Objective To evaluate the correlation of the baseline clinical and laboratory test index with death,and to discuss the independent risk factors for long-term prognosis in elderly HIV/ AIDS patients who had accepted highly active antiretroviral therapy (HAART).Methods 1671 cases of HIV/AIDS patients were included in retrospective cohort study,divided into death group (183 cases) and non-death group (1488 cases) according to HIV/AIDS related death event,and followed up for 2 days to 120 months,an average of 427 days.Results During the period of followup,the proportion of male (12.45％) was higher than that of women (6.9％) in death group(x2 =10.42,P＜0.01).The mortality ratio of the WHO stage Ⅲ and Ⅳ was higher than that of the WHO stage Ⅰ and Ⅱ (x2 =18.67,P＜0.01).The mortality ratio was significantly higher in HIV/AIDS patients with baseline CD4+ T lymphocyte cell ＜100 cells/mm3 than ＞100 cells/mm3 (x2 =52.59,P＜0.01).The platelet (PLT),hemoglobin (HB),and blood glucose levels were lower in death group than in non-death group (P ＜ 0.05),but serum creatinine (SCR) and AST (aspartate aminotransferase) levels were higher than that in the non-death group (P＜0.05).There was no significantly differences between the death group and the non-death group in the index of white blood cell (WBC),blood urea nitrogen (BUN),total cholesterol (CH),triglyceride (TG),alanine aminotransferase (ALT) and total bilirubin (TB) levels (all P＞ 0.05).Multiple logistic regression analysis revealed that the WHO stage (OR=0.777,95％ CI:0.612～0.987,P＜0.05) and the baseline level of CD4+ T lymphocytes cell (OR=1.345,95％ CI:1.089～1.662,P＜0.01) were independent risk factors for long-term outcomes in elderly HIV/AIDS patients.Conclusions The WHO stage and baseline CD4+ T lymphocyte cell level are the independent risk factors for long-term prognosis in HIV/AIDS patients over 60 years of age.Early discovery and early beginning HAART can effectively improve the prognosis of elderly HIV/AIDS patients.

Objective To assess the effects of p27mt gene transfection on the proliferation and apoptosis of human hepatocellular carcinoma cell (HCC) lines SMMC-7721. Methods A replication deficient adenovirus vector encoding p27mt (Ad-p27mt) was used and p27mt cDNA was transfected into human SMMC-7721 cell lines in vitro. The synthesis of DNA in SMMC-7721 cells was determined by using 3H-thymidine incorporation; the cell apoptosis was determined by flow cytometry, TUNEL method and DNA fragmentation analysis. Results The virus titer was 7.95?1012 cfu/ml, the transduction efficiency was 100 % when multiplicity of infection ≥50, FCM analysis revealed a sub-G1 cell peak in Ad-p27mt transduced hepatocellular carcinoma cell lines. Agarose electrophoresis showed marked ladder .The difference of apoptotic index between the Ad-p27mt group and the control group was statistically significant (58.6?4.3, vs 4.5?1.6, P

Objective To investigate the micro-anatomical approach to resect both intracranial and extracranial jugular foramen tumors in one-stage. Methods With the aid of surgical microscope, fifteen cadaver heads were used to study the microsurgical anatomy of high cervical part and jugular foramen, measure relative data. Results Detailed dissection was performed on high cervical part between the 1st cervical vertebra and the 4th cervical vertebra, resect foramen processus transversi of the 1st cervical vertebra, free vertebral artery 2nd and 1st cervical vertebra segment and horizontal segment. The jugular tubercle, jugular tunisia and part of the occipital condylus was drilled away as much as possible, total exposure of lateral semicircular canal was completed after the removal of the mastoid revealed labyrinthinem. Then the sigmoid sinus and jugular bulb were skeletonized. The vertical of segment of facial nerve was fully skeletonized to study the necessity of the facial nerve translocation. Full exposure to the sigmoid sinus, open jugular foramen. JF areas expanded, and the measured parameters revealed. The distance was (29.65 ± 3.24)mm from mastoidalec to oncentrated focus of condyle (10.18 ± 0.81)mm from hinder margin of condyle to endostoma of hypoglossal canal. The left distance was (6.8 ± 0.35)mm from jugular foramen to perpendicular part of facial nerve, right was (4.6 ± 0.33)mm. Conclusions Total exposure of JF can be achieved through the approach we described, and will enable the facial nerve, cochlea, and the structure of the vertebral artery to be performed. Both intracranial and extracranial tumors can be removed in a one-stage procedure related to anatomical parameters. Improve the cure, reduce complication and lower mortality.

