Objective To evaluate the choice of therapeutic methods and MRI diagnosis of acoustic neuroma.Methods The MRIimaging and clinical materials of 60 patients with acoustic neuroma were analyzed,48 cases were underwent an operation,12 cases weretreated conservatively or gamma knife treatment,follow-up ranged from 1 to 4 years.Results There were 62 tumors round the internalauditory canal.There were 58 cases with single acoustic neuroma and two cases with couples acoustic neuroma.28 tumors demonstratedhypointense and 30 tumors demonstrated hypo-and isointense signals on T_1 weighted image.38 tumors demonstrated hyperintense and 24tumors demonstrated hyper-and isointense signals on T_2 weighted image.The Ⅶ,Ⅷ nerves affected side were thickened than that ofopposite side in 32 patients.After Gd-DTPA administration 24 tumors were homogeneously enhanced,26 tumors were inhomogeneously or circularly enhanced in 50 acoustic neuromas of 48 cases.Operation was still the main election for acoustic neuroma.Conclusion MRI is an effective method in the diagnosis of acoustic neuroma,and providing advice for clinics in making therapeutic programs.

Objective:To investigate the expression and clinical significance of Nusap1 in hepatical carcinoma. Methods:The expression of Nusap1 protein in 61 specimens of hepatical carcinoma was examined by immunohistochemistry. Based on the levels of Nusap1 expression, the 61 specimens were divided into a high Nusap1 expression group and a low Nusap1 expression group. The correlation between Nusap1 expression with clinicopathologic features and prognosis of hepatical carcinoma was analyzed. Results:TherateofhighNusap1expressionwas54.1%inhepaticalcarcinoma.TherateofhighNusap1 expression was 21.3%in noncarcinoma, with signiifcant difference between the 2 groups (P<0.01).Nusap1 overexpression had signiifcant correlation with histological differentiation, tumor size, liver cirrhosis,lymphaticmetastasis,tumorthrombiandearlyrecurrence(P<0.05),butnotwithsex,age,AFP level,tumornumber,TNMclassificationandtumorencapsulation(P>0.05).Survivalanalysissuggested thatthe6monthand12monthnoncarcinomasurvivalratewassignificantlylowerinthehighNusap1 expression group [33.3%(11/33), 17.9%(5/33)] than that in the low Nusap1 expression group [89.3%(25/28), 53.6%(15/28);P<0.005]. Conclusion:Nusap1 is overexpressed in hepatical carcinoma and is a valuable prognostic factor for hepatical carcinoma.

