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.

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 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.

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 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.

BACKGROUND:Severe abdominal infection after liver transplantation is the serious perioperative complications in liver transplant recipients, and it is one of the major reasons of death or loss of liver function. OBJECTIVE:To investigate the etiology, diagnosis and treatment of severe abdominal infection after orthotopic liver transplantation. METHODS:The clinical data of 186 cases of abdominal infection that received orthotopic liver transplantation between March 2004 and November 2011 were retrospectively analyzed. RESULTS AND CONCLUSION:Among the 186 patients, 16 patients had severe abdominal infection. Among the 16 patients, five patients had the infection due to the biliary anastomotic leakage caused large effusion in the gap under liver;10 patients had infection due to the peripheral liver massive hematocele caused by liver transplant surgery wounds extensive bleeding;one patient had injection due to left subphrenic large effusion caused by lower esophagus fistula after transplantation. Twelve patients had second operation within 3 days after diagnose, and there was no death;four patients had second operation after diagnosed for 3 days, one patient dead due to multiple organ failure at 21 days after liver transplantation and 5 days after second surgery. The results show that severe abdominal infection after liver transplantation is one of the serious perioperative complications in liver transplant recipients, and active recovery, multiple organ support and removal of infected lesions with control ing surgery as wel as the adequate drainage and other comprehensive treatment measures are the key points for the treatment of severe abdominal infection after liver transplantation.

Objective To explore the expression of PIWIL1 protein and DICER enzyme in hepa tocellular carcinoma (HCC) and their significance.Methods Immunohistochemical method was used to detect the expression of PIWIL1 and DICER in 47 cases of HCC and the adjacent HCC tissues.Western blot method was used to detect the expression of PIWIL1 and DICER in 31 cases of fresh HCC tissues and their adjacent HCC tissues.The relationship between PIWIL1 and DICER and their relationships were analysed with clinical features.12 cases of normal liver tissues were used as control group.Results The expression of PIWIL1 was high in HCC but low in normal liver tissues (P＜ 0.05).The expression of DICER was high in normal liver tissues but low in HCC (P＜0.05).The expression of PIWIL1 was positively correlated with invasion to adjacent tissues and histological differentiation (P＜0.05).The expression of DICER was negatively correlated with invasion to the adjacent tissues and histological differentiation (P＜0.05).There was a negative correlation between PIWIL1 and DICER (P＜ 0.05).Conclusions High expression of PIWIL1 and low/missing expression of DICER was related to pathological differentiation and invasion of adjacent tissues.

Objective To investigate the safety and short-term effect of anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver.Methods The clinical data of 1 patient with hepatolithiasis combined with liver atrophy-hypertrophy syndrome who was admitted to the Hunan Provincial People's Hospital in April 2014 were retrospectively analyzed.The stones were located in the left and right liver, the involved liver became fibroatrophy, and the hepatic caudate lobe not containing stones became hypertrophy.The body surface area of the patient was 1.65 m2 , standard total liver volume was 1 167.63 mL.According to the result of CT, expected residual liver volume after hepatectomy was 706.12 mL, and the ratio of residual liver volume over the standard total liver was 60.47％.The radio of residual liver volume over the body mass index was 1.21％.The patient received the second exploration of common bile ducts, hepatectomy with the caudate lobe as the sole remnant liver and T tube drainage.The follow-up including recurrence of calculus was performed by outpatient examination and telephone interview up to April 2015.Results The patient underwent caudate lobe as the sole remnant liver following anatomical hepatectomy successfully without blood transfusion.The operation time and volume of intraoperative blood loss were 380 minutes and 350 mL.The peritoneal drainage tube was removed at postoperative day 2 and the patient was discharged at postoperative day 8 with a good recovery of liver function.The postoperative pathological examination showed that there were focal biliary epithelial papillary hyperplasia combined with light-medium atypical hyperplasia and no canceration.The T tube cholangiography two month later showed that there were unobstructed lower bile duct and no residual intra-and extra-hepatic stones.The liver function was normal.Then T tube was removed and patient resumed normal life.During the 1-year follow-up, no chills and fever, jaundice and abdominal pain occurred, no calculus was detected by B-ultrasonography, and computed tomography reexamination showed that remnant liver volume was increased and no intra-and extra-hepatic bile duct stones were detected.Conclusion Anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver is safe and feasible, with a good curative effect.