Cultivating clinical comprehensive ability is one of the core and main purposes for surgical clinical education.According to the characteristics in clinical teaching of hepatobiliary surgery,we combined basic theory with clinical practice and discussed on the problems of how to improve medical students' clinical comprehensive abilities including clinical operational ability,logical thinking ability,scientific research innovative ability and the doctor-patient communication ability and how to cultivate medical ethics and professional competence from aspects of basic clinical skills training,translational medicine concept,etc.

Objective To employ Borrelia burgdorferi( B. burgdorferi) , a culturable and genetical-ly transformable spirochete, as a surrogate system to study Treponema pallidum ( T. pallidum) gene function. Methods Bioinformatic analysis revealed that the T. pallidum gene tp0111 encodes the putative sigma factor RpoN. We constructed a B. burgdorferi shuttle vector harboring tp0111. The shuttle vector was then trans-formed into the B. burgdorferi rpoN mutant strain. The phenotype of the resulting B. burgdorferi strain was then determined. Results We successfully constructed the B. burgdorferi rpoN mutant carrying the T. palli-dum gene tp0111. We found that tp0111 could partially complement the B. burgdorferi rpoN mutant. Con-clusion This work provides the first experimental evidence showing that tp0111 is the rpoN gene of T. palli-dum. It also demonstrates that B. burgdorferi can be used as a surrogate system for studying T. pallidum gene function.

Objective To study the expression and clinical significance of the SALL4 in human gastric carcinoma tissues. Methods The expression of SALL4 in 91 samples of gastric carcinoma and 37 samples of normal gastric tissues was detected by RT-PCR,Western blot and immunohistochemistry,and its relationship with the clinical data were analyzed statistically.Results The positive expression rate of SALL4 in gastric carcinoma(74.7%)was significantly higher than that(18.9%)in normal gastric mucosa tissues(P <0.05).Moreover,with the decreased with the differentiation of gastric carcinoma,the positive expression rate of SALL4 was increased.The expression of SALL4 mRNA and protein in gastric carcinoma tissues were significantly higher than that in normal gastric tissues(P <0.050).The expression levels of SALL4 were relevant to lymph node metastasis(P =0.001),infiltra-tion depth(P =0.029)and the differentiation degree of gastric carcinoma(P =0.050).Conclusion SALL4 was highly expressed in gastric cancer tissues and relevant to lymph node metastasis,infiltration depth and the differentiation degree,which may have play an important role in the development of gastric cancer.

Objective:To investigate the clinical efficacy of bilateral route minimal- incision necrosectomy combined with continuous lavage for the treatment of infected necrotizing pancreatitis (INP).Methods:The retrospective and descriptive study was conducted. The clinical data of 20 patients with IPN who were admitted to Daping Hospital, Army Medical University from April 2016 to July 2019 were collected. There were 11 males and 9 females, aged (42±9)years. All the 20 patients underwent bilateral route minimal-incision necrosectomy, and then be continuous perfused and drainage within the purulent cavity postoperatively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detected patients fever, abdominal pain, abdominal distension, diarrhea, peripancreatic residual infection and survival up to January 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: of the 20 patients who underwent surgery successfully, 14 patients underwent upper abdomen combined with left retroperitoneal approach, 1 patient underwent upper abdomen combined with right retroperitoneal approach, and the other 5 patients underwent upper abdomen combined with bilateral retroperitoneal approach. Fourteen of the 20 patients underwent additional surgery including 10 cases undergoing jejunostomy, 2 cases undergoing gastrostomy combined with jejunostomy, 1 case undergoing laparoscopic cholecystectomy combined with jejunostomy, and 1 case undergoing cholecystectomy. The operation time and volume of intraoperative blood loss of 20 patients were (228±41) minutes and 100 mL (range, 50-700 mL), respectively. (2) Postoperative situations: 20 patients began continuous perfused with 0.9% sodium chloride solution within the purulent cavity at postoperative day 2 (range, day 1-14). Six of the 20 patients had postoperative complications including 1 case with postoperative gastric fistula combined with intraperitoneal hemorrhage who underwent laparotomy hemostasis combined with gastrostomy at day 13 postoperatively, 1 case with postoperative duodenal fistula who underwent gastrointestinal anastomosis and jejunostomy at day 111 postoperatively, 1 case with postoperative retroperitoneal residual tissue necrosis and infection who underwent peripancreatic necrotic tissue debridement and drainage at day 11 postoperatively, 1 case with postoperative gallbladder fistula who underwent cholecystectomy at day 71 postoperatively, and 2 cases with postoperative pancreatic fistula who were cured with conservative treatment. The duration of hospital stay after 1st operation of the 20 patients were 42 days (range,20-178 days). (3) Follow-up: all 20 patients were followed up for 6.0 to 45.0 months, with a median follow-up time of 14.5 months. During the follow-up, 1 case developed secondary diabetes, and none of patient showed clinical manifestation such as fever, abdominal pain, abdominal distension and diarrhea. The peripancreatic residual tissue of all 20 patients absorbed well, and none of patient died.Conclusion:Bilateral route minimal-incision necrosectomy combined with continuous lavage is safe and feasible for the treatment of INP.

