�ΰ�����������״

??Present status of immunotherapy for hepatocellular carcinoma YANG Yang*??CHEN Wen-jie??ZHANG Qi. *Department of Hepatic Surgery??Institute of Organ Transplantation??the Third Affiliated Hospital of Sun Yat-sen University??Guangzhou 510630??China
Corresponding author??YANG Yang??E-mail??yysysu@163.com
Abstract The development of biotherapy??especially immunotherapy which is the most important form of biotherapy??could meet the pressing need of better treatment modalities for Hepatocellular carcinoma (HCC) and has captured the increasing imagination of scientists and doctors. The immunotherapy??including adoptive cell transfer??tumor vaccines and checkpoint inhibi¬tors??focuses on the whole immune system besides cancer cells. And the strategies of immunotherapy to harnesses the power of the immune system improve the ability against liver cancer and then recover the immune system. Now that some clinical trails have shown that immunotherapy can effectively treat some forms of cancer and contribute to disease stabilization??live quality??and long-term survival. Therefore??cancer immunotherapy could be used more widely and be integrated them with other cancer therapies to get more therapeutic benefit.     

胆肠吻合术后胆管结石内镜治疗疗效评估（附17例报告）

目的 评估内镜逆行胰胆管造影（ERCP）治疗胆肠吻合术后并发胆管结石的成功率、安全性和有效性。方法 回顾性分析2012年4月至2014年3月上海交通大学医学院附属新华医院行ERCP治疗17例胆肠吻合术后胆管结石病人的临床资料。 结果 17例病人中,胆肠Roux-en-Y吻合术后病人13例,胰十二指肠切除术后胆管空肠吻合病人4例。成功进入空肠输入袢到达胆肠吻合口14例（82.4%）。4例行诊断性ERCP,10例为治疗性操作,均成功行取石+经内镜鼻胆管引流术（ENBD）。无消化道穿孔及出血相关并发症。结论 对于胆肠吻合术后胆管结石的病人,使用ERCP进行诊治安全、可行。     

胆囊颈部肉瘤样癌向胆总管腔内芽生致梗阻性黄疸1例报告

正胆囊肉瘤样癌临床罕见,本质属于上皮性癌,肉瘤样成份并非来源于真正的间叶组织,细胞形态呈梭形,但实际为一种未分化癌。其恶性度高,预后差,早期诊断困难,确诊需要癌组织免疫病理学检测~([1-2])。肝外胆管疾病引起梗阻性黄疸多系原发性胆管癌、胆管结石或胆管损伤性狭     

肝内胆管癌肝切除术后“教科书式结局”影响因素分析及预测模型建立

目的 分析肝内胆管癌（ICC）病人肝切除术后“教科书式结局”（TO）的影响因素,构建预测TO评分模型。方法 回顾性分析2011年1月至2017年1月东南大学附属中大医院和中国人民解放军东部战区总医院八一医院收治的261例行肝切除术的ICC病人临床病理资料,分析影响TO的独立危险因素,根据危险因素的权重构建预测TO的评分模型。结果 261例ICC病人中,67例（25.7%）术后发生TO。年龄、肝硬化、手术时间和T分期［第8版美国癌症联合委员会（AJCC）癌症分期］为术后TO的独立预测因素。依此4项因素构建的评分模型显示了较好的预测准确性,最佳截断值为-1.9分,其敏感度为67.2%,特异度为62.9%。一致性检验显示其预测概率和实际发生概率有着较好的一致性（χ2=1.350,P=0.853）。结论 基于年龄、肝硬化、手术时间、T分期4个因素建立的评分模型可较准确地预测ICC病人术后TO的可能性,即手术时间短、无肝硬化、肿瘤直径<5 cm的年轻ICC病人肝切除后获得TO的可能性更大。     

