Photorhabdus virulence cassette promotes bacterial invasion into macrophages by activating NF-κB and MAPK signaling pathway / 生物工程学报

Photorhabdus is a Gram-negative bacterium from the family Enterobacteriaceae that lives in a symbiotic association with nematode or insects. In addition to the role of being insect pathogens, one species called Photorhabdus asymbiotica (Pa) causes human infection around the world. Nevertheless, how does this transkingdom infection occur remains elusive. Here we focus on one pathogenic determinant called Photorhabdus virulence cassette (PVC) that is founded in the Pa genome and many other pathogens. The RNA-seq and qPCR data showed that the NF-κB and MAPK pathways were drastically activated in the PVC-treated mammalian macrophages. Western blotting assays using samples treated with various inhibitors of the affected pathways confirmed the results we have observed for MAPK pathway previously. p65 translocation assays validated the NF-κB activation in the macrophages after PVC treatment. Moreover, the bacterial phagocytosis by macrophage was also promoted by PVC at the early stage, and this phagocytosis was inhibited by cytoskeleton inhibitors. Thus, the results indicated that PVC is involved in the bacterial invasion by activating NF-κB and MAPK signaling pathway, providing a new perspective for analyzing the pathogenicity of Pa in human infections.

FOLFIRINOX in treatment of pancreatic cancer: a single-institutional experience / 中华肝胆外科杂志

Objective:To review the clinical efficacy and safety of the FOLFIRINOX (oxaliplatin, irinotecan, leucovorin, fluorouracil) regimen in treatment of pancreatic cancer.Methods:The clinical data of 31 patients with pancreatic cancer who were treated with the FOLFIRINOX regimen from July 2016 to December 2019 at the Department of General Surgery, China-Japan Friendship Hospital were retrospectively analyzed. For the 20 males and 11 females who were enrolled into this study, their age ranged from 29 to 80 years (mean 56.9 years). The FOLFIRINOX regimen was used as neoadjuvant therapy in 12 patients, postoperative therapy in 10 patients with liver-metastases, and postoperative adjuvant therapy in 9 patients (as second-line chemotherapy in 7 patients and as first-line chemotherapy in 2 patients). The clinical efficacy and adverse reactions of chemotherapy were evaluated.Results:In this study, 8 patients received the modified FOLFIRINOX regimen. Of the remaining 23 patients who received the standard FOLFIRINOX regimen, 10 (43.3%) were converted to the modified regimen because of adverse events. On clinical efficacy evaluation after neoadjuvant therapy: 5 patients achieved partial remission (PR), 3 stable disease (SD) and 4 progression disease (PD). The disease control rate (DCR) was 66.7% (8/12). For 10 patients got remission of abdominal pain, 5 patients underwent surgical resection. For the 10 patients with liver-metastases, 6 achieved PR, 1 SD, 3 PD. For 7 patients got disease control. For 8 patients had remission of abdominal pain, 1 patient underwent surgical resection. For the 7 patients who received second-line chemotherapy, 2 achieved PR and 5 PD. No tumor recurrence or metastases were found in the two patients after the first-line chemotherapy. Adverse events above grade three in all the patients included neutropenia in 12 patients (38.7%), leukopenia in 7 patients (22.6%) and thrombocytopenia in 1 patient (3.2%).Conclusions:The FOLFIRINOX regimen was efficacious with a high DCR rate and controllable adverse events. Balancing its efficacy and safety showed this regimen to be beneficial to patients with pancreatic cancer.

