Intrahepatic cholangiocarcinoma (ICC) is a highly malignant liver tumor with strong invasion and poor prognosis. ICC originates from the bile duct and locates in the liver, so it is classified as either primary liver cancer or cholangiocarcinoma, which the classification is indeterminate and the pathological typing is still debatable. The mechanism of ICC induced by many high-risk factors is still unclear. There are no characteristic manifestations in early symptom and no specific tumor markers, and the diagnosis of ICC mainly depends on imaging examination, which enhanced CT and MRI are the most important evaluation method. TNM staging of ICC is of great significance to guide the treatment, nevertheless, the division of T stage updated by AJCC 8th Edition is still controversial. Radical surgery is the only way to cure ICC currently, but there are still many controversies on definition of R0 resection and the scope of lymph node dissection. The application of local therapy and the rapid development of immunity and targeted therapy bring new hope for the transformation therapy of locally advanced patients, however, the efficacy needs to be verified by multi center large sample clinical studies. To grasp the current focus issues in diagnosis and treatment of ICC timely will be an important direction of basic and clinical research of ICC in the future.

Objective To investigate the clinical efficacy of total laparoscopic hysterectomy(TLH) with separating and blocking uterine arteries.Methods From January 2004 to June 2006,68 cases of uterine benign diseases underwent TLH by blocking uterine arteries after separating and clipping uterine arteries with Titanic clip.Results All operations were performed successfully without conversion to open surgery and complications.1 patient,who had twice gastrohysterectomy histories,underwent bipolar coagulating uterine arteries as to the failure of separating bilateral uterine arteries.Pelvic adhesion release was performed in 18 cases,unilateral or bilateral adnexectomy in 14 cases,oophorocystectomy in 8 cases,appendectomy in 1 case,and cholecystectomy in 1 case simultaneously.The operation time was 90-185 min,(112.6?27.5)min.The time of separating uterine artery in one side was 3-15 min,(5.2?3.4)min.The intraoperative blood loss was 50-150 ml,(86.5?39.6)ml.The time to first bowel movement was 18-48 h,(27.3?4.8)h.The rate of postoperative pyrexia was 4.4%(3/68),and the hospital stay was 4-7 d,(5.1?1.8) d.A follow-up period of 2-6 months,(3.5?1.6) months,showed 3 cases of vaginal dropping hemorrhage 1-2 months after operation,which was cured with the use of antibiotics and hemostatics for 5-7 d.Conclusions TLH with separating and blocking uterine arteries is a safe,effective and feasible procedure with less complication,so it is worthy of being recommended.

Objective To investigate the clinical value of classic intrafascial supracervical hysterectomy(CISH) by including the clipping of the uterine artery.Methods A total of 60 cases of benign uterine diseases were included in the study.After the uterine artery had been dissected and clipped on both sides under laparoscope,classic intrafascial supracervical hysterectomy was performed.Results All the operations were performed successfully under laparoscope.No conversions to open surgery were needed.Operating complications happened in no case.The operating time was 72~186 min(91.4?26.3 min),the amount of blood loss was 50~150 ml(76.5?20.6 ml),the time to postoperative gastrointestinal function recovery was 18~30 h(22.7?5.8 h),and the volume of pelvic drainage within 24 hours,50~160 ml(80.5?31.8) ml.Postoperative body temperature was elevated to 38.5 ℃ in 2 cases,the postoperative pyrexia rate being 3.3%.The length of postoperative hospital stay was 4~7 d.Follow-up for 6~18 months(10.6?4.2 months) in the 60 cases showed 3 cases of small amount of vaginal bleeding at 1~3 months,which were cured with the use of antibiotics and hemostatics for 5~7 d.Conclusions Classic intrafascial supracervical hysterectomy by including the clipping of the uterine artery is a safe and effective improvement to CISH technique.

