Xanthogranulomatous cholecystitis (XGC) is a rare type of chronic cholecystitis characterized by severe proliferative fibrosis with infihration of macrophages and foamy cells in the gallbladder wall.Since XGC and gallbladder carcinoma have similar clinical manifestations and radiological features,XGC is often misdiagnosed as gallbladder carcinoma in clinical practice,which leads to unnecessary extensive surgical resection and has an adverse effect on patients.At present,the preoperative diagnosis of XGC is still based on imaging results (ultrasound,computed tomography,and magnetic resonance imaging),and a definite diagnosis of this disease relies on intraoperative frozen biopsy or postoperative pathological examination.Meanwhile,XGC should be differentiated from gallbladder adenomyomatosis,gallbladder carcinoma,and gallbladder actinomycosis.Laparotomy or laparoscopic cholecystectomy is the major method for the treatment of XGC,but laparoscopic cholecystectomy is associated with a longer time of operation,more complications,and a higher rate of conversion to laparotomy.Therefore,surgeons are facing difficulties in preoperative diagnosis and intraoperative decision-making process of XGC.

Objective : To study the protective effects of two antioxidants on the influence of passive smoking on learning and memory ability of mouse offspring. Method: Passive smoking model of pregnant mice was established. Learning and memory ability was evaluated by water maze and long term potentiation (LTP). Nitric oxide (NO) content and nitric oxide synthase (NOS) activity of brain, vitamin E(VE) concentration and reactive oxygen species (ROS) of serum were determined. Results: Latency (the swimming time from beginning to endpoint) and errors (the number of entering blind end) in control and two antioxidant groups were shorter as compared with tobacco smoking (TS) group after 6 d in water maze test, and still shorter after 10 d in control and TS+VE groups. LTP was inhibited in TS group but increased significantly in two antioxidant groups. NOS activitiy was significantly higher in TS group in comparisonwith the control. NO content of TS+VE group was significantly lower than TS and TS+Q groups. Serum VE concentration and ROS level were correlated with the results of latency in water maze and LTP. Conclusion: Passive smoking of the pregnant mice may restrain LTP formation through disturbance of hippocampus function, and reduce the learning and memory ability of the offspring and VE may protect such effects.

Objective To compare the setup errors of two position fixation, head-neck-shoulders immobilization system and trunk immobilization system in radiotherapy for esophageal cancer, and to provide technical guidance for the fixed modes and determination of plan target volume (PTV) in the intensity modulated radiation therapy (IMRT) of esophageal cancer. Methods 97 thoracic esophageal cancer patients treated with radiotherapy were collected and divided into two groups: head-neck-shoulders group (51 patients immobilized with head-neck-shoulders immobilization system) and trunk group (the other 46 patients immobilized with trunk immobilization system). Before the weekly radiotherapy, all the patients received cone-beam CT (CBCT) scan to get the setup errors of X axis (left and right), Y axis (head and foot) and Z axis (front and back) on line. Results In the head-neck-shoulders group, the errors in X, Y and Z direction were (0.333 ±0.400) cm, (0.333 ±0.291) cm and (0.238 ±0.256) cm, respectively. In trunk group, the errors were (0.327±0.255) cm, (0.582±0.501) cm and (0.189±0.154) cm, respectively. There were statistically significant differences in the setup errors in Y axis and Z axis between the head-neck-shoulders group and the trunk group (P< 0.05). Conclusions In the radiotherapy for thoracic esophageal carcinoma, there is no difference in the X axis setup error between head-neck-shoulders system and trunk immobilization system. The Y axis setup error of head-neck-shoulders group is less than that of the trunk group. The Z axis setup error of trunk group is less than the head-neck-shoulders group.

