Objective To investigate the incidence of hepatocellular carcinoma (HCC) among patients with esophageal varices bleeding previously treated with endoscopic sclerotherapy, and to evaluate the factors influencing prognosis of HCC patients.Methods The clinical data of patients (from April 1987 to May 2003) who had received sclerotherapy for esophageal varices bleeding, and also that of HCC patients who had had sclerotherapy for esophageal varices bleeding were retrospectively reviewed. The survival rates of HCC patients were evaluated with Wilcoxon-Gehan method. Sixteen risk factors for HCC were assessed by multivariate analysis (Cox model). Results A total of 934 cases were treated with sclerotherapy, among which 109 patients suffered from HCC while 825 patients did not. In 22 HCC patients with esophageal varices bleeding sclerotherapy was not given. 31 out of 825 patients (3.76%) developed HCC during the follow-up period. 17 out of 31 patients received regular follow-up while 14 cases did not. The median surviving time of 31 patients was 13 months. The survival rate of patients with HCC under regular follow-up was significantly higher than that of patients under irregular follow-up(P=0.0002); risk factors, i.e. Child-Pugh classification, age and regular or irregular follow-up, were significantly related to the prognosis of patients with HCC(P=0.039、0.029 and 0.021, respectively). Conclusion Surveillance of patients with decompensated liver cirrhosis may increase the diagnostic rate of small HCC and prolong life expectancy; sclerotherapy can lower the incidence of HCC and it may play an active role in decreasing the incidence of HCC.

Objective To compare the efficacies of laparoscopic colorectal resection and conventional open surgery by collecting and investigating related studies with Meta-analysis.Methods Randomized controlled trials(RCT) on the outcomes of laparoscopic colorectal resection and conventional open surgery that published between January 1989 and March 2008 in English were collected and analyzed.The quality of the original investigations was evaluated,and the low-level reports were excluded.Then the odds ratio(OR) for the incidence of early postoperative small bowel obstruction between the two methods were calculated.ResultsTotally 12 studies including 3032 cases were analyzed.Among which,1522 patients received laparoscopy,33 of them developed early postoperative small bowel obstruction.1510 cases underwent open surgery,and 71 of these patients showed small bower obstruction before being discharged form hospital.The pooled OR was 0.46 with a 95% confidence interval of(0.30-0.69).Conclusion Compared with open surgery,laparoscopic colorectal resection is superior in the incidence of early postoperative small bowel obstruction.

Objective: To investigate the influence of total body irradiation with different doses of 60Coγ on wound breaking strength during wound healing in rats. Methods: Rats were exposed to 60Coγ radiation at dosages of 4,6 ,and 8 Gy. Within 30 min after irradiation, full thickness skin wounds were made on the shaved back of rats to establish animal models of irradiated-trauma injury plus skin wounds (n=20), and non-irradiated rats with pure incision injury were used as controls (n=10). The rats were sacrificed at day 10 after treatment, and the full thickness skin wounds were harvested. Bio-mechanics method and histopathology examination were used to evaluate the wound breaking strength and histological features after healing. Results: The wound breaking strength of model groups were greatly retarded with the increase of irradiation doses. Statistical results showed that on day 10 the wound breaking strength values were significantly different between 4 Gy group ([114.26±0.29] g) and control group ([117.12±1.86] g, P>0.05), and the wound breaking strength values of 6 Gy group ([91.87±1.96] g) and 8 Gy group ([55.26±2.64] g) were significantly lower than that of the control group (P<0.05). H-E staining showed that the wounds in the irradiation trauma groups had looser and disorder collagenous fiber and less fibroblast proliferation than control group. Conclusion: Radiation injury may result in delayed wound healing, and the wound breaking strength decreases with the increase of irradiation dose in model of irradiation injury plus full thickness skin wounds.

〔Abstract〕 By use of the decision tree algorithm and diagnostic indexes , the paper sets up the discrimination rules to make differential diagnosis of Primary Hepatocelluar Carcinoma ( PHC) based on basic data of 95 patients with PHC and 190 patients with liver cirrhosis , in-cluding the CT diagnosis, testing results of imaging and serologic markers such as the HbsAg , AFP, CEA and AFU, sex and age, etc.As indicated by the results , the data mining technology represented by the decision tree can support the differential diagnosis of PHC .

