Objective To study the long-term results of using an autologous vascularized pedicled flap of gastric tissues in the repair of traumatic bile duct strictures.Methods From 2002 to 2016,38 patients with traumatic bile duct strictures underwent repair using an autologous vascularized pedicled flap of stomach tissues.The postoperative morbidity,mortality,long-term clinical results,liver function and the rate of biliary stricture recurrence were studied.Results The overall complication rate was 18.4％ (7/38).A delay in healing of the incision wound occurred in 4 patients,biliary fistula in 2,and ascites in 1.Two patients died of malignant tumor.The median follow-up was 92 (61 ～ 107) months and the follow-up rate was 100％.Excellent results were obtained in 97.2％ (35/36) of patients.Abnormal liver function was detected in 1 patient which improved with treatment using choleretic drugs.The remaining 35 patients had normal liver functions with absence of abdominal pain.Conclusions To repair traumatic bile duct strictures using an autologous vascularized pedicled flap of stomach tissues was safe and reliable,and good long-term outcomes are available.

Objective To investigate the metabolic changes in free fatty acids in the livers of obese rats with type 2 diabetes.Methods Thirty male SD rats were randomly divided into control group(Con group) and diabetes mellitus group(DM group),with 15 in each group.Rats in Con group and DM group were fed with normal diet and high-fat diet,respectively.Eight weeks later,OGTT and ISI test were performed to identify insulin resistance.Then the insulin-resistant rats received intraperitoneal injection of low-dose streptozocin(STZ) to induce type 2 diabetes.After giving high-fat diet further for six more weeks,8 rats of each group were sacrificed and artery blood and liver sample were obtained for further analysis.The mRNA levels of diacylglycerol O-acyltransferase 1(DGAT1),carnitine palmitoyltransferaseⅠ(CPTⅠ),palmitoyl-CoA oxidase(ACOX1),D-bifunctional protein(DBP) and L-bifunctional protein(LBP),which were involved in fatty acids metabolism,were evaluated by RT-PCR.The protein level of DBP was evaluated by Western blotting Peroxisome fatty acids ?-oxidation was measured by spectrophotometry.Free fatty acids in blood and liver were determined by gas chromatography.Oil red staining was used to determine the fat accumulation in liver.Results The mRNA expressions of DGAT1,CPTⅠ,ACOX1 and LBP increased(P

Objective To analyze the factors related to glare occurred after the phakic intraocular lens (P-IOL) implantation,and to raise the standard for the P-IOL selection.Design Retrospective case series.Participants 104 patients with high myopia underwent P-IOL implantation in Beijing Tongren Hospital.Methods In 104 cases,22 cases (22 eyes) were implanted angle supported Phakic6 designed accord with corneal symmetry,54 cases (54 eyes) were implanted iris fixed Verisyse,and 28 cases (28 eyes) were implanted posterior chamber PRL.Selection of the diameter of P-IOL optics depended on P-IOL diopters.The pupil diameter,the P-IOL optic center position,the pupil and corneal center position were measured with anterior segment optical coherence tomography (OCT).The contrast sensitivity (CS) under different condition (day,day and glare,night,night and glare) and in different space frequency (1.5,3,6, 12,18c/d)were examined with Optec6500 system.Main Outcome Measures Glare incidence,CS,and the influence of pupil diameter and P-IOL location to glare.Results None of the 104 P-IOL eyes occurred glare in day time.59 eyes (56.73%) complained of glare in dime condition.The glare incidence was 63.18% (14/22) in Phakic6 eyes,55.56% (30/54) in Verisyse eyes,and 53.27% (15/28) in PRL eyes (P=0.691).CS of all surgical eyes were improved in day time with or without glare luminous environment (P=0.000).And the CS of halo-complaining eyes was lower than of no halo eyes in night time with or without glare luminous environment (P=0.000).Glare oc- curred more frequently in eyes with the pupil diameter larger than P-IOL diameter in clime condition after surgery (10 in Phakic6 eyes, 20 in Verisyse eyes,12 in PRL eyes,all P

