Objective To evaluate the clinical pathway (CP) for treatment of hepatic cystic echinococcosis.Methods Data were retrospectively obtained from hospitalized patients with hepatic cystic echinococcosis (CE) who were treated surgically between April 2011 to December 2012.Patient treated with the clinical pathway (the CP group) were compared with patients who were treated with conventional treatment (the non-CP group).The following outcomes were compared:the average length of in-hospital stay,the hospital charges,patient's satisfaction,patient's knowledge about his/ her own health and postoperative complications.Results For the CP groups,the length of in-hospital stay,the hospital charges,the patient's satisfaction and the health knowledge for the patients were (10.25±1.26)d,(19600.25±1520.73) yuan,(46.4 5±2.14),(83.50±8.02),respectively.The corresponding figures for the non-CP group were (14.25 ± 1.50) d,(23931.25 ± 1629.17) yuan,(42.65 ± 1.93),(74.50 ± 12.60),respectively.There were significant differences between the 2 groups (t=-4.086,-4.074,8.351,3.811 ; P＜0.05).The postoperative complications,including bile leakage,bleeding,ascites and pleural effusion,were 2,0,2 cases in the CP group,and 0,4,5 cases in the non-CP group.There were no significant difference between the 2 groups (x2 =0.17,0,0.6; P＞0.05).Conclusion Our initial clinical experience showed that the clinical pathway decreased the length of in-hospital stay and hospital charges,and provided quality and efficient clinical services to patients with hepatic cystic echinococcosis.

Objective To compare the efficacy of radical and quasi-radical hepatectomy for the treatment of end-stage hepatic alveolar echinococcosis(HAE)with involvement of major blood vessels and viscera.Methods The clinical data of 41 patients with end-stage HAE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2002 to January 2010.All patients were divided into radical hepatectomy group (13 patients)and quasi-radical hepatectomy group(28 patients)according to whether blood vessels were reconstructed and repaired.The operation time,blood loss,length of hospital stay,recurrence and metastasis of HAE,pleural effusion,ascites,biliary complications and death between the 2 groups were compared.All data were analyzed by using the t test or chi-square test.Results The volume of blood loss,length of hospital stay,number of patients with recurrence and metastasis of HAE,obstructive jaundice and number of dead patients were(326 ±115)ml,(22 ± 18)days,0,0,and 0 in the radical hepatectomy group,and were(24 ± 20)ml,(15 ± 12)days,10,10 and 10 in the quasi-radical hepatectomy group,there were significant differences between the 2 groups(t =13.41,1.47;x2 = 4.36,4.36,4.36,P ＜ 0.05).The operation time,number of patients with pleural effusion and ascites,bile leakage,cholangitis and number of patients died perioperatively were(407 ± 146)minutes,4,0,1 and 1 in the radical hepatectomy group,and(263 ± 93)minutes,2,2,2 and 1 in the quasi-radical hepatectomy group,there were no significant differences between the 2 groups(t = 3.81;x2 = 2.30,0.04,0.34,0.04,P ＞ 0.05).Conclusions Radical hepatectomy should be the first choice when construction of infringed vessels can be achieved.Quasi-radical hepatectomy has lower operation risks for avoiding important vessels injury.

Purpose:To investigate the relationship between cell apoptosis and dephosphorylated RB protein in human breast cancer. Methods:In our work,human breast cell lines (MCF-7/S,the chemosensitive cell line and MCF-7/ADR,the chemoresistent cell line)were evaluated. Chemosensitivity of two cell lines was evaluated by the MTT colorimetric assay;the expressive levels of dephosphorylated RB protein were detected with immunocytochemistry. Apoptosis rates were determined by flow cytometry(FCM). Results:ADR inhibited proliferation of chemosensitive cell line MCF-7/S ,the 50% inhibition concentration (IC 50 ) was 0.128 ?g/ml;And IC 50 of MCF-7/ADR was 10.89 ?g/ml. The chemotherapeutic sensitivity of MCF-7/S was more than that of MCF-7/ADR by 86 times . Before treatment with ADR,phosphorylated RB protein was positive in two cell lines,but dephosphorylated RB protein was negative;After treatment of different concentration ADR,when the concentration of ADR was increased,expression of dephosphorylated RB protein elevated accordingly in MCF-7/S,but no significant change in MCF-7/ADR. Apoptosis and cell cycle was detected by FCM assays shows ADR induced apoptosis of MCF-7/S more than MCF-7/ADR(P0.05).

