Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and individualized surgical plans for patients.

Objective To explore the effects of different concentrations of propofol postconditioning against glutamate neurotoxicity to brain slices of neonatal rats.Methods The brain slices of neonatal rats were prepared and cultured in complete medium.They were randomly divided into five groups:the normal control group,glutamate injury group(RI group),1 mg/L propofol postconditioning group(PL1+RI group),3 mg/L propofol postconditioning group(PL3+RI group),5 mg/L propofol postconditioning group(PL5+RI group),12 cases in each group.The RI,PL1+RI,PL3+RI,PL5+RI groups were cultured for 6 days,then the brain slices were moved into the culture medium containing glutamate(1 mmol/L) and incubated for 30 minutes.And then,respectively,the brain slices of RI group were put into another complete culture medium,the PL1+RI group,PL3+RI group and PL5+RI group were put into the medium containing corresponding concentrations of propofol medium and long chain fat emulsion injection.All of the above were cultured for 24 hours in order to establish the injury model.The numbers of the Nissl body,the LDH release rates and the brain tissue damage rates of each brain slice were detected to evaluate the effects of propofol postconditioning on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.Results Compared with the RI group,the numbers of the Nissl body of the PL1+RI group,PL3+RI group and PL5+RI were higher,the LDH release rates and the brain tissue damage rates of the PL1+RI group,PL3+RI group and PL5+RI were lower,the diferences were significant(P<0.05).Among the three PL+RI groups,the LDH release rates and the brain tissue damage rates of the PL3+RI group were lower than those of the other two groups,the diferences were significant(P<0.05),at the same time,the numbers of Nissl body were more than the other two groups,the diferences were significant(P<0.05).Conclusion Propofol postconditioning has protective effects on the reperfusion injury in the glutamate-damaged brain slices of neonatal rats.However,the protective effects are not dose-dependent,and 3 μg/mL is the best dose of propofol to keep the glutamate-damaged brain slices from reperfusion injury in this research.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Chronic Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Pterygopalatine Fossa ; innervation ; Rhinitis ; physiopathology ; therapy ; Smell ; Treatment Outcome ; Young Adult

Persistent infection of hepatitis C virus (HCV) remains as a worldwide threat to public health,which involves a complex interaction between virus- and host related factors.HCV is classified as six genotypes and many subtypes according to the sequence heterogenecity.HCV genotype should be determined prior to treatment initiation since it plays a key role in selection of therapeutic regimen for chronic hepatitis C.Development of the antiviral treatment with protease inhibitor in combination with pegylated IFN-α and ribavirin requires the accurate determination of subtypes,e.g. 1a and 1b,as well.Genotyping methods based onsequenceanalysis, reversehybridizationorreal-timePCRhavebeendevelopedand evaluated.Some issues,however,should be settled to standardize the utility and result interpretation of these methods.More recently,host genotypes of IL28B have been found to be closely associated with HCV spontaneous clearance and the response to antiviral therapy.Moreover,polymorphisms in inosine triphosphate pyrophosphatase gene affect ribavirin-induced anemia.Therefore, host genotyping will be beneficial in predicting the outcome of chronic hepatitis C and monitoring the drug-induced adverse events.

Synovial sarcoma is a high grade malignant soft tissue tumor. Its diagnosis and differential diagnosis are difficult. In most cases the reciprocal chromosomal translocation between chromosome X and chromosome 18 could be found and characterized synovial sarcoma. This article reviewed the relationship between chromosomal translocation and the diagnosis, histological type and prognosis of synovial sarcoma.

Objective To compare the clinical features and treatment between elderly onset rheumatoid arthritis(EORA)and young onset rheumatoid arthritis(YORA).Methods The EORA patients (n=60)and the YORA patients (n =90)were compared regarding sex ratio,activity of pathogenetic condition,disease severity,extra-articular manifestations,complications,laboratory indexes,and therapeutic schedules.Results The female/male ratio was 36/24(1.50 ∶ 1.0)in group EORA,and 69/21(3.3 ∶ 1.0)in group YORA,with higher female/male ratio in in group YORA.The frequency of morning stiffness,proximal interphalangeal joint involvement and metacarpophalangeal joint involvement were lower in group EORA(53.3 ％,46.676％ and 61.67 ％) than in group YORA (72.2 ％,77.8 ％,81.11％) (x2 =5.521,15.385,6.960,P =0.018,0.000,0.008 respectively).Large joints involvement at onset of rheumatoid arthritis was higher in group EORA(38.33 ％)than in group YORA(18.89 ％)(x2=6.960,P=0.008).The joint swollen and tender counts were comparatively less (16.51 ± 7.34) and (15.92 ± 8.44) in group EORA than in group YORA(22.46 ± 7.58) and (23.8 ± 8.93) (t =5.080、5.740,all P =0.000) respectively.The accumulated disease activity score(DAS28)was higher in group EORA(5.86± 1.57)than in YORA(4.92± 1.64) (t=3.360,P =0.001).HAQ score was lower in group EORA(0.83 ± 0.85)than in group YORA (1.16±0.91) (t=2.43,P =0.02).Comorbid conditions such as osteoarthritis,osteoporosis,cardiovascular disease and chronic renal insufficiency were more frequent in group EORA (51.7 ％,31.7 ％,18.3 ％ and 15.00％)than in group YORA(27.8％,15.6％,5.6％ and 4.4％)(x2 =11.722,5.445,6.168,5.067,P=0.001,0.020,0.013,0.024).The positive rate of RF were more higher in YORA(70.00％)than in group EORA (48.33％)(x2 =7.126 P=0.008).The synthetic or biologic traditional DMARDs (disease modifying antirheumatic drugs)were widely used in group YORA(78.9％ and 31.1％)than in group EORA(40.0％ and 10.0％)(x2 =14.940,9.153,P =0.000,0.002).The more frequently used program with glucocorticoids hormonal therapy was received in group EORA(38.3 ％)than in group YORA(20.00 ％)(x2 =6.092 P=0.014) Conclusions EORA patients differs from YORA patients in many of ways,including a more balanced gender distribution,atypical presentation at onset of disease,more frequent involvement of large joints,seronegativity in a higher percentage,and less frequent positivity of anti CCP-antibody,which makes diagnosis more difficult in the earlier period.Therapy of EORA with DMARDs should be instituted based on disease activity,if there is no contraindication.

