Flagella is an unique structure that presents in appropriate half of bacillus,few coccus,and all of spirilla and vibrio.It is associated with bacterial motility and plays an important role in bacterial infection and immunity as well as classification.This review focused on the research progress on bacterial flagella,including staining methods,the structure and function of flagella gene,as well as immunegenicity.of flagellin.

Objective To investigate the risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.Methods Literatures on the risk factors of laparoscopic anterior resection of rectal cancer were retrieved from August 2003 to August 2013,and then a Meta analysis was carried out based on the data.Data were expressed by odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the data was analyzed using the chi-square test or I2 test.Data were pooled using the fixed or random model.Results Eight literatures including 3 289 patients with rectal cancer were retrieved.The incidence of anastomotic leakage was 6.050％ (199/3 289).The incidence of anastomotic leakage after laparoscopic anterior resection of rectal cancer in males was significantly higher than females (OR =2.17,95％ CI:1.54-3.06,P ＜0.05).Neo-adjuvant chemotherapy might increase the risk of postoperative anastomotic leakage (OR =1.53,95％ CI:1.00-2.32,P ＜ 0.05).Interoperative blood transfusion might increase the risk of postoperative anastomotic leakage (OR =4.80,95％CI:2.98-7.73,P ＜0.05).Patients with low rectal cancer had greater risk of anastomotic leakage than those with high rectal cancer (OR =1.60,95％ CI:1.14-2.23,P ＜ 0.05).Number of linear stapler firings greater than 3 increased the risk of postoperative anastomotic leakage (OR =0.46,95％ CI:0.27-0.78,P ＜ 0.05).The ASA classification of anethesia risk,depth of tumor infiltration,lymph node metastasis,preventive colostomy were not correlated with the incidence of postoperative anastomotic leakage (OR =0.66,0.91,1.25,0.78,95％CI:0.36-1.20,0.55-1.51,0.75-2.09,0.50-1.23,P＞0.05).Conclusion Male,neo-adjuvant chemotherapy,interoperative blood transfusion,low rectal cancer,number of linear stapler firings greater than 3 are the main risk factors for anastomotic leakage after laparoscopic anterior resection of rectal cancer.

Objective To study the effects of bundles of care on complications and unplanned extubation rate of neonatal in PICC .Methods 116 cases of neonatal which didn′t accept the bundles of care ware group A ,the other 93 cases of neonatal which accepted the bundles of care ware group B .Two groups were observed and compared on the incidence of complications and un-planned extubation rate and so on .Results The complications in A group treatment were 70 cases(60 .3% ) ,while there were 25 ca-ses in group B(26 .9% ) ,the group B was significantly lower than the group A (P<0 .05) .Mechanical phlebitis ,catheter occlusion , catheter ectopic and other aspects of ectopic group B were significantly lower than in group A (P<0 .05) .The rate of unplanned ex-tubation and catheter blockage in group B were significantly lower than A (P<0 .05) .The total rate of ectopic and right basilic vein ectopic rate in group B were all significantly lower in group A (P<0 .05) .Group B unplanned extubation rate and catheter blockage weresignificantlyloweringroupA(P<0.05).Gestationalagedidn′thaveimpactoncomplications(P>0.05),birthweightand catheter days had more impact on neonatal complications (P<0 .05) .Conclusion The cluster management can reduce the incidence of neonatal PICC complications ,reduce unplanned extubation rates ,better play the role of PICC ,try to arrange an experienced staff of medical operations for children of low birth weight newborns .

Objective To summarize the experience of individualized treatment for hepatic artery thrombosis after liver transplantation.Methods From October 2002 to January 2015,5 patients with hepatic artery thrombosis after liver transplantation were treated with surgical exploration,interventional therapy or thrombolytic therapy according to the reasons.Results All the 5 patients were cured without serious complications.Conclusions There are many reasons for the occurrence of hepatic artery thrombosis after liver transplantation.Early diagnosis is the key point,and individual treatment highlights the concept of precision medicine.

BACKGROUND:Bone marrow mesenchymal stem cel s have attracted widespread attention for the capabilities of self-renewal and muti-differentiation, which have been used in treatment of various diseases.
OBJECTIVE:To study the effect of three-dimensional spheroid culture system on the stemness and senescence of bone marrow mesenchymal stem cel s.
METHODS:Mesechyaml stem cel s were isolated from the bone marrow of C57/B6 mice, 3 weeks old, and cultured onto the culture plates coated with or without chitosan. After 5 days of culture, the cel phenotype and expression of stemness related markers CD44 and Sca-1 were analyzed by flow cytometry. PI and Annexin-V staining were used to detect cel apoptosis. Also,β-Gal staining was applied for identification of aging.
RESULTS AND CONCLUSION:The mouse mesenchymal stem cel s began to form spheroids on day 3. The stemness-related markers, including CD44 and Sca-1, expressed higher in spheroid mesenchymal stem cel s than the cel s under normal culturing. Compared with the normal culture group, the apoptosis and senescence of cel s from spheroid culture were lower. The results indicate that the formation of spheroids on chitosan films can increase the stemness, decrease the apoptosis and slow the senescence of mesenchymal stem cel s.

