Objective To discuss the clinical application of lapraroscopic subtotal cholecystectomy in the acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.Methods Retrospective analysis of the clinical data,surgical approaches,and short term and long term complications of 74 cases of acute cholecystitis in the period from January 2002 to September2005 in our hospital.Results In the 74 cases operated by subtotal cholecystectomy using laparoscopy,during laparoscopic procedure,71(95.9%) operations were successful;a case of Mirizzi syndrome could not be confirmed to have the residual stones in cystic duct and another case of the same syndrome was not confirmed to have the duodenum fistula.These two cases were then dealt with by conventional surgery and constituted 2.7% of the total cases.One case was dealtd with by second surgery because of the residual stones of cystic duct after lapraroscopic subtotal cholecystectomy and constituted 1.3% of the total cases.One case was found with minor bile leakage and constituted 1.3% of the total cases.Cholangiography was conducted 41 cases during operation,of whom,39 cases were normal and 2 cases failed.No death occurred with the operation of the lapraroscopic subtotal cholecystectomy.Conclusion It is safe and effective to apply laparoscopic subtotal cholecystectomy to treat acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.

Objective To investigate the changes of liver function and white blood cell of patients with liver cirrhosis,portal hypertension and secondary hypersplenism underwent laparoscopic splenectomy(LS) and open splenectomy(OS).Methods We analyzed 76 clinical data of patients with liver cirrhosis,portal hypertension and secondary hypersplenism,among those 27 underwent LS,49 OS from Mar 2003 to Mar 2006 retrospectively.Blood samples were obtained and analyzed preoperatively and postoperatively on days 1,3, and 7,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),directed bilirubin(DBil) and white blood cell(WBC).Results Between LS and OS,the serum levels of Tbil and Dbil had significant difference on the 1st postoperative day(P

Objective To explore diagnosis and treatment of biliary hypoplasia with huge choledochal cyst in infants.Methods From Feb 2003 to Dec 2011,278 choledochal cyst cases were treated in our hospital.There were 3 infant cases of biliary hypoplasia with huge extrahepatic choledochal cyst diagnosed and treated during this period.All patients underwent cholangiogram demonstrating patent,but markedly diminutive extrahepatic biliary structures.After excision of the cyst,hepatic duct was injured in 1 case.The cyst wall was removed,a stent was put inside of hepatic duct,and Roux-en-Y hepaticojejunostomy was porformed.Results All three patients (ages from 1 month to two months) received the Roux-en-Y hepaticojejunostomy,none of our patients has developed stenosis and fistula of the Roux-en-Y hepaticojejunostomy.Intraoperative cholangiogram showed the huge choledochal cyst and diminutive intrahepatic ducts.All three cases were followed-up for 1-5 years,there was no jaundice and nor stones formation.Conclusions In cases of huge choledochal cyst when intraoperative cholangiogram demonstrates a diminutive biliary tree with huge choledochal cyst,great care is required during cyst excision in order not to injury the hepatic duct.Stent placement into hepatic duct helps bile flow at early stage after surgery.

Purpose To study the values of liver histopathological assessment grading score in differential diagnosis between biliary atresia ( BA) and infantile hepatitis ( IHS) . Methods Thirty four cases of BA and sixteen cases of IHS were analyzed retrospectively, which were diagnosed by biopsy. A hepatic histopathological assessment grading score was developed. This consisted of eight features such as cholestasis, hepatocellular damage, bile duct proliferation, portal edema, portal inflammation, portal fibrosis, extramedullary hemopoiesis and multinucleated giant hepatocytes. The total scores were 24 points. All the cases were assessed one by one. Results The total scores of BA were significantly higher than that of IHS (P<0. 001). The frequencies of bile duct proliferation, portal fibrosis and portal edema were significantly higher in BA than that in IHS group, while the frequency of multinucleated giant hepatocytes was significantly higher in IHS than that in BA group. Conclusions This scoring system is helpful in differentiating BA from IHS.

Objective To explore the correlation of the gene polymorphism of the two single nucleotide polymorphisms(SNPs)rs1443434andrs925489onforkheadboxEl(FOXE1)withthehighnormalthyroidstimulating hormone ( TSH) level in Chinese Han population. Methods 1 400 subjects with normal serum TSH and thyroid peroxidase antibody(TPOAb) levels were included. According to TSH or TPOAb levels, the subjects were divided into high normal TSH group(H-TSH group,n=195) and normal TSH control group(TSH control group,n=1 205) or high normal TPOAb group ( H-TPOAb group, n=711 ) and low normal TPOAb group ( L-TPOAb group, n=689 ) , respectively. The genotypes on the two SNPs of all the subjects were performed by whole-genome genotyping chips. Results There were significant differences in rs925489 genotypic distributions and allele frequencies between H-TSH group and TSH control group(both P<0. 05). The genotype TT and allele T in H-TSH group were significantly higher than those in TSH control group(89. 75% vs 83. 15%, 94. 62% vs 91. 29%). The normal TSH levels were positively associated with rs925489 genotypic distributions after adjustment for sex, age, and high density lipoprotein cholesterol(P<0. 01). There were no significant differences in rs1443434 genotypic distributions and allele frequencies between two TSH groups or two TPOAb groups. Conclusion FOXE1 rs925489 gene polymorphism may be correlated with the high normal TSH level in Chinese Han population.

