Objective To investigate the value of modified T staging system in the diagnosis and treatment of hilar cholangiocarcinoma (HCCA).Methods The clinical data of 95 patients with HCCA who were admitted to the Memorial Sun Yat-Sen Hospital from December 1995 to January 2010 were retrospectively analyzed.Based on the results of imaging examination,preoperative staging was determined according the modified T staging system.The prognosis of the patients in difference T stages were compared.The data were analyzed by using the chi-square test and Fisher exact test.The survival curve was drawn by Kaplan-Meier method and the survival rate was compared by using the Log-rank test.Results The diagnostic rates of ultrasound + magnetic resonance cholangiopancreatography (MRCP),ultrasound + computed tomography (CT) or spiral CT were 93％ (37/40) and 66％ (23/35),respectively.The diagnostic rates of ultrasound + CT or spiral CT and endoscopic retrograde cholangiopancreatography (ERCP),ultrasound + CT or spiral CT and MRCP were 14/15 and 15/15,respectively.Of the 95 patients,44 received operation (including 28 cases of radical resection and 16 cases of palliative resection),16 received exploratory laparotomy,and 35 received simple internal or external drainage.For patients in T1,T2 and T3 stages,the resection rates were 71％ (30/42),50％ (12/24) and 7％ (2/29),respectively,with significant differences (x2 =30.182,P ＜0.05).The negative rates of the resection margins of patients in T1 and T2 stages were 77％ (23/30) and 5/12,respectively,2 patients in T3 stage were found with tumor residuals at the resection margin.There was a significant difference in the radical resection rate among patients in different T stages (x2 =8.204,P ＜ 0.05).Of the 44 patients who received surgical treatment,30 (68％) received concomitant partial hepatectomy.The ratios of patients in T1 and T2 stages who received concomitant partial hepatectomy were 70％ (21/30) and 9/12,respectively,with no significant difference (x2 =0.101,P ＞ 0.05).Fourteen (32％) patients received tumor resection.The incidences of complications and perioperative mortalities were 53％ (16/30) and 10％ (3/30) for patients who received concomitant partial hepatectomy,and 5/14 and 1/14 for patients who received tumor resection,with no significant differences between the 2 groups (x2 =1.188,0.094,P ＞ 0.05).The median survival time of patients who received concomitant partial hepatectomy was 29 months,which was significantly longer than 19 months of patients who received tumor resection (x2 =11.317,P ＜0.05).Eighty-six patients were followed up,and the median time of follow up was 15.6 months (range,3-70 months).The 1-year cumulative survival rates of patients in T1,T2 and T3 stages were 73.8％,58.0％ and 9.2％,respectively,and the 3-year cumulative survival rates of patients in T1,T2 and T3 stages were 33.5％,12.1％ and 0,respectively.The median survival time of patients in T1,T2 and T3 stages were 24,16 and 7 months,respectively.The prognosis of patients was getting poor as the increase of the T stages (x2 =37.07,P ＜ 0.05).Conclusions The modified T-staging system is beneficial to preoperative evaluation of patients with HCCA.Concomitant partial hepatectomy could improve the radical resection rate and prolong the median survival time of HCCA patients.