Objective To seek a new method to identify viability of myocardium by adenosine stress echocardiography combined with quantitative tissue velocity imaging(QTVI)and tissue tracking(TT).Methods Fifteen healthy canines were selected to establish the models of acute myocardial infarction and reperfusion by ligating anterior descending branch of coronary artery for 90 minutes and then releasing the artery to get reperfusion.After reperfusion.peak velocity in systole(Vs),peak velocity in isovolumic contraction(VIVC)and the displacement in systole(Ds)were measured on anterior wall and anterior septum at baseline.The 2,3,5-triphenyl tetrazolium chloride(TTC)staining was set as a"gold standard"for defining the viable and non-viable groups.The sensitivity and specificity of assessing myocardial viability were determined with QTVI and TT.Comparison of variables between viable and non-viable group was made by using t test.One way analysis of variance and LSD-t test were used to estimate the significance of differences in different states.Results Compared with baseline,Vs,VIVC and Ds decreased significantly(P＜0.01)after reperfusion in both viable and non-viable group.After administration of adenosine,Vs and Ds increased(P＜0.05),but VIVC didn't change significantly compared with that before administration of adenosine in viable group(P＞0.05).Variables in non-viable group didn't change significantly after administration of adenosine(P＞0.05).By receiver operating characteristic(ROC)analysis for predicting myocardial viability,when a cutoff value of △Vs(%)rate was 17.9,the sensitivity and the specificity was 78.6%and 81.1%,respectively,and when the cutoff value of △Ds(%)rate was 18.4,the sensitivity and the specificity was 75.0%,83.6%,respectively.Combined △Vs(%)with △Ds(%),the sensitivity and specificity to prediction of myocardium viability could reach 94.6%and 68.0%,respectively.Conclusions When the viability of myocardium after myocardial infarction is assessed by using the method of adenosine stress echocardiography with QTVI and TT,the sensitivity and the specificity are greatly enhanced.

Objective To assess the applicability of the Modification of Diet in Renal Disease (MDRD)formula to kidney function impaired Chinese diabetic patients.Methods Glomerular filtration rates(GFRs)in 463 Chinese diabetic patients(219 female,244 male,aged 14 to 88)were estimated by measuring ~(99m)Tc-DTPA clearance and with equations based on serum creatinine(Scr)and cystatin C(Cys C)concentrations.GFRs derived from various equations were compared with the ~(99m)Tc-DTPA clearance GFRs and their relative accuracies were assessed with ROC analysis.All the Scr measurements were performed with both the Roche enzymatic assay and the Beckman LX20 kinetic alkaline picrate assay,and Cys C with immunonephelometric and immunoturbidimetric assays.Results The reciprocals of Cys C and Scr were linearly correlated with ~(99m)Tc-DTPA clearance GFRs(r=0.830 and 0.690,repectively).The correlation of GFR with Scr could be expressed by an adjusted MDRD equation:GFR [ ml?(min?1.73 m~2)~(-1)]=175?(Scr)~(-1.154)?(age)~(-0.203)?0.742(female)?0.827,where 0.827 was a coefficient for Chinese.The adjusted equation showed a better accuracy than the MDRD equation(areas under the ROC curve 0.818 vs 0.644).The adjusted equation was also more accurate than equations obtained in previous Chinese studies.GFRs were also estimated by using Cys(in mg/L)with the following equation:GFR [ ml?(min?1.73 m~2)~(-1)] = 63.24?(Cys C)~(-0.3378).The accuracy of the Cys equation was similar to the Scr equation,or better in patients aged 60 and above.The Roche enzymatic results which were traceable to the isotope dilution mass spectrometry(IDMS)methods were significantly lower than Beckman LX20 results,but the results were closely correlated with each other(Y = 0.94X-0.02).When non-traceable Scr results were used,the coefficient needed to be adjusted.Conclusions GFRs can be estimated with equations based on either Scr or Cys C.GFR estimation should use standardized Scr results and take into account ethnic effects.

