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.

Objective To explore the purifying effects of clean bottling workshop in jugged or bottled drinking water manufacturing enterprise in Wuhan. Methods 32 manufacturing enterprises were sampled to test the purifying levels of bottling workshops according to GB50073-2001 The Criterion for Purifying Workshop Design, GB/T16294-1996 Detecting Method for Suspended Particle in Clean Shop or Area of Medical Industry and GB/T16249-1996 Testing Method for Sedimentation Bacteria in Clean Room or Area of Medical Industry. The microorganism determination was based on GB17324-1998 The Hygiene Standard for Bottled Drinking Pure water and GB8537-1995 The Hygiene Standard for Drinking Natural Mineral water and CJ94-1999 The Hygiene Standard for Bottled Drinking Water. Results The qualified rate was 78.1% for the count of dust in air and 81.3% for the count of bacteria in air of bottling workshops of 32 manufacturing enterprises.Among 32 manufacturing enterprises, 25(78.2%) and 8(25%) enterprises accorded with the requirement of 10 000 and 1 000 purifying level of air in whole bottling workshop respectively,only 2 accorded with the requirement of 100 purifying level of air at product line in bottling workshop. The qualified rate was 84.4% for temperature,light,noise,87.5% for flow rate, 46.9% for relative humidity, 34.4% for air pressure difference between indoor and outdoor.After the performance of sanitary management, the qualified rate of microorganism in barrelled water increased from 61.1% in 2001 to 84.1% in 2002. Conclusion The application air cleaning facility in bottling workshop of jugged or bottled drinking water manufacturing enterprise can improve the sanitary quality of microorganism in barrelled water.

Objective To investigate the clinical application value of fluorescence PCR in vitro diagnosis(IVD)reagent kits in the HLA-B27 detection by comparing 2 kinds of HLA-B27 IVD reagent kit approved by CFDA.Methods A total of 573 clinical blood samples were collected and detected for HLA-B27 by the approved reagent kits based on the fluorescence PCR technique and the flow cytometry.The samples with inconsistent testing results by the two kits were further confirmed by the PCR sequencing.At the same time,about 5% samples of the positive results detected by the fluorescence PCR method were extracted for conducting the re-testing.Results Among 573 samples,191 samples were HLA-B27 positive and 382 cases were HLA-B27 negative by flow cytome-try;the same samples had 194 cases of HLA-B27 positive and 379 cases of HLA-B27 negative by real-time PCR.With flow cytome-try as reference of the final results,the positive coincidence rate of the two kinds of kit was 96.33%(184/191),the negative coinci-dence rate was 94.76%(362/382),27 samples had inconsistent results from the two kinds of assay(accounting for 4.71% of the to-tal number of samples),the total coincidence rate was 95.29% [(184+362)/573],the Kappa value was 0.896(P =0.02);the chi-square test P =0.021,the two kinds of testing method had the high consistency,but the differences existed in the testing results. The re-testing results by PCR sequencing(including 27 samples with inconsistent results by two kinds of kit)were entirely consist-ent with the fluorescence PCR testing results.Conclusion Compared with the authority method flow cytometry for HLA-B27 tes-ting in clinic,the fluorescence PCR kit may present more accurate judging ability for the HLA-B27 testing on the basis of ensuring the higher consistency of the testing results,is easier compared with the sample preparation and operating procedures,and has the stronger clinical application value and prospects s.

OBJECTIVE: To observe the influence of Xiaotan Sanjie Recipe on growth of the transplanted tumor and expressions of proliferating cell nuclear antigen (PCNA) and epidermal growth factor receptor (EGFR) in tissue of the gastric carcinoma of nude mice, and to explore the mechanism of Xiaotan Sanjie Recipe in restraining the multiplication of the stomach cancer. METHODS: MKN-45 gastric carcinoma model in nude mice was established. Forty-five nude mice were randomly divided into control group, Xiaotan Sanjie group and 5-fluorouracil (5-FU) group. Drugs were given on the next day of inoculation. Mice in the control group were given normal saline, and mice in the Xiaotan Sanjie group were given Xiaotan Sanjie Recipe. Intraperitoneal injection of 5-FU was administered in the 5-FU group. The expressions of PCNA and EGFR were examined by using streptavidin peroxidase (SP) conjugate technique, and the tumor weight and pathological characteristics were also observed. RESULTS: Compared with the control group, Xiaotan Sanjie Recipe significantly restrained the growth of the transplanted tumor, and reduced the expressions of PCNA and EGFR in tissue of the gastric carcinoma of nude mice (P<0.05). CONCLUSION: Xiaotan Sanjie Recipe can disturb the synthesis of DNA and reduce the proliferous activity of cancer cells by decreasing the expressions of PCNA and EGFR.

