Abstract:Objective: To evaluate the efficacy of multiple hepatic segmentectomies for complex hepatolithiasis. Methods: The clinical data of 93 patients with hepatolithiasis who underwent multiple liver segmentectomies were retrospectively analyzed. The procedures included 5 cases of right lobectomy, 7 cases of right posterior lobectomy, 2 cases of right posterior lobe plus left lateral lobe resection, 1 case of segment VIII plus caudate lobectomy, 3 cases of segment VIII and left lateral lobe resection, 2 case of subtotal segment VII and VIII plus left lateral lobe resection, 5 cases of right anterior lobectomy, 2 cases of segment IV and V resection, 5 cases of segment IV, V and VIII resection, 19 cases of left lobectomy, 4 cases of left and caudate lobectomy, 6 cases of segment IV resection, and 32 cases of left lateral lobectomy. Additional choledochojejunostomy was performed in 22 cases. All the patients underwent cholecystectomy, cholangioscopic exploration and/or stone extraction, and common bile duct T-tube drainage. Results: There was no operative mortality. Postoperative complications occurred in 17 cases (18.2%),including 2 cases of bile leakage (2.2%), 1 case of subphrenic infection (1.1%), 6 cases of wound infection (6.4%), 3 cases of pulmonary infection (3.2%), 6 cases of pleural effusion (6.4%), and 2 cases of stress ulcer (2.2%). All of these complications resolved before the patients were discharged. In 9 cases, residual stones were found after operation and they were completely removed by cholangioscopy in 5 of them. Follow-up was obtained in 89 cases (95.7% of the whole group), of whom 3 cases with concomitant cholangiocarcinoma died of tumor recurrence and 3 cases developed bile duct stone recurrence. Conclusion: Multi-segmentectomies as the main operation modality is effective in the treatment of complex hepatolithiasis.

Abstract:Objective: To compare the clinical efficacies among laparoscopic, minilaparotomy and conventional open choledocholithotomy. Methods: The clinical data of 217 patients with cholecystolithiasis and choledocholithiasis undergoing surgical treatment in recent five years were analyzed. Of the patients, 69 cases underwent laparoscopic procedure (laparoscopic group), laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE); 85 cases underwent minilaparotomy surgery (minilaparotomy group), LC plus open choledocholithotomy via a small laparotomy incision; and 63 cases underwent conventional open surgery (open surgery group), open cholecystectomy and choledocholithotomy. The related clinical indexes among the three groups were compared and analyzed. Results: The intraoperative bleeding volume, time to bowel function recovery, postoperative pain, complication incidence and hospital stay of the laparoscopic group and minilaparotomy group were significantly better than those of the open surgery group. The average time of operation and pneumoperitoneum in the minilaparotomy group were shorter than those in the laparoscopic group (both P<0.05). Conclusion: Both LCBDE and auxiliary minilaparotomy surgery have the advantages of minimal invasion, quicker recovery and less pain. Minilaparotomy procedure can shorten the operative and pneumoperitoneum time compared with LCBDE, so it is especially suitable for patients who cannot tolerate a long pneumoperitoneum time and elderly patients with poor cardiopulmonary function.

Abstract:Objective: To investigate the application value of enteral nutrition after surgical resection of hilar cholangiocarcinoma. Methods: The clinical data of 89 patients with hilar cholangiocarcinoma undergoing surgical resection in Kailuan hospital, during a period of 24 years, were retrospectively analyzed. Of the patients, 52 cases received early postoperative enteral nutrition (EN group) and 37 cases had parenteral nutrition (PN group). The differences in the incidence of bile leakage, time period for bowel function recovery, icteric index, postoperative body temperature and hospitalization costs etc. between the two groups were compared. Results: Compared with PN group, EN group showed quick return of bowel function, low incidence of bile leakage, rapid postoperative temperature recovery, and low hospitalization costs (all P<0.05). Conclusion: Enteral nutrition is safe and feasible after surgical resection for cholangiocarcinoma. It can not only improve the nutritional status of the patients, but also promote recovery of bowel function and reduce the incidence of bile leakage.

