Objective To determine the most appropriate method in the treatment of choledocholithiasis. Methods The clinical data of 135 patients who received either laparoscopic common bile duct exploration (LCBDE) or laparoscopic transcystic common bile duct exploration (TC-BDE) from May 2005 to July 2009 were retrospectively studied. Results All patients were cured of choledocholithiasis. In 13 patients three trocars were used, in 89 patients four trocars were used, and in 33 patients conversion to open operation was done. Of the 102 patients in whom minimal invasive surgery was successfully carried out, TC-BDE was done in 6 patients and LCBDE in 96 patients. Primary closure of common bile duct (CBD) was carried out in 33 patients while T-tube drainage was done in 63 patients. Six patients had a transient bile leak which healed spontaneously in 3 to 4 days. Retained stone was detected in 2 patients which was successfully retrieved through choledochoscopy. Conclusion An individualized treatment approach is the most reasonable way to manage CBD stones. The choice of the procedure depends on the number and size of stones, the surgeons experience and the patient's choice.

More than 20 studies published during the past 10 years concerning preoperative radiotherapy in rectal cancer were reviewed carefully. And we evaluated the role of IMRT being routinely used in preoperative treatment of rectal cancer.

The delineation of clinical target volume (CTV) is a critical step in planning conformal radiotherapy for rectal cancer.Several guidelines suggest different subvolumes and anatomical boundaries in radiotherapy for rectal cancer, potentially leading to a misunderstanding of CTV definition.This article reviews recent advances in the delineation of CTV in radiotherapy for rectal cancer.

Objective To investigate the changes of pathogens distribution and antimicrobial resistance in children with urinary tract infection (UTI) in 10 years. Methods The results of urine culture and drug sensitivity in children with UTI from January 2001 to December 2003, and from January 2011 to December 2013 were retrospectively analyzed.Results In recent 10 years, there was no obvious change in the ratio of gram-negative bacteria to gram-positive bacteria. Escherichia coli was still the main bacteria causing UTI in children. The detection rate of enterococcus was signiifcantly increased from 18.3%in 2011-2013 to 7.5%in 2001-2003 (P<0.05) and it had become the second pathogenic bacteria. The isolation rate of ESBLs producing strains was signiifcantly higher in 2011-2013 than in 2001-2003 (P<0.05). The rate of Escherichia coli sensitive to imipenem re-mained at 100%and it is also sensitive to enzyme inhibitors antibiotics and nitrofuranto. Sensitivities to antibiotics were changed in different species of enterococcus. Conclusions The distribution of pathogens and antimicrobial resistance in children with UTI are constantly changing. The clinician should pay close attention to changes of epidemiology in the region and hospital and rational use of antimicrobial drugs.

Objective To evaluate the uncertainty of the small bowel dose?volume and the normal tissue complication probability (NTCP) during intensity?modulated radiotherapy (IMRT) for rectal cancer, and to provide a reference for the dose limit and protection of the small bowel during IMRT for rectal cancer. Methods A total of 20 patients with rectal cancer who received postoperative adjuvant radiotherapy from March 2014 to August 2015 were enrolled in this study, including 10 patients receiving CT scan in the supine position and 10 patients in the prone position. All patients received computed tomography ( CT) scan before the treatment and at weeks 1, 2, 3, and 4 of treatment, and they were defined as Plan, 1W, 2W, 3W, and 4W CT groups, respectively. The small bowel loop ( BL ) and peritoneal space ( PS ) were delineated on the images. The IMRT plan based on the Plan CT was copied to the 1W, 2W, 3W, and 4W CT groups, and then the small bowel dose?volume and NTCP were assessed for all CT groups. The paired t?test was used for comparison between groups. The Pearson method was used to analyze the correlation between NTCPC(chronic NTCP) and dose?volume. Results A total of 89 CT images of 20 patients were obtained. In all the patients, the volumes of BL and PS were 25121 cm3 and 132416 cm3 , respectively, and the shift% was 2315% and 1134%, respectively. The V15 of BL and PS was 18486 cm3 and 79245 cm3 , respectively, and the shift% was 3169% and 370%, respectively. The V30 of BL and PS was 8801 cm3 and 64573 cm3 , respectively, and the shift% was 3766% and 1049%, respectively. The V15 of BL in 35% of patients and V15 of PS in 20% of patients, the Dmax of BL in 50% of patients, and the NTCP of 15% of patients in the course of treatment exceeded the safety limits. The 1?4W CT groups had a significantly higher NTCPC than the Plan CT group (402% vs. 320%, P=0104), and their SD% was 4168%. There was a significant correlation between NTCPC and V30?V50 of BL (R>0400, P=0000). The NTCPA ( acute NTCP ) and NTCP C in the supine position were significantly higher than those in the prone position ( 6230% vs. 5674%, P=0061;488% vs. 322%, P=0145 ) . Conclusions Small bowel motility leads to an uncertainty of the adverse event assessment during IMRT for rectal cancer. The change in BL is significantly larger than that in PS and the change in BL and PS in the supine position is significantly larger than that in the prone position. Using the prone position and minimizing V15 and V30 when designing the treatment plan can reduce the NTCP A and NTCP C in the small bowel.

