Gene mutation is the molecular basis of the pathogenesis of primary liver cancer, and precise treatment based on gene mutation is an important direction for the treatment of liver cancer in future.This article introduces the current status, complexity, and prospects and future directions of precise treatment for liver cancer from the aspects of complex gene mutations in liver cancer, level of mutation detection, and limitations of clinical trials.It is pointed out that there are many challenges in precise treatment for liver cancer, but precise treatment still has a promising future.

Objective To investigate the clinical and pathological features of primary hepaticepithelioid hemangio endothelioma (EHE) and try to improve the understanding and diagnosis of this disease.Methods From January 2007 to January 2013,the data of 17 patients with hepatic EHE were retrospectively analyzed,which included clinical,pathological and radiological characteristics,treatment and survival condition of these patients.Results Among 17 cases of hepatic EHE,there were 11 female and six male with the mean age of 46.2 years.Seven patients had right upper quadrant pain of dull pain in liver and the left 10 cases were without any symptoms.The liver function of most patients (15 cases) was normal.The admission diagnosis was mostly misdiagnosed as hepatocellular carcinoma (metastatic liver carcinoma six cases,primary liver carcinoma four cases).Extrahepatic metastasis was found in three patients before operation.The major lesion of the tumor was multiple nodules (10 cases) and most of which were under liver capsule.Retraction of the liver capsule was found in the imaging examination.The features of pathology were intracellular lumen and vacuoles formed in small cells,in which single or couple red blood cells could be found.Nuclear deviation was found in single tumor cell which looked like signet ring cells.The results of immunohistochemistry indicated the positive rate of factor vimentin (4/5) antigen and CD34 (15/17) was high.Surgical resection (14 cases) was the main treatment of hepatic EHE.Fourteen patients were still alive followed up for two to 72 months after operation.Conclusions The incidence of hepatic EHE is low,and it was susceptible to middle aged women and without obvious symptom.No obvious abnormality is found in laboratory examination.Surgical resection is the main treatment which enabled a good prognosis.

Objective To construct an eukaryotic expression vector encoding an shRNA targeting CA916798. Methods According to the CA916798 cDNA sequence in GenBank, 2 pairs of oligo nucleotides were designed and synthesized. After primer annealing, they were inserted into plasmid pGenSil-l to construct the shRNA eukaryotic expression vector. The recombinant plasmid were transformed into DH5?, and the positive strain were identified by enzyme digestion and sequence analysis. The recombinant vector were transfected into A549/CDDP cells with Lipofectamine 2000. Drug sensitivity and proliferation of the transfected cells were measured by MTT test. Results The pRNAi-CA916798 shRNA of recombinant plasmid was constructed successfully. The growth of A549/CDDP cells transfected by pRNAi-CA916798 shRNA was slowly than that of those with blank vector transfection after 1.0 ?g/ml CDDP treatment (P

Objective To study the clinical value of detection of peripheral blood natural killer(NK) cells subsets in patients with malignant hematological diseases.Methods A total of 100 patients with malignant blood disease were enrolled from March 2014 to April 2016 as the observation group,including 50 cases in acute stage and 50 cases in mild stage.At the same time,100 health subjects were enrolled as the control group.The number of NK cells in peripheral blood and the changes of subgroups were compared.Results The number of NK cells in the different groups were compared,the absolute numbers and relative numbers of NK cells in the acute phase of leukemia and lymphoma were much lower than those in the control group(P<0.05).While the absolute number and relative number of NK cells in mild stage of leukemia and lymphoma were higher than that in acute phase(P<0.05).After treatment,the absolute number and relative number of NK cells in patients with leukemia and lymphoma were higher than before treatment(P<0.05).Before treatment,levels of CD56bright and CD56dim in patients with leukemia and lymphoma were statistically different with those of control group(P<0.05).After treatment,CD56bright and CD56dim levels were significantly improved in both groups(P<0.05).Conclusion The number of peripheral blood NK cells in patients with hematological malignancies could be reduced,and the cells function might be compromised.Detection of NK cell subsets could be with guiding significance in the treatment of malignant hematologic disease.

