Objective To compare the therapeutic effects of laparoscopic and open surgery treatment for choledocholithiasis.Methods Forty-six cases with choledocholithiasis were randomly divided into laparoscopic surgery group(n = 21)and open surgery group(n = 25).Comparison was conducted between the two groups in terms of operative time,hospitalization day,anorechlnl exhaust time,cases of postoperative pain,the amount of intraoperative bleeding and postoperative complications.Results Hospitalization day(10.5 ±2.4d),anorechlnl exhaust time(27.2 ±9.4h),cases of postoperative pain(28.6%)in the laparoscopic surgery group were significantly better than those in open surgery group(14.3 ±2.5d,54.6 ±12.5h,88.0%)(P ＜0.05).The operative time and the amount of intraoperative bleeding was not significantly different between two groups(P ＞ 0.05).The rate of infection of incisional wound in the laparoscopic surgery group(0%)was lower than that of open surgery group 24.0%(P ＜ 0.05).No residual calculi and bile leakage were found in both groups.The other postoperative complications were not significantly different between the two groups(P ＞ 0.05).Conclusion Laparoscopic choledocholithotomy is safe,effective and feasible.Compare with open surgery,it is a less invasive proceduce for the treatment of choledocholithiasis with the virtue of little trauma,fast recovery,short hospitalization days and few complication.

To explore new agents of quinolone derivatives with high antibacterial activity, 7-(4-alkoxyimino-3-methyl-3-methylaminopiperidin-1-yl)quinolones were designed and synthesized, and their activity against gram-positive and gram-negative strains was tested in vitro. Sixteen target compounds were obtained. Their structures were established by 1H NMR, HRMS and X-ray crystallographic analysis. Compounds 14k and 14m-14o show good antibacterial activity against the tested five gram-positive strains and five gram-negative strains (MIC: 0.25-16 micromg x mL(-1)), of which the most active compound 14o is 8-fold more potent than levofloxacin against S. pneumoniae (MIC: 4 microg x mL(-1)), and comparable to levofloxacin against S. aureus, S. epidermidis, E. faecalis and E. coli (MIC: 0.25-1 microg x mL(-1)), but generally less potent than gemifloxacin.

Objective To evaluate the efficacy of high resolution MR T2WI combined with DWI in evaluation of pathological complete response after neoadjuvant therapy in rectal cancer.Methods Totally 364 patients with locally advanced rectal cancer who recieved neoadjuvant therapy and radical surgery,underwent MR scanning before and after neoadjuvant therapy,were enrolled in this study.The diagnostic efficacy of high resolution MR T2WI and high resolution MR T2WI combined with DWI in evaluation on pathological complete response after neoadjuvant therapy in rectal cancer were compared.Results Finally 49 cases were demonstrated pathologic complete response.Accuracy,sensitivity,specificity,positive predictive value and negative predictive value of high resolution MR T2WI and high resolution MR T2WI combined with DWI in predicting on pathological complete response after neoadjuvant therapy were 82.69％ (301/364),40.82％ (20/49),89.21％ (281/315),37.04％ (20/54),90.65％ (281/310)and 87.36％ (318/364),65.31％ (32/49),90.79％ (286/315),52.46％ (32/61),94.39％ (286/303),respectively.Sensitivity had statiatical significant difference between two methods (x2 =4.96,P=0.03).Conclusion Compared with high-resolution T2WI,the combination of DWI and high-resolution T2WI can improve the diagnostic efficacy in evaluation of pathologic complete response of locally advanced rectal cancer.

