Abstract:The epidemic of the novel coronavirus 2019 (2019-nCoV)-associated pneumonia (abbreviated as NCP) is currently raging in China. It has been proven that 2019-nCoV can be transmitted from human-to-human. According to the latest clinical reports, hospital-associated spread of NCP is not rare, which poses great threats to both the medical staff and in-hospital patients. Under the epidemic situation, surgeons who practice general surgery should be aware of the epidemiological features and clinical manifestations of NCP, especially the digestive tract and abdominal symptoms caused by this condition, to avoid misdiagnosis and missed diagnosis. The emergent or urgent surgeries should be performed properly and timely on the basis of aggressive exclusion and prevention of NCP. During emergent surgery for patients with NCP, the prevention and control rules framed by the local health administration or local medical institution should be strictly followed, all members of the surgical team must function in a coordinated fashion, class 2 or 3 prevention measures should be provided to all personnel, and the operation should be performed in a negative-pressure operating room. If the local hospital does not have the above capability, the patients with NCP requiring urgent surgery should be transferred immediately to a hospital with appropriate services.

Abstract:Currently, the epidemic of novel coronavirus pneumonia (NCP) is still ongoing. The pathogen of this disease was newly named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hernia and abdominal wall diseases, as common disorders among population, are likely need emergency surgery. Under the new situation of NCP outbreak, surgeons who practice surgery for hernia and abdominal wall diseases should properly conduct the classified diagnosis and treatment of the hernia and abdominal wall disease, and select the appropriate surgical procedure, following the guidelines and routine diagnosis and treatment methods and complying with the guidelines for diagnosis and treatment of NCP; pay sufficient attention to self-protection according to different risk levels in the meantime of proper diagnosis and treatment and nursing process optimization. The patients with hernia or abdominal wall disease should also actively cooperate with the medical staff to complete the examination and inpatient surgical treatment in accordance with the process.

Abstract:At present, the outbreak of novel coronavirus pneumonia (NCP, WHO named as COVID-19) poses a serious threat to the lives and health of people in China. Under the background of the NCP epidemic, there many new challenges for surgeons who practice vascular surgery, such as how to handle the patients attending vascular surgery outpatient clinics, how to deal with the serious and critical patients requiring emergency vascular surgery, how to safely perform the vascular surgery procedures, and how to properly perform the postoperative management and follow-up of vascular surgery patients. Here, the authors based on the latest literature data and the prevention and control experience of the hospital where the authors work, address the above issues and also offer the personal suggestions, with the hope of serving as a lead-in to further discussions, and inspiring the vascular surgeons to think about how to conduct the vascular surgical diagnosis and treatment during the epidemic of NCP, so as to improve the clinical practice.

Abstract:The outbreak of novel coronavirus (SARS-CoV-2)-infected pneumonia (NCP, WHO named as COVID-19) with a concentrated eruption in Wuhan, China has posed a serious threat to the health of people, which has so far spread to 25 countries and regions. As of 13 February 2020, the cumulative number of confirmed cases was 63 946 and the cumulative number of suspected cases was 10 109, with a fatality rate of 2.06%. The main routes of transmission of SARS-CoV-2 are currently considered to be by droplets and close contacts, while the possibility of aerosol or fecal oral transmission still cannot be ruled out. The latest study indicated that the NCP has a very high transmission rate (R0=3.77). According to regulations issued by the National Health Commission, the surgical operations should be confined to emergency or urgent cases during the epidemic period. At present time, there are no relevant guidelines or recommendations as well as available experiences in China and abroad for when the operations are performed and how the perioperative prevention and protection are carried out in patients with suspected or confirmed NCP. According to incomplete statistics, there were a total of 50 perioperative patients with NCP admitted in the Zhongnan Hospital of Wuhan University and Renmin Hospital of Wuhan University during the epidemic period. Of the patients, 2 cases with NCP diagnosed after operation infected 16 people who were medical staff or relevant personnel, and 48 cases with suspected or confirmed NCP before operation did not infect any of the medical staff or relevant individuals after specific prevention and protection measures were implemented. Here, the authors based on the quarantine measures framed during the NCP epidemic and the prevention and protection experiences of Xiangya Hospital, and combined with the data of cases from the above two hospitals in Wuhan, discuss how to carry out a standard operation and make effective prevention and protection measures during perioperative period under the epidemic situation of NCP. 

