The First Affiliated Hospital of Xi’an Jiaotong University has experienced more than 60 years’ history in the diagnosis and treatment of gallbladder carcinoma (GBC). From 1956 to 2018, 3 430 cases of GBC were treated, including 1941 cases of surgical treatment and 703 cases of radical resection. The data comparison between 1956-2008 and 2009-2018 revealed that the radical resection rate increased from 19.9% to 48.3%. The mean survival time after regional radical resection and extended radical resection was (23.1±15.4) and (17.5±16.2) months, respectively, from 2004 to 2008. Compared with those between 2013 and 2017, the mean survival time after regional radical resection and extended radical resection was (31.5±2.0) and (18.6±3.9) months, respectively, and the median survival time was 31.0 and 11.0 months, respectively. By comparing the GBC data longitudinally, the mode of diagnosis and treatment of GBC in our hospital has changed significantly in the past 10 years, which is mainly reflected in the change of GBC staging system, the progress of imaging diagnosis mode, the standardization of surgery and the development of adjuvant treatment. All of these have significantly improved the prognosis of GBC.

ABSTRACT:Objective To investigate the prevalence of thyroid nodules in Xi’an City by ultrasonography and study the correlation between thyroid nodules and the components of metabolic syndrome.Methods We recruited 4 527 subjects in this cross-sectional study and divided them into thyroid nodules (TN)group and non-thyroid nodules (NTN)group.The height,weight,blood pressure,blood sugar,lipid,and serum uric acid were measured and analyzed.The relationship between thyroid nodules and thyroid function was assessed in the subjects who received TT3,TT4,TSH,TGAB,and TPOAB tests.Results ① The prevalence of thyroid nodules was 31.8% and was significantly higher in the female patients (38.4% vs.27.1%,χ2=64.44,P<0.001).However,the prevalence of metabolic syndrome was 9.1% and was significantly higher in the male ones (11.4% vs.5.9%,χ2=40.39,P<0.001).② Compared with that in NTN group,TT3 in TN group was significantly increased (t=6.04,P<0.001), but the other indexes did not obviously change in the two groups (P>0.05).③ Age,systolic blood pressure,and TG,LDL-C and serum uric acid levels were remarkably higher in TN group than in NTN group (P<0.001 ). Conclusion The prevalence of thyroid nodules in Xi’an City is noticeably high.High systolic blood pressure level, dyslipidemia and elevated uric acid are associated with thyroid nodules.Therefore,screening and management of the individuals with aforementioned characteristics deserve more attention.

OBJECTIVETo analyze the clinical features of patients with gallbladder cancer from 17 hospitals in 5 Northwestern provinces (autonomous region) of China from 2009 to 2013.

METHODSA total of 2 379 cases with gallbladder cancer in 17 tertiary hospitals from 5 Northwestern provinces of China from January 2009 to December 2013 were reviewed retrospectively. The clinical data was collected by standardized "Questionnaire for Clinical Survey of Gallbladder Cancer in Northwestern Area of China". χ² test was used to analyze the data.

RESULTS(1) Gallbladder cancer from 17 hospitals accounted for 1.6%-6.8% of all bile tract diseases from 2009 to 2013 in Northwestern China, average was 2.7%. Gallbladder cancer accounted for 0.4%-0.9% of abdominal surgery, average was 0.7%. (2) The incidence of gallbladder cancer was higher in the aged females, the ration of female to male was 1.0 to 2.1. The average age of gallbladder cancer was (64 ± 11) years. The occupation of patients was mainly farmers (χ² = 147.10, P < 0.01). (3) 57.2% of the gallbladder cancers were associated with gallstones. (4) The main pathological patterns of gallbladder cancer were moderate and poor differentiated adenocarcinoma, showing an aggressive malignancy. TNM stage IV accounted for 55.1% of all cases, which was associated with the poor prognosis. (5) The curative resection rate was 30.4%.

CONCLUSIONSGallbladder cancer is common in the aged females and mainly at advanced stage. The screening and follow-up of high-risk groups with ultrasound and other methods regularly could increase the early diagnosis rate of gallbladder cancer, aggressive surgical resection combined with other comprehensive treatment could improve the prognosis of patients.

