Objective To evaluate special diagnosis and treatment of occult breast cancer. MethodsDiagnostic means used included breast roentgenography,selective mammary ductography, fine needle aspiration and excision biopsy in 28 cases. ResultsBreast roentgenography detected 4 cases ( 7/16), selective mammary ductography identified 4 cases(4/6). The definite diagnosis rate by lump biopsy and immunohistochemistry was 10 cases (10/13). Postoperative follow-up was abtained in 18 cases,with 5 dying of recurrence or distant metastases. Among them 4 patients underwent only axillary node excision. Conclusion Nipple discharge,localized thickening the gland are very important clue to the diagnosis of occult breast cancer.Lump biopsy and immunohistochemistry is a mainstay for the final establishment of the diagnosis of breast cancer. Radical or modified radical mastectomy with adjuvant radiotherapy and chemotherapy is a suitable treatment modality for occult breast cancer.

Objective To develop and validate a simple and reliable HPLC method for the analysis of flee and total carnitine in human serum and to investigate its clinical significance. Methods After proteins in serum were precipitated with a precipitating reagent, carnitine in serum was derivatized to form its ester. HPLC separation of the sample solution was performed on a Lichrospher SiO2 column and detected by ultraviolet absorbance at 260 nm. A mobile phase composed of acetonitrile-citric acid-triethanolamine was found to be the most suitable for this separation at a flow rate of 1.2 ml/min and enabled the baseline separation of the carnitine from interferences with isocratic elution. The free and total carnitine levels in serum were studied in 347 subjects. Results Under the chromatographic conditions described, the carnitine derivative had a retention time of approximately 10 min. Good separation and detectability of carnitine in human serum sample were obtained. The method proved to be linear in the range of carnitine from 0 μmol/L to 400 μmol/L The relative standard deviations of within-assay ( n = 5 ) for free and total carnitine analysis were 3.36% and 1.97% , respectively, and between-assay (n =7) for free and total carnitine analysis were 3.04% and 1.77%, respectively. The average recovery was 98. 2% for free camitine and 96.3% for total carnitine, respectively. The average L-carnitine concentrations in the 347 subjects were as follows: total carnitine (52. 2 ± 8. 6 ) μmol/L, free carnitine ( 42. 3 ± 8. 3 ) μmol/L and acylcarnitine ( 9. 9 ± 2. 9 )μmol/L in the male group ( n = 182), and total carnitine (48.2 ± 9. 9 ) μmol/L, free camitine ( 37.9 ±8. 7) μmol/L and acylcarnitine ( 10. 3 ± 3.5 ) μmol/L in the female group ( n = 165 ). Statistical analysis showed that total and free carnitine levels of male were higher than that of female ( P <0. 01 ) while there was not statistical difference of acylcarnitine levels between two groups ( P > 0. 05). Conclusion The method has been successfully applied to the simultaneous determination of free and total carnitine in serum with good sensitivity, specificity and repeatability, and this is a useful guidance for the clinic therapy and the mechanism study on the diseases associated with carnitine.

Objective: Carnitine,the only carrier for the fatty acid crossing into mitochondria for oxidization,has a significant effect on the metabolism serum lipids.The purpose of this study is to investigate the effects of different doses of carnitine supplement on serum lipids in hyperlipemia rabbits. Methods: Twenty-eight rabbits were equally randomized into a control and three experimental groups,the former fed on high-fat diet,and the latter on carnitine at the dose of 100,200 and 400 mg/kg respectively every day in addition to high-fat diet.Blood samples were collected from the central artery of the rabbits for the measurement of the total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein B(ApoB) and free carnitine in the serum,their body weight obtained at 0,1,2,3,4 and 5 weeks,and the effects of different doses of carnitine supplement were observed on serum lipids.Results: All the 28 rabbits were included in the result analysis.The hyperlipemia model was successfully established after 4 weeks of high-fat diet.Compared with the control group,the experimental groups showed a remarkable decrease in the levels of TC,TG,LDL-C and AapoB and an increase in that of HDL-C in the serum,positively correlated with the dose and time of carnitine supplement.With the lengthening of time,the effects of different doses of carnitine supplement on the serum lipids was gradually decreased.Conclusion: Carnitine supplement can inhibit the increase of the levels of TC,TG,LDL-C and AapoB in the serum of the rabbits with hyperlipemia induced by high-fat diet and the effect is positively correlated with the dose and time of carnitine supplement.

