OBJECTIVE To investigate the protective effect and mechanism of saikosaponin C （SSC） on acute liver injury （ALI） in mice induced by carbon tetrachloride （CCl4） based on serum metabolomics. METHODS Forty mice were divided into blank group （water）， model group （water）， positive control drug group （Biphenyl diester drop pills， 150 mg/kg）， and SSC low- and high-dose groups （2.5， 10 mg/kg） using the random number table method， with 8 mice in each group. They were given water/ relevant drugs， once a day， for 7 consecutive days. One hour after the last administration， all mice were intraperitoneally injected with 0.2% CCl4 olive oil to induce ALI model， except for the blank group. After 17 hours of the modeling， the liver index of mice was calculated. The levels of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， lactate dehydrogenase （LDH）， tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and IL-1β in serum of mice were detected. The histopathological changes of liver tissue were observed. Meanwhile， the serum metabolomics of mice were analyzed by liquid chromatography-mass spectrometry. RESULTS Compared with the blank group， the levels of liver index， ALT， AST， LDH， TNF-α， IL-6， and IL-1β in the model group were significantly increased （P＜0.01）. Hepatocytes were edema， vacuolar degeneration， more necrosis， and a large number of inflammatory cells were infiltrated. Compared with the model group， liver index and serum index levels of mice were significantly decreased （P＜0.05 or P＜0.01）， accompanied by marked improvement in histopathological damage to the liver tissue. The metabolomics results showed that compared with the model group， there were 63 up-regulated and 256 down-regulated differential metabolites in the serum of mice in the SSC high-dose group， including prostaglandin B2， 20-hydroxy-leukotriene B4， 5- hydroxy-L-tryptophan， 7α -hydroxycholesterol， etc.； these metabolites were primarily involved in metabolic pathways such as arachidonic acid metabolism， 5-hydroxytryptamine synapse， primary bile acid biosynthesis. CONCLUSIONS SSC exerts a protective effect against CCl4-induced ALI by down-regulating the level of key metabolites such as prostaglandin B2 and 20-hydroxy-leukotriene B4， and then ruducing metabolic pathways such as arachidonic acid metabolism， 5- hydroxytryptamine synapse， and primary bile acid biosynthesis.

Objective:To investigate the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma at multiple centers in China.Methods:Between December 2015 and August 2019, the clinical data of 143 patients who underwent LRHC in Affiliated Hospital of North Sichuan Medical College, Second Hospital of Hebei Medical University, Affiliated Hospital of Xuzhou Medical University, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hunan Provincial People′s Hospital, the First Hospital Affiliated to Army Medical University, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, West China Hospital of Sichuan University, Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Chongqing Medical University were collected prospectively. There were 92 males and 51 females with age of (64±11) years (range: 53 to 72 years). Bismuth type: type I, 38 cases (26.6%), type Ⅱ, 19 cases (13.3%), type Ⅲa, 15 cases (10.5%), type Ⅲb, 28 cases (19.6%) and type Ⅳ, 43 cases (30.0%). The patients within the first 10 operation cases in each operation time (the first 10 patients in each operation team) were divided into group A (77 cases), and the patients after 10 cases in each operation time were classified as group B (66 cases); the cases with more than 10 cases in the center were further divided into group A 1 (116 cases), and the center with less than 10 cases was set as group A 2 (27 cases). T test or Wilcoxon test was used to compare the measurement data between groups, and the chi square test or Fisher exact probability method was used to compare the counting data between groups. Kaplan Meier curve was used for survival analysis. Results:All patients successfully completed laparoscopic procedure. The mean operation time was (421.3±153.4) minutes (range: 159 to 770 minutes), and the intraoperative blood loss was 100 to 1 500 ml (median was 300 ml) .Recent post-operative complications contained bile leakage, abdominal bleeding, abdominal infection, gastrointestinal bleeding, and delay gastric emptying, pulmonary infection, liver failure, et al.The post-operative hospital stay was (15.9±9.2) days. The operation time in group B was relatively reduced ( (429.5±190.7)minutes vs. (492.3±173.1)minutes, t=2.063, P=0.041) and the blood loss (465 ml vs. 200 ml) was also reduced ( Z=2.021, P=0.043) than that in group B. The incidence of postoperative biliary fistula and lung infection in patients in group A was significantly higher than that in group B (χ 2=4.341, 0.007; P=0.037, 0.047) .Compared with group A 2, the operation time in group A 1 was relatively reduced( (416.3±176.5)minutes vs. (498.1±190.4)minutes, t=2.136, P=0.034) , the incidence of bile leakage and abdominal cavity infection in group A 1 was lower than that in group A 2 (χ 2=7.537, 3.162; P=0.006, 0.046) . Kaplan Meier survival curve showed that the difference of short-term survival time between group A and group B was statistically significant ( P<0.05) . Conclusions:The completion of laparoscopic hilar cholangiocarcinoma radical surgery is based on improved surgical skills, and proficiency in standardized operation procedures.It is feasible for laparoscopic radical resection of hilar cholangiocarcinoma to well experienced surgeon with cases be strictly screened, but it is not recommended for widespread promotion at this exploratory stage.

