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.

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.

Objective To explore the effect of eletroacupuncture (EA) on angiogenesis after cerebral ischemia and reperfusion through observing the number of peripheral blood endothelial progenitor cells (EPCs) and the expression of vascular endothelial growth factor (VEGF) in the hippocampus.Methods Among 50 male Sprague-Dawley (SD) rats,10 were randomly selected as a control group (CG).Qi deficiency and blood stasis were induced in the other 40 rats by intragastric administration of dahuang daily for 7 days.A model of focal cerebral ischemia and reperfusion injury was then created by thread-occlusion of the middle cerebral artery,except in 10 rats selected for the sham operation group (SOG) who received the same operation without tightening the thread.The successfully modeled rats were divided into a model group (MG,n =10) and an electroacupuncture group (EAG,n =10).The rats in EAG started acupuncture treatment the next day after modeling,while no treatment was given to those in the other groups.On day 1,3 and 7 after the modeling,the neurological functioning of the 4 groups was assessed using Basso-Beattie-Bresnahan locomotion scoring and the number of EPCs in the peripheral circulation was detected by flow cytometry.On the 8th day,all the rats were decapitated and the VEGF expression was detected immunohistochemically.Results The average BBB locomotion score of the EAG rose significantly from (4.50 ± 1.05) on day 1,to (13.67 ± 1.21) on day 3,and then further to (20.00 ±0.89) by day 7,significantly higher than that of MG at the same time points,but still significantly lower than that of the control group.The average number of EPCs in the peripheral circulation in the MG also increased from (26.83 ± 6.05) on day 1 to (33.67 ± 5.39) on day 3,and decreased to (32.83 ± 5.04) on day 7 after modeling,significantly lower than that of the CG [(45.50 ±9.40),(42.17 ±4.62) and (41.33 ±5.50)],the SOG [(58.00 ±8.05),(59.67±4.84) and (53.83 ±5.38)[and the EAG [(66.17 ±4.36),(127.50 ±73.75) and (55.00 ±35.15)] at each time point.After occlusion,the average expression of VEGF-positive cells in the hippocampus of the EAG [(27.80 ± 2.39)％] was significantly higher than that of the MG,and both were significantly higher than that of the CG.Conclusions Eletroacupuncture can up-regulate VEGF expression and EPCs in the peripheral blood in rats after cerebral ischemia-reperfusion,which can promote angiogenesis and neural functional recovery.

Objective To explore the effect of inadequate reduction of the medial wall on the postoperative varus deformity following calcaneal fracture surgery and other influencing factors of varus deformity.Methods A retrospective analysis was conducted of the 60 patients with calcaneal fracture involving the medial wall (60 feet) who had been treated from October 2005 to September 2015.They were 51 men and 9 women,18 to 55 years of age (average,38.4 years).According to the Sanders classification,24 patients belonged to type Ⅱ,30 to type Ⅲ,and 6 to type Ⅳ.We measured the integrity of the pre-and post-operative medial walls,the height and width of the pre-and post-operative calcanei,the pre-and post-operative B(o)hler angles and the pre-and post-operative calcaneal varus angles for statistical analysis.Results The effect of postoperative height reduction of the medial wall on the postoperative correction of varus angle was significantly larger than that of the lateral wall (P ＜ 0.05).The higher the integrity of the postoperative medial wall,the larger the correction of the postoperative varus angle.The normal rate of postoperative calcaneal varus angle significantly decreased with the increased Sanders classification severity (P =0.001).The postoperative reduction of the height and width of the calcaneus and the integrity of the preand post-operative medial walls were significantly positively correlated to the normal rate of postoperative calcaneal varus angle (P ＜ 0.05).Conclusions The medial wall has a large influence on the postoperative calcaneal varus angle.The higher integrity of the preoperative medial wall,and the more adequate reduction and fixation of the postoperative medial wall as well,the higher rate of postoperative normal calcaneal varus angle.The postoperative reduction of the calcaneal height also affects the varus angle.When the heights of the medial and lateral walls are recovered,the normal rate of varus angle is the highest;when reduction of the medial wall is inadequate but reduction of the lateral wall is fine,the normal rate of varus angle is the lowest.