Objective To study the expression and the clinical significance of hypoxia-induced factor-1α (HIF-1α) in gallbladder cancer tissues,and the role and mechanism of HIF-1α in metformin-suppressed metastasis in gallbladder carcinoma GBC-SD cells.Methods 24 specimens of gallbladder cancer tissues and 5 specimens of chronic cholecystitis were collected from the First Affiliated Hospital of Zhengzhou University between June 2016 and February 2017.Immunohistochemistry and qPCR were used to detect the expression of HIF-1α in gallbladder cancer tissues,in adjacent non-cancer tissues and in chronic cholecystitis,and the clinical significance was analyzed.The model of metastasis was induced by hypoxia;the wound healing assay and the Transwell assay were used to detect the ability of cell metastasis;the expressions of HIF-1α and VEGF in gallbladder carcinoma GBC-SD cells were detected by western blotting assay and immunofiuorescence.Results The expression of HIF-1α in gallbladder cancer tissues was higher than the adjacent non-cancer tissues and in chronic cholecystitis.The expression of HIF-1α was correlated with lymph node metastasis and TNM staging in gallbladder cancer tissues (P ＜ 0.05).The wound healing rate after 48 h in the negative control group and in the treatment with hypoxia group (1％ O2) in GBC-SD cells were (46.5 ± 4.8) ％ and (67.3 ± 4.0) ％,respectively.The Transwell data showed that the numbers of metastasis after 24 h in the negative control group and in the treatment with hypoxia group GBC-SD cells were (147.4 ± 11.7) and (234.4 ± 17.7),respectively.When compared with the negative control group,treatment with hypoxia significantly increased the ability of metastasis and up-regulated the expression of HIF-1α and VEGF in GBC-SD cells (P ＜ 0.05).The wound healing rate after 48 h in the negative control group,the metformin group,the hypoxia group and the metformin and hypoxia group in GBC-SD cells were (40.6 ± 7.1) ％,(16.4 ± 9.4) ％,(69.5 ± 4.0) ％ and (22.4 ± 7.4) ％,respectively.The Transwell data showed that the numbers of metastasis after 24 h in the negative control group,the metformin group,the hypoxia group and the metformin and hypoxia group in GBC-SD cells were (148.4 ± 6.9),(90.0 ± 8.4),(185.8 ± 10.2) and (113.4± 8.6),respectively.When comparcd with the hypoxia group,treatment with metformin and hypoxia significantly decreased the ability of metastasis and down-regulated the expression of HIF-1α and VEGF in GBC-SD cells (P ＜ 0.05).The wound healing rate after 48 h in the negative control group,the 2MeoE2 group,the hypoxia group,the 2MeoE2 and hypoxia group in GBC-SD cells were (43.4 ±4.4)％,(25.9 ±9.0)％,(63.3 ±2.2)％,(46.2 ±4.5)％,respectively.The Transwell data showed that the numbers of metastasis after 24 h in the negative control group,the 2MeoE2 group,the hypoxia group,the 2MeoE2 and hypoxia group in GBC-SD cells were (144.2 ± 12.6),(80.2 ±7.7),(203.8 ±7.0),(124.0 ± 5.2),respectively.When compared with the hypoxia group,treatment with HIF-1α inhibitor 2MeoE2 and hypoxia significantly decreased the ability of metastasis and down-regulated the expression of HIF-1α and VEGF in GBC-SD cells (P ＜ 0.05).Conclusions The expression of HIF-1 α was correlated with lymph node metastasis and TNM staging in gallbladder cancer tissues.Treatment with hypoxia significantly increased the expression of HIF-1α and VEGF and promoted metastasis of GBC-SD cells,while treatment with metformin decreased the ability of metastasis induced by hypoxia via inhibiting the HIF-1o/VEGF pathway in GBC-SD cells.

