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Background Using effective scolicidal agents intraoperatively is essential to lessen the recurrence rate of hepatic echinococcosis. However, severe hypernatremia may occur after hypertonic saline (HS) has been applied as the scolicidal agent. The aim of this study is to report on pediatric patients with severe hypernatremia after hepatic echinococcus surgery. Methods Patients who presented to West China Hospital between January 2010 and February 2017 were retrospectively analyzed. Children under 16 years with echinococcosis treated by resection were included in the study. Results A total of 26 children were enrolled in this study, including 16 boys and 10 girls with a median age of 8 (2–16). 24 (92.3 %) cases were cystic echinococcosis (CE) and two (7.7 %) were alveolar echinococcosis (AE). According to Clavien-Dindo classification of surgical complications, the complication rate of all 26 patients was 19.2 %, among which three cases belonged to Grade I, one to Grade III b and 1 to Grade IV. Two children encountered severe hypernatremia (sodium: 155.3 mmol/L and 190.0mmol/L). Data showed classic clinical features of severe hypernatremia: profound and persistent bradycardia, hypotension and coma. After treatment, they recovered well without any neurologic sequelae. All patients were followed up regularly for a median time of 38 months (range 4–89 months); the overall disease-free survival was 100.0 %. Conclusions HS irrigation of intra-abdominal echinococcosis may cause acute hypernatremia and severe consequences. Diagnostic suspicion and early intervention are vital tools for avoiding morbidity and mortality.

The most commonly used clinical methods are enzyme-linked immunosorbent assay (ELISA) and quantitative PCR (qPCR) in which ELISA was applied for the detection of protein biomarkers and qPCR was especially applied for nucleic acid biomarker analysis. Although these constructed methods have been applied in wide range, they also showed some inherent shortcomings such as low sensitivity, large sample volume and complex operations. At present, many methods have been successfully constructed on the basis of DNA nanotechnology with the merits of high accuracy, rapid and simple operation for cancer biomarkers assay. In this review, we summarized the bioassay strategies based on DNA nanotechnology from the perspective of the analytical attributes for the first time and discussed and the feasibility of the reported strategies for clinical application in the future.

Stimuli-responsive nanomachines are attractive tools for biosensing, imaging, and drug delivery. Herein, we demonstrate that the orientation of macromolecules and subsequent dynamic interactions at the biomolecule-nanoparticle (bio-nano) interfaces can be rationally controlled to engineer stimuli-responsive DNA nanomachines. The success of this design principle was demonstrated by engineering a series of antibody-responsive DNA walkers capable of moving persistently on a three-dimensional track made of DNA functionalized gold nanoparticles. We show that drastically different responses to antibodies could be achieved using DNA walkers of identical sequences but with varying number or sites of modifications. We also show that multiple interfacial factors could be combined to engineer stimuli-responsive DNA nanomachines with high sensitivity and modularity. The potential of our strategy for practical uses was finally demonstrated for the amplified detection of antibodies and small molecules in both buffer and human serum samples. Unlike many DNA-based nanomachines, the performance of which could be significantly hindered by the matrix of serum, our system shows a matrix-enhanced sensitivity as a result of the engineering approach at the bio-nano interface.

Dee EC, Freret ME, Horick N, et al. Patterns of failure and the need for biliary intervention in resected biliary tract cancers after chemoradiation. Ann Surg Oncol. 2020/08/01 2020. https://doi.org/10.1245/s10434-020-08967-9. Hoehn RS, Wima K, Ertel AE, et al. Adjuvant therapy for gallbladder cancer: an analysis of the National Cancer Data Base. J Gastrointest Surg. 2015;19(10):1794–801. https://doi.org/10.1007/s11605-015-2922-0. Article PubMed Google Scholar Lee GC, Ferrone CR, Tanabe KK, et al. Predictors of adjuvant treatment and survival in patients with intrahepatic cholangiocarcinoma who undergo resection. Am J Surg. 2019;218(5):959–66. https://doi.org/10.1016/j.amjsurg.2019.02.036. Article PubMed Google Scholar Ben-Josef E, Guthrie KA, El-Khoueiry AB, et al. SWOG S0809: a phase II intergroup trial of adjuvant capecitabine and gemcitabine followed by radiotherapy and concurrent capecitabine in extrahepatic cholangiocarcinoma and gallbladder carcinoma. J Clin Oncol. 2015;33(24):2617–22. https://doi.org/10.1200/JCO.2014.60.2219. CAS Article PubMed Google Scholar Horgan AM, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(16):1934–40. https://doi.org/10.1200/jco.2011.40.5381. Article PubMed Google Scholar Ma WJ, Jin YW, Wu ZR, et al. Meta-analysis of randomized clinical trials of adjuvant chemotherapy for resected biliary tract cancers. HPB. 2020;22(7):939–49. https://doi.org/10.1016/j.hpb.2020.02.001. Article PubMed Google Scholar Download references The authors acknowledge the Sichuan Science and Technology Program (2018JY0019), the Fundamental Research Funds for the Central Universities (2019SCUH0021), the Post-Doctor Research Project, West China Hospital, Sichuan University (2019HXBH025), and the Sichuan University Postdoctoral Interdisciplinary Innovation Start-up Fund (0040204153244). Department of Biliary Surgery, West China Hospital of Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China Wen-Jie Ma MD & Rong-Xing Zhou MD You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar W-J M performed the majority of manuscript; R-X Z revised the manuscript critically and gave the final approval of the version to be published. Correspondence to Rong-Xing Zhou MD. The authors declare no conflict of interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions Ma, W., Zhou, R. Do Any Subgroups of Resected Biliary Tract Cancers Patients That Benefit the Most from Adjuvant Chemoradiation Therapy?. Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-09128-8 Download citation Received: 06 August 2020 Accepted: 13 August 2020 Published: 11 September 2020 DOI: https://doi.org/10.1245/s10434-020-09128-8

Herein, we introduce a sequence-specific plasmonic loop-mediated isothermal amplification (LAMP) assay with dual, complementary color readouts enabled by CRISPR Cas12a. Using this assay, any double-stranded LAMP amplicon containing a 5'-TTN PAM sequence can be recognized by Cas12a through a specific CRISPR RNA. The signal transduction is achieved using two orthogonal plasmonic systems mediated by Cas12a.

