Objective To discuss how to improve judgement and technique for avoiding bile duct injury during laparoscopic cholecystectomy(LC).Methods The clinical data of 39 860 patients treated by LC between October 1992 and October 2005 were analyzed retrospectively.Bile duct injury occured in 46 patients.Results Bile duct repair and T-tube drainage was performed in 26 patients and bile duct end-to-end anastomosis and T-tube drainage was performed in 4 patients,with the T-tube indwelling time for 3~12 months.The Roux-en-Y cholangiojejunostomy was conducted in 11 patients,the ligation of accessory hepatic duct was conducted in 5 pauients,the re-operation for bile duct stenosis in 4 patients,and the re-operation for stenosis after cholangiojejunostomy,in 2 patients.Conclusions Intensive anatomic knowledge and skillful surgical performance can avoid or minimize the incidence of bile duct injury.Early detection and active repair of the bile duct injury for preventing acute inflammation is the most important measure to avoid repeated operations.

Objective To explore the management of unsuspected gallbladder carcinoma (UGC) discovered during laparoscopic cholecystectomy (LC). Methods From January 2000 to May 2007, 15 560 cases of LC were performed in our hospital, UGC was discovered in 28 of the cases. Clinical data of the 28 patients were analyzed retrospectively. Results Among the 28 cases of UGC, 12 were discovered intraoperatively, and 16 were diagnosed postoperatively.Radical cholecystectomy was performed on the 12 cases who were detected during the operation,and 5 of the 16 patients who were diagnosed after the operation.LC was carried out in the remaining 11 cases. Postoperative pathological examination showed TNM stageⅠin 3 cases, stageⅡin 23, and stage Ⅲ in 2. The patients were followed up for 7-66 months with a mean of 22 months. During the period, 19 patients died. The 1-, 3-, and 5-year survival rate of the 17 patients who received radical cholecystectomy were 76.5% (13/17), 23.5% (4/17), and 11.8% (2/17), respectively. Whereas, in the 11 patients who underwent LC, the 1-year survival rate was 45.4%; moreover, none of the 11 survived for more than 2 years. Conclusions For high-risk population, attention should be paid to UGC during operation. Most of the UGCs discovered during LC are early-stage carcinomas, which should be treated with standard radical cholecystectomy, but not LC.

Objective To investigate the clinical significance of YMDD mutation during Lamivudine therapy on chronic hepatitis B.Methods Fluorometric analysis PCR, ELISA were used to estimate the YMDD mutation, HBVDNA quantative level and HBeAg for HBV of 72 cases with chronic hepatitis B before therapy (0 month), and after Lamivudine therapy for 9,12,18 months.Results The YMDD mutation was not observed in these cases before Lamivudine therapy. The mutation was found in 8 cases (11.1%), 17 cases (23.6%) and 28 cases (38.9%) at 9, 12, 18 month for therapy. The YMDD mutation rate rose with the therapy time lasting (P＜0.05). Moreover, the YmDD mutation rate in the patients with HBVDNA quantity higher than 108 copies/ml was significantly higher than that in the patients with HBVDNA quantity lower than 108 copies/ml (P＜0.005). The YMDD variation rate in patients with HBeAg positive and in patients with HBeAg negative showed no significant difference (P＞0.05). The HBeAg negative conversion rate was significantly higher in non-mutation group than that in mutation group (P＜0.05).Conclusion The serum virus quantity may be regard as an early estimate indication of the development of YMDD mutation during Lamivudine therapy.

Objective To discuss about the relationship between the occurrence of the uterine cervix cancer and the risk factors.MethodsAmong the patients we collected,92 patients were diagnosed to have the cervical cancer,63 patients were diagnosed as CINⅢ (the cervical intraepithelial neoplasia,CIN),and 252 patients belonged to the control group.All patients had not been cured before.We used the questionnaire to investigate them about the dietary habit and other information.Through using different statistical Methods ,we explored the relationship between the cervical cancer and the potential factors.ResultsWe found out that many factors contributed to the happening of the cervical cancer,such as gynecopathy(χ2=19.31,P＜0.01),the first time of the menses(F＝11.62,P＜0.01),the first time of the sex life(F＝25.76,P＜0.01),the first time of the parturition (F＝28.02,P＜0.01),the times of the pregnancy and the parturition(F1＝13.98,P1＜0.01;F2＝4.78,P2＜0.01),the culture degree(χ2＝10.70,P＜0.05),the infection of HPV(χ2＝179.95,P＜0.01),the level of the folic acid (F＝3.39,P＜0.05) and so on.The result of the logistic regression analysis showed that keeping the habit of drinking tea(OR＝0.321,β＝-1.136,P＜0.05),paying attention to the sanitation of the sex life(OR＝0.387,β＝-0.950,P＜0.05),putting off the first time of the sex life(OR＝0.551,β＝-0.596,P＜0.05),and the higher level of the folic acid (OR＝0.502,β＝-0.688,P＜0.05) were the protective factors tothe occurrence of the uterine cervix cancer.Meanwhile,the infection of the HPV(OR＝27.215,β＝3.304,P＜0.01),many times of the parturition(OR＝1.846,β＝0.613,P＜0.05) and the passive smoking (OR＝1.673,β＝0.515,P＜0.05) were the risk factors.ConclusionsWith the higher level of the folic acid,the less possibility you will get the cervical cancer.There exists many measures to prevent the happening of the cervical cancer,like keeping the healthy sex life,keeping far away from the passive smoking,not to give birth too early or too many and preventing being infected the HPV.What's more,having the good habit of drinking tea and paying attention to the supplement of the folic acid and Vitamin B12 may be the effective method to prevent the occurrence of the cervical cancer.

