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 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.

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.

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 explore the impact of intervention of weight management (WM)on readmission rate of patients with congestive heart failure(CHF).Methods sixty-six CHF patients were divided into the control group(34 cases)and the intervention group(32 cases).The patients in the intervention group received the weight management intervention for 6 months after discharge,while the control group was carried on the conventional education and follow-up.The ability of WM and readmission rate of patients due to onset of CHF were compared between the two groups.Results Six months after the intervention,significant differences were found on the scores of weight monitoring,WM related-knowledge,belief and practice in the intervention group,but only WM related-practice was improved in the control group.The readmission rote due to onset of CHF was reduced in the intervention group.Conclusions WM intervention could significantly improve the ability of WM and reduce readmission rate due to CHF onset of CHF patients.

This study was aimed to evaluate the hemostatic effect and mechanism of action for water decoction of Blumea megacephala (Randeria) Chang et Tseng in order to understand its influence to the liver function. The glass slides method and capillary tube method were used in the measurement of the coagulation time (CT). And the tail-cutting method was used to measure the bleeding time (BT), prothrombin time (PT), activated part clotting live en-zyme time (APTT), thrombin time (TT), content of plasma fibrinogen (FIB), platelet count (PLC), plasma complex cal-cium time (PRT), alanine aminotransferase (ALT) and aspartate transaminase (AST). The results showed that intragastric administration with different doses of water decoction of Blumea megacephala (Randeria) Chang et Tseng (6.7 g·kg-1, 13.4 g·kg-1, 26.8 g·kg-1) can reduce CT and BT of mice. And intragastric administration with different doses of wa-ter decoction of Blumea megacephala (Randeria) Chang et Tseng (4.7 g·kg-1, 9.4 g·kg-1, 18.9 g·kg-1) can produce different degrees of impact on PT, APTT, TT and PRT of rats. Certain dose of water decoction of Blumea megacepha-la (Randeria) Chang et Tseng can reduce ALT and AST. It was concluded that Blumea megacephala (Randeria) Chang et Tseng had the hemostatic effect and its mechanism of action may be through the activation of the intrinsic and extrinsic coagulation system. There was no obvious damage to the liver.

Objective To investigate the risk factors for postoperative liver failure of patients with hepatocellular carcinoma (HCC) and bile duct tumor thrombus through a risk evaluation model.Methods The clinical data of 107 patients with HCC and bile duct tumor thrombus who received hepatic resection at the Eastern Hepatobiliary Surgery Hospital from March 2002 to February 2011 were retrospectively analyzed.All patients were divided into the non-liver failure group (98 patients) and liver failure group (9 patients).Risk factors associated with liver failure were analyzed and a risk evaluation model was established.All data were analyzed using the bivariate regression model,and factors with significance were further analyzed using the multivariate regression model.Results Of the 107 patients,105 received hepatic resection + choledochotomy + thrombectomy and 2 received hepatic resection + extrahepatic bile duct resection + cholangiojejunostomy.The operation time was 2.0-5.5 hours,and the intraoperative blood loss was 200-3500 ml.In the non-liver failure group,5 patients had pleural and peritoneal effusion,3 had biliary bleeding,2 had incisional infection,1 had biliary infection,1 had bile leakage,1 had stress-induced ulcer of upper digestive tract and 1 had thoracic epidural hematoma.The bleeding of the patients with thoracic epidural hematoma was stopped after thoracic spinal decompression,but subsequent paraplegia occurred.In the liver failure group,2 patients died of postoperative acute liver failure,and 7 patients died of postoperative subacute liver failure (death caused by tumor recurrence or medicine was excluded).The results of univariate analysis showed that preoperative total bilirubin,albumin,pre-albumin,albumin/globulin ratio,distribution of tumor thrombus,operative blood loss and ratio of postoperative residual liver volume to the total liver volume were correlated with the postoperative liver failure in patients with HCC and bile duct tumor thrombus (OR =3.017,0.191,0.248,2.681,9.048,4.759,13.714,P ＜ 0.05).The results of multivariate analysis showed that preoperative total bilirubin ＞ 256.5 μmol/L,albumin/globulin ratio ≤ 1.3 and postoperative residual liver volume ＜ 50％ were the independent risk factors of postoperative liver failure (OR =5.537,11.107,172.450,P ＜ 0.05).The risk evaluation model was Z =1.77 × preoperative total bilirubin + 2.408 × preoperative albumin/globulin ratio + 5.150 × ratio of postoperative residual liver volume to the total liver volume-17.288.The risk of postoperative liver failure increased as the increase of Z value.The risk of postoperative liver failure ＞ 50％ when the Z value ＞ 0.Conclusions Preoperative total bilirubin ＞ 256.5μmol/L,albumin/globulin ratio ≤ 1.3 and postoperative residual liver volume ＜ 50％ were the independent risk factors of postoperative liver failure.Risk evaluation model is helpful in screening the risk factors so as to decrease the incidence of postoperative liver failure.