Prediction of early postoperative recurrence is of great significance for follow‐up treatment. However, there are few studies available that focus on high‐risk factors of early postoperative recurrence or even the definition the exact time of early recurrence for hilar cholangiocarcinoma. Thus, we aimed to examine the optimal cut‐off value for defining the early in patients with R0 resection of hilar cholangiocarcinoma and to investigate prognostic factors associated with early recurrence. Two hundred and fifty‐eight patients with R0 resection of hilar cholangiocarcinoma between 2000 and 2015 were included. The minimum P value approach was used to define the optimal cut‐off of early recurrence. The prognostic factors associated with early recurrence were investigated. The optimal cut‐off value for dividing patients into early and non‐early recurrence groups after R0 resection of hilar cholangiocarcinoma was 12 months. Sixty‐two patients were recorded as early recurrence, and the remaining 196 patients were labeled as non‐early recurrence. Multivariate logistic regression analysis indicated lymph node metastasis (OR = 2.756, 95% CI 1.409‐5.393; P = 0.003), poor differentiation (OR = 1.653; 95% CI 1.040‐2.632; P = 0.034), increased postoperative CA 19‐9 levels (OR = 1.965, 95% CI 1.282‐3.013; P = 0.002), neutrophil‐to‐lymphocyte ratio > 3.41 (OR = 5.125, 95% CI 2.419‐10.857; P 60 years (OR = 2.018, 95% CI 1.032‐3.947; P = 0.040) were independent determinants of early and non‐early recurrence. Poor differentiation (HR = 2.609, 95% CI 1.600‐4.252; P

Mitochondrial trans-2-enoyl-CoA reductase (MECR) is a protein-coding gene, and the protein encoded by this gene is an oxidoreductase that catalyzes the last step in mitochondrial fatty acid synthesis (mtFASII). Numerous studies have shown disorder of lipid metabolism is closely related with malignance, especially in liver cancer. Through pre-experiment, we found that the expression of MECR gene was highly expressed in hepatocelluar carcinoma (HCC) cell lines in vitro. This suggests that the MECR gene may play a role of oncogene in HCC. Therefore, we conducted a preliminary experimental study on the role of MECR gene in HCC cells in vitro. Objective to explore whether the MECR gene can affect the malignant biological behavior of HCC. We selected HCC cell line BEL-7404 as experimental cell, which involves the highest expression of MECR in the pre-experiment. We constructed MECR knockdwon lentivirus vector, and then infected HCC cell lines to down-regulate MECR expression, and establish negative control group (NC). Through various experiments of cytology, our study showed that knockdown of MECR inhibited cell proliferation and colony formation, promoted apoptosis, and inhibited metastasis in HCC cell lines BEL-7404. MECR might serve as a novel gene therapeutic target for the treatment of HCC. Further study is needed to elucidate the signaling pathway through which MECR functions in HCC.

Herein, we describe two homogeneous conversion systems that can convert protein recognition into the release of predesigned output DNA for the activation of DNA nanomachines. With high conversion efficiency, this strategy allows us to initiate DNA nanomachines to respond to any proteins, opening up the possibility of applying DNA nanomachines in clinical practice.

Herein, a DNAzyme-powered nanomachine responsive to multiple hepatocellular carcinoma (HCC)-related miRNAs derived from clinical samples was designed. Initially, three types of nanomachines were constructed with dye molecule [(fluorescein (FAM), tetramethylrhodamin (TMR), and Cyanine 5 (Cy5)]-labeled DNA-RNA chimeric substrates and a specific recognized probe for the corresponding miRNAs target. Once the target miRNAs were captured by two recognizing probes, the DNA nanomachine was initiated, leading to the hybridization between the DNAzyme and the substrates. With the help of a cofactor, the automatic operation of the nanomachine was driven by cyclic cleavage of the DNAzyme. Meanwhile, we also explored the recognition behavior between the recognizing probe and the target miRNA. Subsequently, these DNAzyme-powered nanomachines were developed for the homogeneous and simultaneous detection of three target miRNAs at the femtomloar level. Furthermore, the potential in clinical diagnosis was proven by the successful determination of target miRNA in real clinical samples. Thus, this nanomachine-based strategy possesses significant potential to be an innovation in miRNA analysis methodology.

Optimal treatment of patients with various types of liver tumors or certain liver diseases frequently demands major liver resection, which remains a clinical challenge especially in children. Eighty seven consecutive pediatric liver resections including 51 (59%) major resections (resection of 3 or more hepatic segments) and 36 (41%) minor resections (resection of 1 or 2 segments) were analyzed. All patients were treated between January 2010 and March 2018. Perioperative outcomes were compared between major and minor hepatic resections. The male to female ratio was 1.72:1. The median age at operation was 20 months (range, 0.33–150 months). There was no significant difference in demographics including age, weight, ASA class, and underlying pathology. The surgical management included functional assessment of the future liver remnant, critical perioperative management, enhanced understanding of hepatic segmental anatomy, and bleeding control, as well as refined surgical techniques. The median estimated blood loss was 40 ml in the minor liver resection group, and 90 ml in major liver resection group (P

Cells take advantage of the spatial organization to accelerate the reaction kinetics of diverse components within a crowded intracellular environment. Inspired by this, we hereby designed a principle of spatial constraint to overcome limitations of response kinetics in DNAzyme-powered DNA nanomachines. First, we proposed the type-1 of spatially constrained DNA nanomachines (scDN-1) by co-localizing the aptamer probe and power unit (DNAzyme), allowing the DNA nanomachines to accomplish faster cyclic cleavage of DNAzyme as intramolecular reactions. To expand the scDN into the clinical practice, Type 2 spatially constrained DNA nanomachines (scDN-2) with constrained antibody probes were then constructed through Holliday junction assembly, which increased the effective local concentration to obtain the improved kinetics. With an accelerated response kinetics, this design principle allows DNA nanomachines to accomplish the response to tumor markers in real patients' samples within 30 min, significantly broadening the bioanalytical applications of DNA nanomachines to clinical practice.

