Objective To investigate causes and the treatment of jaundice following laparoscopic cholecystectomy (LC). Methods A retrospective analysis of records of 11 cases of jaundice following LC out of 2047 cases between October 1995 and December 2001 was made. Results The incidence of postoperative jaundice was 0.54% (11 of 2047). Jaundice was due to bile leakage (45.4%, 5 of 11), residual choledocholithiasis (18.2%, 2 of 11), acute pancreatitis (18.2%, 2 of 11), biliary stricture (9.1%, 1 of 11) and acute liver infraction (9.1%, 1 of 11). Three kinds of procedures-endoscopic operation, open operation and conservative treatment-were executed respectively and had obtained satisfactory results. Conclusions Bile leakage and residual choledocholithiasis were the leading causes of jaundice following LC. Prompt etiologic therapy may effectively relieve the symptoms.

BACKGROUND: Calcium phosphate cement (CPC) can strengthen the immediate and early fixation of screws by improving the quality of bone and the surface of screws. OBJECTIVE: To evaluate the biomechanical efficacy of CPC in augmentation of anterior cervical unicortical screw fixation. DESIGN: A study of controlled observation. SETTING: Department of Orthopaedics of First Xiangya Hospital of Xiangya Medical College of Central South University. MATERIALS: Experiments were performed at the Room of Electromechanical Tensile Property of College of Material Science and Engineering of Central South University from September 2003 to January 2004. Anterior cervical unicortical screw (pure titanium) was produced by Zhangjiagang Xinda Medical Equipment Co., Ltd. Injectable calcium phosphate cement was produced by Shanghai Ruibang Biomaterial Co., Ltd. Axial pull-out sleeve was produced by Machine Manufacture Center of Central South University. METHODS: ①Sixteen cervical vertebrae (C3-6) of four fresh young man cadavers with fine results in bone mineral density (BMD) test and sixteen cervical vertebrae (C3-6) of 4 fresh old man cadavers with poor results in BMD test were selected. Specimens were provided by Department of Anatomy of Xiangya Medical College of Central South University. Mortal remains of the deceased were donated according to the will of the dead. Informed consents were obtained from their family members. Twelve vertebrae were selected in each group for three tests. Six vertebrae were selected in pull-out test, and six vertebrae in cyclic bending test and shearing test. Screw holes, which were 8 mm apart from the midline and 5°inclined centrally, were made on both sides in the front part of the vertebra. Cortical bone was not penetrated. ②A screw was randomly inserted into one side hole, which was considered to be a control group. Pull-out test was performed on material testing machine at 5 mm/min. The screw hole was filled with CPC (0.10-0.15 mL) to repair the screw hole, and then the screw was implanted, which was considered to be a restoration group. The screw hole was injected with CPC, and then the screw was implanted, which was considered to be a augmentation group. 24 hours later, pull-out test was conducted again at 37 ℃. ③The screw was randomly implanted into one side hole (as a control group). The screw hole was injected with CPC, and then screw was implanted (as an augmentation group). Both groups received cyclic bending test and shearing test. MAIN OUTCOME MEASURES: ①The maximal axial pull-out strength of screws, ②displacement of screws after cycle bending test, ③the maximal shear strength after cycle bending test. RESULTS: ①The axial pull-out test: In normal vertebrae, axial pull-out strength was (313±64)N, (376±88)N and (446±121)N in the control group, the restoration group and the augmentation group respectively. In osteoporotic vertebrae, axial pull-out strength was (106±47)N, (154±67) N and (191±80)N in the control group, the restoration group and the augmentation group respectively. The axial pull-out strength in the restoration group and augmentation group was significantly bigger than in the control group (P < 0.05). ②The cyclic bending test: The displacement of the unicortical screw in the augmentation group was much smaller than in the control group (P < 0.05). ③ In normal vertebrae, the maximal shear strength was (301±79)N and (395±105)N in the control group and the augmentation group respectively. In the osteoporotic vertebrae, the maximal shear strength was (87±39)N and (149±63)N in the control group and the augmentation group respectively. The maximal shear strength was significantly bigger in the augmentation group than in the control group (P < 0.05).CONCLUSION:CPC can enhance the axial pull-out strength and shearing ability of the screw. The augmentation is more evident in osteoporosis patients.

