Objective:To evaluate the clinical value of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (ICC) after surgical resection.Methods:A retrospective study was conducted on the clinical data of 156 patients who underwent surgery for ICC in Eastern Hepatobiliary Surgery Hospital of Naval Military Medical University from November 2010 to December 2017, including 94 males and 62 females, aged (60.0±9.5) years. Curative surgery was performed in 114 cases. Of 64 cases were in stage Ⅰ according to American Joint Committee on Cancer (AJCC), including 38 cases of non-lymph node dissection (NLND) and 26 cases of LND; 21 cases were in AJCC stage Ⅱ, including 11 cases of NLND and 10 cases of LND; 22 cases were in AJCC stage Ⅲb, including 14 cases of LND and 8 cases of lymph node resection (LNR); 5 cases were in AJCC stage Ⅲa, 2 cases were in AJCC stage Ⅳ. Univariate and multivariate Cox regression analysis were used for the risk factors of ICC prognosis. The log-rank test compared the survival rates of the two groups.Results:Cox multivariate analysis indicated that lymph node metastasis was independent risk factors for prognosis in patients with ICC ( HR=1.96, 95% CI: 1.09-3.55, P=0.026). A total of 114 patients were included in the curative surgery group. The 1-, 3-, and 5-year overall survival (OS) rates of the negative lymph node group ( n=91) were 65.9%, 47.3% and 35.6%, respectively, which were significantly better than those of the positive lymph node group ( n=23) who had 1-, 3-, 5-year OS rates of 56.5%, 17.7% and 0, respectively (χ 2=8.11, P=0.004 ). In stage Ⅰ and Ⅱ patients, there were no significant differences in 1-, 3-, 5-year OS rates between the NLND group and the LND group (both P>0.05 ). In stage Ⅲb patients, the LND group had 1-, 3-, 5-year OS rates of 71.4%, 29.8% and 0, respectively, significantly better than those of the LNR group who had 1-, 3-, 5-year OS rates of 37.5%, 0 and 0, respectively (χ 2=6.45, P=0.011). Conclusions:Lymph node metastasis is an independent risk factor affecting the prognosis of ICC. Lymph node dissection should be performed cautiously in ICC with AJCC stage Ⅰ and Ⅱ, while routine lymph node dissection is recommended in ICC with AJCC stage Ⅲb.

Allografts ; COVID-19 ; China/epidemiology* ; Disease Outbreaks ; Humans ; Kidney Transplantation/adverse effects* ; SARS-CoV-2

The human gut is populated by a complex community of microbiota that coexists with the host to maintain homeostasis.Macrogenomic and metabonomics analysis shows that the imbalance in gut microbiota composition and diversity, some bacterial components, metabolites and the signaling pathways mediated by them are involved in the occurrence and development of a variety of diseases, especially in the elderly.Intestinal microorganisms are one of the important factors affecting age-related diseases and can provide insights on treatment strategies for the elderly.This review focuses on the composition of the intestinal microbiota, interaction between the microbiota and the host, features of the gut microbiota in common geriatric diseases and pathogenic mechanisms.

Artificial joint replacement is an important means for the treatment of severe joint end-stage diseases such as hip and knee joint,which has obtained satisfactory clinical efficacy,but the postoperative periprosthetic osteolysis (PPO),which is mediated by wear particles,restricts the long-term effect of artificial joints.It is found that wear particles increase the expression of cytokines and inflammatory factors by stimulating the cells around the prosthesis,activate different signaling pathways,promote the imbalance between bone formation mediated by local osteoblasts and bone resorption mediated by osteoclast so as to lose of the local bone mass,and eventually produce osteolysis and aseptic loosening.This article reviews the different signal pathways activated by wear particles in recent years,in order to explore the pathogenesis of PPO and to open up new avenues for its prevention and treatment.

