Gallstone disease is highly prevalent in clinic,particularly in women and some specific ethnic groups.The formation of water-insoluble cholesterol crystals is due to a misbalance between the three major lipids present in the bile:cholesterol,bile salts,and phospholipids.Many proteins implicated in biliary lipid secretion in the liver are regulated by several transcription factors,including nuclear receptors LXR and FXR.Human and murine genetic,pathophysiological evidence is consistent with the relevance of these nuclear receptors in gallstone formation.In addition,there is emerging data that also suggests a role for estrogen receptor ESR1 in abnormal cholesterol metabolism leading to gallstone disease.A better comprehension of the role of nuclear receptor function in gallstone formation may help doctors to design new and more effective therapeutic strategies for this highly prevalent disease condition.

Objective To report the early mortality and associated risk factors after damage control operation (DCO) in patients with severe abdominal trauma.Methods A total of 146 patients hospitalized from January to March in 2015 were retrospectively analyzed.Early death was defined as death occurring within 72 h of first surgery and before the definitive surgery.Based on the death definition, the subjects were divided into death group and survival group.The two groups were compared for gender, age, injury time, injury classification, vital signs, need for cardiopulmonary resuscitation, Glasgow coma score (GCS), injury severity score (ISS), hemoglobin, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), blood pH, base excess, operative time, and postoperative acute physiology and chronic health evaluation score Ⅱ (APACHE Ⅱ).Logistic regression analysis was applied to examine the predicators of early postoperative mortality.Results There were 118 patients (80.8％) in survival group and 28 patients (19.2％) in death group.Survival and death groups differed significantly with regard to the percent of elderly (6.8％ vs.21.4％), percent of patients with multiple injury (62.7％ vs.85.7％), body temperature [(36.1 ± 0.4) vs.(35.2 ± 0.8) ℃], percent of patients with greater ISS (31.4％ vs.64.3％), PT [(12.1±1.5) vs.(13.9±1.2)s], bloodpH (7.25±0.04vs.7.08±0.11), base excess [(-8.9±2.8) vs.(-10.6±3.3)mmol/L], postoperative APACHE Ⅱ[(12.8 ± 1.8) vs.(17.5 ± 2.0) points] (P ＜ 0.05).Logistic regression analysis identified the age (OR=1.512, 95％ CI 1.112-4.157,P＜0.05), ISS (OR =1.313,95％ CI 1.134-5.442, P ＜ 0.05), APACHE Ⅱ (OR =1.361,95 ％ CI 1.182-5.222, P ＜ 0.05) as the independent risk factors for early mortality.Conclusion The patients underwent DCO for severe abdominal trauma has a high early mortality, which is closely associated with the age, injury severity and postoperative medical status.

Objective To study the causes of conversions to open surgery during laparoscopic cholecystectomy (LC). Methods We retrospectively analyzed clinical data of conversions to open surgery during LC in this hospital between April 1998 to March 2002. Results Of 1368 cases of LC, conversions were required in 60 cases, the rate of conversion being 4.39%. Reasons leading to conversions included: 17 cases of adhesion in abdominal cavity and Calot's triangle, 14 cases of acute cholecystitis or recovery period of acute cholecystitis, 2 cases of carcinoma of gallbladder, 5 cases of internal fistula of blie duct to intestinal tract, 2 cases of common bile duct stones, 6 cases of atrophic cholecystitis, 2 cases of bleeding, 2 cases of bile duct injuries, 2 cases of Mirrizi's syndrome, 1 case of biliary fistula, 1 case of xanthogranulomatous cholecystitis, and 6 cases of other reasons. Conclusions Conversions to open surgery during LC are chiefly due to the unclear exposure of Calot's triangle, as well as the inadequacy of skills and experience of surgeons.

Objective To evaluate the safety and therapeutic effects of laparoscopic-assisted resection of the right colon for right colon cancer.Methods Laparoscopy-assisted resection of the right colon was performed on 21 patients with right colon cancer.The separation of the mesentery,ligation of the mesenteric vessels,and lymphectomy were completed by laparoscopy.And the resection of the right colon and end-to end anastomosis of the residual bowels were performed through a small incision in the abdomen.Results The operation was completed in all the cases without conversion to open surgery.The operation time was 136-248 min(mean,153.6 min).The length from the upper and lower ends of the resected colon to the tumor was(10.8?3.6)and(10.2?3.5)cm respectively.A mean of 9.7?4.9 lymph nodes were resected.One patient developed infection of the incision,and was cured by debridement 3 months later.A mean of 19 months(range,3-36)follow-up was achieved in 17 of the patients.During this period,liver metastasis occurred in 2 patients(8 and 20 months respectively after the operation).No implantation at the incision or puncture site was found in this series.Conclusions Laparoscopic-assisted resection of the right colon is safe and feasible for patients with colon cancer.The outcome of this procedure is as good as that of open surgery.

