Objective:To discuss the clinical application with choledochoscope paul gall stone under laparoscopic. Methods: Selected 45 cases of gallbladder stones with extrahepatic bile duct stones in patients as research subjects in the first general surgery 242 hospital of harbin from January 2010 until May 2013. used a random number table, patients were divided into two groups,25 cases in the observation group, used laparoscopic Choledochofiberscope Paul gall stone surgery;the control group of 20 patients, used laparoscopic cholecystectomy, compared surgical results, surgery and hospitalization data, postoperative complications situation. Results: Clinical efficacy markedly effective, ineffective, the total efficiency of the treatment was statistically significant; hospitalization, surgery time comparing the results with statistical significance;patients with diarrhea, complications steatorrhea, pancreatitis, stone recurrence comparison, the results are statistically significant. Conclusion:Paul Choledochofiberscope laparoscopic gall stone surgery can effectively improve the efficiency of treatment, and have shorter operative time, surgical advantages of simple, easy to control while surgery, gallbladder and bile duct stones are better minimally invasive treatment.

Background Studies showed that microRNA (miR)-375 suppresses the growth,apoptosis,migration and adhesion of tumor cells,and it plays a regulation to the changes of vascular endothelial growth factor (VEGF) in tumor tissue to arrest neovascularization.However,whether miR-375 intervenes the formation of new blood vessel in eyes is unelucidated.Objective This study was to explore the effects of miR-375 on human retinal capillary endothelial cells (HRCECs) function induced by hypoxia.Methods HRCECs were cultured using IMDM and divided into normal control group,CoCl2 model group,CoCl2 +miR-375 mimic group,CoCl2 +miR-375 mimic control group,CoCl2+miR-375 inhibitor group and CoCl2 +miR-375 inhibitor control group,and hypoxia cell models were created by adding 200 μmol/L CoCl2.MiR-375 and frizzled 4 (FZD4) small interfering RNA (siRNA) were transfected into the cells by 50 nmol/L miRNA lipidosome for 48 hours.The proliferation of the cells was detected by MTT assay;migrated number of the cells was examined by Transwell chamber assay;ELISA was employed to detect the concentrations of VEGF and VE-cadherin in the medium;the expression of β-catenin,cyclinD1,matrix metalloproteinase-2 (MMP2) and VEGF proteins were analyzed by Western blot;tube length of vessel formation was evaluated by Matrigel assay.Cultured cells were divided into normal control group,CoCl2 model group,CoCl2 +mock group and CoCl2 + FZD4 siRNA group,the relative expression of FZD4,a miR-375 targeted gene,was detected by luciferase reporter.Results The relative expression of miR-375 mRNA was significantly increased in the CoCl2 +miR-375 mimic group compared with the CoCl2 + miR-375 mimic control group and reduced in the CoCo2 + miR-375 inhibitor group compared with the CoCo2 + miR-375 inhibitor control group (t =-19.237,8.764,both at P＜0.01),with a higher transfected efficacy for miR-375.The cell proliferative fold,migrated cell number,VEGF and VE-Cadherin contents in the medium and the tube length were significantly different among the CoCl2 model group,CoCl2 +miR-375 mimic group,CoCl2 +miR-375 mimic control group,CoCl2 +miR-375 inhibitor group and CoCl2 +miR-375 inhibitor control group (F =24.324,26.776,14.113,19.225,15.040,all at P＜0.001),and those in the CoCl2 +miR-375 mimic group were evidently reduced in the CoCl2 +miR-375 mimic group compared with the CoCl2 +miR-375 mimic control group,while those in the CoCl2 +miR-375 inhibitor group were considerably elevated in comparison with the CoCl2 +miR-375 inhibitor control group (all at P＜0.01).The expressions of β3-catenin,cyclinD1,MMP2 and VEGF protein were significantly different among the normal control group,CoCl2 model group,CoCl2 +miR-375 mimic group,CoCl2+miR-375 mimic control group,CoCl2 +miR-375 inhibitor group and CoCl2 +miR-375 inhibitor control group (F=11.753,13.283,16.770,10.334,all at P＜0.001).In addition,the cell proliferative fold,migrated cell number and the tube length were significantly increased in the CoCl2 model group and CoCl2+mock group,and those in the CoCl2+FZD4 siRNA group were decreased in comparison with the CoCl2 +mock group (all at P＜0.05).Conclusions MiR-375 inhibits the growth,migration and tube formation ability of HRCECs in hypoxic status probably by regulating the activation of Wnt pathway via directly targeting FZD4.