Objective: This study aims to analyze the effects of catastrophic disease insurance (CDI), especially to evaluate the influences of CDI on the discrepancy of benefits between the patients covered by the Employee's Medical Insurance (EMI) and the Resident's Medical Insurance (RMI).Methods: The data used in the study are collected from the health insurance database of Zhuhai City in the years of 2012 and 2014.A descriptive analysis is made to depict the general situation of CDI in the city, and a logistic regression model is used to analyze the factors that affect the probability to get the benefits of CDI.Moreover, a triple difference model is built up to probe into the CDI's effects on the discrepancy of reimbursement ratio between patients covered by EMI and RMI.Results: The benefits of CDI favor the patients with old age, high medical expenditures and chronic diseases.When other factors are controlled, patients covered by EMI have lower probability to get CDI benefits than those covered by RMI.Within the patients with high medical expenditures who have gotten the CDI benefits, those covered by EMI enjoy higher reimbursement ratio than those covered by RMI, but CDI decreases the discrepancy by 3.2%.Conclusions: Since the CDI gives more favor to the vulnerable population and narrows the gap of the benefits between EMI and RMI, the policy improves the equity of health security.

Objective: To search for biomarkers for human familial prion disease. Methods: Two-dimensional differential gel electrophoresis (2D-DIGE) proteomic analysis has been performed in frontal lobe tissues of 3 patients suffering from human familial prion disease (PrP) and 3 age-and sex-matched patients suffering from sudden death due to heart failure without neurological disease. Results: The maps revealed 14 polypeptide chains differentially modulated in the PrP samples, among those, 7 could be identified upon digestion and MALDI-TOF/MS analysis, of which 6 appeared to be up-regulated, 1 being down-regulated. Conclusions We highlight Galectin-1(Gal-1), ryanodine receptor 2 (RyR2), ubiquitin, Rab-interacting lysosomes protein-like protein 1 (RILPL-1) profillin 2 (PFN2), in the differential map. These proteins are related to neurogenesis, the clearance of misfolded proteins, stasis of calium channel, myoclonus and so on. These proteins are potential biomarkers or targets for treatment of prion disease.

Objective To investigate the effect of intrathecal injection of morphine on patients with severe rectum cancer pain.Methods According to random number table method,28 patients with severe rectum cancer pain,admitted to our hospital from April 2014 to April 2015,were divided into two groups:intrathecal injection of morphine group (group Ⅰ) and epidural injection of morphine group (group E,n=14).Patients in group Ⅰ were treated with intrathecal injection of morphine,and group E with epidural injection of morphine;initial dose of group Ⅰ was 1/300 of daily average dosage,and group E 1/30 of daily average dosage;the additional dose of two groups was 1/10 of initial dose,with a locked time of 30 min.Resting and moving visual analogue scale (VAS) scores,life scores of quality of life questionnaire (QLQ)-C30,and daily dose of morphine were observed on the day before analgesia (T0),first week after analgesia (T1),second week after analgesia (T2),and first month after analgesia (T3).Nausea and vomiting,skin itching,retention of urine,and headache were recorded at the four points.Results As compared with those at T0,the resting and moving VAS scores and daily dose of morphine were significantly lower,life scores of QLQ-C30 at the T1,T2 and T3 were significantly higher in both two groups (P＜0.05).As compared with those in group Ⅰ,the resting and moving VAS scores and daily dose of morphine in group E were significantly higher,life scores of QLQ-C30 in group E were significantly lower at the T1,T2 and T3 (P＜0.05).The incidence of complications in group Ⅰ (21.4％)was significantly lower than that in group E (71.4％).Conclusion The effect of analgesia with intrathecal injection of morphine is better than that of analgesia of epidural injection of morphine in the treatment of severe rectum cancer pain.

OBJECTIVETo compare the application valuable of flexible spatial scan statistics and kulldorff scanning window in the cluster detection and early warning of hepatitis A.

METHODSThe case numbers and incidence data of hepatitis A in 2012 for all the counties (cities, districts)in Yunnan province were collected from China Information System for Disease Control and Prevention and the total number was 1 335. By extracting the time length by month, the flexible spatial scan statistics was tested by retrospective analyses of hepatitis A data in Yunnan in 2012 and compared the results with the Kulldorff circular scan statistic analyses.

