Hepatocellular carcinoma (HCC) is the fifth most common cancers worldwide, which ranks as the second of cancer-related death. Each year, more than half of the new and death cases occur in China. Vascular invasion is one of the important biological characteristics of HCC. HCC with portal vein tumor thrombus is closely related to the prognosis of patients, but there is no consensus on the best treatment method.Based on domestic and foreign literatures, the authors discuss the current status and progress of treatment for HCC with portal vein tumor thrombus, in order to explore the optimal treatment.

Objective To evaluate the clinical outcomes of a reformed endoscope assisted ureteral stripping technique in post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.Methods Seven post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidneys(2 males and 5 females)with average age of 54 years old were recruited.Standard retroperitoneal laparoscopic nephrectomies were performed for all patients after placement of a 5 F ureteral stent as the ureteral stripper. After the closure of the ureter at the lower kidney pole level with metal clips, the distal ureter was separated and the ureteral muscle layer and serous membrane layer were split. The ureter muscle layer was then tied tightly to the ureteral stent tip. The ureter and the stent were pulled out through urethra. Transurethral resection around the everted ureteral orifice was performed and the ureter was removed afterwards. The graft function, operation time,complication and estimated blood loss were recorded.Results All the 7 patients successfully underwent the operations and no major complication such as ureteral disruption, stripping embarrassment and converting to open operation happened. The mean operation time was 126 min (ranging from 105 to 160 min) and the mean blood loss was 124 ml (ranging from 80 to 160 ml). Introvesical chemotherapy with farmorubine hydrochloride was performed 3 weeks after surgery. The mean preoperation and 6 months post-operation creatinine and urea nitrogen levels were 136.5μmol/L, 138. 6μmol/L and 7.42 mmol/L, 7.80 mmol/L respectively and there was no statistical difference. There was no tumor recurrence during 6 month follow-up except one case having simultaneous bladder cancer had bladder cancer relapse 3 months after operation and required another TURBt.Conclusion The reformed endoscope assisted ureteral stripping technique is minimally invasive and convenient in the treatment of post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.

Objective To evaluate the effect of surgical treatment on patients with retroperitoneal fibrosis. Methods The medical records of 24 retroperitoneal fibrosis patients (19 men and 5 women;mean age,52 years) who had been surgically treated from January 1985 to December 2003 were retrospectively analyzed.The initial clinical presentations included low back and abdominal pain in 11 cases,acute anuresis in 5 and incidental bilateral hydronephrosis in 8.Double-J inter-ureter drainage was performed in 11 cases, among whom the procedure failed in 4 cases, and then they underwent pricking pyelostomy.After their general condition improved,ureterocutaneostomy and ureterolysis were performed in 2 cases and 1 case, respectively.Of them 1 case died of acute myocardial infarction 3 months later.Thirteen cases who had good general condition at diagnosis underwent ureterolysis. Results One patient developed renal function failure due to repeated urinary infection 3 years after operation.One died of acute myocardial infarction 3 months after operation.The other 22 patients recovered well,and their mean creatinine level decreased from 450.9?mol/L before operation to 318.2 ?mol/L (1 month) and 265.2 ?mol/L (3 months),respectively,after operation. Conclusions Prompt and appropriate relief of urinary obstruction with surgical treatment can effectively protect the renal function in patients with retroperitoneal fibrosis.

BACKGROUND: Beta thalassaemia is a monogenic disease, which lacks effective clinical treatments. Hematopoieticstem cell transplantation currently is the only radical treatment for beta thalassaemia, but the limits of suitable donor and costs minimize its clinical application. Given the technology of reprogramming using somatic cells is well established,gene therapy using induced pluripotent stem cells has become the new direction of beta thalassaemia treatment.OBJECTIVE: To put forward the advantages of CRISPR/Cas9 technology in gene therapy of beta thalassaemia in thefuture by summarizing the mechanisms of three kinds of gene editing technologies and the preliminary experimentalresults in animal models.METHODS: In order to search relevant articles about beta thalassaemia, the first author retrieved PubMed database andCNKI (from 1989 to 2015) using the key words of beta thalassemia, genetic therapy, genome editing, homologousrecombination, iPSCs in English and Chinese, respectively. After eliminating literatures which were irrelevant toresearch purpose or containing a similar content, 67 articles were chosen for further analysis.RESULTS AND CONCLUSION: Gene editing technology has made considerable progress and three kinds of directedgene editing technologies have been developed, including ZFNs, TALENs, CRISPR/Cas technology. By targeting inducedpluripotent stem cells from thalassemi patients, these three kinds of gene editing technologies have been expected tocorrect pathogenic genes of thalassemia. The CRISPR/Cas system is more simple, rapid, safe and efficient than the others.The CRISPR/Cas9 system is expected to repair β-globin genes in the induced pluripotent stem cells, germ cells, fertilizedeggs and embryos from beta thalassaemia patients, laying the foundation for future clinical application.

