BACKGROUND:For depressed skul fractures in children, retaining their skul and narrowing surgical incision meet the concept of minimaly invasive surgery as important as ensuring the surgical safety and therapeutic effects, which is also the requirement of children’s parents. OBJECTIVE:To explore the curative effects of in suit replantation of free bone fragments based on a smal incision in children with depressed skul fractures. METHODS: Fifteen patients with depressed skul fractures, aged 3-16 years, were selected and subject to CT examination and manual examination of the scalp at fractured site under general anesthesia for labeling fracture range. Then, one or two bone fragments corresponding to the fracture site and size were selected. A smal incision with a length equal to the outer edge of bone fragments removed. Postoperative folow-up was employed for observation of clinical effects. RESULTS AND CONCLUSION:An incision, 5-7 cm in length, were made, and one bone fragment was removed from six cases, and two bone fractures were removed from nine cases. Intraoperatively, there were six cases of epidural hematoma, three cases of subdural hematoma, six cases of brain contusion and bleeding. For fracture fixation, one skul lock was used in eight cases, two skul locks in six cases, and three bone plates in one cases. Postoperative CT showed 12 cases of good fracture reduction displayed basic symmetry with the contralateral skul; 3 cases showed partialy depressed bone fragments that were less than 0.5 cm; 6 cases had a little skul defects with a diameter < 1.0 cm; 6 cases had mild epidural hematoma or effusion which was eliminated after conservative treatment. Eleven of 15 cases were folowed for 2 month to 3 years, and showed no changes in skul shape on CT films compared with those at discharge and presented with good stability. In addition, there were one case of mild limb paralysis, one case of mild language barriers, and one case of mild seizures, but al these cased were wel controled by drugs. These findings indicate that in situ replantation of partialy free bone fragments is suitable for depressed skul fractures in children.

Objective To explore the safety and feasibility of laparoscopic hepatectomy combined with radiofrequency ablation for primary liver cancer difficult to manage.Methods A retrospective study was conducted to analyze the clinical data of 16 patients who underwent laparoscopic hepatectomy combined with radiofrequency ablation in the Zhejiang Provincial People's Hospital from Apr 2015 to Dec 2017.Results 2 more tumors were found by intraoperative laparoscopic ultrasound.All patients underwent laparoscopic hepatectomy combined with radiofrequency ablation successfully.There were 2 laparoscopic left hepatectomy combined with radiofrequency ablation,2 laparoscopic right hepatectomy combined with radiofrequency ablation,6 laparoscopic left lateral lobectomy combined with radiofrequency ablation,4 laparoscopic right postrior lobectomy combined with radiofrequency ablation and 2 irregular laparoscopic hepatectomy combined with radiofrequency ablation.The intraoperative blood loss ranged from 100-800 ml.The average operative time was (283 ± 112) min.The length of postoperative hospital stay ranged from 5 to 12 days.The tumor-free survival rate after operation is 100％ (16/16) on 6 to 38 months follow up.Conclusion It is safe and feasible to carry out laparoscopic hepatectomy combined with radiofrequency ablation in difficult to manage primary liver cancer.

Objective To evaluate intraoperative ultrasound combined with near-infrared imaging in laparoscopic liver tumor resection.Methods 15 cases undergoing laparoscopic hepatectomy at our department from Ju12017 to Sep 2017 were enrolled in this study.We observed the volume of resected liver,ICG test,the ability of detected lesion overlooked by preoperative imaging,operation time,blood loss,hospital stay,postoperative complication,final pathological result,and tumor margin.Results We have done laparoscopic hepatectomy in 15 cases by intraoperative ultrasound and near-infrared imaging.There was no conversion to open surgery,blood loss was (220 ± 159) rnl,operation time was (136 ±6) min,hospital stay was (8.6 ± 2.1) d,tumor margin was (1.6 ± 1.1) cm,all were tumor negative.There was no major complications such as postoperative bleeding,nor perioperative death.There were pleuraleffusion in 3 cases and bile leakage in one,all were cured by drainage.Conclusion Intraoperative ultrasound combined with near-infrared imaging during the process of laparoscopic hepatectomy helps in assuring safe tumor margin and preserving normal liver parenchyma.

Objective : To investigate the effect of chemotherapeutic drug resistance induced by CLDN18⁃ARH⁃GAP26 fusion mutation gene in gastric cancer cells , and to investigate the sensitization effect of ginsenoside in the treatment of chemotherapeutic drug resistance caused by the expression of CLDN18⁃ARHGAP26 fusion mutation gene. Methods : The side population (SP) cells and non⁃side population ( NSP) cells of gastric cancer cell line BGC⁃823 were labeled with immunomagnetic bead antibody , and the lentiviral vector with overexpression of CLDN18⁃ARHGAP26 fusion mutation gene was selected for transfection with NSP cells. qPCR was used to detect the mRNA levels of CLDN18⁃ARHGAP26 fusion mutation and ATP Binding Cassette Subfamily G Member 2 (ABCG2) . The expression of EMT⁃related proteins E ⁃Cadherin and Vimentin was detected by Western blot. The sensitivity of transfected cells to oxaliplatin was detected by CCK⁃8. The effect of ginsenoside on drug resistance of transfected cells was detected by CCK ⁃ 8 . The expression of E ⁃ Cadherin and Vimentin in transfected cells was detected by Western blot after ginsenoside treatment. Results : qPCR detection showed that the expression of CLDN18⁃ARH⁃GAP26 fusion mutant gene in NSP cells transfected with overexpressed CLDN18⁃ARHGAP26 fusion mutant gene was significantly higher than that of the non⁃transfected group , and the expression of ABCG2 mRNA was significantly cells with over⁃expressed CLDN18⁃ARHGAP26 fusion mutation gene was lower than that in the non⁃transfected transfected cells to oxaliplatin was lower than that in the non⁃transfected group. The survival rate of transfected cells sion of E ⁃Cadherin protein in the transfected cells treated with ginsenoside was higher than that in the untreated group , and the expression of Vimentin protein was lower than that in the untreated group. Conclusion Ginsenoside can reverse cell EMT transformation and oxaliplatin resistance induced by CLDN18⁃ARHGAP26 fusion mutated gene expression in gastric cancer tissues.