Molecular targeted therapy has become a new hot spot with the in -depth basic research on advanced biliary tract cancer (ABTC).Phase ⅡandⅢtrials of the molecular targeted therapies for ABTC are summarized to provide new insights into clinical practice. Phase II trials have shown that vascular endothelial growth factor receptor inhibitor and mitogen-activated protein kinase inhibitor do not ex-hibit good anti-tumor activity,but epidermal growth factor receptor (EGFR)inhibitor has proven to be safe and effective in the treatment of ABTC.The only multicenter,open-label,randomized,controlled phase Ⅲ trial has shown that nilotinib combined with gemcitabine and oxaliplatin,as the first-line chemotherapy for ABTC,cannot significantly increase the overall survival in patients.Subgroup analysis has shown that standard chemotherapy combined with nilotinib can significantly increase the progression-free survival in patients.These results indicate that EGFR inhibitor is effective to control the progression of ABTC,suggesting that EGFR might be a novel therapeutic target.

Liver is one of the most predilection sites of hematogenous metastasis of a variety of malignances,especially for gastrointestinal tumors.Surgical resection was the first choice for the treatment of liver metastases,while it could not apply to patients who had multiple metastatic lesions or other organs involvement.Interventional technique has been widely recognized for the advantages of minimal trauma,little pain,quick recovery and obvious efficacy.

Budd-Chiari syndrome (BCS)is a rare liver disease,and there are mutual influences between BCS and pregnancy.The rela-tionship between BCS and pregnancy is systematically discussed,and the points we should pay attention to in the diagnosis and treatment of this disease are pointed out as follows:First,pregnancy is a risk factor for BCS;pregnant women with the clinical manifestations of portal hy-pertension and (or)inferior vena cava hypertension should be highly suspected of having BCS.Second,pregnancy is risky in BCS patients;pregnancy is allowable in BCS patients who have a stable condition after treatment,but they should be kept under rigorous surveillance dur-ing pregnancy and after delivery to avoid thrombosis recurrence.Third,BCS may lead to infertility in women;patients with unexplained in-fertility should be evaluated by abdominal ultrasound and computed tomography to clarify the diagnosis of BCS.

In patients with liver cirrhosis,variceal bleeding is a common fatal complication of portal hypertension.Varices are present in al-most half of patients with cirrhosis at the time of diagnosis.Since transjugular intrahepatic portosystemic shunt (TIPS)was first applied clini-cally in 1988,the relevant information about TIPS has been continually updated and perfected by lots of clinical trials.The role of TIPS in the prevention and treatment of variceal bleeding in cirrhotic patients with portal hypertension,including primary prevention of variceal bleeding,treatment of acute variceal bleeding,and prevention of rebleeding,is reviewed.TIPS is an effective treatment for variceal bleeding in cirrhotic patients with portal hypertension.Along with the technical development,TIPS will be available for more and more patients and will play an increasingly important role in the prevention and treatment of variceal bleeding among cirrhotic patients with portal hypertension.

An early and accurate response evaluation is essential for clinicians to decide whether to continue the treatment with current thera-peutic regimen or to make necessary changes.This article briefly introduces the development of response evaluation criteria for tumors,elab-orates on the application of radiological evaluation criteria in local interventional therapy or sorafenib treatment of hepatocellular carcinoma (HCC),compares the four radiological evaluation criteria,i.e.,World Health Organization (WHO)criteria,Response Evaluation Criteria in Solid Tumors (RECIST),European Association for the Study of Liver (EASL)criteria,and the modified RECIST (mRECIST),and thinks that EASL criteria and mRECIST are better than WHO criteria and RECIST and can predict the prognosis of HCC patients at earlier time points.

Objective To evaluate the therapeutic effect of implanted drug delivery system (DDS) in patients with inoperable pancreatic carcinoma.Methods During 1998 to 2004,145 patients with no indication for operation were randomly divided into two groups.In 73 patients with regional interventional chemotherapy group (group A),percutaneous left subclavain artery port-catheter DDS implantation with the tip in common hepatic artery was performed, and regional chemotherapy infusion were done in every 1 to 2 month. In 72 patients with systemic chemotherapy group (group B), the chemotherapy were given via peripheral vein in every 1 to 2 month. The FAM(adriamycin 40 mg/m2+mitomycin 6 mg/m2+fluorouracil 375 mg/m2) were selected in two groups. Results In group A, after 2-10 (average 7.6) cycles of chemotherapy, 4 patients reached complete release (CR) and 49 patients reached partial release (PR). In group B, after 1-7 (average 3.8) cycles of chemotherapy, no patient reached CR and 25 patients reached PR. The effective ratio was 60.2% and 34.7% in group A and B, respectively. The survival time ranged from 3 to 34 months (median 13.5 months) in group A and 1 to 13 months (median 6.2 months) in group B. Among the 56 patients with obstinate pain in group A, 27 patients were free of pain and 22 patients got partially alleviation 2-3 weeks after chemotherapy. Among the 54 patients with obstinate pain in group B, 11 patients were free of pain and 14 patients got partially alleviation 2-3 weeks after chemotherapy. The pain-releasing ratio in group A and group B was 87.5% and 46.3%. There were no severe damage of liver, kidney, heart and bone marrow in group A. Twenty five patients in group A experienced mild digestive side-effect and decrease of white blood cells, all of them completed the chemotherapy. In group B, 3 patients experienced bone marrow arrest, one died of severe damage of liver and kidney, and 67 patients displayed digestive side-effect and decrease of white blood cells. The ratio of side-effect in group B was 90.3%. The differences of effective ratio, survival time and side-effect ratio between group A and B were statistically significant (P