Objective: Invasion and metastasis are the main causes of carcinoma mortality; hence, the timely blocking of the invasion and metastasis of carcinoma has become a research hotspot. The present study aims to investigate the expression levels of Tiam-1 mRNA and HPA-1 mRNA and their correlation with the invasion and metastasis of hepatocellular carcinoma. Methods: From May 2009 to Jan 2012, 65 hepatocellular carcinoma patients admitted consecutively in our hospital for surgical treatment were included in this study. Real-time fluorescent quantitative reverse transcriptase polymerase chain reaction (RT-PCR) was used to investigate the expression levels of Tiam-1 mRNA and HPA-1 mRNA in hepatocellular carcinoma, paired adjacent hepatocellular carcinoma (2 cm from the carcinoma), and surgical marginal normal hepato mucosa tissues (5 cm from the carcinoma). RT-PCR was also used to analyze their correlation with the clinicopathological characteristics of hepatocellular carcinoma. Results: The expression level of HPA-1 mRNA was significantly higher in hepatocellular carcinoma (43.83±11.62) than in paired adjacent hepatocellular carcinoma (14.82±8.16) and normal hepato mucosa tissues (6.02±5.36) (P<0.001). The expression level of HPA-1 mRNA was higher in paired adjacent hepatocellular carcinoma than in normal hepato mucosa tissues (P<0.05). The expression of Tiam-1 mRNA was higher in hepatocellular carcinoma (35.28±11.81) than in paired adjacent hepatocellular carcinoma (12.94±6.25) and normal hepato mucosa tissues (4.17±3.49) (P<0.05). The expression level of Tiam-1 mRNA was higher in paired adjacent hepatocellular carcinoma than in normal hepato mucosa tissues (P<0.05). The expression levels of Tiam-1 mRNA and HPA-1 mRNA were closely associated with the degree of differentiation, depth of infiltration, lymph node metastasis, vessel metastasis, and TNM (Tumor, Node, Metastasis)staging of gastric carcinoma (P<0.05). Spearman rank correlation analysis demonstrated a significant correlation between Tiam-1 and HPA-1 (OR=0.523, P<0.05). Conclusion: The expression levels of Tiam-1 mRNA and HPA-1 mRNA were high in hepatocellular carcinoma. Meanwhile, the increased ex-pression levels of Tiam-1 and HPA-1 can promote the invasion and metastasis of hepatocellular carcinoma. Moreover, the determination of Tiam-1 and HPA-1 may be valuable for the treatment and prognosis of hepatocellular carcinoma.

Objective To explore the clinical characteristics and treatment in elderly patients with gastric bezoars. Methods Totally 49 patients with gastric bezoars were retrospectively analyzed,and among them,36 patients were aged 65-77 years, 48 cases underwent sequential therapy,1 elderly patient underwent surgical operation. Results There were differences in etiology, medical histories, clinical manifestations and therapeutic efficacy between elderly and non elderly patients with gastric bezoars.There were 42％ (15/36) of elderly patients eating glutinous rice cakes,4 cases with gastric surgery histories,6 cases with diabetes in elderly patients,but in non eldcrly patients only 8％ (1/13) of patients eating glutinous rice cake,and there were no cases with surgery histories and diabetes. Gastric bezoars in 48 cases were cleared away by sequential therapy. 1 elderly patient developed intestinal obstruction after surgical operation and died of infectious shock. Conclusions There are some different characteristics between elderly and nonelderly patients with gastric bezoars.Sequential therapy is safe and effective for elderly patients with gastric bezoars.

