Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.

Acute ischemic stroke is characterized by high morbidity, high disability and high mortality. The effectiveness and safety of endovascular therapy in the treatment of acute ischemic stroke have been recognized, but there are few studies on perioperative blood pressure control, and the best blood pressure control management strategy has not yet reached a consensus. This article reviews the blood pressure management during the perioperative period of endovascular treatment.

Numerous studies of relationship between epigenomic features have focused on their strong correlation across the genome, likely because such relationship can be easily identified by many established methods for correlation analysis. However, two features with little correlation may still colocalize at many genomic sites to implement important functions. There is no bioinfor-matic tool for researchers to specifically identify such feature pairs. Here, we develop a method to identify feature pairs in which two features have maximal colocalization minimal correlation (MACMIC) across the genome. By MACMIC analysis of 3306 feature pairs in 16 human cell types, we reveal a dual role of CCCTC-binding factor (CTCF) in epigenetic regulation of cell identity genes. Although super-enhancers are associated with activation of target genes, only a subset of super-enhancers colocalized with CTCF regulate cell identity genes. At super-enhancers colocalized with CTCF, CTCF is required for the active marker H3K27ac in cell types requiring the activation, and also required for the repressive marker H3K27me3 in other cell types requiring repression. Our work demonstrates the biological utility of the MACMIC analysis and reveals a key role for CTCF in epigenetic regulation of cell identity. The code for MACMIC is available at https://github.com/bxia888/MACMIC.

Objective    To establish a model of tracheomalacia in beagle dogs. Methods    Six healthy male beagles were selected with a weight of 12-15 kg and age of 12-18 months. The dog was placed in supine position after being anesthetized. Then midline incision was performed on dogs' cervical skin and main trachea was dissected. Six continuous cartilage rings separated from the tracheal wall were removed. Finally, the endotracheal mucosal was examined and the wound was sutured layer by layer. Different degrees of cartilage were removed to simulate different degrees of tracheomalacia. The beagle dogs were classified into two groups (n=3 in each group): a mild tracheomalacia (MTM) group (part of the cartilage near the trachea membrane was retained) and a severe tracheomalacia (STM) group (cartilage was removed as much as possible). Results    The dogs in the MTM group survived for a long time after the operation, showing symptoms of airway stenosis such as wheezing and coughing. The dogs were killed at postoperative week 2, and the pathological examination was performed. In the STM group, severe asphyxia occurred in the experimental animals after tracheal intubation removed, and all dogs died within 1 hour after surgery. Postoperative bronchoscopy revealed that the trachea of the MTM group dogs collapsed in the phase of inhalation, but it could maintain a certain patency. The trachea of the STM group dogs collapsed completely in the phase of inhalation. Postoperative X-ray showed that the diameter of the airway in the MTM group was reduced and trachea did not completely collapse. In the STM group, the trachea collapsed completely at the cartilage removed segment. Pathological examination showed that the cartilage in the MTM group was partially removed and tracheomalacia was obvious in the cartilage removed segment. In the STM group, most of the cartilage was removed with only few cartilages left. Conclusion    The clinical symptoms of tracheomalacia in different degrees can be simulated and repeatable. Animal models can be established by controlling the degree of removal of tracheal cartilage ring in dogs. This method provides a simple, repeatable and standardized large animal model for the treatment and transformation of tracheomalacia.

Objective:To explore the efficacy and safety of domestic RECO flow restoration device in acute intracranial large-vessel occlusion (LVO).Methods:This study was a multicenter, prospective, randomized, open, controlled trial; 136 patients with acute intracranial LVO at 7 Chinese stroke centers from February 2014 to August 2016 were randomly assigned into an experimental group (thrombectomy by RECO device, n=67) and a control group (thrombectomy by Solitaire device, n=69). The efficacy and safety of patients from the two groups were compared and analyzed. The primary efficacy end point was set as achievement of good recanalization (modified thrombolysis in cerebral infarction [mTICI] grading≥2); the secondary efficacy end points included good prognosis (modified Rankin scale scores≤2 90 d after thrombectomy), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained, or mortality within 90 d of thrombectomy. The safety end points included any device-related serious adverse events, symptomatic intracerebral hemorrhage or serious adverse events within 24 of thrombectomy. Results:There was no statistically significant difference between the experimental group and the control group in successful rate of good recanalization (91.0% vs. 86.9%), good prognosis rate (62.7% vs. 46.4%), time from puncture to achieving good recanalization/time from puncture to final angiogram on condition that good recanalization was not gained([85.4±47.0] min vs. [89.9±53.3] min), and mortality within 90 d of thrombectomy (13.4% vs. 23.2%, P>0.05). There were no device-related serious adverse events in all patients. No significant differences were found in the incidences of symptomatic intracranial hemorrhage (1.5% vs. 7.4%) or serious adverse events (death [1.5% vs. 1.4%] and brain hernia [4.5% vs. 0.0%]) between the two groups ( P>0.05). Conclusion:The domestic RECO flow restoration device is an effective and safe mechanical thrombectomy stent retriver for acute intracranial LVO.

