Objective To study the reasons of the conversion to laparotomy during laparoscopic cholecystectomy. Methods Correlative literatures were retrieved from 1994 to 1999, and were tabulated and critically appraised in terms of sample size, outcomes, and the causes of the conversion to laparotomy. Results In the 5260 cases of LCs, 169(3.21%) converted to laparotomy. The data examined revealed a bile duct injury in 22 cases (13%), bleeding in 25(14.8%), severe adhesion in 81(48%), acute choecystitis in 16(9.5%), bile leakage in 3 (1.8%), gastric cancer in 1(0.6%), carcinoma of gallbladder in 10(6%), distension of common bile duct and choledocholith in 4 (2.4%), fistula of gallbladder in 2 (1.2%), injury of stomach or bowel in 4(2.4%), unsatisfactory pneumoperitoneum in 1 (0.6%). Conclusions The major causes of the conversion to laparotomy during laparoscopic choecystectomy are severe adhesion, injury of bile duct and bleeding.

Objective To investigate the general conditions of the injury of blood vessels during laparoscopic cholecystectomy in China. Methods The cases of the injury of blood vessels complicated with laparoscopic cholecystectomy and its locations and reasons were reviewed according to articles published in the last years in CMCC. Results There were 86 cases (0.26%) of blood vessel injury in 33584 paitnets received laparoscopic cholecystectomy. The positions of bleeding included cystic artery (47), cholecyst bed (24), puncture port (6), hepatic vein(2), hepatic artery(1), and others places(6). 5 patients died of the bleeding Conclusions The injury of blood vessels complicated with laparoscopic cholecystectomy was considered as one fatal technical complication. It is one of the major causes of laparotomy and reoperation.

Objective To study the effect of PEI on disseminating HCC cells in the peripheral blood in patients with recurrent HCC. MethodsWe examined blood samples from 29 recurrent HCC patients by nested RT-PCR for the determination of AFP?mRNA before and 1, 2, 3 and 4 weeks after PEI.ResultsBefore PEI 14 (48%) patients out of the 29 cases with recurrent HCC were positive with AFP?mRNA. Four weeks after a course of PEI only 2 cases (7%) remained AFP?mRNA positive.ConclutionsPEI effectively eradicating disseminating HCC cells in the peripheral blood shows a favourable potential for the treatment of recurrent HCC.

Objective:To study the factors in primary liver carcinoma complicated with cholecystitis or cholecystolithiasis after hepatectomy. Methods: Clinical and follow-up data were analyzed in 400 patients. Results: Cholecystitis or cholecystolithiasis were found in 86 cases after hepatectomy (20.75%).Incidence of cholecystitis or cholecystolithiasis in patients complicated with hepatitis B, posthepatic cirrhosis, ascites and porta hepatis occlusion was higher than that in non-hepatitis B,non-posthepatic cirrhosis and ascites patients. There was no obvious difference in incidence between with blood transfusion or without and the length of porta hepatic occlusion. Conclusion: It is concluded that multiple factors participates in this process,including proneness to the disease before operation, mechanic reason,insufficient blood supply of gall bladder, etc .Depressed function of cholecyst constriction,cholestasis and changes of bile components may lead to the inflammation of cholecyst and the formation of gallstone.

Objective: To screen and identify oxaliplatin-resistance-associated proteins in CRC (colorectal cancer) cell lines using proteomics technologies in order to find new biomarkers for individual therapy of CRC. Methods: Oxaliplatin-resistant human CRC cell line HT-29/L-OHP (oxaliplatin) was established. The total proteins in HT-29 and HT-29/L-OHP cells were extracted. The differentially expressed proteins between HT-29 and HT-29/L-OHP cells were screened and identified using 2-DE (two-dimensional gel electrophoresis) and MALDI-TOF-MS (matrix assisted laser desorption-ionization time-of-flight tandem mass spectrometry). Some proteins obtained were validated by Western blotting. Results: The 2-DE maps of total proteins in HT-29 and HT-29/L-OHP cells were established. Of the 38 protein spots identified as differentially expressed proteins (over two-fold, P < 0.05) between HT-29 and HT-29/L-OHP cells, 37 protein spots were positively identified by MALDI-TOF-MS (17 proteins were up-regulated and 20 proteins were down-regulated as compared with the parental HT-29 cells). The result of Western blotting showed that the PCBP1 [poly (C)-binding protein-1] and TUBB2A (tubulin beta 2A ) proteins were up-regulated while ANXA3 (annexin A3) and STIP1 (stress-induced-phosphoprotein 1) proteins were down-regulated in HT-29/L-OHP cells. The result of Western blotting was consistent with that of proteomics. Conclusion: There were 37 oxaliplatin-resistance-associated proteins in CRC identified in this study which may provide useful evidence in further research on mechanism of oxaliplatin-resistance in CRC. Copyright © 2013 by TUMOR.

