Objective To study preventive measures against conversions to open surgery during laparoscopic cholecystectomy(LC).Methods The study was based on 25 cases of conversions to laparotomy out of 852 cases of LC(2.93%)from December 1999 to October 2005 in this hospital.The clinical data revealed a bile duct injury in 3 cases,bleeding in 1 case,severe adhesion in abdominal cavity or between the gallbladder and neighboring tissues in 9 cases,disturbed anatomy and adhesion in the region of the Calot's triangle in 5 cases,cholecystoduodenal fistula in 2 cases,and Mirizzi syndrome(type Ⅱ)in 5 cases.Results The conversion to open surgery was successfully completed in all the 25 cases.No complication was encountered.Follow-up examinations for 1～2 years showed no bile duct stenosis.Conclusions Proper preoperative patient selection and use of intraoperative preventive measures are helpful to minimize the possibility of conversion to open surgery.

Objective: To compare regeneration of motor fibers with that of sensory fibers by end to side neurorrhaphy and compare the effect of end to side neurorrhaphy with that of end to end neurorrhaphy. Methods: 20 SD rats were randomly divided into two groups: group A and group B. In group A, the right peroneal nerve was sectioned and the distal end was sutured laterally to the tibial nerve; in group B, the right peroneal nerve was sectioned and sutured with end to end neurorrhaphy. All left sides of two groups were used as control. Retrograde transportation of HRP was observed after 28 weeks. Results: The labelled neurons were also found in the anterior horn of the spinal cord and the spinal ganglia. Conclusion: The regenerative nerve fibers had motor fibers as well as sensory fibers by end to side neurorrhaphy. The effect of end to side neurorrhaphy is not as good as that of end to end neurorrhaphy. [

Background and purpose:Estrogen receptor (ER)-positive breast cancer always presents a dilemma for resistance to endocrine therapy in a long time. The recent studies showed that the expression of estrogen-responsive ifnger protein (Efp) and polo-like kinase 3 (Plk3) had a close relationship with breast cancer development. This study was to explore the expression correlation between Efp and Plk3 in ER-positive breast cancer in order to understand the inlfuence of Efp and Plk3 on the drug resistance.Methods:The expression of Efp and Plk3 in 74 cases of ER-positive breast cancer was detected by SP immunohistochemistry. The clinical signiifcance was then analyzed. Real-time lfuorescent quantitative polymerase chain reaction (RTFQ-PCR) and Western blot were used to detect the expression of Efp and Plk3 in ER-positive MCF-7 cells.Results:No signiifcant relationship was found between Efp and Plk3 expression and the clinicopathological features of 74 cases of ER-positive breast cancer (P>0.05). The number of cases whose Efp showed positive expression was 51 (68.9%), while the number of cases whose Plk3 showed positive expression was 23 (31.1%). Chi-square test analysis showed the expression of Efp and Plk3 was negatively correlated in 74 cases of ER-positive breast cancer (χ2=8.837,P<0.05). The result of RTFQ-PCR showed that the expression of Efp mRNA in MCF-7 cells was up-regulated by estrogen stimulation, whereas Plk3 mRNA was not changed. The result of Western blot showed that the expression of Efp protein in MCF-7 cells was increased by estrogen and MG132 stimulation, whereas Plk3 protein was decreased.Conclusion:The expression of the Efp protein is negatively correlated with Plk3 protein in ER-positive breast cancer. High expression of Efp may be involved in the resistance to endocrine therapy.

[Absrtact] Objective To investigate the effect of anatomic quantitative target evaluation of class-room teaching on students' professional knowledge learning ability. Methods Twenty-five international students of 6-year program of grade 2013 were chosen as the experimental group, while twenty-seven Chinese students coming from the same class of grade 2013 and fifteen international students of 6-year program of grade 2012 were chosen as two control groups; quantitative and non-quantitative evaluation were imple-mented respectively by classroom questions and answers; teaching effects were evaluated by scales in the separation of teaching and examination, by records of answers for in-class questions and by questionnaire survey; SPSS 20.0 was used to make statistical analysis, one-way ANOVA and Kruskal Wallis test to com-pare the scores of three groups of students, P<0.05 indicates statistic significance. Results Compared with control groups, the accuracy of answers for class questions were improved greatly in the experimental group (2/3~3/4) vs. (1/2) and (2/3~3/4) vs. (1/2) and the average test scores (80.62±5.93) vs. (79.62±5.93) and (80.62 ±5.93) vs. (70.16 ±6.36) of the experimental group students were higher than control groups, the difference was statistically significant between the control group and the control group (P=0.045). Conclusions
Quantitative evaluation of teaching objectives in anatomy class can improve the learning attitude of foreign students and enhance their academic ability.

