Objective:To analyze the causal relationship between lifestyle-based factors and the occurrence and development of hepatobiliary malignancies by Mendelian randomization study method,and to provide the potential clinical evidence for the prevention and treatment of hepatobiliary malignancies.Methods:The data from large-scale,independent genome-wide association studies(GWAS)were selected,and seven-step inclusion criteria for the instrumental variable screening were set up.The exposure lifestyles included the percentage of carbohydrate intake,percentage of fat intake,percentage of protein intake in the diet,coffee intake,weekly alcohol consumption times,leisure electronic screen exposure time,moderate to vigorous intensity physical activity(MVPA)during leisure time,sedentary behavior at work,age at first smoking,daily smoking quantity,current smoking status,and past smoking status,totaling 12 phenotypes.The primary analysis method used was the random effect model of the inverse variance weighted(IVW)method,and the heterogeneity was detected by Cochrane's Q test and the horizontal pleiotropy was detected by MR-Egger intercept method.Results:The current smoking status was significantly positively correlated with the increasing risk of extrahepatic cholangiocarcinoma(OR=1.607,95%CI:1.113-2.322,P=0.011).Higher coffee intake was causally linked to a higher risk of liver cancer and intrahepatic cholangiocarcinoma(OR=1.000,95%CI:0.999-1.000,P=0.012).In the physical activity,more MVPA was associated with the lower risk of liver cancer and intrahepatic cholangiocarcinoma(OR=0.998,95%CI:0.996-0.999,P=0.002).The Cochrane's Q test results showed that there was mild heterogeneity between MVPA and extrahepatic cholangiocarcinoma(Q=18.354,P=0.049)as well as the percentage of protein intake and intraphepatic cholangiocarainoma(Q=12.715,P=0.026),and the MR-Egger intercept method results showed there was no horizontal pleiotropy.Conclusion:There is a causal relationship between current smoking status and extrahepatic cholangiocarcinoma,and there is a causal relationship between more MVPA and the lower risk of liver cancer and intrahepatic cholangiocarcinoma.Education on smoking and physical activity for the patients may offer potential benefits for the prevention of hepatobiliary malignancies.

Objective Port-wine stains are a kind of dermatological disease of congenital capillary malformation.Based on the biological characteristics of port-wine stains and the advantages of microneedle transdermal administration,we intend to construct a nanodrug co-loaded with rapamycin(RPM),an anti-angiogenesis drug,and photochlor(HPPH),a photosensitizer,and integrate the nanodrug with dissolvable microneedles(MN)to achieve anti-angiogenesis and photodynamic combination therapy for port-wine stains.Methods First,RPM and HPPH co-loaded nanoparticles(RPM-HPPH NP)were prepared by the emulsification solvent-volatilization method,and its ability to generate reactive oxygen species(ROS)was investigated under 660 nm laser irradiation.Mouse hemangioendothelioma endothelial cells(EOMA)were used as the subjects of the study.The cellular uptake behaviors were examined by fluorescence microscopy and flow cytometry.The cytotoxicity effects of RPM-HPPH NP with or without 660 nm laser irradiation on EOMA cells were examined by MTT assays(with free RPM serving as the control).Then,hyaluronic acid(HA)dissolvable microneedles loaded with RPM-HPPH NP(RPM-HPPH NP@HA MN)were obtained by compounding the nanodrug with HA dissolvable microneedle system through the molding method.The morphological characteristics and mechanical properties of RPM-HPPH NP@HA MN were investigated by scanning electron microscope and electronic universal testing machine.The penetration ability of RPM-HPPH NP@HA MN on the skin of nude mice was evaluated by trypan blue staining and H&E staining experiment.Results The RPM-HPPH NP prepared in the study had a particle size of 150 nm and generated large amounts of ROS under laser irradiation.At the cellular level,RPM-HPPH NP was taken up by EOMA cells in a time-dependent manner.The cytotoxicity of RPM-HPPH NP was higher than that of free RPM with or without laser irradiation.Under laser irradiation,RPM-HPPH NP exhibited stronger cytotoxic effects and the difference was statistically significant(P＜0.05).The height of the needle tip of RPM-HPPH NP@HA MN was 600 μm and the mechanical property of a single needle was 0.75048 N.Trypan blue staining and HE staining showed that pressing on the microneedles could produce pores on the skin surface and penetration of the stratum corneum.Conclusion RPM-HPPH NP@HA MN can deliver RPM-HPPH NP percutaneously to the lesion tissue and realize the synergistic treatment of port-wine stains with anti-angiogenic therapy and photodynamic therapy,providing a new strategy for the construction of nanodrug-loaded microneedle delivery system and the clinical treatment of port-wine stains.

