Objective:To study the combined use of endoscopic balloon dilation with endoscopic biliary brushings in diagnosis of bile duct strictures.Methods:A prospective single center study was conducted at the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology. All patients with suspected malignant bile duct strictures shown on CT or MRI imaging from January 2018 to January 2020 were reviewed. All patients gave informed consent to the endascopic retrograde cholangiopancreatography procedures. Their clinical and follow-up data were analyzed. All patients underwent endoscopic balloon dilation of bile duct strictures. Before and after balloon dilation, biliary brush cytology was performed, and the results were used to classify the patients into the control group and the experimental group. Pathological examination of the brush cytology samples was carried out by a single chief pathologist. Presence of cancer cells or significant heterogeneous cells indicated a positive brush cytology test. Negative patients who still highly consider cholangiocarcinoma and agree to surgery and whose gross specimen is confirmed to be malignant after surgery should be considered as false negative by brush examination; it is difficult to judge that patients with cholangiocarcinoma have progress after 2 months of follow-up should be considered as false negative by brush examination. Any progression of disease indicated that the brush test was wrong and the test was again classified as false negative. Only when there was no progression of strictures was the possibility of a benign biliary stricture being considered. The advantage test (McNemar test) was used to analyze the difference between the two diagnostic methods.Results:Of 39 patients who were included in this study, there were 26 males and 13 females, with an age of (68.0 ± 5.2) years. Cholangiocarcinoma was diagnosed by histopathology, surgery or at 2 months follow-up in 35 patients. In the control group, 17 patients had a positive brush test (sensitivity rate was 48.6%, 17/35). In the experimental group, 26 patients had a positive brush test (sensitivity rate was 74.2%, 26/35). In addition, 2 patients in the control group had a positive brush test, while in the experimental group, a negative brush test. A total of 28 patients were positive in the two groups. The sensitivity rate of the brush test was 80.0% (28/35). There were significant differences between the two groups ( P<0.05). Conclusion:Endoscopic balloon dilation combined with endoscopic biliary brushings improved the sensitivity of pathological diagnosis of cholangiocarcinoma, and endoscopic biliary brushings before and after balloon dilation improved the sensitivity of diagnosis.

OBJECTIVETo investigate the mutant alleles of thiopurine S-methyltransferase (TPMT) among Jing Chinese.

METHODSPolymerse chain reaction-single strand conformation polymorphism (PCR-SSCP) techniques were developed for assaying exons 5, 7 and 10 of the TPMT gene respectively and were used to detect mutant TPMT alleles among Jing Chinese.

RESULTSTwo cases of TPMT*3C (A719G) heterozygotes were identified in 103 Jing Chinese; other deleterious alleles such as TPMT*2 (G238C), TPMT*3A (G460A/A719G) and TPMT*3B (G460A) were not found; 27 cases of silent mutant allele TPMT*1S (T474C) were also identified (5 homozygotes and 22 heterozygotes).

CONCLUSIONThe PCR-SSCP assay established and adopted in this study was sensitive and reliable, which could be used to detect mutant TPMT alleles. Allele frequency of TPMT*3C is low among Jing Chinese (1.0%), and TPMT*3C appears to be the most prevalent deleterious allele in this population.

Adolescent ; Alleles ; Asian Continental Ancestry Group ; genetics ; China ; Exons ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Male ; Methyltransferases ; genetics ; Mutation ; Polymerase Chain Reaction ; Polymorphism, Single-Stranded Conformational

OBJECTIVETo investigate the association of the polymorphisms of cytochrome P450 2C9 (CYP2C9) exon 4 608T/G, 561A/C, 537A/C and 527A/C, and -65G/C with warfarin sensitivity.

METHODSA total of 102 patients under warfarin anticoagulant therapy were selected. During follow-up, warfarin dosage and associated Prothrombin Time-International Normalized Ratio (P-INR) values were recorded. Simultaneous monitoring of incidence of bleeding and thrombosis adverse effect was recommended. Genetic polymorphisms of the above mentioned loci were identified by polymerase chain reaction and DNA sequencing.

