[Summary] The controversy remains on whether the Oddi sphincter function should be preserved or deprived in the treatment of hepatolithiasis .The surgical approaches achieving both hepatobiliary lesions clearance and Oddi sphincter preservation have been widely accepted .The biliary-enterostomy is suspected to increase the risk of reflux cholangitis and cholangiocarcinoma due to iatrogenic Oddi sphincter deprivation.Endoscopic sphincterotomy (EST) as a minimally invasive method still needs further research to determine its role in hepatolithiasis management .

Objective To evaluate the effects of treatment with different fluids on systemic inflammatory response in newborn rabbits with septic shock. Methods One hundred New Zealand white rabbits (3-5 days, 45-70 kg) were randomly divided into 5 groups (n = 20 each):group Ⅰ sham operation (group S); group Ⅱ sepsis (group CLP); group Ⅲ lactated Ringer's solution (group R); group Ⅳ 6% HES (group HES) and group V (group R+ HES). The animals were anesthetized with intraperitoneal ketamine and midazolam. Sepsis was induced by cecal ligation and puncture (CLP). The animals in group R and HES received lactated Ringer's solution and 6% hydroxyethyl starch (HES) 30 ml/kg infused iv over 1 h respectively immediately after CLP,while group R+ HES received Ringer's solution 20 ml/kg and 6% HES 10 ml/kg. Nio fluid was infused in groups S and CLP. Carotid artery and jugular vein were cannulated for MAP monitoring, blood sampling and drug and fluid administration. MAP was recorded immediately (T1) and at 0.5, 1, 2, 4, 8 h (T2-6) after CLP. Arterial blood samples were collected at T6 for determination of plasma IL-6 and IL-10 concentrations. Results Compared with those at T1, MAP decreased significantly after CLP at T4-6 in group CLP and at T5.6 in group R but hypotension did not develop after CLP in group HES and R + HES. Plasma IL-6 concentration was significantly higher in group CLP and R than in group S. There was no significant difference in plasma IL-6 concentration between group S and group HES and R + HES. Plasma IL-10 concentration was significantly lower in group CLP and higher in group HES than in group S. There was no significant difference in plasma IL-10 concentration between group S and group R and R + HES. Plasma IL-6 concentration was significantly lower, while plasma IL-10 concentration was significantly higher in group R + HES and HES,and plasma IL-10 concentration was significantly higher in group R or6% HES infused iv alone in maintaining the balance between pro-and anti-inflammatory cytolines in newborn rabbits with septic shock.

Objective To further understand the etiology,definition,clinical manifestation,prognosis and treatment of cutaneous leukocytoclastic vasculitis.Method Retrospective study of23patients with leuko-cytoclastic vasculitis followed up at Peking Union Medical College Hospital from1990to2001.Results Twenty patients were classified as hypersensitive vasculitis,one of whom was diagnosed as Wegeners granulo-matosis2.5years later,two were diagnosed as urticarial vasculitis,and one was systemic lupus erythematosus.Conclusion Cutaneous leukocytoclastic vasculitis,which is usually a benign syndrome,may be caused by in-fection or drugs.Its main clinical manifestaions are skin symptoms.

BACKGROUND:The biological extracellular matrix materials become the focus of pelvic floor repair materials research because of its excellent biocompatibility and mechanical compatibility. However, bacterial infection can damage the function of biological repair materials. ＜br> OBJECTIVE:To prepare the biologic antimicrobial materials for pelvic tissue function repair. ＜br> METHODS:Chitosan and tigecycline-loaded chitosan nanoparticles suspension was prepared by the electrostatic adsorption and self-aggregation of nanoparticles preparation techniques. Then the suspension was coated onto the surface of extracellular matrix materials. The morphological examination was performed by scanning electron microscope. The antibacterial property was detected by solid plate microbial culture method. ＜br> RESULTS AND CONCLUSION:Infrared spectra displayed that aromatic ring skeleton vibration peak of chitosan occurred on the biologic antimicrobial materials, and it was significantly widened at about 3 359 cm-1, indicating the composite coating was successful to modify the surface of extracellular matrix materials. As a very smal dose of tigecycline, there was no characteristic absorption peak on the infrared spectra. Scanning electron microscopy showed the porous structure of the material surface with some nanoparticles adhesion. The prepared materials had good antibacterial properties on Staphylococcus aureus and Escherichia coli, and the inhibition zone diameter was significantly increased with the increasing concentration of antibacterial agent. The biologic antimicrobial materials for pelvic tissue function repair were prepared successful y.

0.05). Conclusions The upstream lesions of biliary tract must be dealt with thoroughly in the treatment of hepatolithiasis. EST should not be the first choice for hepatolithiasis preparatory to determining whether or not lesions like stricture are present in intrahepatic ducts.

