The incidence rate of biliary tract cancer is increasing year by year. Systemic therapy is the most important treatment for patients with advanced or unresectable biliary tract cancer. Gemcitabine combined with cisplatin is still the standard first-line chemotherapy, while gemcitabine combined with TS-1 and gemcitabine combined with nab-paclitaxel are also the first-line treatment options. Studies have confirmed that immunotherapy as a back-line treatment has a significant advantage in survival, and the disease control rate of nivolumab is 61% and the median overall survival is more than 1 year. In addition, targeted drugs targeting FGFR2, IDH1/2, HER-2 and other major driving genes of biliary tract cancer also show good antitumor activity, and become research hotspots in the treatment of advanced biliary tract cancer. Summarizing the research progress of systematic chemotherapy, immunotherapy and molecular targeted therapy for advanced biliary tract cancer can provide help for clinical practice.

Objective To analyze relevant factors of cervical intraepithelial neoplasia residual or recurrence after loop electri‐cal excision procedure(LEEP) .Methods We observed the patients who were histopathologically confirmed CIN and treated with LEEP in our hospital from January 2006 to September 2012 ,and investigated the postoperative residual and recurrence .Then we an‐alysed relevant factors of residual or recurrence .Results (1)After at least 2 years of follow‐up ,26 cases showed residual or recur‐rence(the residual rate was 0 .97% and the recurrence rate was 4 .08% ) .(2)Overall severity of residual or recurrence had been re‐duced ,but the severity and recurrence of preoperative severity was positively correlated(r=0 .354 0 ,P<0 .05) .(3)Age ,smoking , preoperative high‐risk HPV load ,post‐operative the same type of HPV continuous infection ,endocervical involvement ,lesions in‐vo1ving quadrants ,and post‐operative TCT results between the recurrence group and non‐recurrence group were statistically signifi‐cant different(P<0 .05) .Conclusion CIN residual or recurrence after LEEP might be affected by many factors ,and the treatment should be individualized .

Objective To identify differences in the anal sphincter surface electromyography (sEMG)variables in spinal cord injury (SCI) subjects with different severities. Methods One hundred and ten SCI patients' impairments were classified as ASIA A,B,C or D using the International Standards for the Neurological Classification of Spinal Cord Injury.The evaluation was pedormed using sEMG equipment with an inserted anal sensor electrode and the Glazer pelvic floor muscle sEMG protocol.The sEMG variables were recorded and compared. Results There was no significant difference in sEMG variables between groups A and B,but the mean and maximum sEMG values of groups C and D in flick contractions ( 1 s),tonic contractions ( 10 s),and endurance contractions (60 s) were significantly higher than those of group A.Compared with group C,the mean and maximum sEMG values of group D were all significantly higher. Conclusions The sEMG data from the anal sphincter during contractions decreases significantly after SCI.Glazer's pelvic floor muscle sEMG protocol is a noninvasive and convenient real-time assessment.It is a useful complementary tool for quantitative assessment of the pelvic floor muscles of SCI patients.

Objective To explore the causes of postoperative recurrence in patients of nodular goiter,the selection of method for reoperation and the postoperative complications. Methods The clinical data of 278 nodular goiter patients admitted in the first affiliated hospital of Harbin Medical University between 2001 and 2008 were analyzed retrospectively,including the methods and complications for first operation and reoperation. Results In the first operation,79 eases received simple eminectomy and 167 cases received partial lobectomy,accounted for 28.4% and 60.1%,respectively. Unilateral subtotal lobectomy plus contralateral eminectomy was performed in 23 cases and subtotal thyroideetomy was conducted in 9 cases,accounted for 8.3% and 3.2%,respectively. Postoperative complications occurred in one hundred and twenty-three cases,the incidence being 8.2% (23/278). Unilateral subtotal Iobectomy plus contralateral partial iobectomy was reperformed in 37 cases and bilateral subtotal thyroidectomy in 241 cases. Postoperative complications occurred in 12 cases,the incidence being 4.2%(12/278). No postoperative recurrence of nodular goiter was found. Conclusions Recurrence of nodular goiter is closely associated with the scope of previous surgical treatment,and correct operative manipulation may reduce the recurrent rate.

