Cholangiocarcinoma is a malignant tumor that occurs in the bile duct epithelium,it is the second most common malignant tumor of the liver and bile duct after hepatocellular carcinoma.Imaging examination is an important method to detect bile duct cancer;the purpose of imaging is to determine the location of the tumor,and the extent of invasion and distant metastasis.Different imaging methods have their advantages and disadvantages,so they should be chosen based on the condition of patients,or be optimized as the combined detection.

BACKGROUND:A few studies have reported that autologous chondrocyte implantation is better than microfracture for treating cartilage defects of the knee. But there are few meta-analyses on the clinical outcomes of autologous chondrocyte implantation versus microfracture. OBJECTIVE:To evaluate the effects of autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee based on existing clinical data. METHODS:A systematic search for control ed clinical trials or control ed prospective observational studies published from 1979 to January 2015 was done in electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Central Register, Wanfang, CNKI and VIP. The literatures about the effects of autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee were retrieved. We screened the retrieved literature according to the inclusion and exclusion criteria and performed a Meta-analysis with the software RevMan 5.2 after identification of the relevant data. RESULTS AND CONCLUSION:Eight studies were enrol ed according to the selection criteria, which revealed a statistical y significant difference, representing a clinical y relevant superiority of autologous chondrocyte implantation over microfracture, in IKDC scores at final fol ow-up [weighted mean difference (WMD),-9.93;95%confidence interval (CI):-13.16 to-5.43;P<0.000 01] and available scores at 5-year fol ow-up [standard mean difference (SMD),-0.30;95%CI: -0.55 to-0.05;P=0.02). In contrast, there were no significant differences, thus representing no clinical relevant superiority of microfracture versus autologous chondrocyte implantation, in Tegner scores at final fol ow-up (WMD=0.44;95%CI:0.04 to 0.84;P=0.03), Lysholm scores at final fol ow-up (WMD=-10.21;95%CI:-33.68 to 13.26;P=0.39), and available scores at 2-year fol ow-up (SMD=-0.25;95%CI:-0.92 to 0.43;P=0.47). These findings demonstrate that autologous chondrocyte implantation can result in a better long-term outcome than microfracgure. However, whether autologous chondrocyte implantation has a better treatment effect than microfracture in general needs more research.

Objective To analyze the clinical feature of thalassemia with pulmonary hypertension and investigate the influence of pulmonary hypertension on thalassemia.Methods From June 2007 to July 2011,clinical data of 19 patients with thalassemia complicated with pulmonary hypertension in TEDA International Cardiovascular Hospital of Tianjin Medical University and Affilated Hospital of Guilin Medical College were analyzed retrospectively.Twenty-two cases of thalassemia without pulmonary hypertension were as a control group,and follow-up time was set as 4 months to 24 months.Observed indicators included age,hemoglobin(Hb),lactate dehydrogenase (LDH),serum ferritin (SF),tricuspid regurgitation velocity (TRV) and left ventricular ejection fraction (LVEF).Results SF and TRV of the case group[(693.6 ± 234.6)μg/L and (2.6 ± 0.1)m/s] were significantly higher than those of the control [(209.5 ± 100.1) μg/L and (2.1 ± 0.3)m/s,all P ＜ 0.05]; but the differences between case and control group in Hb[(90.8 ± 10.7)g/L vs (89.3 ± 10.5)g/L],LDH[(320.9 ± 103.7)U/L vs (355.8 ± 140.3)U/L] and LVEF[(66.2 ± 7.1)％ vs (64.2 ± 4.7)％] were not statistically significant (all P ＞ 0.05).Logrank analysis showed that the prognosis was poor in patients with thalassemia complicated with pulmonary hypertension (x2 =4.95,P ＜ 0.05).Multiple regression analysis indicated that age and serum ferritin remained as predisposing risk factors for tricuspid regurgitation velocity,and serum ferritin had a greater impact on the velocity.Conclusion In patients with thalassemia complicated with pulmonary hypertension,the prognosis is poor; age and SF may be factors involved in the development of pulmonary hypertension.

