Objective:To study and compare the impact of lymph node metastasis and dissection on the prognosis of intrahepatic cholangiocarcinoma (ICC) patients at different anatomical locations, as well as the effect on prognosis.Methods:A retrospective analysis was conducted on the clinical data of 150 ICC patients who underwent radical surgical resection at the 904th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from September 2017 to September 2020. Among them, 86 were males and 64 were females, with the age of (56.2±12.9) years. Differences in albumin-bilirubin (ALBI) grade, preoperative lymph node metastasis risk, number of lymph nodes dissected, lymph node metastasis, and postoperative survival between peripheral and central ICC patients were compared to analyze the impact of lymph node dissection on the prognosis of ICC patients at different locations.Results:There were statistically significant differences in ALBI grade, preoperative lymph node metastasis risk, the number of lymph nodes dissected, and lymph node metastasis between 98 cases of peripheral ICC and 52 cases of central ICC (all P<0.05). The 3-year overall survival rates for peripheral and central ICC patients were 30.6% and 15.4%, respectively, with a statistically significant difference ( χ2=8.46, P=0.004). Among central ICC patients, the 3-year overall survival rates for those with ≥6 lymph nodes dissected and <6 lymph nodes dissected were 16.7% and 12.5%, respectively, with a statistically significant difference ( χ2=3.96, P=0.046). In the high-risk central ICC patients with preoperative lymph node metastasis, the 3-year overall survival rate of ≥6 lymph nodes dissection ( n=22) and <6 lymph nodes dissection ( n=12) were 13.6% and 8.3%, respectively, with statistical significance ( χ2=5.55, P=0.019). Conclusions:The prognosis of peripheral ICC patients is better than that of central ICC patients. For central ICC patients with a high preoperative lymph node metastasis risk, adequate lymph node dissection can lead to a better prognosis.

Objective:To investigate the expression and clinical significance of Golgi phosphoprotein 3 (GOLPH3) and NOD-like receptor protein 3 (NLRP3) in gallbladder carcinoma (GBC).Methods:Surgical specimens and clinical data were collected from 63 patients with GBC who underwent radical cholecystectomy in the 904th Hospital of Joint Logistic Support Force of PLA from January 2014 to January 2019. In the GBC group, there were 21 males and 42 females, with an average age of 62.5 years. For 30 patients with mild to moderate atypical hyperplasia of gallbladder during the same period were included in the precancerous lesion group, including 9 males and 21 females, with an average age of 62.4 years. Normal gallbladder specimens from 20 patients who underwent surgical resection due to liver trauma or giant hepatic hemangioma were collected and included in the normal group, including 7 males and 13 females, with an average age of 61.9 years. The expressions of GOLPH3, NLRP3, Ki-67 were detected by immunohistochemistry. Log-rank test and Cox regression were adopted to analyze the GOLPH3 and NLRP3 expression and survival prognosis of gallbladder cancer patients.Results:Expression of GOLPH3 and NLRP3 in the tumor group, precancerous lesion group and normal group was decreased separately. In GBC tissues, the level of GOLPH3 and NLRP3 was positively correlated with the Ki-67 expression ( r=0.972 and r=0.969, both P<0.05). Multivariate analysis showed that high level of GOLPH3 ( HR=4.891, 95% CI: 1.776-13.470) and NLRP3 ( HR=3.006, 95% CI: 1.273-7.099) was an independent risk factor for predicting the postoperative survival of patients with GBC (both P<0.05). Conclusion:GOLPH3 and NLRP3 are highly expressed in GBC tissues, and high expression of GOLPH3 and NLRP3 is an independent risk factor for postoperative survival in patients with GBC.

OBJECTIVES: To investigate the effect of adriamycin (ADM), idelalisib or ADM and their combination on cell proliferation and intracellular concentration of ADM, and to explore the reversal effect of idelalisib on drug resistance to ADM. METHODS: The K562 and K562/ADM cells were respectively treated with ADM and idelalisib at different concentrations. The 50% inhibitory concentration (IC RESULTS: The cell survival rates were significantly decreased in a dose-dependent manner when the cells were treated with different doses of ADM (0.001-10.000 mg/L ). The IC CONCLUSIONS Idelalisib exerts effect on inhibition of the proliferation in myeloid leukemia K562 and K562/ADM cells, which may partially reverse the drug resistance of K562/ADM cells to ADM. The mechanisms for the effect of idelalisib may be related to increasing the accumulation of ADM and inducing the cell apoptosis in the K562 and K562/ADM cells.
ATP Binding Cassette Transporter, Subfamily B, Member 1 ; Cell Proliferation ; Doxorubicin/pharmacology* ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Humans ; K562 Cells ; Leukemia, Myeloid ; Purines ; Quinazolinones

