Intrahepatic cholangiocarcinomas (ICCA) are primary intrahepatic malignancies originating from biliary epithelia.While both hepatocellular cancer and ICCA can present as mass lesions within the liver,these cancers are distinct in their morphology,etiology,pathology,natural history and response to therapy.There is a need for accurate and sensitive molecular markers for the diagnosis of ICCA.Recent advances in elucidating molecular and genetic characteristics of ICCA offer the potential of molecular-based diagnosis of ICCA.Specific genetic mutations of IDH1/2,BAP1,p53,and KRAS,FGFR gene fusions and alterations in microRNA have all been described in ICCA.Although there are no accurate serum or biliary biomarkers currently available for diagnosis of ICCA,several potential candidates have been identified.Knowledge of specific genetic or molecular abnormalities offers potential for individualized approaches for the treatment of patients with ICCA in the future.

Reforming the managerial system and the educational system of higher medical education is the requirement of the social development in the twenty-first century. The article expounds the fundamental characteristics of medical education including small scale, longer-duration program, and high expenditure. It emphasizes the significance of following the rule of medical education, and analyzes the important position of medical college and the relation of medical college to affiliated hospitals and other related colleges in the comprehensive university. Based on the requirement of the social development and the trend of higher medical education internationalization, it also analyzes the necessity of the adjustment on the medical educational system and the way of the adjustment.

Objective To investigate the changes of psychological state and family environment of the patients with neurosis (including depression and anxiety) in the process of treatment. Methods The Hamilton depression scale (HAMD), Hamilton anxiety scale(HAMA), self-rating depression scale(SDS), self-rating anxiety scale(SAS), family environment scale(FES), and family adaptability and cohesion scale(FACESⅡ-CV) were used to evaluate the changes of psychological state and family relationship in the process of treatment among patients with depression and anxiety hospitalized in general hospitals (n=45) and their family members (n=45). Results Before intervention, values of HAMD, HAMA, SDS and SAS in patients were higher than normal ones, and were in line with the corresponding diagnostic criteria. After psychological intervention and medication for 2 to 3 months, symptoms such as depression and anxiety were improved significantly, and values of the above scales were within normal ranges. Besides, there was also significant improvement in FES and FACESⅡ-CV after intervention among the patients. All the values of the family members were in the normal ranges before intervention, however, significantly positive changes were observed after intervention. Conclusion With the improvement in depression and anxiety after intervention among patients, the psychological pressure of family members is released, and family relationship is partially restored. The rehabilitation of patients plays an important role in the restoration of family function.

Objective To evaluate urodynamic diagnosis of intrinsic sphincter deficiency (ISD) in female stress urinary incontinence. Methods Leak-point pressures (LPP) and maximum urethra close pressures (MUCP) were detected in 30 patients with female stress urinary incontinence,among whom there were 11 cases with type Ⅲ,19 type Ⅱ/Ⅲ. Results Of type Ⅲ incontinence the LPP was less than 50 cmH 2O in 10 out of 11 and in 17 out of 19 type Ⅱ/Ⅲ incontinence the LPP 50～100 cmH 2O ( P

Objective To study the relation between changed atrial load and atrial septal motion.Methods Forty one patients with valve diseases,7 patients with congenital heart diseases, and 12 normal subjects were involved.Two dimensional image was obtained by transesophageal echocardiography.The thickness,wave time and velocity were showed during atrial septal motion by omni directional M mode echocardiography (OME).Results With increase of the volume load and pressure load in the atrium,the atrial septal thickness increased, and the velocity of atrial septal motion increased or reduced.Conclusions OME shows that the thickness and velocity of atrial septal motion relates with condition of atrial load.

OBJECTIVE To investigate the effect of nuclear factor-kappa B ligand-receptor activator of nuclear factor-kappa B-osteoprotegerin(RANKRANKL-OPG)system on bone resorption in middle ear cholesteatoma,and the reasons why middle ear cholesteatoma in children were more aggressive. METHODS The expression of RANKL and OPG in 21 adults cholesteatoma,17 children cholesteatoma and 18 normal external meatal skin was studied with immunohistochemistry. Semiquantitative analysis was used for comparison and statistical analysis. RESULTS RANKL-positive cells and the ratio of RANKL/OPG in cholesteatoma were significantly higher than that in external meatal skin(P

