Hilar cholangiocarcinoma (HCCA) or Klatskin tumor is a scirrhous adenocarcinoma that arises from the conjunction of bile duct and hepatic ducts.Hepatic magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) are important methods for the diagnosis of HCCA.In this article,the clinical data of 42 patients in the Changhai Hospital and 18 patients in the Eastern Hepatobiliary Surgery Hospital who received MRI and MRCP examination from October 2010 to October 2012 were retrospectively analyzed.According to the pathological features,HCCA could be divided into mass-forming type,infiltrating type and intraductal type.Based on the results of imaging examination and intra-and postoperative pathological examination,Bismuth-Corlette types were decided pre-and postoperatively.The coincidence rate of pre-and postoperative Bismuth-Corlette types was 89.7％ (35/39).Infiltration of liver parenchyma was both detected pre-and postoperatively in 19 patients (16 patients were detected by MRI preoperatively),and the sensitivity of MRI was 84.2％ ; vascular invasion was both detected pre-and postoperatively in 10 patients (12 patients were detected by MRI preoperatively),and the sensitivity of MRI was 83.3％ ; hilar and retroperitoneal lymph node metastasis was both detected pre-and postoperatively in 6 patients (4 patients were detected by MRI preoperatively),and the sensitivity of MRI was 66.7％.Combined application of different sequences and techniques of MRI is helpful in the diagnosis,staging and treatment of HCCA.

ObjectiveTo investigate the significance of synchronic heart rate variation(HRV) and blood pressure variation(BPV) in the evaluation of coronary artery disease(CAD).MethodsOne hundred and three patients who received coronary artery angiography were divided by the lesion degree into occlusion group (28 cases with more than 1 complete-occlusion coronary artery),non-occlusion group (45 cases with more than 1 coronary artery stenosis ≥50％ but without complete-occlusion) and control group (30 cases without stenosis ≥50％).Occlusion group and non-occlusion group were divided by lesion location into left anterior descending (LAD) lesion (32 cases),left circumflex ( LCF ) lesion (23 cases ) and right coronary artery(RCA) lesion (18 cases).And these two groups were also divided by lesion branch number into 1 lesion branch (23 cases),2 lesion branches (19 cases) and 3 lesion branches(31 cases).The time domain indexes of HRV were detected and calculated by 24 h dynamic blood pressutre and ECG,including standard deviation of normal number of R-R intervals (SDNN),standard deviation of per 5 min average normal R-R intervals(SDANNind),24 h average of standard deviation of per 5 min normal R-R intervals(SDNNind),root mean square of standard deviation of adjacent normal R-R intervals (rMSSD),and percentage of the difference of adjacent normal R-R intervals ＞ 50 ms (PNN50).And indexes of BPV were detected,including daytime systolic pressure standard deviation (dSSD),daytime diastolic pressure standard deviation (dDSD) and nighttime systolic blood pressure standard deviation (nSSD).The correlations between synchronic HRV and BPV and different coronary artery lesions were analyzed.ResultsSDNN,SDANNind significantly decreased and dSSD obviously increased with the aggravation of coronary stenosis,and there was statistical significance[ ( 115 ± 35 ) ms vs.(98 ± 25 ) ms vs.( 78 ± 28 ) ms,( 100 ± 30) ms vs.( 86 ± 23 ) ms vs.( 70 ± 29 )ms,(14 ± 3) mm Hg (1 mm Hg=0.133 kPa) vs.(20±4) mm Hg vs.(28±2) mm Hg](P＜0.05).rMSSD and PNN50 decreased,dDSD and nSSD increased with the aggravation of coronary artery stenosis,but there was no statistical significance (P＞0.05).SDNN and SDANNind in patients with LAD lesion and LCX lesion were significantly lower than those in control group,and dSSD was obviously higher than that in control group (P ＜ 0.01 or ＜ 0.05 ).SDANNind,rMSSD,PNN50,dDSD and nSSD in patients with LAD lesion and LCX lesion had no significant difference compared with those in control group (P ＞ 0.05 ).SDNN,SDANNind,SDNNind,rMSSD,PNN50,dSSD,dDSD and nSSD in patients with RCA lesion had no statistical significance compared with those in control group ( P ＞ 0.05 ).All the indexes of HRV tended to descend and indexes of BPV trended to raise with the increasing number of coronary artery lesion branches.But only the changes of SDNN,SDANNind,SDNNind,rMSSD,PNN50 and dSSD had statistical significance (P ＜ 0.05).Conclusions The more significantly HRV decreases and dSSD increases in patients with coronary artery disease,the more serious the coronary artery stenosis is and the wider the lesions are.The lesions are commonly located in LAD.It has certain guiding value for the evaluation of coronary artery diseases.