Contents in orthopaedic are independent relatively and finding out the internal relations during them is helpful to improving the effect of orthopaedic teaching.Transfer theory is important tools for clinical teaching practice,and finding out the common characteristics between the orthopaedic chapters is primary for the theory.This research focuses on the following fields:fractures,nerve injury,infection,tumor and deformity.After the common characteristics between these chapters were analyzed and discussed,we concluded that the transfer theory is helpful in orthopaedic teaching practice,especially for students' comprehension and memory,but still we should avoid some negative effects in teaching process.

Humans ; Isocitrate Dehydrogenase ; genetics ; Leukemia, Myeloid, Acute ; genetics ; Mutation

In this paper, all the intrahepatic arterioportal shunts (IHAPSs) that result from the functional redistribution of hepatic arterial and portal venous blood flow are defined as functional IHAPSs (F-IHAPSs) so as to make the differentiation from organic IHAPSs (O-IHAPSs) that result from the intrahepatic arterioportal fistula or direct communication, such as those IHAPSs that are associated with advanced hepatocellular carcinoma (HCC) and other malignant hepatic tumors as well as those IHAPSs that are accompanied by congenital hepatic vascular malformations, hereditary hemorrhagic telangioectasia (HHT) and liver trauma (including iatrogenic injury), etc. In F-IHAPSs, the most common one is formed by the compensatory (or secondary) increase of arterial blood flow that is caused by the decrease of hepatopetal portal blood flow due to a variety of reasons; its formation mechanisms can be divided into three categories:(1) trans-sinusoidal type, such as the F-IHAPSs that is associated with cirrhosis;(2) post-sinusoidal type, such as the F-IHAPSs that is accompanied with the acute stage of Budd-Chiari syndrome; and (3) pre-sinusoidal type, such as the F-IHAPSs that occurs along with the gastrointestinal hemorrhagic shock. Another kind of F-IHAPSs has been commonly seen in some hepatic diseases that have primary increase of hepatic arterial blood flow, including hypervascular hepatic cavernous hemangioma, small hepatocellular carcinoma that has rich blood supply, hepatobiliary inflammatory diseases, etc.;and in this paper they are all classified as F-IHAPSs category, however, the formation mechanisms of such F-IHAPSs vary with their basic diseases. Clinically, imaging diagnosis of F-IHAPSs can be made based on the following three signs:(1) all kinds of hepatic diseases that have concomitant intrahepatic arterioportal fistula or direct communication, as mentioned above, have been definitely excluded:(2) hepatic artery DSA reveals early visualization of portal vein in arterial phase, known as the characteristic sign of F-IHAPSs;and/or: (3) hepatic dynamic enhanced CT/MR scanning demonstrates transient enhancement of liver parenchyma in arterial phase, especially early visualization of portal vein is also present; in this case the diagnosis of F-IHAPSs can be undoubtedly confirmed. However, in making differential diagnosis, F-IHAPSs must be carefully differentiated from O-IHAPSs, local hepatic parenchymal perfusion caused by hepatic aberrant vein or by abnormal hepatopetal draining vein from systemic circulation, etc. In addition, when cirrhosis-related transient hepatic parenchymal enhancement presents as a solitary small nodule, differentiation with small HCC should be taken into consideration. In order to provide the readers with a complete and up-to-date understanding of F-IHAPSs, the relevant example illustrations, figures and graphics are accompanied with the text.

Objective To evaluate the protective effects of different modes of ventilation on the lungs on the operated side during one-lung ventilation (OLV ) in patients undergoing thoracic surgery .Methods Forty-five ASA physical status Ⅰ or Ⅱ patients of both sexes ,aged 45-64 yr ,weighing 65-80 kg ,were randomly divided into 3 groups (n=15 each) using a random number table :group A ,group B and group C .After induction of anesthesia ,the patients were intubated with double-lumen tube and OLV was performed .During OLV ,the lung on the operated side was collapsed naturally in group A ,positive pressure ventilation (FGF 2 L/min) was applied in the lung on the operated side in group B ,and high-frequency jet ventilation (frequency 100 beats/min ,driving pressure 0.5 kg/cm2 ) was used in the lung on the operated side in group C .Immediately after intubation (T0 ) , and at 1.5 h (T1 ) and 2 h (T2 ) of OLV ,blood samples were taken from the central vein and radial artery for determination of the serum interleukin-6 (IL-6 ) and IL-8 concentrations .The net release of IL-6 and IL-8 was calculated .Blood samples were taken from the radial artery at T0-2 for blood gas analysis and for determination of surfactant protein A (SP-A) concentration in the serum .Respiratory index (RI) was calculated .The non-cancer tissues 1.0 cm × 1.0 cm × 1.0 cm which were extracted from the lung cancer specimens were used for microscopic examination of the pathological changes of lungs which were scored .Results Compared with group A ,the net release of IL-6 and IL-8 ,serum SP-A concentration ,RI and pathological scores were significantly decreased at T1 ,2 in B and C groups ( P<0.05) .Compared with group B ,the serum SP-A concentration and RI were significantly decreased at T1 ,2 , and the net release of IL-6 was increased at T2 in group C ( P< 0.05 ) .Conclusion Continuous positive ventilation and high-frequency jet ventilation both can effectively protect the lungs on the operated side during OLV in patients undergoing thoracic surgery ,and the efficacy of high-frequency jet ventilation is better .

