Objective To explore the value of direct measurement of liver stiffness in evaluating the pathological severity hepatitis B related cirrhosis.Methods The liver stiffness of 113 patients with various kinds of surgical liver diseases was measured directly by Shaw’s sclerometer.Based on the distribution of liver stiffness value（LSV），liver stiffness is divided into three grades， grade Ⅰ（LSV：2 to 6HC），grade Ⅱ（LSV：7 to 11HC），grade Ⅲ（LSV：12 to 16HC）.The severity of liver cirrhosis of 76 patients with hepatitis B background was pathologically evaluated using the Laennec staging system，and the correlation between LSV and pathological grade of liver cirrhosis was analyzed.Results There was a significant correlation between LSV and pathological grade of liver cirrhosis（r=0.693，P<0.05）.The AUC of LSV for estimating mild，moderate and severe cirrhosis were 0.91，0.81 and 0.80，respectively.Conclusion There was a significant positive correlation between LSV and pathological grade of liver cirrhosis.LSV can be used as an effective parameter in evaluating the pathological severity of liver cirrhosis.

Objective To discuss the diagnose and therapy of obstructive jaundice which could not be managed by surgery.Methods Five inpatient case reports of obstructive jaundice that could not be managed or failure to be managed just by surgery in recent one year.Results These 5 patients（0.9%） had average ALP value of （242.1±80.1）U/L，GGT value of （520.5±259.4）U/L，TBIL value of （216.1±97.9）μmol/L，and DBIL value of （120.5±64.7）μmol/L，which can be diagnosed of cholestasis.Among these patients，one patient diagnosed of hepatic hilar carcinoma who received left hemi-hepatectomy and choledochojejunostomy still had cholestasis after surgery.One patient who received common biliary operation for choledochal lithiasis had cholestasis after operation.The other 3 patients are relief from cholestasis after medication therapy.Conclusion The surgeons should be cautious of this kind of patients with obstructive jaundice originated from both intra- and extra-hepatic biliary obstruction.Multidisciplinary therapy（MDT） is an appropriate pattern for the patients with no obvious evidence of obstruction in bile duct on image.

Objective To elucidate the the clinical features，and the principles in diagnosis and treatment of hepatic perivascular epithelioid cell tumor（PEComa）.Methods The clinical data of 8 cases with PEComas from January，2010 to December 2018，were studied．We analyzed the clinical characters，imaging manifestation，treatment and prognosis of these cases with hepatic PEComa.Results Among the 8 patients，4 had single liver tumor，3 had multiple liver and kidney tumors，and 1 had multiple liver and kidney tumors.Four patients underwent right lobe tumor resection，three underwent left lobe tumor resection，and one underwent bilateral lobe tumor resection.Operation time was 180-310min，average（255.0±15.7）min，peroperative bleeding was 100-400ml，average（258.8±32.6）ml.All the 8 cases were confirmed as PEComa by pathology.Postoperative follow-up showed no recurrence.Conclusion Hepatic PEComa is a relatively rare liver tumor，which is definitively diagnozed by post-operative pathological examination.Surgical resection is an optimal therapy for hepatic PEComa.The major of hepatic PEComa is benign tumor，so the prognosis is relatively well.

