Objective To evaluate the feasibility of laparoscopic cholangiotomy for radical excision of upper cholangiocarcinoma. Methods Four trocars were placed at the umbilical area, right upper and lower abdomen, and below the xiphoid. A 3 cm incision was made at the left upper abdomen for Roux-en-Y jejunojejunostomy. The gallbladder, inferior segment of the left medial liver, and the middle-upper segment of the bile duct were resected. And then the tumor and the adjacent 1 cm bile duct were excised. Afterwards, the proper hepatic artery, portal vein, and the surrounding connective tissues and lymph nodes were removed. Finally, the bile-jejunum Roux-en-Y anastomosis was performed. Results The hepatic duct bifurcation was involved by the cholangiocarcinoma in all the 4 cases. The diameter of the tumor was 1-1.5 cm. The resection of the inferior segment of the left medial liver and middle and upper segments of the bile duct, and dissection of the lymph nodes at the hepatic porta were completed successfully. The operation was accomplished in all the cases with an operation time of 270, 255, 270, and 230 mins, and the intraoperative blood loss was 500, 400, 300, and 400 ml, respectively. Postoperative pathological examination showed highly differentiated adenocarcinoma in all the cases. Cases 2 and 3 developed bile leakage after the operation and were cured 20 or 15 days later. In all the cases, the jaundice disappeared after the operation. Their appetite recovered, and the body weight was increased by 3, 3.5, 2, and 2 kg, respectively. Conclusions Upper cholangiocarcinoma can be radically excised by using laparoscopy. The resection of cholangiocarcinoma and part of liver tissues, dissection of surrounding connective tissues and lymph nodes, and bile duct reconstruction can be accomplished under a laparoscope. Thus,we consider that laparoscopic cholangiotomy is feasible for radical excision of upper cholangiocarcinoma.

As a milestone in the development of personalized comprehensive treatment for breast cancer, molecular subtype classification quantitatively characterizes breast cancer as heterogeneous diseases rather than a single disease in terms of onset risk, natural course, and treatment response. The significance of molecular subtype classification has been widely confirmed in prediction of the efficacy of systemic treatment and prognosis of systemic metastases and risk of death. However, the association between molecular subtype and local?regional recurrence ( LRR) risk as well as the impact of molecular subtype classification on radiotherapy strategy still needs more attention. This review discusses the association between molecular subtype and LRR risk as well as the significance of molecular subtype classification in guiding radiotherapy strategy.

In order to arouse the working enthusiasm of the entire staff and give expression to the value of labor and skills, our hospital has implemented reform in the distribution system. Bonus given to clinical departments is linked both to the amount and quality of work and to economic profits; bonus to medico technical departments is given by means of deducting a percentage from the income and expenditure surplus in a way of progressive decrease; bonus given to functional departments is equivalent to 90% of the average bonus given to medical service departments; and bonus to logistical service departments is given, if possible, by the piece and mark. As a result of the reform, the distribution system has become more rational, the working enthusiasm and efficiency of the staff have been enhanced, operational income and income structure have improved, and social benefits bave been raised, with the satisfaction rate reaching over 90%. Of course, there still exist some difficulties in the reform.

Objective To discuss the application of endoscopic techniques in the treatment of calculus of intrahepatic or extrahepatic duct. Methods Laparoscopy in conjunction with duodenoscopy or cholangioscopy was adopted in 96 cases of calculus of intrahepatic or extrahepatic duct, including 72 cases of cholecystolithiasis complicated by choledocholithiasis, 16 cases of simple choledocholithiasis and 8 cases of left intrahepatic duct calculus complicated by choledocholithiasis. The surgical procedures included laparoscopic cholecystectomy (LC) combined with EST (37 cases), LC combined with cholangioscopic exploration (54 cases), and laparoscopic left hepatic lobectomy combined with cholangioscopic exploration (5 cases). Results Postoperative re-examination revealed no residual calculus in 93 out of 96 patients. Small amounts of biliary leakage occurred in 4 patients and healed spontaneously within a mean time of 10 days. No other severe complications took place. A conversion to open surgery was required in 3 patients, 2 of which were high bile duct stricture and 1 of which were severe portal adhesion. Conclusions Endoscopy in the treatment of calculus of intrahepatic or extrahepatic duct is feasible. Proper application of multiple endoscopic techniques is a safe, effective and minimally invasive means for the treatment of cholelithiasis.

