Objective To investigate the efficacy of modified VDLP (vincristine + daunorubicin + L-asparaginase + prednisone) for acute lymphoblastic leukemia (ALL) in elderly patients and its adverse reactions.Methods 31 elderly patients diagnosed as ALL at the initial visit from Jan.2009 to Dec.2014 were randomly divided into the experiment group (n=16) and the control group (n=15).Patients in the control group received traditional VDLP chemotherapy (vincristine 2 mg at 1,8,15 days;daunorubicin 30-40 mg/m2 at 1,2,15,16 days;L-asparaginase 6 000-10 000 U at 11,14,17,20 days;prednisone 1 mg/kg at 1 to 14 days),whereafter underwent a gradual dose reduction and drug withdrawal within 1-2 weeks.Patients in the experiment group received the modified VDLP chemotherapy (vincristine 2mg at 1,8,15 days;daunorubicin 30-40 mg/m2 at 1-3 days;L-asparaginase 6 000-10 000 U at 11,14,17,20 days;prednisone 1 mg/kg at 1 to 14 days),whereafter underwent a gradual dose reduction and drug withdrawal within 1-2 weeks.The complete response (CR) rate and complications were recorded.Results The CR rates were 53.3％ in modified VDLP group and 58.3％ in VDLP group,and there was no statistically significant difference between two groups (P ＞ 0.05).The treatment-related mortality and the incidence of severe infection had significant differences between the modified VDLP and VDLP groups (6.3％ vs.46.3％,31.3％ vs.66.7％,both P＜0.05).Conclusions Compared with VDLP,the modified VDLP is more tolerable and suitable for the elderly patients with ALL.

Objective To explore a new technique to treat the benign stricture at hilar bile duct of plastic anastomosis, so as to obtain the theoretical basis and the feasibilities of practical application in treating the benign stricture at hilar bile duct with plastic anastomosis through the animal experiments. Methods 30 miniature pigs were randomly divided into three groups. Group A (control group):2 centimeters of the bile duct above the duodenum was isolated;Group B:The same separation of bile duct with group A, then making physical injury on it with the clamps and electric heat;Group C:Making bile duct injury model in group C as group B,and then monitoring of the diet, feces, urine, ALT, AST and bilirubin etc. When the bile duct stricture was formed, taking the plastic anastomosis operation in this group. After all the operations, we observed the diet, mental state and the color of the urine of animals in all the three groups, and tested ALT,AST,T-BIL and D-BIL levels on the pre- and post-day and every 7 days after surgery respectively. After three months of the surgery,we executed all the pigs,picked up part of the liver tissue,then preserved them by liquid nitrogen for pathological examination. Results From the day before operative-day to the 30 days after operation, there was no significant change in ALT, AST, T-BIL and D-BIL in group A,while the relative indicators of group B and C had obvious changes ( <0.05) . The indicators of group B were significantly increased 21 days after surgery, compared with pre-operation and 14 days after operation respectively ( <0.05) . In group C, the indicators were significantly declined 14 to 21 days after the plastic anastomosis compared with pre-operation (<0.05) . Conclusions Treating benign stricture at hilar bile duct of miniature pigs by plastic anastomosis is feasible and practicable. This study provides an experimental basis for clinical application of plastic anastomosis in treatment of benign stricture at hilar bile duct.

The treatment of central nervous system diseases has always been a hot topic,owning to its complexity and existence of blood-brain barrier.In recent years,studies on mesenchymal stem cells-derived exosomes (MSCs-EVS) showed that MSCs-EVS are not only potential therapeutic drugs for central nervous system diseases,but also natural carriers of therapeutic drugs due to their good biocompatibility and ability to cross the blood-brain barrier.This paper reviews the application and underling mechanism of MSCs-EVS in treatment of central nervous system diseases,and looks forward to its applications in central nervous system disease.

Laparoscopic hepatectomy has been routinely used in all tumor types of the liver, but for tumors in the Ⅵ, Ⅶ and Ⅷ segments of the liver (referred to as tumors in a special position of the liver in this paper), laparoscopic hepatectomy has some difficulties in aspect of vision and operation due to the deep anatomical position. In the process of continuous experience accumulation, hepatobiliary surgeons have explored different surgical positions, surgical methods and surgical paths to solve the encountered difficulties. For tumors located in a special position of the liver, conventional laparoscopy, change of surgical posture, thoracoscopic or combined laparoscopy and retroperitoneal laparoscopy are effective and feasible. All of them have their own advantages.