Objective:To study the safety and efficacy of laparoscopic cholecystectomy (LC) in treatment of T2a and lower stages of gallbladder carcinoma.Methods:A retrospective study was performed on patients who were diagnosed with gallbladder cancer and underwent surgical treatment from January 2016 to January 2021 at Hunan Provincial People's Hospital. These patients were divided into the simple treatment group and the radical treatment group based on the surgical methods used. The simple treatment group consisted of 64 patients who underwent LC for accidental gallbladder cancers. The radical treatment group consisted of 30 patients who underwent laparoscopic radical cholecystectomy (LRC). The baseline characteristic of the two groups of patients were matched in a 1∶1 ratio using propensity score matching. After matching, there were 26 patients in each of the 2 groups. There were 7 males and 19 females in the simple group, with mean ± s. d. age of (60.6±9.6) years. There were 8 males and 18 females, with mean ± s. d. age (60.9±9.1) years in the radical treatment group. Blood loss, operation time, postoperative hospital stay, biliary leakage, acute pulmonary embolism, and incisional infection were compared between the two groups.Results:In the simple group, the operative time was (78.7±62.9) min, intraoperative blood loss was (10.7±11.6) ml and postoperative hospital stay was (4.4±2.6) d. These results were significantly better than those in the radical group with operative time (298.7±101.3) min, intraoperative blood loss (161.9±96.7) ml and postoperative hospital stay (9.9±4.0) d (all P<0.05). There were no significant difference in the postoperative complications and disease free survival rates between the two groups (both P>0.05). Conclusion:LC was safe and effective for treatment of T2a and lower stages of gallbladder cancer, and it could achieve a similar disease-free survival rate as LRC.

Objective:To establish a good model of incomplete ablation of ectopic implanted tumor of liver, and explore the changes in the molecular landscape of residual cancer, cancer in nude mice.Methods:Eight immunodeficient BALB/c nude mice were used to establish an ectopic tumor model with the MHCC97-H hepatoma cell line, and they were randomly divided into experimental group and control group, with 4 mice in each group. The experimental group underwent simulated clinical incomplete ablation, and the control group only underwent false ablation. The differences between the models were evaluated by ultrasonic diagnostic equipment, thermal imaging cameras, HE staining and high-throughput whole transcriptome sequencing.Results:Liver cancer ectopic implantations in nude mices were all successful. The experimental group showed that the temperature of the tumor around the tip of the needle monitored by the thermal imaging camera was at 50-73.9 ℃. Compared with the control group, the HE staining of the experimental group mostly showed the coexistence of necrotic area-degeneration area-tumor cell area. The necrosis area was (23.75±13.77)%, and the degeneration area was 50%(30%). High-throughput whole transcriptome sequencing revealed that there were hundreds of overlapping stable molecular landscapes in the incomplete ablation simulation model both in vivo and in vitro.Conclusions:By establishing an ectopic implantion model of nude mice with incomplete ablation of residual liver cancer, it can provide a basis for studying the biological characteristics of incomplete ablation of residual cancer at the molecular level.

