The diagnosis of polypoid lesions of the gallbladder plays a key role in the selection of treatment methods.However we still lack of effective means to exclude the malignant transformation currently.It is believed that lesions,whose diameter more than 10 mm,tend to be malignant.In addition,multiple imagings and related risk factors can also bring us some valuable tips.This article summarizes the current research progress related to the differential diagnosis of the disease,hoping to provide help for the clinicians in the timing of operation for such disease.

BACKGROUND: As a method to effectively improve organic tolerance and velocity, altitude training has been gradually accepted by the coaches,and it is a problem to be solved to find the optimal altitude.OBJECTIVE: To establish rat models of stimulating altitude training, and observe the changes of myocardial cell structure in the altitude training, so as to provide scientific animal models for the physiological studies of altitude training, and provide more scientific theoretical evidence for the altitude training of athletes.DESIGN: Based on the division of altitude region in aerospace medicine,the experimental animals were divided into different altitude training groups and control groups. Morphological characters of cellular and subcellular structures were observed under electron microscope, the biochemical analysis of cardiac troponin T were performed, and then the myocardial injury was completely analyzed from two pathways of morphology and biochemistry.SETTING: Laboratory of Sports and Human Sciences, Tsinghua University.MATERIALS: The experiments were carried out in the Laboratory of Sports and Human Sciences, Tsinghua University from January 2000 to December 2002. Totally 372 male SD rats were used. The experimental materials included hypobaric oxygen chamber, Japanese H-500 transmission electron microscope and the kit for testing serum cardiac troponin T index.METHODS: After adaptive swimming training for 1 week, all the 372 rats were randomly divided into 9 groups and 54 subgroups, only 6 groups of them were analyzed in this experiment, including stimulating acute altitude hypoxia training at 4 000 m group (n=32), hypoxia without training group (n=24), stimulating acute altitude training at 4 000 m followed by reoxygen training for 1 week group (n=32), stimulating acute altitude training at 4000 m followed by reoxygen training for 2 weeks group (n=32), increasing altitude training group (n=32) and plain training control group (n=24). Rats in the plain training control group lived and trained in normal conditions,and those in the other groups all trained with swimming in the stimulating altitude environment for 4 weeks. They were trained for 7 days every week,once a day and 60 minutes for each time for 4 weeks. The serum cardic troponin T index of rats was detected and observed with enzyme-linked immunoabsorbent assay (ELISA). After stimulating acute altitude training at 4 000 m for 4 weeks followed by reoxygen training for 2 weeks, the rats were killed, and a small piece of myocardial tissue was taken from left and right ventricles, then double-stained with uranyl acetate and lead citrate,and the ultrastructure of the sections was observed with Japanese H-500 transmission electron microscope.MAIN OUTCOME MEASURES: The serum cardiac troponin T index of rats trained at different altitude, and the results of spectrum and observation of myocardial ultrastucture under electron microscope were mainly observed.RESULTS: ① Changes of body mass: The myocardial increasing rate in the hypoxia training group was significantly different from those in the hypoxia without training control group and plain training control group (P ＜ 0.01), and there was also significant difference between the latter two groups (P ＜ 0.05). The increasing rate of body mass was significantly different among the hypoxia training group, hypoxia without training control group and plain training control group (22.41％, 28.14％, 33.48％,P ＜ 0.01-0.05). ② Results of cardiac troponin T: Compared with the hypoxia without training group, the value of cardiac troponin T in the hypoxia training groups was significantly different, and significantly increased with weeks of training (P ＜ 0.01). During the hypoxia altitude training below 4 000 m for 1-4 weeks, the value of cardiac troponin T ranged in creased from 0.09 to 0.128 μg/L, and it gradually recovered to 0.09 μg/L after reoxygen training in plain for 2 weeks. ③ The results of observation under electron microscope showed that after acute hypoxia training at 4 000 m for 4 weeks, myocardial mitochondrial structure occurred mild swelling with the prolongation of training, and for the rats received reoxygen training in plain for 2 weeks, the thick and thin myofilaments of myocardial fibers formed light and dark bands were clear and distinct, and the myotomes arranged orderly, besides clustered or scattered glycogen granules, a great amount of mitochondria also existed among muscular bundles, no swelling, degeneration of vacuoles, lysis necrosis, interstitial edema and other pathological changes were observed.CONCLUSION: It is safe to train rats at any altitude below 4 000 m. The acute exercise training of great intensity directly at 4 000 m will cause the mild injury of cardiac subcellular structure, and the increase of cardiac troponin T concentration. The training by means of increasing altitude has slighter influence on the myocardial injury, and the recovery after training is also faster.

