In recent years,hepatocellular carcinoma (HCC)has become the second leading cause of cancer-related death worldwide.Due to the insidious onset of this disease,only 20%-30%of the patients with HCC have the opportunity for surgical resection or liver transplan-tation.At present,interventional therapy has become the first choice for patients with intermediate-stage HCC and some patients with late-stage HCC,and more and more scholars have realized the importance and necessity of comprehensive interventional therapy for HCC.The comprehensive interventional therapy of transcatheter arterial chemoembolization (TACE)in combination with various methods (TACE com-bined with local treatment,TACE sequential surgery,or TACE combined with systemic treatment)provides many therapeutic approaches and achieves good therapeutic effects.However,the indications,timing,and recurrence and metastasis after treatment for such combination ther-apies await further investigation.

Objective To investigate the expression of E-cadherin (E-cad), CD44v6 and VEGF-C in esophageal carcinoma and investigate their relationship with lymph node metastasis. Methods The expression of E-cad, CD44v6 and VEGF-C was detected with immunohistochemical EnVision method in 56cases of esophageal carcinoma and 12 cases of normal esophageal mucosa. Results Among 56 cases of esophageal carcinoma, the positive expression rates of E-cad in esophageal carcinoma was 55.4 %(31/56),significantly lower than that in normal esophageal mucosa 100.0 %(12/12) (P ＜0.05). The positive expression rates of CD44v6 and VEGF-C were 71.4 % (40/56) and 62.5 % (35/56), significantly higher than that in normal esophageal mucosa (P ＜0.05). The positive rates of E-cad was 31.3 % (10/32) in the group of positive lymph node metastasis, significantly lower than that in the group of positive non-lymph-node metastasis 87.5 % (21/24) (P＜0.05). The positive rates of CD44v6 and VEGF-C were 84.4 % (27/32) and 75.0 % (24/32) in the group of positive lymph node metastasis ,significantly higher than that in the group of positive non-lymph-node metastasis 54.2 % (13/24) and 45.8 %(11/24) (P＜0.05). E-cad was negatively correlated with lymph node metastasis; CD44v6 and VEGF-C were positively correlated with lymph node metastasis (P ＜0.05). Conclusion E-cad, CD44v6 and VEGF-C play important roles in the process of soakage and metastasis of esophageal carcinoma. The combined detection of E-cad, CD44v6 and VEGF-C can help to prodict biological behaviors and prognosis of esophageal carcinoma.

Objective The anti-UV-B radiation mechanism of UV-B tolerance strain KFS-9 was studied from the profile of metabolites.Methods The compounds were separated by column chromatography and their structures were elucidated based on GC-MS,LC-TOF-MS,EI-MS and NMR analyses.Results Three unsaturated fatty acids(identified as 9-hexadecenoic acid,9,12-octadecadienoic acid and 11-octadecenoic acid) and 1,2-benzenedicarboxylic acid able to absorb ultraviolet were isolated from the petroleum ether extract of the fermentation liquid of Pantoea agglomerans KFS-9.Fraction(Ⅱ) was isolated from the ethyl acetate extract and was composed of 2,3-butanediol and a series of high unsaturated aroma compounds.Fraction(Ⅱ) had a wide absorption peak,and it could protect E.coli from UV-B damage in some sense.Conclusion Strain KFS-9 produced metabolites that were able to absorb UV to build a natural barrier and so improved the tolerance to UV radiation.The UV-B radiation protection test to the E.coli also showed fraction(Ⅱ) was not the only protector,and there definitely existedother materials and mechanism to protect the strain.

Objective This study aimed to investigate the incidence and the cause for duodenalbiliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct Methods After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilirubin and direct bilirubin in blood were performed for all patients. Two to five days [ an average of (3.3 ±0. 9) days ] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P ＜ 0. 05 was considered to be statistically different Results In 14 cases, radioactivity was successfully detected in the bile 2-5 days after stent implantation. Twelve of them was detected to have radioactivity in the bile 2 hours before extubation with duodenal-biliary reflux. The technetium count in the bile accounted for 1.82% of the total intake dose. There was no radioactivity in the bile in 2 cases. In 14 patients, there were no symptoms of cholangitis such as high fever, chills, increased jaundice, and so on after stent implantation. The mean of white blood cell count was (7.59 t2. 62) × 109/L, and the median of neutrophil percentage was 0. 74. Compared with those before stent implantation, the difference did not reach statistical significance ( t = 0. 423, Z = 1. 036, P ＞ 0. 05 ).After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92. 2 and 74. 3 μmol/L. Compared with those before stenting,the difference was statistically significant (Z= -3. 170, -3. 170, P ＜0.05). Conclusions There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux.

