Objective To investigate the effects of preoperative biliary drainage ( PBD ) on the morbidity and mortality of pancreaticoduodenectomy in patients with malignant obstructive jaundice in the lower bile duct. Methods Clinical data of 74 cases undergoing pancreaticoduodenectomy from Jan. 2000 to Dec. 2005 with preoperative total bilirubin level over 85 μmol/L were collected and retrospectively analyzed. Comparison was performed between patients receiving PBD and those not. Before surgery. The parameters sincluding perioperative situation, in-hospital death rate, post-operative complications and were calculated to evaluate the influence of pre-operative biliary drainage on the outcomes. Univariate analysis and Logistic analysis were used to identify the risk factors for post-operative complications. Results Forty (40/74) cases received PTCD procedure. The total bilirubin was significantly reduced from (338. 10±88. 38 )μwnol/L to ( 228. 50±82.24) μ,mol/L in PTCD population and was significantly lower than ( 328. 60±93. 02) μmol/L of the non-PTCD group. There was no significance between the two groups in terms of total complications and individual complication Logistic regression analysis showed that preoperative TB over 340 μmol/L and blood loss over 600 ml were important risk factors for post-operative complications. Conclusion High pre-operative total bilirubin over 340 μmol/L increases the risk of post-operative complications in the patients with malignant jaundice. Preoperative biliary drainage is useful to reduce the total bilirubin and improve the hepatic function of the patients. Prolonged pre-operative biliary drainage could be considered in the patients with high preoperative bilirubin,poor nutritional condition and impaired coagulation to enhance the tolerance of surgery.

Ezrin protein function as molecular linker between the actin-cytoskeleton and the plasma membrane,which involves in the formation of microvilli and the maintenance of cello-morphology, movement, adhereance as well as survival, intimate studies of its structure and function have been done. At present many studies indicate that Ezrin involves in the tumor development and tumor metastasis,relate to prognosis. To study Ezrin protein in tumor will provide us other way and standard for diagnose and treatment of tumor and prognostic evaluation.

Objective To discuss the effect of blood glucose monitoring during pregnancy and pregnancy outcome in patients with gestational diabetes mellitus (GDM). Methods One hundred and fifty-three GDM patients from July 2007 to July 2008 were analysed.The cases were divided into satisfactory group (74 cases)and unsatisfactory group (79 cases) based on the level of bleod glucose and compared the pregnancy outcome between the two groups. Results The incidences of pre-eclampsia, polyhydramnios, macrosomia, neonatal hypoglycemia, hyperbilirubinemia of satisfactory group were lower than those of unsatisfactory group(5.41% vs 17.72%,4.05% vs 20.25%, 12.16% vs 31.65% , 5.41% vs 20.25%,8.11% vs 30.38%). The difference is statistically significant (P <0.05). The incidence of premature rupture of membranes, premature birth, postpartum hemorrhage, fetal distress of satisfactory group were lower than those of unsatisfactory group, but there was no significant difference between the two groups. Conclusion GDM can cause great harm to maternal and child health, and satisfactory blood glucose control during pregnancy may reduce maternal and child complications.

The expression mode in presentations may affect the efficiency during the teaching. In this study, we used a random-controlled trial to compare the educational efficiency in three different expression modes: script, pictures, animation. Test scores and questionnaire survey were statistically analyzed. It showed that the presentations with animation led to the highest average test score of the students. Visual objects could attract students' interest, enhance memory, and academic achievement. A proper insert of visual objects in teaching presentation is encouraged in the education of medical neurobiology for those medical students.

Objective To investigate the effects of lappaconitine on the perioperative immune function.Methods Twenty-four ASA I or II patients aged 23-64 yr undergoing elective radical mastectomy (8 patients),iaminectomy and vertebral canal decompression (8 patients) or femoral head replacement (8 patients ) were randomly divided into 2 groups (n=12 each): control group (C) and lappaconitine group (L).In group L ondansetron 4 mg was given IV and lappaconitine 8 mg was infused IV over 30 rain before induction of anesthesia.In group C equal volume of normal saline was infused instead of lappaconitine.Anesthesia was induced and maintained with propofol,remifentanil and rocuronium.Lappaconitine 0.28 mg/ml was continuously infused at 2 ml/h after induction of anesthesia in group L.When the patients recovered from anesthesia after operation,PCA with 0.28 mg/ml lappaconitine was started (background infusion 2 ml/h,bolus dose 0.5 ml and lockout interval 15 min).In group C pethidine 50 mg and droperidol 2.5 mg were given IM on demand.Venous blood samples were taken at 30 rain before induction of anesthesia(T1,baseline),immediately (T2) and at 24 h(T3) and 48 h (T4)after operation for determination of TNF-α,IL-2,IFN-γ and sIL-6R concentration by ELISA.CD3,CD4,CD8 and NK cell expression was determined using flow cytometry and the ratio of CD4/CD8 was calculated.The concentrations of IgA,IgM,IgG,CD3 and CD4 were determined by radioimmunoassay.Results Plasma SIL-6R and TNF-α concentrations were significantly lower while IL-2,IgA,IgG,IgM concentrations and CD4/CD8 ratio were significantly higher after operation in group L than in group C.Conclusion Lappaconitine can improve perioperafive humoral immune function thus contributing to its analgesic and anfi-inflammatory effects.

