Objective To pay close attention to and reverse the increasing trend about missed diagnosis and misdiagnosis of carcinoma of gallbladder and bile duct in laparoscopic cholecystectomy(LC). Methods By using retrospective analysis of 17 cases of missed diagnosis and misdiagnosis of carcinoma of gallbladder and bile duct in LC, their Clinical features and proposing protective measures were summarized. Results Seventeen patients including 14 with carcinoma of gallbladder and 3 with carcinoma of bile duct received various therapeutic measures according to their own conditions or aspirations. Conclusion Rapid intraoperative frozen section diagnosis is required for the cases with suspected carcinoma in LC and second operation is performed for those who are pathologically diagnosed with malignant tumor after the first one. No pathological diagnosis is strictly prohibited.

Objective To explore the emergency management and prevention of iatrogenic injury of in-ferior vena cava. Methods A retrospective study was undertaken to investigate the operative procedure and post-operative outcome of 7 patients suffering from iatrogenic injury of inferior vena cava in the course of three nephrectomy, one fight adrenal gland tumor resection, one fight surgical kidney, one right upper retro-peritoneal tumor and one pancreaticoduodenectomy. The gross hemorrhage was controlled by local pressure. Then, abdominal incision was done. Firm pressure on the inferior vena cava was performed to right side for temporary control of hemorrhage. The bleeding part could be found when the hematocele was cleaned. And continuous suture should be done with 3-0 silk or absorbable suture after the crevasse was clamped. Results In these 7 cases, 1 died of hemorrhagic shock and the other 6 had significant effect postoperatively. The asso-ciated injuries were healed well except 1 case of slight edema of lower extremity. Conclusion Iatrogenic inju-ry of inferior vena cava can be treated successfully with correct procedure. Furthermore, the injury could be avoided with exactitude intraoperative procedure.

Objective To explore the diagnostic and therapeutic methods for male breast cancer. Methods Clinical data of 11 cases of male breast cancer treated in our hospital from 1992 were analyzed (retrospectively). Results 2 patients were diagnosed at advanced stage and survived 6 and 8 months (respectively) after biopsy. The other 9 patients received radical mastectomy. 3 were lost to follow-up, 1 was found to have pulmonary metastasis after 5 years and combined treatment of traditional Chinese medicine and western medicine was given. Nodules were found under the axillary fossa in another patient at five years after surgery and the nodules were recurrent carcinoma as confirmed by biopsy. The patient has survived for 7 years with radiotherapy and chemotherapy. The other 4 cases have survived 0.5 to 7 years respectively, and are undergoing treatment. Conclusions Early diagnosis of male breast cancer should be emphasized. Aggressive surgery combined with other auxiliary treatments are effective.

Objective To explore methods for the treatment and prevention of residual gallbladder.Methods Clinical data of 56 patients with residual gallbladder were retrospectively analyzed.Results All 56 cases were diagnosed through clinical imaging examination and cured by selective operation of residual gallbladder resection.Conclusion The residual gallbladder can be diagnosed by repeated biliary symptoms in patients with a history of cholecystectomy and imaging examination.Residual gallbladder resection is an effective therapy for the treatment of residual gallbladder.

Pancreatic neuroendocrine neoplasms (pNENs) are clinically rare,however,it shows an in creasing trend recent years.Surgical management,such as radical resection or debulking,plays an important role in this field.Different procedures can be applied to tumors with different types,locations,and developing stages.The optimal clinical management of pNENs involves a multidisciplinary approach in order to improve prognosis.

Objective To investigate the correlation of CT image features of mesenteric fibromatosis and its pathological characteristics.Methods Data of 12 mesenteric fibromatosis proved histopathologically in PLA General Hospital and Jiangsu Taizhou People's Hospital from March 2006 to March 2015 were retrospectively reviewed.Results There were 5 males and 7 females with ages ranging from 13 to 67.On the CT image,the masses varied from 3.9 cm to 33.0 cm in diameter.8 of them were round or oval well-circumscribed masses,and 4 were irregular with blurry border.10 of 12 cases were totally similar density,which was ranged from 27 HU to 39 HU.Contrast enhanced CT scan showed moderate enhancing masses in l0 of 12 cases.Macroscopic examination of these specimens revealed that the sections of 11 were solid,firm,grey and yellowish,and 1 was solid-cystic.On the histopathology,the masses consisted of homogeneous spindle shaped fibroblasts,myofibroblasts and collagen.Tumor cells were embedded in a collagen network interrupted by fibrotic sections.Immunohistochemical analysis revealed that the tumor cells expressed Vimentin,H-caldesmon and β-catenin.Conclusions Mesenteric fibromatosis is a rare disease with characteristic CT images,which were based on their pathological characteristics.CT images form the basis of preoperative diagnosis of this disease.