Objective To discuss the effect of gene transfection of rAAV2/1-NPY-EGFP on KA-induced rat seizures,EEG and the expression of hippocampal phosphorylated Tau protein.Methods Altogether 72 healthy male Wistar adult rats were randomly divided into three groups:control group,KA group and NPY group(n=24).The epileptic models were established by the injection of KA 2 μl (0.4 μg/μl) five times to the right side of the hippocampus CA3 area every three days.rAAV2/1-NPY-EGFP group,in which 10 μl of rAAV2/1-NPY-EGFP (titer 5× 1011 v.g./ml) was injected to the lateral ventricle in successful rats chronic model,while KA group was injected with an equal dose of saline.The control group was injected with an equal dose of saline both in the hippocampal CA3 area and the lateral ventricle.The seizure situation,the onset latency and EEG were observed at 2 weeks and 4 weeks after vector injection.Then the expression of phosphorylated Tau protein in hippocampus were detected with Western blotting.Results (1) Scale and latency of each seizure onset in rats of rAAV2/1-NPY-EGFP group (12.13 ± 8.06) had no significant difference at 2 weeks (P＞ 0.05) compared with KA group (12.10± 8.07).The scale of seizure in rats of rAAV2/1-NPY-EGFP group(6.06±3.78) significantly reduced at 4 weeks(P ＜0.05).Latency of seizure onset (79.06±8.83min) significantly increased at 4 weeks(P＜0.05),EEG epileptic discharge frequency and wave amplitude decreased (P＜ 0.05) at 4 weeks.The control group had no seizures.(2)Compared with the control group,the expression of phosphorylated Tau protein in KA group and NPY group significantly increased(P＜0.05) at 2 weeks and 4 weeks,and the expression of phosphorylated Tau protein in the NPY group (1.15±0.16 RQ value) at 4 weeks significantly decreased (P＜0.05) compared with the KA group(1.87± 0.23 RQ value).Conclusion rAAV2/1-NPY-EGFP gene transfection significantly reduces scale of seizure onset and prolongs latency of seizure onset in KA-induced rat model.rAAV2/1-NPY-EGFP gene transfection may play anti-epileptic and neuroprotective effects through inhibiting the expression of phosphorylated Tau protein in hippocampus of KA-induced epileptic rat model.

ObjectiveTo explore the clinic symptom and the characteristics of video,tightly close,intracranial electroencephalogram (EEG) of patients with central region diastematia epilepsy. Methods Retrospective analysis of 9 patients with central region diastematia epilepsy admitted from June,2007 to August,2009.The characteristics of all patients' seizure symptom and EEG manifestation were analyzed using patients' medical history,video and EEG records.ResultsPatients with central region diastematia epilepsy had relatively long sezure history.The duration of seizure was commonly short,with frequent episode and no obvious intelligence impairment.The seizure was often accompanied with the hyperkinesia in the lower limbs.Scalp EEG showed discharges with low amplitude waves in the mean line area.The superhigh amplitude and regular rhythm slow sharp wave could be found in the diastematia cortex EEG.All patients had an Engel Class Ⅰ outcome after surgery.ConclusionThe seizure symptoms are characteristic in the patients with central region diastematia epilepsy,and some special manifestations can be found in different phase,wave amplitude,rhythm,lead array.

