Carcinoma of gallbladder is the most frequently encountered malignancy of the biliary system. Early diagnosis is very difficult and the tumour resection rate is low,and the prognosis of carcinoma of gallbladder is very poor. With the increasingly widespread acceptance of laparoscopic cholecystectomy (LC),the number of cases of unsuspected gallbladder carcinoma (UGC) has increased. However,management of UGC is a difficult issue in the absence of established guidelines. High age and history of stones are the risk factors for gallbladder carcinoma and they are related to UGC. Surgical handling and pneumoperitoneum play an important role in the metastasis. The surgical approach used for cholecystectomy would not seem to influence the outcome in patients with UGC. The tumour stage is the most important prognostic factor. To understand UGC better, we review its clinical characteristics,investigation,prognosis and especially the recent advances in the diagnosis and treatment of this disease.

Objective To investigate the constituents in Lysimachia congestiflora.Methods The constituents were isolated by the silica gel column chromatography,and their structures were identified by spectroscopy methods.Results ?-Stigmasterol(1),quercetin(2),myricetin 3′-methyl ether(3),syringetin-3-O-?-L-arabinofuranosid(4),ardicrenin(5) and ardisiacrispin A(6) were isolated and identified.Conclusion Six compounds have been isolated from Lysimachia congestiflora,and ardicrenin(5) is isolated from this species for the first time.

Objective To investigate the role of vascular endothelial growth factor (VEGF)in the pathogenesis of bronchial asthma and chronic obstructive pulmonary disease (COPD). Methods Thirty patients with stable bronchial asthma (asthma group), 28 patients with stable COPD (COPD group), and 24 healthy subjects (control group) were studied. Lung function, inflammatory cell differentials in sputum and the level of VEGF in induced sputum were determined by induced sputum method and ELISA method respectively. Results The levels of eosinophils in induced sputum in asthma group were 0.9 (0.4-1.4) × 109/L, significantly higher than those in COPD greup[0.1 (0-0.2)×109/L], and control group[0.0(0-0.1) × 109/L] (P < 0.05). The levels of neutrophils in COPD group were 2.3 (1.8-2.8) × 109/L, significantly higher than those in asthma group [1.1 (0.2-1.9) × 109/L], and control group [1.0(0.8-1.2) × 109/L] (P < 0.05). The levels of VEGF in asthma group, COPD group and control group were (2.3 ± 0.5), (0.3 ± 0.1), (0.9 ± 0.2) μg/L, respectively, and significant difference was showed between each group (P < 0.05). The VEGF level in induced sputum was positively correlated with the number of eosinophils in induced sputum in asthma group (γ = 0.62,P < 0.05), and was negatively correlated with FEV<,1>% (γ =-0.56, P < 0.05). The VEGF level in induced sputum was positively correlated with FEV1% in COPD group (γ = 0.43, P < 0.05), and was not correlated with the number of neutrophils in induced sputum (γ = 0.21, P > 0.05). Conclusions The concentration of VEGF in induced sputum increases in patients with bronchial asthma. VEGF may take part in the airway inflammatory development of asthma. The concentration of VEGF in induced sputum decreases in patients with COPD. VEGF may take part in the incidence of COPD.

Objective:To explore the expression of B7-1,B7-2 and B7-H1 on tumor-infiltrating dendritic cells(TIDC) and on splenic dendritic cells(SDC),and to investigate TIDC-mediated and SDC-mediated T-cell function after blocking B7-H1 expression in these dendritic cells.Methods: The TIDCs and SDCs were isolated from tumor-bearing mice using anti-mouse CD11c magnetic beads.The expression of B7-1,B7-2 and B7-H1 on TIDC and SDC was analyzed using flow cytometer.T cells were co-cultured with TIDCs or SDCs for the mixed lymphocyte reaction(MLR),and monoclonal antibodies to B7-H1 or the isotype control antibodies were added to the MLR cultures.T-cell proliferation was assessed using XTT method and the secretion of IL-10 was detected using ELISA.Results: B7-1 and B7-2 positive TIDCs were significantly less than SDCs(P0.05).T-cell proliferation stimulated by TIDCs was weaker than that stimulated by SDCs;T cells produced more IL-10 after TIDCs stimulation than after SDCs stimulation(P

