Objective To explore the effect of 1-alpha,25-dihydroxy-cholecalcifero(1,25(OH)2D3)on liver fibrosis and its mechanism. Methods Degree of liver fibrosis was assessed through pathological detection and blood biochemical examination of liver function. Immunohistochemical assay was used to detect expressions of α-SMA,TGF-βand collagen I to observe activation level of hepatic stellate cells. Impact of 1,25(OH)2D3 on CD4+T cell differentiation was analyzed by flow cytometry,ELISA,and RT-PCR. Results 1,25(OH)2D3 improved the structure of the liver tissue and liver fibrosis. Expressions of collagen I ,TGF-βandα-SMA were significantly ele-vated in the liver tissue in rats with fibrosis(P < 0.05)but were markedly decreased after treatment with 1,25 (OH)2D3(P < 0.05). After 1,25(OH)2D3 treatment,the proportion of Th17 cells reduced while that of Th2 in-creased;concentration levels of IFNγ,IL-17A,and IL-22 markedly declined but IL-4 elevated(P>0.01);and ex-pressions of RORγt and T-bet decreased whereas GATA3 expression increased(P>0.01);as compared with those in the control group. Conclusions 1,25(OH)2D3 can alleviate the degree of liver tissue by lowering HSC activation and regulating Th cell differentiation.

In recent years, the diagnosis and treatment of adenocarcinoma of esophago-gastric junction (AEG) has attracted more and more clinical attention. At present, there are two kinds of definitions and classifications. One is about AEG, proposed by the Siewert from Germany, the other is about esophagogastric junction cancer, proposed by the Nishi from Japan, and the former is adopted in China. The authors analyze the differences and shortcomings in definition and classifi-cation between the Siewert and the Nishi, and propose a modified classification based on the histo-pathology of the esophagogastric junction in China (squamous cell carcinoma accounts for the majority in the lower esophageal segment and adenocarcinoma is rare), which is completely different from Western countries such as Europe and America. In this modified classification, malignant tumors within 3 cm above and below the esophagogastric junction are defined as esophagogastric junction cancer(including squamous cell carcinoma, adenocarcinoma, etc.), and tumor center above or below esophagogastric junction are defined as type Ⅰ and type Ⅱ. If the tumor center is located at esopha-gogastric junction, squamous cell carcinoma is defined as type I, and adenocarcinoma is defined as type Ⅱ. According to this definition and classification, the authors discuss the surgical approach, the extent of esophagectomy and gastrectomy, the extent of lymphadenectomy, and the tumor staging.

Rectourethral fistula (RUF) is a kind of intractable disease with special anatomical site, complex condition, and even serious infection. The common causes are iatrogenic trauma after radical prostatectomy, pelvic trauma and injury after local radiotherapy. At present, surgical approaches for RUF include transperineal approach, transsphincter approach, transabdominal approach and transanal approach.Traditional surgical treatment has the limitations of large trauma, high incidence of complications and slow recovery. Transanal minimally invasive surgery (TAMIS) for RUF has the characteristics of simple operation, small trauma and quick recovery. The purpose of this paper is to introduce the methods and experience of RUF treatment with TAMIS.

Objective: Non-technical skills (NTS) are necessary to evaluate the comprehensive quality of surgeons. In this study, we proposed the concept of C-NTS, a scoring criterion for NTS based on real scenarios (for example, history taking) and video recording, and verified its practical application effects. Methods: Study objects were divided into the tutor group and the student group. The tutor group contained four senior attending physicians in gastrointestinal surgery department of one tertiary hospital (all male with doctor degree). The student group had four rotating surgeons who were randomly selected from the same department in 2018 (two males and two females). Before and after the training, the tutor rated the same anonymous video by C-NTS. One-factor analysis of variance was used to compare the differences between and within the groups, and Kendall concordant coefficient was used to test the consistency by SPSS 22.0. Results: After the tutor receiving training, Kendall concordant coefficient was increased from 0.425 to 0.853 and the latter suggested the difference had statistical significance (P=0.017), which confirmed the effectiveness of the training. Conclusion C-NTS has preliminarily solved the difficulty of homogenization of NTS assessment. Relevant C-NTS discussions and trainings for clinical tutors may be beneficial to save time and manpower in clinical teaching and evaluation.