Objective: Our aim was to investigate the alteration of p16 gene in human pancreatic carcinoma. Methods: A total of 66 human pancreatic tissue specimens, comprising 51 with pancreatic carcinomas and 15 normal pancreatic tissue specimens, were examined for homozygous deletion and mutation of p16 gene by using PCR-SSCP method. Results: No mutation and deletion was detected in 15 normal pancreatic tissue samples. Of 51 pancreatic carcinoma specimens, only one was found mutation for p16 gene in PCR-SSCP assay, and the deletion of the p16 gene in 23 samples were confirmed by using PCR, with a 45% p16 gene deletion rate. Conclusion: These data suggest that p16 gene alterations may play a role in the progression of human pancreatic carcinoma.

Karacoline is a compound found in the plant Aconitum kusnezoffii Reichb. Although Aconitum kusnezoffii Reichb is widely used for the treatment of pain, very few studies have been carried out on the use of karacoline due to its potential toxicity. In this study, we selected key matrix metalloproteinases (MMPs), collagen II, and aggrecan as targets due to their association with intervertebral disc degeneration (IDD). Using these targets, we then used network pharmacology to predict a series of molecules that might exert therapeutic effects on IDD. Of these molecules, karacoline was predicted to have the best effect. Tumor necrosis factor (TNF)-αis known to promote the degeneration of the extracellular matrix in IDD. We therefore applied different concentrations of karacoline (0, 1.25, or 12.88μM) along with 100 ng/mL TNF-αto rat nucleus pulposus cells and found that karacoline reduced the expression of MMP-14 in IDD by inhibiting the nuclear factor (NF)-κB pathway, while collagen II and aggrecan expression was increased. This suggested that extracellular matrix degradation was inhibited by karacoline (P<0.05). Our data therefore reveal a new clinical application of karacoline and provide support for the use of network pharmacology in predicting novel drugs.

Objective To stuay the serum levels of sCD40L,hsCRP,ICAM-1 and VCAM-1,and the expression of CD40L of the CD4+T cells in patients withacute coronary syndrome(ACS),and to explore the relationship between CD40L and inflammatory factors and the effects of CD40/CD40L on ACS.Method Thirty-two coronary heart disease patients without history of other discernible systemic disease and medicine of steroids or immunosuppressants taken were divided into acute myocardial infarction group(AMI,n=11),unstable angina pectoris group(USP,n=14)and stable angina pectoris group(SAP,n=7).The control group was composed of eight healthy volunteers(CON group).Theexpression of CD40L Was determined by flow cytometry(FCM).Serum sCD40L.ICAM-1 and VCAM-1 were determined by using ELISA.The serum hsCRP was assayed by using immunoturbidimetry.Data were analyzed with SPSS 11.0 software for windows.Results The expression percentage(%)of CD40L of the CD4+T cells,and the serum levels of sCD40L,hsCRP,ICAM-1 and VCAM-1were sifnificantly higher in patients of AMI group than those in patients of other groups(P＜0.05 or P＜0.01).Similarly,those biomarkers in patients of UAP group were usually higher than those in patients of CON or SAP groups(P＜0.05).There Was a positive correlation between the expression of CD40L and the serum level of VCAM-1 in paients of AMI group(P＜0.05),and likewise,a positive correlation also existed between the serum level of sCD40L and other factors,hsCRP,ICAM-1 as well as VCAM-1,in patients of AMI group(P＜0.05).Conclusions The enhanced expression of CD40L of the CD4+T cells and high serum level of sCD40L are present in patients with acute coronary syndrome.The hsCRP,ICAM-1 and VCAM-1 play roles in the pathogenesis of ACS,and they have correlation with enhanced expression of CD40L and high serum level of sCD40L.Therefore,CD40L and sCD40L may be used as indicators of risk in coronary heart disease.

Objective To determine the levels of soluble thrombomodulin(sTM) in patients with acute pulmonary embolism (PE), and evaluate sTM clinical significance.Methods The sTM levels were determined with enzyme linked immunosorbent assay in PE patients, and compared with healthy control group. Eighteen PE patients were divided into massive PE group and non - massive PE group, non - respiratory failure group and respiratory failure group, and compared the sTM level in the groups. Results Level of sTM in PE patients was higher than that of control group (P

Objective To investigate the variation of biomarker of coagulation, anti-coagulation, fibrinolysis in elderly critical patients and find out whether they are related to the disease severity. Methods Sixty-seven patients were no less than 60 years old. Eligible criteria: coincidence with the diagnostic criteria of systemic inflammatory response syndrome (SIRS) and APACHE Ⅱ score was no less than 10 scores. Blood sample was drawn from the venous for the test of biomarker (APTT, PT, TT, D-D, Fib, AT-Ⅲ , PC, PAI-1). According to the existent status,all the patients were divided into two groups:survival group (43 cases) and death group(24 cases) ,meanwhile,according to the diagnostic criteria of MODSE,all the patients were divided into MODSE group (30 cases) and non-MODSE group (37 cases). Results There were significant differences in APACHE Ⅱ score between MODSE group and non-MODSE group, survival group and death group [(25.83 ± 1.19) scores vs(18.1±20.73) scores and(18.81±0.72) scores vs(26.50 ± 1.42) scores](P <0.01). The PT and D-D in MODSE group anti death group were higher than those in non-MODSE group and survival group, the differences were significant (P <0.05),while the activity of AT-Ⅲand PC in MODSE group and death group were lower than those in non-MODSE group and survival group, the differences were significant (P <0.05). The PT,D-D and PAI-1 were positively correlated to APACHE Ⅱ score (related coefficients were 0.328, 0.308, 0.335,P <0.05). The AT-Ⅲ and PC were negatively correlated to APACHE Ⅱ score (related coefficients were -0.469, -0.559,P <0.01). Conclusions The abnormality of eoagnlation-fibfinolysis system exists in elderly critical patients. The extended PT, elevated D-D and PAI-1 ,descended PC and AT-Ⅲ are the hints of disease severity and poor prognosis.