With effective adsorption and quenching efficiency, graphene oxide (GO) can be utilized for sensing biomolecules such as nucleic acids and proteins. In these assays, the fluorophore-labeled nucleic acid (reporter) is usually adsorbed by GO first, followed by adding the target molecules to bind the reporter, thus restoring the fluorescence signal. However, the kinetics of fluorescence recovery is usually very slow because the target is probably adsorbed by GO and compromises the binding of the target and the reporter. Herein, we proposed a toehold-regulated strand displacement strategy to accelerate the kinetics of GO-based biosensing. In this strategy, the toehold of the duplex mediated a competitive assembly with the aim of eliminating the adsorption of the target by GO, facilitating the binding of the target and the reporter. While the duplex with the toehold of the target-blocker DNA or reporter-blocker DNA was formed, the rigid structure of the duplex weakened the adsorption of the target by GO and enhanced the recognition of the target by the reporter. This strategy achieved up to 2.6-fold enhancement in fluorescence signal restoration for nucleic acid detection, while there was 3.2-fold enhancement in fluorescence signal restoration for thrombin detection. It has also been demonstrated that this strategy can be used for the determination of DNA and thrombin in diluted serum with excellent specificity.

A DNAzyme-powered micromachine with anti-interfering properties and displaying resistance to being inhibited by biological matrices was built. This micromachine was able to respond to a specific target in high-concentration serum or whole blood.

Colloidal nanoparticle biosensors capable of on-particle biocatalysis are powerful tools for amplified detection of biomolecules. The development and practical uses of such concentric amplifiers can be complicated because of the on-particle biorecognition that involves varying interfacial factors at the biomolecule-nanoparticle interfaces. Herein, we reason that a nanoparticle biosensor equipped with an in-solution biorecognition element may be better fabricated, predicted, controlled, and performed. The in-solution biorecognition shall also be streamlined with the on-particle biocatalysis so that the overall analytical and kinetic performance is not compromised. As a testbed, we introduce a concentric DNA amplifier driven by an enzyme-powered three-dimensional DNA nanomachine, where a DNA walker can be instantly assembled onto a spherical nucleic acid (SNA) track through a polyadenosine anchor. As such, the free DNA walker can participate in reactions in a homogeneous solution before assembling to the SNA track. The instant and stable assembly enabled by both adsorption and complementary base pairing also ensures rapid on-particle biocatalysis. We demonstrate that the in-solution biorecognition effectively eliminates the binding hindrance encountered by the on-particle biorecognition and thus significantly reduced energy barriers for the detection of nucleic acids and proteins. Because of the in-solution biorecognition, our system can also be plugged readily into complex DNA strand displacement networks for rapid signal amplification.

Growing evidence indicates that microRNAs are involved in tumorigenesis and progression of hepatocellular carcinoma (HCC). However, the functional mechanisms of miR-205 in HCC remain largely unknown. Here, we demonstrate that miR-205 expression was significantly down-regulated in HCC tissues and cell lines and was correlated with metastatic pathologic features and shorter disease-free and overall survival. Overexpression of miR-205 dramatically inhibited HCC cell proliferation, apoptosis, migration, invasion, epithelial-mesenchymal transition (EMT) in vitro, and tumor growth in vivo. We subsequently identified semaphorin 4C (SEMA4C) as a novel target of miR-205. Furthermore, high expression levels of SEMA4C were frequently found in HCC tissues and were associated with poor prognosis. Ectopic expression of SEMA4C restored the suppressive effect of overexpressed miR-205 on migration, invasion, and EMT. Taken together, our findings provide new insight into the critical role of miR-205 in regulating tumor growth, invasion, and EMT of HCC, suggesting miR-205 may serve as a promising therapeutic target and novel prognostic indicator for patients with HCC.-Lu, J., Lin, Y., Li, F., Ye, H., Zhou, R., Jin, Y., Li, B., Xiong, X., Cheng, N. MiR-205 suppresses tumor growth, invasion and epithelial-mesenchymal transition by targeting SEMA4C in hepatocellular carcinoma.

Herein, we constructed magnetic immunoassay-based diagnostic platform for cancer biomarker of patient’ s sample by coupling rolling circular amplification with ICP-MS. Tumor biomarker (alpha-fetoprotein, AFP, Carcinoembryonic antigen, CEA) from clinical sample was initially captured by biotinylated antibody functionalized on the surface of magnetic beads, and then recognized by a secondary antibody that linked with a RCA(Rolling Circular Amplification)-primer. Up addition of RCA-template and DNA polymerase, one single target recognition event can be converted into multiple predesigned DNA sequences. This specific sequence can be hybridized with DNA-conjugated AuNPs and form a DNA-AuNP complex for ICP-MS measurement. Under the optimal experimental parameters, this platform can detect AFP and CEA in 20% serum, as low as 2 pg/mL and 5 pg/mL, respectively, which rivalled ELISA. We anticipate this methodology for tumor biomarker detection can be used for clinical diagnosis in future.

The wide field-of-view Cherenkov telescope array (WFCTA), which consists of 18 wide field telescopes, is one of the main detectors used in the Large High Altitude Air Shower Observatory (LHAASO) . The WFCTA collects Cherenkov light and fluorescence signals from cosmic ray showers and converts them into electrical signals that are then processed by an electronic system based on a field-programmable gate array (FPGA) for later physical analysis. The high altitude of the array and the difficulties involved in disassembling the electronics inside the telescope mean that an electronic remote update solution with high fault tolerance and simple operation is required. The proposed remote update solution for the LHAASO-WFCTA electronic readout system is based on Xilinx Multiboot and is intended to implement remote updates without appended circuits. When compared with other remote update solutions based on Multiboot, the solution used on the WFCTA saves numerous resources in the original FPGA program, eases the timing constraint burden, and enhances security. This solution has been successfully implemented and used in remote updating of FPGAs in the LHAASO-WFCTA several times.

The wide field of view Cherenkov telescope array (WFCTA) of the Large High Altitude Air Shower Observatory (LHAASO) is intended to detect atmospheric Cherenkov light or fluorescence. The photomultiplier tube (PMT) array is designed to enable atmospheric monitoring in real time and telescope calibration. This paper introduces the design of the analog circuit for the PMT array. The analog board has 16 channels, where each channel contains a shaping circuit, a high gain circuit and a low gain circuit. The shaping circuit uses a charge integrating circuit, and the amplifier module is composed of a noninverting amplifier circuit and a full differential amplifier circuit. Test results indicate that the dynamic range of the designed circuit is more than 3.2 orders of magnitude, the small signal resolution is less than 20%, the corresponding resolution of large signals is less than 4%, and the relative deviation from linearity is less than 5%. These performance indicators exceed the requirements of the project.

