Surgical resection offers hilar cholangiocarcinoma patients the only chance for cure and long-term survival.Hepatectomy,extrahepatic bile duct resection,regional lymphadenectomy and hepatojejunostomy are the current treatment of choice for most patients with hilar cholangiocarcinoma.Because of the aggressive nature of hilar cholangiocarcinoma and the absence of effective adjuvant therapy,surgical therapy still remains a challenge to hepatopancreatobiliary surgeons even in the precise surgery era.Controversies exist over preoperative assessment and staging,the use of preoperative biliary drainage,preoperative portal vein embolization,the range of hepatic resection,portal vein resection and construction,hepatic arteriectomy and the range of lymphadenectomy.This article reviews the surgical management of hilar cholangiocarcinoma with a focus on these controversies.

To find out the health need of the city population in Guangzhou and the service level of the city's medical units and to set up a public health service system to answer the need of the market e- conomy,an investigative analysis is here focused on the health state and health service need of the city's population,the allocation of the health resources and the utilization of the city's health resources,eco- nomic factors,ways of medical payment,the cultural and age composition of the population structure, and the impact of the service personnel quality on the utilization of the service.It is suggested that the government increase its fund appropriation on public health,establish neighborhood medical leagues, start medical insurance,speed up cooperative medicine in the countryside,and complete the medical se- curity system.

Blood transfusion in liver surgery still plays an important role.However,blood transfusions may cause immunosuppression recipients and hinder the body' s immune response against the tumor,promotes tumor metastasis and recurrence.How to resolve this contradiction? We must study and research the effects of allogeneic blood transfusion on liver cancer metastasis and recurrence after hepatic resection,and to find strategies to improve the liver cancer prognosis.

The progress of liver surgery is characterized by precision,minimal invasion and effectiveness in the 21 st century.Establishment of painless liver surgery ward and implementation of pain management in the perioperative period are not only the central content of enhanced recovery after surgery,but also one of the core connotation in precision liver surgery research.Conducting training programs for medical staffs,emphasizing health education of pain,selecting the reasonable pain assessment strategy,combination of preemptive analgesia and multimodal analgesia in the perioperative period and paying attention to individualized analgesia are important contents of construction of painless liver surgery ward.To carry out multicentre clinical study energetically,explore clinical pathway for the construction of painless ward and perioperative analgesic model are the development orientation for the construction of painless liver surgery ward.

The application of enhanced recovery after surgery (ERAS) in hepatectomy is safe and feasible.The related researches of the clinical strategies of ERAS involved in colonic surgery instead of management of basic diseases of liver,and the influence of portal hypertension and hepatitis B virus infection on the ERAS has not been emphasized.According to the clinical strategies of ERAS in colon surgery,the basic diseases and the characteristics of liver were focused,and the clinical strategies of ERAS in the era of precision liver surgery were proposed.Through concerted efforts of the multidisciplinary team and a joint of surgeons,nurses and patients,the establishment of multicentre clinical studies under guidance of evidence-based medicine (EBM) will show clearly a development direction of the clinical strategies of ERAS in the era of precision liver surgery.

Perioperative immunosuppression exists in cancer patients are as a result of their own disease,and postoperative pain inhibit immunological function.The effective postoperative analgesia can relieve the suppression of cell-mediated immunity,as well as reducing tumor recurrence and metastasis.However,diverse range of analgesic agents and techniques have a different impact on immune function.This article reviews the influence of various analgesic agents and techniques on the perioperative immune function of cancer patients so as to provide more suitable analgesia techniques,which is beneficial for regulating of immune balance,lessening tumor recurrence and improving prognosis.

Objective To compare cerebralspinal fluid acetylcholine (ACh) and choline (Ch) in patients with Alzheimer's disease (AD) and vascular dementia (VD), and their correlation with cognitive impairment.Methods First, dementia scales of 22 ADs, 22 VDs and 20 controls were scored using MMSE. Then the concentrations of CSF ACh and Ch in AD and VD were examined using the high-performance liquid chromatography with electrochemical detector (HPLC-ECD). Finally, the scores of MMSE and concentrations of ACh and Ch were compared. Results The ACh concentrations in AD[(10.7?5.1)nmol/L] and VD [(16.8?7.4)nmol/L] were found to be significantly lower than in controls [(34.5?9.0)nmol/L]( P =0.001), and showed a significant positive correlation with MMSE scores. The Ch concentration in AD CSF [(627.6?145.1)nmol/L] was approximately the same as in controls [(716.0?159.4)nmol/L], and showed no correlation with MMSE scores. The Ch concentration in VD CSF [(887.4?187.4)nmol/L] was significantly higher than in AD ( P =0.001) and controls ( P =0.002).Conclusion (1)The depression of ACh is correlated with cognitive impairment, suggesting ACh is an important neurotransmitters for memory. (2) VD may have a similar pathogenesis as AD. (3) The depression of AD ACh concentration and elevation of VD Ch concentration in CSF may be a role in their differentiation. (4) The application of acetylcholinesterase inhibitors is suitable for AD and VD.

ObjectiveTo summarize the complications after precise hepatectomy for primary liver cancer and explore the prevention experiences.MethodsThe clinical data of 120 primary liver cancer patients who underwent precise hepatectomy in Anhui Provincial Hospital from August 2008 to October 2011 were retrospectively analyzed.The common complications after hepatectomy and the management measures of the complications were studied.Results Related complications were found in 19 cases,including 7 cases of pleuraI effusion,3 cases of pneumonia,1 case of intra- abdominal hemorrhage,2 cases of up gastrointestinal bleeding,1 case of abdominal abscess,1 case of hepatic failure,1 case of bile leakage,2 cases of would infection,1 case of urinary tract infection.ConclusionsPrecise hepatectomy has characteristics of preoperative accurate assessment,intraoperative fine operation and postoperative excellent management,which reduce the incidence of postoperative complications.

The miR-17-92 cluster,consisting of six individual microRNAs,including miR-17,miR-20a,miR-18a,miR-19a,miR-19b and miR-92a-1,is a kind of typical oncogenic polycistron microRNA.MiR-19 (containing miR-19a and miR-19b),as the key oncogenic component in miR-17-92 cluster,is overexpressed in human cancers including lymphomas,leukaemia,lung cancer,breast cancer and multiple myeloma,and has been one of research focus in recent years.It is found that miR-19 promotes tumor growth,invasion and metastasis through negative regulation of target genes such as PTEN,PP2A,Bim,SOCS1,and is correlated strongly with PI3K-AKT-mTOR pathway.MiR-19 plays an important role in tumor genesis and development.

Objective To evaluate the causes of postoperative complications in severe liver rupture and explore the prevention experienees.Methods The clinical data of 66 liver rupture patients who underwent surgical treatment in our hospital from January 2005 to July 2012 were retrospectively analyzed.The commou complications after surgery and the treatment measures of the complications were sludied.Results There were 9 deaths of severe liver rupture after surgery and related complications were found in 22 cases,including bile leakage (5 cases),intrahepatic abscess (3 eases),subphrenic infection (3 cases),pleural effusion (8 cases),intra-abdominal hemorrhage (2 cases),stress ulcer bleeding (2 cases).Conclusions Using damage control theory could improve the cure rate.Precise liver transection and postoperative excellent management was able to reduce the incidence of postoperative complications in severe liver rupture.