Unexpected gallbladder cancer (UGC) is a sort of gallbladder cancer discovered during or after laparoscopic cholecystectomy (LC) which was diagnosed as benign gallbladder disease before surgery. With the high incidence of gallstones in China, the number of patients with UGC increases as well.However, due to the lack of randomized controlled trials on UGC, unified treatment has not been established, and argues on how LC will influence the prognosis of UGC still exist. Surgery for gallbladder cancer is technically challenging. The extent of resection varies based on a number of factors, and controversy exists regarding what constitutes an acceptable resection. We believe that satisfying treatment results are based on the surgical techniques, acute evaluation of different cases and wisely-chosen surgical procedures. This paper summarized therapeutic strategies for UGC based on our clinical experiences.

Objective:To explore effect of objective life status and psychological factors on the life satisfaction (SLS) in retired carders.Methods:Two hundred and forty-four retired carders were assessed with Quality of Life Inventory (QOLI), The Elderly's Coping Style Questionaire and Social Support Questionaire.Results:The correlation analysis showed that SLS was significantly related with OIQL, coping style, social support,and life expectation.Multiple stepwise regression analysis revealed that objective indicators about physical state and mental state from OIQL distancing style from positive coping and social support had significant effect on SLS.

Objective To investigate the clinical efficacy and safety of TAPP surgery in inguinal hernia repair for the elderly by different mesh materials.Methods 24 elderly patients (32 cases) with inguinal hernia were randomly divided into the two groups.The control group was repaired by the braid mesh,while the other 16 cases in the observation group were repaired by the three dimension mesh.The operative indicators,the VAS pain score,the incidence rate of complications and recrudesce rate were compared between the two groups.Results The operative time,time length of staying and costs of the two groups were close,no statistical differences were found (all P ＞ 0.05) ; VAS scores of postoperative 24h,48h,72h of the observation group were (0.97 ± 0.76) points,(0.62 ± 0.55) points,(0.49 ± 0.37) points respectively,which were significantly lower than those of the control group (t =6.331,6.031,5.882,all P ＜0.05).The incidence rate of complication in control group was 16.67％ (2/12),no statistical difference was found between two groups (x2 =0.000,P ＞ 0.05).No recurrence was found in two groups.Conclusion The three dimension mesh and the braid mesh in TAPP are safe and effective,the three dimension mesh has better performance in pain.

We collected the clinical information of 21 in-patients diagnosed as Lyme disease in Peking Union College Univemity Hospital from Apr. 1994 to Jan. 2008. The clinical manifestations, laboratory tests, therapy and prognosis were analyzed retrospectively. 16 of 21 (76%) patients had fever, 14 of 21 (67%) eases had skin lesion, 17 patients had nervous symptoms, 10 cases showed arthrosis and only 2 of 21 eases involved in heart. The antibiotics of penieilin,ceftriaxone and doxyeycline were used for therapy. All of the 21 patients improved clinically and discharged. 12 cases were followed up for 1 month to 12 years and 2 of them relapsed, both of whom were in Stage Ⅲ. 8 cases remained persistent symptoms. As the manifestations of Lyme disease are complicated, for clinical borderline cases the prompt detection of etiological agent may be useful for early diagnosis. The antibiotic therapy should begin as early as possible to avoid developing chronic Lyme disease.

Background and purpose: VATS lobectomy has gained popularity for lung tumor around the world during the recent twenty years.Complete anatomic resections and node dissections are routinely being performed at many centers under VATS, but some thoracic surgeons are concerned regarding the safety, benefit and radical resection of this operative method. Our study was aimed to evaluate the reliability and feasibility of pulmonary resection and lymphadenectomy by video-assisted mini-thoractomy (VAMT) for patients with lung tumor.Methods:From August to September 2006,radical lobectomy or pneumonectomy and systemic lymphadenectomy were performed on 9 patients with lung tumor through video assisted mini-thoracotomy surgery.incidence of complications, total number of dissected lymph nodes,number of metastatic lymph nodes,survival and life quality were evaluated.Results:Totally 100 lymph nodes were removed at average 15.0 minutes, and there was no accident and death happened in the whole operation which only consumed 2.3 hours. Serious postoperative complications and death also did not happen.Conclusions:Video assisted mini-thoracotomy surgery should fulfill the same quality lymphadenectomy and lung tumor definitive resection.