RESULTSThe results of flexible scanning window showed that there were fifteen hepatitis A spatial clusters in Yunnan province in 2012 and in July, these areas including Gejiu county, Mengzi county and Wenshan county had the strongest clusters (the log likelihood ratio (LLR) = 52.66, P = 0.001). The results of Kulldorff scanning window showed that there were twenty hepatitis A spatial clusters and these areas including Gejiu county, Hekou county, Maguan county, Mengzi county, Pingbian county, Wenshan county had the strongest clusters (LLR = 47.82, P = 0.001). The results of the flexible scanning window were the same as the actual monitoring results. But the results of Kulldorff scanning window showed that in May and June some areas without incidence had the clusters.

CONCLUSIONFlexible scanning window can detect the monthly clusters of the Hepatitis A. Flexible scanning window had a higher accuracy than Kulldorff irregular circular scanning window. Flexible spatial scan statistics had the value in the use of spatial aggregation detecting on hepatitis A.

Objective To compare the application valuable of flexible spatial scan statistics and kulldorff scanning window in the cluster detection and early warning of hepatitis A.Methods The case numbers and incidence data of hepatitis A in 2012 for all the counties( cities, districts) in Yunnan province were collected from China Information System for Disease Control and Prevention and the total number was 1 335.By extracting the time length by month, the flexible spatial scan statistics was tested by retrospective analyses of hepatitis A data in Yunnan in 2012 and compared the results with the Kulldorff circular scan statistic analyses.Results The results of flexible scanning window showed that there were fifteen hepatitis A spatial clusters in Yunnan province in 2012 and in July, these areas including Gejiu county, Mengzi county and Wenshan county had the strongest clusters(the log likelihood ratio(LLR) =52.66,P=0.001). The results of Kulldorff scanning window showed that there were twenty hepatitis A spatial clusters and these areas including Gejiu county, Hekou county, Maguan county, Mengzi county, Pingbian county, Wenshan county had the strongest clusters (LLR=47.82,P=0.001).The results of the flexible scanning window were the same as the actual monitoring results.But the results of Kulldorff scanning window showed that in May and June some areas without incidence had the clusters.Conclusion Flexible scanning window can detect the monthly clusters of the Hepatitis A.Flexible scanning window had a higher accuracy than Kulldorff irregular circular scanning window. Flexible spatial scan statistics had the value in the use of spatial aggregation detecting on hepatitis A.

Objective To compare the application valuable of flexible spatial scan statistics and kulldorff scanning window in the cluster detection and early warning of hepatitis A.Methods The case numbers and incidence data of hepatitis A in 2012 for all the counties( cities, districts) in Yunnan province were collected from China Information System for Disease Control and Prevention and the total number was 1 335.By extracting the time length by month, the flexible spatial scan statistics was tested by retrospective analyses of hepatitis A data in Yunnan in 2012 and compared the results with the Kulldorff circular scan statistic analyses.Results The results of flexible scanning window showed that there were fifteen hepatitis A spatial clusters in Yunnan province in 2012 and in July, these areas including Gejiu county, Mengzi county and Wenshan county had the strongest clusters(the log likelihood ratio(LLR) =52.66,P=0.001). The results of Kulldorff scanning window showed that there were twenty hepatitis A spatial clusters and these areas including Gejiu county, Hekou county, Maguan county, Mengzi county, Pingbian county, Wenshan county had the strongest clusters (LLR=47.82,P=0.001).The results of the flexible scanning window were the same as the actual monitoring results.But the results of Kulldorff scanning window showed that in May and June some areas without incidence had the clusters.Conclusion Flexible scanning window can detect the monthly clusters of the Hepatitis A.Flexible scanning window had a higher accuracy than Kulldorff irregular circular scanning window. Flexible spatial scan statistics had the value in the use of spatial aggregation detecting on hepatitis A.