Objective To investigate the expression of hMLH1 and hMSH2 in hilar cholangiocarcinoma and its relation to clinical features and prognosis of the tumor.Methods The expression of hMLH1 and hMSH2 was determined with immunohistochemistry in 54 specimens of hilar cholangiocarcinoma and 25 of normal bile duct tissue.Lahoratory data were then analyzed statistically together with the related clinicopathological data.Results 1)hMLH1 and hMSH2 were expressed in 24 and 21 out of the 54 cases of hilar cholangiocarcinoma(44.4%,38.9%)and 23 and 21 of the 25 normal cases(92%,84%),respectively(P＜0.05).2)The expression of hMLH1 and hMSH2 in hilar cholangiocarcinoma had no association with the age,gender,tumor size and Bismuth type(P＞0.05)but close relation to lymph node metastasis and pathological changes(P＜0.05).3)The 2-year survival rate was markedly lower in hMLH1-negative patients than in hMLH1-and hMSH2-positive ones (15%vs.45.4%,23.5%vs.44%,P＜0.05).Conclusions Joint action of hMLH1 and hMSH2plays an important role in the oncogenesis and metastasis of hilar cholangiocarcinoma.These two may be valuble factors to indicate prognosis of the tumor.

Objective:To study the expression of Survivin and p27～(kipl)and their relationship with the clinical features of gallbladder cancer.Methods:Fifty specimens of gallbladder cancer,20 specimens of chronic cholecystitis,20 specimens of polypoid lesions of gallbladder(PLG)were included,the expression of Survivin and p27～(kipl)were detected using immunohistochemistry assay.Results:In 50 cases of gallbladder cancer,39 cases expressed Survivin and 22 cases expressed p27～(kipl).There was a negative correlation between the expression of p27 and survivin(P0.05),but the expression of p27～(kipl)was related to the pathological grade,clinical stage and lymph node metastasis of gallbladder cancer(P

Objective To evaluate hepatic enhancement technology with MRI and its clinical application.Methods 147 patients underwent enhanced MRI scanning and an automatic injector.Total dose of contrast agent for each patient was 10 to 15ml(0.2mmol/kg)at a rate of 2ml/s,Two-phase enhancement were performed at a delay of 30 and 70 seconds respectively after the initiation of bolus injection.Results Good visualization of two phases for both hepatic artery and portal vein were achieved in 147 patients in addition to branches of abdominal aorta,hepatic artery,splenic artery,portal vein,inferior vena cava and vasculatures in hepatic port.The 4 patients did not have ideal two-phase images for various reasons.Conclusion MRI with bolus injection using an automatic injector can satisfy the diagnosis for hepatic diseases.

Objective:To study the differences in angiogenesis and its maturation between the periphery and center. of hepatocellular carcinoma (HCC). Methods:Thirty-one cases proved surgically and pathologically were selected. After surgery, two sections were gotten from the tumor periphery and center. Continuous slices were stained with immunohistochemistry of five antibodies against VEGF, Flk-1, PCNA.The expressions of VEGF,Flk-1, and PCNA, and some vascular parameters were counted including the number, mean area, total area, circumference, diameter, distance between adjacent vessels(DAV), variety index of microvessel and mature vessels. The arterioles , veinlets, mature vessel index and mean perfused fraction (mPF)were also calculated. The differences of the vascular parameters above between the periphery and center were analyzed. Results: The differences in the number, diameter, and variety index of microvessel, the number and total area of mature vessel, the arterioles and the ratio of arteriole or veinlet, mature vessel index and mPF were statistical differences between the periphery and center of the tumor (P

Objective: To evaluate the liver function status in patients with obstructive jaundice using in vivo 31-phosphorus magnetic resonance spectroscopy (31P-MRS). Methods:31P-MRS scan with a single voxel on hepatic parenchyma was carried out in 31 patients with obstructive jaundice and in 40 healthy controls. Intracellular pH value (pHi), and some metabolic parameters including phosphomonoester (PME), phosphodiester (PDE), inorganic phosphate (Pi), ?-ATP, ?-ATP, ?-ATP, lower energetic phosphate (LEP), and the ratios of PME/ATP, Pi/ATP, PME/PDE, PME/Pi, PDE/Pi and PDE/ATP were calculated. Serum markers of liver function including AST, ALT, TBIL, DBIL, IBIL, TP, ALB, GLO, A/G, ALP and GGT were also recorded. The relationship between themwas analyzed. Results: 31P-MRS showed an increase in PME, PDE, PME/ATP, PME/Pi, PDE/ATP and LEP in jaundice patients compared with controls (P