Objective To observe the physique and anatomy changes in patients with nasopharyngeal carcinoma (NPC) during intensity-modulated radiotherapy (IMRT), using repeated CT images and deformable registration technique, and analyze their impact on delivery dose distribution.Methods Ten NPC patients were randomly selected from those who had received IMRT treatment.Gross tumor volume of nasopharyn (GTVnx), GTV of metastastatic lymph node (GTVnd), clinical target volume (CTV) and normal tissue or organ (OAR) were re-contoured on the in-course repeated CT images using a kind of deformable registration and auto-segmentation software according to the original planning contouring.Changes in volume of treatment targets and organs at risk were evaluated and the trends were then analyzed.Dose distributions were recalculated with repeated CT images and compared to the original plans.Results The volume of GTVnx were decreased by 6.44%,10.23% and9.72%(F=1.34,P=0.278) in the 2-,4-and 6-week after IM RT comparing with before IM RT, with 6.59%, 30.98 % and 35.13 % (F = 9.22, P =0.000) in GTVnd, 0.73%, 1.86% and 1.41% (F=0.33,P=0.722) in CTV1, -1.78%, -6.47%and -9.34% (F =16.89 ,P =0.000) in CTV2, 13.96%, 32.97% and 37.77%(F=17.17,P=0.000)in the left parotid , and 3.56% , 29.57% and 35.63% (F = 13.49 , P = 0.000) in the right parotid.The mean dose change rate of GTVnx were -0.39%, 0.08% and 0.32% (F =0.15 ,P =0.860) in the 2-,4- and 6-week after IMRT comparing with planning faction dose, with 0.53%, 1.19% and 0.69% (F=0.81,P=0.455) in GTVnd, 1.95%, 2.70% and 3.78% (F=0.61,P=0.552) in the spinal cord,0.32%, 0.81% and 0.62% (F=0.03,P=0.975) in the brain stem, 4.50%, 4.66% and 7.20% (F=0.33,P=0.725) in the left parotid, 2.20%, 7.17% and 7.12% (F= 1.24,P=0.306) in the right parotid.Conclusions The GTVnd, CTV2 and parotids shrinks obviously along with the treatment times for NPC patients during IMRT.Although changes in fraction dose of GTV, CTV, spinal cord, stem and parotids are not significant, further study with larger samples is needed.

Objective To investigate the sedative and hypnotic interaction between remifentanil and propofol by target-controlled infusion (TCI) during induction of anesthesia.Methods Third-two ASA Ⅰ or Ⅱpatients,aged 22-63 yr,body mass index 18-25 kg/m2,scheduled for elective surgery under general anesthesia,were randomly divided into 4 groups(n=8 each).Group Ⅰ only received TCI pmpofol.GroupⅡ,Ⅲ,and Ⅳreceived a target concentration of 2,4 or 6 ng/ml remifentanil respectively.While the blood-effect site concentrations of remifentanil were equilibrated,patients received TCI of propefol,with an initial target concentration of 0.5μg/ml.After the blood-effect site concentrations of propofol were equilibrated then with 0.5μg/ml increments until the loss consciousness was achieved.The eyelash reflex and state of consciousness were assessed and radial arterial blood sample 6 ml was taken every 3 min to determine the remifentanil and propofol concentrations in blood.Propofol and remifentanil concentrations in blood were measured by reversed-phase high-performance liquid chromatography and high-performance liquid chromatography with ultraviolet detection respectively.The sedative and hypnotic interaction between propofol and remifentanil was determined with a pharmacodynamie interaction model by regression analysis and determined using the isobolographic method.Results Propofol concentrations in blood were lower in group Ⅱ,Ⅲ and Ⅳ than group Ⅰ(P<0.05).The propofol concentratopms in blood were significantly decreased in trun with the increase in the remifentanil concentrations in blood in group Ⅱ-Ⅳ(P<0.05).At loss of eyelash reflex and loss of consciousness of patients,the pharmacodynamic interaction model by curve fitting was superior to linear regression (P<0.05).At loss of eyelash reflex of patients,the curve fitting result showed EC50,prop=2.77μg/ml and EC50,rem=26.67 ng/ml,and the isobolographic method equation is ECprop/2.77+ECrem/26.67=0.69.At loss of consciousness of patients,the curve fitting result showed EC50,prop==3.76μg/ml and EC50,rem=31.56ng/ml,and the isobolographic method equation is Ecprop/3.76+Ecrem/31.56=0.65.Conclusion Remifentanil (Cp 2-6 ng/ml) and propofol by TCI shows a synergistic type of pharmacodynamic interaction on the sedative and hypnotic during induction of anesthesia.

