The precise surgical treatment for hepatobiliary diseases has been a challenging topic in hepatobiliary surgery for a long time.A perfect preoperative plan can help the surgeon make R0 resection of the lesion and preserve the healthy tissue as much as possible.In addition,all of these depend on the application of different imaging modalities,especially three-dimensional reconstruction technique.But some limitations of 3D reconstruction should be noted:different surgeons may have different views for one object because of different observation points;or it cannot be used for intraoperative re-orientation and so on.3D printed model can overcome some disadvantages of 3D reconstruction.This paper reviewed related literature that reported the usage of 3D printed model in hepatobiliary surgery.

Objective To discuss the effect of damage control applied for an earthquake pelvic fracture. Methods One case of pelvic fracture in the 5.12 Wenchuan earthquake was treated by damage control in May, 2008. The patient was managed with anti-shock measures and temporal fixation of fracture in the first stage and minimally invasive surgery under fluoro-navigation system in the second stage. Results After two-stage damage control, the patient obtained stable vital signs, satisfactory reduction and internal fixation with no complications. Conclusion Damage control strategy for the earthquake pelvic fractures can improve the survival of patients and decrease their complications.

Objective To study the surgical treatment and the related risk factors of cholangioenterostomy anastomotic stenosis.Methods We retrospectively analysed the clinical data of 41 patients who underwent surgical treatment for cholangioenterostomy anastomotic stenosis in the PLA General Hospital from January 1,2008 to November 30,2014.Results All patients' clinical symptoms were alleviated and they were discharged home.No one died perioperatively.Anastomotic restenosis happened in 5 patients.Conclusions Reoperation for cholangioenterostomy anastomotic stenosis was difficult.The surgeon should make the anastomosis as large as possible to decrease the risk of restenosis.A T tube should be used when necessary.

Objective To explore the etiology and clinical prevention regime for hepatitis B virus reinfection in patients after orthotopic liver transplantation. Methods One hundred and twenty eight orthotopic liver transplantation recipients with hepatitis B virus related end-stage liver diseases were analyzed retrospectively. The patients' primary diseases included chronic fulminant hepatitis B, end-stage liver cirrhosis and liver carcinoma. All the patients were given lamivudine pre-transplantation to prevent hepatitis B virus reinfection. Single lamivudine was administered post-transplantation in 3 cases; lamivudine combined with hepatitis B immunoglobulin were given in 125 cases. Adefovir dipivoxil was administered to the patients with hepatitis B virus reinfection. All the patients were followed-up for 3～48 months. Results Two out of the three patients who received single lamivudine developed hepatitis B virus reinfection. The reinfection occurred in one patient 6 months after orthotopic liver transplantation, and the other patient was found to be reinfected 9 months after transplantation. Five out of the 125 patients who received lamivudine and hepatitis B immunoglobulin (small dosage) developed hepatitis B virus reinfection. To 3 patients with hepatitis B virus reinfection adefovir dipivoxil was given, and hepatitis B virus-DNA negative conversion was observed after three months of treatment. Conclusions Treatment with lamivudine and low dose of hepatitis B immunoglobulin post-transplantation may offer an effective prevention against hepatitis B virus reinfection. Adefovir dipivoxil is effective for patients with reinfection of hepatitis B virus by suppressing its variant replication.

Objective To understand medical students on the awareness level, attitude , behavior and requirement of professional bilingual teaching, so as to provide reference for bilingual teaching. Methods A self- administered was conducted among medical students from different speciality. Results There was a significant difference in awareness level of professional bilingual teaching between nursing students and clinical medicine students (χ2=4.95, P<0.05). Majority students (81.3%) supported carring out bilingual teaching. Teachers and students' foreign language level, selection of bilingual textbook, teaching mode and environment of bilingual teaching are the main influencing factors on earring out professional bilingual teaching. Conclusion Professional bilingual teaching should be implemented designedly, selectively and systematically according to practice condition of different speciality and different subject.

