Objective To explore the clinical effect of cholangioscopic Holmium laser lithotripsy for bile duct refractory residual stone and orthomorphia for intrahepatic bile duct membranous stenosis. Methods The final diagnosis was established by T tube retrograde cholangiography and cholangioscopy in 12 patients with refractory bile duct residual stone. Twenty-nine stones distribute in extrahepatic and intrahepatic bile duct and 5 intrahepatic bile duct membraneous stenosis were found in 3 cases. All patients underwent Holmium laser lithotripsy and orthomorphia. Results The stone clearance rate was 100% in 12 patients after cholangioscopic holmium laser lithotripsy. No serious complication occurred in patients after 5 membranous stenosis orthomorphia. Follow-up observation on 11 patients shows no obvious recurrence of symptom and stones. Conclusion Holmium laser lithotripsy and orthomorphia are safe and effective in the treatment of bile duct refractory residual stone and stenosis.

Humans ; Lung Neoplasms ; diagnosis ; therapy ; Mesothelioma ; diagnosis ; therapy ; MicroRNAs

Objective To investigate the predictive value of continuous dynamic monitoring of intrapulmonary shunt (Qs/Qt) in patients with acute respiratory distress syndrome (ARDS).Methods A prospective observational study was conducted.The adult patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Tianjin Third Central Hospital from June 2014 to December 2015 were enrolled.Baseline characteristics,demographic data and relevant physiologic data were recorded.All patients were divided into survivors and non-survivors according to the outcome of patients within 28 days.Artery and mixed venous blood was collected immediately after admission for blood gas analysis,and daily Qs/Qt within 7 days was continuously monitored in ARDS patients.The receiver operating characteristic curve (ROC) was used to evaluate the prognosis accuracy of Qs/Qt.Results In 46 enrolled ARDS patients,20 died,and 26 survived.During the first 7 days of ARDS,the mean Qs/Qt in survivors showed an increasing tendency [(23 ± 6)％,(27 ± 6)％,(28 ± 9)％,respectively,at 1-3 days] and a downtrend tendency from 4 days [(27 ± 5)％,(25 ± 4)％,(19 ± 4)％,(16 ± 2)％,respectively,at 4-7 days].However,a rising tendency of Qs/Qt in non-survivors was found at 1-7 days [(28 ± 7)％,(30 ± 3)％,(33 ± 6)％,(33 ± 11)％,(34 ± 5)％,(33 ± 6)％,(35 ± 6)％,respectively],and Qs/Qt from the 5th day in non-survivors was significantly higher than that in survivors (all P ＜ 0.05).The fluctuation of oxygenation index (PaO2/FiO2) within 1 week in both groups was small,and PaO2/FiO2 (mmHg,1 mmHg =0.133 kPa) at 1-7 days in survivors was 167.37±43.98,180.55±39.90,174.27±35.47,188.64±39.74,252.54±49.22,239.35±25.63,248.93±45.64,respectively,and it was 168.65±35.54,182.31 ± 32.36,159.80 ± 34.39,176.97 ± 31.75,200.69 ± 45.33,185.98 ± 36.47,and 175.43 ± 30.98 in non-survivors respectively.PaO2/FiO2 was significantly lower in non-survivors than survivors from 5 days (all P ＜ 0.05).It was shown by ROC curve that area under ROC curve (AUC) for Qs/Qt evaluating the prognosis on the 5th day was 0.958,and 95％ confidence interval (95％CI) was 0.777-0.999 (P ＜ 0.000 1,Z =13.13).When the cut-off value of Qs/Qt was 28％,sensitivity and specificity were 83.3％ and 90.0％,respectively.AUC for PaO2/FiO2 evaluating the prognosis on the 5th day was 0.790,and 95％CI was 0.577-0.928 (P =0.002 1,Z =3.08).When the cut-off value of PaO2/FiO2 was 223 mmHg,sensitivity and specificity were 69.2％ and 81.8％,respectively.Conclusion Dynamic Qs/Qt surveillance can help physician to analyze the changes of the patient's condition,and it was better than PaO2/FiO2,and can be an important evaluation indicator of prognosis for ARDS patients.

