Objective To summarze our experience and evaluate the therapeutic effect of hepatectomy for intrahepatic bile duct stones. Methods The clinical data of 316 patients suffering from intrahepatic lithiasis who underwent hepatectomy from Feb. 1985 to Dec. 2004 were retrospectively analyzed. Stones distribution, operation modality, postoperative complications, and therapeutic effect were evaluated. Among the 316 patients, 192 cases(60.76%) were treated with left lateral hepatectomy, 58 cases(18.35%) with left hemihepatectomy, 12 cases(3.80%)with quadarate lobectomy, 54 cases(17.09%) with right hemihepatectomy or segmentectomy, and 14 cases(4.43%)with left and right segmentectomy. Additional biliary procedures including common bile duct exporation and cholangio-enterostomy were performed in 184 patients(58.23%). Results Postoperative complications occurred in 56(17.72%)cases, including biliary fistula, hemobilia, and subdiaphragmatic infections. Three patients(0.95%)died. The follow-up study conducted in 258 patients(81.65%)for an average of 10.3 years showed that excellent results were achieved in 90.31% of the patients. Conclusions Regular hepatic lobectomy/segmentectomy is the most effective treatment for intrahepatic lithiasis.

Objective To explore the metabolism and chronic complication features of type 2 diabetes mellitus patients with hyperferritemia. Methods:A total of 268 type 2 diabetic patients with a disease course of more than 5 years, who were hospitalized in our hospital between January to December 2019 were included in this retrospective study. Serum ferritin was measured by Chemiluminescence in each participant. Patients with other diseases, which might affect serum ferritin level, were excluded. According to the results of serum ferritin, the patients were divided into hyperferritemia group ( n=115) and normal ferritin group ( n=153). The metabolic indexes, including C-reactive protein, blood glucose, blood lipid, liver and kidney function, were measured. Chronic complications and comorbidities, including diabetic retinopathy, urinary microalbumin excretion, hypertension, coronary heart disease and cerebrovascular disease were evaluated. The correlation between hyperferritemia and various variables was analyzed. Results:Body mass index, the levels of serum urea nitrogen, uric acid, C-reactive protein, alanine aminotransferase and γ-glutamyltranspeptidase, as well as prevalence of diabetic retinopathy, microalbuminuria, hypertension and coronary heart disease, were significantly higher in hyperferritemia group than in normal ferritin group (all P<0.05). Hyperferrinemia was positively correlated with C-reactive protein ( r=0.262, P<0.001), coronary heart disease ( r=0.232, P<0.001), alanine transpeptidase ( r=0.216, P<0.001), urea nitrogen ( r=0.201, P=0.001), diabetic retinopathy ( r=0.169, P=0.008) and microalbuminuria ( r=0.176, P=0.004). Multivariate logistic regression analysis showed that hyperferrinemia was an independent risk factor of coronary heart disease and diabetic retinopathy ( OR=2.246, 95% CI 1.310-3.849, P=0.003; OR=2.232, 95% CI 1.287-3.870, P=0.004, respectively) in this patient cohort. Stepwise linear regression showed that there was a significant correlation between hyperferrinemia and microalbuminuria (β=0.165, P=0.009). Conclusions:Our results show that the level of serum C-reactive protein, alanine aminotransferase, γ-glutamyltranspeptidase, urea nitrogen, uric acid and microalbuminuria are significantly increased and the risk of coronary heart disease and diabetic retinopathy are higher in type 2 diabetic patients with hyperferritemia.

Objective To study the effect of vagus nerve stimulation (VNS) on the expression of multidrug resistance-associated protein (MRP1) in brains of rats with drug refractory epilepsy.Methods Rat models based on the lithium-pilocarpine epileptic rats were induced with sodium phenobarbital (PB).Then,the rats were randomly divided into three groups:VNS group (n=7),sham-VNS group (n=6) and control group (n=6); VNS through stimulation device was given to the rats in the VNS group,stimulation device without VNS was given to the rats in the sham-VNS group,and rats in the control group were only given conventional feeding.Behavioral changes and number of seizures were recorded by continuous video monitoring during the whole process.And the amount of MRP1 over-expression in each group was detected following a four-week VNS.Results (1) The seizure frequency in VNS group (2.6±1.0 per week) was significantly decreased as compared with that in sham-VNS group (5.3±1.1 per week) or control group (5.2±1.3 per week) after a four-week VNS (P＜0.05).(2) The MRP1 expression in VNS group had significantly statistical differences as compared with that in the sham-VNS group and control group (the absorbance values:9120±1496,19556±1462 and 20231±1710,P＜0.05).Conclusion VNS can effectively decrease the seizures frequency through reducing the MRP1 over-expression.

