Tumor budding is a distinct pathomorphological feature observed in various types of solid tumor. In recent years， tumor budding has been recognized as an important biological feature associated with tumor invasion and metastasis， and it has become a new focus in the research on tumor progression. Although studies have explored the role of tumor budding in different types of tumor， there are studies in the field of hepatocellular carcinoma （HCC）. This article systematically reviews the research advances in tumor budding in HCC， with a focus on the mechanism of tumor budding， the association between tumor budding and tumor progression， and the potential application of tumor budding in prognostic assessment， in order to provide new insights and strategies for the early diagnosis and treatment of HCC.

Objective:To compare clinical features of patients with pyogenic liver abscesses with and without septated lobulations.Methods:Patients diagnosed to have pyogenic liver abscesses who were treated in our hospital from January 2011 to March 2021 were enrolled into this retrospective study. There were 203 males and 132 females, with age of (56±14) years old. The patients were divided into two groups by findings on computed tomography and ultrasound into the septated lobulation group ( n=68) and the non-septated lobulation group ( n=267). The clinical data of these patients were compared. Results:In the septated lobulation group, the neutrophil count was 9.17(5.97, 12.33)×10 9/L and the TBil was 17.65(11.92, 27.84) μmol/L. These were significantly higher than the corresponding figures of 7.81(5.42, 10.81)×10 9/L, 12.90(9.00, 19.68) μmol/L, respectively in the non-septated lobulation group ( P<0.05). The difference in the maximum diameters of the septated lobulation group was also significantly larger than the non-septated lobulation group ( P=0.032). Additionally, pus culture showed the proportion of Klebsiella pneumoniae positive patients in the septated lobulation group was significantly higher than that in the non-septated lobulation group [41.18% (28/68) vs. 25.84% (69/267), P=0.013]. The use of fluoroquinolones in patients in the septated lobulation group was higher than that in the non-septated lobulation group [20.59% (14/68) vs. 10.11% (27/267), χ 2=5.54, P=0.019]. Conclusion:Compared to patients without septated lobulations, those with septated lobulations had a larger diameter of abscesses, a higher positive rate of Klebsiella pneumoniae on pus culture and a higher proportion of patients receiving fluoroquinolones.

OBJECTIVE: To determine the carrier rate for 21 inherited metabolic diseases among a Chinese population of childbearing age. METHODS: A total of 897 unrelated healthy individuals (including 143 couples) were recruited, and DNA was extracted from their peripheral blood samples. Whole exome sequencing (WES) was carried out to screen potential variants among 54 genes associated with 21 inherited metabolic diseases. Pathogenic and likely pathogenic variants and unreported loss-of-function variants were analyzed. RESULTS: One hundred fourty types of pathogenic/likely pathogenic variants (with an overall number of 183) and unreported loss-of-function variants were detected, which yield a frequency of 0.20 per capita. A husband and wife were both found to carry pathogenic variants of the SLC25A13 gene and have given birth to a healthy baby with the aid of preimplantation genetic diagnosis. The detected variants have involved 40 genes, with the most common ones including ATP7B, SLC25A13, PAH, CBS and MMACHC. Based on the Hardy-Weinberg equilibrium, the incidence of the 21 inherited metabolic diseases in the population was approximately 1/1100, with the five diseases with higher incidence including citrullinemia, methylmalonic acidemia, Wilson disease, glycogen storage disease, and phenylketonuria. CONCLUSION This study has preliminarily determined the carrier rate and incidence of 21 inherited metabolic diseases among a Chinese population of childbearing age, which has provided valuable information for the design of neonatal screening program for inherited metabolic diseases. Pre-conception carrier screening can provide an important measure for the prevention of transmission of Mendelian disorders in the population.
Asians/genetics* ; China ; Exome ; Female ; Humans ; Infant, Newborn ; Metabolic Diseases/genetics* ; Mitochondrial Membrane Transport Proteins/genetics* ; Oxidoreductases/genetics* ; Whole Exome Sequencing

Objective:To explore whether CT image post-processing software can accurately measure (associating liver partition and portal vein ligation for staged hepatectomy, ALPPS) related (future liver remnant, FLR).Methods:Clinical data of 9 liver cancer patients undergoing ALPPS were retrospectively analyzed in the Second Affiliated Hospital of Air Force Military Medical University from Mar 2015 to May 2019. All cases were divided into 2 groups by measurement: CT′s image post-processing software, or Myrian software. Two groups were compared with each other by paired t-test. Results:FLR from group CT′s image post-processing software was larger than that by Myrian software, there was statistical difference ( t=2.512, P=0.019). The mistakes of FLR measurements by the radiologist using CT′s image post-processing software couldbe caused by: (1)Lacking theoretical knowledge of liver surgery; (2) Adding devitalized tissue of hepatic section into future liver remnant; (3) Concept confusion about liver anatomy; (4) Lack of precision measurement. Conclusions:The inaccuracies generated during the ALPPS related future liver remnant measurements in CT′s image post-processing technique are all caused by human factors. These problems could be solved if the radiologist who operates 3D reconstruction receives liver surgery training or works with liver surgeons.