The impact of arterial injury level on blood supply of distal limb in lower limb trauma / 中华骨科杂志

Objective To explore the impact of arterial injury on distal limb blood supply in lower limb trauma. Meth?ods Retrospective analysis of 93 patients with different levels of lower limb arterial injury admitted to our hospital from June 2014 to August 2017. There were 84 males and 9 females aged 43.54±9.90 years (ranging 25-65 years). Revascularization was performed through open reduction. Patients were divided into three groups according to their arterial injury locations. Proximal ves?sels were along the superficial femoral artery, from its beginning to the point where it was divided into the descending genicular ar?tery and direct periosteal branches. Intermediate vessels were from the dividing point on the superficial femoral artery to the popli?teal artery before it was divided into the medial inferior genicular artery. Distal vessels were from the dividing point on the poplite?al artery to the distal end of the peroneal artery. The duration from injury to revascularization in the three groups were 13.67±5.99 h, 11.15±4.43 h, and 11.92±5.48 h, respectively. There was no significant difference between groups (F=1.564, P=0.215). ISS in the three groups were 13.00±3.74, 12.77±3.81, and 11.50±3.99, respectively. There was no significant difference between groups (F=1.445, P=0.241). The following items were compared among the three groups, postoperative creatine kinase, arterial blood lac?tate and limb compartment cut. Results Creatine kinase of the intermediate vascular group was 8 743.15±6 968.48 u/L, proximal vascular group 1 467.67±1 810.27 u/L, distal vascular group 2 893.51±1 304.56 u/L. The data of intermediate vascular group were higher than those of proximal and distal vascular groups with significant difference among the groups (F=22.587,P=0.000). The lactate of the intermediate vascular group was 3.20 ± 1.51 mmol/L, proximal vascular group 1.63 ± 0.46 mmol/L, distal vascular group 1.85±0.69 mmol/L with significant difference among the groups (F=20.612,P=0.000). The compartment cut of the intermedi?ate vascular group was incised in 24, but not in 15. The proximal vascular group was not incised in 18, while 15 was incised and 21 not incised in distal vascular group. The rates of compartment cut were 61.5%, 0 and 41.7%, respectively with significant differ? ences (χ2=19.156, P=0.000). Conclusion In lower limb injuries, the intermediate vascular (from the superficial femoral artery after it is divided into the descending genicular artery and direct periosteal branches to the popliteal artery before it is divided into the medial inferior genicular artery) injury leads to the most severe distal limb ischemia.

Laparoscopic partial splenectomy for splenic solid lesions / 中华普通外科杂志

Objective To analyze the safety and clinical effects of laparoscopic partial splenectomy for splenic solid benign lesions.Methods Retrospective analysis was made on patients with splenic solid benign tumor admitted from Jan 2015 to Feb 2017.Results 6 patients (4 males,2 females) underwent successful partial splenectomy for splenic tumors.Mean patient age was 44.7 years (range,28-58 years).5 patients were diagnosed by wellness examinations,1 patient had abdominal discomfort.The diameter of tumors ranged from 5.0 to 8.3 cm.Tumors were located in the superior lobes in 2 cases and the others were located in the inferior lobes.The operation times were 120-240 min and intraoperative blood loss was 50-1 400 ml (mean,375 ml).Laparoscopic procedure was successful in all patients without major complications.Postoperative pathology showed hemangioma in 5 cases and hemangioendothelioma in one patient.After 3 to 28 months follow-up no patients experienced recurrence.Conclusions Laparoscopic partial splenectomy is safe and effective in patients with focal benign splenic lesion that was located at the edge of the spleen or in the upper or lower pole of the spleen.

Surgical treatment for giant liver hemangioma: an expeience on 119 cases / 中华普通外科杂志

Objective To summarize the experience of surgical treatments for giant liver hemangioma.Methods A retrospective study was made on the clinical data of patients with liver hemangioma larger than 10 cm in diameter,which were divided into two groups (10-＜ 20 cm,88 cases,≥ 20 cm,31 cases).Data included age and gender,presentation,treatment methods,peri-operative indexes,and complications.Results All patients complained symptoms,the average diameter was (16 ± 7) cm.There were 23,7,and 17 cases respectively with anemia,thrombocytopenia and hypofibrinogenemia,all were more often seen in ≥20 cm group (P ＜ 0.001).Five patients were diagnosed as Kasabach-Merritt syndrome in ≥20 cm group.Patients in ≥20 cm group also had greater rates of compression of the porta hepatis (P ＜ 0.001).Patients in ≥ 20 cm group were treated more often by hepatic resections,while enucleations was often done in 10-＜20 cm group.The ≥20 cm group had more blood loss (P ＜0.001)and autologous transfusion (P ＜ 0.001),greater rates of blood transfusion (P ＜ 0.001).There was no significant difference on morbidity between the two groups (P =0.194).Conclusions For giant liver hemangioma both enucleation and hepatic resection could be completed safely in experienced hands.

