Objective To explore the expression of Twist protein in the colorectal cancer (CRC) and its relationship between clinicopathological factors and prognosis of patients.Methods The clinical data of 45 patients with colorectal cancer who were admitted to the First People's Hospital of Shunde from June 2005 to September 2005 were retrospectively analyzed.The colorectal tissue specimens from surgical resection were collected.The expressions of Twist protein in the cancer and paracarcinoma tissues were examined by the immunohistochemistry,and their relationship with clinicopathological factors and prognosis of patients was analyzed.Patients were followed up by outpatient examination and telephone interview until September 2013.The count data were analyzed using the chi-square test and Fisher exact probability.The survival curve was generated using the Kaplan-Meier method,and the survival analysis was conducted using the Log-rank test.The prognosis factors were analyzed by the COX univariate analysis and multivariate analysis.Results The expression of Twist protein in CRC was predominantly detected in the cytoplasm of the tumor cells.The positive expression rates of Twist protein in the CRC and paracarcinoma tissues were 62.2％ (28/45) and 20.0％ (9/45),respectively,with a significant difference (x2 =18.383,P ＜0.05).The positive expression rates of Twist protein were 42.1％ in patients with Ⅰ-Ⅱ stage of CRC and 76.9％ in patients with Ⅲ-Ⅳ stage of CRC.The positive expression rates of Twist protein were 41.7％in patients with N0 stage of CRC and 85.7％ in patients with N1-N2 stage of CRC.The expression of Twist protein in patients with CRC was however associated with the TNM stage and lymph node metastasis (x2=5.662,9.244,P ＜ 0.05).A total of 45 patients were followed up for 10-96 months (median,54 months).The median survival time and 5-year cumulative survival rate in 45 patients with positive expression of Twist protein were 44 months and 10.7％,which were compared with 69 months and 82.4％ in 45 patients with negative expression of Twist protein,with a statical significance in the survival (x2 =26.147,P ＜ 0.05).The results of univariate analysis showed that the expression of Twist protein was an related factor affecting the prognosis of patients [HR =8.669,95％ confidence interval (CI):2.959-25.390,P ＜0.05].The results of multivariate analysis showed that the positive expression of Twist protein was an independent risk factor affecting the prognosis of patients (HR =5.059,95 ％ CI:2.888-8.863,P ＜ 0.05).Conclusiors The increasing expression of Twist protein in the CRC is positively correlated with the occurrence and development of CRC.The positive expression of Twist protein is an independent risk factor affecting the prognosis of patients with CRC.

Objective To investigate the clinical influence about levetiracetam on cognitive function and emotional influence in the patients with partial epilepsy.Methods A total of 62 patients with partial epilepsy were divided into carbamazepine group (30 cases) and levetiracetam group (32 cases) by random digits table method,carbamazepine group was treated by carbamazepine while levetiracetam group was treated by levetiracetam.The patients were assessed before treatment and 4,8,12,16 weeks after treatment by the Montreal cognitive assessment scale (MoCA),self rating anxiety scale (SAS) and self rating depression scale (SDS).Results There was no significant difference in MoCA score between two groups before treatment and 4 weeks after treatment (P ＞ 0.05).MoCA score at 8,12,16 weeks after treatment in levetiracetam group was better than that in carbamazepine group [(22.6 ± 2.1) scores vs.(20.8 ± 2.6) scores,(23.5±2.7) scoresvs.(21.3± 2.8) scores,(24.6±4.7) scoresvs.(21.2±3.0) scores],the difference was statistically significant (P ＜ 0.05).There was no significant difference between SAS score,SDS score between two groups before and after treatment (P ＞ 0.05).Conclusion In the process of treating the patients with partial epilepsy by drug,levetiracetam is superior to carbamazepine on the improvement of cognitive function,but the mood improvement is not obvious.

This study was aimed to verify the chemical component cantharidin from Chinese blister beetle by LC-MS/MS. Components were first processed by HPLC to choose the appropriate separation conditions before LC/MS/MS analysis. Through the positive and negative ions pre-scan, positive ions scanning way was selected in the scanning of each separate component. The scanned maps were obtained and the relative molecular mass was deduced. The results showed that 8 types of cantharidin compounds were identified, including three isomers. It was concluded that LC-MS/MS was able to determine the chemical component cantharidin from Chinese blister beetle rapidly and accurately, which was existed in the body by the form of combined amino acid.