Objective To examine the clinical effect and learning curve of endoscopic thyroidectomy via chest-areolar approach in the treatment of benign thyroid nodules. Methods From January 2012 to May 2016,49 patients underwent endoscopic thyroidectomies via chest-areolar approach in Xuanwu Hospital ,Capital medical university. The clinical characteristics ,prognosis and operation time were retrospectively analyzed. The patients were divided into 9 groups according to the surgical sequence ,and the learning curves were analyzed by using moving average method. Results 49 endoscopic thyroidectomies via chest-areolar approach were performed successfully. The average size of the nodules was(2.80 ± 0.62)cm. 10 patients underwent bilateral thyroidectomy and 39 underwent unilateral thyroidectomy. The average operation time was(157.49 ± 21.23)min. 2 cases received re-operation due to postoperative pathology of malignancy. There were no postoperative recurrent laryngeal nerve injuries. 11 patients suffered from asymptomatic hypocalcemia with parathyroid hormone in the normal range. All of the patients were satisfied with the cosmetic results. The learning curves indicated that 35 endoscopic thyroidectomies were needed to be performed in the early study stage. Conclusions For surgeons with experience of conventional thyroidectomies,endoscopic thyroidectomy via chest-areolar approach is feasible and safe for selected patients. There is a significant learning curve in the application of endoscopic thyroidectomy. In the early study stage of endo-scopic thyroidectomy,35 cases are basically required for beginning surgeons to practice the surgical operation.

Aim To establish insulin resistance cell model on HepG2 cells (human embryonic liver tumor cells )and investigate the effect of berberine hydro-chloride on insulin-resistant HepG2 (IR-HepG2 ) cells.Methods ① IR model was induced by respec-tively using 10 -9 ,10 -8 ,10 -7 ,10 -6 ,10 -5 ,10 -4 mol ·L-1 insulin with 25 mmol · L-1 glucose in HepG2 cells.② HepG2 cells were incubated with 2-NBDG (fluorescent labeled glucose)in a series of concentra-tion:50,100,200,400,600,800 μmol·L-1 and a series of incubation time:20,40,60,80,100 min, to select the optimum concentration of insulin and the optimum incubation concentration and time of 2-NBDG in HepG2 cells.The success of the model was deter-mined by detecting the consumption of glucose in the cell supernatant and the uptake of glucose in HepG2 cells.③To study the effect of berberine hydrochloride on improving insulin resistance on the cell level,met-formin and berberine hydrochloride were used in the IR cells.Results Six concentrations of insulin induced the IR model in different degrees.Although 10 -4, 10 -5 mol·L-1 insulin was significant,a large amount of cells died.10 -6 mol·L-1 insulin was effective and had high survival rate of HepG2 cells,which had sta-tistical significance compared with the normal group. When the incubation concentration of 2-NBDG was more than 100 mol·L-1 ,the fluorescence intensity of the cells was significantly different from the normal group.When the incubation time of 2-NBDG was more than 20 min,fluorescence intensity was significantly different from the normal group.When the incubation time of 2-NBDG was more than 100 min,the fluores-cence quenching phenomenon was obvious in the cells. Berberine hydrochloride and metformin significantly in-creased the glucose consumption and glucose uptake in cell supernatant, which had statistical significance compared with the model group.Conclusions Using 10 -6 mol · L-1 insulin induced IR model in HepG2 cells,the optimum incubation concentration and incu-bation time of 2-NBDG is 200 μmol·L-1 and 80 min, respectively.Berberine hydrochloride and metformin have obvious effect on improving IR in HepG2 cells.