Objective :To explore the clinical value of serum C reactive protein (CRP) combined with hematocrit (Hct) in prediction of severe acute pancreatitis(SAP) .Methods :Seventy five patients ,who were admitted due to AP during April 2011 and December 2014 ,were enrolled .The levels of CRP and Hct ,which were determined within 24 h after admission ,were compared between the patients with SAP and those with mild acute pancreatitis (MAP) .The diagnostic efficiency of CRP combined with Hct in early prediction of SAP was evaluated by ROC curve .Results : The levels of CRP and Hct in SAP group were significantly higher than those in MAP group (P< 0 .05) .The sensitivities of CRP and Hct in the diagnosis of SAP were 61 .56% and 49 .57% ,respectively . The specificities were 83 .27% and 80 .23% ,respectively . And the positive predictive values were 53 .52% and 40 .35% ,respectively .Furthermore ,the negative predictive values were 90 .37% and 85 .26% , respectively .The sensitivity of CRP combined with Hct in diagnosis of SAP was 51 .23% .The specificity was 94 .29% .And the positive predictive value was 76 .12% . Furthermore , the negative predictive value was 87 .23% . Conclusions : CRP combined with Hct is conducive to early diagnosis of the severity of AP .Thus ,it is worthy of clinical practice .

Objective To investigate the effect of carbon dioxide (CO2) pneumoperitoneum with different duration periods on renal function.Methods Eighty-nine patients undergoing laparoscopic operations from October 2009 to December 2011 were divided into 3 groups according to operative time.The patients whose operative time was less than 1 hour belonged to group T1,between 1 hour and 2 hours belonged to group T2,and more than 2 hours belonged to group T3.The levels of serum creatinine,urinary creatinine,urinary microalbumin were detected at preoperation as well as 10 minutes,1 hour,24 hours after operation.Results There was no significant difference regarding of the endogenous creatinine clearance rate(Ccr) postoperatively between group T1 and T2 (P ＞ 0.05).The Ccr levels at 10 minutes after operation in group T3 was significant lower than at preoperation(P ＜0.05),and increased gradually at 1 h and 24 h after operation.The ratio of urinary microalbumin to urinary creatinine (A/C) increased at post-operation compared with at pre-operation in all 3 groups (P ＜ 0.05),but there was no significant difference between the 3 groups after operation (P ＞ 0.05).The renal function post-operation of patients over 60 years old was as same as that of patients less 60 years old in group T1 (P ＞ 0.05).However,the Ccr level in patients over 60 years old at post-operation was lower than that of patients less 60 years old in group T2 and T3 (P ＜ 0.05).Conclusion Long CO2 pneumoperitoneum could lead to the acute and obvious injury on renal function,especially in the patients over 60 years old.Fortunately,the renal function recovered to be normal gradually in a short time.

Objective To identify the types of pulmonary complications after pancreaticoduodenectomy,and to discuss the prevention and management of these complications.Methods Clinical data of 165 cases of pancreaticoduodenectomy in our hospital were retrospectively analyzed.Pulmonary complications were identified,therapeutic effects were observed.Results The incidence rate of pulmonary complications was 19.4％ ( 32/165),case-fatality rate was 6.25％ (2/32),two patients died from pneumonia,respiratory failure and ARDS.Complications mainly included pneumonia 13.9％ (23/165),pleural effusion 4.2％ (7/165),atelectasis 3.6％ (6/165),pneumothorax 1.8％ ( 3/165 ),respiratory failure 2.4％ (4/165) and ARDS 1.2％ (2/165).Conclusion Pulmonary complications after pancreaticoduodenectomy are not rare,especially for pulmonary infection and most are hospital acquired pneumonia.To understand rules and particularity of respiratory physiopathological changes after pancreaticoduodenectomy is very important for patients to safely pass over the perioperative period.

Purpose:To investigate the pathogenesis,diagnos is and treatment of hashimoto's disease(HD) complicated with papillary thyroid c ancer (PTC ). Methods:Clinical data of 12 cases of HD complicated with PTC un dergoing surgery were analysed retrospectively and followed-up for one half to 8 years. Results:In this series papillary thyroid cancer occurred in 25 % (12/48) in patients with HD, but correct preoperative diagnosis was obtained i n 3 (25%) of 12 cases.All patients had thyroid nodules and received thyroidectom y,3 cases underwent functional cervical clearance of lymph nodes. All patients w ere followed up for 6 months to 8 years and there was no death , no recurrence and no metastasis. Conclusions:HD can develop into PTC .The clinical diagnosis of coexistence of HD and PTC is still difficult. The key to diagnosis and rational treatment includes detailed understanding its clinical features, routine examin ation of serum antibodies and ultrasonography, selected scintigraphic thyroid s can or FNAB and finally quick frozen pathologic section in operation. HD complic ated with PTC should be treated surgically.Intraoperative frozen section diagnos is should be performed routinely so that HD complicated with PTC can be diagnose d.The operation procedure should be individualized.All patients should be given small dosage of thyroxine.