Objective To study the effect of applying gastro-bile duct drainage in iatrogentic injury in the bile duct and reasons of iatrogentic injury in the bile duct. Methods Clinical data of 9 cases with iatrogentic injury in the bile duct were studied retrospectively. Results Nine patients with iatrogentic injury in the bile duct were found in time by affnsion examination, choledochoendoscopy or cholangiography intraoperation, including 5 cases in-jured by metal divining rod,2 cases caused by lithotomy, 1 case injured by laparoscopic elastic separating plier and 1 case injured by common hepatic duct transection. The gastro-bile duct was placed into common bile duct through pa-pilla of duodenum, pylorus and the former wall of gastric. All the cases recovered smoothly. The gastro-bile duct was removed in 8 cases in 6 to 10 days later,in 1 cases in 30 days later,who were followed up for 9 months to 5 years, finding no complications such as stricture of bile duct and retroperitoneal infection. Conclusions Intraoperative cho-ledochoendoacopy,affusion examination and cholangiography are helpful to diagnosis. The better results are achieved by appling gastro-bile duct drainage in iatrogentic injury in the bile duct.

Objective To evaluate gastrobiliary duct drainage in the treatment for iatrogenic distal common bile duct injury found during the operation.Methods We analyzed clinical data of 17 cases with application of gastrobiliary duct drainage in immediate treatment for the injury of distal common bile duct found during the operation from June 2010 to June 2016.Postoperative bile drainage,postoperative gastrointestinal function recovery,time for removal of the gastrobiliary duct and hospitalization time were recorded.Postoperative bile leakage,intestinal fistula and pancreatic leakage were observed.Patients were followed up until June 2016.Results The mean volume of bile drainage on the third postoperative day were (310 ± 112)ml,the mean time of postoperative gastrointestinal function recovery were (3.0 ± 1.5) days,time for removal of the gastrobiliary stent were (7.5 ± 1.0) days and hospitalization time were (9.5 ± 1.5) days.There was no postoperative bile leakage,intestinal fistula and pancreatic leakage.All patients were followed up for a median time of 12 months (range,1-45 months).Meanwhile,we found no significant biliary strictures and cholangitis patients.Conclusion Gastrobiliary duct drainage is a simple,rational and effective treatment for iatrogenic injury of distal common bile duct during common bile duct exploration.

Objective To study the effectiveness of different treatment modalities for iatrogenic injury of distal common bile duct during operation.Methods We browsed Chinese Medical Full-text Data-base with the term of “distal common bile duct injury”.All the clinical studies associated with perioperative latrogenic injury of distal common bile duct and adjacent tissue published after 1990 were enrolled,and we collected the clinical data,mortality and reoperation rate with different treatments for analysis.Results Thirty-four case series and case reports with 233 patients were included.14 patients with isolated duodenal injury were excluded.The overall mortality of the remaining 219 patients was 9.6％,and the reoperation rate was 17.4％.A total of 145 patients who were diagnosed with distal common bile duct injury during and after operation from 21 articles were compared.The mortality and reoperation rate were both 1.9％ among 106 patients who were diagnosed during operation.The figures were 43.6％,and 84.6％ among 39 patients who were diagnosed after operation,respectively.In 9 articles with 46 patients,the clinical outcomes of 21 patients who were treated by intraoperative suture was compared with 25 patients who underwent enhanced biliary and retroperitoneal drainage.The mortality and reoperation rates were 0 in both groups.Conclusions Early detection and management are crucial to perioperative common bile duct injury.Furthermore,no significant difference of clinical outcomes observed between bile drainage and perforation suture groups.

Phase angle (PA), derived by bioelectrical impedance analysis, has been used to evaluate nutritional status.It has a unique advantage in diagnosing early malnutrition related to diseases by the detection of human body cell membrane integrity and fluid composition change, and being associated with bad disease prognosis in part of clinical research.Because of its non-invasive, convenient, accurate and affordable technique, it has a wide prospect of clinical application.However, lack of uniform PA reference value somehow limited its application.We summarize the latest clinical research and application situation of PA, and explore the characteristics and the influence factors of PA in different disease group, in order to provide theoretical basis for the Chinese PA reference range.

Objective To establish an animal model with installation of gastrobiliary duct drainage (GBDD) in the primary suture after exploration of common bile duct, to assess the safety and feasibility of GBDD. Methods Thirty dogs were randomly divided into three groups: control group (n=5), primary suture group (n= 10) and GBDD group (n= 15). Serum TBil levels, bile leakage,and complications were observed and compared. Results No increase in serum TBil level was observed in the control group. However, serum TBil levels were significantly increased in the primary suture group compared to the GBDD group (P＜0. 01). GBDD were all successfully withdrawn at mean (7. 0±1.7) days after the operation. No bile leakage was found in the GBDD group, which was significantly different compared to 5/10 bile leakage cases in primary suture group (P＜0. 05). There were 3/10 cases of bile peritonitis, infection of incisional wound and splitted in the primary suture group, while there were no such complications in the GBDD group (all P＞0.05). Conclusions GBDD is safe and feasible. It can shorten biliary drainage time and prevent occurrence of bile leakage.Therefore, it has unique value in clinical application.