Laparoscopic surgery for giant liver hemangiomas: a report of 40 patients / 中华肝胆外科杂志

Objective To analyze the clinical experience of laparoscopic surgery for giant liver hemangiomas.Methods The clinical data of 40 patients who underwent laparoscopic surgery for giant liver hemangiomas from August 2012 to January 2018 in the China-Japan Friendship Hospital were retrospectively analyzed.The diameters of the liver hemangiomas were more than 10 cm for all the patients.The liver functions of all the patients were Child-Pugh class A.The follow-up was up to the end of February 2018.Results Laparoscopic treatment of giant liver hemangioma was successfully performed in 37 patients.Three patients were converted to open hepatectomy.The mean diameter of the giant liver hemangiomas was (10.8± 1.3) cm (ranged 10.0～15.0 cm).The mean operative time for laparoscopic therapy was (154.7±68.0) min (range 70～ 390 min).The mean intraoperative blood loss was 200 (100 ～ 400) ml.20 patients received autologous blood transfusion.Of these 2 patients received in addition allogeneic blood transfusion.The postoperative hospital stay was (6.9t2.0) days (range 4～14 days).Postoperative complications occurred in 3 patients (8.1％).Two patients developed postoperative pleural effusion and one pelvic effusion.Two patients responded well to puncture drainage and one to conservation management.There was no postoperative hemorrhage,bile leakage or air embolism.All patients were followed-up and no liver hemangioma recurrence was detected.Conclusion Laparoscopic surgery was a safe and efficacious procedure in selected patients with giant liver hemangioma.

Differential diagnosis of asymptomatic patients with pancreatic small cystic lesions / 中华普通外科杂志

Objective To analyze the differences between benign and potential malignant small pancreatic cystic lesions.Methods We retrospectively analyzed the clinical and pathological data of asymptomatic patients with pancreatic small cystic lesions and divided them into benign group (including serous cystic neoplasms,lymphoepithelial cyst and pseudocyst) and potential malignant group (including mucinous cystic neoplasms,intraductal papillary mucinous neoplasms and solid pseudopapillary neoplasms).Comparison of clinical data was made between the two groups.Results 46 patients with pathological results were included (22 cases in benign group and 24 cases in potential malignant group).No difference was detected on demographic data and lab results between the two groups.Compared with benign patients,patients in the potential malignant group were more likely to show thicken wall (P =0.000),mural nodule (P =0.000),solid constituents inside the cyst (P =0.001),wall enhancement (P =0.003) and uneven wall on CT scan (P =0.024).The diagnostic sensitivity,specificity and accuracy of the combination of above mentioned CT features for potential malignant diseases were 91.7％,77.3％ and 84.8％,respectively.Conclusions Pancreatic cystic lesions with thicken wall,mural nodule,wall enhancement,solid parts inside the cyst and uneven wall on CT were more likely of potential malignant entities.

Risk factors of massive blood loss during resection of giant liver hemangioma / 中华肝胆外科杂志

