Objective To define the correlation between the proliferating cell nuclear antigen (PCNA) and metastasis-related gene nm-23-H 1, and to correlate their espressions with clinical features,radiosensitivity and prognostic variables in exophageal squamous cell carcinoma (ESCC), to establish some biological parameters obtained prior to therapy though which we can predict radiosensitivity and outcome.Methods PCNA and nm-23-H 1 expression protein were determined by immunohistochemical technique with formalin-fixed paraffin-embedded specimens from 59 patients with ESCC who had received definitive radical radiation and had been followed up for more than 3 years. The values were assessed by distributions of patients , disease factors, including age,sex,lesion site,legth ,histological grade and prognosis.Results The findings showed that the mean labelling indices of PCNA and nm-23-H 1 were significantly higher in ESCC than in the normal esophageal tissue (P0.05).Conclusions PCNA and nm-23-H 1 indices can be taken as biological endpoints to predicting therapeutic response, local and systemic control of disease.

Objective: To investigate the variation of γδ T cells from healthy human peripheral blood(PB)and neonatus cord blood (CB)in proliferation and subtypes with isopentenyl pyrophosphate(IPP), and to acquire enough γδ T cells possessing distinct characteristics for experimental study.Methods: Mononuclear-cells from peripheral blood and cord blood induced by IPP were stained separately with monoclonal antibodies,which were fluorescein-labeled,and then used for assaying the expressing condition of surfaco molecules,as well as to evaluate the variation of γδ T cells on the percentage, subtypes and pbenotypes by FCM.Results:γδ T cells only account for a small proportion in both PB and CB.However,there was a significant difference in the heterogeneity between peripheral blood and cord blood γδ T cells.Vγ9Vδ2 T cells were dominant in peripheral blood γδ T cells.Most of Vγ9Vδ2 T cells in fresh isolated PBMC were central memory-type(CD27~+ CD45RA~-)and effector memory-type(CD27~-CD45RA~-)with IPP, PB γδ T cells proliferated strongly;The effector memory-typo(CD27~-CD45RA~-)turned into the main subtype in all Vγ9Vδ2 T cells,and HLA-DR and B7 molecules were highly expressed on the populations.But the cord blood γδ T cells showed rather complex subgroup heterogeneity,and Vγ9Vδ2 T cells were almost na(i)ve-type(CD27~+ CD45RA~+); Though γδ T cells were expanded(the percent of γδ T cells was increased),and Vγ9Vδ2 T cells were differentiated towards central memory-type and effector memory-type on day 14 with IPP,most of γδ T celLs still remained in the phase of na(i)ve-type(CD27~+ CD45RA~+).Conclusion:Tbere lies great differences of γδ T cells in quantity and subtypes between healthy person peripheral blood and neonatus cord blood.Peripheral blood γδ T cells can be activated and proliferated with IPP, while cord blood γδ T cells have the potential to deferentiate into director memory-type which can be used for experimental and clinical study with the synergy of corresponding cytokines.The immuno-regulation and effector function will be reported in other papers.

ObjectiveTo investigate the clinical application value of two-step separation approach in laparoscopic left lateral sectionectomy (LLLS).MethodsA total of 156 patients undergoing LLLS with two-step separation approach in Hunan Provincial People's Hospital between January 2009 and September 2014 were included in this prospective study. Among the 156 patients, 76 were males and 80 were females with the age ranging from 18 to 75 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were in bladder lithotomy position or straddle position and pneumoperitoneum was established with 4-hole approach and periumbilical puncture. Hepatectomy was performed using two-step separation approach. The liver parenchyma was dissected to the plane of left lateral hepatic pedicle-left hepatic vein using ultrasonic scalpel along the left of falciform ligament. Then, the hepatic pedicle and the left hepatic vein was dissected using Endo-GIA stapler.ResultsAll patients completed the surgery successfully and no case was converted to laparotomy. Eighty-nine patients underwent simple left lateral hepatic artery occlusion and 67 patients did not undergo hepatic inlfow occlusion. The median operation time was 85 (53-150) min and the liver dissection time was 17 (8-35) min. The intraoperative blood loss was 25 (10-100) ml and the postoperative length of stay was 7 (5-10) d. No death case and no serious postoperative complication was observed. Only 7 patients developed mild bile leakage and recovered after effective drainage.ConclusionTwo-step separation approach in LLLS is safe and easy, which can be taken as a standard operation and widely popularized.

Objective: To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC). Methods: A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019. Results: All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory. Conclusions Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.

Objective: To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR). Methods: The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People’s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed. Results: The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525.8±121.8) minutes, and the blood loss (250.0±191.5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well. Conclusions LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.