Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.

Objective To the value of ultrasonic imaging in diagnosis of appendiceal mucinous neoplasms in patients.Methods A retrospective review was performed for the 26 cases undergoing pre-operative ultrasonography and finally diagnosed as appendiceal mucinous neoplasms by pathology.The 26 patients were included in the study,11 elderly patients aged ≥60 years as group A,and 15 younger patients aged ＜ 60 years as group B.The characteristics of the ultrasonic imaging were analyzed.Results Features of ultrasound images leading to diagnosis were summarized as following.The lesion transverse diameter was over 2 cm,with anechoic or hypoechoic area of lesion or onion skin sign inside the lesions.There were distinct borderlines between lesions and surrounding tissues,with no or little blood in the color doppler flow imaging.Conclusions There are same u1trasonography characteristics of appendiceal mucinous neoplasms in two age groups.Improving the knowledge of this disease and grasping the clinical and sonography characteristics are stringent to enhance the accuracy rate of diagnosis.

Objective To investigate the protective effect of the combined application of carlbachol and compound dietary fiber on the intestinal barrier function in burn rats.Methods The 30％ total body surface area (TBSA) Ⅲ scald Wistar rats were randomly divided into four groups.Rats in group A were fed with physiological saline,in group B were fed with compound dietary fiber,in group C were fed with carlbachol and in group D were fed with carlbachol and compound dietary fiber.The rats were sacrificed at 6,12 and 24 hours after treatment,and selected normal rats for control group.Blood samples were taken for detecting plasma endotoxin,D-lactic acid,D-lactic acid content.Tissue samples were harvested from the small intestine for pathological study under light microscopy.Results (1) The damage of the structure of small intestine mucosa was different among 4 groups,and the most obvious was at 24 h after treatment.(2)The level plasma of endotoxin in Group D was (0.517±0.034) EU/L,significant lower than that in group A ((0.659±0.074) EU/L),Group B ((0.589 ±0.027) EU/L) and Group C((0.587±0.026) EU/L),and the difference was significant(P＜0.05).(3) Dlactic acid level in Group D was (102.996±10.102) μg/L,significant lower than that in group A((133.538 ±8.621) μg/L),Group B ((121.223± 10.519) μg/L) and Group C ((122.700± 11.146) μg/L),and the difference was significant(P＜0.05).Conclusion In early stage of burn shock,the therapy of combined with carlbachol and compound dietary fiber has obvious protective effect on rat intestinal barrier.Meanwhile,it is better than the treatment effect of single carlbachol or compound dietary fiber to some extent.

Objective To evaluate the therapeutic effect of combination of sandostatin and growth hormone (GH) in the treatment of severe acute pancreatitis (SAP ). Methods Sixty patients with SAP were divided randomly into 3 groups:(1)Sandostatin treatment(ST) group (n=15);(2)combination of sandostatin with GH treatment(CT) group (n=30) ;(3)control group (n=15). The changes in serum IL-1, IL-6,TNF-? and albumin levels after treatment, and the incidence of complications, the duration of hospital stay and cost were compared among the 3 groups. Results The complications, mortality, duration of hospital stay in the CT group were significantly shorter than those in ST group and control group (all P

ObjectiveTo investigate the features of normal and psoriasis skin on ultrasound biomicroscopy (UBM) and explore the method of thickness measurement.MethodsUsing 50 MHz ultrasound probe of biological microscope, ultrasonographic observation and ultrasonic thickness measurement were conducted in 90 normal adults and 40 psoriasis patients. Innormal patients, ultrasound evaluations were performed at 10 different parts of the body skin.ResultsOn sonogram, the normal skin showed a “sandwich” structure with two parallel hyperechoic bands and the middle isoechoic dots and short liens. The sonograms of the psoriasis skin showed obviously thickened epidermis and dermis, disordered internal structure and clear boundary from adjacent normal skin. The range of the epidermis’ thickness measurement was between the medial forearm (0.12±0.03) mm and the palm (0.29±0.15) mm. The range of dermal thickness measurement was between the back hand (1.18±0.32) mm and parasternal (1.55±0.21) mm. Psoriasis skin was thicker than the uninvolved skin (P<0.001). And the dermis’ thickness of uninvolved skin in psoriasis patients was thicker than that of the normal adults (P<0.001).ConclusionNormal adult’s epidermis, dermis and skin appendages can be shown clearly using 50 MHz ultrasound biomicroscopy. And ultrasound biomicroscopy canaccurately measure the thickness of dermis and epidermis, which provides the basis for the diagnosis and treatment of psoriasis.

