Objective To investigate pre-and intra-operative preventive measures against immediate conversions to open surgery during laparoscopic cholecystectomy(LC).Methods We retrospectively reviewed 568 cases of LC,27 of which underwent an immediate conversion to open surgery.Causes of conversions,surgical techniques,and curative outcomes were analyzed.Results Causes of immediate conversions included: severe adhesion between the gallbladder and neighboring tissues(1.4%),severe acute cholecystitis(1.1%),freezing adhesion in the Calot triangle(0.9%),large stone obstruction proximal to the gallbladder(0.5%),abnormal anatomy of the cystic duct(0.4%),extensive adhesion around the umbilical port(0.4%),and uncontrollable hemorrhage of the gallbladder bed(0.2%).No fatal cases or intra-and post-operative complications were observed.Conclusions Preventive measures should be taken before and during laparoscopic cholecystectomy to minimize the possibility of immediate conversions to open surgery.

Objective To investigate the influence of atorvastatin on tumor necrosis factor - α (TNF- α) of sepsis rats.Methods Sepsis models were established using male SD rats by cecal ligation and puncture (CLP).A total of 100 healthy rats were divided into 4 groups ( n =25) randomly ( random number):sham- operation group,CLP group,low- dose atorvastatin group and high -dose Atorvastatin group.Blood samples of 5 rats in each group were collected at postoperative 0,3,6,12 and 24 hours,to detect tumor necrosis factor - α (TNF - α) levels in plasma.Observe and compare the mobility of rats in each group and specimens of small intestine were taken for histopathological examination by optical microscope.Results At 0 hour,plasmic TNF - α levels in 4 groups were statistically equal (P ＞ 0.05 ).In plasma of sham - operation group,changes of TNF - α levels were not obvious.Compared with CLP group,TNF - α levels in low - dose and high - dose Atorvastatin groups were both significantly lower ( P ＜0.01 ) at postoperative 3,6,12 and 24 hours.And TNF-α levels in high -dose Atorvastatin group were significantly lower than those in low - dose group ( P ＜ 0.01 ) at the 4 time points.The mortality of sepsis was higher in CLP model group than other groups,That of Atorvastatin group was significantly lower than CLP model group but higher than control group and high - dose group was lower than low - dose group.Conclusions Atorvastatin can inhibit the expression of TNF - α in blood plasma of sepsis rats and reduce inflammatory reaction.

BACKGROUND:Studies have found that peripheral blood stem cel s can highly differentiate into vascular endothelial cel s to promote blood vessel regeneration, and improve col ateral circulation, thereby achieving satisfactory outcomes in the treatment of limb ischemia. OBJECTIVE:To observe the clinical effect in diabetic lower extremity vascular disease patients undergoing percutaneous transluminal angioplasty combined with autologous peripheral blood stem cel transplantation. METHODS:Fifty patients hospitalized for diabetic lower extremity vascular disease from March in 2011 to December in 2014 were col ected:25 cases underwent percutaneous transluminal angioplasty as control group;another 25 underwent percutaneous transluminal angioplasty combined with autologous peripheral blood stem cel transplantation as combination group. At 1, 6, 12 months after surgery, subjective scores of affected limb pain and cold sensation were recorded, additional y, objective indicators, including ankle-brachial index, transcutaneous oxygen partial pressure, and claudication distance were detected. RESULTS AND CONCLUSION:Ankle-brachial index scores of the two groups were significantly increased, especial y at 1 month after surgery, but decreased at 6, 12 months, and there was a significant difference compared with that before treatment (P<0.05);at 1, 6, and 12 months, there was no significant difference between the two groups (P>0.05). At 1, 6, and 12 months after surgery, both of transcutaneous oxygen partial pressure and claudication distance in the two groups were significantly increased compared with those before treatment (P<0.05). Furthermore, compared with the control group, these two indicators in the combination group were significantly increased (P<0.05). Within 12-month follow-up, affected limb pain and cold sensation were improved in the two groups, especial y in the combination group. Inevitably, three cases had hypocalcemia during the col ection of peripheral blood stem cel s, and two cases developed fever and 3 cases appeared to have local exudation after surgery. All these symptoms were released by symptomatic treatments, respectively. In conclusion, percutaneous transluminal angioplasty combined with autologous peripheral blood stem cel transplantation for diabetic lower extremity vascular lesions can promote the establishment of affected limb col ateral circulation, to decrease the risk of limb ischemia, which achieves significant outcomes than percutaneous transluminal angioplasty used alone.

Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery.Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study.There were 15 males and 74 females.The patients aged from 42 to 82 years,with the mean age of (64.13 ± 7.20) years.All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations.The BCVA ranged from 0.01 to 0.4,with the mean BCVA of 0.12 ± 0.09.The MH stages was ranged from 2 to 4,with the mean stages of 3.56 ± 0.77.The basal diameter ranged from 182 μm to 1569 μm,with the mean basal diameter of (782.52± 339.17) μm.The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation.Fortyone eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting.The follow-up ranged from 28 to 720 days,with the mean follow-up of (153.73 ± 160.95) days.The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed.Results On the last visit,the BCVA ranged from 0.02 to 0.8,with the mean BCVA of 0.26±0.18.Among 89 eyes,vision improved in 45 eyes (50.56％) and stabled in 44 eyes (49.44％).Eighty-six eyes (96.63％) gained MH closure but 3 eyes (3.37％) failed.By analysis,patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092,2.569;P＜ 0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=-5.413,P＜0.05).However,gender,age,duration,preoperative BCVA,surgery technique,gas types and follow-up time had no relationship with the effect after surgery for IMH (P＞0.05).Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery.However,age,gender,duration,surgery patterns,gas types and followup time showed no effects on operational outcomes.

Objective To study CD40 expression on melanocytes induced by IFN-?and its significance. Methods CD40 expression was detected by flow cytometry. The capacity of melanocytes to stimulate T lymphocytes was evaluated by mixed ly mphocyte reaction and the supernatant cytokine levels were determined by ELISA. ResultsHuman melanocytes(MC) cultured in vitro expressed low but detectable CD40 surf ace protein. The surface expression of CD40 was markedly up-regulated by stimul ation with interferon(IFN)-?with different concentrations for 24 hours,48 hour s and 72 hours, respectively. The expression of CD40 was correlated with IFN-? levels after 24 hour incubation. MC underwent a morphologic change with an incre ased capacity to stimulate allogenic lymphocytes to proliferate after IFN-?sti mulation. Optimal enhancement of stimulating index(SI) was observed at an IFN-?concentration of 300 IU/ml after 72 hour treatment. Meanwhile concentrations o f interleukin-12 but not interleukin-8 or 10 were obviously increased in the s upernatants of cultured MC. Furthermore, ligation of CD40 via soluble CD40 ligan d(SCD40L) could enhance CD80 and ICAM-1 expression, which could be blocked by s pecific monoclonal antibody to CD40L. Conclusions Since CD40-CD40L is a pair of important and special costimulating signal, it is of great value to elucidate t he fact that CD40 is functionally expressed on MC, thus for a better understandi ng of MC′s role in cellular immune responses. MC might activate cytotoxic T lym phocyte directly and not via CD4 positive lymphocyte.

Objective To summarize the experience of laparoscopic cholecystectomy ( LC) for acute cholecystitis (AC).Methods A retrospective study was conducted on 382 patients with AC, who were underwent LC.Results Of all 382 cases,370 cases were successfully finished with LC,and other 12 cases were finished with open surgery(3.14% ).The operation methods are successively anterograde cholecystectomy(267 cases),retrograde cholecystectomy(59 cases) ,anterograde and retrograde cholecystectomy(44 cases).Abdominal drainage was placed in all cases.Post-operation complications occurred in 15 cases (3.93% ).The complications are suppurative infection of sub-ensistemum incision(9 cases) ,abdominal infection(2 cases) ,adhesive ileus(2 cases) ,sub-ensisternum incision hernia(2 cases).There are no death cases,transfusion cases or latrogenic injury in our study.Conclusion The best time window of LC for AC was with in 72 hours since the symptom.The key factors for the surgery were careful dissection of calot's triangle,properly handling with the incarcerated cystic duct stone and thickened cystic duct,avoiding injury of cystic artery and over-dissection of gallbladder bed.Transfer to open surgery when necessary could reduce complications and latrogenic injury.

