Injury of choledocho-pancreatico-duodenal junction refers to the penetrating injury of the bile duct, pancrea-tic duct or duodenal wall in the region of ampulla of Vater. It is often caused by improper operation of surgical instruments, and may lead to leakage of bile, pancreatic or duodenal contents into retroperitoneal space and chemical corrosion in a wide range of retroperitoneal soft tissue, which result in severe secondary infection or even death. Leakage of contrast media, hypertrophy of tissue and anatomical changes were the evidences for injury of choledocho-pancreatico-duodenal junction. Injury of choledocho-pancreatico-duodenal junction can be. divided into 4 types, and treatment selected according to different types of injury is neces-sary for the prognosis of patients.

Hepatolithiasis is a common disease of abdominal surgery,although its incidence appears to decline,China is still a high incidence area with millions of patients with hepatolithiasis.Because of the complex pathogenesis,progressive development and frequent recurrence,it is seriously affecting physical and mental health of patients and quality of life,as well as difficult to define the diagnosis and select treatment methods for hepatolithiasis.The Guideline of the Diagnosis and Treatments of Hepatolithiasis and the Expert Consensus of the Laparoscopic Treatments of Hepatolithiasis (2013 edition) proposed a concise and practical classification system of the hepatolithiasis and summarized the principles of surgical treatments,which includedresecting the lesions,cleaning the stones,correcting the stricture,recovering the drainage and preventing the recurrence .Meanwhile,the application of laparoscopic technique in the treatments of bepatolithiasis was proposed,which played an important role to promote the standard diagnosis and treatments of hepatolithiasis in China.Recent years,more and more evidences from evidence-based medicine further proved the importance of the anatomical hepatectomy in the treatments of hepatolithiasis.With the soaring development of laparoscopic surgery,the combination of laparoscopic hepatectomy with the assistance of other endoscopies are applied more and more frequently.The concept of precise surgery also brings new vitality to the standard diagnosis and treatments of the hepatolithiasis.

Mesenchymal stem cells belong to multipotential stem cells, which is easy to isolate and culture. Many researchers have been exploring various ways to induce bone marrow mesenchymal stem cells into muscle cells. MSCs were induced into muscle cells by using biochemical and biomechanics approaches. These muscle cells could be used for such clinical applications, as treatment for ischemic cardiomyopathy and post-traumatic repair for muscular tissue. In this article we reviewed the research progress on induction of bone marrow mesenchymal stem cells into muscle cells and isolation, purification, and identification of MSC.

Objective To elevate the efficacy and complications of partial splenic embolization(PSE) using the alginate microglobe(AMG) as embolic material for hypersplenism in cirrhosis.Methods 42 patients with hypersplenism and cirrhosis were treated by PSE,AMG of 250～450 ?m were injected into the arteries of inferior splenic pole,the embolization degree was ranging from 40% to 70%.Results 42 times of embolization were performed in 42 patients,after operation, 35 patients had fever and lasted for 3~15 d,38 patients had abdominal pain,of them, 27 patients needed treatment with analgesic.Treatable a little hydrothorax appeared in 6 ,and no serious complication occurred.WBC and PLT counts were increased 24 hour later(P

Objective To evaluate the clinical efficacy, impacts on lung function and cytokines, and safety of azithromycin on the treatment for asthma. Methods Forty patients with asthma were randomized equally to receive azithromycin combined with inhaled cortisteroid (ICS) plus long-acting β_2-agonists (LABA), or only ICS plus LABA for 12 weeks. We evaluated the clinical efficacy including asthma control test scores and lung function, cytokines in induced-sputum including interleukin-4, interleukin-5 and interferon-γ, and the safety of azithromycin. Results After 12 weeks, asthma control test (ACT) scores and lung function were improved obviously, and concentrations of IL-4, IL-5 and IFN-γ in induced-sputum were reduced significantly in both groups. Comparing with the control group, the decline of cytokines in induced-sputum was much more significant in patients treated with azithromycin. No severe adverse events were found in both groups. Conclusions Azithromycin combined with ICS plus LABA is an effective and safe treatment for asthma, which could significantly reduce the level of cytokines elaborated from Th2-type cells in the airways.