Abstract:Objective: To determine the diagnostic value of the combination detection of the tumor markers, CA50, CA125, CA242, CA19-9 and CEA for hilar cholangiocarcinoma. Methods: Ninety patients admitted to our hospital in the recent two years, who were confirmed having hilar cholangiocarcinoma by postoperative pathology, were included in the observation group, and another group of 91 patients with benign biliary tract diseases hospitalized during the same period served as control group. The serum levels of CA50, CA125, CA242, CA19-9 and CEA of the two groups were detected by automatic electrochemiluminescence analyzer, and the sensitivities, specificities and accuracies of the five tumor markers of the two groups were determined, respectively. Results: The serum levels of CA50, CA242, CA19-9 and CEA in the observation group were all significantly higher than those of the control group, (all P<0.01), but the difference of the serum levels of CA125 between the two groups had no statistical significance (P>0.05). In hilar cholangiocarcinoma, the serum CA19-9 showed the highest positive rate (86.67%) among the five markers, followed by CA242 (63.33%), and CA50 (60%), successively. Between the two groups, the positive rates of the five tumor markers, except for CA125, had significant differences (all P<0.05). For the diagnosis of hilar cholangiocarcinoma, serum CA19-9 had the best sensitivity (93.98%), while CEA had the best specificity (94.60%). Conclusion: Combination detection of CA50, CA242, CA19-9 and CEA is helpful for differential diagnosis of hilar cholangiocarcinoma and benign biliary tract diseases.

Abstract:Objective: To determine the applicable scope of three types of surgical approach for laparoscopic cholecystectomy. Methods: The clinical data of 150 patients with benign gallbladder diseases undergoing laparoscopic cholecystectomy (LC) from January to December 2009 were retrospectively analyzed. Results: Of the 150 patients, laparoscopic cholecystectomy was performed via three-port approach in 46 cases, two-port approach in 54 cases, and transumbilical single-port approach in 50 cases. There were no differences among the three groups in the operation successful rate, duration of operation, intraoperative blood loss, and time for intestinal function recovery (all P>0.05). The transumbilical approach was better than the other two approaches in regards to postoperative pain and length of hospital stay (all P<0.05). No complications such as abdominal pain, jaundice, bile leakages, hemorrhage or incisional hernia occurred in any of the patients of the three groups during the follow-up period. Conclusion: Any of the three types of surgical approach can be used for the safe performance of laparoscopic cholecystectomy. However, the selection of the approach should be based on the patient’s individual condition and the principle of surgical safety.

Abstract:Objective: To investigate the influences of different pressures of CO2 pneumoperitioneum on liver function, arterial blood gas, and neck or shoulder pain following laparoscopic cholecystectomy (LC). Methods: One hundred and twenty patients scheduled for elective LC were randomly assigned to group A, B and C, with 40 cases in each group. The CO2 pneumoperitoneum pressure was maintained at 10 mmHg in group A, 12 mmHg in group B and 14 mmHg in the group C. The liver function and blood gas parameters before and after operation, and the incidences of nausea, vomiting, and neck or shoulder pain on the first to third postoperative day of the three groups were compared and analyzed. Results: The preoperative data among the three groups had no statistical differences (all P>0.05), but the parameters of liver function and arterial blood gas as well as the incidence of nausea, vomiting, and neck or shoulder pain after operation were all significantly different among them (all P<0.05). The results showed that the higher the pneumoperitioneum pressure was increased, the more significantly did the parameters of liver function (increase of AST, ALT and TBIL) and arterial blood gas (increases of PO2, and decrease of pH and PCO2 ) change, and the higher was the incidence of nausea, vomiting, and neck or shoulder pain. Conclusion: The CO2 pneumoperitioneum pressure has significant impact on incidence of liver function abnormalities, arterial blood gas derangements, and neck or shoulder pain following LC. Therefore, the pneumoperitioneum pressure should be decreased as low as possible during operation.

Abstract:Objective: To explore the clinical, pathological and imaging characteristics of congenital biliary dilatation (CBD) in children and its management. Methods: The clinical data of 58 pediatric patients with CBD, which was indentified and confirmed by imaging examinations, surgical and pathological findings, were retrospectively analyzed. Results: All the 58 patients exhibited clinical symptoms that mainly were abdominal pain, jaundice and abdominal mass, and some of them were combined with fever and vomiting. All the results of CT (performed in 45 cases), ultrasonography (performed in 40 cases) and magnetic resonance cholangiopancreatography (MRCP) (performed in 17 cases) revealed bile duct dilatation, and 11 cases were diagnosed with pancreaticobiliary maljunction (PBM) by MRCP. Intraoperative cholangiography was successfully performed