Adenocarcinoma ; epidemiology ; pathology ; Aged ; China ; epidemiology ; Female ; Gallbladder Neoplasms ; epidemiology ; pathology ; Gallstones ; epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

Objective To investigate the clinical characteristics, diagnosis and treatment of primary splenic tumors.Methods The clinical data of 47 patients with spleen tumors treated in the First Affiliated Hospital of Medical College, Xi'an Jiaotong University from January 2008 to October 2014 were retrospectively analyzed.Results 28 patients had no symptoms and only on physical examination was a mass found in some patients.There were 12 patients who manifested with upper abdominal discomfort or pain, 2 patients with an epigastric mass, l patient manifested with fever and 2 patients manifested with nausea and vomiting.Preoperative examination showed anemia in 7 patients.Three patients manifested with hypersplenism.Preoperative ultrasonic examination was performed on 39 patients with a diagnostic rate of 89.7％.43 patients underwent CT examination which had a diagnostic rate of 90.7％, MRI was performed in 4 patients and the diagnoses were all correct.Of the 47 patients with splenic tumor, 38 patients had a benign tumor.34 patients were treated by surgery, including 22 patients who underwent open splenectomy, 9 patients laparoscopic splenectomy, 3 patients laparoscopic fenestration of splenic cyst.Malignant tumors were found in 9 patients.Four patients underwent splenectomy, 2 patients were treated by laparoscopic splenectomy.Preoperative examination and postoperative pathological examination showed a benign tumor in 38 patients, including 1 1 patients with a splenic cyst, 6 patients with a cavernous hemangioma, 5 patients with an inflammatory pseudo tumor of spleen (accounting for 57.3％ of all the benign tumor).Malignant tumors included 5 patients with malignant lymphoma, 1 patient with splenic angiosarcoma, 1 patient with gastric carcinoma which metastasizes to the spleen, 1 patient with cervical carcinoma metastasizing to the spleen and 1 patient with liver carcinoma metastasizing to the spleen.Adjuvant chemotherapy and (or) radiotherapy after surgery were performed for patients with malignant lymphoma of the spleen.For 2 patients who were diagnosed early, surgery combined with radiotherapy or chemotherapy and immunotherapy were alive for more than 18 months.Conclusions The clinical manifestations of splenic tumors lack specificity.The diagnosis mainly depends on ultrasonic examination, CT and MRI.Early diagnosis, radical operation and comprehensive treatment are important to improve the prognosis of patients with malignant tumors of the spleen.

