Objective The predictive indexes which affect early neurological deterioration ( END) of patients with acute la-cunar stroke still remain unclear .The purpose of the article was to investigate the correlation between the location and numbers of cere -bral microbleeds (CMBs) and END in patients with first-onset lacunar stroke. Methods 217 patients with acute lacunar stroke hos-pitalized in Anhui Provincial Hospital within 24 hours after occurrence from Mar 2009 to May 2012 were prospectively enrolled .All pa-tients underwent susceptibility-weighted imaging MRI right after admission , followed by the investigation on the relationship of the loca-tion and numbers of CMBs and END . Results END occurred in 76 (35.0%) patients.Among these patients, there were 33 positive cases with CMBs (43.3%).There were no significant difference in END incidence between positive group and negative group (P=0.173).In the comparison of the numbers of CMBs foci , patients with more than 5 foci were more prone to END (P=0.005).Logistic regression analysis showed there was relation between CMBs foci numbers>5 and END (OR=3.14, 95% CI: 1.22 ~8.13), and there was no relation between CMBs foci numbers≤5 and END ( OR=1.12, 95%CI:0.53~2.37)as to CMBs negative patients.No signifi-cant relationship was found in CMBs location and END occurrence ( P>0.05). Conclusion The distribution of CMBs foci has nothing to do with early neurological fluctuation .However , more than 5 CMBs foci might be the independent prediction cause of END .

Objective To observe the growth characteristics and multi-time dynamic contrast-enhanced MR(DCE-MR)findings of rabbit VX2 liver tumor on MR imaging, and to provide a reliable basis for the values of MR in assessment of non-surgical treatment effect of rabbit VX2 liver tumor.Methods 10 rabbit VX2 liver tumor models were established by liver tissue embedding through laparotomy under direct vision and DCE-MRI scaning was performed at the 2nd,3rd,4th and 5th week after establishment.The tumor volume (V)and tumor growth rate (TGR)were calculated at different time points and the signal characteristics were analyzed on MR imaging;then all the rabbits were excuted and HE staining were performed to observe the cancer cells in different places with microscope.Results The TGR at the 3rd week after establishment (404.16%±114.64%)was significantly higher than that at the 4th week (223.49%±65.90%)(t=3.417,P<0.05).The tumors with well-boundary were rim-like enhanced significantly and the central parts were not enhanced on DCE-MR imaging,and the parts between the edge and centre of tumors were heterogeneously mild enhanced. The HE staining results showed that 6 cases of tumor were squamous cell carcinoma and the cells were distributed densely in the edge,the cancer cells and necrosis were distributed equally in the parts between the edge and centre of tumors and the centre of tumors were necrosis parts.Conclusion The rabbit VX2 liver tumor grows rapidly at the 3rd week after establishment, and its histological features can be better reflected by DCE-MRI.

Objective To probe the indication of biliary tract reconstruction without T-tube in orthotopic liver transplantation.Methods We put forward indications of biliary tract reconstruction without T-tube in orthotopic liver transplantation since January 2004 and there were 102 patients who underwent liver transplantation in our hospital without a T-tube in place after biliary tract reconstruction.The incidence of biliary tract complication was observed in these patients.Results All patients were followed up for more than 6 months.The incidence of biliary tract complication was 4.9 percent(5/102)in this group with 3 patients of intrahepatic difluse bile duct stenosis necessitating liver re-transplantation.The other 2 patients with common hepatic duct nonanastomotic stenosis were healed by ERCP plus stent placement.Conclusions Biliary tract reconstruction without T-tube placement helps to decrease the incidence of biliary tract complications resulting from the T-tube removal.