Objective To analyze the literature distribution and research status of benign prostatic hyperplasia (BPH) in the elderly published in Chinese Medical Association journals.Methods The literatures of elderly BPH published in 88 kinds of Chinese Medical Association journals from 2009 to 2013 were collected.The publication year,distribution,content,author,institution and region of these literatures were analyzed.Results From 2009 to 2013,203 articles about elderly BPH were published in 10 kinds of journals.These literatures were published mostly in 2013 (50 articles,24.6％),secondly in 2010 (46 articles,22.7％) and 2009 (43 articles,21.2％),which were mostly published in Chinese Journal of Geriatrics (87 articles,42.9 ％).Most researches were focused on the fields of clinical treatment of BPH in the elderly,etiology,cross-sectional investigation and perioperative nursing,while the progresses in pathophysiology and diagnosis were relatively small,and the most published form was treatise (166 articles,81.8％).Authors who published the most articles were Yang Yong from Department of Urology Surgery in PLA General Hospital and Zhang Xianghua from Department of Urology Surgery in Peking University First Hospital (both,4 articles,3.5 ％),the institutions which published the most articles were Beijing Hospital and Beijing Chaoyang Hospital (both,9 articles,4.4 ％),and the provinces or cities which published the most articles were Beijing (75 articles,36.9％),Shanghai and Zhejiang (both,17 articles,8.4％) and Hunan (16 articles,7.9％).Among the 203 articles,35 articles (17.2％) were supported by founds.Conclusions Chinese Medical Association journals are the important sonrce to acquire literatures on elderly BPH for medical workers.The distribution of journals is relatively concentrated,but the distribution of author,institution and region in these articles is dispersed.Studies on clinical treatment of elderly BPH,etiology,inventory survey and perioperative nursing are especially concerned within nearly 5 years.

Objective To study the chemical constituents of flavonoids in pine needles of Cedrus deodara.Methods Flavonoids were isolated and purified from ethyl acetate extract of pine needles by chromatography on silica gel and Sephadex LH-20.Their structures were identified on the basis of spectroscopic analysis and chemical evidence.Results Five flavonoids were isolated and purified.Their structures were identified as cedrusone A(1),myricetin(2),2R,3R-dihydromyricetin(3),quercctin(4),and 2R,3R-dihydroquercetin(5).Conclusion Compound 1 is a new compound.Compounds 2-5 are isolated from pine needles of this genus for the first time.

To explore the expression potential of heterogeneous genes using the backbone of infectious bronchitis virus (IBV) Beaudette strain, the ectodomain region of the Spike gene (1,302 bp) of IBV H120 strain was amplified by RT-PCR and replaced into the corresponding location of the IBV Beaudette strain full-length cDNA. This recombinant was designated as BeauR-H120(S1). BeauR-H120(S1) was directly used as the DNA template for the transcription of viral genomic RNA in vitro. Then, the transcription product was transfected into Vero cells by electroporation. At 48 h post-transfection, the transfected Vero cells were harvested, and passaging continued. A syncytium was not observed until the recombinant virus had passed through four passages. The presence of rBeau-H120(S1) was verified by the detection of the replaced ectodomain region of the H120 Spike gene using RT-PCR. Western blot analysis of rBeau-H120 (S1)-infected Vero cell lysates demonstrated that the nucleocapsid (N) protein was expressed, which implied that rBeau-H120(S1) could propagate in Vero cells. The TCIDs0 and EIDs0 data demonstrated that the titer levels of rBeau-H120(S1) reached 10(590+/-0.22)TCID50/mL and 10(6.13+/-0.23)EID50/mL in Vero cells and 9-day-old SPF chicken embryos, respectively. Protection studies showed that the percentage of antibody-positive chickens, which were vaccinated with rBeau-H120(S1) at 7 days after hatching, rose to 90% at 21 days post-inoculation. Inoculation provided an 85% rate of immune protection against a challenge of the virulent IBV M41 strain (103EID50/chicken). This recombinant virus constructed using reverse genetic techniques could be further developed as a novel genetic engineering vaccine against infectious bronchitis.
Animals ; Cercopithecus aethiops ; Chick Embryo ; Chickens ; Coronavirus Infections ; veterinary ; virology ; Infectious bronchitis virus ; chemistry ; genetics ; growth & development ; metabolism ; Poultry Diseases ; virology ; Protein Structure, Tertiary ; Spike Glycoprotein, Coronavirus ; chemistry ; genetics ; metabolism ; Transfection ; Vero Cells