Background: The survival benefits of additional resection of the positive proximal ductal margin (PM) in hilar cholangiocarcinoma (HCCA) remains controversial. This retrospective study investigated the effectiveness of additional resection of the invasive cancer PM under different levels of preoperative carbohydrate antigen 19-9 (CA19-9). Methods: Patients who underwent hepatectomy for HCCA from 2000 to 2017 were analyzed. Surgical variables, resection margin status, length of the PM (LPM), prognostic factors, and survival were evaluated. Results: A total of 228 patients were enrolled: 175 PM(−) without additional resection patients (group A), 21 PM(−) after additional resection (group B), 16 PM(+) without additional resection (group C), and 16 PM(+) after additional resection (group D). The median survival of group B (20.99 months) was similar to that of group A (23.00 months; P=0.16), and both were significantly better than those of group C (11.60 months) and D (9.50 months), especially when preoperative CA19-9>150 U/mL (P 10 mm was significantly better compared with those with an LPM ≤10 mm, especially when preoperative CA19-9 was >150 U/ml (P 10 mm group, the survival of group B was comparable with that of group A (P>0.05). Conclusions: HCCA patients could get a survival benefit from a negative PM resulting from additional resection. Survival could be comparable with that of negative PM without additional resection among HCCA patients. An LPM >10 mm is possibly more associated with better survival compared with whether additional resection of the positive PM is performed under different levels of preoperative CA19-9.

A selective reduction-based method was proposed for the sensitive detection of iodide and melamine using chemical vapour generation (CVG) coupled with atomic fluorescence spectrometry (AFS), meanwhile expanding the application of CVG-AFS.

We aimed to examine whether inflammation-based prognostic scores could predict tumor resectability in a cohort of hilar cholangiocarcinoma patients with preoperative hyperbilirubinemia. We also sought to investigate the prognostic factors associated with overall survival in the subgroup of patients with an R0 resection. A total of 173 patients with potentially resectable hilar cholangiocarcinoma, as judged by radiological examinations, were included. The potential relationship of the Glasgow prognostic score (GPS), modified GPS, platelet lymphocyte ratio (PLR), neutrophil lymphocyte ratio (NLR), prognostic nutritional index (PNI), and prognostic index (PI) with tumor resectability were investigated using univariate and multivariate analysis. Among the 173 patients, 134 had R0 resection margins. Univariate analysis identified that patients with PLR ≥ 150, NLR ≥ 3, PNI ≥ 45, GPS (0.1/2), modified GPS (0.1/2), preoperative CA 125 > 35 U/mL, and a tumor size ≥ 3 cm were more likely to have unresectable tumors. Multivariate analysis indicated that tumor size ≥ 3 cm (OR = 2.422, 95% CI: 1.053–5.573; P = 0.037), PLR ≥ 150 (OR = 3.324, 95% CI: 1.143–9.667; P = 0.027), preoperative CA 125 > 35 U/mL (OR = 3.184, 95% CI: 1.316–7.704; P = 0.010), and GPS (0.1/2) (OR = 2.440, 95% CI: 1.450–4.107; P = 0.001) were independent factors associated with tumor resectability. In selected patients with an R0 resection in this cohort, nodal status (P = 0.010) and tumor differentiation (P = 0.025) were predictive of poor survival outcome. Patients with higher GPS, CA 125, and PLR levels, and a larger tumor size, tend to have unresectable tumors even if they were judged as potentially resectable using preoperative radiological examinations.

The objective of the study is to examine the feasibility of hepatic artery resection (HAR) without subsequent reconstruction (RCS) in specified patients of Bismuth type III and IV hilar cholangiocarcinoma. We retrospectively reviewed 63 patients who underwent hepatic artery resection for Bismuth type III and IV hilar cholangiocarcinoma. These patients were subsequently enrolled into two groups based on whether the artery reconstruction was conducted. Postoperative morbidity and mortality, and long-term survival outcome were compared between the two groups. There were 29 patients in HAR group and 34 patients in the HAR + RCS group. Patients with hepatic artery reconstruction tended to have longer operative time (545.6 ± 143.1 min vs. 656.3 ± 192.8 min; P = 0.013) and smaller tumor size (3.0 ± 1.1 cm vs. 2.5 ± 0.9 cm; P = 0.036). The R0 resection margin was comparable between the HAR group and HAR + RCS group (86.2 vs. 85.3%; P > 0.05). Twelve patients (41.4%) with 24 complications in HAR group and 13 patients (38.2%) with 25 complications in HAR + RCS group were recorded (P = 0.799). The postoperative hepatic failure rate (13.8 vs. 5.9%) and postoperative mortality rate (3.4% vs. 2.9%) were also comparable between the two groups. In the HAR group, the overall 1-, 3-, and 5-year survival rates were 72, 41, and 19%, respectively; while in the HAR + RCS group, the overall 1-, 3-, and 5-year survival rates were 79, 45, and 25%, respectively (P = 0.928). Hepatic artery resection without reconstruction is also a safe and feasible surgical procedure for highly selected cases of Bismuth type III and IV hilar cholangiocarcinoma.

Hepatocellular carcinoma (HCC) with sarcomatous change (SC) is a rare malignancy associated with high aggressiveness and poor prognosis; however, its prognostic significance remains unclear. From January 1994 to April 2012, surgically resected HCCs with SC (n = 52) at West China Hospital were retrospectively reviewed. HCC with SC was defined as the concomitant presence of the sarcomatous component occupying at least 10 % (but not predominantly) of the HCC-bearing tissue. To validate its prognostic significance, we compared the clinicopathological features and survival rates of these patients with a cohort of 214 randomly selected ordinary HCC patients during the same period. The clinicopathological characteristics of HCC with SC were similar to those of ordinary HCC, with the exception of capsule formation, adjacent organ invasion, lymph node metastasis, and TNM staging. A total of 45 (86.5 %) HCC patients with SC experienced a recurrence, with a median time to recurrence of 6.0 months. Overall survival (OS) rates in the sarcomatous HCC group at 1, 2, and 3 years were 55.8, 25, and 17.3 %, respectively, which were significantly lower than those in the ordinary HCC group (p