Objective To analyze the risk factors of 30-day mortality in patients with malignant hilar obstruction (MHO) after percutaneous transhepatic biliary metal stent deployment. Methods One hundred and fifty-nine consecutive patients with MHO caused by cholangiocarcinoma or gallbladder carcinoma were enrolled in this study. Percutaneous transhepatic biliary stent (PTBS) implantation was carried out in all the patients. Independent predictors for 30-day mortality were evaluated by logistic regression analysis. Covariates that were incorporated into the multivariate analysis were the variables that reached statistical significance (P < 0.1) in univariate analysis. Two-tailed, P value of less than 0.05 was considered to be statistically significant. Results The 30-day mortality of patient with MHO after metal stent deployment was 9.4%. Univariate analysis indicated that the differences in WBC (OR = 1.224.95%CI [1.07 - 1.44], P < 0.01), INR (OR=78.75, 95%CI [5.02-1 235.70], P<0.01), PT(OR=1.55, 95%CI [1.18-2.04], P<0.01), BUN (OR=1.19, 95%CI [1.02- 1.38], P < 0.05), CRE(OR = 1.02, 95%CI [1.000 - 1.041], P < 0.1) and lymph nodes metastasis(OR = 0.334. 95%CI[0.105 - 1.131], P < 0.1) were statistically significantly between 30-day mortality group and non-30-day mortality group. Multivariate analysis showed that statistically significant differences in WBC (OR = 1.19, 95%CI[1.026 - 1.380], P < 0.05), INR(OR = 151.5, 95%CI [3.13 - 5 440.7], P < 0.05) and CRE (OR = 1.025, 95%CI [1.002 - 1.048], P < 0.05) also existed palliative treatment for patients with malignant hilar obstruction. Active preoperative measures to improve hepatic and renal functions as well as to control infection are necessary in order to reduce 30-day mortality.

Since intra-arterial chemotherapy with the help of implantation of port-catheter system (PCS) was first used in the surgical field in 1981, PCS has been widely employed in the field of interventional radiology. Intra-arterial chemotherapy by implantation of PCS has some certain advantages such as minimal invasion, no need of general anesthesia, etc. Ten randomized clinic trails have been already reported, which indicate that intra- arterial chemotherapy with PCS is obviously superior to systemic chemotherapy in treating hepatic metastasis form colorectal cancer. As for the treatment of advanced biliary tract cancer, pancreatic carcinoma and hepatocellular carcinoma, the relevant reports can be found only in several phaseⅠ/Ⅱclinical trials or in some retrospective cohort studies. This paper aims to make a comprehensive review about the indications, clinical applications and complications of PCS in treating abdominal tumors in order to improve the clinical practice.

Objectives To investigate the immune effect of hepatitis B vaccine under the influence of congenital human cytomegalovirus (HCMV) infection. Methods The newborn rat model of congenital HCMV infection was developed by intra-peritoneally inoculating pregnant rat with HCMV suspension,while the offsprings of healthy rats were used as the control group. Offspring rats in all groups were inoculated with hepatitis B vaccine in the postnatal 1st, 3rd and 5th week and were taken blood from hearts separately in 3rd, 5th, 7th and 11th week. Antibody to Hepatitis B surface antigen (HBsAb) titer in all groups was de-tected by ELISA method. Results The serum HBsAb titer in both groups all showed a trend of increasing gradually with added vaccinating times and decreased differently with time extending after completed vaccinations. Differences among changes of HBsAb titer along with prolonged time in each group were all statistically significant (P<0.001). At all time points (3rd, 5th, 7th, 11th week), the titer of serum HBsAb in congenital HCMV infection group was lower than that in the control group respectively, and there were statistically significant differences (P<0.01). Conclusions Congenital HCMV infection could weaken the im-mune effect of hepatitis B vaccine.

Objective To observe the effects of electroacupuncture on the expressions of autophagy related protein Beclin-1 and apoptosis related protein p53 of hippocampus in rats;To explore the mechanism of electroacupuncture on Alzheimer's disease (AD).Methods The rats were randomly divided into the normal group, the sham-operation group, the model group, and the electroacupuncture treatment group. “Baihui” and “Yongquan” points were taken for electroacupuncture treatment and the treatment course was 7 days. The rats were treated once a day for 4 courses. Changes in morphology and number of Nissl positive cells were examined by Nissl staining in hippocampal CA1 regions. Expressions of Beclin-1 and p53 protein were determined by Western blot analysis.Results Number of Nissl positive cells in CA1 region of the model group was significantly less than that of normal group (P<0.01). After electroacupuncture treatment, number of pyramidal cells and expression of Nissl body significantly increased (P<0.05). Expression of Beclin-1 decreased, while expression of p53 increased in the hippocampus of the model group, compared with that in the normal group (P<0.05). However, electroacupuncture treatment could significantly upregulate the expression of Beclin-1 protein (P<0.01), but downregulate the level of p53 (P<0.05).Conclusion Electro-acupuncture treatment could fight against Aβ-induced neuronal apoptosis, and improve the morphological changes of AD’s hippocampus.