To investigate the effects of manual acupuncture at Shenmen (HT7) or Taiyuan (LU9) on the attention function of the brain, and to lay an experimental foundation for researching brain function and integration mechanisms of the human brain in relation to acupuncture stimulation.

BACKGROUND: Correlation between channel and viscera is a core of athemry on acupuncture and meridian, and is also a key entrance for mech anism of acupuncture. This study was designed to discuss theory onacupuncture and meridian through correlation between heart meridian andelectric discharge activities of sympathetic nerve. OBJECTIVE: To investigate the effect of electroacupuncture at differentsegments of heart meridian on the electric discharge activities of the supe rior sympathetic plexus in rabbits. DESIGN: Randomized controlled animal study. SETTING: Central Laboratory of Channel and Viscera Research, AnhuiCollege of Traditional Chinese Medicine. MATERIALS: The experiment was carried out at the Central Laboratoryof Channel and Viscera Research, Anhui College of Traditional ChineseMedicine in March 2004. A total of 36 healthy chinchilla rabbits weighing(2.8±0.3) kg were randomly divided into three groups with 12 in eachgroup, including multi-electro-acupuncturing the wrist (Shenmen region), elbow (Shaohai region) or axils (Jiquan region) sections of heart meridian. METHODS: One rabbit of the same sex whose body mass was less than10% was selected from each group. Superior sympathetic plexus was sepa rated under Olympus anatomic microscope (Japan), and multiple double electrodes materialized as stainless steel sil were embedded. Then, afterfixing with special gelatum (USA), thoracic cavity was closed, temperaturein anus was controlled at (39±0.5) ℃, and 50 mL/L glucose was drippedinto vein for 2 hours before acupuncture. The changes of heart rhythm vari ability (HRV) and electric discharge activities of superior sympatheticplexus were recorded and analyzed. MAIN OUTCOME MEASURES: HRV, ratio between high frequency(HF) and low frequency (LF) of power spectrum. RESULTS: All rabbits were involved in the final analysis. After elec troacupuncture, the total HRV values and electroactivitic frequencies of thesuperior sympathetic plexus were increased, but LF/HF of power spectrumwas decreased. The decrease at the wrist section was superior to others; theaxils section was inferior to elbow section. CONCLUSION: Electroacupuncture at different segments of heart meridi an can improve the electric discharge activities of the superior sympatheticplexus and the leaf-cardiac function. Among the three groups, the relation ship of functions was the closest between the wrist stem of heart meridianand left heart.

Objective To investigate the association between the genetic polymorphisms in GSTA1 and the clinical outcome of breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy. Methods A total of 137 breast cancer patients receiving cyclophosphamide-based adjuvant chemotherapy were recruited ( 124 cases with infiltrative ductal carcinoma, 5 cases with infiltrative lobular carcinoma and 8 cases with other histological types). PCR-LDR method was used to detect the genotypes of GSTA1. Survival curves were generated by the Kaplan-Meier method, and verified by the log-rank test. Cox proportional hazards regression analysis was used to estimate the prognostic factors in multivariate analysis. Results Of the 137 breast cancer patients, the genotypic frequencies of the GSTA1 * A/* A,* A/* B and * B/* B were 67.2% ( 92/137 ), 31.4% ( 43/137 ) and 1.5% ( 2/137 ), respectively. No significant differences were found between the genotypic frequencies and groups categorization according to age, stage, lymph node metastasis, ER or PR status (x2 = 0. 722,1. 967, 3. 303, 0. 226 and 0. 709, all P ＞0. 05 ) ;through Fisher exact test, also no significant differences were found between the genotypic frequencies and group categorization according to tumor size, histological types and grading ( all P ＞ 0. 05 ) . The recurrence rates in patients with GSTA1 * A/* A and * A/* B or * B/* B genotypes were 47. 8% (44/92) and 31.1% ( 14/45 ), respectively, and the mortality rates were 22. 8% ( 21/92 ) and 17. 8% ( 8/45 ),respectively. Patients with GSTA1 * A/* B and * B/* B genotypes were significantly associated with reduced hazard of relapse (x2 =18.723, P＜0. 01)and mortality (x2 =7.352, P＜0.01), compared to cases with the common * A/* A genotypes, according to Kaplan-Meier survival analysis and log-rank test. Moreover,Cox multivariate analysis showed that GSTA1 polymorphisms appeared to be an independent risk factor for recurrence-free survival ( OR =0. 222, 95% CI:0. 108-0. 458, P ＜0. 01 ) and overall survival ( OR =0. 362,95% CI:0. 145-0. 902, P ＜ 0. 05 ). Conclusion These data indicate that GSTA1 polymorphism may be a potential prognostic factor for recurrence-free survival and overall survival in breast cancer patients treated with cyclophosphamide-based adjuvant chemotherapy.

