Hepatocellular carcinoma with portal vein tumor thrombus (PVTT),an advanced stage of disease,is common.Patients who have hepatocellular carcinoma (HCC) with PVTT have a poor outcome.The management of HCC with PVTT is a clinical challenge.Although many treatment options are available,there are currently no consensus or guideline on optimal management of HCC with PVTT.To improve understanding of the two guidelines published recently,we compared the similarities and differences between them.

Colorectal liver metastasis (CRLM) is a common liver metastatic tumor with poor prognosis.It was very difficult to treat patients with unresectable and chemotherapytolerant CRLM.With the tumor control rate ranging from 63％ to 78％,Yttrium-90 is both safe and effective in treating unresectable and chemotherapy-tolerant CRLM.The median survival time is 10.5 months,and the 1-,2-,3-year overall survival rates of patients are 44％,20％ and 14％ respectively.For a certain portion of patients,Yttrium-90 has distinct advantages over mo lecular targeted drugs and other local minimally invasive treatment.Though Yttrium-90 treatment has showed certain curative effect,its safety and effectiveness require further confirmation through multi-center randomized controlled trial.

Purpose　To evaluate the effects of ambroxol on prevention of premature babies with hyaline membrane disease(HMD) with prenatal corticosteroids.　Methods　Premature neonates gestational age 26-36 weeks were divided into two groups,receiving:(1) Ambroxol 30 mg/kg through umbilical vein at birth(group A,n=28) and (2) a control group not given ambroxol (group B,n=35).All the babies were exposed prenatally corticosteroids.　Results　(1) Occurrence rate of HMD in group A was 0%,group B was 11.4%,there was significant difference (P<0.05).(2) Mean fetal age of group A was 32.47+/-4.5 pregnant weeks,group B is 32.86+/-7.1 weeks.No significant difference existed.(3) Different fetal age in gruop B,such as pregnant weeks≤32,33-34,35-36,the HMD rate was separately 28.7%,15.38% and 0%,no case was found in group A.(4) There cases of 12 neonatal asphyxia happened in group B,but none of 6 in group A.　Conclusions　Definite effect can be received by applying ambroxol to prevent premature infant HMD after delivery on the bases of adenotropin before delivery.

There are a lot of feasibility studies, using sentinel lymph node biopsy SLNB instead of Alex lymph node dissection (ALND), having got a conseusus that SLNB is a safe and useful method in the treatment of breast cancer. But in clinical practice, there are much false negative rate (FNR) which need to be carefully dealt with for SLNB. In order to diminish the FNR, how many nodes should be the perfect number to lower the FNR? If positive detection was found in the SLN, should ALND always be needed? And when micro metastasis was found in the post operation HE staining? Does it need further treatment? We make a review to discuss those matters.

Objective To assess the impact of radiation on superior epigastric vessel pedicled transverse rectus abdominal myocutaneous (TRAM) for breast reconstruction.Methods Female breast cancer patients were divided into 4 groups:group A (immediate breast reconstruction + radiation therapy,123 cases),group B (immediate breast reconstruction,262 cases),group C (radiation therapy + delayed breast reconstruction,34 cases),group D (delayed breast reconstruction,53 cases) from June 2009 to June 2012 at Department of Breast Oncology,Tianjin Medical University.Patient demographics,operative details,radiation therapy details,postoperative complications,patient-centered evaluation of aesthetic and psychological outcomes were assessed.Results The average follow-up duration was 24.98 ± 6.99 months.2.5％ patients developed delayed wound healing postoperatively.Fat necrosis and flap contracture were seen in 7.0％ and 3.6％ of all patients,respectively.Irradiated patients had a significant statistical difference in cancer staging,involved lymph nodes,tissue invasion and neoadjuvant chemotherapy (P ＜ 0.05).No significant statistical differences were observed in post-operative early complications,but in advanced stage complications.There was no significantly statistical difference in breast aesthetic outcome before and after radiation therapy within four groups.Conclusions For breast reconstruction patients,those without postoperative radiotherapy were suggested immediate breast reconstruction,and those with postoperative radiotherapy were proposed to accomplish breast reconstruction after postoperative radiotherapy.

Objective To study the effect of protein C mutation on venous thrombosis (VTE) by PROC gene sequencing in patients with VTE. Methods Human PROC gene sequence was designed to amplify the third exon region of the PC-Gla domain , and then the PCR products were sequenced to search for a single nucleotide mutation (SNVs). The SNVs was constructed into eukaryotic expression system and a stable expression of wild-type and mutant PC cells were also constructed. At the same time , the distribution of PC levels in normal and VTE patients were detected with ELISA. Results Three single nucleotide mutations were found in different patients. In HUVEC cells, the synthesis of PC decreased in each mutant strain. The PC level in the normal patients , VTE patients , and the mutant samples were detected , which were significantly lower in the mutant samples than that of the VTE group (P = 0.035 3) and the normal level (P < 0.000 1). Conclusion Three mutation sites PCArg-1Cys , PCVal34Met and PCArg9Cys are important genetic factors lead to a significant decrease in plasma PC levels and the increase of VTE risk.

