Various bile duct injuries caused bile leakage or biliary obstruction and severe secondary long-term complications which threaten patients' survival.At present, confirmative surgeries to reconstruct bile flow into gastrointestinal tract remains as a major resort to treat bile duct injury.Successful reconstruction mainly depends on experienced surgeons armed with precisely biliary surgical technology.Surgical repair should be based on cautious preoperative assessment and identification of bile duct injury.The basic principle of reconstruction includes that anastomosis is performed on the healthy bile duct with sufficient blood supply and without inflammation, ischemia and scar.The core of reconstruction includes the exposure of proximal and distal bile ducts and preparation of materials for repair and anastomosis.The definite goal of this surgery is to build up an unobstructed biliary drainage, tension-free mucosa with sufficient blood supply for mucosa anastomosis.

Objective:To explore the diagnostic value of color soppler flow imaging(CDFI) be applied to pseudoaneurysms in different parts of the body.Methods: Retrospectively analyzed clinical data of 29 pseudoaneurysms patients who were diagnosed by Color Doppler Flow Imaging during january 2012-october 2013, to discuss the features of two-dimensional echocardiography and CDFI signal,all the diagnostic results were compared to the operation results.Results: The biggest lump among 29 patients is 6.3 cm×11.8 cm×12.5 cm, located in femoral artery, the smallest one is 2.3 cm×2.8 cm×0.5 cm, located in carotid artery,all the patients were confirmed by operations, The coincident diagnostic rate was 100%, 39 Pseudoaneurysms had been found in total, among these, the number of patients have single Pseudoaneurysms were 22, about 75.86%, 4 patients have one more pseudoaneurysms, about 13.79%, 3 patients have two more pseudoaneurysms,about 10.34%. 23 breachs have been found by two-dimensional echocardiography, and 6 breachs haven’t been found, but all the breachs have been found by CDFI. Back and forth movement flow pattern was the main diagnostic sign.Conclusion: Color doppler flow Imaging is safe and noninvasive,and have high diagnostic value in diagnosing pseudoaneurysms, it is the preferred method in diagnosis.

Clinical practice is an important part for medical students to become qualified doctors.The humanistic skill and medical operation skill training,test and evaluation before clinical practice are necessary.Results showed that the standard and routine training before clinical practice can help interns adapt to their practice life more easily.

Objective:To learn the mental health state of the Guangzhou medical students.Method:Symptom Check List 90(SCL-90) was selected to investigate 605 medical students in Guangzhou Medical College from the first year to the fifth year by stratified cluster sampling.The results were compared with the three regular models of the country.Conclusion:The mental health of the Guangzhou medical students is a little worse than that of the regular model of the adult in the country but is better than that of the regular models of the youth and the college students in the country.(except the body symptom)

Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer.Methods The retrospective cross-sectional descriptive study was adopted.The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected.The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients,and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection.The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination.Observation indicators included (1) operation situations,including surgical procedures,operation time,volume of intraoperative blood loss and number of lymph node dissected,(2) postoperative situations,including time for outoff-bed activity,time for diet intake,time of drainage tube removal,occurrence of complications and duration of hospital stay,(3) results of postoperative pathological examination,including tumor stage and surgical margin,(4) postoperative adjuvant treatment,(5) follow-up situation including the survival of patients,tumor recurrence and metastasis.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Count data were represented as average (range).Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection + lymph node dissection at N1 region.Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection + Roux-en-Y hepaticojejunostomy,without perioperative death.The average operation time,average volume of intraoperative blood loss and average number of intraoperative lymph node dissected were 238 minutes (range,178-430 minutes),250 mL (range,200-600 mL) and 7 (range,4-15),respectively.(2) The patients got out-off-bed activity and normal diet intake at postoperative day 2,with a average time of drainage tube removal of 3 days (range,0-25 days) and an average duration of hospital stay of 5 days (range,3-28 days).Two patients with complications were cured by symptomatic treatment.(3) Results of postoperative pathological examination showed that all the patients received R0 resection,and pathological stage showed that 12 patients were detected in Ⅰ B stage,10 in Ⅱ stage,7 in ⅢA stage and 1 in ⅢB stage.(4) One patient in Ⅲ B stage (pT3N1 M0 stage) received gemcitabine + cisplatin chemotherapy and other patients didn't receive the adjuvant treatment.(5) All the patients were followed up for a median time of 16 months (range,4-32 months),without tumor recurrence and metastasis at Trocar puncture site.There were 25 patients with tumor-free survival and 5 patiens died of tumor recurrence.Conclusion Laparoscopic radical resection of gallbladder cancer is technically safe and feasible,with a satisfactory short-term outcome.

Objective To build an evaluation index system for clinical research project outcomes for the purpose of timely monitoring of research projects,encouraging original research,clinical translation and outcome.Methods Questionnaire survey on prize-winning outcomes and projects completed to develop an initial index system; three rounds of experts consultation in Delphi method to produce the evaluation indexes and weights of these projects.Results We have built an index system comprising five class-1 indexes,ten class-2 indexes,and 29 class-3 indexes.Among such indexes,innovation and leading extent of the current research,R&D of IIPR of the product,and demands of research direction are key ones.Conclusion Evaluation of clinical research projects and the outcomes can monitor key indexes,guide and encourage science innovation and clinical translation.

