Cholelithiasis has still been a common and endemic disease damaging people's health in our country.Management modes and prognosis of this disease have been changed and improved greatly in the past fifty years.Based on our own clinical practice and experience in the People's Hospital of Hunan Province,we reviewed aspects concerning on diagnosis,principles and technical considerations of surgical treatment,summarized background and changes in the past almost half century,which reflected our unremitting efforts and distinctive contributions in management of cholelithiasis.Our experience demonstrated that cholelithiasis should not be considered as a gradually disappearing disease,difficulties and perplexities in dealing with such disease would still be arduous challenges for surgeons,although rates of stone residue and reoperation decreased dramatically.

Objective To describe a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy and explore its clinical application.Methods We retrospectively reviewed clinical data on 57 patients receiving modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy in the Department of Hepatobiliary Surgery,People's Hospital of Hunan Province during the period from February 2016 to August 2016.Results Among 57 cases,38 cases previously underwent conventional basinforming hepatic duct-jejunum Roux-en-Y choledochojejunostomy for the reasons such as hepatolithiasis,iatrogenic proximal bile duct injury,congenital choledochal cyst (Todani type Ⅰ),etc.The mean number of operation was 1-4(1.8 ± 1.3).Errors during reoperation can be classified relevant to cholangiojejunostomy anastomosis,bridging jejunal loop and jejunum-bridging jejunal loop anastomosis.Among 57 cases,bile intestinal anastomotic leakage occurred in one patient,incision fat liquefaction in 3 patients,2 patients experienced stress gastritis,all postoperative complications recovered under conservative management.No postoperative mortality happened.During mean (4.07 ± 3.27) months follow-up period,only 4 patients complained of reflux cholangitis,which could be easily managed by antibiotics use.Conclusions By correcting errors in application of conventional Roux-en-Y choledochojejunostomy,a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy proposed in this study demonstrated preliminary better results.

Objective To research the immunologic reaction and the potential of chemically extracted acellular nerve allograft(CEANA) to repair peripheral nerve defects in primates. Methods Adult SD rats were used as nerve donors and adult male Wistar rats used as nerve recipient hosts. 25 mm long nerve segments were excised from SD rats' sciatic nerves. The nerve segments were decellularized via an improved chemical decelluarization treatment as follows: 1) nerve segments were rinsed with cold sterile Ringer's solution; 2)stabilized by pinning the ends to a thin plastic support, and submerged in 4% Triton-100 solution 12 h; 3)soaked into 72 mM sodium deoxycholate for 12 h; 4)washed in distilled water for 6 h. The procedures were repeated once again. Median nerve segments were obtained from macaques and decellularized according to above procedures. The CEANA from SD rats were implanted into Wistar rats subcutanously. The control group was implantation of fresh nerve allografts from SD rats. The immunogenicity of acellular nerve allograft was tested by immunohistochemical examination of the intensity of CD3+, CD4+ and CD8+ cells that infiltrated the allografts. Median nerve defects for 5 cm were created in three macaques. CEANA were interposed across the gap. The CEANA were anastomosed microsurgically to the epineurium of proximal and distal stumps. Results The number of CD3, CD4 and CD8 positive lymphocytes infiltration in CEANA was far lower than that in the control group of fresh nerve allografts at 2 weeks and 4 weeks after implantation. There was no significant evidence of inflammatory in the CEANA grafted group. In the experiment of nerve regeneration of macaques, electromyographic activity was recorded across the allografts. The conduction velocity of regenerated nerve was (40.5?6.8) m/s. Regenerated axons sprouted from the proximal portion reached the distal portion of the grafts, and Schwann cells were also present in the central portion of the CEANA. Motor end-plates were observed in reinnervated muscles. Conclusion The immunogenicity that would have initiated cell-mediated immunological rejection of CEANA are removed. The implantation of CEANA could repair the defect of median nerve 5 cm long in the arm 5 months postoperatively. The CEANA as a type of substitute of nerve autografts has the potential to repair peripheral nerve defects in primates.

Sepharose 6B was activated by epichlorohydrin in the strong base condition, and then reacted with solution of iminodiacetic sodium. The arms of IDA were conjuncted to the activated Sepharose 6B. Then the products were reacted with the solution of NiSO4. The arms of IDA were chelated with Ni2+,and the chelating resin―Ni2+-IDA could be prepared. The physicochemical indexes and performance in purifying protein of the expressing product were assayed with atomic absorption method and purifying aimed protein-human B lymphocyte stimulator(hBLyS) from the expressing products in E.coli. The results indicated that the performance of made gel is very good, and its price is less than 1/10 of that of commodity gel.

The antibacterial peptide CM4 having potent antifungal activity on inhibitiong the cell wall regeneration of Saccharomyces cerevisiae protoplasts.When the peptide increased,the ratio of the regenerated colonies drop obviously.To study the antifungal mechanism of the antibacterial peptide,fluorescence\|labeled peptide mixted with the protoplast of yeast,then confocal laser scanning microscopy were performed.The results indicated that the peptides interactted with the protoplast membrane and damaged the structure of the membrane,then the permeation of protoplast changed.Finally the protoplasts with the peptide failed to regenerate the cell walls leading to killing the cell.

CD4-Positive T-Lymphocytes ; Child ; Cryptococcosis ; immunology ; Humans ; Lymphopenia ; etiology

ObjectiveTo investigate the clinical application value of two-step separation approach in laparoscopic left lateral sectionectomy (LLLS).MethodsA total of 156 patients undergoing LLLS with two-step separation approach in Hunan Provincial People's Hospital between January 2009 and September 2014 were included in this prospective study. Among the 156 patients, 76 were males and 80 were females with the age ranging from 18 to 75 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients were in bladder lithotomy position or straddle position and pneumoperitoneum was established with 4-hole approach and periumbilical puncture. Hepatectomy was performed using two-step separation approach. The liver parenchyma was dissected to the plane of left lateral hepatic pedicle-left hepatic vein using ultrasonic scalpel along the left of falciform ligament. Then, the hepatic pedicle and the left hepatic vein was dissected using Endo-GIA stapler.ResultsAll patients completed the surgery successfully and no case was converted to laparotomy. Eighty-nine patients underwent simple left lateral hepatic artery occlusion and 67 patients did not undergo hepatic inlfow occlusion. The median operation time was 85 (53-150) min and the liver dissection time was 17 (8-35) min. The intraoperative blood loss was 25 (10-100) ml and the postoperative length of stay was 7 (5-10) d. No death case and no serious postoperative complication was observed. Only 7 patients developed mild bile leakage and recovered after effective drainage.ConclusionTwo-step separation approach in LLLS is safe and easy, which can be taken as a standard operation and widely popularized.