Objective:To study the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) and primary closure of common bile duct after laparoscopic common bile duct exploration (LCBDE) in treatment of choledocholithiasis complicated with moderate and severe cholangitis.Methods:The clinical data of 127 patients with choledocholithiasis complicated with acute cholangitis admitted to Yantai Affiliated Hospital of Binzhou Medical University from January 2021 to August 2023 were retrospectively analyzed. Finally, 45 patients were enrolled, including 20 males and 25 females, aged (71.3±8.2) years. All 45 patients were treated with sequential PTCD and primary closure of common bile duct after LCBDE. The interval from PTCD to primary closure, white blood cell count, total bilirubin, alanine transaminase before and after PTCD, operation time of primary closure, intraoperative blood loss, postoperative retention time of abdominal drainage tube, postoperative hospitalization time, postoperative complications (bile leakage, bleeding, etc.) were analyzed.Results:The serum total bilirubin, alanine transaminase and white blood cell count of 45 patients were (143.2±32.1) μmol/L, (173.6±23.4) U/L, (16.3±2.9)×10 9/L at admission, and (100.5±21.4) μmol/L, (103.5±12.7) U/L, (8.6±1.7) ×10 9/L after PTCD, respectively. The interval between PTCD and primary closure of common bile duct after LCBDE was (4.3±1.1) d, the operative time of primary closure was (123.4±20.5) min, the amount of intraoperative blood loss was (32.6±8.7) ml. The postoperative hospitalization time was (6.8±1.6) d, and the postoperative retention time of abdominal drainage tube was (4.5±1.3) d, and postoperative complications occurred in 7 cases (15.6%), including biliary leakage in 4 cases (8.9%), subxiphoid incision infection in 1 case (2.2%), and effusion in gallbladder fossa with infection in 2 cases (4.4%). Conclusion:The sequential application of PTCD and primary closure of common bile duct after LCBDE in treatment of choledocholithiasis complicated with moderate and severe cholangitis is a safe, effective and minimally invasive method, and primary closure of common bile duct after LCBDE is safe and reliable within 1 week after PTCD.

AIM: To evaluate the combining ability of prostate-specific membrane antigen (PSMA) targeted radioactive drug

MicroRNAs (miRNAs) are endogenous non-coding small molecular RNAs that widely exist in eukaryotes, and mature miRNAs are composed of 20-25 nucleotide sequences. With the deepening of the research on miRNAs in recent years, it has been found that miRNAs play an important role in the development, progression, prognosis, chemotherapy resistance, and early diagnosis of gallbladder carcinoma. This article reviews the research advances in the role of miRNAs in gallbladder carcinoma.

Objective:To investigate the clinical characteristics, treatments and prognosis of ocular toxoplasmosis (OT).Methods:A retrospective clinical trial. Twelve cases (14 eyes) with OT which was confirmed by clinical and laboratory tests were included in the Department of Ophthalmology, Taihe Hospital in Shiyan and the Department of Ophthalmology, Beijing Chaoyang Hospital in Beijing from July 2011 to June 2019. Among the 12 cases, 6 cases were female (7 eyes) and 6 cases were male (7 eyes). The mean age of the participants was 33.4±12.8 years and the duration of illness ranged from 7 days to 30 years. Fungal endophthalmitis, viral uveitis and non-infectious uveitis were misdiagnosed in 2 cases respectively at the first visit. All the patients underwent BCVA, intraocular pressure, slit-lamp microscope, fundus color photography examinations and toxoplasma-specific serological antibodies tests. Intraocular influid were detected for 7 cases, among which 1 case for antibody only, and 6 cases for Goldmann-witmer coefficient (GWC). Of the 6 cases tested for GWC, 4 cases were tested with PCR assay in the ocular fluid addtionally. FFA was performed in 5 cases (6 eyes) and OCT in 6 cases (6 eyes). Eleven cases were treated with antitoxoplasma therapy. The follow-up duration after treatment varied from 1 week to 39 months. BCVA, clinical features and prognosis were retrospectively analyzed.Results:Specific antibody seropositivity of Toxoplasma gondii was detected in all 12 patients. Of the 7 cases tested with intraocular fluid, 1 case was IgG positive and the other 6 cases with 5 cases with GWC >4 and 1 case with 20.3 in 4 eyes. KPs with or without anterior chamber flash or cells could be detected in 6 eyes,congenital macular defect 1 eye, vitreitis 3 eyes (2 eyes with multiple retinal pigmentation foci and 1 eye with tractive retinal detachment), and coexistence of new and old lesions with Kyrieleis arteritis 2 eyes. Nine eyes showed different degrees of vitreous inflammation (75% of 12 active eyes). Single lesion was present in 4 case (4 eyes) and multiple lesions were present in 8 cases (10 eyes). There were no statistically significant changes in BCVA of OT patients before and after treatment ( P=0.83). Involvement or adjacent to macula of he primary lesions, misdiagnosis and mistreatment led to the poor prognosisi of visual acuity. Conclusions:The fundus of OT can show single lesion or multiple lesions, and the active phase is often accompanied by vitreous inflammation. The primary lesion involves or is close to the macular area, misdiagnosis and mistreatment are the main reasons for the poor visual prognosis of patients.

