Objective: To establish a new scoring system based on the clinicopathological features of hepatocellular carcinoma (HCC) to predict prognosis of patients who received hepatectomy. Methods: A total of 845 HCC patients who underwent hepatectomy from 1999 to 2010 at Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. 21 common clinical factors were selected in this analysis. Among these factors, the cut-off values of alpha-fetoprotein (AFP), alkaline phosphatase (ALP) and intraoperative blood loss were evaluated by using a receiver operating characteristic (ROC) curve analysis.The Kaplan-Meier method and Cox regression model were used to evaluate the independent risk factors associated with the prognosis of HCC patients after hepatectomy. HCC postoperatively prognostic scoring system was established according to the minimum weighted method of these independent risk factors, and divided the patients into 3 risk groups, including low-risk, intermediate-risk and high-risk group. The relapse-free survival (RFS) and overall survival (OS) were compared among these groups. Results: The univariate analysis showed that clinical symptoms, preoperative α-fetoprotein (AFP) level, serum alkaline phosphatase (ALP) level, tumor size, tumor number, abdominal lymph node metastasis, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, the severity of hepatic cirrhosis, intraoperative blood loss, the liver operative method, pathological tumor thrombus, intraoperative blood transfusion, perioperative blood transfusion were significantly associated with median RFS of these HCC patients (P<0.05). Alternatively, clinical symptoms, preoperative AFP level, serum ALP level, tumor size, tumor number, abdominal lymph node metastasis, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, the severity of hepatic cirrhosis, intraoperative blood loss, the liver operative method, pathological lymphocyte invasion, pathological tumor thrombus, intraoperative blood transfusion, perioperative blood transfusion were significantly associated with the median OS of these HCC patients (P<0.05). The multivariate analysis showed that AFP ≥20 ng/ml, clinical symptoms, tumor diameter ≥5 cm, multiple tumors, macrovascular invasion or tumor thrombus, extrahepatic invasion or serosa perforation, moderate and severe liver cirrhosis, non- anatomic resection were the independent risk factors of RFS and OS (P<0.05). The independent risk factor of RFS was intraoperative bleeding loss ≥325 ml (P<0.05); The independent risk factors of OS were abdominal lymph node metastasis and pathological tumors thrombus (P<0.05). The respective weight of 11 independent factors was used to establish the scoring system (scores range from 0 to 26). In the score system, 0 to 5 points were defined as the low-risk group (286 cases), 6 to 12 points were determined as the intermediate-risk group (503 cases), more than 13 points were classified as the high-risk group (56 cases). The median RFS of the low-risk, intermediate-risk and high-risk group were 80, 27 and 6 months, respectively. The differences were statistically significant (P<0.001). The median OS of the three groups were 134, 51 and 15 months, respectively, and the differences were statistically significant (P<0.001). Conclusion This new score system provides effective prediction of postoperative prognosis for HCC patients.

To investigate the inhibitory effect of wogonin on glucose metabolism in human gastric carcinoma MGC-803 cells and its underlying mechanism, Amplex Red Glucose/Glucose Oxidase Assay Kit was used to explore the influence of wogonin on glucose uptake of MGC-803 cells and lactate assay kit was adopted to evaluate the lactate generation of MGC-803 cells. Annexin V/PI staining assay was performed to observe the apoptotic rate of MGC-803 cells. Changes in the expression of hexokinase 2(HK II), glucose transporter 1(GLUT1), pyruvate dehydrogenase kinase(PDHK)and lactate dehydrogenase A(LDH-A)were assessed by Western blot. These results demonstrated that wogonin significantly reduced glucose uptake of MGC-803 cells at certain concentration. Meanwhile, wogonin apparently reduced the lactate generation of MGC-803 cells, without inducing notable cell apoptosis. Besides, with the impact of wogonin, the expression of glucose metabolism related proteins declined obviously. In a word, wogonin could inhibit the glucose metabolism of MGC-803 cells without inducing apparent apoptosis, which may be related to its inhibitory influence on the proteins in glucose metabolism of MGC-803 cells.

