Objective To explore a convenient and safety way for surgical treatment of juxtra-papillary duodenal diverticulum.Methods A total of eighteen patients with juxtra-papillary duodenal diverticulum admitted to Hunan Provincial People's Hospital from May 2011 to May 2013 were involved in this study for retrospective analysis.Results Most of patients were old people and the average age was (55.5 ± 11.2) years in this group.All 18 patients accepted diverticulectomy without operation-mortality.No postoperative complications such as bleeding,duodenal fistula,biliary fistula and traumatic pancreatitis were happened.The average operation time was (2.5 ±0.6) hours.The average blood loss was (35.1 ± 14.2)ml.A total of 16 patients had been accepted follow-up survey.Mean length of follow-up was (10.5 ±2.0)months.Good result rate was 100％.Conclusions Do-not-open the duodenum diverticulectomy is the ideal surgical treatment of juxtra-papillary duodenal diverticulum.

Objective To study the experience on a variety of hepatectomy by occluding the branches of hepatic artery and portal vein to the liver lobe,segment at hilar H fissure.Methods A total of three hun-dred and ninteen patients accepted hepatectomy in Hunan provincial people's hospital from Decemember 2006 to Decemember 2007 were involved in this study for retrospective analysis.Results There were no perioperative deaths and liver function failure in this series of patients.The average amount of blood loss was 70 15ml,and 302 (95 %)cases did not receive transfusion.Postoperative complications such as liver necro-sis,bile leaking,bleeding were not found.Subphrenic abscesses were found in 3 cases,which were cured conservatively.Conclusion Selective regional occlusion of hepatic blood flow during bepatectomy avoided the risk of ischemia-reflow injury of remnant liver,which is safe and effective to prevent massive bleeding and to reduce the incidence of liver failure.

Objective To study the surgical treatment of pancreatolithiasis.Methods The clinical data of thirty-seven patients with pancreatolithiasis admitted to our hospital from 1994 to 2007 were reviewed.Results According to the results of imaging examination (BUS,CT,ERCP) and finding during surgery, pancreatolithiasis was classified into three types: TypeⅠ,the stones were mainly located in the head of pancreas, and Whipple procedure was the treatment of choice. TypeⅡ, the stones were mainly located in the body and tail of pancreas, and resection of the tail of pancreas alone or combined with splenectomy was the management of choice. TypeⅢ, the stones were diffusely scattered in the main duct from the head to tail of pancreas, and pancreatoduodenectomy,together with pancreatolithotomy and pancreatojejunostomy with wide anastomotic stoma was the choice of management. There was no mortality in this series. Within 2 weeks after treatment, symptoms ameliorated to different degrees in all the patients. Thirty one patients were followed up for 6 to 72 months, the results were satisfactory.Conclusions The individualized strategy, based on the type of stone location, is of great importance in the management of pancreatolithiasis. The key of surgical treatment of pancreatolithiasis is as follows: removal of pancreatoliths, excision of diseased pancreas, and adequate pancreatic drainage.

Stage 4 of chronic kidney disease ( stage 4 CKD ) is induced by insufficiency of spleen and kidney , disorder of qi activity, poor circulation of blood and body fluid metabolic disorders. It is a disease due to the internal generation of dampness , turbid , stasis and toxin . Clinical observation has already demonstrated that in-sufficiency of spleen and kidney is the key pathogenesis and characteristics in stage 4 CKD . In this article , the necessity of regulating and nourishing spleen and kidney on stage 4 CKD was discussed from two aspects , which were the disease characteristics and the connotation of regulating and nourishing spleen and kidney . It provided brief and essential syndrome differentiation and treatment strategies in the clinical treatment of stage 4 CKD .

Chronic renal failure ( CRF ) , which is a progressive disease , is difficult to be reversed after the pathological damage was formed . Hence , a variety of integrated and complementary therapies should be used for the lifelong treatment and regulation . This article suggested that therapeutic methods should be given ac-cording to different stages of CRF in its development . Chinese medicine comprehensive therapy should be given to the early and middle stage chronic renal failure patients in order to delay the disease progression . In the uremia stage , replacement therapy should also be used as the basic treatment in order to reduce the general complications of dialysis or a kidney transplant , thereby improving the quality of life of patients . The integra-tion of Chinese medicine therapy on CRF are from three aspects , which are Chinese medicine decoction based on syndrome differentiation , Chinese medicine external therapy and Chinese medicine featured CRF management in order to receive better therapeutic effects .

Malignant tumors are highly heterogeneous in terms of molecular phenotypes such that personalized therapy will be-come the standard for tumor therapy. Molecular classifications of cancer based on differences in biological behavior are important for selecting treatment strategies and prognostication. The unique optical and chemical properties of quantum dots have been widely used in biomedical applications such as tumor diagnosis, monitoring, pathogenesis, treatment, molecular pathology, and heterogeneity based on biological markers. In this study, we discuss the application of quantum dot-based nanotechnology and the molecular classification of cancer in personalized oncology.