OBJECTIVE: To study the effect of oxymatrine on pathological change in brain tissue of newborn mice infected by cytomegalovirus (CMV). METHODS: CMV of TCID50 was inoculated into the brain of the newborn mice, and the morphological change in the brain tissue infected by CMV was observed with light microscope and transmission electron microscope. RESULTS: In the model control group, the results showed that there were some inflammatory cellular infiltration and focal necrosis in the brain tissue of newborn mice infected by CMV. The ultrastructure change in the brain tissue showed that the nuclear membrane of cerebral neurons sunk, the chromatin deformed and fused into masses, the cytoplasm vacuolated, the endoplasmic reticulum disarranged and the Nissl's body was blurred or disappeared. After being treated with oxymatrine (50 mg/kg, ip) for 15 days, those pathological changes of the brain tissue in the newborn mice could be significantly improved. CONCLUSION: Oxymatrine has an obvious inhibition on CMV in vivo.

Objective To investigate thecorrelation between nonmusle myosin heavy chain 9 gene (MYH9) rs12107,signal transducer and activator of transcription (STAT4) rs3024912, Urokinase plasminogen activator (uPA) rs4065 single nucleotide polymorphism and idiopathic Uighur membranous nephropathy (IMN). Methods Patients admittedby People′s Hospital of Xinjiang Uyghur Autonomous Region from June 2011 to May 2015 were selected in the research,of which 45 with IMN (group A),45 patients with IgA nephropathy (group B) and 45 healthy controls(group C). The polymorphisms of rs12107,rs3024912 and rs4065 were measured with direct sequencing, in order to analyzing the correlation between genotype and allele with IMN. Results Group Ars12107 (MYH9) locus genotype CC, C allele (48.9%, 65.6%) frequency were higher than those in group B (13.3%, 33.3%) and group C (20.0%, 46.7%), and the difference was statistically significance (P < 0.05). C allele carriers of the risk of IMN is 2.18 times that of the T allele (95% CI: 1.19-3.97). Univariate Logistic regression analysis of rs12107 CC genotype showed patients with CC genotype faced with high risk of renal failure (OR = 5.56,95% CI:1.27-24.29, P = 0.023) compared with non-CC genotype patients. rs3024912 genotype and allele frequencies showed no significant difference among the three groups (P > 0.05). rs3024912 GG genotype patients showed higher risk of renal failure compared with non-GG genotype patients (95% CI:1.48-26.83, P = 0.013). Only TT genotype was detected on rs4065 locus. TC and CC genotype were not detected. Conclusions MYH9 gene rs12107 locus CC genotype and C allele are associated with susceptibility to IMN in Xinjiang Uygur, and CC genotypes associated with renal function. rs3024912 (STAT4)GG genotype are not susceptibility gene,but associated with renal function in patients with IMN.

Objective To determine the relationship between MEN1 gene mutations and occurrence of multiple endocrine neoplasia type 1 and their inherited characteristics. Methods Genomic DNA was extracted from the peripheral blood lymphocytes of patients and other family members. PCR was performed to amplify all 10 exons of MEN1 gene. The PCR products were directly sequenced. Subclone sequencing was performed to identify the heterozygosity. Results An 18 base pairs of insertion(372-373 insACCTGTCTATCATCGCCG) was identified in one family and a 4 base pairs of deletion (357-360delCTGT) in the other family, both mutations occurred in exon 2 of MEN1 gene in the patients, and the former was a new mutation. Conclusion The MEN1 gene mutations were identified in two Chinese families with multiple endocrine neoplasia type 1, in one of which a novel mutation of MEN1 gene (372-373insACCTGTCTATCATCGCCG) was detected.

Objective To investigate the autophagy and the expression of its related genes in the peripheral blood mononuclear cells (PBMCs) of active systemic lupus erythematosus (SLE) patients.Methods Patients with newly onset or recently-diagnosed SLE (n=20) were enrolled.RA patients (n=10) and healthy blood donors (n=10) were used as controls.PBMCs from all subjects were immediately isolated by Ficoll-Hypaque density gradient centrifugation.And then monocytes were removed by wall sticking method.The morphology was observed using transmission electron microscopy (TEM).Messenger RNA (mRNA) expression of Beclin 1 and microtubule-associated protein 1-light chain 3 (MAPLC3) were determined by reverse transcription polymerase chain reaction (RT-PCR) and real-time quantitative RT-PCR respectively.Results TEM showed autophagic phenomenon in PBMCs from active SLE.On the mRNA level,expression of Beclin 1 and LC3 was significantly increased in fresh isolated SLE cells as compared with RA or healthy donor's PBMCs.Conclusion Based on these results,we can conclude that autophagy occurs in active SLE and the expression of its related genes is significantly higher in active SLE than in RA or normal controls.The enhanced autophagy may indicate its role in the pathogenesis of SLE.