Objective To explore the application effect of hyperbaric oxygen ( HBO ) in the treatment of refractory peptic ulcer .Methods Clinical data of 259 patients with refractory peptic ulcer were retrospectively ana-lyzed.According to whether received HBO therapy , these patients were divided into the HBO group ( n=127 ) and control group(n=132).The total effective rate,Helicobacter pylori(Hp) eradication rate and relapse rate of the two groups were compared .Results The total effective rate ,Hp eradication rate of the HBO group were 93.7%,92.1%, respectively,which were significantly higher than 65.2%,56.1% of the control group (χ2 =31.97,7.32,all P<0.05).The relapse rate of the HBO group was 8.4%,which was significantly lower than 33.3%of the control group (χ2 =12.51,P<0.05).Conclusion HBO combined with conventional drug in the treatment of refractory peptic ulcer has significant effect .

Objective To observe the effects of total flavone from litchi chinensis sonn (TFL) on the liver function in-cluding p16 protein, pro collagen type 3 (PC3) and pro collagen typeⅠ(PCⅠ) in model rats with liver fibrosis induced by bile duct ligation. Methods Forty rats were randomly divided into four groups:sham operation (SO) group, bile duct liga-tion (BDL) group, TFL group and silibinin (SIL) group. Rats were gavaged with saline (5 mL·kg-1·d-1) in SO and BDL group, rats were gavaged with TFL (200 mL·kg-1·d-1) in TFL group and rats were gavaged with SIL (5 mL·kg-1·d-1) in SIL group for four weeks. The serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin direct (BILD) and bilirubin total (BILT) were detected in four groups. The liver tissues were stained by HE and Masson methods. The ex-pression levels of p16, PC3 and PCⅠin liver tissues were determined by Western blot assay. Results The serum levels of ALT (44.6 IU/L±8.0 IU/L), AST (103.8 IU/L±18.1 IU/L), BILD (0.76 μmol/L±0.28μmol/L) and BILT (1.48μmol/L±0.35μmol/L) were lower in SO group. There was a higher level of ALT in BDL group (147.4 IU/L±86.3 IU/L) than that of TFL group (92.9 IU/L±47.3 IU/L). The serum level of ALT was higher in AST group (362.7 IU/L±106.6 IU/L) than that of TFL group (290.1 IU/L ± 171.7 IU/L) and SIL group (250.2 IU/L ± 54.9 IU/L). The serum level of BILD was lower in BDL group (99.71μmol/L±40.87μmol/L) than that of SIL group (137.01μmol/L±38.86μmol/L). The serum levels of BILD and BILT were significantly lower in TFL group (81.48μmol/L±47.50μmol/L, 106.64μmol/L±61.04μmol/L) than those of SIL group (P<0.05). There were small amount of new bile duct and no obvious cells degeneration, small amount of infiltration of in-flammatory cells and collagen deposition in TFL group. The liver fibrosis improved significantly in TFL group than that of BDL group. There were more new bile duct in hepatic portal area in SIL group than those of TFL group. The expression levels of p16, PC3 and PCⅠwere significantly higher in BDL group than those of TFL group. The expression level of PC3 was significantly lower in BDL group than that of SIL group. The expression level of PCⅠwas significantly higher in BDL group than that of SIL group (P<0.05). There was no significant difference in the expression level of p16 between BDL group and SIL group. The expression levels of PC16 and PC3 were significantly lower in TFL group than those of SIL group (P<0.05). There was no significant difference in the ex-pression level of PCⅠbetween TFL group and SIL group. Conclusion TFL can improve the liver function in model rats with choles-tatic liver fibrosis and reduce liver fibrosis, which may be related with inhibitory effects on the expressions of p 16, PC3 and PCⅠ.