Abstract:In period of the epidemic of novel coronavirus pneumonia (NCP; WHO named as COVID-19), how to deal with the life-threatening rupture and hemorrhage of the primary liver cancer (PLC) is one of the urgent clinical problems that have to be solved. The authors think that the treatment of this condition must be undertaken by following the standard operating procedures and with sufficient prevention and protection based on the premise of COVID-19 screening. For those with suspected or confirmed COVID-19, the treatment scenarios should be carefully designed and approaches should be tailored to individual patient based on the integrated consideration of the clinical classification of COVID-19, the degree of rupture and hemorrhage of PLC as well as the tumor and liver function conditions. The general principle is that not only the safety and efficacy must be guaranteed to the patients, and the infectious risks also should be minimized to the healthcare workers. 

Abstract:The epidemic situation of new coronavirus pneumonia (COVID-19) is currently still severe in our country. In the face of the epidemic, how to efficiently and properly carry out breast cancer treatment with implementing the standardized protocol as a premise is not only an extremely urgent medical problem, but also a social issue related to people’s livelihood. Here, the authors combined with the discussion of clinical cases, attempt to offer solutions to the problems in breast cancer treatment resulting from the special circumstances of COVID-19 epidemic, so as to provide ideas for breast cancer treatment during the period of COVID-19 outbreak.

Abstract:Background and Aims: Gallbladder cancer is a common malignant tumor in the biliary system. With difficult early diagnosis and poor prognosis. Studies have demonstrated that the abnormal expression of human epidermal growth factor receptor 2 (ErbB2) may probably play an important role in the occurrence and development of gallbladder cancer. Therefore, this study was conducted to investigate the effect of ErbB2 inhibitor pyrotinib on the general biological behaviors of gallbladder cancer cells in vitro, in order to provide a theoretical and experimental background for the relevant researches and clinical applications. 
Methods: The gallbladder cancer NOZ and SGC-996 cells were used as study models. The time and concentration effects pyrotinib exerted on the two types of cells were determined by CCK-8 assay. Based on the results of CCK-8 assay, the inhibitory concentration 25% (IC25), 50% (IC50) and 75% (IC75) of pyrotinib correspondingly for the two types of gallbladder cancer cells at an optimal treatment time were chosen for the following experiments. Then, the effects of pyrotinib on proliferation, migration and invasion abilities, apoptosis as well as the expressions of apoptosis-related proteins were examined by colony-forming assay, Transwell assay, cytometry analysis and Western blot analysis, respectively. 
Results: The IC50 values pyrotinib with the treatment time of 24, 48, and 72 h were 11.5, 3.6, 1.4 μmol/L for NOZ cells and 5.5, 5.2 and 2.4 μmol/L for SGC-996 cells, respectively. After exposure to corresponding IC25, IC50 and IC75 concentrations of pyrotinib of 48-h treatment (NOZ cells: 1, 3.5, 12 μmol/L; SGC-996 cells: 2.5, 5, 10 μmol/L), both types of gallbladder cancer cells showed significantly reduced number of colony-forming units, attenuated migration and invasion abilities, increased apoptotic rates, and up-regulated expressions of the pro-apoptotic proteins (Bax, cleavaged-caspase 9, cleavage-caspase 3 and cleavage-PARP) while down-regulated expressions of the anti-apoptotic proteins (Bcl-2 and Bcl-2/Bax ratio), and all above changes presented a significant concentration-dependent manner (all P<0.05).
Conclusion: Pyrotinib can inhibit the proliferation, migration and invasion of gallbladder carcinoma in vitro, and exert cell killing effect by promoting apoptosis. It provides a new choice of molecular targeted drug for the treatment of gallbladder cancer.

