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

Alu Elements ; physiology ; Chromosome Aberrations ; DNA Topoisomerases, Type II ; metabolism ; DNA, Neoplasm ; metabolism ; DNA-Binding Proteins ; genetics ; metabolism ; Humans ; Sarcoma ; genetics ; metabolism ; Soft Tissue Neoplasms ; genetics ; metabolism ; Translocation, Genetic

Age Factors ; Aged, 80 and over ; Female ; Hip Fractures ; surgery ; Humans ; Male ; Orthopedic Fixation Devices

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.

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 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 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.