Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Methods The clinical data of 42 patients with Mirizzi syndrome with non-circumferential defect of bile duct who were repaired using own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap were analyzed.The defect in the bile duct were repaired using gallbladder pedicle flap in 30 patients,umbilical venous flap in 8 patients and omental flap in 4 patients.Results All patients were operated successfully.There was no operative mortality.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 d.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9-12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed up for 1-5 years,and had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome is effective.This surgical treatment is a good choice.

Objective To investigate the application of nasal jejunal tube and nasogastric tube of two different catheter ways in improving the severe craniocerebral injury and the low temperature condition and the role of early enteral nutrition support and compare the difference between its curative effect.Methods A total of 120 patients with severe craniocerebral injury underwent normal and low temperature treatment were selected,and they were divided into nasal jejunal tube enteral nutrition(nasal jejunal tube group,60 cases)and nasogastric tube enteral nutrition(nasogastric tube group,60 cases)by simple random sampling.After implement nasogastric tube and nasal jejunal tube,normal pressure using enteral nutrition elemental diet and/or enteral nutrition multi polymerization agent produced the best nutrient solution implementation of early enteral nutrition support,two groups of subjects under the condition of bowel function exists,within 48 h starting enteral nutrition,compared two groups of various nutrition indicators as well as adverse reactions and complications,and Glasgow Coma Scale(GCS)score,Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ)score,etc.Results The patients with severe craniocerebral injury after early nutrition,the various nutrition indicators had improved in two groups.The rise extent of triceps skinfold thickness,arm muscle circumference,serum albumin,prealbumin,transferrin,hemoglobin and other indicators in nasal jejunal tube group was higher than that in nasogastric tube group on the 14th,28th day after admission,and there was significant difference(P ＜ 0.05).The incidence of diarrhea,bloating,vomiting,and stomach contents reflux retention in nasal jejunal tube group was lower than that in nasogastric tube group [5.0％(3/60)vs.18.3％(11/60),10.0％(6/60)vs.21.7％(13/60),5.0％(3/60)vs.21.7％(13/60),15.0％(9/60)vs.16.7％(10/60),11.7％(7/60)vs.48.3％(29/60),8.3％(5/60)vs.21.7％(13/60)],and there was significant difference(P ＜ 0.05).The incidence of complications in nasal jejunal tube group was lower than that in nasogastric tube group [16.7％(10/60)vs.76.7％(46/60)],and there was significant difference(P ＜0.05).The changes of GCS score,APACHE score in nasal jejunal tube group was more obvious than that in nasogastric tube group,and there was significant difference(P ＜ 0.05).Conclusions Early nasal jejunal tube enteral nutrition for the severe craniocerebral injury after the low temperature condition in clinical enteral nutrition implementation is feasible and reasonable,compared with a nasogastric tube feeding,can obviously reduce the complications of enteral nutrition and reach goals earlier nutritional therapy,can improve the prognosis.

Objective To design a worksheet generation software for satisfy the two CHEMCLIN ? 600 instruments (CC 600) and laboratory information system(LIS) data transmission needs in Daxing Hospital of Capital Medical University ,ensure consis‐tency and uniqueness of the test sample number .Methods Microsoft Visual Studio 2010 and DotNetBar for Windows Forms were used to develop a work table generation software .Results Work table generation software had good interface ,and the CC 600 sys‐tem interaction had the advantage of simple operation ,generation of working table was operating normally ,and data transmission with laboratory information system was correct .Conclusion The worksheet generation software solves CC 600 linking problem be‐tween different test batches ,gives full play to the detection performance of the two instruments ,clinical application effect is good .

