Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.

Objective By comparing the therapeutic effects of different nutrition support,to elementarily evaluate the protocol of nutrition support with ω-3 polyunsaturated fatty acids in patients undergoing hepatectomy.Methods Retrospective and comparative analysis was applied.From January 2009 to January 2011,82 patients undergoing liver resection were selected from Nanjing Drum Tower Hospital and divided into three groups according to different nutrition supporting protocol:total parenteral nutrition group (23,TPN for short),combined enteral nutrition group (30,EN for short),ω-3 PUFAs group (29).TPN group was given total parenteral nutrition.EN group was given both parenteral and enteral nutrition.ω-3 PUFAs group was given parenteral nutrition,enteral nutrition and ω-3 PUFAs.By comparing the general situation,the incidence of post-operation complications and index of liver function,the effect of different nutrition supporting plans could be comprehensively evaluated.Results (1) None patients from any groups had severe complications such as bile leakage and hemobilia.Slight complications included ascites and pleural effusion.No difference is of significance in statistics science.(2) Compared with TPN group,patients from EN and ω-3 PUFAs group had shorter defecating time and post-surgery hospital stay,the difference is of significance in statistics science (P =0.001,t =4.624; P =0.001,t =5.019).There was no significant difference between EN and ω-3 PUFAs group (P ＞ 0.05).(3) For patients received operation with major hepatectomy (≥4 segments),ALT in ω-3 PUFAs group was lower than EN group in the 3rd and 5th day after operation (P=0.024,t =2.432; P=0.042,t =2.144).(4) For patients with cirrhosis,TB in ω-3 PUFAs group was lower than EN group in the 3rd and 5th day after operation (P =0.032,t =2.202; P =0.035,t =2.183).Conclusions It is beneficial to use nutritional support in patients received hepatectomy.For patients received major hepatectomy and patients with cirrhosis,nutrition support with ω-3 PUFAs had better protective effects.

A xylosidase gene, labeled as BH1068 in genome of Bacillus halodurans C-125, was successfully cloned and overexpressed in Escherichia coli JM109. The purified enzyme was thoroughly characterized and its xylosidase function was unambiguously confirmed. It has maximum activities in neutral condition and is stable over a wide range of pH (4.5-9.0). The enzyme has a broad temperature optimal (35 degrees C-45 degrees C) and is quite stable at temperature up to 45 degrees C. The unique pH and temperature profiles of the enzyme should allow a wide range of xylanolytic operational conditions. With high specific activity of 174 mU/mg protein for its artificial substrate (p-nitrophenyl-beta-xylose) and low xylose inhibition (inhibitor constant Ki = 300 mmol/L), this enzyme is among the most active and high tolerant bacterial xylosidase to xylose inhibition. Its high synergy with commercial xylanase has been demonstrated with beechwood xylan hydrolysis, achieving a hydrolysis yield of 40%. Its neutral pH optimal and high tolerance to product inhibition complements well with its fungal counterparts that are only optimal at acidic pH and susceptible to xylose inhibition. In conclusion, this enzyme has high potential in the saccharification of xylan and xylan-containing polysaccharides.
Amino Acid Sequence ; Bacillus ; classification ; enzymology ; genetics ; Cloning, Molecular ; Escherichia coli ; genetics ; metabolism ; Hydrolysis ; Molecular Sequence Data ; Recombinant Proteins ; genetics ; metabolism ; Substrate Specificity ; Xylose ; metabolism ; Xylosidases ; genetics ; metabolism

Glucose metabolic disorder is a common issue in sepsis and it leads to an increase in mortality. However, the therapeutic methods of the glucose metabolic disorders in sepsis patients need to be improved. Studying the mechanism of glucose metabolism disorder, and adjusting the existing treatment measures are especially significant in curing the sepsis. This review summarizes recent animal experiments and clinical studies about glucose change after septic complications, focusing on the treatment of three disorders including hyperglycemia, hypoglycemia, and blood glucose variability. They definitely provide new ideas for the control of blood glucose in sepsis patients.

Sepsis is a critical complication of severe trauma, large area burns, infection, and major surgery etc., which can induce septic shock and multiple organ dysfunction syndrome (MODS), and its incidence and mortality are always high. Nuclear factor-E2 related factor 2 (Nrf 2) is an important transcription factor of antioxidant stress response. It plays a key role in the treatment of sepsis by regulating the expression of antioxidant enzyme and phase Ⅱ detoxification enzyme mediated by antioxidant response element (ARE). In this article we review the changes, related regulation mechanism and reversing measures of Nrf 2 in sepsis, aiming to provide a reference for the effective intervention measures of sepsis.

