Hepatolithiasis is still a common biliary disease in China with unknown pathogenesis and poor long-term outcomes.Surgery is probably the only curative treatment to hepatolithiasis.However,surgeons and patients cannot keep trouble from high recurrence and reoperation rates after surgery.Hepatolithiasis is a serious disease,which can cause cholangitis,liver abscess,liver cirrhosis,and even cholangiocarcinoma.Sphincter of Oddi,which controls the unidirectional outflow of bile and separates the bile duct from the bacteria-filled intestinal tract,is thought to be a gatekeeper of the almost-sterile biliary tract.Dysfunction of sphincter of Oddi,including stenosis,spasm and laxity,is closely associated with biliary disease,A lax sphincter of Oddi will aggravate bilioenteric reflux,leading to biliary infection and calculi development eventually.This issue has gradually gained enough attention.How to evaluate sphincter of Oddi function reliably and restore or replace its function,which is key to treat hepatolithiasis and prevent its recurrence,remain unclear.

Translational medicine is a new concept in China.It sets up a bridge between basic research and clinical work,and aims to transfer the basic study results to clinical practice as soon as possible.It is necessary for a surgeon to master the research idea of translational medicine in order to be expert in science and technique.Many unsolved clinical problems could be found in routine work,which is an advantage for translational medicine research.How to raise questions in routine clinical work and get these questions resolved in laboratory,and then apply the results to clinical work is a demand for surgeons nowadays.In this article,the research idea of translational medicine is introduced based on an example of the research on the relationship between rapamycin and hepatocellular carcinoma.

Objective:To compare the fracture resistance of roots of mandibular premolar with different apical preparation diameters.Methods:Sixty single-rooted single canal permanent mandibular premolar teeth extracted newly for orthodontic reason without immatureness,fracture or cracks were selected,with a curvature less than 10°,and internal length:short diameter of less than 2 at a level 5 mm from the apex.All the teeth were decoronated,leaving roots 13 mm in length.The initial apical file size for the teeth was ≤ 15#.The roots were assigned to 6 groups based on weights with random block design.Group A:blank control group,no instrumentation was performed.Groups B-F:the master apical file (MAF) was 40#,45#,50#,55# and 60#,respectively.In the five experimental groups the roots were instrumented using hand files with step-back technique at 1 mm increments,resulting in a taper of 0.05.The irrigant used was distilled water.After mounted in acrylic resin,all the teeth were subject to vertical loading using an Instron testing machine until fractured.The occurrence of fractures was detected when the applied load suddenly decreased.The fracture load values and fracture modes were recorded.Oneway ANOVA and post-hoc Tukey test were used to determine the difference of fracture load values between the groups (P ＜ 0.05).Chi-square tests were used to compare the modes of root fracture.Results:Five experimental groups exhibited lower fracture load values than that of control group [(1 444 ± 155) N].The mean fracture load values for roots instrumented to an apical diameter of 50# [(1 027 ± 128) N],55# [(994 ± 150) N] and 60# [(983 ± 166) N] were significantly lower than that of control group and 40# group [(1 339 ± 131) N] and 45# [(1 287 ± 144) N] (P ＜0.05).Buccal-lingual fracture,mesio-distal fracture and compound fracture occurred 55％,13％ and 32％,respectively.No difference of fracture mode was detected in the six groups.Conclusion:The fracture resistance reduced significantly when the roots were instrumented to an apical diameter of 50# or larger.

Objective:To measure the real temperatures on the pluggers of three continuous-wave de-vices, and to provide theoretical reference to evaluate thermal damage and heat ’s influence on the filling materials.Methods:The dual channel K type thermocouple was contacted to various sizes ’ pluggers in three different continuous-wave devices (BeeFill, Elements, B&L), and the highest temperatures at dif-ferent points ( tip, and 2 mm, 5 mm, 10 mm from the tip) of the pluggers ( preset temperature was 200℃) were recorded.The measurements were performed 5 times.T-test was used to compare the real tem-peratures at the tips with that set on the display and one-way ANOVA was used to compare the tempera-tures of the pluggers in different devices , sizes and points .Results:The highest temperature was at the tip of BeeFill 40/0.03 plugger (198.7 ±7.7) ℃, but there was on statistical differences between that and the preset temperature 200℃.The temperatures of the remaining pluggers were obviously lower than 200 ℃(P<0.05).The lowest temperature of the pluggers was detected at 10 mm from the tip of BeeFill 60/0.06 plugger (69.9 ±4.0) ℃.The highest temperature of each plugger was detected at the tip or 2 mm from the tip (112.1 to 198.7℃,and the median was 140.8℃).Conclusion:The real temperature of most continuous-wave pluggers included in this study is below the set temperature 200 ℃.