// Bei Li 1, * , Zhen You 1, * , Xian-Ze Xiong 1 , Yong Zhou 1 , Si-Jia Wu 1 , Rong-Xing Zhou 1 , Jiong Lu 1 and Nan-Sheng Cheng 1 1 Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China * These authors have contributed equally to this work Correspondence to: Nan-Sheng Cheng, email: nanshengcheng@yeah.net Keywords: hilar cholangiocarcinoma; red blood cell distribution width; systemic inflammatory response; prognosis Received: August 09, 2017 Accepted: October 05, 2017 Published: November 25, 2017 ABSTRACT Background : Although the red blood cell distribution width (RDW) has been reported as a reliable predictor of prognosis in several types of cancer, the prognostic value of RDW in hilar cholangiocarcinoma (HC) has not been studied. Methods : A retrospective analysis of 292 consecutively recruited HC patients undergoing radical resection was conducted. The optimal cutoff value of RDW was determined by the receiver operating characteristic curve (ROC). Survival analysis by the Kaplan-Meier method, the difference between the clinico-pathologic variables and survival were evaluated by log-rank analysis. Multivariate analysis identified independent prognostic risk factors of overall survival (OS). Results : ROC analysis suggested that the optimal cutoff value for the RDW was 14.95. Linear correlation analysis revealed that RDW is associated with white blood cell count (P = 0.007), neutrophil-to-lymphocyte ratio (P = 0.02), and hemoglobin (P < 0.001), albumin (P < 0.001). In a multivariate analysis, the RDW was an independent prognostic factor for OS (HR = 1.755, 95% CI 1.311-2.349, P < 0.001). Conclusions : Elevated RDW may be regarded as an indicator of systemic inflammatory response which might facilitate HC growth and metastasis. Current evidence suggests that RDW may have clinical significance in predicting OS after surgery in HC patients.

// Hai-Jie Hu 1, * , Rong-Xing Zhou 1, * , Anuj Shrestha 1, 2 , Yong-Qiong Tan 1 , Wen-Jie Ma 1 , Qin Yang 1 , Jiong Lu 1 , Jun-Ke Wang 1 , Yong Zhou 1 and Fu-Yu Li 1 1 Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China 2 Department of General Surgery, Gandaki Medical College, Pokhara, Nepal * Co-author and contributed equally to this work Correspondence to: Fu-Yu Li, email: lfy_74@hotmail.com Yong Zhou, email: 1063557621@qq.com Keywords: hilar cholangiocarcinoma, prognostic factors, DeOliveira staging system, tumor size, survival outcome Received: June 08, 2017 Accepted: September 23, 2017 Published: October 23, 2017 ABSTRACT Objective: To determine the correlation of different tumor-size cutoffs with prognostic factors and survival outcomes to provide a reference for the modification of the T-stage classification in the DeOliveira staging system for hilar cholangiocarcinoma (HCCA). Materials and Methods: We retrospectively analyzed 216 patients who underwent curative surgery for HCCA (mean tumor diameter, 2.8 cm) between 2000 and 2013. Univariate and multivariate logistic regression were used to assess the correlation of tumor-size cutoffs with various factors. Results: Tumor differentiation (odds ratio [OR]: 1.649, 95% confidence interval [CI]: 1.065–2.555, P = 0.025), node status (OR: 1.971, 95% CI: 1.060–3.664, P = 0.032), resection margin (OR: 2.465, 95% CI: 1.024–5.937, P = 0.044), and hepatectomy (OR: 2.373, 95% CI: 1.226–4.593, P = 0.01) were independently correlated with the 2-cm cutoff, while tumor differentiation (OR: 1.755, 95% CI: 1.062–2.091, P = 0.028), node status (OR: 2.166, 95% CI: 1.054–4.452, P = 0.035), and tumor margin (OR: 2.539, 95% CI: 1.089–5.919, P = 0.031) were independently associated with the 3-cm cutoff. Conclusions: The 2-cm and 3-cm cutoffs were strongly correlated with resection margin, node status, tumor differentiation and survival. The 2-cm cutoff may be added to the DeOliveira staging system.

Background Appendiceal phlegmon and abscess account for 2% to 10% of acute appendicitis. People with appendiceal phlegmon or abscess usually need an appendicectomy to relieve their symptoms and avoid complications. The timing of appendicectomy for appendiceal phlegmon or abscess is controversial. Objectives To assess the effects of early versus delayed appendicectomy for appendiceal phlegmon or abscess, in terms of overall morbidity and mortality. Search methods We searched the Cochrane Library (CENTRAL; 2016, Issue 7), MEDLINE Ovid (1950 to 23 August 2016), Embase Ovid (1974 to 23 August 2016), Science Citation Index Expanded (1900 to 23 August 2016), and the Chinese Biomedical Literature Database (CBM) (1978 to 23 August 2016). We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform search portal (23 August 2016) and ClinicalTrials.gov (23 August 2016) for ongoing trials. Selection criteria We included all individual and cluster-randomised controlled trials, irrespective of language, publication status, or age of participants, comparing early versus delayed appendicectomy in people with appendiceal phlegmon or abscess. Data collection and analysis Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We performed meta-analyses using Review Manager 5. We calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes with 95% confidence intervals (CI). Main results We included two randomised controlled trials with a total of 80 participants in this review. 1. Early versus delayed open appendicectomy for appendiceal phlegmon Forty participants (paediatric and adults) with appendiceal phlegmon were randomised either to early appendicectomy (appendicectomy as soon as appendiceal mass resolved within the same admission) (n = 20), or to delayed appendicectomy (initial conservative treatment followed by interval appendicectomy six weeks later) (n = 20). The trial was at high risk of bias. There was no mortality in either group. There is insufficient evidence to determine the effect of using either early or delayed open appendicectomy onoverall morbidity (RR 13.00; 95% CI 0.78 to 216.39; very low-quality evidence), the proportion of participants who developed wound infection (RR 9.00; 95% CI 0.52 to 156.91; very low quality evidence) or faecal fistula (RR 3.00; 95% CI 0.13 to 69.52; very low quality evidence). The quality of evidence for increased length of hospital stay and time away from normal activities in the early appendicectomy group (MD 6.70 days; 95% CI 2.76 to 10.64, and MD 5.00 days; 95% CI 1.52 to 8.48, respectively) is very low quality evidence. The trial reported neither quality of life nor pain outcomes. 2. Early versus delayed laparoscopic appendicectomy for appendiceal abscess Forty paediatric participants with appendiceal abscess were randomised either to early appendicectomy (emergent laparoscopic appendicectomy) (n = 20) or to delayed appendicectomy (initial conservative treatment followed by interval laparoscopic appendicectomy 10 weeks later) (n = 20). The trial was at high risk of bias. The trial did not report on overall morbidity or complications. There was no mortality in either group. We do not have sufficient evidence to determine the effects of using either early or delayed laparoscopic appendicectomy for outcomes relating to hospital stay between the groups (MD −0.20 days; 95% CI −3.54 to 3.14; very low quality of evidence). Health-related quality of life was measured with the Pediatric Quality of Life Scale-Version 4.0 questionnaire (a scale of 0 to 100 with higher values indicating a better quality of life). Health-related quality of life score measured at 12 weeks after appendicectomy was higher in the early appendicectomy group than in the delayed appendicectomy group (MD 12.40 points; 95% CI 9.78 to 15.02) but the quality of evidence was very low. This trial reported neither the pain nor the time away from normal activities. Authors' conclusions It is unclear whether early appendicectomy prevents complications compared to delayed appendicectomy for people with appendiceal phlegmon or abscess. The evidence indicating increased length of hospital stay and time away from normal activities in people with early open appendicectomy is of very low quality. The evidence for better health-related quality of life following early laparoscopic appendicectomy compared with delayed appendicectomy is based on very low quality evidence. For both comparisons addressed in this review, data are sparse, and we cannot rule out significant benefits or harms of early versus delayed appendicectomy. Further trials on this topic are urgently needed and should specify a set of criteria for use of antibiotics, percutaneous drainage of the appendiceal abscess prior to surgery and resolution of the appendiceal phlegmon or abscess. Future trials should include outcomes such as time away from normal activities, quality of life and the length of hospital stay.