Objective:To valuate the relationships between operation modus,pathological characteristics and the prognosis on hilar cholangiocinoma(HCC). Methods:The clinical features,diagnostic methods,operation modus and histopathology results of the 223 cases with HCC were analyzed retrospectively. Results:1) Radical excision had been performed in 85 cases with the excision rate of 38.1%,1,3,5 years survival rates were 58.8%,30.9%,8.8% respectively. Palliative therapy had been performed in 110 cases; the median life span was 8 months. The average life span of those who had given up treatment was about 5 months. 2) In 132 cases of HCC,121 cases were adenocarcinoma,accounting for 91.7%. Well-differentiated was 29 cases (24.0%),medium-differentiated was 43 cases (35.5%),and poor-differentiated was 49 cases(40.5%). The others accounted for 8.3%,in total. The 1,3,5 years survival rate after radical excision of the well-differentiated and the medium-differentiated groups were 55.0%,40.0% and 15.0% respectively,those of the poor-differentiated group were 45.8%,16.7% and 0% respectively. 3) According to the Bismuth Corlette grouping type I was 20.1%,type II was 23.2%,type IIIa was 10.3%,type IIIb was 23.2%,type IV was 7.2%,and the others were 16.0%. Conclusions:1)Radical excision is the key to raise the long-term survival rate. The average life span of those who had given up treatment was about 5 months,which can reflect the natural life span. 2) Poor-differentiated adenocarcinoma accounted for considerable proportion in histopathology types of the hilar cholangiocarcinoma. 3)Bismuth Corlette grouping has some certain limit and disadvantages in the application.

Objective To observe the MRI findings of limb gunshot wound and investigate their pathomorphological basis through animal models.Methods Sixteen mongrel dogs were divided into four groups randomly. The hind legs of dogs shot with handgun were undergone 0.5 T MRI scans at 5 h, 24 h, 48 h, and 72 h after wounded, respectively. The gross changes, HE staining light microscopic findings and MRI findings of wounds were observed.Results Permanent tract was a zone of tissue defect. In the tract, blood of 5 h group′s and pus of 24 h, 48 h, and 72 h groups showed T 1WI hypointense signal and T 2WI hyperintense signal. In contusion zone, the main pathological change was homogeneous coagulating necrosis of muscle fibers. MRI images showed irregular line, dot, or block T 1WI isointense signal, T 2WI hypointense signal, and no enhanced after Gd-DTPA injected in all groups. In concussion zone, the main pathological changes of 5 h group were edema, degeneration, and lysis of cells and lots of erythrocytes in the tissue interspace. Besides these, a large quantity of leucocytes and pus cells appeared, the lysis of degenerated cells near the contusion zone and the edema of such area, with passage of time, were more obviously in groups 24 h, 48 h, and 72 h. In MRI, concussion zone showed slightly hypointense T 1WI signal, hyperintense T 2WI, signal and T 2WI signal got higher and the adjacent contusion zone got clearer with time pass. Concussion zone could be enhanced obviously.Conclusion MRI can reflect the lesion of tissue in limb gunshot wound accurately during seventy-two hours after wound. The T 2WI and contrast-enhanced T 1WI are valuable. The special tissue-defect area, coagulating necrosis of cells, and large range injury of blood vessels and cells are the important pathomorphological basis which cause the MRI findings of gunshot wound different from normal trauma.

Objective To investigate the effects of probiotics combined with dietary intervention on pe-ripheral blood glucose and lipid metabolism indicators,placental tissue insulin signaling pathway proteins ex-pression and pregnant outcome in the patients with gestational diabetes mellitus(GDM).Methods A total of 83 patients with GDM in this hospital from December 2021 to December 2022 were selected as the study sub-jects and divided into the probiotics group(probiotics combined with diet intervention,43 cases)and control group(simple diet intervention,40 cases)by the random number table method.The levels of peripheral blood glucose,lipid and insulin resistance related indicators before the intervention and in 8 weeks after the interven-tion were compared between the two groups.The histological changes of placenta were observed by HE stai-ning.The pathological indicators were compared between the two groups.The expression levels of insulin re-ceptor substrate-1(IRS-1),glucose transporter 4(GLUT4)and synaptosome-associated protein of 23 kDa(SNAP23)in placental tissue were detected by immunohistochemistry.The pregnant adverse outcomes were compared between the two groups,and the clinical efficacy of probiotics was evaluated.Results Compared with the control group,the levels of fasting blood glucose(FBG),fasting insulin(FINS),serum triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)in 8 weeks after intervention in the probiotics group were significantly decreased(P＜0.05),and the level of serum high density lipoprotein cholesterol(HDL-C)was significantly increased(P＜0.05).There were no significant differences in the incidence rates of poor villi maturation,thickening of dry villi arterioles and capillary filling in villi interstitial between the two groups(P＞0.05).Compared with the control group,the expression levels of IRS-1,GLUT4 and SNAP23 in placen-tal tissue of the probiotics group were significantly increased(P＜0.05).The incidence rates of neonatal hy-poglycemia and neonatal hyperbilirubinemia in the probiotics group were significantly lower than those in the control group(P＜0.05).Conclusion Compared with simple dietary intervention,probiotics combined with dietary intervention has more advantages in improving glucose and lipid metabolism of GDM patients,moreo-ver reduces the adverse events occurrence in newborns.

