Objective To study the causes of conversions to open surgery during laparoscopic cholecystectomy (LC). Methods We retrospectively analyzed clinical data of conversions to open surgery during LC in this hospital between April 1998 to March 2002. Results Of 1368 cases of LC, conversions were required in 60 cases, the rate of conversion being 4.39%. Reasons leading to conversions included: 17 cases of adhesion in abdominal cavity and Calot's triangle, 14 cases of acute cholecystitis or recovery period of acute cholecystitis, 2 cases of carcinoma of gallbladder, 5 cases of internal fistula of blie duct to intestinal tract, 2 cases of common bile duct stones, 6 cases of atrophic cholecystitis, 2 cases of bleeding, 2 cases of bile duct injuries, 2 cases of Mirrizi's syndrome, 1 case of biliary fistula, 1 case of xanthogranulomatous cholecystitis, and 6 cases of other reasons. Conclusions Conversions to open surgery during LC are chiefly due to the unclear exposure of Calot's triangle, as well as the inadequacy of skills and experience of surgeons.

Objective To evaluate the safety and therapeutic effects of laparoscopic-assisted resection of the right colon for right colon cancer.Methods Laparoscopy-assisted resection of the right colon was performed on 21 patients with right colon cancer.The separation of the mesentery,ligation of the mesenteric vessels,and lymphectomy were completed by laparoscopy.And the resection of the right colon and end-to end anastomosis of the residual bowels were performed through a small incision in the abdomen.Results The operation was completed in all the cases without conversion to open surgery.The operation time was 136-248 min(mean,153.6 min).The length from the upper and lower ends of the resected colon to the tumor was(10.8?3.6)and(10.2?3.5)cm respectively.A mean of 9.7?4.9 lymph nodes were resected.One patient developed infection of the incision,and was cured by debridement 3 months later.A mean of 19 months(range,3-36)follow-up was achieved in 17 of the patients.During this period,liver metastasis occurred in 2 patients(8 and 20 months respectively after the operation).No implantation at the incision or puncture site was found in this series.Conclusions Laparoscopic-assisted resection of the right colon is safe and feasible for patients with colon cancer.The outcome of this procedure is as good as that of open surgery.

Objective To investigate the surgical techniques of laparoscopic procedures in the management of stones straddling between the cystic duct and the common bile duct. Methods Clinical data of 19 cases of stones straddling between the cystic duct and the common bile duct treated by laparoscopic cholecystectomy (LC) from January 2001 to June 2003 were retrospectively reviewed. Results The operations were completed by opening the gallbladder ampulla and/or the cystic duct in all the patients. The stones were 0 4~0 6 cm in diameter (mean,0 5 cm).The drainage was removed 48 hours ofter the surgery.The patients were discharged from hospital 3~5 days postoperatively.Follow-up checkups in the 19 cases for 2~24 months (mean,10 months) found no residual stones. Conclusions Thorough exposure of the union of the cystic duct with the common bile duct and the opening of the cystic duct to expel the stones is the best way to manage stones straddling between the cystic duct and the common bile duct under laparoscope, and also the most effective method to prevent postoperative residual stones.

Objective To investigate the expression and clinical significance of zinc finger gene 217 (ZNF217) in human papillary thyroid carcinoma.Methods The expressions of ZNF217 mRNA and protein were detected by quantitative realtime PCR and Western blot in papillary thyroid carcinoma tissues (n =20) and adjacent normal tissues (n =20),and the data were analyzed.Results The expressions of ZNF217 mRNA and protein in papillary thyroid carcinoma were significantly higher than those in adjacent normal tissues (96.72 ± 44.19 vs 4.86 ±3.55,0.994 ± 0.172 vs 0.195 ± 0.061,both P＜0.01),being higher in the papillary thyroid carcinoma with capsule invasion compared with that without capsule invasion (P＜0.01).The expressions of ZNF217 mRNA and protein in papillary thyroid carcinoma were not related to gender,age,tumor size,TNM stage or lymph node metastasis (all P＞0.05).Conclusions The overexpression of ZNF217 may be associated with the oncogenesis and progress of papillary thyroid carcinoma and capsule invasion,and thus is expected to become a new target for prevention and treatment of papillary thyroid carcinoma.

Objective To investigate the effect of imbedding chemotherapy of sustained release of 5-fluorouracil on the healing of colonic stoma in dog. Methods Twenty-eight adult hybrid dogs were randomly divided into chemotherapy group (n=22) and control group (n=6). The canine sigmoid colon were firstly detached and then anastomosed via median abdominal incision, 200 mg sustained release of 5-fluorouracil was imbedded in the mesentery 1.0-1.5 cm away from colonic stoma in chemotherapy group, whereas the control substance was injected into the dogs in control group. Tissue samples were collected from mesentery and stomas on 3, 5, 7, 10 and 15 days after operation, respectively, in order to observe the healing of stoma. The drug concentrations in the stoma and in the tissues that were 0, 1, 3, 5, 7, 10 and 15 cm away from the imbedding point were also measured by high performance liquid chromatography method at different phases. Results The tissues from colonic stoma only showed inflammatory reaction at early stage, with no necrosis and cellular degeneration. It was observed that the stoma healed basically on the tenth day after operation. The drug concentrations in the tissues gradually decreased at the range of 0-15 cm over time, but all of which were higher than the anti-tumor effective concentration (0.10 ?g/g). Conclusion The imbedding chemotherapy of sustained release of 5-fluorouracil in mesentery has little effect on the healing of stoma, and it could remain an effective anti-tumor concentration in a period of time.