Objective To evaluate contrast-enhanced ultrasound (CEUS) for the diagnosis and follow-up of hepatocellular carcinoma ( HCC) patients after percutaneous radiofrequence ablation ( RFA). Methods The data of 46 HCC cases were reviewed in our study. Results of contrast enhanced computed tomography (CT) , ultrasound contrast agent sonography and grey ultrasound were compared with each other pre- and after percutaneous radiofrequence ablation. Results Contrast agent ultrasound imaging had the same value with CT in preoperative diagnosis of HCC, with postive likelihood ratio of 1.26 and 1.31, respectively,sensitivity of 97% and 91% and specificity of 23% and 31% respectively. For grey ultrasound the positive likelihood ratio was 0.99, sensitivity and specificity was 76% and 23% respectively. The sensitivity and specificity of contrast-enhanced ultrasound after percutaneous radiofrequence ablation was 60% and 90% respectively, and the postive likelihood ratio and negative likelihood ratio was 6. 18 and 0. 44 respectively. The difference was significant while compared with CT (P = 0. 012). All cases were followed-up from 1 to 9 months, and all were alive with recurrence found by contrast-enhanced ultrasound in 3 cases. Conclusions Contrast agent ultrasound imaging is sensitive and effective in the diagnosis of HCC and follow-up after percutaneous radiofrequence ablation.

Objective To study serum IL-22 levels in patients with pulmonary tuberculosis and diabetes mellitus (PPTDM) and to analysis their clinical significance.Methods ELISA was used to detect serum IL-22 levels in 30 cases PPTDM pa-tients,30 cases pulmonary tuberculosis (PTB)patients,30 cases diabetes mellitus (DM)patients and 30 cases healthy vol-unteers (HV).Results Serum IL-22 levels of PPTDM patients (54.4±4.81 pg/ml)were significantly lower than those in diabetes mellitus (DM)patients (72.36±5.12 pg/ml)and healthy volunteers (HV)(68.32±3.08 pg/ml)(t=2.557,P =0.013;t=2.437,P =0.018),respectively.There was no significantly different of serum IL-22 levels between PPTDM and PTB patients (t=1.190,P =0.239).Serum IL-22 levels of diabetes mellitus coincident with pulmonary tuberculosis (DM-PTB)patients (64.62±8.59 pg/ml)were significantly higher than those in pulmonary tuberculosis coincident with diabetes mellitus (PTB-DM)patients (44.21±2.68 pg/ml)(t=2.267,P =0.031).Conclusion IL-22 may play an important role in PPTDM development.

Objective To explore the efficacy and prognostic factors of postoperative intensity?modulated radiotherapy ( IMRT) with or without chemotherapy in rectal cancer. Methods A retrospective analysis was performed on the clinical data of 218 patients with rectal cancer, who underwent postoperative IMRT in our hospital from January 2009 to December 2013. The Kaplan?Meier method was used to calculate survival rate;the log?rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The follow?up rate was 97. 7%. The 1?and 3?year overall survival rates were 90. 8% and 75. 2%, respectively, the 1?and 3?year disease?free survival rates were 85. 3% and 70. 5%, respectively, and the 1?and 3?year locoregional recurrence?free survival rates were 96. 7% and 88. 1%, respectively. The incidence of grade 3?4 acute adverse reactions was 28. 4%, mainly manifested as leukopenia ( 13. 8%) and diarrhea ( 11. 0%) . Univariate prognostic analysis showed that preoperative carcinoembryonic antigen ( CEA) and CA199 levels, maximum tumor diameter, tumor location, degree of differentiation, depth of tumor invasion, number of lymph node metastases, TNM stage, perineural invasion, surgical procedure, total mesorectal excision, preoperative bowel obstruction, and preoperative anemia were the predictors of survival ( P=0. 006, 0. 000, 0. 000, 0. 017, 0. 000, 0. 016, 0. 000,0. 011,0. 001,0. 006,0. 037 and 0. 010) . Multivariate prognostic analysis showed that preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction, and preoperative anemia were the predictors of survival ( P=0. 000,0. 000,0. 000,0. 001 and 0. 001) . Conclusions Postoperative IMRT with or without chemotherapy is an effective method for rectal cancer with mild adverse reactions and high compliance. Preoperative CEA level, tumor position, TNM stage, preoperative bowel obstruction, and preoperative anemia are independent prognostic factors for the overall survival.