Abstract:Objective: To investigate the effect of shRNA-mediated nerve growth factor β (NGF-β) down-regulation on proliferation and apoptosis of the human cholangiocarcinoma cell line QBC939 in vitro. Methods: The stable QBC939 cells transfected with the NGF-β shRNA were constructed. Then, the QBC939 cells were divided into interference group (transfected with NGF-β shRNA) and control group (transfected with empty plasmid). The effect of transfection was determined by Western blot method. The proliferative and colony formation ability of the QBC939 cells was assessed by CCK-8 assay and sphere formation assay, respectively. The cell cycle and apoptosis of the QBC939 cells were detected by flow cytometry. Results: Compared with the control group, the QBC939 cells of interference group presented markedly deceased ability of cell proliferation and colony formation, and significantly reduced ratio of S-phase cells (P<0.05) and increased apoptotic rate (P<0.05). Conclusion: NGF-β inhibition can decrease the proliferative and colony formation ability of QBC939 cells, which is related to the action of S-phase block and apoptosis enhancement.

Abstract:Objective: To investigate the molecular mechanism of survivin regulaion of the apoptosis-related signaling in human cholangiocarcinoma cells. Methods: The siRNA targeting survivin gene and nontargeting control siRNA were constructed, and human cholangiocarcinoma QBC939 cells were divided into three groups that were survivin targeting siRNA transfection group, control siRNA transfection group and untransfection group, respectively. After transfection, the surviving expression in the QBC939 cells, QBC939/siRNA (–) and QBC939/siRNA (+) cells was determined by Western blot to identify the interference effect, and then, the apoptosis rate, capase-3 activity, and expression of caspase-3, caspase-9 and procaspase-9 in the QBC939 cells of above three statuses were detected by flow-cytometry, capase activity detection kit and Western blot, respectively. Results: The protein expression level of survivin in the QBC939/siRNA (+) cells was significantly decreased (P<0.05), and there was no obvious alteration in the QBC939/siRNA (–) cells compared with the untransfected QBC939 cells (P>0.05). Compared with the untransfected QBC939 cells, the QBC939/ siRNA (+) cells presented enhanced apoptosis, increased caspase-3 activity, and upregulated expression level of caspase-3 and caspase-9, but downregulted expression level of procaspase-9 (all P<0.05). In each of the above indexes, the differences between the QBC939/siRNA (–) cells and untransfected QBC939 cells had no statistical significance (all P>0.05). Conclusion: In cholangiocarcinoma cells, apoptosis inhibition by survivin is possibly due to the inactivation of caspase-3 and caspase-9 via procaspase-9 activation.