Objective:To discussed the diagnostic value of magnetic resonance cholangiopancreatography (MRCP), and the use of laparoscopic surgery in management of patients with choledochal cyst with extrahepatic bile duct anomaly.Methods:Of 330 consecutive patients who underwent laparoscopic choledochectomy at Guangzhou Women and Children's Medical Center from January 2010 to September 2018, there were 23 patients with extrahepatic bile duct anomaly. The data of these patients were retrospectively analyzed. There were 4 males and 19 females, with an average age of 3.2 (range 0.3~9.0) years. According to whether the extrahepatic bile duct anomaly was diagnosed by preoperative MRCP, these patients were divided into the preoperative MRCP diagnosis group and the preoperative MRCP undiagnosed group. The impact of MRCP in diagnosing bile duct anomaly to prevent bile duct injury, on operation time, hospital stay and the types of extrahepatic bile duct anomaly on outcomes of laparoscopic treatment were analyzed.Results:All the 23 patients with choledochal cysts complicated by extrahepatic bile duct anomaly were confirmed at surgery. The incidence of extrahepatic bile duct anomaly was 6.97% (23/330). There were 47.8% of type II AHD (11/23); 36.8% of type III AHD (7/23); 4.3% of type IV AHD (1/23); 17.4% (4/23) of the type with communication with accessory bile duct (CABD). The preoperative MRCP diagnosis group consisted of 14 patients, while the preoperative MRCP non-diagnosis group consisted of 9 patients, including 2 patients without MRCP. The diagnostic rate of MRCP in preoperative diagnosis of extrahepatic bile duct anomaly was 66.7%(14/21). The preoperative MRCP undiagnosed group, when compared with the preoperatives MRCP undiagnosed group, had a significantly higher bile duct injury rate [preoperative MRCP diagnosis group 7.1%(1/14), preoperative MRCP non-diagnosis group 55.6%(5/9)], and a significantly longer operation time [preoperative MRCP diagnosis group(232.6±10.0) min, preoperative MRCP undiagnosed group (278.9±22.45)min], (all P<0.05). Laparoscopic surgery was completed in 22 of 23 patients. One patient was converted to open surgery. AHD reconstruction was needed in 11 patients with type II AHD and 1 patient with type IV AHD. Seven patients with type III AHD did not require any surgical intervention for the anomaly. The 4 patients with CABD underwent simple ligation. Postoperative chyloperitoneum developed in 1 patient, who successfully responded to conservative treatment. Postoperative recovery was uneventful in the remaining patients. At a median follow-up of 2 years (range 1 to 5 years), no further complications, including intrahepatic bile duct dilatation and hepatic atrophy were detected. Conclusions:MRCP was effective in preoperative diagnosis of choledochal cysts with extrahepatic bile duct anomaly. It helped to decrease intraoperation injuries to bile duct anomalies. MRCP was also useful in classifying patients with extrahepatic bile duct anomaly to better preoperatively planning of surgical treatment strategies. Laparoscopic surgery could be completed in the majority of these patients with good postoperative results.

Objective To investigate the expression of nucleolar spindle-associated protein 1(NuSAP1) in hepatocellular carcinoma (HCC) and in non-cancerous tissues,and to study the correlation between NuSAP1 and early recurrence and prognosis of HCC.Methods The expression of NuSAP1 in 61 cases of HCC and non-cancerous tissues were assessed by RT-PCR,quantitative PCR and immunohistochemistry.The relationship between the expression and the clinicopathological features was studied.Results The levels of mRNA and protein in HCC were higher than the non-cancerous tissues (P＜0.05).On univariate analysis,the expression levels of NuSAP1,mRNA and protein in HCC were significantly associated with TNM classification,lymphatic metastasis,early recurrence,tumor thrombosis and histological differentiation (P＜0.05).Multivariate analysis showed early recurrence was associated with the expression of NuSAP1 protein in HCC (P＜0.05).Overexpression of NuSAP1 protein was correlated with poor outcome of the patients with HCC (x2=15.846,P＜0.001).Conclusions NuSAP1 was overexpressed in hepatocellular carcinoma.Overexpression of NuSAP1 was associated with early postoperative HCC recurrence and bad prognosis.

BACKGROUND: Inhibiting the degradation of extracellular matrix in the intervertebral disc can delay the degenerative process of intervertebral disc. Matrix metalloproteinases-3 (MMP3) is considered as a key enzyme for degradation of extracelular matrix components such as type II collagen and aggrecan.
OBJECTIVE:To construct the short hairpin RNA lentiviral vector targeting human MMP3 gene and to detect its efficiency of gene silence by infecting human degenerative nucleus pulposus cells.
METHODS:According to the human MMP3 mRNA (NM_002422.4) sequence, four groups of the short hairpin RNA gene sequences targeting MMP3 were designed, synthesized and annealed to form double stranded DNA fragments, which were connected with the LV3 vectors digested by BamHI andEcoRI enzymes, and then transfected into the competent cels. The positive clones were identified by PCR, and analyzed by sequencing. The packaging and titer of lentivirus were determined after transfecting 293T cells. Human degenerative nucleus pulposus cels were infected with lentivirus vector, and the transfection efficiency of each group was observed under inverted fluorescence microscope. The interfering efficiency was detected by real time-PCR and western blot at 72 and 96 hours.
RESULTS AND CONCLUSION:The ds-oligo DNA was successfully inserted into the lentiviral vector as confirmed by electrophoresis and sequence analysis. The recombinant lentivirus was harvested from 293T cels with a viral titer of 1-5 ×108 TU/mL. RNA interference targeting the GCC AGG CTT TCC CAA GCA AAT sequences with the highest interfering efficiency in MMP3 gene at 72 and 96 hours resulted in suppression of MMP3 mRNA expression by 98% and 72%, respectively; and at 96 hours, the interfering efficiency of protein expression was 57.2%. The recombinant lentivirus vector containing RNA interference targeting MMP3 gene is successfuly constructed, which lays a foundation for further studies on the MMP3 function and gene therapy.

