Hepatolithiasis is a common biliary tract disease in China and other Asian countries.It has insidious onset,recurrent disease,and may lead to biliary cirrhosis or even cancer in the late stage without inter-vention.At present,surgery is considered to be the best choice for treatment.In the 21st century of minimally inva-sive surgery,traditional procedures such as partial hepatectomy,choledochotomy,cholangioenterostomy and liver transplantation can be performed with the assistance of laparoscopy and da Vinci robots,and emerging endoscopic techniques such as endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic cho-ledochoscopic lithotripsy(PTCSL)have also been developed,bringing better treatment for patients with hepatoli-thiasis.As treatment options are becoming more varied,there are also some clinical problems that need to be addressed.In this article,we would like to briefly review the current surgical treatment modalities in order to provide a theoretical basis for optimizing the treatment modalities.

Objective:To investigate the clinical efficacy of insulin degludec/insulin aspart on type 2 diabetes mellitus in patients with poor efficacy of oral hypoglycemic drugs.Methods:A total of 100 patients with type 2 diabetes mellitus in Tianfu Hospital of Chongqing Energy Investment Health Industry Company Limited from August 2020 to August 2021 were included in this study. They were randomly assigned to receive either insulin degludec/insulin aspart combined with Metformin (observation group, n = 50) or nsulin aspart 30 injection and Metformin (control group, n = 50). All patients were treated for 3 months. Changes in fasting plasma glucose level, 2-hour postprandial glucose level , and HbAlc after treatment relative to those before treatment as well as clinical efficacy were determined in each group. Results:Forty-eight patients in the observation group and forty-six patients in the control group completed the course of treatment. Fasting blood glucose level and 2-hour postprandial glucose level in the observation group were (6.24 ± 1.12) mmol/L and (8.34 ± 2.34) mmol/L, respectively and they were significantly lower than (6.91 ± 1.86) mmol/L and (10.72 ± 2.48) mmol/L, respectively in the control group ( t = 3.28, 4.76, both P < 0.05). The level of HbAlc was not significant between the two groups ( P > 0.05). The hypoglycemia rate in the observation group was significantly lower than that in the control group [2% (1/48) vs. 13% (6/46), χ2 = 4.09, P < 0.05]. The daily dose of insulin in the observation group was less than that in the control group [(13.5 ± 2.8) IU vs. (15.6 ± 3.1) IU, t = 3.28, P < 0.05)]. Conclusion:Compared with insulin insulin aspart 30, the insulin degludec/insulin aspart has a stronger hypoglycemic effect on fasting plasma glucose level and 2-hour postprandial glucose level in the treatment of type 2 diabetes mellitus in patients with poor efficacy of oral hypoglycemic drugs, leading to a less daily dose of insulin.

Objective:To investigate the correlation of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone(PTH)and bone turnover markers with the glomerular filtration rate(GFR)in elderly male patients with type 2 diabetes mellitus.Methods:The study included a total of 426 non-dialyzed male T2DM patients with a disease course of more than 10 years, of whom 206 aged 60-86 years(the elderly group, 69.8±5.7 years old)and 220 aged 40-59 years(the middle-aged group, 50.1±5.3 years old). According to the estimated GFR(eGFR)calculated using the CKD-EPI formula, patients in each group were divided into four subgroups: Group 1(at CKD1 stage), Group 2(at CKD2 stage), Group 3(at CKD3 stage)and Group 4(at CKD4/5 stage). Levels of 25(OH)D, parathyroid hormone(PTH), procollagen type 1 N-terminal propeptide(P1NP), and C-terminal telopeptide of type Ⅰ collagen(β-CTX)in each group were measured.Results:The median level of 25(OH)D was 17.10(11.30-21.60) μg/L in 426 patients, of whom 292(68.5%)showed vitamin D deficiency.The level of 25(OH)D decreased significantly in the elderly group compared with the middle-aged group(15.10 μg/L vs. 17.15 μg/L, Z=-2.165, P=0.030), while the proportions of patients with vitamin D deficiency were similar in the two groups(68.4% vs. 68.6%, χ2=0.002, P=0.966). With decreasing eGFR, the proportion of patients with vitamin D deficiency gradually increased in the elderly.In the elderly cases, compared with the Group 1 and Group 2, the level of 25(OH)D in Group 3 dropped significantly (10.85 μg/L vs. 16.80 μg/L, Z=-2.808, P=0.005; 10.85 μg/L vs. 15.60 μg/L, Z=-2.099, P=0.044), and Group 4 showed an even more pronounced decrease than Group 3(6.65 μg/L vs. 10.85 μg/L, Z=-1.956, P=0.048). The level of 25(OH)D decreased significantly in the middle-aged patients at the CKD4/5 stage.The levels of PTH and β-CTX were negatively correlated with the 25(OH)D level( r=-0.348 and -0.263, P<0.001), and the level of negative correlation was affected by eGFR. Conclusions:In non-dialysis elderly male patients with T2DM, PTH and bone turnover marker β-CTX levels are negatively correlated with the 25(OH)D level, and the negative correlations are affected by eGFR.

