Objective To explore the genetic impact of three newly discovered single nueleotide polymorphism (SNP) sites of the transforming growth factor (TGF)-β1 gene on the susceptibility of the chronic hepatitis B virus (HBV) infection. Methods Genome DNA was extracted from the peripheral blood samples of 115 cases suffering from the chronic HBV infection (74 chronic hepatitis B, 41 cirrhosis) as well as 41 healthy volunteers. Thereafter, genotyping of rs2241715, rs2241716 and rs4803455 sites of the TGF-β1 gene was performed by genotype-specific polymerase chain reaction (PCR) analysis. The data were analyzed by the ehi square test and Fisher exact test. Results There was a significant difference of rs2241715 genotypes and allele frequencies between healthy volunteers and patients with chronic hepatitis B and cirrhosis (χ2 = 11.419, P＜0.01 and χ2 = 6.218, χ2 = 5.961,P＜0.05,respectively). Interestingly, the risk relative of subjects with T/T genotype suffered from chronic hepatitis B (OR = 2. 974, 95% CI = 1.209 - 7. 314, P = 0.018) and cirrhosis (OR = 3.228, 95%CI=1.201-8.675, P=0.020) was dramatically higher than that in patients with T/G or G/G genotypes. Conclusion The TGF-β1 rs2241715 T/T genotype appears to be associated with the chronic HBV infection.

ObjectiveTo observe the efficacy of maintenance hormonal treatment after response to chemotherapy in advanced breast cancer. Methods8 patients with advanced breast cancer were treated with chemotherapy,maintenance hormonal therapy were given after response to chemotherapy.The efficacy was evaluated every 2 cycles of chemotherapy and 2 months of endocrine therapy according to RECIST standard.Results8 patients received chemotherapy for 2-8 cycles (median 4 cycles). All patients got PR, the duration of chemotherapy was 1-6 months (median 2 months), the time to failure of chemotherapy was 4 months. Until the last follow-up day (31th December 2010), the time to progression was 6-86 months (median 13.5 months).Survival was 6-86 months(median 21.5 months).Seven patients quit the chemotherapy due to severe side effects of hematologic toxicity,fatigue or nausea vomiting.One patient died because of allergy to paclitaxol.Conclusion Maintenance hormonal treatment after patients with metastatic breast cancer response to chemotherapy may prolong the duration of effective therapy and improve the QOL.

We summarized the epidemiological investigation results of the first case of human infection with avian influenza A(H9N2) virus in Chengdu,China,in order to provide references for dealing with similar diseases scientifically in the future.The methods of field epidemiology and laboratory testing were used to collect the H9N2 case's clinical and epidemiological data,as well as collect and test the samples of the H9N2 case and the relevant environment,so that the possible sources of infection,the epidemiological characteristics and clinical features could be analyzed.Results showed that the H9N2 case contacted with poultry within 10 days before the onset of illness and the H9N2 virus nucleic acid was detected in the patient's specimen by PCR.This case suffered from several chronic diseases for a long time,although active treatments were taken this time,she died soon after onset.Her living environment,the chicken leftovers from cooking,and surrounding poultry markets were polluted by H9 avian influenza virus.Through the investigation,we could deduce that the infection source of this case was the chicken infecting H9N2 viruses from surrounding poultry markets.This would be the first fatality associated with influenza A (H9N2) virus infections in humans.And though avian influenza A(H9N2) virus was low pathogenic,infection could cause severe symptoms or death in people with severe underlying diseases.

