Iatrogenic bile duct injuries (BDIs) and subsequent benign biliary stricture is a medical catastrophe which is associated with significant perioperative morbidity and mortality,reduced long-term survival rate and poor quality of life.For most major BDIs (Strasberg classification E1-E4),the recommended method of repair is hepaticojejunostomy (HJ).We conducted a retrospective review aiming to examine the surgical technique of high HJ at our institution.This review highlights 4 aspects in the operation which include the hepatoduodenal ligament exposure,hepatic artery and its branches protection,exposing the intrahepatic bile duct above the stricture plane,and HJ techniques.Overall,the optimal long-term result of surgical management depends on the availability of experienced hepatobiliary surgeons and a considerable large HJ anastomosis above the stricture.

Hilar cholangiocarcinoma remains a formi-dable challenge to hepatopancreatobiliary surgeons since the reported resection of a primary cancer originating at the hepatic duct confluence by Brown and Myers in 1954. Emerging evidence has indicated that aggressive surgery with a curative resection offers a better option for long-term survival compared with conservative therapy. Liver transplantation has also been considered as a management opportunity for the treatment of cholangiocarcinoma. However, the survival rate has been poor due to the high proportion of disease recurrence. This review highlights recent techniques in hilar cholangiocarcinoma resec-tion, with special attention to the management of the resection margin, clinical skills of liver resection, lymph node clearance, and portal vein or hepatic artery resection or reconstruction. In addition, technical advances have been proposed in hepatopan-creatoduodenectomy and liver transplantation for hilar cholangio-carcinoma treatment. In the current hepatic procedures, promis-ing survival outcomes have been obtained in patients with hilar cholangiocarcinoma, exhibiting a decreased operative mortality and a steady improvement in long-term survival. Overall, the correct clinical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholan-giocarcinoma.

BACKGROUND:It has been a hotspot in the treatment of spinal fracture by minimaly invasive approach.Compare with open operation,minimaly invasive surgery has less trauma,less bleeding,less tissue damage and shorter hospital stay.But no clinical study focuses on the reduction effect of minimaly invasive percutaneous screw fixation and maintenance of vertebral height.OBJECTIVE:To compare the difference of minimaly invasive percutaneous screw combined with articular process bone grafting and simple screw fixation in the treatment of thoracolumbar fracture on maintaining vertebral height.METHODS:Clinical data of 79 patients with T11-L2 thoracolumbar fractures (AO type: A1,A2,A3,B1) wereretrospectively analyzed.Among them,41 cases were treated by percutaneous pedicle screw fixation combined with articular process bone grafting,while 38 cases were treated by percutaneous pedicle screw fixation,from January 2010 to September 2013.Perioperative indicators in the two groups,visual analogue scale scores,and Oswestry Disability Index before and after surgery,as wel as at final folow-up were compared between the two groups.The anterior and posterior of vertebral height,the recovery of Cobb's angle were evaluated.RESULTS AND CONCLUSION:The patients in the grafting group were folowed up for 4-36 months and those in the non-grafting group were folowed up for 5-30 months,there was no significant difference in the folow-up time between the two groups (P=0.25).The operation time,intraoperative blood loss,postoperative ambulation time and hospital stay showed no significant difference between the two groups (P＞0.05).The folow-up results showed that,no significant difference was found in visual analogue scale scores and Oswestry Disability Index between the two groups (P＞0.05).However,the anterior and posterior of vertebral height,the recovery of Cobb's angle in the grafting group were significantly better than that in the non-grafting group (P＜ 0.05).The short-term efficacy and security are similar between the two surgery methods in the treatment of thoracolumbar fracture.However,minimaly invasive percutaneous screw combined with articular process bone grafting shows great advantages in recovering and maintaining the long-term stability.

Objective To construct recombinant retroviral vector containing human hepatocellular carcinoma-related gene ANGPTL4 ( angiopoietin-like 4) cDNA and to evaluate antitumor effect of recombinant retroviral vector-mediated human ANGPTL4 gene transfer. Methods ANGPTL4 cDNA was cloned in vitro from human liver cell lines HL-7702 and subcloned into plasmid vector pMSCV and sequenced. High-tiler recombinant retrovirus pMSCV-ANGPTLA and blank retrovirus pMSCV packaged under mediation of lipofectamine infected HepG2 cells in vitro, respectively. Flow cytometry and fluorescence microscopy detected expression of GFP (green fluorescence protein) in HepG2 cells. The expression of ANGPTL4 mRNA in HepG2 cells was determined. Results Recombinant retroviral vector pMSCV-ANGPTL4 was constructed successfully. Titer of recombinant retrovirus pMSCV-ANGPTL4 packaged is 1. 4 ? 106 infective viral grains /ml. Titer of blank retrovirus pMSCV packaged was 1. 5 ? 106 infective viral grains /ml. Positive cell rate of HepG2-ANGPTL4 cells group expressing GFP was 68.45% , and average intensity of fluorescence of HepG2-ANGPTL4 cells group was 31.67 -fold as that of HepG2 cells group. Positive cell rate of HepG2-pMSCV cells group expressing GFP was 77.72%, and average intensity of fluorescence of HepG2-pMSCV cells group was 64. 87 -fold as that of HepG2 cells group. The expression of ANGPTL4 mRNA in HepG2-ANGPTL4 cells group was higher than that in HepG2-pMSCV cells group (154%) and HepG2 cells group( 161%). The proliferation rate of HepG2-ANGPTL4 cells group in vitro was lower than HepG2-pMSCV cells group and HepG2 cells group (P

