Objective:To analyse the clinical characteristics of mercury-toxic nephrotic syndrome and to find the risk factors.Methods:A total of 126 patients with mercury-toxic admitted to Beijing Chaoyang Hospital from January 2017 to January 2020 were selected as the research objectives. General data such as age, gender, mercury exposure history of all patients and laboratory data such as urine mercury and urine creatinine were collected. The clinical manifestations and pathological types of patients with mercury-toxic nephrotic syndrome were analyzed, and the risk factors of mercury-toxic nephrotic syndrome were found by univariate and multivariate logistic regression analysis.Results:Among the 24 patients with mercury-toxic nephrotic syndrome, 1 was poisoned by respiratory tract, 6 were poisoned by digestive tract, and 17 were poisoned by skin absorption. In addition to the manifestations of kidney injury, some of the patients also showed neurological symptoms such as dizziness, fatigue, hand tremor, and limb pain. The main pathological types were membranous nephropathy (9 cases) and micropathological nephropathy (10 cases) . The results of multivariate logistic regression analysis showed that the digestive tract and skin absorption pathways of mercury were risk factors for mercury-toxic nephrotic syndrome ( OR=21.099, 23.840, P<0.05) . Conclusion:The absorption pathway of mercury has an important influence on the pathogenesis of mercury-toxic nephrotic syndrome, especially in patients with mercury poisoning absorbed by the skin and digestive tract, the risk of complicating nephrotic syndrome is higher.

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare and enhanced CT or MRI can be used for its diagnosis. Surgical procedure is the main treatment for HCC with BDTT. The authors introduce the experiences of recurrent patient with HCC and BDTT who was treated with targeted therapy plus immunotherapy, in order to provide reference for its clinical diagnosis and treatment.

【Objective】 To investigate the expression of pyruvate kinase M2 (PKM2) in intrahepatic cholangiocarcinoma (ICC) and the effect of PKM2 on the proliferation and epithelial-to-mesenchymal transition (EMT) of ICC cells. 【Methods】 PKM2 expression was evaluated in ICC tissues and cell lines by Real-time quantitative reverse-transcription polymerase chain reaction (RT-PCR), and immunohistochemistry assays. In vitro, we knocked down PKM2 expression in ICC cell lines and investigated the biological function and the underlying mechanism of PKM2 in ICC. 【Results】 RT-PCR results showed that PKM2 was highly expressed in ICC (P<0.05). Moreover, PKM2 knockdown inhibited cell proliferation and the invasive capacities of ICC cells, and inhibited Wnt/ β-Catenin signaling, which subsequently regulated EMT signaling pathway in vitro. 【Conclusion】 PKM2 expression in cholangiocarcinoma is significantly higher than that in adjacent tissues. PKM2 can regulate EMT and invasion and metastasis of ICC via the Wnt/β-Catenin signal.

Objective:To analyse the clinical characteristics of mercury-toxic nephrotic syndrome and to find the risk factors.Methods:A total of 126 patients with mercury-toxic admitted to Beijing Chaoyang Hospital from January 2017 to January 2020 were selected as the research objectives. General data such as age, gender, mercury exposure history of all patients and laboratory data such as urine mercury and urine creatinine were collected. The clinical manifestations and pathological types of patients with mercury-toxic nephrotic syndrome were analyzed, and the risk factors of mercury-toxic nephrotic syndrome were found by univariate and multivariate logistic regression analysis.Results:Among the 24 patients with mercury-toxic nephrotic syndrome, 1 was poisoned by respiratory tract, 6 were poisoned by digestive tract, and 17 were poisoned by skin absorption. In addition to the manifestations of kidney injury, some of the patients also showed neurological symptoms such as dizziness, fatigue, hand tremor, and limb pain. The main pathological types were membranous nephropathy (9 cases) and micropathological nephropathy (10 cases) . The results of multivariate logistic regression analysis showed that the digestive tract and skin absorption pathways of mercury were risk factors for mercury-toxic nephrotic syndrome ( OR=21.099, 23.840, P<0.05) . Conclusion:The absorption pathway of mercury has an important influence on the pathogenesis of mercury-toxic nephrotic syndrome, especially in patients with mercury poisoning absorbed by the skin and digestive tract, the risk of complicating nephrotic syndrome is higher.