Objective　To study the preventive effect of hepatic metastasis from colorectal cancer and the immune function influence on postoperative patients with colorectal cancer treated by TIL, rIL-2 and cyclophosphamide by portal vein infusion. Methods　One hundred and twenty-four patients with advanced colorectal cancer (Dukes B and Dukes C stage) were randomly divided into immunotherapy group and control group. The control group were treated with 5-Fu and MMC by intravenous injection after resection of colorectal cancer. The immunotherapy group were treated with TIL, rIL-2 and cyclophosphamide by portal vein infusion after resection of the tumor, then with chemotherapy as the control group. All cases were followed-up for 3 years. Results　Eight cases (12.3%) had hepatic metastases from colorectal cancer in the immunotherapy group, but nineteen cases (33.2%) in the control group. There was significant difference between the two groups (P>0.05). The NK, IL-2 activity and CD3, CD4, CD4/CD8 levels in peripheral blood of the immunotherapy group increased significantly after treatment (P<0.05). Conclusions　The TIL, rIL-2 and cyclophosphamide treatment after resection of colorectal cancer is effective in improving antitumorgenic immune function, and preventing hepatic metastases.

Objective　To explore the relationship of pathological types of lung cancer with sex, age, site, and clinical diagnosis. Methods　The data of 1 310 patients with lung cancer diagnosed with fibrobronchoscopy, was retrospectively analyzed. Results　①The preliminary clinical diagnosed lung cancers which were comfirmed by fibrobronchoscopic biopsy later were mainly small cell lung cancer. ②The percentage of squamous carcinoma was significantly greater in male (78.0%) than in female (49.7%), but the percentage of adenocarcinoma was significantly higher in female (38.1%) than in male (13.1%)(P<0.0001). ③Among the patients with lung cancer, 53.7% was from 40 to 59 years old and 40.2% over 60. The average age of male patients (56.9 years old) was significantly greater than that of female (51.1 years old) (P<0.0001). ④ The average age of patients with squamous carcinoma and adenocarcinoma was greater in male than in female, but that with small cell carcinoma and squamous carcinoma was greater in female than in male. ⑤The percentage of male with lung cancer in the left lung (37.3%) was greater than that of female (26.0%), but the female had lung cancer in the right lung (59.7%) while male had (49.3%). The left and right upper lobe was more (45.4%) in male, but the right upper and lower lobe was more(43.3%) in female. Conclusion　①The fibrobronchoscopic examination is very important in the diagnosis of lung cancer. ②The pathological types and sites of lung cancer is different in different sex and age, which provide the exact bases for medical and surgical treatment for lung cancer.

ObjectiveTo establish a mouse model for genital tract infection with different serovars of Chlamydia trachomatis(Ct),and to provide a basis for understanding the relationship between Ct serovars and virulence.MethodsSix-week-old female BALB/c mice were divided into 4 groups:study group (pretreated with progesterone and inoculated with 4.0 × 107 inclusion-forming units(IFU) of Ct serovar E,F,J and K,respectively),progesterone-control group(pretreated with progesterone and inoculated with culture medium of McCoy cells),non progesterone-control group(inoculated with 4.0 × 107 IFU of Ct serovar F),blank control group receiving no treatment.At 4 and 7 days after the inoculation,the appearance of vulva was observed,vaginal swab specimens were obtained and subjected to cell culture,direct immunofluorescence assay and real-time fluorescence-based PCR for the detection of Ct.ResultsA slight inflammation of the genital tract was observed in the mice 4 days after the inoculation with Ct serovar E,F,J or K in the study group.Cell culture,direct immunofluorescence assay and real-time fluorescence-based PCR all confirmed that Ct was present in vaginal specimens from the study group,but absent from the control groups.The longest duration of infection was 21 days in 1 out of 11 mice inoculated with Ct serovar K,followed by 17 days in 1 out of 11 mice inoculated with Ct serovar J,14 days in 5 out of 11 mice with Ct serovar F and in 2 out of 11 mice with Ct serovar K.Conclusion The model for genital tract infection with different serovars of Ct can be established in mice at a right age bypretreatment with progesterone and inoculation with a certain amount of Ct.

