objective To evaluate endoscopic surgery for high risk patients over 70 years old with severe acute cholangitis. Methods From October 1991 to October 2003, 84 high risk patients over 70 years old suffering from severe acute cholangitis were included and divided into laparotomy surgery (ST) and endoscopic surgery (ET) group. Results 80 patients were cured. The care rate was 81.2% in ST group and 91.6% in ET group. The mortality rate was lower in ET compared with ST (9.1% vs 18.8%). The rate of complication was reduced from 37.5% in ST group to 13.9% in ET group. The average duration of drainage was reduced from 49.4 days in ST group to 18.6 days in ET group. The total treatment days were shortened from 46.2 days to 22.8 days comparing ST with ET. Conclusions Endoscopic surgery should be the first choice for the senile and high risk patients with severe acute cholangitis. Endoscopic surgery was convenient, with mininal injury, safe and effective, and period of treatment was shortened, especially for elderly or critically ill patients, as well as those with MODS or previous billiary operations.

Objective To investigate the change in potassium channel in ventricular myocytes in vitro derived from diabetic rats and the effect of insulin and dichloroaectic acid(DCA). Methods The diabetic rat model was established by injection of streptozocin(STZ) peritoneally using male Sprague-Dawley rats with body weight 150-200 gram. Ventricular myocytes were isolated by enzymatic method and the whole-cell patch clamp technique was used to record the potassiumion currents. Results The I to density of ventricular myocytes in diabetic rats was significantly decreased compared with control rats[at+60 mV, 15.90?1.19 pA/pF (n=25) vs 28.55?0.97 pA/pF (n=12), P

The paper reported an investigation of the pharmacokinetics of SN-38 (7-ethyl-10-hydroxy-camptothecin) in rats and the tissue distribution in mice after injection of irinotecan hydrochloride nanoparticles (CPT-11) via tail veins. An LC-MS/MS method was established to determine the concentrations of SN-38 in whole blood of rats and in different tissues of mice. The pharmacokinetics and tissue distribution of SN-38 were compared after the intravenous injection of CPT-11 NPs and CPT-11 solution. Compared with irinotecan solution, the elimination half-life of SN-38 was prolonged from 2.17 h to 2.67 h after the intravenous injection of CPT-11 NPs, but its AUC had little change. After the injection of CPT-11 NPs in mice, over time, the concentrations of CPT-11-metabolized SN-38 in CPT-11 NPs were significantly higher in the whole blood, colon and lungs than those in CPT-11 solution, followed by in the spleen and liver, but those in the heart and brain had no change. However, the amount of SN-38 in the kidneys was reduced with time. CPT-11 NPs could prolong SN-38's (one of its metabolites) blood circulation time in rats and significantly increased the concentration of CPT-11-metabolized SN-38 in the whole blood, colon and lungs of mice. CPT-11 NPs made SN-38 efficiently target-bind to the colon and lungs of mice.

Objective To analyze the molecular cytogenetic abnormalities and pathogenesis of pediatric Burkitt lymphoma (BL) by array comparative genomic hybridization (aCGH).Methods First,immunophenotype,molecular genetics and EB virus (EBV) infection status were detected using immunohistochemistry and fluorescence in situ hybridization in 21 pediatric BL patients.Second,in addition to detecting genome-wide genetic gain/deletion status,aCGH results with EBV infection status were also correlated.Results aCGH results showed genetic alterations in 19 cases (90.5 ％).Generally,frequency of chromosomal gain was higher than chromosomal deletion.The regions of frequently-occurring small DNA genomic fragment gains (≥40 ％ cases) were 3q21.1,5p13.2,19q13.32,12q23.1,14q32.33,6q27,20p13 and 20p11.21.Large DNA fragment gains and deletions could be detected in 42.9 ％ (9/21) cases in the 14q24.2 and 14q32.33 regions.There was no significant difference in genetic alterations between EBV (+) and EBV (-) BL cases (P≥0.05).Conclusion aCGH results show that BL cases have complex genetic alterations,which have no significant difference between EBV(+) and EBV(-) cases.Most BL cases show large DNA segment deletion or acquisition of 14q,indicating that 14q gene alteration plays an important role in the pathogenesis of BL.