RESULTSThe average age of the 102 patients was (62.1+/-10.5) years. The body mass index (BMI) was (24.7+/-3.8) kg/m2. Mean daily warfarin requirement was from 1.250 to 5.077 mg/day when therapeutic PT-INR (1.5-2.5) was maintained. DNA sequencing showed no polymorphisms of 608T/G, 561A/C, 537A/C, 527A/C in CYP2C9 exon 4. Warfarin daily dosage in CYP2C9 exon 4 -65C carriers was 3.106+/-0.619 mg/d, while it was (2.555+/-0.708) mg/d in individuals with wild-type -65G (P=0.020). Receiver operating characteristic (ROC) analysis showed that warfarin daily dosage of more than 2.5 mg/d can be used to predict the CYP2C9 exon 4 -65GC genotype (AUC: 0.770, P=0.005, 95%CI:0.626-0.915). Logistic regression indicated that BMI was an independent factor of bleeding during anti-coagulation therapy (OR=0.794, 95%CI: 0.651-0.970, P=0.024).

CONCLUSIONThe Chinese population are, generally, warfarin-sensitive. Exon 4 of the CYP2C9 gene is highly conserved in this population. The warfarin maintenance dosage in CYP2C9 exon 4 -65CG carriers was significantly higher than those with wild-type -65GG. The clinical significance needs further investigation with more large-scale, multi-center trials.

Adult ; Alleles ; Anticoagulants ; pharmacology ; therapeutic use ; Aryl Hydrocarbon Hydroxylases ; genetics ; Cytochrome P-450 CYP2C9 ; Exons ; genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Middle Aged ; Point Mutation ; Polymorphism, Genetic ; Thrombosis ; drug therapy ; Warfarin ; pharmacology ; therapeutic use

OBJECTIVETo investigate the diagnostic value of FICTION (Fluorescence Immunophenotyping and Interphase Cytogenetics as a Tool for the Investigation of Neoplasms) technique, combining immunofluorescence and fluorescence in situ hybridization (FISH), to detect genetic aberrations in multiple myeloma (MM).

METHODSBone marrow samples were collected from 18 MM and 2 plasma cell leukemia (PCL) patients. Probes targeting IgH and MMSET were prepared using a Nick Translation Kit from Bacterial artificial chromosome (BAC) clones. The immunophenotyping was achieved via the CD138 tyramide signal amplification (TSA)-mediated immunofluorescence, followed by FISH with the prepared probes \[t(4;14), t(11;14), t(14;16)\] and the commercial deletion probes (13q and p53) to detect common genetic aberrations in MM.

RESULTSAll the 20 samples were assayed with the probes mentioned above, and revealed 4 cases with t(4;14), 6 with t(11;14), 1 with t(14;16), 3 with p53 deletion; and 8 with 13q deletion. The remaining 4 cases had none of the 5 aberrations.

CONCLUSIONFICTION technique facilitates the detection of genetic abnormalities of MM in situ; enhances both efficiency and sensitivity of positive detection, thus, could be used as the screening test of molecular diagnosis of MM to guide coming-up risk-adapted therapy and evaluate prognosis.

Adult ; Aged ; Aged, 80 and over ; Cytogenetics ; Female ; Fluorescent Antibody Technique ; Humans ; Immunophenotyping ; In Situ Hybridization, Fluorescence ; Male ; Middle Aged ; Multiple Myeloma ; diagnosis ; genetics

OBJECTIVETo investigate the treatment of postoperative chyle leak after surgery for digestive malignancies.

METHODSFrom December 2008 to February 2012, in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, clinical data of 19 patients with chyle leak after digestive system cancer surgery were retrospective analyzed.

RESULTSNineteen cases of chyle leak were all identified between the second and the fourth postoperative day and were all initially managed with conservative treatment including early fasting, parenteral nutrition(PN), 24-hour continuous infusion of somatostatin, and low pressure suction drainage. Eight patients were treated successfully for 6 to 10 days with a significant reduction of the daily drainage volume. Ten patients had enteral nutrition(EN) and their drain tubes were repeatedly washed with 30 ml of compound meglumine diatrizoate injection every day until the drainage volume decreased to 200 ml/day. The time to resolution of chyle leak in these ten patients ranged from 12 to 24 days. One patient had no significant decrease in fluid drainage and developed abdominal distension after one week of conservative treatment. Surgical closure of chyle leak was performed on the 11th postoperative day, abdominal cavity drainage tube was removed on the 4th postoperative day. The patient was discharged home in good condition.

