[Laparoscopic treatment for incidental gallbladder cancer: a retrospective 10 years study from a single institution].

Objective: To explore the feasibility of laparoscopic treatment for incidental gallbladder cancer(IGBCA) and analyze the factors influencing prognosis. Methods: A retrospective study of 71 patients with IGBCA received laparoscopic treatment at Department of General Surgery, Peking University Third Hospital from January 2007 to December 2016 was conducted,the clinicopathological data and prognosis were analyzed. There were 18 males and 53 females,aged 23 to 81 years. They were divided into two groups based on the presence of intraluminal mass in the gallbladder. Sixty-five of the 71 patients received laparoscopic radical resection, the prognosis of them were compared with 14 patients with open radical resection. Results: Among the 71 patients,65 patients received radical resection,3 patients simple gallbaldder resection and 3 patients palliative resection. Postoperative complications occurred in 6 patients. IGBCA were detected by frozen section in 57 patients,with the accuracy of 96.5%,while the accuracy of T stage is 43.8% in the 48 patients received T stage evaluation during frozen section examination. The T stages based on final pathology were Tis(n=6),T1a(n=5),T1b(n=10),T2(n=46),and T3(n=4).The number of harvested lymph node was 4.7±2.9(range:2-12).There are 14 patients with lymph node metastasis. The 50 patients with intraluminal gallbladder mass include 21 patients with ≤T1b stage and 29 patients with ≥T2 stage, while the 21 patients without intraluminal gallbladder mass are all with ≥T2 stage. The median survival time of the 71 patients was 33 months, with the 5-year cumulative survival rate 67.3%. The 5-year cumulative survival rate is 78.5% for the 65 patients who received radical resection,comparable with those who received open radical resection(P=0.485).Univariate analysis demonstrated that T stage, lymph node metastasis, G grade, lymphovascular invasion, neural invasion, acute cholecystectomy, bile spillage, gallbladder mass and preoperative CA19-9/CEA were the most important prognostic factors(P<0.05). Conclusions: Laparoscopic treatment for IGBCA is feasible, especially for those with intraluminal gallbladder mass. The accuracy of frozen section examination in evaluating T stage is low.

[Surgical strategies for treatment of T1b gallbladder cancers diagnosed intraoperatively or postoperatively].

OBJECTIVE: To explore the surgical strategies for the treatment of T1b gallbladder cancer patients diagnosed intraoperatively or postoperatively. METHODS: A retrospective analysis of 42 patients with T1b gallbladder cancers was performed. There were 14 patients diagnosed intraoperatively and 28 patients diagnosed postoperatively. The reevaluations of T stages were conducted in the 28 T1b gallbladder cancer patients diagnosed postoperatively by the professional pathologist. After T stage reevaluation, 25 confirmed T1b patients with complete follow-up data were divided into simple cholecystectomy group and ra-dical resection group, and the clinicopathologic characteristics between the two groups were analyzed. RESULTS: Only 2 of the 14 T1b gallbladder cancer patients diagnosed by the intraoperative frozen specimen proved to be T1b on postoperative paraffin pathology, and for the remaining 13 patients, T2 was in 11 patients, and T3 in one patient. The rate of misdiagnosis was 85.7% by the intraoperative frozen specimens, postoperative T stages were equal or higher than intraoperative T stages. Two of the 28 postoperatively diagnosed T1b patients were proved to be T2 after reevaluation, the rate of misdiagnosis was 7.1%, the reevaluated T stages were equal to or higher than the previous stages. Twenty-five confirmed T1b gallbladder cancer patients had complete follow-up data, 11 of whom underwent simple cholecystectomy and the remaining 14 radical resections. No patient had vessel or perineural invasion on pathology in the 25 confirmed T1b patients. Metastasis was absent in all the 30 lymph nodes examined, which achieved from 14 patients with radical resection. The survival rate after simple cholecystectomy was comparable to that after radical resection (P=0.361). Only one patient with radical resection had abdominal cavity implantation relapse, who received gallbladder compression during operation and 2 years later died from metastasis. CONCLUSION: Intraoperatively diagnosed T1b gallbladder cancer should receive radical resection. Reevaluation of the T stage is necessary and the initial step for postoperative diagnosed T1b gallbladder cancer patients. The pros and cons of radical surgery for definitive T1b patients should be carefully evaluated, and systemic chemotherapy is recommended for those with bile spillover.

