Hilar cholangiocarcinoma is a rare tumor with a poor prognosis.Due to advances in preoperative imaging and enhanced comprehension of tumor biological behavior,surgical management of hilar cholangiocarcinoma has evolved since its original description.Currently,it has been accepted that complete surgical resection provides the only possibility for cure or long-term survival,however,the surgical management of hilar cholangiocarcinoma is extremely challenging because of its anatomical location and vascular proximity.In order to achieve complete resection, several surgical approaches have been investigated and evaluated regarding major hepatic resection,lymph node dissection,vascular resection,extended resection and liver transplantation,however,there are still many disputations. Furthermore,many surgical technical difficulties exist in biliary reconstruction after resection owing to anatomical problems.Focusing on the disputes and problems mentioned above,we herein review and discuss surgical strategies in managing hilar cholangiocarcinoma.

Background and purpose: Ovarian cancer is the common gynecological cancer, and the drug resistance of anti-tumor drug was one of major reasons for therapy failure, some studies considered that there is a closed relationship between Gankyrin and drug resistance. In this study, we investigated the effects and mechanisms of Gankyrin silencing on reversing the cisplatin resistance of ovarian cancer drug-resistant SKOV3/DDP cell line. Methods:The expression of Gankyrin in SKOV3 and SKOV3/DDP cells was measured by real-time PCR assay, MTS assay was employed to determine the effect of Gankyrin on SKOV3/DDP sensitivity to cisplatin, apoptosis rate and intracellular concentration of rhodamine-123 (Rh-123) were determined by lfow cytometry, the expression of multi-drugs resistant protein MDR1, Caspase-3/8, Survivin and Bcl-2 were determined by Western blot and real-time PCR. The phosphorylation of AKT and expression of p53, NF-κB and PTEN were analyzed by Western blot assay. Results:The expression of Gankyrin was increased in SKOV3/DDP cells, Gankyrin silencing was able to increase the cisplatin sensitivity of SKOV3/DDP. Before and after gene silencing, the reverse folds (RF) to cisplatin were 1.81 and 2.45, respectively, the intracellular levels of Rh-123 were 1.73 and 2.42 fold, the apoptosis rates were 2.23 and 4.23 fold,the expressions of MDR1, Survivin and Bcl-2 were downregulated, the mRNA expressions of MDR1 were 62.8%and 21.6%, the mRNA expressions of Survivin were 24.5%and 10.3%, the mRNA expressions of Bcl-2 were 47.5%and 18.4%, the levels of Caspase-3/8, p53 and PTEN were elevated, phosphorylation of AKT and expression of NF-kB were downregulated compared with control group. Conclusion:Gankyrin silencing was able to reverse the cisplatin resistance of SKOV3/DDP cells by inhibiting the drug eflfux and promoting cell apoptosis, the PTEN/AKT/NF-κB/p53 may be the key pathway.

Objective To investigate the relationship between polymorphism of the estrogen receptor(ER) gene and bone mineral density(BMD), and bone metabolism in Chinese postmenopausal healthy women. Methods In 246 postmenopausal healthy women, aged 44-78 years (average 61 years), BMD of lumbar spine and femoral neck, Ward and trochanteric areas were measured by dual energy X ray absorptiometry. Biochemical indexes(serum Ca, P, ALP, PTH, CT)were measured and PvuⅡ and XbaⅠ restriction fragment length polymorphism(RFLP) of ER were analysed by polymerase chain reaction restriction fragment length polymorphism(PCR RFLP). The relationship between polymorphism of the ER gene and BMD, and bone metabolism were evaluated. The RFLP was represented as Pp(PvuⅡ) and Xx(XbaI). Results In the PPxx genotype, Z score values of BMD were significantly lower than those in other genotypes. Conclusion RFLP of ER gene associated with BMD in postmenopausal healthy women and this might explain the cause of postmenopausal osteoporosis in Chinese women.

Objective:To investigate the clinical efficacy of Neurotropin combined with oxycodone hydrochloride in moderating the severe pain in neuropathic cancer pain (NCP) patients. Methods: NCP patients who received drug therapy with a visual analog scale (VAS) score of>4 were randomly divided into the placebo combined oxycodone group (group A) and Neurotropin combined oxy-codone group (group B). The VAS score, pain relief rate, frequency of pain outbreaks, average dose of oxycodone per day, and adverse drug reactions between the two groups were compared. Results:The VAS scores in groups A and B both had significant reduction after treatment (P<0.05), whereas the VAS score in group B after 14 days of treatment decreased more significantly than that in group A (P=0.03). The pain relief rate in group B patients 14 days after treatment was significantly higher than that in group A (P<0.001). The out-break pain in groups A and B 7 and 14 days after treatment significantly decreased, whereas the outbreak pain in group B was signifi-cantly lower than that in group A (P values were 0.07 and 0.07, respectively). The average dose of oxycodone per day in group B 14 days after treatment was lower than that in group A (P<0.001). Adverse reactions, such as nausea and vomiting, in group B were signifi-cantly less than those in group A (P<0.05). Conclusion:Neurotropin combined with oxycodone can effectively lower the NCP, average dose of oxycodone per day, and adverse reactions.