OBJECTIVE To investigate the blocking activities of a series of potential α1-adrenoceptor (α1-AR) antagonists (Compounds B1 -B9) on α1-AR.METHODS ① A series of potential α1-adrenoceptor (α1-AR) antagonists,indolylpiperidine derivative (IPD) and Compounds B1 -B9,with indolylpiperidine moiety and different substitutes were synthesized through the coupling of indolylpiperidine and piperazine derivatives.② Inotropic responses experiment was used to examine blocking effects of IPD and Compounds B1 - B9 in isolated rat atria by phenylephrine (PE) stimulation.③ Blocking effect of IPD and Compounds B1 - B9 on phosphorylation level of extracellular signal-regulated kinase (ERK) in PE treated HEK293 cells was tested by Western blotting.RESULTS ① Potential α1-adrenoceptor (α1-AR) antagonists with indolylpiperidine moiety and different substitutes were synthesized successfully.② PE caused a dose-dependent inotropic response which was inhibited by pre-incubation of phentolamine (Phen),a non-selective α1-AR antagonist,IPD and Compounds B1,B3,B4,B7,B8 and B9,respectively; IPD and Compounds B4 and B8 caused an obvious rightward shift of inotropic response-curve,the pA2 values for IPD and Compounds B4 and B8 were 6.72 ± 0.21,6.86 ± 0.29 and 6.67 ± 0.19,respectively.③ Phosphorylation level of ERK1/2 was inhibited by pre-incubation with Compounds B1,B2,B3,B5,B6,B7,B8 and B9 or IPD in PE treated α1A-AR stably expressed HEK293 cells; PE-stimulated phosphorylation level of ERK1/2 was inhibited by pre-incubation with Compounds B2,B4,B7 or B8 in α1B-AR stably expressed HEK293 cells.CONCLUSION Compound B4 has a selective blocking activity on α1B-AR,and Compounds B1,B3,B5,B6 and B9 or IPD have a selective blocking activity on the phosphorylation level of ERK1/2.

The gradually acidified tumor microenvironment plays a key role in the formation and advance of hepatocellular carcinoma. Under the regulation of acidic microenvironment, the differentiation and function of immune cells change to immunosuppression, which further leads to the occurrence of immune escape of hepatocellular carcinoma. In this paper, the formation of acidic microenvironment of hepatocellular carcinoma, the changes of various immune cells in acidic microenvironment and their effects on the occurrence and development of hepatocellular carcinoma, as well as their further mechanisms are reviewed in order to provide new ideas for the study of immunotherapy of hepatocellular carcinoma.

The clinical characteristics of the pneumonia includes hyperthermia, cough and pectoralgia, etc with simultaneous mixed signs of inflammatory infiltration, consolidation, cavity/air sac and abscess in pulmonary CT scan, and these signs change rapidly. Respiratory failure and septic shock frequently occur in severe such patients, resulting in refractory management and relatively long therapeutic course. The timely diagnosis, use of sensitive antibiotics, respiratory and nutritional support, etc comprehensive effective measures can elevate the rescue success rate with severe hematogenous staphylococcus aureus pneumonia.

Objective To explore the application values of GeneXpert MTB/RIF assay (Xpert assay) for rifampicin resistance and multidrug resistant tuberculosis (MDR-TB).Discordance of Xpert and L-J proportion DST of rifampicin was analyzed.Methods Specimens of 1 300patients from January 2014to June 2016in our hospital were collected for solid culture, Xpert assay and L-J proportion drug susceptibility test (DST).Rifampicin resistance detected by Xpert assay was compared with L-J proportion method as a gold standard.Sequencing of rpoB gene and determination of minimum inhibition concentration were accomplished on the discordant MTB strains between Xpert and L-J proportion DST.Results Compared with the DST, the sensitivity, specificity, positive and negative predictive value of Xpert assay for rifampicin resistance were 99.31％, 97.82％, 92.88％and 99.80％, respectively.Among 1 300culture-positive specimens, mutations were detected from 309specimens by Xpert assay, which included 125initial treatment and 184retreatment patients.Among309specimens with rpoB gene mutations, mutations detected by probes E, D and B were common, and the rates were 65.70％, 14.56％and 10.68％, respectively.Totally 239patients were MDR-TB[77.35％ (239/309) ], of which 94initial treatment patients[75.20％ (94/125) ]and 145retreatment patients[78.80％ (145/184) ]were MDR-TB.Among 22strains which were detected rpoB gene mutations by Xpert, but sensitive by L-J proportion DST, 6strains had no mutation in rpoB gene rifampicin resistance determining region (RRDR);16strains had mutations, which were mainly located in L511Pcodon (8strains) and L533Pcodon (4strains).Among 2strains which had no rpoB gene mutation by Xpert, but were resistant by L-J proportion DST, 1strain had no mutation in rpoB gene RRDR region;1strain had mutation which was located in E546G codon outside RRDR region.Conclusion Xpert assay can be used to rapidly detect rifampicin resistance and to screen MDR-TB.Mutations in codon 511and 533are related to low-level resistance to rifampicin.