Objective To explore the application value and prospect of selective Ⅰ phased Laparoscopic Cholecystectomy（LC） combined with Endoscopic Retrograde Cholangiopancreatography（ERCP） of the elderly patients in the patients with cholecystolithiasis combined with choledocholithiasis.Methods 60 cases of elderly patients with cholecystolithiasis combined with choledocholithiasis were collected in the two hospitals.The liver function and MRCP examination were performed before the operation，and patients were selected with normal liver enzyme，no jaundice and no abdominal pain as an observation group（30 cases），Ⅰ phased LC+ERCP，and 30 cases of middle-aged patients and young patients with same diseases were collected as the control group in the same period，the two groups of patients in the operation time，intraoperative bleeding，hospital care time and cost and other aspects of the situation were compared，and the satisfaction of the patients were investigated.Results The operative time of the observation group and the control group was（84.2±9.9）min and（81.2±14.1）min，respectively，and the intraoperative blood loss was（50.5±13.0）ml and（50.2±8.3）ml，respectively.The postoperative time of getting out of bed was（10.7±1.4）h and（10.2±1.5）h，respectively，and the hospitalization cost was（29322±854.8）yuan and（29233±878.9）yuan，respectively，which all showed no statistical significance（P>0.05）.The length of stay in the observation group and control group was（7.2±1.1）d and（6.5±0.8）d，respectively，with statistically significant differences（P<0.05）.No serious complications such as bleeding，perforation，bile leakage，intestinal leakage and bile duct injury occurred during and after operation in the two groups，there was no statistically significant difference in the incidence of complications（P>0.05）.Patients' satisfaction score was（96.23±2.70）in the observation group and（96.33±2.63）in the control group，the difference was not statistically significant（P>0.05）.Conclusion In the elderly patients with cholecystolithiasis combined with choledocholithiasis，the appropriate patients were selected.Ⅰ phased LC+ERCP treatment is a safe and reliable operation.Although the number of days in hospital is prolonged，it is still of high clinical value and application prospect.It is worth further promotion.

Objective To explore the common methods of treatment of laparoscopic common bile duct stone exploration.Methods There were 306 cases of common bile duct stones treated with LCBDE.The clinical data of patients undergoing laparoscopic common bile duct incision and lithotripsy will be divided into three groups according to different surgical methods：double J tube group（102 cases），common bile duct primary suture group（106 cases），T tube drainage group（98 cases）.Operative，perioperative and postoperative complications were compared among the three groups.Results All patients completed the operation successfully.The T-tube placement group had a longer operation time[（129.3±12.24）min]，the primary suture group of common bile duct was the shortest[（105.1±5.93）min];longer hospital stay[（10.8±1.42）d]，double J tube drainage group followed[（10.2±1.41）d]，the primary suture group of common bile duct was the shortest[（8.7±1.50）d].The T-tube placement group had the longest postoperative exhaust time[（4.65±0.91）d]，the primary suture group of common bile duct was the shortest[（2.64±1.07）d].The T-tube placement group was the largest group in the total hospitalization cost[（25278.0±294.71）yuan]，the primary suture group of common bile duct was the shortest[（16727.5±193.52）yuan].The differences between the three groups were statistically significant（P<0.05）.The Incidence of postoperative complications of double J tube group，common bile duct primary suture group and T tube drainage group were 4.9%，5.6% and 2.0%，respectively（P＞0.05）.Conclusion The primary suture of the common bile duct during LCBDE is clinically feasible.However，it is necessary to strictly control the surgical indication.If necessary，the T-tube of the common bile duct should be inserted.

Objective To study the efficacy and safety of transcatheter arterial chemoembolization（TACE） plus Sorafenib in hepatic carcinoma.Methods 92 hepatic carcinoma patients treated from September 2015 to June 2017 in our hospital were selected.Patients were grouped by random number table，46 cases each group.The control group was treated with TACE； the observation group was treated with TACE plus Sorafenib.The therapeutic effect，hepatic function，life quality and adverse reactions were probed.Results The total effective rate in the observation group（52.17%） was significantly higher than control group（36.96%）（P＜0.05）； before treatment，the index of TBIL（total bilirubin），ALT（alanine aminotransferase） and ALB（albumin） showed no statistical differences（P＞0.05）；after treatment，the values of TBIL，ALT and ALB in the observation group were lower than control group； the related index in the control group were significantly higher than before（P＜0.05）； before treatment，the ADL（activity of daily living） scores showed no statistical differences（P＞0.05）；after treatment，the ADL scores in the observation group were higher than control group（P＜0.05）； the adverse event rate in the observation group（24 cases） and control group（21 cases） showed no statistical differences（P＞0.05）.Conclusion The TACE plus Sorafenib can increase the therapeutic effect，reduce the hepatic injury，improve the life quality and decrease the adverse event rate.The safe and reliable therapy is worthy of clinical application and promotion.