[Objective] To study the methods of inducing bone mesenchymal stem cells(BMSCs)of rabbits into chondrocytes in vitro and the interaction of transforming growth factor ?1(TGF-?1),insulin-like growth factor-Ⅰ(IGF-Ⅰ)and basic fibroblast growth factor(bFGF).[Methods]BMSCs of rabbits were primarily cultured and subcultured in vitro,and then divided into four groups according to the difference of factors:group A receiving TGF-?1 and bFGF;group B receiving TGF-?1 and IGF-Ⅰ;group C receiving TGF-?1;group D receiving no cell growth factor.After three weeks all the four groups were detected by methyl thiazolyl tetrazolium(MTT)assay,measurement of glycosaminoglycan(GAG)and immunohistochemistry.[Results]Immunohistochemical detection of collagen Ⅱ was positive in groups A,B and C.The results of the MTT assay and the GAG content in groups A and B were obviously higher than those in groups C and D.[Conclusion]Rabbit BMSCs can be induced into chondrocytes under certain conditions.TGF-?1,IGF-Ⅰ and bFGF have synergy effect in the differentiation from BMSCs into chondrocytes.

Objective To explore the surgical safety and clinical efficacy of combined anterograde and retrograde method exposing porta hepatis for the treatment of the intrahepatic cholangiocarcinoma invading porta hepatis.Methods The retrospective descriptive study was conducted.The clinicopathological data of 3 patients with left intrahepatic cholangiocarcinoma invading porta hepatis who were admitted to the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from February 2015 to May 2016 was collected.All the 3 patients underwent left hemihepatectomy combined with caudate lobectomy after preoperative lab and imaging examinations and the evaluations of liver function and residual liver volume.The surgical procedures followed as:anterograde dissection of porta hepatis,exposure of hilar plate,left hemihepatectomy combined with caudate lobectomy,right artery resection and reconstruction,hilar cholangioplasty and bilioenteric anastomosis.Observation indicators included:(1) surgical situations:operation time,time of hepatic artery~ anastomosis and volume of intraoperative blood loss;(2) postoperative pathological examinations;(3) postoperative situations:postoperative complications (biliary fistula,hemorrhage,abnormal liver function,gastroplegia) and postoperative chemotherapy;(4) follow-up:postoperative patients' survival and carcinoma occurrence.Follow-up was performed to by outpatient examination up to December 2016.The follow-up included clinical symptoms such as abdominal pain,chills,fever and jaundice,liver function and tumor marker examination,and color ultrasound Doppler or abdominal enhanced computed tomography (CT) was performed to detect carcinoma recurrence.Measurement data was represented as average (range).Results (1) Surgical situations:all the 3 patients underwent successful left hemihepatectomy combined with caudate lobectomy using combined antegrade and retrograde method exposing porta hepatis,including 1 combined with right hepatic artery resection and reconstruction,without perioperative death.The average operation time,average time of hepatic artery anastomosis and average volume of intraoperative blood loss of 3 patients were 493 minutes (range,430-570 minutes),11 minutes and 526 mL (range,450-600 mL),respectively.(2) Postoperative pathological examination showed 3 patients were diagnosed with cholangiocarcinoma,2 with nerve bundles invaded and 2 with No.12 lymph node metastasis,with negative margins of bile duct and hepatic artery.(3) Postoperative situations:3 patients are not complicated with biliary fistula and gastroplegia.One patient with postoperative liver dysfunction after right artery resection and reconstruction underwent anti-infection,hepatoprotection and anti-hepatic encephalopathy therapies,and then was improved and discharged from hospital at 4 weeks postoperatively.The other 2 patients recovered steadily without complications such as hypohepatia,and then respectively discharged from hospital at 17 and 20 days postoperatively.All the 3 patients underwent chemotherapy of gemcitabine combined with S-1 for 8 courses at week 4 or 5 postoperatively.(4) Follow-up:all the 3 patients were followed up for 7-20 months,with good general conditions and normal liver function and without cholangitis symptoms.One patient received right artery reconstruction,and CT reexamination at postoperative month 3 showed fine imaging of right hepatic artery.There was no sign of carcinoma recurrence.Conclusion The combined anterograde and retrograde method exposing porta hepatis for the treatment of the intrahepatic cholangiocarcinoma invading porta hepatis can increase the radical resection rate and surgical safety.

