Myeloma bone disease (MBD) is the most common complication of multiple myeloma (MM). The pathogenesis of MBD is associated with the increase of osteoclast activity and the inhibition of osteoblast function, which seriously affects the quality of life of patients. Normal bone remodeling is maintained by bone cells, osteoclasts and osteoblasts balancing bone formation and bone resorption. A variety of cytokines can affect bone formation and bone resorption by regulating the activity of bone cells, osteoclasts and osteoblasts. Recent studies have reported that the molecules and pathways related to osteoclast activation and osteoblastic inhibition include the receptor activator of nuclear factor-κB ligand/osteoprotegerin pathway, activin-A, Wnt signal inhibitor Dickkopf-1 (DKK1) and sclerostin, etc. These molecules can affect tumor growth and provide the possibility for the development of new drugs and the treatment of MBD and MM. This article reviews the latest progress in the pathogenesis and treatment of MBD.

Objective: To detect the expression of B cell transposition gene 3(BTG3) in pancreatic ductal adenocarcinoma(PDAC), and explore its relationship with postoperative recurrence and metastasis of tumor. Methods: Six self-paired frozen PDAC specimens and 3 normal pancreatic tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected and the expression of BTG3 was detected by qPCR. Ten normal pancreatic tissues and 52 cases of PDAC tumor and paracarcinomatous tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected from June 2009 to December 2016. The expression of BTG3 and relationship among BTG3 and clinicopathological characteristics of PDAC and patients′ prognosis were detected and analyzed using immunohistochemistry.χ² test, Kaplan-Meier method and Cox regression model were used to analyzed the data. Results: The results of qPCR showed that expression level of BTG3 in PDAC (0.63±0.17) was lower significantly than that in paracarcinomatous (0.96±0.04) and normal tissues (1.00)(t=4.673, 5.502; both P<0.05). Immunohistochemistrv showed that BTG3 mainly expressed in the cytoplasm.The high expression rate of BTG3 in PDAC tumor tissues was 25.0%(13/52), which was remarkably lower than that in paracarcinomatous tissues(65.4%) and normal liver tissues(7/10)(χ²=17.120 and 5.849, both P<0.05). The low expression of BTG3 in PDAC was correlated with primary tumor, and TNM stage(χ²=7.704, P=0.006; U=154.000, P=0.018, respectively). Survival analysis showed that disease free survival rate of patients with low expression of BTG3 was significantly less than that with high expression(χ²=192.493, P<0.01). The Cox multivariate analysis demonstrated that low expression of BTG3 was independent risk factors for disease free survival in patients with PDAC after a curative resection(RR=3.366, 95%CI: 1.040-10.889, P=0.043). Conclusion BTG3 may be involved in the occurence and development of tumor, and its low expression may be associated with poor prognosis in patients with PDAC.

Objective To explore the expression and clinical significance of lysine oxidase(Lox)in primary lesion of esophageal carcinoma(ESC A)and bone metastasis lesion based on bioin-formatics.Methods The Cancer Genome Atlas(TCGA)and Gene Expression Profiling Interactive Analysis(GEPIA)databases were used to screen for differentially expressed genes between ESCA and normal esophageal tissues.Follow-up information of patients with surgery for esophageal cancer in the Fourth Hospital of Hebei Medical University from January 2016 to December 2020 were screened,and the clinical materials of patients diagnosed as bone metastasis during the follow-up period were collected.Western blot was used to verify the expression of Lox in ESCA and normal esophageal tis-sues;immunohistochemical staining was used to detect the expression of Lox in human ESCA tissue and normal tissue;the impact of Lox expression on survival was explored by Kaplan-Meier curve and Cox regression.Results Through the analysis of ESCA data in GEPIA and TCGA databases,it was found that the expression of Lox in ESCA lesions was significantly higher than that in normal tissues(P＜0.05);the Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene Ontology(GO)enrichment analyses found that Lox may be involved in the information conduction of various signaling pathways;the Western blot result showed that the expression of Lox in cancer tissue was higher than that in adjacent normal tissue(P＜0.05);the analysis of follow-up data found that patients with high expression of Lox were more likely to have multiple bone metastases;survival analysis revealed that patients with high Lox expression had significantly shorter bone metastasis free survival and o-verall survival compared to patients with low Lox expression(P＜0.05);Cox regression found that Lox was an independent risk factor for prognosis of patients with esophageal cancer bone metastasis.Conclusion Lox is highly expressed in ESCA and significantly related to clinical prognosis,which can be used as an effective target for the diagnosis and treatment of ESCA.