CONCLUSIONMost postoperative chyle leak after surgery for digestive malignancies can be successfully managed with conservative treatment. Somatostatin and the drainage are the main therapeutic approaches. When chyle leak is not resolved with conservative treatment, surgical treatment should be considered to prevent serious complications.

Adult ; Aged ; Anastomotic Leak ; therapy ; Chyle ; Digestive System Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies

Objective To evaluate the MRI features of central neurocytoma (CNC). Methods Thirteen patients with CNC (7 males and 6 females, aged 18-28), admitted to our hospital fiom January 2007 to January 2010, were chosen; preoperative plain and contrast enhanced MRI scans were performed on these 13 patients and 1 also received CT scan. The clinical and imaging data and pathological features of these patients were retrospectively analyzed. Results The largest tumor enjoyed its maximum diameter of 3.2-8.5 cm; the CNC in 12 patients located at the lateral ventricle and that in 1 patient at the parenchyma of the left frontal and temporal lobes. Lobulated solid tumors were noted in these lesions,showing T1 isointense and T2 hyperintense in MRI; some multiple, scattered cystic lesions showed stronger T1 and T2 signal than the former ones; vascular "flow void" signal was shown in 6 patients in T2WI, and slightly weak T1 signal was shown in 8. All the tumors demonstrated inhomogeneous enhancement and the tumor vessels in 6 patients were noted under contrast MRI. Focal calcification was found. Conclusion CNC in the lateral ventricle enjoys typical location; considering the age of patients, non-contrast and contrast MRI findings, correct diagnosis of CNC can be made; however, CNC outside the lateral ventricle is hard to diagnose.

Objective To investigate the effect of HER-2/neu siRNA on proliferation of human glioma cell lines U251MG and T98G which over-express HER-2/neu, and explore its mechanism.Methods Liposome-mediated HER-2/neu siRNA was transfected into human glioma cell lines U251MG and T98G;lipofectin group was established as controls. The mRNA and protein levels of HER-2/neu were detected by real-time PCR and Western blotting 3 d after the transfection. The proliferation of glioma cells was investigated using methyl thiazolyl tetrazolium (MTT) assay 3 and 4 d after the transfection. The effects of HER-2/neu siRNA on AKT/FOXO1 pathway and protein expression of p27 and Cyclin D1 were studied using Western blotting. Results HER-2/neu mRNA and protein expressions in the transfected U251MG cells were decreased to (28.833±4.174)% and (22.167±1.955)% while those in cells of the lipofectin group were (92.067±5.698)% and (96.100±1.682)%, respectively,with significant differences (P=0.000, 0.001). HER-2/neu mRNA and protein expressions of the transfected T98G cells were decreased to (28.067 ±6.165)% and (12.433 ±8.864)% while those in the untransfected cells were (96.000 ±5.110)% and (94.333 ±3.215)%, respectively, with significant differences (P=0.001, 0.008). Three d after the transfection, the rates of proliferation in the transfected T98G and U251MG cells were (58.467±5.561)% and (63.933±5.363)%, respectively;4 d after the transfection, the rates of proliferation in the transfected T98G and U251MG cells were (57.500±4.770)% and (60.167±3.253)%, respectively;an obvious decrease was noted as compared them with cells of the lipofectin group (P=0.020, 0.023, 0.021, 0.008). Cyclin Dl expression was decreased, while p27 protein expression was up-regulated in the transfected cells as compared with those in cells of the lipofectin group (P<0.05). Moreover, the levels of phosphorylated AKT and phosphorylated FOXO1 were decreased in the transfected cells as compared with those in cells of the lipofectin group (P<0.05).Conclusion The specific siRNA targeting HER-2/neu in human glioma cell lines U251MG and T98G could inhibit the cell proliferation, which might relate to the suppression of AKT/FOXO1 pathway and the regulation of expresion of thier downstream molecules such as p27 and Cyclin D1.