Objective To evaluate the value of the application of ultrasonic elastography and ultrasound contrast imaging on thyroid microcarcinoma(TMC). Methods The in-patients with thyroid lesions admitted in the Second People's Hospital of Foshan City from January 2013 to April 2014 were enrolled. Two-dimensional ultrasonography was used to screen the 162 solid thyroid nodules with a diameter ≤10 mm;they were examined by ultrasonic elastography and ultrasound contrast imaging respectively,and the result of pathological examination was regarded as the golden standard to compare the sensitivity and specificity between ultrasonic elastography and ultrasound contrast imaging for the diagnosis of TMC. Results The pathological results showed there were benign nodules 118 and malignant nodules 44 in number. The sensitivity,specificity,incidence of accuracy,positive predictive value and negative predictive value of the diagnosis of TMC by ultrasonic elasticity imaging,ultrasound imaging,and elasticity imaging combined with ultrasound imaging were much higher than those by two-dimensional ultrasonography〔sensitivity:88.64%(39/44),90.91%(40/44),95.45%(42/44)vs. 81.82%(36/44);specificity:91.53%(108/118),92.37%(109/118),95.76%(113/118)vs. 85.59%(101/118);accuracy:90.74%(147/162), 91.97%(149/162),93.26%(151/162)vs. 84.56(137/162);positive predictive value:79.59%(39/49),81.63%(40/49),83.67%(41/49)vs. 67.92%(36/53);negative predictive value:95.58%(108/113),96.46%(109/113), 97.35%(110/113)vs. 92.66%(101/109),all P<0.05〕. Conclusion For the diagnosis of TMC,both ultrasonic elastography and ultrasound contrast imaging have rather high value,and when they are combined together to be applied for the diagnosis,the result is the best.

AIM: To explore the curative effect of methylprednisolone with octreotide retrobulbar injection therapy on thyroid associated ophthalmopathy.
METHODS:Fifty- one cases ( 96 eyes ) with thyroid associated ophthalmopathy were treated with methylprednisolone ( 500mg/d ) for 3d, and then retrobulbar injection of octreotide (0. 1mg/mo) for 3mo in one course. Symptoms and signs of the patients were observed before and after the treatment course.
RESULTS: Symptoms of 49 cases were improved significantly. In all cases, the mean value of exophthalmus of the patients was significantly decreased after the treatment by 3. 1 ± 1. 4mm. The height of palpebral fissure was significantly decreased after the treatment by 2. 4 ± 0. 9mm, there were statistically significant difference before and after treatment (P<0. 05).
COCLUSION: Methylprednisolone with octreotide retrobulbar injection therapy can improve symptoms and signs of the patients with thyroid associated ophthalmopathy with high safety and no obvious side effect.

Objective To investigate clinical and pathological features of primary cutaneous CD30 + anaplastic large cell lymphoma(PC-ALCL). Methods Clinical and pathological data were collected from 7 patients with PC-ALCL and analyzed retrospectively. Results Of the 7 patients, 6 were male and 1 was female, with an average age of 52 years. PC-ALCL was characterized by solitary (n = 3)or multiple (n = 4)erythematous nodules, lumps and/or plaques with (n = 6)or without (n = 1)ulceration. Systemic involvement was observed in none of the 7 patients. Histopathological examination showed diffuse distribution of tumor cells in the dermis, which were large with rich cytoplasm and atypical nuclei. Mitotic figures were seen. An immunohistochemical study of tumor cells showed positive staining for CD30 and cytotoxic protein, but negative staining for CD20, CD56,anaplastic lymphoma kinase(ALK). Epstein-Barr virus-encoded RNA in situ hybridization was negative. Conclusions PC-ALCL is a rare primary cutaneous low-grade malignant T-cell lymphoma, which can be confirmed by clinical manifestations as well as histopathological and immunohistochemical examinations. It usually has good prognosis with rare systemic involvement and metastasis.

Objective To explore the efficacy of various managements of indurative biliary fistula after HCE operation.Methods 31 patients who underwent surgery for indurative biliary fistula after HCE operation in Xinjiang Medical University were studied retrospectively.Cholangiography and common bile duct exploration through a T tube were done in 15 patients,cholangiography and decompression through a T tube which led to the orifice of the fistula of the cavity in 8 patients,hepatectomy in 4 patients,lobe resection + choledochojejunostomy in 2 patients,total pericystectomy in 1 patient,and cavity abscess debridement in 1 patient for severe infection of the abdominal cavity,followed by hemihepatectomy after half a year.Result On follow-up of 1-8 years,choledochojejunostomy had to be done in 1 patient for stricture of the bile duct after T tube drainage,hepatectomy in 1 patient for bile leakage after the cavity abscess debridement operation,and bile leakage in 1 patient after hepatectomy although with drainage the patient was cured.Conclusion The results suggested that hepatectomy and total pericystectomy completely solved the problems arising from indurative biliary fistula.However,these procedures are complicated,and have higher operative risks.Cholangiography and common bile duct exploration solved the cavity-related problems.For patients with severe calcified cavities which communicated with large hepatic ducts,cholangiography and decompression through a T tube put into the orifice of the fistula of the cavity solved the indurative biliary fistula efficaciously and safely.