ObjectiveTo investigate the role of radionuclide hepatobiliary scintigraphy in the evaluation of gallbladder contraction function, and to provide a theoretical basis for preoperative evaluation of gallbladder contraction function in patients undergoing laparoscopic-hard endoscopic gallbladder-preserving cholecystolithotomy. MethodsA total of 47 patients with gallstones who were admitted to The Second Affiliated Hospital of Air Force Medical University from June to December, 2016, and underwent 99mTc-EHIDA hepatobiliary imaging to evaluate gallbladder contraction function were enrolled. The radioactive count of the gallbladder was measured after fat meal and gallbladder contraction function was evaluated. A comparative analysis was performed based on intraoperative exploration and gallbladder-preserving outcome. ResultsA total of 26 patients with negative results of the EHIDA gallbladder contraction test underwent a successful gallbladder-preserving surgery, and some of them had no recurrence of stones after 24 months of follow-up. Among the 12 patients with impaired gallbladder contraction function shown by EHIDA, 1 underwent cholecystectomy due to roughness of the gallbladder wall and deposition of a large amount of cholesterol crystal, and 11 underwent gallbladder-preserving cholecystolithotomy. Among the 9 patients without the image of the gallbladder, 1 was found to have stones with a diameter of 2 cm embedded in the neck of the gallbladder by intraoperative exploration and underwent gallbladder-preservation surgery, and no recurrence of gallbladder stones was observed after 24 months of follow-up; the remaining 8 patients underwent cholecystectomy. Conclusion99mTc-EHIDA hepatobiliary scintigraphy has a certain value in evaluating gallbladder contraction function, but it cannot be used as the only evidence for the selection of surgical approach. Laparoscopic-hard endoscopic intraoperative exploration is a strong evidence for the selection of gallbladder-preserving surgery, and formal industry standards can be developed.

Objective To evaluate the laparoscopic splenectomy and pericardial devascularization in patients with portal hypertension.Methods In this study,205 patients who underwent splenectomy and pericardial devascularization in the Second Hospital of Air Force Medical University between Jan 2013 and Jan 2018 were divided into 135 patients undergoing laparoscopic surgery(LSD group) and 70 patients undergoing open surgery (OSD group).Results Operation time,intraoperative blood loss,intraoperative blood infusion,time of postoperative abdominal drainage-tube removal,time of gastrointestinal function recovery and duration of hospital stay were respectively (150 ± 37) min,(223 ± 129) ml,(91 ± 138) ml,(4.0 ± 1.0)d,(33 ±9)h,(5.6 ± 1.0)d in the LSD group,(183 ±42) min,(346 ± 131) ml,(214 ± 182) ml,(5.5 ± 1.3)d,(42 ± 14)h,(7.5 ± 1.4)d in the OSD group,with statistically significant differences between groups(t =-2.203,-4.980,-2.830,-5.553,-2.307,-6.635,all P ＜ 0.05).The main complications included pancreatic fistula,intra-abdominal bleeding,intra-abdominal infection,pulmonary infection,refractory ascites,portal vein system thrombosis and incision infection,and there were respectively 0,1,2,2,3,13,0 in the LSD group and 3,4,6,6,7,14,3 in the OSD group,with statistically significant differences between groups (x2 =5.872,4.792,6.179,6.179,6.010,4.335,5.872,all P ＜ 0.05).All the 205 patients received follow-up for a median time of 38 months (12-72 months).Gastroscopy showed improvement of esophageal and gastric varices in postoperative 6 months.Conclusion Laparoscopic splenectomy and pericardial devascularization for the treatment of portal hypertension is safe,feasible and effective.