Objective:To examine the role of the number of lymph nodes examined(NLNE) on the prognosis of patients with curatively resected gallbladder carcinoma(GBC).Methods:The clinicopathological data and prognosis of 401 patients with GBC who underwent radical surgery from six institutions of China from January 2013 to December 2017 were analyzed retrospectively. There were 153 males(38.2%) and 248 females(61.8%), with age of (62.0±10.5) years (range: 30-88 years). Fifty-three patients(22.2%) were accompanied by jaundice. All patients underwent radical resection+regional lymphadenectomy.R0 or R1 resection was confirmed by postoperative pathological examination.The different cut-off values of NLNE were determined by the X-tile software, the optimal cut-off values were identified by analyzing the relationship between different cut-off values of NLNE with survival rate. Kaplan-Meier method was used for survival analysis. Univariate and multivariate analysis were implemented respectively using the Log-rank test and Cox proportional hazard model.Results:Among the 401 patients enrolled, 135 cases (33.6%) had lymphatic metastasis, of which 98 cases were in N1 stage(24.4%) and 37 cases were in N2 stage(9.2%).A total of 2 794 NLNE were retrieved, with a median count of 6 (5).The median positive lymph nodes count was 0 (1), and the median positive lymph nodes ratio was 0 (IQR, 0-0.2). Since the 12 and 15 were determined as the cut-off values by X-tile, all patients were divided into three groups of 1-11, 12-15 and ≥16.The 3-year survival rate of the three groups was 45.2%, 74.5%, 12.0% respectively, with statistically significant difference between three groups (χ 2=10.94, P<0.01). The results of multivariate analysis showed that NLNE was an independent prognostic factor for overall survival ( P<0.05). Further analysis was performed specifically for subgroup of T stages. For T1b patients, the prognosis of the NLNE with 1-7 group was significantly better than that of the ≥8 group(χ 2=4.610, P<0.05). For T2 patients, the prognosis of the TLNE ≥7 group was significantly better than that of 1 -6 group (χ 2=4.287, P<0.05). For T3 and T4 patients, the prognosis of the TLNE with 12 - 15 group was significantly better than that of 1 -11 group (χ 2=5.007, P<0.01) and ≥16 group (χ 2=10.158, P<0.01). Conclusions:The NLNE is an independent factor affecting the prognosis of patients with GBC.For patients with stage T1b,8 lymph nodes should be retrieved; for patients with stage T2,extensive dissection of more than 6 lymph nodes can significantly improve the prognosis.For advanced patients (stages T3 and T4), extensive dissection with 12-15 lymph nodes is recommended. However, it fails to get more survival benefits by dissecting more than 16 lymph nodes.

Objective:To examine the role of the number of lymph nodes examined(NLNE) on the prognosis of patients with curatively resected gallbladder carcinoma(GBC).Methods:The clinicopathological data and prognosis of 401 patients with GBC who underwent radical surgery from six institutions of China from January 2013 to December 2017 were analyzed retrospectively. There were 153 males(38.2%) and 248 females(61.8%), with age of (62.0±10.5) years (range: 30-88 years). Fifty-three patients(22.2%) were accompanied by jaundice. All patients underwent radical resection+regional lymphadenectomy.R0 or R1 resection was confirmed by postoperative pathological examination.The different cut-off values of NLNE were determined by the X-tile software, the optimal cut-off values were identified by analyzing the relationship between different cut-off values of NLNE with survival rate. Kaplan-Meier method was used for survival analysis. Univariate and multivariate analysis were implemented respectively using the Log-rank test and Cox proportional hazard model.Results:Among the 401 patients enrolled, 135 cases (33.6%) had lymphatic metastasis, of which 98 cases were in N1 stage(24.4%) and 37 cases were in N2 stage(9.2%).A total of 2 794 NLNE were retrieved, with a median count of 6 (5).The median positive lymph nodes count was 0 (1), and the median positive lymph nodes ratio was 0 (IQR, 0-0.2). Since the 12 and 15 were determined as the cut-off values by X-tile, all patients were divided into three groups of 1-11, 12-15 and ≥16.The 3-year survival rate of the three groups was 45.2%, 74.5%, 12.0% respectively, with statistically significant difference between three groups (χ 2=10.94, P<0.01). The results of multivariate analysis showed that NLNE was an independent prognostic factor for overall survival ( P<0.05). Further analysis was performed specifically for subgroup of T stages. For T1b patients, the prognosis of the NLNE with 1-7 group was significantly better than that of the ≥8 group(χ 2=4.610, P<0.05). For T2 patients, the prognosis of the TLNE ≥7 group was significantly better than that of 1 -6 group (χ 2=4.287, P<0.05). For T3 and T4 patients, the prognosis of the TLNE with 12 - 15 group was significantly better than that of 1 -11 group (χ 2=5.007, P<0.01) and ≥16 group (χ 2=10.158, P<0.01). Conclusions:The NLNE is an independent factor affecting the prognosis of patients with GBC.For patients with stage T1b,8 lymph nodes should be retrieved; for patients with stage T2,extensive dissection of more than 6 lymph nodes can significantly improve the prognosis.For advanced patients (stages T3 and T4), extensive dissection with 12-15 lymph nodes is recommended. However, it fails to get more survival benefits by dissecting more than 16 lymph nodes.