Objective:To investigate the clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 122 patients with diffuse hepatolithiasis who were admitted to Hunan Provincial People's Hospital from January 2010 to December 2015 were collected. There were 39 males and 83 females, aged from 21 to 82 years, with a median age of 51 years. After perihilar hepatectomy, the first, second and third divisions of hepatic ducts were opened longitudinally. Strictures in the bile ducts were relieved by stricturoplasty and internal bile duct anastomosis, and stones were removed by multiple methods under direct vision. After resection of severe atrophic liver segment along the plane of hepatic atrophy or bile duct stricture, T-tube or hepaticojejunos-tomy was used for internal drainage. Observation indicators: (1) surgical situations; (2) stricture relief and stone removal. (3) Follow-up. Follow-up was conducted by Wechat, telephone interview or outpatient examination. Patients were followed up once every 3 months in the postoperative 1 year through liver function and abdominal B-ultrasound examination. Subsequently, liver function and abdominal B-ultrasound were reexamined once a year. Magnetic resonance cholangiopancreato-graphy and computed tomography were performed when cholangitis or stone recurrence was suspected to analyze stone recurrence and patient survival. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations: for the 122 patients, the operation time, hepatic portal occlusion time, volume of intraoperative blood loss, duration of postoperative hospital stay were (253±71)minutes, 15 minutes(range, 14?38 minutes), 200 mL(range, 100?1 100 mL), (12±5)days. Postoperative complications occurred to 40 of 122 patients. There were 9 cases of incision infection, 8 cases of bile leakage (5 cases of bile leakage at hepatic section, 3 cases of choledochojejunostomy leakage), 8 cases of septicemia, 7 cases of pleural effusion, 5 cases of abdominal abscess, 3 cases of liver failure, 1 case of biliary bleeding. Some patients had multiple complications. Among the 122 patients, 2 cases died after operation, including 1 case of postoperative liver failure and 1 case of disseminated intravascular coagulation caused by biliary-intestinal anastomotic leakage complicated with sepsis. Patients with bile leakage and abdominal abscess were improved after puncture and drainage under the guidance of B-ultrasound. Patients with cholangiojejunal anastomotic bleeding were embolized through the right hepatic artery. The other complications were improved after conservative treatment. (2) Stricture relief and stone removal: 85 of 88 patients with biliary stricture were relieved, with the stricture relief rate of 96.59%(85/88). Among the 122 patients, 103 cases had stones completely removed and 19 cases had residual stones. The immediate stone clearance rate was 84.43%(103/122). Of the 19 patients with residual stones, choledochoscopy was refused in 3 cases and choledochoscope lithotripsy was performed in 16 cases, of which 7 cases were removed and 9 cases were still residual stones. Of the 122 patients, 110 cases were finally removed stones, 12 cases were eventually residual stones, and the final stone clearance rate was 90.16%(110/122). (3) Follow-up: among the 122 patients, 120 cases including 110 cases with find stone removal and 10 cases with residual stones were followed up for (78±14)months. The 1-, 3, 5-year stone recurrence rates of 120 patients were 0.83%(1/120), 6.67%(8/120), 9.17%(11/120), respectively. The 1-, 3-, 5-year stone recurrence rates of 110 patients with final stone removal were 0, 5.45%(6/110), 5.45%(6/110), respectively. The number of cases with stone recurrence at postoperative 1-, 3- and 5-year of 10 patients with residual stones were 1, 2, 5 cases, respectively. Of 120 patients with follow-up, 1 case died of end-stage liver disease, and the other patients had good survival.Conclusion:Perihilar surgical techniques for diffuse hepatolithiasis is safe and effective.

Post-stroke cognitive impairment (PSCI) is a series of syndromes caused by stroke, involving impairment of one or more cognitive functions, such as attention, language function, executive function, visuospatial cognition, episodic memory and working memory, etc. The traditional treatment methods of PSCI include drug therapy and cognitive training. The treatment modalities are limited and the maintenance effect is not good. Therefore, an auxiliary treatment method is urgently needed to improve its therapeutic effect. Transcranial direct current stimulation (tDCS) is a safe and mature non-invasive brain stimulation technique, which generates weak direct current (1-2 mA) through electrodes placed on the scalp to change the resting membrane potential of neurons, regulate the excitability of the cerebral cortex, so as to achieve the purpose of treatment. This article reviews the effect of tDCS on PSCI, and hopes to provide reference and guidance for its rehabilitation treatment.

Objective: To develop a simple radiotherapy information system for the developments of multiple hospital areas. Methods: Using C/S+ B/S dual technology architecture, Visual Studio 2015+ C#+ HTML5+ JavaScript+ PostgreSQL9.5 were utilized as the programming tools selected for development. The two-dimensional barcode, intelligent IC card, identity card recognition, face recognition, speech synthesis and other technologies were integrated and applied in the radiotherapy process management. The normal business processes were designed by default automatic processing. Previous multi-step operation was simplified to single-key operation. Results: System development was completed and implemented at the end of 2017, which connected the south and north hospital areas. The system not only resolved the problem that required the doctors to manually input or make telephone call for consulting patients’ data, but also achieved paperless business process in different departments. The outstanding advantage was reflected in the aspects of intelligence and optimization. Approximately 95% of the normal flows could be completed by single-key automatic processing, and the remaining 5% requiring special operations (such as, modification or deletion, etc.) were prompted and restricted to ensure data security and system stability. Conclusion The application of this system improves the level of information management in the departments and saves the cost of supplies and human resources.