Objective Using 7.0 T diffusion tensor imaging(DTI) to study myocardial fibers character in isolated rats heart in aspect of water molecular diffusion, myocardial mechanics and microstructure. Methods Fixed male rats heart (n=10) underwent DTI and the myocardial structures were quantitatively measured by Diffusion Toolkit and Matlab. The characteristic of myocardial fibers arrangement was observed and FA values and ADC values of myocardial fibers, myocardial fibers density and length, mean helix angle of left ventricular were calculated as well. Mean helix angle of anterior wall, ventricular septum, lateral wall and posterior wall of epicardium and endocardium were compared by using one?way ANOVA. Results The SD rats' myocardial fibers appeared in compact and inerratic distribution from epicardium to endocardium. Compared with HE staining, regular direction and arrangement in fibers were showed in myocardial fibers tracer map and tensor map in papillary muscle plane. Quantitative analysis showed that ADC value of SD rats' myocardial fibers was (9.6 ± 3.6) × 10-4 mm2/s, FA value was 0.80 ± 0.04, myocardial fibers density was (981±24) tracks/mm3 and myocardial fibers length was (6.18±1.71)mm. Mean helix angle of left ventricular epicardium to endocardium ranged from-81.37° to 0° and then gradually change to 82.83° . There were no significant differences in mean helix angle of anterior wall, ventricular septum, lateral wall and posterior wall of epicardium and endocardium, respectively (F=2.25, 0.40, P>0.05). Conclusions This study shows that DTI is an effective method to quantitatively measure the characteristics of myocardial fibers. This study provides useful information for further study of myocardial fibers in heart disease models.

A series of andrographolide derivatives with the structure of 12-N-substituted-14-deoxyandrographolide were synthesized from the parent compound andrographolide.Their antitumor activities were preliminarily evaluated on various cancer cell lines and compound 4d stood out due to its potent growth inhibitory effect in comparison with andrographolide.Compound 4d also demonstrated significant antitumor effect on human hepatoma HepG2cells in vitro and on sarcoma 180 (S180) and hepatoma 22(H22)-bearing mice in vivo.Then,the apoptosis induced by compound 4d in HepG2cells was detected by Annexin V/PI double staining assay.Further mechanic study showed that the expression of p53 and Bax was significantly elevated and that of Bcl-2was downregulated in 4d-treated HepG2cells.Collectively,these data suggested that compound 4d had remarkable antitumor effect both in vitro and in vivo and could effectively induce apoptosis via a p53-dependent pathway in HepG2 cells,thus deserving further investigation.

OBJECTIVE:To make clear the antimicrobials used for inpatients in our hospital from September 1999 to March 2000 METHODS:We sampled the records of discharged patients at the ratio of 1/3 of sickbeds in our hospital,and filled in "the questionnaire of antimicrobials used in clinical department" item by item,finally,we carried out comprehensive analysis RESU_LTS:More than half was administration of single and basic antimicrobial Combined use of antimicrobials for severe and mixed infections was rational The rate of using antimicrobials was high(79 64%),especially in preventing perioperative infections,reached nearly 100% The starting-point was high in choice of drug and the newly-developed,special and expensive drugs occupied the front place in order of consumption Combined use of drugs was unduly prevalent Most of treatment depended on experience The rate of bacterial drug resistance test was only performed in 10% of patients CONCLUSION:Rational use of drugs is the main trend,however,the measure directed against existing problem should be worked out

