Objective To examine the serum Tuftsin content of hypersplenism patients treated by radiofrequency ablation(RFA) or splenectomy, and compare the influence of two curative methods.Methods Totally 33 patients of hypersplenism were randomly assigned to receive RFA(n=17) and splenectomy(n=16).Before and after operation,the serum Tuftsin content was detected by reverse phase-high performance liquid chromatography.Results Relief of hypersplenism was achieved in both group.Because the spleen was resected,serum Tuftsin content in splenectomy group significantly decreased(P0.05).Conclusion Radiofrequency ablation for hypersplenism has good curative effect and significantly preserves body's resistance to infections and tumors.

Two systems which covered nearly 1. 1 billion people in China’s social health insurance, namely the New Rural Cooperative Medical Scheme ( NRCMS ) and the Urban Residents’ Health Insurance System ( URHIS ) , have been depended mainly on government support with high percentage of premium subsidies. This paper deals with the current situation and probes into the main subsidy policy problems by making an overall analysis on the policies of 31 cross-country provinces , and in result points out four problems including the long-term mechanism shortage, in-distinct responsibility between governments at different levels, the equity deficiency and the subsidies inefficiency. Finally, the paper concludes with enlightening some corresponding policies and suggestions.

Due to the theoretical and technique limitation of traditional surgery,surgical treatment of complex intrahepatic biliary diseases was left for an unresolved difficult problem of the last century.Uncertainties of the anatomical,physiological,pathological changes and surgical techniques in the intrahepatic biliary tract contribute to this complexity.Through integrated application of modern scientific technology and traditional medicine methods and systematic optimization and innovation of biliary surgical theories and techniques,authors have developed a paradigm of precision biliary surgery which is characterized by high quantification,visualization and controllability.The establishment of the precise biliary surgical system solves the difficulty in surgeries for intrahepatic biliary diseases,puts forward the biliary surgery from extrahepatic ducts,hilar ducts to intrahepatic ducts,entering a new segment era of the biliary surgery marked by precision treatment of intrahepatic biliary diseases.

Objective To evaluate the changes of some humoral immune indices of patients with hypersplenism treated by radiofrequency ablation (RFA). Methods Totally 33 patients met inclusion criteria were randomly assigned to receive RFA (17 patients) as trial group and splenectomy (16 patients) as control group. The level of serum immune globulin,complement and tumor necrosis factor (TNF) in venous blood was determined preoperatively and postoperative 1 week,1 month,and 6 months. We evaluated intergroup differences in immune function by comparing the indices. Results In the trial group,no significant differences were found in humoral immune indices between postoperative and preoperative values. Although the level of postoperative serum complement did not change significantly,serum IgM was lowered significantly (P0.05). Conclusion Because part of the spleen is remained in RFA,the humoral immune function is reserved better than that of splenectomy.

Optimization of surgical treatment of biliary dilatation (BD) depends on reasonable clinical classification and standardized classification-based treatment strategy.Due to increasing limits and defects of classic Todani classification,a new classification named Dong-classification has been proposed,which was based on a large series analysis from a single referral center.Some important parameters including anatomical location and range of BD,pathogenic factors,and different surgical managements were main considerations in the new classification.After practical application and evaluation,Dong-classification has been improved step by step.It is believed that Dong-classification may contribute to improving surgical treatment decision and selecting reasonable operative plan.

Objective:To investigate the prognostic value of preoperative inflammatory indicators for hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 73 patients with primary HCC who underwent radical partial hepatectomy in the Beijing Tsinghua Changgung Hospital of Tsinghua University from December 2014 to July 2019 were collected. There were 57 males and 16 females, aged from 33 to 81 years, with a median age of 58 years. Results of blood examination indicators at the first time in hospital were determined for patients. Observation indicators: (1) the best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics; (2) follow-up; (3) influencing factors for prognosis of HCC patients; (4) comparison of clinicopathological parameters of HCC patients; (5) comparison of predictive value for overall survival. Follow-up was conducted using outpatient examination and telephone interview to determine postoperative survival of patients up to September 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). The best cut-off values ??for continuous variables were obtained using the maximally selected rank statistics based on survival at endpoint of follow-up. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Kaplan-Meier method was used to calculate survival rates, and Log-rank test was used for survival analysis. Univariate analysis was performed using the Log-rank test. Multivariate analysis was performed using the COX proportional hazard model. The time-dependent receiver operating characteristic curve (ROC) was used to compare the predictive value of independent prognostic factors. Results:(1) The best cut-off values of?? preoperative inflammatory indicators calculated by the maximally selected rank statistics: the best cut-off values of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and prognostic nutrition index (PNI) were 3.46, 131.05, and 45.65. (2) Follow-up: 73 patients were followed up for 31 months (range, 2-57 months). Twenty patients died during the follow-up. (3) Influencing factors for prognosis of HCC patients: results of univariate analysis showed that NLR, PNI, tumor diameter, and tumor differentiation degree were related factors affecting prognosis of patients ( χ2=10.213, 4.434, 5.174, 4.306, P<0.05). Results of multivariate analysis showed that NLR and tumor differentiation degree were independent factors affecting prognosis of patients ( hazzard ratio=4.429, 13.278, 95% confidence interval as 1.662-11.779, 1.056-10.169, P<0.05). (4) Comparison of clinicopathological parameters of HCC patients: of 73 patients, 64 cases had NLR<3.46 and 9 cases had NLR≥3.46. Cases with tumor length >5 cm or ≤5 cm, neutrophils, lymphocytes were 23, 41, (2.9±1.2)×10 9/L, (1.7±0.6)×10 9/L for 64 patients with NLR<3.46, versus 8, 1, (5.8±2.9)×10 9/L, (1.0±0.3)×10 9/L for 9 patients with NLR≥3.46; there were significant differences in above indicators between the two groups ( χ2=7.017, t=2.982, -3.168, P<0.05). (5) Comparison of predictive value for overall survival: time-dependent ROC curves of NLR and tumor differentiation degree for 1-, 2-, 3-, 4-year survival rates had the area under curve of 0.735,0.611, 0.596, 0.574 and 0.554, 0.583, 0.572, 0.556, respectively. NLR had better predictive value for overall survival of patients than tumor differentiation degree. Conclusion:Preoperative NLR is an independent factor affecting prognosis patients, and its predictive efficacy is better than tumor differentiation degree.

