With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
Humans ; Aged ; Aged, 80 and over ; Biliary Tract Surgical Procedures ; Gallstones ; Laparoscopy ; Treatment Outcome ; Aging ; Retrospective Studies

Objective:To investigate the prognostic value of preoperative inflammatory indicators for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 73 patients with primary HCC who underwent radical partial hepatectomy in the Beijing Tsinghua Changgung Hospital of Tsinghua University from December 2014 to July 2019 were collected. There were 57 males and 16 females, aged from 33 to 81 years, with a median age of 58 years. Results of blood examination indicators at the first time in hospital were determined for patients. Observation indicators: (1) the best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics; (2) follow-up; (3) influencing factors for prognosis of HCC patients; (4) comparison of clinicopathological parameters of HCC patients; (5) comparison of predictive value for overall survival. Follow-up was conducted using outpatient examination and telephone interview to determine postoperative survival of patients up to September 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). The best cut-off values ??for continuous variables were obtained using the maximally selected rank statistics based on survival at endpoint of follow-up. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates, and Log-rank test was used for survival analysis. Univariate analysis was performed using the Log-rank test. Multivariate analysis was performed using the COX proportional hazard model. The time-dependent receiver operating characteristic curve (ROC) was used to compare the predictive value of independent prognostic factors. Results:(1) The best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics: the best cut-off values of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutrition index (PNI) were 3.46, 131.05, and 45.65. (2) Follow-up: 73 patients were followed up for 31 months (range, 2-57 months). Twenty patients died during the follow-up. (3) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that NLR, PNI, tumor diameter, and tumor differentiation degree were related factors affecting prognosis of patients ( χ2=10.213, 4.434, 5.174, 4.306, P<0.05). Results of multivariate analysis showed that NLR and tumor differentiation degree were independent factors affecting prognosis of patients ( hazzard ratio=4.429, 13.278, 95% confidence interval as 1.662-11.779, 1.056-10.169, P<0.05). (4) Comparison of clinicopathological parameters of HCC patients: of 73 patients, 64 cases had NLR<3.46 and 9 cases had NLR≥3.46. Cases with tumor length >5 cm or ≤5 cm, neutrophils, lymphocytes were 23, 41, (2.9±1.2)×10 9/L, (1.7±0.6)×10 9/L for 64 patients with NLR<3.46, versus 8, 1, (5.8±2.9)×10 9/L, (1.0±0.3)×10 9/L for 9 patients with NLR≥3.46; there were significant differences in above indicators between the two groups ( χ2=7.017, t=2.982, -3.168, P<0.05). (5) Comparison of predictive value for overall survival: time-dependent ROC curves of NLR and tumor differentiation degree for 1-, 2-, 3-, 4-year survival rates had the area under curve of 0.735,0.611, 0.596, 0.574 and 0.554, 0.583, 0.572, 0.556, respectively. NLR had better predictive value for overall survival of patients than tumor differentiation degree. Conclusion:Preoperative NLR is an independent factor affecting prognosis patients, and its predictive efficacy is better than tumor differentiation degree.

The current epidemic of Corona Virus Disease 2019 (COVID-19) poses a serious threat to people′s health and lives. Following the national policies and deployment, medical community in China invests large amounts of medical resources to help Hubei. However, some hospitals nationwide have suspended outpatient and inpatient services. The authors analyze the underlying causes of suspension of medical services and its harm to patients, and summarize the optimization of disease diagnosis and treatment during the COVID-19 outbreak. In further, they propose reasonable suggestions on safe medical management in general hospitals outside the epidemic area, in order to attract the attention of medical institutions and medical colleagues.

The invasion,metastasis and drug resistance of hepatocellular carcinoma are the main factors affecting the prognosis of patients.Recent studies have shown that the interaction between tumor cells and the tumor microenvironment is critical for tumor cell survival,proliferation,stem cell characteristics acquisition,invasion,metastasis and drug resistance.This article discussed the progress of hepatocellular carcinoma tumor microenvironment from the contribution of hepatitis virus,liver fibrosis to microenvironment,and microenvironmental cell components and non-cellular components.