Objective To explore the safety of enteral nutrition(EN)support in non-blood circulation disorders of elderly patients with intestinal obstruction.Methods A total of 40 patients (22 men and 18 women aged 62-84 years)with intestinal obstruction were enrolled in this study.Ileus tubes were rapidly placed in these patients with the assistance of endoscopy and X-ray.Afterwards patients were equally randomized into parenteral nutrition(PN)and EN(PN+EN)group and PN only group.The clinical outcomes and complications were recorded and compared.Results The average time for catheter placement was(24.83 4±7.95)minutes.Abdominal pain were relieved within 1-2 hours in26 pafienta(65.0%)and within 48 hours in 11 patients(27.5%).In the PN+EN group,EN was provided(25.25±8.17)hours after catheter placement,and most patients could tolerate EN.Laboratory findings were not significantly different at admission between two groups.The mean prealbumin leveh were below than normal level at admission but returned normal after one week,which were significantly different inside each group(P<0.05)but were not significantly different between these two groups.The triglyceride leveh were higher than the normal level at admission but returned normal after treatment;however,the difference between the two groups was not significant.The laboratories tests were also not significantly different between two groups one week after admission.Conclusion EN support is safe for elderly patients with intestinal obstruction after effective gastrointestinal decompression.

Objective To analyze the clinical features of adult patients with acute intestinal obstruction secondary to Meckel's diverticulum and the experience in management of the disease.Methods The clinical data and pathological features of 9 patients with acute intestinal obstruction secondary to Meckel' s diverticulum were retrospectively analyzed. Results All patients were diagnosed with acute intestinal obstruction secondary to Meckel's diverticulum via abdominal cavity exploration and underwent surgical treatment. Before surgical treatment, 1 out of 9 patients was correctly diagnosed as acute intestinal obstruction secondary to Meckel's diverticulum, and the other 8patients were diagnosed as acute intestinal obstruction. Diverticulum was resected in 5 cases and the rest 4 cases received partial excision of small intestine including the diverticulum. Pathological examination showed that all patients had inflammatory changes in diverticulum. Some patients were complicated with mucosal erosion, small ulcers, bleeding or perforation. Forty-four percent (4/9) of diverticula contained ectopic tissue. All patients were cured. Conclusion Meckel's diverticulum is a rare cause of acute intestinal obstruction and preoperative diagnosis is difficult. Diverticulum,howere,is likelihood to develop strangulation or contains ectopic tissue, so that the surgical treatment should be performed early.

Objective:To investigate the effect of plasma exosome miR-18a-3p on of apoptosis and cell cycle cumulus cells (CCs) in polycystic ovary syndrome (PCOS) via targeting CITED2.Methods:qRT-PCR assay was used to detect the expression of miR-18a-3p in plasma, plasma-derived exosome and CCs of patients no matter with PCOS and non PCOS. After being transfected with miR-18a-3p mimic, the exosome was co-cultured with CCs, the cell cycle distribution and apoptosis of CCs were detected by flow cytometry assays. Gene ontology (GO) analysis was performed and CITED2 was included in follow up experiments. pcDNA3.1-CITED was transfected into CCs and then co-cultured with exosome to explore the co-effect of miR-18a-3p and CITED2 on the cell cycle and apoptosis of CCs.Results:The plasma-derived exosome isolated from CCs with PCOS were identified successfully, and the expression of miR-18a-3p was significantly decreased in plasma, exosome and CCs in PCOS, compared with that in non-PCOS (all P<0.05) . CITED2 could be regulated as a target of miR-18a-3p in CCs. Compared with NC group, overexpression of miR-18a-3p could significantly decrease proportion of CCs cells in G0/G1 phase and inhibit their apoptosis in PCOS patients (all P<0.05) . The effect of over-expressing miR-18a-3p could be partially reversed by up-regulating CITED2 (all P<0.05) . Conclusions:Plasma exosomal miR-18a-3p has the effect to induce the S phase of CCs cells, subsequently inhibit apoptosis, then restrain the progression of PCOS. Plasma exosomal miR-18a-3p is expected to play a paramount role in the target therapy of PCOS.