Objective To evaluate the efficacy and safety of endoscopic mucosal resection (EMR) for rectal carcinoid tumors. Methods From January 2006 to January 2009, EMR was performed in 28 patients with rectal carcinoids, who were followed up to evaluate the therapeutic effect and safety. Results Tumor diameters varied from 0.4 cm to 1. 2 cm (mean 0.7± 0. 2 cm). Negative resection margin was a-chieved in 26 cases (92. 9% ), tumor margin within 0. 1 cm of resection margin in 1 (7. 1% ) , and two margins coincided in 1 patient (7. 1% ). Hemostasis was performed with metal clips in 14 patients (50% ) and argon plasma coagulation (APC) in 9 (32. 1% ). Except for rectal bleeding in 1 patient (3. 6% ) , no other complications were observed. There was no recurrence in any patients during a follow-up of 6-36 months. Conclusion EMR is a useful and safe method for treatment of small rectal carcinoid tumor which does not cross submucosal layer.

Objective To investigate the effects of postoperative sleep deprivation on the expression of choline acetyltransferase (ChAT) in hippocampi of aged rats.Methods Forty-eight male Wistar rats,aged 20 months,weighing 500-600 g,were randomly divided into 4 groups (n =12 each) using a random number table:control group (group C) ; operation group (group O) ; sleep deprivation group (group S) ; postoperative sleep deprivation group (group OS).Sleep deprivation was induced in the rats by housing them on small platforms over water.They fell into the water if they lost muscle tone.All the rats had free access to food and water.In group OS,splenectomy was performed,and all the rats underwent 24 h sleep deprivation after the rats were awake.All the rats underwent 24 h sleep deprivation at the corresponding time point in group S.Morris water maze test was carried out at 24 h after operation.The number of ChAT positive cells in the hippocampal CA1 region was counted after completion of Morris water maze test.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,and the frequency of crossing the original platform and the number of ChAT positive cells in the hippocampal CA1 region were decreased after operation in O and OS groups,and no significant changes were found in the parameters mentioned above in group S.Compared with group O,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,the frequency of crossing the original platform was decreased,and there was no significant difference in the numberof ChAT positive cells in the hippocampal CA1 region in group OS,and no significant changes were found in the parameters mentioned above in group S.Compared with group S,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,and the frequency of crossing the original platform and the number of ChAT positive cells in the hippocampal CA1 region were decreased after operation in group OS.Conclusion The mechanism by which postoperative sleep deprivation induces cognitive decline is not related to the expression of ChAT in hippocampi of aged rats.

Objective To analyze the clinical efficacy of internal rib fixation combined with external chest fixation and mechanical ventilation for traumatic flail chest with pulmonary contusion.Methods Sixty cases of traumatic flail chest with pulmonary contusion treated from January 2011 to December 2014 were assigned to experimental group (30 cases) and control group (30 cases) according to the random number table.Patients in control group received thoracic external fixation combined with mechanical ventilation.In experimental group the patients received the same care but in addition they had rib fixation.The two groups were compared with regard to general condition, arterial blood gas as well as vital signs before treatment and 24 hours after treatment, lung function 3 months after discharge, complication rate and mortality.Results ICU stay [(6.8 ± 1.0) d], hospital stay [(15.0 ± 1.8) d] and duration of mechanical ventilation [(4.8 ± 1.0) d] in experimental group were significantly lower than these in control group [(13.6 ± 2.5) d, (21.4 ± 2.6) d, (10.3 ± 1.3) d, respectively] (P ＜ 0.01).After treatment for 24 hours in either group, the pH value, PaO2, oxygenation index and systolic pressure (SBP) were significantly increased, and partial pressure of carbon dioxide (PaCO2), heart rate (HR) and respiratory rate (RR) were significantly lowered as compared to these before treatment (P ＜0.05).After treatment for 24 hours, experimental group demonstrated significantly enhanced levels in pH value,PaO2, oxygenation index and SBP but lowered levels in PaCO2, HR and RR as compared to control group (P ＜ 0.05).Three months after discharge, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), 75％ forced expiratory flow (FEF75％) and total lung capacity (TLC) in experimental group were (81.7 ±2.6)％, (75.4 ±4.1)％, (83.2 ±4.6)％,(69.1 ±2.3)％, and (88.7 ±3.4)％ respectively, significantly higher than (69.0 ±3.6)％, (71.3 ± 3.9) ％, (78.9 ± 4.3) ％, (62.3 ± 3.3) ％, and (79.0 ± 4.6) ％ respectively in control group (P ＜0.01).In experimental group, there were four cases of pulmonary infection (13％), three pulmonary atelectasis(10％) and one intercostal neuralgia (3％).In control group, there were six cases of pulmonary infection (20％), five pulmonary atelectasis (17％), four intercostal neuralgia (13％) and four thoracocyllosis(13％)(P ＜0.05).There was no significant difference in mortality between the two groups.Conclusion Treatment effect of internal rib fixation for flail chest with pulmonary contusion is improved in combination with mechanical ventilation and external chest fixation.