Objective To summarize the experience of the laparoscopic common bile duct exploration for choledocholithiasis and cholecystolithiasis.Methods From Jan 2014 to May 2018,laparoscopic common bile duct exploration were successfully completed in 112 cases of choledocholithiasis and cholecystolithiasis.Results Laparoscopic common bile duct exploration was performed successfully in 14 cases through cystic duct,while in 78 cases through the mini-incision at insertion of cystic duct,and in 20 cases through direct incision of common bile duct.In 3 cases T-tube was placed.9 cases developed bile leakage postoperatively and recovered after 3-7 days of conservative treatment.Conclusion Laparoscopic common bile duct exploration through cystic duct is the first choice of common bile duct exploration followed by mini-incision at insertion of cystic duct.Laparoscopic exploration of common bile duct via choledochotomy was performed when there was abnormal anatomy of cystic duct.

Objective To analyze our experience in laparoscopic common bile duct ( CBD) explo-ration using a 5 mm choledochoscope through a micro-incision at the junction between the cystic duct and the CBD for patients with choledocholithiasis and cholecystolithiasis. Methods From January 2014 to May 2018, laparoscopic common bile duct exploration through a micro-incision at the cystic duct-CBD junction was performed in 77 patients with choledocholithiasis and cholecystolithiasis at Beijing Tongren Hospital, Capital Medical University. Results Laparoscopic common bile duct exploration was performed successfully through a micro-incision in 77 patients with primary suturing of the micro-incision. The range of operation time, blood loss, and hospital stay were 65～150 min, 10～50 ml, and 4～9 d respectively. Seven patients developed minor bile leakage postoperatively and were treated successfully after 3 ～7 days of conservative treatment. Conclusion Common bile duct laparoscopic exploration using a choledochoscope for choledocho-lithiasis and cholecystolithiasis through a micro-incision at the junction of cystic duct and CBD was a safe and effective method.

Objective:To report a case of combined oxidative phosphorylation deficiency 28 (COXPD28) in China, identified the pathogenic mutation and explored the pathogenic mechanism preliminarily.Methods:The clinical characteristics of a patient with COXPD28 were retrospectively analyzed and the pathogenic mutations were identified by mitochondrial gene sequencing and whole exome sequencing. The wild-type and mutant plasmids of pathogenic genes were constructed, and effect of mutation on protein expression by quantitative real-time PCR (qPCR) and Western blot were evaluated. Statistical methods mainly used one-way ANOVA and LSD test.Results:A 21 year old female patient presented with lactic acid poisoning due to repeated chest distress and wheezing since childhood. The sequencing of the whole exon group gene found that solute carrier family 25 member 26 (SLC25A26) gene had a compound heterozygous mutation (c.34G>C, p.A12P; c.197C>A, p.A66E), which was the first report in China. In vitro function test showed that the expression levels of SLC25A26 mRNA and S-adenosylmethionine carrier (SAMC) protein in cells transfected with SLC25A26 mutant plasmid were significantly lower than those transfected with wild type plasmid. The p.A66E mutant plasmid reduced the expression level of SLC25A26 mRNA and SAMC protein to 6% and 26% of wild type plasmids respectively (both P<0.001), while p.A12P mutant plasmid decreased to 62% and 82% of wild type plasmids respectively ( P<0.001, P=0.044). When the double mutant (p.A66E+p.A12P) plasmids were co-transfected, the expression levels of SLC25A26 mRNA and SAMC protein decreased to 47% and 57% of the wild type plasmids, respectively ( P<0.001, P=0.001). Conclusion:The pathogenic mutation gene of this patient with COXPD28 is SLC25A26 gene mutation (p.A66E, p.A12P), which causes the decrease of SLC25A26 expression level, mitochondrial oxidative phosphorylation dysfunction, and induces COXPD28.