Objective To explore the expression and clinical significance of lysine oxidase(Lox)in primary lesion of esophageal carcinoma(ESC A)and bone metastasis lesion based on bioin-formatics.Methods The Cancer Genome Atlas(TCGA)and Gene Expression Profiling Interactive Analysis(GEPIA)databases were used to screen for differentially expressed genes between ESCA and normal esophageal tissues.Follow-up information of patients with surgery for esophageal cancer in the Fourth Hospital of Hebei Medical University from January 2016 to December 2020 were screened,and the clinical materials of patients diagnosed as bone metastasis during the follow-up period were collected.Western blot was used to verify the expression of Lox in ESCA and normal esophageal tis-sues;immunohistochemical staining was used to detect the expression of Lox in human ESCA tissue and normal tissue;the impact of Lox expression on survival was explored by Kaplan-Meier curve and Cox regression.Results Through the analysis of ESCA data in GEPIA and TCGA databases,it was found that the expression of Lox in ESCA lesions was significantly higher than that in normal tissues(P＜0.05);the Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene Ontology(GO)enrichment analyses found that Lox may be involved in the information conduction of various signaling pathways;the Western blot result showed that the expression of Lox in cancer tissue was higher than that in adjacent normal tissue(P＜0.05);the analysis of follow-up data found that patients with high expression of Lox were more likely to have multiple bone metastases;survival analysis revealed that patients with high Lox expression had significantly shorter bone metastasis free survival and o-verall survival compared to patients with low Lox expression(P＜0.05);Cox regression found that Lox was an independent risk factor for prognosis of patients with esophageal cancer bone metastasis.Conclusion Lox is highly expressed in ESCA and significantly related to clinical prognosis,which can be used as an effective target for the diagnosis and treatment of ESCA.

OBJECTIVETo investigate the effect of treatment on end-stage liver disease and type-I diabetes mellitus with simultaneous liver-pancreas-duodenum transplantation.

METHODIn September 2003, one patient with chronic hepatitis B, liver cirrhosis, hepatic cellular cancer, and insulin-dependent diabetes received simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation. Liver and pancreas graft function was monitored after transplantation.

RESULTSThe function of pancreas allograft was recovered immediately and the patient became insulin-independence postoperatively. The liver allograft was experienced an acute rejection episode and reversed by intravenous bolus methylprednisolone. The recipient was currently liver disease-free and insulin-free more than 21 months.

CONCLUSIONSThe simultaneous liver-pancreas-duodenum transplantation is an effective method in the treatment of end-stage liver disease and type-I diabetes mellitus.

Diabetes Mellitus, Type 1 ; complications ; surgery ; Duodenum ; transplantation ; Female ; Follow-Up Studies ; Graft Rejection ; prevention & control ; Humans ; Immunosuppressive Agents ; therapeutic use ; Liver Cirrhosis ; complications ; surgery ; Liver Neoplasms ; complications ; surgery ; Liver Transplantation ; Male ; Middle Aged ; Pancreas Transplantation ; Transplantation, Homologous