Objective To explore the computed tomography (CT) features of gastric cancer invasion to the pancreas and significance in the assessment of resectability of primary lesions.Methods The retrospective cohort study was conducted.The clinical data of 31 gastric cancer patients who were admitted to the Peking University Cancer Hospital between February 2011 and August 2016 were collected.Of 31 patients receiving CT examinations,11 who were diagnosed with suspected pancreas invasion by preoperative CT examinations but operation confirmed no invasion were allocated into the pancreas negative (PN) group,11 who were confirmed as pancreas invasion and under vent radical gastrectomy of gastric cancer combined with pancreas resection were allocated into the pancreas invasion (PI) group,and 9 who were confirmed as pancreas invasion and had unresectable primary lesions were allocated into the pancreas invasion non-resected (PI-NR) group.Observation indicators:(1) morphologic type of contact surface between gastric cancer and pancreas;(2) comparison of CT findings among the 3 groups:primary lesion location,tunor thickness,Borrmann type,serosa pattern of gastric cancer,judging obvious region invaded by gastric cancer,contact or invasion site with pancreas,contact length between gastric cancer and pancreas,pattern,clarity and CT values of contact surface or peripancreas invaded and normal peripancreas;(3) treatment or follow-up situations.All the patients underwent radical resection and palliative resection for gastric cancer or non-operation according to results of exploration.Telephone interview was performed to detect the survival of patients up to February 2017.Measurement data with skewed distribution were described as M (Qn),and comparisons among groups were done by the Kruskal-Wallis test.Comparison of count data were done by the Fisher exact probability.Results (1) Morphologic type of contact surface between gastric cancer and pancreas:there were 4 types according to results of CT examination.Type Ⅰ.pancreas contacted with gastric cancer and there was no change in the morphology and radian of contact surface.Type Ⅱ:pancreas contacted with gastric cancer and radian of contact surface became flattened or shallow depression.Type Ⅲ:contact surface showed a inserted sign or obvious depression.Type Ⅳ:pancreas didn't contact with gastric cancer and there was increased density in fat space between pancreas and gastric cancer,with a smudge sign or strip-and sheet-like opacity.Of 31 patients,type Ⅰ,Ⅱ,Ⅲ and Ⅳ were detected in 5,10,4 and 12 patients,respectively.(2) Comparison of CT findings among the 3 groups:nodular protrusion,spiculation and strip shape,clounding patch opacity of serosa panern of gastric cancer were detected in 1,6,4 patients in the PN group and 5,4,2 patients in the PⅠ group and 0,2,7 patients in the PI-NR group,respectively,with a statistically significant difference (X2=10.054,P＜0.05).Two,8 and 8 patients in the PN,PI and PI-NR groups had obvious tumor invasion located at a adjacent region between stomach and pancreas,with a statistically significant difference (X2 =11.259,P＜0.05).Contact or invasion site with pancreas located at head,body and tail of pancreas was detected in 6,5,0 patients in the PN group and 1,7,3 patients in the PI group and 5,4,0 patients in the PI-NR group,respectively,with a statistically significant difference (X2=8.390,P＜0.05).Type Ⅰ,Ⅱ,Ⅲ and Ⅳ of contact surface between gastric cancer and pancreas were detected in 5,6,0,0 patients in the PN group and 0,4,4,3 patients in the PI group and 0,0,0,9 patients in the PI-NR group,respectively,with a statistically significant difference (X2=29.291,P＜0.05).Number of patients with clear and ambiguous contact surface was 10,1 patients in the PN group and 0,11 patients in the PI group and 0,9 patients in the PI-NR group,respectively,with a statistically significant difference (X2 =26.227,P＜ 0.05).CT values of contact surface or peripancreas invaded were-46 HU (-57 HU,-20 HU) in the PN group and-34 HU (-41 HU,-25 HU) in the PI group and-10 HU (-15 HU,-10 HU) in the PI-NR group,respectively,with a statistically significant difference (Z=15.306,P＜0.05).CT values of normal peripancreas were-87 HU (-96 HU,-76 HU) in the PN group and-88HU (-70 HU,-1 HU) in the PI group and-83 HU (-98 HU,-74 HU) in the PI-NR group,respectively,with statistically significant differences in CT values between contact surface or peripancreas invaded and normal peripancreas among the 3 groups (Z=12.581,13.780,7.793,P＜0.05).(3) Treatment or followup situations:of 31 patients,22 underwent radical gastrectomy and 9 underwent simplex exploration or short surgery.All the 31 patients were followed up for 6.0-71.0 months,with a median time of 13.5 months.Postoperative 1-and 2-year survival rates were 82.6％ and 77.1％.Conclusions There are significant differences in pancreatic invasion and resectability between CT features of contact surface of gastric cancer and pancreas and tumor classification.CT features include that pancreas contacts with gastric cancer in the PN group,radian of contact surface becomes flattened and with a inserted sign in the PI group,and there are increased density in fat space between pancreas and gastric cancer and a smudge sign or strip-and sheet-like opacity in the PI-NR group.

