Due to the theoretical and technique limitation of traditional surgery,surgical treatment of complex intrahepatic biliary diseases was left for an unresolved difficult problem of the last century.Uncertainties of the anatomical,physiological,pathological changes and surgical techniques in the intrahepatic biliary tract contribute to this complexity.Through integrated application of modern scientific technology and traditional medicine methods and systematic optimization and innovation of biliary surgical theories and techniques,authors have developed a paradigm of precision biliary surgery which is characterized by high quantification,visualization and controllability.The establishment of the precise biliary surgical system solves the difficulty in surgeries for intrahepatic biliary diseases,puts forward the biliary surgery from extrahepatic ducts,hilar ducts to intrahepatic ducts,entering a new segment era of the biliary surgery marked by precision treatment of intrahepatic biliary diseases.

Objective To investigate the factors in association with colorectal disorders in adult recipients of liver allograft. Methods A retrospective cohort study was carried out with clinical, microbiological and management data regarding diarrhea in 218 adult recipients of liver allograft from Jan. 2003 to Dec. 2006. Results Of the 218 patients, 68(31.2%) of them, who did not history of ulcerative colitis, were found to have diarrhea after orthotopic liver transplantation. Among these 68 patients, diarrhea was probably caused by administration of immunosuppressive agents in 35 cases (51.4%), in 12 cases (17.6%) diarrhea was antibiotics associated, and in 5 cases (7.4%) it was due to intraperitoneal infection. The other pathogenic factors included fungal infection in 3 cases (4.4%), cytomegalovirus infection in 3 cases (4.4%), Roux-en-Y choledochojejunostomy in 8 cases (11.8%) and some other unknown problem related in 2 cases (2.9%). Diarrhea occurred soon after transplantation in most cases. Of the 68 patients, the symptom of diarrhea occurred in the first 2 months in 45 cases (66.2%), and in the next 4 months in 23 cases (33.8%), i.e. the symptoms occurred 5-180 days after transplantation. Conclusion Immunosuppressive agents, antibiotics, fungal infection and cytomegalovirus infection are the top four common causes of diarrhea after orthotopic liver transplantation. The outcome is good with appropriate conservative management.

Objective To detect VP1 and 2A genes of Enterovirus type 71 (EV71) isolated from clinical specimens of patients with light or heavy symptoms and analyze the homogeneity and phylogenetic tree. Methods Fifty clinical specimens of children with hand-foot-and-mouth disease ( HFMD) were dealed with, which were tested by RT-PCR assay with specific primer pairs for EV71. EV71 isolates from patients with light or heavy clinical symptoms were tested by RT-PCR assay with two specific primer pairs for VP1 and 2A genes of EV71 respectively. All of the PCR products were sequenced and compared with that of previously isolated EV71 isolates available from GenBank by homogeneity and phylogenetic tree analyses. Results The RT-PCR results indicated that 30 isolates were EV71, 13 of 30 isolates were from clinical specimens of patients with light symptoms of hand-foot and mouth, the other were from clinical specimens of patients with heavy symptoms of complications. VP1 genes and 2A genes of 10 EV71 isolated strains including 5 light strains and 5 heavy strains were sequenced and compared with that of previously isolated 5 EV71 Chinese isolates available from GenBank (fuyangEU703814.1, xi_anHM003207. 1, shandongEU753418.1, shenzhenFJ607337.1, henanGU366191. 1) by homogeneity and phylogenetic tree analyses. The homogeneity of VP1 and 2A genes of the 10 EV71 isolated strains and 5 previously isolated strains were between 94.7% -99.4% and 93.6% -99.3% respectively, with the representative isolates of A and B genotypes was between 81.0%-84. 6% and 78. 4%-82. 2% respectively. The data suggested that all of the 10 Chinese isolates belong to EV71 genotype C. There were only 87.8% -90.2% homology among these 10 strains and the representative strains of C1, C2, C3 sub-genotypes of EV71 but 96. 8% -99.6% homology among these 10 strains and the representative strains of C4 sub-genotypes of EV71, this suggested that these 10 Chinese isolates composed the C4 sub-genotype, of the C genotype, that formed a single branch in the phylogenetic tree. Conclusion EV71 of sub-genotype C4 distributed in Mainland China, and VP1 genes have close genetic relationship between isolated strains. There is no obvious difference in 2A genes between clinical specimens of patients with light or heavy symptoms by homogeneity and phylogenetic tree analyses.

