Objective To study the expression of CCR4 in gallbladder carcinoma tissues,and to determine its relationship with clinical pathological factors and its influence on prognosis of gallbladder cancer.Methods The expressions of CCR4 in gallbladder carcinoma tissues,and chronic cholecystitis gallbladder mucosal tissues were detected using immune histochemical methods and they were analyzed together with the clinical records.Survival analysis was used to compare the expressions of CCR4 between the positive group and the negative group.Multiple factors analysis was carried out using the Cox regression model.Correlation between the expressions of CCR4 in gallbladder tissues and the clinical pathologic factors was done using the Chi-square test.Results CCR4 is expressed tan-yellow in gallbladder cell cytoplasm and/or cell membrane.The expression of CCR4 protein in the gallbladder carcinoma was obviously higher than in the chronic cholecystitis gallbladder epithelial tissues (P ＜ 0.05).A high expression of CCR4 was not correlated with patients' age,gender,pathological classification,distant metastasis and nerve/lymphatic invasion factors.It was,however correlated with tumor lymph node metastasis (P ＜ 0.05) and histological grading (P ＜ 0.05).Kaplan Meier survival analysis showed the postoperative survival between the CCR4 positive group and the negative group were significant different (P ＜0.05).On multiple factors analysis,CCR4 expression level was an independent risk factor of survival of patients after gallbladder surgery.Conclusions The chemokine receptor CCR4 expressed in gallbladder carcinoma.Its level of expression correlated with lymph node metastasis and histological grading.It was an independent risk factor of survival in patients with gallbladder carcinoma after surgery.As it was associated with invasion and metastasis of gallbladder carcinoma,antitumor treatment targeting CCR4 is expected to become a novel treatment of gallbladder carcinoma.

Objective To discuss features of laparosco pi c cholecystectomy (LC) in children. Methods A total of 54 chi ldren underwent LC from October 1992 to December 2003. The operations were carri ed out after the creation of a CO2 pneumoperitoneum at the flow rate

Objective To discuss how to improve judgement and technique for avoiding bile duct injury during laparoscopic cholecystectomy(LC).Methods The clinical data of 39 860 patients treated by LC between October 1992 and October 2005 were analyzed retrospectively.Bile duct injury occured in 46 patients.Results Bile duct repair and T-tube drainage was performed in 26 patients and bile duct end-to-end anastomosis and T-tube drainage was performed in 4 patients,with the T-tube indwelling time for 3~12 months.The Roux-en-Y cholangiojejunostomy was conducted in 11 patients,the ligation of accessory hepatic duct was conducted in 5 pauients,the re-operation for bile duct stenosis in 4 patients,and the re-operation for stenosis after cholangiojejunostomy,in 2 patients.Conclusions Intensive anatomic knowledge and skillful surgical performance can avoid or minimize the incidence of bile duct injury.Early detection and active repair of the bile duct injury for preventing acute inflammation is the most important measure to avoid repeated operations.

Objective To explore the management of unsuspected gallbladder carcinoma (UGC) discovered during laparoscopic cholecystectomy (LC). Methods From January 2000 to May 2007, 15 560 cases of LC were performed in our hospital, UGC was discovered in 28 of the cases. Clinical data of the 28 patients were analyzed retrospectively. Results Among the 28 cases of UGC, 12 were discovered intraoperatively, and 16 were diagnosed postoperatively.Radical cholecystectomy was performed on the 12 cases who were detected during the operation,and 5 of the 16 patients who were diagnosed after the operation.LC was carried out in the remaining 11 cases. Postoperative pathological examination showed TNM stageⅠin 3 cases, stageⅡin 23, and stage Ⅲ in 2. The patients were followed up for 7-66 months with a mean of 22 months. During the period, 19 patients died. The 1-, 3-, and 5-year survival rate of the 17 patients who received radical cholecystectomy were 76.5% (13/17), 23.5% (4/17), and 11.8% (2/17), respectively. Whereas, in the 11 patients who underwent LC, the 1-year survival rate was 45.4%; moreover, none of the 11 survived for more than 2 years. Conclusions For high-risk population, attention should be paid to UGC during operation. Most of the UGCs discovered during LC are early-stage carcinomas, which should be treated with standard radical cholecystectomy, but not LC.

Objective To discuss the remedy and clinical effect of traumatic splentic rupture.Methods Clinical data of 32 cases of traumatic splentic rupture were retrospective analyzed.Results No dead cases,6 cases were cured by conservative treatment,18 cases were explored by laparoscope,and 14 cases remained spleen,4 cases were converted to traditionary splenectomy.Traditionary splenectomy was done on 8 cases directly.Conclusions Ⅰ,Ⅱ grade of traumatic splentic rupture may choose conservation treatment or remain spleen by laparoscope operation.Splenectomy should be done on Ⅲ,Ⅳ grade of traumatic splentic rupture in time.

Objective To investigate the operative indications for polypoid lesions of gallbladder(PLG) and avoid cholecystectomy for PLG without operation signs.Methods Retrospective analysis of 828 cases of PLG confirmed by pathologic examination was made.Results (1)Cancer should be suspected when a patient is older than 50 years or has a polypoid lesion larger than 1.0 cm.(2)The cholecystectomies for PLG accounted for 2.7%-7.1%of all cholecystectomies in the corresponding period,and cholesterol polyps accounted for 86.11%of all PLG,and carcinoma of gallbladder accounted for 1.92%of all PLG.Conclusion At present most of PLG accepting cholecystectomy are cholesterol polyps,so the high-risk factors of the neoplastic polyps and the operative indications for PLG should be considered deliberately.

