The wound healing research in the biliary tree lag significantly behind similar studies on the skin and gastrointestinal tract. This is at least partly attributable to the difficulty to study on the biliary tract. But clinical relevance, more interest in biliary epithelial cell (BEC) pathophysiology, and widespread availability of BEC cultures are factors reversing this trend. In the extra-hepatic biliary tree,ineffectual wound healing, scarring and stricture development are pressing issues. In the smallest intra-hepatic bile ducts either impaired BEC proliferation or an exuberant response can contribute to liver disease. Chronic inflammation and persistent wound healing reactions in large and small bile ducts often lead to hepatic cirrhosis and liver cancer.

Tumor inhibiting protein p33ING1b is the key expressive product of inhibitor of growth 1.It plays critical role in cell multiplication ,period control ,senescence ,repair of DNA damage ,apoptosis ,and chroma-tin remodeling.The abnormal expression of p33ING1b is closely related to the occurrence and development of tumor.This paper reviews tumor inhibiting protein p 33ING1b in the research development of tumors in digestive system.

Spontaneous choledochocyst perforation in adults is a rare disease with more acute onset and rapid progression of the disease.Most cases of spontaneous choledochocyst perforation are misdiagnosed due to the lack of typical symptoms,meanwhile,treatment remains controversial,and accordingly it is hard for doctors to make a decision on treatment.Nevertheless,the individualized treatment can be performed on patients according to the clinical symptoms and conditions of patients combined with the medical history,laboratory and imaging examinations or other special procedures.In this article,the diagnosis and treatment of spontaneous choledohocyst perforation were summarized on the basis of global literatures and analyses of the pathogeny and clinical presentation of this disease.

Objective To investigate the effects of nutritional support on the hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection. Methods Twenty-nine patients with digestive tract fistula complicated with severe abdominal infection were administered parenteral nutrition (PN) for 4 to 8 days, and then followed by enteral nutrition (EN) or EN + PN. The body weight, serum albumin, transferrin, prealbumin, fibronectin were monitored before and on the 10th and 28th day after nutritional support. Results The levels of serum prealbumin and fibronectin were increased significantly on the 10th day after nutritional support (t = 3.72, 3.52, P <0.01). The body weight, the levels of serum albumin, transferrin, prealbumin and fibronectin were significantly higher than those before nutritional support (t=3.97, 6.57, 7.09, 3.51, 3.58, P<0.01). Conclusion Nutritional support is effective in alleviating hypermetabolism of patients with digestive tract fistula complicated with severe abdominal infection.

Objective: To study the relationship between blood pressure (BP) rhythm and cognitive function in elder hypertension patients. Methods: Our research included in 2 groups: Hypertension group:n=74 patients≥80 years and Control group, n=36 elder subjects without hypertension. 24-hour ambulatory blood pressure monitoring (ABPM) was conducted in both groups. According to nocturnal BP reduction rate, Hypertension group was further divided into 4 subgroups as Dipper type BP subgroup, Non-dipper type BP subgroup, Anti-dipper type BP subgroup and Super-dipper type BP subgroup. Cognition function was evaluated by Mini-menta state examination (MMSE) form, MMSE score was compared among different groups and subgroups. Results: By MMSE score, the abilities of orientation, memory, attention, calculation and recall were different between Hypertension group and Control group,P<0.05. By MMSE score, the abilities of orientation and memory were different between Anti-dipper type BP subgroup and Dipper type BP subgroup,P<0.05; the abilities of orientation, memory, attention, calculation and recall were different between Non-dipper type BP subgroup and Dipper type BP subgroup,P<0.05; the memory was different between Super-dipper type BP subgroup and Dipper type BP subgroup,P<0.05. Conclusion: In elderly hypertension patients, compared to those with normal BP rhythm, the abnormal BP rhythm patients had the higher probability to suffer from cognitive dysfunction which was mainly as decreased abilities of orientation, memory, attention, calculation and recall.

Objective To investigate the expressions and clinical significance of HMGB1 and mutp53 in bile duct carcinoma tissue.Methods The expressions of HMGB1 and mutp53 were detected by immunohistochemistry in 47 cases cholangiocarcinoma tissue and 25 cases normal biliary duct tissue,and their correlation with clinicopathological parameters of cholangiocarcinoma was analyzed.Results The expression of HMGB1 and mutp53 was positive in 78.72％ (37/47) and 63.83％ (30/47) respectively of the cases with cholangiocarcinoma tissue,and 12.00％ (3/25) and 4.00％ (1/25)respectively of the cases in normal biliary duct tissue(all P ＜0.01).The expression of HMGB1 and mutp53 in cholangiocarcinoma tissue was relating to degree of tumor differentiation,lymph node metastasis,perineural invasion and TNM-staging(all P ＜ 0.05),and no relation to age,gender,serum bilirubin level,metastasis of tumor and site of tumor(all P ＞0.05).The expression of HMGB1 was positively correlated with that of mutp53 in bile duct carcinoma tissue(r =0.574,P ＜ 0.05).Conclusion The expressions of HMGB1 and mutp53 were increased in cholangiocarcinoma tissue,both of them play critical role for the occurrence,development,invasion and metastasis of cholangiocarcinoma.