Objective:To investigate the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma at multiple centers in China.Methods:Between December 2015 and August 2019, the clinical data of 143 patients who underwent LRHC in Affiliated Hospital of North Sichuan Medical College, Second Hospital of Hebei Medical University, Affiliated Hospital of Xuzhou Medical University, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hunan Provincial People′s Hospital, the First Hospital Affiliated to Army Medical University, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, West China Hospital of Sichuan University, Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Chongqing Medical University were collected prospectively. There were 92 males and 51 females with age of (64±11) years (range: 53 to 72 years). Bismuth type: type I, 38 cases (26.6%), type Ⅱ, 19 cases (13.3%), type Ⅲa, 15 cases (10.5%), type Ⅲb, 28 cases (19.6%) and type Ⅳ, 43 cases (30.0%). The patients within the first 10 operation cases in each operation time (the first 10 patients in each operation team) were divided into group A (77 cases), and the patients after 10 cases in each operation time were classified as group B (66 cases); the cases with more than 10 cases in the center were further divided into group A 1 (116 cases), and the center with less than 10 cases was set as group A 2 (27 cases). T test or Wilcoxon test was used to compare the measurement data between groups, and the chi square test or Fisher exact probability method was used to compare the counting data between groups. Kaplan Meier curve was used for survival analysis. Results:All patients successfully completed laparoscopic procedure. The mean operation time was (421.3±153.4) minutes (range: 159 to 770 minutes), and the intraoperative blood loss was 100 to 1 500 ml (median was 300 ml) .Recent post-operative complications contained bile leakage, abdominal bleeding, abdominal infection, gastrointestinal bleeding, and delay gastric emptying, pulmonary infection, liver failure, et al.The post-operative hospital stay was (15.9±9.2) days. The operation time in group B was relatively reduced ( (429.5±190.7)minutes vs. (492.3±173.1)minutes, t=2.063, P=0.041) and the blood loss (465 ml vs. 200 ml) was also reduced ( Z=2.021, P=0.043) than that in group B. The incidence of postoperative biliary fistula and lung infection in patients in group A was significantly higher than that in group B (χ 2=4.341, 0.007; P=0.037, 0.047) .Compared with group A 2, the operation time in group A 1 was relatively reduced( (416.3±176.5)minutes vs. (498.1±190.4)minutes, t=2.136, P=0.034) , the incidence of bile leakage and abdominal cavity infection in group A 1 was lower than that in group A 2 (χ 2=7.537, 3.162; P=0.006, 0.046) . Kaplan Meier survival curve showed that the difference of short-term survival time between group A and group B was statistically significant ( P<0.05) . Conclusions:The completion of laparoscopic hilar cholangiocarcinoma radical surgery is based on improved surgical skills, and proficiency in standardized operation procedures.It is feasible for laparoscopic radical resection of hilar cholangiocarcinoma to well experienced surgeon with cases be strictly screened, but it is not recommended for widespread promotion at this exploratory stage.

