Objective:To evaluate the efficacy of total laparoscopic surgery vs. open surgery for hilar cholangiocarcinoma. Methods:The clinical data of 45 patients undergoing laparoscopic radical resection of hilar cholangiocarcinoma and 42 patients by open surgery from Mar 2017 to Mar 2021 were retrospectively analyzed.Results:There was no significant difference in demographics, Bismuth classification and excision extension between the two groups (all P>0.05). The laparoscopic surgery used longer time ( t=-1.366, P<0.05). The intraoperative blood loss, number of lymph node dissection and postoperative hospital stay favored laparoscopic method( t=0.043, t=0.026, t=-1.852, P<0.05). R 0 radical resection rate，postoperative complications were also in favor of laparoscopic surgery ( χ2=3.216, χ2=2.566, all P<0.05). There was no significant difference in postoperative pathology and in hospital expenses (all P>0.05). The 1- and 3-year survival rate of the laparoscopic group was superior (all P<0.05). Conclusions:In spite of longer operational time，patients in laparoscopic hilar cholangiocarcinoma radical resection group have shorter postoperative in hospital stay and longer postoperative survival time.

Objective:To compare the embedding anastomosis with the intermittent eversion anastomosis on the pancreatic fistula rates after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of 116 patients who underwent LPD at the Center Hospital of Xianyang City affiliated to Xi' an Jiaotong University Health Science Center from March 2016 to March 2020 were retrospectively studied. According to the method of pancreaticojejunostomy used, these patients were divided into the following two groups: the embedding anastomosis group ( n=55) and the intermittent eversion anastomosis group ( n=61). The duration of pancreaticojejunostomy, bilioenterostomy and gastrointestinal anastomoses, and the amounts of intraoperative blood loss and postoperative complication rates were compared between the two groups. Results:Of 116 patients in this study, there were 67 males and 49 females, with a median age of 61.5 years. No perioperative death occurred in the 2 groups. The operation time, digestive tract reconstruction time and pancreaticojejunostomy time in the embedded anastomosis group were (260±20), (65±15) and (35±15) min, respectively, which were significantly lower than those in the intermittent eversion anastomosis group (305±25), (81±25) and (45±12) min, (all P<0.05). The grade A and B pancreatic fistula rates in the embedded anastomosis group were 27.3%(15/55) and 21.8%(12/55), respectively, which were significantly higher than those in the intermittent eversion anastomosis group [8.2%(5/61) and 6.6%(4/61)], (all P<0.05). The postoperative hospital stay in the intermittent eversion anastomosis group (10.3±1.1) d was significantly lower than that in the embedding anastomosis group [(15.2±3.2) d, P<0.05]. Conclusion:In LPD, when compared with embedded pancreaticojejunostomy, intermittent eversion pancreaticojejunostomy reduced the postoperative pancreatic fistula rate and shortened the postoperative hospital stay.

In recent years, with the rapid development of rigid ureteroscopy and flexible ureteroscope lithotripsy in the field of urology, great changes have been made in the treatment of urinary calculi. Although flexible ureteroscope lithotripsy is easy to be damaged and expensive to maintain, it has high technical requirements for doctors, but it does not need to establish other traumatic channels, but uses the natural cavity of human urinary system, It has been paid more and more attention by urologists and has a good development prospect. Stone free rate is an objective index to judge the efficiency of flexible ureteroscope lithotripsy. The stone free rate and treatment after flexible ureteroscope lithotripsy have always been a difficult problem. Many scholars at home and abroad have studied the influencing factors of stone free rate after flexible ureteroscope lithotripsy, studies have shown that large stone load, hard stone composition, narrow angle of renal pelvis and calyceal and severe hydronephrosis are the main risk factors leading to the reduction of postoperative one-time stone free rate. In this paper, the research results in this field at home and abroad will be summarized.