Abstract:Objective: To investigate the mechanism of the antireflux action of intussusception valve constructed in the biliary intestinal limb of Roux-en-Y cholecystojejunostomy after biliary tract surgery. Methods: Twenty adult rabbits were equally randomized into the experimental group and control group. After common bile duct ligation, the biliary reconstruction in the experimental group was performed using Rouxen- Y cholecystojejunostomy with an intussusception valve created in the biliary intestinal limb, while the procedure in the control group was Roux-en-Y cholecystojejunostomy alone. Rabbits of the two groups were bred 3 months after surgery, and then their isoperistaltic pressure (IPP) and antiperistaltic pressure (APP) in the reconstructed biliary tract was measured, meanwhile a contrast X-ray examination was also performed. Results: The IPP values of the experimental group and control group were (5.91±1.46) cmH2O (1 cm H2O=0.098 kPa) and (4.82±0.39) cmH2O, and the APP values of them were (14.32±1.67) cmH2O and 胆肠Roux-en-Y 吻合胆道重建术是胆道疾病 切除或肝移植后常用的重建胆道的方式[1]。该术 式不仅重建了胆汁引流通道，也有一定的抗反流 作用。目前尽管诸多抗反流措施被应用于胆道重建 中[2-4]，也获得了相应的临床效果[5-6]，但胆道重建 术后逆行感染仍是一个未能完全解决的问题[7-10]。 作为一种抗反流措施，在重建胆道的同时于胆支 肠袢加行人工套叠瓣，经临床研究证实有确切的 抗反流作用[11-12]。但对套叠瓣抗反流作用的研 究尚缺乏基础实验的理论支持，且对其抗反流机 制的认识也缺乏客观依据。因此，本研究通过动 物实验测定套叠瓣两端胆道压力的变化，旨在探 讨套叠瓣在Roux -en-Y 胆道重建中的抗反流作 用机制。 1　材料与方法 1.1 材料 1.1.1 实验动物　成年健康家兔25 只， 体质量 2.5~3.0 kg，平均（2.8±0.5）kg。雌雄不限。购 于大理学院实验动物中心。 1.1.2 制剂和器械　20% 乌拉坦100 mL（ 大理 学院药学院制剂室配制）；20 mL:0.2 g 装丙泊 酚注射液（四川蜀乐药业股份有限公司生产）； 250 mL 装5% 葡萄糖氯化钠注射液；0.5 g 装氨 苄青霉素粉针剂。75% 乙醇棉球和5% 碘伏棉球。 76% 泛影葡胺20 mL/ 支。另备常用小手术器械 及用品，自制测压管数根。 1.2 实验方法 1.2.1 动物分组和观察指标　家兔随机分为实验 组和对照组。实验组行胆囊空肠Roux-en-Y 吻合 加胆支肠袢套叠瓣成形胆道重建术；对照组仅行 胆囊空肠Roux-en-Y 吻合胆道重建术。两组均在 确认成形的胆道通畅后，结扎胆总管。术后3 个 月再次手术测定胆道压力，并进行胆道造影。 1.2.2 手术操作　先用20% 乌拉坦3 mL/kg 经 兔耳缘静脉注射麻醉，仰卧位固定，持续5% 葡 萄糖氯化钠注射液缓慢静脉滴注。术中用丙泊酚 1~2 mg/kg 静脉注射以维持麻醉效果。取上腹部正 中切口， 探查胆囊、胆总管及小肠。在距Trietz 韧带15 cm 处游离肠系膜并切断小肠。远端上提 与胆囊吻合， 上提肠袢无张力， 约15 cm； 近端 小肠与远端小肠行端侧吻合，实验组在肠肠吻合 口上方约5 cm 处胆支肠袢上成形1 个套叠瓣， 即将近端肠袢套入远端肠袢0.5 cm（因成年家兔 小肠直径约1 cm， 套入瓣膜长度为小肠直径的 1/2），平均（0.5±0.1）cm。因肠壁较薄，未剥 去套入肠壁的浆膜层。丝线缝合固定。检查各吻 合口吻合确切通畅后，将胆总管用丝线结扎，逐 层关腹，术毕。对照组除未做套叠瓣外其余操作 与实验组相同。 术后每日注射氨苄青霉素0.25 g/kg 预防感 染， 连续用药3 d。术后第1 天即给予进食并开 始正常饲养。两组术后饲养条件相同，饲养观察 3 个月。3 个月后再次手术打开腹腔测压。 1.2.3 胆道测压和造影　3 个月后再次手术打 开腹腔， 直视下分别经套叠瓣近端和远端肠管 穿刺灌注测压[13]， 生理盐水灌注速度为30 mL/ min，用自制测压管测定套叠瓣两端胆道顺流压 （isoperistaltic pressure，IPP）和逆流压（antiperistaltic (4.90±0.37) cmH2O, respectively. Statistical analysis indicated that the APP value of experimental group was significantly higher than that of control group (P<0.01), but the IPP values between the two groups had no statistical difference (P>0.05); the APP values were significantly higher than the IPP values in experimental group (P<0.01), but the two values showed no statistical difference in control group (P>0.05). Contrast examination showed that the intussusception antireflux valve in the biliary limb of the small bowel could restrict the entering of contrast material into its upper segment. Conclusion: Intussusception valve exerts effective action against reflux in the biliary tract reconstructed with Roux-en-Y biliary-enteric anastamosis through increasing APP of the biliary limb of the Y structure.

Abstract:Objective: To investigate the effect of glucagon-like peptide 2 (GLP-2) on bacterial translocation and endotoxemia in rats with bile duct ligation. Methods: Seventy-two SD rats were equally randomized into sham operation group, model group and GLP-2 treatment group, and rats in model and GLP-2 treatment group underwent common bile duct ligation. After surgery, rats of the GLP-2 treatment group were subjected to daily intraperitoneal injection of GLP-2 [250 μg/ (kg?d)], and those of the sham operation group and model group received the same volume of PBS by using exactly the same regimen. The phosphatidylinositol 3-kinase (PI3K) expression in the intestinal mucosa, and the bacterial translocation rate and development of endotoxemia of the rats were detected at day 1, 3, and 7 after surgery. Results: The PI3K expressions in the intestinal mucosa of rats of the model group decreased significantly at day 3 and 7 after surgery compared with those of the sham operation group or GLP-2 treatment group (all P<0.05), and although those somewhat decreased in the GLP-2 treatment group, the differences had no statistical significance compared with sham operation group (all P>0.05). In the model group, the rates of bacterial translocation to the liver and spleen increased gradually and both reached 100% on day 7 after surgery. The overall rates of bacterial translocation to the two organs were 75.0% and 66.7%, respectively. In the GLP-2 treatment group, the rates of bacterial translocation to the two organs increased slowly, and the overall rates of bacterial translocation were 37.5% and 25.0% respectively, which were significantly lower than those in the GLP-2 treatment group (both P<0.05). The endotoxin content of the portal vein blood elevated gradually with time in both model group and GLP-2 treatment group, but it was significantly lower in GLP-2 treatment group than that in model group at each observation point (all P<0.05). Conclusion: GLP-2 has inhibitory effect on the bacterial translocation from the intestinal tract and development of endotoximia in rats with common bile duct ligation, and the mechanism is probably related to its enhancement of PI3K expression in intestinal mucosa and thereby protecting gut barrier function.

