G protein-coupled receptor 17(GPR17)is a G protein-coupled receptor whose func-tional diversity is regulated by multiple mechanisms,including receptor dimerization and epigenetic modifications.It is involved in the development of the nervous system,injury repair,and the progres-sion of various neurological diseases.This study integrated a three-dimensional functional network of neurodevelopment-injury repair-metabolic regulation to elucidate the normal developmental process and pathological progression of GPR17 in the nervous system.In the nervous system,GPR17 partici-pates in the fate regulation of oligodendrocyte lineage cells and the activation of microglia,and also affects the pluripotency regulation of neural precursor cells and adult neural tissues.Under neuro-pathological conditions such as demyelinating diseases,brain injuries,and gliomas,GPR17 expres-sion is abnormal.Inhibiting its expression can alleviate myelin sheath damage,while activating its ex-pression can induce the differentiation and apoptosis of glioma cells.Additionally,GPR17 is involved in the regulation of metabolism,aging,and cognitive dysfunction.Although significant progress has been made in current research,the signal transduction mechanisms during development and the spe-cific action pathways in neurological diseases still require further exploration.Given the multifunction-ality and key role of GPR17 in the nervous system,this field holds promise for providing novel ideas and therapeutic strategies for neural development,injury repair,and the treatment of related diseases.

Objective To investigate the application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation.Methods The retrospective cohort study was conducted.The clinical data of 58 patients with recurrent hepatolithiasis who underwent laparoscopic biliary reoperation in the Chengdu Second People's Hospital were collected.There were 33 males and 25 females,aged from 31 to 85 years,with an average age of 54 years.Thirty-one of 58 patients who underwent laparoscopic biliary reoperation using ligamentum teres hepatis approach were divided into the ligamentum teres hepatis group,and 27 patients who underwent laparoscopic biliary reoperation using regular anatomy and positioning were divided into the regular operation group.Observation indicators:(1) intraoperative situations;(2) postoperative recovery;(3) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recurrence of bile duct stone up to August 2018.Doppler ultrasonography of biliary tract was performed once at 3,6 and 12 months postoperatively and once at every 12 months after 1 year.Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed by rank sum test.Count data were analyzed using the four-grid table chi-square test or Fisher exact probability.Results (1) Intraoperative situations:all patients underwent successful laparoscopic biliary reoperation,without conversion to open surgery and perioperative death.During the intraoperative exploration,7,8,16 patients in the ligamentum teres hepatis group and 5,8,14 patients in the regular operation group were respectively found peritoneal omental adhesions,hilar omental adhesions and hilar intestinal adhesions.The operation time and volume of intraoperative blood loss were (125± 24) minutes,40 mL (range,15-100 mL) in the ligamentum teres hepatis group and (150 ± 36) minutes,55 mL (range,20-350 mL) in the regular operation group,respectively,with statistically significant differences between the two groups (t =-3.162,Z =-2.768,P＜0.05).The primary suture of bile duct,T-tube drainage and intraoperative stone removal were detected in 10,21,26 patients of ligamentum teres hepatis group and 9,18,23 patients of regular operation group,respectively,with no statistically significant difference between the two groups (x2 =0.008,0.019,P＞0.05).Postoperative residual biliary calculi were removed by choledochoscope through T-tube sinus in outpatient department after 8-week carrying T-tube.(2) Postoperative recovery:the time to initial anal exsufflation and duration of postoperative hospital stay were respectively (31 ± 7) hours,(7.2± 1.5) days in the ligamentum teres hepatis group and (35±10) hours,(7.1±1.3)days in the regular operation group,with no statistically significant difference between the two groups (t=-l.814,0.036,P＞0.05).(3) Follow-up:5 of 58 patients were lost to follow-up,including 3 in the ligamentum teres hepatis group and 2 in the regular operation group.Fifty-three patients were followed up for 6-40 months,with a median follow-up time of 28 months.No recurrence of bile duct stone was found in the ligamentum teres hepatis group.One patient in the regular operation group had recurrence of common bile duct stones at 36 months postoperatively and underwent endoscopic sphincterotomy stone.Conclusion Laparoscopic biliary reoperation for patients with recurrence of hepatolithiasis is a safe and effective method,and it can also quickly determine the location of common bile duct,with advantages of less blood loss and shorter operation time.

