Objective:To synthesize hydroxyapatite/poly (lactic-co-glycolic acid)(HA/PLGA) composites by substituting calcium ions in HA with Cu and Gd ions, characterize their physicochemical properties, and evaluate their feasibility for orbital bone defect repair.Methods:Different ratios of Cu-, Gd-, and Cu/Gd-substituted HA nanoparticles (Cu@HA, Gd@HA and Cu/Gd@HA) were synthesized via hydrothermal synthesis using copper nitrate, gadolinium nitrate, calcium chloride, and ammonium hydrogen phosphate.HA/PLGA, Cu@HA/PLGA, Gd@HA/PLGA, and Cu/Gd@HA/PLGA composites were prepared.HA/PLGA was prepared by co-preparing different ratios of nanoparticles with PLGA via phase inversion and solvent evaporation.The nanoparticles and composites were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), inductively coupled plasma (ICP), environmental scanning electron microscope (ESEM) and micro-computed tomography (Micro-CT). Composite homogeneity was assessed by elemental analysis and the contact angle was measured to evaluate hydrophilicity.Imaging capability of composites was assessed by magnetic resonance imaging (MRI) and T1-weighted.CCK-8 method was used to detect the cytotoxicity of nanoparticles and their extract.Orbital bone defects model was established in 20 rats, which were randomly divided into 4 groups, and implanted with respective composites.Eight weeks after transplantation, the implants were evaluated using Micro-CT and MRI, and osteogenesis, collagen distribution and biocompatibility were assessed by hematoxylin-eosin staining, Masson, and Sirius red staining.All animal experiments complied with the regulations of the Laboratory Animal Ethics Committee of Dalian Medical University and were approved (No.AEE23104).Results:XRD and ESEM results showed that co-doping with Cu/Gd induced less HA lattice distortion than single doping.FT-IR results showed that the nanoparticles doped with Cu and Gd ions were consistent with the HA infrared absorption spectrum.ICP results revealed a higher Ca content in 0.5Cu/Gd@HA and 0.5Cu@HA samples than in 0.5Gd@HA sample.There was a statistically significant overall difference in contact angles among different groups of composites ( F=5.040, P<0.05), among which the 0.5Cu/Gd@HA/PLGA composite exhibited the smallest contact angle and the best hydrophilicity.There was no statistically significant difference in porosity among different groups of composites ( F=0.004, P>0.05). MRI results showed that Gd-doped composites displayed enhanced development and that the signal intensity of the 0.5Gd@HA/PLGA group was the highest.Micro-CT scanning results showed that the composition of the composite material doped with Cu and Gd was better than that of the pure HA/PLGA group, indicating that the metal ions Cu and Gd could promote bone growth.CCK-8 results showed that the nanoparticles and their extracts had no obvious cytotoxic effects.Eight weeks after modelling, Micro-CT showed that the 0.5Cu/Gd@HA/PLGA material degraded well in vivo and the staining results of bone tissue sections in the bone defect area suggested that tissues around the implanted material and rat organs in different groups did not show biological toxicity.In addition, the Gd-doped composites showed good magnetic imaging characteristics when implanted in animals. Conclusions:Cu/Gd@HA/PLGA composites exhibit favorable physicochemical properties, biosafety, osteogenic potential, and MRI contrast and have good clinical application prospects for orbital bone repair.

Objective:To synthesize hydroxyapatite/poly (lactic-co-glycolic acid)(HA/PLGA) composites by substituting calcium ions in HA with Cu and Gd ions, characterize their physicochemical properties, and evaluate their feasibility for orbital bone defect repair.Methods:Different ratios of Cu-, Gd-, and Cu/Gd-substituted HA nanoparticles (Cu@HA, Gd@HA and Cu/Gd@HA) were synthesized via hydrothermal synthesis using copper nitrate, gadolinium nitrate, calcium chloride, and ammonium hydrogen phosphate.HA/PLGA, Cu@HA/PLGA, Gd@HA/PLGA, and Cu/Gd@HA/PLGA composites were prepared.HA/PLGA was prepared by co-preparing different ratios of nanoparticles with PLGA via phase inversion and solvent evaporation.The nanoparticles and composites were characterized using X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), inductively coupled plasma (ICP), environmental scanning electron microscope (ESEM) and micro-computed tomography (Micro-CT). Composite homogeneity was assessed by elemental analysis and the contact angle was measured to evaluate hydrophilicity.Imaging capability of composites was assessed by magnetic resonance imaging (MRI) and T1-weighted.CCK-8 method was used to detect the cytotoxicity of nanoparticles and their extract.Orbital bone defects model was established in 20 rats, which were randomly divided into 4 groups, and implanted with respective composites.Eight weeks after transplantation, the implants were evaluated using Micro-CT and MRI, and osteogenesis, collagen distribution and biocompatibility were assessed by hematoxylin-eosin staining, Masson, and Sirius red staining.All animal experiments complied with the regulations of the Laboratory Animal Ethics Committee of Dalian Medical University and were approved (No.AEE23104).Results:XRD and ESEM results showed that co-doping with Cu/Gd induced less HA lattice distortion than single doping.FT-IR results showed that the nanoparticles doped with Cu and Gd ions were consistent with the HA infrared absorption spectrum.ICP results revealed a higher Ca content in 0.5Cu/Gd@HA and 0.5Cu@HA samples than in 0.5Gd@HA sample.There was a statistically significant overall difference in contact angles among different groups of composites ( F=5.040, P<0.05), among which the 0.5Cu/Gd@HA/PLGA composite exhibited the smallest contact angle and the best hydrophilicity.There was no statistically significant difference in porosity among different groups of composites ( F=0.004, P>0.05). MRI results showed that Gd-doped composites displayed enhanced development and that the signal intensity of the 0.5Gd@HA/PLGA group was the highest.Micro-CT scanning results showed that the composition of the composite material doped with Cu and Gd was better than that of the pure HA/PLGA group, indicating that the metal ions Cu and Gd could promote bone growth.CCK-8 results showed that the nanoparticles and their extracts had no obvious cytotoxic effects.Eight weeks after modelling, Micro-CT showed that the 0.5Cu/Gd@HA/PLGA material degraded well in vivo and the staining results of bone tissue sections in the bone defect area suggested that tissues around the implanted material and rat organs in different groups did not show biological toxicity.In addition, the Gd-doped composites showed good magnetic imaging characteristics when implanted in animals. Conclusions:Cu/Gd@HA/PLGA composites exhibit favorable physicochemical properties, biosafety, osteogenic potential, and MRI contrast and have good clinical application prospects for orbital bone repair.

