Objective To compare the value among three hilar cholangiocarcinoma (HCC) staging systems,Bismuth-Corlette classification,TNM staging system and MSKCC classification,in predicting the resection rate and prognosis of HCC patients.Methods The clinical and histopathological data of 154 HCC cases were analyzed retrospectively.Three different staging methods were performed respectively to analyze the correlations with respectability and survival.Chi-square test and Kaplan-Meier analysis were applied to find clinical and histopathological factors related to prognosis.Results There was no significant difference in resectability between Bismuth-Corlette classification or TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ.The resection rates of MSKCC T1,T2 and T3 were 68.6％,44.8％,19.2％respectively (x2 =20.03,P =0.000).With higher T stage,resection rate obviously declined.The survival predicted by TNM staging and MSKCC classification was better than Bismuth-Corlette classification.Tumor differentiation,LN involvement,distant metastasis,margin status,TNM stage and MSKCC classification were significantly correlated with survival.Conclusions The MSKCC classification predicted resectability better than Bismuth-Corlette classification and TNM staging system,while both MSKCC classification and TNM staging system predicted survival better than Bismuth-Corlette classification.Clinical and histopathological factors such as tumor differentiation,LN involvement,metastasis,margin status,TNM staging,MSKCC classification were correlated with survival.

Objective To investigate the mechanism of interlekin-6 (IL-6) in wound healing of human biliary epithelial cells ( BECs ).Methods BECs were cultured in IL-6 at different concentrations:0 ng/L(0 ng/L group),10 ng/L (10 ng/L group),50 ng/L (50 ng/L group),100 ng/L (100 ng/L group),1000 ng/L ( 1000 ng/L group).The effects of IL-6 on the phosphorylation of signal transducer and activator of transcription 3( STAT3 ) and the expression of trefoil family factors 3 (TFF3) were detected.BECs were divided into untreated group,STAT3-RNAi group (BECs transfected with STAT3 RNAi adenovirus) and Control-RNAi group (BECs transfected with vacant RNAi adenovirus).The effects of IL-6 on the expression of TFF3 were detected after RNAi of STAT3.In vitro wound models were constructed for the untreated group,STAT3-RNAi group and Control-RNAi group,and the effects of IL-6 and TFF3 on BECs of the 3 groups were detected.All data were analyzed by using the Student's t test,analysis of variance or Sidak test.Results The expressions of phosphorylated STAT3 in the 50 ng/L group,100 ng/L group and 1000 ng/L group were 0.240 ± 0.052,0.714 ± 0.124,0.327 ± 0.069,respectively,which were significantly higher than 0.033 ± 0.011 of the 0 ng/L group (q =5.246,17.260,7.451,P ＜ 0.05 ).The contents of mRNA and protein of TFF3 increased as the increase of IL-6 concentration (q =12.045,9.889,P ＜ 0.05).After RNAi of STAT3 of the BECs,the expression of TFF3 decreased when the concentration of IL-6 was 1000 ng/L.The expression of TFF3 of the STAT3-RNAi group was 0.037 ± 0.005,which was significantly lower than 0.267 ± 0.038 of the Control-RNAi group and 0.301 ± 0.042 in the untreated group ( q =12.135,13.929,P ＜ 0.05 ).In the in vitro wound model,the speed of BECs migration in the STAT3-RNAi group was (9.1 ± 1.5 ) μm/h,which was slower than (25.1 ± 3.8 ) μm/h of the Control-RNAi group after 12 hours of interference with IL-6 (q =7.737,P ＜ 0.05 ).The speed of BECs migration of STAT3-RNAi group was (39.2 ± 4.7) μm/h after adding 1 g/L of recombinant TFF,which was significantly faster than that of the Control-RNAi group (q =14.507,P ＜0.05).Conclusion IL-6 promotes cell migration and wound healing by activating STAT3 and up-regulating TFF3 expression.

Objective To retrospectively analyze pulmonary function changes after growing rod surgery for progressive early-onset scoliosis.Methods Ten cases of progressive early-onset scoliosis treated with growing rod technique from September 2002 to July 2011 were enrolled in the study.There were 3males and 7 females,aged from 6 to 9 years (average,7.0±1.1 years).Four patients had finished the final fusion surgery (Group fusion),and 6 patients (Group non-fusion) were in the process of periodic lengthening.Forced vital capacity (FVC),FVC/predicted FVC ratio,forced expiratory volume in one second (FEV1),FEV1/predicted FEV1 ratio,Cobb’s angle,and C7-S1 distance before each surgery were recorded.Lung function changes and correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance) were analyzed.Results In Group fusion,both FVC and FEV1 increased,and FVC showed a significant difference.In Group non-fusion,FVC and FEV1 also increased and both showed a significant difference.FVC/predicted FVC ratio and FEV1/predicted FEV1 ratio both changed similarly and did not show statistical differences in the two groups.There were no significant correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance).Conclusion Pulmonary function improves after growing rod surgery for progressive early-onset scoliosis.The pulmonary function changes do not correlate with changes of Cobb’s angle and C7-S1 distance.