Objective: To investigate the clinical and immunological laboratory features, mutations in SH2D1A gene and SAP protein expression in four children of two families with X-linked lymphoproliferative disease type 1(XLP-1). Method: Four patients (Family A including Patient 1 and Patient 2, Family B including Patient 3 and Patient 4) and their maternal relatives were enrolled in this study. The clinical manifestation, EBV infection status and chest CT scan were analyzed. The absolute and relative numbers of lymphocyte subsets, T lymphocyte proliferative response, SAP protein expression were assessed by flow cytometry. Quantification of signal joint TCR rearrangementexcision circle (sjTRECs), CDR3 spectratyping of TCRvβ and gene mutation of SH2D1A were detected by PCR based on genomic DNA or cDNA. Result: Four male patients from two families were diagnosed with XLP-1. The ages of disease onset were more than 1 year, more than 1 year, more than 1 month and 6 months. The ages at diagnosis were nine years and ten months, sixteen years and eight months, fourteen years and ten months, four years and nine months. All patients had recurrent infections and EBV infection. Patients 1, 2, and 3 had agammaglobulinemia and Patient 4 had hypogammaglobulinemia. Chest CT scan showed all patients had atelectasis and pneumonia, and Patient 3 had bronchiectasis. Patient 3 was diagnosised as Burkitt lymphoma. For immunological function, all patients exhibited reduced CD4/CD8 ratios, increased numbers of exhausted T lymphocyte, decreased number of NK cell. The numbers of total B lymphocyte and naïve B lymphocyte were normal, but the number of memory B lymphocyte declined in all cases. Four patients′ copy numbers of sjTRECs were low and CDR3 spectratypings of TCRvβ showed mildly skewed. But their T lymphocyte proliferative response was normal. SAP protein expression in four cases were measured by flow cytometry. Two patients from Family A were absent and two patients from Family B showed decreased values. SH2D1A gene sequence analysis showed that the patients of Family A harbored a nonsense mutation (c.163 C>T; p.R55X) in exon 2. Their mother and two sisters were carriers. A missense mutation of SH2D1A gene (c.278 G>A; p.G93D) in exon 3 was found in the patients of Family B. The mother was carrier. Four patients remain survived, Patient 3 gave up treatment, other three patients received IVIG therapy. Conclusion Four patients with XLP-1 from two families characterized by agammaglobulinemia have an extreme vulnerability to Epstein-Barr virus (EBV) infection. The functions of T cell, B cell and NK cell are impaired at different stages. The detection of SAP protein and SH2D1A gene are the key methods for diagnosis of XLP-1.

Objective To quantitatively observe the value of relationship between nodule and corresponding capsular with ultrasonography in assessment of malignant and benign thyroid nodules.Methods A total of 79 cases with subcapsular tumors of thyroid gland confirmed pathologically were analyzed retrospectively,and the relationship between tumors and capsule was analyzed.Longitudinal diameter of nodules (from the junction of nodule and capsule to the deepest of nodule,V) and distance from nodule protruding thyroid capsule to the highest point of nodule (L) were measured,and L/V was evaluated.Diagnostic efficiency of L/V in diagnosis of malignant thyroid nodule was evaluated.Results The average L/V of benign and malignant nodules was 0.241± 0.041 and 0.162± 0.054,respectively (t=-7.367,P＜0.01).The area under ROC curve of L/V in diagnosis of benign and malignant thyroid nodules was 0.87 (P＜0.01).When L/V=0.225,the sensitivity was 82.17％,and the specificity was 87.53％;when L/V=0.245,the sensitivity was 67.10 ％,and the specificity was 95.12％.Conclusion Ultrasonography can clearly show the relationship between thyroid nodules and capsule,and L/V can be used for differential diagnosis of benign and malignant thyroid nodules.