Objective To study the effects of citrullinated vimentin (cVim) on the maturation and immunologic function of dendritic cells (DCs) from rheumatoid arthritis (RA) peripheral blood.Methods In the present study,mononuclear cells were isolated from the peripheral blood of patients with RA and cultivated in media containing GM-CSF and IL-4 to generate immature DCs (imDCs).The imDCs generated were stimulated with citrullinated vimentin and vimentin.LPS was used as the positive control and PBS was used as the negative control.The expression of surface molecules on the DCs,such as CD14,CD80,CD83,CD86,MHC Ⅰ and MHC Ⅱ were analyzed with FACS.The capability of the stimulatory activity of the DCs on allogeneic T cells in mixed reaction was tested by MTS.t-test was used for statistical analysis.Results Compared to untreated DCs,DCs treated with LPS increased the expression levels of MHC Ⅱ,CD80,CD83 and CD86 (1.07±0.14,1.25±0.13,1.90±1.08,2.44±0.65,P＜0.05),while cVim increased the expression levels of MHC Ⅱ ( 1.18±0.09,P＜0.05) and CD83 ( 1.97±0.99,P＜0.01 ),and Vim decreased the expression levels of CD80 (0.82±0.18,P＜0.01 ).It was demonstrated that the expression levels of MHC Ⅱ on DCs pulsed with cVim were significantly higher than that of the DCs with LPS,but the expression levels of CD80 and CD86 were not significantly different.The expression levels of MHC Ⅱ and CD83 on DCs pulsed with cVim were significantly higher than that of the DCs with Vim.The mixed lymphocyte reaction showed that the DCs induced by LPS and cVim trigerred the proli-feration of allogenic T cells obviously.Conclusion This result suggests that cVim could promote the phenotypic maturation of DCs and increase the expression of costimulatory molecules.

Objective The study was performed to analyze the diagnosis and treatment of blue rubber bleb nevus syndrome of Chinese patients by evaluating the researches in China.Methods Chinese Journal Full-text Database,Wangfang Data and Weipu Chinese Medical Journal Database were searched for the clinical data of the patients with blue rubber bled nevus syndrome.Results Among the 50 patients,31 cases were male,and 19 cases were female.All patients (100％) had the venous malformations of the skin.Thirty-five (70％) cases had melena,13 (26％) cases had bloody stool,and 35(70％) had dizziness and palpitation.Blue rubber bled nevus syndrome were diagnosed with gastroscopy (40/48,83.33 ％),coloscopy (30/41,73.17％) and small intestinal examination (23/25,92％).Fourteen cases received symptomatic treatment.Twelve cases received therapeutic endoscopy,which lesions were located in stomach and colon.Sixteen cases received operation,and 2 cases were treated by laparoscopy and endoscopy.Conclusions Blue rubber bleb nevus syndrome is a rare disease.The skin and gastrointestinal system are involved in all patients with blue rubber bleb nevus syndrome in China.The routine examination for diagnosis of blue rubber bleb nevus syndrome should include examination of the small intestine.It still needs further research about effective treatment of blue rubber bleb nevus syndrome.