We found that the obstacles to communication mostly came from patients,doctors and students in the light of recent communication conditions and experience of surgical probation teaching.The way to improve students'communication ability included raising the level of competence of clinical teachers teams,adopting the idea of"seeing patients as relatives",paying attention to culturing themselves,keeping a good image,mastering linguistic communication techniques,and being good at conversation with patients.

Objective:To explore the risk factors for laparoscopic cholecystectomy (LC) for acute cholecystitis.Methods:The LC clinical data on 153 patients with acute cholecystitis were summarized and analyzed by stepwise logistic regression(forward).Results:It was found that among the 153 cases of acute cholecystitis,125 underwent laparoscopic cholecystectomy successfully and 28(18.30%) had conversion to open cholecystectomy.The risk factors for unsuccessful LC in acute cholecystitis included previous upper abdominal operation or recurrence history,rigidity in right upper abdomen,leukocytosis,stone incarceration on the neck of the gallbladder and no visualization of the gallbladder sonographically,more than 72 hours of onset of symptomatic cholelithiasis.In addition,conversion to open cholecystectomy should be made unconditionally,once intensive dense adhesion and unclear discrimination of Calot′s triangle happened for the duration of LC.Conclusion:The risk score for LC in acute cholecystitis in the study is helpful for evaluating completely the patients of LC before operation,and for increasing success rate and decreasing complication incidence of LC.

Objective To explore the clinical characteristics and prognostic factors of patients with hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods The clinical data of 39 patients with hepatolithiasis associated with intrahepatic cholangiocarcinoma in the First Affiliated Hospital of Chongqing Medical University from Jan 2006 to Jun 2013 was retrospectively analyzed. Results The main clinical manifestations of hepatolithiasis associated with intrahepatic cholangiocarcinoma included recurrent fever, abdominal pain, jaundice and hepatic percussion pain. Among the 39 cases, the patients older than 60 years accounted for 69.2 % (27/39), and the duration of hepatolithiasis more than 10 years accounted for 76.9 % (30/39). Remarkable differences were found in serum CA19-9 and surgery methods (both P< 0.05). Conclusions Recurrent fever, abdominal pain, jaundice and hepatic percussion pain are the main clinical manifestations for the patients who are diagnosed with hepatolithiasis associated with intrahepatic cholangiocarcinoma. Advanced age and longer duration of the disease may be the high risk factors. Serum CA19-9 levels and surgical methods are the important prognostic factors.

OBJECTIVE: To investigate the expression of peroxisome proliferator-activated receptor γ (PPAR-γ) in the sinus mucosa of chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP). METHOD: Using immunohistochemistry and RT-PCR, testing the content of PPAR-γ in sinus mucosa and nasal polyps of patients with chronic sinusitis without nasal polyps and normal inferior turbinate, and analyzing the differences. RESULT: The PPAR-γ was found both in sinus mucosa of CRSsNP, nasal polyps of CRSwNP and in normal inferior turbinate; (2) The expression of PPAR-γ in sinus mucosa of CRSsNP and nasal polyps of CRSwNP was lower than that in normal inferior turbinate tissue, and the differences was prominent in statistics; (3) No differences in the expression of PPAR-γ were obtained in sinus mucosa of CRSsNP and nasal polyps of CRSwNP. CONCLUSION The PPAR-γ expressed in human nasal mucosa, meanwhile it was descending in sinus mucosa of CRSsNP and nasal polyps of CRSwNP. The long-term inflammations resulted from CRSsNP and nasal polyps of CRSwNP might relate to PPAR-γ, it suggested that PPAR-γ agonists may offer a new therapy for the treatment of Chronic Rhinosinusitis.
Chronic Disease ; Humans ; Immunohistochemistry ; Inflammation ; Nasal Mucosa ; Nasal Polyps ; metabolism ; PPAR gamma ; biosynthesis ; Rhinitis ; metabolism ; Sinusitis ; metabolism ; Turbinates

Background and purpose: It was reported that Sonic Hedgehog (SHH) signaling pathway was involved in carcinogenesis and progression of various tumor types. This study was designed to observe the expression of Shh and Gli2 in SHH signaling pathway in hepatocellular carcinoma (HCC) and to study the relationship between the expression of Shh and Gli2 and different clinicopathlogical characteristics, and further to explore the clinical significance. Methods: We studied 30 HCC tissues and 10 normal liver tissue slices using immunochemistry for the expression of Shh and Gli2, 10 fresh HCC tissues, adjacent-tumor tissues and 2 HCC cell lines HepG2, Huh7 by using RT-PCR for the mRNA expression of Shh and Gli2. Results: Immunochemistry showed in 30 HCC tissue slices,the positive ratios of the components of SHH signaling pathway Shh, Gli2 were 63.3% (19/30) and 66.7% (20/30), respectively. Expression of Gli2 was significantly correlated with the pathological grade and the tumor invasion in hepatic portal vein (P=0.017 and P=0.024). Shh and Gli2 did not express in normal liver tissue. RT-PCR showed Shh and Gli2 were detected as positive in both HCC tissues and lines. The expressions of Shh mRNA and Gli2 mRNA were higher in HCC than in adjacent-tumor tissues (P<0.05). The expressions of Shh mRNA and Gli2 mRNA were higher in Huh7 than in HepG2 cell lines, but no significant difference was found between them (P>0.05). Conclusion: The expressions of Shh and Gli2 were elevated in HCC, which indicated that SHH signaling pathway may be involved in human HCC carcinogenesis. The study may be useful for treatment of HCC.

