Objective To evaluate the timing,feasibility and necessity of early laparoscopic cholecystectomy (LC) in management of patients with mild to moderate acute pancreatitis with gallbladder stones.Methods The clinical data of 75 patients with mild to moderate acute pancreatitis and gallbladder stones treated from September 2010 to August 2014 in our hospital were analyzed retrospectively.32 patients underwent LC within 48 hours of the pancreatic attack.The results were compared with those from 43 patients with delayed LC.Results All the patients were operated by experienced surgeons.There were no significant differences between the two groups in operation time,postoperative complications,intraoperative blood loss,conversion rates,white blood cell count,percentage of neutrophils and blood amylase before and after the operation (P ＞0.05).Patients who received delayed LC had longer hospital stay [(10.6 ± 1.3) vs (17.1 ± 1.8),P ＜ 0.05].The readmission rate in patients with delayed LC was 30.2％ (13/43),and most admissions occurred within 2 ～4 weeks of hospital discharge.In patients with early LC,one patient developed necrotic pancreatitis and died of septic shock.All the remaining patients were cured.Conclusions It is safe,feasible and necessary to perform LC within 48 h in patients with mild to moderate acute pancreatitis and gallbladder stones.Such patients have a high readmission rate and the best timing of delayed LC is within 2 ～ 4 weeks after discharge from hospital.

Hepatocellular carcinoma (HCC) development is closely related to overexpression of tumor promoters or down-regulation of tumor suppressors.The mammalian sirtuin family was found to be a nicotinamide adenosine dinucleotide (NAD/NADH)-dependent histone deacetylase (HDAC),which implicated in the regulation of critical biological processes through deacetylation modifying on histone and nonhistone.SIRT1 can regulate metabolism,aging,inflammation and cancer progression.In particular,more and more evidence proves that SIRT1 can act as a tumor promot er in hepatocellular carcinoma through deacetylation on tumor suppressors.On the other hand,SIRT1 can strongly suppress metabolic syndrome-associated liver cancer in the mouse model.This review will discuss the expression of sirtuin family member in liver cancer and its clinical significance.

AIM:To study the main chemical components of traditional Tibetan medicine Pazhu Capsule(Calcitum,Fructus Chebulae,Semen Granati,Fructus Piperis,Fructus Piperis Longi,etc.) in the treatment of gastropathy. METHODS: The soluble components of Pazhu Capsule were extracted by supercritical-CO_2 fluid.The components were measured by GC-MS and the relative amount of them were determined by peak area normalization.(RESULTS:)22 components were identified.The main components were piperine(44.2%),9,12-Octadecadienoic acid(z,z)(21.1%),Azuleno[45-b] furan-2(3H)-one,3a,4,6a,7,8,9,9a,9b-octahydro-6-methyl-3,9-bis(methylene)-,[3as-(3a.alpha.,9a.alpha.,9b.beta.)](10.55%),n-Hexadecanoic acid(4.8%) and 2(3H)-Benzofuranone,6-ethenylhexahydro-6-methyl(33.5%).CONCLUSION: The main components of the Tibetan medicine Pazhu Capsule are piperine and 9,12-Ocatadecadienoic acid,both contents are up to 65.3% of the total extracts.

Objective To investigate the risk factors affecting early mortality in spontaneous rupture in patients with hepatocellular carcinoma (HCC)and explore the effective treatment.Methed A retrospective study of 34 consecutive patients with spontaneous rupture of HCC from January 1998 to January 2008 was conducted.Followup was conducted for more than 3 years.18 clinical ,biochemical and pathological factors influencing 30-day mortality were analyzed.Results 30-day mortality rate was 38% (n=13).Univariate analysis showed that presence of cirrhosis,Child's C status,shock on admission,higher blood transfusion requirement,raised α-fetoprotein (AFP),raised alkaline phosphatase(ALP)and raised aspartate transaminase(AST)were all associated with increased risk early death (P＜0.05).Multivariate analysis displayed that shock was an independent risk factor affecting early death.The median survival time was 14.4 months in 8 patiens receiving emergency curative rescection and 44.4 months in 5 cases underwent delayed curative resection,and the 1-and 3-year survival rate were 63% (5/8)and 13% (1/8)in the former group and 80% (4/5)and 60% (3/5)in the latter group.Conclusion Poor prognosis of spontaneous rupture of HCC is associated with poor liver reservation,advanced disease and large volume of haemorrhage.Shock and blood transfusion requirement are the independent factors affecting early mortality.Curative resection is a definite treatment and delayed curative resection following initial haemostasis has a safer and more effective result.

Objective To investigate the current human resources and continuing education of clinical laboratories in Ningxia's hospitals and identify problems to resolve.Methods A questionnaire survey was made to study the current human resources in clinical laboratories of hospitals in Ningxia,and the data obtained were analyzed.Results There were 676 laboratory staff employed in 75 clinical 5.1.In terms of education,the ratio their titles ranging from postgraduate,graduate,college Differences in their continuing education are significant statistically.Conclusion Imbalance is found in the distribution of academic titles,education and age groups in such clinical laboratories,with a shortage of those of high academic title and education,and great gaps in continuing education.