Objective To explore the changing rule of schistosomiasis endemic situation in Gaoyou City,so as to provide the evidences for schistosomiasis control in lake and marshland regions. Methods The endemic data of schistosomiasis of Gaoy?ou City from 1970 to 2009 were collected to analyze the endemic patterns of schistosomiasis in different control stages compre?hensively. Results In the first years of infection control stage(1970-1975),transmission control stage(1976-1994)and transmission interruption stage(1995-2009),the prevalence rates of schistosomiasis were 4.20%,0.80%and 0 in human and 3.00%,0.51%and 0 in cattle respectively. In 1984,the positive rate of crowd stool tests fell to 0.04%,which was reduced by 99.05%compared with that in 1970. From 1970 to 1980,the positive rates of stool tests of people and livestock were positively correlated significantly(r=0.67,P<0.05). After 1985,no local infection patients or cattle were found. No schistosome infect?ed Oncomelania hupensis snails were found from 1970 to 2009. Conclusion The comprehensive control measures have been insisted in Gaoyou City in different prevention and control stages. Although the snail situation is undulate,the prevalence of schistosomiasis steadily declines and the interruption of transmission has achieved.

ObjectiveTo evaluate the feasibility and safety of endoscopic intraductal radiofrequency ablation (RFA) for unresectable malignant biliary strictures.MethodsA total of 12 patients with malignant biliary obstructions,who were unsuitable for surgical resection,were prospectively selected for this study.During ERCP,when successful biliary cannulation achieved,a bipolar radiofrequency probe was introduced into bile duct over a guidewire.RFA was given to the tumor lesion under fluoroscopy,followed by stent placement.The patients were closely observed and followed up after the procedure.ResultsSuccessful RFA was achieved in all patients before stents insertion ( plastic and metal stents in 6 respectively,additional pancreatic stents were given to 3).Mild complications of cholangitis and pancreatitis occurred in 1 patient respectively,which were cured with short-term management.Jaundice was promptly controlled in 7 patients (58.3％ ).During the mean follow-up duration of 3.4 (range 0.5-5.5) months,one patient died of cardiocerebral accident and others survived without obvious disconffort.The 1- month and 3- month stent patency was 100％ (12/12) and 80％ (8/10),respectively.ConclusionIt is technically feasible and safe to perform endoscopic intraductal RFA for the palliation of biliary malignancies.The short-term outcome is satisfying,however,long-term result and the better therapeutic schedule need further evaluation.

Objective To evaluate endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and management of biliary cast syndrome after orthotropic liver transplantation. Methods A total of 71 consecutive patients with abnormal liver function and MRCP findings after liver transplantation underwent ERCP for diagnosis and management. Their data were retrospectively reviewed. Results A total of 188 sessions of ERCP were carried out on the 71 patients, most of whom were found to have stenosis of anastomotic stoma and/or bile duct. Bile sludge was found and removed in all patients diagnosed within 3 months after liver transplantation, while pigmentoid stones were found and removed in patients diagnosed within 3-6 months and biliary casts in patients diagnosed at more than 6 months. Each patient underwent 2.6 sessions averagely. Biliary casts were formed at an average time of 22. 7 ± 15.6 months after transplantation. PostERCP complications included 2 cases of pancreatitis and 3 cholangitis, with an occurrence rate of 2. 6%(5/188), which were all controlled with conservative treatment. The follow-up data was available in 56 patients showing improvement in liver function after ERCP, among who 42 met the endoscopic criteria of cure,1 0 received second liver transplantation because of progressive sclerosing cholangitis and 4 died from diseases other than liver transplantation. Conclusion Therapeutic ERCP for the biliary cast syndrome after liver transplantation is feasible, safe and effective, and can be performed repeatedly with good short-term effect.

