Objective To investigate the stability of 1% lauromacrogol foam sclerosant prepared with different liquid-to-air ratio in order to find out the optimal liquid-to-air ratio. Methods According to Tessari technique, two 10 ml disposable plastic syringes and one three-way plastic stopcock were used to mix 1%lauromacrogol with room air, and liquid-to-air ratios from 1∶1 to 1∶9 were separately employed to make the preparation of the foam sclerosant. Each kind of liquid-to-air ratio was used to separately make bubbles for 5 times, the foam half-life time (FHT), the foam drainage time (FDT) and the foam coalescence time (FCT) were recorded, and their mean values were calculated. The optimal liquid-to-air ratio was defined as the intermediate values of all the above measured indexes. Results When the liquid-to-air ratio was 1 ∶ 1, 1 ∶2, 1 ∶ 3, 1 ∶ 4, 1 ∶ 5, 1 ∶ 6, 1 ∶ 7, 1 ∶ 8 and 1 ∶ 9, the FHT of 1% lauromacrogol foam sclerosant was 184.8, 169.3, 135.9, 110.8, 111.5, 92.6, 76.3, 74.7 and 49.9 seconds respectively; the FDT was 10.6, 17.8, 14.6, 13.7, 13.0, 12.3, 10.7, 11.5 and 12.6 seconds respectively; while the FCT was 108.4, 79.8, 41.8, 20.3, 10.4, 0, 0, 0 and 0 seconds respectively. Conclusion Based on Tessari technique, the indoor air, two 10 ml disposable plastic syringes and one three-way plastic stopcock are used to prepare 1%lauromacrogol foam sclerosant, and the optimal liquid-to-air ratio is 1 ∶ 2.

Objective To observe the protective effect on retinal ganglion cells (RGC) and the safety of intravitreal injected acteoside in rats.Methods A total of 50 male Sprague Dawley rats with the weight of 190-210 g were used in this study.Fifteen rats were used for safety experiment of intravitreal injection of acteoside.The rats were divided into group A,B,C,control group and blank group,three rats in each group.The rats in group A,B and C were received intravitreal injection of 5 μl acteoside at the concentration of 1,2,and 5 mg/ml,respectively.Phosphate buffer solution (PBS) was injected in rats of control group.No treatment was performed for blank group.The retinal structure was examined by hematoxylin-eosin (HE) staining of retinal frozen sections at one,two and three weeks after injection.The retinal ultrastructure was examined by ultrathin section under transmission electron microscope at one and three weeks after injection.Others 35 rats were used for experiment of protective effect of acteoside on RGC.The rats were divided into operation group A and B (n=8),sham operation group C and D (n=8),and blank group (n=3).The optic nerve of rats in operation group was clamped for 10 seconds after optic nerve exposure,while the optic nerve of rats in sham operation group was exposed only.The rats in operation group A and B were received intravitreal injection with 5 μl acteoside (1 mg/ml) and 5 μl PBS respectively.The rats in sham operation group C and D were received intravitreal injection with 1 μl acteoside (1 mg/ml) and 1 μl PBS respectively.No treatment was performed for blank group.The retinal structure was examined by HE staining of retinal frozen sections at one,two and four weeks after injection.Immunohistochemistry was used to measure the expression of growth associated protein 43 (GAP-43).RGC apoptosis was assessed by the terminal deoxynucleotidyl transferase mediated dUTP-biotin nick-end labelling (TUNEL) method.Software of SPSS 13.0 was used for the data statistical analysis in this study.Results In the safety experiment of intravitreal injected acteoside,there was no abnormity of cornea,anterior chamber,lens,vitreous cavity and retina after injection.At one,two and three weeks after injection,the retina structure was normal without significant apoptosis,necrosis and inflammatory cell infiltration.The ganglion cell layer showed slightly edema; there was no obvious change of retinal ultrastructure after injection of acteoside with 5 mg/ml and 2 mg/ml,but slight change with the format of 1 mg/ml.Transmission electron microscopy showed that intravitreal injection of 5μl acteoside at the concentration of 2 or 5 mg/ml can induce significant changes of micro-structures of retina,while injections at 1mg/ml can only induce minor changes.In the experiment of protective effect of acteoside on RGC,light microscope revealed that the cell showed typical changes of apoptosis in operation group,but not in sham operation group and blank group.At the first and second week after injection,compared with the sham operation group and blank group,the RGC number was decreased in operation group.The difference of RGC numbers between operation group A and B was statistically different (F=26.206,P＜0.05).The RGC numbers in operation group continues to decrease at the fourth week after injection,there was obvious difference compared with the first and second week after injection (F=17.364,P＜0.05),but there was no difference of RGC numbers among sham operation intra-group and between sham operation group and blank group at all the time points.Immunohistochemistry showed that at the first week after injection,the integrated absorbance (IA) value in operation group was higher than that in other groups (F=33.466,P＜0.05) ; there was no difference of IA value between operation group A and B.At the second week after injection,IA value in operation group A had slightly declined,but higher than that in operation group B (F=14.391,P＜0.05).At the fourth week after injection,IA value in operation group A declined further,but also higher than that in other groups (F=4.178,P＜0.05).TUNEL showed that on the first week after injection,RGC apoptosis rate in operation group was increased than that in other groups (F=15.365,P＜0.05).At the second week after injection,RGC apoptosis rate in operation group was decreased,and it in operation group A was lower than that in operation group B (F=15.365,P＜0.05).At the fourth week after injection,RGC apoptosis rate in operation group was decreased obviously,there was no difference compared with other groups (F =2.057,P ＞ 0.05).There was no difference of RGC apoptosis rate between sham operation group and blank group at all the time points.Conclusion Intravitreal injection of 5 μl acteoside (1mg/ml) is safe for rat retina,and can up-regulate GAP-43 expression and inhibit RGC apoptosis in optic nerve crush rats.

