Objective To evaluate the efficacy of laparoscopic and open operation combined with endoscopic nasobiliary drainage(ENBD) in the management of choledocholith. Methods 44 cases treated by laparoscopic common bile duct exploration (LCBDE) and 34 ones by open common bile duct exploration(OCBDE) combined with ENBD and primary suture of common bile duct were retrospectively analyzed from January 1997 to July 2001. Results All cases were operated on successfully. The clearance rate of stones was 100%(78/78). No postoperative complications such as bile leakage, hemobilia, cholangitis, etc occurred. Postoperative hospital stay was (6 2?1 3)days in group LCBDE and (7 4?2 1)days in group OCBDE. 57 cases had been followed up for (1～4 5)years with an average of 2 6 years, and ultrasoundgraphy showed no bile duct stricture and recurrent stones. Conclusions LCBDE or OCBDE combined with ENBD and primary suture of common bile duct is safe and reliable.

Objective To study on the method of applying laparoseopy for the treatment of choledo cholithiasis after biliary tract operation, and to evaluate its therapeutic efficacy. Methods Thirty-seven cases of common bile duct stones after operation from October 1999 to December 2003, received laparoscopic common bile duct exploration (LCBDE) were retrospectively analyzed. Results Satisfactory results were accepted in 35 cases and the rest two cases converted to laparotomy. Thirty cases had got primary healing by the help of employing endoscopic nasobiliary drainage (ENBD) , 7 cases received T-tube drainage. There was neither residual stones left nor serious after-effect including biliary fistula and hemobilia happened. Mean operative time was ( 168 ?30. 2) min. Mean postoperative stay in hospital was (11.5?1.3) d. Recurrences of calculi and bile duct stricture never happened within 6-48 m follow-up study. Conclusion The laparoscopic procedure is technically feasible and safe alternative, however, the technique in lyses of adhesions, dissection and suture of choledochus are quite difficult, therefore it is recommended to be performed in experienced hands expected to minimize the occurrence of complications, and firmly mastered the indications of conversion to laparotomy as far as possible.

Objective To investigate the clinical value of serum soluble intercellular adhesion molecule-1 (sICAM-1 )in patients with primary biliary cirrhosis (PBC)and autoimmune hepatitis (AIH).Methods Sixty-one PBC patients and 59 AIH patients,who were hos-pitalized or visited the outpatient department from June 2012 to September 2013,as well as 50 healthy controls,were included in the study. The PBC patients included 29 incipient cases,21 cases in remission,and 11 recurrent cases;the AIH patients included 26 incipient cases, 20 cases in remission,and 13 recurrent cases.Serum sICAM-1 level was measured by double-antibody sandwich enzyme-linked immu-nosorbent assay,and serum levels of alanine aminotransferase (ALT)and total bilirubin (TBil)were determined by biochemical enzyme as-say.Comparison between groups was made by analysis of variance;Pearson correlation analysis was performed.Results Among PBC pa-tients,the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.484);the remission group had a significantly higher serum sICAM-1 level than the control group (P=0.000).Among AIH patients, the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.802);no significant difference in serum sICAM-1 level was seen between the remission group and control group (P=0.281).For patients with PBC and AIH,serum sICAM-1 level was positively correlated with serum levels of ALT (r=0.664,P=0.000;r=0.784,P=0.000) and TBil (r=0.715,P=0.000;r=0.580,P=0.000).Conclusion Serum sICAM-1 may be involved in the immunologic injury in PBC and AIH.In patients with PBC and AIH,the elevation of serum sICAM-1 level is closely correlated with the severity of liver damage. Clinical monitoring of serum sICAM-1 level may play an important role in severity assessment,prognostic evaluation,and therapy guidance among patients with autoimmune liver diseases.