Objective To establish a trimethyltin chloride (TMT) -induced learning and memory impairment model in rats, and to investigate the protective effects and potential mechanisms of ferulic acid. Methods Specific pathogen-free male SD rats were randomly divided into control group, TMT intoxication group, fluoxetine group and 25, 50, 100 mg/kg ferulic acid group. The rats in the last five groups were injected with a dose of 8 mg/kg body weight TMT solution, and the rats in control group were injected with the same volume of 0.9% sodium chloride solution. After 24 hours of TMT injection, the rats in fluoxetine group were treated 10 mg/kg body weight of fluoxetine, the rats in the three ferulic acid groups were treated with ferulic acid at doses of 25, 50, and 100 mg/kg body weight, respectively. The rats in the control group and TMT intoxication group were treated with the same volume of 0.9% sodium chloride solution, once per day for continuous gavage for 28 days. Morris water maze experiment and light-dark box test were used to assess the learning and memory abilities of the rats. The mRNA and protein expressions of nuclear transcription factor-κB (NF-κB), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the rat hippocampus were detected by real-time quantitative polymerase chain reaction and Western blot. The levels of reactive oxygen species (ROS) and malondialdehyde (MDA) and the activities of superoxide dismutase (SOD) and catalase (CAT) in the rat hippocampus were detected by enzyme-linked immunosorbent assay. Results Compared with the control group, rats of TMT intoxication group on day four had prolonged escape latency (P<0.05), fewer platform crossing (P<0.05), shorter time spent in the target quadrant and shorter latency to enter the dark compartment (all P<0.05). The mRNA and protein relative expression of NF-κB, TNF-α and IL-1β increased (all P<0.05), ROS and MDA levels increased (all P<0.05), SOD and CAT activities decreased (all P<0.05) in the rat hippocampus of TMT intoxication group on day four compared with that of the control group. Except for the terms of escape latency and target quadrant period of the rats in the 25 mg/kg ferulic acid group, rats in three ferulic acid groups on day four had lower escape latency (all P<0.05), more platform crossing (all P<0.05), longer period in the target quadrant and longer latency to enter the dark compartment (all P<0.05), compared with TMT intoxication group. Except for the relative protein expression of TNF-α in the rats of 50 mg/kg ferulic acid group, the mRNA and protein expression of NF-κB, TNF-α and IL-1β decreased (all P<0.05), ROS and MDA levels were reduced (all P<0.05), and the activities of SOD and CAT increased (all P<0.05) in the hippocampus of rats of 50 and 100 mg/kg ferulic acid groups compared with TMT intoxication group. Conclusion Ferulic acid can reverse TMT-induced learning and memory impairment in rats, and its mechanism of action may be related to alleviating oxidative stress damage and excessive inflammatory response in rat hippocampus.