Objective To investigate the relationship between cathepsin L and apoptosis cell in rats after cerebral ischemia reperfusion.Methods Sixty healthy male Sprague-Dawley Rats (10-12 weeks old,260-300 g) were chosen.Based on the random number table method,the rats were randomly divided into sham-operated control group (Sham group,n =10),ischemia-reperfusion group (model group,n =25),and Z-FY-DMK intervention group (CLI group,n =25).Rats were randomly divided into 6 h,12 h,24 h,and 48 h four subgroups in model group and CLI group,respectively.Modified transient middle cerebral artery occlusion was made as Longa described,the intervention groups were injected intracerebroventricularly Z-FY-DMK (20 μg / 1μ1 ×5 μl) preoperative 30 min prior to surgery,Sham group and schemia reperfusion injury (IRI) group were injected intracerebroventricularly dimethyl sulfoxide (DMSO) 5 μ1 (10ml/L) at the same time.Cell apoptosis was detected by terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) straining.Western blotting was used to detect the expression of cathepsin L and caspase-3.Results In the cortical area of ischemic brain,apoptosis cells of sham operation group were rare,while apoptosis of nerve cells of model group with 6 hours reperfusion were visible,and were gradually increased in the order of 12 hours,24 hours and 48 hours.At the same time point,the apoptosis cells of CL intervention group (6 h,12 h,24 h,48 h) were obviously less than model group (P ＜0.05).Western blotting found little visible cathepsin L protein expression in ischemic cerebral cortex preoptic in the sham group.For model group,the cathepsin L expression initially increased in sub groups with 6 hours reperfusion,reached to a peak in sub groups with 12 hours and 24 hours,and remained a high level in sub groups with 48 hours reperfusion.Compared to model group,the cathepsin L expressions of CL intervention group were obviously decreased at all time points (P ＜ O.05).Conclusions Cathepsin L may be involved in neuronal apoptosis by means of caspases 3 pathway.

Objective To compare the efficacies of anatomic and nonanatomic mesohepatectomy for central type hepatocellular carcinoma.Methods The clinical data of 85 patients with central type hepatocellular carcinoma undergoing hepatectomies were retrospectively analysed.36 patients underwent anatomic mesohepatectomy and the other 49 patients did nonanatomic mesohepatectomy.The operative time,intraoperative blood loss,incidence of postoperative complications,postoperative drainage volume,time to flatus and length of postoperative stay between the two groups were compared.Results There were no significant differences in the general condition,organ function,tumor size and location between the two groups before operation (P ＞ 0.05).The intraoperative blood loss,incidence of postoperative complications,drainage volume were significantly less but the operative time longer in anatomic mesohepatectomy group than nonanatomic hepatectomy group (P ＜ 0.05).No differences between the two groups were found in regard to the time for flatus and length of postoperative hospital stay (P ＞ 0.05).Tumor recurrence developed in 7 cases in group A and 20 cases in group B (P ＜ 0.05).Conclusions Anatomic mesohepatectomy has the advantages of less surgical trauma,less exudation and complications in patients with central type hepatocellular carcinoma.

Objective To summarize the experience in surgical management of bile duct injury. Methods The clinical data of 683 patients with bile duct injury who were admitted to the Hunan People's Hospital from August 1990 to December 2008 were retrospectively analyzed. Of all the patients, seven received hepatectomy +T tube drainage, two received liver repair + T tube drainage, four received external biliary drainage + hepatectomy,27 received liver repair or hepatectomy + silicone support, 233 received temporary portal triad clamping + gelatin sponge hemostasis, 72 received biliary repair + T tube drainage, 248 received hepatobiliary basin Roux-en-Y anastomosis, 22 received external biliary drainage, 61 received long arm T tube drainage, two received pancreaticoduodenectomy and five received hepatectomy + T tube drainage. The surgical outcomes were evaluated by analyzing the results of the follow-up. Results The surgical outcomes were ranked excellent, good and poor according to the condition of patients and the results of imaging examination. Six hundred and twelve patients were followed up for 8 months to 19 years, and the surgical outcomes were excellent in 337 patients (55.1%), good in 214 patients (35.0%) and poor in 61 patients ( 10.0% ). Conclusion The surgical outcome of bile duct injury could be satisfactory if the approach of the surgery is properly selected.

Objective To summarize the experience in operation manner and surgical technique of refractory cholelithiasis.Methods A total of five hundred and twenty one patients with refractory cholelithiasis admitted to Hunan Provincial People's Hospital from Jan.1990 to Dec.2007 were involved in this study for retrospective analysis.Results All patients in this group accepted surgery.Apart from three cases of perioperative death with liver and kidney failure,the remaining five hundred and eighteen cases had no serious complications,were cured and discharged.The imaging examination showed residual stone in seventy cases,accounting for fifteen percent.Four hundred and twenty one patients were followed up.The mean time of follow-up was seven years and six months (range 5 months - 17 years).Good result rate was 90.1%(381/423).Conclusions Most intractable cholelithiasis can be cured radically.Individual surgery programme,fine and standard surgical procedure are the key to treatment effect.