Objective To propose new policies and strategies that will optimize the transformation of medical research achievements at hospital level.Methods In this paper,we systematically analyzed the characteristics and influencing factors of the transformation of medical research achievements based on the status quo in our hospital.Results In our hospital as an example,major problems in the transformation of medical research achievements identified as low investment,low conversion rate,complex procedures,multi-links existed and more multi disciplinary cooperation needed.Conclusions The hospital can take some measurements to optimize the transformation of medical research achievements,such as more stream lined management of scientific research project,establishing and improve the platform for scientific research transfer,increasing the funding,strengthening cooperation among different disciplinaries,building a professional team to promote the transfer and so on.

Objective To study on the effectiveness and reliability of endoscopic varicose vein ligation (EVL) combined with hand-assisted laparoscopic splenectomy (HLS) in portal hypertensive patients. Methods Retrospectively 15 cases of EVL combined with HLS were reviewed from June 2001 to October 2004. These patients with severe esophageal varicose and hypersplenism were adapted to perform endoscopic varicose vein ligation, then 1 -2 weeks after the varicose became milder or disappeared, hand-assisted laparoscopic splenectomy was conducted. Results The number of preoperative ligation was 2. 2 times in average. Esophageal varicose was completely disappeared in 11 and mild in 4. There were no postoperative complications, conversion and death in Hand-assisted laparoscopic splenectomy. The average postoperative count of platelets were (38-67) ? 106/L preoperatively raised to (89-310) ? 106/L postoperatively. In the follow up period (average 17. 6 months) , no varicose vein bleeding happened. Conclusions EVL combined with HLS is not only minimal invasive, but also a secure and effective measure for portal hypertension.

The abdominal visceral fat content in obese SD rats induced by high fat diet for 10 weeks was significantly higher than that in control group [(26±6 vs 13±3)g,P<0.01] ,along with increased CRP mRNA expression in abdominal visceral fat (0.901±0.085 vs O. 402±0.036, P<0.01). As compared with normal control group, in the high fat group the concentrations of CRP in portal vein [(743.8±95.8 vs 558.3 ±118.3) mg/L, P<0.01] and peripheral vein[(596.3±38.9 vs 485.8±30.2) mg/L,P<0. 05] were higher. The concentration of CRP in portal vein was significantly higher than that in peripheral vein in high fat diet group(P<0.01) ,but this was not evident in control group. These results suggest that the increased CRP expression in visceral adipose tissue may partially account for the elevation of serum CRP in obesity.

Objective To investigate the white matter microstructural changes of cingulation and congni-tive function impairment in patient with major depression. Methods 25 middle-aged first episode patients and 24 nondepressed comparison participants were enrolled,and all the subjects scanned by diffusion tensor imaging and tested by Wisconsin Card Sorting Test. Correlation analysis was done respectively for both two groups with FA and WCST items. Results Male patients with depression decreased FA in the middle frontal lobe ( - 29 24 32,16 voxels),the left superior temporal lobe (-36 -34 16,11 voxels),the sub-gyral of temporal lobe ( -45 1 - 15/ - 47 - 6 - 9; 16/10 voxels) and the right lobe of cingulate (18 - 2 29,22 voxels). And the female patients with depression shows reduced FA in the inferior frontal lobe ( -42 23 4/45 24 6; 15/21 voxels) ,the left precentral gy-rus (39 -44 -15,17 voxels) ,the right medial frontal gyrus (6 16 -18; 10 voxels) ,the left superior temporal lobe ( -55 -31 15; 89 voxels) ,the sub-gyral of temporal lobe ( -38 - 12 - 19;12 voxels) and the right anterior cingulate gyrus (71 26 -9; 15 voxels) (P<0.001 ,cluster > 10 voxels). The Regions of interests analyze with cingulate only found reduced FA in the right lobe of female group(0.26 ±0.05,0.33 ±0.08; P=0.03). Correlation were found between the right anterior cingulate and Rpe (r= -0.49, P = 0. 03) ,the right middle cingulate and Rpe (r= -0.56, P = 0. 01) in depressed patients. No significant association were found in healthy control group(P> 0.05). Conclusion Cingulate white matter fiber is abnormal in first episode depression and these abnormalities may be one of the pathophysiology of major depression.