Objective To investigate the effects of hedysarum polybotys saccharide (HPS) on lipid metabolism and the expression of stearoyl-CoA desaturase-1(SCD-1) gene in rats with non-alcoholic fatty liver disease (NAFLD). To discuss the interfering effects of HPS on NAFLD. Methods The SD rats were randomly divided into the blank control group and the experiment group. Rats in the experiment group were fed with lipid rich food for 8 weeks to establish model and were randomly divided into model group, drug positive group and HPS group. After 8 weeks of drug intervention, the level of ALT, AST, TC, TG, HDL-c and LDL-c were measured with automatic chemistry analyzer, and expression of SCD-1 gene was measured by semi-quantitative polymerase chain reaction.Results Compared with blank control group, serum ALT, AST and TC, TG, LDL-c of model group were higher (P<0.05,P<0.01), the level of HDL-c of model group and the expression of SCD-1 gene were lower (P<0.01). Compared with model group, HPS was useful to decrease serum ALT, AST, LDL-c, TC and TG (P<0.05,P<0.01), and increase the level of HDL-c (P<0.01) and the expression of SCD-1 gene (P<0.01).ConclusionHPS had a positive effect on regulating lipid metabolic disturbance of NAFLD rats and promoting the expression of regulatory gene SCD-1.

ObjectiveTo investigate the clinical efficacy of warm needling moxibustion plus tricolor medicinal paste in treating knee osteoarthritis.MethodNinety-one patients meeting the diagnostic criteria were randomly allocated to a treatment group (45 cases) and a control group (46 cases). The treatment group was given warmneedling moxibustion plus tricolor medicinal paste and the control group, warm needling moxibustion alone. The clinical therapeutic effect and the WOMAC score were observed in thetwo groups. An improvement in the symptoms of knee osteoarthritis was assessed in the patients after treatment.ResultIn both groups, there were statistically significant pre-/post-treatment differences in the pain and daily activity scores and the WOMAC total score (P<0.05) but not in the morning stiffness score (P>0.05). There were statistically significant differences in the daily activity score and the WOMAC total score (P<0.05) but not in the pain and morning stiffness scores (P>0.05) between the two groups.Conclusion The study shows that warm needling moxibustion plus external application of tricolor medicinal paste has a marked improving effect on the pain, swelling and physiological functions in patients with knee osteoarthritis. Improving lower limb function further in daily activities can produce a satisfactory and stable therapeutic effect.

Objective To compare the outcomes of giant hepatic hemangioma undergoing enucleation and hepatectomy and to summarize our experience of surgical management of liver hemangioma.Methods A retrospective study was conducted in patients undergoing giant hepatic hemangioma resection (lager than 10 cm in size) in General Hospital of PLA,during 2006 through 2014.Patients were divided into two groups according to the types of operation.Results Of 145 patients with giant liver hemangioma,81 underwent enucleation and 64 had hepatectomy.The differences of tumor size (12.0 cm vs.15.5 cm,u =3.68,P ＜0.01),time of operation (210 min vs.280 min,u =3.89,P ＜ 0.01) and the ratio of inflow control (81.5％ vs.56.3％,x2 =10.91,P ＜ 0.01) of enucleation and hepatectomy was significant.The difference of intraoperative blood loss (500 ml vs.800 ml,u =1.85,P =0.07) and the postoperative morbidity (8.6％ vs.7.8％,x2=0.03,P =0.86) was not statistically significant.There was no inhospital mortality in both groups.Conclusions Both of enucleation and hepatectomy are effective operative approaches for giant liver hemangioma,patients with liver hemangioma should be prudently chosen for surgery,and the operation type should be individualized with the guidance of precision liver surgery.

Objective To investigate the effects of reciprocal inhibition on motor function connectivity in the brains of stroke patients.Methods Thirty patients with stroke were randomly divided into a treatment group (n =15) and a control group (n =15).The control group underwent normal limb positioning,medium frequency electrotherapy,circulated compression of the limbs,etc.The treatment group received conventional rehabilitation treatment plus reciprocal inhibition treatment for 30 min daily,6 times a week for 4 weeks.All of the patients were assessed before and after treatment using the Canadian neurological scale (CNS),the Frenchay activities index (FAI),the motricity index (MI) and functional magnetic resonance imaging of the motor cortex in a resting state (rs-fMRI).Results In both groups the average CNS,FAI and MI scores improved significantly.Compared with the control group,the changes in FAI and MI scores in the treatment group improved significantly more.The coefficient of functional connectivity of the bilateral motor cortex decreased significantly after treatment in both groups.In the treatment group the motor cortex functional connectivity correlated significantly with the improvements in MI scores.Conclusions Reciprocal inhibition can accelerate the improvement of extremity motor function and ability in the activities of daily living significantly after stroke.It reduces functional connectivity in the bilateral motor cortex in ways significantly correlated with improvements in motor function.