Aim To investigate the effect of SM-1 on seven main cytochrome P450(CYP450)in human liver microsomes.Methods Substrate or SM-1 was incubated with human liver microsomes for 30 min in vitro,and divided into control group and experimental group.The effects of SM-1 on the main phase I metabolic enzymes in human liver microsomes was detected by HPLC.Phenacetin,bupropion,paclitaxel,tolbutamide,omeprazole,dextromethorphan,testosterone were investigated as probe drugs.Results Inhibition rate of SM-1 on the classical substrate of human liver microsomal CYP was 0.05％,3.37％,0.08％,2.07％,4.20％,-0.15％and 10.84％,respectively.Conclusions SM-1 may have inhibitory effect on CYP3A4.Attention should be paid to the interaction of clinical drug induced by CYP enzyme inhibition.

Objective:To investigate the immune mechanism of Shengxian decoction in experimental autoimmune myasthenia gravis(EAMG) rats. Methods:Lewis rats were immunized with the rat sequence 97-116 of the AChRαsubunit(Rα97-116) in CFA, 25 of which were successful. They were randomly divided into 5 groups:EAMG model group,prednisone group(5. 4 mg/kg),Shengxian decoction low, medium, high dose groups ( dosage 2. 6 g/kg, 5. 2 g/kg, 10. 4 g/kg ) . Clinical symptoms, weight, and the decrement percentage of RNS(5 Hz) were evaluated,and ELISA were adopted to determine the titers of AChR Ab,TGF-β,IFN-γ,IL-2,IL-4 and IL-17 in serum. Results:After molding,the percentage of decrement of RNS in each group noticeably increased by more than 10% in comparison with that in the CFA control group ( P<0. 01 or P<0. 05 ) . At the same time, they were also subjected to progressive decreasing weight and typical myasthenia symptoms,showing the successful molding. With medication,the decrement percentage of RNS of rats in the groups with low,medium and high dose of Shengxian decoction were all on obvious decline with alleviated weight decrease (P<0. 01),testifying to the symptom improvement. Compared with the CFA control group,the groups with low,medium and high dose of Shengxian decoction were coupled with decreasing AChR Ab content(P<0. 05),rising TGF-βlevel and reducing IFN-γ,IL-2,IL-4 and IL-17 level(P<0. 01 or P<0. 05). Conclusion: Shengxian decoction can turn the decrement percentage of RNS around,improve the progressive weight decrease in EAMG rats and increase the weight gains. By up-regulating the TGF-βlevel,lowering IFN-γ,IL-2,IL-4 and IL-17 level,preventing B cells from producing AChR Ab and reducing the content of AChR Ab in serum,it will soothe the damage of NMJ to AChR and cure EAMG.

Objective To compare the effect of pericardial devascularization with that of the modified Sugiura procedure in management of portal hypertension. Methods From 1990 to 2008, 236patients with portal hypertension underwent operations including pericardial devascularization in 147and modified Sugiura in 89 in our hospital. Results There were 12 perioperative deaths (8.2 % ), and 2 rebleedings (2 % ) in the pericardial devascularization group, and 7 perioperative deaths (7.9 % ) and 2 rebleedings(3.4 % ) in the modified Sugiura group. The follow-up rate was 91.9 % in the pericardial devascularization group and 87.8% in the modified Sugiura group respectively, in a period from 6 months to 19 years. The 1-, 3-and 5-year rebleeding rates were 5.7%,15.2% and 25.5% in the pericardial devascularization group and 6.9%, 16.3%, 29.5 % in the modified Sugiura group, respectively. The 1-, 3- and 5-year survival rates were 87.8% ,79.1% and 69.7% in the pericardial devascularization group and 95.8 %,85.0%, 76.9 % in the modified Sugiura group, respectively. Conclusion Modified Sugiura procedure and pericardial devascularization have differences in perioperative mortality as well as rebleeding and survival rates.

Objective To investigate the clinical value of hemostatic silk in prevention of wound bleeding and wound healing after endoscopic submucosal dissection (ESD). Methods Experiment group: animal model was made by rabbit underwent ESD simulation in its' stomach and laying hemostatic silk on its' wound;control group: animal model was made by pig underwent ESD simulation in its' colon without any healing management. All the ulcers sites were endoscopically and pathologically examined to evaluate the hemorrhage and healing of the wound on 3 days, 1 week, 2 weeks and 4 weeks after the procedure. Results The blood loss in experiment group was significantly lower than that in control group. The wounds of all the experimental pigs underwent colon ESD successfully covered with hemostatic silk postoperatively. Endoscopic pathological examination shown better healing procedure in experiment group. No procedure-related adverse event occurred in both groups. Conclusions Hemostatic silk has potential application value in healing the wound after ESD demonstrated by animal experiment.