Objective To investigate the efficacy of minimally invasive treatment by combination of external fixation with limited internal fixation for unstable distal radius fractures. Methods From September 2003 to September 2007,43 patients with unstable distal radius fractures were treated with external fixation combined with Kirschner wire fixation. According to AO classification,there were 10 cases of C1,21 cases of C2,and 12 cases of C3. Two external fixation clamp stand screws were inserted into the dorsal radius in operation,then external clamp stand was fixed when manipulative reduction were performed after C-arm perspective. The broken bones were sledged by Kirschner wire when articular facet and bone block were not peaceful and could not achieve reduction by traction. When the bone block was instable,a Kirschner wire fixation was needed. Bone graft through a limited incision were performed for bone defect if necessary. Results All of the 43 cases achieved anatomical reduction after the operation. The mean operaton time was 62.4 min (range from 43 to 121 min). And the mean intraoperative blood loss was 15.3 ml (ranged from 6 to 30 ml). The patients were discharged from hospital in 3 to 14 days with a mean of 5.5 days. After being discharged,they were followed up for 6 to 24 months (mean,12 months),during which,re-examination showed bone union and improved articular activities in all the cases. According to the Dienst scale system,30 patients achieved excellent,8 were good,and 5 were fair. The rate of excellent and good results was 88.4% (38/43). Conclusion External fixation combined with limited internal fixation is a simple,reliable and effective method for treatment of the unstable distal radius fractures.

50; 3 female patients had minor ISRS. Among all factors, female patients had higher incidence of ISRS than male (P=0.038); balloon-expanding after stenting and accompanying with other artherosclerosis of periphery vessel had correlation about ISRS (P=0.037, P=0.016). Conclusion The severe restenosis rate is acceptable. Female patients were more likely to have ISRS. Balloon-expanding maybe have effect on reducing incidence of ISRS and controlling artherosclerosis was helpful.

Objective To investigate the effect of imbedding chemotherapy of sustained release of 5-fluorouracil on the healing of colonic stoma in dog. Methods Twenty-eight adult hybrid dogs were randomly divided into chemotherapy group (n=22) and control group (n=6). The canine sigmoid colon were firstly detached and then anastomosed via median abdominal incision, 200 mg sustained release of 5-fluorouracil was imbedded in the mesentery 1.0-1.5 cm away from colonic stoma in chemotherapy group, whereas the control substance was injected into the dogs in control group. Tissue samples were collected from mesentery and stomas on 3, 5, 7, 10 and 15 days after operation, respectively, in order to observe the healing of stoma. The drug concentrations in the stoma and in the tissues that were 0, 1, 3, 5, 7, 10 and 15 cm away from the imbedding point were also measured by high performance liquid chromatography method at different phases. Results The tissues from colonic stoma only showed inflammatory reaction at early stage, with no necrosis and cellular degeneration. It was observed that the stoma healed basically on the tenth day after operation. The drug concentrations in the tissues gradually decreased at the range of 0-15 cm over time, but all of which were higher than the anti-tumor effective concentration (0.10 ?g/g). Conclusion The imbedding chemotherapy of sustained release of 5-fluorouracil in mesentery has little effect on the healing of stoma, and it could remain an effective anti-tumor concentration in a period of time.

Objective To investigate the p53 gene mutations in Chinese patients with epithelial skin cancers. Methods Biopsies of 22 squamous cell carcinoma(SCC)and 18 basal cell carcinoma(BCC)were analyzed by polymerase chain reaction denaturing gradient gel electrophoresis(PCR-DGGE) and DNA sequencing for alterations in the exons 5～8 of p53 tumor suppressor gene. Results p53 gene mutations were found in 32.5%(13/40)of tumor tissues and 92.3%(12/13) of the mutations occurred at sun exposed areas. 36.4%(8/22)of SCC tissues and 27.8%(5/18) of BCC tissues presented p53 gene mutations. Of the 13 mutations within the exons examined, 76.9%(10/13) were missense mutations and 23.1%(3/13) were nonsense mutations. Twelve of the 13 mutations were of single nucleotide substitutions. Six of the 13 mutations involved dipyrimidine sites, where a C was replaced by a T or CC was replaced by TT(five C→T transitions and one CC→TT transition). Conclusion Ultraviolet(UV) radiation might be related to the pathogenesis of skin cancer. Mutations of p53 gene caused by solar UV might play a significant role in UV tumorigenesis, although other carcinogens might also be involved.