Objective To investigate the risk factors leading to complications in patients undergoing laparoscopic cholecystectomy (LC). Methods Clinical data of 11?974 patients undergoing LC from Mar. 1991 to June 2003 were collected and analyzed retrospectively. Fifteen clinical factors were recruited for the study in relation to surgical complications. Data were analyzed by ?2 test and Logistic regression. Results The overall operative complication rate was 1.896%. The procedure was shifted to open surgery in 2.389% of all cases, Logistic regression analysis revealed that Calot triangle adhesion, stage, expertise of the team, gallbladder wall thickness, gallbladder and vicinity adhesion were important risk factors for complications. Conclusion LC complications can be prevented by good training, strictly following protocol, and timely shifting to open surgery.

Background and purpose: The incidence of breast cancer increases as patients age, elderly patients account for a large proportion. Due to the insufifcient systemic therapy, more complications and poorly physical condition, the prognosis of elderly patients is often worse than the younger. The aim of this study was to investigate the safety and tolerance with non-anthracyclin regimen as adjuvant chemotherapy in elderly breast cancer patients. Methods:From Nov. 2008 to Jan. 2012, 56 patients (≥65 years) after surgical excision were enrolled into this study. The patients were divided into two groups:TC and PC groups. Each patient received 4 or 6 cycles of chemotherapy of PC (175 and 600 mg/m2, respectively;n=21) or TC (75 and 600 mg/m2, respectively;n=35), administered intravenously every 3 weeks, as adjuvant chemotherapy. Radiation therapy (as indicated) and endocrine therapy, for patients with hormone receptor-positive disease, were administered after completion of chemotherapy. Results: In this study, 50 patients completed chemotherapy as plan, the proportion of two groups were above 90%. After a median follow-up of 33 months, the median disease-free survival(DFS) and overall survival(OS) were not reached. The relapse-free rate and survival rate were 89.5%and 100%in the PC regime group, which were 90.3%and 96.8%in the TC regime group. Major toxicities included:neutropenia, leucopenia, alopecia, nausea, vomiting and various degree of peripheral neuropathy. The incidence of gradeⅢ-Ⅳneutropenia was 76.2%in PC group vs 48.6%in TC group (P=0.044). The most common cause for withdrawing from treatment was to be unable to tolerate the adverse effects. Conclusion:Adjuvant chemotherapy with paclitaxel and cyclophosphamide is safe, tolerable and promising for elderly breast cancer patients.

Ranpirnase (onconase, ONC) is a new drug, with weak RNase activity and strong cytotoxicity to various tumor cells in vitro and in vivo. This study is to obtain recombination onconase (rONC) with high bioactivity. Based on the codon preference of Pichia pastoris, we designed and synthesized the gene according to cDNA sequences of ONC and the α mating factor's prepeptide. We screened positive clones after transforming the recombination plasmids into P. pastoris X-33, GSS115 and SMD1168. We screened the best combination of seven different vectors and host strains. Moreover, we optimized culture condition in shake flasks and 10 L bioreactor, and purified rONC from the supernatant after inducing it with 0.25% methanol by aqueous two-phase extraction coupling G50 molecular exclusion method. The highest rONC production was 13 mg/L in pPICZα-A/X-33/ONC combination under the condition of pH 5.5 and 23 degrees C in shake flasks for 7 d; and that the highest rONC production was 180 mg/L when the induction is performed in the lower basic salt medium with pH 5.5 in the 10 L bioreactor for 7 d. The yield of rONC is more than 90% at a purity of above 95%. rONC can kill various tumor cells in vitro. The expression and purification of rONC would be useful for further investigation of this new drug.
Antineoplastic Agents ; metabolism ; Bioreactors ; Cell Line, Tumor ; Codon ; DNA, Complementary ; Genetic Vectors ; Humans ; Pichia ; metabolism ; Recombinant Proteins ; biosynthesis ; Ribonucleases ; biosynthesis