Objective To compare the dose volume and normal tissue complication probability (NTCP) of small intestine between intensity-modulated radiotherapy (IMRT) with dose constraints to the peritoneal space (PS) and the bowel loop (BL) in the treatment of rectal cancer,and to investigate the feasibility of placing a dose constraint to the PS instead of the BL in protection of the small intestine.Methods A total of 24 patients with rectal cancer undergoing postoperative adjuvant radiotherapy were enrolled as subjects.In the 24 patients,12 were treated in supine position an.d 12 in prone position.The weekly computed tomography (CT) scans from pre-treatment to weeks 1-4 of treatment were defined as Plan,1 W,2 W,3 W,and 4 W.Contours of PS and BL were delineated on all CT images.Based on the Plan CT images,two IMRT plans,PPS and PBL,were designed with dose constraints to the PS and BL,respectively.The method was applied to 1-4 W CT images.For each CT scan,the dose volume and NTCP of the small intestine were evaluated in PPs and PBL.Results A total of 109 sets of CT images were acquired from 24 patients,and 218 plans were designed and copied.The median volume of the PS and BL was 1339.28 and 250.27 cm3,respectively.For the Plan CT scans,V15 values of the PS in PPs plan and the BL in PBL plan were 918.96 and 199.57 em3,respectively.For all CT scans,the dose volume of the small intestine in PPs,in most cases,was lower than that in PBL,while V15 values in Ps and PBL were 170.07 and 178.58 cm3 (P=0.000).The dose volume of the small intestine was correlated with V15 (P=0.000).PPs had significantly lower NTCP of chronic and acute adverse reactions than PBL(2.80％ vs.3.00％,P=0.018;57.32％ vs.58.64％,P=0.000).In patients with prone and supine treatment positions,most of the dose volume and NTCP of the small intestine in Ps were significantly lower than those in PBL(P＜0.05 for V10,V15,V30,and NTCP of acute adverse reactions).Conclusions It is feasible to place a dose constraint to the PS instead of the BL for protection of the small intestine during IMRT for rectal cancer.V15＜830 cm3 can be referred to as the objective function of dose restraint.

Objective:To investigate and analyze the current status of multimodality therapy for resectable gastric cancer, aiming to provide reference for optimizing the multimodality treatment strategy for gastric cancer.Methods:Clinical data of patients diagnosed with gastric adenocarcinoma undergoing radical gastrectomy in the Second Affiliated Hospital of Soochow University were retrospectively analyzed. Clinical characteristics, preoperative medical comorbidities, pathological features, surgical and perioperative status and clinical efficacy were recorded. The gap between the diagnosis and treatment procedures and the standard guidelines was analyzed. The changes in the multimodality treatment patterns for gastric cancer were understood.Results:A total of 265 patients were included in this study. All patients were divided into two cohorts: early[2008] and late[2013] cohorts. In the early cohort, 127 patients were assigned, and 138 cases in the late cohort. In the early cohort, 67 patients (52.8%) underwent D 2 lymph node dissection, significantly less than 83 patients (60.1%) in the late cohort ( P<0.01). In the early and late cohorts, the proportion of patients with the number of lymph node dissection of ≥15 was 5.5% and 52.8%( P<0.01). The median number of lymph node dissection was increased from 6 to 16. The proportion of patients receiving neoadjuvant chemotherapy in the early and late cohorts was 2.4% and 3.6%( P=0.55). In the early cohort, the proportion of patients treated with postoperative chemotherapy and postoperative adjuvant chemoradiotherapy was 62.6% and 2.4%, significantly higher compared with 58.0% and 8.0% in the late cohort ( P=0.04). In addition, the proportion of patients receiving postoperative chemotherapy in the early cohort was 62.2%( n=79) and 58.0%( n=80) in the late cohort ( P=0.48). Conclusions:Although the level of radical gastrectomy has been continuously improved and standardized in China, which still lags behind the standard D 2 radical gastrectomy in Japan and South Korea. Adjuvant therapies including postoperative adjuvant radiotherapy can bring clinical benefits. However, the proportion of patients receiving adjuvant therapy is still low, and the multimodality therapy of gastric cancer should be widely applied.