Objective To explore the effect and potential mechanism of suppressors of cytokine signaling 3 (SOCS3) knockout on cell viability and apoptosis of retinal ganglion cells (RGCs) after optic nerve injury.Methods The optic nerve transection was used to construct optic nerve injury model of rats,and RGCs were isolated after optic nerve injury.The experimental animals were divided into optic nerve transection injury (ONT) group and sham-operation (Sham) group.The expression of SOCS3 in RGCs was detected by Western blot and RT-PCR in each group.Subsequently,SOCS3 siRNA was transfected into RGCs of Sham group and ONT group,and the experimental were further subdivided into blank control group,negative control group and SOCS3 silence groups.Cell viability was measured by CCK8 and MTr methods.Apoptosis was detected by Hoechst 33342 staining and flow cytometry.Furthermore,the mTOR siRNA and SOCS3 siRNA were co-transfected into RGCs,and cell viability and apoptosis were detected.Results The expression of SOCS3 was dramatically increased at 3 days after injury in the ONT group when compared with Sham group (P =0.049),and it showed an increased tendency gradually along with the extension of injury time.Compared with the blank control in the ONT group,SOCS3 silence markedly promoted cell viability [(49.47 ± 7.35) ％ vs.(73.24 ± 8.70) ％],reduced cell growth inhibition [(27.25 ±0.75)％ vs.(10.96 ± 1.07)％] and apoptosis [(23.06 ± 1.43)％ vs.(10.65 ± 1.77)％].The result of Hoechst 33342 staining indicated that SOCS3 silence ameliorated the cell apoptosis induced by ONT.In addition,SOCS3 silence significantly improved pS6 expression at 2 weeks after injury,and mTOR and SOCS3 co-silence reduced cell viability,increased cell growth inhibition and apoptosis compared with SOCS3 silence group after injury.Conclusion SOCS3 silence promotes injury-induced cell viability of RGCs and suppresses injury-induced apoptosis of RGCs via up-regulating mTOR activity in the later period of injury.

Objective To explore the feasibility, safety and the efficacy of peroral endoscopic myotomy (POEM) for pediatric patients with achalasia.Methods A total of 21 patients (mean age 2 years, range 11 months-7 years) with AC were enrolled and underwent POEM from January 2012 to December 2014.Procedure-related complications, reflux esophagitis were observed.Eckardt score and the pressure of the lower esophageal sphincter (LES) were analysed.Results All patients underwent POEM successfully.No serious POEM-related complications were observed.During a mean follow-up period of 20.4 months (range 9-36 months), mean Eckardt score decreased from 8.1 to 0.8 after treatment (P ＜ 0.01).Mean LES treatment also decreased from 30.2 mmHg to 11.5 mmHg after the operation (1 mmHg =0.133 kPa, P ＜ 0.01).Reflux esophagitis developed in four patients (19.0％ ,4/21).Conclusion POEM is safe and effective treatment for pediatric patients with achalasia.