Congenital bile duct cysts, which is a kind of malformation of bile duct, will lead to the inflammation in the bile duct system for a long time. Therefore, patients with cholelithiasis and cyst canceration have a risk. Surgical operation is the only treatment option for the congenital bile duct cysts patients. Resection of the cysts and complete " biliary-pancreatic duct shunt" are the key points of the standardized treatment of congenital bile duct cysts. The non-standard surgical treatment will bring the postoperative complications such as the stricture of choledochojejunostomy, the remnant cysts and even the canceration of cysts, which will seriously affect the quality of life and threaten the health of patients. Based on the retrospective study of congenital bile duct cysts patients in Eastern Hepatobiliary Hospital, the author proposed a new classification system according to the pathological and anatomical characteristics of congenital bile duct cysts. The congenital bile duct cysts can be divided into three regions and five types, i. e. localized type and diffuse type of extrahepatic bile duct cysts of hilar, trunk and terminal type; central type; and intrahepatic bile duct cysts of limited and diffuse type. It is our hope that this typing system will accurately guide the design and implementation of surgical treatment plans for congenital bile duct cysts and reduce the risk of long-term postoperative complications for patients.

9).Renal pathology revealed 3 patients with class Ⅳ, 1 patient with class Ⅱ. Image results showed diffuse pulmonary infiltration lesions. Bronchial lavage fluid was hemorrhage. Three patients recovered after treatment with corticosteroid and intravenous cyclophosphamide therapy. Conclusions Diffuse alveolar hemorrhage is rare serious complications of lupus nephritis. Aggressive immunosuppressive therapy should be started early for a favorable outcome.

Objective To detect the changes of hemodynamics in patients with portal vein embolization (PVE) before surgery for hilar cholangiocarcinoma, and analyze the relationship between hemodynamics and liver hypertrophy. Methods The clinical data of 21 patients with hilar cholangiocarcinoma who were admitted to the Eastern Hepatobiliary Surgery Hospital from April 2008 to December 2009 were retrospectively analyzed.Relevant hemodynamic variables were detected and analyzed before and 3, 7, 14 days after PVE. Data were processed using Student t test or linear correlation analysis. Results The main portal vein pressure after PVE was (25.9 ± 4.1 ) cm H2O ( 1 cm H2O = 0.098 kPa), which was ( 3.5 ± 2.5 ) cm H2O higher than that before PVE [( 22.4 ± 4.1 ) cm H2O] ( t = - 6. 504, P ＜ 0.05 ). The blood flow velocity in the non-embolized branch of portal vein increased after PVE, and reached peak [(26 ±9)cm/s] at the seventh day after PVE. A positive correlation was found between the hypertrophic rate of the non-embolized lobes and the ratio of embolized lobes to total liver volume ( r = 0. 593, P ＜ 0. 05 ). Conclusion Greater scope of the embolized vascular bed of portal vein induces higher hypertrophic rate of non-embolized liver.

