Reoperation on biliary tract diseases is a kind of complex and difficult surgery,with the high risk and recurrence rate.Benign biliary tract diseases included residual and recurrence of bile duct stone,bile duct injury and benign biliary stricture,which are still the most common causes for reoperation.The common causes,application of the precision surgery and new mode of multidisciplinary team (MDT) for the reoperation on benign biliary diseases were explored in this paper.With the techniques developments of minimal invasive and precision surgery,the new mode of MDT for the reoperation on benign biliary diseases will provide the best individual diagnosis and treatment to the patients.

Objective To study the expressions of Chemerin in hepatocellular carcinoma (HCC) and HCC cell lines,and to demonstrate the relationship between the expressions and prognosis.Methods The expressions of Chemerin protein in normal hepatocellular tissues,HCC and their paired tissues were detected by immunohistochemical staining of SABC; the expressions of Chemerin protein in HCC,cell lines and immortalized hepatocyte cell lines were detected by RT-PCR.Results The positive expression rates of Chemerin were 56.67％,90.00％,100％ in HCC,HCC cell line and normal hepatocellular tissues respectively,and the differences were significant (P＜0.05).The expressions of Chemerin mRNA in HCC paired tissues were higher than in HCC (P＜0.05).There was a higher expression of Chemerin mRNA in immortalized hepatocyte cell line LO2 ; but a lower expression in HCC cell lines.The expressions of Chemerin were related to lymph node metastasis,portal vein tumour thrombi,differentiation and TNM stage but not related to sex,age,tumour size,HBsAg and AFP.Conclusions Down-regulated expression of Chemerin may play an important role in the development,progression and metastasis of HCC.It may be a molecular marker for prognosis of HCC.

Objective To explore the effects of baicalin on the expression of ICAM-1 in lung injury induced by severe acute pancreatitis(SAP). Methods SAP model was induced by injection of 62mmol/L sodium taurocholate solution into biliopancreatic duct. A total of 72 SD rats were randomly divided into 3 groups: sham operation group, SAP group and SAP treated with BA group. Myeloperoxidase(MPO) activity in lung tissue was examined at 3, 6 and 12h. The expression of ICAM-1 in lung tissue was determined by immunohistochemical technique. The pathological changes of pancreas and lung tissue were examined under optical microscope. Results The levels of MPO activity, which were similar between SAP group and Baicalin group in the early 3 hours, were dramatically lower in Baicalin group at 6h, 12h(P

Objective To observe the effects of DanShen on the growth of hepatocellular carcinoma in malignant obstructive jaundice in the SD rat model. Methods The model was established by vaccination of transplanting tumour in the porta hepatis with the walker-256 hepatocarcine line, and then obstruction was caused by the infiltration and metastasis of hepatocellular carcinoma. ② The SD rats were divided into four groups: the rats treated by 0.9% NS (n=12), the rats treated by Inosine + Vitamin C (n=20), the rats treated by DanShen (n=20) and the rats treated by 5-FU(n=20). ③ The liver function, morphological changes and the expression of PCNA VEGF and ICAM-1 in carcinoma and peri-carcinoma tissues, adjacent lobe (left-internal lobe) as well as lung tissues were observed after four experimental groups were successively treated by four medicines. ④ Statistical analysis was done to the experimental results. Results ① The growth of rats treated by DanShen injection showed that liver injury caused by malignant obstructive jaundice was significantly relieved compared with liver function and pathological morphological changes in other groups(P0.05); ③ The expression of PCNA VEGF and ICAM-1 in carcinoma, peri-carcinoma adjacent lobe (left-internal lobe) tissues as well as lung tissues were significantly downgraded in groups treated by DanShen injection compared with those in groups treated with 0.9%NS and Inosine combined with Vitamine C (P0.05). Conclusion DanShen injection not only has protective effects on liver injury caused by obstructive jaundice, but the medicine can inhibit the proliferation and growth of hepatocarcinoma, interfere with the vascularization of tumors, and prevent recurrence and metastasis of hepatocarcinoma.

Cell secreted sulfatase 2 is an endogenous sulphate esterase, which can hydrolyze the sulphate groups in extracellular matrix or on the chain of heparan sulphate on the outer surface of cell membrane, which can dissociate the growth factor bound to heparan sulphate proteoglycan, improve the local concentration of growth factor and activate the downstream signal. Sulfatase 2 is highly expressed in a variety of tumors, and the increased expression of sulfatase 2 in hepatocellular carcinoma is associated with poor prognosis. Sulfatase 2 can promote tumor progression by activating multiple signaling pathways in hepatocellular carcinoma cells. Inhibit the activity of hepatocellular carcinoma cell sulfatase 2, and then inhibit the proliferation, migration and tumorigenesis of hepatocellular carcinoma cells. In this paper, the research progress of sulfatase 2 and its role in the occurrence and development of hepatocellular carcinoma is summarized.