Severe trauma or massive deep burn can cause significant immunosuppression associated with sepsis and multiple organ failure. Dendritic cell (DC), as the professional antigen presenting cells and activating factor of immune response, plays an extraordinary role in initiating and regulating congenital and adaptive immune response. The quantity, functional changes, relevant molecular mechanisms and reverse measures of DC after trauma/burn were reviewed in order to intensively study the changes of DC after trauma/burn and provide a reference for exploring effective intervention measures for trauma/burn.

Objective:To investigate the effect of bone marrow derived mesenchymal stem cells (BMSC) transplantation on bone metabolism and its mechanism in ovariectomized osteoporosis rats.Methods:Forty clean SD female rats aged 7 weeks were divided into 4 groups according to the random number table method: sham operation group, model group, the transplantation group, positive control group, in addition to control the rest of the group were performed bilateral oophorectomy build osteoporosis rats model, after 2 months of model establishment, rats in transplantation group were injected with 80 μl/kg PBS solution containing bone marrow mesenchymal stem cells through tail vein, rats in sham operation group and model group were injected with the same amount of PBS solution through tail vein, and rats in positive control group were given Xianlinggubao (0.5 g/100 g) by gavage every day. Serum and femur were collected 14 days after treatment. Hematoxylin and eosin staining (HE) was used to observe the histopathological changes of femur. Micro-CT was used to measure bone mineral density and bone parameters. The expression levels of osteocalcin, osteoprotegerin, alkaline phosphatase and insulin-like growth factor 1 were detected by enzyme-linked immunosorbent assay (ELISA) kit. The serum levels of calcium, phosphorus and magnesium were measured by spectrophotometer. The protein expressions of RANKL, OPG, TRAF6 and NF-KB1 in femur of each group were detected by Western blot.Results:Compared with the sham operation group, the bone mineral density (BMD) of the model group was decreased by (0.28±0.01) g/cm 3, bone volume fraction (BMD) was decreased by (0.28±0.01) g/cm 3. BV/TV) decreased by (19.73±2.02) %, trabecular thickness (Tb.Th) decreased by (0.082±0.008) mm, trabecular number (Tb.N) decreased by (1.60±0.17) mm -1 and trabecular separation/spacing (Tb.Sp) increased (0.273±0.024) mm, osteoprotegerin (489.49±55.29) ng/L, alkaline phosphatase (229.13±15.05) U/L, insulin-like growth factor-1 (236.64±14.32) μg/L, and osteocalcin were decreased (1.866±0.109) μg/L, calcium (11.98±1.09) mg/dl, phosphorus (6.85±0.68) mg/dl, and magnesium decreased (0.62±0.04) mg/dl) , the relative expression level of RANKL increased (1.05±0.09) , the relative expression level of OPG decreased (0.58±0.08) , the relative expression level of RANKL increased (0.74±0.10) , and the relative expression level of NF-kB1 increased (1.01±0.11) ( P<0.05) ; bone mineral density, bone mineral density, bone mineral density BMD (0.38±0.04 g/cm 3, BV/TV (26.73±2.74) %, Tb.Th (0.094±0.006) mm, Tb.N (2.67±0.09) mm-1 and Tb.Sp were decreased (0.241±0.026) mm) , osteoprotegerin (720.09±67.41) ng/L, alkaline phosphatase (269.48±14.15) U/L, insulin-like growth factor 1 (IGF-1) decreased (335.95±24.13) μg/L, and osteocalcin increased (1.392±0.153) μg/L, calcium (7.12±0.53) mg/dl, phosphorus (4.54±0.32) mg/dl, magnesium (0.87±0.08) mg/dl. RANKL relative expression level increased (0.59±0.05) , OPG relative expression level decreased (0.97±0.10) , RANKL relative expression level increased (0.45±0.06) , NF-kB1 relative expression level increased (0.72±0.06) ( P<0.05) ;bone mineral density, bone mineral density, bone mineral density BMD (0.36±0.05) g/cm 3, BV/TV (28.72±3.20) %, Tb.Th (0.096±0.011) mm, Tb.N (2.85±0.24) mm -1 Tb.Sp was basically unchanged (0.241±0.027) mm, osteoprotegerin was decreased (716.78±36.90) ng/L, alkaline phosphatase was basically unchanged (270.65±18.59) U/L, and insulin-like growth factor 1 was decreased (336.94±17.50) μg/L, osteocalcin (1.377±0.101) μg/L, calcium (7.13±0.80) mg/dl, phosphorus (4.58±0.71) mg/dl, and magnesium (0.89±0.04) remained unchanged mg/dl, the relative expression level of RANKL increased (0.55±0.08) , the relative expression level of OPG decreased (0.98±0.13) , the relative expression level of RANKL was basically unchanged (0.40±0.05) , and the relative expression level of NF-kB1 increased (0.65±0.09) ( P<0.05) . Conclusion:Bone marrow mesenchymal stem cell transplantation can improve osteoporosis in ovariectomized rats by regulating bone metabolism and serum levels of calcium, phosphorus and magnesium, which may be related to RANKL/OPG/TRAF6 pathway.

