Tumor in the caudate lobe is difficult for surgical treatment due to its unusual local anatomy.As the development of surgical techniques,the success rate of caudate lobectomy is increased.In recent years,the concept of precision hepatectomy aiming to reduce the iatrogenic damage from hepatectomy and improving the recovery of patients on the basis of radical treatment has been raised.This article summarized the experiences of precision hepatectomy for the treatment of huge tumor in the caudate lobe which was performed in the Ruijin Hospital of Shanghai Jiaotong University.With the help of precision hepatectomy concept and techniques,a more satisfactory result both in safety and prognosis was achieved.

Objective To investigate the correlation between pathologic features and contrast?enhanced ultrasound in patients with breast ductal papilloma. Methods From January 2014 to January 2016,80 patients with breast intraductal tumor treated in our hospital were selected,including 20 cases of breast ductal carcinoma (ductal carcinoma group) and 60 cases of benign tumor (benign group). Both groups received conventional ultrasound, ultrasonic angiography,and pathological feature analysis. Results Breast surrounding hyperecho,internal micro calcification,border edge burr and posterior echo attenuation were more frequently seen onconventional ultrasound in ductal carcinoma groupthan inbenign group(P<0.05). The average scores of contrast?enhanced ultrasound were significantly higher in ductal carcinoma group than in the control group(P<0.05). In the ductal carcinoma group, there were statistical significant differences betweenpatientswith different lymph node metastasis dukes staging ,and differentiation types (P < 0.05). Spearman rank correlation coefficient analysis showed that breast intraductal carcinoma lymph node metastasis and dukes staging,differentiation types were markedly correlated with pathological features and ultrasound imaging (r=0.341,0.368,and-0.289;P<0.05). Conclusions Conventional ultrasound and contrast?enhanced ultrasound have very good imaging featuresin the diagnosis of breast intraductal cancer ,and there is correlation between pathologic features and contrast?enhanced ultrasound in patients with breast ductal papilloma,which can provide values for early diagnosis of breast ductal carcinoma.

Objective To study the distribution of genotypes of Candida albicans isolated from different body sites of patients with candidal vulvovaginitis(CVV).Methods PCR was designed to amplify group I intron-containing region in25S rDNA of Candida albicans.The strains of Candida albicans could be classified into three genotypes:genotype A(~450bp),B(~840bp)and C(~450bp and~840bp),on the basis of different ranges of bands of amplicons.Results Sixty women with CVV were recruited,of whom54were caused by Candida albicans.Among the54patients39had non-recurrent CVV and15had recurrent CVV(RCVV).Candida albicans could be isolated simultaneously from different body sites in32of54patients,including19(19/39)with non-RCVV and13(13/15)with RCVV.A total of92strains of Candida albicans were isolated from vagina,tongue and anus in54patients with CVV.Eighty strains of genotype A,8of genotype B and4of genotype C were found.The same genotypes of Candida albicans in different body sites were identified in24patients,and the different genotypes were identified in8patients.Conclusion Genotype A is predominant in CVV.The other two genotypes(B and C)are not commonly seen,and mainly isolated from non-vaginal sites.The colonization of Candida albicans in the non-vagina sites is more frequent in RCVV than that in CVV,and the intestinal reservoir theory may play a role in the relapse of RCVV.

Objective To investigate the effects of selenium-and zinc-enriched probiotics on the content of selenium and zinc in blood,antioxidation function and intestinal microflora in canine.Method Eight 18-month native canines,female and male in half,were randomly divided into the control and treatment groups on average.The control group received basal diet,the treatment group received basal diet supplemented with 2.0g selenium-and zinc-enriched probiotics everyday.To determine the experimental indices,the samples were collected on D0,D15 and D30,respectively.Results Compared with the control group,on D15,the content of selenium and zinc in blood,blood GPX,serum SOD,T-AOC and the amount of Lactobacillus in the experimental group were significantly increased,while the amount of Escherichia coli significantly decreased,but the serum MDA and the amount of Bifidobacterium,Staphylococcus and Enterococcus had no significant change.On D30,the content of selenium in blood,serum SOD,T-AOC and the amount of Lactobacillus were very significantly increased,while the content of zinc in blood,blood GPX and the amount of Bifidobacterium significantly increased;but serum MDA and the amount of Escherichia coli,Staphylococcus and Enterococcus very significantly decreased.Conclusion Selenium-and zinc-enriched probiotics could increase content of selenium and zinc in blood,enhance antioxidation function,improve and regulate the intestinal microflora.