Objective To investigate the relationship between the apolipoprotein B (ApoB) gene Xba Ⅰ and EcoR Ⅰ polymorphisms and cholelithiasis in Han and Mongolian population in the Midwest Area of Inner Mongolia.Methods The clinical data of 100 patients with cholelithiasis and 115 healthy individuals at the First Affiliated Hospital of Medical College of Baotou from April to October in 2010 were collected.A case-control study which detected ApoB alleles of patients with cholelithiasis (cholelithiasis group) and healthy individuals (control group) in Han nationality and Mongolian nationality in the Midwest Area of Inner Mongolia was conducted by polymerase chain reaction-restriction fragment length polymorphism,which included Xba Ⅰ (X + X +,X + X-,X-X-,X +,X-) and EcoR Ⅰ (E + E +,E-E-,E + E-,E +,E-).The serum lipid (including triglyceride,total cholesterol,high density lipoprotein and low density lipoprotein) levels in different groups were detected.The count data and the measurement data were analyzed using the chi-square test and t test,respectively.Results Genotype X + X + was not found in the Han and Mongolian population,and Xba Ⅰ (X +) or EcoR Ⅰ (E-) alleles was not found in the Mongolian population.The levels of low density lipoprotein were (2.8 ± 0.9)mmol/L in the cholelithiasis group,which was significantly higher than (1.9 ± 0.8) mmol/L of the control group in the Han population (t =2.800,P ＜ 0.05).The levels of high density lipoprotein and low density lipoprotein were (1.7 ± 0.3) mmol/L and (3.5 ± 0.8) mmol/L of the cholelithiasis group,which were significantly higher than (1.2 ± 0.3) mmol/L and (2.8 ± 0.9) mmol/L of the control group in the Mongolian population (t =7.596,2.549,P ＜ 0.05).The levels of triglyceride,total cholesterol,high density lipoprotein and low density lipoprotein of the cholelithiasis group in the Mongolian population were (3.1 ± 1.6) mmol/L,(5.6 ± 1.0) mmol/L,(1.7 ± 0.3) mmol/L and (3.5 ± 0.8) mmol/L,which were significantly higher than (1.2 ± 0.6) mmol/L,(4.4 ± 1.2) mmol/L,(1.3 ± 0.3) mmol/L and (2.8 ± 0.9) mmol/L of the cholelithiasis group in the Han population (t =5.501,3.667,4.448,3.430,P ＜ 0.05).The levels of triglyceride,total cholesterol,low density lipoprotein were (2.6 ± 1.7) mmol/L,(5.1 ± 1.1) mmol/L and (2.8 ± 0.9) mmol/L of the control group in the Mongolian population,which were significantly higher than (1.3 ±0.7)mmol/L,(3.9 ±0.9) mmol/L and (1.9 ±0.8) mmol/L of the control group in the Han population (t =4.298,4.772,3.888,P ＜ 0.05),while the level of high density lipoprotein was significantly higher of the control group in the Han nationality than the control group in the Mongolian population (t =1.997,P ＜ 0.05).The levels of low density lipoprotein in patients with genotypes X + X-,X-X-of the cholelithiasis group in the Han population were (2.7 ± 0.1) mmol/L and (2.6 ± 1.0) mmol/L,and the levels of low density lipoprotein in patients with genoeypes E + E ±,E + E-/E-E-were (2.6 ± 1.0) mmol/L and (2.5±0.4)mmol/L,with no significant difference (t=0.225,0.124,P＞0.05).Conclusion In the Midwest area of Inner Mongolia,the Mongolian population might be more susceptible to cholelithiasis than the Han population.No relationship between the rare alleles X +,E-and the increase of blood lipids,which indicates that X + and E-of ApoB may not be a risk factor of cholelithiasis.

Objective To evaluate the value of urinary normal and modified nucleosides in the diagnosis of primary gallbladder carcinoma.Methods Between March 2011 to September 2012,28 patients with primary carcinoma of the gallbladder (PCG) were included in this study.Spontaneous urine samples were collected and 10 kinds of urinary nucleosides in the sample were determined by reversed-phase high performance liquid chromatography method.Another 62 patients with benign gallbladder disease and 70 healthy volunteers were enrolled as controls.Routine clinical tumor markers,including serum CA19-9 and CA125 levels of the PCG patients were also evaluated.Results 10 kinds of nucleoside had a good linear correlation (r＞0.99),and the recovery rate was between 87.4％ ～121.5％ range,and the accuracy rate was between 87.7％ ～121.3％,and the RSD of precision was between 1.5％～10.5％ range.In addition to adenosine and cytidine,the mean levels of the rest of the urinary nucleosides in the PCG group were much higher than those of the controls (P＜0.01).Based on principal component analysis,89.3％ of the PCG patients were correctly identified,which was much higher than those detected by CA19-9 (60.7％) and CA125 (67.9％) (P＜0.01).Conclusion Urinary nucleosides may become additional tumor markers which when combined with other clinical methods may help in the screening and early diagnosis of primary gallbladder cancer.