BACKGROUND:Electrospun polylactic acid/polycaprolactone nanofibers (ENF) are a kind of self-synthesized biodegradable material. Our preliminary studies have indicated that the biomaterial exhibits excel ent biocompatibility;however, the research about its mechanics is stil little. OBJECTIVE:To explore the effects of static pressure on the cytocompatibility of adipose-derived stem cel s on the ENF scaffold. METHODS:Adipose-derived stem cel s were seeded onto the ENF scaffold, and then cultured in the low-glucose DMEM supplemented with 10%fetal bovine serum. The mixed constructs were submitted to the static pressure at 0, 15, 30, and 45 kPa for 4 hours using a static pressure device, respectively. Subsequently, the proliferation, adhesion and viability of adipose-derived stem cel s on the ENF scaffold were detected using MTT assay and living/dead staining to evaluate the cytocompatibility. RESULTS AND CONCLUSION:MTT assay showed that there were significant differences in absorbance values among groups by one-way analysis of variance after 4 hours of loading with different static pressures in vitro. Under 0-30 kPa static pressure, the absorbance values increased with static pressure, but the absorbance values declined until the pressure reached 45 kPa, and multiple comparisons between groups showed significant difference. The significant differences in the cel attachment percentage by MTT assay could be found among groups. The living/dead staining results supported the above findings. Furthermore, the significant differences in percentage of living cel s among groups were shown using either one-way analysis of variance or paired t test. In conclusion, the appropriate static pressure can promote the cytocompatibility, proliferation, adhesion and viability of adipose-derived stem cel s on the ENF scaffold. But the excessive pressure is likely to inhibit the cel ular biological behaviors, thus affecting cytocompatibility of adipose-derived stem cel s with the ENF scaffold.

ObjectiveTo analyze the risk factors of pulmonary infection for critically ill ICU patients with tracheotomy,and investigate the methods to prevent nosocomial lung infection. Methods94 patients in ICU with pulmonary infection after tracheotomy from March 2008 to March 2010 were analyzed retrospectively,they were set as the observation group.100 patients in synchronization without pulmonary infection after tracheotomy were set as the control group.The general condition,diagnosis and treatment methods and care,the environment,etc.were studied,the risk factors for nosocomial pulmonary infections after tracheotomy were analyzed.The care methods and points to prevent lung infections for critically ill ICU patients after tracheotomy were summarized. ResultsThe study showed that the respiratory system diseases in critically ill patients,smoking history,low seniority of nursing staff,long-term use of large dose of antibiotics,application of H2 blockers and antacids,and many patients in the same ward were risk factors for critically ill patients with pulmonary infection. ConclusionsLung infection after tracheotomy in critically ill ICU patients was affected by many factors.In the actual operation,we should targeted to avoid infection led by treatment and care factors,environmental factors,control and prevention measures should especially be strengthened for patients with respiratory diseases to prevent lung infection.

HCV RNA positive serum was first selected by RT-PCR test kit from several anti-HCV positive sera obtained from Xi'an.HCV RNA extrac ted from the elected sera was converted to cDNA by reverse transcription with ra ndom primer.Half-nested PCR was performed.The amplified product was 852 bp.The purified PCR product was digested by restriction endonucleases and then ligated to epressio vector pET-22b\++.Its nucleotide sequence was determined by dideoxy chain termination method.A comparison of the sequence with several isolates rep orted previously showed that the sequence belonged to HCV type Ⅱ.