Objective To evaluate the risk factors of massive blood loss in resection of giant liver hemangioma.Method The clinical data of 141 patients who underwent giant liver hemangioma resection were retrospectively studied.These data included general physical condition,laboratory tests,radiologic findings,and various surgical parameters.The patients were divided into the massive blood loss group (＞ 1 000 ml,n =27) and the minor blood loss group (≤1 000 ml,n =114).Logistic regression was performed to determine the risk factors of intraoperative massive blood loss.Results The average diameter of the liver hemangioma was significantly greater in the massive blood loss group than that in the minor blood loss group [(21.7 ± 8.5) cm vs.(14.1 ± 5.3) cm,P ＜ 0.05].The incidences of preoperative leukopenia,anemia,thrombocytopenia and prolonged prothrombin time were higher in the massive blood loss group than that in the minor blood loss group (48.1％ vs.16.7％,37.0％ vs.11.4％,25.9％ vs.3.5％,22.2％ vs.3.5％,respectively,all P ＜ 0.05).Hepatic hemangioma with compressed hepatic veins,inferior vena cava and porta hepatis were more frequently found in the massive blood loss group than in the minor blood group (55.6％ vs.14.9％,44.4％ vs.14.0％,55.6％ vs.12.3％,respectively,all P＜0.05).Logistic regression analysis demonstrated a diameter of hemangioma greater than 15 cm was a risk factor of intraoperative massive blood loss during surgical resection.Conclusions Giant hepatic hemangioma may cause disorders in the hematological and coagulation systems.Compression of major hepatic vessels raised technical difficulty and risks in surgery.Hemangioma with a diameter greater than 15 cm was recognized as a high-risk factor of intraoperative massive blood loss.

Analysis of primary site and pathology on 903 patients with neuroendocrine neoplasms / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the primary site and pathological feature of neuroendocrine neoplasm (NEN), especially the NEN of digestive system.</p><p><b>METHODS</b>Clinicopathological data of NEN patients at China-Japan Friendship Hospital from January 2012 to December 2016 were retrospectively analyzed. Tumor primary sites were summarized. Association between tumor site and pathological grading in gastroenteropancreatic neuroendocrine neoplasm(GEP-NEN) was examined.</p><p><b>RESULTS</b>There were a total of 903 cases of NEN. Sites of primary tumor included the digestive system in 699 cases(77.4%), the thorax(including lung, thymus and mediastinum) in 87 cases(9.6%), other sites in 60 cases (6.6%), unknown in 57 cases(6.3%). Among 699 GEP-NEN cases, the primary sites included the stomachin in 207 cases (29.6%), pancreas in 201 (28.8%), rectumin in 185 (26.5%), duodenum in 43(6.2%), jejunum and ileum in 18(2.6%), appendix in 15 (2.1%), gallbladder in 11(1.6%), esophagus in 10(1.4%), and the colon in 9 cases (1.3%). Pathologically, the tumor grading was neuroendocrine tumor (NET) G1 in 336 cases(48.1%), NET G2 in 203 cases (29.0%), neuroendocrine carcinoma (NEC) G3 in 139 cases (19.9%). All the esophagus NEN(10/10), most gallbladder NEN(9/11) and colon NEN(6/9) were poorly-differentiated NEC (G3), while all appendix NEN(15/15), most stomach NEN(147/207, 71.0%), pancreas NEN (156/201, 77.6%), rectum NEN (169/185, 91.4%), duodenum NEN (31/43, 72.1%), jejunum and ileum NEN(16/18, 88.9%) were well-differentiated NET G1 or G2.</p><p><b>CONCLUSIONS</b>The most common primary site of NEN is the digestive system. The stomach, pancreas and rectum are most common primary sitesof GEP-NEN. Difference in pathological grading is quite greatin different primary sites of GEP-NEN. Most NENs fromesophagus, colon and gallbladder are poorly-differentiated NEC.</p>

Effect of fast acupuncture at Zusanli (ST36) on the recovery of gastrointestinal function after ;abdominal non-gastrointestinal surgery / 国际中医中药杂志