Objective To analyze the clinicopathological and immunohistochemical characteristics of renal cell carcinoma (RCC) bone metastasis, and to explore the pathological characteristics and high-risk factors of bone metastasis in RCC patients. Methods A retrospective study was conducted on the clinicopathological and immunohistochemical characteristics of 1 694 RCC patients without bone metastasis and 133 RCC patients with bone metastasis, who were admitted to Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2012 to Dec. 2017. The paired pathological data of primary and bone metastatic lesions were analyzed in 25 RCC patients whose primary and bone metastatic lesions were removed successively or simultaneously in Changzheng Hospital. Results Compared with the RCC patients with bone metastasis, the proportion of males was significantly lower in the RCC patients without bone metastasis (70.1% [1 188/1 694] vs 84.2% [112/133], P<0.01), and the proportion of clear cell RCC (CCRCC) patients was also significantly lower (83.4% [1 412/1 694] vs 93.6% [103/110], P=0.004). Fuhrman nuclear grade III/IV accounted for 17.7% (247/1 398) and 51.6% (32/62) in the CCRCC patients without bone metastasis and with bone metastasis, respectively, and the difference was significant (P<0.001). The proportion of the patients having tumor invasion or breakthrough of the renal capsule was 44.0% (11/25) in the 25 patients with bone metastasis having matched data and 18.9% (320/1 694) in the RCC patients without bone metastasis, and the difference was significant (P=0.002). Matching analysis showed that the Ki-67 marker index was significantly lower in the primary lesions than that in the bone metastatic lesions (median [lower quartile, upper quartile]: 5.0% [2.0%, 6.0%] vs 6.0% [3.0%, 15.0%], P<0.001). Conclusion CCRCC is more prone to bone metastasis than non-CCRCC. Male, Fuhrman grade III/IV and invasion of renal capsule are high risk factors of bone metastasis. The Ki-67 marker index is higher in bone metastatic lesions than that in primary tumor, suggesting that the pathological characteristics of primary and bone metastatic lesions are not identical and the pathological analysis may guide treatment.

Objective To establish a long-term survival prediction model for hepatocellular carcinoma (HCC) patients after liver transplantation based on up-to-seven (Up7) criteria, and to validate the prediction model in different liver transplantation criteria, so as to assist clinical decision-making for the treatment of HCC. Methods We retrospectively analyzed the clinical and follow-up data of 251 HCC patients who underwent liver transplantation with Up7 criteria. Stepwise regression method was used to conduct multivariate Cox regression analysis to obtain the independent predictors of long-term survival after HCC liver transplantation, and to establish the survival Cox regression prediction model. R 3.4.3 software was used to score the prediction model, and the decision tree technique was used to determine the cut-off value. The Kaplan-Meier survival curve of the HCC patients after liver transplantation was drawn to validate the prediction model in different criteria (Shanghai Fudan criteria, University of California, San Francisco [UCSF] criteria and Italy Milancriteria), and the difference between groups was analyzed by log-rank test. The receiver operating characteristic (ROC) curve was used to test the predictive effectiveness of the model. Results Multivariate Cox regression analysis suggested that α-fetoprotein (AFP), total bilirubin (T-Bil), microvascular invasion (MVI) and tumor maximal diameter (Diameter) were the independent predictors of long-term survival of HCC liver transplant recipients after liver transplantion. We built the ATMD (AFP, T-Bil, MVI, Diameter) model using these factors: h (t, x)=h0 (t) exp (0.284×Diameter [cm]+0.773×MVI [yes=1; no=0]+0.404×lg AFP [ng/mL]+0.003×T-Bil [μmol/L]). The cut-off value of ATMD model was 1.44. The scores being more than 1.44 were defined as the high-risk group, and scores being 1.44 or less were defined as the low-risk group. The cases in the high-risk and low-risk groups who met the Up7 criteria, Shanghai Fudan criteria, UCSF criteria and Italy Milan criteria had 87 and 164, 33 and 144, 29 and 134, and 29 and 131, respectively. Kaplan-Meier survival analysis showed that the cumulative survival rates of the liver transplantation recipients with Up7 criteria, Shanghai Fudan criteria, UCSF criteria or Milan criteria were significantly different between the high-and low-risk groups (P<0.001, P=0.008, P<0.001, P=0.001). The areas under the ROC curve of the three-year survival of the liver transplantation recipients predicted by ATMD model were 76.63%, 75.87%, 73.32% and 69.41%, respectively. Conclusion The ATMD model has a good survival prediction ability for the HCC patients meeting Up7 criteria, Shanghai Fudan criteria, UCSF criteria or Milan criteria. It is of great significance for preoperative decision-making and postoperative risk assessment of HCC liver transplantation recipients meeting the above criteria.