Objective To investigate the clinical effect of laparoscopic reverse papillary intubation through cystic duct and laparoscope combined with duodenoscope in the treatment of cholecystolithiasis and thining choledocholithiasis.Methods The retrospective cohort study was adopted.The clinical data of 192 patients with cholecystolithiasis and thining choledocholithiasis who were admitted to Chengdu Second People's Hospital between May 2012 to August 2015 were collected.The 96 patients who underwent laparoscopic reverse papillary intubation through cystic duct were allocated into the case group,and the other 96 who received surgery by laparoscope combined with duodeuoscope were allocated into the control group.All the patients underwent laparoscopic cholecystectomy (LC) according to routine approaches.The 96 patients in the case group received the placement of 4 Fr ureter catheter via cystic duct and placement of common bile duct inserted through the duodenal papilla under laparoscope,and then the duodenal papilla was resected using needle knife along the ureter catheter and stones were removed by basket lithotriptor and ball lithotriptor.The 96 patients in the control group received the intubation using the bow knife with zebra guidewire,and stones were removed by basket lithotriptor and ball lithotriptor.During the operations,it was observed whether there were residual stones by nasobiliary radiograph.The comparison was made between the 2 groups concerning (1) surgical situation:intubation and operation time.(2) Postoperative alanine transaminase (ALT),postoperative aspartate transaminase (AST),postoperative total bilirubin (TBil),postoperative blood amylase,postoperative lipase,complications and extubation time.(3) Situation of follow-up:follow-up was done by outpatient examination or telephone interview up to November 2015.The stones recurrence was detected by retrograde cholangiography through nasal bile duct,magnetic resonance cholangiopancreatography (MRCP) or ultrasonic examination.Measurement data with normal distribution were represented as x ± s.Comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Results (1) Surgical situation:2 groups both underwent successful LC.Ureteral catheter in the case group was successfully imbedded through cystic duct,including 8 patients with being difficult to intubate.Five patients in the control group were failed in endoscopic sphincterotomy (EST) due to periamullary diverticula or other causes,and then EST was performed again by the duodenal papilla through ureteral catheter which was intubated through cystic duct.Operation time of the case group and control group was (89 ± 17) minutes and (105 ± 26) minutes,respectively,with a statistically significant difference between the 2 groups (t =5.05,P ＜ 0.05).(2) Postoperative situation:ALT,AST,TBil of the case group and control group were (163 ±54)U/L,(87 ±38)U/L,(43 ± 18)tmol/L and (147 ±49) U/L,(101 ± 26) U/L,(37 ± 17) μmol/L,respectively,showing no statistically significant differences (t =0.97,1.21,0.84,P ＞ 0.05).Postoperative blood amylase and lipase of the case group and control group were (151 ± 41) U/L,(198 ± 72) U/L and (395 ± 142) U/L,(549 ± 217) U/L,respectively,showing statistically significant differences (t =16.18,15.05,P ＜ 0.05).No pancreatitis was found in the case group while 6 patients in the control group complicated with mild pancreatitis were improved by symptomatic treatment of fasting,somatostatin administration and acid suppression,with no severe pancreatitis.No complications such as intestinal perforation,bile duct perforation and massive hemorrhage were detected in both groups after operation.No death occurred.The nasal bile duct in the patients without pancreatitis was removed at postoperative day 3.The nasal bile duct in the patients with pancreatitis was removed after the remission of abdominal pain and diet intake.In the case group,it was difficult to remove the nasal bile duct of 1 patient.Nasal bile duct radiograph showed that the bending section of nasal bile duct was mistakenly sutured by the absorbable thread at the lower margin of incision of junction of cystic ducts,and yet there was unobstructed biliary drainage.The nasal bile duct was removed and the patient was discharged from hospital at postoperative day 19.The abdominal drainage tubes were removed at postoperative day 3 to5 in both groups.(3) Of 192 patients,151 were followed up for a median time of 10 months (range,3-12 months).Patients had good recovery without recurrence of abdominal pain,jaundice and stones.Conclusion Laparoscopic reverse papillary intubation through cystic duct for the treatment of cholecystolithiasis and thining choledocholithiasis is safe and feasible,and it can also reduce incidence of pancreatitis after nasobiliary drainage.

