Objective To summerize the experience in diagnosis and surgical treatment for hilar cholangiocarcinoma in recent years.Methods 86 consecutive cases of hilar cholangiocarcinoma were surgically treated in this hospital from Jan. 1992 to Oct. 1998. Results The tumor resection rate was 37%(32/86) in this series. The postoperative morbidity and mortality rate were 47% and 7% respectively. The median survival time in palliative resection group was 16 months and the 1-year, 3- year, 5-year survival rate was 63%,21%,15% respectively. For curative resection,the median survival time was 19 months and the 1-year, 3- year, 5-year survival rate was 80%,35%,25% respectively( P =0 038). For drainage group, the median survival time was 5 months and the 1-year, 3- year, 5-year survival rate was 28%,8 4%,5% respectively.Conclusion Early diagnosis, improvement of patients′ general preoperative condition and the surgical expertise may help in increasing the curative resection rate and reducing postoperative morbidity and mortality rate, which are keys to prolong patients′ survival.

Objective To evaluate the application of 64-slice computed tomography (CT) and software-assisted image analysis in preoperative evaluation and surgical planning of hilar cholangiocarcinoma. Methods The clinical data of six patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of Sun Yat-sen University from June to December, 2009 were retrospectively analyzed. All six patients underwent 64-slice CT scanning before the operation, and then three-dimensional (3D) reconstruction of the liver, tumor, blood vessels and bile ducts was achieved with the assistance of Myrian (R) XP-Hepatic software. The relationships of the tumor, blood vessels and bile ducts were illustrated in the 3D model. Virtual liver resection was carried out for surgical planning. Results The 3D models of the liver, tumor, blood vessels and bile ducts were successfully constructed . The 3D models were able to be rotated and magnified as necessary. Preoperative evaluation and surgical planning were in accordance with actual surgery. The relative accuracy of the software-assisted image analysis system for calculating the hepatic volume to be resected was 5%. Patients recovered well without occurrence of hepatic failure. Conclusion Sixty-four-slice CT scanning and software-assisted image analysis are important for preoperative evaluation and surgical planning of hilar cholangiocarcinoma.

Objective:To analyze the perception and evaluation of rural patients with hypertension and diabetes on the health management services , thereby identifying the problems and proposing countermeasures .Methods:570 rural patients with hypertension and diabetes were investigated by the stratified random sampling method .Descriptive statistic method and logistic regression analysis were applied to analyze the rural patients'perception and evaluation on the health management services .Results: The majority of rural patients with chronic diseases such as hypertension and diabetes were alerted of the health management service .The satisfaction rate on the disease control effect was 82.28%, and that among patients below the age of 60 years old was lower than that of the others ( P <0.05 ) . 77 .24%of patients deemed that some services such as on-site visit , physical examination and prevention of complica-tions were deficient (the selection rates among patients were 11.90%, 10.41% and 9.29% respectively).The health management services problems mainly included deficiency of on-site visits, incomplete medical equipments and service items ( the selection rates among patients were 16.36%, 9.29%and 8.92%respectively ) .Conclusions:In order to improve the quality and positive effect of health management for patients with hypertension and diabetes , the collaborative mechanism between township institutions should be developed , the government should increase invest-ment in rural public health , strengthen the rural heath personnel brainstorming , and on-site visits and debates on health should be reasonably arranged according to the needs of rural patients , and the quality and effectiveness of the management of hypertension and diabetes together with other chronic diseases should be improved .

