Objective To study the expression of chemokine stromal cell-derived factor-1 and its receptor CXCR4 in gallbladder carcinoma and evaluate the relationship between the expression of SDF-1 and CXCR4 protein and the clinicopathology,and lymph node metastasis of gallbladder carcinoma.Methods The expression of SDF-1 and CXCR4 protein in 41 cases of gallbladder adenoma carcinoma was examined by immunohistochemical technique(SP),and the relation of SDF-1/CXCR4 biology axis to clinicopathological parameter was also analyzed.Results The positive expression rate of SDF-1 and CXCR4 in gallbladder carcinoma was 68.3%(28/41)and 51.2%(21/41)respectively,in normal gallbladder mucous was 5%(1/20)and 5%(1/20)respectively,in cholecystitis and gallstone was 6.7%(6/90)and 5.6%(5/90)respectively,and there is significantly different among the three groups in SDF-1 and CXCR4 expression values(P＜0.001,P＜0.001,respectively).There is significant difference among histological grade group,Nevin stage group,histological differentiation,lymph node or distal organ metastasis group in SDF-1 and CXCR4 expression value(P＜0.05,respectively).However,there is no significant difference among sex group,age group,tumor size group,and gallstone presence group in SDF-1 and CXCR4 expression value(P＞0.05,respectively).The expression of SDF-1 was positively correlated to CXCR4(r=0.68,P＜0.01).Conclusion Up-regulated SDF-1 and CXCR4 is associated with the carcinogenesis and metastasis of gallbladder carcinoma.

Objective Shh and Ptch have been known to play critical roles in the hedgehog pathway and the hedgehog pathway activation occurs in the gastrointestinal cancers. This study was to detect the expression of Shh and Ptch in gallbladder carcinoma, and explore their correlation to gallbladder carcinoma. Methods The expression of Shh and Patch protein in 41 specimens of primary gallbladder carcinoma, 20 specimens of normal gallbladder and 21 specimens of adenoma tissue were assessed by immunohistochemistry.Results The positive expression rate of Shh and Ptch in gallbladder carcinoma was 75.6% (31/41) and 78.0% (32/40) respectively, in normal gallbladder mucous was 5% ( 1/20 ) and 5% ( 1/20 ) respectively,in gallbladder adenoma was 4.7% ( 1/21 ) and 9.6% (2/21) respectively, and there was significant differenee between the three groups in Shh and Patch expression values(P ＜0.001 ). However, there was no significant difference between age group, histological grade group, histologic type group, Nevin stage group,lymph node or distal organ metastasis group, and gallstone presence group in Shh and Ptch expression value (P ＞ 0.05, respectively). The expression of Shh was positively correlated to Ptch (r = 0.72, P ＜ 0.01 ).Conclusion These data support our hypothesis that Hh signaling is dysregulated in human gallbladder carcinognesis.

End stage liver disease is a serious threat to human health.Existing conventional therapies are far from ideal,and orthotopic liver transplantation is limited by the lack of donor liver.A new therapy,transplantation of hepatic stem cell,is a promising approach.Hepatic oval cells are hepatic stem/progenitor cells(HSC/HPC)during hepatic regeneration,and they are being referred to as hepatic precursor cells.It got its name because of its oval nucleus,high nuclear/cytoplasmic ratio and other morphological features.Research has shown increasingly importance in the knowledge of hepatic oval cells.There are many signaling pathways in hepatic oval cells activation and proliferation.As a branch of the Wnt signaling pathway,Wnt/β-catenin signaling pathway has a significant effect on hepatic oval cells activation and proliferation.However,the exact mechanisms of this process have not been completely elucidated.This review describes the role of Wnt/β-catenin signaling pathway in hepatic oval cell activation and proliferation.

Objective To analyze the CT staging and evaluate its role in assessing the resectability of the gallbladder carcinoma.Methods The CT scans of 47 patients who had pathologically confirmed gallbladder carcinoma were retrospectively reviewed and the CT stages of gallbladder carcinoma were used to evaluate the resectability.Results Before operation,three patients were in stage Ⅰ(6.4%,3/47),14stageⅡ(29.8%,14/47),10 stageⅢ(21.7%,3/47),20 stage Ⅳ(42.6%,20/47),however,after operation,three patients were in stage Ⅰ(6.4%,3/47),14 stageⅡ(29.8%,14/47),8 stage Ⅲ(17.0%%,8/47),22 stage Ⅳ(42.6%,20/47).The accurate rate of CT staging confirmed by operation was 91.5%(43/47).The treatment procedures of gallbladder carcinomas included radical operation,palliative excision and exploratory laparotomy.For 47 patients with gallbladder carcinomas,radical operation was performed in 30 cases(3 stage Ⅰ,14 stageⅡ,7 stage Ⅲ,6 stage Ⅳ),palliative excision 15 cases(1 stage Ⅲ,14 stage Ⅳ),exploratory laporatory 2 eases(2 stage Ⅳ).Conclusion The staging of gallbladder carcinoma with CT may provide definite value in evaluating respectability of gallbladder carcinoma.

