Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and individualized surgical plans for patients.

Objective To understand the gene distribution and drug resistance rate of integron gene of extended spectrumβ‐lac‐tamases(ESBLs) producing Klebsiella pneumonia infection in ICU elderly patients in order to provide the basis for rational use of antimicrobial agents .Methods The BioMerieux VITEK‐2 Automated Microbes Identification System was adopted to conduct the bacteria identification and drug susceptibility test on various clinical specimens of ICU elderly patients in our hospital from January 2013 to December 2015 .The integron gene in 167 strains of ESBLs‐producing Klebsiella pneumoniae was analyzed by PCR ,and the gene was identified by sequencing .Results Among 386 strains of Klebsiella pneumoniae ,the detection rate of ESBLs‐producing strains was 43 .26% ;the positive rate of integron was 50 .89% ,the detected integron was class Ⅰ integron;aadA2 ,aadA1 ,aada16 , dfra27 and arr‐3 genes were amplified from integron variable region;the drug resistance rate of ESBLs‐producing integron gene pos‐itive strains was significantly higher than that of integron gene negative strains .Conclusion the ICU elderly patients with ESBLs‐producing Klebsiella pneumoniae infection is closely related to the integron gene and integron plays an important role in bacterial drug resistance .

Objective: To investigate the root canal configuration and the incidence and location of the isthmus in extracted maxillary second premolar with single root. Methods: 60 maxillary second premolars were included in the study. 1 mm root was cut from the apical end of root. The transverse section was stained with methylene blue dye and viewed with a surgical operating microscope. 1 mm increment sections were made and stained and observed by the same way from apex to 6 mm. The number of canals as well as the type of canal isthmuses were recorded. Results: 41.67% maxillary second premolar with single root had two canals. Canal isthmus happened more frequently in the apical 4 mm levels. Conclusion: The incidence of isthmus in the maxillary second premolar was highest in the apical 3-to 5-mm level. Canal morphology in the apical 1-to 6-mm is complicated.

Evidence-Based Practice ; Humans ; Practice Guidelines as Topic

Evidence-Based Medicine ; Evidence-Based Practice ; Humans ; Practice Guidelines as Topic

Evidence-Based Practice ; Practice Guidelines as Topic

Adrenocorticotropic Hormone ; therapeutic use ; Brain-Derived Neurotrophic Factor ; physiology ; Child, Preschool ; Female ; Humans ; Methyl-CpG-Binding Protein 2 ; genetics ; Mutation ; Rett Syndrome ; drug therapy ; genetics

Objective To observe and evaluate the expression and significance of Nogo-66 receptor (NgR) mRNA in adult rats′ optic nerve. Methods Optic and sciatic nerves of 8 adult rats were used to make the sections, which were divided into 3 groups: optic-nerve experimental group, sciatic-nerve control group, and optic-nerve negative control group. In situ hybridization was used to observe the expression of NgR mRNA in optic nerve and sciatic nerve. Results The expression of NgR mRNA in the 8 rats was positive in optic nerve and negative in sciatic nerve. The positive signals were arranged along the long axis of optic nerve. Conclusion The expression of NgR mRNA is positive in optic nerve while negative in sciatic nerve in adult rats, which suggests that the positive expression and distribution of NgR may be related to the poor regenerate ability of optic nerves.

Objective To investigate the role of oestrogen receptors and enteric mast cells in the pathogenesis of irritable bowel syndrome (IBS) . Methods Biopsies from 59 patients with IBS and 24 control subjects were analyzed blindly for the number of mast cell ( MC ) , estrogen receptors and progestogen receptors in terminal ileum , caecum and descending colon (DC). Immunohistochemical methods were used to detect the estrogen receptors (ER) , progestogen receptors (PR) and MC. And double Immunohistochemical staining was used to manifest the expression of oestrogen receptors in intestinal MC. Results The cells positive for ER were morphologically similar to the MC (R = 0. 884, P

Zymonomas mobilis was transformed with a polyhydroxybutyrate synthesis operon phbCAB equipped with a pdc promoter from Z. mobilis. For the first time,PHB was produced in recombinant Z.mobilis. Shake flask studies indicated that accumulation of PHB in Zymomonas mobilis increased approximately 10% ethanol productivity for the first 48h of anaerobic fermentation. After that,the PHB effect was observed as insignificant probably due to the exhaustion of the sugar.