Gallstone disease is highly prevalent in clinic,particularly in women and some specific ethnic groups.The formation of water-insoluble cholesterol crystals is due to a misbalance between the three major lipids present in the bile:cholesterol,bile salts,and phospholipids.Many proteins implicated in biliary lipid secretion in the liver are regulated by several transcription factors,including nuclear receptors LXR and FXR.Human and murine genetic,pathophysiological evidence is consistent with the relevance of these nuclear receptors in gallstone formation.In addition,there is emerging data that also suggests a role for estrogen receptor ESR1 in abnormal cholesterol metabolism leading to gallstone disease.A better comprehension of the role of nuclear receptor function in gallstone formation may help doctors to design new and more effective therapeutic strategies for this highly prevalent disease condition.

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 efficacy of minimally invasive treatment by combination of external fixation with limited internal fixation for unstable distal radius fractures. Methods From September 2003 to September 2007,43 patients with unstable distal radius fractures were treated with external fixation combined with Kirschner wire fixation. According to AO classification,there were 10 cases of C1,21 cases of C2,and 12 cases of C3. Two external fixation clamp stand screws were inserted into the dorsal radius in operation,then external clamp stand was fixed when manipulative reduction were performed after C-arm perspective. The broken bones were sledged by Kirschner wire when articular facet and bone block were not peaceful and could not achieve reduction by traction. When the bone block was instable,a Kirschner wire fixation was needed. Bone graft through a limited incision were performed for bone defect if necessary. Results All of the 43 cases achieved anatomical reduction after the operation. The mean operaton time was 62.4 min (range from 43 to 121 min). And the mean intraoperative blood loss was 15.3 ml (ranged from 6 to 30 ml). The patients were discharged from hospital in 3 to 14 days with a mean of 5.5 days. After being discharged,they were followed up for 6 to 24 months (mean,12 months),during which,re-examination showed bone union and improved articular activities in all the cases. According to the Dienst scale system,30 patients achieved excellent,8 were good,and 5 were fair. The rate of excellent and good results was 88.4% (38/43). Conclusion External fixation combined with limited internal fixation is a simple,reliable and effective method for treatment of the unstable distal radius fractures.

Objective To report the early mortality and associated risk factors after damage control operation (DCO) in patients with severe abdominal trauma.Methods A total of 146 patients hospitalized from January to March in 2015 were retrospectively analyzed.Early death was defined as death occurring within 72 h of first surgery and before the definitive surgery.Based on the death definition, the subjects were divided into death group and survival group.The two groups were compared for gender, age, injury time, injury classification, vital signs, need for cardiopulmonary resuscitation, Glasgow coma score (GCS), injury severity score (ISS), hemoglobin, platelets, prothrombin time (PT), activated partial thromboplastin time (APTT), blood pH, base excess, operative time, and postoperative acute physiology and chronic health evaluation score Ⅱ (APACHE Ⅱ).Logistic regression analysis was applied to examine the predicators of early postoperative mortality.Results There were 118 patients (80.8％) in survival group and 28 patients (19.2％) in death group.Survival and death groups differed significantly with regard to the percent of elderly (6.8％ vs.21.4％), percent of patients with multiple injury (62.7％ vs.85.7％), body temperature [(36.1 ± 0.4) vs.(35.2 ± 0.8) ℃], percent of patients with greater ISS (31.4％ vs.64.3％), PT [(12.1±1.5) vs.(13.9±1.2)s], bloodpH (7.25±0.04vs.7.08±0.11), base excess [(-8.9±2.8) vs.(-10.6±3.3)mmol/L], postoperative APACHE Ⅱ[(12.8 ± 1.8) vs.(17.5 ± 2.0) points] (P ＜ 0.05).Logistic regression analysis identified the age (OR=1.512, 95％ CI 1.112-4.157,P＜0.05), ISS (OR =1.313,95％ CI 1.134-5.442, P ＜ 0.05), APACHE Ⅱ (OR =1.361,95 ％ CI 1.182-5.222, P ＜ 0.05) as the independent risk factors for early mortality.Conclusion The patients underwent DCO for severe abdominal trauma has a high early mortality, which is closely associated with the age, injury severity and postoperative medical status.

Objective To study the clinicopathologic characteristics and differential diagnosis of T-cell immunophenotype in intestinal non-Hodgkin's lymphoma(NHL).Methods The clinicopathologic characteristics of 13 cases with intestinal T-cell lymphoma were analyzed by light microscopy and immunohistochemistry(Envision detection method).Results The lesions of 8 cases with T-cell lymphoma were found on the small intestine and 5 on the colon.Grossly,8 cases showed ulcer pattern,3 polypoid pattern and 2 presented as a regional thickening of intestinal wall.The tumor cells were medium to large size with pleomorphic nuclei and inflammatory background.The neoplastic lesions expressed the immunophenotype of peripheral T cells.The neoplastic cells of 13 cases(100%)expressed leukocyte common antigen(LCA);10(76.9%)cases expressed CD3;9(69.2%)CD45RO;5(38.5%)EB virus(EBV);3(23.1%)CD56 and 2(15.4%)vimentin(VIM).All the cases were negative for CD20,CD79a,CK,CDX2,NSE,CgA and CD117.ConclusionIntestinal T-cell lymphoma is a rare,aggressive neoplasm with poor prognosis and should be distinguished from other malignant tumors of intestine.