OBJECTIVETo study the effect of Jinlida on changes in expression of skeletal muscle lipid transport enzymes in fat-induced insulin resistance ApoE -/- mice.

METHODEight male C57BL/6J mice were selected in the normal group (NF), 40 male ApoE -/- mice were fed for 16 weeks, divided into the model group (HF), the rosiglitazone group ( LGLT), the Jinlida low-dose group (JLDL), the Jinlida medium-dose group (JLDM), the Jinlida high-dose group (JLDH) and then orally given drugs for 8 weeks. The organization free fatty acids, BCA protein concentration determination methods were used to determine the skeletal muscle FFA content. The Real-time fluorescent quantitative reverse transcription PCR ( RT-PCR) and Western blot method were adopted to determine mRNA and protein expressions of mice fatty acids transposition enzyme (FAT/CD36), carnitine palm acyltransferase 1 (CPT1), peroxide proliferators-activated receptor α( PPAR α).

RESULTJinlida could decrease fasting blood glucose (FBG), cholesterol (TC), triglyceride (TG), free fatty acid (FFA) and fasting insulin (FIns) and raise insulin sensitive index (ISI) in mice to varying degrees. It could also up-regulate mRNA and protein expressions of CPT1 and PPARα, and down-regulate mRNA and protein levels of FAT/CD36.

CONCLUSIONJinlida can improve fat-induced insulin resistance ApoE -/- in mice by adjusting the changes in expression of skeletal muscle lipid transport enzymes.

Animals ; Apolipoproteins E ; deficiency ; genetics ; Blood Glucose ; metabolism ; CD36 Antigens ; genetics ; metabolism ; Carnitine O-Palmitoyltransferase ; genetics ; metabolism ; Dietary Fats ; adverse effects ; metabolism ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Hypoglycemic Agents ; administration & dosage ; Insulin ; metabolism ; Insulin Resistance ; Lipid Metabolism ; drug effects ; Male ; Metabolic Diseases ; drug therapy ; enzymology ; genetics ; metabolism ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Muscle, Skeletal ; drug effects ; metabolism

BACKGROUNDCervicothoracic junction spinal tuberculosis (CJST) in children is uncommon, especially when accompanied by a huge abscess. However, its consequences can be severe. Because of the special anatomic location of the cervicothoracic junction, surgical treatment is difficult and rarely reported. The aim of this clinical study was to assess the effectiveness of combined anterior and posterior approaches for focal debridement, decompression, allografting and anterior instrumentation in the treatment of CJST in children.

METHODSTen pediatric CJST patients underwent focal debridement and cord decompression through combined anterior and posterior approaches. Then an appropriate allograft and titanium plate were applied to reconstruct the spine. The patients were asked to wear head-neck-chest braces for six months and received regular anti-tubercular drugs therapy for 12 months.

RESULTSThe patients were followed-up for an average of 26 months (range, 15-32 months). There was no recurrent tuberculous infection. The bone grafts incorporated well and the instrumentation was stable. Cervical and thoracic kyphosis was successfully corrected from 40° (range, 30-52°) before the operation to 18° (range, 12-26°) post-operation. Neurological function was improved in all patients.

CONCLUSIONSCombined anterior and posterior approaches for focal debridement, decompression, bone allografting and anterior instrumentation provided an effective means of treatment in children of CJST with a huge abscess in the posterior part of the vertebral body.

Bone Transplantation ; Cervical Vertebrae ; surgery ; Child, Preschool ; Debridement ; Decompression, Surgical ; Female ; Follow-Up Studies ; Humans ; Male ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery

Animals ; Athletic Performance ; Drugs, Chinese Herbal ; pharmacology ; Free Radicals ; metabolism ; Male ; Mice ; Mice, Inbred Strains ; Morinda ; Myocardium ; metabolism ; Physical Conditioning, Animal

