There are many cases of biliary stent migration. Generally, biliary stent migrates distally. While, biliary stent rarely migrates proximally. Here we reported the case of a 49-year-old woman who underwent robot assisted right hemihepatectomy, and placement of a biliary stent for complicating bile leakage. The patient was discharged from hospital after recovering from bile leakage. Five months later, a follow-up examination revealed that the biliary stent had shifted into the liver, leading to liver perforation. We fully removed the stent by using a stone retrieval balloon and a snare. We suggested that when useing a biliary stent, it is necessary to consider of appropriate length of the stent and inform the patient when to return to the hospital for stent removal, in order to avoid stent migration and complications occurrence.

Objective:To explore the effects of anterior temporal lobectomy on the mini-mental state examination (MMSE) score, memory of patients with intractable temporal lobe epilepsy.Methods:104 patients with refractory temporal lobe epilepsy admitted to our hospital from June 2013 to June 2019 were selected, of which 68 cases were treated surgically as the observation group and 36 cases were treated medically as the control group. MMSE score, memory and social functions were compared between the two groups.Results:The total effective rate of the observation group was 95.59%, which was significantly higher than 83.33% of the control group ( P<0.05). The MMSE score of the observation group was significantly higher than that of the control group at 1 month and 6 months after treatment ( P<0.05); the MMSE score of the control group at 6 months after treatment was significantly higher than that before treatment ( P<0.05). Six months after treatment, performance intelligence quotient (PIQ), verbal intelligence quotient (VIQ) and full intelligence quotient (FIQ) in the observation group were significantly higher than those in the control group ( P<0.05), and there was significant difference between the two groups ( P<0.05). The memory quotient (MQ) of observation group was lower than that of control group 1 month after treatment ( P<0.05), and higher than that of control group six months after treatment ( P<0.05). Six months after treatment, the scores of social function and comprehensive quality of life in the observation group were significantly higher than those in the control group ( P<0.05), and there were significant differences between the two groups ( P<0.05). There were 4 cases of complications in the observation group after treatment, all of them improved after drug treatment, without other serious complications. Conclusions:Anterior temporal lobectomy is effective in the treatment of refractory temporal lobe epilepsy, it can improve cognitive and memory functions and social behavior function of patients, and has less complications after operation, with certain clinical application value.

Objective: To explore the difference of liver inflammation and fibrosis in patients with chronic hepatitis B virus (HBV) infection and chronic hepatitis C virus (HCV) infection, and to investigate the relationship between hepatic pathology and alanine aminotransferase (ALT). Methods: 57 patients with chronic HCV infection and 346 patients with chronic HBV infection who were hospitalized at Shengjing Hospital of China Medical University from January 2012 to September 2016 were enrolled. In chronic HBV infection, including 88 cases whose ALT were more than two times of upper limited of normal (ALT≥2×ULN) and 258 cases whose ALT were less than two times of upper limited of normal (ALT < 2×ULN).All the patients were underwent liver biopsy. Chronic HBV infection (ALT≥2×ULN and ALT < 2×ULN) and chronic HCV infection were compared respectively. Statistical analyses were performed using a Univariate χ²-test and Mann–Whitney U test for comparison. Correlations between variables were analyzed using Spearman's rank correlation. Results: In chronic HBV infection group, 169 cases (48.8%) had inflammation grade≥2 (G≥2), 98 cases (28.3%) had fibrosis stage≥2 (S≥2), 81 cases (23.4%) with G≥2 and S≥2.In the ALT < 2×ULN group, there were 109 cases (42.2%) with G≥2, 62 cases (24%) with S≥2, 49 cases (19%) with G≥2 and S≥2. In the ALT≥2×ULN group, 60 cases (68.2%) with G≥2, 35 cases (39.8%) with S≥2, 31 cases (35.2%) with G≥2 and S≥2. The grade of inflammation and fibrosis have significantly different between ALT≥2×ULN group and ALT < 2×ULN group (χ² = 17.66, χ² = 8.06, P < 0.01). In chronic HCV infection group, 47 cases (82.5%) with G≥2, 20 cases (35.1%) with S≥2, 20 cases (35.1%) with G≥2 and S≥2. ALT had no correlation with inflammation and fibrosis (P > 0.05). The grade of inflammation was significantly different between chronic HCV infection and chronic HBV infection whose ALT < 2×ULN (χ² = 30.19, P < 0.01) but the fibrosis have no difference (χ² = 2.96, P > 0.05). Compared with chronic HBV infection whose ALT≥2×ULN, both inflammation and fibrosis had no significantly different (χ² = 3.65, χ² = 0.32, P > 0.05 respectively). Conclusion In chronic HBV infection whose ALT < 2×ULN, about 30%-40% liver tissue with significant necroinflammation and /or fibrosis. About 80% chronic HCV infection with significant necroinflammation, and the grade of inflammation has no correlation with ALT. The grade of inflammation has significantly different between chronic HCV infection group and chronic HBV infection group whose ALT < 2×ULN.

ObjectiveTo investigate the diagnostic significance of different pathology techniques (Immunohistochemistry and ISH)to detect EBV on bone marrow biopsy tissues of hemophagocytic syndrome. Methods Histological,immunohistochemicalandinsituhybridizationwereusedtostudythe hemophagocytic features and expression of LMP-1,EBER and other markers.Results25 out of 51 cases (49.0 ％)showed an active proliferation growth pattern while other 12 cases(23.5 ％)demonstrated a deterioration morphological character compared with their same age group. The left 14 cases (27.5 ％) showed a normal myeloproliferative pattern. 91.4 ％ (32/35) expressed CD68/KP-1 and 89.5 ％ (17/19) cases expressed CD68/PG-M1, which showed an abnormal increase of monocytes. 26 out of 51 cases (51.0 ％) were positive for EBER,while EBER and immunohistochemistry on LMP-1 were detected simultaneously in 41 cases.The EBER were positive in 19 cases(46.3 ％)but none for LMP-1(P =0.000).ConclusionHypoplasia or hemophagocytic features could be detected on bone marrow biopsy tissues of hemophagocytic syndrome, which might be slightly difficult to diagnose. So immunohistochemistry would be essential. Meanwhile, the detection of EBER is more helpful than LMP-1 for diagnosis.

AIM: To study the efficacy and adverse reactions of carnitine on patients with acute cerebral infarction.　METHODS: One hundred and thirty-five patients with acute cerebral infarction diagnosed by CT or MRI were randomly divided into 2 groups, on the basis of conventional therapy. Sixty-eight patients in carnitine group (M37,F31; age 60 a± s 17 a) received carnitine 2-3g, iv, drip, qd for 28 d. The other 67 patients of control group (M39, F28; age 63 a±17 a) received compound salvia miltirrhiza 20 mL in dextran-40 glucose injection 500 mL, iv, drip, qd for 28 d.　RESULTS: The total effective rates of carnitine group and control group for acute cerebral infarction were 80％ and 55％, respectively (P<0.05). No adverse reactions were found.　CONCLUSION: Carnitine is safe and effective in the treatment of acute cerebral infarction.