Objective To research the clinical efficacy of Sini decoction adjustment combined rabeprazole enteric capsules in treatment of gastroesophageal reflux cough and its effect on interleukin 8 (IL-8) and substance P (SP), the mast cell tryptase (MCT) levels.Methods 92 cases of gastroesophageal reflux cough were divided into control group and experimental group by drawing method , each had 46 cases.Control group were treated by rabeprazole enteric capsules, experimental group were treated with rabeprazole enteric capsules based on the control group.The curative effect, cough symptoms integral, IL-8, SP, MCT, gastric dynamic element (MOT) and the gastrin-releasing (GAS), pulmonary function and safety were compared between two groups.Results The total effective rate of experimental group(93.47%) was higher than the control group(76.08%), the difference was statistically significant (P<0.05).After treatment, the symptoms of experimental group(1.53 ±0.19) points was higher than the control groupthe difference was statistically significant(1.96 ±0.24)points,P<0.05.The IL-8, SP, MCT levels of experimental group were all lower than the control group ( P<0.05 ) .The MOT, GAS, and lung function of experimental group improved more significantly than the control group ( P <0.05 ) .The security between two groups has no significant difference .Conclusion The curative effect of Sini decoction adjustment combined Rabeprazole enteric capsules in treatment gastroesophageal reflux cough is obvious, can decrease IL-8, SP, MCT levels.

Objective To investigate the effect of preconditioning electrostimulation of fastigial nucleus (FNS) on the neuronal mitochondrion of rats early after cerebral ischemia. Methods Forty Wistar rats were used and divided into 5 groups: a normal control group, a sham FNS group and 3 FNS groups. The FNS of the rats in the FNS groups was conducted for 1 hr, 1 day or 7 days, respectively, before the models of middle cerebral artery occlusion(MCAO)were made with them. Three hours after the model was established, the animals were sacrificed and the water content of the brain of the ischemic side was measured. The neuronal mitochondrion was observed by electron microscope, and its Vv, specific volume (Sv) and specific surface (Ss) were analyzed. The rats in the normal control group were not given any special treatment. For the rats in the sham-FNS group, intrinsic neurons of FN were destroyed with ibotenic acid (IBO), and 5 days later, the FN was electrically stimulated, and 1 day later, MCAO models were made. Results Three hours after MCAO, the water content of the brain increased and neurological function score decreased in the sham-FNS group, while the Vv and Sv of neuronal mitochondrion increased and the Ss decreased, which were significantly different from those of the normal control group(P

Objective To investigate the effects of Naoluoxintong which is representative prescription of supplementing Qi and activating blood therapy(Yiqihuoxue),the prescription of supplementing Qi therapy(Yiqi) and the prescription of activating blood therapy(Huoxue) on local cerebral ischemia-reperfusion injury rats.To observe the changes of neural stem cells(NSCs) and correlated SVZ factors.Methods Models of local cerebral ischemia-reperfusion were established by thread-occluding the MCA.The time points were observed at 1,3,7 d after reperfusion following 2 h of MCAO respectively.The expression levels of Nestin were measured by immunohistochemical staining.Results The expression of Nestin of treatment groups increased significantly compared with model group at 7 d(P

Objective To investigate the changes in gastric intramucosal pH(pHi) and the effect of hyperoxic liquid on intramucosal pH(pHi) after myocardial ischemia-reperfusion injury in rabbits.Methods Twenty healthy male adult rabbits,weighing 2.3-3.0 kg,were randomly divided into two groups: control group(n=10) and hyperoxic liquid group(n=10).Hyperoxic liquid group received the routine infusion of hyperoxic liquidle of 10 mL/kg for seven days,while control group received the routine treatment infusion of saline instead of hyperoxic liquid of 10 mL/kg.Seven days later,the myocardial ischemic reperfusion model(I/R) was established,and ECG and homodynamic indexes were monitored simultaneously.Hemodynamic indexes and pHi were measured before myocardial ischemia,30 min after myocardial ischemia as well as 1 h and 2 h after reperfusion.Results Hyperoxic liquid could lower ST segment and improve hemodynamic indexes.pHi decreased significantly after myocardial ischemia-reperfusion injury in both groups.Compared with that in control group,pHi was significantly higher at 1 h and 2 h after reperfusion in hyperoxic liquid group(P