Objective To investigate the clinical features of multiple primary malignancies ( MPM) in patients with kidney malignancy .Methods The clinical data of 111 patients suffered from MPM associated with kidney malignant tumor in Yantai Yuhuangding Hospital and Affiliated Yantai Hospital of Binzhou Medical College from April 1984 to December 2014 were retrospectively analyzed .Results Among the 111 cases,there were 100 cases with two primary malignancies ,9 with three cancers and 2 cases with four or five cancers.Synchronous MPM were 37 cases,and metachronous 74 cases.The interval between the first and the second primary malignancy was between 0 and 348 months,with average of 46 months and median of 16 months.One hundred and seventy-two cases were treated by operation , and 64 cases by conservative therapy.The proportion of operation from the first to the fifth cancers were 89.2%(99/111),59.5%(66/111),54.5%(6/11),50.0%(1/2),0%(0/1),respectively,with the trend of declining.Finally 95 cases (85.6%) were followed up ,with 53 cases survived and 42 cases died.From the diagnostic date of the first primary cancer,overall survival in 1 year,3 years,5 years,10 years were 97.2%,77.2%,67.8%,48.4%, respectively.Median survival time was 120 months.From the diagnostic date of the last primary cancer , overall survival in 1 year,3 years,5 years were 81.4%,53.4%,48.2%,respectively.Median survival was only 48 months.Univariate analysis showed that the cumulative survival rate was higher in patients with operation than conservative therapy ( P =0.000 ) , in metachronous group than synchronous group ( P =0.009).COX proportional hazard model showed metachronous MPM (OR=3.870,95%CI 1.702-8.801,P=0.001),aggressive operation of the first primary cancer (OR=0.107,95%CI 0.018-0.647,P=0.015) and the second cancer (OR=0.313,95%CI 0.131 -0.750, P=0.009) were independent prognostic factors. Conclusions The main treatment of MPM associated with kidney malignancy is aggressive operation, radiotherapy, chemotherapy and biological therapy are adjuvant .Early detection and early operation for MPM are beneficial for increasing the survival of the patients .

Objective To investigate the expression of human leukocyte antigen F (HLA-F) in hepatocellular carcinoma (HCC) tissues and to evaluate its relation to clinicopathological features and prognosis of HCC.Methods HLA-F expression of tumor lesions and their adjacent normal liver tissues from 115 HCC patients were analyzed by immunohistochemistry,and its relationship between HLA-F expression and the clinicopathological features and prognosis of HCC patients was also analyzed.Results HLA-F expression was positive in 47.0％ (54/115) of the HCC lesions and in 10.6％ (7/66) of the normal liver tissues (x2 =24.799,P ＜ 0.05).HLA-F expression in HCC lesions was significantly correlated with portal vein invasions (x2 =7.644,P =0.006),tumor number (x2 =4.210,P =0.040) and patient sex (x2 =6.759,P =0.009).The mean survival time of the HLA-F positive HCC patients was 34.0 months(95％ CI:27.5-40.5 months),which was significantly shorter than that of HLA-F negative HCC patients(44.6 months,95％ CI:38.3-50.9months) (x2 =5.148,P =0.023).HLA-F expression was an independent predictor of overall survival of HCC patients.Conclusions Positive HLA-F expression is negatively correlated with the prognosis of HCC patients.

Objective To design an intramedullary nail that had the same ends and could be connected to hairline pointer and employ it to fixate mid-shaft clavicular fractures. Methods Sixty adult clavicles and five fresh adult cadaveric clavicles were employed to measure full length, angle between lateral and middle segments, angle between middle and medial segments as well as the narrowest outer and inner diameters of the clavicle. The interlocked intramedullary nail with the same structure of two ends was designed and used to fixate mid-shaft clavicular fractures. The nail was inserted in retrograde manner and locking screws could be inserted at beth ends. Results The full length, angle between lateral and middle segments, angle between middle and media] segments as well as the narrowest outer and inner diameters of the clavicle were (14.82 ± 1.15) cm, 30°, 30°, (1.00±0.16) cm and (0.50± 0. 18) cm respectively. After conversely placing guide pin from the fracture end, expanding medullary cavity and adjusting the nail, the designed nail was inserted into the medullary cavity from the distal or proximal ends of the clavicle, which was locked by interlocked screws. Conclusions Self-made nail takes advantages of less surgical invasion, visible fracture reduction and stable fracture fixation for treatment of mid-shaft clavicular fractures. While the biomechanieal properties of the nail need further investigation.

