Objective To understand the effect of the resect margin(RM)to hepatectomy for primary hepatocellularcarcinoma(PHC).Methods In 544 cases,72 cases were small PHC(≤3cm),473 cases were large PHC(＞3cm). Four groups were classified according to the distance of RM The 5-year recurrence rate and survival rate after hepatic resection in each group were analyzed. Results RM with residue cancer or cancer embolus had a high 5-year recurrencre rate and lower survival rate in both small and large PHC. Small PHC with RM≥1.0cm and large PHC with RM≥2.0cm had higher 5-year survival rate and lower recurrence rate. Conclusion We recommend RM≥1.0cm for smallPHC and RM≥2.0cm for large PHC.

To identify the factors that affect the hospital social responsibility(HSR)level based on theoretical analysis.79 TCM hospitals in Jiangsu Province were surveyed with questionnaires,with the data analyzed by the multiple linear regression model.The research results show the following: 1. Hospital’s financial performance,hospital size,and the congress of medical workers are positive factors to the HSR level.2.Pressure from HSR performance of neighboring hospitals has a significant negative impact.3.Hospital’s financial performance and hospital size have a significant positive impact on its intention to fulfill HSR.4.Hospital location has a significant negative impact on its intention to fulfill HSR.

Objective To study the relationship between hospital attributes and hospital social responsibility (HSR)behaviors,and measures to improve HSR performance.Methods 79 TCM hospitals in Jiangsu Province was surveyed with questionnaires for their HSR performance in 201 1 and 2012,with the data analyzed by independent two-sample t-test.Results In terms of HSR contribution,different levels of hospitals have statistical significance in bad debt,accomplishment of government mandatory missions,environmental protection,education and research,and social welfare activities.Hospitals in different regions have statistical significance in education and research,low-profit medical services and cheap drugs provision.Teaching hospitals make statistical significance in accomplishment of government mandatory missions,environmental protection,education and research,and social welfare activities.In terms of HSR willingness,different levels of hospitals have statistical significance in accomplishment of government mandatory missions,price discount,and education and research.Hospitals in different regions have statistical significance in health services with positive social effects,education and research,and social welfare activities.Teaching hospitals make statistical significance in education and research. Conclusions Secondary hospitals need to invest more resources on HSR.Hospitals in underdeveloped areas must pay more attention to environmental protection,education and research.Non-teaching hospitals need to strengthen quality of care,accomplishment of governmental mandatory missions and environmental protection.

Objective To explore the diagnosis and management of functional pancreatic endocrine tumor.Methods Clinical data of 19 cases of functional pancreatic endocrine tumor were retrospectively analyzed.Results 15 cases of insulinoma,2 cases of gastrinoma and 2 cases of glucagonoma were qualitatively diagnosed.The positive rate of preoperative diagosis for type B ultrasonic inspection,CT,MRI,EUS,selective portovenous sampling and intraoperative type B ultrasonic inspection was 15.8％ (3/19),67.5％ (10/16),71.4％ (5/7),87.5％ (7/8),100％(2/2) and 85.7％(6/7) respectively.Of the total 19 cases,7 cases underwent open surgery,11 cases unde rwent laparoscopic surgery,and one case didn't undergo any surgery as liver metastasis had occurred when glucagonoma was diagnosed.The operation methods included tumor enucleation (n=13),distal pancreatic resection (n=3),distal pancreatic resection plus splenectomy (n=1),and pancreatic head resection with duodenum preserved (n=1).Conclusions The measurement of serum insulin,gastrin and glucagon is the main basis for qualitative diagonosis of pancreatic endocrine tumor.Two stage spinal CT thin scanning is the main method for tumor location.Intraoperative type B ultrasonic inspection is the supplement to preoperative location.Tumor enucleation is the main choice of treatment.

Objective To explore the safety and efficacy of hepatic resection with selective hepatic vascular exclusion(SHVE). Methods SHVE was used in 246 consecutive patients undergoing major or complex liver resection in our center. Preoperative demographic and clinical data,details of the surgical procedure, pathologic diagnosis, postoperative course and complications were collected and analy zed. Results From January 2000 to July 2007, liver resections were performed IJnder SHVE in 246 patients; total SHVE, right partial SHVE and left partial SHVE in 145, 54 and 47 patients, respectively. SHVE was converted to total hepatic vascular exclusion(THVE)in 3 patients to repair the wall of inferior vena cava(IVC). Hemodynamic tolerance to SHVE was excellent, only with a slight increase in systemic and pulmonary vascular resistance during clamping.There were no deaths. and the morbidity was 24.8%.The mean leyth of hospital stay was 9.6 days(range 8-18) .Conclusion Our study showed that SHVE is a safe and effective procedurei and it is applicable to liver tumors near but not invade the inferior vena cava.

Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma.Methods A total of 62 patients with cervical adenosquamous carcinoma,149 patients with cervical adenocarcinoma,and 2687 patients with cervical squamous cell carcinoma,all of whom were in stage Ⅰ B-Ⅱ A and were treated from 2006 to 2012,were enrolled,and some of them received postoperative pelvic radiotherapy ± para-aortic extended field radiation ±afterloading radiotherapy.The chemotherapy regimen consisting of DDP,TP,and FP was given to these patients.The chi-square test was used for comparison of general clinical data,the Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis.Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features (P=0.107-0.639).The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy (P=0.000).In the patients treated with surgery and radiotherapy,those with adenosquamous carcinoma had the shortest median survival time,followed by those with adenocarcinoma and squamous cell carcinoma (P =0.134,0.787);in the patients treated with surgery and concurrent chemoradiotherapy,those with adenocarcinoma had the shortest median survival time,followed by those with adenosquamous carcinoma and squamous cell carcinoma (P=0.131,0.643),and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma (P =0.000).In the patients with adenosquamous carcinoma and adenocarcinoma,the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy (P=0.037,0.003),but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients (P=0.861,0.655).In the patients with adenosquamous carcinoma,the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis (P =0.003) and prolonged median overall survival and disease-free survival (both increased by 17 months) (P=0.811,0.799),as compared with those treated with postoperative radiotherapy,while in the patients with adenocarcinoma,the median overall survival and disease-free survival were reduced by 11 and 9 months,respectively (P=0.330,0.115).Conclusions Compared with postoperative radiotherapy,postoperative concurrent chemoradiotherapy for early-stage high-risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis.Compared with radiotherapy,postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time.

OBJECTIVE To study the gene chip joint pyrosequencing technology in the newborn genetic deafness gene mutation screening, and provide a theoretical basis for the early diagnosis and prevention of genetic deafness. METHODS 2000 Neonatal EDTA umbilical cord blood was collected and genomic DNA (gDNA) was extracted. Microarray chip was used to detect four deafness gene at 9 mutation sites. And the positive result of gene chip detection was verified by pyrosequencing.RESULTS Among the GJB2 mutations, there were 1 case of 35delG mutation type, 3 cases of 176 del16 mutation type, 57 cases of 235del C mutation type, 9 cases of 299 del AT mutation type, 6 cases of GJB3 gene 538C>T mutation type. There were 5 cases of 1555A>G mutations and 1 case of 1494C>T mutations in mitochondrial 12S rRNA. There were 6 cases of 2168A>G mutation type and 23 cases of IVS7-2A>G mutations in SLC26A4. 103 cases of newborns carry the mutated gene in 2,000, the gene mutation rate is 5.15%. CONCLUSION All the four genes mutation at nine mutation sites are found in newborns with family history of non-hereditary deafness, and GJB2 gene mutation is common. The screening of genetic deafness in newborns is very important for early diagnosis and prevention of hereditary hearing loss. In particular, the diagnosis of mitochondrial 12S rRNA gene mutation can prevent the occurrence of deafness caused by drug use, for the genetic mutation of these carriers' health is of great significance.

Objective To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration. Methods Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct (CBD) stones. After extraction of stones, an 8F J-stent (pigtailed) was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed. Results The stent dislodged and was discharged with stool at the 13th (10-18) postoperative day . Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD. Conclusions Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of choledochoscpe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.

Objective To study the clinical,imaging and pathological features of hepatic angiomyolipoma,and to investigate methods in improving the preoperative diagnosis rate.Methods The imaging features and treatment experience of 73 patients with hepatic angiomyolipoma who had been admitted to the Eastern Hepatobiliary Surgery Hospital from 2000 to 2007 were retrospectively analyzed.All patients were classified according to the imaging features and corresponding treatments were applied.Results Of all patients,7 were diagnosed preoperatively.The diagnostic rate of B ultrasound,computed tomography and magnetic resonance imaging were 0,13%(7/56)and 6% (2/33),respectively.According to the results of imaging examination,6 patients were with the type of hemangioma,17 with the type of lipoma,4 with the type of leiomyoma and 46 with mixed type.One patient was treated by radiofrequeney ablation and 72 by surgical resection.Twenty-four patients were presented with pulmonary infection,pleural effusion,ascites or slight hepatic dysfunction.Postoperative immunohistochemical assay demonstrated that HMB45 had the highest positive expression rate,then followed by smooth muscle actin,vimentin,proliferating cell nuclear antigen,CD34,polyclonal carcinoembryonic antigen,CD18,CD19 and p53.One patient died of postoperative tumor recurrence.Conclusions Hepatic angiomyolipoma is easy to be misdiagnosed,while imaging classification is helpful in the diagnosis.Surgical resection is beneficial to patients with hepatic angiomyolipoma.

Objective To study the changes of resting-state brain activity in knee osteoarthritis(KOA)patients with chronic pain.Methods The data of 21 KOA patients (KOA group) and 21 healthy controls (HC group) who underwent standard resting-state fMRI scan were analyzed with regional homogeneity (ReHo) method to observe the changes in the patients in contrast to the controls.Results Compared to HC group,patients of the KOA group showed ReHo changes in bilateral frontal lobe,bilateral parietal lobe,bilateral temporal lobe,bilateral cerebellum,limbic system and default-mode network.Conclusion Patients with chronic pain demonstrate abnormal neuron activities in the brain regions, and control loops not only related with pain but also related with emotive function disorder and cognitive impairment.