Set pair potential, indicates an identical-discrepancy-contrary trend of two sets discussed in the case of specific problems. This trend can show weak tendency of regional water environmental system vulnerability, consequently set pair potential has been used to analyze its driving factors. In traditional set pair, contrary degree is restricted since that contrary degree does not vanish is the necessary condition by definition, as a result that traditional set pair potential does not have general validity. Therefore taking advantage of exponential function to improve the traditional set pair potential, and a new definition of set pair exponential potential was proposed. Then an analysis model of driving factors of regional water environmental system vulnerability was established based on this new potential and the model was used to analyze the factors in Anhui province, China. Some results have been obtained that the driving factors of water environmental system vulnerability in Anhui province mainly include: degree of regional development level, per capita water resources, marsh area ratio, soil erosion area ratio, industrial wastewater standard discharge rate and the ratio of investment in water environmental governance (protection) to GDP.

No consensus exists regarding the optimal management of concomitant gallbladder stones and common bile duct stones (CBDS). Previous studies showed a significant association between the presence of obstructive jaundice and increased risk of postoperative complications and conversion to open surgery. This retrospective study evaluated the effectiveness and safety of one-stage (laparoscopic cholecystectomy [LC] plus laparoscopic common bile duct exploration) management versus two-stage (preoperative endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy 1 LC) management for patients with obstructive jaundice, concomitant gallbladder stones, and CBDS. One-stage management (n = 88) or two-stage management (n = 122) was used for 210 eligible patients between January 2009 and March 2011. Both types of management proved to be effective and safe. No significant difference was observed in terms of stone clearance from the common bile duct (CBD), postoperative morbidity, mortality, or conversion to open surgery. However, one-stage management was more cost-effective and decreased the number of procedures. In addition, postoperative hospital stay and operative time were shorter for patients who received one-stage management. Especially for patients with CBD greater than 1 cm in diameter, one-stage management is a better choice.

Typical human paragonimiasis demonstrates an elevated eosinophil count, positive immunoblot, nodular shadows of the lung and pleural thickening with pleural effusion, and these symptoms may be confused with chest cancer. In the present case, a rare case of human paragonimiasis mimicking chest cancer and abdominal wall metastasis is described, the 39-year-old male patient was admitted in our hospital for cough, weight loss 5 kg and a firm mass in right upper abdominal wall. The laboratory test showed unremarkable hematology and biochemistry results. Chest X-ray, Plain computed tomography of the chest and abdomen showed right pleural effusion, several nodules in right lower lung and a mass in the right upper abdominal wall. The initial diagnosis was lung or chest cancer with abdominal wall metastasis, and the abdominal wall mass was resected for the final diagnosis. The biopsy revealed eosinophilic granuloma with Charcot-Leyden crystal formation infiltrated in the muscular fibers. Subsequent to assessment of the antibodies against parasites, the final diagnosis of paragonimiasis was made.

To evaluate short-term outcomes following intraoperative biliary lavage for hepatolithiasis.A total of 932 patients who were admitted to the West China Medical Center of Sichuan University between January 2010 and January 2014 and underwent bile duct exploration and lithotomy were retrospectively included in our study. The patients were divided into the lavage group and the control group. Related pre-, intra-, and postoperative factors were recorded, analyzed, and compared between the two groups in order to verify the effects of biliary lavage on the short-term outcome of patients with hepatolithiasis.Amongst the patients who were included, 678 patients with hepatolithiasis were included in the lavage group, and the other 254 patients were enrolled in the control group. Data analyses revealed that preoperative baseline and related intraoperative variables were not significantly different. However, patients who underwent intraoperative biliary lavage had prolonged postoperative hospital stays (6.67 d vs 7.82 d, P = 0.024), higher hospitalization fees (RMB 28437.1 vs RMB 32264.2, P = 0.043), higher positive rates of bacterial cultures from blood (13.3% vs 25.8%, P = 0.001) and bile (23.6% vs 40.7%, P = 0.001) samples, and increased usage of advanced antibiotics (26.3% vs 38.2%, P = 0.001). In addition, in the lavage group, more patients had fever (37.5 °C, 81.4% vs 91.1%, P = 0.001) and hyperthermia (38.5°C, 39.7% vs 54.9%, P = 0.001), and higher white blood cell counts within 7 d after the operation compared to the control group.Intraoperative biliary lavage might increase the risk of postoperative infection, while not significantly increasing gallstone removal rate.