Objective To evaluate the efficacy and safety of thromboprophylaxis with low molecular weight heparin after lumbar decompressive surgery.Methods Between January 2004 and April 2011,patients who had undergone lumbar decompressive surgery and had high or very high risk of venous thrombosis were selected.All patients received subcutaneous injection of low molecular weight heparin (Fraxiparine),starting at 6 hours after surgery with a half dose and subsequently once every 24 hours with full dose until discharge.When 24-hour drainage volume was less than 50 ml,the drainage tube was removed 2 hours prior to low molecular weight heparin administration.The occurrences of deep venous thrombosis (DVT),pulmonary embolism (PE),bleeding complications and side effects were recorded.Results Seventy eight patients were enrolled in the study.The average time of drug use was 8.5 days.No symptomatic DVT,PE and major bleeding events occurred.Drainage tube was placed in all patients except 3 patients with lumbar disc herniation.The mean total drainage volume was (319.5±218.5) ml,and the average time from operation to removal of drainage tube was (43.2±14.4) hours.Incision site ecchymosis occurred in 1 patient,incision bleeding in 1 patient,mild elevation in hepatic aminotransferase levels in 4 patients,and mild anaphylaxis in 1 patient.Conclusion It is effective and safe to prevent VTE with low molecular weight heparin for patients with high or very high risk of venous thrombosis after lumbar decompressive surgery.

Objective To investigate the distribution of high pathogenicity island(HPI)in multiple-drug-resistance gram-negative bacilli and analyze the protein sequence.Methods To amplify thefyuA-irp2 gene cluster of the 84 isolates by multiple polymerase chain reaction(PCR),the product was subsequently sequenced.Results The positive rate ofirpl,irp2,irp3,irp4 and fyuA was 40.48％,41,67％,5.95％,O％and 16.67％,respectively.Theamino sequence offyuA comefromEC06748,Kp7151 and PAE7 was usedto compare with AL590842,there are 100％identities.Amino sequence ofirp2 come from Kp49 and Kp51 have 99％identities with AAA27636.1,but amino sequence of irp2 come from EC04 and EC07 only have 90％identities with 1176840.The GenBank accession number is FJ211852 and FJ211851.Amino sequence ofirpl come fromKp 10,Kp49 and Kp51 have 99％identities with AL590842。and amino sequence ofirp3 come from EC03,Kp51,Kp10 and Kp49 have 97％identities with CAA73128.There are the same mutation among the same species,and different mutation among different species.Conclusion There was different extant mutant lost in thefy～t-i,v2 gene cluster in multiple-drug-resistanee gram-negative bacilli.

Objective To retrospectively analyze the application of single and dual growing rod techniques in treatment of early onset scoliosis,and compare the early results of two techniques.Methods Retrospective study was done on 18 cases of early onset scoliosis treated with growing rod technique from November 2002 to March 2009.Single growing rod group included 5 cases and dual growing rod group included 13 cases.We compared the operation time,intra-operative bleeding,correction rate,changes in distance between C7-S1 and incidence of complications of the first operation between two techniques.Results The average post-operative follow-up duration was 39.9 months (14-89).There was no difference in operation time,intra-operative bleeding and incidence of complications between two techniques.There was no difference in preoperative coronal Cobb angle and preoperative sagittal Cobb angle between single growing rod group and dual growing rod group.Correction rate of dual growing rod group was significantly superior to single growing rod group in coronal plane (P＜0.01),but not in sagittal plane.Increase of the distance between C7-S1 dual growing rod group was significantly larger than the single growing rod group (P＜0.05).Conclusion Growing rod technique is an effective option for early onset scoliosis.Dual growing rod technique is relatively superior to single growing rod technique in correction outcomes.

Objective To study the optimal timing of preoperative injection of indocyanine green in laparoscopic liver tumor resection under indocyanine green fluorescent navigation to obtain the most satisfactory fluorescence imaging effects.Methods 60 patients with liver tumors who underwent laparoscopic hepatectomy from April 2017 to October 2018 were retrospectively studied on the intraoperative fluorescence imaging effects.A simple grading of the fluorescence imaging effects was developed.The ICG R15 and preoperative injection times of ICG were correlated with the intraoperative fluorescence imaging effects.Results Of 60 patients with liver tumors,59 patients underwent laparoscopic liver resection and one patient was converted to open surgery.The overall satisfaction rate of intraoperative fluorescence imaging was 73.4％ (44/60).In the patients with an ICG R15 rate ≤ 7％,it was easier to obtain good fluorescence imagings when the preoperative administration time was longer than 48 hours.Even when the preoperative administration time was longer than 5 days,satisfactory fluorescence imaging effect could still be obtained in these patients.In the patients with an ICG R15 rate ＞ 7％,intraoperative fluorescence imagings were unsatisfactory when the administration time was less than 6 days.Relative better imagings were obtained in these patients when the preoperative administration time was more than 6 days.Conclusions When the pre-operative ICG injection dose was not changed,the preoperative administration time should be adjusted according to the value of the ICG R15 to obtain better intraoperative fluorescence imaging effects of the liver tumors.The optimal timing needs to be further studied by a large case study.