Objective:To investigate the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma at multiple centers in China.Methods:Between December 2015 and August 2019, the clinical data of 143 patients who underwent LRHC in Affiliated Hospital of North Sichuan Medical College, Second Hospital of Hebei Medical University, Affiliated Hospital of Xuzhou Medical University, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hunan Provincial People′s Hospital, the First Hospital Affiliated to Army Medical University, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, West China Hospital of Sichuan University, Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Chongqing Medical University were collected prospectively. There were 92 males and 51 females with age of (64±11) years (range: 53 to 72 years). Bismuth type: type I, 38 cases (26.6%), type Ⅱ, 19 cases (13.3%), type Ⅲa, 15 cases (10.5%), type Ⅲb, 28 cases (19.6%) and type Ⅳ, 43 cases (30.0%). The patients within the first 10 operation cases in each operation time (the first 10 patients in each operation team) were divided into group A (77 cases), and the patients after 10 cases in each operation time were classified as group B (66 cases); the cases with more than 10 cases in the center were further divided into group A 1 (116 cases), and the center with less than 10 cases was set as group A 2 (27 cases). T test or Wilcoxon test was used to compare the measurement data between groups, and the chi square test or Fisher exact probability method was used to compare the counting data between groups. Kaplan Meier curve was used for survival analysis. Results:All patients successfully completed laparoscopic procedure. The mean operation time was (421.3±153.4) minutes (range: 159 to 770 minutes), and the intraoperative blood loss was 100 to 1 500 ml (median was 300 ml) .Recent post-operative complications contained bile leakage, abdominal bleeding, abdominal infection, gastrointestinal bleeding, and delay gastric emptying, pulmonary infection, liver failure, et al.The post-operative hospital stay was (15.9±9.2) days. The operation time in group B was relatively reduced ( (429.5±190.7)minutes vs. (492.3±173.1)minutes, t=2.063, P=0.041) and the blood loss (465 ml vs. 200 ml) was also reduced ( Z=2.021, P=0.043) than that in group B. The incidence of postoperative biliary fistula and lung infection in patients in group A was significantly higher than that in group B (χ 2=4.341, 0.007; P=0.037, 0.047) .Compared with group A 2, the operation time in group A 1 was relatively reduced( (416.3±176.5)minutes vs. (498.1±190.4)minutes, t=2.136, P=0.034) , the incidence of bile leakage and abdominal cavity infection in group A 1 was lower than that in group A 2 (χ 2=7.537, 3.162; P=0.006, 0.046) . Kaplan Meier survival curve showed that the difference of short-term survival time between group A and group B was statistically significant ( P<0.05) . Conclusions:The completion of laparoscopic hilar cholangiocarcinoma radical surgery is based on improved surgical skills, and proficiency in standardized operation procedures.It is feasible for laparoscopic radical resection of hilar cholangiocarcinoma to well experienced surgeon with cases be strictly screened, but it is not recommended for widespread promotion at this exploratory stage.

Objective:To investigate the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma at multiple centers in China.Methods:Between December 2015 and August 2019, the clinical data of 143 patients who underwent LRHC in Affiliated Hospital of North Sichuan Medical College, Second Hospital of Hebei Medical University, Affiliated Hospital of Xuzhou Medical University, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hunan Provincial People′s Hospital, the First Hospital Affiliated to Army Medical University, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, West China Hospital of Sichuan University, Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Chongqing Medical University were collected prospectively. There were 92 males and 51 females with age of (64±11) years (range: 53 to 72 years). Bismuth type: type I, 38 cases (26.6%), type Ⅱ, 19 cases (13.3%), type Ⅲa, 15 cases (10.5%), type Ⅲb, 28 cases (19.6%) and type Ⅳ, 43 cases (30.0%). The patients within the first 10 operation cases in each operation time (the first 10 patients in each operation team) were divided into group A (77 cases), and the patients after 10 cases in each operation time were classified as group B (66 cases); the cases with more than 10 cases in the center were further divided into group A 1 (116 cases), and the center with less than 10 cases was set as group A 2 (27 cases). T test or Wilcoxon test was used to compare the measurement data between groups, and the chi square test or Fisher exact probability method was used to compare the counting data between groups. Kaplan Meier curve was used for survival analysis. Results:All patients successfully completed laparoscopic procedure. The mean operation time was (421.3±153.4) minutes (range: 159 to 770 minutes), and the intraoperative blood loss was 100 to 1 500 ml (median was 300 ml) .Recent post-operative complications contained bile leakage, abdominal bleeding, abdominal infection, gastrointestinal bleeding, and delay gastric emptying, pulmonary infection, liver failure, et al.The post-operative hospital stay was (15.9±9.2) days. The operation time in group B was relatively reduced ( (429.5±190.7)minutes vs. (492.3±173.1)minutes, t=2.063, P=0.041) and the blood loss (465 ml vs. 200 ml) was also reduced ( Z=2.021, P=0.043) than that in group B. The incidence of postoperative biliary fistula and lung infection in patients in group A was significantly higher than that in group B (χ 2=4.341, 0.007; P=0.037, 0.047) .Compared with group A 2, the operation time in group A 1 was relatively reduced( (416.3±176.5)minutes vs. (498.1±190.4)minutes, t=2.136, P=0.034) , the incidence of bile leakage and abdominal cavity infection in group A 1 was lower than that in group A 2 (χ 2=7.537, 3.162; P=0.006, 0.046) . Kaplan Meier survival curve showed that the difference of short-term survival time between group A and group B was statistically significant ( P<0.05) . Conclusions:The completion of laparoscopic hilar cholangiocarcinoma radical surgery is based on improved surgical skills, and proficiency in standardized operation procedures.It is feasible for laparoscopic radical resection of hilar cholangiocarcinoma to well experienced surgeon with cases be strictly screened, but it is not recommended for widespread promotion at this exploratory stage.