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.

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 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.

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.

ObjectiveTo investigate the expression of programmed death receptor ligand 1 ( PD-L1 ) of peripheral blood mononuclear cells (PBMCs) in patients with hepatic cystic echincccccosis (HCE) and its relation with interferon-γ.MethodsThe clinical data of 63 patients with HCE who were admitted to the First Affiliated Hospital of Xinjiang Medical University from June 2010 to February 2011 were retrospectively analyzed.All patients were divided into HCE active group (38 patients) and HCE non-active group (25 patients) according to the system established by the World Health Organization's Informal Working Group on Echinocoecosis.Twenty patients with hepatic hemangioma or healthy individuals were recruited in normal control group.The positive rate of PD-L1 expression was detected by flow cytometry and immunocytochemistry.The expression of interferon-γ was detected by enzyme-linked immtmosorbent assay (ELISA).All data were analyzed by the t test,one-way analysis of variance,LSD test and chi-square test.The relationship between the expression of interferon-γ and positive rate of PD-L1 expression was analyzed by the Pearson test.ResultsThe results of flow cytometry showed that the positive rates of PD-L1 expression in the HCE active group,HCE non-active group and normal control group were 12.1％±3.8％,10.9％ ± 2.5％ and 9.1％ ±2.5％,respectively.There was a significant difference in the positive rate of PD-L1 expression between the HCE active group and normal control group (t =3.327,P ＜ 0.05 ).The results of immunohistochemistry showed that the positive rates of PD-LI expression in the HCE active group,HCE non-active group and normal control group were 11.9％ ± 3.4％,i0.6％ ± 2.9％ and 9.5％ ± 3.6％,respectively.There was a significant difference in the positive rate of PD-L1 expression between the HCE active group and normal control group (t =2.470,P ＜ 0.05 ).The expressions of intefferon-γ in the HCE active group,HCE non-active group and normal control group were ( 141 ± 38 ) μμg/L,( 124 ± 32 ) μg/L and ( 105 ± 42 ) μg/L.There wasasignificant difference in the expression of interferon-γ between the HCE active group and normal control group ( t =3.280,P ＜ 0.05).The results of flow cytometry and immunohistochemistry revealed that the positive rate of PD-L1 expression was positively correlated with the expression of interferon-γ( r =0.59,0.61,P ＜ 0.05 ).Conclusion With the help of interferon-γ,PD-L1 may play an important role in promoting the immune.evasion of echinococcus.

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.

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 evaluate DWI in the assessment of viability of hepatic alveolar echinococcosis (HAE) by comparing DWI with PET-CT results. Methods 18-fluorodeoxy glucose(18F-FDG) PET-CT and DWI(b values=0, 800 s/mm2) were retrospectively analyzed in 8 patients with clinically verified HAE. The metabolic activity of HAE lesions in both techniques were determined by two independent radiologists respectively. Kappa test was assessed between the results of two observers. Results Sixteen lesions (composed of 14 HAE and 2 cystic echinococcosis, CE) were detected. (1)Eight lesions (≥2 cm) showed perilesional hyper-signal intensity on DWI, mainly around the lesion bounding by normal liver parenchyma. One patient (≥2 cm) had oral drug therapy for three years, and the lesion showed discontinuous perilesional hyper-signal intensity on DWI after the therapy. Five lesions (<2 cm) were depicted as nodular high signal on DWI.(2)Eight lesions (≥2 cm) showed perilesional increased FDG uptake on PET-CT, while 5 lesions (<2 cm) displayed as“hot pot”. One patient (leison≥2 cm) who had oral drug therapy for three years showed hepatic defect without any FDG uptake in post-treatment PET-CT. Two CE lesions showed negative results on both DWI and PET-CT. The Kappa value of 0.880 indicated a good coincidence between DWI and PET-CT in depicting the metabolic activity of HAE (P=0.006). Conclusions This preliminary study showed the value of DWI in assessing HAE viability. DWI should be routinely used as one of the techniques in the evaluation of HAE.