Abstract:Background and Aims: Intrahepatic cholangiocarcinoma (ICC) is an extremely malignant tumor arising from the epithelial cells of the second-order or more proximal bile ducts. The poor prognosis of this disease is mainly due to the insufficient understanding of the pathogenesis, lack of early diagnosis methods and limited treatment modalities. The investigations on molecular biomarkers of ICC may help the early diagnosis, prognostic estimation and treatment recommendations. The aim of this study was to investigated the expression of the pro-inflammatory factor, high mobility group protein 1 (HMGB1) in ICC tissue and its clinical significance as well as its relationship with tumor microangiogenesis.
Methods: The HMGB1 expressions and tumor microvascular density (MVD) counts (CD31 expressions) in surgical specimens of ICC tissue and tumor adjacent tissue from 65 ICC patients and 30 specimens of normal bile duct tissues were detected by immunohistochemical staining. The relations of HMGB1 expression and MVD count with the clinicopathologic factors of ICC patients and their correlation in ICC tissue were determined, and their influences on prognosis of ICC patients were also analyzed.
Results: Both HMGB1 expression and MVD count presented a significant decreasing order in ICC tissue, tumor adjacent tissue and normal bile duct tissue (all P<0.05). The HMGB1 expression was significantly associated with the degree of tumor differentiation, vascular invasion and lymph node metastasis (all P<0.05), while the MVD count was significantly associated with vascular invasion of the tumor (P<0.05); there was a significant positive correlation between HMGB1 expression and MVD count in ICC tissue (r=0.330, P=0.008). In the whole group of ICC patients, the postoperative 1-, 3- and 5-year survival rates of patients were 55.4%, 36.9% and 7.7%. The survival rate in patients with positive HMGB1 expression was significantly lower than that in patients with negative HMGB1 expression (χ2=6.278, P=0.012), and in those with high MVD count was significantly lower than that in cases with low MVD count (χ2=5.101, P=0.024); the survival rate in patients with characteristics of both positive HMGB1 expression and high MVD count was significantly lower than those with only one or none of the characteristics (all P<0.05).
Conclusion: The HMG1 expression is elevated in ICC tissue and is closely related to the invasion, metastasis and prognosis of ICC. The action mechanism may be probably associated with HMG1 inducing tumor microangiogenesis through various signaling pathways and then promoting growth and progression of the tumor. HMG1 can be potentially used as an indicator for prognostic assessment and decision-making, and also provides a new direction for the targeted drug development.