Objective To compare the protective effect of ischemic preconditioning(IP) and caspase inhibitor on ischemia reperfusion(IR) injury of the liver in rats,and to investigate the possible mechanism. Methods SD rats subjected to 60 or 120 minutes of 70% hepatic ischemia and 3 hours of reperfusion,respectively,then divided randomly into 6 groups: (1)Ischemia/ reperfusion group 1 (IR 1 group);(2)IR 2 group;(3)Ischemia preconditioning group 1(IP 1 group);(4)IP 2 group; (5)Caspase inhibitor treatment group1(T 1 group);(6)T 2 group.Serum levels of aspartate aminotransferase (AST) and alanine aminotransfernase (ALT),and liver Caspase-3 activity, hepatocytes apoptosis,and animal seven-day(7 d) survive rate were determined. Results Both ischemic preconditioning and Caspase inhibitor treatment could protect the liver against IR injury,and their protective effect in IP 1 group and T 1 group was equally at 3h reperfusion after 60min ischemia. At 3h reperfusion after 120min ischemia, the effect of inhibiting Caspase-3 activity and decreasing hepatocyte apoptosis in T 2 group were significantly superior to those in IP 2 group(P0.05). Conclusions Both IP and Caspase inhibitor treatment can protect the liver against IR injury in rats,and the protective effect is no significant difference between the two methods.However IP is more simple?safe and cheaper comparing with Caspase inhibitor treatment.

Objective To isolate and identify pathogenic f ungus in a patient with intracranial infection.Methods Specimens were taken from the spinal fluid of the patient.Then,microsco py and fungal culture were done to identify the pathogen.The hi stopathologic features were reprod uced through animal pathogenicity s tudy in a mice model.Results According to the colony appearance i n culture medium,the morphological features in microscopy,such as conidia arrangement and size,germ tube forming site,this fungus was identified as Bipolaris spicifera.Hyphae and swollen hyphal cells resembling chlamydospores,septate pi gmented hyphae were observed in brain tissue specimen of mice experimental model,which were consiste nt with phaeohyphomycosis.Conclu-sion This is the first case of phaeohyphom ycosis caused by Bipolaris spicifera reported in China.

ObjectiveTo discuss the relationship between patella location and chondromalacia patella,explore its mechanism and clinical significance.Methods Knee joint MRI was performed in 1052 patients (506 men and 546 female).Among them,there were 299 patients( 100 men and 199 female)with chondromalacia patella.They were divide into the group of 1-19,the group of 20-39,the group of 40-59 years old and the group of older than 60 years to compute the positive rate respectively.Insall-Salvati method was used to measure the length of chondromalacia ligaments(L) and the length of chondromalacia path(P).The relationship between patella location and chondromalacia was tested by using t test and x2 test.ResultsThe total positive rate of chondromalacia patella was 28.4％ (299/1052).In female it was 36.4％ (199/546) and in men was 19.8％ (100/506).The group of 1-19 years old had 16 patients ( 16.8％,16/95).The group of 20-39 years old had 71 patients( 17.9％,71/396).The group of 40-59 years old had 116 patients ( 33.2％,116/349 ).The group of older than 60 years had 96 patients (45.3％,96/212).The positive rate of chondromalacia patella increased with age.The L/P value of normal group and chondromalacia patella group were 1.15 ±0.15 and 1.24 ±0.17 respectively.The L/P value of normal group of men and women were 1.13 ± 0.15 and 1.17 ± 0.14 respectively.The L/P value of chondromalacia patella group of men and women were 1.20 ±0.17 and 1.26 ±0.16 respectively.The InsallSalvati index of age groups showed significant differences.The L/P value of pathological changes group and normal group of 1-19 years old were 1.38 ± 0.25 and 1.24 ± 0.16 respectively.The L/P value of pathological changes group and normal group of 20-39 years old were 1.24 ± 0.17 and 1.15 ± 0.16 respectively.The L/P value of pathological changes group and normal group of 40-59 years old were 1.24 ±0.16 and 1.12 ±0.12 respectively.The L/p value of pathological changes group and normal group of older than 60 years were 1.21 ±0.16 and 1.12 ±0.12 respectively.All of them had significant differences (P ＜ 0.01 ).ConclusionsThe positive rate of chondromalacia patella for female is higher than that for men,which also increases with age.High patella location is relevant to chondromalacia patella.