[Summary] The controversy remains on whether the Oddi sphincter function should be preserved or deprived in the treatment of hepatolithiasis .The surgical approaches achieving both hepatobiliary lesions clearance and Oddi sphincter preservation have been widely accepted .The biliary-enterostomy is suspected to increase the risk of reflux cholangitis and cholangiocarcinoma due to iatrogenic Oddi sphincter deprivation.Endoscopic sphincterotomy (EST) as a minimally invasive method still needs further research to determine its role in hepatolithiasis management .

Objective To investigate the intracellular signal transduction pathway of insulin promoting stem cell factor (SCF) expression in colonic smooth muscle cells (SMCs).Methods Colonic SMCs from SD rats were isolated and cultured, which were identified by α-actin immunofluorescence cytochemistry staining.SMCs were divided into 3 groups for experiment. ①Insulin concentration gradient group:Adding different insulin concentrations (0,2.5,5,20,40 and 80 mg/L) into SMCs culture and cultured for 16 hours; ② Insulin time point group:SMCs were cultured with insulin (40 mg/L) for different time durations (0,8,16,24 hours); ③ Signal pathway blocking group:SMCs were pretreated with LY-294002 or PD-98059,and then induced with insulin (40 mg/L) for 16 h.The proliferation of SMCs was examined by MTT method.The change of SCF expression was determined by Western blot and RT-PCR.Results ① Insulin at concentration of 5 mg/L remarkably promoted SMCs proliferation,and there was no significant difference in its effect with insulin concentrations at 20,40,80 mg/L (all P＜0.05).② Compared with no insulin adding group,low and medium dose of insulin (2.5,5,20 mg/L) already had a role in promoting SCF mRNA and SCF protein expression (all P ＜ 0.05). It reached maxium effect when insulin concentration was at 40 mg/L(P＜0.05),and there was no significant difference between insulin concentration at 40 mg/L and 80 mg/L (P＞0.05).③ Compared with time 0 hour,the expression of SCF increased after insulin worked on SMC (40 mg/L) for 8 hours (P＜0.05),and reached the peak after 16 hours (P＜0.05),and there was no significant difference between 24 hours and 16 hours (P＞0.05).④ Compared with blank control group and solvent control group,both insulin-induced SCF expression reduced after pretreated with LY-294002 or PD-98059 (all P＜0.05).Conclusions Insulin can promote SMCs proliferation,and in certain range the induction of SCF synthesis in colon SMCs is in dose and time dependent manners.The effect may be related to PI3K and MAPK signal pathway.

Objective To probe the changes of RAGEmRNA expression in renal tissue of.streptozotocin (STZ)-induced diabetic rats. Methods Quantitative reverse transcription polymerase chain reaction (RT-PCR) was used in control rats and diabetic rats for 12 weeks. Results After 4 weeks of diabetes inducement, RACEmRNA level showed a continuous increase both in diabetic renal cortex and medulla. However, this enhancement could not be observed in 2 weeks of diabetes. In addition, after 8 weeks diabetic rats had significantly higher glycated Hb(GHb). Conclusion Gene expression of RAGE in renal tissue of diabetic rats is altered and the excessive gene expression of RAGE may enhance the AGEs-RAGE interactions which would contribute to the development of diabetic nephropathy. Furthermore, this change occurs as a result of hyperglycemia-induced AGEs formation.

Objective To study the multi-slice spiral CT (MSCT) perfusion imaging in evaluating the changes of blood supply of hepatocellular carcinoma( HCC ) before and after transcatheter hepatic arterial chemoembolization (TACE). Methods Before and after TACE, MSCT perfusion was performed in 17 patients with HCC. The perfusion indexes such as hepatic blood flow (HBF), hepatic blood volume(HBV),mean transit time (MTT),hepatic arterial fracture (HAF),permeability surface (PS), hepatic artery perfusion (HAP), portal venous perfusion (PVP) were calculated. The hemodynamic changes of HCC after TACE were evaluated according to perfusion parameters. Results After TACE, HBF,HBV and HAP found in MTT and PS before and after TACE (P > 0.05). Conclusion The parameters of MSCT perfusion imaging( HBF, HBV and HAP) can effectively evaluate the hemodynamic changes of HCC after TACE, and has important value in chnical application.

Objective:To evaluate the effectiveness on the prevention of behavior problems of life skills education combining school-based and parent-involved approaches for third-grade students in China.Methods:This research was targeted at the population of third-grade children in two elementary schools in Qinhuangdao City,Hebei Province.Nine regular school classrooms were randomly divided into three groups:the intervention group(n=208),internal control group(n=209) and external control group(n=204).The intervention included 26-hour competence promotion for students and 5-hour parent training.The Rutter Scale by parent and teacher were used to evaluate the effects at pretest,posttest and 6-month follow-up.Results:Improvement was observed among children in the intervention group than those in the control groups.The statistical difference was significant(P

Objective To discuss the method and surgical technique in treatment of the displaced acetabular fracture.Methods The study involved 66 patients with displaced acetabular fracture treated operatively with reconstruction plates from August 2005 to June 2009.Based on the fracture typing,the surgical techniques including anterior ilioinguinal,posterior Kocher-Langenbeck,combined ilioinguinal and Kocher-Langenbeck and Y shaped approach were performed in 12,30,22 and 2 patients,respectively.Results The operation time was mean 3.4 hours(1.5-6.5 hours),with mean blood loss of 550 ml(range,350-1 200 ml).All patients were followed up for average 29 months(range,12-46 months).According to Matta evaluation standard,the reduction of acetabular fracture was anatomical in 34 patients,imperfect in 25 and unsatisfactory in seven.According to the modified Merled' Aubigne and Postel clinical evaluation standard,the clinical outcome was graded as excellent in 23 patients,good in 29,fair in eight and poor in six.Conclusion The factors key to successful operation include correct fracture classification,good approach anatomy,proficient technique of reduction and fixation,and reasonable perioperation measures.