Objective To observe the effect of fast acupuncture at Zusanli(ST36) on the recovery of gastrointestinal function after abdominal non-gastrointestinal surgery. Methods In this randomised placebo-controlled single-blind clinical trial, patients received abdominal non-gastrointestinal surgery were assigned to a treatment group and a control group. The treatment group received fast acupuncture and the control group received superficial conciliative acupuncture. The acupuncture was taken at both sides of Zusanli (ST36) for 1 minute respectively during 7-8 a.m. and 7-8 p.m..We began from the first postoperative day and stopped when the patients got initial postoperative flatus or stool, or at the end of the fifth postoperative day. Results 37 controlled patients were assigned to the treatment group (18 patients) and the control group (19 patients) randomly. There were no differences on general information between the two groups. The treatment group had stronger feeling than the control group on the comparison of the acupuncture sensation level (5.7 ± 3.0 vs. 2.7 ± 2.2;t=-3.471, P=0.001). For the treatment group, the initial postoperative flatus or stool time is 19 hours earlier than the control group (65.9 ± 18.1 h vs. 85.0 ± 24.5 h; t=2.682, P=0.011). And the treatment group patients’ postoperative abdominal distension is lesser than the control group (P=0.006). Conclusion Fast acupuncture at Zusanli(ST36) can promote the recovery of gastrointestinal function after abdominal non-gastrointestinal surgery, and can also lighten the patients’ postoperative abdominal distension.

A meta-analysis of proximal femoral nail antirotation and total hip arthroplasty for treating intertrochanteric fractures in the elderly / 中国组织工程研究

BACKGROUND: Now, the current study has not yet confirmed two treatment methods of the proximal femoral nail antirotation and total hip arthroplasty for treating intertrochanteric fractures in the elderly, which method has more advantages, and there is no clear conclusion at present. OBJECTIVE: To systematical y compare the repair effect of proximal femoral nail antirotation and total hip arthroplasty for treatment of intertrochanteric fractures in the elderly. METHODS: We searched the related literatures from 2011 to 2015 on Wanfang database, PubMed, MEDLINE and Embase database by computer. We retrieved the journals in China by hand and col ected randomized control ed trials on proximal femoral nail antirotation and total hip arthroplasty in the treatment of intertrochanteric fractures in the elderly. Intraoperative blood loss, operation time, hospitalization time, ambulation time after operation, and Harris score were selected as evaluation indexes. Data were analyzed using RevMan 5.2 software. RESULTS AND CONCLUSION: Final y, 7 Chinese literatures were included, with 811 patients. The results of meta analysis showed that the hospitalization time and ambulation time after operation were significantly shorter in the total hip arthroplasty group than in the proximal femoral nail antirotation group (P 0.05). These results confirmed that the internal fixation of proximal femoral nail antirotation in minimal y invasive therapy when reducing operation time and blood loss has a certain advantage. The total hip arthroplasty can make the recovery of hip function earlier, al ow early weight-bearing walking, reduce the patients’ bedridden time and reduce the complications in bed. Thus, the clinicians in the practical work should choose the appropriate therapy with considering the patient’s condition, damage degree, fracture type, and financial capability.

Advances of cancer stem cell markers in colorectal cancer / 国际肿瘤学杂志

Cancer stem cells (CSCs) markers are specific molecules to identify CSCs.Recent findings demonstrate that CSCs markers associated with colorectal cancer mainly include CD133,CD29,CD166,CD44,Nanog,etc.These markers can take park in the initiation and progression of cancers by various molecular mechanisms,which have the potential to be used as therapeutic targets as well as prognostic indicators.

Novel guidance system assistance percutaneous pedicle screw placement for thoracolumbar vertebral fracture without nerve injury / 局解手术学杂志

Objective The aim of this study was to compare recent clinical efficacy between a novel guidance method for percutaneous pedicle screw placement and the conventional fluoroscopic method for long segments thoracolumbar vertebral fracture without nerve injury. Methods A total of 38 patients with thoracolumbar vertebral fracture in our hospital from September 2010 to December 2012 were divided into group A and group B.Eighteen patients in group A underwent 200 percutaneous pedicle screw fixation by conventional fluoroscopic meth-od.Twenty patients in group B underwent 210 percutaneous pedicle screw fixation by a novel guidance method.All the operation for 38 cases were performed by the same surgeon.The time of insertion,radiation exposure,and accuracy of the screw placement between the two groups were compared.The accuracy of screws was evaluated and graded by two consecutive postoperative CT of operation segment for two groups. Results The mean time for a single pedicle screw placement was (13.11 ±2.32)minutes in group A and (10.35 ±1.92)minutes in group B,respectively.The average radiation exposure was (8.11 ±1.15)s in group B and (13.07 ±2.06)s in group A respectively.The differ-ences were statistically significant for both screw placement and radiation exposure times (P 0.05).Conclusion The novel guidance system can significantly reduce the insertion time and radiation expo-sure for long segments percutaneous pedicle screw placement,which provides the same accuracy for screw placement compared with the con-ventional method.

Proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture in the elderly：a meta-analysis / 中国组织工程研究

BACKGROUND:Now a lot of studies have confirmed that in contrast with the dynamic hip screw, the proximal femoral nail anti-rotation has a better therapeutic effect on the treatment of intertrochanteric fractures in the elderly, but there is no definite conclusion on the specific superiority at present. OBJECTIVE:To compare the curative effects of proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture using a meta-analysis. METHODS: We searched VIP database, Wanfang database, PubMed database and Embase database from 2011 to 2015, and colected randomized controled trials on proximal femoral nail anti-rotation and dynamic hip screw in repair of intertrochanteric fracture. Operation time, intraoperative blood loss, hospital stays, fracture healing time, Harris score, length of incision, bed time walking after the operation were used as evaluation indexes of meta analysis. Data were analyzed using RevMan 5.3 software. RESULTS AND CONCLUSION:In the end, we used 9 literatures, which contained 858 patients of intertrochanteric fractures in the elderly. The time of publication was from 2011 to 2015, and al of them were published in Chinese. The results of Meta-analysis showed that, compared with dynamic hip screw, proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly could effectively reduce operation time, blood loss, hospital stays, fracture healing time, length of incision and the time of walking after the operation was earlier, and it could obtain better recovery of hip function. We can point out that compared with dynamic hip screw, proximal femoral nail anti-rotation has certain advantages in the treatment of intertrochanteric fractures in the elderly. In some conditions, the patients and the hospitals can give priority to choose the proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly.

Meta analysis of reconstruction plate and Kirschner wire fixation for the treatment of clavicle fractures / 中国组织工程研究

BACKGROUND:At present, a large number of studies have confirmed that reconstruction plate compared to Kirschner wire in the treatment of clavicular fracture showed good effects, but there is no precise report on the specific advantages at present. Clinical randomized controled study is less, and lacks of systematic evaluation. OBJECTIVE:To systematicaly evaluate the efficacy and safety of the treatment of the clavicle fractures with the reconstruction plate and the Kirschner wire by using a meta-analysis. METHODS: We retrieved the MEDLINE, Embase, PubMed, Cochrane library, CNKI, Wanfang database and VIP database from 2008 to 2015 by computer to colect al controled study relevant to reconstruction plate and Kirschner wire in the treatment of clavicle fracture, and screened the literatures that met the inclusion criteria. Al literatures were analyzed in strict quality evaluation. Excelent rate, delayed healing of incision, malunion, postoperative infection, loosening of internal fixation, postoperative fracture displacement, operation time, intraoperative bleeding volume and fracture healing time were selected as the evaluation indexes of a meta-analysis. Meta-analysis was performed with RevMan 5.2 software from the Cochrane Colaboration. RESULTS AND CONCLUSION:Finaly 12 Chinese articles published from 2008 to 2014 were included, with 911 patients. Meta-analysis results showed that compared with Kirschner wire, the reconstruction plate has a certain advantage in improving the excelent and good rate, shortening the delayed wound healing and reducing deformity healing, reducing postoperative infection, preventing the loosening of internal fixation and avoiding postoperative fracture displacement. However, the two surgical methods in the treatment of clavicular fracture were not significant in operation time, intraoperative blood loss and fracture healing time. These results suggest that compared with the Kirschner wire, reconstruction plate fixation for treatment of clavicular fracture had better curative effect. The reconstruction plate can be firstly selected in the permit of patient economic conditions and hospital conditions. Due to the limited sample size in this study, the multicenter, large-sample and long-term clinical randomized controled studies with more strict design are needed to increase the reliability of the evidence.