Objective To evaluate the combination of transvaginal conventional ultrasonography and shear wave elastography ( SWE) on the diagnosis of endometrial cancer ,and establish a predictive Logistic regression model . Methods Clinical information collection ,transvaginal conventional ultrasonography ,and SWE check were performed in 112 patients w ho were post‐menopausal vaginal bleeding with ≥5 mm thick endometrium . T he Emax and Emean of Young′s modulus for the endometrium were obtained . Pathology was used as the gold standard ,ROC curve was plotted ,which could be used to evaluate the Young′s modulus on the diagnostic effectiveness on endometrial cancer . Single factor analysis and bring logistic regression methods were applied to assess the values of the clinical variables ,transuaginal conventional ultrasonography variables ,and Young′s modulus in the identification of endometrial cancer . Results In 112 cases of endometrial lesions diagnosed by pathology ,there were 84 cases of benign lesions ( benign group) and 28 cases of cancer( malignant group) . Both Emax and Emean in malignant group were larger than benign group [ (53 .00 ± 16 .07) kPa vs ( 31 .99 ± 13 .89) kPa ,( 27 .25 ± 9 .28) kPa vs ( 19 .94 ± 10 .37) kPa ,all P ＜0 .001] . In the logistical regression analysis ,body mass index ,endometrial thickness ,blood flow grading and Young′s modulus were identified as independent risk factors for endometrial cancer . T he accuracy ,sensitivity and specificity of the logistic regression model in the prediction of endometrial cancer were 89 .29% ,82 .14% , and 91 .67% , respectively . T he area under the ROC curve was 0 .928 . Conclusions T ransvaginal conventional ultrasonography combined SWE technique has an important value in the diagnosis of endometrial cancer .

Objective:To establish the normal values of water-perfused high resolution esophageal manometry (HREM)(GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing in Chinese population.Methods:From September 1, 2019 to June 30, 2020, 91 healthy volunteers receiving water-perfused HREM (GAP-36A) at resting period, water swallowing, semisolid swallowing and solid swallowing were selected from 9 hospitals (Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; the First Affiliated Hospital of Dalian Medical University; the Second Hospital of Hebei Medical University; the Second Affiliated Hospital, Naval Medical University; the First Affiliated Hospital, Sun Yat-sen University; the First Affiliated Hospital, University of Science and Technology of China; Aviation General Hospital of China Medical University; the Affiliated Hospital of Medical School of Nanjing University and the First People′s Hospital of Yichang). Parameters included the position of the upper and lower edges of the upper esophageal sphincter (UES) and lower esophageal sphincter (LES), the length of the LES and UES, the position of the pressure inversion point (PIP), the resting pressure of UES and LES and swallow-related parameters such as the distal contraction integral (DCI), 4 s integrated relaxation pressure (IRP), distal latency (DL) and UES residual pressure. One-way analysis of variance, post-hoc test and sum rank test were used for statistical analysis.Results:A total of 87 healthy volunteers were enrolled, including 40 males and 47 females, aged (38.5±14.2) years old (ranged from 19 to 65 years old). The position of the upper and lower edges of the LES was (42.7±2.8) and (45.6±2.8) cm, respectively, the length of the LES was (2.9±0.4) cm, and the position of PIP was (43.3±2.8) cm. The position of the upper and lower edges of the UES was (18.1±3.0) and (22.6±2.0) cm, respectively, and the length of the UES was (4.8±1.0) cm. The resting pressure of LES and UES was (17.4±10.7) and (84.1±61.1) mmHg (1 mmHg=0.133 kPa), respectively. The DCI value at solid swallowing was higher than those at water swallowing and semisolid swallowing ((2 512.4±1 448.0) mmHg·s·cm vs. (2 183.2±1 441.2) and (2 150.8±1 244.8) mmHg·s·cm), and the differences were statistically significant ( t=-4.30 and -3.74, both P<0.001). The values of 4 s IRP at semisolid swallowing and solid swallowing were lower than that at water swallowing ((4.6±4.1) and (4.9±3.9) mmHg vs. (5.4±3.9) mmHg), and the differences were statistically significant ( t=3.38 and 2.09, P=0.001 and 0.037). The DL at water swallowing was shorter than those at semisolid swallowing and solid swallowing ((8.5±1.8) s vs. (9.8±2.2) and (10.6±2.8) s), and the DL at semisolid swallowing was shorter than that at solid swallowing, and the differences were statistically significant ( t=-10.21, -13.91 and -4.68, all P<0.001). The UES residual pressure at water swallowing was higher than those at semisolid swallowing and solid swallowing (9.5 mmHg, 6.5 to 12.3 mmHg vs. 8.0 mmHg, 4.5 to 11.7 mmHg and 5.5 mmHg, 2.0 to 9.3 mmHg), and the UES residual pressure at semisolid swallowing was higher than that at solid swallowing, and the differences were statistically significant ( t=3.48, 10.30 and 6.35, all P<0.001). Conclusions:The normal values of water-perfused HREM (GAP-36A) in Chinese population at resting period, water swallowing, semisolid swallowing and solid swallowing can provide a reference basis for clinical diagnosis and treatment for patients receiving water-perfused HREM examination.