Gallbladder carcinoma (GC) is the most common malignant tumor in bile duct system.Xanthogranulomatous cholecystitis (XGC) is a benign inflammatory gallbladder disease.It is often misdiagnosed between them.This paper,through reviewing the literature and summarizing our own clinical experience,will give a better understanding on the two diseases,which was summarized as follows:inflammation is important both in the pathogenesis of GC and XGC,and we can make the correct diagnosis and choose an appropriate treatment by analy zing the feature of disease history,image data and rapid intraoperative pathological diagnosis.Radical resection remains the first choice in the treatment of GC,but the extent of resection is controversial.Normally,cholecystectomy is sufficient for curing XGC,but different surgeries are needed according to the specific disease conditions.

Objective To discuss the clinical feasibility and safety of modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) which was developed by the team of biliary surgery department from Shanghai Eastern Hepatobiliary Surgery Hospital.Methods Clinical data of 289 patients receiving modified invaginated pencreaticojejunostomy approach in pancreaticoduodenectomy were retrospectively studied.Wilcoxon signed-rank test,Chi-square and logistic regression tests were comprehensively used to evaluate the postoperative complications and the association with POPF.Results One hundred and sixtythree of 289 patients (54.6％) experienced postoperative complications after pancreaticoduodenectomy procedure.There were 45 onsets of severe complications,accounted for 17.6％ (45/255).Perioperative mortality was 3.1％ (9/289).The most common complications included celiac effusion and infection (26.6％),delayed gastric emptying (17.6％),gastroenterological tract fistula (12.4％),gastroenterological tract hemorrhage (9.7％).Additionally,the incidence of POPF was 9.3％,which all conformed as biochemical fistula (6.9％) and grade-B fistula (2.4％).Conclusions As a risk factor,POPF may play crucial role in celiac hemorrhage and infection associated with pancreaticoduodenectomy.Modified invaginated pencreaticojejunostomy approach (Jiang's anastomosis) with easy manipulation,wide indication,safe and effective performance,could be recommended to reduce POPF incidence.

Objective:To investigate the impact of cleavage factor Im25(CFIm25)on VSMCs-specific knockdown in the context of hyperlipidemia.Methods:Mice models were constructed with specific knockout of CFIm25 in VSMCs(CFIm25f/+ TaglnCre)and control mice(TaglnCre).The mice were fed a normal diet or high-fat diet(HFD)for 18 weeks and their body weight changes were monitored.ELISA was used to measure serum total cholesterol(TC), triacylglycerol(TG), high-density lipoprotein(HDL-C)and low-density lipoprotein(LDL-C)levels.The extent of aortic lipid deposition in mice was assessed by oil red O staining.Results:During the feeding of a high-fat diet, CFIm25f/+ TaglnCre mice showed a significant increase in body weight compared to the control group[Male(1.01±0.06)g and(0.87±0.31)g, t=7.53, P<0.05; Female: (0.64±0.02)g and(0.35±0.04)g, t=9.68, P<0.05].After 18 weeks of high-fat diet feeding, CFIm25f/+ TaglnCre mice had significantly higher levels of TC[(6.80±0.35)mmol/L and(3.76±0.87)mmol/L, t=5.63, P=0.004], TG[(0.97±0.21)mmol/L and(0.42±0.10)mmol/L, t=4.08, P=0.015], and LDL-C[(5.20±0.30)mmol/L and(2.00±0.98)mmol/L, t=5.40, P=0.006]compared to the TaglnCre group.Specifically, TC levels increased by 80.72%, TG increased by 132.79%, and LDL-C increased by 160.32%.There was a significant increase in aorta lipid deposition and atherosclerotic plaque area in CFIm25f/+ TaglnCre mice( P<0.05). Conclusions:The research indicated that VSMCs-specific CFIm25 knockdown in mice further worsened hyperlipidemia and atherosclerotic lesions.