Objective:To investigate the feasibility and clinical value of MRI quantitative evaluation technique in detecting sternocleidomastoid muscle fibrosis in patients with nasopharyngeal carcinoma (NPC) after radiotherapy.Methods:From August 2019 to March 2021, 45 patients with clinically confirmed NPC after radiotherapy and 30 healthy controls who underwent physical examination in Lishui Hospital of Zhejiang University were enrolled in our study. According to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) classification criteria of late radiation reactions respectively, the sternocleidomastoid muscle injury in the NPC group was divided into grade Ⅰ, Ⅱ and Ⅲ, which included 8, 32 and 5 patients respectively. All patients underwent T 1 mapping and T 2 mapping imaging of the neck. Firstly, the mapping images of sternocleidomastoid muscle between the two groups were analyzed and compared. Using NUMARIS/4 software of Siemens image post-processing workstation, the region of interest was manually drawn along the edge of sternocleidomastoid muscle at the level of laryngeal chamber in axial mapping diagram. Then, T 1 and T 2 values and the long and short diameters of sternocleidomastoid muscle were measured respectively. Finally, the differences of the parameters between the two groups were compared by independent sample t-test, Spearman rank correlation was used to analyze the relationship between the average T 1 and T 2 values of bilateral sternocleidomastoid muscles and the grade of late radiation injury. Results:Compared with the control group, the shape of sternocleidomastoid muscle in the NPC group was smaller in shape, with irregular edge and uneven increase of T 1 mapping color scale. There was no significant difference in muscle signal in T 2 mapping. The T 1 values of left and right sternocleidomastoid muscles in the NPC group were (1 524.7±97.6) and (1 496.5±93.2) ms respectively, which were significantly higher than those in the normal control group [(1 231.5±85.3) and (1 275.9±90.9) ms] ( P<0.05), and the T 2 values of left and right sternocleidomastoid muscles in the NPC group were (28.4±4.8) and (28.4±3.6) ms respectively, which were lower than those in the normal control group [(30.4±3.5) and (30.4±3.5) ms] ( P<0.05). The long and short diameters of bilateral sternocleidomastoid muscles in the NPC group were shorter than those in the control group ( P<0.05). The average T 1 and T 2 values of bilateral sternocleidomastoid muscles in NPC patients after radiotherapy were (1 510.6±95.4) and (28.4±4.2) ms respectively, The T 1 value was positively correlated with the classification of advanced radiation injury ( r=0.78, P<0.001), and T 2 value was negatively correlated with the level of advanced radiation injury ( r=-0.87, P<0.001). Conclusion:Mapping quantitative evaluation technique can noninvasively and objectively detect and evaluate sternocleidomastoid muscle fibrosis after NPC radiotherapy, which has potential clinical application value.

Objective:To investigate the effect of jejunal loop fixation in the reoperation for anastomotic stricture after cholangiojejunostomy.Methods:From Jan 2016 to Jan 2020, clinical data of 15 patients undergoing reoperations for anastomotic stenosis was analyzed retrospectively.Original anastomosis was removed and Roux-en-Y cholangiojejunostomy and jejunal loop fixation were performed in all cases. Two different types of jejunal loop fixation were used. One with a blind loop of 10-15 cm at the proximal side of the anastomosis, which is fixed with a mark of the abdominal wall under the xiphoid process. The second is to mark and fix the jejunal side wall and the right abdominal wall about 10 cm from the distal side of the anastomosis. A T tube is placed in the intestine through the central part of the fixed intestinal wall.Results:Five cases underwent blind loop fixation, 10 cases underwent lateral wall fixation. There were 3 complications after operation, including 1 case of bile fistula, 1 case of incision infection, 1 case of abdominal hemorrhage, all were cured by conservative treatment, and there was no perioperative death. One case had postoperative anastomotic stenosis in the follow-up. The patient underwent jejunal puncture under local anesthesia, and was cured by percutaneous choledochoscopy.Conclusions:The possibility of restenosis should be considered in the reoperation of anastomotic stenosis. The jejunal loop should be fixed and marked during the operation in high risk patients. Once the anastomotic stricture recurred, choledochoscopy could be performed by puncture and dilation of fixed loop of intestine to avoid reopen surgery.

The incidence of inflammatory myofibroblastic sarcoma is low, and bladder origin is more rare. We reported a 58-year-old patient with painless gross hematuria for one week. Total abdominal CT examination showed soft tissue mass in the anterior wall of the bladder, which was considered as bladder cancer, and bladder tumor resection was performed. Postoperative pathology showed inflammatory myofibroblastic sarcoma. Therefore, radical cystectomy was performed because of the high degree of malignancy. There was no recurrence during 3 years follow-up.