cartilage defects.
OBJECTIVE:To summarize the drawn materials, preservation, quality control and clinical monitoring of al ogeneic osteochondral grafts supported by the osteochondral tissue bank.
METHODS:The first author searched PubMed and CNKI for the relevant articles published before 2013 using the key words of“tissue bank, knee, articular cartilage, preservation, transplantation”in English and Chinese, respectively. After retrieval, we summarized the drawn materials, preservation, quality control and clinical monitoring of al ogeneic osteochondral grafts supported by the osteochondral tissue bank.
RESULTS AND CONCLUSION:Nineteen of 194 retrieved articles were enrol ed according to inclusive and exclusive criteria. The results show that al ogeneic bone and cartilage transplantation is an ef ective method for the treatment of articular cartilage defects, and the establishment of the osteochondral tissue bank can provide safe and active tissues for the treatment of articular cartilage defects. Now, the osteochondral tissue bank is stil in the initial stage.

Objective:To study the curative efficacy of metformin combined with Jinlida granules in the treatment of gestational diabetes mellitus and its effects on the serum vascular endothelial growth factor (VEGF),adiponectin (APN) and homocysteine(Hcy) levels.Methods:94 patients of gestational diabetes mellitus who were treated from July 2014 to July 2016 in our hospital were selected.According to random number table,those patients were divided into the observation group (n=47) and the control group (n=47).On the basis of routine treatment,such as control diet,reasonable exercise and healthy diet,etc,the control group was treated with metformin,while the observation group was combined with Jinlida granules on the basis of the control group.The changes of blood glucose,blood lipid and serum VEGF,APN and Hcy before and after treatment were compared between the two groups,the incidence of maternal complications and neonatal adverse outcomes were compared.Results:Compared with before treatment,the blood glucose,blood lipid of both groups after treatment were significantly improved (P ＜0.05),the fasting plasma glucose (FBG),postprandial 2h blood glucose (2hPG),glycosylated hemoglobin (HbAlc),total cholesterol (TC),triacylglycerol (TG),low density lipoprotein cholesterol(LDL-C) of observation group were significantly lower than those of the control group,the serum high density lipoprotein cholesterol (HDL-C) level was significantly higher than that of the control group(P＜0.05);after treatment,the serum VEGF,APN and Hcy levels were significantly improved than those before treatment in both groups (P＜0.05),and the serum VEGF,and Hcy levels of observation group were lower than those of the control group,the serum APN level was higher than that of the control group (P ＜ 0.05);the incidence of gestational hypertension,hydramnios,cesarean section and premature delivery of observation group was significantly lower than that of the control group (P ＜0.05);the incidence of giant child,neonatal Jaundice and neonatal respiratory distress in the observation group was significantly lower than that of the control group (P＜0.05).Conclusion:Metformin combined with Jinlida granules was effective for the gestational diabetes mellitus,which could effectively control the blood glucose,blood lipid levels and might be related to the regulation of serum VEGF,APN and Hey levels.

Objective To determine the volume reduction of the primary olfactory cortex (POC) in patients with Alzheimer disease (AD) and investigate the potential relationship of functional olfactory activation and anatomical atrophy changes. Methods Twelve patients with AD, eight patients with mild cognitive impairment (MCI) and twenty normal controls (NC) underwent standardized UPSIT (University of Pennsylvania smell identification test) behavior smell test and neuropsychological tests. Then all of the subjects underwent the high resolution MRI and an olfactory fMRI scan on a 3T system. Volumetric measurement of the POC was conducted and the areas were also saved as a ROI which would be used during the processing of fMRI data to get the activation voxels in local region. The Kruskal-Wallis rank test was used to examine the significance of POC volume and activation in three groups, If P-value was less than 0.05,Bonferroni method was used for multiple comparisons. The correlation between the anatomical volume and functional activation was analyzed with partial correlation adjusted for age. Results The POC volume of NC, MCI and AD groups were 3024--4734, 1409--4553 and 1561--3759 mm~3, and the medians were 3749, 2752 and 2156 mm~3. The activation voxels of each group were 0--2360, 0--2160 and 0--100 mm~3, while the medians were 430, 40 and 0 mm~3. There were significant differences of both POC volume atrophy and activation between the three groups, with a trend of reduction from NC to MCI to AD group (H is 14.942 and 16.587, both P<0.05). The volume of olfactory activation at POC was highly correlated with the volume of POC (r=0.364, P=0.023). Conclusions In this study, we explored the morphological and functional changes in the POC. It is revealed that POC suffers prominent local atrophy and dysfunction as well as hippocampus in AD. These results can provide neuropathological and neurofunctional bases for olfactory deficit in Alzheimer Disease.

