ObjectiveTo evaluate result of palliative operation for hilar cholangiocarcinoma. Methods The clinical data of 179 cases of cholangiocarcinoma during the last 20 years were analysed retrospectively. Results The operative mortality rate was 10 1%, there was no significant difference between the groups. The rate of cholangitis after operation in the Roux en Y choledochjejunostomy group (15 1%) and bridge internal drainage group (10 0%) was significantly lower than that of PTCD (or ERBD) internal drainage group (35 7%, P

Objective To investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on motor function and excitability of motor cortex in Parkinson's disease (PD) patients and to study the mechanism of PD from the electrophysiology. Methods Twenty-eight patients with PD received 1 Hz rTMS therapy for 15 d. Thirty normal volunteers were enrolled as controls. Unified Parkinson's Disease Rating Scale (UPDRS) and motor evoked potential (MEP) were adopted as assessment indicators. The excitability of motor cortex was assessed by rest motor threshold (RMT), central motor conduction time (CMCT) and the amplitude of MEP. Results The initial RMTs and CMCTs of PD patients were significantly lower than those of the controls, but MEP amplitudes were not significantly different. After rTMS treatment, motor function of PD patients improved, RMTs increased and CMCTs prolonged. Conclusion In PD patients, motor function disorder and increased motor cortical excitability were observed. Low frequency rTMS may inhibit these changes to some extent.

Objective To evaluate the changes in and the regularity of brainstem evoked potentials (BA-EPs) in Parkiuson's disease (PD) as an objective criterion for early diagnosis and assessment. Methods Thirty-five healthy SD rats were divided into two groups at random. Twenty-two rats were in the experimental group and 13 in the control group. The rats were injected with 8 μg of 6-OHDA solution in the right substantia nigra pars compacta (SNc) and the right ventral tegmentum area (VTA) to create a PD model. The BAEPs of the rats in the experimental group were recorded in a quiet shielded room before the 6-OHDA injection, and one week and two weeks after injec-tion. The control group rats were injected with saline (Ns) and their BAEPs were recorded at the corresponding times. One week and two weeks later, the model rats were injected with apomorphine (APO) and their rotating cycles were counted. Results The Ⅱ , Ⅳ, andV PLs and the Ⅲ-Ⅴ IPLs on the fight ears of the experimental group were prolonged significantly compared with the control group one week after APO injection. There was no significant differ-ence in the BAEPs of the left ears after the first week. After two weeks, the Ⅱ , Ⅳ, and Ⅴ PLs and the Ⅲ-Ⅴ, and Ⅰ-Ⅴ IPLs of the right ears in the experimental group were prolonged significantly compared with the controls and the Ⅳ, and Ⅴ PLs and the Ⅲ -Ⅴ , and Ⅰ-Ⅴ IPLs on their left ears were prolonged significantly. Conclusion In the early course of a PD model in rats, their BAEPs show abnormal changes, which indicates that BAEP could be an ob-jective criterion for early diagnosis and assessment of PD. BAEP may serve as one index of damage in PD. The Ⅲ-Ⅴ PL and Ⅰ-Ⅴ iPL are sensitive indices of PD.

Objective To observe any differences in motor cortex excitability between Parkinson's disease (PD)patients and patients with multiple system atrophy (MSA) and to explore whether motor evoked potentials (MEPs) can be used as an electrophysiological indicator for differentiating the 2 diseases.Methods Thirty-four PD patients, 22 MSA patients and 15 age- and sex-matched healthy control subjeets were included in this study. Relaxed motor thresholds (RMTs), central motor conduction time (CMCTs) and MEP amplitudes (AMPs) were recorded in all three groups. The relationships of RMT, CMCT and AMP with the severity of the disease were observed.Results Average RMT in the PD group was significantly lower than that in the MSA and control groups. Average RMT in the MSA group was also significantly lower than that in the control group. There was no significant difference among the three groups with regard to CMCT. AMP in the PD group was significantly higher on average than in the MSA and control groups, but there was no significant difference between the MSA and control groups. RMT decreased and CMCT shortened progressively with the severity of the disease in the PD group, but not in the MSA group.Conclusions There were differences in motor cortex excitability between PD patients and MSA patients. MEP RMTs and CMCTs may be valuable for identifying PD and MSAc but the clinical significance of the amplitude differences remains to be further explored.