Effect of phosphatidylserine on memory in patients and rats with Alzheimer's disease.

The aim of this study was to investigate the effect of phosphatidylserine (PS) on memory of patients and rats with Alzheimer's disease (AD). In total, 57 AD patients were recruited from our hospital, and were divided into two groups: 25 in the control group and 32 in the observation group. Next, 300 mg/d of PS was given to the rats in the observation group for 12 continuous weeks based on the control group. AD rats were divided into three groups: control group, PS 30 mg/kg group, and PS 15 mg/kg group. Learning memory ability and free radical levels in the brain were detected after treatment. In AD patients, vocabulary and picture matching scores in the two treatment groups increased after treatment (P < 0.05). Moreover, the scores in the treated group were significantly greater than the control group (P < 0.05). In AD rats, PS treatment reduced the escape latent period of AD rats, increased SOD and OH(-), and decreased acetylcholinesterase levels (P < 0.05). Compared with PS 15 mg/kg, PS 30 mg/kg group was significantly more efficacious (P < 0.05). Compared with the AD model group, hippocampal cells showed normal arrangement, karyopyknosis decreased, and the pathological changes in the two PS groups were considerable. In conclusion, PS decreased cholinesterase, improved memory, and improved hippocampal inflammation injury in AD brains by increasing SOD and OH(-) levels.

Sonographic appearance of cervical lymphadenopathy due to infectious mononucleosis in children and young adults.

AIM: To depict the grey-scale and Doppler features of cervical lymphadenopathy due to infectious mononucleosis (IM) and to compare the findings with other benign conditions and lymphoma. MATERIALS AND METHODS: One hundred and four patients <30 years old with 138 enlarged lymph nodes (LNs) were enrolled for sonographic analysis. These LNs were grouped as: IM LNs (59 LNs in 30 patients), lymphoma (30 LNs in 30 patients), bacterial lymphadenitis (24 LNs in 20 patients), tuberculosis (TB; 14 LNs in 13 patients), and reactive hyperplasia (11 LNs in 11 patients). Sonographic assessments included shape, echotexture, hilum, border, matting, cystic necrosis, calcification, and vascular pattern. For each sonographic feature, Fisher's exact test was performed to determine whether the difference between IM LNs and any another aetiology were statistically significant. RESULTS: IM LNs tended to be round in shape (69%), heterogeneous in echotexture (61%), absent of echogenic hilum (66%), indistinct margins (80%), bilateral distribution (91%), and matting (83%) [even bilateral matting (66%)], and central hilar vascularity (89.8%). On analysis, bilateral matting had the highest specificity to IM LNs; however, its sensitivity was relatively low. In contrast to IM LNs, TB LNs were more likely to have unilateral matting, cystic necrosis, and calcification. Indistinct margins and decreased echogenicity of the hilum were more frequently seen in IM LNs than in bacterial LNs. Furthermore, central hilar vascularity was a common feature of IM LNs and other benignity, which can distinguish these from lymphoma and TB LNs. CONCLUSION: Although an individual sonographic feature had considerable overlaps between IM LNs and other aetiologies, the combination of several features may be helpful in the diagnosis of IM.

Dural arteriovenous fistula at the foramen magnum presenting with subarachnoid hemorrhage: case reports and literature review.

BACKGROUND AND PURPOSE: Spinal dural arteriovenous fistulas (DAVFs) may arise at any level from the foramen magnum to the sacrum. Only a few case series of DAVFs at the foramen magnum have been reported, especially with patients presenting with subarachnoid hemorrhage (SAH). We performed a retrospective study of four such cases and summarize experiences in the diagnosis and surgical treatment of a DAVF at the foramen magnum. METHODS: Four male patients, aged from 35 to 51 years, were admitted with severe headache. The cranial computerized tomography scans of all four patients showed SAH, with hemorrhage in the fourth ventricle with or without hemorrhage in the occipital horns of the lateral ventricles. Pre-operative digital subtraction cerebral angiography showed a DAVF at the foramen magnum draining to medullary veins and/or the straight sinus and the confluence of sinuses. Two DAVFs were fed by the vertebral artery, whilst the others were fed by dural branches of the occipital artery and/or the ascending pharyngeal artery. RESULTS: Three patients underwent direct microsurgical electrocoagulation and disconnection of the arteriovenous shunt via an enlargement of the foramen magnum and a hemilaminectomy at C1 by the far lateral suboccipital approach. Post-operative angiography confirmed complete obliteration of the fistula. CONCLUSIONS: Cerebral digital subtraction angiography is an effective and accurate method for examination of a DAVF at the foramen magnum. It can be treated effectively and with minimal surgical trauma by microsurgical electrocoagulation and disconnection of the shunt.