Objective:This study aims to evaluate the clinical effect and adverse reactions of oxaliplatin or irinotecan plus capecitabine treatment for colorectal liver metastases. Methods:Data from 125 cases of colorectal liver metastasis patients were continuously enrolled and randomized into two groups, i.e., 63 in group one (treatment group) and the other 62 in group two (the control group). Capecitabine was administered at 1 000 mg/m2 doses, twice a day from d1 to d14, to all patients. Irinotecan was administered at 150 mg/m2 in d1 to group one, and oxaliplatin was administered at 130 mg/m2 in d1 to group two. The drug administration cycle lasted for 21 days in both regimens, with at least 6 administration cycles. The total course was for 6 months at most. The therapeutic efficacy, median progression-free survival time, median survival time, short-term clinical effect, and adverse drug reaction were monthly determined. Results:The overall response rates and disease control rates were 33.3%and 66.7%in group one, respectively, and 35.5%and 70.9%in group two, respectively, with no significant differences between the groups (P>0.05). The median survival time and median progression-free survival time were 14 months and 5 months in group one, respectively, and 12 months and 5 months in group two, with no significant differences between the two groups (P>0.05). The level-Ⅲand-Ⅳadverse drug reactions mainly include hematological toxicity, gastrointestinal reactions, and hand-foot syndrome. The diarrhea frequency is obviously higher in group one than in group two, and the difference between the two groups is sta-tistically significant (P<0.05). No significant differences were observed in the other adverse reactions between the groups (P>0.05). Conclusion:The Oxaliplatin or Irinotecan plus Capecitabine treatment is effective for colorectal liver metastases, which enhances survival rate and reduces patient suffering because of it has less side effects and good tolerance. The treatment must be further generalized and clinically applied.

Objective To explore the value of Artis zeego robot imaging system endoscopic retrograde cholangiopancreatography (ERCP) for biliary calculi. Methods ERCP was performed on 12 patients with biliary tract dilation, diagnosed by B ultrasonography. Artis zeego robot was used simultaneously to acquire 3D images and biliary system reconstruction. The diagnostic consistency was assessed based on endoscopy and surgery if necessary. Results 3D rotating acquisition and biliary reconstruction were performed in the 12 patients. All diagnosis coincided with those of surgery and ERCP findings, achieving a consistency rate of 100%. Patients with extrahepatic bile duct stones of uncertain number (n = 2), with suspected biliary duct calculi ( n = 1 ) and with suspected intrahepatic bile duct stones ( n = 2) under ERCP were all diagnosed by the robot imaging system. Conclusion During ERCP, 3D rotating image acquisition and biliary reconstruction with Artis zeego robot is helpful for precise diagnosis of biliary tract stones.

Objective To compare and evaluate the clinical efficacy and side effect of vinorelbine plus gemcitabine and vinorelbine plus cisplatin combinations in advanced non-small-cell lung cancer(NSCLC). Methods 56 cases with non-treated advanced NSCLC were unrandomly divided into two groups: the GN group (27patients) treated with vinorelbine plus gemcitabine, the NP group (29 patients) treated with vinorelbine plus cisplatin,1/3 weeks×2～6 cycles. Results For the GN group, the overall response rate was 37.7 %, MTTP was 5.1months,one year survival rate (1-ySR) was 40.7 %. There were no significant difference in the response rates and the survival rates for the GN group compared with the NP group (P ＞0.05); But on the side effect of toxicities, WHO grade anemia and nausea/vomiting and tiredness of the GN group was significantly milder than the NP group (P ＜ 0.05). Conclusion Vinorelbine combined Gemcitabine regimen (GN) is active and well-tolerated. It is worth to investigate GN recommended as the first line chemotherapeutic regimen for the treatment of patients with advanced NSCLC.

OBJECTIVEThis study was to establish an animal model to imitate facial nerves injury by explosion.

METHODSThe impact was simulated by detonator blast in the distance of 5 cm, 10 cm and 15 cm over the face of dogs under anesthesia and the edge injury of masseters were made by rifle-shot steel ball to imitate segment injury in real explosion. The dogs were killed after different time of injury and the heart, lung, brain and facial nerve were taken to observe the pathological changes in order to evaluating the wound effect in different distances.