Objective To investigate incidence,risk factors and the prevention strategy of local recurrence 6 months after surgery for metastatic bone tumors.Methods Data of 797 patients who had undergone operations for metastatic bone tumors from March 1997 to March 2012 were retrospectively analyzed.Sixty-three patients (7.9％) who had local recurrence 6 months after operation were enrolled in the recurrence group,including 40 males and 23 females,and the average age at the time of operation was 55.21 years.Seven hundred thirty-four patients were enrolled in the non-recurrence group,including 432 males and 302 females,with an average age of 56.49 years.The risk factors for local recurrence 6 months after operation for metastatic bone tumors were statistically analyzed.Results The statistical analysis showed the risk factors for local tumor recurrence 6 months after surgery for metastatic bone tumors included preoperative general condition (10.9％ vs 6.2％),the rate of progress of the primary tumor (10.1％ vs 6.1％),site of bone metastasis (9.1％ vs 3.9％),surgical method (11.4％ vs 6.4％),whether local radiotherapy was performed preoperatively (28.0％ vs 6.6％),whether local radiotherapy was performed postoperatively (8.7％ vs 2.8％),whether sensitive systemic therapy was performed preoperatively (12.2％ vs 6.1％),whether sensitive systemic therapy was performed postoperatively (10.3％ vs 5.6％) and whether local therapy was performed in primary tumor site (10.1％ vs 5.8％).Multivariate analysis showed the independent risk factors included preoperative general condition (OR=0.534),rate of progress of the primary tumor (OR=2.164),site of bone metastasis (OR=2.906),whether local radiotherapy was performed preoperatively (OR=3.184),whether sensitive systemic therapy was performed preoperatively (OR=2.344) and whether sensitive systemic therapy was performed postoperatively (OR =0.468).Conclusion When the patients has following conditions:poor preoperative general condition,fast progressive primary tumor,metastatic tumor in the axial skeleton,application of local radiotherapy preoperatively,and application of sensitive systemic therapy,the surgical treatment should be chosen cautiously.

Objective To evaluate the effect of surgical treatment in facial nerve paralysis.Methods Clinical data of 29 cases in facial nerve paralysis were retrospectively analyzed.All of the 29 cases of facial paralysis,18 cases is the suppurative otitis media,9 cases is the temporal bone fracture,2 cases is the neoplasms of the temporal bone.The 29 cases of facial nerve paralysis were surgical treatment.8 cases by vertical segment or horizontal segment of facial nerve decompression,19 cases by the stylomastoid foramen to the geniculate ganglion of facial nerve decompression,2 cases by the itratemporal course of facial nerve decompression.1 case was underwent end-to-end anastomosis,2 cases of the greater auricular or the sural nerve graft for repairing facial nerve defect.All data were analyzed with Rank sum test.Results Makes a follow-up visit for 6～18 months,the facial nerve function(House-Brackman grading system)before the technique Ⅱ 6.9%,Ⅲ17.2%,Ⅳ34.5%,Ⅴ 31.0%,Ⅵ 10.3%,after the technique,restores Ⅰ 6.9%,Ⅱ27.6%,Ⅲ27.6%,Ⅳ 24.1%,Ⅴ 13.8%,statistics analysis facial nerve function restoreS has the significance difference(P＜0.005).Conclusions The facial nerve decompression and the nerve graft are useful method to treat facial paralysis.Surgical treatment of facial paralysis is satisfied in the suppurative otitis media and the temporal bone fracture.

Dedifferentiated chondrosarcoma(DDCS)comprises approximately 10%of all chondrosarcomas and has the worst outcome with a 5-year survival of 10%.The preferred localizations are the femur,humerus and pelvis.DDCS represents a special form of chondrosarcoma characterized by the presence of well-differentiated cartilaginous component in juxtaposition with malignant mesenchymal tumor of high-malignancy grade.The diagnosis of DDCS is highly complicated,requiring detailed radiological and histopathological evaluation as well as precise bioptic technique.The dedifferentiated component is typically a high-grade sarcoma(usually grade 3 or 4),which can be either an osteosarcoma,a malignant fibrous histiocytoma or an anaplastic spindle cell sarcoma.In approximately one-third of the radiographs,one-third of the MR images,and one-half of the CT scans, the tumors demonskates bimorphic features.Recently,array-based comparative genomic hybridization(array-CGH)studies have been performed on frozen chondrosarcoma(including DDCS)specimens.There is a statistically significant association between high-grade tumor(grade Ⅲ and dedifferent ated)and the recurrent genetic deletions at 5q14.2～q21.3,6q16～q25.3,9p24.2～q12,and 9p21.3.One of the most commonly deleted regions of DDCS involved chromosome 9.Earlier investigations of DDCS showed p53 mutation and p53-LOH in the anaplastic component.It is also accompanied by Rt-LOH.P161NK4 and E-cadherin promotor methylation were observed in the low grade chondroid compartment of DDCS.While p161NK4,FHIT,and E-cadherin were methylated in highly malignant osteosarcomatous compartment of the tumor.Surgical resection of the tumor within wide or radical margins is the most important treatment.The value of neoadjuvant or adjuvant therapy remain uncertain.Several new drug targets have been identified and phase Ⅱ studies are currently ongoing.Current phase Ⅱ trials open for DDCS patients used the following medicine:apomab(proapoptotic selective agonist of Ap02L/TRAIL death receptor),perifosine(serine/threonine kinase Akt inhibitor),dasatinib(multitargeted small-molecule tyrosine kinase inhibitor),and the combination of gemcitabine and docetaxel.More recently,several phase Ⅰ studies have reported incidental responses of DDCS to newer targeted agents,such as histone deacetylase and vascular endothelial growth factor antisense oligodeoxynucleotide.The prognosis for patients with DDCS remains poor. The poor prognosis of the DDCS is determined by nonchondroid high grade component caused by invasive growth and formation of metastases.Therefore,early diagnosis and prompt surgical treatment may improve the outcome.