[Analysis on clustered regularly interspaced short palindromic repeats loci polymorphism of Yersinia pestis and its area distribution in Gansu province].

Objective: To study the clustered regularly interspaced short palindromic repeats (CRISPR) loci polymorphism of Yersinia pestis and its area distribution in Gansu province. Methods: A total of 203 strains of Yersinia pestis isolated from 1962 to 2014 were selected for the culture and extraction of DNA. Three pairs of CRISPR primers were used to amplify the strain DNA by PCR, and the PCR products were sequenced. The groups and genotypes of strains were determined according to the spacer and spacer arrangement of CRISPR loci in the strain. Cluster analysis was done by using the software BioNumerics 5.10. Results: A total of 16 spacers, including 9 species of YPa loci, 4 species of YPb loci and 3 species of YPc loci, were found in the 203 strains of Yersinia pestis. A new spacer of a1' was found. The 203 strains were divided into 5 CRISPR genotypes and classified into 5 CRISPR clusters (Cb2, Ca7, Ca7', CaΔ5' and Ca35'). Each cluster showed significant area-specific characteristics, Cb2 was mainly distributed in Huining country and Pingchuan district, Ca7 was mainly found in Aksai Kazak autonomous country, Ca7' was mainly found in Xiahe country, Ca35' was mainly found in Subei Mongolia autonomous county and Yumen city and CaΔ5' was mainly distributed in Sunan Yugur autonomous county. Conclusions: The strains from different plague foci in Gansu were distinguished by CRISPR, all kinds of clusters showed the obvious area specific characteristics. It is important to study the evolution of Yersinia pestis in Gansu and trace the molecular biology origin of human plague.

Combined effects of niacin and chromium treatment on vascular endothelial dysfunction in hyperlipidemic rats.

Combined treatment with niacin and chromium has been found to have a protective effect against oxidative damage to different tissues of hyperlipidemic rats. But its effects on vascular endothelial dysfunction are less clear. This study was performed to investigate the effect of combined treatment with niacin and chromium on vascular endothelial dysfunction, with the aim of gaining insight to the mechanisms by detecting the expression levels of ox-LDL and LOX-1. Twenty-four male, 4-week-old Wistar rats were randomly divided into three groups: control group (CG; n = 8), high-fat group (HF; n = 8), and drug control group (DG; n = 8). In CG group, rats were fed with pellet chow. In HF group, rats were fed with high-fat diet for 12 weeks. In DG group, rats were fed with the same high-fat diet and treated with CrCl(3) x 6 H(2)O (250 microg/kg days) and niacin (100 mg/kg days) by gavage technique for 12 weeks. At the end of the 12th week, samples from aorta and blood were collected. In HF group, the serum levels of total cholesterol (TC), low-density lipoprotein (LDL), oxidized low-density lipoprotein (ox-LDL) and endothelin (ET) were higher, whereas the levels of high-density lipoprotein (HDL), serum NO were lower than those in CG group. The levels of serum TC, LDL, ox-LDL and ET decreased and HDL, NO levels increased in DG group when compared with HF group. The levels of LOX-1, ICAM-1 were also observed in abdominal artery. In HF group, the protein and mRNA expression of LOX-1, ICAM-1 were elevated comparing with CG group. In DG group, the protein and mRNA expression of LOX-1, ICAM-1 were decreased obviously, but still differed significantly from those in CG group. ox-LDL was related positively to TC, LDL, ET, ICAM-1 and LOX-1, but related negatively to NO and HDL. These findings indicated that combined treatment with niacin and chromium has potential therapeutic protection of endothelial function by down-regulating ox-LDL/LOX-1 signaling pathway.