ObjectiveTo explore the surgical treatments and the efficacy of hilar cholangiocarcinoma.MethodsClinical data of 113 patients with hilar cholangiocarcinoma in District of Huangdao, the Affiliated Hospital of Medical College Qingdao University from June 1999 to June 2009 were studied retrospectively. The informed consents of all patients were obtained and the ethical committee approval had been received. There were 55 males and 58 females with age ranging from 37 to 70 years old and a median age of 61 years old. After admitted in hospital, the patients underwent a comprehensive medical examination and received routine tests of liver function, tumor markers and imaging examinations. The surgical treatments included radical resection, palliative resection, internal drainage and external drainage. The patients were followed up after operation. The operation, death and incidence of complications were observed. Survival analysis were conducted using Kaplan-Meier method and Log-rank test.ResultsThere were 22 cases with hilar cholangiocarcinoma of Bismuth-Corlette typeⅠ, 13 cases typeⅡ, 21 cases typeⅢa, 18 cases typeⅢb, 39 cases typeⅣ. The surgical resection rate was 72.6% (82/113), including radical resection (n=53), palliative resection (n=29), internal drainage (n=19), external drainage (n=12). Three cases died after operation, including 2 cases died of liver failure, 1 case died of upper gastrointestinal bleeding. After operation, upper gastrointestinal bleeding were observed in 3 cases, hepatic encephalopathy in 5 cases, bile leakage in 18 cases, abdominal infection in 3 cases, pleural effusion in 11 cases, wound infection and dehiscence in 7 cases. The 1-, 3-, 5-year cumulative survival rate were 76%, 39%, 11% respectively for patients of radical resection, 74%, 21%, 4% for palliative resection, 35%, 2%, 0 for internal drainage, and 28%, 0, 0 for external drainage. There were significant differences in the survival rates for patients of 4 surgical treatments (χ2=21.367,P<0.05).ConclusionImprovement of preoperative evaluation and selection of appropriate surgical approach help to improve the outcome and survival rate of patients with hilar cholangiocarcinoma.

Objective To study the clinical, endoscopic and pathological features of gastrointestinal and mesenteric reactive nodular fibrous pseudotumor (RNFPT). Methods A retrospective analysis was conducted on data of 24 RNFPT patients in Nanjing Drum Tower Hospital admitted from October 2008 to June 2016. The clinical, endoscopic, pathological and immunohistochemical characteristics were analyzed. Results Among the 24 patients, 16 complained about discomfort in the upper abdomen and 10 had a history of surgery or trauma. Twenty-one had isolated masses and 3 had multiple masses, with diameter of 0. 5-4. 0 cm. Endoscopically, the tumors were mainly hard submucosal masses with broad base, and smooth surface with no mucosal bridge. Seventeen patients underwent endoscopic ultrasonography, which showed low echoes in lesions and nonuniform echoes partly. Among them, 13 lesions derived from muscularis, 4 others from submucosa. Microscopically, the tumors had clear boundary with no envelope, and most areas showed disorderly arranged spindle cells and extensively collagenous degenerated mesenchyma. The spindle cells had shuttle fibroblast-like morphology and elongated nucleus with no visible necrosis or mitosis. Inflammatory cells scattered between the tumor cells, and lymphoid follicles and calcium deposition could be seen in local areas. Immunohistochemically, SMA was focally positive in 7 cases and only 4 cases expressed CD117 scattered. Desmin, Dog-1, CD34, ALK-1 and S-100 were all negative, and Ki-67 proliferation index was lower than 1％. Conclusion RNFPT has diverse clinical manifestations, with a good prognosis and unlikely recurrences, and should be distinguished from spindle cell tumors.

Objective:To understand the duration of survival and related influencing factors of HIV/AIDS patients in Liuzhou city.Methods:Both life table method and Kaplan-Meier method were used to calculate the average survival time of HIV/AIDS patients aged ≥15 years reported in Liuzhou city from 2008 to 2018. Factors related to the duration of HIV/AIDS patients were analyzed by univariate and multivariate Cox regression models.Results:A total of 14 856 patients with HIV/AIDS were involved in this study and with the average duration of survival time as 98.74 (95 %CI: 97.73-99.75) months. The cumulative survival rates of 1, 3, 5 and 10 years were 77.0%, 72.0%, 68.0%, 61.0% respectively. Results from the multivariate Cox proportional risk regression analysis showed that factors as sex, level of education, age when HIV infection was confirmed, occupation, route of transmission, source of samples, results of the first CD 4 test and antiviral treatment were all related to the duration of survival to the HIV/AIDS patients. Conclusions:Strategies involving early detection of HIV infection, improvement of the CD 4 initial detection rate and early antiviral treatment will help to significantly reduce the risk of death in HIV/AIDS population. Focus should be on male, middle-aged and elderly (over 41 years old), junior high school education or below farmers and migrant worker populations.