Objective To conduct an empirical study for quantifying the anastomosis between two vessels after skin expanded technique by the method of angiography and to provide a precise basis for vascular study in skin flap.Methods Bilateral skin flaps based on deep iliac circumflex vessels were elevated from the abdominal wall including deep superior epigastric vessels.One was expanded at the boundary between two vessels and the other unexpanded.An X-ray image was obtained by carotid arterial injection of gelatin-lead oxide mixture.Three parallel lines with equal intervals perpendicular to long axis of the two vessels were designed at the communication area.Vessel anastomosis quantity was determined by counting the number of marks derived from the intersections of the lines and the vessels and statistical analysis was carried out.Results The marks of intersection in expanded group were more than unexpanded group with statistical significance.Conclusions The method for quantifying vessel anastomosis in skin flap is reliable.The principles of this procedure may also be applied to other experimental and elinical studies.

Objective To investigate the clinical efficacy of atlantoaxial pedicle screw fixation plus bony fusion in treatment of traumatic upper cervical instability.Methods From October 2009 to August 2013,29 patients with traumatic upper cervical spine instability were treated with posterior atlantoaxial pedicle screws.The patients underwent autografting (n =19) and allografting (n =10) for spinal fusion.Surrcal outcomes were recorded including intraopcrativc blood loss,operation time,with or without nerve,blood vessel and spinal cord injury,wound healing and bone fusion rate.Results All operations were completed smoothly with operation time of 110 minutes (range,85-135 minutes) and blood loss of 150 ml (range,80-500 ml).At the follow-up of 10 months to 5 years (mean 18 months),bony fusion was detected for all the patients.Postoperative radiographs verified all patients were bony fusion with satisfactory cervical spine stability.No complications of reduction loss,fixation failure,and spinal cord or vertebral artery injury were observed except for 1 patient with low viruleut infection and 2 with delayed wound healing.Conclusion Single posterior atlantoaxial pedicle screw fixation provides security and reliable stability in treatment of upper cervical instability,however wound healing problems should be taken seriously.

Objective To determine the dynamic change of serum procalcitonin (PCT) level after traumatic brain injury and the rclated clinical significance.Methods Serum levels of PCT and adrenocorticotropic hormone (ATCH) in 137 patients with traumatic brain injury and 20 normal volunteers were measured by electrochemiluminescence assay.Correlation between serum PCT level and severity of traumatic brain injury was evaluated.Results Percentage of serum PCT level at low inflammatory-risk threshold detected from day 1 to day 14 after admission was descended from 80.3％ to 63.5％.Meanwhile,the percentage of serum PCT level at high inflammatory-risk threshold was a rising-fall-rising trend,but the percentages of serum PCT level at median and definite inflammatory-risk thresholds showed sustained increase from 13.9％ to 27.0％ and 0.7％ to 3.7％ separately.Based on the Glasgow Coma Scale (GCS),the dynamic change of serum PCT level demonstrated a distinct bimodal pattern in severe injury group,a gradual falling after rising mode in middle injury group which was significantly and positively correlated with GCS (r =0.463,P ＜ 0.05),and a rising-falling-slight rising tendency in minorinjury group.In addition,the GCS in each group only closely related to the positive detections of serum PCT level detected at days 3 and 7 (x2 =10.32,16.31 respectively P ＜ 0.01).Serum ATCH level at day 1 was far higher than that at day 14 in severe injury group and was significantly higher in severe injurygroup compared with minor and middle injury groups (P ＜ 0.01 or 0.05).Conclusions Positive serum PCT may be predictive of the traumatic brain injury and injury degree within 3-7 days after the injury.The dynamic change of serum PCT is associated with the specialized mechanism of traumatic brain injury and neuronendocrine response,and it may be a useful parameter to assess posttraumatic stress response and prognosis.

Objective To explore the surgical treatments through anterior and posterior approaches for anterior and posterior compression of cervical spinal cord. Methods The clinical data of 25 cases of anterior and posterior compression of cervical spinal cord from June 1999 to November 2003 were summarized retrospectively. There were 18 males and seven females with age range of 28-56 years (average 36.4 years). Of all,18 cases were with tricolumnae fractures of cervical spine caused by traffic injury,five with cervical herniation and two with malignant macrophage tumor in vertebral body and annex and vertebral lamina. Results All 25 cases underwent internal fixation decompression with I-stage combination operation of anterior and posterior approaches. Of 18 cases with tricolumnae fractures,one died and 17 recovered in various degrees. In five cases with cervical herniation,the positive sign disappeared basically. Two cases of malignant giant-cell tumor appeared metastatic carcinoma in the lungs 10 months after operation. Conclusions The I-stage combination operation of anterior and posterior approaches is an ideal way for the patients suffering from anteropsterospinal compression in cervical spinal cord. It can not only decompress completely the cervical spinal cord,stabilize the wounded cervical vertebra,but also facilitate nursing and function training and be beneficial to the recovery of spinal cord function.