Objective To study the acute effect of vagus nerve stimulation (VNS) on status epilepticus (SE) in rats.Methods Forty-eight male Wistar rats were randomly divided into 4 groups:Group A (VNS preconditioning group),accepted VNS at 2 h before pilocarpine injection,Group B (VNS treatment group),accepted VNS immediately after pilocarpine injection,Group C (negative control group),implanted with electrode without stimulation,and Group D (SE model group),without electrode implantation (n=1 2).Lithium-pilocarpine was used to kindle the rats to establish SE models.Stimulation parameters used in the procedure of VNS were as follows:frequency,30 Hz; pulse width,0.5 ms; current,1 mA; and duty cycle,on-30 s,off-30 s.Behavior changes were observed and caspase-3 expression in dentate gyrus was detected 72 h after pilocarpine injection.Results (1) The seizure frequencies of grade Ⅳ and Ⅴ (Racine grading) in group A and B were significantly fewer than those in group C and D (P＜0.05); the seizure frequency of grade Ⅴ in group A was significantly fewer than that of group B (P＜0.05); SE latency in group A was significantly longer than that in other groups (P＜0.05).(2) Expressions of caspase-3 in the dentate gyrus of group A and B were significantly lower than those of group C and D (absorbancy values being 5854.7±856.5,6244.8±806.0,11957.0±1948.1 and 11543.2±1734.7,P＜0.05).Conclusion VNS has an acute seizure-suppressing effect on SE in rats and it can also reduce neuronal apoptosis induced by SE in hipocampus.

Objective To summarize the common causes and types of circuit failure after vagus nerve stimulator (VNS) implantation,and analyze the available methods of resolving these problems.Methods Three patients with postoperative circuit fault in the 97 patients performed VNS implantation for drug refractory epilepsy in our hospital from October 2011 to January 2014,and three patients with postoperative circuit fault performed surgery in other hospitals at the same period were chosen in this study.The causes of circuit failure of these 6 patients were identified by performing system diagnostics and X-ray evaluation.A revision surgery may be necessary if a broken or damaged lead was suspected.Results In these 6 patients of device failure,two patients were due to the disconnection of the lead from the pulse generator;the lead impedance became normal after re-inserting the existing lead connector pins into the pulse generator following proper lead insertion techniques.Four patients performed lead revision surgery to replace or remove the existing lead;in 3 of them,the helices and associated scar tissues were removed from the vagus nerve under the microscope,and a new set of electrodes was placed;in one of them,the lead was transected as much as possible and the distal portion of the lead was severed at the neck following the removal of pulse generator.There were no complications such as hoarse voice,dyspnea,slow rhythm,subcutaneous hematoma or infection after the revision surgery.Five patients were followed up,indicating the devices work normally.Four patients had obvious improvement,and one patient had no significant improvement after the revision surgery.Conclusions The high lead impedance is the main manifestation of circuit failure after vagus nerve stimulator implantation.Surgical exploration is an effective method to identify and resolve these problems.

Objective To explore the insula sensory features and analyze its electrophysiological characteristics based on stereo-electroencephalograph (SEEG).Methods The clinical data of 16 drug-refractory epilepsy patients,admitted to our hospital from December 2013 to June 2016,were retrospectively analyzed.All patients were implanted with SEEG electrodes;totally,34 electrodes (257 contacts) located in insular lobe.Micro current stimulation was performed every adjacent two contacts to get the sensory mapping and the stimulus threshold of the insula.Results Of all the 257 contacts,160 presented clinical symptoms (positive contacts);there were 149 contacts with sensory manifestations,of which 72 were on the left side and 77 on the right.Sensory symptoms of insula mainly included both somatic sensation and visceral sensation.The threshold of somatosensory was (4.9±2.9) mA,and the threshold of visceral sensation was (6.0±2.9) mA,without significant difference (P＞0.05).No significant difference was noted between the left insula sensory ([6.2±3.1] mA) and the right insula sensory ([5.7±2.8] mA,P＞0.05).It showed sensation abnormal of larynx,lingua,face and limb when the middle and posterior short gyrus,as well as anterior and posterior long gurus,respectively,were stimulated;insula sensory showed anatomy distribution,with different stimulated sensitivities.The sensory function showed parallel distribution with the insular gyrus from the middle short gyrus to posterior long gurus,as laryngeal-lingual-facial (nasal and lips)-limb sensation,and the thresholds of the five insular gurus were (6.0±3.1) mA,(4.7±1.5) mA,(8.0±2.9) mA,(5.1±2.4) mA and (4.5±2.6) mA,respectively,with statistically significant differences (P＜0.05).Conclusions The sensitivity of somatic sensation and visceral sensation of the insula monitored by SEEG is similar,as well as the left and right side.The sensory threshold and sensory fan-shaped distribution play important roles in conforming insular symptoms and location for clinician.