The purpose of this study was to investigate whether hemoglobin-based oxygen carrier (HBOC) could protect the heart from intense exercise-induced myocardial dysfunction. Adult male Sprague-Dawley rats were subjected to 5-h intense prolonged running on treadmill with or without HBOC pre-treatment. Immediately after exercise, the heart rate (HR) and oxygen delivery capacity of the blood were measured. After 1 h of rest, echocardiography was performed to assess the post-exercise cardiac function. Then all the hearts were isolated and perfused using the Langendorff model for 1 h. Our results proved that pronged exercise caused significant LV dysfunction, while HBOC pre-treatment attenuated such a damage, as evidenced by the increased oxygen delivery, cardiac fractional shortening (FS), rate-pressure product (RPP), ±dp/dt and coronary flow rate (CF) and decreased myocardial necrosis. The releases of cardiac enzymes, including creatine kinase-MB (CK-MB) and cardiac troponin-I (cTnI) were markedly reduced. No significant difference of cardiac infarct size was observed among groups. In addition, HBOC significantly elevated superoxide dismutase (SOD) activity and decreased hydrogen peroxide (H 2 O 2 ) formation, which indicated the exercise-induced cardiac oxidative damage was inhibited. In conclusion, HBOC pre-treatment showed a promising cardioprotective effect on prolonged exercise-induced cardiac dysfunction, which was probably associated with its ability to decrease myocardium oxidative stress.

Double primary hepatic cancer, consisting of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) located separately within a single liver simultaneously, is extremely rare. The present study reports a case of double hepatic nodules, in which HCC and ICC occurred simultaneously in the right hepatic lobe. The 47-year-old male patient, who was a carrier of hepatitis B virus, was admitted to our hospital for physical examination, which revealed two liver masses. The results of initial laboratory tests, including liver function tests, were within normal limits, with the exception of mildly elevated aspartate aminotransferase and alanine aminotransferase, and decreased albumin levels. α-fetoprotein was in the normal range, while carbohydrate antigen 19-9 was marginally elevated. Abdominal ultrasonography and enhanced computed tomography revealed two tumors located in segments (S) VI and VII of the liver, respectively, with malignant behavior. Examination of the two masses following resection of S VI and VII confirmed a diagnosis of combined HCC and ICC. After 8 months of follow-up, no signs of recurrence have been observed with chemical therapy.

Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies.English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analysis. Data were extracted independently by two reviewers using a predefined spreadsheet.The incidence of PBM was higher in GBC patients than in controls (10.60% vs 1.76%, OR: 7.41, 95% CI: 5.03 to 10.87, P0.00001). The proportion of female patients with PBM was 1.96-fold higher than in GBC patients without PBM (80.5% vs 62.9%, OR: 1.96, 95% CI: 1.09 to 3.52, P=0.12). GBC patients with PBM were 10 years younger than those without PBM (SMD: -9.90, 95% CI: -11.70 to -8.10, P0.00001). And a difference in the incidence of associated gallstone was found between GBC patients with and without PBM (10.8% vs 54.3%, OR: 0.09, 95% CI: 0.05 to 0.17, P0.00001). Among the GBC patients with PBM, associated congenital dilatation of the common bile duct was present with a higher incidence ranging from 52.2% to 85.7%, and 70.0%-85.7% of them belonged to the P-C type of PBM (the main pancreatic duct enters the common bile duct). No substantial heterogeneity was found and no evidence of publication bias was observed.PBM is a high-risk factor for developing GBC, especially the P-C type of PBM without congenital dilatation of the common bile duct. To prevent GBC, laparoscopic cholecystectomy is highly recommended for PBM patients without congenital dilatation of the common bile duct, especially relatively young female patients without gallstones.

Rationale Pancreatic alveolar echinococcosis (AE) is an exceptionally rare disease; no more than 10 cases have been published to date. It is characterized as extensive local tissue infringement and destruction; thus, extended surgical resection, such as duodenopancreatectomy, is often needed to obtain a negative resection margin so as to improve the long-term outcome and prognosis. Patient concerns A middle-aged Tibetan man was admitted due to a 16-year history of recurrent pain in the right upper abdomen. Magnetic resonance imaging scan showed a cystic lesion in the VI segment of his liver and several cystic lesions in the head of pancreas. Diagnoses Pancreatic AE. Interventions The patient adopted a preserved surgery of partial cystectomy and completely removing the content of the cyst and then soaking by hypertonic saline combined with adjuvant medical therapy of albendazole. Outcomes The patient was monitored on a regular basis at the outpatient department; the patient is still alive and has already survived 8 years till now. Lessons A preserved surgery combined with adjuvant medical therapy of albendazole can also contribute to a good survival outcome for AE located at the head of pancreas.

Rationale: Pancreatic mucoepidermoid carcinoma (MEC) is a rare disease with no more than 10 cases reported in literature. The prognosis is poor and few patients can survival more than 1 year. Patient concerns: We presented a case of patient manifested as left upper abdominal pain. Computed tomography demonstrated a low-density shadow measuring 2.1 × 2.4 cm situated at the transition area of neck and body of the pancreas with obscure boundary and irregular enhancement. The preoperative symptoms and imaging features were unspecific. Diagnoses: Pancreatic MEC. Interventions: Curative surgery of distal pancreatectomy was conducted. Postoperatively, the patient subsequently underwent 8 cycles of chemotherapy using cisplatin (25 mg/m2) on day 1 to day 3; and gemcitabine (1000 mg/m2) on day 1 and day 8, repeated every 21 days. Outcomes: The patient was monitored on a regular basis at our outpatient department and survived 23 months after surgery. Lessons: Preoperative diagnosis of pancreatic MEC is difficult. Patients with pancreatic MEC may have a survival benefit from the multimodal treatment of curative surgery combined with chemotherapy.

Plentiful publications have inspected the feasibility of fast-track surgery programs during hepatic surgery, but the potency of these studies has not been discussed profoundly so far. Our goal was to assess the effects of fast-track programs on surgical outcomes compared with traditional surgical plans for liver surgery. The following databases were searched: PubMed, Cochrane library, Embase, Science Citation Index Expanded, etc. Studies meeting our inclusion criteria were included. All interrelated data and the methodological quality of included studies were extracted and assessed. We applied risk ratio and weighted mean difference as the estimated effect measures. Sensitivity analysis was performed to perceive the reliability of our findings. Altogether, 14 studies with 1400 patients were analyzed. Meta-analysis of randomized controlled trials demonstrated that implementation of fast-track surgery programs could observably decrease the total length of hospital stay, complication rate, postoperative first flatus time, and hospitalization expense, and did not compromise mortality and readmission rate. The above findings were also in line with the results of case-control studies. Fast-track surgery programs are feasible and effective for liver surgery. Future studies should optimize fast-track surgery programs catering to liver surgery.

