Objective To evaluate the prognostic value of combined analysis of the biomarker Krüppel-like factor 4 (KLF4) and the Milan criteria in hepatocellular carcinoma (HCC) patients treated by orthotopic liver transplantation (OLT).Method The clinicopathological data and outcome of the recruited 105 HCC patients undergoing OLT from October 2001 to April 2009 were retrospectively analyzed.KLF4 expression in HCC and paired non-tumor tissue was detected by immonohistochemistry and confirmed by Western blotting analysis.Five-year overall survival (OS) and recurrence-free survival (RFS) rate and survival curves of the grouped patients were calculated and plotted by Kaplan-Meier method.Result The level of KLF4 expression was lower in HCC than that in paired non-tumor tissue (P＜0.05).KLF4 expression was significantly lower in poorly differentiated HCC than that in well-moderately differentiated HCC (P =0.008).Loss of KLF4 was an independent risk factor for predicting tumor recurrence and survival of HCC after OLT (HR =0.459 and 5.42,respectively,P＜0.001).The level of KLF4 expression could not differentiate the OS and RFS rate in the patients with tumors meeting the Milan criteria,whereas the OS and RFS rate in the patients with tumors exceeding the Milan criteria differentiated according to KLF4 expression.The patients with tumors beyond the Milan criteria and exhibiting moderate to high KLF4 expression had unexpectedly favorable 5-year OS (91.7％) and RFS (70.5％) rate.Conclusion KLF4 is a useful biomarker for prognostication of HCC patients undergoing OLT.Integrated use of KLF4 biomarker and the Milan criteria improves accurate prediction of survival and tumor recurrence for HCC patients after OLT.

Liver transplantation (LT) is one of the most important curative treatment for hepatocellular carcinoma (HCC).In the past decade,great achievements have been made in the field of liver transplantation in China.The incidence of postoperative complications and hospital mortality have significantly decreased due to growing experience and maturity of surgical techniques.However,tumor relapse after LT still negatively impact on the long-term outcome of patients with HCC.HCC recurrence and patients' survival after LT are closely related to preoperative screening of patients,listing priority,local treatment and postoperative management.Successful management of these procedures determines the final therapeutic effect of LT on patients with HCC.In this article,the above issues were explored and discussed according to the current situation of domestic transplant community through revision of the literatures in combination with the clinical experiences.

Liver transplantation may be the best curative treatment for patients with cirrhosis and primary hepatocellular carcinoma. However, tumor recurrence and metastasis is still a difficult problem of liver trans-plantation. Postoperative adjuvant chemotherapy has been employed in an attempt to eliminate micrometasta-ses, and could improve long-term survival after LT for hepatocellular carcinoma. Although the specific chem-otherapy and its efficacy remain controversial, it has been widely used as a safe, feasible and effective meth-od in several clincial institutions.

Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease.

Objective To investigate the early clinical effects of percutaneous kyphoplasty in the treatment of age-related osteo-porotic vertebral compression fractures .Methods Retrospected 54 cases with osteoporotic verebral compression fractures were treated with PKP ,summarized early clinical effects and complications .analysis of preoperative and postoperative wound vertebral height average recovery rate ,Cobb Angle ,VAS scores and ADL scores .Results Operations in all the 54 cases were completed smoothly ,47 cases for 6 to 24 months follow-up(mean 13 .5 months) .postoperative pain in 31patients obtained remission immedi-ately ,1 week after operation ,12 cases with lower back pain and need the non-steroidal anti-inflammatory medications ,the symptoms remissed significantly or disappeared after 8 weeks postoperatively .At the last follow-up ,4 patients still had low back pain and need oral analgesics .Preoperative and postoperative wound vertebral height average recovery rate ,Cobb Angle ,VAS scores and ADL scores was statistically significant .Conclusion PKP is a minimally invasive ,effective and safe procedure that provides pain relief and stabilization of spinal stability and activities under the bed early ,and improves quality of life at the same time .Grasping the indi-cations Strictly and holding the surgical skills can be obtained clinical results efficiently and safely .