Objective To analyze the distribution and antibiotic resistance of pathogens isolated from sputum in early postoperative patients after esophageal surgery, and investigate the risk factors of pulmonary infections after esophageal carcinoma and reasonable application of antibiotics during perioperative period.Methods The clinical data of 414 patients with esophageal carcinoma who were admitted to the Affiliated Hospital of Binzhou Medical University from January 2012 to June 2014 were retrospectively analyzed.The second generation cephalosporins were used as preventive antibiotics for the 181 patients between January and December 2012 and the third generation cephalosporins were used for the 233 patients between January 2013 and June 2014.Sputum samples were collected and inspected before operation and in the first three days after operation for observing distribution and antibiotic resistance of pathogens.The incidence of postoperative pulmonary infection was observed in the two kinds of patients.The risk factors closely related to the occurrence of postoperative pulmonary infections were analyzed.Comparison of rate and univariate analysis were done by chi-square test.Multivariate analysis was done with logistic regression.Results The positive rate of early post-operative sputum culture was 24.64％ (102/414), 32.04％ (58/181) in patients receiving the second generation cephalosporins and 18.88％ (44/233) in patients receiving the third generation cephalosporins, respectively, with a significant difference between the two generations of cephalosporins (x2 =9.502, P ＜ 0.05).A total of 131 strains of pathogens were isolated from early postoperative sputum samples including 12 strains of gram-positive bacteria and 119 strains of gram-negative bacteria.The top three bacteria were Klebsiella pneumoniae subsp pneumoniae (33 trains), Acinetobacter baumannii (20 strains) and Pseudomonas aeruginosa (19 strains).The resistance rate of gram-negative bacteria in early postoperative sputum samples to meropenem, ciprofloxacin and levofloxacin were 5.0％-25.0％, 2.6％-15.2％, 2.6％-20.0％, respectively.Among cephalosporins, the resistance rate to ceftriaxone, cefotaxime, cefepime, ceftazidime, cefuroxime and cefazolin were 10.3％-20.0％ , 5.3％-30.0％ , 12.8％-31.6％, 15.4％-42.1％ , 21.2％-55.0％ and 15.2％-60.0％, respectively.The overall postoperative pulmonary infection rate was 18.60％ (77/414).The pulmonary infection rate of patients receiving the second generation cephalosporins was 26.52％ (48/181), which was higher than 12.45％ (29/233) of patients receiving the third generation cephalosporins (x2=13.326, P ＜ 0.05).The results of univariate analysis showed that smoking, chronic obstructive pulmonary disease, application of the second generation cephalosporins during the perioperative period and early postoperative sputum culture positive were correlated with the postoperative pulmonary infection after esophageal carcinoma surgery (x2 =5.149, 22.765, 13.326, 159.092, P ＜ 0.05).Multivariate statistical analysis with logistic regression demonstrated that application of the third generation cephalosporins during the perioperative period was independent protective factor of postoperative pulmonary infection (OR =2.582, 95％ confidence interval: 1.331-5.009, P ＜ 0.05).Conclusions The pathogens from sputum in early postoperative period after esophageal surgery are complicated with gram-negative bacteria as the main pathogens especially Klebsiella pneumoniae subsp, pneumoniae, and different levels of antibiotic resistance are ubiquitous.The third generation cephalosporins can effectively prevent the postoperative pulmonary infection after esophageal carcinoma surgery.

This article demonstrated the myofascial trigger points theory and the application of related techniques in the clinical prac-tice of sports rehabilitation, such as the treatment of athletes injury pain, rehabilitation of movement function limitation, elimination of sports fatigue and so on. The clinical treatments based on the myofascial trigger points theory are simple, effective, noninvasive, and with short recovery time and low recurrence rate. It provides scientific theoretical and practical foundation for the prevention, diagnosis, treat-ment and rehabilitation for sport injury.