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of different molecular subtypes of breast cancer . Methods Sixty-two cases breast cancer patients with 62 breast lesions confirmed as breast cancer by postoperative pathology were selected . Referencing of St . Gallen standard and according to immunohistochemical markers of estrogen receptor ( ER) ,progesterone receptor(PR)andhumanepidermalgrowthfactorreceptor2(Her-2)expression,allthecasesweredivided into Luminal epithelium A or B ( Luminal A/B) subtype( 26 patients ) ,Her-2 over-expression subtype( 16 patients) and triple negative ( TN ) subtype ( 20 patients ) . CEUS and routine ultrasonography were performed for all patients before surgery ,and the contrast enhancement patterns and perfusion parameters were recorded . Whether there was a difference between the contrast enhancement patterns and perfusion parameters in different subtypes of breast cancer was analyzed . Results ① The contrast enhancement pattern showed more radioactive gathering( 76 .9% , P ＜0 .05) ,lower perfusion(69 .2% , P ＜ 0 .05) ,and lower maximum intensity ( IMAX) in the Luminal epithelium subtype than those in the Her-2 over-expression subtype and the TN subtype(all P ＜0 .05) ;② The contrast enhancement pattern showed more cardiac enhancing (93 .8% , P ＜0 .05) ,perfusion defect(75 .0% , P ＜0 .05) ,and shorter peak time (TTP) in Her-2 over-expression subtype than those in the Luminal epithelium subtype and the TN subtype(all P ＜0 .05) ;③The pattern of the TN subtype contrast enhancement showed more clear boundary( 80 .0% ,P＜0 .05) ,comparing to the other two types ,the perfusion parameters was no significant different( P ＞0 .05). Conclusions Different molecular subtypes of breast cancer have different contrast enhancement patterns and perfusion parameters ,CEUS can provide valuable imaging information for the diagnosis of breast cancer molecular typing before surgery .

Objective:To evaluate the safety and short-term clinical postoperative functional outcomes of a novel 3D-printed porous prosthesis of the distal tibia for the bone defect after tumorectomy.Methods:From December 2017 to December 2019, a total of eight patients diagnosed with malignant bone tumor of the distal tibia were enrolled in this study. All cases received standard preoperative chemotherapy, after which osteosarcoma resection was performed and ankle arthrodesis was reconstructed using a 3D-printed prosthesis developed by our medical center. The contact surface between the distal part of the prosthesis and the talus is a 3D-printed porous surface, which is conducive to ankle fusion. The length of the prosthesis is adjusted by the conical mounting part of the modular prosthesis. The proximal part of the prosthesis can be fixed either biologically or with bone cement. At postoperative follow-up, the function of the fused ankle was assessed by radiographs and the monthly Musculoskeletal Tumor Society (MSTS) score.Results:Of the 8 patients, 5 were male and 3 were female, aged 8-29 years (mean 16.1±7.4 years), including 7 osteoblastic osteosarcomas and 1 telangiectatic osteosarcoma. Among the procedures, the mean length of osteotomy was 16 cm (11-20 cm). The method of fixation of the proximal part of the prosthesis included one case with 3D-printing of trabecular metal bone, one case with autogenous fibular graft, and six cases with bone cement. All patients were followed up for 7-39 months (mean 15.6±10.5 months). The distal prosthesis and talus were completely fused in all cases. The mean fusion duration was 4.3±0.7 months. The mean MSTS score was 84.2%±3.0% (mean 80%-90%). No tumor recurrence, wound complications, or prosthesis loosening were observed during the follow-up period.Conclusion:The novel 3D-printed distal tibial prosthesis is a safe and effective technique for reconstruction of a massive bone defect after tumorectomy of a malignant bone tumor, with high fusion rate, few complications, and satisfactory postoperative function.

Infectious and inflammatory diseases are important diseases threatening human health. Without timely control, a series of complications will occur in patients, such as sepsis, inflammatory factor storm, and even lead to death. It has been found that cytochrome P4501A1 (CYP1A1) plays a key role in the development of infectious and inflammatory diseases through aromatic hydrocarbon receptor (AhR) dependent and non-dependent pathways in different cells and organs induced by different substances. The non AhR dependent regulatory mechanism of CYP1A1 and the different roles of CYP1A1 in infection and inflammation is reviewed in order to provide reference for further research on the relationship between CYP1A1 and infection and inflammation.