Objective To explore the diagnosis and treatment of Castleman's disease (CD) of the abdomen and pelvis.Methods The clinical data of 51 cases of abdomen and pelvis CD were analyzed retrospectively from Jan 2007 to Oct 2017 in the First Affiliated Hospital of Zhengzhou University.Patients were divided into two groups according to the different clinical classifications:Localized CD (n =42) and Multicentric CD (n =9).Results 32 cases of LCD were asymptomatic (76％),others accompanied by abdominal or waist pain,abdominal distention.The main pathological type was hyaline vascular (93％),which can be cured by surgical treatment (41/42).MCD always accompanied by multiple superficial and deep lymph node enlargement in the whole body.Most of them suffered from anemia,fever,weight loss and dyspnea.CRP increased,hypoproteinemia,globulin increased,neutropenia were found.The main pathological type was plasma cell type (56％).There were no progress in 3 cases,and 6 cases were on remission after operation.Conclusion The diagnosis of abdomen and pelvis CD depends on pathological examination.LCD clinical symptoms are mild and good prognosis after surgery.However,MCD clinical manifestations are complex,and relatively poor prognosis after comprehensive treatment.

Objective To investigate the application value of choledochoscopy and imaging examination in the diagnosis and treatment of residual bile duct stones.Methods The retrospective descriptive study was conducted.The clinical data of 618 patients who underwent choledochoscopy and imaging examination after operation of hepatolithiasis in the First Affiliated Hospital of Zhengzhou University between April 2014 and September 2018 were collected,including 300 males and 318 females,aged from 19 to 89 years,with an average age of (58 ± 12)years.Observation indicators:(1) situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination;(2) stone extraction situations of patients with hepatolithiasis.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage,and analyzed using the chi-square test or Fisher exact propability.Results (1) Situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination:all the 618 patients underwent choledochoscopy,and 505 of them underwent the imaging examination before choledochoscopy.① Of patients undergoing single imaging examination,72 received ultrasonography,with false-negative rate of 29.17％ (21/72);37 received CT examination,with false-negative rate of 10.81％(4/37);33 received T-tube cholangiography,with false-negative rate of 39.39％ (13/33).② Of patients undergoing combined two imaging examinations,61 received ultrasonography + CT,with false-negative rate of 8.20％ (5/61);129 received ultrasonography + T-tube cholangiography,with false-negative rate of 12.40％ (16/129);52 received CT + T-tube cholangiography,with false-negative rate of 5.77％(3/52).③ There were 121 receiving ultrasound+CT+T-tube cholangiography,with false-negative rate of 7.44％ (9/121).There were statistically significant differences in the false-negative rates of combined two or three examinations of ultrasound + CT+ T-tube cholangiography and single imaging examination (x2=40.83,P＜0.05).The further analysis showed a statistically significant difference among the single imaging examination (x2=7.70,P＜0.05).There was no statistically significant difference among the combined two of imaging examinations (x2=2.10,P＞0.05).There were statistically significant differences in the combined three examinations of ultrasound +CT+T-tube cholangiography and ultrasound and T-tube cholangiography examination respectively (x2=16.23,21.62,P＜0.05).There was no statistically significant difference in the combined three of imaging examinations and CT examination and combination of CT+T-tube cholangiography respectively (P＞ 0.05).There was no statistically significant difference in the combined three of imaging examinations and combination of ultrasound+CT examinations and combination of ultrasound+T-tube cholangiography (x2=0.33,1.71,P＞0.05).Seventy-one patients without residual bile duct stone by preoperative imaging examination were detected residual bile duct stones by intraoperative choledochoscopy,and residual bile duct stones of 36,31 and 4 patients are respectively distributed around the distal common bile duct,small intrahepatic bile duct,left and right hepatic ducts,common hepatic duct and remaining common bile duct.(2) Stone extraction situations of patients with hepatolithiasis:of 618 patients,cases with 1,2,3,4,5,6,7,8,9 and 10 times of residual bile duct stones clearance were respectively 392,116,48,39,9,6,3,2,2 and 1.Residual bile duct stones clearance frequency of patients was an average of 1.73 times.There were 63.43％(392/618) and 96.28％(595/618) of patients had stone clearance with once and ≤ 4 times of stone extraction,respectively.Conclusion The negative results of preoperative imaging examinations cannot be as standards of bile duct stone clearance before choledochoscopy,and the best choice is to detect whether there are residual bile duct stones and remove the stones combined with choledochoscopy.