Objective To investigate the correlation between plasma D-dimer with delayed encephalopathy (DE) in patients with acute carbon monoxide poisioning(ACOP).Methods According to the severity of disease,100 patients with ACOP were divided into mild group (27 cases),moderate group (31 cases),severe group (42cases).And depending on whether DE occured,all patients were divided into DE group(20 cases) and no DE group (80 cases).4 venous blood samples were obtained separately from each subject in 1,7,14 days after their admission to hospital by using latex immunoturbidimetry.The levels of blood plasma D-dimer of patients in each group were detected by immune turbidimetry and analyzed,1th,7th and 14th day after admission.Results The plasma D-dimer level of the mild group at different time points was in the normal range,and the difference was not statistically significant(all P ＞ 0.05) ;The plasma D-dimer level of the severe group and moderate group was significantly higher than that of the mild group(all P ＜0.01),and it reached a peak in one week(7 days),and showed a downward trend after two weeks(14 days).The DE all occurred in the moderate and severe group.The plasma D-dimer levels of the DE group were higher than those of no DE group from admission to the 7 th and 14 th day (all P ＜ 0.01).Conclusion The dynamic monitoring plasma D-dimer is helpful in assessing to the severity and prognosis of ACOP,and could surpport positive clinical significance for the prevention and treatment of DE.

Objective To evaluate the effects of selective hepatic vascular occlusion SHVO) on the prognosis of patients undergoing hepatic resection for huge liver cancer.Methods The clinical data of 49 patients who received huge liver cancer resection at the Zhejiang People's Hospital from January 2005 to January 2010 were retrospectively analyzed.Based on the type of hepatic vascular occlusion,all patients were divided into Pringle's maneuver group (24 patients) and SHVO group (25 patients).The intraoperative condition,postoperative recovery of hepatic and renal function,incidence of complications,survival rate and recurrence rate of liver cancer of the 2 groups were compared.All data were analyzed by using the t test or Fisher exact probability.The survival curve was drawn by using the Kaplan-Meier method and the survival of the 2 groups was compared by using the Log-rank test.Results Hepatectomy was successfully performed on all the patients.Time for blood occlusion were (32 ±19) minutes in the Pringle's maneuver group and (34 ± 22)minutes in the SHVO group,with no significant difference between the 2 groups (t =2.45,P ＞ 0.05).The volume of blood loss of the Pringle's maneuver group was (736 ± 543) ml,which was significantly greater than (273 ± 298) ml of the SHVO group (t =6.87,P ＜0.05).The incidences of hepatic vein rupture were 21％ (5/24) in the Pringle's maneuver group and 24％ (6/25)in the SHVO group,with no significant difference (x2=1.45,P＞0.05).The course of 3 patients was complicated by hepatic vein rupture and hemorrhage and 1 by air embolism in the Pringle's maneuver group,while no hemorrhage or air embolism happened in the SHVO group.Four patients in the Pringle's maneuver group and 3 in the SHVO group were found with vascular invasion,while the resection margins were negative.There was no significant difference in the hepatic function in the 2 groups before operation.The levels of alanine aminotransferase in the SHVO group at postoperative day 1 and 3 were significantly lower than those in the Pringle's maneuver group (t=7.12,6.35,P ＜ 0.05).There was no significant difference in the levels of blood urea nitrogen and creatinine between the 2 groups (P ＞ 0.05).Acute hepatic dysfunction was found in 4 patients in the Pringle's maneuver group,but no patients with acute hepatic dysfunction was found in the SHVO group.The 1-and 3-year tumor-free survival rates were 58％ and 21％ in the Pringle's maneuver group,which were significantly lower than 72％ and 30％ in the SHVO group (x2 =5.32,6.07,P ＜ 0.05).The 5-year tumor-free survival rates were 21％ in the Pringle's maneuver group and 20％ in the SHVO group,with no significant difference between the 2 groups (x2 =1.78,P ＞ 0.05).Conclusion SHVO is safe,feasible and effective to prevent hemorrhage and postoperative acute hepatic dysfunction,and it is also helpful in reducing early-stage tumor recurrence and improving the tumor-free survival rate in patients with huge liver cancer.