Objective To observe the postoperative dynamic changes of body temperature (BT),C-reactive protein (CRP) and white blood cell (WBC) count.Methods One hundred and two consecutive patients with surgically treated intracranial or spinal lesions,admitted to our hospital from July 2011 to February 2012,were chosen and divided into group A (non infection) and group B (infection) depending on whether postoperative bacterial infections (POBIs) were occurred.Evaluation of postoperative BT and CRP levels,as well as WBC count,was performed.Results WBC and BT levels would elevate in majority of patients with or without POBIs one day after the operation; the difference between the two groups showed no significant difference (P＞0.05).Elevation of BT and WBC levels was noted in 23.8％ and 21.4％ patients from group A and in 88.9％ and 83.3％ patients from group B five days after the operation,with significant difference between the two groups (P＜0.05).Similar results were seen seven day after the operation.Five and seven days after the operation,78 patients (92.8％) and 68 patients (80.9％) still had abnormal CRP level in group A.ROC curve revealed that better diagnostic performance five and seven days after the operation could be found as compared with that one and three days after the operation.Conclusion Elevation of serum CRP,WBC and BT levels can occur in patients with or without POBIs on the first three days of neurosurgical operation; persistent anomalies or secondary elevation could indicate ongoing infection,which needs attention from clinic.

Background and objective Diagnostic modes may play an important role in treatments, but minimal in-formation is available regarding their relationship in patients with lung cancer. hTis study may contribute to decision making in clinics and public health centers.MethodshTe records of 505 hospitalized surgical patients with lung cancer at the Department of hToracic Surgery, West China Hospital of Sichuan University from January 2013 to December 2013 were retrospectively reviewed. hTe patients were categorized into physical examination group (PEG, 131 patients) and symptomatic group (SG, 374 patients). Surgical approach, pathological stage, and diagnostic mode were analyzed.Results Low-dose computed tomography (46.6%, 61/131) and computed radiography (51.1%, 67/131) were used as key diagnosis methods in 131 patients in PEG. hTe percentage of hospitalized surgical patients with lung cancer detected via physical examination in the city (35.4%, 80/229) was also signiifcantly higher than in the township (18.1%, 50/276) (P<0.001). hTe ratio of stage I lung cancer detected via physi-cal examination in the city (46.8%, 59/126) was signiifcantly higher than that in the township (27.3%, 33/121) (P=0.001). hTe proportion of patients who underwent VATS lobectomy was signiifcantly higher in PEG (73.3%, 96/131) than that in SG (44.4%, 166/374) (P<0.001), and the ratio of patients at stage I was signiifcantly higher in PEG (70.2%, 92/131) than that in SG (41.4%, 155/374) (P<0.001).Conclusion hTe use of physical examination is more prevalent in cities than that in towns, and its combination with mini-invasive surgical treatment contributes to early diagnosis of patients with lung cancer.

Background and objective hTere are incresing lung cancer patients detected and diagnosed at the in-termediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health con-sciousness. hTe aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary compli-cations in stage I non-small cell lung cancer (NSCLC) patients, based on routine laboratory tests, basic characteristics, and in-traoperative variables in hospital.Methods hTe 421 patients atfer lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratiifed into complica-tion group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications atfer lobectomy in 30 days.Results Of them, 64 (15.2%) patients were ifnally identiifed and selected into the complication group, compared with 357 (84.8%) in non-complication group: pneumonia (8.8%, 37/421) was the primary complication, and other main complications included atelectasis (5.9%, 25/421), pleural effusion (≥middle) (5.0%, 21/421), persistent air leak (3.6%, 15/421); hTe operation time (P=0.007), amount of blood loss (P=0.034), preoperative chronic obstructive pulmonary disease (COPD) (P=0.027), white blood cell (WBC) count (P<0.001), neutrophil-lymphocyte ratio (NLR) (P<0.001) were signiif-cantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078,P<0.001) and WBC count (OR=1.451, 95%CI: 1.212-1.736,P<0.001) were independent risk factors for postoperative cardio-pulmonary complications.Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD, may be the independent risk factors of the occurrence of postopera-tive cardio-pulmonary complications.