Objective To investigate the advantages and indications of combined laparoscopic surgery(CLS). Method 488 casesof laparoscopic procedures were given from May 1992 to February 2002.Among them 21 were CLS.Laparoscopic common bile duct exploration (LCBDE)+Laparoscopic cholecystectomy(LC)(7);Laparoscopic fenestration of liver syst+LC(4),LC+Laparoscopic appendectomy(4);LC+hand-assisted laparoscopic splenectomy(2);laparoscopic cystectomy for pancreatic pseudocyst+LC (1);LCBD+LC+Laparoscopic fenestration of right renal cyst(1)and LC+laparoscopic partial hepatectomy for small liver cancer(1). Results The combined procedures were succesful in all the 21 cases with no complications. Conclusions CLS has expanded the field of laparoscopy and advantages of minimally invasive nature and indications should be strictly choosen for the procedure.

Objective To investigate the feasibility and clinical value of laparoscope combined with choledochoscope in the treatment of intra- and/or extrahepatic bile duct cholelithiasis. Methods 10 patients with intra- and/or extrahepatic bile duct stones underwent common bile duct incision exploration to remove stones under laparoscope combined with fiber-choledochoscope from September 2000 to March 2002. Common bile duct was directly sutured or T-tube drainage was performed. Results All cases were operated on successfully without conversion to open operation. There was no serious complication except 1 case of postoperative bile leakage cured by conservative treatment. The residual stones of 2 cases were removed by choledochoscope. Conclusions Laparoscope combined with choledochoscope in the management of intra- and/or extrahepatic bile duct stones is a safe, reliable and minimally invasive procedure. However, it is important to choose indications.

Objective To study the application value of T lymphocyte subsets and inflammatory factors in evaluating severity andprognosisofaplasticanemia.Methods 40patientswithaplasticanemiainthehospitalwereenrolledinthestudyasAAgroup, which was further divided into acute aplastic anemia(AAA) subgroup and chronic aplastic anemia(CAA) subgroup .In addition to that ,40 healthy people who received physical examination in the hospital during the same period were enrolled in the study as con‐trol group .Then blood routine tests were performed ,T lymphocyte subsets content in peripheral blood and serum inflammatory fac‐tor content were detected and the results were compared .Results Th1 ,Th17 contents and Th1/Th2 ,Th17/Treg ratio in AA group were higher than those in control group(P<0 .05) ,while Th2 ,Treg contents were lower(P<0 .05);Th1 ,Th17 contents and Th1/Th2 ,Th17/Treg ratio in AAA group were higher than those in CAA group(P<0 .05) ,while Th2 ,Treg cells contents were lower . Serum IL‐2 ,IFN‐γ ,IL‐17 contents in AA group were higher than those in control group(P<0 .05) ,while IL‐4 ,IL‐6 ,IL‐10 contents were lower(P<0 .05);serum IL‐2 ,IFN‐γ,IL‐17 contents in AAA group were higher than those of CAA group ,while IL‐4 ,IL‐6 , IL‐10 contents were lower .Hb ,PTL contents were negatively correlated with Th1 ,Th17 contents and serum IL‐2 ,IFN‐γ ,IL‐17 contents ,while positively correlated with Th2 ,Treg cells contents and serum IL‐4 ,IL‐6 ,IL‐10 contents .Conclusion Peripheral blood T lymphocyte subsets and serum inflammatory factors contents in aplastic anemia are abnormal and are correlated with the severity and prognosis related indicators .