Objective To study the expression of P73 and its relationship with expression of Survivin in colon carcinoma. Methods The expression of P73 and Survivin was studied by immunohistochemical technique in 46 cases of colon carcinoma and 12 cases of normal colon mucosa. Results The P73 expression rate of colon carcinoma was significant higher than that of normal colon mucosa(χ2 = 13.42, P ＜0.01 ). Overexpression of P73 was related to the pathological grade and Dukes stage ( ( χ2 = 8.01, P ＜0.01 ), and it was closely related to lymphatic metastasis of colon carcinoma( P ＜0.01 ). There was a positive relation between P73 and Survivin( rs =0.487, P ＜0.01 ). Conclusions The expression of P73 was closely associated with Survivin in colon carcinoma. The results suggested that the overexpression of P73 and Survivin was involved in the tumorigenesis and development of colon carcinoma and P73 and Survivin might be used as a new tumor marker in metastasis and prognosis of colon carcinoma.

Bone is the most common site for metastasis from prostate cancer, and bone metastases also is one of the main causes for the death of the patients with prostate cancer. Since the patients with bone metastases from prostate cancer still have relatively long survival periods after treatmemt, how to properly choose the treatment option for the metastatic patients is imperative in terms of improvements in both quality of life and life expectation. This paper summary pathophysiology, risk evaluation clinical assessment and the current status of the treatment options of prostate cancer with bone metastases, it also lays out the background for the individualized treatment plan that still needs to be further investigated.

Objective To investgate the inhibitory effect of Phyllanthus Urinaria L compound on proliferation of hepatoma cell HePG2 in vitro and to explore its mechanism.Methods The influence of different concentrations of Phyllanthus Urinaria L compound at different time on HePG2 proliferation was compared by MTT colorimetric assay and cell growth curve assay.The cell apoptotic rate and morphological changes of HePG2 were observed by flow cytometry,fluorescence microscope and electron microscope.Results Phyllanthus Urinaria L compound can inhibit the proliferation of human hepatoma cell line HePG2.Within a certain limit of concentrations,the higher the concentration and the longer the acting time,the stronger the inhibition.Co-cultured with 500 ? g/mL Phyllanthus Urinaria L compound for 72 h,the inhibitory rate reached 93.58 % and IC50 was 240 ? g/mL.Phyllanthus Urinaria L compound at different concentrations had an certain effect on inducing cell apoptosis.Conclusion Phyllanthus Urinaria L compound can inhibit the proliferation of hepatoma cell,and its mechanism may be related with the induction of hepatoma cell HePG2 apoptosis.

Objective To explore the efficacy of lamivudine and interferon in sequential therapy for chronic hepatitis B.Methods 92 cases of chronic hepatitis B patients were randomly divided into treatment group(n=46) and control group(n=46).In the treatment group,the patients were treated with lamivudine 100mg/d for 5 months,then combined with recombinant ?-2b interferon(IFN) 5Mu/dose,muscle injection,once per two days.Then the lamivudine was discontinued at sixth month and the patients were continuously treated with only interferon for 5 months.In the control group,the patients were treated with only lamivudine 100mg/d for 18 months.Results At the end of treatment,the normalization rate of ALT,HBV-DNA negative conversion rate and HBeAg/anti-HBe seroconversion rate were 93.5%,89.1% and 54.3% in the treatment group,then they were 82.6%,71.7% and 19.6% in the control group.Six months later,the sustained response rate of HBV-DNA conversion between treatment group and control group were 84.8% and 32.6%.Conclusion Lamivudine and interferon has better short-term efficacy in sequential therapy for chronic hepatitis B and it is worth further studying.

