Objective To investigate the efficacy of TACE combined with radiofrequency ablation (RFA) in treatment of advanced hepatocellular carcinoma.Methods A total of 72 patients with advanced hepatocellular carcinomas were analyzed retrospectively,including 35 patients underwent TACE combined with RFA (combined group),37 patients underwent single TACE (control group).After the operation,the short-term effect,the changes of liver function,serum alpha-fetoprotein (AFP) level,the complication and the long-term survival rates of the two groups were compared.Results The total effective rate of the combined group (29/35,82.86％) was significantly higher than that of control group (20/37,54.05％;P=0.009).In the combined group,the AFP reduced to (102.19±32.13)μg/L,and the control group reduced to (218.46±49.87)μg/L,which had statistical difference (P＜0.001).The survival rates of 1-year,2-year and 3-year in the combined group were 82.86 ％,54.29 ％,34.29 ％ with a median survival time of 25 months;while in the control group those were 54.05％,32.43％,13.51％ with a median survival time of 16 months;there were statistically significant differences in the survival rate between two groups (P=0.009).After treatment,the hepatic functions of both group had a transient change,and 2 weeks after the operation,there was no significant difference between the two groups (all P＞0.05).Conclusion The combination of TACE and RFA is an effective method for the treatment of advanced hepatocellular carcinoma.

Objective To study the therapeutic effect of EUS-guided biliary drainage (EUS-BD) on patients with malignant obstructive jaundice when ERCP failed.Methods From January 2014 to January 2016,all patients with malignant obstructive jaundice during hospitalization underwent EUS-guided biliary drainage (group A,36 cases) or PTCD treatment (group B,30 cases) by draw after failed ERCP.Operation success rate,liver function recovery time,complication rates,length of hospital stay and hospital costs were observed and compared.Results There was no significant difference in the operation success rates between two groups [94.44％ (34/36) VS 86.67％ (26/30),P＞0 05)].And there were significant differences in liver function recovery time (25.79± 6.48 d VS 30.24 ± 8.49 d),incidence of complications [5.56％ (2/36) VS 23.33％ (7/30)],length of hospital stay (21.54±4.73 d VS 25.68 ± 8.56 d) and hospitalization costs (23.5±8.4 thousand yuan VS 32.8±6.5 thousand yuan,P＜0.05).Conclusion EUS-guided biliary drainage could be the first option for its noninvasiveness and efficacy,when ERCP failed in patients with malignant obstructive jaundice.

Objective:To explore the effectiveness of comprehensive care and help system to promote the rehabilitation of patients with depression,through the case study of 1 typical college student with depression.Method:Through the establishment of the community network support system:teacher's home visits and talk,professional counseling,love and support from dormitory roommates,classmates and relatives,we provided a three-in-one community comprehensive support system and comprehensively used health education,social support,cognitive therapy and other methods,in order to promote the rehabilitation of patients with depression.Results:Through the systematic and scientific comprehensive care,the patient basically freed from the shadow of depression and put into the clinical practice with a positive attitude.Conclusion:Comprehensive Care Education is possible to promote the rehabilitation of college students with depression.

Objective To study the role of risk factors associated with hemodynamics in patients with intracranial artery stenosis.Methods Eighteen patients with local stenosis of middle cerebral artery were recruited in this study retrospectively.According to patients′clinical symptoms and magnetic resonance imaging findings, they were divided into the symptomatic group (n=13) and the asymptomatic group (n=5).Wall shear stress ( WSS) , oscillatory shear index ( OSI) , velocity and pressure of the stenotic artery wall were compared between the two groups after reconstructing 3-dimentional model of hemodynamics.Then related risk factors of hemodynamics were analyzed in symptomatic intracranial atherosclerotic stenosis.Results There were no statistically significant differences between the two groups in the parameters such as age, sex, degree of artery stenosis, mean arterial pressure and some medical histories of hypertension and diabetes.The results showed obvious changes of hemodynamics in local artery stenosis.The WSS(78.69(68.15,117.65) Pa vs 39.34(22.76,60.54) Pa,U=4,P=0.003), pressure of the stenotic artery wall (1 815.14(1 242.44,4 398.84) Pa vs 735.55(361.17,1 528.78) Pa,U =7,P=0.010)and velocity of the local stenosis(3.87(2.58, 4.52) m/s vs 2.31(1.38,3.12) m/s,U=12,P=0.046) in the symptomatic group were much higher than those in the asymptomatic group; however, there were no significant differences between the two groups in OSI.Conclusions Hemodynamic features do exist in local intracranial atherosclerotic stenosis.The WSS, wall pressure and velocity of the local stenosis may be vital risk factors associated with symptomatic intracranial atherosclerotic stenosis.