Objective To observe the effect of a high temperature environment on IL-17 concentration , neutrophil and lymphocyte in peripheral blood of soldiers on a training task .Methods Totally 160 health training soldiers were randomly and equally divided into two groups .The test group was trained and exposed to an environment of ( 32 ±1 )℃ vs control group at ( 22 ±1 )℃ for 2 hours before the IL-17 levels in venous blood were measured and peripheral neutrophils and lymphocytes were determined.Results The body temperatures were (38.74 ±0.26),(39.23 ±0.24),and (39.51 ± 0.34)℃after training for 40 min,50 min,and 60 min under a high temperature environment , respectively, and there was a significant increase of body temperature compared to the soldiers trained under normal conditions (P <0.05).Their perceived exertion rating was 17.62 ±0.66, 18.03 ±0.56, and 18.47 ±0.84, respectively, much unlike the control group (P<0.05).After 2 hours of training under high temperature , the concentration of IL-17 was (7.12 ±4.03) pg/ml, while the number of neutrophils and lymphocytes was (6.43 ±1.27) ×109/L and (9.84 ±1.36) ×109/L, respectively in peripheral blood, significantly higher than in the control group (P <0.05).Conclusion The body temperature and rating of perceived exertion of the training soldiers are significantly elevated under a high temperature environment, and the concentration of IL-17, and the neutrophils and lymphocytes counts in peripheral blood are increased .

Objective To assess the safety and effectiveness of yttrium-90 (90Y) radioembolization for patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT).Methods The PubMed was searched for all clinical reports from 1991 to 2017.Results A total of 17 clinical studies including 662 patients were qualified for the analysis.The median time to progression was 5.8 months,and median disease control rate was 68.4％.The median survival was 10 months in all patients,including the median OS of 13.8,6.5 months of Child-Pugh class A and B patients,respectively,the median OS were 13.4,5.4 months respectively in branch and main PVTT patients,and the median OS were 3.7,9.5 months of patients who received resin and glass based microspheres,respectively.The median radioembolization induced liver disease was 36.3％.The median abdominal pain,nausea/vomiting,fatigue,and fever were 18.8％,17.6％,11.1％,and 1.4％.Conclusion 90y radioembolization is an effective treatment for HCC and PVTT,which is an alternative treatment choice for HCC and PVTT.

Objective:To investigate the effect of Astragaloside Ⅳ-mediated Endothelial progenitor cells derived exosomes (EPC-Exos) on the biological function of EPC-Exos damaged by high glicose.Methods:EPCs from human umbilical cord blood were isolated and cultured in vitro. the EPC-Exos secreted by EPCs were extracted by ultracentrifugation combined with ultrafiltration, and identified by specific markers CD9, CD63 and CD81, respectively. After the cells were cultured for 24 hours with AS-IV at 100 mg/L and PBS at the same volume, the morphological characteristics of EPC-Exos were observed by transmission electron microscope. Human endothelial cells were isolated, cultured and identified in vitro. The identified endothelial cells were pretreated with 30 mmol/L glucose for 120 h and randomly divided into experimental group and control group, at the same time set the normal group. The cells were cultured for 24 hours, the effects of EPC-Exos on proliferation, adhesion, migration and angiogenesis of endothelial cells damaged by high glucose were observed by using cell counting kit-8 (CCK-8) Cell Proliferation Assay Kit, cell scratch test, adhesion assay and in vitro angiogenesis assay by Matrigel. Results:Compared with the normal group, the proliferation, migration, adhesion and tubulogenesis of human endothelial cells in the control group were significantly lower ( t=24.35, 6.80, 10.65, 9.62, P<0.05). Compared with the control group, the proliferation, adhesion, migration and tubulogenesis of human endothelial cells in the experimental group were significantly enhanced ( t=30.68, 5.99, 5.40, 8.25, P<0.05). Conclusions:EPC-Exos mediated by AS-Ⅳ can significantly improve the biological function of human endothelial cells damaged by high glucose and has the potential to modulate endothelial neovascularization in diabetic rats.

Pancreas arises from dorsal and ventral anlagens on an embryological basis,with a difference in histocytology.Immunohistochemical staining for an anti-pancreatic polypeptide can be performed to discriminate between the dorsal and ventral pancreas because of the difference in the amount of pancreatic polypeptide contained by the dorsal and ventral pancreas.Differences of survival in patients were approved due to the difference in histocytology between the dorsal and ventral pancreas,including the ability of local invasion,lymph node metastases,and nerve plexus invasion.