Objective To choose optimal concentration and volume of Gd-DTPA solution as a oral gastrointestinal negative contrast agent for MRCP.To evaluate the role of Gd-DTPA solution in improving image quality of MRCP.Methods In vitro experiment:Gd-DTPA solution was made with different concentrations.T1WI,T2WI,two-dimensional single slice fast spin echo sequence and three-dimensional half-fourier acquisition single-shot fast spin echo sequence were performed to measure the signal intensity of these contrast agents respectively,so Gd-DTPA solution with the optimal concentration can be decided as oral negative gastrointestinal contrast agent on MRCP.Clinical study:The Gd-DTPA solution with optimal concentration and volume was regarded as an oral negative gastrointestinal contrast agent of MRCP.Twenty-four patients were performed with MRCP before and after (5--10 minutes and 10--15 minutes)administration of oral negative gastrointestinal contrast agent and image quality was analyzed.Statistical analysis was performed using analysis of variance with SPSS 10.0.Results When the concentration of Gd-DTPA solution was ≤0.01 mol/L,the contrast agent was hyperintense on T1WI.On T2WI,when the concentration was ≥0.015 mol/L,it was as hypointense as basic ground; On 2D FSE MRCP images,controls were hyperintense and the contrast agent with concentration ranging from 0.0025 mol/L to 0.03 moL/L was hypointense.On 3D HEAST MRCP image,controls were hyperintense and when the eoncentration of Gd-DTPA was ≥0.01 mol,the contrast agent was hypointense.The Gd-DTPA solution with the concentration of 0.01 mol/L and the volume of 100 ml was chosen as MRCP oral negative gastrointestinal contrast agent.On MRCP images after oral administration of the contrast agent,in 10-15 minutes,the average grade scores within 24 patients of the intrahepatic bile duct,the common hepatic bile duct,the gall bladder,the common bile duct and pancreatic duct(the average grade scores were respectively 3.63,3.46,3.08,3.71,3.87,3.88,3.79,3.71,3.50) were somehow higher than in 5--10 minutes(the average grade scores were respectively 3.54,3.46,3.00,3.79,3.96,3.87,3.71,3.67,3.54),but showed no statistical difference(P>0.05).However,the scores of the third branch of the intrahepatic bile duct,the common bile duct and pancreatic duct after oral administration of the contrast agent were significantly higher than those before administration of oral contrast agent(the average grade scores were respectively 2.79,3.71,3.50,3.42,3.25) (F=4.36,4.75,7.86,8.05,7.55,P<0.05).Conclusion The0.01 mol/L oral Gd-DTPA contrast agent is optimal because it can suppress the high signal from the retention of the stomach and duodenum completely.It can be regarded as MRCP oral negative gastrointestinal contrast agent.After oral contrast administration,the image quality of MRCP is improved obviously and the pancreaticobiliary tree is clear 5-10 minutes later.

Objective To investigate the clinicopathologic features and treatment of thyroid microcarcinoma (TMC). Methods From January 1997 to December 2006,311 patients who underwent surgery and defined as TMC(tumor size≤1 cm)were enrolled. Results TMC was identified incidentally by frozen pathologic examination on thyroidectomy specimens in tentative benign goiters in 181 patients; another 130 patients with clinically detectable primary tumors or suspected nodal metastases were grouped to as clinically overt TMC. The clinically overt TMC had a higher incidence of bilateral multifocal tumors (18.5%vs.9.4%,P=0.03),and cervical lymph node metastases(27.7%vs.10.5%,P=0.000)than that in clinically occult TMC group. Conclusion TMC may vary considerably in clinical and biologic behaviors between these two subtypes: clinically overt and occult. Lobectomy for single lesion, total or near total thyroidectomy for multifocal with central compartment nodal dissection should be performed, lateral nodal dissection was not carried out unless US or physical examination detected nodal metastases. Lobetomy, subtotal or more limited thyroidectomy for occult TMC, diagnosed incidentally following thyroid surgery for initially tentative benign thyroid disease, could all be treatment of choice depending on the preference of surgeons.