Objective:To compare efficacy of percutaneous vertebroplasty (PVP) with radiotherapy and radiotherapy alone for bone me-tastasis pain. Methods:A total of 247 bone metastasis patients with pain were analyzed. The radiotherapy group comprised 158 cases, whereas the combination group comprised 89 cases. We mainly observed the effect of pain treatment, behavioral states, and im-proved emotional condition. The side effects and complications were also investigated. Daily medicine consumption of background pain treatment was observed between the two groups. Analysis was done by SPSS 17.0 statistical software. Numerical variables were analyzed using t test and comparisons between groups used chi-square test. Results:The VAS scores of radiotherapy group decreased from 8.12±1.45 to 3.06±1.68 after treatment (P<0.05), and combination group VAS scores from 8.46±1.73 to 2.45±1.47 (P<0.05). The time to pain relief following PVP and radiotherapy were 1.63±0.81 and 8.56±2.87 days, respectively (P<0.001). The breakthrough pain frequency was 4.56 ± 1.98 times/day, which decreased to 1.57 ± 0.98 times/day after PVP (P<0.05). By contrast, the breakthrough pain frequency was 4.73±2.24 times/day before treatment, which decreased to 3.56±1.56 times/day after radiotherapy. No serious compli-cations were observed in the two groups. The depression and anxiety mood in the combination group improved after treatment. Daily medicine consumption in radiotherapy group increased after therapy. However, daily medicine consumption in combination group was reduced after therapy. Conclusion:PVP with radiotherapy can effectively relieve bone metastasis pain and improve patients' quality of life and it is worthy of promotion in clinical practice.

Objective To observe the effect of PM2.5 on the secretion of NO, ET-1 and the proliferation of rat vascular smooth muscle cell(VSMC) in vitro.Methods VSMCs were treated with PM2.5 collected from urban area of Zhanjiang,at the doses of 10,20,50,100 and 200 ?g/ml.After 24 hours of treatment, the levels of NO and ET-1 in the VSMCs were detected by nitrate reductase method and radioimmunoassay respectively, the proliferation of VSMCs was detected by MTT.Results At the concentrations of 10-200 ?g/ml, with PM2.5 increased, the level of NO in VSMCs decreased from(43.53 ?3.46)?mol/L to(29.28?2.28)?mol/L(F=18.89,P

Objective To determine the values and variation tendency of a disintegrin and metalloprotease 12-S(ADAM12-S)of early pregnancy, and discuss the value of ADAM12-S to the ectopic pregnancy in the first trimester.Methods 150 early pregnancy cases (from the 5th to 10th week of pregnancy)were selected in Huanggang Women &Children's Healthcare Hospital.There were 102 cases of normal pregnancy,48 cases of ectopic pregnancy.The AutoDELFIA immunoassay platform was used to measure the value of ADAM12-S in the serum.Results Of the 102 normal pregnancies, the values of ADAM12-S in 5th-10th week of pregnancy linearly increase with gestationalage.The correlation coefficient was 0.9217 (P<0.05).While the values of ADAM12-S in the ectopic pregnancy group were significantly lower than the normal pregnancy group and not linearly increased with gestationalage.The correlation coefficient was 0.2817.There was statistically significant difference between the two groups (P<0.05).Conclusion The values of ADAM12-S is stable in the first trimester of normal pregnancy,while it is much more lower in abnormal pregnancy.ADAM12-S has great significance in the diagnosis of ectopic pregnancy of the first trimester.

Nerve root compression due to ligamentum flavum hematoma is extremely rare, with less than 70 cases reported in the literature. The clinical presentation and images were similar to those of spinal epidural tumors. Herein, we reported a previously healthy 64-year-old female who presented with right radicular leg pain. Neurological examination was consistent with right L5 root compression. The magnetic resonance imaging revealed a mass posterior to the L5 thecal sac, appearing as high intensity on T1-weighted and T2-weighted images. During operation, the dark hematoma within the ligamentum flavum was found. The pathological examination confirmed the diagnosis of hemorrhage. Her prognosis following surgery was excellent.
Sciatica

Objective To investigate the protective effects of aspirin on hypoxic brain neural cells of rat and the effects of extracellular calcium on the neuroprotective effect of aspirin. Methods The hypoxic cell model was established by adding Na2S2O4 to the calcium or calcium free medium. Cultured primary cortical neurons of rat were pretreated with ASA in vitro. The change of intracellular free calcium and neuroglobin (NGB) were observed and analyzed by laser scanning confocal microscope. Results The expression level of [Ca2+]i and NGB increased significantly in the chemical hypoxia group(P

Objective To clone and express bradyzoite antigen 1(BAG1) gene of T. gondii,and analyze the immunoreactivity of the recombinant product. Methods The differentiation of T. gondii RH strain tachyzoites into bradyzoites was induced in vitro,and the coding sequence of BAG1 was amplified from bradyzoites by RT-PCR. The PCR product was analyzed by sequencing. The BAG1 coding sequence was further subcloned into the plasmid pET32a(+). The plasmid pET32a(+)-BAG1 was then transformed into BL21(DE3) to express after IPTG induction. The expression product was purified with Ni-NTA agarose and the purified BAG1 was further analyzed by Western blotting and ELISA. Results BAG1 cDNA was amplified from bradyzoites. After IPTG induction,BAG1 was expressed in a fusional form in E. coli. Western blotting showed that the purified recombinant protein could be specifically recognized by sera from mice chronically infected by T. gondii B36 strain. ELISA showed that the positive rate of T. gondii IgG antibodies of 350 human sera detected by the recombinant BAG1(17.4%) was higher than by recombinant SAG1 (12.6%)(P