Objective To evaluate the clinical efficacy and safety of preoperative endovascular embolization of Solid Hemangioblastomas.Methods The data bases including Wan Fang,CNKI(China National Knowledge Infrastructure),VIP Database,PubMed、Medline、Springer were searched for the related studies.Two independent surgeons assessed trails for eligibility and quality,and all data marching the standards were abstracted for Meta-analysis by RevMan 5.3.Results 8 randomized controlled trails(RCT)were included.Selected analysis of embolized and non-embolized groups of Solid Hemangioblastomas were observed for variables of clinical efficacy in surgery time,number of blood loss and transfusions,complete resection,there were statistical difference.(P＜0.000 01,WMD=-1.18,95％CI[-1.16,-0.71];P＜0.000 01,WMD=-464.17,95％CI[-492.17,-437.24];P＜0.000 01,WMD=-238.81,95％CI[-282.84,-194.77];P＜0.006,RR=1.17,95％CI[1.05,1.31]).Conclusion The preoperative endovascular embolization is beneficial for Hemangioblastomas because it can shorten the time of surgery,diminish the necessity of intra-operative blood loss and transfusion,it also raises the ratio of complete resection of Solid Hemangioblastomas.

Objective:To investigate the characteristics of atelectasis and its relationship with the degree of diaphragm inhibition in elderly patients with artificial pneumoperitoneum under general anesthesia.Methods:Patients of both sexes, aged 20-80 yr, of American society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 20-29 kg/m 2, scheduled for elective laparoscopic cholecystectomy under general anesthesia, were divided into 2 groups ( n=20 each) according to age: young and middle-aged group and elderly group.Total intravenous anesthesia was applied and intraoperative pressure of artificial pneumoperitoneum was set at 10 mmHg.Before anesthesia, at 5 min of mechanical ventilation, at 5 min of artificial pneumoperitoneum, at 20 min of artificial pneumoperitoneum, at 5 min after the end of artificial pneumoperitoneum and at 15 min after extubation, diaphragmatic excursion (DE) was measured at the right diaphragm point using M-mode ultrasound.The minimal DE was recorded and the maximum degree of diaphragm inhibition was calculated.B-mode was used to assess the lung ultrasound images at the upper bedside lung ultrasound in emergency (BLUE) point, the lower BLUE point and the diaphragm point, and the cumulative scores before anesthesia and perioperative maximum cumulative scores of lung ultrasound score (LUS) were recorded. Results:Compared with the young and middle-aged group, the maximum cumulative scores of LUS were significantly increased, the degree of DE before anesthesia, the perioperative maximum degree of diaphragm inhibition were increased ( P<0.05), and no significant change was found in LUS cumulative scores in elderly group ( P>0.05). Conclusion:The degree of atelectasis is more serious in the elderly patients with artificial pneumoperitoneum under general anesthesia, and the mechamism may be related to the increased degree of diaphragm inhibition.

Objective: To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic. Methods: The clinical data of 41 patients with choledochal cyst type Ic, 47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital, PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed. The diameters of the common bile duct, the left and the right hepatic ducts were measured and compared. Results: The maximum diameter of the left hepatic duct (LHD), right hepatic duct (RHD) and common bile duct (CBD) were significantly different (all P<0.05) in patients with choledochal cyst type Ic compared to patients with distal choledochal obstruction. The CBD/LHD ratio and CBD/RHD ratio were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), but the maximum diameters of LHD and RHD were not significantly different (both P>0.05), while the ratios of CBD/LHD and CBD/RHD were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), the maximum diameter of LHD and RHD was also significantly larger (P<0.05), while the ratios of CBD/LHD and CBD/RHD were not significantly different (P>0.05). The proportion of pancreaticobiliary maljunction (PBM) in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruction and simple gallstone or polyp (P<0.05). Conclusions For patients with choledochal cyst type Ic, their CBD shows obvious dilation, while there is no obvious dilation in LHD and RHD. It is helpful to conduct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios.

Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.