Objective To investigate relationship between polyethylene wear and decrease of femoral offset after total hip arthroplasty (THA).Methods Ninety patients who had undergone unilateral THA were recruited in this study.Coreldraw 12.0 software was used to measure change of femoral offset on the basis of immediate anteroposterior radiographies of bilateral hip after THA.In the light of the decreasing value of femoral offset (F),all patients were equally into 5 groups:F＜2 mm,2≤F≤4 mm,4＜F≤6 mm,6＜F≤8 mm and 8＜F≤ 10 mm.At final follow up,some parameters about polyethylene wear were measured by using Coreldraw 12.0 software on the basis of anteroposterior radiographies of bilateral hip.Results The linear wear volume was 0.72±0.13 mm in group F＜2 mm,0.78±0.11 mm in group 2≤F≤4 mm,0.87±0.09mm in group 4＜F≤6 mm,0.99±0.09 mm in group 6＜F≤8 mm,and 1.17±0.15 mm in group 8＜F≤10 mm.The linear wear rate was 0.132±0.025 mm/yr in group F＜2 mm,0.139±0.019 mm/yr in group 2≤F≤4 mm,0.159±0.029 mm/yr in group 4＜F≤6 mm,0.183±0.032 mm/yr in group 6＜F≤8 mm,and 0.213±0.023 mm/yrin group 8＜F≤ 10 mm.The linear wear angle was 5.0°±3.5° in group F＜2 mm,3.2°±3.8. in group 2≤F≤4mm,-4.3°±4.9° in group 4＜F≤6 mm,-8.7°±4.1° in group 6＜F≤8 mm,and -13.0°±4.7° in group 8＜F≤ 10mm.For three parameters above,there were significant differences between groups,except between group F＜2 mm and group 2≤F≤4 mm.Conclusion The femoral offset should be restored to its anatomic status in THA to avoide superior lateral displacement of center of the femoral head,which could result in uneven stress distribution and increase polyethylene wear.

Objective To investigate the preliminary clinical outcome following PCL-retaining total knee arthroplasty (TKA) with 0°or 5°posterior tibial slope. Methods From Jan 2008 to Mar 2009, 84 patients (84 knees) with osteoarthritis (OA) underwent primary PCL-retaining TKA operations by the same surgical team. Among them, 27 patients (7 males, 20 females, with the average age of 69.5 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5° posterior tibial slope (group A); 57 patients (15 males, 42 females, with the average age of 67.4 years) underwent TKA using a cutting block and intramedullary cutting guide designed to impart a 5°posterior tibial slope (group B). The preoperative demographic data and functional data had no statistical differences. The postoperative tibial posterior angle, maximum extension, maximum flexion and Knee Society Score (KSS) were compared between the two groups. Results All patients were followed up 12～24 months with an average of 15.7 months. No paralysis, wound infection, prosthesis dislocation and loosening were found. The postoperative tibial posterior angle was 5.7°±2.1° in group A and 0.9°±0.6°in group B (P＜ 0.05). The postoperative maximum extension was 0.8°±0.3°in group A and 1.2°±0.4°in group B (P ＞0.05). The postoperative maximum flexion was 115.7°±4.8°in group A and 101.1°±5.6°in group B (P＜ 0.05). The postoperative KSS was 87.6±5.9 in group A and 83.3±7.2 in group B (P ＞0.05). Conclusion Increasing tibial posterior slope improved the postoperative maximum flexion, but not the maximum extension and KSS, in PCL-retaining TKA.

Objective To compare the clinical efficacy of subinguinal microsurgical and single -port laparoscopic high ligation in the treatment of varicocele.Methods 218 patients with varicocele were enrolled in this study.According to the digital table,they were randomly divided into two group.148 cases were treated by subinguinal microscopic varicocelectomy(microscopic group),70 cases were treated by single -port laparoscopic high ligation varicocele(single -port laparoscopic group).Postoperative follow up was 3 -24months.The operative duration,length of hospital stay,hospitalization expense,postoperative complications and semen quality parameters were compared between the two groups.Results There were statistically significant differences in operative duration and hospitalization expense between the two groups(all P <0.05).There was no statistically significant difference in length of hospital stay (P >0.05).In the 218 followed -up patients,the sperm concentration and motility (grade a + b sperm)all significantly improved,which of the microscopic group and single -port laparoscopic group preoperation were (19.1 ± 8.2)×106 /mL,(18.2 ±7.9)×106 /mL and (22.7 ±7.8)%,(21.6 ±8.9)% respectively,which at 3 -6 months after operation were (56.2 ±10.8)×106 /mL,(45.8 ±12.9)×106 /mL and (58.8 ±9.7)%,(44.6 ±10.7)%, there were statistically significant differences compared with preoperation (t =6.227,9.579,all P <0.05 ). Conclusion The surgical methods in the treatment of varicocele can improve the quality of patients,but microscopic group is obviously better than single -port laparoscopic group in improvement of semen quality parameters,safety, patient -based compliance and economy.