Objective:To explore the performance of the attention-multiple instance learning (MIL) framework, an attention fusion network-based MIL, in the automated diagnosis of chronic gastritis with multiple indicators.Methods:A total of 1 015 biopsy cases of gastritis diagnosed in Fudan University Cancer Hospital, Shanghai, China and 115 biopsy cases of gastritis diagnosed in Shanghai Pudong Hospital, Shanghai, China were collected from January 1st to December 31st in 2018. All pathological sections were digitally converted into whole slide imaging (WSI). The WSI label was based on the corresponding pathological report, including "activity" "atrophy" and "intestinal metaplasia". The WSI were divided into a training set, a single test set, a mixed test set and an independent test set. The accuracy of automated diagnosis for the Attention-MIL model was validated in three test sets.Results:The area under receive-operator curve (AUC) values of Attention-MIL model in single test sets of 240 WSI were: activity 0.98, atrophy 0.89, and intestinal metaplasia 0.98; the average accuracy of the three indicators was 94.2%. The AUC values in mixed test sets of 117 WSI were: activity 0.95, atrophy 0.86, and intestinal metaplasia 0.94; the average accuracy of the three indicators was 88.3%. The AUC values in independent test sets of 115 WSI were: activity 0.93, atrophy 0.84, and intestinal metaplasia 0.90; the average accuracy of the three indicators was 85.5%.Conclusions:To assist in pathological diagnosis of chronic gastritis, the diagnostic accuracy of Attention-MIL model is very close to that of pathologists. Thus, it is suitable for practical application of artificial intelligence technology.

Herpes simplex virus (HSV), including HSV-1 and HSV-2, is an important pathogen that can cause many diseases. Usually these diseases are recurrent and incurable. After lytic infection on the surface of peripheral mucosa, HSV can enter sensory neurons and establish latent infection during which viral replication ceases. Moreover, latent virus can re-enter the replication cycle by reactivation and return to peripheral tissues to start recurrent infection. This ability to escape host immune surveillance during latent infection and to spread during reactivation is a viral survival strategy and the fundamental reason why no drug can completely eradicate the virus at present. Although there are many studies on latency and reactivation of HSV, and much progress has been made, many specific mechanisms of the process remain obscure or even controversial due to the complexity of this process and the limitations of research models. This paper reviews the major results of research on HSV latency and reactivation, and discusses future research directions in this field.
Herpes Simplex ; virology ; Herpesvirus 1, Human ; physiology ; Humans ; Virus Activation ; physiology ; Virus Latency ; physiology ; Virus Replication

Objective To investigate the effect of CaMK Ⅱ expression on apoptosis of rat hepatocytes BRL-3A.Methods Rat BRL-3A cells were stable passage were cultured.The CaMK Ⅱ γ protein (LV-CaMK Ⅱ γ group) and CaMK Ⅱ γshRNA (shRNA group) lentiviral expression systems were constructed.The corresponding blank vectors (LV-NC group and shRNA-NC group) and normal saline (CON group) were perfused into the control groups.The expression levels of CaMK Ⅱ,Cyt C and MF proteins were detected by Western blotting,and the apoptosis rate of BRL-3A cells was measured by Tunel method.Results The protein expression of CaMK Ⅱ,Cyt C and AIF in LV-CaMK Ⅱ γ group was significantly higher than that in CON group (P＜0.05).The protein expression of CaMK Ⅱ,Cyt C and AIF in shRNA group was significantly lower than that in CON group (P＜ 0.05).There was no significant difference among CON group,LV-NC group and shRNA-NC group (P＞0.05).At the same time point,the apoptosis rate of hepatocytes in LV-CaMK Ⅱ γ group was significantly higher than that in CON group (P＜0.05).At the same time point,the apoptosis rate of hepatocytes in shRNA group was significantly higher than in CON group (P＜0.05).There was no significant difference in the apoptosis of hepatocytes among CON group,LV-NC group and shRNA-NC group (P＞0.05).Conclusion The specific CaMK Ⅱ signaling pathway can inhibit the apoptosis of BRL-3A cells,while the enhanced CaMK Ⅱ signaling pathway promotes the apoptosis of BRL-3A cells.

