Humans ; Consensus ; Pancreatic Neoplasms/therapy* ; Neuroendocrine Tumors/therapy*

Objective: To describe the molecular epidemiological characteristics of norovirus gastroenteritis outbreaks in Zhuhai from 2011 to 2016. Methods: Anal swab specimens were collected from 576 cases with 56 outbreaks of acute norovirus gastroenteritis from 2011 to 2016. Specimens were tested by real-time RT-PCR. Three to four of norovirus positive specimens were selected from every outbreak to amplify the VP1 gene by RT-PCR and one strain was chosen randomly from every outbreaks to determine the genotype by phylogenetic tree analysis. Results: Eight genotypes were identified from 56 outbreaks and all of them belonged to GⅡ genogroup. The genotype of norovirus strain changed with prevalence time. The GⅡ.4/2006b was dominant from 2011 to 2012, and replaced by GⅡ.4/Sydney _2012 during the 2012—2013 norovirus season, and both of them never appeared after Feb. 2013. GⅡ.17 was the only genotype during the 2014—2015 norovirus season. All the 7 outbreaks occurred from 2015 to 2016 were caused by GⅡ.3 norovirus. The GⅡ.17and GⅡ.3 were identified from Apr. to Sep. 2016; GⅡ.p16-GⅡ.2 were the only genotype in 12 outbreaks from Nov. to Dec. 2016. The GⅠ genogrope was never identified from 2011 to 2016 in Zhuhai. Conclusions The Norovirus GⅡ was the only pathogeny which caused the outbreaks of norovirus gastroenteritis. The recombinant norovirus strain GⅡ.p16-GⅡ.2 emerged and caused large outbreaks in the last two months of 2016 in Zhuhai; several recombinant strains of the GⅡ.p16 RdRp gene were found now, which suggests that attention should be focused on the prevalence and evolution of the recombinant norovirus.

Objective To explore indicator value of blood flow of uterine arteries in second trimester uterine artery by Doppler ultrasound and early diastolic notch in the prediction of preeclampsia development,and to analyze the relationship between these values and pregnancy outcomes and neonatal prognosis.Methods A total of 89 puerperae cases with preeclampsia underwent pregnant examinations in our hospital were retrospectively reviewed,and were divided into mild preeclampsia (group A) and severe preeclampsia (group B),and 100 women with normal singleton pregnancies were selected as control group(Group C).Four-dimensional ultrasound was adopted to detect pulsatility indices (PI),resistance indices (RI) and early-diastolic notch of bilateral uterine arteries in the three groups from 20 to 26 gestational weeks.The pulsatility index (PI) and resistance index (RI) of the uterine artery were measured,and the number of early diastolic waves was recorded.The relationship between these values and the outcomes of pregnancy and neonates was analyzed.Results Neonatal prognosis of Group B was worse than that of group A and group C (P ＜ 0.05);The uterine artery PI and RI of group B were higher than that of group A and group C (P ＜ 0.05).The early diastolic notch of group A and group B was higher than that of group C (P ＜ 0.05).Conclusion The indicator value of blood flow in uterine artery and the early diastolic notch in the second trimester could monitor the occurrence of preeclampsia,especially severe preeclampsia and they are useful to predict preeclampsia severity and prenatal prognosis.

Objective To explore indicator value of blood flow of uterine arteries in second trimester uterine artery by Doppler ultrasound and early diastolic notch in the prediction of preeclampsia development,and to analyze the relationship between these values and pregnancy outcomes and neonatal prognosis.Methods A total of 89 puerperae cases with preeclampsia underwent pregnant examinations in our hospital were retrospectively reviewed,and were divided into mild preeclampsia (group A) and severe preeclampsia (group B),and 100 women with normal singleton pregnancies were selected as control group(Group C).Four-dimensional ultrasound was adopted to detect pulsatility indices (PI),resistance indices (RI) and early-diastolic notch of bilateral uterine arteries in the three groups from 20 to 26 gestational weeks.The pulsatility index (PI) and resistance index (RI) of the uterine artery were measured,and the number of early diastolic waves was recorded.The relationship between these values and the outcomes of pregnancy and neonates was analyzed.Results Neonatal prognosis of Group B was worse than that of group A and group C (P ＜ 0.05);The uterine artery PI and RI of group B were higher than that of group A and group C (P ＜ 0.05).The early diastolic notch of group A and group B was higher than that of group C (P ＜ 0.05).Conclusion The indicator value of blood flow in uterine artery and the early diastolic notch in the second trimester could monitor the occurrence of preeclampsia,especially severe preeclampsia and they are useful to predict preeclampsia severity and prenatal prognosis.