Marine-derived biopolymers are excellent raw materials for biomedical products due to their abundant resources, good biocompatibility, low cost and other unique functions. Marine-derived biomaterials become a major branch of biomedical industry and possess promising development prospects since the industry is in line with the trend of "green industry and low-carbon economy". Chitosan and alginates are the most commonly commercialized marine-derived biomaterials and have exhibited great potential in biomedical applications such as wound dressing, dental materials, antibacterial treatment, drug delivery and tissue engineering. This review focuses on the properties and applications of chitosan and alginates in biomedicine.

Objective To explore the application value of three-dimensional visual (3DV) assessment and virtual reality (VR) study of type Ⅲ and Ⅳ hilar cholangiocarcinoma with portal vein as the axis.Methods The CT image data of 10 patients who were diagnosed as Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma by B-ultrasound and CT in Zhujiang Hospital,Southern Medical University were imported into 3D visualization system (3DVS) for 3D image reconstruction,and the portal vein was used as the axis for 3DV analysis and evaluation.The 3D data were then imported into the VR development engine to perform VR research,so as to help the operation planning.Both of the image data were taken into the operation room for intraoperative navigation.Results 10 patients completed 3D visualization reconstruction and VR model transformation.According to the 3D visualization of hepatic hilar hepatocarcinoma,there were 1 case of type Ⅱ,2 cases of type Ⅲa,5 cases of type Ⅲb,1 case of type Ⅳa and 1 case of type Ⅳb.The portal vein was classified according to Cheng type:6 cases of type Ⅰ,3 cases of type Ⅱ,and 1 case of type Ⅲ.The hepatic artery was classified according to Michels type:5 cases of type Ⅰ,1 case of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅸ.The 3DV assessment and VR study were almost consistent with the intraoperative findings.No liver failure or death occurred during the perioperative period.Conclusion The 3DV assessment and VR study with the portal vein as the axis have potential application for the surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.

Objective To explore the efficacy of partial splenic embolization (PSE) in the treatment of hypersplenism secondary to liver cirrhosis using Meta-analysis.Methods Randomized control studies,cohort studies and case-control studies concerning the efficacy comparison of PSE and splenectomy in the treatment of hypersplenism secondary to liver cirrhosis were searched on PubMed,Embase,Cochrane Library,Wanfang data,CNKI,Cqvip and CBM for Meta-analysis.The cut-off time for searching was July 25,2015.RevMan software designed by Cochrane cooperation network was used for statistical analysis.The major outcomes indexes were preoperative and postoperative levels of platelet,leukocyte and hemoglobin.The secondary outcomes indexes were operative time,intraoperative bleeding and hospital stay.Results A total of 10 studies were selected.Meta-analysis showed the levels of platelet (mean difference [MD]-87.68,95 ％ CI [-125.70,-49.65]),leukocyte (MD-4.03,95％CI [-5.74,-2.33]) and hemoglobin (MD-0.79,95％CI [-1.48,-0.11]) after PSE treatment were higher than those before,and the levels of platelet (MD-128.31,95％CI [-162.59,-94.03]),leukocyte (MD-5.22,95％CI [-6.65,-3.80]) and hemoglobin (MD-1.42,95％CI [-2.66,-0.18]) after splenectomy were higher than those before the operation.The differences of platelet (MD 54.45,95％CI [37.60,71.30]),leukocyte (MD 1.71,95％CI [-0.01,3.42]) and hemoglobin (MD 0.78,95％CI [-0.01,1.56]) between postoperative and preoperative levels for PSE was lower than those for splenectomy.Compared with splenectomy,PSE exhibited less intraoperative bleeding (MD-71.33,95 ％ CI [-78.13,-64.54]),shorter operative time (MD-34.08,95％CI [-34.78,-33.38]) and shorter length of stay (MD-5.59,95％CI [-7.38,-3.79]).Conclusion PSE is a mini-invasive therapy,which can be used to effectively treat hypersplenism secondary to liver cirrhosis.

Persistant infection of high-risk human papillomavirus (HPV) is the primary cause leading to cervical cancer, which is ranked as second cancer threatening the health of women following breast cancer.Development of HPV vaccine is very important because there is no effective therapeutics for cervical cancer.Three currently licensed HPV vaccines based on major capsid protein L1 in the foreign market confered good safety and efficacy in clinical trials, but the current price is expensive due to high cost, which limits the wide application in developing countries.So far, the vaccines have not been launced in China market.Here, we review the progress and the current status of the HPV vaccine, which will attract the readers’ interest on the forthcoming emergence of HPV vaccine in China.

