Objective To explore the reasons of biliary restenosis after interventional treatment for malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma and to discuss its management. Methods During the period from June 2010 to Sep. 2013 at authors’ hospital, a total of 36 patients with high biliary obstruction caused by Bismuth Ⅱ - Ⅳ type of hepatic hilar cholangiocarcinoma received percutaneous transhepatic cholangial stenting (PTCS), and as the patients developed biliary restenosis after PTCS percutaneous transhepatic cholangial drainage (PTCD) had to be carried out. All the patients had complete data. Serum total bilirubin, direct bilirubin, glutamyltranspetidase and alkaline phosphatase levels were determined on the operation day and at five days after PTCS and PTCD. The short - term remission of malignant obstructive jaundice produced by PTCS and PTCD were assessed. The causes of biliary restenosis were analyzed by comparing the CT and/or MRI images as well as the cholangiography and drainage test results which were performed at the first and second admission to hospital. Results The interval time from operation to restenosis was 31 - 468 days, with an average of 132.8 days. The effective rates of PTCS and PTCD for relieving jaundice were 77.8% and 75.0% respectively. The main causes of restenosis included the formation of biliary sludge, acute cholangitis and tumor growth. Conclusion PTCS is an effective means to relieve the malignant obstructive jaundice caused by hepatic hilar cholangiocarcinoma, however, the incidence of biliary restenosis after PTCS is higher, which may be mainly due to the tumor growth. Nevertheless, subsequent PTCD can effectively improve the liver function, control biliary infection, remit biliary obstruction and relieve the clinical symptoms.

Objective This study was aimed to determine the expression of matrix metalloproteinase-11 ( MMP-11 ) and MMP-12 in cervical cancer and the relationship between their expression with clinicopathological characteristics and the potential use as a prognostic and therapeutic agent.Methods Streptavidin-biotin-protein-linked peroxidase method(ie,SP) immunohistochemical method was used to detect the expression of MMP-11,MMP-12 in 20 cases of normal cervical tissue,36 cases of CIN tissue,g0 cases of cervical cancer.MMP-11 and 12 expression in cervical cancer and clinicopathological parameters of relevance were analyzed,and the relationship between MMP-1 1,-12 was studied in the development of cervical cancer for a preliminary study.Results The positive expression rate (82.50％,g1.25％ )of MMP-11 and-12 in cervical cancer was significantly higher than that of cervical dysplasia ( CIN ) specimens ( 69.44％,61.11％ ) and normal cervical tissues(5.00％,0),the difference was statistically significant ( P ＜0.05).(2)The expression of MMP-11 and-12 in cervical histological grade,clinical depth of stromal infiltration,with or without vascular invasion,with or without lymph stage,node metastasis was different.The difference was statistically significant ( P ＜0.05).(3)MMP-11 and-12 expression was significantly correlated.Conclusions The expression of MMP-11and-12 in cervical cancer tissues prompts that MMP-11 and-12 plays a central role in the course of invasion and metastasis of cervical carcinoma.MMP-11 and-12 joint detection may have a reference value in terms of the inchoate diagnosis of the cervical cancer,the evaluation and prognosis of tumor malignances degree.

Neuron is the basic structure and functional unit of nervous system. Once the neurons are damaged or lost, the balance of neuroregulation will be destroyed and a series of nervous system diseases will be induced. Parkinson's disease (PD) is a kind of chronic neurodegenerative disease caused by selective loss of many dopaminergic neurons in the dense region of the substantia nigra in the ventral midbrain. At present, conventional drugs and adjuvant therapies can only relieve clinical symptoms to a certain extent, but cannot fundamentally delay the progress of the disease. With the rapid development of stem cells and reprogramming technologies around the world, cell transplantation to deal with neurodegenerative diseases including Parkinson's disease has become a new and potential therapy. This paper mainly summarizes the molecular mechanisms of Parkinson's disease, the preparation of autogenous dopaminergic neurons and the research progresses of dopaminergic neurons transplantation in the treatment of Parkinson's disease.