Objective:To observe the effect of emotional stimulation on the formation process of atherosclerosis ( AS) ,and explain the role of hydrogen sulfide ( H2 S) in atherosclerotic lesions. Methods:Twenty-four Sprague-Dawley rats were randomly divided into AS group, qi-stagnation and blood-stasis AS group and the control group. The AS group was fed with special diets, the qi-stagnation and blood-stasis AS group was fed with special diets and emotional stimulation, and the control group was fed with normal diets. During the experiment, the indicators including the characterization score, H2 S content, four items of the natural bleeding and blood coagula-tion, tissue blood flow and blood lipid were respectively detected in the 4 th, 8 th and 12 th week. Results:Compared with those in the AS group, since the 4 th week, the rats in qi-stagnation and blood-stasis AS group were with significantly decreased activity, slow re-sponse, lackluster fur and dark purple tongue (P<0. 01);the level of plasma lipid increased significantly, and increased further with time extension(P<0. 05 or P<0. 01);since the 8 th week, APTT and FIB changed significantly (P<0. 05),the blood flow to skin, liver and kidney decreased significantly (P<0. 05);the content of H2S was significantly higher in the 12 th week (P<0. 01). Con-clusion:Emotional stimulation promotes the formation of AS model,and the gas molecule system of H2 S plays a regulatory role in the qi-stagnation and blood-stasis AS animal model.

BACKGROUNDTissue microarray provides a convenient shortcut for immunohistochemical staining. The aim of this study is to investigate the clinicopathologic and prognostic values of survivin and cyclooxygenase-2 (COX-2) expression level in patients with non-small cell lung cancer (NSCLC).

METHODSExpression of survivin and COX-2 was detected in 88 cases of NSCLC and 5 cases of normal lung samples by immunohistochemical staining on tissue microarray sections. All cases were followed up for more than 5 years.

RESULTSCytoplasmic and nuclear expression rate of survivin in NSCLC was 94.3% and 79.5%, respectively, and positive expression rate of COX-2 was 71.6%, however, neither survivin nor COX-2 expression was observed in normal lung tissues (P < 0.005). Nuclear expression of survivin was markedly higher in smokers than that in non-smokers (P=0.002). The positive expression of COX-2 was significantly related to gender, smoking, histologic subtype and lymph node metastasis (P < 0.05). Univariate analysis showed that patients with positive expression of COX-2 had worse overall survival (P=0.014), however, survivin expression was not related to survival. Multivariate analysis showed that neither survivin nor COX-2 was independent prognostic factor for survival.

CONCLUSIONSThe results indicate that survivin highly expresses in NSCLC, so the ubiquitous expression makes it a potential novel parameter for diagnosis of NSCLC. Aberrant expression of COX-2 is related to worse overall survival, which may be useful to predict prognosis for NSCLC.