[Epidemiological characteristics of outbreaks of norovirus-Gâ ¡.2, Gâ ¡.17 and Gâ ¡.4/Sydney in Guangdong province, 2013-2017].

Objective: To understand the epidemiologic characteristics of outbreaks, caused by norovirus-GⅡ.2、GⅡ.17 and GⅡ.4/Sydney in Guangdong Province from 2013 to 2017 and to provide scientific evidence for epidemic prevention and control. Methods: Incidence data of norovirus outbreaks in Guangdong from January 1(st) 2013 to November 30(th) 2017 were collected from Public Health Emergency Management Information System. RT-PCR was performed for every case of each outbreak to detect norovirus nucleic acid and gene sequencing was conducted to identify the genotype of norovirus. Characteristics of norovirus GⅡ.2, GⅡ.17 and GⅡ.4/Sydney outbreaks were analyzed. Directly standardized method was used to calculate the proportion of symtoms as diarrhea and vomitting. Results: From January 1(st) 2013 to November 30(th) 2017, a total of 167 norovirus outbreaks were reported in Guangdong, and 115 outbreaks were caused by norovirus GⅡ.2, GⅡ.17 and GⅡ.4/Sydney respectively. The outbreaks caused by norovirus GⅡ.2 accounted for 39.68% (25/63) in primary schools, 28.57% (18/63) in child care settings, 25.40% (16/63) in middle schools and 6.35% (4/63) in universities. Outbreaks caused by norovirus GⅡ.17 accounted for 41.03% (16/39) in middle schools, 20.51% (8/39) at workplaces, 15.38% (6/39) in primary schools, 12.82% (5/39) in universities, 5.13% (2/39) in communities and child care settings respectively. The outbreaks caused by norovirus GⅡ.4/Sydney accounted for 53.85% (7/13) in universities, 15.38% (2/13) in child care settings and at workplaces respectively, 7.69%(1/13) in primary schools and middle schools respectively. The outbreaks caused by norovirus GⅡ.2 had 77.78% (49/63) of contact transmission, 17.46% (11/63) of food-borne transmission. The outbreaks caused by norovirus GⅡ.17 showed 53.85% (21/39) of food-borne transmission, 15.38% (6/39) of contract transmission, 12.82% (5/39) of water-borne transmission. The outbreaks caused by norovirus GⅡ.4/Sydney had 53.85% (7/13) of food-borne transmission, 38.46% (5/13) of the contact transmission. In terms of the clinical manifestations, the standardized proportion of vomit was 73.76% and the proportion of diarrhea was 42.85% in cases infected with norovirus GⅡ.2, the proportion of standardized of vomit was 76.37% and the proportion of diarrhea was 51.40% in cases infected with norovirus GⅡ.17, with the standardized proportion of vomit was 54.10% and the proportion of diarrhea was 55.95% in cases infected with norovirus GⅡ.4/Sydney. Conclusions: The outbreaks caused by norovirus GⅡ.2 through contact transmission mainly occurred in primary schools, child care settings and middle schools. The outbreaks caused by norovirus GⅡ.17 through food-borne transmission mainly occurred in middle schools and at workplaces. The outbreaks caused by norovirus GⅡ.4/Sydney food-borne transmission and contact mainly occurred in universities.

[Analysis of BPPV in patients with bone mineral density results].