Objective To preliminary investigate the clinical efficacy of whole brain simultaneous integrated boost intensity-modulated radiotherapy ( SIB-IMRT ) in patients diagnosed with brain metastases ( BM) . Methods Fifty-two cases of BM admitted to our hospital from January 2016 to December 2017 were equally recruited and randomly divided into the observation and control groups. Patients in the observation group were treated with SIB-IMRT, and those in the control group received conventional whole brain radiotherapy (WBRT).The clinical efficacy and prognosis were statistically compared between two groups. Results The ORR in the observation group was 77％, significantly higher than 27％ in the control group (P=0. 00).The median survival in the observation group was 384 d,significantly longer compared with 211 d in the control group (P=0. 00).All patients in both groups successfully completed corresponding treatment. Acute adverse reactions were mainly 1-2 grade reactions. Conclusions SIB-IMRT is an efficacious and safe treatment of BM,which yields tolerable adverse events and deserves application in clinical practice.

Objective:To investigate the correlation between the osseous structure of temporomandibular joint (TMJ) and three different status of anterior disc location, so that it could guide the clinical diagnosis further.Methods:Fifty-two patients [46 females and 6 males, with an age of (27.8±8.3) years] who treated with MRI and cone beam CT, were recruited from the Temporomandibular Joint Specialist Clinic, The First Affiliated Hospital of Xinjiang Medical University, between March 2018 to December 2021. According to the radiographic findings of the level of anterior disc displacement (ADD) in TMJ, patients were divided into three groups: normal articular disc position (NADP, n=28 TMJs), anterior disc displacement with reduction (ADDWR, n=28 TMJs), and anterior disc displacement without reduction (ADDWoR, n=28 TMJs). In the light of the reconstructed three-dimensional model, ten representative morphological parameters including condylar volume (CV), condylar superficial area (CSA), fossa volume (FV), fossa superficial area (FSA), the proportion of the condylar volume in the articular fossa (CV%), the proportion of the condylar superficial area in the articular fossa (CSA%), superior joint space (SJS), anterior joint space (AJS), posterior joint space (PJS), and medial joint space (MJS), were measured respectively under one-way analysis of variance (ANOVA), Kruskal-Wallis Htest and receiver operator characteristic curve(ROC curve) analyses. Results:CV and CSA values varied significantly in the pathological progression from normal location to irreversible anterior displacement in TMJ. For CV value, NADP group [(1 834.90±667.67) mm 3]>ADDWR group [(1 747.34±369.42) mm 3]>ADDWoR group [(1 256.29±418.27) mm 3] [ t=4.31, P(NADP-ADDWoR)<0.001; t=3.66, P(ADDWR-ADDWoR)<0.001], for CSA value, NADP group [(859.27±216.01) mm 2]>ADDWR group [(838.23±118.82) mm 2]>ADDWoR group [(669.14±150.26) mm 2] [ t=4.27, P(NADP-ADDWoR)<0.001; t=3.80, P(ADDWR-ADDWoR)<0.001]. The difference of SJS value in NADP group [(2.22±0.88) mm], ADDWR group [(1.94±0.64) mm] and ADDWoR group [(1.45±0.57) mm], was statistically significant [ t=4.11, P(NADP-ADDWoR)<0.001; t=2.63, P(ADDWR-ADDWoR)=0.010]. The results of MJS in NADP group [(5.03±1.41) mm], ADDWR group [(3.86±1.32) mm], and ADDWoR group [(4.91±1.65) mm] were significantly different [ t=3.00, P(NADP-ADDWR)=0.004; t=2.63, P(ADDWR-ADDWoR)=0.009]. As calculated by the ROC curve analysis, CV, CSA and SJS showed that (AUC CV=0.77, AUC CSA=0.76; AUC SJS=0.76) for the NADP and ADDWoR groups, and (AUC CV=0.80; AUC CSA=0.80; AUC SJS=0.72) for the ADDWR and ADDWoR groups. While the diagnostic accuracy of MJS for the comparison in NADP versus ADDWR and ADDWR versus ADDWoR was respectively AUC (NADP-ADDWR)=0.73, and AUC (ADDWR-ADDWoR)=0.69. Conclusions:CV, CSA, SJS, and MJS were significantly associated with the different disc displacement status, and the condyle in TMJ ADD exhibited three-dimensionally altered dimensions. They could be considered as promising biometric markers to diagnose the ADD status.