Objectives: To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer. Methods: The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test. Results: Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05). Conclusion With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.

Objective To evaluate the effect of aminolevulinic acid-based photodynamic therapy (ALA-PDT) on the expression of Toll-like receptor 2 (TLR2) and downstream signaling pathway molecules,and secretion of cytokines in murine RAW264.7 cells.Methods The RAW264.7 murine macrophages were induced by inactivated Propionibacterium acnes suspension for the establishment of a cell model of inflammation.The cultured RAW264.7 cells were divided into 5 groups:blank control group receiving normal culture followed by the treatment with phosphate buffer saline (PBS),model group treated with inactivated Propionibacterium acnes suspension followed by the treatment with PBS,and three ALA groups treated with inactivated Propionibacterium acnes suspension followed by the treatment with 0.03,0.06 and 0.12 mmol/L ALA,respectively,and infrared radiation at a dose of 16 J/cm2.Enzyme-linked immunosorbent assay (ELISA) was performed to detect levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the culture supematant of RAW264.7 cells,and Western blot analysis to determine the protein expression of TLR2 and myeloid differentiation factor 88 (MyD88),as well as p38,c-Jun N-terminal kinase (JNK),extracellular signal-regulated kinase (ERK),inhibitor of κB kinase α (IκBα) and their phosphorylated forms (p-p38,p-JNK,p-ERK and p-IκBα).Results Compared with the blank control group,the model group showed significantly higher levels of TNF-α ([0.34 ± 0.02] ng/L,P ＜ 0.01) and IL-6 ([0.21 ± 0.03] ng/L,P ＜ 0.05).Compared with the 0.03 mmol/L ALA group,the 0.12 mmol/L ALA group showed a similar level of TNF-α ([0.03 ± 0.01] ng/L,P ＞ 0.05),but a significantly lower level of IL-6 ([0.07 ± 0.01] ng/L,F =114.813,P ＜ 0.01).The protein expression of TLR2,MyD88,p-p38,p-IκBα,p-JNK and p-ERK was all significantly higher in the model group (0.90 ± 0.14,1.11 ± 0.13,0.84 ± 0.04,1.45 ± 0.20,2.56 ± 0.06,3.70 ± 0.40) than in the blank control group (all P ＜ 0.01),and gradually decreased along with the increase of ALA concentration in a dose-dependent manner.Conclusion Photodynamic therapy can suppress the expression of TLR2 in RAW264.7 murine macrophages,and decrease the secretion of cytokines likely by the TLR2 signaling pathway.