At present, the percutaneous transhepatic cholangiodrainage (PTCD) and the self-expandable metal stent implantation are commonly recognized as an effective treatment for inoperable malignant biliary obstruction, but the restenosis of biliary stent significantly affect the therapeutic result and prognosis.Percutaneous transhepatic intraductal radiofrequency ablation can be used together with biliary stent implantation, which can prolong the patency time of biliary stent and control the local tumor at the narrowed segment, thus, the therapeutic effect of malignant biliary obstruction can be reliably improved. As a kind of newly-developed therapy, its clinical safety is especially important. This paper aims to make a review about the safety of percutaneous transhepatic intraductal radiofrequency ablation combined with biliary stent implantation in treating malignant biliary obstruction.

0.05).Conclusions Neither the new nor old SIRS diagnostic criteria had a high conforning rate with neonatal critical illnesses;There was no significant difference between them in each clinical item.It shows that the new SIRS diagnostic criteria is not superior to the old one,therefore we should improve the neonatal SIRS diagnostic criteria in the future.

Antihypertensive Agents ; therapeutic use ; Humans ; Hypertension ; therapy ; Practice Guidelines as Topic

Objective To explore the effect of fibroblast growth factor receptor(FGFR)inhibitor BGJ398 on the vasculogenic mimicry(VM)formation of glioma cells. Methods The phosphor-FGFR(pFGFR)was de-tected by Western blot,the expressions of MMP2 and MMP14 were detected by Western blot and immunocytochem-istry;the VM formation of U87MG and U251MG was tested by tube formation assay;subcutaneously implanted tu-mor model in nude mouse was established and tumor sections were CD34/PAS double-stained to detect the forma-tion of VM in vivo. Results Western blot showed that pFGFR in the experimental groups decreased significantly (P < 0.05);western blot and immunohistochemical staining showed that the expression of MMP2 and MMP14 in the experimental groups decreased significantly compared to the control group. In the tube formation assay ,the tube formation of U87MG and U251MG cells were restrained. In the subcutaneously implanted tumor model ,the VM number of the experimental group(13.85 ± 3.96)was significantly lower than that in the control group(26.40 ± 5.06,P < 0.05). Conclusions In vivo and in vitro experiments confirmed that BGJ398 can inhibit the activa-tion of FGFR,and inhibit the VM formation of glioma cells. These indicate FGFR signaling pathway is involved in the formation of VM.

Objective:To explore the application and effect of team-based learning (TBL) combined with flipped classroom in the teaching of physiology.Methods:A total of 70 medical students were selected and randomly divided into two groups, experimental group ( n=34) and control group ( n=36). Both groups studied digestion physiology by different method. In the experimental group, the students were taught by TBL combined with flipped classroom. The control group was given traditional teaching. The students studied and discussed problems in a team, and shared the answers in the flipped classroom. The effects of teaching were evaluated by the final test scores and the self-made questionnaire. SPSS 17.0 was used for t test on data comparison between the two groups. Results:The test scores of digestion physiology in the experimental group were (5.47±1.02) points, which were significantly higher than those of the control group (4.42±1.63) points, with significant differences ( P=0.020). A total of 34 questionnaires were issued and 34 valid questionnaires were collected, with an effective rate of 100%. The questionnaire results showed that TBL combined with flipped classroom was accepted and approved by about 82% of students in the experimental group who agreed that the teaching model helps enhance students' initiative and interest in learning, develop their sense of cooperation and comprehensive application ability. Conclusion:TBL combined with flipped classroom is feasible and effective in the physiological teaching, and it can be popularized in medical courses.

Objective : To evaluate the effect of gingival stem cells-derived exosomes (GMSC-Exos) treatment on the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in rats with periodontitis, so as to provide the evidence for periodontitis treatment. Methods: Forty specific pathogen-free (SPF) rats at ages of 8 weeks were randomly divided into 4 groups, including the blank group, periodontitis group, GMSC-Exos group and PBS group. Rats in the periodontitis group, GMSC-Exos group and PBS group were modeled for periodontitis using the ligature method. Rats in the blank group and periodontitis group were given no treatment, while rats in the GMSC-Exos group and PBS group were given 20 μL GMSC-Exos and PBS by injection, respectively. The periodontal index was measured in all rats 4 weeks post-treatment, and the TNF-α and IL-6 levels were measured in rat serum samples using enzyme-linked immunosorbent assay (ELISA). The TNF-α and IL-6 gene expression was quantified using the polymerase chain reaction (PCR) assay in the gingival tissues of the rat left upper maxillary area, and the periodontal tissues in the left upper maxillary areas were sampled for pathological examinations. Periodontal clinical indexes, IL-6 and TNF-α levels were compared in each group. Results: The gingival sulcus bleeding index, gingival index, probing depth, and plaque index in the GMSC-Exos group (1.87±0.41, 1.03±0.19, 1.91±0.09 and 1.11±0.17) were higher than those in the blank group (0.96±0.31, 0.83±0.31, 1.09±0.05 and 1.01±0.38), but lower than those in the periodontitis group (2.65±0.50, 1.36±0.22, 2.61±0.07 and 1.51±0.26) and PBS group (2.44±0.50, 1.23±0.20, 2.49±0.10 and 1.39±0.28) (all P<0.05). The serum IL-6 and TNF-α levels in the GMSC-Exos group [(205.97±11.47) and (90.11±8.57) pg/mL] were higher than those in the blank group [(143.10±4.87) and (80.07±5.13) pg/mL], but lower than those in the periodontitis group [(367.33±13.89) and (158.29±13.10) pg/mL] and PBS group [(364.23±13.62) and (140.60±11.73) pg/mL] (all P<0.05). The IL-6 and TNF-α mRNA expression in the rat gingival tissues in the GMSC-Exos group (1.09±0.14 and 1.61±0.29) was higher than that in the blank group (0.99±0.10 and 1.06±0.14), but lower than that in the periodontitis group (1.63±0.09 and 3.63±0.26) and PBS group (1.58±0.11 and 3.79±0.32) (all P<0.05). Pathological examinations showed alleviation of periodontal tissue destruction, inflammatory cell infiltration and alveolar bone resorption, and no obvious root dental root regeneration in the junctional combined epithelium in the GMSC-Exos group relative to the periodontitis group and the PBS group. Conclusion Administration of GMSC-Exos may reduce periodontal inflammation and alveolar bone resorption by inhibiting IL-6 and TNF-α expression in rats with periodontitis.