No abstract available.

Objective To explore the application value and clinical efficacy of one half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced in pancreaticoduodenectomy.Methods The retrospective cross-sectional study was conducted.The clinical data of 17 patients with pancreatic neoplasms and ampullar neoplasms who underwent pancreaticoduodenectomy at the Second Affiliated Hospital of Harbin Medical University from May to September 2015 were collected.One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced method was applied to the digestive tract reconstruction after pancreaticoduodenectomy in the 17 patients.Observation indicators included:(1)surgical situations:surgical procedures,operation time,time of pancreaticojejunostomy,volume of intraoperative blood loss,tumor sizes,(2) postoperative situations:recovery time of gastrointestinal function,postoperative complications,duration of postoperative hospital stay,(3) postoperative pathological examinations,(4) follow-up.Patients were followed up by outpatient examinations including color Doppler ultrasound or abdominal computed tomography (CT) and telephone interview detecting abdominal pain or distention and general situations (diet,sleep) up to October 2015.Measurement data were represented as average (range).Results (1) Surgical situations:all the 17 patients underwent successful operations without perioperative death,including 16 undergoing radical pancreaticoduodenectomy and 1 undergoing pancreaticoduodenectomy and left liver resection.The average operation time,average pancreaticojejunostomy time,average volume of intraoperative blood loss and average tumor size were 276 minutes (range,230-440 minutes),12 minutes (range,9-16 minutes),310 mL (range,200-950 mL) and 3.25 cm2(range,1.92-5.60 cm2),respectively.(2) Postoperative situations:the average recovery time of gastrointestinal function was 3 days (range,1-7 days).Three patients had postoperative complications,including 1 patient with pancreatic fistula (Grade A) and 2 patients with delayed gastric emptying,and all of them had been healed after symptomatic and supportive treatments.The results of T-tube cholangiography or CT before hospital discharge showed that there was no leakage around the anastomoses.The average duration of postoperative hospital stay was 10 days(range,6-20 days).(3) The postoperative pathological examinations showed 5 patients of pancreatic ductal adenocarcinomas,4 of common bile duct ampulla area adenocarcinomas,3 of duodenal papillary adenocarcinomas,3 of pancreatic intraductal papillary mucinous neoplasms and 2 of duodenal ampullary adenocarcinomas.(4) Followup:all the 17 patients were followed up for 1-4 months and the abdominal color Doppler ultrasound or CT showed that there was no evidence of tumor recurrence or leakage around anastomoses.Conclusion One half layer pancreaticojejunostomy with the posterior wall of pancreas reinforced is safe and feasible,and it can reduce the rate of pancreatic fistula successfully.

This paper introduced the concept of humanistic therapy and its connotation and application in the field of surgery, the spiritual essence and the docking and bioethics.The authors also analyzed the perioperative patients need humanistic therapy, including technology, ethics, psychology, the needs of the practice; discusses the humanistic therapy in clinical practice,includes:practice conditions, personnel, measures and problems.

Hepatocellular carcinoma (HCC) combined with inferior vena cava (IVC) tumor thrombosis is regarded unresectable.Most of the patients received non-surgical treatment or gave up treatment,and the prognosis of these patients is poor.As the development of surgical treatment,the success rate of surgical treatment for HCC combined with IVC tumor thrombosis is increasing yearly.In May of 2012,one patient with HCC combined with IVC tumor thrombosis received hepatic Ⅴ,Ⅶ and Ⅷ segmentectomy + tumor thrombosis removal from the IVC at the Second Affiliated Hospital of Harbin Medical University.Preoperative computed tomography showed space-occupying lesions in the segments Ⅴ,Ⅶ and Ⅷ,and the IVC was filled with tumor thrombi.The volume of the left liver was 489 cm3,which was under the limit for survival.In order to preserve the remnant liver,right hepatectomy with reservation of hepatic segment Ⅵ,and the tumor thrombi in the IVC were removed with total hepatic vascular exclusion.The patient was recovered with no tumor recurrence or metastasis at postoperative month 18.