Objective:Analyze BPPV in patients with ultrasonic bone mineral density to investigate the relationship between the BPPV and bone density. Method:A total of 88 included subjects were selected from patients admitted to the Otolaryngological Department of Renhe Hospital, Beijing. Meanwhile, 76 healthy persons were included as control. The control group had similar age and gender distributions to the test group, and all healthy subjects had no history of vertigo in recent one year. Both groups underwent regular otolaryngological examinations, videonystagmography（VNG）,ultrasound bone densitometer test. According to gender, age, listening to group. Result:①Bone density of the test group was significantly lower than the control group（-2.010±1.658 vs 0.3605±0.875）,the difference was statistically significant（P<0.01）；②Incidence rates of bone mass loss（35 in 88,39.77%）and osteoporosis（26 in 88, 29.55%）bone mineral density decreased incidence of 69.32%, in the test group was significantly higher than that in the control group（bone mass loss, 13 in 76, 17.10%; osteoporosis 6 in 76,7.89%）, bone mineral density decreased incidence of 25.00%,the difference was statistically significant（P<0.01）；③The test group and control group according to different age groups, the test group all ages bone density T values significantly lower than the control group（P<0.01）,the difference was statistically significant. In the age groups, the incidence of bone loss was higher in the test group than that in the control group, the difference was statistically significant(P<0.01).④In the gender group, bone density of the test group women were significantly lower than the control group, the difference was statistically significant（P<0.05）； especially after the age of 60.⑤In the test group, 27 cases of bone mineral density is normal, with normal hearing 19 cases (70.37%), hearing loss 8 cases(29.63%);61 cases of bone loss, including normal hearing 48 cases (78.69%),hearing loss 13 cases (21.31%). The difference between hearing loss and bone loss had no statistical significance(P>0.05).⑥The logistic regression results showed that the prompt Higher bone mineral density T value was BPPV protection factors, OR=0.686,(P<0.01,95%CI: 1.32-5.85). Conclusion:BPPV in patients with bone mineral density value is lower than the normal control group, there is a higher incidence of bone loss, at the same time, along with the age increasing on the rise, especially women.

Nuclear accumulation of glioma-associated oncogene 2 protein and enhanced expression of forkhead-box transcription factor M1 protein in human hepatocellular carcinoma.

The hedgehog (Hh) signaling pathway has been reported to be crucial in human carcinogenesis and tumor progression. Glioma-associated oncogenes (Gli), are zinc finger transcription factors which mediate the transcriptional response to Hh signaling. To explore the role of Gli in the development and progression of hepatocellular carcinoma (HCC), we investigated the expression of Gli2 and FoxM1 (forkhead-box transcription factor M1) which is one of the Gli downstream target genes modulating cell cycle progression in 91 specimens of human HCCs with immunohistochemistry. These immunostaining results were compared with various clinicopathologic parameters. Immunoreactivity of Gli2 and FoxM1 was observed respectively in 84.6% (77/91) and 80.2% (73/91) cases of HCC tumor tissues, and this was considerably higher than expression in the peritumoral tissues. Distribution of Gli2 and FoxM1 proteins in tumor cells was nuclear with or without cytoplasmic staining, or cytoplasmic alone. Statistically, increased nuclear immunopositivity of Gli2 protein correlated significantly with poorer tumor differentiation (P<0.05), as well as with portal vein tumor thrombosis (P<0.05). In addition, overexpression of FoxM1 protein was significantly associated with increased tumor grade (P<0.01) and advanced tumor stage (P<0.05). Moreover, there was a significant association between the expressions of Gli2 and FoxM1 proteins in HCC (r=0.464, P=0.000). This is consistent with the concept that in human HCC, the Hh signaling pathway is involved in the differentiation and proliferation of tumor cells, in part through inducing nuclear accumulation of Gli2 protein and subsequent upregulation of FoxM1 protein.

Appearance of denuded hepatic stellate cells and their subsequent myofibroblast-like transformation during the early stage of biliary fibrosis in the rat.

To investigate the early in vivo response of hepatic stellate cells in biliary fibrosis, we examined rat livers during the first 7 days after bile duct ligation using light microscopy, immunohistochemistry, electron microscopy, and immunoelectron microscopy. At day 1 after bile duct ligation, alpha-smooth muscle actin-positive fibroblasts appeared and then increased in number around the proliferating bile ductules. With time, the destruction of the external limiting plate became accentuated because of the invasion of the proliferating bile ductules and periductural fibrosis. At day 7, stromal cells containing fat droplets appeared in the fibrous tissue adjacent to the periportal parenchyma; these are termed denuded hepatic stellate cells. In the fibrous tissue disconnected from the liver parenchyma, the denuded hepatic stellate cells were replaced by myofibroblast-like cells. Meanwhile, the expression of transforming growth factor-beta1 on biliary epithelial cells increased. These results indicate the dual origin of myofibroblasts in experimental biliary fibrosis, the periductural and periductal fibroblasts in the initial stage, and the denuded hepatic stellate cells in the subsequent stage. These two types of stromal cells may undergo myofibroblastic transformation by the transforming growth factor-beta1 secreted by the proliferating biliary epithelial cells.