OBJECTIVE: To figure out the etiological factors and overall mortality of the patients with acute intestinal obstruction, and to explore the rational period of conservative therapy before operation. METHODS: Medical records of all the patients with acute intestinal obstruction admitted to West China Hospital from 1995 to 2002 were retrospectively reviewed. The etiology of the obstruction was categorized, and the correlation of mortality and time interval between conservative therapy and operation was analyzed. RESULTS: There were 705 patients with acute intestinal obstruction included. There were 71.1% of the obstruction lesions located on the small bowel, and 82.6% of the patients experienced simple obstruction. The most frequent cause was adhesions (62.0%), and next was neoplasms (23.7%). There were 57.6% of the patients underwent the surgical treatment. The overall mortality rate was 1.6%, and the mortality rates in conservative therapy and surgical intervention groups were 1.3% and 1.7% respectively. The intestinal necrosis rate was increased gradually with the prolongation of time interval between conservative therapy and operation, and the death might occur 24 hours after strangulation. CONCLUSION: The epidemiological transition to adhesive obstruction still exists in China, and it is similar to that in Western countries. In our experience, near half of the patients with simple obstruction may achieve palliation by conservative therapy. Surgical intervention is indicated for the patients with prolonged and non-palliated simple obstruction, or strangulation disease within the first 24 hours.

To investigate the exon mutation of vitamin K-dependent gamma-glutamyl carboxylase (GGCX or VKDC) in patients with calcium oxalate urolithasis, renal cortex and peripheral blood samples were obtained from severe hydronephrosis patients (with or without calculi), and renal tumor patients undergoing nephrectomy. GGCX mutations in all 15 exons were examined in 44 patients with calcium oxalate urolithiasis (COU) by polymerase chain reaction (PCR) and denatured high pressure liquid chromatography (DHPLC), and confirmed by sequencing. Mutation was not found in all COU samples compared to the controls. These data demonstrated that functional GGCX mutations in all 15 exons do not occur in most COU patients. It was suggested that there may be no significant association between the low activity and mutation of GGCX in COU.

Solitary fibrous tumor (SFT) in bladder is extremely rare. In this study, we reported one case of bladder SFT and reviewed the only ten cases of the disease that had been reported so far. The patient suffered from residual urine sensation and urethral pain. Cystoscopy revealed a 7-cm protruding mass at the dome of the bladder, and bladder mucosa biopsy showed normal differentiation of the bladder mucosa with a small amount of inflammatory cells. Radical resection of the tumor was performed in this patient. Pathological examination found uniform, haphazardly arranged spindle cells, the majority of which were CD34-positive and Vimentin-positive and proved that the mass was a solitary fibrous tumor. Within a period of 9 months of follow-up, no reoccurrence was found.

As the same safety and oncologic effect of open gastrectomy, laparoscopic radical gastrectomy has been widely used in the treatment of gastric cancer. Supra-pancreatic lymph node dissection is the key and difficult prospect in laparoscopic radical gastrectomy for gastric cancer. The authors investigate the indication, operative preparation, boundary of supra-pancreatic lymph nodes and dissected standard, surgical complication of 4K laparoscopic radical gastrectomy, and described the experience and operative procedures of supra-pancreatic lymph node dissection with the surgeon on right position.