The incidence of pancreatic cancer is gradually increasing worldwide. The overall 5-year survival rate of pancreatic cancer is about 5%, because the early diagnosis is difficult and the radical resection rate is low in pancreatic cancer. The keys of improving the poor prognosis of pancreatic cancer are early diagnosis and radical resection. Detection of serum tumor markers has an important utility in the diagnosis, prognosis and surveillance of pancreatic cancer. CA19-9 is the most widely used and best validated serum tumor marker for pancreatic cancer although it has some limits. With the development of molecular biological techniques in recent years, several potential serum tumor markers for pancreatic cancer are undergoing evaltation, including MIC- 1, M2- PK, OPN, RCAS1, and so on. This paper is to review the current status of serum tumor markers of pancreatic cancer.

Objective To discuss the effective surgical treatment of intrahepatic lithiasis combined with high hepa-t ic duct strictures. Methods Two hundreds and sixteen cases of intra hepatic lithiasis and high hepatic duct strictures treated in this hospital fr om January 1993 to October 2002 were analysed retrospectively.Results One hundred and eighty- three cases underwent different selective operation by selected time; 33 case s complicated with acute obstructive suppurative cholangitis underwent emergency were performed single biliary drainage, in which 30 cases were re-operated. Th e operative procedure were: hepatic lobectomy,high cholangiotomy and plastic repair,exposure of hepatic duct of the 2nd and the 3rd order,and plastic re pair with own patch and choledochojejunostomy.Two hundreds and six cases w ere cured,the curative rate was 95.4%; 8 cases improved (3.7 %), and 2 cases died (0.9%).Conclusion The best effective surgical treat ment of intrahpatic lithiasis is hepatic lobectomy. Exposure of hepatic duct of the 2nd and the 3rd order is a satisfactory to release the hepatic duct str ictures and to clear the intrahepatic lithiasis. For patients with normal extr ahepatic bile duct and Oddi's function, plastic repair of bile duct with own patch is possible to keep the normal form and function. Cholang ioscopy may play an important role in the treatment of intrahepatic tr act lithiasis during operation.