Aim To study the effect of genistein on contractility of isolated papillary muscles in guinea pig and its mechanisms.Methods Isolated guinea pig papillary muscles were suspended in organ baths containing KH solution,and the effect of genistein on contractility of myocardium was observed after an equilibration period.Results Genistein and isoprenaline hydrochloride showed positive inotropic effects on contractility of myocardium in a dose-dependent manner(1～100 ?mol?L~(-1)) Propranolol(1 ?mol?L~(-1)) and verapamil hydrochloride(0.5 ?mol?L~(-1)) attenuated the positive inotropic effect of isoprenaline hydrochloride(2 ?mol?L~(-1)),but did not change the effect of genistein(100 ?mol?L~(-1)).Furthermore,the enhancement of the contractility induced by elevation of extracellular Ca~(2+) concentration in papillary muscles did not show any change after pretreatment with genistein(1,10 ?mol?L~(-1)).Finally,the positive inotropic effect of genistein was attenuated partially by tamoxifen(1 ?mol?L~(-1)),however,was not influenced by sodium orthovanadate(1 ?mol?L~(-1)).Conclusions Genistein has the positive inotropic effect on guinea pig papillary muscles,which is not related to the activation of Ca~(2+) channel on cell membrane,? adrenoceptor and tyrosine kinase pathway,but this effect may involve in uptake and utilization of sarcoplasmic reticulum Ca~(2+).

Objective:To study the changes of cardiopulmonary function in patients with rheumatoid arthritis,and to analyze the correlation between the changes ofcardiopulmonary function with oxidative stress and the peripheral blood lymphocyte attenuation factor.Methods:130 cases of patients with rheumatoid arthritis were studied as case group, and 50 cases of healthy persons were studied as normal control group.Detected the heart function parameters of two groups,which contained EF%,SV%,FS%,E A,E/A;lung function parameters of FVC,FEV1,MVV,PEF;B and T lymphocyte attenuation factor expression and activation level.Peripheral Cytokine(IL-17 and TNF-α,IL-4,IL-35) and oxidative stress index (ROS,MDA,SOD,TAOC) were detected by enzyme linked immu-nosorbent assay.Results:The indexes of cardiac function in the case group were significantly lower than that in the control group.103 cases had abnormal cardiac function index in the case group,which accounted for 79.23% of the case group,while the E/A had the highest abnormal rate.The case group had thickening of LADd, increasing of peak A, decreasing of EF, E peak and E /A, than the normal control group,the differences were statistically significant (P<0.05).Compared with normal control group,pulmonary function parameters were significantly lower in case group.88 cases of case group had abnormal pulmonary function,accounting for 67.69% of the case group.Among them,the abnormal rate of PEF was the highest.Pulmonary function indexes of case group was significantly lower than that of the control group, the difference was statistically significant ( P<0.05 ).Correlation analysis showed that the correlation coefficient of cardiac function indexes EF with CD24+cells and CD19+CD24+cells were respectively -0.353 and -0.457,which had negative correlation,with ROS the correlation coefficient was 0.459,which had positive correlation.The correlation coefficient of the cardiac function indexes in FS with CD24+cells,and CD19+CD24+cells was -0.395 and -0.421,which had negative correlation; the correlation coefficient of peak A and CD19+cell was 0.423,which had positive correlation;the correlation coefficient of E/A and BTLA was 0.393,which had obvious positive correlation.SV and MDA,SOD were positively correlated.The parameters of lung function with hs-CRP and ESR had significantly negative correlation.The correlation coefficient of lung function parameters FVC with BTLA and CD19+CD24+were 0.513 and 0.596,which had a significant positive correlation,with the correlation coefficient and CD24+BTLA+, TNF-αwere -0.451 and-0.351,which had significantly negative correlation.The correlation coefficients of FEV1 with CD24+CD19+, TAOC and IL-4 were 0.535,0.466 and 0.519,which showed a positive correlation,with CD24+BTLA+,MDA were -0.461 and -0.358,which had significantly negative correlation.The correlation coefficient of PEF with SOD,TAOC,IL-4,IL-35 were 0.547,0.482, 0.643 and 0.452,which had significantly positive correlation,with MDA,ROS,IL-17 were -0.451,-0.423 and -0.417,which had a significant negative correlation ( P<0.05 ).Conclusion: RA imbalance of oxidative stress and cell immune disorders which runs through the whole process in the heart and lung injury.Therefore,in clinical treatment,treatment of joint symptoms in RA patients needs restore the body′s redox homeostasis,in order to increase the level of BTLA,activate B cell and,T cell,thereby inhibiting immune and inflammatory response,reducing the heart and lung function impairment.