Objective To investigate the safety of minimally invasive surgery in the treatment of intracerebral hemorrhage and the effect on serum cystatin C（Cys-C） and aquaporin 4（AQP4）.Methods 90 patients with hypertensive intracerebral hemorrhage were selected and randomly divided into two groups，each with 45 cases.The observation group received minimally invasive surgery，while the control group received traditional craniotomy.Then surgical related indexes，clinical efficacy and serum Cys-C and AQP4 levels were compared between the two groups.Results The wound length，operation time，intraoperative bleeding volume and hospitalization time of the observation group were better than those of the control group[（3.11±1.03）cm vs（15.48±3.72）cm；（47.34±10.39）min vs（63.96±19.57）min；（15.48±2.52）ml vs（76.93±9.81）ml；（13.28±6.64）d vs（23.76±4.82）d；P<0.05]； The treatment compliance rate and effective rate of the observation group were significantly higher than those of the control group（95.56% vs 77.78%； 93.33% vs 75.56%；P<0.05）.The incidence rate of complication and mortality in the observation group were significantly lower than those in the control group（13.33% vs 28.89%； 2.22% vs 8.89%；P<0.05）.The serum levels of AQP4 and Cys-C in the observation group were significantly lower than those in the control group[（0.04±0.01） mg/L vs（0.22±0.01） mg/L；（0.90±0.03） mg/L vs（1.35±0.16） mg/L；P<0.05].Conclusion The application of minimally invasive surgery has the advantages of small wounds，low blood loss and quick recovery，can further reduce serum AQP4 levels in patients with cerebral hemorrhage.

Objective To observe the clinical efficacy and safety of location-guided double-point and double-channel intracranial puncture in the treatment of hypertensive cerebral hemorrhage in basal ganglia.Methods 58 cases of hypertensive cerebral hemorrhage in basal ganglia were treated by location-guided  intracranial puncture and orientation.15 cases in the experimental group were treated with double-target and double-channel minimally invasive puncture and catheter drainage，while 43 cases in the control group were treated with single-channel puncture and catheter drainage.The clinical data and therapeutic effects of the two groups were summarized and analyzed.Results There was no significant difference in general data between the two groups（P>0.05）.51 patients were successfully punctured and the drainage tube was placed into the ideal target; there was no bleeding during puncture in both groups.The average indwelling time of the experimental group was（3.1±0.6）d，the clearance rate of hematoma after operation was 87.4%，the hospitalization time of NICU was（3.8±0.8）d，and the average hospitalization time was（10.6±1.6）d.The average indwelling time of the control group was（4.4±0.8）d，the clearance rate of hematoma after operation was 81.2%， the average hospitalization time of NICU was（5.5±1.3）d，and the average hospitalization time was（16.6±3.3）d.The average indwelling time，hospitalization time and NICU time of experimental group was significantly shorter than that of control group（P<0.05）.No intracranial infection occurred in both groups.Six months follow-up showed that the good prognosis rate of the experimental group was 66.67%，while that of the control group was 72.09%.There was no significant difference（P>0.05）.Conclusion Location-guided double-target and double-channel intracranial puncture is simple and feasible for the treatment of hypertensive intracerebral hemorrhage.The success rate of puncture is high.Compared with single-channel puncture，the risk of operation is not significantly increased，but the efficiency of hematoma drainage is higher，which can reduce NICU and total hospital stay，and is conducive to early rehabilitation of patients.

Objective To summary and analysis of the surgical treatment and effect of tricuspid valve infective endocarditis.Methods The clinical data of 51 patients with right heart infective endocarditis treated by cardiovascular surgery were retrospective analyzed.All patients underwent extracorporeal circulation of neoplasm removal，combined with cardiac deformity correction and tricuspid valve surgery，postoperative antibiotics for 2～4 weeks.Result Secondary thoracotomy in one patient postoperative bleeding，one of patients with postoperative year mitral valve vegetations，one of patients with postoperative March intermittent fever lasted 4 years again three tricuspid valve vegetations two operation，one of patients with subarachnoid hemorrhage，acute kidney injury，sepsis，referral.50 cases of patients were cured and discharged，followed up for 6 months to 13 years，the symptoms of heart failure were obviously improved and 2 cases had relapsed.Conclusion Surgery can effectively treat tricuspid valve infective endocarditis caused by congenital heart disease，valvular disease or heart surgery，and get satisfactory results.