Objective To evaluate the value of lung function and blood gas analysis in early diagnosis and treatment of inter‐stitial lung disease(ILD) .Methods The pulmonary function and blood gas of 26 cases of ILD patients were tested ,and indicator change was analyzed by paired t test .Results Detection comparison showed that the indicators were significantly improved :VC in‐creased 24 .6% (P<0 .01) ,FVC increased 18 .1% (P<0 .01) ,DLCO increased 25 .6% (P<0 .01);blood gas analysis of PaCO2 decreased 21 .2% (P>0 .05) ,PaO2 increased 8 .2 % (P>0 .05) .Conclusion Lung function and blood gas measurement are impor‐tant in the early diagnosis and treatment of ILD ,which can provide the necessary basis for clinical diagnosis ,treatment and progno‐sis .

Objective To compare the effect of pancreatic duct stent internal versus external drainage in the prevention of postoperative complications after pancreaticoduodenectomy through the method of Meta analysis.Methods PubMed,Embase and the Cochrane Library,were searched for randomized controlled trials (RCTs) concerning pancreatic duct stent in the prevention of postoperative complications after pancreaticoduodenectomy.All these databases were searched from their establishment to March 31,2015.The data was reviewed and extracted by two investigators independently.Then,the Cochrane network RevMan 5.3 software was used for statistic analysis.Results As a result,this meta analysis has got 3 RCTs,including 362 participants.The outcomes in our study design were classified as major and minor one.The former was the outcomes of the major postoperative complications,like postoperative pancreatic fistula and delayed gastric emptying.The minor outcome were postoperative morbidity,mortality and intestinal obstruction.The results of meta analysis were:(1) Postoperative total pancreatic fistula rate (A/B/C):three studies showed a statistic difference between the internal and external drainage groups (OR =0.59,95％CI:0.36-0.97,P =0.04).(2) Postoperative pancreatic fistula rate (B/C):three studies showed a statistic difference between the internal and external drainage groups (OR =0.44,95％ CI:0.20-0.97,P =0.04).(3) Postoperative incidence rate of delayed gastric emptying:three studies showed a certain statistic difference between the internal and external drainage groups (OR =0.42,95 ％ CI:0.23-0.79,P =0.007).(4) Post-operative incidence rate of total mortality:three studies showed no certain statistic difference between the internal and external drainage groups (OR =0.81,95 ％ CI:0.23-2.86,P =0.74).(5) As for the postoperative incidence rate of total complications and intestinal obstruction,the heterogeneity was bigger than 50％.So we made an analysis of the cause of heterogeneity.We deduced that it may be caused by the different and complicated perioperative management.Then,we used the random effect model rather than the fixed effect model to make a quantitative analysis.No statistical difference was found eventually in both this two marks.Conclusions By comparing the outcomes in both internal and external drainage groups,we found pancreatic duct stent external drainage could effectively decrease the incidence rate of postoperative pancreatic fistula rate and delayed gastric emptying.But when the limit studies and sample size considered,this conclusion still need to be certificated with more high-quality clinical research.

Objective To make a clinical summary of the variation of cystic duct so as to collect 20 years of operative experience and to provide evidence for preventing injury of bile duct in laparoscopic cholecystectomy. Methods A retrospective analysis were made for 20 000 patients experienced laparoscopic cholecystectomy in the second affiliated hospital of Chongqing medical university and Chonggang General Hospital from April,1993 to December,2011. Results There were 3 265 cases of cystic duct variation which occupied 16. 33% of the 20 000 patients. And there were 3 200 cases of variation in the junction of cystic duct, 51 cases of short cystic duct;and 14 cases of gall-bladder surrounded by the liver. Most of the variation were found in the junction of cystic duct, including 371 cases (11. 36%) of cystic duct accompanied the common hepatic duct and then made a lower confluence;995 cases (30. 47%) of cystic duct traversed above the com-mon hepatic duct and then made a confluence, 643 cases (19. 69%) of cystic duct traversed below the common hepatic duct and then made a confluence;963 cases (29. 49%) of gallbladder neck attached to the common bile duct;and 228 cases (6. 98%) of higher confluence of cystic duct and common bile duct. Conclusion The rate of cystic duct variation accounted for a high rate, and most of the patients were found with a variation in the junction of cystic duct. Being familiar with the categories of cystic duct, discriminating the anatomic structure carefully, using choledochoscopic examination when necessary, and masterting reasonable time to make a transfer to laparocholecystotomy were reliable methods for coping with the injury of bile duct caused by variation of cystic duct.