Objective To explore the association between circulating endothelial cells (CECs)and atherosclerosis in maintenance hemodialysis(MHD)patients. Methods A crosssectional study was performed to investigate the association between CECs and carotid atherosclerotic change in 65 MHD patients,25 non-hemodialysis patients with chronic kidney disease(CKD)of stage 4 or 5(CKD-non-HD)and 24 age-and Sex-matched healthy controls. CECs in peripheral blood were determined by multiparametrie flow cytometry(FCM).CECs were labeled with CD3-PerCP and CD146-PE before FCM and identified as CD3dim,CD146bright.Atherosclerosis in both groups Was assessed by the measurement of common carotid arery intimamedia thickness (CCA-IMT)and plaque of the common carotid arteries with ultrasound scanner. Results CECs were significantly higher in pre-dialysis patients[(151.52±98.24) cell/ml]and CKD-non-HD patients[(183.00±81.38)cell/ml ] compared with control group[(106.50± 24.14)cell/ml](P<0.05 and P<0.01,respectively).But the number of CECs was not significantly different between MHD and CKD-non-HD patients.CCA-IMT was also significantly higher in MHD patients[(0.94±0.36)mm]and CKD-non-HD patients [(1.02±0.37)mml compared with control group[(0.75±0.15)mm](P<0.05 and P<0.01,respectively).The number of pre-dialysis CECs was positively correlated with CCA-IMT in MHD patients(r=0.328,P<0.01).Multivariate analysis showed that CEC level was a strong independent risk factor of CCA-IMT. Conclusion InMHD patients, CEC level is associated with carotid atherosclerosis and may be used as a marker to evaluate the endothelial damage.

Objective To investigate the expressions of Slit2 and Nogo-A in the ipsilateral hippocampus after cerebral hemorrhage in rats.Methods A total of 64 adult Sprague-Dawley (SD) rats was randomly divided into control and model groups.Collagenase Ⅶ was used to induce cerebral hemorrhage model.Immunohistochemistry was used to detect the expressions of Slit2 and Nogo-A in hippocampus at the cerebral hemorrhage side at the time points (24 h,7 d,14 d,and 21 d).Results Compared to the control group,the expressions of Slit2 and Nogo-A were significantly enhanced in model group (P ＜0.01),with the highest level at the 7 d.Conclutions Cerebral hemorrhage can significantly enhance expressions of Slit2 and Nogo-A with a positive correlation of Slit2 and Nogo-A,which might have an important effect on the recovery of brain injury.

Radiotherapy and chemotherapy have little or no effect on advanced renal cell carcinoma, leading to a poor prognosis. Several factors couLd affect the survival rate of RCC. Some RCC patients could partly respond to immunotherapy.The newly emerging targeted therapy has a dramatic tuning point in improving outcomes for RCC. Further understanding of the anti-RCC mechanisms involves in chemokine-mediated angiogenesis and RCC cell proliferation. These new agents include Sorafenib, Sunitinib, Temsirolimus, Bevacizumab, etc. Combination treatment with immunotherapy may lead to improved outcomes in this disease.

Objective: To explore the association of the serum levels of cytokine IL-10 with the occurrence of cachexia from patients with low-third gastric cancer. Methods: Radioimmunoassay was used to examine the serum levels of IL-10 in 150 patients with low-third gastric cancer and 135 healthy controls. Results: The serum levels of IL-10 were significantly higher in patients with low-third gastric cancer than controls(Z=-11.862, P<0.01). The serum levels of IL-10 were significantly higher in patients with low-third gastric cancer of clinical stageⅢ/Ⅳ than those with clinical stageⅠ/Ⅱ(Z=-10.028, P<0.01). The serum levels of IL-10 were significantly higher in patients with cachexia than those without(Z=-10.369, P<0.01). Logistic regression analysis showed that IL-10 was associated with odds ratios of 1.599 (95%CI:1.299-1.870, P<0.01) for cachexia. Conclusion: The serum levels of IL-10 are possibly associated with the occurrence of cachexia from patients with low-third gastric cancer.