AIM: To investigate the angiogenesis status,the expression of vascular endothelial growth factor(VEGF),angiopoietin-1(ANG-1),angiopoietin-2(ANG-2),thrombospondin-1(TSP-1) in cholangiocellular carcinoma(CCC) and relationship with tumor angiogenesis,differentiation,invasion and metastasis.METHODS: 33 specimen of surgically resected CCC were investigated.Immunohistochemical staining of CD34,VEGF,ANG-1,ANG-2 and TSP-1 was carried out.RESULTS: The mean MVD was(87.2?52.6)/mm2.VEGF positive expression was found in 75.6% cases;ANG-1 positive expression was observed in 36% cases;ANG-2 positive was detected in 57.6% cases and 45.5% cases exhibited positive TSP-1 expression.VEGF and ANG-2 expressions were found to be associated with significant higher level of MVD(P

ObjectiveTo investigate the effects of losartan on angiotensin (Ang)Ⅱ-induced the generation of oxidative stress and expression of transforming growth factor β1(TGF-β1) in rat proximal tubular epithelial cells and to explore its underlying mechanism. MethodsNRK-52E cells, a rat proximal tubular epithelial cell line, were applied to explore the antioxidationand antifibrosis of losartan. The expression of three subunits of nicotinamide-adenine dinucleotide phosphate (NADPH) oxidase, including p47phox, Nox-4, p22phox, and TGF-β1 were determined by real-time RT-PCR and/or Western blot. The generation of reactive oxygen species (ROS) was measured by DCF fluorescence analysis. Superoxide dismutase (SOD) in the supernatant was measured by colorimetric method. Results10-7 mol/L Ang Ⅱ up-regulated p22prox, p47phox and Nox-4 mRNA and protein expression, and the mRNA increased by 5.57-fold, 5.55-fold and 9.41-fold at 24 h (P<0.01, respectively) and the protein increased by 4.53-fold, 4.17-fold and 6.50-fold at 24 h (P<0.01, respectively) as compared with control. Losartan greatly reduced the mRNA elevation of p22prox, p47phox and Nox-4 by 2.71-fold, 2.18-fold and 5.23-fold (P<0.01, respectively) and reduced the protein elevation by 3.20-fold, 2.30-fold and 4.30-fold (P<0.01, respectively) as compared with control. Losartan also inhibited ROS generation induced by Ang Ⅱ in rat proximal tubular epithelial cells. SOD level in the supernatant was markedly decreased after Ang Ⅱ stimulation, while losartan could increase SOD levels (P<0.01). Furthermore, losartan signficantly inhibited Ang Ⅱ-induced TGF-β1 mRNA up-regulation by 64% (P<0.01). ConclusionsLosartan acts as an anti-oxidative and anti-fibrotic agent via the mechanisms of blocking NADPH oxidase-dependent oxidative stress and inhibiting TGF-β1 expression.

Objective:To investigate the gene expression of TCR V? subfamily T cells and clonality in peripheral blood CD4+ and CD8+ cells from patients with chronic myelogenous leukemia-chronic phase(CML-CP).Methods:The complementarity determining region 3(CDR3)of TCR V? subfamily genes in peripheral blood mononuclear cells(PBMCs),sorted CD4+ and CD8+ cells from 19 CML-CP patients were amplified using RT-PCR,the products were further by genescan analysis to identify the clonality of T cells.Results:Only 1 to 21 V? subfamilies were detected in peripheral blood CD4+ and CD8+ cells from patients with CML.The most frequent expression of V? subfamily was V?13 followed by V?9.Clonal expanded T cells in some V? subfamilies could be identified in both CD4+ and CD8+ cells,especially in CD8+ cells.The clonal expanded of V?21 subfamily in CD4+ cells and V?11 subfamily in CD8+ cells were identified most frequently.Conclusion:The restricted distribution of TCR V? repertoire has been found in CD4+ and CD8+ cells in patients with CML.Clonal expanded CD4+ cells and CD8+ cells have been identified which may relate to host immune response to CML antigen and may play a important role in anti-CML effect.