By means of searching the ancient and modern literature,this study mainly investigated the etiology and pathogenesis of IBD,summarized the rules of acupoint selection and the experimental mechanism of the moxibustion treatment for IBD,providing the basis and theoretical evidence of acupoint selection and moxibustion therapy for clinical practice and studies.Ancient literatures were retrieved in TCM database system,while modern literatures in Pubmed,CNKI and VIP database from January,2005 to January,2016.Finally,comprehensive analysis was implemented among the selected literatures.It was found that the pathogenesis of IBD was associated with exogenous evils,diet,emotion,and fatigue during chronic diseases in TCM.The treatments of acupuncture and moxibustion for IBD should consider both the primary symptoms and root causes by regulating functional activity of Zang and Fu and also warming and nourishing the spleen and stomach.On this basis,acupoint selection mainly focused on the stomach meridian with the functions of invigorating spleen and stomach,elevating clear qi and descending turbid,recovering the bowel function and strenthening the body and antidiarrhea.Modern research upon the scientific basis of TCM indicated that moxibustion stimulated the thermoreceptors around the acupoints leading to the increased degranulation of mast cells.Immune factors were impacted with the regulation of transcriptional activators in the bowel for repairing mucosal barrier and preventing intestinal fibrosis in IBD.In conclusion,moxibustion was effective on warming and nourishing spleen and stomach and regulating the function activity of bowel for the prevention and treatment of IBD.Achievements were made in the mechanism researches on IBD based on the TCM theory.However,some profound mechanisms need in-depth exploring.

Objective:To investigate the effects of different preoperative biliary drainage methods on bile bacterial culture and drug resistence of malignant obstructive jaundice.Methods:The retrospective and descriptive study was conducted. The clinical data of 317 patients with malignant obstructive jaundice who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2018 were collected. There were 216 males and 101 females, aged (62±10)years. Of 317 patients, 158 cases had no preoperative biliary drainage, 115 received preoperative biliary drainage by percutaneous transhepatic choledochal drainage (PTCD), 44 received preoperative biliary drainage by endoscopic retrograde biliary drainage (ERBD). Observation indicators: (1) bile bacteria in different preoperative biliary drainage methods; (2) clinicopathological characteristics of patients with positive bile bacteria; (3) drug resistance of bile bacteria in different methods of preoperative biliary drainage. Measurement data with normal distribution were expressed as Mean± SD. Count data were expressed as absolute numbers or percen-tages, and comparison between groups was analyzed by the chi-square test. Bonferroni correction was used for pairwise comparison. The inspection level was 0.016 7 in the multiple comparison. Results:(1) Bile bacteria in different preoperative biliary drainage methods: of 317 patients, 116 cases were positive for bacterial culture, including 168 strains of 43 bacterial types. There were 46 strains from 36 patients without preoperative biliary drainage, 49 strains from 39 patients with preoperative PTCD and 73 strains from 41 patients with preoperative ERBD. ① The positive rate of bacteria for 317 patients was 36.59%(116/317). The positive rates of bacteria for patients without preoperative biliary drainage, patients with preoperative PTCD and patients with preoperative ERBD were 22.78%(36/158), 33.91%(39/115) and 93.18%(41/44). There was a significant difference in the positive rate of bacteria among the three groups ( χ2=74.066, P<0.05). There was no significant difference between patients with preoperative PTCD and patients without preoperative biliary drainage ( χ2=4.137, P>0.016 7), but there were significant differences between patients with pre-operative ERBD and patients without preoperative biliary drainage or patients with preoperative PTCD ( χ2=72.305, 44.718, P<0.016 7). ② The overall multiple bacterial rate was 36.21%(42/116). The multiple bacterial rates for patients without preoperative biliary drainage, patients with preoperative PTCD and patients with preoperative ERBD were 19.44%(7/36), 23.08%(9/39) and 63.41%(26/41). There was a significant difference in multiple bacterial rate among the three groups ( χ2=20.431, P<0.05). There was no significant difference between patients with PTCD and patients without preoperative biliary drainage ( χ2=0.147, P>0.016 7), but there were significant differences between patients with preoperative ERBD and patients without preoperative biliary drainage or patients with preoperative PTCD ( χ2=15.133, 13.215, P<0.016 7). ③ The overall prevalence rate of multi-drug resistant organism was 30.95%(52/168). The prevalence rates of multi-drug resistant organism for patients without preoperative biliary drainage, patients with preoperative PTCD and patients with preoperative ERBD group were 15.22%(7/46), 26.53%(13/49) and 43.84%(32/73). There was a significant difference in the prevalence rate of multi-drug resistant organism among the three groups ( χ2=11.447, P<0.05). There was no significant difference between patients with PTCD and patients without preoperative biliary drainage ( χ2=1.827, P>0.016 7). There was a significant difference between patients with preoperative ERBD and patients without preoperative biliary drainage ( χ2=10.497, P<0.016 7), but there was no significant difference between patients with preoperative ERBD and patients with preoperative PTCD ( χ2=3.772, P>0.016 7). (2) Clinicopatho-logical characteristics of patients with positive bile bacteria: age, the history of abdominal surgery, degree of jaundice and location of biliary obstruction of patients were not related to the positive rate of bacterial culture ( χ2=4.865, 1.423, 4.922, 0.030, P>0.05). (3) Drug resistance of bile bacteria in different methods of preoperative biliary drainage: for patients without preoperative biliary drainage, the drug resistance rate of Gram-positive bacteria to nitrofurantoin, linezolid and tigecycline was 0, and the drug resistance rate of Gram-negative bacteria to piperacillin/tazobactam, gentamicin, tobramycin, amikacin and imipenem was 0. For patients with PTCD, the drug resistance rate of Gram-positive bacteria to linezolid and tigecycline was 0. For patients with ERBD, the drug resistance rate of Gram-positive bacteria to linezolid and tigecycline was 0. In terms of Gram-positive bacteria, linezolid, tigecycline, vancomycin and nitrofurantoin were the top four antibiotics with the lowest resistance rate. In terms of Gram-negative bacteria, imipenem, piperacillin/tazobactam, amikacin and tobramycinn were the top four antibiotics with the lowest resistance rate. Seven strains of fungi showed no resistance to antifungal drugs. Conclusions:Patients with preoperative ERBD are more vulnerable to infectious complications, and more likely to form drug resistant organism and multi-drug resistant organism. For Gram-positive bacteria infection, linezolid, tigecycline and vancomycin can be used for treatment. For Gram-negative bacteria infection, imipenem, piperacillin/trzobactam, amikacin and tobramycin can be used for treatment.