Abstract:Background and Aims: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with poor prognosis, and its etiology and pathogenesis are still elusive. Therefore, identification of reliable prognostic factors and survival biomarkers of HCC patients is of great clinical importance. This study was to screen the prognostic immune-related genes of HCC through bioinformatics approach, and then construct a prognostic risk score model based on an immune-related gene signature, so as to provide a basis for prognosis evaluation and individualized treatment decision-making regarding the HCC patients. 
Methods: The clinical information and RNA-seq data (377 HCC samples and 50 adjacent non-cancerous samples) of HCC patients were obtained from the TCGA database. The information of immune-related genes was downloaded from the Immport database, and the differentially expressed immune-related genes were selected from HCC tissues using the limma package of R software. The immune-related genes closely related to the overall survival (OS) among the HCC patients (344 cases with complete clinical record in the 377 HCC patients) were determined by univariate and multivariate Cox proportional risk regression models, and then the prognostic risk score model based on an immune-related gene signature was constructed by using the determined genes, by which the prognostic risks of the HCC patients were scored. Meanwhile, 50% cases (172 cases) were randomly picked up from the above model sample as an internal validation sample for internal validation. Kaplan-Meier method was used to analyze the survival status between patients with high and low risk score, and the accuracy of the risk score was evaluated by ROC curve and C-index analysis. Finally, the relations of the risk score with the clinicopathologic factors of HCC were analyzed, and the effectiveness of this risk score as an independent prognostic risk factor for HCC was ascertained by univariate and multivariate Cox regression analysis.
Results: A total of 329 differentially expressed immune-related genes between HCC tissue and tumor adjacent were identified, in which 24 were significantly associated with the OS of the HCC patients (all P<0.001), and 9 genes that included PSMD14, S100A11, FABP6, RBP2, LCNL1, FCN2, NDRG1, CSPG5 and NR6A1 were determined as high-risk genes for OS by using forward and backward selection algorithm in multivariate Cox proportional hazards regression analysis. According to the classification by the 9-gene signature based prognostic risk score model, the OS in patients with high risk score was significantly worse than that in patients with low risk score in the model sample (P=1.715E-08), and the same result was also obtained in the internal validation sample (P=2.222E-05). The 1- and 3-year values of the area under the ROC curve (AUC) were 0.790 and 0.733 in the model sample, and were 0.799 and 0.743 in the internal validation sample, respectively. The results of C-index analysis showed that the C-index values in the model sample and the internal validation sample were 0.715 (95% CI=0.683–0.829) and 0.756 (95% CI=0.668–0.762), respectively. Tumor grade, pathological stage, T stage and new tumor events were correlated with the risk score (all P<0.05). Univariate and multivariate Cox analysis showed that the risk score was an independent prognostic factor for HCC (univariate: HR=1.057, 95% CI=1.041-1.074, P<0.001; multivariate: HR=1.050, 95% CI=1.033-1.067, P<0.001).
Conclusion: Nine immune-related genes closely related to the prognosis of HCC patients are identified by TCGA database mining, and a 9-gene signature based prognostic risk score model is developed, which may help the clinicians to assess the prognosis of the HCC patients and design a personalized treatment plan for them.

Abstract:Background and Aims: Gallbladder cancer is a malignant tumor originating from the biliary tract system, with insidious onset, high degree of malignancy and dismal prognosis. Golgi phosphorylation protein 3 (GOLPH3) is an oncogene that participates in the occurrence and development of tumors through initiating a series of signaling pathways. The expression profile and clinical significance of GOLPH3 in gallbladder cancer have not reported yet. Given that angiogenesis is an essential requirement for tumor growth, this study was conducted to investigate the expression of GOLPH3 in gallbladder cancer and its relations with the pro-angiogenic factor VEGF and tumor angiogenesis. 
Methods: Eighty specimens of gallbladder carcinoma tissue and 30 specimens of chronic cholecystitis tissue obtained from surgical resection in the 904th Hospital of Joint Logistic Support Force of PLA from January 2010 to December 2018 were collected. The expressions of GOLPH3 and VEGF and microvascular density (MVD) counts (distinguished by CD34 expression) in these specimens were determined by immunohistochemical staining. The relations of GOLPH3 and VEGF expressions and MVD count with the clinicopathologic factors and prognosis of the gallbladder cancer patients were analyzed, and the correlations among GOLPH3 and VEGF expressions and MVD count in gallbladder cancer tissue were also analyzed.
Results: Both positive expression rates of GOLPH3 and VEGF as well as the MVD count in gallbladder cancer tissue were significantly higher than those in chronic cholecystitis tissue (all P<0.05). The GOLPH3 expression and MVD count in gallbladder cancer tissue were significantly related to the degree of tumor differentiation, lymph node metastasis and the TNM stage of the patients (all P<0.05), and the VEGF expression in gallbladder cancer tissue was significantly related to the TNM stage and lymph node metastasis of the patients (all P<0.05). In gallbladder cancer tissue, there was a significant positive correlation between GOLPH3 expression and VEGF expression (r=0.437, P<0.05), and both their expression were positively correlated to the MVD count (r=0.416 and 0.433, both P<0.05). Survival analysis showed that the survival rate in patients with positive GOLPH3 or VEGF expression was significantly lower than that in respective negative ones (χ2=5.300 and 6.023, both P<0.05), while the survival rate of patients with high MVD count was significantly lower than that in those with low MVD count (χ2=11.986, P<0.05). 
Conclusion: The expression of GOLPH3 is closely associated with the malignant clinicopathologic features of gallbladder cancer and unfavorable outcomes of the gallbladder cancer patients. Based on the finding of pairwise correlations of GOLPH3 with VEGF and MVD, it is speculated that it facilitates the tumor angiogenesis by regulating the expression of VEGF, and thereby promote the growth and metastasis of gallbladder carcinoma.