BACKGROUND:Effects of different oxygen partial pressures on cytokine secretion of human adipose-derived stem cells have been differently reported. These differences may be caused by varying oxygen partial pressures.
OBJECTIVE:To investigate the influence of different oxygen partial pressures on cytokines secreted from human adipose-derived stem cells.
METHODS:Human adipose-derived stem cells were cultured in vitro and identified by its immunophenotype. Human adipose-derived stem cells were divided into five groups and cultured under different oxygen partial pressure conditions (1%, 3%, 5%, 10%, 21%) for 24 hours, respectively. With quantitative real-time PCR and enzyme linked immunosorbent assay, the secretion of cytokines, vascular endothelial growth factor, hepatocyte growth factor, nerve growth factor, keratinocyte growth factor, from human adipose-derived stem cells were analyzed on the gene and protein levels.
RESULTS AND CONCLUSION:Human adipose-derived stem cells were positive for CD71, CD73, CD90, CD105 and negative for CD34, CD45, CD54, HLA-DR. From the aspect of gene level, hypoxia (1%, 3%O 2 ) promoted the expression of vascular endothelial growth factor and nerve growth factor from human adipose-derived stem cells (P<0.01), and significantly elevated the expression of hepatocyte growth factor (P<0.05);however, there was no significant influence on keratinocyte growth factor under hypoxia (P>0.05). Based on the protein level, protein secretion of hepatocyte growth factor and vascular endothelial growth factor from human adipose-derived stem cells was increased under hypoxia (P<0.01), but no changes occurred in nerve growth factor and keratinocyte growth factor. After cultured under hypoxic environment, human adipose-derived stem cells were promoted to express gene vascular endothelial growth factor, hepatocyte growth factor and nerve growth factor, as wel as to secrete protein keratinocyte growth factor and vascular endothelial growth factor.

Objective To explore whether Forkhead O transcription factor-3a (FoxO3a) activity affects the capability of sphere-formation of ovarian cancer SKOV3 cell line.Methods Sphere-forming cells (SFCs) were obtained and amplified through suspended culture with conditioned medium of the stem cells in SKOV3 cell line.After SKOV3 cells were transfected with FoxO3a specific siRNA,the protein expressions of FoxO3a and Bmi1 and the ratio of sphere-formation were compared with Western blot and sphere-forming assay,respectively.Results Compared to parental cells,SFCs from SKOV3 cell line had higher ratio of sphere-formation and over-expressed Bmi1 and pFoxO3a.Transfection of FoxO3a specific siRNA down-regulated the protein expression of FoxO3a and upregulated expression of Bmi1 in SKOV3 cells,and enhanced the capability of sphere-formation.Conclusions Silence of FoxO3a leads to enhanced capability of sphere-formation in SKOV3 cell line.

Objective To investigate the adjustment of miRNA-155 on CD4+ CD25+ Treg regulative T cell in peripheral blood in patients with acute cerebral infarction (ACI) and its pathogenesis. Methods Sixty patients with ACI were divided into three groups according to clinical neurological deficit score. Twenty healthy volunteers were enrolled into the control group. The expression levels of plasma miR-155 mRNA and Foxp3 mRNA were detected by real-time quantitative PCR(qRT-PCR). IL-10 levels in plasma were detected by ELISA. Results Expression of miR-155, Treg, Foxp3 mRNA and levels of IL-10 were significantly increased in patients with ACI compared with normal control group, with statistical differences; Expression of miR-155, Treg, Foxp3 mRNA and levels of IL-10 were gradually increased. The values showed significant statistical difference among the mild, moderate and severe ACI groups (P < 0.01). Among the patients,the levels of miR-155, Treg, Foxp3 mRNA and levels of IL-10 in the survival group were obviously lower than those in the non (P<0.05 or P<0.01). There was a positive correlation between miR-155 and Treg, Foxp3 mRNA (P < 0.01). Conclusion This study suggests that miR-155 is involved in the cell proliferation regulation of CD4+ CD25+ Treg cells,and plays some role in the immunological dissonance with ACI.

Objective To study the efficacy of combining Entecavir with TACE to treat patients with primary hepatocellular carcinoma with undetectable levels of HBV-DNA.Methods From Aug 2011 to Sep 2013, patients with HBV-related hepatocellular carcinoma but with undetectable levels of HBV DNA who underwent TACE were divided into the treatment group (treated with Entecavir antiviral therapy) and the control group.The endpoints of the study were HBV reactivation rates, liver function, and survival rates.Results Using our predefined inclusion and exclusion criteria, 64 patients with primary liver cancer were divided into the treatment group (n =32) and the control group (n =32).The transaminase and bilirubin levels were raised and the albumin level was reduced at 5 days after TACE.However, there were no significant differences between the 2 groups (P ＞0.05).At 12-month follow-up after TACE, 8 (25.0％) patients developed HBV reactivation in the control group and 2 (6.3％) in the treatment group, the difference was significant (P ＜ 0.05).The level of transaminase was significantly higher in the HBV reactivation group when compared with the no HBV reactivation group (P ＜ 0.05).The overall 6-and 12-month survival rates in the treatment group and the control group were 93.8％ and 84.4％ vs 90.6％ and 59.4％ respectively.There were significant differences in the 12-month survival rates (P ＜ 0.05).Conclusion Entecavir combined with TACE to treat patients with HBV-related primary liver cancer with undetectable HBV-DNA effectively reduced HBV reactivation and improved survival at 12 months.