Objective To observe the effect of electroacupuncture on urodynamic alteration in rats after complete T10 spinal cord transection.Methods Thirty-one female Sprague-Dawley rats were divided randomly into a sham operation group (n=10),a model group (n=11) and an electroacupuncture (EA) group (n=10).The spinal cords of the rats in the latter two groups were completely transected at the T10 level.Pressure was applied to the rats'lower abdomens every day while in the EA group electroacupuncture with continuous wave electricity was applied to the guanyuan (RN4) and sanyinjiao (SP6) acupoints for 15 min.The treatment was carried out daily for consecutive 7 days.Urodynamic examinations were carried out after the treatment course had finished.Results At the 9th day after the operation,average residual urine volume and bladder capacity in the EA group were both significantly lower than in the model group.Residual urine volume and bladder capacity were lowest in the sham operation group.Average voided volume and voiding rate in the EA group were significantly higher than in the model group.The average voiding rate was highest in the sham operation group.The average vesical pressure of the urine leak point and bladder compliance of the EA group rats were significantly lower than those of the model group The average vesical pressure of the urine leak point and bladder compliance of the sham operation group were lowest of all.All of these differences were statistically significant at the 1％ level of confidence.Conclusion EA can improve the lower bladder's detrusor reflex state and urinary tract function soon after complete T10 spinal cord transaction,at least in rats.

Objective To study the expression of ZNF217 and EF1α gene in the pathological scars and to investigate role and probable mechanism in the pathogenesis of abnormal scar.Methods Quantitative real-time PCR and Western blot were performed to detect the expression and distribution of mRNA and protein of ZNF217 and EF1α in hypertrophic scar (10 cases),keloid (10 cases),normal scar (10 cases),and normal skin (10 cases),and statistics was used to analyze the data.Results The expression of ZNF217 mRNA and protein in the normal skin,normal scar,hypertrophic scar and keloid were 1.46±0.397,1.45±0.265,4.49±0.999,5.47±0.808; 0.276±0.0211,0.299±0.0150,0.743t0.0509 and 0.747±0.0377,respectively.The expression of EF1α mRNA and prorein in the normal skin,normal scar,hypertrophic scar,and keloid were 1.47±0.469,1.47±0.218,5.10±1.68,5.74±1.92; 0.505±0.0371,0.518±0.0153,0.780±0.0369 and 0.792±0.0290,respectively.The positive rate of mRNA and protein of ZNF217 and EF1α was not statistically different between the hypertrophic scar and keloid (P＞0.05),while they were all remarkably significant in comparison between normal scar and abnormal scar (P＜0.01).In pathological scar mRNA and protein of ZNF217 and EF1α showed a strong positive correlation.Conclusions The expression of ZNF217 and EF1α is increased in pathological scar.Therefore,ZNF217 and EF1α overexpression may play an important role in the proliferation of fibroblasts and in the pathogenesis of pathological scar.

AIM: To study the suppressive effect of glycogen synthase kinase-3β( GSK-3β) knockdown by RNA interference on the formation of keloid .METHODS:Human keloid fibroblasts ( KFB) in vitro were transfected with 3 pairs of specific GSK-3βsmall interfering RNA (siRNA).The best siRNA to inhibit the GSK-3βexpression in human KFB was screen by RT-PCR and Western blot .The expression of GSK-3βand related proteins at mRNA and protein levels in the KFB was determined by RT-PCR and Western blot .RESULTS: The GSK-3βsiRNA1434 remarkably inhibited the expression of GSK-3βat mRNA and proteins levels in the human KFB .After transfection with GSK-3βsiRNA, the protein levels of β-catenin, p-GSK-3β, Wnt2 and cyclin D1 were all decreased.KFB growth became slow.With the extension of time, the inhibition of cell growth increased , and the cell doubling time was significantly delayed .CONCLUSION:siRNA targeting GSK-3βefficiently knocks down the expression of GSK-3βin the human KFB, and inhibits the activation of Wnt signaling pathway , thus inhibiting the growth of keloid .GSK-3βmay be a potential therapeutic target for keloid .

Per2 gene plays one of the most critical roles of clock gene which modulates circadian rhythm both in the physiological, biochemical and behavioral processes of organisms. The distributions of per2 gene include suprachiasmatic nucleus of the hypothalamus, central nucleus of amygdala, bed nucleus of the stria terminalis, hippocampus and other components of limbic system; it affects the emotional and visceral activities through participating in the system of circadian rhythm. The central per2 gene regulates the hypothalamus-pituitaryadrenal axis through integration of light input, steroid hormones and other neurotransmitters integration, acting on the target organs, and presentes a circadian rhythm of movement. This article reviewed the morphology and biology of per2 gene, and its participation in limbic system regulating the circadian rhythm of motional and visceral activities.

Objective To study the expression of WWOX and C-JUN in keloid and to approach their role and mechanism in the pathogenesis of keloid.Methods Immunohistochemical SP methods were used with computer pathological image analysis.Western blot and reverse transcription polymerase chain reaction (RT-RCR) were performed to detect the expression of WWOX and C-JUN in keloid and normal skin with statistical analysis.Results In keloid,the expression of WWOX protein was located in the cytoplasm of fibroblasts,and the expression of WWOX protein and its mRNA decreased,with significantly statistical difference (P＜0.05) compared to normal skin in the control group; the expression of C-JUN protein was located in the cell nucleus and cytoplasm of fibroblasts,with increased expression of C-JUN protein and its mRNA,with significantly statistical difference (P＜0.05) in comparison to normal skin in the control group.The expression of both was negative correlation (r=-0.626,P＜0.01).Conclusions Both WWOX with low expression and C-JUN with high expression are keloid-related genes,having significantly negative correlation between them,which may be one of the mechanisms for the keloid formation.It indicates that the WWOX protein may be an inhibitory factor to the expression of C-JUN protein,and the genes may play a major role in the pathogenesis of keloiod through fibroblasts.