To explore the risk factors of hepatolithasis-associated intrahepatic cholangiocarcinoma (HICC) and the clinical value of serum tumor-related markers for the detection of HICC.Clinical data were collected from 58 patients pathologically diagnosed as HICC between 2005 and 2011 in West China Hospital of Sichuan University and 189 patients diagnosed as hepatolithiasis alone in the same period as matched control group. Logistic regression analysis was used to detect the independent risk factors of HICC and ROCs curve were constructed to assess the diagnostic value of CA199, CEA, GGT and ALP.The patients in both HICC group and control group presented similar clinical symptoms except weight loss. The results of univariate analysis suggested cholangioenterostomy (P0.001), early stone removal (OR = 0.001), family history of cancer (P = 0.001) were associated with the incidence of HICC. The results of Multivariate analysis suggested diabetes mellitus (OR = 3.621, 95% CI: 1.333-9.834, P = 0.012), family history of cancer (OR = 16.830, 95% CI: 1.937-146.21, P = 0.010), cholangioenterostomy (OR = 5.115, 95% CI: 1.733-15.098, P = 0.003), early removal of stone (OR = 0.315, 95% CI: 0.128-0.771, P = 0.011) and CA199100 IU/mL (OR = 5.478, 95% CI: 2.539-11.820, P0.001) were independent risk factors for hICC. Serum CA199 and CEA level presented low diagnostic accuracy, a combined test (CA199100 IU/mL or CEA5 ng/mL) showed better diagnostic performance with a 71.05% of sensitivity and 82.05% of specificity.Cholangioenterostomy, diabetes, early and complete stone removal were independent risk factors for hepatolithiasis-associated ICC. A combined test of CA199 and CEA could be an effective detecting tool for HICC.

Primary hepatic sarcomatoid carcinoma (SC) is an extremely rare malignancy composed of both carcinomatous and spindle cell sarcomatous components. Our aim was to clarify the clinical features and prognosis of patients with this disease. Between January 1996 and August 2012, 28 patients were histologically diagnosed as primary hepatic SC after surgical resection. Their demographic, clinicopathological, and survival data were retrospectively reviewed. There were 22 men (78.6 %) and 6 women (21.4 %), with a median age of 53 years (range 29–73 years). The median overall survival was 11.5 months, and the 1-, 2-, and 3-year overall survival rates were 50, 21.4, 14.3 %, respectively. The patients who received radical resection had obviously better survival compared with those underwent palliative resection (15.6 vs. 7.6 months, P = 0.001). Multivariate analysis revealed that TNM stage [HR 8.737, 95 % CI 1.263–60.430, P = 0.042] and local invasion [HR 4.734, 95 % CI 1.382–16.220, P = 0.013] were independent risk factors for overall survival. Primary hepatic SC is highly aggressive malignancy with extremely poor prognosis. Radical resection at an early stage may contribute to a relatively favorable prognosis for this uncommon disease.

Background Neuroendocrine carcinoma is rare with a proportion of less than 2% in gallbladder malignancies, cases of gallbladder neuroendocrine cell carcinoma coexisting with adenocarcinoma are exceptionally rare, and the prognosis is dismal. Methods Herein, we presented an unusual case of poorly differentiated gallbladder neuroendocrine cell carcinoma coexisting with poorly differentiated adenocarcinoma who survived 20 months after the multimodal treatment (MT) of extended surgery and postoperative chemotherapy. Results Our result indicated that for advanced gallbladder neuroendocrine cell carcinoma coexisting with adenocarcinoma, MT including extended surgical approach combined with postoperative chemotherapy may contribute to a relatively good survival outcome. Conclusion MT may contribute to a relatively good survival outcome for advanced gallbladder neuroendocrine cell carcinoma coexisting with gallbladder adenocarcinoma.

In order to investigate the role of acupuncture in the regulation of cellular immune function, the changes of T lymphocyte subsets (CD3+, CD4+, CD8+), soluble interleukin-2 receptor (SIL-2 R) and beta-endorphine (beta-EP) in the peripheral blood of patients with malignant tumors before and after acupuncture were observed with double blind method. Forty patients were divided randomly into two groups, 20 for each. One group treated with acupuncture and the other one for control. Results showed that acupuncture has the effect of enhancing the cellular immunity of patient with malignant tumor. Acupuncture treatment could increase the percentage of T lymphocyte subsets CD3+, CD4+ and the CD4+/CD8+ ratio (P < 0.01) and the level of beta-EP, as well as decrease the level of SIL-2 R (P < 0.01). The correlation analysis of the three criteria showed there was a positive correlation between beta-EP and T lymphocyte subsets and a negative correlation between beta-EP and SIL-2 R, there was also a negative correlation between T lymphocyte subsets and SIL-2 R. Based on these results, a discussion on the acupuncture immunomodulation network was conducted in this article in order to explore the possible mechanism of acupuncture on immunomodulation.

Studies investigating the associations between Cytochrome P4502E1 (CYP2E1) polymorphisms and colorectal cancer (CRC) risk report conflicting results. We conducted a meta-analysis to assess the association between CYP2E1 gene Rsa I/Pst I, Dral T/A and 96-bp insertion polymorphisms and CRC susceptibility. Two investigators independently searched the Medline, Embase, CNKI, Wanfang, and Chinese Biomedicine Databases. Summary odds ratios (ORs) and 95 % confidence intervals (95 % CIs) for CYP2E1 polymorphisms and CRC were calculated in a fixed-effect model (the Mantel-Haenszel method) and a random-effects model (the DerSimonian and Laird method) when appropriate. Ultimately, 12, 5, and 4 studies were found to be eligible for meta-analyses of Rsa I/Pst I, Dral T/A, and 96-bp insertion polymorphisms, respectively. Our analysis suggested that the variant genotype of Rsa I/Pst I were associated with a significantly increased CRC risk (c2/c2 vs. c1/c1, OR = 1.36, 95 % CI = 1.04-1.77; recessive model, OR = 1.35, 95 % CI = 1.04-1.75). Moreover, similar results were observed between CYP2E1 96-bp insertion polymorphism and CRC risk (dominant model, OR = 1.25, 95 % CI = 1.07-1.45), while no association was observed between CYP2E1 Dral T/A polymorphism and CRC susceptibility in any genetic model. No publication bias was found in the present study. This meta-analysis shows that CYP2E1 Rsa I/Pst I and 96-bp insertion polymorphisms may be associated with CRC risk. The CYP2E1 Dral T/A polymorphism was not detected to be related to the risk for CRC.