Objective To investigate the surgical management of unsuspected gallbladder carcinoma (UGC) after laparoscopic cholecystectomy ( LC ). Method The clinical data of 11 cases of UGC incidently found after LC from October 2003 to August 2009 were retrospectively analyzed. Results According to Nevin staging, 2 cases were stage Ⅰ , 6 cases were stage Ⅱ , 2 cases were stage Ⅲ and 1 case was stage Ⅳ.Four cases were treated by LC,including 2 cases with stage Ⅰ and 2 cases with stage Ⅱ ;another 7 cases were treated by radical resection after LC. All patients were followed up for 1-66 months after operation, 2 cases with stage Ⅰ were observed alive up; 2 cases with stage Ⅱ treated by LC died less than 3 years after operation, 3 of the 4 cases with stage Ⅱ treated by radical resection were alive up, only 1 died in 21 months after operation; 2 cases with stage Ⅲ died in 8 months and 10 months respectively, 1 case with stage Ⅳ died in 1 month after operation. Conclusions It is difficult to diagnose the UGC preoperatively. LC is sufficient for patients with Nevin stage Ⅰ , radical resection after LC is required for patients with stage Ⅱ or more advanced stage. If tumors are located in the neck of gallbladder, radical resection is required regardless of their stage.

Objective: To study the chemical constituents from Selaginella doederleinii and their bioactivities. Methods: Column chromatography on silica gel, RP-C18, and Sephadex LH-20 columns was used to separate and purify the chemical constituents. The structures were elucidated by physicochemical properties and spectroscopic analyses. The inhibition of EtOAc fraction on the tumor cells was tested in vivo and in vitro. Results: Eleven compounds were obtained from EtOAc fraction and identified as flavonoids and phenolic acids. These compounds were asamentoflavone (1), robustafavone 4'-methyl ether (2), 5, 5″, 7, 7″, 4', 4‴-hexahydroxy-(2', 8″)-biflavone (3), 7, 4', 7″, 4‴-tetra-O-amentoflavone (4), 5, 5″, 7, 7″, 4', 4‴-hexahydroxy-(2', 6″)-biflavone (5), ginkgetin (6), isoginkgetin (7), quercetin-3-O-α-D-arabinfuranosi (8), nobiletin (9), gallic acid (10), and shikimic acid (11). Two alkaloids, berberine (12) and palmatine (13) were obtained from n-BuOH fraction. The bioassays indicated that EtOAc fraction could inhibit the growth of HeLa and HepG2 in vitro with IC50 values of 0.12 and 0.60 mg/mL, respectively. The tumor-inhibition rate in S180-bearing mice was 43%. Conclusion: Compound 5 is a new natural product, and compounds 3, 6-10, 12, and 13 are isolated from the plant for the first time.

Objective To compare different incidence between lateral position and horizontal position in the Burr holes irrigation drainage(BHID).The BHID is wildly known as the most frequently used neurosurgical treatment of chronic subdural hematoma(CSDH).Methods A total of 80 cases were selected which were undergone BHID during January 2010 and December 2015,and the incidence of intracranial pneumatocele was compared after operation.All of cases came from the Second People′s Hospital of Tai Zhou City.Results There were 5 cases(out of 50,10%)having moderate intracranial pneumocephalus but no numerous intracranial pneumocephalus in lateral position,while 26 cases(out of 30 cases,87%)in horizontal position emerging moderate amount or more intracranial pneumatocele.And there were 8 cases'numerous pneumatocele in the horizontal postion group.There was no tension pneumothorax emerging in both groups.Both groups had statistical difference (χ2 =46.43,P <0.01.Conclusion BHID in lateral postion is a simple and effective method for CSDH,and it is conducive to reduce postoperative intracranial pneumatosis.That is worthy of application and promotion.

Objectives To evaluate the impact of virtual hepatectomy and computer-assisted risk analysis on surgical planning and intraoperative strategy for major hepatectomy.Methods Twentytwo consecutive patients (17 males and 5 females) were admitted to the hospital from January to December in 2010 for complicated major hepatectomy.CT scanning was performed with 64-MSCT.All the data of imaging were transferred to the Myrian(R) XP-Liver system (IntrasenseR,France).The following steps were undertaken by a radiologist and a surgeon majoring in liver surgery: step 1,image analysis and 3-D reconstruction; step 2,virtual resection and liver volumetry; step 3,computer-assisted risk analysis for hepatic dysfunction,followed by adjustment of the operative planning.Results The three-dimensional reconstruction models of the liver by the Myrian(R) XP-Liver system were visualized.The ideal simulation effect was achieved comparing the virtual imaging with the actual operation.Of the 22 patients who underwent complicated major hepatectomy,complete tumor removal (R0 resection) was achieved in 20 patients.There were 2 patients who received a R1 resection as microscopic tumor cells were found at the cutting margin of the right portal vein and bile duct.No patient died during the hospital stay.After computer-assisted risk analysis,the operative planning and surgical strategies were changed in 6 patients.Conclusions The application of the hepatic three-dimensional reconstruction and virtual hepatectomy using the Myrian(R) XP-Liver system provided important preoperative data for good preoperative planning and intraoperative strategy in complex hepatectomy.