Abstract:Objective: To monitor the state of liver injury after acute biliary obstruction in rats. Methods: Male Wistar rats were randomly divided into experimental group (common bile duct ligation) and control group (sham operation). At defined time points after surgery, the general status, jaundice, and biochemical parameters variations as well as the liver pathological changes of the animals were assessed. Results: In control group, all the observation parameters had no obvious abnormalities after surgery. In experimental group, the animals showed reduced body weight gain, decreased motor activity and overt jaundice, but all tended to improve after the third postoperative day; the total bilirubin (TBIL) and direct bilirubin (DBIL) levels increased significantly after surgery, peaked on the third day and then gradually decreased; the level of aspartate aminotransferase (AST) increased rapidly after surgery, reached a peak on the first and second postoperative day, and dropped rapidly after the third postoperative day; the level of alanine aminotransferase (ALT) attained a peak on the second postoperative day and declined gradually from the third　postoperative day; the Metavir scores of the rats’ liver tissues increased progressively during the course of the experiment, and there was clear collagen fiber hyperplasia from the third operative day. Conclusion: The acute stage of liver injury secondary to acute biliary obstruction is within the first week following onset, during which time the liver injury reaches a climax on the second and third day, and hepatic fibrosis also develops.

Abstract:Objective: To investigate the protective effect of anti-TNF-α monoclonal antibody (anti-TNF-α) against the myocardial impairment induced by acute obstructive jaundice. Methods: Twenty-four male SD rats were equally randomized into the model group (undergoing common bile duct ligation), anti-TNF-α treatment group (with administration of anti-TNF-α after common bile duct ligation) and sham operation group. The rats of the anti-TNF-α treatment group were injected with anti- TNF-α (1 mg/kg) through tail vein from the third postoperative day for 5 consecutive days, and those of the　model group and sham operation group were given the same volume of saline under the same administration regimen. On the seventh postoperative day, the serum level of creatine kinase (CK-MB) and TNF-α, the malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in myocardial tissues of the rats were detected; the morphological changes in the myocardial tissues of the rats were also assessed. Results: Except for the sham operation group, rats in both the model group and anti-TNF-α treatment group began to present jaundice that gradually increased. The serum CK-MB and TNF-α levels and the myocardial MDA contents were significantly increased, and the myocardial SOD activities were significantly decreased on the seventh postoperative day in both the model group and anti-TNF-α treatment group compared with the sham operation group (all P<0.01). However, the changes of above indexes in the anti-TNF-α treatment group were less evident than those in the model group and all the differences had statistical significance (all P<0.01). The myocardium from the sham operation group had no obvious pathological change under the light microscope, while the rats of the model group showed sparse atrophied cardiac muscle fibers with necrosis and cloudy swelling, and the pathological changes of myocardial impairment was relatively mild in anti-TNF-α treatment group. Conclusion: TNF-α may be an important mediator in myocardial injury following acute obstructive jaundice, and anti-TNF-α can lessen the myocardial injury by antagonizing the action of TNF-α.

