Primary gallbladder cancer is a relatively common biliarv malignant tumor but with a high mortality rate.Most patients with this disease reach an advanced stage when late onset symptoms occtur, and the prognosis tends to be poor even after radical operation.Searching for new diagnostic approaches of primary gallbladder, standardizing treatment strategy, conducting multieenter clinical trials of new drug, developing preventive measures according to different situations are significant methodls to improve the treatment effect prognosis.In this article, we reviewed the research progress of high risk factors, diagnostics, and treatment strategies of primary gallbladder cancer.

Objective To investigate the role of glucocorticoid-induced tumor necrosis factor ligand (GITRL) in regulating the inflammatory reaction of kupffer cells.Methods The kupffer cells and T cells of mice were isolated and divided into 6 groups after being co-cultured:control group,kupffer cells and T cells were cultured in DMEM only; lipopolysaccharide (LPS) group,kupffer cells and T cells were cultured in media with LPS (1 mg/L) ; LPS + GITRL siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with GITRL siRNA ; LPS + control siRNA group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control siRNA; LPS + pEGFP-N1 GITRL group,kupffer cells and T cells were cultured in media as the LPS group after transfected with pEGFP-N1 GITRL plasmid; LPS + pEGFP-N1 control group,kupffer cells and T cells were cultured in media as the LPS group after transfected with control plasmid.After 24 hours of treatment,the expressions of GITRL and PDL1 of kupffer cells were detected by immunofluorescence and western blot,respectively.The proliferation and apoptosis of T cells were measured by MTF assay and Annexin V/PI flow cytometry,respectively.The expression of tumor necrosis factor (TNF-α) in the supernatant fluid was measured by ELISA.All data were analyzed using the independent t test and one-way analysis of variance.Results The transfection efficiencies of GITRL siRNA and pEGFP-N1 GITRL were 90％ and 85％,respectively.Compared with normal kupffer cells,the protein expression of GITRL of kupffer cells transfected with GITRL siRNA was significantly decreased,while the protein expression of GITRL of kupffer cells transfected with pEGFP-N1 GITRL was significantly increased (t =41.72,13.10,P ＜ 0.05).There was no significant difference in the protein expressions of GITRL between normal kupffer cells and those in the control groups (F =2.27,P ＞ 0.05).The fluorescence intensity of GITRL in the LPS group was significantly higher than that in the control group (t =49.29,P ＜ 0.05).Compared with LPS group,the activation of GITRL expression by the LPS was significantly suppressed in the LPS + GITRL siRNA group (t =9.84,P ＜ 0.05),while the expression of GITRL in the LPS + pEGFP-N1 GITRL group was significantly increased (t =5.78,P ＜ 0.05).There was no significant difference in the GITRL expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.86,P ＞ 0.05).The expression of PDL1 in the LPS group was significantly lower than that in the control group (t =18.83,P ＜0.05).Compared with LPS group,the expression of PDL1 in the LPS + pEGFP-N1 GITRL group was significantly suppressed (t =11.79,P ＜ 0.05),while the expression of PDL1 in the LPS + GITRL siRNA group was significantly stronger (t =19.08,P ＜ 0.05).There was no significantly difference in the expression of PDL1 in the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =2.22,P ＞ 0.05).The proliferation of T cells was increased and the number of apoptotic T cell was decreased in the LPS group when compared with control group (t =49.43,40.11,P ＜ 0.05).Compared with LPS group,the proliferation and apoptosis of T cells in the LPS + pEGFP-N1 GITRL group had the same trend (t =5.77,12.64,P ＜0.05); while the proliferation of T cells was decreased and the apoptosis of T cells was increased in the LPS + GITRL siRNA group (t =17.00,49.90,P ＜ 0.05).There was no significant difference in the proliferation and apoptosis of T cells among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =1.87,1.35,P ＞ 0.05).The expression of TNF-α was significantly higher in the LPS group than that in the control group (t =125.68,P ＜ 0.05).Compared with the LPS group,the expression of TNF-α was significantly decreased in the LPS + GITRL siRNA group (t =119.65,P ＜ 0.05),while the expression of TNF-α in the LPS + pEGFP-N1 GITRL group was significantly increased (t =147.70,P ＜ 0.05).There was no significant difference in the TNF-α expression among the LPS + control siRNA group,LPS + pEGFP-N1 control group and LPS group (F =0.14,P ＞ 0.05).Conclusion Kupffer cells suppress the expression of PDL1 by upregulating GITRL,and thus activate the proliferation of T cells and promote the inflammatory reaction.The immunologic balance may be recovered after the interference of GITRL to restrain the inflammatory reaction.

S-adenosylmethionine(SAM) is a physiologically active molecule in all the organizations and the human body fluids, and it is important to participate in a variety of biochemical reactions, the regulation of liver regeneration, liver cells differentiation and various sensitivity of the injury. The SAM affects the liver through a variety of ways. It is confirmed that the SAM and MTA can block the LPS-induced TNF-α of Kupffer cells to protect the liver. In a word, S-adenosylmethionine may be beneficial to LPS-induced liver in-jury in clinical treatment.

