Cholelithiasis has still been a common and endemic disease damaging people's health in our country.Management modes and prognosis of this disease have been changed and improved greatly in the past fifty years.Based on our own clinical practice and experience in the People's Hospital of Hunan Province,we reviewed aspects concerning on diagnosis,principles and technical considerations of surgical treatment,summarized background and changes in the past almost half century,which reflected our unremitting efforts and distinctive contributions in management of cholelithiasis.Our experience demonstrated that cholelithiasis should not be considered as a gradually disappearing disease,difficulties and perplexities in dealing with such disease would still be arduous challenges for surgeons,although rates of stone residue and reoperation decreased dramatically.

Objective To describe a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy and explore its clinical application.Methods We retrospectively reviewed clinical data on 57 patients receiving modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy in the Department of Hepatobiliary Surgery,People's Hospital of Hunan Province during the period from February 2016 to August 2016.Results Among 57 cases,38 cases previously underwent conventional basinforming hepatic duct-jejunum Roux-en-Y choledochojejunostomy for the reasons such as hepatolithiasis,iatrogenic proximal bile duct injury,congenital choledochal cyst (Todani type Ⅰ),etc.The mean number of operation was 1-4(1.8 ± 1.3).Errors during reoperation can be classified relevant to cholangiojejunostomy anastomosis,bridging jejunal loop and jejunum-bridging jejunal loop anastomosis.Among 57 cases,bile intestinal anastomotic leakage occurred in one patient,incision fat liquefaction in 3 patients,2 patients experienced stress gastritis,all postoperative complications recovered under conservative management.No postoperative mortality happened.During mean (4.07 ± 3.27) months follow-up period,only 4 patients complained of reflux cholangitis,which could be easily managed by antibiotics use.Conclusions By correcting errors in application of conventional Roux-en-Y choledochojejunostomy,a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy proposed in this study demonstrated preliminary better results.

[Objective]To evaluate the reliability of proximal femoral nail anti-rotation(PFNA) in treatment of intertrochanteric fracture using K-wire apex distance(KAD) intraoperatively to control tip apex distance(TAD).[Method]From January 2007 to January 2009,44 cases of intertrochanteric fractures were treated by closed reduction internal fixation with PFNA.Intra-operative KAD and post-operative TAD were measured and analyzed for their correlation.[Result]Follow-up was given to 42 patients for 6-18 months(averaged,10 months).Bone union was achieved after 11-23 weeks(averaged,13 weeks).Intra-operative KAD were 13-31 mm,with an average of 21.75 mm.Post-operative TAD were 18-35 mm,with an average of 24.61 mm.Recurrence of cerebral infarction was found in 1 case.No infection,deep vein thrombosis,intramedullary nailing rupture,screw broken or femoral fracture was found.[Conclusion]With the help of intra-operative fluoroscopy,the distance from the end of Kirschner's wire to joint surface(KAD) plays an important role in controlling TAD,and it could prevent relative complications such as helical blade cutting-out of femoral head.

Chronic lymphocytic leukemia (CLL), the most frequent form of leukemia in Western countries, is characterized by the clonal proliferation and accumulation of neoplastic B lymphocytes in the blood,bone marrow,lymph nodes and spleen.During the past decades,important advances have been made in the understanding of the biology,pathology,diagnosis and treatment of CLL.In the 53rd ASH annual meeting,lots of new discoveries about the biology, prognosis, and treatment of CLL were introduced which lead us to further understand CLL and may provide more or better treatments for CLL patients.

High grade B-cell lymphoma (HGBL) has been defined as a separate entity in World Health Organization classification in 2016 and is considered to be clinically aggressive. People make continuous analysis of the subgroups and accurate treatments, such as the comparison between the prognosis of HGBL-not otherwise specified and double-hit lymphoma (DHL), transformed and primary DHL, myc partner/bcl-2/bcl-6 translocation, TP53 expression, serum albumin, chemoimmunotherapy, hematopoietic stem cell transplantation, T cells with chimeric antigen receptors therapy, etc. This report will address the progress of HGBL prognosis and therapy in the 58th American Society of Hematology Annual Meeting.

Objective To study the clinical characteristics and effects of surgical treatment of children with thalamic tumors.Methods The clinical data of 22 cases were retrospectively studied and followed-up 6 months to 9 years.Results There were 13 boys and 9 girls,their ages ranging from 3 to 13 years.The average duration of symptoms before diagnosis about 2 months.Headache and papilledem were the most symptoms and signs,respectively.Most children′s thalamic tumors were low grade tumors with clear verge.In this group,good results were obtained that total remove 9 cases,subtotal remove 8 cases,partial remove 3 cases,biopsy 2 cases and no surgical death.Conclusions Clinical character of children thalamic tumors is distinct and good surgical results in the nearly future.The long results are determined by type of pathology.

