Objective To analyze the surgical management and prognosis of hilar cholangiocarcinoma(HCC).MethodClinical data of 72 patients with HCC were retrospectively analyzed.Results There was a significant difference in the 3- and 5- year survival rates and median survivals among the groups treated with different surgical methods(x2 =28.1,P＜ 0.01 ).Univariate analyses conducted for the 16 factors which might affect prognosis showed the surgical method,lymphatic metastasis,positive margin,as well as the type of pathology and staging were of statistically significant prognostic value (P＜0.05).On a multivariate analysis using the Cox proportional hazards model,surgical management,lymphatic metastasis and the type of pathology and staging were independent prognostic factors (regression coefficient 1.4157,1.1072,1.6435).ConclusionRadical excision is an important prognostic factor for HCCa and extended resection improved the long-term survival rates of radical surgery.

Objective:To evaluate the value of CK19 mRNA detection in diagnosis of breast cancer. Methods: Patients were categorized into 3 groups:Group 1 consisting of 77 stageⅠ/Ⅱbreast cancer patients, group 2 consisting of 77 stage Ⅲ/Ⅳ breast cancer patients, and control group consisting of 40 non-cancer volunteers. Total RNA was extracted from peripheral blood cells with the RNA Kit as described by the manufacturer, which was followed by one step RT-PCR of RNA. Agarose gel electrophoresis and sequencing were carried out to confirm the amplification of expected sequence (314 bp). ?~2 test was used to compare CK19 mRNA positive rates in different stages of breast cancer. Results: 15/77 (19.48%) of stage Ⅰ/Ⅱ breast cancers patients, 31/77 (40.26%) of stage Ⅲ/Ⅳ breast cancers patients and 2/40 (5.00%) of non-cancer volunteers demonstrated positive RT-PCR results. The positive rate of CK19 mRNA in peripheral blood of stage Ⅰ/Ⅱ or stage Ⅲ/Ⅳ breast cancer patients was significantly higher than that of non-cancer volunteers(P=0.037, P=0.001). The positive rate of CK19 mRNA in peripheral blood of stage Ⅲ/Ⅳbreast cancer patients was significantly higher than that of stageⅠ/Ⅱbreast cancer patients(P=0.005). Conclusion: CK19 RT-PCR is a promising method for detecting circulating tumor cells in patients with breast cancer, which may provide valuable information for tumor staging and treatment.

Objective To establish a method for quantitative detection of hepatitis B virus covalently closed circular DNA(HBV cccDNA ) in infected cells. Methods The transfected cell line HepG2.2.15 which can consistently produce Dane particles was maintained in DMEM containing 380 ?g/ml G418 and 10% fetal bovine serum. Cells in the exponential period were harvested from flasks, then intracellular HBV cccDNA was extracted from pellet containing 1?10~6 cells with mini plasmid extraction kit (QIAGEN).The extraction product was further purified by mung bean nuclease to remove HBV relaxed circular DNA possibly remained. HBV cccDNA was quantitatively detected by fluorescent PCR with selective primer set and Taqman MGB probe. Culture medium before exponential period, HBV DNA positive and negative serum samples from patients with chronic hepatitis B (mild) were amplified simultaneously to test the specificity of the fluorescent PCR method. Plasmids containing whole HBV genome were amplified with the same primer set and fluorescent probe to determine the sensitivity of the method. Results HBV cccDNA was detectable in HepG2.2.15, and the average quantity was 18 copies per cell approximately. No detectable fluorescent signal was observed when culture and serum samples were amplified. The detectable HBV cccDNA was as low as 10~3 copies per ml at least by this method. Conclusions This method is convenient, highly specific and highly sensitive. It can be utilized in the quantitative detection of intracellular HBV cccDNA as well as in the screening and evaluation of antiviral agents.

OBJECTIVE To study the synchronous electromyograhic features of suprahyoid muscles [anterior digastric muscle(AD), posterior digastric muscle(PD),stylohyoid muscle(STH),mylohyoid muscle(MH)and geniohyoid muscle(GH)] and intrinsic laryngeal muscles [lateral cricoarytenoid muscle(LCA)and posterior cricoarytenoid muscle(PCA)]. METHODS Synchronous electromyograhic features of 13 dogs were observed under the circumstances of breath, swallowing and phonation. RESULTS ①AD, PD, STH, MH, GH and PCA discharged during inspiratory phase, while LCA discharged during expiratory phase. ②During swallow, suprahyoid muscles and LCA showed intensive synchronous discharge. The myoelectricity of PCA was suppressed while myopotential can be detected during intermission. ③During phonation, AD, PD, LCA and PCA showed an intensive synchronous discharge, while emergence time of PCA was later. GH and STH showed no myoelectricity activities. CONCLUSION①During phonation and swallowing, MH is synchronized with LCA. It can be chosen as the backup muscle for the reestablishment of glottic adduct function. ②During inspiratory phase, GH is synchronized with PCA. It can be chosen as the backup muscles for the reestablishment of vocal cord abduct function.