Purpose To investigate the effects of chemotactic factor CCR4 on the abi1ity of pro1iferation,ce11 cyc1e,invasion,and mi-gration of human ga11b1adder cancer ce11. Methods Western b1ot was used to detect the expression 1eve1 of CCR4 in ga11b1adder carci-noma ce11s. Ga11b1adder carcinoma ce11s was infected by means of s1ow virus,the CCR4 gene si1encing was conducted using siRNA-CCR4 interference techno1ogy. Ga11b1adder carcinoma ce11s GBC-SD were divided into three groups( GBC-SD,GBC-SD/CCR4-RNAi and GBC-SD/contro1). CCL17,a 1igand of CCR4,was used to act on these three groups of ce11s. CCK8 method was used to detect the ce11 pro1iferation abi1ity of three groups. F1ow cytometry was used to test ce11 cyc1e. Tanswe11 assay was app1ied to detect ce11 migration and invasion abi1ity. Western b1ot was performed to detect the expression of its corresponding 1igands CCL17 and CCL22 proteins. Re-sults CCR4 gene si1ence did not inf1uence ce11 cyc1e and pro1iferation of ga11b1adder ce11 GBC-SD,but can significant1y inhibit GBC-SD ce11 invasion and movement abi1ity,CCR4 gene si1ence had no inf1uence on the expression of CCL17 and CCL22 gene in tumor ce11s. Conclusion Ga11b1adder carcinoma ce11s GBC-SD express chemokine receptor CCR4,chemokine receptor CCR4 can promote the invasion and metastasis of GBC-SD ce11s.

Objective:To investigate the role of LncRNA-TUG1 in the injury of intestinal epithelial cells induced by lipopolysaccharide (LPS).Methods:LPS was used to treat HIEC-6 human intestinal epithelial cells for 24 h to construct a sepsis injury model. Whole transcriptome RNA sequencing was used to analyze the expression changes of mRNA, microRNA and lncRNA in HIEC-6 cells after LPS treatment. Real-time fluorescence quantitative (qRT-PCR) and Western blot was performed to detect the expression changes of lncRNA-TUG1, microRNA-132-3p (miR-132-3p), SIRT1 mRNA and SIRT1 protein in HIEC-6 cells after LPS treatment. The expression levels of LncRNA-TUG1, miR-132-3p and SIRT1 were artificially changed by in vitro transfection. qRT-PCR and Western blot were used to confirm the regulatory effect of lncRNA-TUG1 on microRNA-132-3p and SIRT1. CCK-8 and flow cytometry were used to analyze the effects of LncRNA-TUG1, miR-132-3p and SIRT1 on the proliferation and apoptosis of HIEC-6 cells. The dual luciferase report analysis was used to verify the targeting relationship between LncRNA-TUG1, miR-132-3p and SIRT1. Statistical analysis was performed using SPSS 17.0, and differences between the two groups were compared using independent sample t test. Results:RNA sequencing results showed that the expressions of lncRNA-TUG1 and SIRT1 were decreased in HIEC-6 cells after LPS treatment ( t=3.26, P<0.05 and t=2.55, P<0.05), but the expression of miR-132-3p was increased ( t=4.12, P<0.05). In vitro cell experiments, the expression of lncRNA-TUG1 and SIRT1 were decreased in HIEC-6 cells treated with LPS ( t=5.69, P<0.05 and t=5.712, P<0.05), while the expression of miR-132-3p was increased ( t=3.88, P<0.05). Overexpression of lncRNA-TUG1 increased the proliferation rate ( t=6.55, P<0.05) and decreased the apoptosis rate ( t=3.94, P<0.05) of LPS-treated cells. Upregulation of lncRNA-TUG1 decreased the expression of miR-132-3p ( t=4.66, P<0.05), and increased the mRNA and protein levels of SIRT1 ( t=3.91, P<0.05). Transfection of miR-132-3P mimic could inhibit the mRNA ( t=4.08, P<0.05) and protein levels of SIRT1. In LPS-treated cells, the cells co-transfected with miR-132-3pmimic and siRNA-SIRT1 had a lower proliferation rate ( t=4.55, P<0.05 and t=5.67, P<0.05) and a higher apoptosis rate ( t=3.90, P<0.05 and t=4.22, P<0.05) than those transfected with only pcDNA3.1-lncRNA-TUG. Conclusions:lncRNA-TUG1 may act as a ceRNA to regulate miR-132-3p/SIRT1, therefore alleviating HIEC-6 cell injury caused by LPS. Intervention of lncRNA-TUG1/miR-132-3p/SIRT1 regulatory pathway may become a potential strategy to prevent sepsis-induced intestinal mucosal damage.

ObjectiveTo evaluate the influence of electrotome on permanent and temporary cardiac pacemaker in laparoscopic cholecystectomy ( LC),and the application of cardiac pacemaker to the cases of cholecystolithiasis combined with bradyarrhythmia.MethodsClinical data of 215 patients with permanent or temporary cardiac pacemaker who underwent were studied for the preoperative and postoperative variation of pacemaker function,and for the influence of electricity coagulation during the operation on cardiac pacemaker function.ResultsLC was successfully completed in all 215 patients.The function of cardiac pacemaker was not obviously interfered during the operation,and the parameters of cardiac pacemaker did not remarkably change after the operation.ConclusionCardiac pacemaker is slightly interfered when electrotome and electrocoagulation were used in LC; LC is feasible and safe for patients with bradyarrhythmia by placement of cardiac pacemaker.