Objective To investigate clinical efficacy and prognostic factors of hilar cholangiocarcinoma.Methods The retrospective case-control study was conducted.The clinicopathological data of 322 patients with hilar cholangiocarcinoma who were admitted to the Xiangya Hospital of Central South University between December 2005 and November 2015 were collected.Preoperative staging and classification of tumor and treatment planning were carried out according to the results of laboratory and imaging examinations.Observation indexes:(1) clinical features and results of assisted examinations;(2) treatments and results of pathological examination;(3) followup and survival;(4) prognostic factors analysis:gender,age,preoperative highest total bilirubin (TBil),preoperative carcinoembryonic antigen (CEA),preoperative CA19-9,preoperative CA242,preoperative CA125,treatment methods and TNM staging.The follow-up of outpatient examination and telephone interview was perfornmed to detect patients' survival up to November 2016.Survival curve was drawn using the Kaplan-Meier method.Survival and univariate analyses were done using the Log-rank test,and multivariate analysis was done using the Cox proportional hazard model.Results (1) Clinical features and results of assisted examinations:among the 322 patients,there were 301 patients with a chief complaint of jaundice.Of the 322 patients,the preoperative highest levels of TBil,DBil,ALT and AST in 322 patients were 3.9-785.2 μmol/L,1.6-410.2 μ mol/L,14.8-484.5 U/L and 21.4-539.8 U/L,respectively.Levels of ALP and GGT in 272 patients were 93.8-1 890.0 U/L and 2.0-1 832.8 U/L,respectively.Seventy-seven of 292 patients had an elevated CEA level,272 of 298 patients had an elevated CA19-9 level,153 of 260 patients had an elevated CA242 level and 86 of 260 patients had an elevated CA125 level.According to Bismuth-Corlette type,24 patients were detected in type Ⅰ,115 in type Ⅱ,55 in type Ⅲa,63 in type Ⅲb and 65 in type Ⅳ.(2) Treatments and results of pathological examination:Of the 322 patients,104 patients underwent radical resection,including 79 with hilar bile duct resection (9 combined with vascular resection and reconstruction) and 25 with extended hepatic lobectomy (16 combined with caudate lobectomy),and 218 patients underwent palliative treatments,including 134 with external biliary drainage and 84 with internal biliary drainage.Five patients were dead in the perioperative period,of which 2 died of acute liver failure,1 died of systemic infection and multiple organ failure,1 died of acute renal failure and 1 died of acute suppurative cholangitis,septic shock and disseminated intravascular coagulation.Of 263 patients receiving pathological examination,adenocarcinoma was detected in 253 patients (12 with high-differentiated adenocarcinoma,85 with moderate-differentiated adenocarcinoma,33 with low-differentiated adenocarcinoma and 123 with indefinite differentiation),mucinous adenocarcinoma in 5 patients,cholangiocarcinoma in 3 patients and neuroendocrine carcinoma in 2 patients.TNM staging of 322 patients:stage Ⅰ was detected in 8 patients,stage Ⅱ in 53 patients,stage Ⅲ in 132 patients,stage Ⅳ in 96 patients and indefinite stage in 33 patients.(3) Follow up and survival:among the 322 patients,296 were followed up for 12-132 months,with a median follow-up time of 65 months,including 94 with radical resection and 202 with palliative treatments.Among the 296 patients,the median survival time and 1-,3-,5-year survival rates were 10 months,47.1％,20.2％ and 9.5％,respectively.0f296 patients with follow-up,median survival time and 1-,3-,5-year survival rates were 31 months,84.0％,46.2％,25.0％ in 94 patients receiving radical resection and 7 months,29.9％,8.1％ and 2.3％ in 202 patients receiving palliative treatment,respectively,with a statistically significant difference between the 2 groups (x2=78.777,P＜ 0.05).Among the 94 patients receiving follow-up and radical resection,the median survival time and 1-,3-,5-year survival rates were 31 months,82.1％,45.1％,25.7％ in 73 patients undergoing hilar bile duct resection and 35 months,90.5％,49.8％,22.1％ in 21 patients undergoing hepatic lobectomy,respectively,with no statistically significant difference (x2=0.186,P＞0.05).Among the 73 patients undergoing hilar bile duct resection,median survival time and 1-,3-,5-year survival rates were 16 months,57.1％,0,0 in 7 patients combined with vascular resection and reconstruction and 34 months,84.6％,49.5％,27.5％ in 66 patients undergoing simplex hilar bile duct resection,respectively,showing a statistically significant difference (x2 =11.977,P＜ 0.05).(4) Prognostic factors analysis:results of univariate analysis showed that preoperative highest TBil,preoperative CEA,preoperative CA242,preoperative CA125,treatment methods and TNM staging were related factors affecting prognosis of patients with hilar cholangiocarcinoma (x2=25.009,18.671,9.359,33.628,94.729,77.136,P＜0.05).Multivariate analysis showed that preoperative highest TBil ≥ 342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ and Ⅳ were the independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma (HR =2.270,2.147,3.166,2.351,95％ confidence interval:1.587-3.247,1.446-3.188,2.117-4.734,1.489-3.712,P＜0.05).Conclusions Prognosis of hilar cholangiocarcinoma is still unsatisfactory.The R0 resection is the key in radical surgery.Preoperative highest TBil≥342.0 μmol/L,preoperative CEA ≥ 5.00 μg/L,palliative treatments,TNM stage Ⅲ-Ⅳ are independent risk factors affecting the poor prognosis of patients with hilar cholangiocarcinoma.