Objective To observed the expression of serum TNF-α and IL-10 in rats with severe acute pancreatitis (SAP) at different altitudes,and to explore the relationships between TNF-α and IL-10,the pathological changes of the pancreas,and the experimental basis for clinical diagnosis and treatment of SAP.Methods 72 specific pathogen free (SPF) Wistar male rats were divided randomly into three groups:1 500 meters altitude (group L),3 300 meters altitude (group M),and 4 300 meters altitude (group H).These three groups were then each divided randomly into four subgroups:control (group n),6 hours after pancreatitis (group p 6 h),12 hours after pancreatitis (group p 12 h),and 24 hours after pancreatitis (group p 24 h).Pancreatitis was induced by intraductal administration of 5％ sodium taurocholate hydrate (NaTc).The rats were killed at 6,12,and 24 hours after NaTc injection in groups p.The group n rats were killed after 6 hours of pancreas observation.Blood samples and pancreatic tissues were collected post mortem and enzyme-linked immunosorbent assay (ELISA) measured serum TNF-α and IL-10.Results Compared with the control (group n),histopathological scores,IL-10,and TNF-α in the same altitude had a significant difference (P ＜ 0.05) in group p at each time point.In the same altitude of group p,histopathological scores and IL-10 were increased with time elapsed (P ＜ 0.05),while TNF-α was decreased with time elapsed (P ＜ 0.05).There was a significant difference between group Mp and Lp in histopathological scores,IL-10,and TNF-α (P ＜ 0.05),and the same result between group Hp and Lp (P ＜ 0.05),but there was no significant difference between group Hp and Mp (P ＜ 0.05).Meanwhile,IL-10 had a positive relationship with histopathological score,but TNF-α had a negative relationship with histopathological score.Conclusions The level of TNF-α increased with increasing altitude but significantly reduced with elapsed time.The level of IL-10 increased with both increasing altitude elapsed time.These results suggested that TNF-o and IL-10 might play a important role at different times in severe acute pancreatitis.

Objective To determine the frequency of Toll-like receptor 4 (TLR4)polymorphisms Asp299Gly and Thr399Ile in a cohort of hematopoietic stem cell transplant recipients and their donors in China.Method We examined the polymorphisms in 208 peripheral blood samples collected from 104 recipients and their donors in a single center between 2007-2012 in Zhejiang Province,China,and Asp299Gly and Thr399Ile TLR4 gene polymorphisms were detected using the sample DNA amplification products direct sequencing and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.Result Both methods didn't demonstrate TLR4 polymorphisms Asp299Gly or Thr399Ile base mutation in our samples.Conclusion The TLR4 Asp299Gly and Thr399Ile polymorphisms are very rare in our part of the population of hematopoietic stem cell transplantation.

Objective To evaluate the safety and efficacy of a newly designed anti-reflux metallic stent (ARMS) for malignant extra-hepatic biliary obstruction. Methods A total of 23 patients with unresectable biliary malignancy in the middle or lower part of common bile duct underwent endoscopic retrograde cholangiopancreatography (ERCP) and ARMs placement. The success rate, early complications, stent patency and patients' survival were recorded. Results The ARMSs were successfully placed in all patients and no procedure-related complication was recorded. The average operation time was similar to that of self-expanding metallic stents (SEMs). In 22 patients completing the follow-up, the total serum bilirubin dropped to normal within one month in 20. ARMs dysfunction occurred in 6, including tumor in-growth in 1, overgrowth in 2, and stent dislodgement in 3. Other patients were free of biliary symptoms until death or at the end of follow-up. The average stent patency of ARMs was 14 months. Patency rates at 3, 6, and 12 months were 95%, 74% and 56%, respectively. The mean patient survival was 7. 9 months ( 1-14 months).Postoperative survival rates at 3,6 and 12 months were 91.0%, 81.3% and 17. 2%, respectively. Conclusion Endoscopic placement of novel ARMs in patients with extra-hepatic biliary tumors is feasible,safe and effective.