Objective To investigate the diagnosis and treatment of ruptured hepatic cystic echinococcosis (HCE).Methods The clinical data of 109 patients with HCE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 1994 to December 2009 were retrospectively analyzed.The diagnosis was based on the results of serological examination,epidemiological history,clinical manifestation and imaging findings.Of the 108 patients who received surgical treatment,67 received classic endocystectomy(classic group)and 41 received improved endocystectomy(improved group).The operation time,operative blood loss,length of postoperative hospital stay,time of drainage,effusion and infection of residual cavity,biliary fistula,pleura]effusion,local recurrence,dissemination and implantation of HCE,and death of the 2 groups were compared.All data were analyzed using the t test and chi-square test.Results The diagnostic rates of ultrasound,computed tomography and magnetic resonance imaging were 93%(101/109),99%(70/71)and 7/7,respectively.The positive rate of serological examination was 100%(61/61).Of the 109 patients,1 died of anaphylactic shock.The operation time and operative blood loss were(3.2 ± 0.3)hours and(104.0 ± 11.5)ml in the classic group and(3.3 ±0.4)hours and(110.0 ±23.8)ml in the improved group,respectively.There were no significant differences in the operation time and operative blood loss between the 2 groups(t =-1.474,-1.758,P ＞0.05).The length of hospital stay and time of drainage were(15.3 ± 4.3)days and(28.0 ± 4.6)days in the classic group and(9.3 ± 1.2)days and(7.6 ± 0.8)days in the improved group,respectively.There were significant differences between the 2 groups in the length of hospital stay and time of drainage(t = 8.628,28.088,P ＜0.05).The incidence rates of effusion and infection of residual cavity,biliary leakage,local recurrence,dissemination and implantation of HCE of the classic group were significantly higher than those in the improved group(x2 =4.335,3.888,5.691,4.581,10.153,P ＜0.05).Twenty-one patients received reoperation because of HCE recurrence or severe complications.Conclusions Epidemiological history,clinical manifestation,imaging findings and serological examination are important for the diagnosis of ruptured HCE.Improved endocystectomy + peritoneal lavage with hypertonic saline + administration of anti-HCE drugs is the optimal treatment for ruptured HCE.

Objective To study the results of emergency treatment of ruptured hepatic cystic echinococcosis (HCE).Methods A standardized management protocol for hepatic echinococcosis was introduced by the First Hospital of Xinjiang Medical University in 2002.This study included 185 patients who received emergency treatment for ruptured HCE between 1994 and 2009.The patients were divided into group A (from 1994 to 2001) and group B (from 2002 to 2009).The clinical characteristics and surgical treatment results were compared retrospectively.Results In patients with ruptured HCE into the abdomen,classical endocystectomy (Group A1 ) resulted in significantly more postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay,recurrence and peritoneal seeding than improved endocystectomy (Group B1 ) (P＜0.05).The operation time and blood loss were not significantly different between group A1 and B1 (P＞0.05).For patients with ruptured HCE into the biliary tree,classical endocystectomy (Group A2 ) resulted in significantly higher postoperative complications in residual hepatic cavity,time of drainage,postoperative hospital stay and recurrence than improved endocystectomy (B2) (P＜0.05).Operation time,blood loss and peritoneal seeding were not significantly different between group A2 and B2 (P ＞ 0.05). Only one patient (0.54％) died from allergic shock in this series of patients.Conclusions Improved endocystectomy was an efficacious surgical treatment for ruptured HCE and it is recommended for emergency surgery.

Objective To analyze the efficacy of different treatment methods for end-stage hepatic alveolar echinococcosis combined with obstructive jaundice.Methods A retrospective study was conducted on the diagnosis and treatment of 55 patients with end-stage hepatic alveolar echinococcosis combined with obstructive jaundice managed from January 2000 to January 2013 at the First Affiliated Hospital of Xinjiang Medical University.The patients were divided into two groups according to the treatment options:group A,the palliative surgery group (n =38,69.1％) using palliative resection and biliary decompression ; and group B,the interventional group (n =17,30.9％) using percutaneous transhepatic cholangial drainage (PTCD).We analyzd the general data,preoperative and postoperative liver function,operation time,blood loss,average hospital stay,duration of postoperative tube drainage of abscess cavity,degree of lesion with invasion into the first porta hepatis,progressive lesion,continuous invasion and/or distant metastasis,biliary complications,mortality,and cumulative survival rates.The t-test or t'-test was used to analyze continuous data and the chi-square test was used to analyze categorical data.Parallel log rank test and Kaplan-meier method were used to calculate survival rates in survival analysis.Results When compared with group B,group A had significantly longer operative time,more blood loss,and longer average hospital stay (P ＜0.05).The postoperative total bilirubin,direct bilirubin,γ-glutamyl transpeptidase and alkaline phosphatase,aspartate aminotransferase,alanine aminotransferase were significantly higher than in group B (P ＜0.05).The level of post operative albumin was lower in group A than in group B.The two groups of patients (A and B) had similar background including general data (gender,age,nation),preoperative liver function,duration of postoperative tube-drainage of abscess cavity,degree of lesion-invasion into first porta hepa tis,progressive lesion-invasion and/or distant metastasis,biliary complications,mortality,cumulative survival rates and survival curves.Conclusions Interventional treatment is an effective treatment for end-stage hepatic alveolar echinococcosis combined with obstructive jaundice.It has the advantages of minimal invasiveness,simplicity,safety and repeatability.It may replace traditional palliative surgery in the future.