Objective To develop an integrated standard operation procedure (SOP) for in-hospital emergency care of severe acute pancreatitis (SAP), and to explore the clinical application value. Methods We designed an integrated SOP for in-hospital emergency care of SAP by consulting some experts from emergency intensive care unit (ICU) quality control centers in Shanghai, referencing relevant literature and SAP guidelines at home and abroad, and considering the clinical practice and the experience gained in the integration of “emergency-ICU” contraction at Changzheng Hospital of Navy Medical University (Second Military Medical University). Forty-two SAP patients meeting the SOP criteria, who were admitted to Department of Emergency of Changzheng Hospital of Navy Medical University (Second Military Medical University) between Jul. 2015 and Jan. 2017, were included and set as optimization group. Forty SAP patients, who were admitted to the Department of Emergency between Jan. 2014 and Jun. 2015, were set as routine group. Clinical data of the patients were compared between the two groups, including treatment efficiency, white blood cell count, neutrophil ratio, C-reactive protein level, procalcitonin level, blood amylase level, blood glucose level, blood lactic acid level, serum creatinine level, oxygenation index, modified CT severity index (MCTSI) score, intra-abdominal pressure, urinary neutrophil gelatinase-associated lipocalin (NGAL) level and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on 72 h and 1 week after admission, complications and survival. Results The proposed SOP mainly referred to the international standard for diagnosis and treatment of SAP in 2012. The updates were mainly in the emergency first visit and comprehensive treatment scheme. In the former, the emergency surgery doctor was changed to emergency green channel (resuscitation room). In the latter, several clinical protocols were added, such as intrarenous injection of a large dose of ulinastatin, rapid infusion of human albumin (intravenous injection of furosemidum when necessary), standardized full-thatch mirabilite external application and coloclysis of sterile solution of rheum officinale. Compared with the routine group, the total rate of treatment efficiency was significantly better, and hospital stay, exhaust recovery time, bloating relief time, ICU duration time, and continuous renal replacement therapy time were significantly shorter in the optimization group (all P0.05). There were significant differences in the white blood cell count, neutrophil ratio, oxygenation index, MCTSI score and intra-abdominal pressure and the levels of C-reactive protein, procalcitonin, blood glucose, lactic acid, serum creatinine, urinary NGAL on 72 h and 1 week after admission between the two groups (all P0.05). The levels of blood amylase were significantly different between the two groups on 72 h after admission (P0.01). The incidences of acute renal failure, acute respiratory distress syndrome, ascites, abdominal compartment syndrome, pancreatic pseudocyst and pancreatic abscess were significantly lower in the optimization group than those in the routine group (all P0.05). Compared with the routine group, the survival time was significantly longer and the survival rate within two months was significantly higher in optimization group (P0.05). Conclusion The proposed in-hospital integrated emergency SOP can standardize the diagnosis and treatment process of SAP, improve the efficiency of treatment, and reduce mortality of patients.

Objective To study the effect of miR-141 on the proliferation of head and neck squamous cell carcinoma (HNSCC) cells. Methods The expressions of miR-141 in 19 HNSCC tissues and the matched adjacent normal tissues were analyzed by qRT-PCR. The miR-141 in Hep-2 or SCC-9 cells was overexpressed or down-regulated by miR-141 mimics or miR- 141 ASO transfection. Then the effects of overexpression or down-regulation of miR-141 on cellular proliferation were analyzed by MTT experiment. The targeted genes of miR-141 were predicted by bioinformatics algorithms. Results The expression of miR-141 in HNSCC tissues was found significantly lower than that in matched normal tissue (P<0. 05). Overexpression of miR141 significantly inhibited the proliferation of Hep-2 and SCC-9 cells, and down-regulation of miR-141 significantly promoted the proliferation of Hep-2 and SCC-9 cells (P<0. 05). Bioinformatics algorithms showed that ZEB1 was likely to be a targeted gene of miR-141 in HNSCC. Conclusion miR-141 may inhibit HNSCC cell proliferation via ZEB1.