Hilar cholangiocarcinoma is a rare biliary malignant tumor derived from the biliary epithelial cell. The primary current treat-ments for hilar cholangiocarcinoma include surgery and chemotherapy, as well as radiation and photodynamic therapies (PDT). A com-plete resection with negative margins is the only treatment with the potential for cure and the only way to maximize survival. Howev-er, over half of the patients in the advanced stage of hilar cholangiocarcinoma lost the chance for surgery. Radiotherapy and chemo-therapy can prolong patient survival;however, these lack reliable data. Most patients who cannot be treated surgically undergo biliary stenting to relieve the biliary obstruction. The PDT is a new method to treat various malignant tumors. Several clinical studies have shown its local tumor ablation capability. Thus, PDT has broad application prospects in the treatment of unresectable hilar cholangio-carcinoma.

Objective To detect the expression and effect of human tumor necrosis factor related apoptosis-inducing ligand (hTRAIL) in vivo,by using a novel double expressing adenoviral vector encoding hTRAIL and firefly luciferase ( luc ) gene ( ad -luc-hTRAIL),in which luc was used as reporter gene.Methods Lung cancer A549 cell xenografts in 16 nude mice models were established in subcutaneous inoculation way,the adenovirus vectors ( ad-luc-hTRAIL,ad-hTRAIL,ad-luc) and phosphate buffer saline (PBS) (n =4) as control were injected into tumor respectively.The size of the tumor was measured at different time points (4,7,10,14,21,28 d)after injection.The activity of luciferase in surface of the tumor was detected in vivo by using high-sensitivity cooled-charged coupled device(CCD) camera.The expression of hTRAIL was demonstrated by immunohistochemistry staining after sacrificing the animals at different time points,and immunohistochemical scores (IHS) were measured. The apoptosis rate of tumor cells was detected by using TUNEL and calculated. Analysis of variance,the paired t test and linear correlation analysis was used for the statistics. Results The growing speed of tumour xenografts was more slowly in ad-luc-hTRAIL and ad-hTRAIL groups than PBS group (t =2.71,2.72,P ＜ 0.05 ).The tumor volumes of ad-luc-hTRAIL,ad-hTRAIL,ad-luc and PBS groups 28 days after injection were (208.4 ± 42.3 ),( 181.5 ±23.9),( 403.1 ± 54.0 ) and ( 427.0 ± 59.3 ) mm3, respectively. There was no significant difference between ad-luc group and PBS group(t =2.07,P ＞ 0.05).The expression of luciferase in ad-luc-hTRAILgroup reached its peak at 7th day ( 1.37 ± 1.04),and then decreased quickly.The IHS and apoptosis rate in ad-luc-hTRAIL and ad-hTRAIL groups reached their peaks at 7th day,the peak values of IHS were 6.25 ±2.06 and 6.5 ± 2.89,the peak values of apoptosis rate were (60.75 ± 8.06 ) ％ and ( 61.50 ± 8.47 ) ％,respectively.The amount of luciferase expression ( absolute number of photons detected by CCD camera)was linear positive correlated with IHS and apoptosis rate ( rphotons/IHs =0.942,rph /rate =0.842,rIHs/rate =0.887,P ＜ 0.05 ).Conclusion The target gene hTRAIL can be transfected into lung cancer A549 cell xenografts nude mice models efficiently with a high level expression,and the therapeutic effect of hTRAIL can be monitored by detecting the expression of luc.

Objective:To investigate the mechanism of Buguozhi Decoction in improving learning-memory of vascular dementia model rats.Methods:The rat models with VaD were established by bilateral occlusion of both common carotid arteries(2 一V0).The gene expressions of ER-?,NR2B were evaluated by RT-PCR and immunohistochemistry.Results:Buguozhi Decoction can significantly improve mRNA and protien pruducts of ER-?,NR2B gene in hippocampus of the vascular dementia model rats,compared with the model group(P

Objective To investigate the efficacy of precise hyperthermic intraperitoneal perfusion chemotherapy (HIPEC) in the treatment of advanced pancreatic cancer.Methods Thirty-six patients with advanced pancreatic cancer were analyzed retrospectively.Eighteen patients who received HIPEC combined with radiotherapy and chemotherapy were assigned as the treatment group and the other 18 patients who received chemotherapy and radiotherapy were assigned as the control group.Recent curative efficacy,Karnofsky Performance Status (KPS) score,postoperative complications and survivals between the two groups were analyzed,respectively.Results Significant differences were found between two groups in total short-term effective rate (P ＜ 0.05).The total short-term effective rate of treatment group and control group were 66.67％ (12/18) and 27.78％ (5/18),respectively.The increment of KPS score of treatment group was significantly higher than that of control group (P ＜ 0.05).There was no significant difference between two groups in postoperative complications (P ＞ 0.05).The median overall survival time (OS) of treatment group was 11 months (7 ～ 31 months),and the median OS of control group was 7 months (4 ～ 18 months).The survival of the treatment group was longer than the control group (P ＜ 0.05).Conclusions HIPEC treatment improved significantly the survival and life quality of advanced pancreatic cancer patients.With acceptable morbidity and mortality rates,HIPEC regime was an effective treatment modality for patients with advanced pancreatic cancer.