Objective To explore the effects of adriamycin-loaded immuno-nanoparticles on multidrug resistance (MDR) of hepatoma cell line SMMC-7721/ADM. Methods The cytotoxicity of the adriamycin-loaded immuno-nanoparticles on the bepatoma cell line SMMC-7721/ADM in vitro and the tumor cell-binding ability of adriamycin-loaded immuno-nanoparticles were detected. Results The effect of the cytotoxicity of adriamycin-loaded immuno-nanoparticles on the hepatoma cell line SMMC-7721/ADM was significantly better than that of adriamycin-loaded nanoparticles. Adriamycin-loaded immuno-nanoparticles had the specific binding ability with the hepatoma cell line SMMC-7721/ADM. Conclusions Adriamycin-loaded immuno-nanoparticles can overcome the MDR of the tumor in vitro. The mechanism may be that immuno-nanoparticles could adhere to the tumor cell membrane, and the release of the loaded adriamycin creates a high local concentration in the extracellular medium. The increased concentration gradient improves the diffusion of adriamycin from the extracellular medium to the intracellular medium.

Objective Studying the experience of total hip revision in the femur side with AML prosthesis retrospectively,and to analyze its value.Methods Thirty-five cases were revised with AML prosthesis after failed total hip arthroplasty in the femur side,the bone loss was I-Ⅲb according to Paprosky classification.Results Mean follow-up periods was 17 months,no screenage of prosthesis subside,migrating and more bone loss were showed in all cases postoperatively.Mean Harris score was increased from 37 to 92.Conclusion AML prosthesis is a good choice for the total hip revision in the femur side with I-Ⅲb by Paprosky classification.