With the widespread adoption of screening mammography, the incidence of ductal carcinoma in situ (DCIS) has been dramatically increased. The spectrum of local treatment advances from mastectomy to breast conservation surgery plus whole breast irradiation (WBI), and hypofractionated WBI or accelerated partial breast irradiation. Although the efficacy of WBI on reducing local recurrence is clear, such benefit in the low-risk DCIS is still controversial. Further studies are required to establish a more precise local recurrence risk stratification system for better tailoring local treatment in patients with DCIS. In this review, the latest advances and controversies in surgery, radiation therapy and local recurrence risk stratification system for patients with DCIS were summarized.

Objective To investigate the value of global longitudinal strain (GLS) in detecting severe coronary artery stenosis (SCAS) in patients with coronary artery disease. Methods Fourty-two patients with SCAS confirmed with coronary arteriongraphy (CAG) underwent two-dimensional strain echocardiography. GLS, wall motion score index (WMSI) and left ventricular ejection fraction (LVEF) were obtained. Taking CAG as gold standard, the sensitivity, specificity and areas under the ROC curve (AUC) of definition of SCAS with GLS, WMSI and LVEF were calculated, respectively. Fifteen healthy volunteers were recruited as control. Results ①Definition of one or more branches with severe stenosis: The sensitivity and specificity was 77.51% and 100% with GLS of -17.50% as a cutoff value, 70.01% and 100% with WMSI of 1.00, and 57.51% and 100% with LVEF of 59.21%. ②Definition of two or more than two branches with severe stenosis: The sensitivity and specificity was 62.52% and 80.81% with GLS of -11.05% as a cutoff value, 56.22% and 65.31% with WMSI of 1.60 and 56.21% and 65.42% with LVEF of 54.31%. ③The correlation coefficient was 0.78 between GLS and LVEF, and -0.82 between WMSI and LVEF. The AUC of detecting one or more branch with severe stenosis with GLS, WMIS and LVEF was 0.87, 0.80 and 0.78, respectively, and AUC of GLS was more than that of LVEF (P＜0.01). AUC of detecting two or more than two branches with severe stenosis with GLS, WMIS and LVEF was 0.76, 0.64 and 0.64, AUC of GLS was more than that of LVEF and WMSI (all P＜0.01). Conclusion GLS can be used in detecting SCAS, and the value of GLS is better than that of WMIS and LVEF.

Objective:To explore the application value of MRI texture analysis in combination with imaging features to predict the WHO/International Society of Urological Pathology (ISUP) nuclear grading in pre-operative patients with clear cell renal carcinoma (ccRCC).Methods:MRI images of 78 patients diagnosed as ccRCC by surgical pathology from July 2016 to July 2020 in First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. According to the WHO/ISUP grading system, the patients were divided into low grade group (49 cases, grade Ⅰ in 2 cases and grade Ⅱ in 47 cases) and high grade group (29 cases, grade Ⅲ in 25 cases and grade Ⅳ in 4 cases), and then were assigned to training set ( n= 63) and validation set ( n=15) in a ratio of 7∶3 using random indicator method. MRI radiological features were evaluated and MRI imaging texture features were extracted. The largest-diameter slice of lesion on cross-sectional images was selected and ROIs were drawn on T 2WI and corticomedullary phase (CMP) images, respectively. Quantitative texture analysis software MaZda was used to extract texture features, including gray-scale histogram, co-occurrence matrix, run-length matrix, gradient, autoregressive model and wavelet transform. The extracted texture features were preliminarily selected by the combination of Fisher, probability of classification errorand average correlation coefficient, and interaction information, and then the reduced texture parameters or imaging features were tested by the independent sample t test, Mann-Whitney U test or χ 2 test. Parameters with statistically significant differences were used to construct a multi-factors binary logistic regression model and the ROC curve was used to analyze its effectiveness in predicting high grade ccRCC. Results:In training set, there were significant differences intumor length, shape and margin, enhancement degree of CMP, vein thrombosis and 47 texture features between the low and high grade ccRCC groups. In the training set, 7 multi-factors binary logistic regression model were constructed, including radiological features model (M1), T 2WI texture features model (M2), CMP image texture features model (M3) and combination radiological features of T 2WI texture features model (M4), combination radiological features of CMP images texture features model (M5), combination T 2WI texture features of CMP images texture features model (M6) and combination of all features model (M7). The area under ROC curve of M7 in predicting nuclear grading of ccRCC was the largest, which were 0.901 (95% CI 0.828-0.974) and 0.820 (95% CI 0.564-0.974) in the training set and validation set, respectively. Conclusion:MRI texture analysis combined with imaging features is hopeful to be an effective preoperative noninvasive method in predicting WHO/ISUP grading of ccRCC.