Objective To carry out a Meta-analysis on the published data in order to evaluate the clinical efficacy of gemcitabine（GEM） combination with high intensity focused ultrasound（HIFU） in the treatment of advanced pancreatic carcinoma（PC） in China.Methods A comprehensive search was performed in WANFANG（1999～2018），CAJD（1995-2018），VIP（1989～2018） and CNKI（1994～2018） databases to collect the randomized controlled trials（RCTs） which to GEM combination HIFU with in the treatment of PC，and to analyze the RCTs in Meta-analysis method.Results 718 patients were analyzed in the 15 RCTs which met the inclusion criteria.The Meta-analysis results suggested that，compared with the simple HIFU or GEM treatment group，there were higher clinical effect rates， clinical benefit rates，half one year survival rates，one year survival rates and lower levels of CA19-9 in GEM combination with HIFU treatment group（P<0.05）.Conclusion The clinical efficacy of GEM combination with HIFU in the treatment of advanced pancreatic carcinoma is positive，and better than the simple GEM or HIFU treatment.

Objective To observe the effect of Isorhamnetin on the cell senescence of colon cancer cell line SW48.Methods Different doses of Isorhamnetin were incubated with the SW48 cells，then the effect of Isorhamnetin on the apoptosis of SW48 cells was detected by Annexin V / PI assay，and the change of cell senescence was observed by β-GAL.The cell proliferation was measured by CCK8 assay and BrdU incorporation assay.Finally，the expression of cell senescence related proteins were detected by Western blot.Results The apoptosis rates of SW48 was remain similar when the concentration of Isorhamnetin was under 40nM，thus 10nM，20nM and 40nM Isorhamnetin were used in the further experiments.The cell senescence of SW48 cells was elevated after Isorhamnetin incubation for 48h，with cell proliferation reduced，and the expression of cell senescence related proteins was enhanced obviously.Conclusion Isorhamnetin may inhibit the proliferation and growth of cancer cells by promoting cell senescence.

Objective To analyze the clinical value of carboxymethyl chitosan rinse in preventing systemic inflammatory response syndrome（SIRS）and bacteriuria after ureteroscopic lithotripsy（FURL）.Methods A total of 200 patients with urinary tract calculi from December 2016 to June 2018 were enrolled in this study.They were treated with FURL.They were randomly divided into control group and observation group，100 cases each.The control group was washed with normal saline during operation.The observation group was rinsed with a carboxymethyl chitosan rinse.Serum CRP levels，WBC counts，and neutrophil percentages were compared before and 2h and 24h after surgery.The incidence of SIRS and bacteriuria in the two groups was compared.Results The serum CRP level，WBC count and neutrophil percentage in the observation group were significantly lower than those in the control group at 2h and 24h after operation.The difference was statistically significant.The percentage of neutrophils at 2h after surgery in the observation group and control group was （81.12±9.96）% and（88.56±14.17）%，respectively；CRP at 24h after surgery was （5.07 ± 2.25） mg/L and（9.93±3.41） mg/L，respectively；WBC counts at 24h after surgery was （8.94± 2.77）×10⁹/L and（10.31 ± 3.30）×10⁹/L，respectively；The percentage of neutrophils at 2h after surgery at 24h after surgery was （77.32±10.43）% and（82.12±7.57）%，respectively（P＜0.05）.The incidence rates of SIRS and bacteriuria in the observation group were 2.0% and 4.0%，while in control group was 14.0% and 16.0%.The difference between the two groups was statistically significant（P＜0.05）.Conclusion Carboxymethyl chitosan rinsing solution can effectively prevent SIRS and bacteriuria after FURL，and it has good safety and effectiveness.