Objective To investigate the expressiorn of microRNA-622(miR-622) and dual specificity tyrosine phosphorylation-regulated kinase 2 (DYRK2) in colon cancer tissues and cell lines and explore the effect of miR-622 on SW11l6 cells migration and invasion.Methods Eighty-two colon cancer tissues and paired para-tumor tissue specimens were collected.C.olon cancer cell line SW1116,SW480 and normal human colon epithelial cell line NCM460 were cultured.MiR-622 was detected by using Real time PCR,DYRK2 expression was measured by using immunohistochemistry,Real time PCR anid Western blot in tissue level and cell level,respectively.The relation of miR-622 and DYRK2 was analyzed by Pearson correlation analysis.miR-622 mimics transfection was conducted to up-regulate miR-622,while negative control,NC group were transfected with control sequence.Expression of DYRK2 was evaluated by using Real time PCR and Western blot,while Transwell chamber assays were used to assess the migration ability changes.Results Real time PCR and Western blot results showed that miR-622 mRNA was highly expressed in colorectal cancer tissue and colon cancer cell SW1116,whereas DYRK2 mRNA and protein were lowly expressed when compared with paracancerous tissue and normal colonic epithelial cell line NCM460.An obvious negative correlation was showed between miR-622 and DYRK2(r=0.916,P＜0.01).Compared to NC group,DYRK2 mRNA and protein expression were down-regulated after transfection of miR-622 mimics,which was observerd through Real time PCR and Western blot(P＜0.01).Correspondingly,compared to NC group,the migration ability of SW116 was remarkably enhanced after transfection of miR-622 mimics(P＜0.01).Conclusion The expression of miR-622 is high and DYRK2 is low in colon cancer.Up-regulation of miR-622 could negatively regulate DYRK2 expression and promote SW1116 cells migration.

Objective To evaluate the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) in the treatment of bile duct calculi. Methods Clinical data of 236 patients with bile duct calculi in Shaanxi Provincial People's Hospital between September 2012 and March 2015 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 98 males and 138 females, aged from 15-95 with a median of 58 years old. Laparoscopic surgery was performed via four-port approach. The anterior wall of common bile duct was cut in a length of 0.5 to 1.5 cm below the junction of cystic duct and common bile duct. Calculi were removed with a choledochoscope under laparoscope. After the calculi were removed completely, incision of the common bile duct was primarily sutured with 4-0 absorbable thread or a T tube was placed for drainage. Results LCBDE was performed successfully on 233 patients, with a rate of conversion to open laparotomy 1.3%(3/236), including 1 case was converted to laparotomic radical cholecystectomy for gallbladder carcinoma, 2 cases receiving laparotomic hepaticojejunostomy for hilar bile duct stricture. 225 cases underwent common bile duct exploration, 8 cases underwent cystic duct exploration. 161 cases underwent primary suture of common bile duct, and 72 cases received placement of T tube. The calculi incarcerated in the lower end of common bile duct or deep located at intrahepatic bile duct in 16 cases were removed completely after lithotripsy under a choledochoscope. The median length of operation was 95(60-225) min, the intraoperative blood loss was 60(20-250) ml, and the postoperative length of stay was 6.5(4.0-15.0) d. No perioperative death was observed, and the incidence of postoperative complications was 6.9%(16/233), including 9 cases of bile leakage, 3 cases of residual calculi, 3 cases of mild pancreatitis and 1 case of peritoneal effusion. The patients were followed up for 10-40 months, and no recurrent calculi or biliary stricture occurred. Conclusions LCBDE is a safe and effective minimally invasive surgical treatment for patients with bile duct calculi, which is characterized by less trauma, rapid recovery and less complications.

Objective To investigate the causes and treatments for the congestion after pig-tail catheter drainage of liver abscess.Methods Clinical data of 3 patients with complicated liver abscess admitted to Tangdu Hospital of Air Force Military Medical University from April 2016 to January 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Case 1,male,aged 84 years;Case 2,female,aged 57 years;Case 3,female,50 years.The pig-tail catheter was clogged after being placed in 3 patients for drainage and the drainage catheters were therefore rotated clockwise or counter clockwise.Results After multiple rotations,the head end of drainage catheter was loosened and unclogged and necrotic tissues was drained out.Mild or moderate fever was observed in cases 1 and 3 after rotating the pig-tail catheter,which was relieved spontaneously.3 patients presented with mild bleeding after rotating the catheter and no significant change was noted in Hb.After the drainage catheter was unobstructed,the fever was relieved and all were cured and discharged.No recurrence was observed at postoperative 1 year.Conclusions For the intractable congestion of pig-tail catheter in liver abscess patients,rotating and loosening the catheter can be a good appoach.