Objective To study the effects of repeated transcranial magnetic stimulation(rTMS)on Parkinson's plus syndrome(PPS).Methods Fifteen in-patients with PPS were studied between 2005 and 2008.The patients received 1 Hz rTMS at an intensity 30%over the threshold.The rTMS was applied on the hand representive area of the bilateral first motor cortex,50 stimulations on each side,5 arrays,for 5 min,once daily for 15 d.Hamilton's depression scale(HAMD),Hamilton's anxiety scale(HAMA),the unified Parkinson's disease rating scale(UPDRS,which can be subdivided into UPDRS Ⅰ,UPDRS Ⅱ and UPDRS Ⅲ),an activities of daily living scale(ADL),the mini-mental state examination(MMSE)and motor evoked potential(MEP)were assessed before and immediately after 15 d of rTMS treatment. Results Average HAMD,HAMA,UPDRS,UPDRS Ⅱ and UPDRS Ⅲ scores all decreased,and ADL scores increased significantly after treatment,while UPDRSⅠand MMSE scores were unchanged before and after treatment.No significant changes in resting motor threshold or central motor conduction time of the MEP were observed after rTMS treatment. Conclusion Clinical symptoms of PPS patients improved after rTMS treatment and side effects were few.Depression,anxiety,motor function and ability in the activities of daily living improved greatly.Repeated transcranial magnetic stimulation is a potential treatment for PPS patients.There may be no correlation between the effective mechanism of rTMS and cortex excitation.

Objective To investigate the secondary metabolites of the South China Sea spine body sponge Acanthella cavernosa.Methods The acetone extract of A.cavernosa was isolated and purified by repeated column chromatography on sili-ca gel,sephadex LH-20,and high-performance liquid chromatography (HPLC).Structures were determined by spectroscopic analysis and comparison with reported data.Results Nine compounds were isolated.Their structures were determined as kali-hinol E (1),kalihinol A (2),10-epi-kalihinol X (3),10-epi-kalihinol I (4),1 H-indole-3-carboxylic acid methyl ester (5), 1H-indole-3-carboxylic acid (6),3-buten-2-one,4-(2,3,6-trimethylphenyl)-(3E)(7),aristolone (8),and 5α,8α-epidioxy-(22E,24R)-erost-6,22-dien-3β-ol (9).Conclusion Compounds 5 to 8 were isolated from the sponge of genus Acanthalla for the first time.

Ninety-one patients over 60 year old with type 2 diabetes mellitus(T2DM) were selected from our outpatient department. The patients of experimental group uploaded their blood glucose data detected with glucometers, and obtained integrated management called " Mobile Health(M-health)" management such as medicines,diet,exercise from medical groups. The patients of control group got medical care in a traditional way without receiving other interventions. Regular follow-up was conducted in 2 groups every 3 months. The results showed that 3 months later,postprandial 2h plasma glucose in the experimental group was significantly improved compared with that of control group (P<0.05). Six months later, postprandial 2h plasma glucose and HbA1Clevels in the experimental group showed a decline comparing to the baseline, showing a statistical significance compared with control group(P<0.05). These results suggest that smartphone-based telemedicine is helpful of blood glucose control in elderly T2DM patients.

