Objective To investigate the clinical effect of selective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in the treatment of elderly patients with acute severe cholecystitis,as well as the most appropriate timing for selective operation.Methods A total of 90 patients with acute severe cholecystitis aged above 60 years who were admitted to Department of Hepatobiliary Surgery in The First Hospital of Jilin University from January 2015 to June 2016 were enrolled,and according to the time of selective LC,they were divided into group A (with 2 months),group B (2-4 months),and group C (＞4 months),with 30 patients in each group.The clinical effects of PTGD and selective LC were observed.The t-test was used for comparison of continuous data between two groups,an analysis of variance was used for comparison between three groups,and LSD-t test was used for comparison between any two groups;the chi-square test was used for comparison of categorical data between groups.Results All the patients underwent successful PTGD,and the time to abdominal pain remission was 2.52 ± 0.76 hours.Body temperature returned to normal with 24-72 hours after surgery,and there were significant improvements in laboratory markers (white blood cell count,neutrophil count,and liver function) (all P ＜ 0.05).No patient experienced complications such as bile leakage,hematobilia,pneumothorax,and colon perforation caused by puncture,and there was no case of PTGD after the tube was detached.There were significant differences between the three groups in gallbladder wall thickness before LC (F =8.029,P ＜ 0.001),time of operation (F =24.674,P ＜ 0.001),intraoperative blood loss (F =12.864,P ＜ 0.001),length of hospital stay (F =22.844,P ＜ 0.001),rate of conversion to laparotomy (x2 =12.345,P =0.002),and incidence rate of complications (x2 =8.750,P =0.013).Compared with group A,groups B and C had significantly lower gallbladder wall thickness before LC,intraoperative blood loss,length of hospital stay,rate of conversion to laparotomy,and incidence rate of complications (all P ＜ 0.05),and group B had significantly lower time of operation,intraoperative blood loss,and length of hospital stay than group C (all P ＜ 0.05).Conclusion Selective LC with 2-4 months after PTGD has a marked clinical effect and high safety in the treatment of elderly patients with acute severe cholecystitis.

Phthalate esters widely exist in the environment. It has been demonstrated that they are harmful to human bodies. Phthalate mono-esters are the first metabolite of phthalate esters. In general,biotransformation or metabolism of xenobiotics most frequently result in detoxification of the chemical and facilitates excretion from the body. However,this may not be the case for phthalates. In the present paper,metabolism of phthalate esters and the toxicity of the phthalate mono-esters were reviewed,not only the effect of their mutagenesis,teratogenesis and carcinogenesis,but also their toxicity on reproduction,development,hormones,nuclear receptor,inflammation and obesity were included.

Objective To observe the effect of Fuzhenghunao capsule on NE of the locus ceruleus and myocardial tissues in rats with intracerebral hemorrhage. Methods 72 rats were randomly divided into 4 groups:sham,model,Fuzhenghunao and Angongniuhuang. The content of NE were tested by the high performance liquid phase-electrochemical method at 6 h,24 h and 72 h of post-operation. Result NE was obviously increased in sham group,and decreased in two treatment groups. Conclusion Fuzhenghunao capsule could be used to inhibit the activation of locus ceruleus noradrenalin system and protect myocardial tissues by regulating NE content.

In order to reveal the treatment mechanism of Chinese medicine with the effect of activating blood and resolving putridity, we selected acetyl-11-keto-beta-boswellic acid (AKBA) and arsenic trioxide (ATO), the main monomeric components of frankincense and arsenolite which are two most commonly used Chinese medicine with effect of activating blood and resolving putridity. We combined AKBA and ATO as a compound, and explored its regulatory role in productions and activities of matrix metalloproteinase (MMP)-1, MMP-2 and MMP-9 in human skin fibroblasts (HSFbs) and human acute monocytic leukemia cell line THP-1 in inflammatory state.

Objective:To discuss the application of antithrombotic drugs in myocardial infarction patients with thrombocytopenia. Methods:The therapy for one myocardial infarction patient with primary thrombocytopenia was discussed and summarized. Based on the related literatures, the characteristics of case, application status and adverse reactions of antithrombotic drugs and anticoagulant drugs were summarized. Results: The adjustment of antithrombotic drug treatment regimen for the patient was reasonable. Conclu-sion:Antithrombotic drugs applied in acute myocardial infarction patients with thrombocytopenia are safe. If patients complicate with other diseases, individualized antithrombotic therapy should be carried out according to particular case.

Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases, which as a group can degrade essentially all extracellular matrix components. The proteolytic property of the MMPs is important during wound healing to remove debris and facilitate cell migration. Targeting towards the decreased MMPs activities is a new treatment strategy for healing chronic wounds. Salvia miltiorrhiza is a popular Chinese herb that could promote chronic ulcers healing for topical use. Salvianolic acid B (Sal B) is the most abundant bioactive component in Salvia miltiorrhiza. The research was designed to explore the inhibitory effects of Sal B on MMP-1, MMP-2 and MMP-9 activities.