Autophagy genes associated with chondrocyte apoptosis: protection and balancing effects / 中国组织工程研究

BACKGROUND:Autophagy can occur in chondrocytes under the low supply of nutrients. Different from necrosis and apoptosis, autophagy can make chondrocytes survive in insufficient supply of nutrients, which may be an important mechanism for the self-protection of chondrocytes. OBJECTIVE: To review the mechanism and effect of autophagy gene to protect the articular cartilage and inhibit osteoarthritis. METHODS:A computer-based search was perform in CNKI, Wanfang, PubMed to retrieve articles addressing autophagy gene and osteoarthritis published from January 2000 to January 2015. The keywords were autophagy, osteoarthritis, articular cartilage, chondrocytes in Chinese and autophagy, osteoarthritis, beclin1, LC3 in English. Totaly 269 articles were initialy searched, and finaly, 38 articles were included in result analysis. RESULTS AND CONCLUSION:Apoptosis of damaged chondrocytes is the main mechanism of articular cartilage degeneration, which can further develop into osteoarthritis. The damage and death of cels is one of the important mechanisms of cartilage degeneration, thus, to prevent damaged chondrocyte apoptosis may help cartilage repair, thus aleviating the progression of osteoarthritis. Autophagy can inhibit damaged chondrocyte apoptosis, which changes the limitations of traditional treatments for osteoarthritis. However, the current research on autophagy genes associated with osteoarthritis is stil at the primary stage, and further studies are needed on how to induce authopagy pathway in the cartilage, how to do the signal transduction and how to have an effect on the survival of chondrocytes.

Relationship between CCL20/CCR6/Th17 axis and vascular invasion and metastasis in patients with primary hepatocellular carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the role of CCL20/CCR6/Th17 axis in vascular invasion and metastasis of primary hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Expression levels of CCL20 mRNA in the normal human liver cell line L-02, and human hepatocellular carcinoma cell lines Hep3B, Huh7 and HepG2 were quantified by using SYBR green real time PCR. CCL20 secretions from these cell lines were quantified by using ELISA. The chemotactic effect of HCC cell line Hep3B on human peripheral blood mononuclear cells was determined by using transwell chemotaxis assay. Pre-therapy serum levels of IL-1α, IL-1β, IL-6, IL-8, IL-10, IL-17, IL-23, IFN-γ, TNF-α and CCL20 in 93 patients with HCC were measured by using 9-plex array and ELISA. All the patients were chronic hepatitis B virus associated HCC, and 51 cases were those with vascular invasion and metastasis (metastasis group) and 42 cases were not (non-metastasis group). CCL20 and CCR6 mRNA expressions in the HCC and tumor-adjacent tissues were determined by using SYBR Green real time PCR in 41 patients, among them, 20 cases were from the group of patients with metastasis and 21 cases were from the group of patients without metastasis. The CCL20 expression was further determined by immunohistochemistry.</p><p><b>RESULTS</b>The HCC cell lines expressed and secreted higher amount of CCL20, which effectively recruited CCR6(+) T cells. Pre-therapy serum levels of CCL20 in 93 HCC patients were (38.2 ± 28.4)pg/ml, significantly increased than those with benign hepatic hemangiomas [(7.8 ± 17.8)pg/ml, P < 0.01]. In addition, the serum levels of CCL20 were positively correlated with the tumor diameters in HCC patients (r = 0.32, P = 0.0018). CCL20 was dominantly expressed in the cytoplasm in HCC cells, and it was also expressed by some infiltrating immune cells. The mRNA expression levels of CCL20 of the tumor tissues were significantly higher than that in the tumor-adjacent tissues (P < 0.05). Multivariate logistic regression analysis showed that serum levels of IL-17 and CCL20 were independent risk factors of metastasis in HCC patients (P < 0.05 for both). CCL20 mRNA showed no statistically significant differences between patients with metastasis and without metastasis in both tumor tissues and tumor-adjacent tissues (P > 0.05 for both). But the patients with metastasis showed significantly higher expressions of CCR6 both in their tumor [5.75 (1.79, 19.13)]and tumor-adjacent tissues [7.99 (4.49, 19.54)] than those with non-metastasis [1.69 (0.76, 2.87) and 3.58 (1.84, 4.32), P < 0.05 for both].</p><p><b>CONCLUSION</b>CCL20/CCR6/Th17 axis may promote vascular invasion and metastasis hepatocellular carcinoma.</p>