Objective To study the clinical and pathological features of hepatic steatosis in patients with chronic hepatitis B (CHB)based on a matched case-control study.Methods Cross-sectional study was carried out on CHB patients who received liver biopsy in the Department of Infectious Diseases, Shunde First People′s Hospital from January 2006 to December 2014.Clinical data of the patients were collected.A total of 216 matched pairs were created according to gender and age.The clinical and pathological feathers of both groups were compared and analyzed. Quantitative data with normal distribution were compared by t test and those with abnormal distribution were compared by nonparametric rank sum test of two- or multi-independent samples. Categorical data were compared by χ2 test. Results In matched pairs,rates of overweight/obesity were 84.2% in fatty liver group and 18.5 % in non-fatty liver group (χ2 =189.30,P =0.001 ),patients with high cholesterol in the two groups were 30.6% and 13.4%,respectively (χ2 =18.47,P =0.001 ),high triglycerides were 27.3% and 9.7%, respectively (χ2 =22.15 ,P =0.001),high low-density lipoprotein were 16.7% and 5 .6%,respectively (χ2 =13.50,P =0.001),high uric acid were 31 .0% and 15 .3%,respectively (χ2 =15 .04,P =0.001 ) and rates of alcohol history were 38.9% and 25 .9%,respectively (χ2 =8.08,P =0.001).The differences of hepatitis B virus (HBV)DNA and status of hepatitis B e antigen between the two groups were not statistically significant (both P >0.05 ).Compared to fatty liver group,rates of hepatic inflammation activity degree ≥ 3 (54.6% vs 37.5 %,χ2 = 12.75 ,P <0.01 )and fibrosis staging ≥ 3 (53.2% vs 41 .7%,χ2 =5 .80,P =0.016)in non-fatty liver group were both significantly higher.Conclusions CHB patients with overweight/obesity,high cholesterol,high triglycerides,high low-density lipoprotein,high uric acid and drinking history are more likely to develop hepatic steatosis.The inflammatory grade and fibrosis stage in non-fatty liver group are more serious than those in fatty liver group.

ObjectiveTo investigate the influencing factors for hepatocyte steatosis in patients with chronic hepatitis B (CHB) and the high-risk population by classification tree model analysis, and to establish a simple method to assess the risk of hepatocyte steatosis in CHB patients. MethodsThe clinical data and pathological results of the CHB patients who underwent liver biopsy in Department of Infectious Diseases, The First People's Hospital of Shunde, from January 2006 and December 2014 were collected. The classification tree model was applied to analyze the influencing factors for hepatocyte steatosis, and index value curve, misclassification matrix, and error of estimation were applied for overall evaluation of classification results of the classification tree model. ResultsThe influencing factors for hepatocyte steatosis in CHB patients were body mass index (BMI), total cholesterol, and low-density lipoprotein, and the most important factor was BMI. This classification tree model had a sensitivity of 84.3%, a specificity of 81.5%, an accuracy of 82.9%, and an error of estimation of 0.171, suggesting that this model was well fitted. ConclusionClassification tree model analysis shows that the pathogenesis of hepatocyte steatosis in CHB patients is closely related to the influencing factors BMI, total cholesterol, and low-density lipoprotein. A simple classification method is established based on these factors to evaluate the risk of hepatocyte steatosis in CHB patients. It is necessary to conduct further clinical studies to investigate the clinical value of this method.

ObjectiveTo analyze the prevalence and clinical features of hepatic steatosis in patients with chronic hepatitis B. MethodsThe clinical data of patients with chronic hepatitis B who were hospitalized at the Department of Infectious Diseases, the First People′s Hospital of Shunde, Guangdong, China, from January 2006 to December 2014, were retrospectively collected for analysis and comparison of clinical and pathological indicators. The patients were divided into fatty liver group and non-fatty liver group depending on the presence or absence of fatty liver. Continuous data of the two groups were compared using the t test and categorical data were compared using the χ2 test. If data were not normally distributed, comparisons were made using the Mann-Whitney U test. ResultsThe incidence of fatty liver increased with age (P＜0.05) and peaked at an age of ≥45 years in both groups. Fatty liver was more likely to occur in men than in women below 30 years and between 30 and 44 years (P＜0.05). Diabetes, abnormal levels of cholesterol, triglycerides, low-density lipoprotein, and uric acid, and a history of alcohol consumption were significantly more frequent in the fatty liver group than in the non-fatty liver group (P＜0.05). Levels of body mass index, gamma-glutamyl transpeptidase, albumin, blood urea nitrogen, creatinine, uric acid, glucose, total cholesterol, triglycerides, low-density lipoprotein, apolipoprotein A, apolipoprotein B, aspartate aminotransferase were significantly different between the two groups (P＜0.05). Inflammation and fibrosis were significantly milder in the fatty liver group compared with the non-fatty liver group (P＜0.05). Patients in the non-fatty liver group were more likely to be complicated by grade 3 liver inflammation and stage 3 fibrosis (P=0.001 and P=0.015). ConclusionFatty liver patients are more likely to present with glucose and lipid metabolism disorder. Hepatic steatosis is not significantly correlated with HBeAg, but may be somewhat associated with HBV DNA, inflammation grade and fibrosis stage. Further studies are needed to establish their connections. .