Objective To investigate the effect of dexmedetomidine combined with ulinastatin on postoperative delirium in elderly patients undergoing resection of gastrointestinal tumor. Methods A total of 180 elderly patients (97 males,83 females,aged 65-80 years,ASA grade Ⅱ orⅢ)who underwent laparoscopic surgery for gastrointestinal tumor,were randomized into four groups (n =45 each):dexmedetomidine group (group D),ulinastatin group (group U),dexmedetomidine+ulinastatin group (group DU)and control group (group C).Patients in group D were given a loading dosage of dexmedetomidine 0.5 μg/kg intravenously 1 5 min before the induction of general anesthesia,followed by a continuous infusion of 0.3 μg·kg-1 ·h-1 ,and dexmedetomidine was ad-ministered till 40 min before the end of surgery.Patients in the group U were given a loading dosage of ulinastatin 10 000 U/kg intravenously in 20 min.In group DU,dexmedetomidine and ulinastatin were administered in accordance in group D and group U respectively.Patients in group C were given 0.9% saline solution.The volume of blood loss,the time of operation and recovery,the adverse reac-tions after surgery were recorded.The concentration of dopamine (DA),adrenaline (AD),norepi-nephrine (NE)were measured within the preoperative 1 d (T0 ),within the first hour of surgery (T1 ),within the postoperative 1 d (T2 ),2 d (T3 ),3 d (T4 ).The confusion assessment method Chi-nese reversion (CAM-CR)was used to screen POD on T0 ,T2-T4 .Results The levels of DA,AD and NE in the group C and group U at T1-T4 significantly elevated than those at T0 (P <0.05);the levels of DA at T1 and the levels of AD at T1 ,T2 in group D and group DU significantly elevated than those at T0 (P <0.05).The levels of DA,AD at T3 ,T4 and the levels of NE at T1-T4 in group D and group DU were significantly reduced compared with those in the group C and group D (P <0.05 ). Compared with the group C,the incidence of POD was significantly reduced in the group D,group U and group DU (P <0.05).Among the three groups (D,U and DU),the difference were not statisti-cally significant in the incidence of POD.Conclusion Dexmedetomidine or ulinastatin may reduce the rate of POD in elderly patients undergoing laparoscopic surgery for gastrointestinal tumor.Compared with the administration of ulinastatin or dexmedetomidine alone,combined application of dexmedeto-midine and ulinastatin does not reduce the incidence of POD.

Objective To investigate the effects of different concentrations of sevoflurane on Survivin expression in human adenocarcinoma cell line A549. Methods A549 cells were obtained from Shanghai Cell Biology Medical Research Institute, Chinese Academy of Sciences and inoculated in 96 well culture plate. After being cultured for 24 h, the cells were randomly divided into 4 groups: Ⅰ , Ⅱ , Ⅲ and Ⅳ groups exposed to 95 % O2 -5 %CO2,1.7%, 3.4% and 5.1% sevoflurane respectively. A549 cells were exposed to sevoflurane for 2, 4 and 6 h respectively and then cultured for another 48 h in Ⅱ , Ⅲ and Ⅳ groups. Proliferation of A549 cells were measured by methyl thiazolyl tetrazolium (MTT) assay, and apoptosis was detected with flow cytometer at 48 h after 2, 4 and 6 h sevoflurane exposure. The expression of Survivin in A549 cells was determined by Western blot analysis at 48h after 4 h sevoflurane exposure. Results The rate of proliferation inhibition and percentage of apoptotic cells were significantly higher while the expression of Survivin was significantly lower in a concentration-dependent manner in Ⅱ , Ⅲ and Ⅳ groups as compared with group Ⅰ . Conclusion Sevoflurane can inhibit proliferation and induce apoptosis of A549 cells by inhibition of Survivin expression.