Objective To establish a reliable approach for quantification of colony forming unit(CFU)of Mycobac-terium tuberculosis (M.tb)by measuring optical density(OD).Methods M.tb suspension H37Ra was prepared using low-power ultrasonic or glass bead beating methods,and was two-fold serially diluted,OD at 600nm (OD600)of each dilution ratio was measured respectively,OD600 and dilution curve were analyzed to determine the optimum approach for preparing bacterial suspension,linear range of OD600,as well as linear relationship between OD600 and CFU.Results OD600 was 0.1 -0.6,linear regression analysis of OD600 and dilution ratio within linear range revealed that correlation coefficient (R2 )of glass bead beating and low-power ultrasonic methods were 0.98 and 1 .00 respectively,both presented a good correlation,low-power ultrasonic method was better than glass bead beat-ing method,bacterial suspension dispersed more evenly.Linear regression analysis results of OD600 and CFU val-ues showed that the regression equation of glass bead beating method and low-power ultrasonic method were CFU=2.35×107 ×OD600+4.42×105 and CFU=3.26×107 ×OD600+6.89×105 respectively.Conclusion Low-power ultrasonic method is a good method for preparation of M.tb suspension,combined the measurement of OD600 value, it can be a reliable and rapid method for quantitative analysis of M.tb.

Objective To investigate the effect of wire?reinforced epidural catheters on the success rate of epidural catheterization for labor analgesia. Methods A total of 200 nulliparous parturients who re?ceived labor analgesia voluntarily, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 20-45 yr, with body mass index<35 kg∕m2, were divided into 2 groups (n=100 each) using a random number table: common catheter group ( group Ⅰ) and reinforced catheter group ( group Ⅱ) . After suc?cessful epidural puncture, the corresponding catheter was inserted inⅠandⅡgroups. The development of difficult insertion, intravascular catheter insertion or paresthesia during insertion was defined as a failure of epidural catheterization. The occurrence of the failure of epidural catheterization was recorded. Results Compared with group Ⅰ, the failure rate of epidural catheterization was significantly decreased in groupⅡ( P<0.05) . Conclusion Wire?reinforced epidural catheters can raise the success rate of epidural catheter?ization for labor analgesia.

Objective To investigate the surgical method and clinical efficacy of hilar cholangio carcinoma in Bismuth type Ⅳ.Methods The retrospective descriptive study was adopted.The clinical data of 1 patient with hilar cholangiocarcinoma in Bismuth type Ⅳ who was admitted to the Renji Hospital affiliated to Shanghai Jiaotong University in October 2014 were collected.The patient had complaint about right upper abdominal pain for half month.Enhanced CT scan showed soft-tissue mass at hepatic hilum.After accurate assessment,the patient underwent radical resection of hilar cholangiocarcinoma + right hemihepatectomy + perihilar resection + right caudate hepatectomy + Roux-en-Y hepaticojejunostomy.The operation time,volume of intraoperative blood loss,results of pathological examination,postoperative complications,time of drainage tube removal,discharge time and follow-up were observed.The follow-up was performed to detect the life quality and tumor recurrence by outpatient examination and telephone interview up to July 2015.Results The patient received successful radical resection of hilar cholangiocarcinoma + right hemihepatectomy + perihilar resection + right caudate hepatectomy + Roux-en-Y hepaticojejunostomy.Operation time and volume of intraoperative blood loss were 480 minutes and 300 mL,respectively.The result of pathological examination showed that the size of hilar bile duct was 4 cm× 3 cm × 2 cm and poor-differentiated adenocarcinoma infiltrated through bile duct into liver tissues and right branch of portal vein.Two lymph nodes in the 8th group,1 in the 12a group and 3 in the 12p group were positive by detection,showing the metastasis of cancer cells.The resection margins of liver and bile ducts were negative,achieving a R0 resection.The patient had a removal of negative pressure drainage tube at postoperative day 7 and discharged from hospital at postoperative day 12,with a good recovery and without the complications of biliary fistula,abdominal infection and hepatic failure.During the 9-month follow-up,there was a good life quality and no tumor recurrence.Conclusion The radical resection rate of Bismuth type Ⅳ tumor can be increased by accurate preoperative evaluation,rational surgical approach,individualized surgical planning and precise intraoperative procedures.