Objective To evaluate the effect and result of xenotransplantation with alginic polylysine alginic(APA) microencapsulated neonatal swine islets for the treatment of IDDM patients.[WT5”HZ] Method [WT5”BZ] The neonatal pig islets were microencapsulated with APA technique and cultured in vitro. The secretion of insulin, glucose stimulated insulin release test and histological examination between the microencapsulated and unmicroencapsulated neonatal pig islets were compared. 3 patients with IDDM received a xenotransplantation of microencapsulated neonatal pig islets by laparoscopic procedure. The change in blood glucose level, C peptide and the dose of insulin used were observed before and after the xenotransplantation. [WT5”HZ]Results [WT5”BZ] No significant difference was found between microencapsulated and unmicroencapsulated neonatal pig islets in vitro in terms of biological activity of the islets. The levels of serum C peptide in two of the 3 recipients increased by 11 and 23 times respectively, the postoperative dose of insulin needed decreased by 63% in one, insulin independency was achieved in the other recipient.In these two cases,the microencapsulated islets have functioned effectively for up to 80 ds.[WT5”HZ] Conclusion [WT5”BZ] APA microencapsulated neonatal pig islets have good biological activity and survived while transplanted into IDDM recipients. Omentum minus cavity xenotransplantation of microencapsulated neonatal pig islets by laparoscopic technique is safe, capable of repeated transplantation.

Objective To investigate the feasibility and security of omentum minus cavity xenotransloantation of alginic-polylysine-alginic(APA) microencapsulated neonatal swine islet cells by laparoscopic procedure. Methods 5 patients with IDDM received the xenotransloantation of APA microencapsulated neonatal pig islets in omentum minus cavity by laparoscopic procedure.The patients' general conditions,the change in fast blood glucose level,serum C-peptide and the dose of insulin used were observed before and after the xenotransplantation. Results No complications occurred during operation and after operation.The levels of serum C-peptide increased by 3 to 23 times respectively and the post-operative dose of insulin needed decreased obviously.Insulin independency was achieved in one recipient for up to 31 months. Conclusions Omentum minus cavity xenotransplantation of APA microencapsulated neonatal pig islets for the treatment of IDDM patients by laparoscopic technique is safe and practicable.

Objective To investigate the efficiency and safety of laparoscopic hepatectomy (LH) and open hepatectomy (OH) in patients with hepatocellular carcinoma (HCC). Methods A total of 45 HCC cases undergoing hepatectomy from January 2008 to December 2010 in our hospital were divided into LH group ( n =21 ) and OH group ( n =24 ).Their clinical efficiency and safety were compared and analyzed. Results The amount of intraoperative blood loss and blood transfusion in LH group were significantly higher than that of OH ( respectively x2 =3.973,x2 =4.862,all P ＜ 0.05 ).LH is associated with less postoperative complications and duration of hospital stay,compared with OH ( respectively x2 =4.746,t =-2.717,all P ＜0.05).Cumulative survival rates in both groups were not statistically significant ( x2 =0.172,P ＞ 0.05 ).However tumor-free survival rate in LH was significantly higher,superior to that of OH (x2 =4.543,P ＜ 0.05). Conclusions LH and OH are all safe and effective hepatectomy for HCC.LH has the advantage of less complication and shorter hospital stay.

Objective To analyze the major causes of reoperation for abdominal injuries and explore the effective preventive measures so as to enhance operation quality for abdominal injuries. Methods The data of 33 patients undergoing relaparotomy for abdominal injuries during the last 10 years was analyzed retrospectively. Results There were 25 closed injuries and 8 stab penetrating injuries in this group. The causes of reoperation were mainly missed injuries in initial laprotomy 10 cases,inappropriate surgical procedures 8 cases, postoperative complications 13 cases, and negative relaparotomy 2 cases. In these 33 patients, 40 times of reoperation were performed, and among them 2 patients sustained 3 times of laparotomy respectively. Overall mortality rate was 12%(4/33). The main causes of death were MODS resulted from consumption coagulopathy and/or severe septic complication after reoperation. Conclusions The effective preventive steps to decrease the incidence of reoperation in patients with abdominal injuries include complete interventional exploration, right operational methods and sufficient drainage in initial laparotomy for a surgeon.

Objective To evaluate the value of ERCP in treating hepatocellular carcinoma complicated with tumor thrombi in bile duct.Methods To analyze retrospectively the results of 15 cases of hepatocellular carcinoma with tumor thrombi in the bile duct including ERBD 8 cases and ENBD 7cases,EMBE after ENBD 4 cases, EST with clearance of tumor thrombi and cytological brush 12 cases, ERCP conjugated with other compositive treatments 9 cases.Results The common feature of cholangiography is filling defect in the bile duct as the so called "tennis bat" sign and "flocculation" sign, 13 cases have got drainage successfully after ERCP with the effective rate 86 7%, Satisfactory results were obtained in patients received ERCP conjugated with other compositive treatments.Conclusion ERCP is very important treatment of hepatocellular carcinoma with tumor thrombi in the bile duct; the "tennis bat" sign and "flocculation" sign were the very important evidences of tumor thrombi in the bile duct. If combined with other compositive treatment such as surgery and TAE, ERCP is very effective treatment for the releasing symptoms, improving living quality and prolonging life span in these patients, even in some patients radical cure could be obtained.

ObjectiveTo evaluate the feasibility of angioscopically external valve suture repair. MethodAngioscope was introduced through the terminal great sapherous to the first venous valve of superficial femoral vein. With general femoral vein, deep femoral vein, superficial femoral vein blocked, heparin-contained NS was used to establish water column, and video-guided angioscopy demonstrates the valve′s shape and its degree of defect and deformation. Twelve patients with primary deep venous insufficiency underwent video-valvuloplasty.ResultsPostoperative phlebography showed disappearance of reflux in 9 cases, and significantly reduced reflux in 3 cases. There was no morbidity postoperatively. Conclusion Angioscopic external suture valve repair is safe and effective in the treatment of femoral superficial venous insufficiency.