Objective To compare the impact of patient controlled epidural analgesia with patient controlled intravenous analgesia on postoperative recovery and complications in patients undergoing laparotomy pancreatic surgeries.Methods Forty patients undergoing pancreatic surgeries, 27 males and 13 females, aged 18-70 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n=20 each).Patients in group E received T8-9 or T9-10 epidural block, 2% lidocaine test dose was given to ensure the location of epidural catheter, after that, each patient in group E was given 0.375% ropivacaine 5 ml into epidural space before skin incising and incision closures.Meanwhile, patients in groups E and V received propofol-sevoflurane combined intravenous inhalation anesthesia.After surgery, patients in group E received patient controlled epidural analgesia while patients in group V received patient controlled vein analgesia.Length of hospital stay, time to ambulation and exhaust defecation were recorded.Other complications were compared.Results Compared to group V, patients in group E showed earlier ambulation [(50.4±4.2) h vs (64.2±5.0) h, P<0.01], shorter hospital stays [(18.5±8.5) d vs (21.5±6.8) d, P<0.05].There was no statistically significant difference in flatus time between the two groups [(39.7±4.1) h vs (39.5±8.4) h].There was no significant difference in complications between the two groups.Conclusion The present study shows that for patients undergoing pancreatic surgeries, patient controlled epidural analgesia could effectively release post-operative pain, shorten the ambulation time and length of hospital stay with no extra complications.

Objective To investigate the expression of 14-3-3ε protein in the bladder urothelial carcinoma (BUC) and to explore its association with the clinicopathologic features.Methods The bladder urothelial carcinoma samples were divided into three groups:normal control group of 10 cases,low-grade malignant BUC group of 25cases (includes 5 cases of papilloma,10 cases of PUNLMP and 10 cases of low grade non-invasive papillary urothelial carcinoma),high-grade malignant BUC group of 21 cases (includes 11 cases of high-grade non invasive papillary urothelial carcinoma and 10cases of infiltrating carcinoma).The expression and location of 14-3-3ε in three groups were detected by immunohistochemical EnVision and the relationship with clinicopathologic parameters was analyzed.Results 14-3-3ε expression was observed in the cytoplasm of the cell.The expression of 14-3-3ε in normal control group was 90 ％ (9/10),low-grade malignant BUC group was 72.0 ％ (18/25),high grade malignant BUC group was 14.3 ％ (3/21).It correlated with histological grading but had not showed correlation with other clinicopathologic parameters.There was significant difference in 14-3-3ε expression between the high grade malignant BUC group and the low-grade malignant BUC group,the high grade malignant BUC group and norml control group (all P ＜ 0.05).Conclusions 14-3-3ε plays an important role in carcinogenesis of BUC.It may be a biomarker for early diagnosis and classification of BUC and shows promise for clinic application.

This study was aimed to observe the therapeutic effect onendometritis rat model by Gui-Zhi Fu-Ling (GZFL) capsuleand its mechanism. Endometritis rat model was replicated. After 15 days, rats were randomly divided into six groups, which were the sham operation group, model group, lowdosage (0.5 g·kg-1) of GZFL capsule group, middle dosage (1.0 g·kg-1) of GZFL capsule group, large dosage (2.0 g·kg-1) of GZFL capsule group, and Fu-Ke Qian-Jin (FKQJ) capsule (1.2 g·kg-1) group. After 28-day intragastric administration of medication, pathological changes of endometrium were observed. The contents of monocyte chemoattractant protein-1 (MCP-1), interleukin-1β (IL-1β), interleukin-10 (IL-10) were determined in blood serum.The expression of TGF-β1 in endometritis rats were measured by immunohistochemistry. The results showed that GZFL capsule canobviously alleviate the pathologi-cal damage of endometrium in rat model. In comparison with sham operation group, the serum IL-10 content in the model group was significantly decreased, contents of MCP-1and IL-1β were significantly elevated; the TGF-β1 pro-tein expression was significantly elevatedin the uterus tissues. After the treatment of GZFL capsule, compared with the model group, the serum IL-10 was obviously elevated in the treatment group. The contents of MCP-1 and IL-1βwere obviously decreased. The expression of TGF-β1 in the uterus tissues was obviously decreased. It was concluded that GZFL capsule had treatment effect on endometritis. The mechanism may be related to the regulation of inflam-matory cytokines.