Objective To investigate the efficacy and feasibility of segment-orientated anatomical liver resection for the treatment of hepatic alveolar echinococcosis (HAE) in the middle lobe of the liver.Methods The clinical data of a female patient with HAE in the middle lobe of the liver who was admitted to the First Affiliated Hospital of Xi'an Jiaotong University in September 2013 were retrospectively analyzed.Before operation,various surgical plannings were facilitated by a three-dimensional reconstruction system,and then the surgical planning was determined with the assistance of the multivariate analysis (volume measurement of liver,resectability of remnant functional liver,evaluation of vascular resection and reconstruction,Child-Pugh score and indocyanine green retention at 15 minutes).Segment-orientated anatomical liver resection(segment Ⅴ,Ⅷ and Ⅳb) was performed on the patient.There was a close relationship between the HAE and the first and the second hepatic portal during operation,and the anatomical liver resection of segment Ⅴ,Ⅷ and Ⅳb was precisely carried out.The patient was followed up by outpatient examination and telephone interview every month up to April 2014.The condition of the liver was observed by B ultrasound and computed tomography examinations.Results The three-dimensional reconstruction of the CT data of the patient clearly displayed the anatomical structure and adjacent relationship between the tumor,abdominal organs and major abdominal vessels.The preoperative evaluation of the anatomy of tumor based on three-dimensional images was confirmed with operative findings.The operation time and volume of blood loss were 410 minutes and 1 000 mL,respectively.The patient did not receive blood transfusion.The intraoperative vital signs of the patient were stable.There were no complications such as hepatic insufficiency.The duration of postoperative hospital stay was 15 days.Surgical incision was healed at discharge.The results of blood routine and blood biochemistry test,daily diet and basic self-care ability were in normal condition.HAE was diagnosed based on the result of pathological examination.Albendazole was administered with 1 200 mg/d after operation.The patient was followed up for 6 months and returned to work.The weight of the patient increased by 5 kilograms than that at discharge,without complaint of discomfort.There was no recurrence of HAE and hepatic echinococcosis of organs.Conclusions Segment-orientated anatomical liver resection is not only a method for complete resection,but also maximizes the functional remnant of liver on the basis of intraoperative three-dimensional reconstruction system together with selective hepatic inflow occlusion and vessel reconstruction technique.The patient gets a full recovery with satisfactory outcome.

Interactions between hepatocellular carcinoma (HCC) cells and the tumor stromal microenvironment have profound effects on tumor growth,epithelial-mesenchymal transition (EMT),invasion and metastasis.Activated hepatic stellate cells (HSCs) are the major subtype of stromal cells in the liver tumor microenvironment.HCC cells can induce the activation of HSCs during carcinogenesis,while activated HSCs promote HCC cells growth and migration through secreting growth factors,inducing angiogenesis and immune suppression.Bidirectional interactions between HCC cells and HSCs may function as an ＂amplification loop＂ to further enhance metastatic growth in the liver.In this review,we summarized the most recent data from the research on HSCs and its relationship with HCC.

Objective Methods To explore the value of VEGF levels in serum and pleural effusion for diagnosis of benign and malignant tumors, and evaluate clinical value of VEGF-A, C, D in malignant pleural effusion.Methods Serum and pleural effusion of 34 cases patients with lung cancer were collected in our hospital, the application of ELISA method for the detection of VEGF level in serum and pleural effusion in patients with lung cancer and with benign pleural effusion.VEGF-A, C, D levels were detected.Results VEGF levels in serum and pleural effusion in malignant group were significantly higher than those in benign group(P<0.05).In addition, patients with lung cancer before initial treatment, the VEGF levels in serum and pleural effusion of distant metastasis group were significantly higher than those of without distant metastasis group(P<0.05).There was a correlation between the level of VEGF and the malignant pleural effusion(r=0.878, P<0.05).No correlation existed between VEGF level and benign pleural effusion.The content of sVEGF-A in serum had no statistical difference in cancer group and benign group.Effusion supernatants of pVEGF-A content in lung cancer group were higher than those in benign effusion group(P<0.05).pVEGF-A and sVEGF-A levels were similar in benign effusion group. Effusion supernatants pVEGF-A in malignant group was higher than that in benign effusion group(P<0.05).pVEGF-A was significantly higher than that of sVEGF-A in malignant effusion(P<0.05).Serum VEGF-C, VEGF-D content had no significant difference between cancer group and benign group. pVEGF-C, pVEGF-D content had no significant difference between cancer group and benign group.Conclusion Level of VEGF in serum and pleural effusion detection would help to diagnose and differentially diagnose benign and malignant pleural effusion.Effusion VEGF-A is different in benign and malignant effusion, which may become benign and malignant effusion tumor markers.