Intrahepatic cholangiocarcinoma is an uncommon malignant tumor,and its incidence has been increasing in the recent 30 years. Since patients have no specific clinical manifestations in early stage,the diagnosis of this disease is often very difficult,with a low rate of radical resection in late stage and poor prognosis.Therefore,as for patients with intrahepatic cholangiocarcinoma,early screening and diag-nosis is of vital importance.Imaging examination is an important method for the diagnosis of intrahepatic cholangiocarcinoma,and when com-bined with laboratory markers and pathological examination,it can increase diagnostic rate and reduce the rate of missed diagnosis.It is im-portant in clinical practice to select reasonable methods based on the patient′s actual condition.

Objective To detect the gene expression difference between gastric cancer tissue and lymph node metastasis,screen different express genes,and study its mechanism of metastasis and the relationship with biological behavior.Methods Using U133plus 2.0 gene chip technology,we detected the gene expression difference between gastric cancer tissue and epithelial cells of lymph node metastasis in five patients,and screened out the differentially expressed gene Twist-l.In vitro,the cell proliferation and apoptosis level were measured by using gene over-expression and gene knockout.Metastasis ability of carcinoma cells was detected by cell scratch assay.The expression changes of epithelial-mesenchymal transition (EMT)-associated protein (E-cadherin,Vimentin) in Twist-1 overexpression and gene knockout cells were determined by Western blot.Finally,we detected the expression of Twist-1 in gastric cancer tissue,and its correlation with TNM stage was analyzed.Results The expression of Twist-1 was higher in epithelial cells than in gastric cancer tissue (12.12±3.21 vs.2.07±0.71,P＜0.01).There was no correlation of the expression of Twist-1 with cell proliferation(absorbance of cell proliferation:negtive control 0.84±0.16,null vector control 0.74 ±0.06 and Twist-1 expression cell 0.71 ± 0.07) and apoptosis [cell apoptosis rate:negtive control (2.05±0.08)％,null vector control (4.31±0.07)％ and Twist-1 expression (3.95±0.09)％],but cell migration ability enhanced.In Twist-1 over-expression group,the level of E-cadherin was decreased,while vimentin increased.Conclusions Twist-1 gene changes might be correlated with the metastasis of gastric cancer by the way of EMT.

Objective To retrospectively investigate the endoscopic characteristics and pathological features of colorectal polyps in over-aged patients (≥80 years). Methods The 1617 colonoscopies performed between January 2006 and December 2010 were enrolled in our retrospective analysis. The detection rate, size, location, form and pathological feature of polyps in 150 over-aged patients were investigated, and they were compared with those in 832 young patients (＜60 years) and 635 old patients (60-79 years) with colorectal polyps. Results The detection rate of polyps was 62.0% in over-aged group, and was significantly higher than in young group and old group (30.2% and 48.7%, respectively, χ2=56.58 and 8.64,both P＜0.001). The malignant transformation rate of ascending colon polyp was 5.4% in over-aged group, and was significantly higher than in young group (1.2%, χ2=4.90, P＜0.05), but there was no significant difference between over-aged group and old group (3.9%, χ2=0.36, P＞0.05). There were no statistical differences in canceration rate, polyp diameter, morphology and adenomatous polyp rate among the three groups. The malignant transformation rate was significantly increased in adenomatous polyps with diameter over 2 cm, but didn't reach statistical significance. Conclusions The polyp detection rate is noticeably higher in the over-aged than in the old and the middle-aged, and the malignant transformation probability is also increased. The colonoscopy indications in the high risk age groups should appropriately be broadened, they should receive regular intervals follow-up, and undergo polypectomy in time if necessary.

Objectives To determine the incidence of de novo neoplasms after liver transplantation and methods of prevention.Methods The clinical data of 605 patients after liver transplantation carried out from May 2000 to December 2010 in our centre were analysed.The patient's gender,age,primary disease and the clinical characteristics of post-transplantation de novo neoplasms were analysed.Results The incidence of de novo post-transplantation neoplasms was 1.80％.There was one case of post-transplantation lymphoproliferative disorders (PTLD),one case of pulmonary blastoma,one case of acute myelogenous leukemia,one case of bladder tumor,one case of gastric carcinoma,one case of sigmoid colon carcinoma,one case of carcinoma of rectum,one case of renal clear cell carcinoma and two cases of hepatocellular carcinoma.Conclusion There was a low incidence of de novo posttransplantation neoplasm in our centre than that reported in the West,probably because of variations in patient selection,immunosuppression regimens used,patients' age and different patient ethnic groups.Early diagnosis and treatment of de novo neplasm helped to improve prognosis.

Objective To compare the clinical effects of patellar resurfacing with patella reservation and patellaplasty in the total knee arthroplasty(TKA)for osteoarthritis so as to discuss appropriate management of patellas in TKA.Methods A retrospective study was conducted on 198 patients with osteoarthritis treated by TKA from January 2002 to December 2008.There were 62 patients managed by patellaplasty(patellaplasty group)and 136 patients by patellar resurfacing with patella reservation(patellar resurfacing group).The osteophytes of the patella were removed to make the articular surface of patellas similar to the primary one.Knee Society Score(KSS),Bristol patellar score,satisfaction survey and evaluation of joint range of motion(ROM)were performed during the regular follow-up.Incidence of postoperative anterior knee pain were analyzed and X-ray films were reviewed to understand the condition of the implants.Results A total of 125 patients were followed up,including 43 patients from the patellaplasty group and 82 from the patellar resurfacing group.The mean follow-up period was 51 months(range,36-80 months).Both groups showed significant improvement of each score postoperatively.No significant differences were found between the two groups regarding KSS score,patellar score and patient satisfaction in the follow-up one year later;but KSS function score in the patellar resurfacing group was superior to that in the patellaplasty group,with statistical difference.The incidence of anterior knee pain of the two groups had no statistical significance.Postoperative radiographs revealed no significant differences between the two groups concerning patellofemoral congruence,incidence of postoperative anterior knee pain or incidence of patellar related complications.Conclusion Patellar resurfacing with patella reservation for osteoarthritis in TKA can achieve satisfactory patellofemoral congruence and low incidence of intraoperative anterior knee pain,with comparable mid-term results with patellaplasty.

Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement.

Objective To statistically analyze data of blood transfusion from General Hospital of Chengdu Military Command,Mianyang field blood station,Deyang field blood station and other military medical institutions from May 12 to June 30,2008 so as to provided certain references for reasonable blood supportability in wartime and disaster.Methods A statistical analysis was done on data of blood collection and supply including self-taken blood and assembled blood,total amount of blood supply as well as the transfusion information of inpatients injured by earthquake in our hospital.Results The amount of self-taken blood was 5 111 U,the amount of assembled blood 3 380 U and the total amount of blood supply 1 0405.5 U.But blood transfusion was 4 090.6 U in 132 patients admitted into General Hospital of Chengdu Military Command.In addition,the crest-time of transfusion appeared at 96 hours after earthquake.Moreover,patients with fractures received the highest rate of blood transfusion and crush syndrome patients received the most blood transfusion and the highest per capita transfusion.Conclusions Blood supportability in earthquake is different from that in wartime and other disasters in aspects of transfusion time,blood types and blood transfusion volume.It is important to analyze the characteristics of transfusion in patients injured by earthquake for national strategy of blood supportability in disasters and for blood supportability in the wartime.

ObjectiveTo develop a quantitative method for simultaneously determining multi-components in Rhei Radix et Rhizoma using one chemical reference substance.MethodsThe contents of multi-components were calculated by the UV relative correction factors (RCFs) of chrysophanol,physcion,and rhein to emodin.ResultsThe values of RCFs at 274 nm for rhein,chrysophanol,and physcion to emodin were 0.712,0.674,and 1.051.The calibration curves were linear over the ranges of 0.02-4.08,0.02-4.12,0.07- 12.92,and 0.02-3.68 μg/mL for rhein,emodin,chrysophanol,and physcion,respectively.The contents of emodin in 18 samples were determined by the extemal standard method,and the contents of the other three anthraquinone aglycones were calculated according to their RCFs.ConclusionNo significant difference is found in comparison with the classical method,indicating that the RCFs have high reliability within their linear ranges and could be used in quality control of Rhei Radix et Rhizoma.The quantitative analysis of multi-component with a single marker is especially suitable for herbal medicines containing unstable or hard to be purified components as quality control markers.

OBJECTIVE:To explore the effect of prophylactic use of vitamin B6 with chlorpheniramine on the adverse reactions in fundus fluorescein angiography (FFA). METHODS:326 patients with FFA were randomly divided into observation group and control group. Observation group was orally given Vitamin B6 tablet 10 mg 30 min before angiography+Chlorpheniramine maleate tablet 4 mg;control group was orally given Metoclopramide tablet 10 mg+Chlorpheniramine maleate tablet 4 mg. The occurrence time and incidence of adverse reactions in 2 groups were observed and correlation analysis was conducted. RESULTS:There was no significant difference in the occurrence time of adverse reactions between 2 groups(P>0.05);the incidence of adverse reactions in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). The correlation analysis of adverse reactions in control group showed the occurrence of adverse reactions had no correlation with age and gender of patients(P>0.05). CONCLUSIONS:Prophylactic use of vitamin B6 with chlorphenir arnine can reduce the occurrence of adverse reactions in FFA.

Objective To investigate the differential diagnosis and management of IgG4 associated biliary pancreatic diseases.Methods A total of 18 patients with jaundice and abdominal pain were retrospectively studied.The final diagnosis was 7 cases of type Ⅰ autoimmune pancreatitis (Ⅰ-ALP),4 cases of IgG4-associated sclerosing cholangitis (IgG4-SC),and 7 cases of I-AIP combined IgG4-SC.Results (1)Imaging features:I-AIP patients showed pancreatic head mass,with relatively poor blood supply when under dynamic contrast-enhanced scan,in delay image,enhanced amplitude more than the normal pancreas.IgG4-SC can be seen in patients with symmetrical bile duct wall stenosis and (or) soft tissue mass,the thickened bile duct wall and intraluminal soft tissue mass can be enhanced with bile duct wall thickening.(2) Serological characteristics:Serum IgG4 fluctuated between 59.3 and 1 120.0 mg/dl,CA19-9 fluctuated between 12.2 and 230.8 U/ml.(3) Histopathology:Plasma cells lymphocyte infiltration and fibrosis,immunohistochemical staining showed IgG4 positive cells ＞ 10/hpf,and obliterative phlebitis.(4) Combined with other organ lesions in 6 cases including renal injury,retroperitoneal fibrosis,mesenteric inflammatory nodules,omental inflammatory nodules,submandibular gland enlargementin,and pituitary inflammation.(5)Response to hormone therapy:4 out of 6 operated patients were none resected and we re given hormonotherapy.In twelve non-surgical patients,2 cases abandoned therapy,10 cases were treated with hormone therapy,and improved.Conclusion IgG4 associated biliary pancreatic disease characterized by localized pancreatic or bile duct disease,can be distinguished from malignancy by special imaging,IgG4 elevation,histopathology and positive response to experimental hormonotherapy.