80% defined as category A,B,and C,respectively.Category A drugs were regarded as the focus of management,category B as the second focus of management,category C underwent general management,category D drugs were regarded as the focus in purchase.RESULTS:Hospital first-order drug storeroom and secondary drug storerooms classified their drugs into their own A,B,and C categories (category D was consistent).The consumption sum of category A drugs(about 20% of drugs) accounted for 60%;the consumption sum of category B drugs(about 20% of drugs) accounted for 20%;and the consumption sum of category C drugs(about 60% of drugs) plus that of small quantity of category D drugs accounted for 20%.CONCLUSION:This method can ensure drug supply and help maximize ec-onomical benefits with least human,material and financial resources.

OBJECTIVE:To probe into the tendency and influencing factors of the drug expenses of the inpatients in our hospital.METHODS:The total drug expense,the antibiotic expense and its proportion in the total of the inpatients in our hospital were analyzed statistically in this retrospective study.RESULTS:During 2003～2007,the average daily total drug expense per inpatient was 371.77 yuan with average annual growth rate of 11.94%;the average daily antibiotics cost per inpatient was 110.35 yuan with average annual growth rate of 11.92%.Both the drug expense and antibiotic expense were correlated positively with the consumer price index (CPI).And the proportion of antibiotic expense in the total drug cost remained stable at about 29.68%.CONCLUSION:The average daily drug cost and antibiotic expenses per inpatient between 2003 and 2007 fluctuated yet with upward trend on the whole,and the proportion of antibiotic expense in the total drug cost remained stable.

[Objective]To design an intramedullary nail for mid-shaft clavicular fractures based on the anatomic study of human clavicles.[Method]Sixty adult clavicles and 5 fresh cadaveric clavicles were used to survey data about full length,angle between lateral and middle segments,angle between middle and medial segments and the narrowest outer and inner diameter of clavicle.The designed interlocked intramedullary nail was used to fix mid-shaft clavicular fractures.[Result]The full length of clavicle was about(14.82?1.15) cm.The included angle between lateral and middle segment and included angle between middle and medial segment were all about 30?,the narrowest outer diameter of clavicle was about(1.00~0.16) cm,the narrowest inner diameter of clavicle was about(0.50~0.18) cm.After conversely placing guide pin from fracture end,expanding medullary cavity and adjusting the nail,the designed nail was inserted into the medullary cavity from the distal or proximal ends of clavicle,and the proximal and distal ends of the nail were locked by interlocked screws at last.[Conclusion]Treatment of mid-shaft clavicular fractures with the self-made nail has such advantages as less surgical invasion,visible fracture reduction and stable fracture fixation.The biomechanical properties of the nail will be further investigated.

OBJECTIVE: To work out scientific computation and evaluation method for the working performance of dispensers so as to improve the service quality and motivate the enthusiasm of the dispensers.METHODS: The performance of each dispenser consisted of the coefficient of dispensing prescriptions and coefficient of colligation(weight ratio: 80%∶20%).The coefficient of dispensed prescriptions was derived from the number of prescriptions in the foreground(counter),the quantity of drugs dispensed and the number of dispensed prescriptions in the background;and coefficient of colligation was derived from the service quality and work performance of dispensers.The individual bonus was decided by his performance coefficient.RESULTS: The monthly quantitative evaluation indicators and evaluation results of the work performance and service quality of each pharmacist became available.As compared without this evaluation system,the differences among dispensers in performance coefficient and in dispensing error were markedly decreased after the practice of performance evaluation,and the irrational prescriptions were able to be corrected in time.CONCLUSIONS: The quantitative evaluation method has motivated the working enthusiasm of the dispensers and enhanced both the working efficiency and service quality.Besides,this system can be modified based on the practical situation to be generally approved.