Objective To investigate the clinicopathological and immunophenotype features of hemangiosarcoma.Methods The clinical,pathologic features of 5 cases of hemangiosarcoma,admitted in our hospital during 2006-2014,were retrospectively analyzed.Results Tumors were located in the spleen (n =3),liver(n =1),scalp(n =1),tumor metastasis to the lung or marrow was found in 4 cases.Preoperative misdiagnosis as lymphoma,cavernous haemangiomas or parasite cyst was suggested by ultrasonography or CT,and final diagnosis was established by typical pathological pictures.CD34,CD31,FⅧ and Vim were positive in tumor cells while CK,EMA were negative.The survival time of the patients receiving resection only was 2 days,4 months and 13 months.The survival time of the patients receiving operation plus chemotherapy was 6 months or 48 months.Conclusions Hemangiosarcoma is a rare and aggressive malignant tumor of soft tissue which has poor prognosis.The additional survival benefits provided by chemotherapy remains unproven.

Objective To compare the perioperative outcomes and long-term therapeutic response of laparoscopic splenectomy versus open splenectomy for idiopathic thrombocytopenic purpura.Methods A retrospective analysis of 124 patients who under-went splenectomy(68 LS and 56 OS)for ITP between January 2011 and January 2015 was conducted.Results Patients undergoing LS were found to require a longer operative time(P <0.05 )but had reduced hospital stay,lower intra-operative blood loss(P <0.05),less postoperative pain,earlier drain removal,and decreased incidence of complications(P <0.05).Conversion to OS was re-quired in 4 patients for excessive loss of blood(5.8%).Deep venous thrombosis(DVT)was observed in 1 patients after OS.One pa-tient died from pneumonia after LS.Mean follow-up of (33±11.8)months was performed in LS group and of (32±12.9)months in OS group.50 patients(73.5%)in LS group and 43(76.7%)in OS group reached sustained complete haematological response(P >0.05).Kaplan-Meier analysis showed that there was no significant difference in the relapse-free survival rate between the groups (P =0.679).Conclusion Compared with open splenectomy,laparoscopic splenectomy for patients with ITP has similar long-term therapeutic response,but it has advantages of minimally invasiveness.

Objective To investigate the relationship between low serum calcium concentration and hematoma volume in patients with intracerebral hemorrhage.Methods Between January 2012 and October 2014,870 consecutive patients with intracerebral hemorrhage admitted to the Department of Neurosurgery,West China Hospital,Sichuan University were enrolled prospectively.The patients completed laboratory serum calcium concentration and head CT examinations within 24 h after attack,and the baseline data and laboratory findings were collected.According to the normal reference value of laboratory serum calcium concentration,the patients were divided into a hypocalcemia calcium group (<2.1 mmol/L;n=193) and a normal calcium group (2.1-2.7 mmol/L;n=677).Spearman correlation analysis was used to analyze the correlation between the blood serum calcium concentration and the hematoma volume on admission.Results (1) The hypocalcemia group compared with normal calcium group,the proportion of male patients was high (73.6% [n=142] vs.66.0% [n=447]),the median score for Glasgow coma scale was lower (9 vs.11),and the median hematoma volume was larger (33.86 cm3 vs.21.69 cm3).The differences were statistically significant (all P<0.05).(2) Spearman correlation analysis showed that the lower serum calcium level on admission was weakly negatively correlated with the volume of hematoma in patients with intracerebral hemorrhage (r=-0.113,P<0.01).Conclusion The study suggested that the hypocalcemia on admission was mostly males in patients with intracerebral hemorrhage,the condition was serious,the volume of hematoma was larger,and the lower serum calcium concentration was negatively correlated with the hematoma volume.

Objective To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration. Methods Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct (CBD) stones. After extraction of stones, an 8F J-stent (pigtailed) was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed. Results The stent dislodged and was discharged with stool at the 13th (10-18) postoperative day . Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD. Conclusions Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of choledochoscpe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.

