Objective To explore the effects of salmeterol/fluticasone propionate complicated or combined with N-acetylcysteine on the pulmonary function and arterial blood gas analysis of the patients with chronic obstructive pulmonary disease (COPD), and to evaluate its curative effect.Methods 84 cases of COPD patients were randomly divided into combination treatment group (n=44)and simple treatment group (n=40).The patients in combination treatment group were treated with salmeterol/fluticasone propionate combinated with N-acetylcysteine while the patients in simple treatment group were treated only with salmeterol/fluticasone propionate, both of which were followed up for 6 months.The changes of pulmonary function (FEV1%FVC,FEV1%Pred,PEF daily variation rate:ΔPEF%)and the arterial blood gas analysis indexes (PaO2 and PaCO2 )of the patients in two groups were recorded before treatment, 3 months after treatment, and 6 months after treatment. Results The FEV1%FVC,FEV1%Pred and PaO2 of the patients in combination treatment group and simple treatment group were obviously increased 3 and 6 months after treatment compared with before treatment (P<0.01 ), and the PaCO2 were obviously decreased (P<0.01).And there were significant differences of the indexes mentioned above of the patients between two groups (P<0.05 );but the indexes of each group had no significant differences between 3 months and 6 months after treatment (P>0.05).TheΔPEF% of the patients in two groups had no significant differences between inter-group and intra-group before and after treatment (P > 0.05 ). Conclusion Combination of salmeterol/fluticasone propionate and N-acetylcysteine can obviously improve the pulmonary function and arterial blood gas analysis indexes of the COPD patients, which is superior to the simple application of salmeterol/fluticasone propionate and has definite and lasting curative effect on the treatment of COPD.

Objective To summarize our experience of laparoscopic surgery for complex choledochal cysts (type Ⅳ-A). Methods The clinical data of 65 children of choledochal cyst undergoing laparoscopic choledochal cyst resection were retrospectively reviewed from 2002 to 2009 in our institute.Among those type Ⅳ-A cyst was found in 16 patients. Hepaticojejunostomy was performed using a Roux-en-Y jejunal loop after extrahepatic cyst excision and ductoplasty. Results Laparoscopic procedures were successfully performed in 16 patients with type Ⅳ-A cysts. The stenotic segment was splited or excised and a wide hepaticojejunostomy was completed at the porta hepatis in 8 patients with a stricture extending to the level of common hepatic duct. The constrictive confluence of the bilateral hepatic duct was incised and the bi-ductal cystojejunostomy was achieved at the bifurcation in 4 cases. A septum was found at the orifice of right hepatic duct and was excised through the hilar stoma in 2 cases. A downstream stricture of the left hepatic duct was incised from the hilum to the dilated segment along the lateral wall in 2 patients, so that a long intrahepatic cystojejunostomy was completed in an oblique course. Postoperative complications developed in 2 cases including temporary bile leakage in one case and anastomotic stricture in another. The intrahepatic cysts were remarkably reduced in size during the follow-up. Conclusions With the magnified laparoscopic view, the radical resection of extrahepatic cyst and correction of the intrahepatic bile ductal stenosis can be easily performed. Laparoscopic hepaticojejunostomy and/or intrahepatic cystojejunostomy is effective and safe for children with type Ⅳ-A choledochal cysts.

Objective To examine the changing levels of serum iron and hemoglobin in Streptococcus pneumoniae-induced rat pneumonia model and the relationship among infection severity,serum iron and hemoglobin.Methods Sixty Sprague Dawley (SD)rats were randomly assigned to one of the four groups,1 5 SD rats in each group,including three treatment groups and one control group. Low, medium and high doses of bacteria were administered to the animals in the treatment groups respectively through tracheal cannula.The severity of pneumonia was indicated by the level of bacterial load.The animals in the control group did not receive bacterial challenge.The mean serum iron and hemoglobin levels were calculated on day 3,5, and 7 to analyze the relationship between bacterial dose and serum iron or hemoglobin levels.Results The serum iron level in the animals receiving medium or high doses of bacteria was significantly lower compared with that in control group on day 3 (P=0.009,P=0.005).The serum iron level in the animals receiving low dose of bacteria showed significant difference compared with that in the control group on day 5 (P=0.007).The hemoglobin level in the animals receiving medium or high doses of bacteria was significantly different from that in the control group on day 5 (P=0.031,P=0.046).The hemoglobin level in the animals receiving low dose of bacteria did not show significant difference compared with that in the control group on day 3,5 or 7.The bacterial dose level was negatively correlated with the mean level of serum iron (correlation coefficient r=-0.65,r=-0.53,r=-0.61,respectively).There was no definite correlation between the bacterial dose and the mean hemoglobin level.Conclusions Streptococcus pneumoniae infection may be associated with lower serum iron and hemoglobin levels in rats.The severity of infection is negatively correlated with serum iron level,but not hemoglobin level.