Objective To investigate the L-carnitine combined with transurethral seminal endoscopic dilatation of the ejaculatory duct effect analysis of obstructive azoospermia and prognosis.Methods 40 cases of patients with obstructive azoospermia were studied in our hospital.According to the simple random method were divided into control group and observation group，20 cases in each group.Patients underwent transurethral seminal endoscopic dilatation of the ejaculatory duct after operation，the control group was given oral vitamin E，observation group received oral l-carnitine.The therapeutic effect，active sperm rate，forward motile sperm rate，TNF- alpha，ROS level，and pregnancy status of the spouses of the two groups were compared before and after treatment.Results The effective rate of the control group was 60%，and the effective rate of the observation group was 80%.The treatment effect of the observation group was significantly better than that of the control group（P<0.05）.After treatment，two groups of patients with active sperm rate，forward movement sperm rate were higher than before treatment（P<0.05）； the observation group after treatment of active sperm rate，forward movement sperm rate was significantly better than the control group（P<0.05）.The two groups of patients with follow-up，patients in the control group after treatment，12 cases（12/20，60%） detection of sperm after treatment in the observation group were 18 cases（18/20，90%） detection of sperm； observation group of spouses of patients with clinical pregnancy and live births were higher than the control group（P<0.05）.Conclusion Therapeutic effect of L-carnitine combined with transurethral seminal endoscopic dilatation of ejaculatory duct obstructive azoospermia significantly，can effectively improve the patients with azoospermia，and improve the outcome of pregnancy after treatment.

Objective To investigate the pathological features of intercellular adhesion molecule-1（ICAM-1） and endothelial cell specific molecule-1（ESM-1） in renal allograft rejection.Methods 20 patients who underwent renal transplantation in our hospital were selected and were divided into the normal group of 10 cases and rejection group of 10 cases accorded to the rejection of transplanted kidney.Recorded the pathological immunohistochemistry of ICAM-1 and ESM-1 in different renal tissues，and renal function changes were recorded.Results The renal function of the normal group continued to improve until the normal level was restored，the renal function of the rejection group were decreased after operation compared the difference of creatinine between the two groups at postoperative 1d，3d，7d and 1months were statistically significant（P<0.05）.The positive rates of ICAM-1 and ESM-1 expression in the normal group were 80.0% and 90.0%，respectively，and were 10.0% and 10.0% in the rejection group，respectively，compared the difference were statistically significant（P<0.05）.Conclusion Transplanted renal rejection is common，the positive rate of pathological expression of ICAM-1 and ESM-1 are related to the degree of rejection，they also have certain correlation with renal function.

Primary hepatocellular carcinoma（HCC）is one of the most common malignant tumors in the clinic.Liver transplantation（LTx）is recognized as the most effective treatment for the end-stage liver disease.In China，HCC is the main indication for LTx.In this paper，the research progress of LTx for HCC on the aspects of indications，individualized immunosuppressive protocol and treatment of tumor recurrence.

Laparoscopic surgery plays an essential role in the treatment for primary liver cancer.With the dissemination of the concept of precise hepatectomy，indocyanine green fluorescence fusion imaging technology has been widely recognized in the application of hepatectomy.As an emerging technology which shows great clinical value and promotion prospects.

Mirizzi syndrome is a special type of gallstone，with a low incidence and is relatively rare in clinical practice.The disease lacks specific clinical manifestations and is difficult to diagnose before surgery.Most patients are diagnosed during surgery.Because of the anatomical variation of the disease，iatrogenic biliary tract injury is easily caused during surgery，so biliary surgeons need to be more vigilant about the disease.This article intends to review the latest developments in the pathogenesis，pathological type，clinical manifestations，diagnosis and treatment of Mirizzi syndrome，in order to provide reference for biliary surgeons.

Gastric cancer is one of the leading causes of morbidity and mortality around the world.A large number of studies have confirmed that Helicobacter Pylori infection is closely related to the occurrence of gastric cancer，but the role of bacteria other than Helicobacter Pylori is yet to be established.Herein，we review the literature of how the non-Helicobacter Pylori influence the development of gastric cancer in the past decades and pave the way for further study on the relationship between non-HP and gastric cancer.It can provide new ideas for early detection，prevention and clinical intervention of gastric cancer.