Objective To explore the method and value of percutanously interventional therapeusis for treatment of obstructive jaundice caused by hepatocellular carcinoma accompanied with bile duct thrombosis.Methods Sixteen cases with bile duct thrombosis proved by pathology and imaging examinations were retrospectively analyzed.According to the clinical symptoms, all the patients received percutaneous transhepatic biliary drainage (PTBD) including permanent external drainage, temporary internal drainage and implantation of covered stents.Serum total bilirubin (TBIL) after the interventional therapeusis were measured and compared with that before the treatments by t test to evaluate the efficacy of these treatments.The relief of clinical symptoms was also reviewed to evaluate the efficacy of these treatments.The patients were followed up within 2 years.Results The PTBD was successfully performed in 16 cases.Permanent external drainage, temporary internal drainage and implantation of covered stents were performed in 2 patients, 7 patients and 7 patients respectively.TBIL after the interventional therapy decreased significantly (t=7.366, P<0.01) to (161.2±80.5) μmol/L averagely from (261.9±77.2)μmol/L before the treatments.All the patients died before the end of followed-up.The average survival time was 204 days (30 to 391 d)and the median survival time was 200 days.Bleeding and infection were the main complications, which could be controlled successfully by routine treatments.Conclusion With high achievement ratio and good efficacy, percutanously interventional therapeusis are good choices for the treatments of obstructive jaundice due to bile duct thrombosis.

Objective To improve the differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) by a contrast analysis of imageological features.Methods Thirty-six patients who had postoperative pathological with Asian AIP standards and 95 patients who had postoperative pathological consistent with PC.The imageological results of these AIP and PC patients were analyzed.Results AIP was significantly less than PC in the enhanced CT of a mass or enlargement of the pancreatic head,enlargement of the lymph nodes around the pancreas,dilation and interrupt in pancreatic and bile duct,peripheral vascular and organ involvement (11/27 vs.28/40,2/27 vs.17/40,13/27 vs.32/40,1/27 vs.10/40,8/27 vs.26/40,2/27 vs.15/40,0/27 vs.15/40,0/27 vs.10/40,P ＜ 0.05).AIP was significantly more than PC in the enhanced CT of a diffusely enlarged pancreas,calcification or pancreatic calculus,capsule-like rim or the vague peripancreatic fat interval (4/27 vs.0/40,7/27 vs.0/40,10/27 vs.6/40,P ＜ 0.05).AIP was significantly less than PC in the three-dimensional ultrasonography of dilation diameter of pancreatic duct and dilation of common bile duct [(0.421 ± 0.270) cm vs.(0.594 ± 0.270) cm,1/18 vs.16/26,P＜ 0.05].AIP was significantly less than PC in the magnetic resonance cholangiopancreatography of dilation of common bile duct and interrupt in pancreatic duct (7/13 vs.16/18,1/13 vs.10/18,P ＜ 0.05).Conclusion AIP as a unique type of chronic pancreatitis can be distinguished from PC on distinctive imageological features

Objective To investigate the nutritional status of elderly inpatients with benign orthopedic diseases and to assess its relationship with clinical outcomes.Methods Nutritional Risk Screening 2002 ( NRS 2002) was used to prospectively investigate undernutrition and nutritional risk in elderly patients hospitalized between April 1 and May 31, 2012 in Beijing Hospital for benign orthopedic diseases.Associations between nu-tritional status and clinical outcomes were analyzed.Results A total of 520 patients were included, with a mean age of (75 ±7.09) years.The mean body mass index (BMI) was (23.20 ±3.83) kg/m2, mean dominant-hand grip strength was (16.87 ±19.19) kg, mean mid-upper arm circumference was (25.62 ±3.81) cm, mean calf circumference was (31.92 ±4.02) cm.Compared with patients aged 65-79 years, patients≥80 years showed significantly lower hand grip strength [ (13.58 ±15.92) kg vs.(18.48 ±20.42) kg, P=0.004].All the pa-tients completed NRS 2002, which showed that 9.31%of the patients had undernutrition (BMI≤18.5 kg/m2), and 45.19%had nutritional risk (NRS 2002 score≥3).Compared with patients aged 65-79 years, patients≥80 years had significantly higher incidence of undernutrition (13.97% vs.7.21%, P=0.024) and nutritional risk (52.38%vs.41.76%, P=0.024), higher incidence of infectious complications in patients with nutritional risk (10.21%vs.5.26%, P=0.044), longer hospital stay [ (11.66 ±5.76) days vs.(10.42 ±4.37) days, P=0.016], and higher hospital expense [(20.28 ±1.811) thousand yuan vs.(16.39 ±1.362) thousand yuan, P=0.016].Conclusion Elderly patients hospitalized for benign orthopedic diseases have a high incidence of undernutrition and nutritional risk, which is associated with worse clinical outcomes.