Objective To study the levels of serum homocysteine(Hcy) ,high-sensitivity C-reactive protein (hs-CRP) and blood lipid and their correlation in the different age stage patients with cerebral infarction .Methods 352 patients with cerebral infarction receiving treatment in the hospital from December 2011 to November 2013 were selected as the study subjects and divided into the youth group ,middle age group and elderly group by age ,with contemporaneous 134 healthy individuals of physical examination as the control group .Serum lipids ,hs-CRP ,Hcy levels and the rate of abnormal test results were compared among 4 groups and the bi-variate correlation analysis was performed .Results The serum hs-CRP ,Hcy levels in the youth group were higher than those in the control group ,while the high density lipoprotein cholesterol(HDL-C) level was lower than tha tin the control group ,the difference was statistically significant (P<0 .05) .The serum low density lipoprotein cholesterol(LDL-C) ,total cholesterol (TC) ,hs-CRP and Hcy levels in the middle age and the elderly groups were significantly higher than those in the control group ,while the HDL-C level was significantly lower than that in the control group ,the difference was statistically significant (P<0 .05) .The abnormal rates of HDL-C ,hs-CRP and Hcy test results in the youth ,middle and elderly groups were significantly higher than those in the control group with statistical difference (P< 0 .05) .The abnormal rates of LDL-C detection results in the middle age group and elderly group were significantly higher than that in the control group ,the difference was statistically significant (P<0 .05) .Hcy ,hs-CRP and lipid in the youth group ,middle group and elderly group had no significant correlation ;HDL-C was negatively correlated with hs-CRP (P<0 .05);TC was positively correlated with LDL-C ,HDL-C and triglyceride(P<0 .05) .Conclusion Hyperhomocys-teinemia is an independent risk factor for cerebral infarction occurrence ,has no significant correlation with blood lipid and hs-CRP levels ,and can be used as a reliable indicator of the disease condition monitoring .

Objective To observe the effects of Shenhong (SH) combined with chemotherapeutic drugs on curative effect, symptoms improvement, and immunology function in metaphase or terminal cancer patients.Methods All 598 patients were divided into two groups. The control group had 205 patients treated with chemotherapeutic drugs. The SH-treated group had 393 patients treated with SH combined with chemotherapeutic drugs. Results Compared with control patients, the total remission was 42.0% in SH-treated patients. The improvement rates of pain, cough, debilitation, and anepithymia were 71.9%. The Karnofsky grade was increased by 27.0%. CD+3 and CD+4 were increased by 11.6% and 19.3%, but CD+8was decreased by 22.6% at the same time. The patients CD+4 / CD+8 was enhanced by 54.2%, while the NK cell activity and marophage phagocysis were significantly improved. The content of Ig G and Ig A were increased in the same group. Conclusion The curative effect of SH combined with chemotherapeutic drugs was higher than that of control group. The therapeutic effect of SH is explained by its potential regulation activity on immun system.

Background and purpose:Lower expression of E-cadherin is associated with metastasis of cancer cells, however, the correlation between E-cadherin and glucose metabolism has seldom been reported. This article studied the correlation between E-cadherin and glycolysis effect in PANC-1 cells.Methods:Through treatment of transforming growth factor β (TGF-β) in PANC-1 cells to decrease E-cadherin expression, knock-down the gene of E-cadherin interaction protein β-catenin, and overexpressing of E-cadherin, the effects of E-cadherin on the glucose uptake and lactate production ability and on the expression of key glycolytic genes were assessed.Results:E-cadherin negatively regulated the glycolytic effect of PANC-1 cells by inhibiting glucose uptake and lactate production (P<0.05). Moreover, E-cadherin interacting partner β-catenin signiifcantly promoted glucose metabolism transformation in PANC-1 cells (P<0.05). Moreover, key glycolysis regulator sirtuin 3 (SIRT3) could lower E-cadherin expression.Conclusion:Lower expression of E-cadherin induced the transformation of glucose metabolism transformation in PANC-1 cells and manipulation of E-cadherin expression level could change the glycolysis effect. Moreover, through maneuver glycolysis process could inhibit high metastatic potential of pancreatic cancer cells.

Objective To explore the change of miRNA-16(miR-16) level in the patients with multiple my-eloma(MM ) and its relationship with the Mayo risk stratification and prognosis judgment .Methods Each 10 mL of bone marrow samples was collected from 31 cases of MM in the hematology department of the First Af-filiated Hospital of Guangxi Medical University from August 2016 to January 2017 ,and each 5 mL of bone marrow sample was collected from 5 healthy bone marrow donors as the healthy control .The real time fluores-cence quantitative PCR(qRT-PCR) was used to analyze relative the change of miR-16 relative expression level and fluorescence in situ hybridization(iFISH) was used to detect the abnormal gene .Then the relationship be-tween miR-16 relative expression level with Mayo based risk stratification ,and the difference of miR-16 rela-tive expression level between before and after self treatment were statistically analyzed .Results The miR-16 relative expression level in MM patients was increased and positively correlated with the Mayo risk stratifica-tion .Meanwhile in the MM patients with disease progression ,the miR-16 expression was increased . Conclusion miR-16may serve as the indicator for judging the recurrence or progression of MM ,and guides the clinical personalized therapy of MM according to its expression level change .