Objective To evaluate the feasibility and efficacy of Separate stent placement in the palliative treatment of inoperable malignant gastroduodenal obstruction.Methods Thirty four consecutive patients with inoperable malignant gastroduoenal obstruction were treated with peroral placement of Separate stent. Gastroduodenal obstruction was caused by gastric ( n =11), pancreatic ( n =12), matastatic ( n =3), biliary duct ( n =6) or duodenal ( n =2) cancers. Separate outer partial covered stent overlapping with inner bare stent were placed coaxially under fluoroscopic guidance.Results The technical successful rate reached 97% (33 of 34) with no major complication. Symptoms of gastroduodenal obstruction relieved in 33 patients. The average score of food intake capacity improved from 3.8 to 1.2 after Separate stent placment. Stent migration and tumor ingrowth were not detected during the follow up period. Tumor overgrowth was confirmed in one patient and a second stent was placed to solve the problem.Conclusions Peroral placement of Separate stent is a feasible and effective treatment for patients with inoperable malignant gastroduodenal obstruction.

Objective: To explore childhood traumatic experiences of OCD patients who were also diagnosed personality disorders (PDs) and those without PDs. Methods:SCID-I/P was administrated to diagnose OCD patients. PDQ+4 and PDI-IV were then administrated to 44 OCD subjects to determine whether they also suffered from personality disorders. Childhood maltreatment experiences of the sample were measured with Childhood Trauma Questionnaire (CTQ).50 normal control were also collected and subjected to CTQ-SF tests. Results:32 of 44 (72%) OCD patients also met DSM-IV criteria for personality disorders. OCD patients scored significantly higher than normal control in CTQ-SF (Childhood Truma Questionuaire-28 Short Form) and in all domains with the exception of physical abuse. Comparison between OCD subjects with PDs and normal control, the former scored significantly higher in emotional abuse (55.10/32.54), sex abuse (49.63/36.30), physical neglect (52.03/34.76), and emotional neglect domains (55.84/32.32). Whereas OCD subjects without PDs only scored significantly higher in emotional neglect domains compared with normal control (42.50/28.26).Conclusions:Subjects with PDs experienced more severe traumatic events during their early life. "pure OCD" patients, however, might experienced more emotional neglect.

Objective:To investigate the high risk factors of pelvic lymph node metastasis in patients with type Ⅰ endometrial carcinoma in order to provide the basis for making reasonable operation scope.Methods:Risk factors of pelvic lymph node metastasis were analyzed in 136 cases of type Ⅰ endometrial carcinoma.Univariate analysis was performed with Chi square test or Fisher's exact probability method,and multivariate analysis was performed with a logistic regression mode.Results:The positive rate of pelvic lymph nodes in 136 patients with type Ⅰ endometrial carcinoma was 9.56％ (13/136).Univariate analysis showed that histological grade,size of lesion,depth of myometrial invasion and vascular invasion were related to lymph node metastasis(P ＜0.05);Multivariate Logistic analysis showed that low differentiation,deep muscular invasion,tumor diameter≥2 cm and LVSI were independent risk factors of pelvic lymph node metastasis in patients with type Ⅰ endometrial carcinoma(P ＜0.05).Conclusions:The rate of pelvic lymph node metastasis is low in type Ⅰ endometrial carcinoma.Patients with low differentiation,deep muscular invasion,tumor diameter≥2 cm and LVSI are more likely to occur pelvic lymph node metastasis in type Ⅰ endometrial carcinoma.

Abstract Hypertensive disorders of pregnancy (HDP) are a common severe complication during pregnancy, which is characterized by complex etiology, unclear pathogenesis and lack of effective tools for early diagnosis and prediction. Recently, the development of omics technology provides new insights into the research into HDP. Based on national and international publications from 2011 to 2022, this review summarizes the application of genomics, proteomics, metabolomics, and microbiomics in the pathogenesis and prediction of HDP, so as to provide insights into the prediction, prevention and precise treatment of HDP.