BACKGROUND: Biliary complications are the common complication of liver transplantation. However, it is difficult to find the complications, since no obvious characteristic signs on the patients. Magnetic resonance imaging (MRI), especially,magnetic resonance cholangiopancreatography (MRCP) may provide a comprehensive evaluation of the functions and complications of the transplanted liver as a safe, noninvasive and exact technique.OBJECTIVE: To evaluate the manifestation of biliary system after liver transplantation by MRCP and its value of diagnosis of biliary complications.DESIGN: Comparative observation.SETTING: Medical Imaging Center, Nanfang Hospital, Southern Medical University.PARTICIPANTS: A total of 13 male liver transplantation patients aged from 40-58 years, who received imaging examination at Medical Imaging Center, Nanfang Hospital, Southern Medical University from January 2003 to January 2005, were enrolled. Original causes of liver failure included cirrhosis (n =11) and primal hepatic carcinoma (n =2). Ten received orthotopic liver transplantation, while 3 received piggyback orthotopic liver transplantation. Anastomotic mode of bile duct was common bile duct end-to-end anastomosis. The interval between transplantation and MRI examination ranged from 15 days to 1 year. All patients knew the items of examination and agreed to participate in the experiment.METHODS: Thirteen patients with orthotopic liver transplantation underwent turbo spin-echo (TSE) and fast low angle shot (FLASH), MRCP, Gd-DTPA enhanced MRI to analyze the characteristics of each imaging after liver transplantation.MAIN OUTCOME MEASURES: The imaging findings of the reestablished bile duct and complications of bile duct at MRCP.RESULTS: The diameters of bile duct and caliber were normal, no stricture on anastomotic stoma in 3 patients.Thick-section planes of MRCP did not develop biliary duct of one case. Biliary dilation occurred in 8 patients. There were 5 cases of biliary strictures and 2 cases of choledochus stone. Mucocele of bile duct remnant was identified in 2 cases.Bile leakage occurred in 1 case after T-tube was removed. Rejection reaction occurred in 2 cases.CONCLUSION: MRCP not only can display the image of reestablished biliary tract after liver transplantation, but also can exactly diagnose complications rapidly.

Objective:To improve the accuracy of the rotary manipulations of the neck in the treatment of neck pain, according to subjective and objective clinical findings. Methods: Two groups of 60 outpatients diagnosed with neck pain were suited to the manipulation and each group was 30 cases. The diagnosis of neck pain was made with conventional clinical evaluation, including history, palpation examinations, CT scan and X-ray. Group A received a manipulation of obliquely pulling the neck. While group B received manipulation of pulling the rotated and located neck. Subjects received a maximum of 10 treatments over a 3-week treatment period. Both treatment groups were assessed with subjective (cervicodynia, neck discomfort, upper limb numbness, vertigo and tinnitus) and objective (cracking sounds). The cracking sounds during two of the manipu1ations were recorded by a microphone positioned at both sides of the neck. The sounds were compared in patients of two groups. Statistical analysis was conducted with a one-factor within-subjects analysis of variance tests and descriptive statistic. Results: Analysis of the subjective indicated that the cases with upper limb numbness were reduced from 12 to 6 in group 2, while the cases with vertigo and tinnitus were reduced from 13 to 4 in group 1. Analysis of the objective indicated two kinds of neck rotary manipulations act not only on the rotary-side facet joints, but on the opposite to the rotary side on1y in a few cases. The results showed that manipulation of pulling the rotated and located neck has a small action range and centralized action points, while manipulation of obliquely pulling the neck has many action segments and discentra1ized action points. Conclusion: It was concluded that the rotary manipu1ations act mainly on the rotary side, not on the opposite, and that manipulation of obliquely pulling the neck has a wider action range and a better therapeutic effect on cervical upper-segment lesions, while manipulation of pulling the rotated and located neck has a limited action range and is suitable for cervical lower-segment lesions. There were some relations between the joint sounds during the manipulation and clinical curative effect.