Objective To evaluate the diagnostic value of 2D ultrasound (2DUS)-based composite score method and contrast enhanced ultrasound (CEUS) in differentiation between thyroid microcarcinomas and benign micronodules. Methods A total of 216 consecutive patients with 258 thyroid micronodules underwent 2DUS and CEUS examinations before thyroidectomy from June 2011 to October 2013. The scoring of each nodule was based on five 2DUS features including hypoechogencity, irregular shape, macrocalcification, and taller than wide in shape. Microcalciifcation was assigned as 2 points and the remaining features were assigned as 1 point. A composite score was ifnally given to each thyroid nodule ranging from 0 to 6 points. The sensitivity, specificity and accuracy of diagnosing thyroid microcarcinoma by 2DUS composite score method and CEUS were calculated. Results The histopathologic results of all 258 nodules were acquired, including 125 papillary microcarcinomas and 133 benign micronodules. Each nodule′s 2DUS compostie score was ranging from 0 to 6 points. The area of receiver operating characteristic (ROC) curve of 2DUS in diagnosing thyroid microcarcinoma was 0.81. The 2DUS composite score method predicted the thyroid microcarcinoma with sensitivity of 78.4%(98/125), speciifcity of 72.9%(97/133), accuracy of 75.6%(195/258), when the nodule with a score greater than or equal to 3 points was deifned as malignant. Thyroid micronodules′enhancement pattern were divided into 7 types, including early hypoenhancement, hypoenhancement, isoenhancement, hyperenhancement, local nonenhancement, nonenhancement, and ring margin ring enhancement. CEUS predicted thyroid malignant micronodules with sensitivity of 87.2%(109/125), specificity of 75.9%(101/133), and accuracy of 81.4%(210/258), when early hypoenhancement and hypoenhancement pattern was defined as malignant patterns. There were no differences in sensitivity, specificity, and accuracy between 2DUS cumulative score method and CEUS in diagnosing thyroid microcarcinoma (McNemar test, P=0.099, 0.608, 0.096). Conclusion Early hypoenhancement and hypoenhancement are CEUS characteristic enhancement pattern for thyroid microcarcinoma, CEUS has higher sensitivity, speciifcity in diagnosis than 2DUS composite score method, while there are no statistical differences.

Objective Establish an experimental model for primary subchondral bone osteoblasts culture of neonatal SD rat's condylar process. Methods Under the condition of sterile,24-hour SD rat was executed and its condylar process was isolated. Removing cartilage layer, the subchondral bone was exposed obviously, then it was cultured with modified repeating enzymatic digestion-adherent explants method. The cellular morphology was identified with invert microscope and immunohistochemistry staining, the osteoblasts were identified by alkaline phosphorase (ALP) staining and calcified nodules staining, and the proliferation of the acquired cells was examined by methyl thiazolyl tetrazolium (MTT) assay. Results A variety of cell morphologies were observed, such as spindle-shaped, triangular and irregular-shape, and their cell processes were significant. The alkaline phosphatase staining and calcified nodules staining of cultured osteoblasts with mineralized nodules were positive. Cells grew slowly in 1-3 days, and the cells growth reached the highest level at the 8th day. The cells growth trend has gradually slowed down after 8 days. Conclusion The method is an efficient way to culture and obtain purified neonatal SD rat's subchondral bone osteoblasts with typical characteristics.