Objective To evaluate the efficacy of fibercholedochoscopy for the removal of residual stones after a surgical choledochostomy. Methods Two hundred and twenty cases of cholelithiasis underwent fibercholedochoscopy through a surgically formed T tube fistulae for residual stones from Sept. 1993 to Feb. 2002. Results A total of 572 times of fibercholedochoscopy was performed with residual stones totally evacuated in 201 cases (91.4%). Complications developed in 84 cases with no mortality. Conclusion Postoperative fibercholedochoscopy through a T tube fistulae is less traumatic and effective remedy for postoperatively retained common bile duct stones.

Objective To evaluate the performance of peripheral blood T-SPOT.TB and cerebrospinal fluid (CSF) interferon (IFN)-γ detection in the diagnosis of tuberculous meningitis (TBM).Methods Among the 182 consecutive cases with suspected TBM in Huashan Hospital from March 2011 to March 2013,30 patients were included in the case group according to the latest diagnostic criteria of TBM.Thirty-nine patients diagnosed with non-tuberculous meningitis were included in the control group.T-SPOT.TB was employed to detect tuberculosis-specific IFN-γ-secreting T cells in the peripheral blood.And IFN-γ in CSF was detected simultaneously by enzyme-linked immunosorbent assay (ELISA) without antigen stimulation.The CSF was collected from 10 patients of TBM group after anti tuberculosis treatment for 4 weeks to observe the dynamic changes.The t-test was used for analysis of continuous variables with normal distribution and Kruskal-Wallis test was used for analysis of variables with abnormal distribution.Results ()f the 30 TBM cases,6 were confirmed cases and 24 were highly suspected cases.The control group was comprised of 12 viral encephalitis,16 suppurative meningitis and 11 cryptococcal meningitis.The positive rate of T-SPOT.TB was significantly higher in TBM group compared with control group (70％ vs 13％,x2 =12.15,P＜0.01).The mean concentration of CSF IFN γ of TBM group was 244.35 pg/mL,which was significantly higher than that of control group 9.48 pg/mL (Z=-4.646,P＜0.01).The CSF IFN-γ was significantly decreased after 4 weeks of treatment (271.02 pg/mL vs 81.36 pg/mL,Z=-3.099,P=0.002).The sensitivity and specificity of peripheral blood T-SPOT.TB in the diagnosis of TBM were 70％ and 87％,respectively.The area under the receiver operating characteristic (ROC) curve of CSF IFN-γ for TBM diagnosis was 0.819; the optimal cut-off point was 81.36 pg/mL; the corresponding sensitivity and specificity were 83 ％ and 85 ％,respectively.Conclusion Both the detection of peripheral blood T-SPOT.TB and CSF IFN-γ are of great importance for the diagnosis of TBM.Dynamic observation of CSF IFN-γ is important for disease monitoring.

The objective of this study is to investigate the effect of chemokine CXCR4 on the apoptosis of gastric cancer cells through IL-6/STAT3 signaling pathway and to explore the related mechanisms.Fluorescence quantitative PCR and Western blot were performed to detect the mRNA and protein expression levels of the chemokine CXCR4 in human gastric cancer tissues and adjacent non-cancerous tissues(PCT).Next,CXCR4 knockdown and overexpression were achieved by transfecting SGC7901 gastric cancer cell line with lentiviral vectors.TUNEL staining was used to evaluate the apoptosis of SGC7901 cells,while MTT assay was employed to measure cell proliferation.Western blot was conducted to determine the expression of apoptosis-related proteins Bax and Bcl2.Further,enzyme-linked immunosorbent assay(ELISA)was employed to measure the secretion levels of inflammatory cytokines.Real-time fluorescent quantitative PCR(RT-PCR)was utilized to quantify the expression of IL-6 mRNA in the IL-6/STAT3 signaling pathway,and Western blot was performed to analyze the expression of STAT3-Ser727 protein.In addition,after knocking down CXCR4 in SGC7901 cells,IL-6/STAT3 signaling pathway agonist lipopolysaccharide(LPS)was transfected,while in CXCR4-overexpressing SGC7901 cells,IL-6/STAT3 signaling pathway inhibitors angoline or bruceantinol were transfected.Then TUNEL staining was used to assess cell apoptosis,and Western blotting was performed to examine the expression levels of apoptosis-related proteins Bax and Bcl2 in these cells.Data showed that the expression of immune chemokine CXCR4 was increased in gastric cancer tissues,as compared with adjacent non-cancerous tissues.Single-cell gel electrophoresis analysis indicated that knockdown or overexpression of CXCR4 do not induce DNA damage in SGC7901 cells.TUNEL staining,MTT cell proliferation assay and Western blotting demonstrated that knockdown of CXCR4 in SGC7901 cells promoted the apoptosis in SGC7901 cells,while overexpression of CXCR4 inhibited the apoptosis.ELISA showed that knockdown of CXCR4 in SGC7901 cells promotes the expression of pro-inflammatory factors IL-1β and TNF-α,while inhibited the expression of anti-inflammatory factors IL-10 and TGF-β.Conversely,overexpression of CXCR4 demonstrated opposite effects.Finally,the activation of the IL-6/STAT3 signaling pathway significantly reduced the apoptosis induced by knocking down CXCR4 in iSGC7901 cells,whereas the inhibition of IL-6/STAT3 signaling pathway can significantly suppressed the induction of SGC7901 cells proliferation induced by CXCR4 overexpress.In conclusion,immunochemokine CXCR4 regulates gastric cancer cell apoptosis and inflammatory cytokines secretion through IL-6/STAT3 signaling pathway.