Objective To study the relationship between drug resistance and expression of the gene associated with drug resistance in Candida albicans,as well as the secretory proteinase activity of these isolates.Methods The minimum inhibitory concentrations(MIC)to fouconzole and itraconazole in 99 strains of Candida albicans isolated from respiratory tract were measured by broth microdilution method,the M27-A protocol recommended by NCCLS.The gene expressions of CDR1 and MDR1 were semi-quantitatively determined by RT-RCR.The secretory proteinase activity of these isolates was assayed by plate with medium containing bovine serum albumin.Results The rates of drug resistance to fluconzole and itraconazole were 4% and 12.1% respectively.CDR1 expression in the susceptible dose-dependent(S-DD)isolates was higher than those in the susceptible isolates and drug-resistant isolates(P

Objective To study the MRI characteristics of osteoblastoma and to discuss its diagnostic value. Methods Nine patients with osteoblastoma proved by pathology were examined with T_2WI, nonenhanced T_1WI and Gd-DTPA enhanced T_1WI MR imaging before operation MR finding were analyzed. Results Of nine patients, tumor originated from spine in five patients, from skull in three patients and from pelvis in one patient. Of these patients, benign osteoblastoma were in six patients and malignant were in three patients. On MRI, the tumor was an expanded osteolytic lesion, osteoid production formation was low or equal signal intensity on T_1WI and medial or high signal intensity on T_2WI. MRI showed low signal intensity of the calcification or ossification in osteoblastoma on T_2WI, and low or equal signal intensity on T_1WI. The ossified ring of tumor was low signal intensity on both T_1- and T_2WI. The adjacent soft tissue masses were showed on MRI. All patients given gadolinium showed enhancement within the osteoid production and the adjacent soft tissue mass, and no enhancement with ossification and calcification, cystoid and the ossified ring on MRI. The boundary of malignant osteoblastoma was obscure, and adjacent tissue could be invaded.Conclusion MR imaging can show all the characteristics of osteoblastoma well . It is of important value in diagnosis, operative orientation and staging of osteoblastoma, especially for the lesion originated from spine and skull.

Objective To explore the value of CT in diagnosing abdominal leiomyosarcoma.Methods CT findings of abdominal leiomyosarcomas conformed pathologically in 9 patients were analyzed.Results The tumors localized in peritoneum in 3 cases,in stomach in 3 cases,in rectum,colon and uterus in 1 case respectively.On plain CT scan,the tumors appeared as unhomogeneous dense masses with mecrosis at the centre,the periphery of tumors was flocculation or ringlike,and having fluid-fluid level in 1 case.The delayed peripheral enhancement on contrast CT could be seen.Conclusion CT imaging can help to diagnosis the abdominal leiomyosarcoma.

Objective To study the values of quantitative assessment of extraocular muscles in diagnosing the thyroid associated ophthalmopathy(TAO).Methods The maximum section area,short and long diameters of extraocular muscles on orbital coronal CT were measured and the value of R was calculated in 50 healthy persons and 50 patients with TAO.Results The maximum section areas of 228 extraocular muscles in 50 patients with TAO increased,of them,inferior rectus(30.3%) and mediate rectus muscle(23.2%) were common,followed by superior rectus,lateral rectus and superior oblique muscle.Their maximum section areas(70.21 mm2,56.93 mm2,64.06 mm2,58.51 mm2,20.65 mm2,respectively) and the values of R(0.61,0.55,0.61,0.50,0.52,respectively) were larger than that in healthy group(27.72 mm2,27.07 mm2,26.93 mm2,36.74 mm2,9.42 mm2 respectively in maximum section areas) and(0.41,0.35,0.60,0.34,0.44 in the values of R,respectively).There were statistical significant differents between them.Conclusion The quantitative coronal CT measurement,especially the values of R can assess enlargement of extraocular muscles accurately,which may be helpful in diagnosis of TAO.