Objective To investigate the clinical application of 99mTc-DTPA renography in evaluating the glomerular filtration rate (GFR) in living donor kidney transplantation and to assess the dependence of GFR on age and gender in living kidney donors. Methods There were 212 consecutive potential donors in the study. The potential donor evaluation process included as follows: general health status, liver and kidney ultrasound, hepatitis virus infection and HLA-DR matching. If the results met the general requirements for the donor selection criteria, the GFR was measured using the 99mTc-IDTPA renography according to standard procedure (gates method). The GFR ≥ 1.33 ml/s was considered normal, ＜ 1.17 ml/s was defined as the lower limit for donor GFR, and 1.17 ml/s ≤GFR ＜ 1.33 ml/s further underwent measurement of creatinine clearance (CCr). If the CCr was normal, the GFR was considered normal, and otherwise, potential donors gave up kidney donation.All the donors meeting the donor selection criteria were divided into four age groups. On the other hand, the total donors were divided into the groups aged ＞ 55 years and aged ≤ 55 years. The impact of gender and age on GFR was evaluated preoperation due to age-related changes and gender using Kendall's tau-b correlation coefficient. Results In 212 potential donors, 137 cases had a GFR ≥ 1.33ml/s, 55 cases 1.17 ml/s ≤ GFR ＜ 1.33 ml/s and 20 cases GFR ＜ 1.17 ml/s. Thirty-one cases of potential donors with 1.17 ml/s ≤ GFR ＜ 1.33 ml/s gave up kidney donation due to abnormal CCr or other security considerations. 161 (56 females, 105 males) were qualified as successful donors, and the donor age was 42. 91 ± 11.90 years (range 20 to 62 years). The preoperative total GFR (ml/s) in living kidney donors was calculated as 1.51 ± 0.22 for males, it was 1.45 ± 0.18 for females respectively (P＞0.05). Among the four age groups, there was no significant difference in GFR (P＞0.05). The GFR in the donors aged ＞ 55 years and aged ≤ 55 years was 1.48 ± 0.22 and 1.49 ±0.17 respectively (P＞0.05). Correlation analysis revealed that the GFR in all the donors was not related with age (r = -0. 033, P = 0. 69). Also, there was no correlation between age and GFR in men and women(r= -0.053, P=0.571; r= -0.019, P=0.754). Conclusion 99mTc-DTPA renography is reliable and reproducible for the determination of GFR in living kidney donors. In view of acute donor shortage and if properly screened, kidneys with 1.17 ml/s≤ GFR ＜ 1.33 ml/s can be used without increasing the risk to donor. The GFR is not correlated with the age and gender.

AIM: To evaluate the effects of acetyl-11-keto-beta-boswellic acid (AKBA, a main active component from frankincense, one of the traditional Chinese herb for healing wounds) on the activities of matrix metalloproteinase(MMP)-1, MMP-2 and MMP-9.METHODS: Pure human interstitial collagenase (MMP-1) or gelatinase A (MMP-2) was activated by p-aminophenylmercuric acetate (APMA), and was incubated with AKBA for 1 h. The activities of the enzymes were observed by quenched fluorescent substrate. The lysates of rat polymorphonuclear neutrophils [PMNs, rich in gelatinase B (MMP-9)] was incubated with AKBA for 1 h, and activity of MMP-9 was tested by gelatin zymography. Three cell models: activated human dermal fibroblasts by TNF-α, activated THP-1 cells by PMA and fibroblasts-THP-1 co-culture system were established. AKBA was cultured with these cell models for 24 h. The levels of MMP-1, MMP-2 and MMP-9 in the cell culture supernatants were tested by ELISA and activities of MMP-2 and MMP-9 were tested by gelatin zymography assays.RESULTS: AKBA dose-dependently inhibited the activities of human MMP-1 and MMP-2 at the range of 0.1-0.8 mmol/L, with 50% inhibitory concentration (IC50) of 0.18 mmol /L and 0.27 mmol/L, respectively. In the range of 0.05-0.85 mmol/L, AKBA inhibited the MMP-9 activity (P<0.01). Although AKBA promoted fibroblasts to secrete MMP-2, the production of MMP-9 by THP-1 was inhibited. In the cell co-culture system, the inhibitory effects on MMP-1, MMP-2 and MMP-9 productions were also observed.CONCLUSION: AKBA, as a bioactive component of frankincense, has an inhibitory effect on MMPs production and activities, indicating the possible mechanism for healing chronic wounds by frankincense.

Objective To learn the recent development and regional distribution of clinics in China.Methods Based on statistics and a nationwide survey of clinics in the country,a simple linear regression was made to find factors determining clinics regional distribution.Results Clinics in China were found to have grown sizably from 134 000 in 2008 to 155 000 in 2014;medical technology workers to 2.31 per clinic in 2014;and the total revenue of these clinics accounted for only 0.724% of all medical institutions,while there are more clinics in the east than the west regions in China.Conclusions The role of clinics in attracting high quality medical resources to primary care should be further enhanced for development of the hierarchical medical system in China.