Objective:To observe the position of the third molar in the neolithic adults about 6 000 years ago.Methods:On the basis of the maxillary and mandibular specimens preserved in Banpo museum,200 maxillary and mandibular specimens with 383 third molars,187 maxillary and 196 mandibular,were observed for the eruption of the third molar.The teeth in the non-eruption group were further divided into impact group and congenital absent group according to the third molar germ presence testified by X ray.Results:The congenital absent rates of maxillary and mandibular third molar were 26.74% and 17.35%,while the impact rates of maxillary and mandibular third molar were(2.67%) and 14.79% respectively.Conclusion:Both the congenital absent rate and the impact rate of the third molar in neolithic era adults are lower than those in modern,the impact and congenital absence of the third molar are part of degradation of masticatory organ with whole humanity progressing.

Objective To study the role of caspase 3 in ischemic brain damage of rats, and further understand the molecular mechanisms of ischemic cerebral vascular disease.Methods Rat models of the left middle cerebral artery (MCA) occlusion/reperfusion were made using a modification of the intraluminal sature method of Longa established by Belayev, infarct zones were confirmed by 2,3,5 triphenyltetrazolium chloride (TTC) staining, and caspase 3 expression on brain sections at the mRNA and active protein level was detected with in situ hybridization and immunohistochemistry technique, respectively.Results After 2 hours of left MCA ischemia followed by 24 hours of reperfusion, obvious infarct in the MCA dominate regions was confirmed by TTC staining; low levels of caspase 3 mRNA, and fewer of its active protein expression was found in normal brains, sham brains and contralateral brains of MCAO rats; both caspase 3 mRNA and activated protein expression in ipsilateral region were increased after 24 hours of recirculation, and even higher levels were detected at 48 hours of reperfusion.Conclusion Apoptotic mechanism might involve in delayed neuronal death after cerebral ischemia, and caspase 3 might play an important role in ischemic neuronal injury.

Objective:To summarize our experience on the diagnosis and surgical treatment of primary retroperitoneal tumor (PRPT). Methods: The clinical data of 315 patients with primary retroperitoneal tumor (from Jan. 2000 to Jun. 2008) were retrospectively analyzed,and the clinical experience on diagnosis and treatment was summarized. Results: The ratio of benign to malignant tumors in our group was 0. 55 : 1. Totally 294 patients received operation,including 161 cases of radical resection,69 cases of combined resection, and 64 partial palliative resection. Twenty-one patients received no operation. The prognoses of patients who received radical resection for malignant tumors were significantly improved compared with those of patients who received partial palliative resection (P<0. 05). Conclusion: Imaging diagnosis can effectively identify PRPT. Complete resection is the key for treatment of PRPT,and reoperation is an effective treatment for recurrent PRPT.

Objective To investigate the characteristics of marital quality and social support status of the patients with breast cancer during the period of chemotherapy and the correlation of both factors.Methods Seventy-seven patients with breast cancer were divided into beginning-, middle-and final-staging groups of chemotherapy.And they were studied with Olson marital quality questionnaire and Social Support Rating Scale.Results The total scores of marital quality and other factors were the lowest in the mid-chemotherapy group.Among three groups,the mean of the objective support and availability were gradually increased with the chemotherapy going.The score of objective support was higher in the final than beginning chemotherapy groups (P =0.009).There was a positive correlation between marital satisfaction and the objective support (r =0.248, P =0.036), and between the total score of quality of marriage and subjective support (r =0.286, P = 0.015).Conclusion The marital quality of breast cancer patients receiving chemotherapy is poor,and subjective or and objective support might improve the patient's marital quality.