Objective To explore the expressions of circulating microRNAs (miRNAs) in acute liver failure mice induced by D-galactosamine (GalN)/lipopolysaccharides (LPS) and the correlation with miRNAs in the liver.Methods Forty clean grade Balb/C mice,with 32 in the model group and 8 in the control group were enrolled in the study.Liver failure was induced by intraperitoneally injection of D-GalN and LPS in mice of the model group,while mice of the control group were intraperitoneally injected with 1 mL 0.9 ％ sodium chloride solution.Serum and liver samples were collected at 0,3,5,7 hours following administration,and eight mice should be supplied to each sample,and changes of alanine aminotransferase (ALT),aspartate aminotransferase (AST) and histopathology of the liver were observed.miRNA from both the serum and the liver was extracted,miRNA expression profile in the liver at 0,5,7 hours by locked nucleic acid (LNA)-miRNA microarray was analyzed and miRNA by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) was detected.Means of the two groups were compared using one-way ANOVA and correlation analyses were performed using Pearson and Spearman correlation.Results Expression of miRNAs in the liver tissue changed significantly over time with the occurrence of acute liver failure in the mice.Twenty-one miRNAs were up-regulated and 27 were down-regulated,among which miRNA-122 and miRNA-1187 were down-regulated while miRNA-146a and miRNA-155 were up-regulated.It was confirmed by the PCR assay that the expression of miRNA-122 and miRNA-1187 in the liver gradually decreased,while those in the serum were up-regulated over time.However,the expressions of inflammation associated miRNA-155 and miRNA-146a were up-regulated both in the serum and the liver after administration.The expressions of miRNA-122 and miRNA-1187 were negatively correlated between serum and liver (r=-0.477,P=0.0089,r=-0.420,P=0.231),while the expressions of miRNA-155 in serum and liver were positively correlated (r=0.678,P=0.0001).Moreover,the expressions of miRNA-122 (r=0.571,0.554) and miRNA-1187 (r=0.471,0.542) were also positively correlated with serum levels of ALT and AST (all P＜0.05).Liver and serum levels of miRNA-122 and miRNA-1187 changed significantly at 5 hours after administration,which preceded the changes of ALT/AST.Conclusions The expressions of miRNA-122 and miRNA-1187 in serum are well inversely correlated with the corresponding expressions in liver tissues during acute liver failure in mice.The changes of miRNA-122 and miRNA-1187 in the serum precede those of ALT/AST.These data suggest that serum miRNA-122 and miRNA-1187 might be the candidate serum biomarkers for early prediction of liver injury.

Objective To evaluate the gender differences in dose-response curve with cisatra-curium in epileptics.Methods Eighty ASA grade Ⅰ or Ⅱ epileptics were enrolled in this study.All patients were divided into male and the female groups and received the method of single dose injection under midazolam-fentanyl intravenous anesthesia.Each patient received intravenous bolus of 20,30, 40,50μg/kg of cisatracurium respectively.The neuromuscular block was measured by Neuromuscular Transmission Monitor and the responses were defined in terms of the percentages of maximum sup-pression in T1 of TOF of the adductor pollicis muscle.According to log-probit transformation of the data of dose and response,the dose-response curve of cisatracurium was established through linear re-gression.The onset time of cisatracurium was also observed.Results The ED50 ,ED75 ,ED90 ,ED95 values of cisatracurium in male epilepsy patients were 37.2±9.7,48.1±11.3,60.4±12.8,69.3± 14.0 μg/kg and that of female epilepsy patients were 36.6±4.3,47.5±7.7,60.5±14.0,70.1± 19.4 μg/kg.There was no significant difference between the two gender groups.No significant change in onset time was observed among 4 dose groups.Conclusion No gender differences are ob-served in dose-response curve of cisatracurium in epileptics.

Objective To observe the clinical efficacy of successive trigger needling plus motorial needling in treating external humeral epicondylitis.Method Sixty-two eligible subjects with external humeral epicondylitis were randomized into a treatment group and a control group,31 cases each.The treatment group was intervened by successive trigger needling plus motorial needling,and the control group was treated with ordinary acupuncture.The two groups were both treated once a day.After 10 sessions of treatment,the changes of Visual Analogue Scale (VAS) and Activities of Daily Living (ADL) scores were observed,and the clinical efficacies were compared between the two groups.Result The VAS and ADL scores were changed significantly respectively after 1-week and 2-week treatment in both groups (P＜0.05).After the treatment,the changes of VAS and ADL scores in the treatment group were significantly different from those in the control group (P＜0.05).The total effective rate was 96.8％ in the treatment group versus 93.5％ in the control group,and the difference was statistically significant (P＜0.05).Conclusion Successive trigger needling plus motorial needling is an effective approach in treating external humeral epicondylitis,and it can improve the ADL.

OBJECTIVETo study the rule of development of early cancer of gastric cardia in vivo in public screening.

METHODSA prospective cohort study on gastric cardiac cancer was held in the high incidence area of cancer of esophagus and stomach in China. 106 subjects had been examined regularly by endoscopy to observe the change of mucosa in high incidence area of gastric cardiac carcinoma developing at the root of gastric cardiac ridge by taking serial biopsy specimens. All specimens were diagnosed through the normal pathological processes to study the prognosis of pre-cancerous lesion of gastric cardia.