Objective: To study the antitussive, expectorant and antiasthetic effects of Fortunella hindsii leaves. Methods: The antitussive effects were observed by the method of ammonia-induced cough in mice, the expectorant effects were observed by the method of phenolsulfonphthalein excretion in mice, and the antiasthmatic effects were observed by the method of histamine phosphate spray in guinea pigs. Results:The leaves of Fortunella hindsii at low, medium and high doses could decrease the cough times and prolong the cough latent period (P<0. 05 or P<0. 01), high dose could promote the phenol red excretion (P<0. 05), and high and medium do-ses could prolong the incubation period of guinea pigs for asthma caused by histamine phosphate (P<0. 05 or P<0. 01). Conclu-sion:The leaves of Fortunella hindsii have promising antitussive, expectorant and antiasthmatic effects.

Objective To study the protective effect of hyperoxic liquid preconditioning in myocardial ischemia-reperfusion injury. Methods Thirty rabbits were randomly divided into three groups: group A undergoing all procedures except ischemia-reperfusion, group C receiving the routine infusion of hyperoxic liquid 15mL/kg for seven days, and group B receiving the routine treatment infusion of saline instead of hyperoxic liquid 15mL/kg. Seven days later, the myocardial ischemic reperfusion model (I/R) was fabricated, ECG and homodynamic index were monitored simultaneously. Plasma MDA and SOD level was assayed before ligation, 30min after ligation and 1, 2, 3h after reperfusion. Results Hyperoxic liquid preconditioning can lower ST segment and improve index of hemodynamics and significantly reduce myocardial infarction size in group C compared with group B((P

Objective To analyze the clinical feature, treatment and prognosis of ventricular septal rupture after myocardial infarction Methods Clinical data of 16 patients with ventricular septum repture after acute myocardial infarction were who were hospitalized between January 1990 and July 2004 were analyzed retrospectively Results Among 2?057 patients with acute ST segement elevation myocardial infarction, 16(0 7%) patients (8 males and 8 females) were found to have ventricular septal rupture The average age was 59 4?11 6 years 7 (43 8%) patients had hypertension, 5(31 3%) patients had diabetes and 5 (31 3%) patients smoked 15(93 8%) patients were diagnosed as acute anterior infarction and among them, 6 patients also had posterior infarction 1 patient were diagnosed as inferior infarction 11 patients received coronary arteriography and ventriculography, and in 10 cases, the infarct related arteries (IRA) were found to be LAD (90 9%) Total occlusion was found in 9 cases out of the 11 patients (81 8%) Cardiogenic shock was found in 3(18 8%) patients 12 cases (75%) of ventricular septal rupture occurred within the first seven days after the onset of symptoms The defect on rentricular septumn and its size were confirmed by means of ectocardiography The size of the rupture varied from 0 68 cm to 2 5 cm Surgery was performed in 10 (62 5%) patients, and 3 of them survired All the 6 patients who only received medical therapy died within 30 days Conclusion Ventricular septal rupture after AMI was relatively rare which mostly happened in patients with acute anterior infarction Mortality rate was righ in patients who only received conservative medical treatment Surgical therapy could improve the survival rate