强心方对慢性心力衰竭小鼠心功能及心室重构的影响

目的 观察强心方对心力衰竭小鼠心功能及梗死区心肌组织细胞纤维化和心室重构(ventricular remodeling,VR)的影响。方法 将48只雄性C57小鼠腹腔注射阿霉素制作心力衰竭模型,于造模成功后分别给予强心方低剂量及高剂量灌胃,连续灌胃1个月后通过超声心动图检测各组小鼠心功能水平,随后取材。ELISA检测小鼠血清BNP水平,Masson三色染色分别观察梗死区胶原纤维沉积,RT-qPCR检测小鼠心脏组织Anp、β-MHC基因表达水平。结果 心力衰竭发生后,相较于模型组,强心方治疗各组超声心动图检测表明其心功能水平提升,ELISA检测发现心力衰竭指标BNP水平降低,Anp、β-MHC基因表达提示抑制心肌肥大,Masson三色染色分别观察梗死区胶原纤维沉积减少。结论 强心方可以一定程度上改善慢性心力衰竭小鼠心功能水平,其可能通过小鼠减轻心肌肥厚、纤维化等多途径延缓心室重构进程。     

MAC系统在脊柱前路固定中应用初步报告

目的 :探讨MAC系统在脊柱前路固定中应用。方法 :从 2 0 0 2年 11月～ 2 0 0 3年 6月本院应用MAC系统行脊柱前路固定 2 0例。结果 :随访 7～ 11个月 ,平均 9个月 ,经X线拍片植骨全部愈合 ,MAC系统固定良好 ,重建了脊柱的稳定性。神经功能据Frankel分级术后 :A级 1例 ,B级 1例 ,C级 5例 ,D级 4例 ,E级 9例。结论 :前路减压 ,应用MAC系统固定临床效果良好 ,MAC系统确保了脊柱内在的稳定性     

Repair of superficial osteochondral defects with an autologous scaffold-free cartilage construct in a caprine model: implantation method and short-term results

OBJECTIVE: To compare four different implantation modalities for the repair of superficial osteochondral defects in a caprine model using autologous, scaffold-free, engineered cartilage constructs, and to describe the short-term outcome of successfully implanted constructs. METHODS: Scaffold-free, autologous cartilage constructs were implanted within superficial osteochondral defects created in the stifle joints of nine adult goats. The implants were distributed between four 6-mm-diameter superficial osteochondral defects created in the trochlea femoris and secured in the defect using a covering periosteal flap (PF) alone or in combination with adhesives (platelet-rich plasma (PRP) or fibrin), or using PRP alone. Eight weeks after implantation surgery, the animals were killed. The defect sites were excised and subjected to macroscopic and histopathologic analyses. RESULTS: At 8 weeks, implants that had been held in place exclusively with a PF were well integrated both laterally and basally. The repair tissue manifested an architecture similar to that of hyaline articular cartilage. However, most of the implants that had been glued in place in the absence of a PF were lost during the initial 4-week phase of restricted joint movement. The use of human fibrin glue (FG) led to massive cell infiltration of the subchondral bone. CONCLUSIONS: The implantation of autologous, scaffold-free, engineered cartilage constructs might best be performed beneath a PF without the use of tissue adhesives. Successfully implanted constructs showed hyaline-like characteristics in adult goats within 2 months. Long-term animal studies and pilot clinical trials are now needed to evaluate the efficacy of this treatment strategy.     

肾包虫病1例报告

1临床资料 患者，女，37岁，自感右下肢麻木1周，行腰椎MRI检查时发现右肾下极及外侧囊实混杂占位，入院。查体：唇绀，双肾区未触及明显包块，叩痛阴性。尿常规白细胞（＋），血沉正常。双肾MRI平扫加增强示；病灶与右肾下极前部关系紧密，部分病灶位于右肾下极以外，囊性病灶间可见实性结节，部分囊性病灶周围可见钙化。B超：右肾旁囊性病变，穿刺涂片未在到细菌及异常细胞。