Objective: To discovery the central mechanism of acupuncture Heart Meridian precondition myocardial ischemia in gene expression pattern, the authors applied gene chip tech to filter variably expressed genes in hypothalamus. Methods: Rats were seperated into normal, model, acupuncture Heart Meridian group and acup Lung Meridian group randomly. Acute myocardial ischemia rat model was made with ligation left anterior descending branch of the coronary artery. After model succeed, select hypothalamus seperately and mixed the same group together of 3 rats. Then applied Rats U230A genechip refered by Affymetrix Co. to compare the variations between these groups. Results: To compare with normal group, differential expression genes and expression sequence tags (ESTs) in model group were 73 with signal log ratio ≤ 1 and 92 with signal log ratio ≤-1 , mainly included ion channel, calcium/ calmodulin-dependent protein kinase Ⅱ inhibitor, antigen and so on. Similarly, compared with model group, differential expression genes and expression sequence tags (ESTs) were 190 with signal log ratio ≥ 1 and 34 with signal log ratio ≤-1 in acupuncture Heart Meridian group, mainly included 5-hydroxytryptamine receptor, cellular metabolism, fatty, immuno reaction, G-protein coupled receptors, ion transport, signal transductions and so on, while in acupucnture Lung Meridian, the number is 57 and 26 correspondly. Conclusion: There were exactly variations in hypothalamus mechanism that relate to acupuncture Heart and Lung Meridians.

Objective To observe the effects of individual prehabilitation on the functional outcome six weeks after total knee arthroplas-ty (TKA). Methods The patients undergoing TKA from March, 2013 to August, 2015 were randomly divided into prehabilitation group (n=30) and control group (n=29). The prehabilitation group received individual rehabilitation since enrolled in the study. The control group re-ceived no prehabilitation. All the patients received regular pre-surgical education, surgery and post-surgical rehabilitation. Both groups were evaluated with Numerical Rating Scale (NRS) of pain, active range of motion (AROM), Manual Muscle Test (MMT), fall index, TimedUp and Go(TUG), and Hospital for Special Surgery-Knee Scale (HSS-KS). Results The scores of NRS reduced six weeks after TKA (t>2.342, P<0.05) in both groups, and was lower in the prehabilitation group than in the control group before and six weeks after TKA (t>2.827, P<0.01). There was no significant difference in AROM of knee flexion when enrolling and before TKA in both groups (t<0.648, P>0.05), and it increased in the control group six weeks after TKA (t>3.555, P<0.01), and no increasement was found in the prehabilitation group (t<1.608, P>0.05);the AROM of knee extension increased before TKA in the control group (Z=-2.257, P=0.024), and no increasement was found in the prehabilitation group (Z=0, P=1.000), and it decreased six weeks after TKA in both groups (Z>2.247, P<0.05). The muscle strength of trunk extention and flexion enhanced before TKA in the prehabilitation group (t>2.387, P<0.05), and no change was found in the control group (t<0.940, P>0.05). The muscle strength of trunk extensor and the upside of rectus abdominis showed no statistical difference between two groups six weeks after TKA (t<1.656, P>0.05), the muscle strength of the downside of rectus abdominis and external oblique was more in the prehabilitation group than in the control group (t=2.585, P=0.013). There was no significant difference in the fall index be-fore TKA (t<0.350, P>0.05), and it was lower in the prehabilitation group than in the control group six weeks after TKA (t=-2.837, P=0.007). The time of TUG shortened before TKA in the prehabilitation group (t=3.554, P=0.002), and it prolonged in the control group (t=-4.507, P<0.001), there was no significant difference in it between two groups six weeks after TKA (t=-0.497, P=0.622). The score of HSS-KS increased before TKA (t=-2.621, P=0.015) in the prehabilitation group, and no increasement was found in the control group (t=2.073, P=0.053), and they were higher in the prehabilitation group than in the control group before and six weeks after TKA (t>2.092, P<0.05). Conclusion Individual prehabilitation could reduce pain, and improve the trunk muscles, the ability of walking and the function of the knee before and six weeks after TKA.