Objective To explore the effect of laparoscopic bile duct exploration,balloon dilation,and catheter drainage in the treatment of postoperative recurrent choledocholithiasis.Method The data of 61 patients with postoperative recurrent bile duct stones from August 1999 to August 2009 were retrospectively analyzed.The patients received laparoscopic bile duct exploration (LCDE),laparoscopic papillary balloon dilation (LPBD),and laparoscopic papillary balloon dilation endoprosthesis (LPBDE).ResultSatisfactory outcome was achieved in all the 61 patients.Among the 61 patients,20 patients received LPBD and primary suturing,36 patients received LPBDE and primary suturing,and 5 patients received LPBDE and T-tube drainage.There was no residual stone.There was no perioperative mortality or serious complications including biliary leak and hemobilia.On follow up for 1 to 9.5 years in 56 patients,there was no recurrent choledocholithiasis.ConclusionThe procedures were feasible and safe,and they prevent recurrence of choledocholithiasis.

Objective To explore the operative methods and indications of duodenoscopic papillotomy during the course of operation(IEPT)for cholelithiasis.Methods Cholecystectomy was firstly conducted under the condition of laparoscopy or open laparotomy.For the gross choledochus,the common bile duct was cut open to clear the stones.The ureteric catheter and zebra guidewire were inserted into the common bile duct and duodenum.Then they were inserted via duodenoscopy into thepapillum of duodenum.The papillary stenosis was removed with electro-knife by pin-head-like and arch-like to track along the ureteric catheter and zebra guidewire.For the tiny choledochus,the ureterie catheter and zebra guidewire were inserted via the cholecystic duct remnant into the common bile duct and duodenum.Then they were inserted via duodenoscopy to perform papillotomy to clear the stones of the common bile duct with the reticulation and the balloon of duodenoscopy.Results Forthe gross choledochus,IEPT in laparoscopy was successful in 45 cases and the other 2 received other operation.IEPT in open laparotomy was successful in 5 cases.For the tiny choledochus,IEPT in laparoscopy was successful in 73 cases and the other 1 underwent other operation.IEPT in open laparotomy was successfulin 2 cases.Conclusion If patients are suitable,IEPT is safe and effective in the hands of skilled endoscopiests for laparoscopy and open laparotomy.

Objective To evaluate combination of cholcdochoscopy or duodenoscopy with therapeutic laparoscopy (LCDCS) in treatment of detail choledochus stones. Methods Laparoscopic cholecystectomy was firstly performed and followed by choledochoscopy or duodenoscopy. Procedures of therapeutic choledochoscopy were as follows: choledochoscopic exploration via cystic duct remnant, choledochotomy, electrohydralic lithothipsy, drainage of bile duct with ureteral catheter via cystic duct remnant, T-tube drainage, or the suture of duct incision. Procedures of therapeutic duodenoscopy were as follows: access to the common bile duct and duodenum through ureteric catheter and zebra guidewire via cholecystic duct remnant, duodenoscopy via oral cavity into the duodenum papilla, papillotomy with needle-knife or arch-like electro-knife along the ureteric catheter or zebra guidewire, and stone clearance in the common bile duct with the reticulation and balloon of duodenescopy. Results Combination therapy were given to 191 cholelithiasis patients with detail choledochus stones. Combined choledochoscopy were performed in 117 patients. Stones were completely removed and average operation time was 114 min. Bile leakage occurred in 7 cases, but was cured with drainage. Postoperative imaging showed 2 cases of bile duct stenosis at primary closure of duct incision. Combined duodenescopic procedures were performed in 74 patients. Papillotomy and stone clearance were successfully performed in 68 patients, 5 others of whom underwent successful papillotomy only, and another underwent other operations. Average operation time was 97 min. Post-operation mild acut pancreatitis developed in 6 patients. No perforation of intestine or bile duct, bleeding, severe pancreatitis, or death was observed in each group. Conclusion LCDCS was safe and effective with appropriate indications.

Objective To study the adiponectin mRNA expression in omental adipose tissue of type 2 diabetes. Methods RT-PCR method was used to examine the adiponectin mRNA expression. Fasting levels of BG,TG,TC,HDL-C,LDL-C of all the subjects were checked and their blood pressure,height,weight,waist circumference,hip circumference were measured to calculate BMI,WHR. Results The adiponectin mRNA expression in omental adipose tissue was decreased in diabetes group versus non-diabetes group (P<0.05),and negatively correlated with WC,TG,FBG,WHR(P<0.05). Conclusions Type 2 diabetic patients show lower expression of adiponectin mRNA in omental adipose tissue than that of non-diabetic control.WC,TG,FBG, WHR and course of disease are correlated with adiponectin mRNA expression and insulin resistance