92 specimens from patients with invasive ductal carcinoma were investigated. The expression of vascular endothelial growth factor (VEGF) was demonstrated by immunocytochemical staining with an antibody against VEGF and was quantitatively estimated by using computerized image analysis system. Vessels were immunohistochemically highlighted by using an antibody to CD34, and microvessel density (MVD) was quantified. The postoperative survey in univariate analysis showed that the relapse-free-survival (RFS) time of patients with more than 87 microvessels in single microscopic field was significantly worse compared to that of patients with less than 87 microvessels in node-negative patients (P<0.05). Multivariate analysis confirmed that MVD was an independent prognostic indicator for RFS in node-negative patients and all patients (P<0.05～0.01). In addition, there was a closely positive correlation between VEGF and MVD (P<0.01). The results suggested that VEGF plays crucial roles in the promotion of angiogenesis in primary breast carcinoma. VEGF and MVD are closely correlated with biological behavior of primary breast carcinomas. MVD can provide a useful message in predicting the recurrence or metastasis of tumors.

Objective To explore the effect of early tracheal intubation on hypoxemia and level of blood lactate, C-reactive protein(CRP) in patients with severe intracerebral hemorrhage .Methods Fifty-four patients with severe intracerebral hemorrhage were divided into routine tracheal intubation (routine intubation group,n=25) and early tracheal intubation group(early intubation group,n=29) radomly.In routine tracheal intubation group, tracheal intubation was performed only when respiratory failure occurred .In early intubation group , tracheal intubation was performed as long as hypoxemia which can not be fixed by inspiring oxygen , tongue retropulsion or vomit occurred . Levels of artery blood gas analysis , lactate and CRP were tested before and after 2 h ( lactate ) or 24 h ( CRP ) of tracheal intubation .Heart rate and respiratory frequency were also monitored .Results PaO2 , PaCO2 , SaO2 and heart rate were markedly improved after intubation in both groups , levels of lactate and CRP were evidently reduced after intubation in both groups(all P<0.05).After intubation, the PaO2 of early intubation group was significantly higner and the CRP of early intubation group was significantly lower than that of routine intubation group ( all P<0.05);Before intubation, the PaO2 and SaO2 of early intubation group were significantly higher and levels of lactate and CRP were significantly lower than those of routine intubation group ( P<0.05 ) .Conclusion Early tracheal intubation can improve hypoxemia and reduce the level of lactate and CRP in patients with severe intracerebral hemorrhage .

Ductular reaction (DR) is a phenomenon that refers to impaired hepatocellular proliferation and activated hepatic stem cells at times of demand such as hepatic regeneration.The components of ductular reactions are thought to be derived from activated hepatic progenitor cells,intermediate hepatobiliary cells,and reactive ductular cells.DRs are thought to play two roles in hepatocarcinogenesis:their hepatic progenitor cells may undergo malignant transformation and migration,and they may contribute to the development of the tumor's microenvironment.Exploring DR phenotype,cellular diversity,and relationship to hepatocarcinogenesis will further enhance our understanding of the pathogenesis of human hepatocellular carcinoma with an ultimate goal of developing new therapies.

Objective To investigate the clinical and pathological characteristics of urocpithelial sarcomatoid carcinoma of the urinary system,and improve the diagnosis and treatment of these tumors.Methods We reviewed the pathology comfirmed urinary system caicinoma at the General Hospital of PLA from January 1999 to December 2010 and analyzed the clinical and pathological data of cases with sarcomatoid carcinoma in them retrospectively according to the literatures. Results A total of 4386 urinary system carcinoma were comfirmed,among them 18 (0.41％) cases of sarcomatoid carcinoma were identified,including 13 from bladder,4 from ureter and 1 multiple neoplasm of pelvis and ureter.The patients,11 males and 7 female,had a median age of 63.3 years (41-84 yrs).Gross hematuria (18 cases) were the main presenting symptoms,3 with flank pain,4 with pollakisuria,urgency and dysuria (urinary irritation symptoms] and 5 with urinary obstruction.The patient with multiple neoplasm of pelvis and ureter received allograft renal transplantation 7 years ago and took anti-rejection drugs all the way after operation.17 patients underwent surgical resection,9 radical cystectomy,5 radical nephroureterectomy,3 partial cystectomy and the remain was biopsy.Tumor size ranged from 2.5 to 12 cm (median,5.6 cm).Microscopically,coexisting high grade urothelial carcinoma was present in all the 18 cases,12 with sarcomatoid differentiation,3 with sarcomatoid and squamous carcinoma differentiation and 3 with sarcomatoid and glandular differentiation.Sarcomatoid component occupied 10 -90 percent.Immunohistochemical testing showed the sarcomatoid cells were positive for cytokeratin (CK) and vimentin.12 patients died of disease 20 days to 42 months (median,5.3 months) postoperatively.3 patients have been surviving with tumor free for 3,3 and 17 months respectinely,and the other 3 was failure to be followed. Conclusions Sarcomatoid carcinoma of the urinary bladder is a highly malignant disease,and the prognosis is very poor.The diagnosis depends on histopathologic and immunohistochemical studies.Early diagnosis and cystectomy or nephroureterectomy together with chemotherapy/radiotherapy may improve the curative effect.