Objective To investigate the risk factors of hepatitis B virus (HBV) reactivation after microwave ablation (MWA) and its prevention.Methods 72 patients who met the inclusion criteria were enrolled into the study.30 patients were in the control group and 42 patients in the prophylactic antivirus group.Results 8.3％ (6/72) patients developed HBV reactivation.A high HBV DNA load and no prophylactic antivirus therapy were independent risk factors of viral reactivation.Conclusion Prophylactic antivirus therapy can prevent HBV reactivation.

OBJECTIVES: There is less clinical data on multiple myeloma (MM) in China, and the aim of this study was to collect and analyze the clinical data of newly diagnosed multiple myeloma (NDMM) patients in Hunan Province during 1 year, to understand the real clinical features and treatment outcome for Hunan Province patients with MM, and to strengthen the understanding of the standardized diagnosis process and treatment plan of MM. METHODS: The clinical data of 529 patients with NDMM in 12 large-scale general hospitals in Hunan Province from January 1 to December 31, 2019 were collected and analyzed, including baseline data, treatment regimens, duration of treatment, and adverse reactions. The clinical characteristics, treatment, and safety of patients were analyzed by SPSS 21.0. RESULTS: Among the 529 NDMM patients, the age was 33-90 (median 64) years and the male-female ratio was 1.38꞉1. The clinical features ranged from high to low were as follows: Bone pain (77.7%), anemia (66.8%), renal insufficiency (40.6%), hypercalcemia (15.1%). Typing: IgG 46.5%, IgA 24.6%, IgD 2.6%, IgM 0.8%, light chain 15.7%, double clone 3.0%, no secretion 0.6%, absence 6.2%. Staging: Durie-Salmon stage I, II, and III were 4.5%, 10.6%, 77.3%, respectively, and 40 cases (7.6%) missed this data. International Staging System (ISS) stage I, II, and III were 10.4%, 24.4%, and 47.6%, respectively, and 93 cases (17.6%) were missing. Revised International Staging System (R-ISS) stage I, II, and III were 5.5%, 27.0%, 23.1%, respectively, and 235 cases (44.4%) missed this data. Among the 98 NDMM patients in the Third Xiangya Hospital, Central South University, Durie-Salmon (DS) stage missing 2.0%, ISS stage missing 12.3%, and R-ISS stage missing 12.3%.Treatment: Among the 529 patients,475 received treatment, the rate of treatment was 89.8%; 67.4% of the patients were able to complete four courses of chemotherapy at induction phase, 90.3% of the patients received proteasome inhibitor based combination chemotherapy regimen more than once, 67.2% received immunomodulator based regimen more than once, and 59.8% of the patients received proteasome inhibitor and immunomodulator based combination chemotherapy regimen more than once. Curative: Overall response rate (ORR) and high quality response rate (HQR) of the 4-course group were better than those of the 2-course group (ORR: 85% vs 65%, P=0.006; HQR: 68.3% vs 24.0%, P<0.001). The HQR of the standard chemotherapy group was better than that of the non-standard chemotherapy group (65.1% vs 48.2%, P=0.035). Adverse reactions during treatment included hematologic toxicity (17.5%), peripheral neuropathy (24.8%), gastrointestinal adverse events (23.8%), pulmonary infection (25.9%), herpes zoster (4.6%), and venous thrombotic events (1.7%). CONCLUSIONS In 2019, the missed diagnosis rate of MM patients was high, the medium age of diagnosis was older, and the accuracy of patient diagnosis was not high. There is a great difference among medical centers, especially in the stage and risk stratified, nearly half of NDMM patients are not diagnosed with R-ISS stage; the lack of cytogenetic data needs to be supplemented by follow-up studies. A high proportion of patients with NDMM present with bone pain and anemia.Patients received treatment have higher use of chemotherapy regimens containing proteasome inhibitors and/or immunomodulators, but there is a significant gap among different medical centers, and standardized treatment needs to be strengthened. The safety during chemotherapy is controllable.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Female ; Humans ; Immunologic Factors/therapeutic use* ; Male ; Middle Aged ; Multiple Myeloma/therapy* ; Neoplasm Staging ; Pain ; Prognosis ; Proteasome Inhibitors/therapeutic use*