Objective To detect the expression and effect of human tumor necrosis facctor related apoptosis-inducing ligand(hTRAIL)in vitro by using a novel double expressing adenoviral vector encoding hTRAIL and firefly lueiferase (luc) gene (Ad-hTRAIL-luc),in which luc wag used, as reporter gene.Methods A549 cells were transduced with the adenoviral vector encoding enhanced green fluorescent protein (EGFP) gene(Ad-EGFP)at variable multiplicity of infection(MOI).Adenoviral transducfion efficiency wag determined 48 h later.A549 cells were transduced with Ad-hTRAIL-luc at variable MOI.and the following tests were performed 48h later,respectively:the expressive ratio of hTRAIL and the apeptotic ratio of A549 cells were meagnred by flow eytometer;counts per minute(cpm)of luminescence were measurde by scintiUation counters. A549 cells were transduced with Ad-luc at variable MOI, and cpm of luminescence was measured by scintillation counters 48 h later. After A549 cells were transduced with AdhTRAIL-luc,the expressive ratio of hTRAIL,the apoptotic ratio of A549 cells and cpm of luminescence were analyzed by one-way ANOVA.The positive ratio of EGFP and cpm of luminescence (Ad-luc) were analyzed bv nonparametric ANOVA.Results After A549 cells were transfected with Ad-hTRAIL-luc,the expressive ratio of hTRAIL on the cell membrane of the groups were(2.37±0.04)/,(3.16±0.03)/,(3.64±0.03)/,(3.96±0.02)/,(4.24±0.02)/,(4.34±0.02)/ respectively,which showed significant difference between each other (P＜0.01);and the apoptotic ratio of A549 cells were (1.52±0.04)/,(2.93±0.02)/,(3.39±0.02)/,(3.64±0.02)/,(3.86±0.02)/,(4.08±0.02)/,(4.20±0.02)/,respectirely,and it showed significant difference between each other (P＜0.01);cpm of luminescence were 465 561±26 801,1 038 576±29 417,937 655±23 197,786 432±20 028,524 288±16 338,401 566±15 961,respectively,and it also showed significant difference between each other(P＜0.01).There was a positive relationship between the expressive ratio of hTRAIL and cell apoptotic ratio of A549 cells (r=0.984,P＜0.01).Conclusion The double expressing adenoviral vector Ad-hTRAIL-luc can transfer luc and hTRAIL gene to A549 cells efficiently,and the activity of luc may reflect the effect of hTRAIL as well as the expression of hTRAIL.

Objective To investigate the feasibility,efficacy and key points of individually designed endovascular embolization for ruptured tiny aneurysms of anterior communicating arteries. Methods The clinical,DSA imaging,interventional treatment and follow-up data of 21 patients with ruptured tiny aneurysms (21 aneurysms)of anterior communicating arteries from March 2009 to March 2014 were analyzed retrospectively. Thirteen of them were treated with coil embolization only,6 were embolized with microcatheter-assisted technique,and 2 were embolized with balloon-assisted technique. Results (1)One patient was failed to embolize because of technical reason. Immediate postoperative angiography found that in the other 20 patients:14 were packed densely,6 had residual aneurysm necks. (2)Intraoperative complications:One patient had acute occlusion of ipsilateral anterior cerebral artery,the blood vessel was patent after thrombolytic method;2 patients had intraoperative ruptured aneurysm. (3)The modified Rankin scale (mRS)scores of 20 patients with successful embolization at discharge:0-1 in 14 cases,2 in 4 cases, and 3-4 in 2 cases. (4)Follow-up study:20 patients were followed up for 12 months after discharge. The mRS scores:0-1 in 18 cases,2 in 1 case,and 3-4 in 1 case. Clinical follow-up for 6 to 60 months,no aneurysm ruptured. Fifteen patients were followed up for 6 to 60 months with DSA,one of them recurred,and he was treated with supplementary dense packing. Conclusion Endovascular embolization for ruptured tiny aneurysms of anterior communicating arteries is difficult,but it is feasible and effective. The proficient surgical skill,individualized surgical design and appropriate embolism are the keys to improve the embolization effect.