Objective To evaluate the clinical efficacy of limited open reduction combined with percutaneous medial locking plate in treatment of Rüedi-Allg(o)wer type Ⅱ and Ⅲ closed tibial pilon fractures.Methods A retrospective case-control analysis was made on 45 cases of closed tibial pilon fractures treated surgically between June 2008 and December 2015.There were 33 males and 12 females,aged from 26-66 years (mean,44.6 years).All cases were unilateral tibial pilon fractures,among which 18 were on the left while 27 were on the right.Thirty-four cases were combined with fibular fractures.There were 14 cases of type Ⅱ fractures and 31 type Ⅲ fractures according to the Rüedi-Allg(o)wer classification.Using the Tscheme-Gotzen system to evaluate soft tissue injury,two patients were in grade 1,29 patients in grade 2,and five patients in grade 3.On the basis of surgical methods,the cases were divided into Group A,limited open reduction with percutaneous medial locking plate and Group B,conventional open reduction.The operation time,reduction quality,fracture healing time,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale at final follow-up visit and complications were recorded and compared between the two groups.Results The operation time of Group A was shorter than that of Group B (P ＜ 0.05).All patients had been followed up for 12-24 months,among which Group A was 22.5 months and Group B was 20.0 months (P ＞ 0.05).Compared with Group B,Group A was superior in fracture healing time (P ＜ 0.05) and AOFAS ankle-hindfoot scale(P ＜0.05),but was inferior in reduction quality (P ＜ 0.05).Poor wound healing was observed in two cases in each group,yet there was no nonunion in all cases.Conclusion Compared with conventional open reduction,the limited open reduction combined with percutaneous medial locking plate has more advantages in operation time and fracture healing,which can achieve better ankle functions for closed tibial pilon fractures.

Objective To compare the difference between color Doppler flow imaging (CDFI) and superb microvascular imaging (SMI) in the evaluation of vascular grading and the display rate of vascular in papillary thyroid carcinoma (PTC).Methods Between June 2015 and December 2015 in Beijing Chaoyang Hosptial,50 patients with 61 thyroid nodules were detected by ultrasonography,and pathologic types were confirmed as PTC.CDFI and SMI were used to evaluation the same nodule respectively according to Adler's grading criteria.The different flow characteristics were analyzed by the x2 test.Results In CDFI,the vascular grading of 33 patients were 0 ～ Ⅰ and these of 28 patients were Ⅱ ～Ⅲ by CDFI.In SMI,the vascular grading of 6 patients were 0 ～ Ⅰ and these of 55 patients were Ⅱ ～Ⅲ by SMI.There was a significant difference between CDFI and SMI for vascular grading (x2=27.475,P ＜ 0.01).In CDFI,50 patients with PTC showed punctiform and rod-like flow signals,and 5 patients showed more detail internal small branches by CDFI.In SMI,42 patients with PTC showed punctiform and rod-like flow signals,and 17 patients showed more detail internal small branches.There was a significant difference between CDFI and SMI about the display rate of vascular (x2=7.011,P ＜ 0.01).Conclusions Compared with CDFI,SMI is highly improved blood flow sensitivity.It can provide more detail internal small branches in PTC.The characteristics of vascular distribution are similar to strengthening mode of contrast-enhanced ultrasound in PTC,therefore,SMI is worth to further research.