Objective To investigate the expressions of indoleamine 2,3-dioxygenase (IDO) and transcription factor forkhead box P3(FOXP3)in gallbladder adenocarcinoma; and to evaluate the relationship between the expressions of IDO and FOXP3 protein,and clinicopathology and lymph node metastasis of gallbladder carcinoma.Methods The expressions of IDO and FOXP3 in 51 cases of primary gallbladder cancer,90 cases of chronic cholecystitis,and 20 cases of normal gallbladder tissues were studied by immunohistochemical staining. Results The positive expression rates of IDO and FOXP3 in gallbladder carcinoma were 72.5％ (37/51) and 60.8％ (31/51),in normal gallbladder mucosa were 5％ (1/20) and 20.0％ (4/20),in cholecystitis and gallstone were 11.1％ (10/90) and 32.2％ (29/90),respectively.There were significant differences among the three groups in IDO and FOXP3 expressions (P＜0.01).The positive expression rates of IDO and FOXP3 were 7.1％ and 14.3％ for simple hyperplasia,17.7％ and 35.3％ for atypical hyperplasia,40％ and 35％ for gallbladder carcinoma (stages Ⅰ-Ⅲ),and 77.4％ and 64.5％ for gallbladder carcinoma (stages Ⅳ-Ⅴ ).There were significant differences among the four groups in IDO and FOXP3 expressions (P＜0.01).There were significant differences among the Nevin stage groups,lymph node metastasis group and gallbladder stone in IDO and FOXP3 expressions.However,there were no significant differences among the sex groups and the age groups in IDO and FOXP3 expressions (P＞0.05).In gallbladder carcinoma,the expression of IDO had a positive correlation with FOXP3 expression in lymphocyte (γ=0.406,P=0.003).Conclusion In gallbladder cancer,a high-expression of IDO and an expression of FOXP3 in lymphocyte are closely related with immune tolerance of gallbladder carcinoma.The results provide a reference for clinical use of immunotherapy in gallbladder cancer.

To discuss the status quo of gallbladder cancer in China,88 articles published in China were collected and the clinical data of 7882 patients who were suffering from gallbladder cancer was analyzed.The requirements for the literature were:domestic articles published from 1980.1 to 2008.6,the gallbladder cancer cases must exceed 50,the cases must come from the same domestic hospital,and if the cases were reduplicative,the maximum were selected.Analysis of the data showed that primary carcinoma of the gallbladder was the most common malignant tumor in the biliary tract,with a higher incidence in females than males.The cancer's pathologic characteristics of undiscoverable growth and poor differentiation led to its clinical significance of difficult early stage diagnosis,high degree of malignancy,poor prognosis,and adenocarcinoma formation.Although the technique of surgical operation has constantly progressed over time,gallbladder cancer surgery possesses a lower rate of radical resection.Every biliary surgeon should brainstorm and deliberate about how to face the status quo of gallbladder cancer in China.This article participates in that discussion by identifying several noticeable problems in the diagnosis and treatment of gallbladder cancer.

Gastrointestinal cancer is the most prevalent cancer among malignant tumors,with a upward trend in incidence.Since there is absence of specific clinical manifestation as well as low diagnostic rate,patients diagnosed with cancer of digestive tract are mostly in intermediate or advanced stages.Therefore,they lose the best chance of surgery and have a poor prognosis. Metabonomics,a kind of high sensitivity research technology,shows great potential in the exploration of occurrence and development of malignant tumor.The aim of this study was to review the progress of application in gastrointestinal cancer by metabonomics.

Objective To investigate the mechanism on JAK/STAT1 signal pathway in SAHA down-regulation of indoleamine 2,3-dioxygenase (IDO) in gallbladder carcinoma cells.MethodsWe treated gallbladder carcinoma SGC-996 cells with IFN-γ and SAHA.Western blotting was used to detect the expression of IDO,signal transducer and activator of transcription 1 (STAT1) phosphorylation and interferon regulatory factor genes-1 (IRF-1).Confocal microscopy analysis was used to detect STAT1 translocation.Transient transfections and reporter genes assay was used in detecting the activation of γ-activated sites (GAS) and interferon stimulated response elements (ISRE).ResultsIDO expressed in SGC-996 cells in dose- and time-dependent manners when stimulated with IFN-γ.SAHA down-regulated the expression of IDO induced by IFN-γ in a dose-dependent manner.SAHA blocked the expression of IRF-1 induced by IFN-γ.SAHA inhibited the IFN-γ-induced STAT1 phosphorylation and nuclear translocation.SAHA down-regulated IFN-γ-induced activation of GAS and ISRE.ConclusionsSAHA may down-regulate IDO expression through inhibiting the activation of members in JAK/STAT1 signal pathway.This may provide a new immunotherapeutic strategy to break tumor immune tolerance in gallbladder carcinoma.