Objective To study the inhibition effects of oncostatin M (OSM) gene on human breast cancer cell line(michigan cancer foundation-7,MCF-7).Methods MCF-7 cells were infected with the optimized dose of retrovirus expressing OSM.Expression of the target gene was determined by reverse transcriptionpolymerase chain reaction(RT-PCR) and enzyme-linked immunosorbent assay(ELISA).Methyl thiazolyl tetrazolium (MTT) assay was employed to examine growth inhibition effect of OSM gene on MCF-7 cells.Cell apoptosis was determined by flow cytometry.The morphologic changes of nucleus was detected by Hochest staining,in addition,the expression of apoptosis related genes in tumor cells were further detected by RT-PCR.Results OSM gene was well expressed in human breast cancer MCF-7 cell by retrovial vetor and it could significantly inhibit the growth of MCF-7 cell(MTT,P =0.0162,P ＜ 0.05) and induce its apoptosis (Annexin V/PI,P =0.02,P ＜ 0.05).Conclusion OSM gene has significant inhibitory effects on MCF-7 cells,which mechanism might be related to the upregulation of Bax and Caspase3 and the downregulation of Bcl-2.

Objective To investigate the expression of RhoA gene in human hepatocellular carcinoma (HCC) and to discuss its significance during hepatocellular carcinogenesis. Methods Intratumor RhoA expression level was determined and compared with that in adjacent nontumorous hepatic tissues using quantitative real time reverse transcription polymerase chain reaction and Western blot in 64 HCC patients. Results The mRNA levels of RhoA were significantly higher in tumor tissues than that in the unaffected portions (t =3.445 ,P =0.0006). The expression of RhoA mRNA in the primary lesion was higher in patients with venous invasion (t = 2.667, P = 0.009), microscopic satellite lesions (t=2.172,P =0.038), and advanced pTNM stage (stage Ⅱ/Ⅳ; t=2.551,P=0.013) than in those without. There was a significant difference between high RhoA protein levels in the tumor tissues and noncancerous liver tissues in HCC patients (t = 3.532, P = 0.0002), and there was a significant association between high tumor RhoA protein levels and the presence of venous invasion (t = 2.087, P = 0.042), microscopic satellite lesions (t = 2.254, P = 0.031), and advanced pTNM stage (t = 2.812, P = 0.007). Conclusions There is a significant correlation between RhoA expression, tumor stage, and intrahepatic metastasis. The expression of RhoA could be used as a good tumor marker for invasive and advanced carcinoma as well as a prognosis predictor.

A methodology for preparing and certifying the reference material of 3-amino-2-oxazolidinone(AOZ) in eel muscle lyophilisates was presented. Furazolidone was accessed to eel by dipping fish in pond with furazolidone solution at a dosage of ca 0.16 mg/L. With the metabolism of furazolidone in eel, the muscles contain a certain concentration of AOZ as furazolidone metabolite was obtained. Lyophilization of the muscles was performed in one batch and 400 bags of samples were obtained by the procedure of homogenation, cryodesiccation and irradiation. The homogeneity and stability of the sample was examined. The value of the chemical constituent of the sample was certified through the collaborative analysis program participated by 11 laboratories using isotope dilution liquid chromatography-tandem mass spectrometry, and the uncertainty assessment was performed. The reference materials have been approved as certified reference materials by AQSIQ, China (State General Administration of the People′s Republic of China for Quality Supervision and Inspection and Quarantine) in 2009 after one year of trial period. The serial numbers is GBW(E)100180.

Sepsis is divided into sepsis, severe sepsis and septic shock according to the severity. The severe sepsis and septic shock can lead to multiple organ dysfunction syndrome, which is life-threatening. In the early stage of sepsis, catabolism is obviously. Early enteral and parenteral nutrition should actively correct nutrients and vitamin deficiency, and provide the best low protein and moderate amount of non-protein calories. In the recovery period, the body needs enough protein and calories. In different periods of sepsis, patients have different nutritional needs. Therefore, mastering the nutritional support treatment for the sepsis is extremely important for the prognosis of patients.