Cao reported that melagenine extracted from human placenta was effective in the clinical treatment of vitiligo, to elucidate the possible mechanism involved, melagenine and placenta peptide were added to melanocytes in the culture, and the culture without melagenine as control. The results obtained by MTT showed that melagenine can stimulate melanoeyte proliferation, its promoting rate was 42.5%, while placenta peptide got a promoting rate of 5.9%, the difference was significant (P

Objective To examine the effect of endotoxin on myocardial lipid metabolism and determine it′s possible mechanism Methods Sixty nine male Wistar rats (350 450g) were randomly divided into 2 groups: in vivo group and in vitro group In in vivo group endotoxin 0 1?g?kg -1 (small dose)or 1mg?kg -1 (large dose) was injected intrabdominally 3h after endotoxin administration the animals were anesthetized Heart was excised and passively perfused in a Laugendorff apparatus with oxygenated Krebs Heuseleit buffer at 37℃ Non esterified fatty acids (NEFA)and triacylglycerols(TAG) were used as energy supplying substance when the isolated heart had been stabilized for 15min NEFA or TAG was slowly added to the perfusate circuit 1 ml of perfusate was drawn every 10 min until the end of experiment (80 min ) for determination of the effects of endotoxin on NEFA or TAG oxidation and utilization by isolated heart At the end of experiment heart was harvested and frozen for measurement of myocardial lipids and lipoprotein lipase activity In in vitro group endotoxin was added to perfusate (1mg/ml) after the heart was excised and passively perfused In control group endotoxin was replaced by normal saline Results Large dose of endotoxin administered in vivo decreased NEFA oxidation rate by 30% in perfused isolated heart and caused increased accumulation of lipid in myocardial tissue By contrast endotoxin administered in vitro increased oxidation rate of TAG accompanied by an increase in myocardial lipoprotein lipase activity Administration of endotoxin in vivo and in vitro also caused accumulation of various exogenous lipids in myocardium in both NEFA and TAG perfused heart Conclusions This study shows that endotoxin has a significant effect on myocardial lipid metabolism The effect of endotoxin could be either direct or indirect according to the different lipids available

Objective To anatomically reconstruct massive bone deficiency w it h prosthesis-devitalized bone composites after bone tumor resection. Methods Fr om July 1997 to December 2000, twenty-four patients with malignant bone tumor we re treated with a limb salvage procedure including wide tissue resection and rec onstruction. The resected bone were debrided of gross tumor tissues, and treated with 200 g/L saline for 30 minutes and 95% alcohol for 20 minutes, then the dev italized bone was implanted back to resection sites. Eleven diaphysis defects we re reconstructed with devitalized bone fixed with interlocked intramedullary nai ling, the other 13 defects were reconstructed with prosthesis-devitalized bone c omposites. Results The mean follow-up period was two and half years. One patient s had nonunion at the graft-host junction. There were only two patients(9%) dev eloping local recurrence in half to two years after the surgery. These indicate that this method can be accepted by the limb salvage protocol. Conclusion Prosth esis devitalized bone composite enabled surgeons to reconstruct massive bone def iciency after bone tumor resection. Compared with allografts, devitalized bone h as the following advantages: 1) This technique reduces the rate of nonunion; 2) This technique also reduces the rate of local infection; 3) This technique reduc es the cost; 4) Few absorption has been found in devitalized bone at the last fo llow up. Immersion within 200 g/L saline then after 95% alcohol provides thoroug h devitalization of tumor hosting bone.