Objective To discuss the feasibility of stone removal in laparoscopic choledocholithotomy by routine laparotomic instruments. Methods A total of 73 patients with common bile duct stones were divided randomly into 2 groups: the Experimental Group received laparoscopic stone removal by routine laparotomic instruments; the Control Group received stone removal by choledochoscopic net-basket. The stone-free rate, operative time, total hospitalization costs and postoperative complications between the two groups were compared. Results There were no statistical significances in stone-free rate between the Experimental Group ( 94.4% , 34/36) and the Control Group (94.6%, 35/37) ( ? 2=0.000, P =1.000). The operative time in the Experimental Group (150.9 min?26.8 min) was shorter than that in the Control Group (172.3 min?28.6 min) ( t=3.297, P =0.002), whereas the total hospitalization costs in the Experimental Group (4400 yuan?1100 yuan) was lower than that in the Control Group (5000 yuan?1300 yuan) ( t=2.126, P= 0.037). No severe operation-related complications were observed in both of the groups. Conclusions Laparoscopic choledocholithotomy by either routine laparotomic instruments or choledochoscopy is safe and effective. Stone removal by routine laparotomic instruments has the advantages of low costs and short operative time.

Objective To investigate the modifications of surgical technique in adult-to-adult living donor liver transplantation (A-A LDLT) using right lobe liver grafts.Methods From Jan.2002 to Aug.2005,16 patients underwent living donor liver transplantation using right lobe grafts.During operation,a modification,designed to improve the reconstruction of right hepatic vein,the reconstruction of the tributaries of the middle hepatic vein by interpositing a vein graft,and the anastomosis of the hepatic arteries and bile ducts,was done.Results In these series,there were no donor severe complication and death.The graft and recipient weight ratio(GRWR) was between(0.72%) and(1.24%),among these,9 cases

AIM: To observe the influence of Toufengyu Dropping Pill(Rhizome chuanxiong,Radix angelicae dahuricae,etc) on neuropeptide and vasoactive substances in rat's migraine model. METHODS: Rat's migraine model caused by nitroglycerin were given Toufengyu Dropping Pill and rat's behavior and blood levels of NO,CGRP,ET,TXB_2 and 6-keto-PGF_(1a) were measured. RESULTS: The experimental results showed that Toufengyou Dropping Dill could obviously decrease rat's positive reaction number,the blood levels of NO,CGRP,TXB_2 and 6-keto-PGF_(1a),and increase the blood plasma level of ET,and rectify the imbalance of ET/NO ratio. CONCLUSION: Toufengyou Dropping Pill can affect the contents of neurotransmitter,neuropeptide in rat's migraine,then decrease the algoenic and inflammatory substances,relieve the neurogenic inflammation,and increase the pain threshold value,finally be quite effective for migraine.

Objective To investigate the clinical and laboratory characteristics of SSc patients in China. Method The data of 119 consecutive SSc patients based on EUSTAR DATABASE in Peking Union Medical College Hospital from February 2009 to January 2010 were prospectively collected and analyzed. All patients fulfilled ACR classification criteria in 1980 for SSc. Thex2 test and t-test were used to analyze the data. Results (1) Demographic data. Sex ratio (F/M) was 109/10 and the age rang was (44±12) years. There were 65 diffuse cutaneous SSc (dcSSc) patients and 54 limited cutaneous SSc (1cSSc) patients. 112 patients (94.1%) had Raynaud's phenomenon (RP), and the age of RP occurrence was 36 years (13～76 years), among which it was the initial presentation in 91 patients (81.3%) and the disease duration from RP to other manifestation was 12 months.(2) Clinical manifestations. ① The gastrointestinal manifestations (70.6%), especially esophageal involvement (56.3%), articular involvement (54.6%), pulmonary interstitial fibrosis (PIF) (58.8%) were frequently observed, but renal crisis (2.5%), heart block (0) and reduced LVEF (0) were rarely detected. ② Twenty cases (28.6%) out of 70 PIF patients denied any respiratory symptom and were confirmed by HRCT screening. The disease duration from RP to PIF was 34 months(3～352months); 3 case of 24 pulmonary artery hypertension (PAH) patients had no clinical manifestations. The disease duration from RP to PAH was 25 months (4～343 months). Nineteen patients had PIF and PAH simultaneously. ③Peripheral artery disease: SSc patients had a lower ankle brachial index (ABI) level (0.91± 0.19 vs 1.09±0.08, P<0.00l). (3) Laboratory finding. All patients had positive ANA. The positive rate of anti-Scl-70 antibody and ACA was 56.0% and 14.7% respectively. There was no serum sample positive for anti-Scl-70 antibody and ACA. The positive rate of anti-RNA polymerase Ⅲ antibody was 13%. (4) Compared the clinical characteristics and laboratory findings between dcSSc and lcSSc patients, we found that there were significant differences between dcSSc and lcSSc patients in finger ulcer (40.0% vs 20.4%), ACA positive rates (7.7% vs 23.3% , P<0.05). Conclusion The system involvements besides skin in SSc is common, especially PIF and gastrointestinal involvement. According to our data, there are fewer cases with renal crisis and heart block. Because part of patients with PIF have almost no clinical manifestations, so early screening for PIF/PAH is important for early diagnosis and intervention.