RESULTSThe result of 106 subjects who had been observed for four years were: 1. Of 8 normal persons, 3 stayed normal, 4 turned to chronic gastritis, 1 developed early gastric cardiac cancer. 2. Of 61 persons chronic gastritis, 11 was observed to have glandular atrophy, 4 with mild atypical hyperplasia, and 2 with highly atypical hyperplasia. 3. Of 9 subjects showing atrophic chronic gastritis, 5 revealed no change, and 4 became chronic gastritis. 4. Of 22 subjects who revealed mild atypical hyperplasia, 17 resolved, 4 showed no change, and 1 advanced to highly atypical hyperplasia. 5. One person with highly atypical hyperplasia reverted to mild atypical hyperplasia. 6. Of 5 subjects with early gastric cardiac cancer without any treatment, 1 became advanced cancer, 1 still stayed in early stage, and 3 turned to atypical hyperplasia.

CONCLUSION1. The development of early cancer of gastric cardia would proceed through the stages of chronic gastritis, glandular atrophy, and atypical hyperplasia. 2. The early cancer and pre-cancerous lesion of gastric cardia is reversible, though possessing malignant possibility.

Adult ; Aged ; Cardia ; pathology ; China ; Disease Progression ; Female ; Gastritis ; epidemiology ; pathology ; Gastritis, Atrophic ; epidemiology ; pathology ; Gastroscopy ; methods ; Humans ; Hyperplasia ; Male ; Middle Aged ; Precancerous Conditions ; epidemiology ; pathology ; Prospective Studies ; Stomach ; pathology ; Stomach Neoplasms ; epidemiology ; pathology

OBJECTIVETo give some theory support of Cistanche tubulosa cultivation by searching dry matter accumulation and echinacoside content of C. tubulosa.

METHODDry matter accumulation content of C. tubulosa culturing in Huabei plain was analysed in different growth season of C. tubulosa. Echinacoside content was determined by HPLC.

RESULTDry matter accumulation of C. tubulosa showed "S" variation. Dry matter accumulation increased fastest in September among growing seasons. Dry matter amount was 138.58 g after C. tubulosa grew a year. Dry matter amount decreased significantly along with inoculation time retarded. Echinacoside content was 30.59% when C. tubulosa grew in 5 months, decreased guadully after that, and 9.76% in annual.

CONCLUSIONVariation rule of dry matter accumulation and echinacoside content was found in C. tubulosa that grew one year in Huabei plain.

Biomass ; China ; Cistanche ; chemistry ; growth & development ; Glycosides ; metabolism ; Plants, Medicinal ; chemistry ; growth & development ; Seasons

Objective To discuss the clinical effect of the ramified musculocutaneous flap pedicled with the descending branch of lateral circumflex femoral artery treatment of bones and arthrsis of extremity in- fections with soft tissue defects.Methods The muscle flap blooded with the muscular branch of lateral fem- oral muscle and musculocutaneous flap blooded with the musculocutaneous branch were designed,all of which were pedicled with the descending branch of lateral circumflex femoral arteryIn clinic24 cases of bones and arthrosis of extremity infections with soft tissue defects were treated with this kind of ramified musculocutaneous flap.Results Of the 24 cases23 cases were survived while 1 case was lost16 cases were healed at stageⅠ8 cases were healed at stageⅡSinus has formated in 3 casesone of which twicebut they were healed in one year with the treatment of debridmentsFour cases with osteomvelitis and bone defect were treated with bone grafting in the later 6～8 months after the wound has healedTwenty-two cases were followed-up for 6～20 monthsinfcetiou didn't recur.Conclusion This kind of ramified musculocutaneous flap has such ad- vantages as longer blood vessel pediclefilling the defects completely flexible application and stronger anti-in- fectionthat it may be an effective way in treating bones and arthrosises of extremity infections with soft tissue defects.

OBJECTIVEThe aim of this study is to evaluate the relationship between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis.

METHODSA balloon cytological screening was conducted in 4000 participants in high-risk area of esophageal cancer in 1997-1998, 1050 out of these 4000 participants were confirmed as abnormal by cytology. Among them, 867 were given endoscopy examination during which mucosal stain with 1.2% iodine solution was used. The stain images were graded as four categories: Grade 1, dark yellow, protruding inlay-like with clear borders and showing pink after discoloration; Grade 2, between grade 1 and grade 3; Grade 3, light yellow, flat lesion with clear but not sharp borders and Grade 4, dark-brown color. According to the above criteria, the lesions were recorded and graded after the examination. The biopsies were taken from the unstained lesions and underwent pathologic evaluation. A comparison between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis was evaluated. The correlation coefficient was estimated using Spearman's Rank Correlation.