Objective To evaluate the application of inguinal incision in retroperitoneal laparoscopic nephroureterectomy(LNU)in the treatment of upper urinary urothelial carcinoma(UUUC).Methods From Mar.2007 to Jan.2012,186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute.All cases were grouped as inguinal incision group(n =112)and lumbar incision group(n =74)according to specimen retrieval incision.Operative time,estimated blood loss,postoperative analgesia,hospital stay,incision complications,cosmetic satisfaction and tumor recurrence were compared between the 2 groups.Results All the 186 cases of operation were successfully accomplished.There were no differences in tumor stage,tumor grade,mean operative time,blood loss between the 2 groups.In inguinal incision group,the incidence of incision fat liquefaction,incision hernia,incision bulging,lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group.In inguinal incision group,the mean hospital stay was shorter,cosmetic satisfaction(Ⅰ/Ⅱ/Ⅲ)was better(7/24/81 versus 22/18/34,P ＜ 0.01).Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group(5.3％ versus 35.0％,P ＜0.01).Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trauma,less complications,higher cosmetic satisfaction and lower tumor recurrence.

ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.

Objective To evaluate the operative techniques and the methods of the renal function protection in laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods Thirty-six renal tumor patients accepted transperitoneal laparoscopic partial nephrectomy at the 70 degree lateral decubitus position.There were 17 tumors in the upper pole,13 in the lower pole and 6 in the center of kindey.The mean tumor diameter was 2.6 cm(from 0.8 to 4.0 cm).Peke forceps were used to clamp the renal artery and achieve warm ischemia.Cold scissors was used to resect tumors and Hem-o-lok was used to clamp and control the artery bleeding in surgical bed instead of ligature when suturing the kidney parenchyma.Ulinastatin was used to prevent and relieve the ischemical reperfusion injury.The operative time,estimated blood loss,warm ischemia time,intraoperative and postoperative complications and the operative efficacy were recorded.Results All operations were completed successfully,no case was converted to open surgery.The mean operative time was 128 min(95 to 186 min),mean estimated blood loss was 130 ml (40 to 600 ml),mean warm ischemia time was 21 min(16to 28 min).There was no hemorrhage and urinary leakage after surgery.The post-operative renal function was normal in all the cases.The histopathological examination showed that 36 cases were renal cell carcinoma including 31 pT1a,cases and 5 pT1b cases.There was no positive surgical margin.The mean follow-up time was 16 months (from 6 to 30 months).There was no recurrence and metastasis found and renal function was normal in all cases during the follow-up.Conclusions Laparoscopic nephron sparing surgery for renal tumors is a safe and feasible treatment option.This procedure can resect tumor safely and preserve renal function efficiently.The use of Hem-o-lok instead of ligature can significantly reduce the operative time.Ulinastatin can help reducing the ischemical reperfusion injury and thus preserve renal function.

Objective To investigate the detection rate of malnutrition among post-stroke patients in community hospitals and unravel the relevant factors that precipitate malnutrition after stroke. Methods Based on 438 post-stroke patients who were admitted in community hospitals, we examined the demographic characteristics, the nutritional indices and the possible malnutrition related factors through a cross-sectional study.Results The detection rate of malnutrition among post-stroke patients was 52.7%. Group comparison through multivariate logistic regression analysis showed that there was a higher malnutrition detection rate in the post-stroke patients with multiple stroke attacks (three stroke attackes and above, OR = 11.00,95%CI 1. 14-106.34), higher NIHSS scores (group with NIHSS≥15, OR=7.09, 95% CI 2.90-17.36) , higher modified Rankin scales (group mRS 4-5, OR = 15. 77,95% CI 6.61-37.59) (trend test P<0.0001) .The risk of malnutrition was also correlated with the post-stroke depression, poorer family care, no early-stage rehabilitation, history of malignant tumors and severe alcoholism. Conclusions There is a high detection rate of malnutrition among post-stroke patients in community hospitals. There are many factors related to malnutrition among post-stroke patients in the community. More attention to controllable influencing factors would improve the prognosis of post-stroke patients.