Objective:To evaluate the feasibility of using polyethyleneimine(PEI) coated magnetic iron oxide nanoparticles(polyMAG-1000) as gene vectors. Methods:The surface characteristies of the nanoparticles were observed with scan electronical microscope.The ability of the nanoparticles to combine and protect DNA were investigated at different PH after the polyMAG-1000 and DNA were combined at different ratio.The nanoparticles were tested as a gene vectors through transfection models in vitro. Results: Under scan electronical microscope, the diameter of the nanoparticles was about 100 nm. The nanoparticles could bind and condense DNA under acidic ,neutral and alkaline pH conditions. The nanoparticles could transfer gene into cell and express green fluorescent protein(GFP).The efficiency of transfection was the highest when the ratio of the nanoparticles and DNA was 1 ∶ 1(v ∶ w).The difference was marked in the transfection efficiency when magnetic field was added or not. Conclusion: The magnetic iron oxide nanoparticles coated with PEI may be potentially used as gene vectors.

ObjectiveTo determine the bispectral index and dose of propofol at which 50 % of patients fall into unconsciousness during induction (BIS50 and EDs0 ). MethodsThirty unpremedicated ASA Ⅰ-Ⅱ patients scheduled for elective surgery were included in this study. The patients did not take any sedatives or hypnotics and had no psychiatric disease. Loss of consciousness and changes in BIS during induction with propofol were studied by sequential experimental method. The loss of responses to verbal command and eyelash stimulation was used as an induction of unconsciousness. The data obtained were analyzed by linear regression and calculated to determine BIS50 and ED50 using weighted averaging method. ResultsThe BIS50 and ED50 for propofol were 79.17 and 1.0192 ng/kg with the 95％ confidence intervals of 72.08-88.55 and 0.94-1.148 mg/kg respectively. Conclusions The sequential experimental method for determination of ED50 is simple, efficient and reliable and also suitable for determination of BIS50.

Objective To investigate the effectsof quercetin on human umbilical vein endothelial cell (HUVEC)-12 undergoing endothelial-to-mesenchymal transition (EndMT) induced by TGF-β1; To discuss its mechanism of action. Methods Cell activity of intervening by quercetin with different concentrations and TGF-β1 for 72 h was detected by CCK-8 method;RT-PCR and immunofluorescence staining were used to detect the transition of endothelial and stromal markers; Western blot was used to detect the signal transduction pathway; RT-PCR was performed to detect the transcription factors that play crucial roles in the process of transformation. Results The results of RT-PCR and immunofluorescence double staining showed that TGF-β1 (10 ng/mL) stimulated HUVEC-12 cells for 72 h to induce fibroblast phenotype, showing more interstitial markers and less endothelial markers;Western blot and RT-PCR results showed that quercetin inhibited the phosphorylation of smad2/3 in a concentration-dependent manner;After TGF-β1 stimulation, the downstream transcription factors EndMT of snail1, twist1, twist2, ZEB1, and ZEB2 significantly increased, while 100 μmol/L quercetin could down-regulate the five downstream transcription factors. Conclusion Quercetin has anti-fibrosis effects through inhibiting HUVEC-12 cells undergoing EndMT.

Objective To evaluate four tumor markers of insulin-like growth factor 1((IGF-1), CEA, cytokeratin fragment antigen 21-1 (CYFRA21-1), neuron-specific enolase (NSE) for the diagnosis and prediction of treatment response in human lung cancer. Methods Serum samples were taken from three groups: 91 patients with lung cancer, 30 healthy adults and 15 patients with benign pulmonary diseases. Serum IGF-1 was assayed by radioimmunoassay and CEA, CYFRA21-1, and NSE by electrochemiluminescence immunoassay. The differences among the three groups were determined by Kruskal-Wallis one-way analysis of variance (ANOVA) and with Mann-Whitney rank-sum test. Diagnostic efficacy was evaluated by ROC curves. Results The four serum tumor marker levels were significantly higher in lung cancer group, as compared with the benign and the healthy (IGF-1:χ2=26.95,P<0.001, CEA:χ2=49.11,P<0.001; CYFRA21-1:χ2=40.63,P<0.001; NSE:χ2=14.76;P<0.001). The diagnostic sensitivities of IGF-1, CEA, CYFRA21-1 and NSE was 75.6% (34/45), 53.3% (24/45), 66.7% (30/45) and 42.2% (19/45) respectively for lung cancer. The diagnostic sensitivity of IGF-1 combined with CYFRA21-1 was 95.5 %( 43/45) and that of IGF-1 combined with CEA and CYFRA21-1was 97.8%(44/45). Only IGF-1 and CYFRA21-1 showed significant changes before and after treatment (IGF-1: χ2=5.99,P=0.014; CYFRA21-1:χ2=4.99, P=0.025) in cancer group. Conclusions Serum IGF-1, CEA, CYFRA21-1 and NSE are all valuable for lung cancer diagnosis and the combination of those parameters can enhance the diagnostic efficiency. Serum IGF-1 and CYFRA21-1 may also be useful for evaluating the treatment response in lung cancer.