Intrahepatic cholangiocarcinoma (ICC) is a highly malignant liver tumor with strong invasion and poor prognosis. ICC originates from the bile duct and locates in the liver, so it is classified as either primary liver cancer or cholangiocarcinoma, which the classification is indeterminate and the pathological typing is still debatable. The mechanism of ICC induced by many high-risk factors is still unclear. There are no characteristic manifestations in early symptom and no specific tumor markers, and the diagnosis of ICC mainly depends on imaging examination, which enhanced CT and MRI are the most important evaluation method. TNM staging of ICC is of great significance to guide the treatment, nevertheless, the division of T stage updated by AJCC 8th Edition is still controversial. Radical surgery is the only way to cure ICC currently, but there are still many controversies on definition of R0 resection and the scope of lymph node dissection. The application of local therapy and the rapid development of immunity and targeted therapy bring new hope for the transformation therapy of locally advanced patients, however, the efficacy needs to be verified by multi center large sample clinical studies. To grasp the current focus issues in diagnosis and treatment of ICC timely will be an important direction of basic and clinical research of ICC in the future.

Objective: To investigate the epidemiological characteristics of injury cases admitted to department of emergency in sentinel hospitals in Fuyang District, Hangzhou City from 2015 to 2020, so as to provide insights into injury prevention and intervention in rural areas. Methods: Data of injury cases were collected from the department of emergency of two sentinel hospitals in Fuyang District from 2015 to 2020, and the incidence of injury was standardized by the data from the China's seventh national population census in Fuyang District. The demographics, causes, severity and outcomes of injury were descriptively analyzed. Results: Totally 84 360 injury cases were recorded in the department of emergency of two sentinel hospitals in Fuyang District from 2015 to 2020, and the annual average standardized incidence of injury was 15.85%. The injury cases included 48 330 men (57.29%) and 36 030 women (42.71%), and there were 10 653 cases at ages of <19 years (12.63%), 25 398 cases at ages of 19 to <46 years (30.11%), 39 951 cases at ages of 46 to <71 years (47.36%), and 8 359 cases at ages of 71 years and older (9.91%). Taking a private car (motor vehicles and non-motor vehicles) was the predominant way to seek medical care (75 246 cases, 89.20%). Blunt force injury and puncture wound/incision wound (23 668 cases, 28.06%), and fall injury (22 855 cases, 27.09%) were predominant causes of injury, and there were 45 961 cases with mild injury (54.48%), 28 043 cases with moderate injury (33.24%), and 356 cases with severe injury (0.42%). Returning home after hospital treatments was the predominant outcome of injury (74 401 cases, 88.19%). Mild injury was predominant among patients at ages of <19 years (81.48%), with a high rate of transfer to other hospitals (2.43%), and moderate to severe injury was predominant among patients at ages of 71 years and older (43.08% and 0.77%), with a high rate of hospital stay (18.71%) and a high mortality rate (0.14%). Conclusions Mild injury was predominant among patients admitted to the department of emergency of two sentinel hospitals in Fuyang District from 2015 to 2020, and blunt force injury, puncture wound/incision wound and fall injury were predominant causes of injury. There were age-specific epidemiological characteristics of injury cases.

Objective To study the effect of chronic iodine supplement on thyroid of iodine-deficient rats.Methods Iodine-deficient rat models were made by giving 4- week-old rats iodine-deficient fodder for 3 months.These iodine-deficient rats were then supplemented for 8 months 1-,3- and 6- fold iodine which corresponded to the 3 levels of iodine intake found in our epidemiological study in 3 rural communities.Then changes of thyroid after iodine supplement were observed.Results After supplement of 1-,3- and 6- fold iodine to iodine-deficient rats for 8 months,thyroid relative weight did not recover,and iodine accumulated in thyroid.The ultrastructure injuries of swelling mitochondria and dilating endoplasmic reticulum in epithelial cells of iodine-deficient thyroid did not recover,but became worse with iodine supplement increase.Conclusion Iodine supplement alone can not correct the injuries resulting from iodine deficiency;moreover,a sub-pathological state might occur.