Objective To evaluate the feasibility and accuracy of real-time three-dimensional transesophageal echocardiography(TEE) in assessment of left atrial appendage(LAA) function. Methods Forty-two atrial fibrillation patients underwent real-time three-dimensional TEE. LAA ejection fraction based on two-dimensional area measurements(EFA-2D), three-dimensional area measurements(EFA-3D) and three-dimensional volume measurements(EFv-3D) were calculated and related to LAA peak empty velocity (PEV). The variability within observer and interobserver were tested. Results EFA-2D was significantly higher than EFA-3D[(62.84 ± 17.27)% vs (45.39 ± 16.58)%, P = 0.000] and EFv-3D [( 62.84 ±17.27) % vs (48.35 ± 19.37) %, P = 0.001 ], whereas EFA-3D and EFv-3D had no significant difference ( P = 0.158). In a simple linear correlation,the degree of association between EFv-3D and PEV was higher as between EFA-3D and PEV ( r = 0.662 vs 0.604,both P ＜0.05). No significant correlation was observed between EFA-2D and PEV ( r = 0.529, P = 0.130). Variabilities within observer and interobserver were no significant differences by the three methods( P ＞0.05). Conclusions LAA ejection fraction calculation by real-time three-dimensional TEE is feasible and more accurate than by 2D TEE.

Objective To explore the value of uric acid (UA) combined with lipoprotein a [Lp(a)] in prediction of atherosclerotic renal artery stenosis (ARAS) in high risk population with atherosclerosis. Methods A total of 190 patients who were highly suspected for ARAS and received renal artery angiography in Peking Union Medical College Hospital from October 2008 to April 2011 were enrolled in the study.Among these patients,120 were diagnosed as coronary arterial disease (CAD) by coronary artery angiography and 89 were diagnosed as ARAS.The control group included 180 people undergoing routine healthy examination in our hospital.The basic information and lab results such as UA,Lp (a),total cholesterol (TC),triacylglycerol (TG),HDL,LDL,Scr and C-reactive protein (CRP) were collected.Logistic regression analysis was used to identify possible risk factors of ARAS and to establish a new tool to predict ARAS in the high risk population. Results The levels of Scr,UA,Lp (a) and CRP in ARAS cases were significantly elevated compared to control people.For high risk population,there were no significant differences in Scr,lipids,UA and CRP between ARAS cases and non-ARAS cases.Logistic regression analysis showed that UA level＞344 μmol/L was correlated to ARAS independently.Using UA level＞344 μmol/L and Lp (a) level＞242 mg/L as a predicting marker for ARAS in high risk population,the specificity was 96.0％,the positive likelihood ratio was 5.45 (P=0.001),and the odds ratio was 6.78,95％CI (1.90～24.2) (P=0.001). Conclusions In high risk population,the UA may be an independent correlating factor of ARAS.Combining UA with Lp(a) can predict the ARAS.