Objective To explore the effect and mechanism of Gli2 on EMT and invasion in the hepatocellular car-cinoma cell line SMMC-7721.Methods shRNA of Gli2 and Negative control (NC) shRNA were constructed and transfected into SMMC-7721 cells.shRNA-Gli2 group,shRNA-NC group and blank group were set up .Transwell chambers assay , adhesion experiments were used to detect the ability of invasion ,homogeneous and heterogeneous cells intercellular adhesion of each group .Meanwhile, the qRT-PCR, Western blot were used to examine Gli2, E-cadherin ,N-cadherin and vimentin mRNA and protein expression .Results In different hepatocellular carcinoma cell lines and be along with the increasing ability of the invasion in hepatocellular carcinoma cell lines , Gli2 expres-sion was higher .Compared with the shRNA-NC group and blank control group ,the interfered group extensive cells invasion ability was inhibited ( P <0.05 ) , homogeneous cells intercellular adhesion increased and heterogeneous cells intercellular was opposite ( P <0.05 ) , meanwhile , the expression of E-cadherin was declined significantly ( P<0.05 ) ,the expression of N-cadherin , vimentin raised significantly ( P<0.05 ) .Conclusions Silencing Gli2 gene can reverse the EMT of the hepatocellular carcinoma cell line SMMC-7721 and inhibit cell invasion ,its mecha-
nism may be related to the up-regulation of E-cadherin and the dow N-regulation of N-cadherin, vimentin.

Objective To study the application of modified two-hole laparoscopic cholecystectomy ( LC) for exploring new minimal invasive LC approach. Methods 176 patients with calculous cholecystitis and polypus of cholecyst underwent LC through two abdominal holes. Results 174 gallbladders were removed successfully by modified two-hole LC. The average time of operation was 27.8±7.1minute. The average hospitalized stays of post operation were 2.7±0.8 day. There were two patients whose operation had to be converted to tradition three-hole LC. There were no complication and conversion of open cholecystectomy in all patients. During an average follow-up time of 6 monthw, ranged from 3 to 10month, there were no abdominal pain and jaundice happened to patients. Conclusions The application of modified two-hole LC is a safe and effective LC approach on the basis of skillful perform of traditional three-hole LC. It can reduce the injury to patients and advance the technique of ninimal invasive surgery further.

Retmperitoneal ganglioneuroma is a rare neurogenic benign tumor.The prognosis of patients was good when the tumor was completely resected,while the surgical procedure is complicated.In March of 2013,a male patient with complex retroperitoneal ganglioneuroma was treated at the First Affiliated Hospital of Chongqing Medical University.A hypoechoic solid lesion (size,6.5 cm ×4.5 cm) adjacent to the head of the pancreas was detected by color Doppler ultra-sonography 9 months ago,and no any other clinical symptoms were detected.Perioperative abdominal computed tomography and the surgery confirmed that the tumor (size,8.5 cm × 7.5 cm × 4.5 cm) was located beneath the pancreas,encompassing thc ccliac artery,hepatic artery,splenic artery and superior mesenteric artery,surrounding the head and uncinate process of the pancreas,making it impossible to be separated.The tumor was closely connected with the portal vein,superior mesenteric vein,splenic vein and left renal vein.The tumor was separated from the major blood vessels,the body and tail of the pancreas,while the tumor could not be resected from the pancreatic head,and thus tumor resection and pancreaticoduodenectomy were performed.The surgery was extremely diffcult,but the complete removal of tumor was successfully achieved without excision of the major blood vessels and the patient recovered well.

Objective To evaluate the feasibility and clinical efficacy of amputation in situ secondary braches of splenic pedicle for laparoscopic splenectomy(LS)in patients of idiopathic thrombocytopenic purpura(ITP).Methods LS was performed in 41 ITP patients hospitalized in our department from January 2007 to November 2008 by dissecting secondary braches of splenic pedicle.The serosa on the spleen pedicle was opened by using a harmonic scalpel.Then secondary structures of the splenic arteries and veins,one by one,were disconnected from downward to upward,and then double ligated with the Hem-O-lok clips.The ligated section was cut off with the harmonic scalpe1,and then the spleen was resected.Results LS was successfully completed with no conversion to open surgery in all the 41 cases.The operative time was 75 to 180 min,and the estimated intra-operative blood loss was 50 to 800 ml.There were 3 cases of vice spleen and the vice spleen removed.Two cases were converted to traditional LS with Endo-GIA.The period of hospitalization was 4 to 9 d after operation.There was no severe postoperative complication.Platelet counts began to increase significantly after operation,reached to the peak in 5 to 7 d after operation.During the follow-up of 3 to 20 months to all 41 ITP patients,the total effective rate was 85.4%(35/41,including 22 cases of complete response and 13 cases of partial response).Conclusion LS with amputation in situ secondary braches of splenic pedicle is a safe,effective,minimally invasive and low complication in treatment of ITP.It is worth be recommended because of its lower costs in comparison with common LS.

Objective To evaluate the safety and efficacy of combining radiofrequency ablation(RFA) with arsenious acid(AA) locally to treat liver VX2 tumor in rabbits,and to explore its mechanism.Methods Twenty-eight New Zealand White rabbits with implanted liver VX2 tumors were randomly divided into four groups: control group(n= 7),AA group(n=7),RFA group(n=7),and combination(RFA+AA) group(n=7).ALT was measured before treatment and on the day 0,day 3,day 7 and day 14 after treatment,meanwhile ultrasonic(US) examination was performed.All rabbits were killed 14 days after treatment.Vascular endothelial growth factor(VEGF) was examined by immunohistochemistry,and the relationship of VEGF and gross tumor volume was analyzed.Results Combination(RAF+AA) therapy caused little damage to hepatic function but had better inhibited tumor growth.The level of VEGF in AA,RFA and RAF+AA group was lower than that of the control group(P