Objective To study the use of ultrasound-guided percutaneous transhepatic cholecystostomy (PTGD) followed by selective minilaparotomy cholecystectomy (MC) for acute obstructive cholecystitis in the high-risk elderly.Method A retrospective study was conducted on 120 patients who received ultrasound-guided PTGD followed by selective MC from January 2008 to December 2010.Results PTGD+ MC were performed successfully on 120 patients with acute severe obstructive chole cystitis.In all the patients,the abdominal pain was relieved within 2-3 h of operation,and the temperature decreased to normal from 24- 48 h after operation.The average time of drainage was 10 days.In 97 patients MC was performed 1 week after PTGD,and in 23 patients 2 weeks after PTGD.Bleeding from gallbladder bed occurred in 1 patient.No patient suffered from bile leak.There was no major complication or death after PTGD+ MC.Conclusion PTGD followed by selective MC is a simple,efficacious and minimally invasive treatment for high-risk elderly patients with acute obstructive cholecystitis.

Objective To study the clinical,imaging and pathological features of hepatic angiomyolipoma,and to investigate methods in improving the preoperative diagnosis rate.Methods The imaging features and treatment experience of 73 patients with hepatic angiomyolipoma who had been admitted to the Eastern Hepatobiliary Surgery Hospital from 2000 to 2007 were retrospectively analyzed.All patients were classified according to the imaging features and corresponding treatments were applied.Results Of all patients,7 were diagnosed preoperatively.The diagnostic rate of B ultrasound,computed tomography and magnetic resonance imaging were 0,13%(7/56)and 6% (2/33),respectively.According to the results of imaging examination,6 patients were with the type of hemangioma,17 with the type of lipoma,4 with the type of leiomyoma and 46 with mixed type.One patient was treated by radiofrequeney ablation and 72 by surgical resection.Twenty-four patients were presented with pulmonary infection,pleural effusion,ascites or slight hepatic dysfunction.Postoperative immunohistochemical assay demonstrated that HMB45 had the highest positive expression rate,then followed by smooth muscle actin,vimentin,proliferating cell nuclear antigen,CD34,polyclonal carcinoembryonic antigen,CD18,CD19 and p53.One patient died of postoperative tumor recurrence.Conclusions Hepatic angiomyolipoma is easy to be misdiagnosed,while imaging classification is helpful in the diagnosis.Surgical resection is beneficial to patients with hepatic angiomyolipoma.

Objective To perform finite element analysis on a novel motion mode hinged knee prosthesis, and investigate the method of wear simulation on hinged prosthesis and the influence of motion mode on wear of the prosthesis. Methods Based on the finite element model of contact stress on spherical axis prosthesis, the finite element model of wear was established according to Archard wear theory. The kinematics data during different motions were input as loading condition to simulate mechanical environment of the knee arthroplasty in physiological activities. The wear results of spherical axis prosthesis were studied. Results For tibial insert, the average and maximum contact stresses during upstairs and downstairs climbing were higher than those during walking, and the cumulative wear volume during upstairs climbing was larger than that during downstairs climbing and walking. The wear mainly occurred on lower surface of tibial insert during all 3 motions. For rotating bushing, there was only a short period of contact and wear during walking, and the cumulative wear was 0. 19 mm3. Conclusions The spherical axis motion of hinged knee prosthesis can improve the mechanical environment of knee, reduce the wear of rotating bushing, and prolong the prosthesis survival. The finite element simulation can predict the wear of hinged prosthesis effectively, and provide the theoretical basis for design and improvement of the prosthesis.

3-Hydroxy-3-methylglutaryl-CoA synthase (HMGS) is the first committed enzyme in the MVA pathway and involved in the biosynthesis of terpenes in Tripterygium wilfordii. The full-length cDNA and a 515 bp RNAi target fragment of TwHMGS were ligated into the pH7WG2D and pK7GWIWG2D vectors to respectively overexpress and silence, TwHMGS was overexpressed and silenced in T. wilfordii suspension cells using biolistic-gun mediated transformation, which resulted in 2-fold increase and a drop to 70% in the expression level compared to cells with empty vector controls. During TwHMGS overexpression, the expression of TwHMGR, TwDXR and TwTPS7v2 was significantly upregulated to the control. In the RNAi group, the expression of TwHMGR, TwDXS, TwDXR and TwMCT visibly displayed downregulation to the control. The cells with TwHMGS overexpressed produced twice higher than the control value. These results proved that differential expression of TwHMGS determined the production of triptolide in T. wilfordii and laterally caused different trends of relative gene expression in the terpene biosynthetic pathway. Finally, the substrate acetyl-CoA was docked into the active site of TwHMGS, suggesting the key residues including His247, Lys256 and Arg296 undergo electrostatic or H-bond interactions with acetyl-CoA.