Pancreatic ductal adenocarcinoma (PDAC) is among the most devastating human malignancies. The poor clinical outcome in PDAC is partly attributed to a growth-permissive tumor microenvironment. In the PDAC microenvironment, the stroma is characterized by the development of extensive fibrosis, with stromal components outnumbering pancreatic cancer cells. Each of the components within the stroma has a distinct role in conferring chemoresistance to PDAC, and intrinsic chemoresistance has further worsened this pessimistic prognosis. The nucleoside analog gemcitabine (GEM) is usually the recommended first-line chemotherapeutic agent for PDAC patients and is given alone or in combination with other agents. The mechanisms of intrinsic resistance to GEM are an active area of ongoing research. This review highlights the important role the complex structure of stroma in PDAC plays in the intrinsic resistance to GEM and discusses whether antistroma therapy improves the efficacy of GEM. The addition of antistroma therapy combined with GEM is expected to be a novel therapeutic strategy with significant survival benefits for PDAC patients.

Objective:To evaluate Zhuang medicine Fuzheng compound combined with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) in the treatment of advanced epidermal growth factor receptor (EGFR) sensitive mutant non-small cell lung cancer (NSCLC).Methods:A total of 120 patients with advanced NSCLC who met the inclusion criteria from June 2019 to May 2020 in Guangxi International Zhuang Medical Hospital were divided into 2 groups according to the random number table method, with 60 in each group. The control group was treated with TKIs, and the observation group was treated with Zhuang medicine Fuzheng compound combined with EGFR-TKIs. TCM syndrome scores were compared, and the quality of life of the patients was assessed by the Quality of Life Scale (QLQ-C30). The serum levels of carcinoembryonic antigen (CEA), squamous cell carcinoma associated antigen (SCC-Ag) and carbohydrate antigen 50 (CA50) were detected by radioimmunoassay, and the levels of CD3 +, CD4 +, and CD8 + were detected by flow cytometry, and the CD4 +/CD8 + ratio was calculated. The adverse reactions during the treatment were observed and recorded. Results:The objective remission rate in the observation group was 66.7% (40/60) and the disease control rate was 81.7% (49/60), while in the control group were 48.3% (29/60) and 63.3% (38/60), respectively.The differences were statistically significant ( χ2 values were 4.13 and 5.06, P values were 0.042 and 0.025, respectively). After treatment, the scores of chest tightness, shortness of breath, blood in sputum, mental fatigue in the observation group were significantly lower than those in the control group ( t values were 8.72, 5.02, 5.47, all Ps<0.001), After treatment, QLQ-C30 score in the observation group was significantly higher than that of the control group ( t=5.21, P<0.01). After treatment, CEA [(31.45±4.56) mU/L vs. (38.98±5.71) mU/L, t=7.98], SCC-Ag [(4.87±0.93) μg/L vs. (7.29±1.25) μg/L, t=12.03], CA50 [(58.27±7.14) U/L vs. (66.48±7.94) U/L, t=5.96] levels were significantly lower than those in the control group ( P<0.01); CD3 +[(52.43±5.01)% vs. (48.56±4.87)%, t=4.29], CD4 + [(54.89±5.03)% vs. (51.09±5.22)%, t=4.06], CD4 +/CD8 + [(1.95±0.28) vs. (1.65±0.27), t=5.97] significantly higher than those in the control group ( P<0.01), CD8 + [(28.12±2.70)% vs. (31.23±2.64)%, t=6.38] significantly lower than that of the control group ( P<0.01). During the treatment period, the incidence of adverse reactions in the observation group was 13.3% (8/60) and that in the control group was 8.3% (5/60), with a statistically significant difference between two groups ( χ 2=0.78, P=0.378). Conclusion:The Zhuang medicine Fuzheng compound combined with EGFR-TKIs can reduce the level of tumor markers in patients with advanced EGFR-sensitive mutant NSCLC, improve patients' TCM syndromes, quality of life, enhance patient immunity, and improve efficacy.