Objective:Mineral trioxide aggregate (MTA),a wildly used pulp capping material,could affect the proliferation and differentiation of dental pulp cells.The aim of this study is to study the roles of Notch signalling and autophagy in MTA induced human dental pulp cells (hDPCs) proliferation promotions.Methods:Healthy human third molars were collected and hDPCs were isolated by a combined digestion of collagenase Ⅰ and dispase Ⅱ.MTA extracts of different concentrations (0.5,1.0,2.0,5.0,10.0 mg/mL) were used to test the cytotoxicity by cells counting kit (CCK-8) assays and to select the optimum concentration for hDPCs survival..Expressions of Notch1,Hes1,LC3Ⅱ / Ⅰ and p62 in wild type and MTA treated hDPCs were detected by western blotting.Results:MTA extracts in a concentration of 1.0 mg/mL exerted most profoundly promotion effects on the proliferation of hDPCs among all concentrations tested.MTA of high concentration (10 mg/mL) was toxically to cells.Compared with that of wild type hDPCs,the expressions of Notch1 and Hes1(P＜0.05),or p62 and LC3Ⅱ/Ⅰ (P＜0.01) in MTA treated hDPCs were significantly increased.Much lower expression of Notch1 was detected in hDPCs when autophagy was induced by Earle's balanced salt solution (EBSS) starvation for 24 h.Conclusions:MTA could up-regulated hDPCs proliferation with highly relevant in stimulating Notch1-Hes1 signalling and inhibition of autophagy.The study is supposed to provide new insight in unrevealing the mechanisms of MTA mediated dental pulp cells proliferation.

Objective To explore the effects of intermittent catheterization conducted by bladder safe capacity on bladder function rehabilitation among patients with spinal injury.Methods A total of 60 patients with spinal injury and neurogenic bladder of Rehabilitation Department of Spine were selected as subjects by convenience sampling from January 2015 to January 2016. They were randomly divided into intervention group (intermittent catheterization conducted by the bladder capacity scanner) and control group (routinely regular intermittent catheterization). And then, this study compared the recovery of bladder function and the incidence of urinary tract infection of patients in two groups.Results At the fourth week, there were 9 patients with reflex bladder in intervention group more than that (4 patients) in control group with a significant difference (P<0.05). At discharge, there were 18 patients with reflex bladder in intervention group, while there were 14 patients in control group with a significant difference (P<0.05). After intervention, the residual urine volume of intervention group was significantly higher than that of control group (P<0.05). There was no statistically significant difference in bladder compliance between two groups (P>0.05). The difference on cases with urinary tract infection in control group (66 times) and intervention group (35 times) was significant (P<0.05). The times of reflex urination for the first time and bladder functional reconstruction in intervention group were lower than those in control group with significant differences (P<0.05).Conclusions Intermittent catheterization based on individual bladder safe capacity can effectively shorten the times of reflex urination for the first time and bladder functional reconstruction, reduce the residual urine and decrease the incidence of urinary infection.

Objective To evaluate the application value of right hemihepatic blood flow occlusion in the anatomical right posterior lobectomy. Methods Clinical data of 81 patients undergoing anatomical right posterior lobectomy in Hunan Provincial People's Hospital between January 2010 and February 2015 were retrospectively analyzed. The patients were divided into three groups according to the methods of liver blood lfow occlusion. In the right hemihepatic blood lfow occlusion group (methodⅠgroup), there were 26 cases including 12 males and 14 females with a mean of (48±9) years. In the regional blood flow occlusion of right posterior lobe group (method Ⅱ group), there were 34 cases including 15 males and 19 females with a mean of (48±10) years. In the Pringle's maneuver group (methodⅢgroup),there were 21 cases including 10 males and 11 females with a mean of (48±10) years. The informed consents of all patients were obtained and the local ethical committee approval was received. In methodⅠgroup, the right hepatic pedicle occluding band was prepared for spare, or the right hepatic artery and the right branch of portal vein were dissected and occluded separately. In methodⅡgroup, the right posterior branch of right hepatic artery and the right posterior branch of portal vein were separated, ligated and resected on the basis of methodⅠ. In methodⅢgroup, porta hepatis was not dissected. The operation time, intraoperative hemorrhage volume and blood transfusion were observed in three groups. Clinical data among three groups were compared by one-way ANOVA and LSD-t test. Results The operation time in methodⅠgroup was (168±52) min, which was significantly shorter compared with (216±39) and (193±43) min in method Ⅱ and method Ⅲgroup (LSD-t=-4.093, -1.772; P<0.05). The intraoperative hemorrhage volume in method Ⅰ group was (200±62) ml, which was signiifcantly less compared with (403±38) and (303±37) ml in methodⅡand methodⅢ group (LSD-t=-15.671, -12.735; P<0.05). Conclusion Right hemihepatic blood flow occlusion is a safe and feasible technique for controlling hemorrhage during the anatomical right posterior lobectomy, which signiifcantly decreases the intraoperative hemorrhage volume, shortens operation time and reduces surgical risk.