Objective To investigate the clinical result of treating Tillaux-Chaput fractures using the full ankle arthroscopy technique.Methods A retrospective analysis was made on 21 patients with Tillaux-Chaput fractures followed up after treatment by the full ankle arthroscopy technique from May 2013 to May 2015.There were 16 males and 5 females,with the age range of 6-55 years [(25.5 ± 12.8)years].Right ankle was involved in 12 patients and left ankle in 4 patients.Sixteen patients had single TillauxChaput fractures and 5 patients had combined proximal fibular fractures.Diagnosis of Tillaux-Chaput fractures was confirmed by X-rays in 18 patients an CT in 3 patients.Ankle arthroscopy was used through the anterolateral and anteriormedal approaches for closed reduction and internal fixation using one or two Herbert screws.Wound healing,bone union and visual analogue score (VAS) were detected postoperatively.Function assessment was performed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system.Results All incisions healed by first intention,without evidence of nerve,vessel and tendon injuries.Period of follow-up was (15.3 ± 7.1) months (range,12-25 months).Fracture healed within 12 to 36 weeks [(22.6 ±4.6)weeks] after operation.VAS was (0.8 ± 0.3) points after operation,obviously lower than preoperative (8.3 ± 1.3) points (P ＜ 0.05).At the final follow-up,all patients regained normal ankle function and normal walking gait,without the presence of ankle pain and weight-bearing walking pain.AOFAS score was improved from preoperative (51.2 ± 12.5) points to postoperative (92.7 ± 16.5) points (P ＜ 0.05).Based on the AOFAS score,the results were excellent in 19 patients and good in 2 patients,with the excellent-good rate of 100％.Conclsion Full ankle arthroscopy by the anterolateral and anterionnedal approaches provides a precise and effective method for closed reduction and internal fixation of Tillaux-Chaput fractures and deserves clinical application.

Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger.Methods Between August,2013 to August,2015,21 patients (21 fingers) with severely flexion contracture of the burned finger were hospitalized for treatment.According to the Stren classification standard for the interphalangeal joint flexion contracture,all the patients were rated as type Ⅲ.The volar soft-tissue defect with exposed tendons,nerves,vessels or bone ranged from 1.0 cm × 2.0 cm to 2.5 cm × 4.0 cm after scar relaxation.The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm,respectively.The wound were reconstructed with the modified antegrade digital artery island flap.The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound.The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm.All the cases were called back for postoperative follow-up.Results All the reconstructed fingers and flaps survived completely without vascular problems.The donor skin graft survived and wound healed by first intention.All the patients were followed up with 11.5 months (range,6-22 months).The finger appearance was satisfactory.The texture and color of flaps in all cases were good.There was no pigmentation and contraction relapse.The contracted fingers received no cold intolerance.At the final examination,the average values of static 2-point discrimination were 5.2 mm (range,4.3-6.5 mm) of the flap.In the series,based on the Michigan Hand Outcome Questionnaire,18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance.Conclusion The modified antegrade digital artery island flap,which is easy to raise with large flap size and can result with the good finger appearance and function,is an ideal technique for reconstruction of the severe flexion contracture of the burned finger.

Objective To evaluate the effects and security of PFNA and DHS in the treatment of unstable intertrochanteric fractures through meta analysis .Methods The randomized controlled trials(RCT) for comparing PFNA and DHS in the treatment of unstable intertrochanteric fracture were retrieved from MEDLINE ,EMbase ,Pubmed ,Cochrane library ,CBM ,CNKI ,VIP data‐bases by computer .The related orthopedic relevant documents and conference papers were collected by manual retrieval .The Rev‐Man5 .1 statistical software was used for conducting the meta analysis .Results Nineteen RCT were included ,involving 1 690 pa‐tients ,in which 871 cases were treated by using PFNA and 819 cases were treated by using DHS .Compared with DHS ,PFNA had the advantages of little trauma ,less blood loss ,short operation time ,short fracture healing time and postoperative bed time ,good hip function and low incidence of postoperative coxa vara and screw cutting ,but there were no statistical differences in the aspects of length of hospital stay ,fatality rate ,and incidences of fracture nonunion ,breakage of internal fixation ,femoral head necrosis ,short‐ening of the femoral neck ,femoral shaft fractures ,deep vein thrombosis ,urinary tract infection and other complications between the two groups(P>0 .05) .Conclusion The retrieved literatures show that PFNA internal fixation is superior to DHS internal fixation in treatment of unstable intertrochanteric fractures .