Objective: To evaluate the efficacy of postoperative radiotherapy in the treatment of parotid gland carcinoma. Methods: Eighty-six postoperated patients with parotid gland carcinoma( 7 in stage Ⅰ, 28 in stage Ⅱ, 33 in stage Ⅲ and 18 in stage Ⅳ) were radiated by 60Co ?-ray or linear accelerator X-ray combined with electron beam. All patients were diagnosed by pathology and followed up for more than 5 years. Results: The five year survival rate and the local control rate were 73.3% and 87.2% respectively. Poor prognosis was observed in the cases with the neoplastic classification of undifferentiated carcinoma, sequamous cell carcinoma and malignant pleomorphic adenoma, but the better prognosis was obtained in the cases with acinic cell carcinoma and mucoepidermoid carcinoma. Poor prognosis was observed in the cases with stage Ⅲ and Ⅳ of clinical stage. Radiotherapy undertaken in 2 weeks after surgical operation gave higher 5- year survival ratio( 83.8%). The group given 51～60 Gy radiation showed 82.9% of five- year survival rate. Conclusion: The combination of surgery with radiation is effective in the treatment of parotid gland carcinoma.Radiation of 51～60 Gy 2 weeks after operation may result in better prognosis. Neoplastic type and clinical stage are important factors for prognosis.

BACKGROUND: The training task for aircrew of army airmen is very heavy, the evaluation of flight personnel on psychological diathesis is performed to early discover and deal with corresponding questions.OBJECTIVE: To compare the difference of mental health between aircrew and ground crew of army airmen and provide reference data for implementing corresponding norms.DESIGN: Chester sampling investigation and paired design were applied.SETTING: the 71687 Force of Chinese PLA, the 71521 Force of Chinese PLA, Department of Epidemiology, Fourth Military Medical University of Chinese PLAPARTICIPANTS: By chester sampling, 122 aircrew and 122 ground crew of one army airmen in one stationed training troop were randomized in February 2001. The pairs were made at ratio of 1:1 according to age difference less than 3 years and same sex and nationality. The investigated persons were all male, of Han and aged varied from 23 to 52 years.METHODS: Cornell health questionnaire was adopted respectively in investigation of aircrew and ground crew of army airmen. The investigated persons finished and handed in questionnaire independently on the spot in manner of secretion and centralized filling-up. Cornell health questionnaire is composed of 18 sections, including 195 questions, involving 4 aspects,named somatic symptoms, medial and family history, general health and habit and mental symptoms. The total score of Cornell health questionnaire ≥ 30 indicates somatic and mental disturbance and the score of mental section ≥ 10 indicates mental disturbance, both of which are taken as the criteria in comparison of psychological health in receptors of two groups.MAIN OUTCOME MEASURES: Every factor score and total score in somatic and mental sections in Cornell health questionnaire for aircrew and ground crew.RESULTS: The tested results of each 122 cases in either aircrew group or ground crew group entered result analysis. Evaluated results of somatic and mental symptoms in receptors of two groups: the total score was low in Cornell health questionnaire (0-14 scores), of which, the total score in aircrew group was higher than that in ground crew group (81.5% and 59.8%,P ＜ 0.05); the score in mental section was low (0-9 scores), of which, that in aircrew group was higher remarkably than that in ground crew group (99.2% and 91.8%, P ＜ 0.01); the score for the receptors with somatic and mental disturbance (total score≥30, score in mental section ≥ 10) in aircrew group was lower than those in ground crew group (4.1% and 12.3%, P ＜ 0.05); the score for the receptors with mental disturbance (score in mental section≥ 10) in aircrew group was lower remarkably than ground crew group (0.8% and 8.2%, P ＜ 0.01). For somatic section in aircrew group, except the factors of muscle, skeleton and skin, their scores were higher than those in ground crew group (P ＞ 0.05), the scores of the rest factors were all lower than those in ground crew group, of which, the difference was significant in evaluation of factors of eye, ear, nervous system, urinary reproductive system and fatigue in comparison of two groups (P ＜ 0.05). The score of every factor in mental section of aircrew group was lower than those in ground crew group. Except tension factor, in comparison of the rest factors in two groups, the significant difference was present (P ＜ 0.05).CONCLUSION: Overall psychological health state in Cornell questionnaire of aircrew in army airmen was superior to ground crew. Aircrew still presents a part of psychological health questions, mainly in somatic section and inadaptability was the most positive response in mental section, suggesting that aircrew probably presents inadaptable phenomena.