Objective To explore Wang Xingkuan’s rules of syndrome and treatment of chest blocking and heartache (Xiongbixintong).Methods Collection of professor Wang Xingkuan’s 267 consilia of patients with Xiongbixintong for outpatients. Chinese medicine terminology was regulated and Excelldatabase was established. Symptom, syndrome element, pathogenesis and treatment were statistically described by using Weka3.6 software, and Apriori algorithm was adopted for the main pathogenesis→treatment analysis of association rules.Results Symptoms include:chest pain, heart palpitations, shortness of breath, pale tongue (dark) red, etc. Syndrome elements include:in liver, and heart, and blood stasis, phlegm, qi stagnation, etc. The key pathogenesis is liver-heart imbalance, including stagnation of liver qi, heart and blood stasis, deficiency of heart qi-ying, disturbing heart-mind, etc. The principle of treatment is liver-heart Tongzhi, so the treatment is of“liver” with Shu gan-mu;treatment of“heart” contains freeing channels, eliminating phlegm and blood stasis, quiet the heart, replenishing qi-ying, etc. The main pathogenesis related credibility→treatment was higher than 0.50;with high reliability, the liver-heart imbalance→liver-heart Tongzhi was 0.71. Medication includes catharsis and tonic,“catharsis” to salvia, allium macrostemon, pseudo-ginseng, bupleurum, etc;“tonic” to white ginseng, ophiopogon japonicus, radix paeoniae alba, poria with hostwood, polygala tenuifolia, etc. Conclusion “Xintongzhigan, liver-heart Tongzhi, catharsis and tonic” is Wang Xingkuan’s thoughts and experience in treating Xiongbixintong.

Objective: To observe the clinical effect of treating remission-stage cerebral infarction with mind-refreshing and orifice-opening needling method. Method: Six hundred cases of cerebral infraction were randomized on the basis of disease phase. The 234 cases in remission stage were randomized into treatment group (116 cases) and control group (118 cases). Besides routine Western therapies, the cases in the treatment group were combined mind-refreshing and orifice-opening needling method and the cases in the control group were combined with conventional needling method. The treatment was done once every day for 4 weeks. The follow-up was done for six months. Result: the baseline material in the two groups has good compatibility (P>0.05) and the treatment group is better than the control group (P<0.05). Conclusion: the mind-refreshing and orifice-opening method is safe and act to improve symptoms of patients during remission stage, reduce disability, prevent disease progression and improve quality of life.

Myeloid-derived suppressor cells (MDSCs) have strong immunosuppressive activity and are morphologically similar to conventional monocytes and granulocytes. The development and classification of these cells have, however, been controversial. The activation network of MDSCs is relatively complex, and their mechanism of action is poorly understood, creating an avenue for further research. In recent years, MDSCs have been found to play an important role in immune regulation and in effectively inhibiting the activity of effector lymphocytes.Under certain conditions, particularly in the case of tissue damage or inflammation, MDSCs play a leading role in the immune response of the central nervous system. In cancer, however, this can lead to tumor immune evasion and the development of related diseases. Under cancerous conditions, tumors often alter bone marrow formation, thus affecting progenitor cell differentiation, and ultimately, MDSC accumulation. MDSCs are important contributors to tumor progression and play a key role in promoting tumor growth and metastasis, and even reduce the efficacy of immunotherapy. Currently, a number of studies have demonstrated that MDSCs play a key regulatory role in many clinical diseases. In light of these studies, this review discusses the origin of MDSCs, the mechanisms underlying their activation, their role in a variety of clinical diseases, and their function in immune response regulation.