Objective To investigate the differences of efficacy and economic efficiency between neuroendoscope and microscope for intracerebral hematomas cleaning operation. Methods From August 2014 to August 2015, clinical data of 68 cases with intracerebral hemorrhage were analyzed retrospectively. Hematoma evacuation was carried out by microscope in 37 cases (microscope group) received and 31 cases (endoscope group) underwent neuroendoscope. Following parameters were compared: the operation related index (hematoma clearance rate , intraoperative blood loss , the operation time , skin incision , bone window size ) , Glasgow Outcome Scale at 6 months after the operation, complications (intracranial infection, lung infections, gastrointestinal bleeding), medical economic parameters (the postoperative hospital stay, drug cost, cost other than drug, and total hospital cost). Results The hematoma clearance rate, Glasgow Outcome Scale at 6 months after the operation in the endoscope group were significantly better than those in the microscope group (P <0.05). The intraoperative blood loss, the operation time, skin incision, bone window size the postoperative hospital stay , drug costs , no drug costs , and total hospital cost in the neuroendoscope group were significantly lower than those in the microscope group (P < 0.01). The intracranial infection, lung infections in the neuroendoscope group were lower those in the microscope group (P < 0.05). There was no statistical difference in the incidence of gastrointestinal bleeding between the two groups (P > 0.05). The postoperative hospital stay, drug costs , no drug costs , and total hospital cost were significantly less in neuroendoscope group than that in microscope group (P< 0.01). Conclusion Neuroendoscopy has less trauma,there are some advantages of neuroendoscopy for intracerebral hematomas cleaning operation , such as minimal trauma , prominent effect , good prognosis and low cost. It should be widely applied in clinical practice.

Objective To summary the nursing methods of patients who use ultrasound-guided thermal ablation to treat severe secondary hyperparathyroidism.Methods Retrospective analysis was used to analyze the nursing process of 10 patients who use ultrasound-guided thermal ablation to treat severe secondary hyperparathyroidism. Ultrasound-guided thermal ablation was applied to patients with significant cardiopulmonary dysfunction and cannot undergo general anaesthesia operation, and patients suffering from recurrent forearm grafting after parathyroidectomy. So, in the nursing of these patients, we should pay special attention to the observation and management of specific complications in thermal ablation including dyspnea, apnea, laryngeal and recurrent laryngeal nerve injury and hemorrhage, besides the routine psychological care, diet nursing and medication nursing.Results Ten patients in the study who underwent ultrasound-guided thermal ablation, the intact serum parathyroid hormone ( intact parathyroid hormone, iPTH ) , calcium and phosphorus were all decreased, and symptoms like itching, general bone pain also were released. The frequency of precordial pain was reduced and we gain good therapeutic effect.Conclusions Rigorous nursing after ultrasound-guided thermal ablation can promote the recovery of patients with severe secondary hyperparathyroidism.

Objective To compare the differences between two statistical methods for evaluating non-sensitivity of pathogenic bacteria to antimicrobial agents,and explore effect of non-consideration of clinical background on evalua-ting extent of bacterial resistance.Methods Data of Staphylococcus aureus and Acinetobacter spp .in a hospital in the first half year of 2008,2010 and 2013 were collected and conducted statistical analysis with two methods (me-thod 1 :based on all clinically isolated bacteria;method 2 :based on infection-related non-repetitive bacteria),two methods for evaluating bacterial non-sensitive rates to antimicrobial agents were compared.Results The non-sensi-tive rates of Acinetobacter spp .to various antimicrobial agents :statistical results by using method 1 were generally higher than those using method 2,absolute difference between two statistical methods was 10.46%-33.77%;the non-sensitive rates of Staphylococcus aureus to various antimicrobial agents :except compound sulfamethoxazole in 2010 and 2013(difference were 6.17% and 10.21 % respectively),penicillin G (difference was 3.86%),erythromy-cin (difference was 2.71 %),and azithromycin in 2013 (difference was 2.43%),statistical results by using method 1 were generally higher than those using method 2,absolute difference between two statistical methods was 0-18.04%.Conclusion There are deviation in the non-sensitive rates of bacterial strains to antimicrobial agents by using two different statistical methods,deviation is larger in Acinetobacter spp ..The resistance level might be incorrectly higher when evaluating the resistance status without considering clinical background of bacteria.