Objective:To explore the prognostic factors of patients with gallbladder cancer in different anatomical locations.Methods:A retrospective analysis of the clinical data of 140 patients with gallbladder cancer who were surgically treated in the 904 Hospital of the Joint Logistics Support Force from January 2015 to December 2015. Among them, 49 were males and 91 were females, with a median age of 64.0 years. According to the location of gallbladder cancer, they were divided into the neck of the gallbladder and the bottom of the gallbladder. The clinical data of the two groups were compared. The Kaplan-Meier method was used for univariate analysis, and Cox multivariate regression analysis was used to analyze the significant factors of univariate survival to determine the independent risk factors that affect the prognosis of patients with gallbladder cancer. Use Pearson correlation to analyze the correlation between clinicopathological characteristics.Results:Patients in the neck of the gallbladder group had higher levels of preoperative total bilirubin, preoperative albumin, carcinoembryonic antigen, carbohydrate antigen 19-9, extrahepatic bile duct resection (biliary-enteric anastomosis), radical resection, breakthrough of the liver/serous membrane invasion, lymph node metastasis, TNM staging, local recurrence in the operation area in the surgical area were statistically significant ( P<0.05). Univariate analysis suggested that preoperative jaundice, Glasgow prognostic score (GPS), C-reactive protein, carcinoembryonic antigen, carbohydrate antigen 19-9, accidental gallbladder cancer, surgical method, tumor pathological type, tumor differentiation degree, tumor growth location (neck than the bottom of the body) are related to the prognosis (all P<0.05). Cox regression analysis indicated that GPS ( RR=3.272, 95 CI: 1.987-5.388), surgical method ( RR=4.149, 95 CI: 2.561-6.723), tumor location ( RR=0.316, 95 CI: 0.209-0.478), distant metastasis ( RR=1.695, 95 CI: 1.036-2.775) and TNM staging ( RR=3.686, 95 CI: 2.222-6.115) are independent risk factors affecting the prognosis of gallbladder cancer. Correlation analysis suggests that neck tumors are related to later staging, liver bile duct invasion, lymph node metastasis, high inflammation levels, and low radical cure rates. Conclusions:Gallbladder cancer that occurs in the neck of the gallbladder is an independent factor influencing the poor prognosis of patients with surgical treatment. In addition, TNM staging, distant metastasis and Glasgow score are important predictors of survival in patients with gallbladder cancer.

Objective To investigate the expressions and the significance among the three markers TGF β1,Survivin and Caspase-3 in intrahepatic bile duct tissues in patients with intrahepatic bile duct stones.Method Total of 130 paraffin section of intrahepatic bile duct tissue were collected at Department of Pathology,The 904th Hospital of Joint Logistic Support Force of PLA from 2013 to 2018.Total of 50 patients with intrahepatic bile duct stones complicated with bile duct strictures (the stenosis group),40 patients with intrahepatic bile duct stones with chronic inflammation (the inflammation group),and 40 patients with normal liver tissues (the normal control group) were included in this study.The expressions of TGF β1,Survivin and Caspase-3 in liver tissues were detected by immunohistochemistry and compared among the 3 groups to find their correlations with the clinicopathological features of the disease of the patients.Results TGF β1 was expressed in 72.0％ of the patients in the stenosis group,37.5％ in the inflammatory group,and 15.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05);Survivin was expressed in 78.0％ of the patients in the stenosis group,47.5％ in the inflammatory group,and 25.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05);Caspase-3 was expressed in 10.0％ of the patients in the stenosis group,42.5％ in the inflammatory group,and 75.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05).Within the stenosis group,TGF β1 was negatively correlated with Caspase-3 (r =-0.882,P ＜ 0.05),and positively correlated with Survivin (r =0.889,P ＜ 0.05).Survivin and Caspase-3 were also negatively correlated (r=-0.923,P＜0.05).Conclusion Abnormal expressions of TGF β1,Survivin and Caspase-3 were involved in the formation of intrahepatic bile duct stones associated with bile duct strictures.

Hepatolithiasis is a very common hepatobiliary disease in Asia. Recurrent hepatolithiasis frequently lead to incidence of intrahepatic cholangiocarcinoma. The associated intrahepatic cholangiocarci-noma is generally hidden and often covered up by the related clinical symptoms caused by stones, which can easily lead to missed the best time of diagnosisand treatment. This paper mainly showed the diseases of intra-hepatic cholangiocarcinoma associated with intrahepatic cholelithiasis, and expounded the changes of local microenvironment of bile duct tissue from intrahepatic cholelithiasis to intrahepatic cholangiocarcinoma. The purpose of this study is to look for the risk factors related to the development of intrahepatic cholelithiasis to intrahepatic cholangiocarcinoma and to provide a new research direction for the clinical treatment of intrahe-patic cholangiocarcinoma.

