Biliary stricture after cholecystectomy poses difficult management problems to surgeons because of high and stable incidence.In contrast to malignant stricture,benign stricture requires durable repair.Repeated operations may not only increase the suffering of the patient,but also reduce the likelihood of a better outcome. A 56-year-old woman with biliary stricture after cholecystectomy who had undergone several operations in other hospitals was admitted to Chinese PLA General Hospital.Computed tomography (CT) scan showed a dilated biliary tree and localized the level of ductal obstruction in the hepatic hilar stricture.In addition,CT identified fluid collections in the left upper quadrant and no artery injury was detected. Ultrasound-guided percutaneous abdominal drainage was performed to control the abdominal infection. Magnetic resonance cholangiopancreatography classified the injury as Bismuth Ⅲ.The patient with bile leakage and severe abdominal infection was treated with antibiotics before the final operation.On June 1,2012,the patient received Roux-en-Y hepaticojejunostomy.After operation,the patient recovered smoothly without severe complications,such as bile leakage,cholangitis and recurrent stricture.Liver function of the patient was back to normal and T tube drainage was pulled out at the end of 3 months of follow up.

OBJECTIVE:To evaluate the economic effectiveness of different pharmacotherapeutic schemes for the same disease.METHODS:Using pharmacoeconomical cost-effectiveness analysis,four therapeutic schemes for treating peptic ulcer bleeding,schemes A,B,C and D,were compared.RESULTS:The total effect rate of scheme A was the lowest(61.53%).The cost-effectiveness ratios of A,B,C and D were 1.09,10.70,10.74,17.20,respectively.Using sensitivity analysis;the cost-effectiveness ratios were 0.98,9.63,9.66,15.48,respectively.CONCLUSION:Among the four schemes,scheme C was the best one.

Objective To investigate the changes of molecular markers in cultured skin stem cells exposed to UVB in vitro. Methods Skin stem cells were isolated and cultured according to their adherasion ability,and identified by immunohistochemistry using anti-K15 and anti-β-integrin antibodies. Then, a part of the skin stem cells were irradiated with UVB at 10 mJ/cm2 for 2 times. After 24-hour additional culture, the expressions of CD34, beta-catenin and p53 were detected with immunohistochemistry. Results Skin stem cells showed a high density in culture free of irradiation, which were round or polygon with a clear shape, well-distributed cytoplasm, high N/C ratio; mitotic cells could be seen. In unirradiated skin stem cells, beta-catenin was expressed predominantly in cell membrane and cytoplasm, with a positive expression rate of 64.74% and 8.4%in membrane and cytoplasm respectively; p53 was expressed mainly in cell cytoplasm and nuclei, with a positive expression rate of 6.9% in cell nuclei. After exposure to UVB, skin stem cells decreased in cell density and N/C ratios with a deformed and anomalous shape, vacuoles were present in cytoplasm, and some cells experienced karyopyknosis or apoptosis. Additionally, in irradiated cells, beta-catenin was expressed predominantly in cytoplasm with a positive expression rate of 64.74% and 0 in cytoplasm and nuclei, respectively; p53 was expressed mainly in nuclei with a positive expression rate of 100%. CD34 was detected in neither unirradiated nor irradiated skin stem cells. Conclusion UVB can promote beta-eatenin to accumulate in cytoplasm as well as beta-catenin and p53 to migrate from cytoplasm to nuclei.

Humans ; Medicine, Chinese Traditional ; Respiratory Tract Diseases ; prevention & control ; therapy ; virology ; Virus Diseases ; prevention & control ; therapy

Objective To establish QAMS method to determine the contents of three alkaloids in bile processed Coptidis Rhizoma; To compare the results of QAMS with those from external standard method; To prove the feasibility of QAMS.Methods An HPLC method was developed. Berberine hydrochloride was selected as the internal reference substance. 2 relative correction factors (RCF) of berberine hydrochloride to palmatine hydrochloride and to jatrorrhizine hydrochloride were established. Obtained RCFs were used to conduct content calculation (calculated value) to complete QAMS method. At the same time, the contents (measured value) of the three components were also determined by external standard method. Calculated value and measured value were compared.Results The analysis results showed that there was no significant difference between the calculated values and the measured values of the three alkaloids in 10 batches of bile processed Coptidis Rhizoma.Conclusion The QAMS method can be applied in the determination of alkaloids in bile processed Coptidis Rhizoma.

Objective Percutaneous coronary intervention( PCI) is effective in improving the ischemia and prognosis of pa-tients with acute myocardial infarction ( AMI) to reduce the short-term mortality.However, little research has been done on PCI in eld-erly AMI patients.The study aimed to evaluate the efficacy and the safety of percutaneous coronary intervention in elderly AMI patients (≥75 years old) . Methods 213 AMI patients who underwent emergency PCI in Jingling Hospital from January 2012 to December 2013 were divided into 2 groups:elderly group (≥75 years old, n=57) and non-elderly group (<75years old,n=156).Retrospec-tive analysis were made on the clinical data and the coronary intervention features of the patients. Results There were more patients having dyspnea, fatigue and other heart failure symptoms at the onset of first-break AMI in elderly group than in non-elderly group (21.1%vs 3.2%,P<0.0).More women (47.4% vs 16.7%,P<0.01) and more patients with hypertention or diabetes mellitus were found in elderly group.The procedure success rates with TIMI-3 flow grade of post-PCI in both groups were very high (100%). Compared with non-elderly group, the occurrence of the procedure-related complications (3.5%vs 2.6%,P=NS) and major adverse cardiac event rates (8.8%vs 6.4%,P=NS) and in-hospital mortality (5.3%vs 2.6%,P=NS) showed no significant difference.Conclusion There are more atypical clinical symptoms in elderly AMI patients. The emergency PCI in elderly AMI patients can effectively make artery unimpeded with high successful rate, few com-plications and a favorable short-term prognosis.