Objective To investigate the multi-detector computed tomography (MDCT) evaluating the clinical staging of adenocarcinoma of the esophagogastric junction (AEG) after neoadjuvant chemotherapy.Methods The retrospective cross-sectional study conducted.The clinicopathological data of 46 AEG patients who were admitted to the Peking University Cancer Hospital between January 2016 and April 2018 were collected.All patients underwent MDCT before and after neoadjuvant chemotherapy and at preoperative 2 weeks,the distance between tumor center and boundary of esophagogastric junction (EGJ) was judged through coronal measured values and axial formula method.Patients underwent radical resection of gastric cancer + D2 lymph node dissection after neoadjuvant chemotherapy,pathologists reviewed the distance between center of AEG and boundary of EGJ,T staging (ycT) and N staging (ycN) of clinical staging,T staging (ypT) and N staging (ypN) of pathological staging after neoadjuvant chemotherapy were determined according to TNM staging of American Joint Committee on Cancer (AJCC) (8th edition),and tumor regression grading (TRG) was determined according to the criterion established by National Comprehensive Cancer Network.Observation indicators:(1) CT examination after neoadjuvant chemotherapy;(2) clinical staging after neoadjuvant chemotherapy;(3) postoperative pathological examination;(4) postoperative pathological staging;(5) accuracy of clinical staging after neoadjuvant chemotherapy;(6)relationship between imaging changes of CT examination and pathological reactions.Count data were described as absolute number or percentage,and comparisons among groups were analyzed by the chi-square test.Comparisons of ordinal data were analyzed by the non-parametric test.Results (1) CT examination after neoadjuvant chemotherapy:5 of 46 AEG patients,coronal images of CT showed whole tumor and boundary of EGJ,axial images of CT showed EGJ wall thickening,heterogeneous enhancement in all layers of lesions,and unsmooth serosal surface;the distance between tumor center and boundary of EGJ is less than 2 cm by direct measurement,5 patients were confirmed as esophageal cancer staging.For 41 patients,the same coronal image of CT cannot showed whole tumor and boundary of EGJ,axial images of CT showed EGJ wall thickening,heterogeneous enhancement in all layers of lesions,and irregular-shaped serosal surface;27 patients whose calculated values were negative based on formula method used esophageal cancer staging,and 14 patients whose calculated values were positive used gastric staging.(2) Clinical staging after neoadjuvant chemotherapy:among 46 AEG patients,ycT staging:staging ycT1,ycT2,ycT3,ycT4a and ycT4b were respectively detected in 1,6,31,6 and 2 patients;ycN staging:staging ycN0,ycN1,ycN2 and ycN3a were respectively detected in 5,14,23 and 4 patients.(3) Postoperative pathological examination:of 46 patients,38,3,3 and 2 were respectively confirmed as adenocarcinoma,adenocarcinoma with signet-ring cell carcinoma,adenocarcinoma with neuroendocrine carcinoma and adenocarcinoma with squamous carcinoma.Of 46 patients,the distance between tumor center and boundary of EGJ can be observed in 14 patients by gastric cancer staging and 32 patients by esophageal cancer staging.(4) Postoperative pathological staging:ypT staging:1,3,5,29,7 and 1 patients were respectively detected in staging ypT0,ypT1,ypT2,ypT3,ypT4a and ypT4b;ypN staging:17,4,15,9 and 1 patients were respectively detected in staging ypN0,ypN1,ypN2,ypN3a and ypN3b.One,3,16 and 26 patients were confirmed as staging TRG 0,TRG 1,TRG 2 and TRG 3,including 20 patients tumor regression and 26 patients without tumor regression.(5) Accuracy of clinical staging after neoadjuvant chemotherapy:the accuracies of ycT staging and ycN staging were 78.3％ (36/46) and 54.3％ (25/46).(6) Relationship between imaging changes of CT examination and pathological reactions:of 46 patients,33 and 13 had respectively reduced and stable gastric wall thickness of primary lesion.Among 20 patients with tumor regression,17 and 3 had respectively reduced and stable gastric wall thickness of primary lesion;of 26 patients without tumor regression,reduced and stable gastric wall thickness of primary lesion were respectively in 16 and 10 patients,with no statistically significant difference (x2 =3.069,P＞0.05).Of 46 patients,31,14 and 1 had respectively reduced,stable and increased sum of minor diameters of suspicious celiac lymph nodes.The reduced,stable and increased sum of minor diameters of suspicious celiac lymph nodes were detected in 16,4,0 of 20 patients with tumor regression and 15,10,1 of 26 patients without tumor regression,respectively,with no statistically significant difference (Z =-1.629,P＞ 0.05).The changes of gastric wall thickness of primary lesion and sum of minor diameters of celiac lymph nodes before operation were not consistent to that after operation in 3 patients.CT examination showed gastric wall thickness of primary lesion reduced after chemotherapy,and sum of minor diameters of celiac lymph nodes didn't change;pathological staging and clinical staging were respectively in staging ypN0 and ycN1.Conclusion According to the TNM staging of AJCC (Sth edition),the distance between tumor center and boundary of EGJ is judged through coronal measured values and axial formula method and therefore determining to select staging system of esophageal cancer or gastric cancer,meanwhile,rectifying over T3 staging of Siewert Ⅱ gastric cancer and increasing overall accuracy of clinical staging.