Fusion Proteins, bcr-abl ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Male ; Middle Aged

Objective To compare bispectral index (BIS) with narcotrend index (NI) during propofol-remifentanil anesthesia administered by target-controlled infusion (TCI).Methods Ten ASA Ⅰ or Ⅱ pafients aged 18-56 yr weighing 52-67kg undergoing abdominal surgery lasting>1h were included in this study.BIS and NI were monitored simultaneously.Anesthesia was induced with TCI of propofol with target plasma concentration (Cp) of 3～4μg/ml and remifentanil (Cp 3-4ng/ml).Tracheal intubation was facilitated with cis-atracurium 0.3 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained between 30-35 mm Hg.Anesthesia was maintained with TCI of propofol and remifentanil by the anesthesiologist bhnded to BIS and NI values.according to hemedynamic parameters.BIS and narcotrend values were recorded every minute and compared by another anesthesiologist.All data were compared by Bland-Altman analysis and with Kappa coefficient for agreement.The correlation between BIS and NI was tested by Spearman correlation analysis.The number of error ofjudgement (Type Ⅰ was defined as BIS<40 and NI>62;Type Ⅱ was defined as BIS>60 and NI<20)Was counted.Results The correlation and agreement between BIS and NI during maintenance of propofol-remifentanil anesthesia administered by TCI showed good consistency.Conclusion Both NI and BIS Can help anesthesiologist control the depth of anesthesia during TCI of propofol-remifentanil.

Objective To explore clinic manifestations and laboratory investgation of virus encephalopathy.Methods The clinical course,cerebrospinal fluid(CSF),hepatic dysfunction,computerized tomography of 7 cases treated in our hospital from October 1999 to March 2005 were retrospectively reviewed.Results Seven cases of virus encephalopathy were typically associated with a suddent onset of high fever,severe convulsion,rapidly progressive coma,marked elevations of alanine aminotransferase(AST) and aspartate transaminase(ALT).Four cases died,3 cases had severe sequelae.Blood ammonemia was normal,brain CT scans revealed peripheral or basal nuclei low-density areas.Conclusion Children with a sudden onset of high fever,severe convulsions,rapidly progressive coma may have a poor prognosis.

Objective To investigate the clinical value of classic intrafascial supracervical hysterectomy(CISH) by including the clipping of the uterine artery.Methods A total of 60 cases of benign uterine diseases were included in the study.After the uterine artery had been dissected and clipped on both sides under laparoscope,classic intrafascial supracervical hysterectomy was performed.Results All the operations were performed successfully under laparoscope.No conversions to open surgery were needed.Operating complications happened in no case.The operating time was 72~186 min(91.4?26.3 min),the amount of blood loss was 50~150 ml(76.5?20.6 ml),the time to postoperative gastrointestinal function recovery was 18~30 h(22.7?5.8 h),and the volume of pelvic drainage within 24 hours,50~160 ml(80.5?31.8) ml.Postoperative body temperature was elevated to 38.5 ℃ in 2 cases,the postoperative pyrexia rate being 3.3%.The length of postoperative hospital stay was 4~7 d.Follow-up for 6~18 months(10.6?4.2 months) in the 60 cases showed 3 cases of small amount of vaginal bleeding at 1~3 months,which were cured with the use of antibiotics and hemostatics for 5~7 d.Conclusions Classic intrafascial supracervical hysterectomy by including the clipping of the uterine artery is a safe and effective improvement to CISH technique.