Objective To evaluate the effect of sustained silencing Forkhead box Ml (F0XM1) gene by short-hairpin RNA (shRNA) expression vector on cell growth of hepatocelluar carcinoma (HCC) in vitro.Methods Four shRNA expression vectors targeting different sequences of human F0XM1 mRNA were constructed.The expression vector with the best interfering effect and the negative control plasmid were used to transfect HCC cell line QGY-7703, stably transfected cell clones were selected by neomycin (G418).Cell growth was evaluated by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and colony formation was assessed by clonogenic assay.Cell apoptosis was detected by double staining with APC conjugated Annexin V and PI.Results F0XM1 protein was detected with different levels in all these studied human cell lines.The expression vector shRNA-1026 exhibited excellent interference effect after transient transfection, which showed 38.5% and 53.2% reduction of FOXM1 mRNA and protein level respectively.The growth of QGY-7703 cells was inhibited after stable inhibition of FOXM1 expression by shRNA-1026, which was indicated by decreased absorbance value of the test group after culture for 48, 72 and 96 h compared to control group (t = 10.830,3.578 and 5.734 respectively, P ＜ 0.05).Stable inhibition of F0XM1 also led to reduced colony formation ( t = 5.336, P ＜ 0.05 ) and increased apoptosis of QGY-7703 cells in comparison to control cells (t = 6.827, P ＜ 0.05 ).Conclusions Stable silencing F0XM1 gene by shRNA suppresses the growth of HCC cells in vitro.

Objective To investigate the clinical value and surgical methods of pancreaticoduodenectomy (PD) combined with portal vein (PV)/superior mesenteric vein (SMV) resection and reconstruction in the treatment of pancreatic cancer with PV/SMV invaded by tumor.Methods The clinical data of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) and 62 patients of pancreatic head cancer without PV/SMV invaded by tumor (group B) in the same period were collected and analyzed retrospectively from Jan 2014 to Apr 2017.There were no distinct invasion of celiac artery (CA),hepatic common artery (HCA) and superior mesenteric artery (SMA) in two groups of pancreatic cancer patients.The patients of group A underwent PD combined with PV/SMV resection and reconstruction,and the patients of group B were only treated with PD surgery.The complication rate and overall survival time after PD was compared between the 21 patients of pancreatic cancer with PV/SMV invaded by tumor and the 62 patients of pancreatichead cancer without PV/SMV invaded by tumor.'Results The average overall survival time of 21 patients of pancreatic cancer with PV/SMV invaded by tumor (group A) was 19.2 months,specifically with 1-year survival rate of 57.1％ (12/21),2-year survival rate of 28.6％ (6/21),and 3-year survival rate of 14.3％ (3/21).Meanwhile,the average overall survival time of group B was 19.4 months,specifically with 1-year survival rate of 58.1％ (36/62),2-year survival rate of 30.6％ (19/62),and 3-year survival rate of 14.5％ (9/62).The results indicated that no differences for overall survival time of patients treated with PD including 1,2,3-year survival rate between two groups were found (P ＞ 0.05).Conclusions For pancreatic cancer accompanied by PV/SMV invasion without invasion of SMA,CA and HCA,PD combined with PV/SMV resection and reconstruction are safe and feasible surgical procedures.The surgical reconstruction method was determined according to the location and length of the invaded vessels,and also there were no significant differences on the complication rate and overall survival time after PD between the pancreatic cancer patients with invasion of PV/SMV and the pancreatic head cancer patients without invasion of PV/SMV.

Objective To investigate the association between the gene polymorphisms of the DNA damage repair gene X-ray repair cross-complementing gene 1 (XRCC1) and susceptibility to chromosome damage in workers exposed to low-concentration benzene in the jewelcrafting industry.Methods A total of 286 workers exposed to benzene in jewelcrafting enterprises were enrolled as study subjects from January 2013 to December 2014.Gas chromatography was used to measure benzene concentration in workplace,cytokinesisblock micronucleus test was used to analyze the level of chromosome damage in peripheral blood,and the Sequenom technique was used to determine the single nucleotide polymorphisms of XRCC1.Results The timeweighted average concentration of benzene in workplace was ＜0.6 ～1.8 mg/m3,lower than the national occupational exposure limit (6 mg/m3).The distribution of allele frequencies met the Hardy-Weinberg equilibrium in genetics(P＞0.05).Increase in age(RR=1.38,95％CI 1.06～3.75) and increase in working years (RR=1.45,95％CI 1.18～2.58) were risk factors for the increase in micronucleus frequency.Compared with those with the wild-type homozygous genotype,the individuals with XRCC1 rs25487 CT genotype showed a significantly higher risk of increase in micronucleus frequency (RR=1.51,95％CI 1.28～3.87,P＜0.05),and the individuals with XRCC1 rs1799782 AA genotype also showed a significantly higher risk of increase in micronucleus frequency (RR =1.65,95％ CI 1.30～3.12,P＜0.05).There was no clear association between XRCC1 rs25489 polymorphisms and micronucleus frequency (P＞0.05).Conclusion Exposure to lowconcentration benzene may cause chromosome damage in workers exposed to benzene,and the XRCC1 polymorphisms rs 25487 and rs 1799782 may be associated with chromosome damage induced by benzene.