【Objective】 To investigate the profiles of RhC, c, E, and e antigens and phenotypes in 4 704 inpatients from multiple regions, i. e. Nanning, Guangzhou and Shenzhen, and provide data information for compatibility blood transfusion of Rh blood group. 【Methods】 The Rh blood group antigens were detected by microcolumn gel cards from three manufactures. If the test and the control results are inconsistent, a third-party reagent would be used, and traditional tube method for confirmation if needed. The Chi-square test and Fisher's exact test were used to analyze antigen frequency and Rh phenotypes in each region. 【Results】 Among the 4 704 inpatients, the frequency of C, c, E, and e antigen was e(91.77%)>C(85.64%)>c(49.62%)>E(41.60%), and Rh phenotypes distribution was CCee(49.40%)>CcEe(27.53%)>Ccee(8.16%)>ccEE(7.74%)>ccEe(4.89%)>CCEe(0.96%)>ccee(0.83%)>CcEE(0.47%)>CCEE(0.02%). There were significant differences in Rh blood type distribution among Nanning, Guangzhou and Shenzhen(P<0.05). Differences in Rh phenotype distribution between male and female were noticed in Shenzhen(P< 0.05), but not in Nanning or Guangzhou. 【Conclusion】 The distribution of Rh blood group in Shenzhen, Nanning and Guangzhou were significantly different from each other, therefore regional characteristics should be considered when carrying out Rh-compatible blood transfusion, so as to guarantee the security of transfusion and reduce the incidence of unexpected antibodies.

Objective To retrospectively study the clinical value and the advantages in " planned hepatectomy" for the "central type" intrahepatic and extrahepatic choledochal cysts.Methods The clinical data of 7 patients with the "central type" of intrahepatic and extrahepatic choledochal cysts which were treated with "planned hepatectomy" from January 2014 through April 2017 at the Department of Biliary Tract Surgery of the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University were retrospectively analyzed.Results All the patients completed radical resection of the intrahepatic and extrahepatic choledochal cysts in accordance with the " planned hepatectomy".The operations included 6 patients who were treated with percutaneous transhepatic cholangial drainage (PTCD) and 5 patients with portal vein embolization (PVE) prior to the surgical excision.Combined right liver resection was performed in 6 patients,and combined left liver resection in one patient.All the 7 patients had a history of chronic cholangitis.Liver volume tests demonstrated that the hemiliver volume to be removed (the embolized hemiliver) significantly decreased after PVE,whereas the hemilivers to be persevered were remarkably enlarged.No complication associated with PTCD and PVE occurred.The mean postoperative hospitalization was 12 days.Liver function tests suggested all the patients recovered well.No postoperative complication of bleeding,infection or liver function failure was observed,except in one patient who experienced pleural and abdominal effusion.Conclusions Combined subtotal hepatectomy may increase the risk of complications associated with the "central type" intrahepatic and extrahepatic choledochal cysts.The surgical strategy in planned hepatectomy can be used effectively to treat the "central type" of intrahepatic and extrahepatic choledochal cysts,with improved surgical safety,decrease in incidences of postoperative liver function failure and residual choledochal cysts.

Objective: To study the use of MRCP digital quantitative diagnosis in the differential diagnosis of choledochal cyst type Ic. Methods: The clinical data of 41 patients with choledochal cyst type Ic, 47 patients with distal choledochal obstruction and 43 patients with simple gallbladder stones or polyps who were treated at the Eastern Hepatobiliary Surgery Hospital, PLA Naval Medical University from January 2010 to June 2016 were retrospectively analyzed. The diameters of the common bile duct, the left and the right hepatic ducts were measured and compared. Results: The maximum diameter of the left hepatic duct (LHD), right hepatic duct (RHD) and common bile duct (CBD) were significantly different (all P<0.05) in patients with choledochal cyst type Ic compared to patients with distal choledochal obstruction. The CBD/LHD ratio and CBD/RHD ratio were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), but the maximum diameters of LHD and RHD were not significantly different (both P>0.05), while the ratios of CBD/LHD and CBD/RHD were significantly larger (P<0.05). For patients with choledochal cyst type Ic, when compared with patients with simple gallbladder stones or polyps, the maximum diameter of CBD was significantly larger (P<0.05), the maximum diameter of LHD and RHD was also significantly larger (P<0.05), while the ratios of CBD/LHD and CBD/RHD were not significantly different (P>0.05). The proportion of pancreaticobiliary maljunction (PBM) in patients with type Ic choledochal cyst was significantly higher than patients with distal choledochal obstruction and simple gallstone or polyp (P<0.05). Conclusions For patients with choledochal cyst type Ic, their CBD shows obvious dilation, while there is no obvious dilation in LHD and RHD. It is helpful to conduct differential diagnosis of choledochal cyst type Ic by the use of MRCP to observe the presence of PBM and to quantitatively compare the CBD/LHD and CBD/RHD ratios.