Objective To discuss combined detection of pleural biopsy under medical thoracoscopy and pulmonary serum tumor markers in diagnosis of pleural effusion with unknown reason.Methods 76 patients with pleural effusion caused by unknown reason from January 2014 to March 2016 were retrospectively analyzed. Pleural biopsy was conducted under medical thoracoscopy and sent for pathological examination, and 10 ml venous blood was collected from these patients upon admission for testing serum tumor markers (CEA, SCC-AG, ProGRP and CYFRA21-1).Results Among the 76 patients, there were 32 cases with benign lesions (14 with pulmonary tuberculosis, 9 with inlfammatory lesions, 6 with granulomatous inlfammation, 2 with empyema and 1 with hamartoma) and 44 cases with malignant lesions (18 with adenocarcinoma, 13 with squamous carcinoma, 6 with small cell lung cancer, 3 with adeno-squamous carcinoma, 2 with mesothelioma, 1 with large cell carcinoma and 1 with thymoma). The detection of serum tumor markers showed statistically significant differences in the levels of CEA, SCC-AG, ProGRP and CYFRA21-1 in serum between the malignant pleural effusion group and benign pleural effusion group (P = 0.021,P = 0.006,P = 0.003 andP = 0.010). The levels of various serum tumor markers in the malignant pleural effusion group were obviously higher than those in the benign pleural effusion group. According to the pathological results, patients with pleural effusions not caused by lung cancer (2 with mesothelioma and 1 with thymoma) were eliminated from 44 patients with malignant pleural effusions. The rest 41 patients with pleural effusions caused by lung cancer were divided into non-small cell lung cancer and small cell lung cancer according to the pathological types. The results showed that there were statistically signiifcant differences in the levels of CEA, ProGRP and CYFRA21-1 between non-small cell lung cancer and small cell lung cancer (P = 0.036,P = 0.005 andP = 0.008), while there was no statistically signiifcant difference in the level of SCC-AG (P = 0.811).Conclusions Due to high detection rate and high accuracy in detecting pleural effusions caused by unknown reason, medical thoracoscopy is of great signiifcance, especially for the diagnosis of malignant pleural effusions of pleural metastases. However, serum indicators may provide important reference values for us before the pathological results are available. Thus, it is an important means of diagnosing malignant pleural effusions caused by lung cancer and should be promoted in clinic.

Objective To compare the effect of enteral nutrition by jejunum colostomy nutrition infusion pump of patients after Whipple surgery as well as reduce adverse reactions in patients.Methods Sixty-five cases with the implementation of Whipple and jejunum of colostomy were selected as our subjects,who were hospitalized in the Affiliated hospital of Hebei United University from Feb.2009 to Nov.2013.All patients were divided into observation group (33 cases) and control group (32 cases) according to the methods of nutrient input.Patients in observation group were given nutrition infusion pump pumping (15 to 50 ml/h) ;and patients in control group were adopted disposable infusion connection infusion with the speed of 30 drops/min with the thermostat heating temperature and the water pipe.The blood glucose,serum albumin,blood electrolyte concentration of postoperative,and the adverse reactions during input nutrient solution including vomiting,abdominal distention,diarrhea and other adverse circumstance were recorded.Results At 1st,3rd,5th day,there was no statistically significant difference in terms of the levels of glucose,blood albumin,blood C1,Na +,K + between two groups(blood glucose:F inner grouP =3.01,P ＞ 0.05 ; F between group =2.90,P ＞ 0.05 ; F cross group =2.87,P ＞ 0.05 ; serum albumin:F inner group =2.94,P ＞ 0.05 ; F between group =2.89,P ＞ 0.05 ; F cross group =2.76,P ＞ 0.05 ; blood Cl:F inner group =1.78,P ＞ 0.05 ; F between group =1.96,P ＞ 0.05 ; F cross group =1.88,P ＞ 0.05 ; blood Na +:F inner group =1.06,P ＞ 0.05 ; F between group =1.35,P ＞ 0.05 ; F cross group =1.27,P ＞ 0.05 ; blood K +:F inner group =3.12,P ＞ 0.05 ; F between group =3.04,P ＞ 0.05 ; F cross group =2.93,P ＞ 0.05).There were significant differences regarding of the rate of vomiting,abdominal distention,diarrhea and other adverse conditions compared with the infusion enteral nutrition has good clinical effect,postoperative blood (x2 =4.029,4.381,4.905 respectively; P ＜ 0.05).Conclusion The methods of colostomy enteral nutrition with infusion pump after Whipple surgery is proved to be with the better clinical effect in reducing postoperative vomiting,abdominal distention,diarrhea and other adverse conditions compared with the infusion enteral nutrition,and there are no significant difference in the terms of the levels of glucose,blood albumin,blood Cl,Na +,K +.