Objective To investigate the safety, efficacy and key points of technology of endovascular embolization for ruptured wide-necked aneurysms of anterior communicating arteries. Methods The clinical, DSA imaging, interventional treatment and follow-up data of 35 patients with ruptured wide-neck aneurysms of anterior communicating arteries were analyzed retrospectively. Results Immediate postoperative angiography of the 35 patients found 100% occlusion were achieved in 29 (82.9%), 90% occlusion were achieved in 5 (14.3%), and 80%occlusion was achieved in 1 (2.8%). One patient had occlusion in ipsilateral anterior cerebral artery , whose blood vessel was patent after thrombosis. One patient had intraoperative aneurysm rupture. One patient had cerebral infaraction of anterior cerebral artery after the operation. Clinical follow-up was made from 6 to 60 months , and no aneurysms ruptured was found. 21 patients were followed up for 6 to 60 months with DSA. Two of them experienced recurrence, and they were not treated with supplementary packing. Conclusion Endovascular embolization for ruptured wide-necked aneurysms of anterior communicating arteries is more difficult , but it is safe and effective. Flexible choosing of various kinds of embolism technique and designing the most optimal embolism treatment plan are the keys to the improvement of embolization effect.

Objective To reveal the geographical distribution regularity of the normal reference value of old female’s hemoglobin in China,and provide scientific basis for making its unified standards.Methods The normal reference values of 15 690 examples of old female’s hematocrit by the method of hemoglobin cyanide(HiCN)and five geographical factors in 157 areas in China,its distribution regularity and the complex relationship characteristic between geography environment elements were analyzed with the methods of factor analysis,spatial analysis of GIS and correlation analysis.Results By the method of factor analysis,the five factors of geography environment were combined into two common factors F1and F2;the original data was replaced with its scores to infer the regression equation :y^=127.9-0.01009F1-0.01543F2?8.8.And this equation was used to figure out the reference value of 1 288 observation points in China.With support of the model of spatial analysis of GIS,the distribution regulation of old female’s hemoglobin reference value in China and its distribution regularity was west-higher,east-lower,north-higher and south-lower.Conclusion If some area’s altitude(X1),sunshine hours yearly(X2),mean relative humidity yearly(X3),mean temperature yearly(X4),precipitation yearly(X5) are known,this place’s reference value of hemoglobin can be calculated out by using this equation.The reference value of hemoglobin in any areas in China can be gotten from the trend distribution regularity map.

Objective To investigate the changes of electrocardiogram in elderly patients with acute cerebral ischemic infarction (CIS),and to analyze the relationship between the electrocardiogram and the prognosis of the patients.Methods 132 elderly patients with acute CIS in the hospital from January 2013 to December 2016 were enrolled.12 lead electrocardiogram was performed within 48 hours after onset and 7 days after onset,and the relationship between electrocardiogram abnormality and infarct type,severity,and prognosis were analyzed.The independent predictors of poor prognosis based on improved Rankin's score at discharge were evaluated.Results 83 cases (62.88％) had abnormal electrocardiogram.The main type of abnormal electrocardiogram was S-T segment abnormalities,followed by arrhythmia.The severity of illness in patients with abnormal electrocardiogram were significantly more serious than in those who did not detect abnormal electrocardiogram (P ＜ 0.05).The severity of illness in patients detected abnormal electrocardiogram over 2 times were significantly more serious than in those who detected abnormal electrocardiogram only within 48 hours after onset or 7 days after onset (P ＜ 0.05).Shorter time from onset to admission,complete anterior circulation infarction according to Oxfordshire Community Stroke Project (OCSP)classification,abnormal electrocardiogram (＞ 2 times) were independent risk factors for poor prognosis at discharge (P ＜ 0.05).Conclusions Electrocardiogram abnormity is common in elderly patients with CIS,and abnormal electrocardiogram detected over 2 times may indicate poor prognosis,which will benefit for the treatment schemes of patients.

Objective:To observe the clinical characteristics of esophageal reflux after total gastrectomy (ERATG), and to explore the mechanism of occurrence.Methods:Fourteen gastric cancer patients who underwent total gastrectomy were prospectively enrolled in this study. The postoperative symptoms were observed and recorded and 24 h MII-pH with pH monitoring was performed to investigate the characteristics of postoperative reflux.Results:After total gastrectomy patients were with different degrees of ERATG as heartburn, appetite loss, chest tightness and belching. The overall nature of ERATG is mainly weak acid, with a pH between 4 and 7. ERATG involved esophageal-jejunal anastomosis and a length of esophagus 7 cm above the anastomosis. Patients with typical reflux symptoms had a lower pH minimum in the upright position than those without typical symptoms[(4.76±0.71) vs.(5.68±0.37), t=2.866, P<0.05]. Patients with typical reflux symptoms had a higher frequency of reflux of mixed liquid and liquid-air reflux than those without typical symptoms[liquid(31.25±29.76) vs.(4.50±9.14), t=0.011, P<0.05; liquid-air(19.50±12.99) vs.(2.00±2.61), t=0.004, P<0.05]. Conclusion:ERATG is mainly a upward reflux of weakly acidic gas, with typical symptoms of heartburn, appetite loss, chest tightness and belching. Patients with typical symptoms usually have lower pH in the upright position.