Objective: To explore the clinical efficacy of S-1 single agent adjuvant chemotherapy for the patients undergoing radical resection of extrahepatic biliary carcinoma. Methods: The clinical data of 108 patients with extrahepatic biliary carcinoma receiving radical resection who were admitted from January 2014 to June 2017 were retrospectively analyzed. There were 62 males(57.4%)and 46 females(42.6%),with a median age of 59 years (range:26 to 79 years),10 cases(9.3%) in stage Ⅱ,85 cases(78.7%) in stage Ⅲ, and 13 cases (12.0%) in stage Ⅳ, 40 cases(37.0%) of hilar cholangiocarcinoma, 8 cases(7.4%) of middle cholangiocarcinoma, 25 cases (23.2%) of distal cholangiocarcinoma, 35 cases(32.4%) of gallbladder carcinoma.After radical resection of extrahepatic biliary carcinoma, 49 patients receiving S-1 single agent chemotherapy and 59 patients receiving non-special treatment were divided into the chemotherapy group and the operation group,respectively. All the dates of the patients were followed up and collected with the overall survival time,tumor-free survival time,1,2 and 3-year survival rate after operation,and the rate of major toxic reaction during chemotherapy of the chemotherapy group. Survival curve was drawn by the Kaplan-Meier method, and survival analysis was done using the Log-rank test. Results: There were no significant differences in the general date of two groups(sex, age, tumor size, tumor site, TNM stages, degree of differentiation). The median overall survival time and the median tumor-free survival time in the chemotherapy group were 27 months and 21 months,respectively,and in the operation group were 21 months and 17 months,respectively. There were differences between the two groups in the overall survival rates(χ²=3.967,P<0.05) and the 2 and 3-year survival rate(63.3%,36.6%;41.6%,20.4%;χ²=4.510,P<0.05;χ²=6.143,P<0.05),but the 1-year overall survival rate (83.4%,79.7%)was not statistically significant(χ²=0.286,P>0.05). There were no significant differences in the tumor-free survival time,1,2 and 3-year tumor-free survival rate(77.6%,41.4%,33.1%;62.7%,30.9%,21.2%)between the two groups(χ²=0.876,P>0.05;χ²=0.252,P>0.05;χ²=1.571,P>0.05;χ²=3.323,P>0.05,respectively). The main toxic reaction during chemotherapy were dyspepsia(28.6%, 14/49), anemia(26.5%, 13/49), and leukopenia(22.5%, 11/49), all of which were mild. Conclusion S-1 single agent chemotherapy after radical reseetion of extrahepatic biliary carcinoma could effectly improve the survival of patients and all of the main toxic reaction during chemotherapy were mild.

Objective: To investigate the effects of Kindlin-2 on malignant phenotypes of human gallbladder cancer cells and discuss the mechanisms. Methods: The expression level of Kindlin-2 in 30 cases of gallbladder cancer tissues and adjacent non-tumoral tissues collected from the First Affiliated Hospital of Zhengzhou University between September 2012 and May 2013 was assessed by real-time PCR and immunohistochemistry.Lentivirus-mediated Kindlin-2 overexpression was used in gallbladder cancer cell lines GBC-SD and SGC-996.Transwell assay and adhesion assay were investigated to explore the functional role of Kindlin-2 on gallbladder cancer cells.Western Blot was used to test the protein change of epithelial-mesenchymal transition(EMT) characteristics. The t-test was used to analyzed results. Results: The RNA and protein levels of Kindlin-2 in gallbladder cancer tissues were higher than in the non-tumoral tissues (t=4.372, P=0.001; t=7.477, P=0.000). The expression level of Kindlin-2 in gallbladder cancer tissues was correlated with Nevin stage(χ²=5.932, P=0.035). Compared with control groups, the cell-matrix adhesion ability of GBC-SD and SGC-996 with Kindlin-2 overexpression was obviously promoted(1.66±0.03 vs. 1.07±0.22, t=2.710, P=0.041; 2.66±0.24 vs. 1.03±0.02, t=6.610, P=0.020). The number of GBC-SD and SGC-996 cells with Kindlin-2 overexpression passing through the Transwell chamber matrix increased significantly compared with the control groups(116.1±13.9 vs. 54.7±8.4, t=3.781, P=0.019; 136.3±7.5 vs. 64.3±6.4, t=7.302, P=0.002). The wound healing rate of GBC-SD with Kindlin-2 overexpression at 12-hour and 24-hour was higher than that of the group ((42.9±2.2)% vs. (29.7±1.7)%, t=4.690, P=0.009; (65.0±2.4)% vs.(40.4±2.0)%, t=7.945, P=0.001). The wound healing rate of SGC-996 with Kindlin-2 overexpression at 12-hour and 24-hour was also higher than that of the group ((32.9±1.3)% vs. (24.1±1.5)%, t=4.518, P=0.011; (51.3±1.1)% vs. (39.2±1.1)%, t=8.001, P=0.001). The characteristics of EMT were induced in gallbladder cancer cells with Kindlin-2 overexpression, including the up-regulation of N-cadherin, Vemintin and the down-regulation of E-cadherin. Conclusion The expression of Kindlin-2 is up-regulated in gallbladder cancer tissues and Kindlin-2 promoted the malignant phenotypes of gallbladder cancer cells partially by epithelial-mesenchymal transition.