Objective To compare the effect of autologous bone marrow stem cells transplantation on liver function between first and second transplantation in decompensated liver cirrhosis patients.MethodsA total of 45 decompensated liver cirrhosis patients were enrolled, and 23patients in first transplantation group were transplanted with autologous bone marrow stem cells through femoral artery when condition was stable after medical treatment.In second transplantation group, 22 patients were accepted second transplantation in 4-12 month after the first transplantation.All the patients undergone routine blood test, congulation test and liver function examination at the fourth week and eighth week after transplantation.ResultsEight weeks after transplantation, the liver function was improved obviously in both first and second autologous bone marrow stem cells transplantation.The level of albumin in patients of second transplantation group increased from (37.26± 5.90) g/L before transplantation to (42.49 ± 4.80) g/L (P＜0.01), alanine aminotransferase (ALT) decreased from (57.05±45.51) U/L to (44.86±29.19) U/L (P＜0.05),aspartate aminotransferase (AST) decreased from (39.14-±-15.07) U/L to (53.73 ± 24.98) U/L(P＞0.05).Congulation parameters were also improved, prothrombin time (PT) decreased from (16.15±3.01) s to (14.63±2.32) s (P＜0.01), fibrinofen (Fib) increased from (2.44±0.61) g/L to (3.00±0.81) g/L (P＜0.01).Compared with first transplantation group, the albumin level was higher in second autologous bone marrow stem cells transplantation group, which increased from (38.00±6.33) g/L to (42.49±4.80) g/L (P＜0.05), AST and ALT also improved obviously, and there was significant difference between two groups.Meanwhile, Child-Pugh scores decreased from (7.22±0.67) to (6.67±[0.71) (P＜0.05).But there was no significant difference in bilirubin, FIB and PT.ConclusionThe second transplantation of autologous bone marrow stem cells could further improve liver function and maintain symptoms remission of liver cirrhosis.

ObjectiveTo study the effects of membrane molecular weight cut off on a novel bioartificial liver(BAL) system.MethodsHealthy beagles underwent 6-hour treatment with a BAL containing membrane with 200 kDa retention rating or 1200 kDa retention rating.The functional changes and cell viability were characterized.ResultsHepatocyte performance levels such as albumin secretion,urea synthesis and viability were significantly higher in the 200 kDa retention rating group when compared with the 1200 kDa retention rating group (P＜0.05).Significant levels of canine proteins were detected in the BAL medium from the 1200 kDa retention rating group.Fluorescence microscopy further verified that heavy deposition of canine IgG,IgM and complement (C3) on co-culture cells were obtained after BAL treatment in the 1200 kDa retention rating group.ConclusionsSmall membrane molecular weight cut off of BAL could reduce the transfer of xenoreactive antibodies into the BAL medium and improved the performance of the BAL.

Hepatocellular carcinoma(HCC)has become the second leading cause of cancer-related death worldwide,ranking 6th among all tumors.Due to the lack of obvious early symptoms,most patients are diagnosed in the advanced stage,and the clinical benefits of surgical resection and hepatic artery chemoembolization and radiofrequency ablation are very limited.In recent years,the advent of immune-targeted therapies has revolutionized the systemic and systemic treatment of patients with advanced HCC,however,there is a lack of strong clinical evidence on the safety and efficacy of immune and targeted therapies for special populations,including patients with human immunodeficiency virus(HIV)infection,active autoimmune disease,decompensated cirrhosis(Child B or C),patients with diabetes-associated metabolic syndrome,patients with portal hypertension,vascular invasion,or portal vein thrombosis(PVT),and patients with liver transplantation(LT).This article reviews the current research progress of immune and targeted drugs in special populations.