Objective To study the optimum preparation process of gastrodin liposome, characterization its structure.Methods Perpared gastrodin liposome with film-ultrasonic method.The entrapment efficiency as index, quality between lecithin and cholesterol ratio, oil-water phase volume ratio and ultrasonic time as factors by L9 (34 ) orthogonal test to optimize the preparation process.Observed the liposome morphology, particle size and distribution under the microscope, and determined the entrapment efficiency and stability.Results Regression equation was Y=239.75 +0.0207X(n=5), R2 =0.9996, 0.002 to 0.010 mg/mL had a good linear relationship.The optimum of preparation process: lecithin and cholesterol quality ratio was 4:1, water and oil phase volume ratio of 3:1, ultrasonic time control for 60 min;Liposomes showed spherical or oval shape, regular shape, uniform size.The average entrapment efficiency was 60.65%, the average particle size distribution at 327 nm, and it had good stability.Conclusion The preparation of gastrodine liposome has advantages of simple, higher entrapment efficiency and even particle size.The method can be used for embedded water-soluble medicine.

Objective To investigate the mechanisms of the protective effects of dexmedetomidine against the propofol-induced neuroapoptosis in primary cultured cortical neurons.Methods The neurons were cultured 7days and then divided into four groups: vehicle-control group (treated with equal volume of intralipid), propofoltreated group (treated with 500 μmol/L propofol), propofol plus dexmedetomidine treated group (treated with 500 μmol/L propofol and 0.1 μmol/L dexmedetomidine), and LY294002 pretreated group (treated with 500 μmol/L propofol ,0.1 μ mol/L dexmedetomidine and 10 μmol/L LY294002).12 hours after different treatments, neuron viability was measured by MTT assay,neuroapoptosis was detected by Hoechst33258 staining, and the levels of pAkt and Bcl-2 protein were detected by Western blot.Results Compared with the vehicle-reduced group,propofol reduced neuron viability greatly((53.4±4.2)％ vs (99.9±6.3)％;P＜0.01), but increased neuroapoptosis greatly((44.6±4.3)％ vs (5.8±0.4)％;P＜0.01).The levels of pAkt((0.41±0.03) vs (0.86±0.07))and Bcl-2 ((0.15±0.02) vs (0.72±0.03)) were decreased greatly (both P＜0.01).Compared with propofol treatment group, the neuron viability of propofol plus dexmedetomidine group were increased greatly((86.4±5.3) ％ , P＜0.01) ,the neu roapoptosis was decreased greatly ((23.1 ± 3.5) ％, P＜ 0.01), and the levels of pA kt (0.8 ± 0.03) and Bc1-2 (0.52 ±0.05) were increased greatly (both P＜0.01).Compared with propofol plus dexmedetomidine treated group,LY294002 inhibited the protective effects of dexmedetomidine, decreased neuron viability greatly ((64.3±5.1) ％ ,P＜0.01), increased the number of apoptotic neurons((38.8±4.9) ％, P＜0.01), and reduced the levels of pAkt (0.52±0.04) and Bcl-2(0.31±0.02) significantly (P＜0.01).Conclusion Dexmedetomidine exerts the neuroprotective effects against propofol-induced neuroapoptosis by activating the PI3K-Akt-Bcl-2 signalling pathway.

Objective To observe the effect of light emitting diode (LED) red light irradiation on serum lipid in experimental hyperlipidemia rats. Methods 36 healthy male Sprague-Dawley rats were randomly divided into normal control group (n=12) and hyperlipidemic model group (n=24). The normal group was fed with normal diet while the hyperlipidemic model group with fat-rich forage for 6 weeks. The hyperlipidemic model group rats were randomly divided into the hyperlipidemic control group (n=12) and LED treatment group (n=12), and the latter accepted LED red light irradiation for 28 d. The levels of serum lipid including total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), and the activities of lipoproteinesterase (LPL) and hepatic lipase (HL) were detected with biochemical assay. The expression of 3-hydroxy-3-methylglutaryl coenzyme A reducase (HMG-CR) of hepatic tissue were measured with immunohistochemical staining. Results Compared with the hyperlipidemic control group, the levels of serum TC, TG and LDL-C decreased while the serum HDL-C increased significantly in the LED treatment group (P<0.01) after treated with LED. The levels of LPL and HL in serum increased (P<0.01) while the activity of HMG-CR decreased (P<0.05). Conclusion LED red light irradiation might play a regulating effect on serum lipid by enhancing the activities of LPL and HL and inhibiting the expression of HMG-CR to interfere the metabolism of TC, TG, LDL-C and HDL-C.