Abstract:Background and Aims: For patients with recurrent hepatobiliary stones after a repeated operation, how to safely and completely remove the stones, maximally relieve the stenosis in the hilar and even intrahepatic bile ducts, and then construct or repair a patent passage for bile flow has always been a difficult problem in the therapeutic field of biliary surgery. This study was undertaken to determine the clinical efficacy and application value of resection of the quadrate lobe of the liver combined with high-level splitting and plasty of the hilar bile ducts in treatment of hilar bile duct stenosis complicated with hepatolithiasis. 
Methods: The clinical data of 36 patients with complicated hepatobiliary stones treated in Hunan Provincial People's Hospital from July 2015 to June 2019 were retrospectively analyzed. All the 36 patients had a different degree of hilar bile duct stricture, with an average number of previous operations of 2.4. Of them, the stricture located only at the hilar bile duct confluence in 18 cases, and with combined stricture at the right hepatic duct in 8 cases or left hepatic duct in 10 cases.
Results: All patients underwent hepatic quadrate lobe resection, hilar bile duct splitting and plasty, and bilioenteric drainage, and the stones were thoroughly removed during operation by means of lithotomy forceps, tube flushing and choledochoscopic exploration. The average operative time was 354.4 min, and the average intraoperative blood loss was 230.5 mL, and the final stone clearance rate exceeded 90%. After operation, bile leakage occurred in 2 patients, which was improved after aggressive drainage treatment, fat liquefaction and infection of incision occurred in 3 patients and partial intestinal obstruction occurred in 1 patient, which were all improved after conservative treatment. During the 12-48 months of follow-up by telephone and clinic visits, 4 patients developed reflux cholangitis and none of them had recurrent stricture of bilioenteric anastomosis.
Conclusion: Quadrate lobectomy combined with high-level splitting and plasty of the hilar bile ducts can effectively relieve the high-level stricture of the hilar bile ducts and achieve the goal of thorough stone removal and patent bile drainage. Meanwhile, it can avoid extensive liver resection. So, it has certain application value in clinical practice.