OBJECTIVE: This experiment aims to determine the diagnostic value of diffusion-weighted imaging (DWI) in the differentiation of axillary inflammatory lymph nodes from metastatic lymph nodes in rabbit models in comparison with conventional magnetic resonance imaging (MRI). MATERIALS AND METHODS: Conventional MRI and DWI were performed at 4 weeks after successful inoculation into the forty female New Zealand white rabbits' mammary glands. The size-based and signal-intensity-based criteria and the relative apparent diffusion coefficient (rADC) value were compared between the axillary inflammatory lymph nodes and metastatic lymph nodes, with histopathological findings as the reference standard. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the aforementioned criteria and rADC value in differentiating the axillary inflammatory lymph nodes from metastatic lymph nodes. RESULTS: Thirty-two axillary inflammatory lymph nodes and 46 metastatic ones were successfully isolated and taken into pathological analysis. The differences of the aforementioned criteria between the two groups were not statistically significant (p > 0.05). However, the rADC value of the inflammatory lymph nodes (0.9 +/- 0.14) was higher than that of metastatic ones (0.7 +/- 0.18), with significant difference (p = 0.016). When the rADC value was chosen as 0.80, the area under the ROC curve is greater than all other criteria, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for differentiating two groups were 86.2%, 79.3%, 81.2%, 84.2%, and 85.6%, respectively. CONCLUSION: Diffusion-weighted imaging is a promising new technique for differentiating axillary inflammatory lymph nodes from metastatic lymph nodes. Compared with routine magnetic resonance sequences, DWI could provide more useful physiological and functional information for diagnosis.
Animals ; Axilla ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Female ; Inflammation/pathology ; Lymphatic Metastasis/*pathology ; Magnetic Resonance Imaging/*methods ; Mammary Neoplasms, Experimental/*pathology ; ROC Curve ; Rabbits ; Sensitivity and Specificity

Objective To evaluate concomitant anatomical hepatectomy and inferior vena cava (IVC) reconstruction for hepatic cancer. Methods Between Aug 2004 and Jul 2005, three patients with intrahepatic cholangiocarcinoma and two patients with hepatocellular carcinoma suspected to invade the wall of IVC underwent concomitant hepatectomy, IVC resection and reconstruction under portal triad clamping (PTC), total vascular exclusion(HVE) without venovenous bypass. The retrohepatic IVC was repaired by primary suture (n = 2), a Gore-Tex patch (n = 1), and a ringed ePTFE graft ( n = 1). Results Surgery was successful in all cases without operative death. The mean operative time was 345 min (range 300 ~ 450 min) ,and the mean intraoperative blood loss was 1375 ml (range 1200 ~ 1800 ml). The cumulated mean PTC and HVE times were 19 min and 21.2 min respectively. Postoperative complications included pleural effusion in one needing thoracentesis, bile leakage and ascites in one each. During the follow-up, one patient died at 9 months due to recurrence, and the remaining 4 patients were alive at the follow-up of 4 to 15 months. Conclusions Concomitant hepatectomy with IVC resection offers hope for patients with hepatic tumors involving the IVC, who would otherwise have a dismal prognosis.

AIM: To investigate the levels of mRNA, protein of glucosylceramide synthase (GCS) and caspase 3 in the drug resistance induced by doxorubicin in human gallbladder carcinoma cell line GBC-SD, the effect of ceramide metabolism in this process was examined. METHODS: Human gallbladder carcinoma cell line GBC-SD was treated by doxorubicin at concentration of 200 ?g/L for 12 weeks (named GBC-SD12). Cytotoxicity, mRNA and protein of GCS were measured on 1st week, 4th week and 12th week by MTT assays, RT-PCR or Western blotting. The levels of caspase 3 were measured by spectrofluorometry. RESULTS: A 3.8-fold increase in drug resistance to doxorubicin in GBC-SD12 was observed. Up-regulation of GCS mRNA and protein were also detected in GBC-SD12 (P