Objective To investigate the effects of isoflurane and sevonumne on apoptosis and expression of CD44 and CD54 in human lung cancer cell line A549.Methods Human lung cancer A549 cells were obtained from Shanghai Cell Biology Medical Research Institute,Chinese Academy of Sciences,and inoculated in 24 well culture plate.After being cultured for 24 h the cells were randomly divided into 3 groups:group Ⅰ control(group C);group Ⅱ isoflurane (group Iso) and group Ⅲ sevoflurane (group Sev).A 549 cells were exposed to 1.7% isoflurane and 2.5%sevoflurane for 4 h respectively in group Iso and Sev respectively,and were then cultured for another 24 h.Apoptosis and expression of CD44 and CD54 in A549 cells were detected with flow cytometer at 0 (T0),2 h(T1) and 4 h(T2) of and 24 h after(T3) exposure to isoflurane and sevoflurane.Results The percentage of apoptotic cells wag significantly higher at T2 and T3 in group Iso than in group C.The percentage of apoptotic cells was significantly higher at T1,T2 and T3 in group Sev than in group Iso and C.The expression of CD44 and CD54 at T1,T2 and T3 was significantly decreased as compared with the baseline at T0 in group Iso and Sev and was significantly lower in group Iso and Sev than in group C.Conclusion Isoflurane and sevoflurane can induce apoptesis of human lung cancer cell line A549, and sevoflurane is more effective. Isoflurane and sevoflurane can inhibit the expression of CD44 and CD54 of human lung cancer cell line A549.

Objective To discuss the value of preoperative C-reactive protein (CRP) and eryth-rocyte sedimentation rate (ESR) in predicting postoperative infections following multiple fractures. Methods A study was conducted in 78 patients with multiple fractures (complicated with pelvic frac-ture, ISS > 18) treated in our department from December 2006 to March 2009. CRP and ESR levels be-fore second damage control operation as well as postoperative infections were recorded. Meanwhile, the optimal cut-off value was determined by receiver operating characteristic curve and analyzed. Results There were 11 patients with postoperative infection. The preoperative optimal cut-off value of CRP was 50 mg/L, with a sensitivity of 0.909 and a specificity of 0.821. The preoperative optimal cut-off value of ESR was 27.5 mm/h, with a sensitivity of 0.818 and a specificity of 0.791. The combination tests showed the sensitivity and specificity of 0.875 and 0.900 respectively. Conclusion CRP (50 mg/L) can be a sensitive predictive index for postoperative infection in the multiple fractures (complicated with pelvic fractures). Combination test of CRP and ESR can benefit diagnosis of postoperative infection.

ObjectiveTo investigate the effects of sevoflurane on inhibition of invasive activity and migration of human adenocarcinoma cell line A549 by cisplatin.MethodsThe.human lung adenocarcinoma cell line A549 was obtained from Shanghai Cell Biology Institute,Chinese Academy of Sciences and cultured in RPMI 1640 culture medium containing 10％ fetal calf serum.The cells were inoculated in culture plate and cultured for 24 h and randomly divided into 4 groups:control group; 2.5 ％ sevoflurane group ; cisplatin group and cisplatin + 2.5 ％sevoflurane group.In groups sevoflurane,cisplatin and cisplatin + sevoflurane the cells were exposed to 2.5％sevoflurane or/and cisplatin 10μmol/L for 4 h respectively.The invasive activity of the cells was evaluated by Transwell chamber assay.The migration of the cells was determined by wound healing assay.The expression of MMP-2,MMP-9,Ezrin,and Fascin in the cells was detected by Western blot.ResultsBoth 2.5％ sevoflurane and cisplatin depressed invasive activity and migration of the A549 cells and down-regulated MMP-2,MMP-9,Ezrin and Fascin expression in A549 cells.The inhibitory effects of cisplatin on the A549 cells were potentiated by 2.5 ％ sevoflurane.ConclusionSevoflurane can enhance the inhibition of invasive activity and migration of human adenocarcinoma cell line A549 by cisplatin.