Objective To understand the clinical features of patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) complicated by cytomegalovirus (CMV)viremia.Methods The clinical data of 249 cases of HIV/AIDS patients hospitalized in Beijing Ditan Hospital from Oct 2008 to Nov 2009 were analyzed retrospectively,in which 43 HIV/AIDS patients were diagnosed with CMV viremia.The symptoms and signs,cerebrospinal fluid (CSF)tests,and pathological detections by bronchoscope,gastroscope and fibercoloscope were collected.The database was set up using Excel software.The association between cellular immunity and CMV DNA level was determined by SPSS12.0 software.Results Forty-three patients (17.3%)were diagnosed with CMV viremia by positive results of CMV pp65 antigen and CMV DNA tests; 14 patients manifested retinal bleeding or infiltration and 4 patients displayed retinal fibrosis; 1 patient was diagnosed with CMV pneumonitis by pathological results of bronchoalveolar lavage fluid.Low level of CD4+ T lymphocytes and CMV DNA levels were positively correlated.Conclusions CMV pp65 antigen and CMV DNA should be detected in HIV/AIDS patients with CD4+ T lymphocytes less than 100 × 106/L and anti-CMV treatment should be given according to the results.Ophthalmologic examination and bronchoalveolar lavage fluid pathological detection are effective methods in diagnose of CMV retinitis and pneumonitis.

With the development of various laboratory testing techniques such as serum calcium and parathyroid hormone (PTH) , a large number of asymptomatic or normocalcemic primary hyperparathyroidism (PHPT) can be diagnosed early. PHPT has become the third most common endocrine disease affecting human health. Currently, most PHPT, especially normocalcemic primary hyperparathyroidism, are not primary diseases and may be related to vitamin D deficiency/insufficiency and/or insufficient calcium supplementation. That is, the relative hypocalcemia caused by long-term vitamin D deficiency/insufficiency and/or insufficient calcium supplementation leads to parathyroid hyperfunction, stimulates parathyroid hyperplasia, and secretes excessive parathyroid hormone to compensate for the regulation of calcium and phosphorus balance. When it is in the initial reversible stage, it can be cured by internal medicine; if it progresses freely, long-term hypocalcemia stimulation will lead to excessive parathyroid hyperplasia and even tumor occurrence with the formation of so-called PHPT and parathyroidectomy has to be performed. Therefore, routine screening of bone mineral density, calcium, magnesium, phosphours, 25-hydroxyvitamin D, parathyroid hormone and other bone metabolism indicators in the physical examination of general population is beneficial to the prevention and treatment of bone metabolism diseases, urinary stones and hyperparathyroidism. At the same time, attention should be paid to identifying the stage of prehyperparathyroidism in which vitamin D deficiency/insufficiency and insufficient calcium supplementation will stimulate parathyroid hyperfunction. Active intervention on prehyperparathyroidism is an effective way to avoid the development of primary hyperparathyroidism.

BACKGROUND: This study aimed to determine the reasons for conversion and elucidate the safety and efficacy of transition to tenofovir alafenamide/emtricitabine/bictegravir sodium (TAF/FTC/BIC) in highly active antiretroviral therapy (HAART)-experienced HIV-infected patients in real-world settings. METHODS: We conducted a retrospective cohort study. The treatment conversion rationales, safety, and effectiveness in 1684 HIV-infected patients with previous HAART experience who switched to TAF/FTC/BIC were evaluated at Beijing Ditan Hospital from September 2021 to Auguest 2022. RESULTS: Regimen simplification (990/1684, 58.79%) was the most common reason for switching, followed by osteoporosis or osteopenia (375/1684, 22.27%), liver dysfunction (231/1684, 13.72%), decline in tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) with food restriction (215/1684, 12.77%), virological failure (116/1684, 6.89%), and renal dysfunction (90/1684, 5.34%). In patients receiving non-nucleotide reverse transcriptase inhibitors (NNRTI)-containing regimens, lipid panel changes 1 year after switching indicated a difference of 3.27 ± 1.10 mmol/L vs . 3.40 ± 1.59 mmol/L in triglyceride ( P  = 0.014), 4.82 ± 0.74 mmol/L vs . 4.88 ± 0.72 mmol/L in total cholesterol ( P  = 0.038), 3.09 ± 0.70 mmol/L vs . 3.18 ± 0.66 mmol/L in low-density lipoprotein ( P  <0.001), and 0.99 ± 0.11 mmol/L vs . 0.95 ± 0.10 mmol/L in high-density lipoprotein ( P  <0.001). Conversely, among patients receiving booster-containing regimens, including TAF/FTC/EVG/c and lopinavir/ritonavir (LPV/r), lipid panel changes presented decreased trends. We also observed an improved trend in viral load suppression, and alanine transaminase (ALT), aspartate transaminase (AST), estimated glomerular filtration rate (eGFR), and serum creatinine levels after the transition ( P  <0.001). CONCLUSION The transition to TAF/FTC/BIC demonstrated good treatment potency. Furthermore, this study elucidates the motivations behind the adoption of TAF/FTC/BIC in real-world scenarios, providing clinical evidence supporting the stable conversion to TAF/FTC/BIC for HAART-experienced patients.
Humans ; Antiretroviral Therapy, Highly Active/adverse effects* ; Anti-HIV Agents/adverse effects* ; HIV Infections/drug therapy* ; Tenofovir/therapeutic use* ; Retrospective Studies ; Emtricitabine/pharmacology* ; Adenine/therapeutic use* ; Lipids