Objective To investigate the effect of the calmodulin kinase Ⅱ Inhibitor KN-93 on L-typecalcium current(ICa,L)and intracellular calcium concentration([Ca2+]i)in hypertrophic cardiac myocytes.Methods Forty-eight female New Zealand white rabbits were randomized(random number)into four groups(12 animals in each group):the sham operation group(sham group),the left ventricular hypertrophy group(LVH group),the myocardial hypertrophy + KN-93 group(KN-93 group),and the myocardial hypertrophy + KN-92 group(KN-92 group).Myocardial hypertrophy in the rabbits was established by coarctation of the abdominal aorta.In the sham group,the abdominal aorta was dissociated without coarctation.Eight weeks after coarctation,single ventricular myocytes were isolated by enzymaticdissociation,and ICa,L was recorded using perforated-patch recording(PPR)techniques.[Ca2+]i was measured using single-cell calcium imaging with the fluorescence calcium indicator dye fura-2/AM.Results Cardiac hypertrophy was successfully established after 8 weeks of coarctation of the abdominal aorta.The peak ICa,L in the LVH group and the sham group was(1.38 ± 0.3)nA and(0.87 ± 0.1)nA at 0 mV,respectively(P ＜0.01,n =12).There was no significant difference in Ica,L density between the LVH group and the sham group[(6.7 ±1.0)pA/pF vs.(6.3±0.7)pA/pF; P≥0.05,n=12].The addition of either KN-92(0.5 μmol/L)or KN-93(0.5 μmol/L)to the perfusing solution caused a modest steady-state inhibition of peak ICaL(9.4％ ±2.8％,KN-92; 10.5％ ±3％,KN-93)(P≥0.05,n =12)at 0 mV.However,at a higher concentration(1 μmol/L),KN-93 more potently inhibited peak ICa,L(40％±4.9％)compared to KN-92(13.4％ ± 3.7％ ; P ＜ 0.01,n =12).Resting[Ca2+]i levels in fura-2-loaded myocytes isolated from the sham,LVH,KN-92,and KN-93 groups were(98 ± 12.3)nmol/L,(154 ± 26.2)nmol/L,(147 ± 29.6)nmol/L,and(108 ± 21.2)nmol/L,respectively.Conclusions The CaMK Ⅱ specific inhibitor,KN-93,can effectively block ICa,L and reduce intracellular calcium overload in hypertrophic cardiac myocytes.This action may account for the antiarrhythmic effect of KN-93 in hypertrophic ventricular myocardium.

Objective To evaluate the CT and MRI characteristics of Primary Central Nervous System Lymphoma(PCNSL)in immunocompetent patients,and enhance its diagnosis level.Methods CT and MRI data of 20 patients with PCNSL confirmed by histo-pathology were analyzed retrospectively.MRI scans were performed with and without Gadolinium contrast.Two of them had contrast-enhanced CT scan;six had CT scan without contrast administration;1 had CT scan with both non-contrast and contrast enhancement.Re- suits Totally,38 lesions were found in all patients:14 lesions of them were single and 24 lesions were found in 6 patients.Generally,the lesions were located in the surface and/or midline of the brain.The signal features and density were similar to meningioma,and strongly enhancing after contrast administration.Thirty-six of the 38 lesions had spicular sign peripheral to the lesion.Conclusion Although the manifestations of the PCNSL are variety,there are still many characteristics in the medical imaging,especially in the locations,the signal features,and spicular sign in the edge of the lesions after contrast material injection.

ObjectiveTo introduce clinical experience of the modified lateral crural reverse island skin flap with two sets of blood supply system for aged ankle & foot soft tissue defect.MethodsOn the anatomy base that cutaneous artery branches of lateral crural reverse island skin flap and perforating branches of sural neurocutaneous vascular flap were originated from peroneal artery, we designed the modified lateral crural reverse island skin flap located in posterolateral cruris treated for aged ankle & foot soft tissue defect. The modified flap had two sets of blood supply system which were from lateral crural flap and sural neurocutaneous flap.ResultsAll 11 flaps survived. The skin grafting of donor sites healed well. Followed up 3-9 months, six cases were satisfactory. Five cases with extensor defect were regained by tendon transplantation after 3 months of the operations.Conclusion The modified lateral crural reverse island skin flap with two sets of blood supply system is a good method for aged ankle & foot soft tissue defect.

BACKGROUND:Catheter-related infection (CRI) of the central vein is a common cause of nosocomial infection. This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit (EICU) in order to provide the beneficial reference.METHODS:From January 2008 to December 2010, a total of 1363 patients were subjected to catheterization. In these patients, the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1363 patients using the central venous catheter. The peak rate of CRI was 10.79％, with an incidence of 3.05 episodes per 1000 catheter days. Of the 147 patients, 46.94％ had gram-negative bacilli, 40.14％ had gram-positive cocci, and 12.92％ had fungi. Unconditional logistic regression analysis suggests that multiple catheterization, femoral vein catheterization, the application of multicavity catheter, and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.