ObjectiveTo study the proper timing for radical hepatectomy after tumour-down-staging with transcatheter arterial chemoembolization for unresectable primary liver cancer.Method This is a retrospective study of 18 patients with unresectable primary liver cancer who received radical liver resection after tumour-downstaging with transcatheter arterial chemoembolization (TACE) from January 2005 to August 2010 at Zhejiang Province People's Hospital Hepatobiliary Surgery Department.The patients received TACE 1 to 3 times (once n=4,twice n=12,and thrice n=2).After tumour-downstaging,radical liver resection was carried out (right hepatectomy,n =10 ; resection of tumour in right liver + resection of right liver metastases,n=2; resection of tumnour in right liver +radiofrequency ablation of right liver metastasis,n=1; right hepatectomy + removal of portal vein tumour thrombus,n=1 ; left hepatectomy + radiofrequency ablation of right liver metastases,n=2 ;Mesohepatectomy,n=1; and left hepatectomy + excision of liver metastasis,n=1).ResultsAfter TACE,the diameter of the primary tumour reduced by over 30％ in 6 patients (6/18,33.3％);10％～30％ in 8 patients (8/18,44.4％),and 10％ in 4 patients (4/18,22.2％).Before TACE,the tumours were not encapsulated in 6 patients (33.3％).After TACE,only 1 patient (5.6％) had the tumour remained unencapsulated.After TACE in 6 patients,the primary tumour shrunk to be within a hemiliver,and ultrasound and CT showed the tumours to have defined borders and they were away from the porta hepatis and major blood vessels.In another 6 patients,there were metastases to the contralateral hemilivers but these tumours had all shrunk in size.Selective vascular inflow and outflow occlusion technique was routinely used for liver resection.ConclusionFor primary liver cancers which are not resectable,TACE should be used first.When the tumours shrink in size,radical resectional surgery should be performed as soon as possible.The surgical technique should follow the following principles:-preserve as much normal liver parenchyma as possible,use selective vascular inflow and outflow occlusion technique to avoid ischaemia/reperfusion injury to the remnant liver,and to reduce haemorrhage.The surgery should be carried out by experienced surgeon.

Objective To assess the effect of three different liver vascular exclusions on prognosis of patients undergoing hemihepatectomy.Methods Clinical data of 216 patients undergoing hemihepatectomy were analyzed retrospectively.Ninety-eight out of 216 patients received Pringle maneuver during hepatectomy in group A,71 patients of selective liver inflow and outflow vascular exclusions in group B,47 patients using liver hanging maneuver combining with selective liver inflow and outflow vascular exclusions were in group C.Results There was no difference in operation time between the three groups ( t =0.72,0.83,and 0.67,P ＞ 0.05 ).The intraoperative blood loss and transfusion in group B and C were less than that in group A (t =3.72,3.83 and 4.11,4.07,P ＜0.05).Serum albumin level on day 1 and day 3 in group B and C were higher than that in group A (t =3.65,3.77,and 3.90,3.74,P ＜0.05 ).Serum total bilirubin level on day 3 and 5 in group B and C were lower than that in group A ( t =4.13,5.01,and 4.09,3.99,P ＜0.05).Serum alanine aminotransferase on day 1,3 and 5 in group B and C were lower than that in group A ( t =5.36,6.14,and 5.70,7.01,and 4.94,3.98,P ＜ 0.05 ).Postoperative complication rate in group A was higher than that in group B and C ( x2 =13.71 and 23.56,P ＜ 0.05 ).The 3-year survival rate of patients with malignant tumor in the three groups were not significantly different (t =2.38,P ＞ 0.05 ).Conclusions Intraoperative blood loss and transfusion and postoperative complication rate can be reduced,and liver injury can be diminished in hemihepatectomy using selective liver inflow and outflow vascular exclusion alone and or in combination with a liver hanging maneuver.

Objective To evaluate hepatic vein exclusion (HVE) outside the liver in the resection of giant hepatic hemangioma near the second hepatic hilum. Methods From January 2003 to December 2009, giant hepatic hemangiomas near the second hepatic hilum were resected in 19 cases. Preoperatively 19 cases were divided into two groups: HVE group (9 cases) and IVE group ( 10 cases). Data regarding the intra-operative and postoperative courses of the patients were analyzed. Results There was no difference between the 2 groups regarding the age, sex and tumor size. No damage of hepatic vein was happened in HVE group. Resection of the hemangioma was applied in all cases of HVE group, and 1 case in IVE group had right hemi-hepatectomy. Hepatic veins rupture occurred in 4 cases in IVE group and 2 cases of them had massive bleeding, while in HVE group hepatic veins rupture occurred in 5 cases but no massive bleeding occurred. Intra-operative blood loss was significantly less in HVE group than IVE group. The serum ALT value in postoperative day 1 and total bilirubin in postoperative day 3 in HVE group was significantly lower than that of the IVE group. The mean drainage volume in HVE group was significantly less than that of the IVE group on postoperative day 1 and day 2. The total cost of patient in HVE group were significant less than in IVE group. Conclusions The use of hepatic vein exclusion reduces the risk in the resection of giant hepatic hemangioma near the second hepatic hilum.