Primary hepatic carcinoma is one of the common digestive tract tumors.Surgical operation in clinic is still the most effective way to treat it so far.The caudate lobe has often been considered the forbidden zone of hepatic operation in the past due to complicated anatomy.In resent years,with the deepening of knowledge of anatomy and advanced radiological technology,many new operative approachs and operation methods have been explored to improve the situation of caudate lobectomy which is already not rare in clinic now.This article summarized the anatomy of caudate lobe and reviewed the therapy progress of the hepatic carcinomas located caudate lobe.

Objective To study the protective mechanism of S-adenosylmethionine ( SAM) underlying liver injury induced by lipopolysaccharides ( LPS). Methods One hundred BABL/c mice were randomly divided into LPS group and SAM group. Mice in LPS group were intraperitoneally injected with 10 mg/kg LPS,and the mice in SAM group were injected with 100 mg/kg SAM 2 h before receiving the same dose of LPS. The survival rate of mice in 2 groups was recorded in 24,48,72 and 120 h after LPS injection. Histopathological changes in liver of mice were examined in 0,1,3,6,12 and 24 h after LPS injection. Tumor necrosis factor-? ( TNF-?) and interleukin-10 ( IL-10) levels in serum were measured by ELISA analysis at above time points. Expression of Toll-like receptor 4 ( TLR4) and liver X receptor ? ( LXR?) in hepatic tissues was detected by immunohistochemistry and Western blotting. Results SAM increased the survival rate of mice from 50. 0% ,40. 0% ,30. 0% ,and 30. 0% before LPS injection to 80. 0% ,70. 0% ,60. 0% ,and 50. 0% after its injection ( P

Acute pancreatitis (AP) is activated trypsin-induced pancreatic and its peripheral tissue inflammation caused by their own digestion.The activation in advance of trypsinogen and the inflammation cascade in pancreatic acinar cells are thought to be a key mechanism of the onset and development of AP.Autophagy pathway acting as Ⅱ type of programmed cell death occurs in the early pathological course of AP,blockade of which contributes to aggravating necrosis of acinar cells in AP.This article mainly discussed the recent advances in the understanding of autophagy researches and its function in the mechanism of AP.

Objective To discuss the application about the TPDS educational reform of molecular biology in the medical students. Methods Choose 2009 and 2010 7-year program students (174 person) of clinical medicine as the research object, achieve to TPDS teaching; Control group ( 2010 basic medicine and general medicine students , 2011 basic medicine and pediatric medical students (394 person) carry out general teaching model. Taking the students test scores as the main teaching effect evaluation index, the questionnaire survey as the supplement. Statistical analysis was carried out using t test analysis method. Results Molecular biology of the experimental group students scores (94.39 ±4.34)are significantly higher than that of the control group (85.1 ±8.77), and P<0.05. The questionnaire showed that more than 80%students improved themselves in the areas of self-study ability, information collecting ability, problem-solving ability, and team cooperation abilityafter the course of study. Conclusion TPDS educational reform isoptional for the cultivating applied talents, intend to stimulate students' autonomous learning ability, inspire students to independent analysis and solve problems, improve students' unity cooperation spirit and model the humanistic spirit.

Splenectomy for patients with cirrhosis has been well established.However,many issues in relation to postoperative management of these patients remain to be elucidated,mainly including reasons for portal vein thrombosis and anticoagulant use.In light of recent progresses on this topic,the current review summaries and pinpoints influencing factors of portal vein thrombosis,anticoagulant selection and corresponding rationales,monitor measures for anticoagulation,and treatment schemes for bleeding induced by anticoagulation.Our review focuses on issues associated with the selection and withdrawal time of anticoagulant.We conclude that patients undergoing splenectomy can benefit from postoperative anticoagulation,including enhanced postoperative recovery and decreasing incidence of postoperative complications.

Objective To compare the current therapeutic effects between endovenous radiofrequency treatment and conventional surgery for lower limb chronic venous insufficiency (CVI) ,and summarize operative skills and clinical value of endovenous radiofreq uency treatment on CVI .Methods Data of 45 limbs of 41 patients treated by endovenous radiofrequency treatment (endovenous ra-diofrequencytreatmentgroup)and20limbsof20patientsbytraditionalsurgery(traditionalsurgerygroup)wereanalyzedandcom-pared in terms of operation time ,postoperative pain ,postoperative hospitalized duration ,complications ,and one-year recurrence rate .Results Endovenous radiofrequency treatment group had less postoperative pain and shorter postoperarive hospitalized dura-tion than traditional surgery group(P<0 .05) .The operation time had no significant differences between two groups (P>0 .05) . The two groups had few complications and had no recurrence in one year .Conclusion As a minimally invasive treatment for vari-cose veins ,endovenous radiofrequency treatment has less trauma ,rapid recovery ,safe and effective ,and it is worthy to be recommen-ded .

Advances in hepatic surgical technique,perioperative care and improvements in patient selection criteria have increased the number of patients who could undergo major or extended hepatectomy with curative intent.Posthepatectomy liver failure (PHLF) is one of the most serious complications after liver resection.Different risk factors are related to the occurrence of PHLF,among surgery-related factors,massive bleeding and remnant liver volume were related to higher frequency of PHLF.The presence of diabetes and liver disease such as cirrhosis,cholestasis,steatosis had been involved with the occurrence of PHLF.So far there is no good method for the treatment of PHLF,so prevention is very important.