At present, the epidemic of coronavirus disease 2019 is still serious, and the prevention and control of this epidemic is taken seriously throughout the country. As one of the most common acute abdominal diseases in hepatobiliary surgery, gallstones with acute cholecystitis has sudden onset and rapid progression and thus requires early diagnosis and timely and effective treatment. During the prevention and control of the epidemic, patients should be admitted properly to reduce nosocomial infection. Gallstones with acute cholecystitis is often accompanied by pyrexia, and therefore, the presence or absence of severe acute respiratory syndrome coronavirus 2 infection should be clarified. Treatment regimen should be selected appropriately and individualized treatment measures should be developed. While ensuring that patients receive timely and effective diagnosis and treatment, hospitals should adopt prevention and control measures for patients and their caregivers to reduce nosocomial infection. The personal protection of medical personnel should also be taken seriously, and scientific measures should be implemented to guarantee their safety.

Common bile duct stones are a common of digestive system disease, and as one of the long-term complications after Billroth II subtotal gastrectomy, it has attracted more and more attention from clinicians. Common bile duct stones after Billroth II subtotal gastrectomy have a complex pathogenesis, including neurological, humoral, and mechanical factors. Even though there are many methods to remove stones, there are still controversies over the selection of digestive endoscopy, surgical operation, or percutaneous transhepatic approach. Clinicians should fully evaluate the specific conditions of patients and formulate individualized treatment regimens to achieve the best treatment outcome.

Toll-like receptor 4 (TLR4) is a key regulator of innate and adaptive immune response. The role of TLR4 in pancreatic diseases is a research hotspot in recent years, and a large number of studies have shown that TLR4 is closely associated with pancreatic cancer. This article mainly discusses the abnormal expression and regulation mechanism of TLR4 in pancreatic cancer and its potential in cancer treatment, so as to provide new ideas for the pathogenesis and treatment of pancreatic cancer.

Objective To investigate the clinical pathological characteristics and the prognosis of the invasive micropapillary carcinoma (IMPC) of breast cancer.Methods The clinical pathological characteristics of 47 IMPC patients treated in the Second Hospital of Jilin University from Jan.2010 to Dec.2016 were retrospectively analyzed.A long term survival has been followed.Results 47 IMPC patients were all female.The median age was 56(34-76) years old.The median diameter of the tumor was 1.9(0.8-7.0) cm.The rate of axillary lymph node metastasis was 66.7％ (30/44),the median number of axillary lymph node metastasis was 9.5 (1-55),and the metastasis number of 1 to 3 accounted for 43.3％ (13/30),the metastasis number of 4 to 9 accounted for 6.7％ (2/30),and the metastasis number more than 10 accounted for 50％ (15/30).The lymphatic invasion rate was 40.2％(39/97),and the skin and (or) the nipple invasion rate was 15.6％(7/45).The positive rate of ER,PR,HER2,E-Cadherin was 95.7％(44/46),91.3％(42/46),10.5％(4/38),100％(40/40),respectively.The tumor cell growth index marked by Ki-67 was 1％-80％,and 78.3％ patients' tumor cell growth index marked by Ki-67 were more than 20％.Conclusions IMPC is a relatively rare special type of breast cancer,which typically occurs at middle-aged and old female.The expression of ER,PR,E-Cadherin is high and the expression of HER2 is low.It has strong ability and high positive rate of lymph node metastasis,lymphatic invasion,and poor prognosis.