Objective To explore the expression and the changes of ski with time in the injured spinal cord in rats. Methods Sixty adult female Sprague-Dawley rats were randomly divided into sham group (n=30) and injury group (n=30), each group were further divided into 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks subgroups, with 6 rats in each subgroup. Spinal cord injury at T10 was established with modi-fied Allen's technique (10 g × 25 mm) in the injury group. The hindlimbs behavior of rats was rated with Basso-Beattie-Bresnahan (BBB) scores 1 day, 3 days, 1 week, 2 weeks, 4 weeks, 8 weeks and 12 weeks after spinal cord injury. Three rats in each subgroup were stained with HE staining to observe the pathological changes of the spinal cord and the formation of cavity. The other 3 rats were analyzed with im-munofluorescence staining of ski and semi quantitative analysis. Results The BBB scores of each time point were less in the injury group than in the sham group (P<0.05). Necrosis was the major pathological change in the injury groups 1 and 2 weeks after injury;cystic cavity completely formed 4 weeks after injury, with dense scar tissue around it;there was no significant change in the cavity and scar 8 and 12 weeks after injury, however, the adjacent spinal cord was obviously thinner. Ski expressed little in the normal spinal cord, and expressed more and more after injury, peaked at 8 weeks and decreased then. Ski was mainly observed in white matter in the sham group and 12 weeks injury subgroup, which was in gray matter 2, 4 and 8 weeks after injury. Ski was highly expressed around the cavity in injury center and formed high expression band. Conclusion Ski expresses after spinal cord injury in rats, that may be associated with the activation and prolif-eration of astrocytes and the formation of glial scar.

Objective To evaluate the role of imaging diagnosis in surgical treatment of primary aldosteronism(PA). MethodsFrom Jan 1995 to Dec 2004,245 patients with PA were hospitalized in our hospital.Before the operations,all the patients underwent B-ultrasonography and CT scaning,240 received intravenous pyelography and 75 MRI.The preoperative imaging diagnosis were compared with the findings during the operations and postoperative pathologic results. Results Compared with the findings during the operations,the accuracy rates of localized diagnosis for PA with B-ultrasonography,CT scanning and MRI were 92.7%,98.2% and 90.4%,respectively.Compared with the postoperative pathologic results,the accuracy rates of qualitative diagnosis for aldosterone-producing adenoma(APA) with B-ultrasonography,CT scanning and MRI were 83.0%,90.7% and 72.2%,respectively. Conclusion The comprehensive imaging data are helpful in the localized diagnosis of PA.Correct preoperative qualitative diagnosis of APA is the key step for the surgical treatment for PA.

OBJECTIVETo explore the effect of total parenteral nutrition (TPN) supplemented with arginine on cellular immune function of patients with hepatocellular carcinoma (HCC) after radical tumor resection.

METHODSFifty-six HCC patients undergoing radical surgery received fat-free TPN support, routine TPN or TPN with arginine supplementation, and their clinical data were analyzed prospectively. The percentages of T lymphocyte subpopulation and national killer (NK) cells in peripheral blood are determined, and the levels of interleukin-2 (IL-2), IL-4 and interferon-gamma (IFN-gamma) were measured.

RESULTSNo marked changes were noted in peripheral blood CD4+, CD8+ T cells and NK cells, or in IL-2, IL-4 and IFN-gamma levels after fat-free TPN and routine TPN support. TPN supplemented with arginine resulted in significant increase in CD4+ T cells, NK cells and CD4+/CD8+ T cell ratio in the peripheral blood, as well as in IL-2 and IFN-gamma levels. Peripheral blood IL-4 level was decreased significantly.

CONCLUSIONTPN with arginine supplementation can augment the percentages of CD4+ T lymphocytes and NK cells, and increase IL-2 and IFN-gamma levels, suggesting that arginine can enhance cell-mediated immunity in postoperative patients with HCC.

Adult ; Aged ; Arginine ; pharmacology ; Carcinoma, Hepatocellular ; immunology ; metabolism ; surgery ; therapy ; Cytokines ; metabolism ; Dietary Supplements ; Female ; Humans ; Immunity, Cellular ; drug effects ; Liver Neoplasms ; immunology ; metabolism ; surgery ; therapy ; Male ; Middle Aged ; Parenteral Nutrition ; methods ; Postoperative Period ; T-Lymphocyte Subsets ; drug effects ; immunology