Objective To explore the relationship between diameter of liver hemangioma and operation risk.Methods The clinical data of 362 patients with liver hemangioma who were admitted to the PLA General Hospital from January 2006 to January 2014 were retrospectively analyzed.All patients were divided into the 3 groups according to diameter of gross specimen,217 with tumor diameter≥5 cm and ≤ 10 cm in the large hemangioma group,119 with tumor diameter ＞ 10 cm and ≤20 cm in the giant hemangioma group and 26 with tumor diameter≥20 cm in the extremely large hemangioma group.The operation method included open surgery and laparoscopic surgery.Hepatectomy and enucleation of liver hemangioma were major operation procedures.The operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,number of patients with postoperative complications and duration of hospital stay were evaluated.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s,and comparison among groups was analyzed using the ANOVA.Skewed distribution data were described as M (P25,P75),comparison among groups was analyzed by Kruskal-wallis test and pairwise comparison was done by the MannWhitney U test.Results All patients underwent operation successfully without perioperative death,including 315 receiving open surgery (175 in the large hemangioma group,114 in the giant hemangioma group and 26 in the extremely large hemangioma group) and 47 receiving laparoscopic surgery (42 in the large hemangioma group and 5 in the giant hemangioma group).The operation time,volume of intraoperative blood loss,number of patients with blood transfusion,number of patients with postoperative complications and duration of hospital stay were 160 minutes (125 minutes,205 minutes),300 mL (100 mL,500 mL),31,5 and 8 days (7 days,9 days) in the large hemangioma group,220 minutes (175 minutes,275 minutes),500 mL (300 mL,1 000mL),36,5 and 9 days (8 days,10 days) in the giant hemangioma group,330 minutes (280 minutes,420 minutes),1 975 mL (800 mL,4 000mL),20,7 and 11 days (9 days,13 days) in the extremely large hemangioma group,respectively,with significant differences (x2 =84.24,80.94,53.65,31.54,47.67,P ＜ 0.05).The operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion and duration of hospital stay were compared,showing significant differences between large hemangioma group and giant hemangioma group (Z =6.39,6.51,x2 =11.29,Z =4.73,P ＜ 0.05),with significant differences between large hemangioma group and extremely large hemangioma group and between giant hemangioma group and extremely large hemangioma group (Z =7.28,6.91,x2=51.22,Z =5.57,P ＜ 0.05;Z =5.33,4.86,x2=17.69,Z =3.5 1,P ＜ 0.05).Seventeen patients had postoperative complications with an incidence of 4.70％ (17/362),intra-abdominal hemorrhage were detected in 7 patients,perihepatic effusion in 4 patients,pleural effusion in 3 patients,bile leakage in 2 patients and fat liquefaction of abdominal incision in 1 patient.There was no significant difference in the number of patients with postoperative complications between large hemangioma group and giant hemangioma group (x2 =0.41,P ＞ 0.05).There were significant differences in the number of patients with postoperative complications between large hemangioma group and extremely large hemangioma group and between giant hemangioma group and extremely large hemangioma group (x2 =24.96,11.67,P ＜ 0.05).Conclusions Diameber of liver hemangioma is associated with operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,number of patients with postoperative complications and duration of hospital stay,and there is a high risk in the surgical treatment of patients with liver hemangioma diameter≥20 cm.

Objective To investigate the effects of cell hypoxia on radio-inducible activity of early growth response gene-1 (Egr-1) promoter and its mechanisms. Methods The reporter vector of Egr-1 promoter was constructed by inserting the promoter sequence upstream the lucifearase gene in pGL3, which was then transfected into the lung adenocarcinoma A549 cell by liposome. The luciferase activity and H 2O 2 production were detected in the transfected cells exposed to doses of 2, 4, 6, 8, and 10 Gy radiation combined with the oxygen concentrations of 0.1%, 0.5%, 1%, 2.5%, and 5 %. The changes of luciferase activity in the transfected cells exposed to various concentrations of H 2O 2 were observed. Results The reporter vector of Egr-1 promoter was constructed successfully. The radio-inducible activity of Egr-1 promoter decreased significantly in the transfected cells exposed to oxygen concentration below 2.5% in a concentration-dependent manner, as compared with that in the normal control (P

8 hours and without and binding nursing in these 3 groups respectively. Observed the condition of respiratory tract infection in 3 groups. Results The incidence rate of respiratory tract infection in binding nursing groups was 50%, which was significant higher than that of in no binding nursing group (P8 hours group was 66.67%, and this rate had an tendency of rising with the time of binding nursing lasting (P