Objective To evaluate the effect of debridement hepatectomy with selective hepatopetal blood occlusion in the treatment of severe hepatic trauma.Methods The clinical data of 55 patients with severe hepatic trauma treated by debridement hepatectomy with selective hepatopetal blood occlusion were retrospectively analyzed.20,20 and 15 patients were with grade Ⅲ,Ⅳ and Ⅴ hepatic trauma respectively,combined with major peripheral hepatic vascular injury in 14 cases and with other trauma in 35 cases.Additional procedures including liver suture repair in 7 cases,perihepatic gauze packing in 3 cases,inferior vena cava repair in 5 cases,hepatic vein repair in 4 cases,hepatic vein ligation in 3 cases and hepatic artery ligation in 2 cases were performed.Other operations such as craniotomy debridement in 3 cases,cholecystectomy in 6 cases,T tube drainage of common bile duct in 4 cases,splenectomy in 5 cases,pancreatic tail resection in 2 cases,left kidney resection in 1 case,thoracic cavity closed drainage in 9 cases,partial small bowel resection or repair in 4 cases and stomach repair in 1 case were performed as needed.Results The operations were successful in 47 patients.Postoperative complications were observed in 19 cases (34.5％) including coagulation disorders in 1 case,postoperative abdominal bleeding in 2 cases,intestinal obstruction in 1 case,liver and renal dysfunction in 4 cases,abdominal infection in 3 cases,incision infection in 2 cases,pulmonary infection in 4 cases,pleural effuion in 10 cases.Death occurred in 8 patients (14.5％),the cause of death were hemorrhagic shock in 3 cases,combined with severe craniocerebral injury in 2 cases,septic shock in one case,and multiple organ failure in 2 cases.Conclusions Debridement hepatectomy with slective hepatopetal blood occlusion is an effective treatment for severe hepatic trauma.

Objective To study the results of laparoscopic approach in the treatment ot gallbladder and common bile duct stones.Method The authors reviewed data of 60 patients with gallbladder and bile duct stones treated laparoscopically.Results All the 60 patients treated with laparoscopic cholecystectomy and laparoscopic transcystic common bile duct exploration (LcTDE) were successful.There were 1 bile duct stone in 32 patients,and 2 to 6 bile duct stones in 28 patients.The operation time was (38.7±15.1) min and the hospitalization time was (5.5±2.1) days.One patient developed biliary fistula postoperatively which healed after 7 days of conservative treatment.One patient had bile duct residual stone which was treated by ERCP.The remaining patients were well.Conclusion Laparoscopic transcystic common bile duct exploration using a mini incision and primary suturing of the bile duct was simple,safe and efficacious.

Objective To evaluate the efficacy of surgical repair for non-circumferential defect of bile duct in Mirizzi syndrome.Method The clinical data of 32 patients with Mirizzi syndrome with non-circumferential defect of bile duct were repaired using the patient's own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap.Results All the patients were operated success fully.There was no operative mortality.The defects in the bile duct were repaired using gallbladder pedicle flap in 25 patients,umbilical venous flap in 5 patients and omental flap in 2 patients.There were 2 patients who developed postoperative complications.There was one postoperative bile leakage in a patient who was repaired using an umbilical venous flap.The other complication was residual bile duct stones.The patient with postoperative bile leakage was drained through a drainage tube which was removed after 7 days.The residual bile duct stones were removed by endoscopy through a T-tube sinus after 9 months.All patients were confirmed by T-tube cholangiography after 9 to 12 months to have no stones,bile duct stenosis or any other abnormalities.The T-tube was then removed.All patients were followed -up for 1 to 5 years.All patients had no cholangitis,abdominal pain,jaundice or fever.Conclusions Using the patients' own tissues such as gallbladder pedicle flap,umbilical venous flap and omental flap to surgical repair the defect in the bile duct of patients with Mirizzi syndrome was effective.This surgical treatment is a good choice.

Objective To evaluate the anatomical basis of retrohepatic tunnel used for liver hanging maneuver.Methods The anatomy of inferior vena cava ( IVC ) was studied in 20 healthy adult cadavers and 15 patients with advanced cirrhosis who underwent piggyback liver transplantation to confirm the existence of the path of retrohepatic tunnel and count the number of short hepatic veins draining into retrohepatic IVC.Results Short hepatic veins mainly drain into the IVC on its left and right sides.The number of short hepatic veins that drain into the upper or middle portion of the IVC was significantly more than that into the lower portion ( x2 =48.524,P ＜ 0.01 ).On the path of retrohepatic tunnel,most short hepatic veins that drain into the IVC are located on the front side ( F =9.188,P ＜ 0.01 ).There was no significant difference in the number of short hepatic vein between the groups of liver cirrhosis and that of healthy adults ( t =0.405,P ＞ 0.05 ),but anatomic variation of post-hepatic tunnel is common in liver cirrhotics.Conclusions Retrohepatic tunnel was a potential space and had a unique anatomical feature.The establishment of retrohepatic tunnel by liver hanging maneuver is safe in noncirrhotics.However,in advanced posthepatitic cirrhosis,retrohepatic tunnel should be used with caution.