Objective To investigate the relationships among clinical features, endoscopic characteristics and pathologic epithelial types of Barrett esophagus. Methods Magnification chromoendoscopy ( MCE) was performed in 2506 patients with gastroesophageal reflux disease ( GERD) and 106 patients with Barrett esophagus in our hospital during Feb,2003 -Feb,2004 were analyzed. The clinical features, endoscopic characteristics, pathologic epithelial types and their relationships were analyzed. Results The symptoms of gastro esophageal reflux disease ( GERD) were the main presentation of Barrett esophagus but 27 (25. 5% ) cases without such presentation. Four types of mueosal patterns, dot pattern, ridge or villous pattern and irregular/distorted pattern. were noted within the columnar mucosa using high magnification endos-copy: There were three epithelial types within the columnar lined esophagus: intestinal metaplasia (IM ) , cardiac and fundie types. Three epithelial types were noted in the methylene blue staining areas; ridged/vil-lous pattern and irregular/distorted pattern, all of them were in epithelial types of intestinal metaplasia. Conclusion Magnification chromoendoscopy helps to identify areas with IM, and having important significance in diagnosis and clinical follow up of Barrett esophagus.

Background and purpose. Gastric stromal tumor (GST) is the most common mesenchymal tumor of the gastrointestinal tract and most often arises in the stomach. In the past, surgery was the only effective treatment. The diagnosis and treatment of GST has been revolutionized over the past, since expression of the receptor tyrosine kinase KIT (CD117) was shown to occur on these tumors, the outcome of GST treatment has dramatically been improved. This study focused on the therapeutic experience of GST and analyzed the pathological features and prognostic factors of GST in our center. Methods: All the 26 cases underwent surgical resection and three of them were treated over 6 months with imatinib 400 mg/d. The clinical pathological and follow-up data of 26 patients with GST admitted in our hospital between Jan. 2000 and Dec. 2008 were analyzed retrospectively. Results. All the cases underwent curative resections, including palliative liver resection in 3 patients with liver metastasis. Recurrence occured on 6 patients, including 1 case with low risk group, 1 case with intermediate risk group, 4 cases with high risk group. Tumor size ranged from 2 to 15 cm with the mean of 5.5 cm. The immunohistochemistry results revealed that the positive rates of CD117, CD34 and Vimentin were 92.3%, 80.8% and 96.2% respectively. After operation, three patients accepted imatinib mesylate therapy over 6 months. Two of them were alive, but one had liver metastasis. The follow-up period ranged from 4 to 36 months (median: 28 months). Four cases were lost. The 1-, 3-year overall survival rates of 26 cases were 96.2% and 84.6%. Conclusion: Tumor size, location, mitosis and immunohistochemical data are important variables to evaluate GST behavior and prognosis. Surgical resection is the main therapy for GST and targeted therapy will improve the prognosis.

BACKGROUND: Thermotherapy has achieved remarkable therapeutic effect on patients with esophageal cancer. However, there are still some problems which cannot be answered today, such as the damage of esophageal mucosa during deep thermotherapy when metal stent is placed in esophagus. OBJECTIVE: To study the metal stent-caused damages to esophageal mucosa of pigs in radiofrequency hyperthermia. DESIGN, TIME AND SETTING: Observational study which was performed in the Department of Tumor, Affiliated Hospital of Luzhou Medical College from October 2004 to January 2005. MATERIALS: 13 pigs weighing 35-40 kg were used in this study. Esophagus stent of memory alloy with membrane was provided by Zhiye Medical Apparatus Institute of Changzhou, China METHODS: Five points were located for measurement, i.e. the middle of the stent, the exit of the stent, 2 cm and 4 cm a distance from the exit and 4 cm from the entrance. Esophagus of 13 pigs was heated for 30 minutes by SR-1000 radiofrequency hyperthermia machine in frequency of 40.82 MHz, pole plate of 25 cm Ⅱ 25 cm and power of 500-700 W. MAIN OUTCOME MEASURES: The esophageal mucosa was observed with naked eyes. And optical microscopy was used to observe the changes of the esophageal mucosa. RESULTS: Because one pig died of anesthesia and there were troubles of thermal detector lines in 4 pigs, only 8 pigs were included in the final analysis. Level of damage of esophageal mucosa on five temperature checkpoints was observed from grade 0 to 1 in naked eyes, and the difference of damaged level between five checkpoints was not obvious in statistics (H=2.0, P=0.157). Level of the damage was observed from grade 0 to 2 in microscope, and the difference was not obvious in statistics too (H=2.734, P=0.255). CONCLUSION: Influence of the metal stent on esophageal mucosa can be neglected in radiofrequency hyperthermia, and metal stent does not cause obvious mechanical damage or thermal damage to esophageal mucosa of pigs. It is safe and feasible to carry out radiofrequency hyperthermia on placed metal stent esophagus.