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.

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 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.

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 study the application value of different operation methods in the treatment of left hepatolithiasis in special position (the stone is located in the sagittal section of left portal vein and/or near the proximal end of left hepatic vein).Methods:From July 2015 to June 2018, 58 patients with left hepatolithiasis in special position in Department of General Surgery, the First People′s Hospital of Tianmen City of Hubei Province were analyzed retrospectively. According to the different operation methods, they were divided into two groups: left liver excision under laparoscopy and gallbladder incision stone group (left liver excision group, n=28) and laparoscopic left-half liver excision and bile tube excision stone removal group (left half liver excision group, n=30). The operation time, intraoperative bleeding, postopera-tive hospital stay, postoperative biliary fistula, postoperative bleeding, postoperative stone residue and stone recurrence were compared between the two groups.The measurement data with normal distributions were represented as ( Mean± SD), and comparison between groups was done using the t test. The chi-square test and Fisher precision test were used for comparison between counting data. Results:All 58 patients underwent laparoscopic surgery. Left liver excision group surgery time, in-serum bleeding, number of days hospitalized after surgery, number of postoperative bile fistula cases, number of postoperative bleeding cases were (161.53±30.56) min, (203.45±26.69) mL, (9.26±3.3. 86) days, 1 case, 1 case, left half liver excision group (153.16±42.63) min, (198.79±30.82) mL, (9.59±4.01) days 1 case, 1 case, The difference between the two groups was not statistically significant ( P>0.05). The number of postoperative stone residues was more than that of the left liver and outer leaf excision group (4 cases) than that of the left half of the liver excision group (1 case), and the number of postoperative stone recurrence cases was more than that of the latter (1 case), all of which were statistically significant ( P<0.05). The number of stone residues and stone recurrences after left liver excision group was 4 and 5 cases respectively, and the left half liver excision nurses were 1 case and 1 case, respectively, and the difference between the two was statistically significant ( P<0.05). Conclusion:For the left hepatolithiasis in special position (the stone is located in the sagittal section of the left branch of the portal vein and (or near the proximal end of the left hepatic vein in imaging), the lower abdominal left hemihepatectomy + choledocholithotomy is a safer and more effective treatment.

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.

To evaluate the feasibility of using polyethyleneimine (PEI) coated magnetic iron.oxide nanoparticles (polyMAG-1000) as gene vectors. The surface characteristics of the nanoparticles were observed with scanning electron microscopy. The ability of the nanoparticles to combine with and protect DNA was investigated at different PH values after polyMAG-1000 and DNA were combined in different ratios. The nanoparticles were tested as gene vectors with in vitro transfection models. Under the scanning electron microscope the nanoparticles were about 100 nm in diameter. The nanoparticles could bind and condense DNA under acid, neutral and alkaline conditions, and they could transfer genes into cells and express green fluorescent proteins (GFP). The transfection efficiency was highest (51%) when the ratio of nanoparticles to DNA was 1:1 (v:w). In that ratio, the difference in transfection efficiency was marked depending on whether a magnetic field was present or not: about 10% when it was absent but 51% when it was present. The magnetic iron oxide nanoparticles coated with PEI may potentially be used as gene vectors.
Breast Neoplasms/metabolism ; Breast Neoplasms/*pathology ; Cell Line, Tumor ; Ferric Compounds/*chemistry ; Ferric Compounds/metabolism ; Gene Targeting ; Genetic Vectors ; Green Fluorescent Proteins ; Magnetics ; Nanotechnology ; Particle Size ; Polyethyleneimine/chemistry ; Transfection/methods

The aim of this study was to evaluate the feasibility and efficacy of using TRAIL gene to treat breast cancer mediated with a novel carrier - magnetic iron oxide nanoparticles (poly-MAG-1000) coated with PEI. The magnetic iron oxide nanoparticles were used as gene carrier to transfect TRAIL gene into MCF-7 cells. The polyMAG-1000 without TRAIL gene was transfected into the tumor cells as negative control. TRAIL gene transfection with liposome as carrier served as positive control. The apoptosis of cells was detected with TUNEL method. The apoptosis ratio of tumor cells was measured with flow cytometry (FCM). It was found that the apoptosis occurred in the tumor cells after transfection of TRAIL gene mediated by both polyMAG-1000 and liposome. The apoptosis ratio in the group with polyMAG-1000 as gene carrier was (25.11+/-2.85) %, whereas it was (5.06+/- 1.05) % in the control group with polyMAG-1000 (P<0.01). The apoptosis ratio was as low as (18.31+/-2.44) % in the group with liposome as gene carrier (P<0.05, as compared with the group with polyMAG-1000 as gene carrier). It is suggested that TRAIL gene may induce apoptosis in MCF-7 breast cancer cells. The magnetic iron oxide nanoparticles coated with PEI may be a potential gene carrier with high transfection efficacy for cancer gene therapy..