Objective To investigate the efficacy and safety of capecitabine in the treatment of colorectal cancer. Methods Totally 160 elderly patients with stageⅣcolorectal cancer were enrolled in this study. After first-line combined chemotherapy,80 patients were treated with capecitabine monotherapy(maintenance group)and another 80 cases were not(control group). The survival rate was analyzed by Kaplan-Meier curve and the efficiency and incidence of adverse events were compared. Results (1) The Kaplan-Meier curve suggested that the difference between two groups was statistically significant(P<0.05).(2)The response rate of maintenance group was significantly higher than that of control group (P < 0.05). (3)The incidence of adverse events during capecitabine monotherapy was lower than that during combined chemotherapy(P < 0.05).(4)The incidence of adverse reactions during capecitabine monotherapy was similar to that of control group(P > 0.05). Conclusion Capecitabine monotherapy in patients with stage Ⅳ colorectal cancer after combined chemotherapy has a longer median PFS than those without maintenance but similar adverse reactions ,which was worthy of clinical promotion.

Objective To investigate the application value of choledochoscopy and imaging examination in the diagnosis and treatment of residual bile duct stones.Methods The retrospective descriptive study was conducted.The clinical data of 618 patients who underwent choledochoscopy and imaging examination after operation of hepatolithiasis in the First Affiliated Hospital of Zhengzhou University between April 2014 and September 2018 were collected,including 300 males and 318 females,aged from 19 to 89 years,with an average age of (58 ± 12)years.Observation indicators:(1) situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination;(2) stone extraction situations of patients with hepatolithiasis.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage,and analyzed using the chi-square test or Fisher exact propability.Results (1) Situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination:all the 618 patients underwent choledochoscopy,and 505 of them underwent the imaging examination before choledochoscopy.① Of patients undergoing single imaging examination,72 received ultrasonography,with false-negative rate of 29.17％ (21/72);37 received CT examination,with false-negative rate of 10.81％(4/37);33 received T-tube cholangiography,with false-negative rate of 39.39％ (13/33).② Of patients undergoing combined two imaging examinations,61 received ultrasonography + CT,with false-negative rate of 8.20％ (5/61);129 received ultrasonography + T-tube cholangiography,with false-negative rate of 12.40％ (16/129);52 received CT + T-tube cholangiography,with false-negative rate of 5.77％(3/52).③ There were 121 receiving ultrasound+CT+T-tube cholangiography,with false-negative rate of 7.44％ (9/121).There were statistically significant differences in the false-negative rates of combined two or three examinations of ultrasound + CT+ T-tube cholangiography and single imaging examination (x2=40.83,P＜0.05).The further analysis showed a statistically significant difference among the single imaging examination (x2=7.70,P＜0.05).There was no statistically significant difference among the combined two of imaging examinations (x2=2.10,P＞0.05).There were statistically significant differences in the combined three examinations of ultrasound +CT+T-tube cholangiography and ultrasound and T-tube cholangiography examination respectively (x2=16.23,21.62,P＜0.05).There was no statistically significant difference in the combined three of imaging examinations and CT examination and combination of CT+T-tube cholangiography respectively (P＞ 0.05).There was no statistically significant difference in the combined three of imaging examinations and combination of ultrasound+CT examinations and combination of ultrasound+T-tube cholangiography (x2=0.33,1.71,P＞0.05).Seventy-one patients without residual bile duct stone by preoperative imaging examination were detected residual bile duct stones by intraoperative choledochoscopy,and residual bile duct stones of 36,31 and 4 patients are respectively distributed around the distal common bile duct,small intrahepatic bile duct,left and right hepatic ducts,common hepatic duct and remaining common bile duct.(2) Stone extraction situations of patients with hepatolithiasis:of 618 patients,cases with 1,2,3,4,5,6,7,8,9 and 10 times of residual bile duct stones clearance were respectively 392,116,48,39,9,6,3,2,2 and 1.Residual bile duct stones clearance frequency of patients was an average of 1.73 times.There were 63.43％(392/618) and 96.28％(595/618) of patients had stone clearance with once and ≤ 4 times of stone extraction,respectively.Conclusion The negative results of preoperative imaging examinations cannot be as standards of bile duct stone clearance before choledochoscopy,and the best choice is to detect whether there are residual bile duct stones and remove the stones combined with choledochoscopy.