Objective To investigate the expression of peripheral blood (PB) CD4+ CD25+ Foxp3+ regulatory T cells (Tregs) in patients with benign end-stage liver disease after liver transplantation and the relationship between levels of PB Tregs and acute rejection. Methods A prospective analysis was performed on 55 consecutive patients who underwent liver transplantation.Fourteen out of 55 cases suffered from acute rejection after liver transplantation were defined as rejection group,while the rest patients were classified into no acute rejection group. PB was obtained from liver transplant patients at different time points longitudinally: pre-transplant, post-transplant within one year and acute rejection. The circulating CD4+ CD25+ Foxp3+ Tregs in PB were measured by flow cytometry. Blood samples were drawn during acute rejection, at the same time, liver biopsies were performed. The circulating CD4+ CD25+ Foxp3+ Tregs were compared between two groups.Results There was no difference between two groups in levels of circulating CD4+ CD25+ Foxp3 + Tregs cells pre-transplant. However, the levels of circulating CD4+ CD25+ Foxp3+ Tregs in rejection group were decreased significantly as compared with no-rejection group (2. 23 % ± 0. 54 % vs. 2. 99 % ±0. 86 %,P＜0.01). The frequency of CD4+ CD25+ Foxp3+ T cells was negatively correlated with rejection activity index (RAI) (r = - 0. 80, P＜0. 01 ). Conclusion Monitoring PB CD4+ CD25+ Foxp3+ Tregs levels may be helpful in evaluating the immune state and act as a more sensitive marker for acute rejection diagnosis in the patients following liver transplantation.

Objective To study the relationship between serum carbohydrate antigen 19-9 (CA19-9) and blood glucose level in patients with type 2 diabetes (T2DM).Methods Totally 784 T2DM patients and 197 healthy controls were enrolled in this study.Age,duration,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),levels of fasting blood glucose (FBG),postprandial blood glucose (PBG),hemoglobin A1c (HbA1c),total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),blood uric acid,C peptide and CA 19-9 were recorded.Patients were divided into different groups according to the levels of HbA1 c and CA 19-9.The relationship between CA19-9 and influencing factors was analyzed.Results CA19-9 level was increased in T2DM patients compared with healthy controls [(22.08±14.94) U/mlvs.(10.24±6.31) U/ml,t=12.10,P＜0.001].The levels of SBP,DBP,FBG,PBG,C peptide,TC,TG,LDL and UA were higher and HDL C level was lower in T2DM patients than in healthy controls (all P＜0.05).The levels of FBG,PBG and CA19-9 were increased along with the increase of HbA1c level in T2MD patients with HbA1c level under 6.5％,T2MD patients with HbA1c level from 6.5％ to 7.5％,T2MD patients with HbA1c level over 7.5％ [FBG:(6.36±3.70) mmol/L,(9.01±4.01) mmol/L,(11.96±4.73) mmol/L;PBG:(9.69±3.21) mmol/L,(12.18±5.54) mmol/L,(15.27±5.08) mmol/L; CA19 9 (14.33±11.72) U/ml,(18.76±14.39) U/ml,(25.96±17.52) U/ml,respectively,all P＜0.05].The levels of FBG,HbA1c and pancreatic cancer incidence were higher in patients with elevated CA19-9 than with normal CA19-9 [(11.71±5.48)mmol/L vs.(9.78±4.38)mmol/L,(7.49±4.12)％ vs.(6.33±3.70)％,0％ vs.7.8％,t=-3.51,2.55,x2=83.58,allP＜0.05].Pearson correlation analysis showed that CA19-9 level was positively correlated with the levels of HbA 1 c and FBG in T2DM patients (r=0.281,0.134,both P＜0.05).Multiple Logistic regression analysis showed that the levels of FBG and HbA1c were correlated with the increase of CA19 9 in T2DM patients(OR=0.801,0.947,P=0.019,0.026).Conclusions Serum CA19-9 level is significantly increased in T2DM patients compared with the healthy people.Serum CA19-9 level is correlated with blood glucose control.

Objective To investigate the use of laparoscopic ultrasound to exclude cystic duct obstruction and its related risk factors in laparoscopic cholecystectomy.Methods The data of 28 patients who underwent laparoscopic cholecystectomy in our department for cystic duct obstruction from February 2008 to April 2010 were analyzed.Subtotal resection of gallbladder and exclusion of cysticduct were carried out when the gallbladder triangle anatomy was not clear.An abdominal drain was used.Results All the patients were cured and there was no bleeding,abdominal infection,or jaundice.On univariate analysis,risk factors for cystic duct obstruction were adhesions in Calot triangle,gallbladder atrophy,acute cholecystitis,cystic duct stone incarceration,gallbladder wall thickening and white bile.Adhesion in Calot triangle,acute cholecystitis and white bile were independent risk factors on multivariate analysis.Conclusion Excluding cystic duct obstruction by laparoscopic ultrasound for patients who underwent laparoscopic cholecystectomy for cystic duct obstruction is safe and effective.