Abstract:Background and Aims: Laparoscopic cholecystectomy (LC) is the gold standard operation for gallstones with cholecystitis. However, it is difficult and risky to implement the standard LC in conditions where the Calot’s triangle has a distorted anatomical structure or tightly adheres to the adjoining tissues. Laparoscopic subtotal cholecystectomy (LSC) can reduce the surgical difficulty and the open conversion rate, as well as effectively avoid the bile duct and vascular injuries, but the main problem with this procedure is that the conditions of the gallbladder neck duct are uncertain and it may result in retained stones. This study was to investigate the application value of LSC combined with choledochoscopic exploration of the gallbladder neck duct and treat the stone in treatment of complex cholecystectomy. 
Methods: The clinical data of 36 patients undergoing LSC and choledochoscopic exploration of the gallbladder neck duct from January 2014 to January 2018 were retrospectively analyzed. Of the patients, 22 cases had acute suppurative cholecystitis, 5 cases had acute gangrenous cholecystitis and 9 cases had chronic atrophic cholecystitis. Diagnosis in all patients was confirmed by preoperative ultrasound and CT examinations, and 33 patients underwent MRCP, of whom, 28 cases were found with stones or suspected stones in the gallbladder neck duct, and 2 cases had concomitant Mirizzi syndrome.
Results: All the 36 patients underwent LSC and choledochoscopic exploration the neck of gallbladder. During the operation, bile outflow from the neck of the gallbladder was noted in 8 cases, and was not found in 28 cases. In patients with bile outflow, stones were found in 2 cases through the exploration of the gallbladder neck duct, which were removed by a superfine basket. In those without bile outflow, stones were detected in 26 cases and inflammatory stenosis at the distal end of the cystic duct in one case by the choledochoscopic exploration, and exploration was not completed in one case due to a tortuous cystic duct; the methods for stone extraction included that simple basket extraction in 4 cases, plasma lithotripsy plus basket extraction in 16 cases, and Heister spiral valve incision by a needle knife plus plasma lithotripsy and basket stone removal in 6 cases; after stone extraction, bile outflow was detected in 23 cases, and was still not found in 3 cases, of whom, inflammatory occlusion of the cystic duct due to distal inflammatory stenosis was considered in one case, and further exploration was not completed to determine the cause in the other 2 cases due to bile duct distortion. The gallbladder neck duct was closed with a barbed-wire in 35 cases, and suturing could not be performed in 1 case because of the severe inflammation and edema in the gallbladder neck duct, and drainage tube was placed in the gallbladder neck duct. There was conversion to laparotomy, and no bile duct and vascular injuries occurred during operation. The operative time was 50 to 170 min, the intraoperative blood loss was 50 to 120 mL, and the length of postoperative hospital stay was 5 to 10 d. Complications occurred in 7 patients, including choledocholithiasis cholangitis in one case, bile leakage in 2 cases, Trocar site infection in one case, and other non-surgical related complications in 4 cases; one case underwent ERCP choledocholithotomy. The bile leakage stopped in the 2 case after 2 weeks and one month respectively by keeping the drainage tube patent. The follow-up period ranged from 5 months to one year, and no operation related complications occurred.
Conclusion: The application of LSC combined with choledochoscopic exploration of the gallbladder neck duct can provide information about the condition inside the gallbladder neck duct as much as possible and properly deal with the stone incarceration or escape of the stones. It has certain application value in complex laparoscopic cholecystectomy.

Abstract:Background and Aims: Congenital biliary dilatation (CBD) is a relatively common biliary malformation in children, which can occur in any part of both intrahepatic and extrahepatic bile ducts. The patients are prone to develop serious complications such as biliary stones, pancreatitis and cholangiocarcinoma, recurrent cholangitis, portal hypertension, spontaneous cyst rupture with the passage of time. CBD is often associated with pancreaticobiliary maljunction (PBM), and lacks of typical clinical symptoms. Severe abdominal adhesions are found in some patients with acute attack, for whom, the operation is difficult to perform and many postoperative complications may develop. Thus, the diagnosis and treatment of this condition pose a great challenge to pediatric surgeons. This study was to summarize the experiences in diagnosis and treatment of pediatric CBD, so as to provide relevant strategies for clinical work. 
Methods: The clinical data of 44 children with CBD are admitted in Xiangya Hospital of Central South University from June 2010 to August 2017 were retrospectively analyzed. 
Results: Among the 44 cases, there were 38 females and 6 males, with a male-female ratio of 1:6.3. The onset age ranged from 2 to 161 months, and the median onset age was 63 months. The main clinical symptoms were abdominal pain in 30 cases (68.1%), skin scleral jaundice in 20 cases (45.5%) and nausea and vomiting in 7 cases (15.9%). Ultrasound examination was performed in 37 patients, of whom, 30 cases (81.1%) were considered as CBD; 32 patients underwent CT scan, and 29 cases (90.6%) of them were considered as CBD; 20 patients were subjected to MRCP examination, and all of them (100.0%) were considered as CBD, among whom, 18 cases (90.0%) had concomitant PBM. According to Todani classification, 34 patients (77.3%) were classified as type I and 10 cases (32.7%) were classified as type IVA; according to Dong’s classification, there were 26 cases (59.1%) with type C1, 8 cases (59.1%) with type C2, 8 cases (59.1%) with type D1, and 2 cases (4.5%) with type D2 diseases. In 29 pediatric patients who underwent primary cholecystectomy and choledochal cyst resection plus Roux-en-Y choledochojejunostomy, the intraoperative bleeding was (80.0±25.0) mL, and no complications occurred, and the length of postoperative hospital stay was (8.0±1.6) d; in one child who received cholecystectomy, choledochal cyst resection and left hemihepatic resection plus right hepaticojejunal Roux-en-Y anastomosis, the intraoperative blood loss was 150.0 mL, and the postoperative hospitalization was 10 d; in 6 cases undergoing primary choledochal cyst incision plus T-tube drainage, and secondary choledochal cyst resection plus Roux-en-Y choledochojejunostomy 3 months later, the intraoperative bleeding was (500.0±125.0) mL and the length of postoperative hospitalization was (11.0±4.2) d; in one case underwent choledochojejunostomy, the amount of intraoperative bleeding was 200.0 mL, anastomotic fistula occurred after operation, hospitalized for 24 d  postoperatively, and the second operation was performed 6 months later, with intraoperative blood loss of 200.0 mL and postoperative hospitalization of 7 d; 7 children (15.9%) did not receive surgical treatment, of whom, 4 cases had type IVA disease. Forty children were followed up for 20 to 110 months (median follow-up time was 60 months), 35 cases receiving surgical treatment were all recovered well, and 3 cases develop repeated recurrence of symptoms and one case died due to recurrent cholangitis in the 5 cases who did not receive surgical treatment. 
Conclusion: MRCP has a high accuracy for diagnosis of CBD. It can distinguish the presence or absence of the PBM and the PBM type, and the damage of pancreatic duct can be avoided and diseased bile duct can be completely removed the intraoperative according to the display of the confluence of pancreaticobiliary ducts by MRCP during operation, so MRCP can be used as the first choice for CBD diagnosis. The Dong’s classification is helpful for procedure selection, and provides a proper surgical method for some type IVA patients.