Objective To investigate the impact of movement frequency on gross tumor volume (GTV) of moving tumors and coordinate position of the central point based on three-and four-dimensional CT scans.Methods The respiratory motion platform from Modus and 8 phantoms with different shapes and volumes were used to simulate the movement of lung tumors.Three-and four-dimensional CT scans were performed at movement frequencies of 10,15,and 20 times/min.GTV (GTV10,GTV15,and GTV20) and IGTV (IGTV10,IGTV15,and IGTV20) were delineated,and the coordinate position of the central point was obtained.The Friedman test was performed for GTV10,GTV15,GTV20,IGTV10,IGTV15,IGTV20,and the coordinate position of the central point.Results GTV10,GTV15,and GTV20 at the three movement frequencies were 12.41±14.26 cm3,10.38±11.18 cm3,and 12.50±15.23 cm3,respectively (P=0.687),and the positional values were-8.2±96.2 mm,-8.6±96.1 mm,and-8.6±95.7 mm in x-axis (P=0.968),108.2±25.0 mm,110.4±22.5 mm,and 109.0±24.2 mm in y-axis (P=0.028),and 65.2±13.7 mm,65.4± 13.4 mm,and 65.4± 13.2 mm in z-axis (P =0.902).IGTV10,IGTV15,and IGTV20 at the three movement frequencies were 17.78± 19.42 cm3,17.43± 19.56 cm3,and 17.44± 18.80 cm3,respectively (P=0.417),and the positional values were-7.7±95.9 mm,-7.9±95.6 mm,and-7.9±95.1 mm in x-axis (P=0.325),109.4±24.5 mm,109.6±24.1 mm,and 109.2±24.3 mm in y-axis (P=0.525),and 65.5±13.3 mm,65.6±13.4 mm,and 65.5±13.3 mm in z-axis (P=0.093).Conclusions During simulated positioning of thoracic tumors,respiratory movement frequency has no significant impact on target volume established by four-dimensional CT scan.There are no significant differences in three-dimensional target volume established at different respiratory frequencies,but respiratory frequency has a significant impact on the position of the central point of the target volume in y-axis.

Objective:To reveal the action of psoriatic peripheral blood T lymphocytes on keratinocytes proliferation and the significance in the pathogenesis of psoriasis.Methods:Keratinocytes were cocultivated with psoriatic peripheral blood T lymphocytes in comparison with those cocultivated with normal T lymphocytes. Immunohistochemical technique was performed to detect the expression of Ki67, c-Myc and Bcl-xL proteins.Results:There were significant overexpression of Ki67, c-Myc and Bcl-xL proteins in keratinocytes cocultivated with psoriatic T lymphocytes compared with the uncocultivated group and normal T lymphocytes group. Expression of Ki67, c-Myc and Bcl-xL proteins in keratinocytes cocultivated with normal T lymphocytes were not significantly different from the uncocultivated group.Conclusion:Psoriatic T lymphocytes, which have specific activity, can induce keratinocytes abnormal pattern of proliferation. One of the important mechanisms might be its action on the expression of c-Myc and Bcl-xL proteins.

Purpose To explore the clinicopathological characteristics of primary non-Hodgkin lymphoma ( PNHL) of lung. Methods The clinical features, morphology and immunohistopathological phenotypes were retrospectively studied in 28 cases of PNHL and re-viewed of the literature. Results The composition of this group of cases is 18 cases of male, 10 cases female. The a median age of pa-tients was 57 years old. According to the WHO classification, all of the 28 cases of in our PNHL series were diagnosed as non-Hodgkin lymphoma ( NHL) , including 17 mucosa-associated lymphoid tissue extranodal marginal zone lymphomas ( MALT) , 5 diffuse large B cell lymphomas ( DLBLC) , 2 NK/T cell lymphomas and 2 anaplastic large cell lymphomas, 1 mantle cell lymphoma ( MCL) and 1 pe-ripheral T cell lymphomas, unspecified, respectively. One-third PNHL patients presented with specific clinical symptoms such as cough, chest pain, dyspnea, and fatigue, Imaging examination showed unilateral or bilateral pulmonary infiltrate, single lesions or multiple nodules, and the lesions always involved with the trachea, bronchus and lung. Follow-up was completed in 16 patients ( range, 3 to 38 months) . 3 cases were conducted with pneumonectomy, among which 2 cases were given postoperative adjuvant chem-otherapy. Seven patients were given chemotherapy alone, and 5 patients did not give any treatment following initial diagnosis. At the time of last follow-up, 13 patients were alive with disease, 2 patients were died. The tumor metastasis in the left inguinal lymph node was found in one patient after 2 years by surgery. Conclusions It was shown that there was no specific clinical manifestations and fea-tures of pulmonary PNHL. Among of them, the MALT is the most common diseases, and the highly aggressive lymphomas many be oc-cur, such as the DLBLC, NK/T cell lymphoma. The diagnosis of PNHL depends on pathological examination. The immunohistochemi-cal staining and molecular pathological technology may helpful for the diagnosis and differential diagnosis of the tumors.

