Gastrointestinal microbiota is a huge and complex system that has multiple influential factors. As an exogenous pathogen,Helicobacter pylori(Hp)may interact with gastrointestinal microbiota. It has been revealed that Hp infection led to an increase in Lactobacillus acidophilus in intestinal tract and a decrease in Actinobacteria,Bacteroidetes and Firmacutes in stomach. Proton pump inhibitors and antibiotics,the major components of eradication regimens for Hp infection,may also have an impact on gastrointestinal microbiota. On the other hand,gastrointestinal microbiota interferes with Hp’s attachment into gastric mucosa. Probiotics combined with eradication therapy could benefit the eradication rate of Hp infection and reduce adverse events.

Endostatin, a 20 kD (184 aa) C-teminal fragment of collagenⅩⅧ,is the most potent inhibitor of tumor angiogenesis described so for. Endostatin was initially isolated from a murine hemangioendothelioma cell line (EOMA). Purified recombinant murine endostatin generated in E.coli bacteria injected as unfolded suspension, inhibited the growth of a varity of metastatic and primary tumors in mice. However, its widespread application has been hampered by difficulties in the large-scale production of the antiangiogenic proteins. The limitation may be resolved by in vivo delivery and expression of the antitangiogenic gene. This review summarized the advances in endostain research in recent years including structure, the mechanism of generating ,function and therapy.

Objective To explore the therapeutic effect of endoscopic treatment for common bile duct stricture secondary to chronic pancreatitis.Methods The clinical data of 58 patients with common bile duct stricture secondary to chronic pancreatitis diagnosed between January 2007 and January 2014 were retrospectively analysed.Results A total of 58 patients with common bile duct stricture secondary to chronic pancreatitis underwent 157 endoscopic procedures with placement of 204 polyethylene stents.The mean time of stenting was 12.2 months(3-33 months).After treatment,stricture disappeared in 20 patients(34.5％),with a mean stenting period of 7.8 months(3-22 months).Treatment was successful in 37 patients(63.8％),with a mean stenting period of 9.5 months (3-22 months),and was incompletely successful in 12 patients (20.7％) with a mean stenting period of 19.8 months(12-33 months).Nine patients(15.5％) referred to surgery were considered a failure of endoscopic therapy.Conclusion The endoscopic treatment of common bile duct stricture due to pancreatic edema or pancreatic cyst is effective.Endoscopic treatment is a safe,effective and minimally invasive method for common bile duct stricture secondary to chronic pancreatitis,which can be the first option.

Objective To improve the pancreaticoenterostomy technique and drainage in panereatieoduodenectomy, so as to prevent postoperative pancreatic leakage. Methods One hundred and thirty-eight panereaticoduodenectomy cases underwent parachute continuous running suture of pancreaticojejunostomy and extra drainage of the anastomotic stoma. Results The average time of the double-deck continuous invaginated pancreaticoenterostomy was 11 minutes, and there was no pancreaticoenterostomy leakage in all cases, lntraoperative blood loss was 353±61 ml, the average hospital stay was 19.2 days. Pulmonary infection developed in 6 cases, three cases suffered from postoperative upper gastrointestinal bleeding due to stress ulcer, two cases from functional delayed gastric emptying. All these complications were cured by conservative treatment, and there was no mortality in these series. Conclusions The parachute continuous running suture of pancreaticojejunostomy and extra drainage has the advantages of easy performance, saving time and less complications, and is an effective way in the prevention of panereatieojejunostomy leakage.

Objective To explore the practice effect of problem-based learning(PBL) in teaching of pathogen biology and immunology at college level.Methods Three-year clinical majors of class 1 and 2 in Luohe Medical College were chose,class 1 as PBL experimental group(n=100) and class 2 as control group(n=100).Chapter of hepatitis virus was taught respectively using PBL and LBL teaching method.Teaching effect was evaluated by test and questionnaire.Teaching effects between PBL and LBL were compared.SPSS 13.0 was used to do statistical analysis and data were expressed as percentage.Chi-square test was performed and P＜0.05 shows statistically significant differences.Results Results of test showed that excellent and passing rates were higher in PBL group than in LBL group(P=0.000) ; flunked rate was lower in PBL group than in LBL group(P=0.000).Results of questionnaire showed that more than 80％ students thought that PBL can mobilize students' initiatives of learning,train cooperation consciousness and enhance language skills,etc.Conclusions PBL can be used in pathogen biology and immunology for 3-year clinical majors and deserves further application.

