Evidence-based medicine is the clinical medicine of 21th century. The author advocated that clinical gradu-ate students should employ evidence-based medicine to instruct their randomized controlled trial and other clinicalresearch as well as all the process of clinical reseach including the decision of topic, scientific devise and sum-up. Theaim is to cultivate the graduate students to become the persions with wide knowledge and innovative power.

Gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA),a newly applicable hepatocyte-specific contrast agent,can provide both dynamic and hepatobiliary images and has been rapidly accepted by clinicians for the diagnosis of liver lesions and preoperative evaluation.Gd-EOB-DTPA can fulfill hepatic perfusion imaging,detection and characterization of focal liver lesions,evaluation of liver function,and predict biological behaviors of hepatocellular carcinoma (HCC) within the same examination in a relatively short time window.A large number of domestic and foreign studies have confirmed that hepatobiliaryspecific enhanced magnetic resonance imaging (MRI) was significantly superior to MRI scan,enhanced CT and ultrasound in diagnosing HCC.With the help of the advanced imaging techniques,surgeons can accurately diagnose and assess the situation of patients to implement individualized treatment plans,and therefore these will promote the development of precision hepatic surgery.

Colorectal cancer is a kind of common malignant tumor,the incidence of which appears to increase with the developments of social economy and change of life style.Liver metastasis occurred in about 50％ of patients with colorectal cancer,as an important cause of death.In recent years,radiofrequency ablation (RFA) has been used clinically to damage the hepatic metastatic carcinoma.With the characteristics of accuracy,micro-invasive trauma and repeatability,RFA has been extensively used as an effective local treatment.This paper discusses the indications of RFA for colorectal liver metastasis (CRLM),current status of RFA in unresectable and resectable CRLM,application of RFA in combine therapy for CRLM.

Colorectal cancer is easily metastasized to the liver.Surgical treatment is the best choice for the treatment of colorectal cancer,while the treatment strategy should be selected according to different stages of colorectal liver metastases.Liver metastases occurred at the definite diagnosis of colorectal cancer or within 6 months after radical resection of colorectal cancer are synchronous liver metastases,the timing of synchronous liver metastases resection is still under controversy.Liver metastases occurred at 6 months after radical resection are metachronous liver metastases,and for patients with metachronous liver metastases,reoperation should be applied if the indications are clear.Chemotherapy,radiofrequency ablation and interventional therapy provide chances of reoperation for patients who originally cannot received surgical treatment,while confusion exists in their clinical application.Therefore,multi-disciplinary treatment based on individualized condition evaluation is the key point in improving the prognosis of patients with colorectal liver metastases in different stages.

Objective　To explore the relationship between te lomerase activity and bile duct carcinoma and its significance in clinical diag nosis. Methods　Telomerase activities were examined in 23 cases of bile duct carcinoma, 5 cases of carcinoma adjacent tissues and 5 cases of nor mal bile duct tissues respectively with telomerase PCR-ELISA method. Results　Telomerase activity was detected in 18 of 23 cases (78.3%) of b ile duct carcinoma, and was not found in 5 cases of carcinoma adjacent tissues a nd 5 cases of normal bile duct tissues. The detection rate of telomerase activit y had no correlation with patients' age, sex, tumor site and size but significan tly correlated to metastasis of tumor (P<0.05). Conclusion　The level of telomerase activity was significantly higher in bile duct carcino ma and may be served as one of the clinical marker for malignant neoplasm becaus e of its spsecificity.

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.

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.

Objective To investigate the efficacy of two different methods in treatment of liver cancer which sizes ranged from 3 to 6cm ,and provide the basis for clinical treatment methods .Methods A retrospective analysis of the curative effect of liver cancer patients whose tumor diameter were rang from 3 to 6 cm was done .All patients collected from the Forth Cadre′s Sanatorium and Health Center ,Military Region in Shandong province Taian zones at the time of December 2008 to December 2011 who carried out surgical resection or radiofrequency ablation .Results 41 cases of recurrence within a year in surgical group ,the recurrence rate was 32 .5% ,87 cases(69 .1% ) of recurrence ,103 cases(81 .7% ) of recurrence within 3 years ;41 cases of recurrence within a year in radio frequency ablation group ,the recurrence rate was 40 .8% ,51 cases(71 .8% ) of recurrence within 2 years ,60 cases(84 .5% ) of recurrence within 3 years ,a statistically significant difference were found between the two group at the same period time (P<0 .05);1 ,2 ,3 year survival rates were 84 .6% ,69 .8% ,56 .3% in surgical group ,radiofrequency 1 ,2 ,3 year survival rates were 85 .3% ,70 .9% ,53 .4 in radio frequency ablation group ,The difference was not statistically significant at the same period time (P>0 .05) .Conclusion For size between 3 to 6 cm liver cancer ,radiofrequency ablation can be used as the preferred method of treatment .

Objection To study the p21 WAF1 and p53 protein expression in patients with cholangiocarcinoma and its relation to the pathologic grading and metastasis of the tumor.[WT5”HZ] Methods Using immunohistochemical method, we examined p21 WAF1 and p53 protein expression in 48 cases of cholangiocarcinoma and 8 cases of biliary duct tissue with chronic inflammation.[WT5”HZ] Results The expression of p21 WAF1 and p53 was positive in 25% and 54% respectively of the cases with cholangiocarcinoma, and 88% and 0% respectively of the cases in normal bile duct tissue with chronic inflammation (all P

Objective To study the effect of somatostatin analogue (SMS201-995,SMS) on apoptosis of human cholangiocarcinoma SK-ChA-1 cells and apoptosis-regulated gene bcl-2 and bax. Methods The changes of apoptosis and bcl-2/bax gene expression were detected by DNA gel electrophoresis, flowcytometric analysis and immunohistochemistry, in situ hybridization methods in cholangiocarcinoma SK-ChA-1 cells after treated with SMS(100?ng/ml) for 6, 12 and 24 hours.Results The characteristic ladder was not detected by agarose gel electrophoresis after treated with SMS(100?ng/ml) for 6 hours. When the cells were treated for 12 and 24 hours, the ladder of DNA electrophoresis was observed. While the cells were treated with SMS for 6, 12 and 24 hours, the percentage of annexin V-positive cells were (22?5)% ,(39?7)% and(58?10)%. Besides,SMS inhibited bcl-2 protein expression and increased bax protein and mRNA expression. Conclusion SMS can induce SK-ChA-1 cell apoptosis mainly with regulation of bcl-2 and bax gene expression.