OBJECTIVETo investigate clinical outcomes of Kirschner wire as blocking screws combined with interlocking intramedullary nail internal fixation in treating tibial metaphyseal fractures (AO 43A).

METHODSFrom March 2011 to June 2012, 9 patients with tibial metaphyseal fractures were treated with blocking screws Kirschner wire combined with interlocking intramedullary nail, including 7 males and 2 females aged from 23 to 54 years old with an average of 37.4. Postoperative complications, X-ray were observed, AOFAS scoring were used to evaluate function after operation at 12 weeks.

RESULTSAll patients were followed up from 6 to 40 weeks (mean 20.1), and healed at stage I. No serious swelling, infection and skin necrosis occurred. No fracture instability and displacement appeaered at 4 and 8 week after operation. AOFAS score was (95.2±4.6) at 12 weeks after operation and 7 patients gained excellent result and 2 patients good.

CONCLUSIONKirschner wire as blocking screws with interlocking intramedullary nail for treatment of tibial metaphyseal fractures can fix well and perform simply.

Adult ; Bone Screws ; Bone Wires ; Female ; Fracture Fixation, Intramedullary ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

Objective To investigate the effects of reactive oxygen species (ROS) inhibition on the down-regulation of adiponectin (ADPN) in mouse 3T3-L1 adipocytes by advanced glycation end-products (AGEs).Methods AGEs were prepared for incubating with cell.3T3-L1 preadipocytes were cultured in vitro and differentiated into mature adipocytes.Cell differentiation and lipid accumulation were determined by oil red O staining.After being intervened with AGEs,2',7'-dichlorofluorescein diacetate (DCFH-DA) was used as a reactive oxygen species (ROS) capture agent and the fluorescent intensity of 2',7 '-dichlorofluorescein (DCF) was detected by flow cytometry.Adiponectin expression under AGEs in 3T3-L1 adipocytes pretreated with N-acetyl-L-cysteine(NAC) or not was detected by real-time fluorescent PCR and ELISA.Results The level of ROS in 3T3-L1 adipocytes treated with AGEs was increased.mRNA and protein of ADPN were down-regulated.After inhibition with ROS,mRNA and protein expressions of ADPN injured by AGEs were ameliorated.Conclusion Exposure of 3T3-L1 adipocytes to AGEs induces oxidative stress in vitro,which decreases the expression of ADPN,and causes functional impairment of adipose cells and insulin resistance.

BACKGROUND:Studies have found abnormalities in the biological activity and cytokine levels of bone marrow mesenchymal stem cels from psoriasis patients, while the biological activity of skin-derived mesenchymal stem cels from psoriasis lesions is rarely reported.
OBJECTIVE:To explore the influences of skin-derived mesenchymal stem cels from psoriasis lesions on T cel proliferation
METHODS:After isolation and culture, skin-derived mesenchymal stem cels from psoriasis lesions and normal controls were separately co-cultured with peripheral blood T cels. T cel proliferation was detected using MTT assay,andlevels of epidermal growth factor and transforming growth factor β1 in cel supernatant determined using ELISA method.
RESULTS AND CONCLUSION:Skin-derived mesenchymal stem cels frombothpsoriasis lesions and normal controls significantly inhibited T cel proliferation (P< 0.05). Furthermore, skin-derived mesenchymal stem cels from psoriasis lesions exhibited a weaker inhibitory effect on T cel proliferation than normal skin-derived mesenchymal stem cels (P< 0.05). Skin-derived mesenchymal stem cels from psoriasis lesions significantly increased epidermal growth factor but reduced transforming growth factor β1 compared with the normal skin-derived mesenchymal stem cels (P< 0.05). In conclusion, maybe the imbalances of growth factor levels due to skin injury elicit a decrease in the inhibitory effect of skin-derived mesenchymal stem cels from psoriasis lesions on T lymphocytes.