Objective To investigate the association between the gene polymorphisms of the DNA damage repair gene X-ray repair cross-complementing gene 1 (XRCC1) and susceptibility to chromosome damage in workers exposed to low-concentration benzene in the jewelcrafting industry.Methods A total of 286 workers exposed to benzene in jewelcrafting enterprises were enrolled as study subjects from January 2013 to December 2014.Gas chromatography was used to measure benzene concentration in workplace,cytokinesisblock micronucleus test was used to analyze the level of chromosome damage in peripheral blood,and the Sequenom technique was used to determine the single nucleotide polymorphisms of XRCC1.Results The timeweighted average concentration of benzene in workplace was ＜0.6 ～1.8 mg/m3,lower than the national occupational exposure limit (6 mg/m3).The distribution of allele frequencies met the Hardy-Weinberg equilibrium in genetics(P＞0.05).Increase in age(RR=1.38,95％CI 1.06～3.75) and increase in working years (RR=1.45,95％CI 1.18～2.58) were risk factors for the increase in micronucleus frequency.Compared with those with the wild-type homozygous genotype,the individuals with XRCC1 rs25487 CT genotype showed a significantly higher risk of increase in micronucleus frequency (RR=1.51,95％CI 1.28～3.87,P＜0.05),and the individuals with XRCC1 rs1799782 AA genotype also showed a significantly higher risk of increase in micronucleus frequency (RR =1.65,95％ CI 1.30～3.12,P＜0.05).There was no clear association between XRCC1 rs25489 polymorphisms and micronucleus frequency (P＞0.05).Conclusion Exposure to lowconcentration benzene may cause chromosome damage in workers exposed to benzene,and the XRCC1 polymorphisms rs 25487 and rs 1799782 may be associated with chromosome damage induced by benzene.

BACKGROUND:In the initial stage of growth plate injury inflammation,platelet-derived growth factor BB promotes the repair of growth plate injury by promoting mesenchymal progenitor cell infiltration,chondrogenesis,osteogenic response,and regulating bone remodeling. OBJECTIVE:To elucidate the action mechanism of platelet-derived growth factor BB after growth plate injury. METHODS:PubMed,VIP,WanFang,and CNKI databases were used as the literature sources.The search terms were"growth plate injury,bone bridge,platelet-derived growth factor BB,repair"in English and Chinese.Finally,66 articles were screened for this review. RESULTS AND CONCLUSION:Growth plate injury experienced early inflammation,vascular reconstruction,fibroossification,structural remodeling and other pathological processes,accompanied by the crosstalk of chondrocytes,vascular endothelial cells,stem cells,osteoblasts,osteoclasts and other cells.Platelet-derived growth factor BB,as an important factor in the early inflammatory response of injury,regulates the injury repair process by mediating a variety of cellular inflammatory responses.Targeting the inflammatory stimulation mediated by platelet-derived growth factor BB may delay the bone bridge formation process by improving the functional activities of osteoclasts,osteoblasts,and chondrocytes,so as to achieve the injury repair of growth plate.Platelet-derived growth factor BB plays an important role in angiogenesis and bone repair tissue formation at the injured site of growth plate and intrachondral bone lengthening function of uninjured growth plate.Inhibition of the coupling effect between angiogenesis initiated by platelet-derived growth factor BB and intrachondral bone formation may achieve the repair of growth plate injury.