Objective:To explore the characteristics of high-density sign of flat-panel CT (FDCT) after endovascular treatment in patients with acute ischemic stroke (AIS) in the anterior circulation of large vessels and their relation with hemorrhagic transformation.Methods:Seventy-eight patients with AIS in the anterior circulation of large vessels accepted endovascular treatment in our hospital from March 2018 to June 2019 were chosen in our study. All patients underwent FDCT, and they were grouped according to the presence of local high-density sign and occurrence of hemorrhagic transformation. The baseline and clinical data of patients from high-density sign group and non-high-density sign group, and from hemorrhagic transformation group and non-hemorrhagic transformation group were compared and analyzed. The correlation between high-density sign and hemorrhagic transformation was analyzed. The morphological characteristics and distribution of FDCT high-density sign in patients from high-density sign group were analyzed, and univariate and multivariate Logistic regression analyses were used to screen the influencing factors for post-operative hemorrhagic transformation in patients from the high-density sign group.Results:(1) The incidence of high-density sign in these patients after endovascular treatment was 41.0% (32/78); as compared with patients in the non-high-density sign group, patients in the high-density sign group had significantly higher rate of hemorrhagic transformation (6.5% vs. 53.1%, P<0.05) and significantly higher 3-month modified Rankin scale (mRS) scores (2.0 [1.0, 3.0] vs. 3.9 [3.0, 5.3], P<0.05). (2) The incidence of hemorrhagic transformation after endovascular treatment was 25.6% (20/78); as compared with those in the non-hemorrhagic transformation group, patients in the hemorrhage transformation group had statistically higher incidence of high-density sign in FDCT (31% vs. 70%, P<0.05); multivariate Logistic regression analysis showed that FDCT high density sign was an independent risk factor for hemorrhage transformation after endovascular treatment ( OR=1.823, 95%CI: 1.125-2.358, P=0.000). (3) In the 32 patients with FDCT high-density sign, 4 (12.5%), 13 (40.6%) and 7 (21.9%) had high-density sign in the cortex and subcortex, basal ganglia, and subarachnoid space, whose hemorrhagic transformation incidences were 75% (3/4), 53.8% (7/13), and 57.1% (4/7), respectively, and mean 3-month mRS scores were 4.5, 3.0 and 4.0, respectively; another 8 patients (25%) had endovascular FDCT high-density sign, whose hemorrhagic transformation incidence was 87.5% (7/8), and 3-month mRS scores were ≥4. (4) Multivariate Logistic regression analysis showed that the vascular opening time ≤6 h was a protective factor for hemorrhage transformation in patients with FDCT high-density sign ( OR=0.687, 95%CI: 0.193-0.936, P=0.044). Conclusions:In patients with AIS in the anterior circulation of large vessels accepted endovascular treatment, FDCT high-density sign indicates high risk of hemorrhage transformation and poor prognosis, especially in patients having high-density sign in the cerebral cortex, subcortical area and intravascular area. Minimizing the vascular opening time may reduce the risk of hemorrhagic transformation in patients with FDCT high-density sign.

Bio-refinery using cheap biomass focuses mainly on strain improvement and fermentation strategies whereas less effort is made on down-stream processing. Using cheap biomass more impurities are introduced into the fermentation broths than mono-sugar substrate, thus down-stream processing for bio-based chemicals becomes the key problem in industrial production. The technique called salting-out extraction (SOE) was introduced in this review, which is used to separate target products from fermentation broth on the basis of partition difference of chemicals in two phases formed by mixing salts and organic solvents (or amphipathic chemicals) with broth at suitable ratios. The effect of solvents and salts on the formation of two aqueous phases, especially short chain alcohols and inorganic salts, and the application of SOE in recovery of bio-based chemicals, such as lactic acid, 1,3-propanediol, 2,3-butanediol and acetoin were summarized. The bio-chemicals were efficiently recovered from fermentation broth, and most of the impurities (cells and proteins) were removed in the same step. This technique is promising in the separation of bio-based chemicals, especially the recovery of hydrophilic molecules with low molecular weights.
Butylene Glycols ; isolation & purification ; metabolism ; Chemical Fractionation ; methods ; Fermentation ; Lactic Acid ; isolation & purification ; metabolism ; Osmolar Concentration ; Propylene Glycols ; isolation & purification ; metabolism ; Sodium Chloride ; chemistry ; Solvents ; chemistry

Objective To study the development of the first county-level key clinical specialized talent teams in Henan province. Methods Data on the first 30 county-level key clinical specialized talent teams were collected through questionnaire in 2014 and 2017 respectively, and signed rank sum test was conducted to analyze such facts as the changes of medical service volume, academic titles and scientific researches of discipline leaders before and after such construction. McNemar′s test and chi-square test were conducted to study the age structure, seniority, education and technical title makeup of these discipline leaders. Such tests were also conducted to study the age structure, seniority, education and technical title makeup of the talents. These efforts aim to discern the construction achievement of the key clinical specialties. Results The indexes of healthcare capacities of the first batch of clinical key specialties were observed as improved ( P <0. 05 ) in terms of the medical service volume. Of the discipline leaders′ age structure, the 51 -60 age groups accounted for 40. 0％ and 66. 7％ respectively, before and after the construction, scoring a difference of statistical significance ( P <0. 05 ); the number of senior physicians increased by 80 persons, the number of physicians having master or above titles increased by 40 persons;the number of physicians participating in continuing education held by these specialties grew from 146. 50 to 262. 50(P<0. 05). Conclusions The volume of medical service of the first batch of county-level clinical key specialties has been elevated, and a group of talents of high education and senior titles have been recruited. Whereas, the title structure needs to be improved, and more young academic leaders are expected, while more opportunities of further education and training are also expected for the physicians, in order to enhance their professional ability.