ObjectiveTo evaluate the feasibility of a three-dimensional (3 D) operation planning system for precise hepatectomy in patients with giant hcpatocellular carcinoma (HCC).MethodsThe clinical data of 34 patients with giant HCC who received precise hepatectomy at the First Affiliated Hospital of Sun Yat-sen University from May 2009 to May 2011 were retrospectively analyzed.Preoperative evaluation was done based on the computed tomography data,and the resection margin and the volume of resectcd liver were calculated using simulation.The predicted resected liver volume and resection margins were compared with the results of the actual operations.All data were analyzed using the t test,and the correlation between predicted and the actual values was analyzed by calculating Pearson correlation coefficients.Results Hepatic and tumor tissues and the hepatic vessels were reconstructed three-dimensionally using the 3D preoperative simulation software.The volume of simulated resected liver and the length of resection margin were ( 2112 ± 1550 ) ml and ( 12 ± 6) mm,respectively,while the volume of actual resected liver and the length of resection margin were (2031 ± 1411 )ml and ( 12 ± 6)mm,respectively.The predicted and the actual values were statistically correlated ( r =0.961,0.923,P ＜ 0.05 ).There was no significant difference between the predicted and the actual values ( t =1.549,1.143,P ＞ 0.05 ).All patients received precise hepatectomy,and no hepatic failure or death was observed. Conclusion The 3D operation planning system can accurately evaluate the condition of the liver and simulate hepatectomy,and could contribute to safer and more curative precise hepatectomy in patients with giant HCC.

Objective To investigate the expression of p21 and p53 in renal interstitial fibrosis rats and the effect of enalapril on it. Methods Sprague-Dawley rats were randomly divided into 3 groups, shame operation rats group, unilateral urethral obstruction and enalapril treatment group. Histological chan-ges were observed by Masson stain. The expression of p21 mRNA and p53 mRNA was detected by RT-PCR. Results With degree of interstitial fibrosis aggravating, the expression of p21 and p53 increasing,p21 and p53 expression of UUO rats at every time point were positive correlative. Enalapril can inhibit the expression of p21 and p53. Concinsion p21 and p53 expression increased in UUO rats renal cortex and enalapril can significantly inhibit its expression, p21 may participate in the pathogenesis of renal tubule-in-terstitial fibrosis through p53 pathway.

AIM: To evaluate the anti-angiogenesis effect of interferon-?(IFN-?) on cultured human umbilical vein endothelial cells(HUVECs) and human hepatocellular carcinoma(HCC) bearing nude mouse.METHODS: Anti-proliferation test,MTT test,tube-formation test,migration test on cultured HUVECs were employed and the tumor volume and microvascular desity(MVD) of IFN-? treated human hepatoma cell line(HuH7) were meassured.RESULTS: IFN-? displayed apparent inhibitory effects on cultured HUVECs in anti-proliferation test,MTT test,tube-formation test,migration test,and the tumor diameter and MVD in IFN-? treated HuH7 inoculated nude mouse group were significantly less than those in PBS treated HuH7 inoculated nude mouse group.CONCLUSION: IFN-? inhibits tumor growth through anti-angiogenesis.

[ ABSTRACT ] AIM: To investigate the expression and clinical significance of bone morphogenetic protein 3 (BMP3) in hilar cholangiocarcinoma tissues.METHODS: Thirty cases of hilar cholangiocarcinoma specimens were col-lected.The expression of BMP3 at mRNA and protein levels in the tumor tissues and paracancerous tissues was detected by real-time PCR and Western blot.The hilar cholangiocarcinoma paraffin-embedded specimens (n=103) were collected. The protein expression of BMP3 was determined by immunohistochemical method, and the relationship of BMP3 protein ex-pression with clinical pathological characteristics was evaluated.RESULTS:In the 30 patients with hilar cholangiocarcino-ma, the expressions of BMP3 protein and mRNA in 22 cases of tumor tissues were significantly decreased compared with the adjacent normal tissues.The results of immunohistochemistry showed that 87 cases were negative and 16 cases were weakly positive in all 103 cases of hilar cholangiocarcinoma.The expression of BMP3 protein was associated with the tumor TNM staging, lymph node metastasis and tumor differentiation (P<0.05).CONCLUSION:BMP3 gene might be inhibited in human hilar cholangiocarcinoma.The down-regulation of BMP3 gene might be associated with the carcinogenesis and devel-opment of hilar cholangiocarcinoma.