ObjectiveTo investigate the clinical effect of laparoscopic splenectomy and pericardial devascularization (LSPD) in patients with portal hypertension and the long-term effect of LSPD. MethodsA total of 40 portal hypertension patients with Child-Pugh A/B liver function who received LSPD in The First Hospital of Jilin University from August to December 2017 were enrolled as surgical group, and 44 portal hypertension patients with Child-Pugh A/B liver function who received conservative treatment during the same period of time was enrolled as internal medicine group. The patients were followed up to June 30, 2019, and liver function parameters, upper gastrointestinal bleeding, and portal vein thrombosis were recorded for all patients at each time point. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the Bonferroni test was used for further comparison between two groups. The Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution; between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. ResultsAt 6, 12, and 24 months after discharge, compared with the internal medicine group, the surgical group had a significantly higher level of cholinesterase (t=3.527, 3.849, and 5.555, all P＜0.05) and a significantly lower Child-Pugh score (t=2.498, 2.138, and 2.081, all P＜0.05). Compared with the internal medicine group at 12 and 24 months after discharge, the surgical group had a significantly higher level of albumin (t=3.120 and 2.587, both P＜0.05) and a significantly lower incidence rate of upper gastrointestinal bleeding (χ2=4.947 and 5.155, both P＜0.05). At 24 months after discharge, the surgical group had a significantly lower number of patients who had a significant increase in alpha-fetoprotein level than the internal medicine group (χ2=4.648, P=0.031). At 12 months after discharge, the surgical group had a significantly higher incidence rate of portal vein thrombosis than the internal medicine group (χ2=4.395, P=0.036). The surgical group had significant improvements in albumin (F=2.959, P=0.013), cholinesterase (F=11.022, P＜0001), prothrombin time (H=94.100, P＜0.001), and Child-Pugh score (F=3.742, P=0.003) from admission to 12 and 24 months after surgery. ConclusionIn portal hypertension patients with Child-Pugh A/B liver function, LSPD can improve liver function and reduce the incidence rate of upper gastrointestinal bleeding, and the high incidence rate of portal vein thrombosis can be effectively reduced by oral aspirin and rivaroxaban.

Objective To explore the significance of the relative proteins in thrombin sensitive protein(TSP-1) and nuclear factor kappa B (NF-κB) signal pathways by detecting their expressions in different phases of hemangioma and the relations between them and microvessel density(MVD).Methods Forty cases with hemangioma were randomly selected and divided into proliferative group(n =21) and involutional group(n =19) according to Mulliken standard.The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK,NF-κBp65,p-IκBα,p-IKKβ,VEGF and CD34 in endothelial cells were detected by immunohistochemistry.The relevance between the proteins in TSP-1 and NF-κB signal pathways and MVD were compared and analyzed respectively.Results The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK in proliferative hemangioma were all lower than those in involutional hemangioma (F=32.582,47.575,11.645,18.824,13.140;P =0.000,0.000,0.002,0.000,0.001).Conversely,the expressions of NF-κBp65,p-IκBα,p-IKKβ,VEGF in proliferative hemangioma were higher than those in involutional hemangioma(F =7.807,6.323,5.988,4.216;P =0.009,0.018,0.021,0.049).Meanwhile,MVD were different between the two groups(F =7.256,P =0.012).The expressions of TSP-1,CD36,p59fyn and MVD showed a negative relationship(rs =-0.420,-0.519,-0.388;P =0.021,0.003,0.034).Conversely,the expressions of NF-κBp65,pvIκBα,VEGF and MVD showed a positive relationship(rs =0.666,0.611,0.515;P =0.000,0.000,0.004).The expression of TSP-1 and NF-κBp65 showed a negative relationship (rs =-0.413,P =0.023).Conclusions TSP-1 signal pathway and NF-κBp65 signal pathway may be interactive in evolution of infantile hemangioma,which has a potential role by effecting the progress of angiogenesis.

Objective To explore the significance of the relative proteins in thrombin sensitive protein(TSP-1) and nuclear factor kappa B (NF-κB) signal pathways by detecting their expressions in different phases of hemangioma and the relations between them and microvessel density(MVD).Methods Forty cases with hemangioma were randomly selected and divided into proliferative group(n =21) and involutional group(n =19) according to Mulliken standard.The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK,NF-κBp65,p-IκBα,p-IKKβ,VEGF and CD34 in endothelial cells were detected by immunohistochemistry.The relevance between the proteins in TSP-1 and NF-κB signal pathways and MVD were compared and analyzed respectively.Results The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK in proliferative hemangioma were all lower than those in involutional hemangioma (F=32.582,47.575,11.645,18.824,13.140;P =0.000,0.000,0.002,0.000,0.001).Conversely,the expressions of NF-κBp65,p-IκBα,p-IKKβ,VEGF in proliferative hemangioma were higher than those in involutional hemangioma(F =7.807,6.323,5.988,4.216;P =0.009,0.018,0.021,0.049).Meanwhile,MVD were different between the two groups(F =7.256,P =0.012).The expressions of TSP-1,CD36,p59fyn and MVD showed a negative relationship(rs =-0.420,-0.519,-0.388;P =0.021,0.003,0.034).Conversely,the expressions of NF-κBp65,pvIκBα,VEGF and MVD showed a positive relationship(rs =0.666,0.611,0.515;P =0.000,0.000,0.004).The expression of TSP-1 and NF-κBp65 showed a negative relationship (rs =-0.413,P =0.023).Conclusions TSP-1 signal pathway and NF-κBp65 signal pathway may be interactive in evolution of infantile hemangioma,which has a potential role by effecting the progress of angiogenesis.