Abstract:Background and Aims: Cholangiocarcinoma is insidious in its clinical onset, its early detection is difficult, and many patients are at an advanced stage at the time of diagnosis, thus lose the chance of radical treatment. Therefore, the search for a new biomarker for early diagnosis and prediction of treatment efficacy and prognosis of cholangiocarcinoma is of great importance. The tumor type M2 pyruvate kinase (TuM2-PK) To investigate the value of serum tumor type M2 pyruvate kinase is a tumor biomarker discovered in recent years, and may be associated with a variety of tumors. This study was conducted to investigate the change in serum TuM2-PK level in cholangiocarcinoma patients and its diagnostic value for cholangiocarcinoma.  
Methods: The serum TuM2-PK levels in 54 patients with cholangiocarcinoma, 32 patients with bile duct stones and 25 subjects undergoing health maintenance examination were compared. Using TuM2-PK>15 U/mL as the positive standard, the relations of positive rate of the serum TuM2-PK with clinical factors of the cholangiocarcinoma patients were analyzed. The diagnostic efficacy of the serum TuM2-PK level for cholangiocarcinoma was determined by using ROC curve analysis, which was compared with that of CA19-9. Finally, the pre- and postoperative changes in serum TuM2-PK level in cholangiocarcinoma patients and patients with bile duct stones as well as in cholangiocarcinoma patients undergoing radical operation or palliative operation were respectively compared.
Results: The serum TuM2-PK level in cholangiocarcinoma patients was significantly higher than that in patients with bile duct stones or healthy individuals (both P<0.05), while it showed no significant difference between the latter two groups (P>0.05). The positive rate of TuM2-PK in the cholangiocarcinoma patients was significantly associated with the degree of tumor differentiation, lymph node metastasis and clinical TNM stage (all P<0.05). The AUC value of serum TuM2-PK for diagnosis of cholangiocarcinoma was 0.781, with a sensitivity of 84.81% and a specificity of 80.00%, and the sensitivity and specificity of serum CA19-9 for diagnosis of cholangiocarcinoma were 79.63% and 84.00. The sensitivity was increased but the specificity was decreased by their combined examination. The serum TuM2-PK level was significantly reduced after surgery than that before surgery in cholangiocarcinoma patients (P<0.05), but showed no significant difference in patients with bile duct stones before and after surgery (P>0.05); in cholangiocarcinoma patients, the serum TuM2-PK level was significantly reduced after surgery than that before surgery in cases undergoing radical surgery (P<0.05), but showed no significant change in those undergoing palliative surgery before and after surgery (P>0.05).
Conclusion: The serum TuM2-PK level is increased in cholangiocarcinoma patients, and its level is closely related to the tumor progression and treatment efficacy. So, it has certain value in early diagnosis and estimation of treatment effect and prognosis for cholangiocarcinoma.