Objective To analyze the therapeutic effect and tolerability of decitabine monotherapy or combined with arsenic trioxide for the treatment of patients with myelodysplastic syndromes (MDS). Methods Clinical characteristics of 32 patients with primary MDS in North Hospital of Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University from January 2014 to April 2017 were retrospectively analyzed. The clinical data of these patients were collected, and the patients were followed up. Decitabine combined with arsenic trioxide was used in 23 cases, decitabine (20 mg·m-·2d-1) and arsenic trioxide (0.16 mg/kg) were administrated from day 1 to day 5 and was repeated every 4-6 weeks. For the remaining 9 cases, only decitabine was applied, decitabine(20 mg·m-2·d-1) was administrated from day 1 to day 5 and was repeated every 4-6 weeks. The clinicopathological characteristics and the effect of genetic mutations on the efficacy of treatment were investigated. Results Of the 32 patients with primary MDS, 18 were male and 14 were female. The patients were 17-72 years old with a median age of 56 years old. Genetic analysis revealed 10 cases with TP53 mutations, 8 cases with TET2 mutations, 4 cases with U2AF1 mutations, 3 cases with RUNX1 mutations, 3 cases with ASXL1 mutations, 2 cases with NRAS mutations, 2 cases with DNMT3A mutations and 1 case with JAK2 V617 mutation. The follow﹣up time was 2-23 months with a median follow﹣up time of 8 months. A total of 21 cases (65.6%) attained treatment response. Among them, there were 10 cases (31.3%) with complete remission (CR), 5 cases (15.6%) with bone marrow complete remission (MCR), and 6 cases (18.7%) with hematological improvement. There was no significant difference in the efficiency and CR rate between the combination group and the monotherapy group (P＝0.441, P＝0.681). Ten cases were found to have TP53 mutations, of which 7 cases had CR. Multivariate analysis demonstrated that TP53 mutation was an independent risk factor for CR (P＝ 0.037). All patients developed myelosuppression after treatment, of which 16 cases developed pulmonary infection. Conclusions Decitabine combined with arsenic trioxide in the treatment of MDS is effective and well tolerated. The therapeutic effects of decitabine monotherapy or decitabine combined with arsenic trioxide for treatment of patients with TP53 mutations are better than the average levels.

Objective To investigate the mechanism of rapamycin inhibiting the differentiation and proliferation of newborn porcine pancreatic adult stem cells, and to explore the therapeutic methods that may effectively reduce the side effects of rapamycin. Method Porcine NPCCs were treated with rapamycin alone or in combination with IGF-Ⅱ, and the caspase-3 and [ 3 H ]-thymidine uptake assays were performed to detect apoptosis and proliferation. The expression of insulin, PDX-1, NeuroD/Beta2, and Foxo1, a downstream transcription factor of IGF-Ⅱ, were analyzed by RT-PCR and Western blot to evaluate the differentiation ability of pancreatic adult stem cells. Results The NPCCs treated with rapamycin inhibited the proliferation ofβ-cells, increased apoptosis, reduced insulin secretion, inhibited the expression of PDX-1 and NeuroD/Beta2, and decreased the expression of IGF-Ⅱ. Foxo1 expression and induction of Foxo1 from the cytoplasm to the nucleus of the ectopic. The combined treatment of rapamycin and IGF-Ⅱcan reduce the side effects of rapamycin, inhibit the decrease ofβ-cell number and insulin content, repair the expression of insulin, PDX-1, NeuroD/Beta2, inhibit Foxo1 expression and intracellular ectopic. Conclusion Aberrant expression of IGF-Ⅱ and Foxol genes is the key inducing factor of rapamycin inhibiting the proliferation and differentiation of NPCCs, and IGF-Ⅱtreatment can effectively reduce the side effects of rapamycin on NPCCs differentiation.

Micro RNAs are a kind of conserved short non-coding RNAs that regulate life activities at molecular level. Micro RNAs are active in various stages of autophagy after ischemic stroke; micro RNAs play protective or destructive roles in autophagy after stroke. Based on the autophagy process, we discuss the possible mechanism of autophagy regulated by micro RNAs through autophagy related genes or pathways, and analyze the application prospect of micro RNAs in stroke diagnosis and treatment.