Paget's disease of the breast is an uncommon disorder that accounts for 1% to 3% of all mammary tumors. The incidence of underlying carcinoma associated with Paget's disease has been reported in 82% to 100% of cases. The finding of underlying carcinoma reaches almost 100% when a palpable lump is also present. In this rare case, we described a patient presenting with Paget's disease but no palpable lump. However, we found 11 independent regions which were all invasive ductal carcinoma after the operation. Considering this patient, we should pay more attention to a multifocal and multicentric breast carcinoma associated with Paget's disease. Furthermore, we believe the mammography examination and a modified radical mastectomy are the most appropriate treatments for this population in clinical practice.

Objective·To study the change of circulating endothelial progenitor cells (cEPCs) in acute ischemic stroke (AIS) patients within one week after attack,and the correlation of cEPCs with the prognosis.Methods·Ninty-two patients with AIS (AIS group) and 20 patients with risk factors (Risk group) were recruited.The proportion of cEPCs (CD34TKDR+ cells) in peripheral blood mononuclear cells of AIS patients was measured by flow cytometry (FCM) on the first day of admission and the seventh day after attack.Functional recovery was assessed by modified Rankin Scale (mRS) on the 90th day after onset.The cEPCs percentages of AIS patients with different mRS were compared to analyze their correlation.Results·Compared with Risk group,cEPCs percentage of AIS group on the 1st day of admission was lower (P=0.016).In AIS group,compared with poor prognosis group (mRS＞2),eEPCs percentage of good prognosis group on the 7th day after onset (mRS ≤ 2) elevates (P=0.002).The result of multiple linear regression showed that cEPCs percentage on the 7th day after onset was positively correlated with mRS on the 90th day (t=4.608,P=0.011).Conclusion·The percentage of cEPCs in peripheral blood of AIS patients decreases significantly during the acute phase.The percentage on the 7th day after onset is correlated with prognosis of AIS patients.

To observe the dynamic change of parasites in the brains of BALB/c mice infected with Angiostrongylus cantonensis in order to explore its possible mechanism of pathogenesis', BALB/c mice infected with the III stage larvae of A.cantonensis were observed and killed in different times after infection. The number and distribution of parasites in the brains of the infected mice were observed microscopically and macroscopically. It was found that the larvae of A.cantonensis were distributed in the cerebrum and cerebellum of mice in accordance with the rule of parasitization of worms in the host, i.e.multiplication at first and then dropping in number. And the places where the parasites located were damaged due to mechanical action or inflammatory reactions. The time of onset of symptoms, such as ataxia and twitch was coincided with the dynamic changes in the brains of the infected mice.

Objective To compare three different internal fixations using dual plates in treatment of type C distal humerus fractures.Methods A total of 59 patients with type C distal humerus fractures fixed with dual plates between January 2004 and December 2008 were enrolled in the study,including 34 patients managed by perpendicular dual plate internal fixation (Group A),14 patients by dorsal dual plate internal fixation (Group B),and 11 patients by parallel dual plate internal fixation (Group C).Functional outcomes of injured elbow joints were assessed using Mayo elbow performance score (MEPS).Fisher' s exact probability,chi-square test and variance analysis were used to compare the perioperative variables among groups.Results The patients were followed up for average 28 months (range,12-55 months),which showed that all fractures were smoothly healed with satisfactory curative effects in each group.There were no significant differences with respect to functional outcomes among three groups.The patients with surgery difficulty in Group C were more than those in other two groups.Besides,an additional intercondylar screw was always required in Groups A and B,but rarely in Group C.Conclusions All internal fixations with three dual plates are effective in management of type C distal humeral fractures.The location of plates is determined by experiences of orthopedic surgeons and specific fracture type.

Objective To analyze the clinical value of percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice.Methods A total of 479 patients with obstructive jaundice were enrolled in PLA General Hospital from July 2015 to July 2017 underwent percutaneous transhepatic biliary drainage,the preoperative serum total bilirubin was 92 ～ 614 μmol/L,the target bile duct was 2 ～ 16 mm in diameter.The PTBD was ultrasound guided.Results All of the 479 patients underwent PTBD successfully,and 99.6％ showed evident alleviation of jaundice postoperatively.Conclusions Ultrasoundguided PTBD is an effective method for reducing jaundice for preoperative or palliative treatment in patients with obstructive jaundice.The method of operation is worthy of further study.