Objective To investigate the clinical efficacy of total laparoscopic hysterectomy(TLH) with separating and blocking uterine arteries.Methods From January 2004 to June 2006,68 cases of uterine benign diseases underwent TLH by blocking uterine arteries after separating and clipping uterine arteries with Titanic clip.Results All operations were performed successfully without conversion to open surgery and complications.1 patient,who had twice gastrohysterectomy histories,underwent bipolar coagulating uterine arteries as to the failure of separating bilateral uterine arteries.Pelvic adhesion release was performed in 18 cases,unilateral or bilateral adnexectomy in 14 cases,oophorocystectomy in 8 cases,appendectomy in 1 case,and cholecystectomy in 1 case simultaneously.The operation time was 90-185 min,(112.6?27.5)min.The time of separating uterine artery in one side was 3-15 min,(5.2?3.4)min.The intraoperative blood loss was 50-150 ml,(86.5?39.6)ml.The time to first bowel movement was 18-48 h,(27.3?4.8)h.The rate of postoperative pyrexia was 4.4%(3/68),and the hospital stay was 4-7 d,(5.1?1.8) d.A follow-up period of 2-6 months,(3.5?1.6) months,showed 3 cases of vaginal dropping hemorrhage 1-2 months after operation,which was cured with the use of antibiotics and hemostatics for 5-7 d.Conclusions TLH with separating and blocking uterine arteries is a safe,effective and feasible procedure with less complication,so it is worthy of being recommended.

Objective: To explore the effect of bortezomib on migration and invasion of cervical carcinoma HeLa cell and specific molecular mechanism. Methods:The effect of bortezomib on the viability of HeLa cell was measured by MTT assay. The effect of bortezomib on cell migration and invasion was measured by Transwell assay and invasion experiment respectively. The activation of Akt/mTOR signaling pathway and expression level of MMP2, MMP9 were assayed by western blot. Results:MTT assay indicated bortezomib (2.5μM, 5μM, 10μM) could inhibit HeLa cell viability, and the inhibitory rate was highest at 48 h. Transwell assay and invasion experiment results showed that bortezomib inhibited HeLa cell migration and invasion. Western blotting assays presented bortezomib could suppress the phosphorylation of Akt and mTOR, and down-regulate the expression of MMP2 and MMP9. Conclusions:These results suggested bortezomib could inhibit migration and invasion in cervical carcinoma HeLa cell, which might be related to Akt/mTOR signal pathway.

Objective Getting the robust exogenous gene expression vector under the control of porcine insulin promoter, and to lay the foundation for pancreaticβ-cells specific transgene expressing pigs.Method Using porcine insu-lin promoter ( PIP, 1500 bp of the 5′UTR from the porcine INS gene including the first exon and the first intron) to con-struct expression vector, the HindIII restriction site which connected the sequences of PIP and EGFP was designed before ATG, named PIP-HindIII-EGFP.Considering that the different location of restriction site may affect the expression efficien-cy of the transgene, we optimized the expression vector.Firstly the HindIII restriction site was deleted to realize the seam-less connection of PIP and EGFP,the vector was named PIP-EGFP.Also we mutated the 3′intron splicing acceptor site( SA) of the first intron into HindIII restriction site, named as PIP-SA( M)-EGFP.Three different EGFP expression vectors were respectively transfected MIN-6 mouse pancreatic β-cells, pig ear fibroblasts and kidney cells.The transfected cells were cultured for 48 h and harvested for RT-PCR, flow cytometry and Western blot analysis, to analyze and compare the expres-sion efficiency of vectors.Results After transfection,green fluorescence was observed only in MIN-6 mouse pancreaticβ-cells.RT-PCR analysis and product sequencing showed that the three expression vectors did have different stability with in-tron splicing.The PIP-HindIII-EGFP construct and PIP-EGFP vector produced two kinds of mRNA with the first intron spliced and no spliced, indicating the instability of intron splicing.Mutation of the PIP splice site would cause the first in-tron not spliced, while flow cytometry and Western blot displayed that the mutation induced a most efficient expression of the downstream gene.Conclusions A robust and specific β-cells expression vector has been successfully generated by mutating the intron splicing acceptor site of the porcine insulin promoter.It provides the foundation for preparation of pigs with pancreaticβ-cells specifically expressing the transgene.