Objective To analyze the safety and effectiveness of ambulatory surgery in inguinal herniorraphy.Methods The clinical data of 3 852 cases of inguinal hernia repair patients admitted from January 2009 to December 2013 in this single center was analyzed retrospectively.Cases of emergency surgery were excluded.Results All patients had long-term follow-up (12-60 months).1 575 patients underwent day-surgery,mean operation time was (43.84 ± 12.35) min,mean time of ambulation was (1.12 ± 0.91) d,mean time of recovery was (5.78 ± 1.12) d,mean hospitalization was (1.34 ± 0.48) d,mean hospitalization cost was (7 546.49 ±2 962.57) RMB.In contrast,there were 511 patients underwent a non day-surgery,mean operation time was (48.59 ± 14.52) min,mean time of ambulation was (2.43 ± 1.38) d,mean time of recovery was (7.46 ± 2.62) d,mean hospitalization was (4.8 ± 2.91) d,mean hospitalization cost was (9 165.16 ± 4 281.83) RMB.Patients with day-surgery were significantly superior to those with non day-surgery in operation time (P =0.000),mean time of ambulation (P =0.000),mean hospitalization (9 =0.000),mean hospitalization cost (P =0.000) and mean time of recovery (P =0.000).Infection and readmission in non day-surgery patients was higher than that in day-surgery (P =0.000).There was no difference in postoperation pain and hernia recurrence.Conclusions Ambulatory surgery in inguinal herniorraphy is safe with similar recurrence rate;but significantly lower cost and shorter hospitalization.

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Objective To evaluate the effect of external direct current shock on left atrial(LA) diamension and volumes after cardioversion for atrial fibrillation(AF) and the relation between LA size and function.Methods The initial study population included 68 patients with AF.According to cardioversion patterns, the patients were divided randomly into cardioversion with direct-current shock(36 patients) and cardioversion with drugs(32 patients). Echocardiographic evaluations included LA size and volume,LA passive and active emptying volumes were calculated,and LA function was measured as LA ejection force (LAEF).The correlation between LA diameters and volumes and LA systolic function was analyzed. Results LA was dilated in all the patients during AF and the superior-infra dimensions of LA decreased after restoration of sinus rhythm in the patients reverted with external direct current shock and the patients reverted with durgs (P

Objective To create new tetraploid resource of Dioscorea zingiberensis in the hope of potential breeding materials with high yield and high level of diosgenin. Methods Callus with tiny green buds were directly soaked in colchicine solution or cultured in medium plus with colchicine to prohibit the isolation of chromosomes and induce tetraploid mutants. Results Tetraploids were achieved successfully. The most efficient treatment for inducing tetraploid was soaking the tiny buds in 1?103 mg/L colchicine solution for 24 h, the inducing rate could be up to 35. 2%. The induced tetraploids exhibited notable difference with common wild type (diploids) in morphology, physiology, and microscopic structure. ConclusionThe tetraploid plants show the advantages of gigantic size and vigorous growth. Thus, the established technique system to induce tetraploid from tissue cultured callus would provide an efficient alternative pathway for medicinal plants of Dioscorea L. breeding.

Objective To evaluate the role of serum adenosine deaminase in the diagnosis and treatment of acute,chronic hepatitis.Methods WanFang Data,CNKI and PubMed were retrieved in order to screen literature about the relationship between serum ADA and acute and chronic hepatitis,the retrieval time was from the beginning of the database to December 1st,2016.After evaluating quality of the included studies, the meta-analysis was conducted to analyze the relationship between the level of serum ADA and acute,chronic hepatitis via RevMan 5.2 software.Results A total of 28 articles were identified including 1688 cases with acute hepatitis and 1843 cases with chronic hepatitis.The results of meta-analysis showed that the levels and positive rate of serum ADA were significantly higher in the acute hepatitis groups than that in chronic hepatitis groups(MD=4.13,95%CI(0.43,7.84),P=0.03;OR=1.94,95%CI(1.19,3.14),P=0.007).Funnel plots showed significant publication bias,and may have implications for Meta analysis(P=0.001).Conclusion Heterogeneity of the literatures mainly comes from the clinical heterogeneity and statistical heterogeneity.The serum ADA has certain value in the diagnosis and treatment of acute and chronic hepatitis.