Objective To investigate the value of diffusion tensor tractography (DTT) quantitative assessment of corticospinal tract (CST) damage in acute intracerebral hemorrhage (ICH). Methods Thirty-two patients were enrolled in this study. DTT was obtained in early stage of ICH. The CST was reconstructed with Volume One 1.64 and diffusion Tensor Visualizer (dTV) software from Tokyo University. The compression, the displacement, the destruction, and the relative remaining number of the CST were calculated. Results The compression, the displacement and the destruction of the CST were observed in DTT images in all patients. The correlation coefficient between remaining number of the CST and score of Fugl-Meyer after the onset of ICH was 0.75 (P＜0.01). Conclusion DTT can quantitatively evaluate the state of CST injury in acute ICH.

Objective:To investigate the expressions of tumor stem cell marker CD133 and tumor vascular endothelial cell marker CD105 in lung cancer tissue and their clinical significance.Methods:Streptavidin-biotin-peroxidase complex (SABC)-immunohistochemical staining was used to detect the expression of CD133 and CD105 in 65 cases of lung cancer tissue and 30 specimens of adjacent non-cancerous tissue. The relationship between the expression of CD133/CD105 and tumor size, histological types, differentiation, TNM stage, lymphoid metastasis, and prognosis were analyzed. Results:The positive expression rates of CD133 and CD105 in lung cancer tissues were significantly higher than those in adjacent non cancerous tissues, respectively (69.2% vs 26.7% and 67.7% vs 10.0%, both P<0.05). The positive expression rates of CD133 and CD105 in the group with lymphoid metastasis were higher than those with non lymphoid metastasis, respectively (82.5% vs 48.0% and 80.0% vs 48.0%, both P<0.05). The expressions of CD133 and CD105 were positively correlated with lymphoid metastasis with Pearson coefficient r of 0.35 and 0.32, respectively (P<0.05). No significant correlation was found between the expression of CD133/CD105 and tumor size, histological types, differentiation degree as well as TNM stage(P>0.05). The expression of CD133 was positively correlated with the expression of CD105 in lung cancer tissue with Pearson coefficient r of 0.37 (P<0.05). Postoperative median survival periods of CD133 and CD105-positive group were significantly shorter than the CD133 and CD105-negative groups (37 months vs 66 months,35 months vs 70 months, respectively, both P<0.05). Conclusion:The expression of CD133 and CD105 was associated with lymphoid metastasis and prognosis in patients with lung cancer.Their overexpression implies poor prognosis of lung cancer patients.

Objective To explore the changes in β-catenin expression and their significance in ultraviolet ray (UV)-induced development of skin tumor in mice.Methods The back of 60 mice was irradiated for various durations to establish tumor models.Ten mice receiving no irradiation served as the control.Fifteen mice were sacrificed respectively on week 2,4,6 and 8 after the beginning of irradiation and skin tissue specimens were resected from the back of these mice.Hematoxylin and eosin staining was conducted to observe the histopathological changes of skin,and immunohistochemistry and real time fluorescence PCR were carried out to detect the expression of β-catenin.Results Along with the UV irradiation,the exposed skin experienced a series of histological changes.The β-catenin expression was located in cell membrane in unirradiated mice and those irradiated for 2 weeks.There was an attenuation in the expression of β-catenin in cell membrane but an increment in the ectopic expression of β-catenin in 7,9 and 9 of the 15 mice receiving 4-,6- and 8-week irradiation respectively.Compared with the control mice,a significant increase was observed in the ectopic expression rate of β-catenin in mice receiving 4,6 and 8 weeks of irradiation (all P ＜ 0.045).The relative expression level of β-catenin mRNA was 4.893,7.857,10.452,12.481 and 14.702 in unirradiated mice,mice receiving 2,4,6 and 8 weeks of irradiation,respectively,with statistical differences between the 5 groups (all P ＜ 0.05).Conclusions There is an ectopic nuclear expression of β-catenin in cells of UV-irradiated mouse skin,which may be involved in the initiation and progression of skin tumors.

Objective To analyze correlation of drug with acute drug-induced liver injury in 83 patients. Methods According to the international consensus criteria and Danan's causality assessment of a drug in the case of acute liver injury, 83 cases which had been clinically diagnosed as acute drug-induced liver injury were analyzed. Results Among the 590 inpatients of acute hepatitis, 83 (14.07%) were acute drug-induced liver injury, in whom 53 patients had liver cell damage (63.86%), 22 with cholestasis (26.5%), and 8 with mixed type (9.64%). In 34 patients, it was drug related (40.96%), undefined in 37 cases (44.57%), and unrelated in 12 cases (14.47%). Conclusion The international consensus criteria standardized the diagnosis of drug-induced liver injury and are helpful in differential diagnosis, but it needs improvement for actual implementation.