Objective To study the effects of shRNA-CtBP2 on the growth of prostate cancer PC3 cells. Methods There were three experimental groups in this study,which include blank control group, empty plasmid transfected group and transfected shRNA group. CtBP2 mRNA sequence is targeted by 3 pairs of designed interfering shRNA to built shRNA-Ct-BP2 recombinant plasmid then it is transfected into PC3 cells. Reverse transcriptase polymerase chain reaction (RT-PCR) and Western blot assays were used to detect the transcription and expression levels of CtBP2 mRNA and protein, respective-ly. PC3l proliferation was measured by MTT assay. Results Builting shRNA-CtBP2 recombinant plasmid and transfect-ing PC3 cells were successful. Transcription and expression levels of CtBP2 mRNA and protein were significantly decreased in shRNA-CtBP2 transfected PC3 cells. After CtBP2 silencing, cell proliferation was blocked in the shRNA-CtBP2 cells compared to that of blank control group (P<0.01). Conclusion shRNA-CtBP2 could significantly inhibit CtBP2 expres-sion, suppress the growth of PC3 cells, which suggests that CtBP2 may be a new target for PCa gene therapy.

Objective To investigate the importance of elements of teaching aesthetic(appearance aesthetics; language aesthetics; emotion aesthetics; PPT aesthetics; blackboard-writing aesthetics and model aesthetics) in clinical orthopaedic teaching,and to analyze the reasons and significance of them.Methods Totally 137 medical students(2005 and 2006 grade) were investigated by the questionnaire in resent 2 years.They were asked to choose the first two important elements of teaching anesthetic from six elements displayed by four teachers.Results The percentage of appearance aesthetics,language aesthetics,emotion aesthetics,PPT aesthetics,blackboard-writing aesthetics and model aesthetics were showed as 97.4％,88.7％,67.1％,58.9％,13.6％ and 1.2％ respectively.Conclusion Teaching aesthetics is an indispensible part of teaching aesthetically and it is helpful to promote the teaching.We should be focus on PPT aesthetics and appearance aesthetics,which show high percentage in our research.

Objective To investigate effects of volume,distribution and leakage of bone cement in ver- tebroplasty on the adjacent intervertebral bodies using an experimentally calibrated and anatomically accurate fi- nite-element model of elderly L4-L5 vertebral bodies.Methods Computed tomography(CT)scanning was done,at 1 mm intervals,on L4-L5 vertebral bodies of the lumbar spine of an old man cadaver that had no abnormal findings on rnentgenograms.The L4-L5 motion segment data were obtained from the CT scans to establish in computer a three-dimensional finite element model of L4-L5 functional spinal unit(FSU)with the software Ansys 7.0.Compressive load after virtual vertebroplasty on the damaged model,unipedicular and bipedieolar injections and leakage of cement into the intervertebral space,and the resulting endplate and disc stresses of the adjacent vertebral bodies were analyzed in various spatial distributions of the filling material and different loading conditions. An anatomically accurate finite-element model of elderly L4-L5 vertebral bodies was developed.Results The FSU study suggested that changes in stress and strain at adjacent levels were minimal.Furthermore,endplale and disc stresses of the adjacent vertebral bodies were not influenced by bone cement filling volumes or distributions except under bending,whereas asymmetric distribution and leakage of bone cement to the disk increased the stress of adjacent endplates.Conclusion Since asymmetric distribution and significant leakage of cement into the intervertebral space can increase the stresses of endplates of adjacent vertebral bodies and may lead to a fracture, symmetric placement of cement in operation should be achieved and leakage of cement avoided.