Objective To investigate the preoperative plus postoperative neutrophil-lymphocyte ratio (PP-NLR) predicts the outcomes of hepatocellular carcinoma after hepatectomy.Methods The clinical data of 44 patients with partial hepatectomy in the Hepatobiliary Surgery,Beijing Tsinghua Changgung Hospital,Tsinghua University,from December 2014 to March 2018 were retrospectively analyzed.According to the cut-off value,the high NLR is assigned a value of 1 before and after surgery,and the low NLR is assigned a value of 0.Preoperative NLR plus postoperative NLR =0/1/2.The preoperative NLR plus postoperative NLR=0/1 was assigned to one group,and the preoperative NLR plus postoperative NLR=2 was attributed to one group.Recurrence-free survival (RFS) and overall survival (OS) were evaluated by the Kaplan-Meier method,with comparisons using the log-rank test.The Cox proportional hazard model is used for univariate and multivariate analysis.Results Comparison of clinical and pathological data of different PP-NLR,the preoperative and postoperative NLR was higher in the PP-NLR=2 group than in the PP-NLR=l/0 group,and the difference was significant (P＜0.05).Univariate analysis showed that PP-NLR (HR=3.495,95％CI:1.054 ～ 11.589,P ＜ 0.05) and degree of differentiation (HR =3.995,95％ CI:1.050 ～15.198,P＜0.05) were risk factors for OS after liver resection,while preoperative NLR and postoperative NLR alone were not risk factors for overall survival.Multivariate analysis showed that PP-NLR (HR=4.733,95％CI:1.320～16.966,P＜0.05) and degree of differentiation (HR=6.310,95％CI:1.456～27.344,P＜0.05) were independent risk factors for OS after liver resection.Conclusion PP-NLR considers the systemic immune status of preoperative and postoperative,predicts prognosis better than preoperative or postoperative NLR.

For unresectable advanced hepatocellular carcinoma (HCC),besides sorafenib,alternative drugs and treatment modalities are required.Clinical studies of hepatic arterial infusion chemotherapy (HAIC),transcatheter arterial chemoembolization (TACE),and system chemotherapy have shown favorable efficacy and tolerance in advanced HCC patients.In addition,the potential efficacy of sorafenib combined with focal treatment is also an interesting issue.As more therapies become available,decision-making for treating advanced HCC becomes increasingly complex.In our opinion,diverse treatment modalities should be utilized for the best interest of patients.Based on predictive biomarkers,we should develop a precise patient stratification system to select suitable candidates for each treatment modality in future studies,as is useful for improving prognosis of patients with advanced HCC.

Objective To investigate the effectiveness and the best assessment time of the short-latency somatosensory evoked potential (SLSEP) and brainstem auditory-evoked potential (BAEP) in the prognosis prediction of patients with severe cerebrovascular disease. Methods A prospective trial was conducted. The patients with severe cerebrovascular disease and Glasgow coma scale (GCS) ≤ 8 and admitted to the neurological intensive care unit (NICU) of Armed Police Logistics College Affiliated Brain Hospital from December 2014 to May 2015 were enrolled. The patients received SLSEP and BAEP nerve electrophysiological examinations within 24 hours and on 3, 7, 15 days after admission respectively and were graded according to Cant method. GCS was evaluated within 24 hours and on 15 days after admission. The prognosis was evaluated by Glasgow outcome scale (GOS) at six months after the onset of the disease. At different time windows after the onset of the disease, the correlations between different predictive indexes (GCS, SLSEP and BAEP) and outcome (GOS) were analyzed using spearman rank correlation; in the mean time, the efficacy for predicting the prognosis by single index or combined indexes was compared by receiver operator characteristic (ROC) curve. Results Seventy-eight patients were enrolled [men 46, women 32, age range (60.79±12.50) years old]. There were 78, 64, 44 and 19 patients observed at 24 hours and on 3, 7, 15 days after admission because the short-term death of some patients. The graded abnormal rate of SLSEP was 75.64%, 82.81%, 79.55% and 73.98% respectively; and the graded abnormal rate of BAEP was 82.05%, 84.38%, 85.94% and 73.68% respectively. ① Correlation analysis: all the predictors were correlated with GOS within 24 hours and on 3, 7, 15 days after admission, and SLSEP and BAEP grading were moderately correlated with GOS (0.4≤|R| < 0.7). ② The accuracy of the predicting prognosis: the area under the curve (AUC) of GCS on 15 days after admission [AUC = 0.772, 95% confidence interval (95%CI) = 0.561-0.984, P = 0.045] was the maximum when predicting survival. AUC of SLSEP (AUC = 0.825, 95%CI = 0.695-0.955, P = 0.000) and BAEP (AUC = 0.786, 95%CI = 0.646-0.927, P = 0.002) were the maximum on 7 days after admission when predicting death. ③ The effectiveness of the prognosis prediction: the sensitivity of SLSEP grading and BAEP grading were 92.6% and 96.3% respectively, while the sensitivity, specificity and accuracy of SLSEP and BAEP combined prediction were 100% on 7 days after admission. The specificity of GCS was 100% on 15 days after admission. Conclusions SLSEP and BAEP have more close correlation with prognosis compared with the GCS; Continuous dynamic combined evaluation of SLSEP and BAEP has important clinical value for patients with severe cerebrovascular disease possess in the prognosis assessment, the accuracy and the effectiveness of SLSEP and BAEP combined prediction were higher on 7 days especially.