Objective To explore rational and effective treatment strategies by comparing long-term effects of different treatment methods for hepatolithiasis. Methods One hundred and fifty-nine cases of hepatolithiasis treated in this hospital from January 1993 to December 2002 were analyzed retrospectively.Five treatment methods: conservative treatment,choledocholithotomy followed by choledochostomy,hepatolobectomy,hepaticojejunostomy,and hepaticoplasty with the conservation of the Oddi's sphincter,were compared in respect of postoperative complications and long-term outcomes.Results Out of the 159 cases,follow-up was completed in 146 cases(91.8%,146/159) for 2~12 years(median,7 years).Of 16 cases of conservative treatment,15 were followed.Cholangitis occurred in all the 15 cases,with 1 fatal case.Of 47 cases of extrahepatic surgical exploration,the incidence of residual stones was 100%.Follow-up in 43 cases found 32 cases of cholangitis(74.4%) with 7 fatal cases.Of 16 cases of hepatolobectomy,residual stones were noted in 3 cases(12.5%).Follow-up in 15 cases found 4 cases of cholangitis(26.7%) with 1 fatal case.Of 32 cases of hepaticojejunostomy,residual stones were found in 11 cases(34.4%).Follow-up in 29 cases found 14 cases of cholangitis(48.3%) with 3 fatal cases.Of 48 cases of sphincter-sparing operation,residual stones were found in 8 cases(16.7%).Follow-up in 44 cases found 7 cases of cholangitis(15.9%).The incidence of residual stones was significantly higher in cases of extrahepatic surgical exploration than in cases of other treatment(P=0.000).The recurrence rate of cholangitis was significantly higher in cases of conservative treatment and extrahepatic surgical exploration than in cases of other treatment(P

and each of the resistant strains was resistant at least to 5 antibiotics.13 strains out of the 28 harbored plasmids ranging from 1 to 6 in number and 105 Md to 2.7 Md in molecular weight.The plasmid with 50 Md was the most popular one in this study,which may be the epidemic plasmid in the urologic unit.It was also found that 2 different species of bacteria isloated from the patients with infection of the urinary tract showed identical plasmid profile,which indicates that these 2 patients may be associated with each other.

The aim of this study is to analyze how patients with chronic diseases from Shanghai interpret their disease, and how these interpretations influence patients' life satisfaction, intention to escape from their illness and their ability to reflect on the implications of their illness.

Objective To analyze the impact factors and their importance on academic reputation of medical research institutions in China.Methods Seventy medical researchers and 70 medical graduate students were selected by convenience sampling method.Brainstorming and expert consultation were applied to determine the 6 factors affecting the academic reputation of medical research institutions in China.A Face-to-face or e-mail interview was conducted using a designed questionnaire.Six affecting factors were nominated analyzed.Chi-square test was used to cross exam nominated rate and affecting factors;Bonferroni method was also applied to make paired comparisons.Results There is significant difference in nomination rates among 6 impact factors (P ＜ 0.001).Pairwise comparison showed that information obtained by academic exchange (70.49 ％) and the scientific understanding generated from research practice (67.21％) are top 2 impact factors to the medical research institutions;followed by all kinds of ranking list (44.26％),and the celebrity effect (42.62％).Conclusions Scientific communication and research practice are two most important factors affecting the academic reputation of medical research institutions in China.

Objective To detect the hypermucoviscosity phenotype , capsular serotype and virulence gene of Klebsiella pneumonia (K.pneumonia) from various kinds of clinical specimens and understand the characteristics of different K.pneumonia causing infections.Methods A retrospective study was conducted through collection of 178 K.pneumonia isolates from blood, sputum, bronchoalveolar lavage fluid , urine, normally sterilized fluid , puncture fluid from liver abscess and other abscesses between January 2010 and December 2012 in General Hospital of Chinese PLA.String test was carried out for detection of hypermucoviscosity phenotype.Capsular serotype and virulence gene ( rmpA) were checked by polymerase chain reaction.Analysis was made according to the hypermucoviscosity , capsular serotype , rmpA gene , as well as the sources of K.pneumoniae.Statistic data was analyzed by contingency table analysis and χ2 test.Results Eighty-three out of 178 ( 46.6%) strains of K.pneumonia were hypermucoviscous with positive string test, the positive rate of virulence gene rmpA was 92.8%(77/83).K1/K2/K57 capsular serotypes were the predominant serotypes in the group of puncture fluid from liver abscess and other abscesses (75.0%,27/36)than the group of blood (32.4%,12/37), urine(21.7%,5/23) and normally sterilized fluid(25.0%,5/20), and also more than in the group of sputum , bronchoalveolar lavage fluid (50.0%,22/44),χ2 =21.19,P<0.01.The positive rate of string test in the group of puncture fluid from liver abscess and other abscesses (77.8%, 28/36)was significantly higher than the group of blood (29.7%, 11/37), urine (30.4%, 7/23), or normally sterilized fluid (25.0%, 5/20),χ2 =27.90,P<0.01.The positive rate of rmpA gene in the isolates from puncture fluid of liver abscess and other abscesses was higher than other groups.Conclusions As the pathogens of various kinds of infections , mainly abscess and respiratory infection, hypermucoviscous strains of K.pneumonia were of great clinical significance.Capsular serotype K57, as well as K1 and K2, possessed hypermucoviscosity and hypervirulence in China.