Localized primary sclerosing cholangitis mimicking as a Klatskin tumour: report of three cases / 中华肝胆外科杂志

Objective To report three cases of localized primary sclerosing cholangitis (PSC) mimicking a hilar cholangiocarcinoma (Klatskin tumor) and to summarize their clinical characteristics and the ways to differentiate them through a literature review.Method The clinical data of three patients with localized PSC mimicking a hilar cholangiocarcinoma were retrospectively analyzed.The characteristics of laboratory tests and imaging examination were reviewed,and therapy and prognosis were discussed.Results The three patients were all diagnosed to have a hilar cholangiocarcinoma preoperatively,but the diagnosis of PSC was confirmed by histopathology post-operatively.All the three patients had elevated CA19-9,2 patients had elevated anti-nuclear antibody (ANA) and 2 patients had elevated IgG.All the three patients underwent surgical resection and histopathological study showed chronic inflammation of the hilar bile ducts and cholangitis of the intrahepatic portal area.The three patients were followed up from 7 months to 8 years with no symptoms.Conclusions Localized PSC is rare and it can casily be misdiagnosed as a hilar cholangiocarcinoma.Biopsy before surgery is helpful for the differential diagnosis but it is difficult to get a good biopsy sample.Surgical resection is an effective treatment.

Influence of hepatitis B virus factors and antiviral therapy on recurrence after liver resection and transplantation for patients with hepatocellular carcinoma / 中华肝胆外科杂志

At present,hepatectomy are recognized as the firsttreatment option for hepatocellular carcinoma (HCC).However,the patients have high frequency of recurrence after operation.In China,Most of the patients with HCC are related to chronic hepatitis B infection.The hepatitis B virus(HBV) factors such as:genotype,status of hepatitis B e antigen,HBV DNA level in serum and HBV DNA level in liver tissue influence the recurrence of tumors.Antiviral therapy,especially interferon therapy may be the effective method to prevent recurrence.HBV status also can influence the recurrence rate after transplant.

Hepatocellular adenoma and liver adenomatosis: a report of 11 patients / 中华肝胆外科杂志

Objective To review the clinical features,therapeutic approach and prognosis of hepatocellular adenoma(HCA)and liver adenomatosis(LA).Methods The clinical data from patients with histopathological diagnosis confirmed on operative specimens were analyzed retrospectively.Results There were 10 patients with HCA and 1 with LA.The disease was found mainly in females (n=7,63.6％),and only one female patient with LA had a history of use of oral contraceptive.The median age at presentation was 33 years(range,25-70 years).Most patients(n=8,72.7％)had no significant symptom.Tumor markers including CA19-9 and alpha fetoprotein(AFP)were normal.On dynamic ultrasonography,CT and MRI,most lesions showed contrast enhancement in the arterial phase and washout in the portal venous phase and delayed phase.For the 10 patients with HCA,the lesion was solitary.On histopathology,atypia and dysplasia were present in 1 patient,dysplasia in 1 patient,and active tumor cell growth in 1 patient.The patients with liver adenomatosis had multiple lesions and atypia.All patients underwent liver resection.There was no recurrence on follow-up which ranged from 21 to 125 months.Conclusions Most patients had no clinical symptoms.Hepatic steato sis may be a potential cause for HCA and LA.Oral contraceptive plays an important role in the patho genesis of LA.Dynamic imaging examinations were helpful for diagnosis.In view of the associated risks of hemorrhage and malignant transformation,surgical resection is the optimal treatment.The prognosis is good.