ObjectiveTo evaluate the feasibility, safety and the long-termoutcomes of laparoscopy-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC).MethodsWe retrospectively analyzed the clinical and follow-up data of 346 cases after LADG from January 2004 to June 2009, compared with 313 cases after conventional open distal gastrectomy (ODG) for advanced gastric cancer at the same period at our hospital. The surgical safety, postoperative complications, survival rate, and the recurrence and metastasis of cancer were compared.ResultsThere was no significant difference at the average time of LADG and ODG procedures (211 ± 56) min vs.(204 ±41 ) min, but blood loss during operation and length of incision in LADG group were significantly less than in the ODG group. The proximal and distal length were, respectively, (6. 3 ± 2. 0) cm and (5. 7 ± 1.7 ) cm in LADG group and (6. 3 ±2. 1 ) cm and (5.6 ± 1.6) cm in ODG group, the difference was not significant. The number of lymph node dissections was also similar: (33 ± 13) in LADG group and (33 ± 16) in ODG group. The incidence of postoperative complications in LADG group was significantly lower than that in ODG group ( 6. 7％ vs.13. 1％, P ＜ 0. 05). During the follow-up period of 6-72 months (average 37 months), the 1-, 3-and 5-year survival rates were, respectively, 87. 2％, 57. 2％ and 50. 3％ in LADG group and 87. 1％, 54. 1％and 49. 2％ in ODG group, the difference was not significant. The differences in recurrence and metastasis between the two groups were not statistically significant.ConclsionLaparoscopy-assisted gastrectomy for advanced gastric cancer is not significantly different with open surgery in postoperative survival rate or recurrence. It is less traumatic and of fewer complications.

Pancreatoblastoma is a rare kind of malignant tumor of pancreas,which is commonly seen among children.A female child aged 5 years was admitted to the Dapiag Hospital with the chief complaint of painless abdominal mass on June 18,2010.The results of B ultrasound showed acoustic shadow of tumor calcification and an absent of normal pancreatic echo.The results of computed tomography(CT)showed that the tumor was located at the body and tail of the pancreas with a low-density and isopycnic shadow of intermixed huge block.The parenchyma of tumor showed unequal enhancement,the periphery showed lobular-like reticular enhancement,the central necrotic area showed no enhancement,and multiple metastatic foci were observed in spleen and liver under enhanced CT scan.The patient underwent resection of the body and tail of the pancreas and the spleen.Chemotherapeutics with vincristine,cyclophosphamide and doxorubicin were adopted postoperatively.After a period of 6-month follow-up,the results of CT showed that the size of tumor was decreased.

Objective To investigate the clinical value of a new anvil inserting method for esophagogastrostomy or esophagojejunostomy during laparoscopic radical proximal gastrectomy or radical total gastrectomy for gastric cancer.Methods The clinical data of 21 patients with gastric cancer who received laparoscopic radical proximal gastrectomy or radical total gastrectomy at the Southwest Hospital from March 2010 to February 2011 were retrospectively analyzed.Five trocars were inserted through the abdominal wall of the patients.After perigastric lymphadenectomy and mobilization of esophagus,an incision was made on the esophagus above the tumor,and then the anvil with drawn wire attached was inserted into the esophagus.An endo-cutter was applied to cut the esophagus adjacent to the incision left the drawn wire untouched,and then the stem of the anvil was pulled out by the drawn wire for laparoscopic anastomosis. Results The operations were successfully accomplished under the laparoscope with no conversion to open surgery.Fifteen patients received laparoscopic radical total gastrectomy and 6 received laparoscopic radical proximal gastrectomy. The mean operation time,volume of blood loss,time to off-bed activity,passage of flatus and postoperative duration of hospital stay were (257 ± 38) minutes,( 119 ± 32) ml,(2.5 ± 0.5 ) days,( 3.7 ± 0.8 ) days and (7.5 ± 2.6) days,respectively.No perioperative mortality,anastomotic bleeding or anastomotic fistula was detected.One patient was complicated with pulmonary infection + pleural effusion and was cured by conservative treatment; 1 was complicated with anastomotic stenosis which was alleviated by gastroscopic balloon dilation; 1 was complicated by incisional infection and was cured by medical treatment after drainage.No cancer cells were detected at the anastomotic ring or resection margin of the specimen.There were 4 patients with well-differentiated adenoma,8 with moderate-differentiated adenoma and 9 with poor-differentiated mucinous adenoma.There were 5 patients in stage Ⅰ,10 in stage Ⅱ and 6 in stage Ⅲ (UICC staging).Twenty-one patients were followed up for a mean period of (11 ±4) months (range,6-17 months ),no tumor recurrence or metastasis was detected. Conclusions The new technique for anvil insertion is safe,effective and easy for manipulation and learn.It offers a new approach for laparoscopic digestive tract reconstruction.