AIM: To observe the expressions of aquaporin 2 (AQP2) in kidney tissues and the contents of endotoxin (ET), interleukin-1 β (IL-1β), tumor necrosis factor-α (TNF-α) in serum in emphysema model rats, and to investigate the relationship between lungs and kidney in humoral metabolism. METHODS: The rats of emphysema were treated by injecting lipopolysaccharide into the trachea with cigarette smoking. Immunohistochemistry and Western blotting analysis were used to observe the expression of AQP2 in kidney tissues. RT-PCR was applied to detect the expression of AQP2 mRNA in kidney tissues. Blood sample and lung tissue were taken and the levels of ET, IL-1β and TNF-α were measured by radioimmunoassay. RESULTS: AQP2 expression in the kidney tissue in model group was greater than that in control group, and the expression of AQP2 mRNA showed the same results (P<0.01). ET, IL-1β and TNF-α levels in serum and lung tissue in model group were markedly higher than those in control group (P<0.01). CONCLUSION: In the emphysema model rats, AQP2 expression is up-regulated in the kidney tissue. The mechanism of emphysema may be related to increasing the levels of ET, IL-1β and TNF-α in the serum and lung tissue obviously.

The extracting technology of salidroside, tyrosol, crenulatin and gallic acid from Rhodiolae Crenulatae Radix et Rhizoma was optimized. With extraction rate of salidroside, tyrosol, crenulatin and gallic acid as indexes, orthogonal test was used to evaluate effect of 4 factors on extracting technology, including concentration of solvent, the dosage of solvent, duration of extraction, and frequency of extraction. The results showed that, the best extracting technology was to extract in 70% alcohol with 8 times the weight of herbal medicine for 2 times, with 3 hours once. High extraction rate of salidroside, tyrosol, crenulatin and gallic acid were obtained with the present technology. The extracting technology was stable and feasible with high extraction rate of four compounds from Rhodiolae Crenulatae Radix et Rhizoma, it was suitable for industrial production.
Chemical Fractionation ; methods ; Chemistry, Pharmaceutical ; methods ; Coumarins ; isolation & purification ; Drugs, Chinese Herbal ; isolation & purification ; Gallic Acid ; isolation & purification ; Glucosides ; isolation & purification ; Phenols ; isolation & purification ; Phenylethyl Alcohol ; analogs & derivatives ; isolation & purification ; Rhizome ; chemistry ; Rhodiola ; chemistry

Objective To assess the feasibility and safety of combined transgastric and transcolonic endoscopic cholecystectomy in porcine model.Methods Five female miniature swines were subjected to cholecystectomy by the combined transgastric and transcolonic approach using two flexible endoscopes.The gastric wall of the swine was punctured with a needle knife,followed by dilatation with a balloon-dilator via the transgastric access.then a double channel endoscope was advanced into the peritoneal cavity.Another double-channel endoscope was advanced via a transcolonic access.Gallbladder excision was performed using transcolonic endoscope assisted by transgastric endoscope.After eholecystectomy the gastric and the colonic incisions were closed with clips.The animal was examined 14 days after operation.Results Cholecystectomy was failed in 4 swines because of incomplete exposing the gallbladder(3 swines)and hemarrhage during separating the gallbladder from the liver bed(1 swine).Only one swine was successfully performed cholecystectomy.But 3 perforations were found in the diaphragm which might be done by transcolonic endoscope.The swine lost 4 kg 14 days after the operation.The necropsy revealed a complete transmural healing of the gastric incision with minimal adhesions and a complete healing of the colonic incision with heavy adhesions.An abscess with severe adhesions was found in the right lower quadrant.One perforation of the diaphragm healed,and the other two perfolrations merged and formed a diverticulum embedded with the liver.Conclusion Combined transgastric and transcolonic approach appears difficult for cholecystectomy and the safety remains tO be further studied.