AIM:To investigate the effects of gonadotropin-releasing hormone ( GnRH) analogue on the growth of breast cancer cell lines MCF-7 and MDA-MB-231 in vitro and to explore the related mechanisms with PI 3K/Akt or ERK/MAPK pathways .METHODS: The proliferation of human breast cancer cell lines MCF-7 and MDA-MB-231 treatment with triptorelin was detected by MTT assay and the distribution of the cell cycle was determined by flow cytometry .The phosphorylation of the ERK 1/2 and Akt was evaluated by Western blotting .RESULTS:Triptorelin inhibited the prolifera-tion of MCF-7 cells at concentration of 10-5 mol/L after treated for 192 h or at concentration of 10 -4 mol/L after treated for 168 h and 192 h.Triptorelin inhibited the proliferation of MDA-MB-231 cells at concentration of 10 -4 mol/L after treated for 192 h (P<0.05).Treatment with triptorelin for 192 h at concentration of 10 -4 mol/L had no statistical significance effect on phosphorylation of ERK1/2 and Akt(P>0.05).CONCLUSION:Inhibitory effect of GnRH analogue triptorelin on human breast cancer cells is not just the connection with the down-regulation of pituitary hormone , but also a direct in-hibitory effect.The role may not be involved in the activation of ERK /MAPK and PI3K/Akt signaling pathways .

Objective To examine the role of c-Src activation in hepatitis B virus X (HBx) protein induced epithelial-mesenchymal transition (EMT) in liver cancer.Methods SMMC-7721 liver cancer cells were transfected with HBx gene to induce EMT and the activated c-Src expression was evaluated by Western blot.Both the morphological changes and the epithelial and mesenchymal markers expression (real-time PCR,western blot and immunocytochemistry) of HBx-transfected SMMC-7721 cell treated by c-Src kinase inhibitor PP2 and negative control PP3 were observed and compared,respectively.Results The activated c-Src expression in HBx gene transfected SMMC-7721 cells was significantly increased compared to that in mock transfected cells,c-Src kinase inhibitor PP2 could enable the HBx-transfected SMMC-7721 cells to transmit from spindle-like shape to original epithelial morphology.Western blot and immunocytochemistry confirmed that the expression of epithelial markers and mesenchymal markers almost returned to the levels of parental cells,indicating the mesenchymal-epithelial transition.Conclusions c-Src activation plays a key role in the process of EMT induced by HBx protein in SMMC-7721 cells.

Objective To investigate the value and efficacy of continuous renal replacement therapy(CRRT) for treatment of heat stroke patients complicated by multiple organ dysfunction syndrome(MODS). Methods The clinical data of 19 heat stroke patients complicated by MODS admitted into the hospital in a period from July 15,2010 to August 30,2010 and treated by CRRT were analyzed retrospectively. Continuous venovenous hemofiltation(CVVH) mode was used in all patients and the initial temperature of replacement fluid range was 28℃to 32℃persisting in 2.0 to 2.5 hours and afterward it maintained at 36℃. Prognosis and adverse effect were observed,the patients' body temperature,heart rate(HR),mean arterial pressure(MAP),acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,oxygenation index(PaO2/FiO2),the levels of serum urea nitrogen(BUN),serum creatinine(SCr), myoglobin(Mb),creatine kinase(CK),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and arterial lactate(Lac)were monitored before and after CRRT treatment. Results Fifteen patients were cured or improved,and 4 died. Compared with those before CRRT treatment,body temperature(℃),HR(bmp),MAP(mm Hg,1 mm Hg=0.133 kPa),APACHEⅡevaluation(score),PaO2/FiO2(mm Hg)were significantly improved(body temperature:36.8±0.2 vs. 41.6±0.3,HR:93.6±10.3 vs. 132.5±11.4,MAP:69.8±9.9 vs. 45.2±7.7,APACHEⅡ:12.3±3.9 vs. 29.6±4.6,PaO2/FiO2:213.6±95.4 vs. 126.5±87.4,all P<0.05);the levels of BUN(mmol/L),SCr(μmol/L), Mb(μg/L),CK(U/L),ALT(U/L),AST(U/L),Lac(mmol/L)were significantly reduced after the treatment(BUN:23.9±5.3 vs. 42.6±5.4,SCr:123±47 vs. 356±51,Mb:201±45 vs. 468±39,CK:217±32 vs. 843±41,ALT:79±36 vs. 894±88,AST:57±28 vs. 867±92,Lac:3.5±2.4 vs. 16.6±3.9,all P<0.05). In the process of the treatment,hemodynamics was stable,and no obvious side effects occurred. Conclusion CRRT treatment can exactly and safely reduce the core body temperature of patients with heat stroke,and it can also effectively eliminate metabolites of BUN,Cr,Mb,etc,ameliorate the inflammatory reaction and supporting the functions of liver,kidneys and other vital organs,thus the treatment is also safe and effective for such patients complicated by MODS.