Objective To compare the effects and significance of laparoscopic and open D2 gastrectomy on the expression of interleukin (IL)-6 and IL-10.Methods The clinical data of 146 patients with gastric cancer who were admitted to the Southwest Hospital from November 2010 to October 2011 were prospectively analyzed.All the patients were randomly divided into the laparoscopic group (75 patients) and open group (71 patients)according to the sealed envelope method.Laparoscopic or open D2 gastrectomy were performed according to the 14th edition of gastric cancer treatment guidelines of Japan Gastric Cancer Association.Peritoneal lavage fluid was collected at the beginning and the end of operation,and the concentrations of IL-6 and IL-10 in the peritoneal lavage fluid were detected by enzyme linked immunosorbent assay.The measurement data were analyzed using the t test,and the count data were analyzed using the chi-square test.Results The preoperative concentrations of IL-6 in the laparoscopic group and the open group were (34 ± 13)μg/L and (35 ± 12)μg/L,respectively,with no significant difference between the 2 groups (t =-5.110,P ＞ 0.05).The postoperative concentrations of IL-6 in the laparoscopic group and the open group were (4015 ± 1592)μg/L and (6724 ± 2112)μg/L,respectively.The postoperative concentration of IL-6 in the laparoscopic group was significantly lower than that of the open group (t =-8.367,P ＜ 0.05),and the postoperative concentrations of IL-6 were significantly higher than those before operation in the laparoscopic group and open group (t =-59.065,-87.123,P ＜0.05).The preoperative concentrations of IL-10 in the laparoscopic group and the open group were (43 ±9) μg/L and (42 ± 10) μL,respectively,with no significant difference between the 2 groups (t =1.190,P ＞0.05).The postoperative concentrations of IL-10 in the laparoscopic group and the open group were (92 ± 32)μg/L and (62 ± 23)μg/L,respectively.The postoperative concentration of IL-10 was significantly higher than that of the open group (t =6.408,P ＜ 0.05),and the postoperative concentrations of IL-10 were significantly higher than those before operation in the laparoscopic group and the open group (t =-12.680,-6.802,P ＜ 0.05).Conclusion Peritoneal inflammatory reaction is relatively lighter after laparoscopic D2 gastrectomy when compared with open D2 gastrectomy,which might prevent the peritoneal metastasis of gastric cancer mediated by IL-6.

With the development of instrumentation and surgical techniques,laparoscopic gastrectomy has become a promising surgical option for the treatment of gastric cancer.While laparoscopic gastrectomy is high technique-demanding,which hampered its popularization.Compared with traditional laparoscopes,Da Vinci surgical system has more special features,such as flexible robotic arms and three-dimensional imaging,which facilitates surgical procedures.A 58-year-old male patient with gastric cancer underwent Da Vinci surgical system-assisted radical total gastrectomy at the Southwest Hospital in March 2010.The mean operation time and blood loss were 270 minutes and 60 ml,respectively,and the number of dissected lymph nodes was 21.The short-term clinical effect was perfect without postoperative complications.Da Vinci surgical system-assisted radical total gastrectomy is safe and feasible,and it brings challenges to conventional laparoscopes.

Objective To investigate the relationship between the expression of eonnexin 43 (Cx43) and clinicopathologieal characteristics of gastric cancer, and to study the role of Cx43 in peritoneal metastasis of gastric cancer. Methods Thirty-two patients who had gastric cancer and with peritoneal metastasis had been admitted to Southwest Hospital from January 2000 to December 2008. Gastric cancer tissues, adjacent tissues and metastatic peritoneal tissues were obtained postoperatively, and the expression of Cx43 was detected by immunohistochemistry. The relationship between Cx43 expression and clinicopathological characteristics of gastric cancer was analyzed. All data were analyzed via Spearman rank correlation coefficient, Fisher exact probability and chi-square test. Results The expression of Cx43 was mainly detected in the cell membrane and cytoplasm. The positive expres-sion rates of Cx43 in gastric cancer tissues, adjacent tissues and metastatic peritoneal tissues were 34% (11/32), 100% (32/32) and 94% (30/32), respectively. There were significant differences in the Cx43 expression between gastric cancer tissues and adjacent tissues (X~2=28.350, P < 0.01), and between gastric cancer tissues and metastatic peritoneal tissues (X~2 = 21.989, P < 0.01). The expression of Cx43 did not correlate with age and sex of patients (r = -0.030, - 0.169, P > 0.05), but with tumor differentiation, histological type and lymph node metastasis (r = 0.750, 0.642, - 0.357, P < 0.05). Conclusions There is a decreased expression of Cx43 in gastric cancer tissues and a up-regulated expression of Cx43 in metastatic peritoneal tissues. Cx43 may play a positive role in the peritoneal metastasis.