Abstract:Background and Aims: In recent years, an increasing number of researches have reported the relationship between the low expression of liver kinase B1 (LKB1) and the poor prognosis in cancer patients. However, a very few studies have reported opposite results, and some studies have shown that in addition to its anti-cancer effect, LKB1 also has a cancer-promoting effect. In the pathogenesis process of liver cancer, cancer cells may obtain genetic changes and induce cancer cell survival by activating the LKB1/AMPK pathway, such as Ras mutation or Skp2 overexpression. This study was conducted to further determine the relationship between low-expressing LKB1 and poor prognosis in cancer patients.  
Methods: Literature searches were performed in Pubmed, Embase, and Cochrane Library databases by using relevant search terms. After literature screening according to the inclusion and exclusion criteria, data extraction and quality assessment were performed. The the relationship between LKB1 expression and prognosis of cancer patients were evaluated by Meta-analysis, the source of statistical heterogeneity was determined by subgroup analysis, and the influence of each individual study on the overall results was detected by sensitivity analysis.
Results: A total of 23 studies with 4 357 patients were finally. The NOS scores for all included studies ranged from 5 to 8, with a median score of 6.65. Among the studies, 22 reported the overall survival (OS), and the results showed that low LKB1 expression was associated with the unfavorable prognosis of the cancer patients (pooled HR=1.94, 95% CI=1.55–2.43, P<0.001); 12 studies reported the disease-free survival (DFS)/progression-free survival (PFS)/relapse-free survival (RFS), and the results showed that low LKB1 expression was associated with poor DFS/PFS/RFS of the cancer patients (pooled HR=1.53, 95% CI=1.08–2.17, P=0.017). The results of further subgroup analysis revealed that the risk or protective factors were the main source of heterogeneity. Finally, the results of the sensitivity analysis excluded the influence of each individual study on the overall results.
Conclusion: Although a very few studies have reported the pro-cancer effect of LKB1 in tumors, and the increased LKB1 expression may promote cancer development, this study confirms that low LKB1 expression is significantly associated with poor prognosis in patients with different types of cancers. 

Abstract:Epithelial-mesenchymal transition (EMT) is a biological process whereby the epithelial cells convert into mesenchymal phenotype. Increasing studies have found and identified that EMT plays a crucial role through the multistep process of tumor metastasis from its initiation to its completion. So, it is regarded as one of the hallmarks of metastasis and is expected to be a new direction of targeted therapy. Nevertheless, there is still confusion and controversy about its nomenclature, definition, and specific value and regulatory mechanism in metastasis both at home and abroad. Therefore, a further brief review of the concept evolution of EMT and recent advances in metastasis is necessary. 

Abstract:Gastric stump cancer (GSC) refers to a primary carcinoma arising from the gastric remnant more than 5 years after surgery for benign ulcer disease or more than 10 years after surgery for gastric cancer. Because of the atypical clinical presentations of the GSC patients at the early stage, most of them are found in advanced stage when seeking for treatment, which plus the particularity of this condition, result in a poor prognosis. The incidence of GSC has shown an increasing tendency over the years. For discussion of several issues concerning the diagnosis and treatment of GSC in recent years, the authors based on review of the relevant literature at home and abroad, address its pathogenesis, clinical manifestations, treatment methods, prognosis and prevention, and also propose that the postoperative follow-up after the first gastrectomy is particularly important, and early detection, early diagnosis and early treatment are essential for improving the survival rates and the quality of life of the patients.