Objective To explore the clinical effects of S-1 single agent chemotherapy for the patients undergoing radical resection of cholangiocarcinoma.Methods The clinical data of 51 patients receiving radical resection of cholangiocarcinoma who were admitted to the Second Affiliated Hospital of Zhejiang University from November 2011 to December 2013 were retrospectively analyzed.After radical resection of cholangiocarcinoma,25 patients receiving non-special treatment and 26 patients receiving S-1 single agent chemotherapy were divided into the operation group and chemotherapy group,respectively.S-1 was taken orally twice per day.Forty mg/once of S-1 was applied to patients with the body surface area ＜ 1.25 m2,50 mg/once of S-1 was applied to patients with the body surface area ≥ 1.25 m2 and ＜ 1.50 m2,and 60 mg/once of S-1 was applied to patients with the body surface area ≥ 1.50 m2.The 14 days usage and 7 days withdrawal of S-1 were used as one course of treatment.The standard usage of S-1 was 6-8 courses of treatment.All the patients were followed up by outpatient examination and telephone interview till December 1,2014.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results Twenty-six patients in the chemotherapy group finished the courses of chemotherapy without chemotherapy-related death,and 14 patients had chemotherapy adverse reactions with remission after discontinuation of S-1.All the 51 patients were followed up for 5-37 months with a median time of 19 months.The median overall survival time,1-,3-year overall survival rates,tumor-free median survival time and 1-,3-year tumor-free survival rates were 22 months (range,18-27 months),72.3％,42.9％,21 months (range,16-26 months),60.0％,55.0％ in the operation group and 32 months (range,29-35 months),84.6％,44.4％,26 months (range,21-31 months),76.9％,61.9％ in the chemotherapy group,respectively.There was a significant difference in the overall survival between the 2 groups (x2=6.032,P ＜ 0.05).There was no significant difference in the tumor-free survival between the 2 groups (x2=0.498,P ＞ 0.05).Conclusion S-1 single agent chemotherapy after radical resection of cholangiocarcinoma could improve the survival of patients,while no obvious advantages of inhibiting tumor recurrence is observed.

BACKGROUND:Proximal humeral fractures are commonly treated by open reduction and internal fixation, which greatly injuries tissue and noticeably damages local blood supply. However, with the development of material and progress of repair method, complications have obviously reduced. OBJECTIVE: To compare the difference of locking plate and ordinary steel plate in the repair of proximal humeral fractures. METHODS:A total of 68 patients with great displacement and comminuted proximal humeral fractures, who were treated in the Department of Orthopedics, Affiliated Tongren Hospital, Shanghai Jiao Tong University School of Medicine from February 2012 to October 2014, were enroled in this study. According to fixation method, they were divided into two groups. 32 cases in the locking plate group were subjected to locking plate, and 36 cases in the ordinary steel plate group received fixation with T type plate and Clover plate. They were folowed up at the out-patient clinic at 2, 4, 6, 12 and 24 weeks after treatment. The satisfaction rate of shoulder function treatment was assessed using Neer scoring system. They received reexamination before withdrawal of fixator. The incidence of complications was observed in patients. RESULTS AND CONCLUSION: The satisfaction rate was significantly lower in the ordinary steel plate group than in the locking plate group (75%, 81%,P < 0.05). No screw and plate breakage, shoulder seam impact,humeral head necrosis or infection was found in the locking plate group. Six cases suffered from pain. In the ordinary steel plate group, there were screw and plate breakage in five cases, shoulder seam impact in five cases, pain in eight cases, humeral head necrosis in two cases and infection in two cases. The incidence of complications was significantly greater in the ordinary steel plate group than in the locking plate group (P < 0.05). These data suggest that locking plate can be used as the first choice for internal fixation in treatment of proximal humeral fractures. No matter satisfaction rate of repair or complications, it is better than ordinary steel plate fixation.

Serum cortisol levels during oral glucose tolerance test (OGTY) were measured in subjects of type 2 diabetic pedigrees. The results showed that cortisol levels during OGTF were higher in type 2 diabetic patients than those in non-diabetic first-degree relatives and normal controls. Fasting cortisol level was positively correlated with fasting plasma glucose level in type 2 diabetic pedigree members. These results suggest that the dysregulation of hypothalamic-pituitary-adrenal axis may coexist in type 2 diabetic patients.