Objectives To study the risk factors for influencing recrudescence after endovascular embolization of intracranial aneurysms and to establish a regression model to predict the risk of recrudescence in patients with specific intracranial aneurysm after endovascular embolization. Methods From May 2012 to May 2014,429 patients (a total of 441 aneurysms)with intracranial saccular aneurysm who met the inclusion criteria and treated with endovascular embolization at the Cerebrovascular Treatment Center, Changhai Hospital,the Second Military Medical University were analyzed retrospectively. Multiple aneurysms were calculated separately according to per aneurysm. The aneurysms were divided into either a recurrent group (n = 66)or an unrecurrent group (n = 375)according to whether they had recrudescence or not. The differences of 11 factors such as clinical features,treatment technology and materials,and aneurysm anatomy of both groups were compared. Logistic regression was used to analyze the risk factors for recrudescence after endovascular embolization of intracranial aneurysms,and its effectiveness of predicting recrudescence was evaluated. Results There were significant differences in the size of aneurysms (χ2 = 46. 352,P <0. 01),rupture or not (χ2 = 4. 198,P = 0. 040),using stents or not (χ2 = 9. 554,P = 0. 002),and results of immediate postoperative embolization (χ2 = 10. 397,P = 0. 003). The results of multivariate logistic regression analysis showed that non-stent-assisted embolization (OR,4. 076,95% CI 2. 147 -7. 736,P <0. 01),Raymond grade Ⅱ (OR,4. 222,95% CI 1. 537 -11. 579,P = 0. 005),Raymond grade Ⅲ (OR, 4. 467,95% CI 1. 600 -12. 470,P =0. 004),large aneurysms (> 10 -25 mm)(OR,4. 914,95% CI 2. 277 -10. 604,P < 0. 01),and giant aneurysms (> 25 mm)(OR,35. 743,95% CI 3. 511 -363. 837,P = 0. 003) were the risk factors for recrudescence after aneurysm embolization. The effective test results of the regression model in predicting recrudescence showed that the area under the curve of the recrudescence predicting model was 73. 5% . Raymond grade was 56. 6%,and the non -stent embolization was 60. 1%,and the size of aneurysms was 40. 3% . Z test was used to calculate the differences of recurrent scores and non-stent embolization,Raymond grade,the area under ROC curve of aneurysm size. The Z values were 2. 662, 3. 513,and 6. 308,respectively,and the P values were 0. 007,0. 004,and 0. 001,respectively. Conclusions Large or giant aneurysms,non - stent - assisted embolization,incomplete embolization immediately after procedure were associated with the recrudescence after endovascular embolization of intracranial aneurysms. The established regression model may reflect the size of the recurrent risk.

Objective To explore the expression of pituitary tumor transforming gene (PTTG) and c-myc gene in patients with non-Hodgkin lymphoma (NHL),its relationship with NHL and its clinical significance.Methods PTTG mRNA and c-myc mRNA levels in bone marrow mononuclear cell (BMMNC) isolated from 38 NHL patients and 10 chronic lymphadenitis patients were quantified by reverse transcriptionpolymerase chain reaction (RT-PCR).Results mRNA expression of PTTG and c-myc gene in BMMNC was significantly higher in NHL patients than those in normal controls (PTTG:0.567 7±0.270 7 vs 0.071 2± 0.020 1,t =4.706,P ＜ 0.05; c-myc:0.352 6±0.185 4 vs 0.107 3±0.043 5,t =3.303,P =0.002).The expression of PTTG and c-myc gene in peripheral T cell lymphoma and diffuse large B cell lymphoma showed no significant difference (PTTG:0.556 8±0.211 3 vs 0.602 8±0.244 6,t =0.640,P =0.527; c-myc:0.350 1± 0.177 6 vs 0.361 0±0.190 2,t =0.302,P =0.765).Both expression of PTTG and c-myc were positively related to NHL clinical stage and IPI.Expression of PTTG mRNA was positively related to the expression of c-myc mRNA.Conclusion There was overexpression of PTTG and c-myc in NHL,which indicates that PTTG might be involved in tumorigenesis of NHL through direct or indirect activation of c-myc oncogene.

Objective To investigate the feasibility of the arterial wall imaging technology of high-resolution magnetic resonance imaging ( HR-MRI) in the risk assessment of intracranial aneurysm rupture. Methods Fifty-four patients with 66 intracranial aneurysms underwent 3. 0 T HR-MRI multiple sequences arterial wall imaging from November 2013 to March 2015 were analyzed retrospectively. Five patients with ruptured aneurysm were used as a control group. The characteristic differences of aneurysm lesions between an unruptured intracranial aneurysm ( UIA) wall enhancement group and a non-enhancement group were compared. The risk factors for rupture were analyzed according to the size,location, and basic clinical characteristics of aneurysm. Results (1) HR-MRI revealed that whether the aneurysm walls enhanced or not,there were no significant differences in the location size,wide-necked aneurysm or not,and ratios of aneurysm height and neck width (all P >0. 05). (2) The enhancement rates of the aneurysm volume <2 group and ≥2 group were 20%(8/40) and 61. 9%(13/21) respectively,the incidence of the ruptured aneurysm asci was higher than that of UIA,and there was significant difference ( all P<0. 05). There were no significant differences in neck width,rate of aneurysm volume,ratios of aneurysm height and neck width,and enhancement rates among the groups. Conclusion The preliminary results of this study have showed that there is a related trend between the HR-MRI aneurysm wall enhancement and the risk of rupture,but a further large sample follow-up study is needed.