Objective To investigate the effect of PCIA with low-dose fentanyl on plasma endothelin (ET) after craniotomy. Methods 47 cases of selected craniotomy were divided randomly into two groups :experimental group (26cases) and control group (21cases) . Patients in experimental group were treated with PCIA (fentanyl 15ug/kg +ondansetron 8 mg+100 mL NS) but patients in control group were not given PCIA. Then HR,MBP, VAS, ET and side-effects were observed and compared between two groups before treatment and 0, 2, 4, 8, 12, 24, 48 h after treatment.Results In experimental group, HR was lower at 2, 4, 8, 12, 24 and 48 h after treatment than control group. MBP was lower at 0 and 2h after treatment in experimental group than control group. Plasma levels of ET were lower at 8, 24 and 48h after treatment in experimental group than control group. There were significant differences in VAS scores at 2,4,8,12,24 and 48 h after treatment between two groups. There was no significant differences in side reactions including consciousness, respiratory depression, vomiting and sedation between two groups. The incidence of nausea was higher in experimental group than control group. Conclusion PCIA with low-dose fentanyl after craniotomy has good analgesic effect and few side reactions, can reduce the formation of plasma endothelin, and then alleviate brain damage.

Objective To observe the changes in fibrinolytic factors in rats with pulmonary thromboembolism (PTE) after recombinant prourokinase ( rPro-UK) treatment and its significance .Methods PTE was induced in male Sprague-Dawley (SD) rats by injecting heated 125iodine-labeled fibrinogen(Fib) autologous thromboemboli into external jugular veins.Twenty-eight rats were randomly assigned into following groups (7 rats each):①healthy control group;②PTE 5 d group,the rats in which were sacrificed at 5 d after the PTE model was made; ③ PTE3d receiving rPro-UK thrombolytic treament groups including multibolus treatment sub group ( rPro-UK was given in 1 mg/kg on the post-PTE third day followed by 2 consecutive days of a lower dose 0.25 mg/kg and rats were sacrificed 2 h after the last injection at the same time as PTE5d group) and single bolus treatment sub group ( rPro-UK was given in 1 mg/kg on the post-PTE third day followed by 2 consecutive days of 0.5 ml saline and rats were sacrificad at the same time as the former group ).The rats were quickly sacrificad at the fixed time through carotid bleeding and plasma samples were reserved for analysis of uroki -nase-type plasminogen activator (u-PA), urokinase-type plasminogen activator receptor (u-PAR), fibrinogen (Fib) andα2-antiplasmin (α2-AP) .Results ①Plasma concentrations of u-PA and u-PAR were increased were significantly in rPro-UK multibolus treatment sub group than in PTE 5 d group(Pu-PA <0.05,Pu-PAR <0.01)and rPro-UK single bolus treatment sub group(Pu-PA <0.01,Pu-PAR <0.05),correlated with the thrombolysis rate in rPro-UK multibolus treatment sub group (ru-PA =0.766,P<0.05;ru-PAR=0.785,P<0.05).② No difference of plasma Fib and α2-AP was seen between Pro-UK treatment groups and PTE 5 d group(P >0.05).Conclusion ① Plasma levels of endogenous u-PA and u-PAR are increased at different time points after PTE and are further enhanced after Pro-UK treatment, which promotes endogenous fibrinolysis and thrombus lysis .This is probably related to increased synthesis and secretion of endothelial cells which may be a key thrombolytic mechanism of Pro-UK.②Absence of systemic activation of the fibrinolytic system in Pro-UK multibo-lus treatment sub group means that the regimen is feasible and Pro-UK is fibrin specific .