[Objective]To investigate the method and efficiency of operative femoral supracondylar varus osteotomy combined with new blade plate on treatment of valgus deformity of knees.[Method]Thirty-seven patients with 43 knees with valgus deformity were treated with femoral supercondylar varus osteotomy with Giebel blade plate(Link company/Germany)from Oct.2000 to Oct.2005.The study group consisted of seven men with 8 knees and thirty women with 35 knees,the average age of the patients was 31.2 years(range,fifteen to seventy years).Eleven patients with 13 knees had lateralcompartment osteoarthritis,Ahlback stage Ⅰ eight patients with 10 knees and stage Ⅱ three patients 3 knees.The full-length Ap view of the lower extremity and the weightbearing AP view of the knee were obtained before and after operation,as well as the femoral angle and femoral-tibial angle were evaluated.The Giebel blade plates were taken out average 1.5 year after operation and the patients were followed-up,bone union and the change of the correction angles and the pain of the knees were evaluated.[Result]All deformity of the knees were well corrected,the femoral angle were corrected from 71.7?(62?～75?) to 82.1?(78?～85?),the average correction angle was 10.4?(8?～21?).With average 1.5 year follow-up thirty four patients with 40 knees got good bone union,two knees had non-union and we changed the internal fixationwith bone autc-grafting and got good results,as well as lost follow-up for one knee.The pain relieved in 10 knees with lateral osteoarthritis and disappeared in 3 knees after operation.[Conclusion]Femoral supracondylar varus deformity of the knee,the technique is simple and damage is slight,fixation is safety and effective.

[Objective]To introduce the surgical technique of ceramic-on-ceramic total hip replacement and discuss the difference between two implant design.[Method]From November 2001 to June 2006,123 hip in 101 patients were treated by total hip arthroplasty with Osteonics ABC and Option Hip System.The prosthesis was fixed in strict position following some special technique for ceramic components.The theoretic range of motion of two hip systems were measured from experiment in vitro.The different cup positions which impingement happened were record for each prosthesises.[Result]The clinical score and the radiographic position of implants was good without evidence of wear,loosening,osteolysis and ceramic fracture.One chipping of ceramic insert happened during operation,and two patients had temporary irritation of iliopsoas.No other sever complication were found so far such as dislocation and infection.Experiment result:The deepened cup design obviously decreased the hip range of motion and "safe zone" was narrow than the flat cup design.[Conclusion]Ceramic-on-ceramic hip implant highly demands for surgical technique especially accurate cdp position.The deepened cup design cup should be posited with large anteversion.

[Objective]To investigate the method and effeciency of management massive acetabular bone defect with impaction bone grafting plus mesh in revision total hip arthroplasty[Method]Twenty-one patients 21 hips with massive acetabular bone defect were treated with impaction bone grafting plus mesh during Dec 2001 to Jan 2006,including 6 men and 15 women,the average age were 51.9 years at the revision operation(range,38~77 years).The acetabular defects of the patients in this study group were type III(combined defect)according to the American Academy of Orthopaedic Surgeons(AAOS)classification scheme.At first the combined defect was transformed into cavitary defect with metal mesh,then the contained acetabulum was tightly packed with deep-frozen morselized cancellous allograft chips(size 7~10mm),the anatomy of the hip was reconstructed and the cup was inserted after pressurizing the cement directly onto the graft.The AP view of the hip at 3 days,3 months,1 year and yearly after the operation were obtained,cup migration according to the teardrop and radiolucent line were evaluated,at the same time the Harris hip score were also evaluated.[Result]The mean follow-up time was 2.8 years,the mean Harris hip score improved from 46.4 points preoperatively to 81.3 points at the final evaluation,no cup migration were found,except for one dislocation and one sciatic nerve injury,as well as lost follow-up for one hip.[Conclusion]Impaction bone grafting plus mesh is an effective approach to treat massive acetabular bone defect in revision total hip arthroplasty,it can restore bone stock and help the cup to be placed to the anatomic position,as well as provide execellent prothesis stability.