Objective To explore the clinical significance of the precision evaluation of computed tomography angiography and color Doppler image formation technology to the condition of the vascular system in the donor site.Methods From January,2014 to December,2014,CTA and color Doppler were used to examine conditions of the first dorsal metatarsal artery's courser and the size of original caliber in 25 patients with thumb or finger defected.Also the distance between skin and the first dorsal metatarsal artery.The accurate positions and adjacent relations of vessels in donor site were precisely marked and then the vessel original caliber was measured.Results All the first dorsal metatarsal arteries of 25 cases can be appeared clearly in CTA and color Doppler.Blood vessels line and filling results were completely consistent in intraoperative findings.The difference of the vessel original average caliber was statistically significant (P ＜ 0.05) (1.20 ± 0.25 mm,1.41 ± 0.15 mm and 1.3 ±0.2 mm in Doppler,CTA and operation,respectively) while the distance was not significant (P ＞ 0.05)(9.20 ±3.06 mm,10.32 ± 2.76 mm and 0.2 ± 2.6 mm in Doppler,CTA and operation,respectively) All the 25 transplanted toes were survived.Conclusion CTA combined color Doppler image formation technology in thumb or finger reconstruction can objectively reflect the real situation of the vessels in donor sites,and the structural characteristics and classification of anatomy for individualized,and has important clinical value in preoperative foot blood supply assessment.

Chlorides ; metabolism ; Diarrhea ; congenital ; Humans

Objective To observe the accuracy of the five-level adult emergency triage system (FLAETS) in determining the severity of critically ill patients,and to analyze the factors that influenced the accuracy of the triage.Methods The triage information of patients admitted to Huashan North Hospital Affiliated to Fudan University between 1 year before and 1 year (started in July 2014) after the implementation of the FLAETS were retrospective analyzed.The patients who triaged by FLAETS (from September 2014 to August 2015) were served as observational group,and those manual triaged by modified early warning score (MEWS,from July 2013 to June 2014) were set as control group.The patients with triage of Ⅰ,Ⅱ,and Ⅲ levels were enrolled (fatal,critical,urgent),and the triage results of emergency physicians-in-chief on duty were set as gold standard.The gender,age,triage level,the proportion of over-triage,the proportion of under-triage,and mortality were compared between two groups.The reasons for the overtriage and under-triage were analyzed.The accuracy of FLAETS in determining severity of critically ill patients was calculated.Results 18449 patients were enrolled in observational group,and 720,1641 and 16088 patients were triaged as level Ⅰ,level ⅡⅡ,level Ⅲ respectively;17 378 patients were triaged as critically ill patients according to gold standard,and level Ⅰ,level Ⅱ,level Ⅲ were 637,1476 and 15 265 patients respectively.6 352 patients were enrolled in control group,and level Ⅰ,level Ⅱ,level Ⅲ were 204,771 and 5 377 patients respectively;6002 patients were triaged as critically ill patients according to gold standard,and level Ⅰ,level Ⅱ,level Ⅲ were 308,836 and 4 858 patients respectively.There were no statistically significant differences in gender and age between two groups (both P ＞ 0.05).Compared with the control group,the proportion of over-triage of level Ⅲ was significantly lowered [8.3％ (1 329/16088) vs.12.5％ (674/5 377),P ＜ 0.01],the proportion of under-triage of level Ⅱ and level Ⅲ was significantly lowered [level Ⅱ:0.6％ (9/1 641) vs.7.0％ (54/771),level Ⅲ:0.4％ (63/16088) vs.4.7％ (254/5 377),both P ＜ 0.01].The success rate of resuscitation in observation group was significantly higher than that of control group [80.70％ (619/767) vs.75.23％ (410/545),P =0.020],and the mortality was significantly lowered [1.11％ (193/17 378) vs.2.35％ (141/6002),P =0.037].Over-triages were mainly found in patients with chronic obstructive pulmonary disease (COPD),hypertension and the main complaint of chest tightness,shortness of breath,and under-triages were mainly found in patients with the multiple organ dysfunction in the elder,atypical heart disease and pneumothorax.The accuracy rates of level Ⅰ,level Ⅱ and level Ⅲ in observation group (99.37％,97.42％ and 89.58％) were significantly higher than those of the control group (97.51％,92.54％,and 80.16％,all P ＜ 0.01).Conclusion The FLAETS in determining severity of critically ill patients were objective and reliable,which enable the nurse to better handle the relationship of the emergency and the ordinary,the severe and the mild,the priority and the non-priority,which made the patients received timely and effective treatment.