Objective:To investigate the effects of IL-28B in a mouse model of dextran sulfate sodium (DSS)-induced colitis and to analyze the possible mechanism.Methods:Thirty-five male C57BL/6 mice were randomly divided into the following groups with seven mice in each group: control group, DSS group and three IL-28B groups (1.25 μg, 2.5 μg and 5 μg). The mice in the DSS group and IL-28B groups were fed with 2.5% DSS solution and from day 3, the IL-28B groups were given intraperitoneal injection of corresponding IL-28B every day and the DSS group was treated with PBS. During the experiment, the disease activity index (DAI) was evaluated daily. On day 8, the mice were sacrificed and peripheral blood, spleen, mesenteric lymph node and colon samples were collected. The colon samples were observed, measured in length and stained with HE, and histopathological scores were calculated based on HE staining. Changes of immune cells in different samples were detected by flow cytometry. ELISA was used to detect the expression of IL-12, IL-10, IL-1β, IL-6, IL-4 and IL-13 in serum and colon tissues.Results:Compared with the DSS group, the IL-28B group (2.5 μg) had lower DAI scores [(9.40±1.67) vs (3.50±1.73), P<0.01], less shortening of the colon [(5.16±0.61) cm vs (6.91±0.60) cm, P<0.01] and significantly lower histopathological scores [(7.33±0.58) vs (4.33±0.58), P<0.01]. Moreover, compared with the DSS group, the IL-28B group (2.5 μg) showed decreased macrophages in the peripheral blood [(21.39±3.21)% vs (15.63±2.98)%, P<0.05] and spleen [(3.03±0.28)% vs (2.05±0.48)%, P<0.05], and significantly increased mean fluorescence intensity of M2 macrophages in the colon [(1 361.00±293.40) vs (2 074.00±87.61), P<0.05]. IL-12 expression in colon tissues and IL-1β expression in serum were reduced, and IL-10, IL-4 and IL-13 expression in colon tissues was significantly increased in the IL-28B group (2.5 μg) as compared with those in the DSS group [IL-12: (31.72±6.92) pg/mg vs (5.41±3.41) pg/mg; IL-1β: (48.01±16.13) pg/ml vs (12.27±6.26) pg/ml; IL-10: (184.70±46.82) pg/mg vs (444.30±157.80) pg/mg; IL-4: (2.23±0.27) pg/mg vs (3.64±0.80) pg/mg; IL-13: (11.79±0.99) pg/mg vs (22.59±1.92) pg/mg; all P<0.05]. Conclusions:IL-28B might alleviate the severity of acute enteritis in mice by increasing the secretion of IL-4 and IL-13, regulating macrophage differentiation and modulating the expression of inflammatory factors.

Myeloid-derived suppressor cells (MDSCs) have strong immunosuppressive activity and are morphologically similar to conventional monocytes and granulocytes. The development and classification of these cells have, however, been controversial. The activation network of MDSCs is relatively complex, and their mechanism of action is poorly understood, creating an avenue for further research. In recent years, MDSCs have been found to play an important role in immune regulation and in effectively inhibiting the activity of effector lymphocytes.Under certain conditions, particularly in the case of tissue damage or inflammation, MDSCs play a leading role in the immune response of the central nervous system. In cancer, however, this can lead to tumor immune evasion and the development of related diseases. Under cancerous conditions, tumors often alter bone marrow formation, thus affecting progenitor cell differentiation, and ultimately, MDSC accumulation. MDSCs are important contributors to tumor progression and play a key role in promoting tumor growth and metastasis, and even reduce the efficacy of immunotherapy. Currently, a number of studies have demonstrated that MDSCs play a key regulatory role in many clinical diseases. In light of these studies, this review discusses the origin of MDSCs, the mechanisms underlying their activation, their role in a variety of clinical diseases, and their function in immune response regulation.

Objective:To analyze the value of serum ceruloplasmin (CP) levels in predicting the outcome of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF).Methods:The clinical data of 1 751 patients with HBV-ACLF treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2010 to March 2018 were retrospectively analyzed. According to 30-day outcomes, 1 220 survival patients were classified into group A; 465 fatal patients and 46 patients receiving liver transplantation were classified into group B (total 531 cases). Risk factors associated with 30-day survival were estimated using Cox proportional hazards regression. ROC curve analysis was performed to evaluate the predictive value of CP on the 30-day outcome of patients with HBV-ACLF.Results:Multivariate analysis indicated that CP, albumin and alpha fetoprotein were independent protective factors for 30-day survival of HBV-ACLF patients ( P<0.05 or <0.01), while age, white blood cell count, AST, total bilirubin, INR, serum creatinine, HBV DNA, hepatorenal syndrome and hepatic encephalopathy were independent risk factors ( P<0.01). The area under the ROC curve (AUC) of CP was 0.570 (95% CI 0.540-0.599, P<0.01); while AUC of MELD score was 0.783 (95% CI 0.759-0.807, P<0.01) and MELD-Na score was 0.774 (95% CI 0.750-0.798, P<0.01). Compared with MELD score and MELD-Na score, the value of CP in predicting the 30-day prognosis of HBV-ACLF patients was lower ( P<0.01). The cut-off value of CP for predicting 30-day outcome of HBV-ACLF patients was 0.173 g/L, with the sensitivity of 69.4%, and the specificity of 41.6%. According to the cut-off value, the patients were divided into low CP level group (level of CP<0.173 g/L) and high CP level group (level of CP≥0.173 g/L); the 30-day cumulative survival rate of low CP level group was lower than that of high CP level group ( χ2=17.75, P<0.01). Conclusions:Serum CP level can predict the 30-day outcome of HBV-ACLF patients to a certain extent.