ObjectiveTo observe the effect of cluster needling of scalp acupuncture combined with rehabilitation(Tang's Approach) on learning and memory and the expression of hippocampus microtubule-associated protein-2 (MAP-2) in young rats after hypoxic ischemic brain damage (HIBD).Methods80 Wistar young rats were randomly divided into 5 groups: sham group, model group, scalp cluster acupuncture group, environmental stimuli group, and acupuncture with rehabilitation group, 16 rats in each group. Each group was divided into 2 subgroups on the 14th and 28th days after the model. HIBD young animal model was made by ligating left common carotid artery and inspiring 8% oxygen and 92% nitrogen mixture. Learning and memory was observed by Morris water maze, and MAP was observed by immunohistochemistry.ResultsThe results of the Morris water maze test showed that there was significant difference in ability of place navigation and space exploration in the scalp cluster acupuncture group, the environmental stimuli group, and the acupuncture with rehabilitation group compared with the model group (P<0.05), and there was significant difference in ability of place navigation and space exploration in the acupuncture with rehabilitation group compared with the scalp cluster acupuncture group and the environmental stimuli group (P＜0.05). The results of immunohistochemistry showed that there was significant difference in the expression of MAP-2 in the scalp cluster acupuncture group, the environmental stimuli group, and the acupuncture with rehabilitation group compared with the model group (P<0.05), and there was significant difference in the expression of MAP-2 in the acupuncture with rehabilitation group compared with the scalp cluster acupuncture group and the environmental stimuli group (P＜0.05). ConclusionLearning and memory of young rats after hypoxic ischemic brain damage can be improved by Tang's Approach which is possibly related with expression of MAP-2 in hippocampus.

Objective This study describes the protective effect of myocardial isehemic post- conditioning on ischemic-reperfused myocardium (I/ R) of diabetic rat and its Signaling mechanism. Methods Healthy SD rats weighing 25O-30Og were divided into 6 groups; (1) Blank control; (2) Ischemia-reperfusion; (3) Post conditioning; (4) Diabetic postconditioning ; (5) Diabetic ischemia-reperfusion; ( 6) Diabetic blank control group. Ten rats in each group were randomly selected. Introduction of diabetic rat model: 65 mg/kg STZ was injected into the intraperitoneal cavity, until 2 consecutive blood glucose measurements≥ 16.65 mmol/L were reached after48h. The diabetic model was successful when rats had following symptoms, such as more drinking, more eating, polyuria, weight loss and epilation. Langendorff isolated rat heart perfusion was used for the experiment. Following parameters were measured and compared: Coronary perfusion flow, myocardial infarct size, western blot for measurement of P-Akt, changes in myocardium and mitochondrian observed by Electron microscopy. Results Blood glucose concentration in diabetic group was (23. 15±2. 16) mmol/L and (4. 16±0. 31) mmol/L in non-diabetic group. There was a significant difference (P <0. 01) between the two groups. There were more coronary flow in post-conditioning groups (Post group and Dpost group) than ischemia-reperfusion groups (IR group and DIR group) (6.5±1.2、5.6±1.0 vs. 3.4±1.0、2.0±1.3). The myocardial infarction size was smaller in post-conditioning groups than in ischemia-reperfusion groups (25.2±2.1、34.2±3.6 vs. 47.5±3.5 、65.2±4.5). There was more expression of P-Akt and the myocardial fibers and mitochondrian in post-conditioning groups were better preserved. Conclusion Postconditioning has protective effects in diabetic rat hearts. The mechanism may be associated with Akt activation.

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.

AIM: To screen the lentiviral vector carrying siRNA with higher efficiency of suppressing the sphingosine-1-phosphate receptor 2 (S1P2) gene expression in the primarily cultured corpus cavernosum smooth muscle cells of spontaneously hypertensive rats (SHR).METHODS: SHR and SD rats (n=5 each) were used for primarily culturing corpus cavernosum smooth muscle cells.The cells were randomly divided into 6 groups: SHR siRNA-1, SHR siRNA-2, SHR siRNA-3, SHR GFP, SHR control (SHR non-transfection group), and SD control (SD rat control group).Each group had 5 samples with 1.0×105 cells of each sample.At 72 h after transfection (MOI=60) with lentiviral vectors carrying S1P2 siRNA into the SHR corpus cavernosum smooth muscle cells, the expression of GFP was observed under fluorescence microscope.The protein expression of S1P2, ROCK1, ROCK2 and eNOS in the corpus cavernosum smooth muscle cells, and the mRNA expression of S1P2, ROCK1 and ROCK2 were determined by by Western blot and RT-PCR.RESULTS: The transfection efficiency of the corpus cavernosum smooth muscle cells in SHR siRNA-1, SHR siRNA-2, SHR siRNA-3 and SHR GFP groups were>80%.Compared with SHR control group, the mRNA levels and the protein expression of S1P2, ROCK1 and ROCK2 in SHR GFP group showed no remarkable changes, while those in SHR siRNA-1, SHR siRNA-2, SHR siRNA-3 and SD control groups were significantly lower than those in SHR control group (P<0.05).The protein expression of eNOS in SHR siRNA-1, SHR siRNA-2, SHR siRNA-3 and SHR GFP groups were not significantly changed as compared with SHR control group, but that in SD control group was significantly higher than that in SHR control group.CONCLUSION: Three groups of siRNA lentiviral vectors targeting S1P2 inhibit the expression of S1P2 in the corpus cavernosum smooth muscle cells of SHR, and by silencing the S1P2 expression, the expression of ROCK1 and ROCK2 is inhibited.Among them, siRNA-1 has the highest inhibitory efficiency.