Objective To study the distribution and properly of the transparent globules within Hensen cells (HC) of guinea -pig Corti organ .Methods The cochlear epithelial cells were isolated from 10 guinea pigs .The cells of cochlea were marked by Bodipy493/503 ,sudan III ,oil red O ,and osmium tetroxide .Results The transpar‐ent globules within the HCs of the guinea -pigs were green staining by Bodipy493/503 ,jacinth staining by Sudan III ,ruby red by oil red O .And they were black globules stripe as post -fixed in 1% osmium tetroxide .Conclusion The results indicate that the transparent globules within guinea -pigs HCs'lipid droplets by four methods .

OBJECTIVETo investigate the hemodynamics evidence of the descending branch of lateral circumflex femoral artery in a reversed way. To explore the clinical result of using the reversed descending branch of the lateral circumflex femoral artery as the receipt artery for free flaps for reconstruction of the leg soft-tissue defect.

METHODSFrom October 2005 to February 2012, 38 patients with severe leg soft-tissue defects were treated. The proximal antegrade and retrograde mean artery pressure of the descending branch of the lateral circumflex femoral artery in 16 of 38 patients were recorded during operation. All wounds had osteomyelitis, bone and tendon exposure requiring coverage reconstruction. And there was no recipient artery in the injured lower leg for free flaps in all 38 patients. Reversed descending branches of lateral femoral circumflex arteries were used as recipient arteries for free flaps (free latissimus dorsi flap, free thoracoumbilical flap, and free anterolateral thigh flap) in all patients. The flap donor site was closed directly or with the skin graft.

RESULTSThe proximal antegrade mean artery pressure of the descending branch of lateral circumflex femoral artery was(81.6 +/- 12.4) mmHg. The proximal retrograde pressure was(48.2 +/- 10.7) mmHg. The proximal retrograde mean artery pressure was 59.07 percent of the proximal antegrade pressure. The donor skin graft survived and wound healed primarily. After operation, 2 flaps had distal partial necrosis and healing was achieved after dressing change. All the other flaps survived completely without vascular problems. All the patients were followed up for 11 months to 2.5 years (mean, 1.6 years). The flap appearance was satisfactory. The texture and color of flaps in all cases were good.

CONCLUSIONSThe reverse descending branch of lateral circumflex femoral artery is a reliable recipient artery for the free flaps. It is an easy and simple technique that can be used for reconstruction of the defects in the lower leg, with the reversed descending branch of lateral circumflex femoral artery as recipient artery.

Adolescent ; Adult ; Blood Pressure ; Female ; Femoral Artery ; physiopathology ; surgery ; Free Tissue Flaps ; blood supply ; Hemodynamics ; Humans ; Lower Extremity ; injuries ; Male ; Middle Aged ; Soft Tissue Injuries ; surgery ; Young Adult

ObjectiveTo investigate the influence of Mycobacterium tuberculosis (MTB) co-infection and other factors on the HIV replication level in antiretroviral treatment na(i)ve patients.MethodsSix hundred TB patients and 465 HIV infectors were recruited between April 2010 and September 2010.TB coinfections were diagnosed in HIV infected cases with chest X-ray,checking TB in sputum with anti-acid staining and culture of the sputum,histopatholo diagnosis and clinical diagnosis.HIV infections were screened in TB patients with the 3rd generation ELISA antibody test.Sixty-one antiretroviral treatment na(i)ve HIV/TB co-infectors and 34 HIV infectors with CD4 T cell count below 350 cells/μl were included in this study.Information about the demography,epidemiology and results of clinical diagnostic tests of HIV and TB was collected through pathography and questionnaires from all participants.HIV viral load were detected with COBAS AmpliPrep/COBAS TaqMan(R) System of Roche Company.ResultsThe viral load of HIV/TB co-infectors was (5.05±0.93) lg copies/ml,while the viral load of HIV infectors was (5.06±0.76) lg copies/ml,after control of age,race,marital status,education,route of HIV infection,HIV clade and CD4 T cell count,there was no significant difference between the two groups (P=0.94).CRF01_AE HIV-1 infection was associated with higher HIV viral load compared with non CRF01_AE (OR=8.07,95％ CI 1.07-61.20,P=0.04).ConclusionNo obvious effect of MTB co-infection on HIV replication level of HIV infected cases with relatively low CD4 T cell count in Guangxi region,while the CRF01_AE HIV infected individuals showed higher viral load,we should raise concern on the monitoring and treatment on this population.