Clinicopathological analyses of combined hepatocellular carcinoma and cholangio carcinoma / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics and treatment of combined hepatocellular carcinoma-cholangio carcinoma (cHCC-CC).Methods 24 cases of cHCC-CC were collected.The clinical pathological characteristics,imaging,immunophenotyping and clinical features were retrospectively analyzed and reviewed the literature.Results There were 18 males and 6 females in 24 cases of cHCC-CC.The age ranged from 36 to 68 years (mean age was 54.38).Tumour location:right hepatic lobe in 15 cases,left hepatic lobe in 6 cases,both left lobe and right hepatic lobe in 1 case,hepatic caudate and left lateral lobe in 1 case,diffuse nodular liver tumors in 1 case.Grossly,the texture and color of tumor was related to the composition of tumor.Microscopically,classic cHCC-CC had two areas composed of hepatocellular carcinoma area and cholangiocar cinoma area of mixed distribution or migration distribution.3 cases were cHCC-CC with stem cell properties (cholangiolocellular carcinoma type,CLC type).Immunohistochemical staining revealed that HCC like area mainly expressed CD10,CK8,Hepatocyte and CD10,cHCC-CC area expressed CK7 and EMA.CLC type expressed the immunophenotypic features of intermediate type of HCC.Conclusion The clinical manifestations of cHCC-CC are not specific,the preoperative diagnosis is difficult,and it should be combined with pathological characteristics,imaging features and immunophenotype diagnosis.

Total parathyroidectomy with subcutaneous autotransplantation in the treatment of secondary hyperparathyroidism in patients with chronic renal failure / 中华普通外科杂志

Objective To study the clinical effect of total parathyroidectomy with subcutaneous autotransplantation (TPTX + AT) in the treatment of secondary hyperparathyroidism(SHPT) in patients with chronic renal failure.Methods One hundred and thirty-four patients undergoing TPTX + AT in our hospital from January 2013 to October 2014 were includud in this study.The preoperative,postoperative and follow-up intact parathyroid hormone (iPTH),serum calcium,serum phosphorus and calcium-phosphorus product were statistically analyzed.The Kidney Disease Quality of Life Short Form (KDQOL-SFTM) scale was used to evaluate quality of life before and one year after parathyroidectomy.Postoperative complications and recurrence were observed.Results Postoperative iPTH,serum calcium,serum phosphorus and calciumphosphorus product decreased significantly compared with that before surgery.The difference had statistical significance (all P ＜ 0.05).One patient died in perioperative period.Temporary injury of recurrent laryngeal nerve was found in eight patients.Early postoperative hypocalcemia was frequently seen in 124 patients (92.5％) and in 7 cases (5.2％) occured intractable hypocalcemia.The quality of life was significantly improved one year after parathyroidectomy.Recurrence developed in 5 patients after operation.Conclusions TPTX + AT is safe and effective in the treatment of SHPT in patients with chronic renal failure and can significantly improve the patient's quality of life.

Intramuscular and subcutaneous forearm parathyroid autotransplantation after total parathyroidectomy for renal hyperparathyroidism patients / 中华内分泌外科杂志

Objective To compare the effects of intramuscular or subcutaneous forearm parathyroid autotransplantation after total parathyroidectomy on patients with renal hyperparathyroidism.Methods From Jan.2012 to Dec.2013,total parathyroidectomy was carried out in 90 patients with renal hyperparathyroidism.According to the location of their parathyroid autograft,patients were divided into intramuscular group (n =39)and subcutaneous group(n =51).One patient in the intramuscular group and two in the subcutaneous group were excluded for the high levels of intact parathyroid hormone (iPTH) the day after operation.iPHT was analyzed 2 weeks,1 month,3 and 6 months after surgery.Results The time of autotransplantation was significantly shorter in subcutaneous group than in intramuscular group (11.46 (2.63) min vs 22.12 (3.78) min;t =0.632,P ＜ 0.05).iPTH levels were significantly lower in subcutaneous group than in intramuscular group 2 weeks after operation (P ＜ 0.05).There was no significant difference between the 2 groups regarding iPTH levels at 1 month,3 or 6 months after surgery.In the follow-up one patient in intramuscular group and one in subcutaneous group had graft-dependent hyperparathyroidism.Conclusion As compared to intramuscular parathyroid autotransplantation,subcutaneous parathyroid autotransplantation has advantages of simpler to operate,shorter autoimplantation time and easier to autograftectomy.

Diagnosis and treatment of popliteal artery entrapment syndrome / 中华普通外科杂志

Objective To summarize our experience in the diagnosis and management of popliteal artery entrapment syndrome (PAES). Methods This is a retrospective study on 10 patients (13 limbs)who were admitted for symptoms of claudication and the diagnosis of popliteal entrapment was established either with angiography,computed tomographic angiography,magnetic resonance angiogram or during the operation in recent 7 years (2002-2009).All patients were treated surgically. Results The mean age at the time of presentation was (25 ±7) years old (range,17-41 years).Claudication was the most frequent presenting symptom (12 limbs).The surgical procedures consisted of simple musculotendinous dissociation in 1 limb,thrombectomy with balloon angioplasty in 1 limb,musculotendinous dissociation plus thromboendarterectomy with autogenous saphenous vein (ASV)patch angioplasty in 2 limbs,ASV graft interposition or bypass in 6 limbs and graft interposition or bypass in 3 limbs.At a median follow-up of (35 ±27) months (range,2 months-7 years),there were no intraoperative or long-term postoperative complications and all the patients were cured. Conclusions PAES is an unusual but important cause of peripheral vascular insufficiency especially in young patients.A combined approach is necessary for diagnosis.Popliteal artery release alone or with vein bypass or reconstruction is the treatment of choice.

Expression of CD4～+CD25～+regulatory T cells in patients with idiopathic thrombocytopenic purpura / 中国组织工程研究

AIM:It has been recently proved that either decreased number or impaired function of CD4+CD25+regulatory T cells(Treg)can lead to immune dysfunction.Deeper knowledge of CD4+CD25+Treg cells is crucial for a better understanding of the pathogenesis of many diseases,such as autoimmune diseases,graft-versus-host disease,and allergic disease.This study is aimed to investigate the correlation of CD4+CD25+Treg cells in patients with idiopathic thrombocytopenic purpura(ITP)and to analyze the possible immunopathogenesis. METHODS:The experiment was conducted in the laboratory of Institute of Hematology,Chinese Academy of Medical Sciences and Peking Union Medical College from June to September in 2007.After the patients and their relative signed informed consents, peripheral blood was obtained from ITP patients(n=27)and health people(n=15)admitted in the Hematology Hospital,Peking Union Medical College.All patients accorded with the standards of ITP diagnosis and curative effect.The amount of CD4+CD25+ Treg cells in peripheral blood of normal controls and ITP patients before and after therapy was detected by flow cytometry.For those 23 patients who received effective therapy,blood before and after therapy were both obtained,the mononuclear cells(MNCs)were isolated from peripheral blood by density gradient centrifugation,then reverse transcriptase polymerase chain reaction(RT-PCR) was used to analyze the expression of Foxp3 mRNA. RESULTS:The amount of CD4+CD25+Treg cells and the ratio of CD4+CD25+Treg to total CD4+T cells in peripheral blood of ITP patients were obviously decreased than those of the controls(P0.05),but the expression of Foxp3 mRNA in CD4+CD25+ Treg cells was significantly increased(P