Abstract:Objective: To investigate the influence of HBsAg state on survival rate of the patients with gastric liver metastases after synchronous resection. Methods: The systematic follow-up data for 5 years of 31 patients with gastric liver metastases undergoing combined resection of the stomach and liver during recent 10 years were retrospectively analyzed. The survival curves were calculated by Kaplan-Meier method and Log-rank test was used to determine the significance of the survival rates. Multivariate analysis was performed by using Cox's proportional hazards model. Results: Of the 31 patients, 29 cases had a complete systemic follow-up, so the follow-up rate was 93.5%. In the 29 follow-up patients, 3 cases survived without recurrence and 26 cases died due to disease recurrence or metastasis. The 1-, 3- and 5-year cumulative survival rates for the whole group were 62.1%, 22.4% and 12.1%, respectively. The 1-, 3- and 5-year cumulative survival rates for the HBsAg positive patients (14 cases) were 58.4%, 18.7% and 8.9%, and for the HBsAg negative patients (17 cases) were 69.3%, 27.9% and 15.7%, respectively. HBsAg negative patients had better survival chance than HBsAg positive ones (χ2=2.119, P=0.034). The results of multivariate analysis indicated that the risk of death of the HBsAg positive patients after surgery was 1.670 times that of the negative ones, and in addition, the size of liver metastasis and the type of surgical procedure for gastric cancer were independent risk factors for survival (RR=2.121, 95%CI=1.864– 2.378; RR=2.296, 95%CI=2.001–2.591). Conclusion: HBsAg is an independent prognostic factor for patients with gastric liver metastasis after synchronous resection. Therefore, HBsAg status should be taken into account when planning such operations.

Abstract:Objective: To determine the clinical efficacy of laparoscopic surgery for treatment of gastroesophageal reflux disease (GERD). Methods: The clinical data from 33 patients undergoing laparoscopic repair of esophageal hiatal hernia and laparoscopic fundoplication from January 2008 to September 2011 were retrospectively analyzed. Of the patients, laparoscopic fundoplication (Toupét procedure) alone was performed in 5 cases, 25 cases underwent laparoscopic esophageal hiatal hernia repair plus a fundoplication (3 Nissen procedures and 22 Toupét procedures) and 3 cases had laparoscopic esophageal hiatal hernia repair alone. Results: The operations were successfully performed in all patients. The operatiive time was from 90 to 185 min and the average length of postoperative hospital stay was 6 days. There was no conversion to open procedure and no death occurred. No severe postoperative complications were observed. The postoperative follow-up period was from 1 month to 24 months. The symptoms of 32 patients completely disappeared, and 1 patient significantly improved. Conclusion: Laparoscopic repair of esophageal hiatal hernia and laparoscopic fundoplication are minimallyinvasive, safe and effective procedures for gastroesophageal reflux disease.

Abstract:Objective: To investigate the selection of laparoscopic surgical procedure for inguinal hernia repair. Methods: The clinical data of 162 patients (178 sides), who underwent totally extraperitoneal (TEP) repair or transabdominal preperitoneal (TAPP) inguinal heruia repair, between January 2004 and January 2008 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. The clinical results such as the amount of intraoperative blood loss, operative time, time to passage of flatus, postoperative hospital stay, postoperative complications, recurrence rate and long-term chronic pain between the two groups were compared. Results: The general data of the two groups before operation were comparable (all P>0.05). There was no operative mortality and no serious postoperative complications occurred in any of the groups. The time to ambulation, early complications and length of hospital stay between the two groups had no statistical differences (all P>0.05), while the operative time and surgical success rate of recurrent inguinal hernia repair of TAPP group were significantly higher than those of TEP group (both P<0.05), and the time to passage of flatus of TEP group was less than that of TAPP group (P<0.05). Conclusion: Laparoscopic approaches for inguinal hernia repair are safe and each of the two procedures has its advantages and disadvantages. Thus, the choice of procedure may not be uniform and, instead, should depend on the patient’s individual condition and surgeon’s operative experience.

Abstract:

The further surgical management of incidental gallbladder carcinoma (IGBC) has generated a number of problems and controversies. This review paper addresses certain aspects of the diagnosis and surgical management of IGBC, including the pre- and intraoperative diagnosis of IGBC, the selection of operative methods for IGBC of different T stages and their outcomes, and the remedial operation strategy for IGBC.

Abstract:As a signaling transducer, mTOR, one member of the PI3K family, plays an important role in regulation of a variety of physiological functions involving cell growth, proliferation, differentiation and apoptosis etc. This paper overviews the composition of mTOR signaling complexes and the specific functions of the molecules up- and down-stream, and briefly elucidates the role of mTOR signaling pathway in cancer therapy.

Abstract:This paper addresses the relations of clusterin (CLU) with epithelial-mesenchymal transition (EMT), NF-κB and other regulatory factors, so as to clarify the role of CLU in tumor occurrence and metastasis. The expression state of CLU in malignant tumor and its influence on cancer recurrence, as well as on cancer therapy are also reviewed.