Summary: Glomerulosclerosis, defined as phenotype transition of mesangial cell and deposition of extracelluar matrix, remains a chronic disease with excessive morbidity and mortality. The molecular mechanism underlying the suppression of mesangial cell activation is not fully understood. Since activation of peroxisome proliferators-activated receptor γ (PPAR1,) has been proposed to decrease the effects of transforming growth factor-β (TGF-β) on glomerulosclerosis, we examined here whether and how telmisartan, an angiotensin Ⅱ type Ⅰ receptor blocker with PPARγ-modulating activity, inhibited TGF-β-induced giomerulosclerosis in rat glomerular mesangial cells. Protein levels of PPARγ were detected by Western blot. Activation of PPARγ response element (PPRE) was analyzed by luciferase assays. Deposition of extracelluar matrix was tested by confocol laser scanning. The results showed that telmisartan, but not valsartan, another angiotensin Ⅱ type Ⅰ receptor blocker,up-regulated PPARγ protein levels in a dose-dependent manner (P<0.05). Activation of PPRE, represented by luciferase activity, was also increased with higher concentration of telmisartan in a dose-dependent manner (P<0.05). Furthermore, telmisartan inhibited TGF-β-induced α-smooth muscle actin expression and collagen IV secretion in mesangial cells. GW9662, an inhibitor of PPAR-γ,blocked the inhibitory effects of telmisartan on TGF-β-induced glomerulosclerosis in mesangial cells. Our study indicates a benefit of telmisartan as a PPARγ agonist against TGF-β-induced mesangial cells activation in renal glomerulus. It may provide possibility that telmisartan works as a potential agent against diabetic nephropathy and hypertensive renal disease.

Objective:To investigate the effects of ulinastatin combined with meropenem on immune function, interleukin 2(IL-2), interleukin 4(IL-4), interleukin-6(IL-6), interleukin 10(IL-10) and tumor necrosis factor (TNF-) levels in elderly patients with severe infection.Methods:From January 2016 to June 2018, 60 elderly patients with severe infections admitted to the Second People's Hospital of Lishui were randomly divided into control group(30 cases) and observation group(30 cases). The patients in the control group were treated with meropenem, while the patients in the observation group were treated with ulinastatin on the basis of the control group.Both two groups were treated for 14 days.The therapeutic effects, changes of T lymphocyte subsets, IL-2, IL-4, IL-6, IL-10 and TNF-levels, recovery time of gastrointestinal function and occurrence of systemic inflammatory response syndrome(SIRS) before and after treatment were compared between the two groups.Results:The total effective rate of the observation group(93.33%) was higher than that of the control group(66.67%)(χ 2=6.667, P<0.05). After treatment, CD 3+ [(64.38±3.19)%], CD 4+ [(40.39±2.35)%]and CD 4+/CD 8+ (1.65±0.19) in the observation group were higher than those in the control group[(58.94±3.56)%, (35.47±2.87)% and (1.34±0.14)]( t=6.233, 7.265, 3.834, all P<0.05). The serum levels of IL-2[(126.87±17.49)ng/L], IL-4[(8.98±2.14)g/L], IL-6[(176.89±23.1)ng/L], IL-10[(37.94±12.56)ng/L] and TNF-α[(163.45±17.96)ng/L]in the observation group were lower than those in the control group[(343.27±28.56)ng/L, (19.65±4.56) g/L, (346.37±38.98)ng/L, (83.21±18.56)ng/L and (254.37±23.45)ng/L]( t=35.392, 10.602, 20.476, 11.064, 16.860, all P<0.05). The recovery time of gastrointestinal function in the observation group[(5.31±1.29)d] was shorter than that in the control group[(6.97±1.43)d]( t=4.721, P<0.05), while the incidence of SIRS(13.33%) was lower than that in the control group(43.33%)(χ 2=6.648, P<0.05). Conclusion:Ulinastatin combined with meropenem is effective in the treatment of elderly patients with severe infection.It can improve the immune function of the patients, reduce the levels of IL-2, IL-4, IL-6, IL-10 and TNF-, and alleviate the inflammatory reaction.It is worthy of clinical reference.

Portal vein tumor thrombus (PVTT) is a common finding in patients with advanced hepatocellular carcinoma (HCC),and the presence of PVTT usually indicates a poor prognosis.At present,two PVTT classifications are adopted in clinical practice;they are VP classification of Japan and eastern hepatobiliary classification (Cheng's classification).There are some differences in PVTT classification between the above two typing criterion.Certain correlation exists between patient's prognosis and PVTT typing;for example,PVTT of type Ⅰ0 carries the best prognosis,while PVTT of type Ⅳ indicates the worst prognosis.The choice of treatment plan is limited by the type of PVTT for a given patient.Therefore,the optimal therapeutic regimen should be formulated based on the type of PVTT in order to control HCC and to benefit the patient.