Objective To study the value of spiral CT in diagnosing renal cell carcinoma(RCC) and to evaluate the correlation of CT findings with histopathologie features in RCC. Methods 279 cases with RCC proven by surgery and pathology underwent plain and contrast-enhanced CT examinations. The clinic characteristics and CT findings were analyzed statistically and compared with surgical results. Results 90.32% lesions showed medium or obvious enhancement on contrast-enhanced CT,with the exception of granule cells for enhanced uniform, the other cell type of RCC showed heterogeneous enhancement. 32.26% of tumors was of more or less short-burres (χ~2 = 38.2,P<0.01) ,and the there was significant relationship between pathological signs of short burr and the renal capsule involved by tumors. CT qualitative diagnostic rate was 91.40%. CT staging and pathologic staging were of the correla-tive coefficient of 0. 84, while there was not obviously correlation between CT classification of RCC and cancer cell types(P>0.05). Conclusion Spiral CT can better show characteristics of RCC, that can improve the diagnostic accuracy and staging aility for RCC.

Objective To investigate the effect of ligustrazine on the expression of platelet-derived growth factor-?(PDGF-?) receptor and extracellular signal regulated kinase(ERK1/2) induced by angiotensin Ⅱ(AngⅡ) in cardiac myocytes,and explore the mechanism of therapeutic.Methods Cultured cardiac myocytes of neonatal rats were treated with 10-7 mol/L AngⅡ as Ang Ⅱ group,10-7 mol/L AngⅡ plus 10 mg/L ligustrazine as ligustrazine group,the normally cultured neonatal rat cardiac myocytes as control group.Protein synthesis was measured by -leucine incorporation,and the expression of PDGF-? receptor and ERK1/2 was detected by Western blot.SPSS 11.0 software was used to analyze the data.Results There were significant differences among 3 groups(F=20.71 P

Objective To investigate the clinicopathologic features,diagnosis,differential diagnosis and treatment of sclerosing angiomatoid nodular transformation(SANT). Methods The clinical data,pathologic characteristics,immunophenotype and postoperative follow-up of SANT were analysed. Results There were no specific findings in the clinical manifestations of the 4 cases of SANT.Grossly,the cut surface of the masses was gray-white and vague nodularity was observed.Microscopically,it was characterized by the multinodular angiomatoid appearance in a fibrosclerotic stroma.The nodules were composed of slit-like,sinusoid-like vascular spaces and were interspersed with a population of spindly or ovoid cells.It was revealed by immunohistochemistry that the expression of CD34 in some vessels' endothelial cells was positive,and CD8 was negative.While in another vessels' endothelial cells,CD8 was positive and CD34 was negative.The expression of SMA,Actin,Vimentin,Collage IV and CD68 was positive in all of the 4 cases,while that of CD21,Desmin and NSE was negative.No relapse or metastasis was found during the follow-up.Conclusion SANT is a rarely encountered benign lesion of the spleen,which should be distinguished from the malignant tumor of the spleen.The diagnosis counts on the pathologic and immunohistochemical findings.It could be cured by splenectomy with a favourable prognosis.

To review the advance in research of axonal damage mechanism of multiple sclerosis (MS) in recent years. To explain the evidence and effect of morphology and imageology in axonal damage of MS. And, to show the progression in the mechanism of axonal damage in MS.