RESULTSThe animal was injured severely in the distance of 5 cm and could not survive for a long time because of severe damage to brain, heart and lung. The dogs injured at 10 cm could survive after emergency treatment, and there was diffusing hemorrhage in edematous nerve trunk. In the distance of 15 cm, the dogs were injured slightly and, as the distance to the explosive source increased, the local wound became slighter. Under light microscope, the breakage and necrosis of facial nerve fibers could be widely observed, degenerative and necrotic neurons with infiltrating inflammatory cells could be found in the facial nerve nuclei as well.

CONCLUSIONThe dog's traumatic model established by impact wave and segment in this experiment is an appropriate animal model for the research of explosive effect on facial nerves because of its controllable and repeatable injuring conditions.

Animals ; Blast Injuries ; complications ; pathology ; Disease Models, Animal ; Dogs ; Facial Nerve Injuries ; etiology ; pathology ; Female ; Male

Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.

Objective:To discuss the effect of pharmacist intervention on the use of antimicrobial agents in the clinical pathway of community-acquired pneumonia ( CAP) in our hospital to standardize the rational medication and promote the rational use of antimicro-bial agents. Methods:Totally 100 bacterial CAP patients in 2013 ( before the intervention) and 2014 ( after the intervention) in the pneumology department were studied. The antibacterial drug cost, total hospitalization cost, use intensity of antimicrobial drugs, hospi-talization time, therapeutic effects and so on in the two groups were observed during the treatment. Results: There were significant differences between the two groups in antibacterial drug cost, total hospitalization cost, use intensity of antimicrobial drugs, hospitaliza-tion time and so on, whereas there was no significant difference in the curative effect. Conclusion:After the pharmacist intervention, the application of antibiotics is more rational, the antibiotics use density and per capita cost are reduced, the hospitalization day is shortened and the value of pharmacists is also improved.

Objective:To investigate the application value of domestic robotic surgical system in radical resection of hilar cholangiocarcinoma (hCCA).Methods:The retrospective and descriptive study was constructed. The clinicopathological data of a 66-year-old male patient with hCCA who was admitted to the Second Hospital of Shandong University in November 2022 were collected. Radical resection of hCCA was performed using the Toumai? laparoscopic surgical robot system. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Count data were represented as absolute numbers and (or) percentages.Results:(1) Intraoperative conditions. The patient underwent radical resection of hCCA successfully using robotic surgical system, including tumor resection, lymph node dissection, and gastrointestinal reconstruc-tion. The operation time and volume of intraoperative blood loss were 400 minutes and 100 mL, respectively, and no intraoperative blood transfusion was required. (2) Postoperative conditions. The patient began ambulation on postoperative day 1 and began taking liquid food on postoperative day 4. Liver function examination and abdominal computed tomograph (CT) on postoperative day 5 showed a decrease in serum bilirubin, no biliary or intestinal leakage, and no edema or necrosis at the anastomotic site. The abdominal pre-anastomotic and post-anastomotic drainage tubes were removed on the 7th and 9th day after the surgery respectively, and the patient was discharged on the 10th day after surgery. Results of postoperative pathological examination showed moderately to poorly differentiated adenocarcinoma of the bile duct. Immunostaining was positive for CK7 and CK19. The Ki-67 proliferation index was 35%. The proximal and distal resection margin of bile duct were negative. The tumor diameter was 30 mm. Perineural invasion was positive. The surgical specimen margin was negative. Two lymph nodes were identified containing tumor cells positive for malignancy. No tumor cell metastasis was detected in the No.8, No.12 or gastric lesser curvature lymph nodes submitted for pathological examination. (3) Follow-up. The patient was followed up at postoperative 1-, 3-, 5-month after discharge. During follow-up period, results of liver function examination and abdominal CT showed liver function restore to normal levels, no complication such as biliary fistula, intestinal fistula, gastroparesis or tumor metastasis.Conclusion:The Domestic Toumai ? laparoscopic surgical robot system can be applied to radical resection of hCCA.