OBJECTIVE:To observe the clinical effect of tiotropium bromide combined with salmeterol xinafoate and fluticasone propionate in the treatment of medium and severe COPD. METHODS:119 patients with medium and severe COPD were divided into control group(54 cases)and observation group(65 cases)according to admission order. Control group was treated with Salmeterol xi-nafoate and fluticasone propionate powder for inhalation 50 μg,bid;observation group was additionally given Tiotropium bromide powder for inhalation 18μg,qn. Both groups received 1 month of treatment. Lung function indexes as FEV1,FVC and IC,blood gas indexes as SaO2,PaCO2 and PaO2 and inflammatory factors as IL-8 and TNF-α,COPD assessment test(CAT)score were observed in 2 groups,and the occurrence of ADR was also observed. RESULTS:Before treatment,there was no statistical significance in above indexes between 2 groups(P>0.05). After treatment,FEV1,EVC,IC of observation group were increased significantly,SaO2 and PaO2 of observation group were increased significantly,while PaCO2,IL-8 and TNF-αlevels was decreased significantly;those index-es of observation group were significantly better than those of control group,with statistical significance(P<0.05). CAT score of 2 groups were decreased significantly compared to before treatment,and the observation group was significantly lower than control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Tiotropium bromide com-bined with salmeterol xinafoate and fluticasone propionate shows good clinical efficacy and safety in the treatment of medium and se-vere COPD.

Objective To investigate the changes of psychological state and family environment of the patients with neurosis (including depression and anxiety) in the process of treatment. Methods The Hamilton depression scale (HAMD), Hamilton anxiety scale(HAMA), self-rating depression scale(SDS), self-rating anxiety scale(SAS), family environment scale(FES), and family adaptability and cohesion scale(FACESⅡ-CV) were used to evaluate the changes of psychological state and family relationship in the process of treatment among patients with depression and anxiety hospitalized in general hospitals (n=45) and their family members (n=45). Results Before intervention, values of HAMD, HAMA, SDS and SAS in patients were higher than normal ones, and were in line with the corresponding diagnostic criteria. After psychological intervention and medication for 2 to 3 months, symptoms such as depression and anxiety were improved significantly, and values of the above scales were within normal ranges. Besides, there was also significant improvement in FES and FACESⅡ-CV after intervention among the patients. All the values of the family members were in the normal ranges before intervention, however, significantly positive changes were observed after intervention. Conclusion With the improvement in depression and anxiety after intervention among patients, the psychological pressure of family members is released, and family relationship is partially restored. The rehabilitation of patients plays an important role in the restoration of family function.

Objective To evaluate the reliability and validity of the brief version of dysfunctional beliefs and attitudes about sleep(DBAS-16).Methods Participants were out-patients who with insomnia or insomnia comorbided depression disorder or anxiety disorder.All of them were assessed by DBAS-16,Pittsburgh sleep quality index (PSQI),self-rating depression scale (SDS),self-rating anxiety scale (SAS).30 of them were evaluated by DBAS-16 two weeks later.Results 230 patients were assessed,212 pieces of questionnaire with integral answers were collected,The Cronbach α Coefficient of DBAS-16 was 0.786,the Cronbach α coefficients of four subscales were 0.424-0.703.Split-half reliability coefficient of total score was 0.775,split-half reliability coefficient of four subscales were 0.424-0.719.Item-total correlation coefficients ranged from 0.602 to 0.283(all P＜0.05).The testretest reliability coefficient was 0.928,and coefficient of each subscales ranged from 0.709 to 0.907 (all P＜0.05).Confirmatory factor analysis was used to estimate the construct validity.The fit indices:x2/dfwas 1.623,the adjusted goodness of fit index (AGFI) was 0.882,root mean square error of approximation (RMSEA) was 0.054,incremental fit index (IFI)was 0.899,non-normed fit index (NNFI) was 0.871,comparative fit index (CFI) was 0.895.Total DBAS-16 score significantly correlated with PSQI(r=-0.311,P＜0.01),SDS(r=-0.192,P＜0.01),SAS(r=-0.162,P＜0.01).Conclusion The reliability and validity of the brief version of DBAS-16 are adequate.

Objective To review the diagnosis and treatment of primary gallbladder carcinoma in patients older than 70 years.Method The clinical data of 48 patients older than 70 years with primary gallbladder carcinoma treated in our hospital from 2003 to 2010 were retrospectively analyzed.Results The preoperative diagnostic rate was 60.4％.Of 48 patients with primary gallbladder carcinoma,9 received cholecystectomy,18 radical resection,7 extended radical resection,8 palliative operation,while the remaining 6 received biopsy because of metastasis. The 3-year survival rate was 20.8％ and the 5-year survival rate was 8.3％.Conclusions Regular B-ultrasonography,CT-scan and MRI are suggested for elderly patients with chronic diseases of the gallbladder.Radical resection is recommended if clinically possible. Chinese traditional medicine given postoperatively improved the prognosis.