Objective To investigate the normal range of the femoral neck α-angle in normal Chinese adults and classify the morphology of the anterior femoral head-neck junction on CT-based images. Methods Six hundred and fifty-two adult patients (Bilateral: 459 patients, unilateral:193 patients) with the total of 1111 hips (552 left; 559 right, and 654 male; 457 female) without known diseases affecting the proximal femur or symptoms of femoroacetabular impingement (FAI) underwent 64-slice CT scanning for medical purpose with the hip included in the scan range. The volume CT data was used for further analysis in this study. Oblique sagittal plane images paralleling to the axis of the femoral neck were reconstructed with the volume CT data, the image through the middle of the femoral neck was chosen to measure α-angle with AutoCAD2006 software. The morphology of the anterior femoral head-neck junction was classified. Analysis of variance and t-test were performed with SPSS 15.0. Results The mean value of α-angle of all 1111 hips was 38. 2° ±5.3°. The normal range of α-angle in Chinese adults was 28°to 49°.The mean value of left and right α-angles were 38. 0° ±5. 3°and 38.4° ±5. 3° ,respectively, and there was no statistically significant difference between both sides (t = - 1. 231 ,P ＞ 0. 05 ). Males have greater α-angles than females 39. 2° ±5. 8 vs 36. 8° ±4. 1°, with t = -8. 180, P ＜0. 01. There was no statistically significant differences of the α-angles of the seven age groups (F = 1. 765, P ＞ 0. 05 ). In all 1111 proximal femora, 168 were classified as concave type, accounting for 15. 1%, with a mean α-angle of 31.2° ±2. 0°,726 were smooth type, accounting for 65.4%, with a mean α-angle of 37.4° ± 2. 4°, and 217 were flat type, accounting for 19.5%, with a mean α-angle of 46. 4° ±3. 8°. The differences of the α-angles of the three groups reached statistical significance ( F = 1636. 107, P ＜ 0. 01 ). Conclusions The morphology of anterior femoral head-neck junction can be classified into three types: concave type (type Ⅰ ), smooth type (type Ⅱ ) and flat type (type Ⅲ ). This classification could directly reflect α-angle, which helps to recognize the variation of the offset of anterior femoral head-neck junction. This study offers basic data for the diagnosis of FAI.

Objective To observe the effects of eye acupuncture and body acupuncture on tumor necrosis factor-α(TNF-α) expression in the cerebral cortex of rats after ischemia-reperfusion injury,in order to investigate the differences in therapeutic function between eye acupuncture and body acupuncture against acute cerebral ischemia-reperfusion injury. Method 48 Rats established by suture method were randomly divided into control group,sham operation group,model group,eye-acupuncture in point area group,eye-acupuncture outside point area group and body acupuncture group. After reperfusion 24 h,the neurophysical behaviours were accessed by ZeaLonga neurophysical impairment marks;the levels of plasma TNF-αwere determined by ELISA method;the expression of ischemic cerebral cortex TNF-αmRNA was measured by RT-PCR method;the expression of ischemic cerebral cortex TNF-αprotein was detected by western blot. Results After reperfusion 24 h,compared with control group,neurologic impairment marks of eye-acupuncture therapy in point area group and body acupuncture group both decreased obviously (P<0.01),however there were no significant differences between the eye-acupuncture in point area group and body acupuncture group;the levels of plasma TNF-αin rat cerebral cortex after the eye acupuncture therapy and body acupuncture therapy were obviously decreased (P<0.01),however there were no significant differences between the eye-acupuncture in point area group and body acupuncture group; the expressions of TNF-α mRNA and protein in rat cerebral cortex after the eye acupuncture therapy and body acupuncture therapy were also obviously down-regulated (P<0.01),however there were no significant differences between the eye-acupuncture in point area group and body acupuncture group.Conclusion The eye and body acupuncture therapy show the same effects on treating cerebral ischemia reperfusion. The mechanisms of these two therapies may be related to up regulating TNF-αexpression in rat cerebral cortex with ischemia-reperfusion injury.