Objective To study the application effect of clinical pathway teaching in respiratory medicine. Methods Seventy clinical medical students of our department during 2007 to 2009 were randomly divided into two groups. The control group (35 students) was treated by traditional teaching ways, while the experimental group(35 students) was treated by clinical pathway teaching ways, with 5 to 6 students forming a small group. Teachers provided one copy of the CP version to each person in advance. Then progressive questions and discussions were conducted according to the diagnosis, dif-ferential diagnosis and treatment of CP. After its implementation for a certain time, students were co-mprehensively assessed by the practice examination and questionnaire and the statistical analysis was performed by using SPSS 17.0 version statistics software. Results The experimental group's total aver-age score was (90.00±4.00) points, while the control group's total average score was (76.00±7.20) points. There was significant difference between the two groups(P=0.001). The effect of these two kinds of teaching was evaluated and compared in stimulating interest in learning (P=0.002), improving the analytical ability(P=0.004),improving self-study ability(P=0.001), deepening the under-standing of the basic concepts(P=0.112), improving the innovation ability (P=0.005), improving the efficiency of learning(P=0.034), improving clinical comprehensive ability(P=0.016), and improving the ability of language expression(P=0.000), showing that teaching method of clinical pathway could significantly improve clinical teaching effect, and there was statistically significant difference between them. Conclusion Clinical pathway teaching has obvious advantages in cultivating students' diagnostic thinking and clin-ical ability to solve practical problems, and therefore it has better clinical teaching effect than the tra-ditional teaching method.

Objective To explore the effects of adriamycin-loaded immuno-nanoparticles on multidrug resistance (MDR) of hepatoma cell line SMMC-7721/ADM. Methods The cytotoxicity of the adriamycin-loaded immuno-nanoparticles on the bepatoma cell line SMMC-7721/ADM in vitro and the tumor cell-binding ability of adriamycin-loaded immuno-nanoparticles were detected. Results The effect of the cytotoxicity of adriamycin-loaded immuno-nanoparticles on the hepatoma cell line SMMC-7721/ADM was significantly better than that of adriamycin-loaded nanoparticles. Adriamycin-loaded immuno-nanoparticles had the specific binding ability with the hepatoma cell line SMMC-7721/ADM. Conclusions Adriamycin-loaded immuno-nanoparticles can overcome the MDR of the tumor in vitro. The mechanism may be that immuno-nanoparticles could adhere to the tumor cell membrane, and the release of the loaded adriamycin creates a high local concentration in the extracellular medium. The increased concentration gradient improves the diffusion of adriamycin from the extracellular medium to the intracellular medium.

Objective To explore bone formation markers in dexamethasone intervention osteocalcin (OC),bone alkaline phosphatase (BAKP),and type Ⅰ original amino terminal propcptide (PINP) relationship with bone longitudinal growth.Methods The selected thirty-three 4-week-old male SpragueDawley (SD) rats were randomly divided into two groups:the dexamethasone group (n =18) and the control group (n =15).The rats in the dexamethasone group received dexamethasone (200 μg/100 g) by intraperitoneal injection for 10 days.The rats in the control group received matching volume sodium chloride solution.All rats were weighed everyday.The rats were killed by using 10％ chloral hydration at 8 AM of 11 th day.The length of tibiae was measured.The proximal tibiae were excised,fixed and decaleified.Mter paraffin embedded,sections in 5 μm thick were cut.The growth plate sections were stained by haematoxylin-eosin (HE) histochemistry method.Total height of growth plate was measured.The rats decaptitating and the blood were collected.Serum was separated and stored in-80 ℃ refrigerator for analysis.Enzyme -linked immuno sorbent assay (ELISA) method was used to detect the rat OC,BAKP and PINP values.Results The length of growth plate and tibiae of dexamethasone group were significantly decreased contrast the control group:the length of growth plate (P =0.001),and the length of tibiae (P =0.000).There were no significant differences between two groups of the value of OC,BAKP and PINP:OC (P =0.056),BAKP (P=0.122),and PINP (P =0.169).There was positive correlation between the serum OC and the length of tibiae (r =0.454,P =0.08) in control group,the PINP and OC (r =0.521,P =0.026) in dexamethasone group.Conclusions Glucocorticoid inhibit the longitudinal bone growth,to the osteoblasts (OC,BAKP and PINP) of growing rats is not obvious.