RESULTS94.4% (68/72) of the superficial carcinoma and severe dysplasia, 61.8% (73/118) of moderate dysplasia and 27.7% (35/126) of mild dysplasia were distributed in the grade 1 and grade 2 of iodine stain images of which the patterns conforming to the principle and rule of formation of the image by iodine stain.

CONCLUSIONThere is close relationship between the imaging patterns of endoscopy aided by iodine stain and histological diagnosis. The magnitude of exposure of the malignant tissue is the pathologic basis of formation of various images by iodine stain. Iodine stain greatly helps of early detection of esophageal cancer.

Biopsy ; Early Diagnosis ; Esophageal Neoplasms ; pathology ; Esophagoscopy ; methods ; Female ; Humans ; Iodine ; Male ; Precancerous Conditions ; pathology ; Staining and Labeling ; methods

OBJECTIVETo observe the protective effect of ischemic postconditioning on ischemic reperfusion injury of rat liver graft and to investigate the possible mechanism.

METHODSMale Sprague Dawley rats were used as donors and recipients of orthotopic liver transplantation, and the period of cold preservation and anhepatic phase were 100 min and 18 min, respectively. Sixty rats were randomly divided into three groups, twelve rats in control group, twenty-four rats in ischemic reperfusion injury group and ischemic postconditioning group respectively. Control group is sham operation group, only the ligaments around liver were cut off; donor livers in ischemic reperfusion injury group were infused through portal vein with heparinized saline before harvested; ischemic postconditioning group: at very onset of reperfusion after donor liver was implanted, several brief reperfusion-ischemia were given before persistent reperfusion of portal vein. Half recipients of ischemic reperfusion injury group and ischemic postconditioning group were taken blood samples and hepatic tissue samples after 2 hours of reperfusion of liver graft. Rest recipients were taken samples of hepatic tissue after 6 hours of reperfusion. Recipients of control group were taken blood and hepatic tissue samples at corresponding time after abdomen was sutured.

RESULTSCompared with ischemic reperfusion injury group, liver functional parameters, cytokines and peroxidized products contents were lower in ischemic postconditioning group (P < 0.05); meanwhile, the antioxidases contents of hepatic tissue were higher in ischemic postconditioning group than those in ischemic reperfusion injury group (P < 0.05).

CONCLUSIONSIschemic postconditioning could relieve the ischemic reperfusion injury of rat liver graft. Through improving antioxidation capability and cutting down cytokines contents, ischemic postconditioning could apply its protective effect.

Animals ; Glutathione Peroxidase ; metabolism ; Leukocyte Elastase ; blood ; Liver ; blood supply ; metabolism ; Liver Transplantation ; Male ; Malondialdehyde ; metabolism ; Peroxidase ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; metabolism ; prevention & control ; Superoxide Dismutase ; metabolism ; Tumor Necrosis Factor-alpha ; metabolism

Objective To investigate the effect of seafood intake on the urinary iodine level in women for exploring an alternative to iodine supplementation.Methods Healthy pregnant women and non-pregnant women, aged 20～40 years,were selected during their health examination in local women'S health care in 2006.The types of seafood and its intake frequency were recorded from these women.and urine and kitchen salt samples were collected for iodine determination.Results A total of 198 women including 148 pregnant and 50 non-pregnant women were recmitod for this study;they had a median level of urine iodine of 87.51 mg/L.The median levels of urine iodine of83.49,91.52,166.45μg/L in three group women classified as hardly,seldom and often intake of see food showed significant difference(X2=6.202,P<0.05).Urine iodine level in non-pregnant women taking seafood (90.94μg/L)was higher than that in pregnant women(84.79μg/L),the difference being statistically significant (U=3318.00,P<0.05).The urine iodine in pregnant women with seldom intake of seafood(94.46 μg/L)was significantly higher than that in the hardly intake women(83.28 μg/L),the difference being statistically significant (U=1257.5,P<0.05).During late period of gestation,the urinary iodine in the women ofthree statUS of hardly. Seldom and often intake of seafood were 81.93,97.97 and 140.18 μg/L,respective,with significant differences among them.Conclusions A certain amount of seafood taken every week Can increase urine iodine levels,and a direct relationship Was observed.Therefore,we suggest that it is necessary to advocate taking seafood to pregnant women for prevention of cretinism,particularly in the air.as where iodized salt was difficult to implement.