Acute Disease ; Aneurysm, Dissecting ; complications ; Aortic Aneurysm, Thoracic ; complications ; Female ; Humans ; Myocardial Infarction ; etiology

Angioplasty, Balloon, Coronary ; adverse effects ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; therapeutic use ; Postoperative Hemorrhage ; drug therapy

Objective · To evaluate the clinical characteristics of endometrial pathology in postmenopausal women with asymptomatic thickened endometrium. Methods · A retrospective review was conducted of the patients between October 2013 and October 2015 in the International Peace Maternity & Child Health Hospital. The postmenopausal women with asymptomatic thickened endometrium of 5 mm or more found by transvaginal ultrasonography were recruited. They underwent hysteroscopy and endometrial sampling to analyze the relationship between endometrial pathology and endometrial thickness. Results · A total of 257 patients were recruited. The average age was 61.3 years old, the average menopause period was 122 months, and the average endometrium thickness was 8.6 mm. The endometrial pathology included normal atrophic endometrium, endometrial polyp, submucous myoma, intrauterine adhesion, uterine septum, endometrial hyperplasia and endometrial cancer. The most common pathological type was endometrial polyp, accounting for 66.9% of the all patients and 83.9% (172/205) of all pathological types. Three cases of adenocarcinoma (1.2%) were diagnosed. There was significant difference in endometrial thickness among normal endometrium, endometrial polyp and endometrial cancer (P<0.05). The endometrium in endometrial cancer was the thickest, which was (13.20±5.38) mm averagely. There was significant difference in ages among the pathological types (P=0.004). Conclusion · There are few patients of malignancy among asymptomatic postmenopausal women with thickened endometrium. Follow-up visits were recommended to these women.

Objective To study proliferation,secreted cytokines,immune phenotypes and cytotoxicity on Raji cells by cytokine induced killer (CIK) cells co-cultured with dendritic cells (DC).Methods The mononuclear cells from peripheral blood of healthy individuals were extracted,then cultured the cells under 5 ％ CO2 at 37 ℃ for 2 hours.DC were induced from suspended cells,and CIK cells were from adherent cells.After 9 days of nurturing,two types of cells were mixed.CIK cells were cultured alone as the control.The cytotoxic activity of CIK and DC-CIK cells were detected by MTT assay.The morphologies,proliferation,secreted cytokines,and immune phenotypes of the two cells in day 0,3,6,9,12,15 in culture were monitored.Results In day 12 in culture,comparing with CIK cells,DC-CIK cells significantly enhanced the proliferation rate [(42.44±2.68) fold vs (30.01±2.05) fold] (t =11.64,P ＜ 0.05) and had increased IL-2,IFN-γ,IL-12 and TNF-α secretion [(124.34±12.57) ng/L vs (56.32±6.58) ng/L,(496.60±95.32) ng/L vs (247.80± 69.45) ng/L,(84.92±6.07) ng/L vs (24.18±3.31) ng/L,(380.6±45.95) ng/L vs (196.61±24.19) ng/L] (t =15.16,P ＜ 0.05; t =6.67,P ＜ 0.05; t =27.78,P ＜ 0.05; t =11.20,P ＜ 0.05),and there were more CD3+ CD8+ cells and CD3+ CD56+ cells in the co-culture [(71.79±1.73) ％ vs (60.37±3.24) ％,(48.54±3.30) ％ vs (33.07±2.22) ％](t =9.83,P ＜ 0.05; t =12.30,P ＜ 0.05),and DC-CIK cells had a significandy increased cytotoxicity on Raji cells in vitro at the same ratio of effector cells to target cells.Conclusion CIK cells have higher proliferation rate and cytotoxicity against Raji cells when co-cultured with DC.

Objective To study the changes and its clinical prognostic value of plasma endothelin 1 (ET-1) and P-selectin on early in-stent restenosis after percutanous intervention (PCI) in patients with acute coronary syndrome (ACS). Methods Venous blood samples were drawn from a total of 108 patients who underwent PCI before and right after the operation, as well as at 1 week, 2 weeks, 1 month, 3 months and 6 months post-procedure. Plasma was separated immediately by centrifugation at 4℃ and stored at -70℃ until detection. All patients received coronary angiography after six months and were catagorized into the restenosis and non-restenosis group according to the result. Plasma levels of ET-1 and P-selectin of the two groups were analyzed. Results Four cases received acute PCI died and another 4 cases lost follow-up. The remaining cases were divided into the restenosis (n=16) and non-restenosis (n=84) group according to their coronary angiography result. Plasma levels of ET-1 and P-selectin reached the peak concentration in the two groups right after PCI. In the non-restenosis group, plasma levels of ET-1 and P-selectin resumed to pre-opeation level at 24 hours and resumed to normal level at 2 weeks. In the restenosis group, plasma levels of ET-1 and P-selectin did not resume to normal level at 2 weeks but increased persistently, and showed their second peak value at 3-6 months after PCI. Conclusion The risk of restenosis increased accompanied by the persistent increase of plasma levels of ET-1 and P-selectin in early stages (1-2 weeks) after PCI in ACS patients. ET-1 and P-selectin may be regarded as makers for early recognition of restenosis.