Objective:To evaluate the relationship between preoperative estimated glomerular filtration rate (eGFR) and postoperative delirium (POD) in the patients.Methods:Six hundred and twenty-five patients, aged ≥60 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅱ, scheduled for elective total knee and hip arthroplasty under combined spinal-epidural anesthesia, were included. Peripheral blood samples were collected before surgery, and serum creatinine levels were measured by the sarcosine oxidase method, and eGFR was calculated using the MDRD equation. After successful spinal-epidural puncture, cerebrospinal fluid 2 ml was collected for determination of β-amyloid 42 (Aβ42), total tau protein (T-tau) and phosphorylated tau protein (P-tau) by enzyme-linked immunosorbent assay. The patients were divided into POD group and non-POD group (NPOD group) according to the occurrence of POD. The logistic regression analysis was used to identify the risk factors for POD, and the mediating effect of CSF biomarkers was analyzed. The receiver operating characteristic (ROC) curve was drawn to evaluate the accuracy of eGFR and biomarkers in predicting POD.Results:A total of 514 patients were finally enrolled in this study, and the incidence of POD was 16.7%. The logistic regression analysis showed that decreased eGFR and increased levels of P-tau and T-tau in CSF were risk factors for POD, while increased CSF Aβ42 level, Aβ42/P-tau ratio and Aβ42/T-tau ratio were protective factors for POD after adjusting for multiple confounding variables ( P<0.05). Analysis of mediating effet: The direct effect of eGFR on POD was -0.0 005 267, the total effect was 0.0 046 446, T-tau had a partly mediating role and the mediating effect accounted for 11.3% of the total effect. The area under the ROC curve of eGFR and CSF biomarker in predicting POD was 0.812( P<0.001). Conclusions:Preoperative decrease in eGFR is a risk factor for POD, and T-tau in CSF serves as a key mediator in the relationship between eGFR and POD.

Objective To investigate the awareness status of iodine deficiency disorders (IDD) prevention and treatment knowledge of target population in Hubei Province, and to evaluate the intervention effect of IDD health education. Methods From 2013 to 2016, 13 counties (cities and districts) were selected as project counties in Hubei Province each year and 7 counties (cities and districts) were selected each year in 2017-2018. Three townships (towns) were chosen in each project county, and the health education activities were carried out among the grade 4-6 students in the central primary school of each township (town). Three administrative villages were selected in each township (town) to carry out community health education activities. Before and after the implementation of health education, 30 students in a fifth grade class from each central elementary school, and 15 housewives around the school were selected to conduct a questionnaire survey on IDD prevention and control knowledge. Results Totally 5 940 elementary school students and 2,970 housewives were investigated from 2013-2018. After carrying out IDD health education activities, the awareness rates of IDD prevention knowledge among primary school students and housewives were 94.28% (16 801/17 820) and 93.20% (8 304/8 910), respectively, which increased significantly compared with those before the health education intervention [71.60% (12 759/17 820) and 70.93% (6 320/8 910), respectively]. The differences were statistically significant (χ²=3,239.83, 1,500.78，P<0.01). Among the primary school students and housewives, the knowledge awareness rates of IDD prevention and treatment were increased by 22.68% and 22.27%, respectively. Conclusion Health education intervention could significantly increase the awareness of IDD among primary school students and housewives, and it is an important measure to maintain IDD elimination status.

【Objective】 To investigate the early clinical efficacy of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability. 【Methods】 We made a retrospective analysis of 22 cases of lumbar degenerative diseases with lumbar instability treated by full endoscopic lumbar interbody fusion in Department of Orthopedics， Tangdu Hospital of Air Force Military Medical University from January 2019 to June 2020. The operation time， intraoperative bleeding volume， and hospital stay were recorded. The Visual Analogue Scale （VAS） for lower back pain and leg pain and Oswestry disability index （ODI） were compared before operation， 1 week， 1 month， 3 months， 6 months and at the last follow-up after operation. Modified MacNab was used to evaluate the clinical efficacy at the last follow-up. 【Results】 Operations on the 22 patients were all completed successfully. The average operation time was （206.59±5.69） min （with the range of 180-240 min）； the average volume of intraoperative bleeding was （92.73±22.29） mL （with the range of 50-120 mL）； the average hospitalization time was （8.82±1.53） d （with the range of 7-13 d）. All the patients were followed up for an average of （10.95±3.34） months （with the range of 6-18 months）. The VAS score and ODI at each time point after surgery were significantly decreased compared with those before operation （P<0.05）. The modified MacNab used to evaluate the clinical efficacy at the last follow-up showed that the total excellent and good rate was 90.91%， including 17 cases of excellence， 3 cases of good， and 2 cases of fair. 【Conclusion】 The early clinical effect of full endoscopic lumbar interbody fusion in the treatment of lumbar degenerative diseases with lumbar instability is satisfactory.