Objective To explore the diagnostic value of endoscopic ultrasonography(EUS)for the minimal submucosal invasion of early gastrointestinal tumor. Methods A total of 242 patients with early gastrointestinal tumor,who underwent endoscopic submucosal dissection,were retrospectively analyzed. The accuracy of EUS diagnosis was calculated based on postoperative histopathological findings as the golden standard,and influencing factors were also analyzed. Results Overall diagnostic accuracy of EUS for sub-mucosal invasion of early gastrointestinal tumors was 72. 3%(175/ 242),with an overstaging rate of 21. 5%(52/ 242)and an understaging rate of 6. 2%(15/ 242).Tumor size(P = 0. 018)and location(P = 0. 005) had significant effects on the diagnostic accuracy of the minimal submucosal invasion of early gastrointestinal tumor by EUS. The overstaging rate in the lesion length of diameter>3 cm was higher than those of 3 cm or less[27. 0%(33/ 122)VS 15. 8%(19/ 120),P = 0. 807],the overstaging rates of early colonrectal and gastric cancer were also significantly higher than the understaging rate[ Colonrectum:12. 2%(9/ 74)VS 2. 7%(2/ 74),P= 0. 028;Stomach:26. 9%(28/ 104)VS 2. 9%(3/ 104),P = 0. 000]. Conclusion Endoscopic ultrasonography is of diagnostic value for the invasion depth of early cancer in gastrointestinal tract. However,precaution should be taken in large lesions and the tendency of overstaging in gastrointestinal tract.

Objective To investigate the micro -channel percutaneous nephrolithotomy under ultrasound guidance in clinical studies of renal calculi in non -dilated collecting system.Methods Clinical data of 126 patients with renal calculi in non -dilated collecting system treated by ultrasound -guided percutaneous nephrolithotomy microchannel were retrospectively analyzed.Ureteroscopy up to the renal pelvis or ureter segment,zebra guide wire was placed along the guide wire indwelling ureteral catheter end connected to the blood transfusion needle while external saline suspension 100cm.Ultrasound -guided puncture target cup,established 16 -18F channel percutaneous nephro-lithotomy,ureteroscopy downlink percutaneous nephrolithotomy lithotripsy.The clinical data of operation time,stone clearance rate,blood loss,complications were analyzed.Results 124 patients with successful puncture,puncture fail-ure in two patients,conversion to open surgery.118 cases of successful implementation of a single -channel stone, nine cases of postoperative residual stones was found,again two stone surgery in 6 cases,3 cases refused surgery again;six cases were due to stones larger load,operation time exceeded 2h,to 2 stage of stone surgery in 4 cases, 2 cases changed to standard channel.Operation time was 30 -150min,average 78min.A stone clearance rate was 87.3%,summarize stone clearance rate was 95.2%(118 /124).Postoperative hemoglobin level decreased to (16.0 ± 7.6)g/L,7 patients with postoperative bleeding more blood transfusion 400 -800mL,none embolization.4 cases of postoperative fever,septic shock in 1 case,1 case of pneumothorax.Conclusion The micro -channel percutaneous nephrolithotomy under ultrasound guidance in the treatment of renal calculi in non -dilated collecting system is safe and feasible,it is the preferred method of treating renal calculi in non -dilated collecting system.

Objective To evaluate the safety and efficacy of neoadjuvant chemotherapy combined with PA-MSHA injection for the treatment of locally advanced breast cancer. Methods An open, randomized, controlled clinical trial was conducted in this study. 42 locally advanced breast cancer patients were randomly assigned to two groups, namely the experimental group (20 cases) and control group (22 cases). All the patients received chemotherapy of TEC regimen, while, in addition, the patients in experiment group received PA-MSHA injection. After the treatment, the efficacy of treatment was evaluated. The safety and tolerance of patients were also measured during the treatment. Results The overall response rate (CR+PR) [75.0 %(15/20)]in the experiment group was significant higher than that [54.6 %(12/22)]in control group (P < 0.01). Adverse reactions were found for 9 cases in experiment group, four of whom received medical care while the others recovered automatically. Conclusion PA-MSHA injection can significantly enhance the efficaey of neoadjuvant chemotherapy on the patients with locally advanced breast cancer. The PA-MSHA injection which has been proved safety in treatment is an ideal supplementary therapy for breast cancer.