Objective To evaluate the influence of hepatic ischemia-repeffusion injury (HIRI) induced by Pringle maneuver on the prognosis of hepatoceUular carcinoma (HCC) patients after hepatectomy. Methods The chnical data of 315 HCC patients who had been admitted to Southwest Hospital from January 2004 to December 2008 were retrospectively analyzed. The 194 patients who received Pringle maneuver during hepatectomy were in the HIRI group. The control group was composed of 121 patients without portal triad clamping. The pre- and peri-operative characteristics and the prognosis of the patients were analyzed by t test, chi-square test, Kaplan-Meier survival curve, Log-rank test and Cox regression model analysis. Results Patients in the HIRI group were significantly younger than those in control group (median age, 49 vs 59) (X2 =4. 12, P < 0.05). There were 108 patients (55.7%) with large HCC (diameter > 5 cm) in the HIRI group, while the number of patients with large HCC in the control group was 83 (68.6%), with statistical difference between the 2 groups (X2=4. 12, P <0.05). The serum levels of aspartate aminotransferase on postoperative day 3 and day 7 were 255 U/L and 112 U/L, which were significantly higher than 128 U/L and 35 U/L in the control group (X2 =4.57, 5.89, P <0.05). The level of total bilirubin on postoperative day 3 was 56 U/L in the HIRI group, which was significantly higher than 39 U/L in the control group (X2=4.79, P <0.05). The disease-free survival rate and cumulative survival rate in the HIRI group were significantly lower than those in the control group (X2 = 5.93, 8. 32, P < 0. 05). Perioperative blood loss, diameter of tumor, portal triad clamping and portal vein invasion were independent factors influencing the diseasefree survival rate. Conclusions HIRI induced by Pringle maneuver significantly decreases the disease-free survival rate and cumulative survival rate of HCC patients after hepatectomy.

Objective　To establish the animal model of denervation of sympathetic nerve and to explore the effects of denervation of the sympathetic nerve on liver regeneration after partial resection. Methods　The animal model of denervation of sympathetic nerve was made with 6-OHDA. A total of thirty male Wistar rats were divided equally into experimental and control group. The left and middle lobe of liver were resected with improved Higgins and Anderson's method. Meanwhile, denervation was made in the experimental group. All the rats were killed by haemospasia on the 7 th day after operation. HMI, RLR and MI were measured. The rates of DNA synthesis were detected by 3H-TdR method. Results　The concentration of NE decreased extremely on day 3 to day 14 after administration of 6-ONDA. No death happened in all the rats 7 days after liver resection. HMI, RLR, MI and 3H-TdR incorporation significantly decreased in experimental group compared with that in control (P<0.01). Conclusion　The chemical denervation of sympathetic nerve can be aroused by administration of 6-OHDA. Regeneration of the liver is inhibited by the denervation of sympathetic nerves.

Objective To explore the short and long term result and the impact on cell immunity of splenic radiofrequence ablation in patients with hypersplenism.Methods In this study 43 patients were divided into the RFA treatment group(22 cases)and open splenectomy control group(21 cases).Blood samples were collected for blood routine,lymphocyte transformation efficiency,NK cell activity and T lymphocyte subpopulations at 1 week,1 month,6 month,1 year,2 years and 3 years before and after operation respectively and the results were compared between the two groups.Results The hypersplenism of the patients in both groups were relieved.There were no significant difierences in cell indices between the postoperative and preoperative values in the two groups.In the control group,compared with the preoperative values in the trial group,the postoperative NK cell activity and lymphocyte transformation efficiency were significantly reduced(P＜0.05).Even though,with time,the NK cell activity and lymphocyte transformation efficiency were on an increasing tendency after operation but still significantly lower than that before operation.In the control group,compared with the preoperative values,CD4+T cell count and CD4+/CD8+ratio decreased significantly(P＜0.05).Moreover.with time.these indices were on an increasing tendency.CIM+T cell count and CD4+/CD8+ ratio restored to the preoperative values within 30 months(P=0.078)and 36 months(P=0.103)respectively.Conclusion RFA treatment for hypersplenism preserves a part of the spleen and thus preserves patient's cell immunity.This treatment exhibits microinvasiveness and few complications and being easy to operate.Hence,RFA treatment for hypersplenism merits wide clinical application.

Objective This report describes the mechanism of Ginsenoside Re to resist Exercise-induced fatigue based on the observation of effects on MDA content and SOD activity.Methods Thirty male SD rats were divided into 3 groups randomly:Ginsenoside Re group,model group and control group,10 rats in each group.Rats in Ginsenoside Re group were given gastric gavage of Ginsenoside Re once a day,while rats in model and control groups were given the same volume of normal saline.One hour after administration,rats of Ginsenoside Re groups and Model groups received medium-intensity treadmill exercise for 20 minutes at the speed of 15m/min,with a slope of 0 degree,and after 40-mimute break repeated it for another 20minutes.Fourteen days later,MDA content and SOD activity have been tested.Results MDA content in the serum,liver tissue and muscle tissue of Ginsenoside Re group was obviously lower than that in the model group (P