Objective To detect the levels of anti-measles antibody in a healthy population in Jin-shan District of Shanghai and to provide references for making a better immunization strategy against measles in this area. Methods Stratified sampling was used to collect 390 serum sample in 12 age groups with an equal number of males and females as well as resident and floating population. Indirect enzyme-linked immu-nosorbent assay (ELISA) was performed to detect the concentrations of IgG antibody against measles in dif-ferent groups. Results The overall positive rate and protective rate of anti-measles antibody were 78.21% and 41.28%, respectively. No significant difference in the positive rates of antibody was found between males and females, or resident and floating population (P>0.05). Antibody levels varied significantly among different age groups(χ2=191.214,P<0.01). More than 80.00% of the people aged≥1 year were positive for anti-measles antibody and the positive rates in children 3 to 6 years old and people aged ≥40 years reached 100% and over 90.00%,respectively. Infants under 8 months of age,having the lowest posi-tive rate of antibody(10.00%),were susceptible to measles. The highest protective rate was found in chil-dren aged 8 months to 9 years,followed by that in people≥40 years. Levels of anti-measles antibody in peo-ple aged 10 to 39 years mainly ranged from 200 mIU/ml to 800 mIU/ml. No significant difference in anti-body levels was found among people aged≥8 months who had different immunization histories(χ2=1.140,P>0.05). Conclusion The average level of anti-measles antibody was high in Jinshan District in 2015,in-dicating that the people in that area had a relatively high immunity to measles,but the positive rate of anti-body needed to be further improved. Infants under 8 months old and people 10 to 39 years old were the main susceptible groups. It is suggested that measles vaccination efforts should be focused on susceptible popula-tion and women of childbearing age to improve herd immunity.

The prevalence rate of nonalcoholic fatty liver disease (NAFLD) tends to increase in the general population around the world, and the incidence rate of liver malignancies caused by NAFLD is also increasing continuously. Obesity is an independent risk factor for NAFLD. Among the individuals with HIV infection who have a normal body weight, 25% have NAFLD, and lean NAFLD is relatively common in individuals with HIV infection. With reference to related articles in China and globally, this article reviews the epidemiology, pathophysiology, histology, diagnosis, screening, intervention, treatment, and clinical management of NAFLD, in order to improve the awareness of NAFLD in individuals with HIV infection among the public, clinicians, and related institutions.

Objective: Based on the KAP and Prospect theory, to explore, construct and verify the theoretical model and formation mechanism of driving factors of primary care doctors′ willingness to carry out the primary diagnosis. Methods: Using the random cluster sampling method, from April to May 2019, a questionnaire survey was conducted among doctors at 20 primary medical and health service institutions in Hangzhou. The survey covered the primary care doctors′ cognition level of primary diagnosis, their self-evaluation of primary medical care capabilities, evaluation of policies and systems, expectation of primary medical care, and their job satisfaction. Descriptive statistic, multiple linear regression and structural equation model were used to analyze and explore the driving factors and formation mechanism of their willingness to carry out the primary diagnosis. Results: Primary care doctors′ willingness rate for primary diagnosis was 76.4%(308/403). Positive expectation(beta=0.309), cognition level(beta=0.216), evaluation of policies and systems(beta=0.184), and self-evaluation of primary diagnosis capability(beta=0.170), all of which directly affect the said willingness. The total effect of the five types of driving factors on the willingness of the primary diagnosis was as follows: cognitive level of the primary diagnosis(0.536), evaluation of the policy system(0.494), self-evaluation of the primary diagnosis capability(0.436), positive expectations of the primary diagnosis work(0.186), job satisfaction(0.146). Conclusions The cognition of the primary diagnosis, the capability of the primary diagnosis, the policy system and the positive expectation are the important premises, key driving forces, and a strong guarantee and motivation to drive primary care doctors to carry out the primary diagnosis. It is suggested that the government and medical institutions should further improve the cognition level of primary care doctors, focusing on systematically improving the service capability of primary care doctors′ primary consultation, coordinating to improve policy guidance measures such as financial input, medical insurance reimbursement and referral system, establishing and improving incentive measures such as career development, performance appraisal, salary and welfare of primary care doctors.