Objectives:To improve the surgical procedures and investigate the feasibility of the closed placement of nasojejunal tube during Ivor-Lewis esophagectomy. Methods:From January 2010 to December 2013, 85 patients (72 males and 13 females) with esophageal or gastric cardiac carcinoma underwent Ivor-Lewis esophagectomy in our department. Briefly, the general surgical proce-dures were performed as follows:1) stomach mobilization and enlargement of esophageal hiatus and pyloric sphincter digital fracture via laparotomy; 2) tubular stomach reconstruction, esophageal carcinoma resection, and intra-thoracic esophagogatrostomy via right posterolateral thoracotomy;and 3) forward closed placement of feeding tube through the nostrils and jejunum of patients under the guid-ance of a surgeon, who palpates the pylorus through the hiatus with the use of fingers. Results:No operative death or feeding tube-asso-ciated adverse event was observed. Among the 85 patients who have undergone Ivor-Lewis esophagectomy, feeding tube placement in-to the jejunum during surgery failed in 33 cases. The success rate of nasojejunal feeding tube placement was 61.2%(52/85). Twelve pa-tients with successful tube placement did not receive enteral feeding for several reasons and were thereby transferred to parenteral group. Significant differences were observed in terms of the nutritional cost and proportion between enteral feeding and parenteral groups (?1,469 ± 741 vs.?3,223 ± 917, P<0.001;3.4%vs. 7.2%, P<0.001). No differences in postoperative hospital stay and morbidi-ty were observed between the two groups (P>0.05). Conclusion:The novel forward closed placement of nasojejunal feeding tube dur-ing Ivor-Lewis esophagectomy provides a non-invasive, feasible, simple, and economical method for postoperative nutritional support. Surgeons could perform this novel technique successfully in practice.

Objective To investigate the relationship between the expression of β-glucuronidase mRNA in hepatocellular carcinoma(HCC)tissue and the clinicopathologic factors.Methods The expressions of β-glucuronidase mRNA in 25 samples of HCC tissue and 10 samples of normal hepatic tissue were detected by RT-PCR,and the relationship between β-glucurenidase mRNA in HCC tissue and clinicopathologic factors was analyzed.Results The expression of β-glucuronidase mRNA in HCC tissue was not influenced by the age of patient,tumor size and alpha-fetoprotein level.The expression of β-glueuronidase mRNA in patients with portal vein tumor thrombus or lymph node metastasis Was significantly higher than those without(t=7.857,9.341,P＜0.05).Conclusions The expression of β-glucuronidase mRNA is closely related to the existence of portal vein tumor thrombus and lymph node metastasis.β-glucuronidase may play a role in the invasion and metastasis of HCC.

Through a third party to investigate the status of hospital services,combined with the hospital plan and vision for the future to determine the strategy of hospital services and establish a service culture system,using of 3T,workshop mode,our hospital carried out long-term,systematic,targeted full quality service training,to cultivate the culture of hospital services,to further enhance the quality of staff and enhance the overall level of service of the hospital,and to build people satisfied with the brand hospital.

Objective To evaluate the safety and efficacy of the temporary bedside cardiac pacing in controlling torsades de points (TdP) in patients with acquired long QT syndrome (LQTS). Methods Twelve patients with acquired LQTS were enrolled from April 2003 to August 2007 consecutively and their clinical data were analyzed. Bedside cardiac pacing was adopted when other methods couldn't terminate the repeated TdP. Results Twelve patients successfully experienced the temporary bedside cardiac pacing via femoral venous. The average time spent in bedside cardiac pacing was about (10.5±2.4) min. After cardiac pacing the interval of QT and QTc were shortened [ (0.42±0.03 ) svs (0.52±0.06) s, P < 0.05; (0.43± 0.04 ) s vs (0.53±0.05 ) s, P <0.05 ]. The TdP occurred (4.6±1.2 ) times per day before cardiac pacing and it didn't reoccur any more after bedside cardiac pacing. The average time for cardiac pacing was(3.8±1.4) d. When the patients were discharged, the interval of QT and QTe were (0.41±0.02) s and (0.42±0.05) s respectively, there were significant differences compared with that before cardiac pacing(P< 0.05). During 1 year follow-up, the patients didn't experience TdP any more, and the interval of QT and QTe were (0.41± 0.06) s and (0.42±0.05) s respectively. Conclusion The immediate bedside cardiac pacing is a safe and effective way to control the repeated TdP.