Objective To develop a method for the determination of the dynamic parameters of interaction between methotrexate(MTX)enantiomer and dihydrofolate reductase(DHFR).Methods An affinity capillary electrophoresis(ACE)method was adopted.Using bare fused-silica capillary,the electrophoresis buffer was 50 mmoL/L sodium tetraborate with 0.2%Brij-35,pH 9.50.The temperature of separation was controlled at 25℃ and a voltage of 25 kV was applied.The separation of the reaction mixture was performed at a wavelength of 254 nm.The difference of peak areas about the product was used to calculate the inhibitory rate and IC50 values.Results We establish the detection method for the dynamic parameters of interaction between MTX enantioner and DHFR.The separation of the reaction mixture could be achieved within 30 min.The IC50 value of D-(-)-MTX and L-(+)-MTX were 3.17×10-7 and 2.48×10-8mol/L,respective.The IC50 value of the D-(-)-MTX was 31.67×10-8mol/L,the L-(+)-MTX was2.48×10-8mol/L.The IC50 value of the D-(-)-MTX was about 13 times higher than that of the L-(+)-MTX.Conclusions ACE is a rapid.simple and accurate method that can be used to monitor DHFRdynamic reaction.The IC50 values of MTX enantiomer were quite different.The result first indicated that reaction between MTX enantiomer and DHFR had three-dimensional selection.

Objective　To explore the relationship between te lomerase activity and bile duct carcinoma and its significance in clinical diag nosis. Methods　Telomerase activities were examined in 23 cases of bile duct carcinoma, 5 cases of carcinoma adjacent tissues and 5 cases of nor mal bile duct tissues respectively with telomerase PCR-ELISA method. Results　Telomerase activity was detected in 18 of 23 cases (78.3%) of b ile duct carcinoma, and was not found in 5 cases of carcinoma adjacent tissues a nd 5 cases of normal bile duct tissues. The detection rate of telomerase activit y had no correlation with patients' age, sex, tumor site and size but significan tly correlated to metastasis of tumor (P<0.05). Conclusion　The level of telomerase activity was significantly higher in bile duct carcino ma and may be served as one of the clinical marker for malignant neoplasm becaus e of its spsecificity.

OBJECTIVE:To observe the efficacy and safety of Shexiang zhenggu tincture combined with Huoxue zhitong pow-der in the treatment of acute traumatic swelling and pain. METHODS:Totally 160 patients with acute traumatic swelling and pain were randomly divided into group A and group B. Patients in group A were given Shexiangzhenggu tincture for external use,3 times a day;patients in group B were orally added one bag of Huoxue zhitong powder,3 times a day,based on the treatment of control group. 7 d was course and it lasted 2 courses. The clinical efficacy,the scores of visual analogue pain score (VAS) and swelling remission before and after 7 and 14 d treatment and the incidence of ADR were observed. RESULTS:After 7 d treatment, the total effective rate in group A was significantly higher than group B,with significant difference(P<0.05);after 14 d treat-ment,there was no significant difference in the total effective rate between 2 groups (P>0.05). After 7 and 14 d,the scores of VAS and swelling remission were significantly lower than before;14 d treatment was lower than 7 d treatment,and group B was significantly lower than group A after 7 d treatment,with significant differences (P<0.05);there were no significant differences among the scores of VAS and swelling remission in 2 groups after 14 d treatment (P>0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Shexiang zhenggu tincture combined with Huoxue zhitong powder has better efficacy, can relieve the pain and swelling faster,with similar safety.

Objective To observe the feasibility and safety of carotid artery stenting(CAS) for treating the patients with symptomatic carotid artery stenosis.Methods 60 patients who were diagnosed with symptomatic carotid artery stenosis by DSA were performed CAS.Among them, 52 cases were onset stenosis of carotid artery,8 cases were extracanical stenosis.The degree of stenosis was 50%～70% in 14 patients,70%～90% in 28 patients and≥90% in 18 patients.64 stents were placed,and 15 filter protection devices were used.Results The drgree of stenosis was decreased from (73.4?9.5)% to (12.5?8.2)%. The plaques were disappear in 53 cases, many debris were found in 5 filter protection divices. The clinical symptoms of all patients were disappear within one week, the mild paralyse was recover in all patients. There were 53 cases with heart rate slowdown during or after operation,the blood pressure declined in 48 cases,and there were 5 patients with vasospasm, as well as one case with cerebral embolization,one case with sydrome of high perfusion and one case with sydrome of low perfusion or swoon. During flowing up for 3 months to 2 years,no one case was found TIA or cerebral infarction,however,only one case was found mild restenosis by DSA.Conclusions CAS is a safety and efficient method for treatment symptomatic carotid artery stenosis. Lowering the risk of operation is done by handling indication seriously and operation skillfully.