Objective 17β-estradiol is known to have a neuroprotective effect.The aim of this study was to investigate the effects of 17β-estradiol on propofol-induced neuroapoptosis in primarily cultured cortical neurons. Methods Rat cortical neurons were primarily cultured for 7 days and randomly divided into groups A ( vehicle control) , B, and C, treated with equal volume of 20%intralipid, 500 μmol/L propofol, and 500 μmol/L propofol +0.1 μmol/L 17β-estradiol, respectively.At 12 hours after treatment, the morphology of the neurons was observed under the microscope, their survival rate calculated by MTT, their apoptosis was deter-mined by FCM assay, and their mitochondrial membrane potential measured by fluorescent dye rhodamine 123. Results Compared with group A, group B showed a significantly reduced number of neurons, lack of 3-dimensional appearance, unclear contour, and fractured neuron axons, but a remarkable improvement was observed in the propofol-induced morphological damage in group C.The survival rate of the neurons and the mitochondrial membrane potential were markedly decreased in group B ([52.3 ±5.2]% and [59.1 ± 5.3]%) as compared with groups A ( [99.9 ±3.6]%and [99.6 ± 5.8]%) and C ([90.1 ±7.2]%and [89.2 ±7.1]%) (both P<0.01 ) , while the rate of neuroapoptosis significantly increased in group B ([43.4 ±4.6]%) in comparison with A ([3.1 ±0.2]%) and C ([22.3 ±3.2]%) (both P<0.01). Conclusion 17β-es-tradiol can protect against propofol-induced apoptosis of primarily cul-tured neurons by inhibiting the reduction of their mitochondrial membrane potential.

Objective To explore effects of parents exposure to TBT on blood routine of F1 generation mice. Methods 80 mice including 40 males and 40 females, were randomly divided into control groups (CK) , low dose groups (LTBT), middle dose groups (MTBT) and high dose groups (HTBT).They were given dose of TBT (0,0.2,2, 20μg/kg) every day.The experiment lasted 45 days.At 60 days, one female and one male of the same concentration were bred in the same cage according to 1∶1.At postnatal day 60, blood was collected for the determination of blood routine. Results Compared with control group, the number of red blood cells and hemoglobin of F1 generation male mice in LTBT and HTBT groups were significantly increased (P <0.01); Red blood cell volume, mean corpuscular hemoglobin (P <0.01), and the lymphocyte absolute value in F1 generation male LTBT were significantly reduced (P <0.05); HTBT of female mice were significantly increased about the number of red blood cells (P <0.01).A dose-dependent increase of the hemoglobin, red blood cells, and platelet count of F1 generation female experimental groups was observed.Conclusion Parental TBT exposure affects the F1 mice blood routine.There is the greatest influence on LTBT in F1 generation male mice and on HTBT in F1 generation female mice.

BACKGROUNDTo investigate the effect and complication of three-dimensional conformal radiotherapy (3D-CRT) for elderly patients with stage I-III non-small cell lung cancer.

METHODSThirty elderly patients with stage I-III NSCLC who were treated with 3D-CRT from January, 1998 to January, 2002 were retrospectively analyzed. In the 30 patients, 46 targets were treated with 3-5 Gy per fraction to a total dose of 42-66 Gy. The effect and complication were analysed.

RESULTSThe overall 1-, 2-, 3-year survival rates and the median survival time were 65.8%, 41.2%, 20.6%, and 23 months respectively. The overall 1-, 2-, 3-year local control rates were 59.8%, 31.1%, and 28.3%. The overall incidence of radiation pneumonitis was 16.7% (15/30) with grade≥3 of 6.7%, and one case was died from rediation pneumonitis. The incidence of radiation pulmonary fibrosis was 10.0% (3/30), and the incidence of radiation esophagistis was 43.3% (13/30), but both two side effects were slight.

CONCLUSIONS3D-CRT can improved the survival in elderly patients with stage I-III non-small cell lung cancer by escalating radiotherapy doses.