Objective To evaluate the liver damage induced by chemotherapy in patients with cancer and positive for hepatitis B virus (HBV) markers.Methods From January 2005 to January 2012,913 cancer patients were treated by chemotherapy including HBV-positive patients (HBV-positive group,288 cases) and HBV-negative patients (HBV-negative group,625 cases).The changes of hepatic function after chemotherapy between two groups were compared.Results The incidence of hepatic toxicity in HBV-positive group was higher than that in HBV-negative group [24.0％ (69/288) vs.11.4％ (71/625)],and there was significant difference between two groups (P＜ 0.01).The incidence of degree 11Ⅲ-Ⅳ hepatic toxicity was 11.4％ (14/123) in HBV-DNA-positive patients and 0.6％ (4/625) in HBV-negative group.In a variety of chemotherapy,there was significant difference in the incidence of hepatic toxicity in TP(paclitaxel +cisplatin),CAF(cyclophosphamide + doxorubicin + fluorouracil),CHOP(cyclophosphamide + doxorubicin +vincristine + prednisone) between two groups (P ＜ 0.05).The incidence of hepatic toxicity was highest in TP,which was 34.6％ (18/52) in HBV-positive group and 16.5％ (20/121) in HBV-negative group.Conclusion HBV infection is associated with higher risk of hepatic toxicity in patients with cancer during chemotherapy.

Objective To study the effect of granulocyte-macrophage colony-stimulating factor ( GM-CSF) secreting liver cancer vaccine on killing activity of cytotoxic T lymphocytes ( CTL) of transplanted liver cancer mice and its mechanism.Methods There were three groups:liver cancer vaccine group (A group), liver cancer group (B group) and PBS group (C group).The transplanted liver cancer model was builded with injection of H 22 hepatoma cells, while the GM-CSF secreting liver cancer vaccine group and PBS group was builded.GM-CSF secreting liver cancer vaccine group and PBS group were establised.The levels of CD8 +T cell in peripheral blood were detected by flow cytometry.The killing activity of cytotoxic T lymphocytes ( CTL) of spleen cells was detected by MTT method.The expression levels of tumor necrosis factor-α( TNF-α) and interferon-γ(γ-INF) were detected by Western blot.Results The flow cytometry results showed that, compared with B group, the levels of CD8 +T cell of A group significantly increased (P<0.01).MTT results showed that, compared with B group, the killing activity of cytotoxic T lymphocytes (CTL) in A group significantly increased (P<0.01).Western blot results showed that, compared with B group, the expression levels of tumor necrosis factor-α(TNF-α) and interferon-γ(γ-INF) in A group significantly decreased (P<0.01).Conclusion GM-CSF secreting liver cancer vaccine can significantly inhibit the activity of H22 cell, and its possible mechanism of action may be to activated CD8 +T expression, improve cytotoxic activity of CTL of spleen cells, and reduce TNF-αand γ-INF protein expression.

Objective To detect the spreading scope of rectal cancer to mesorectum by RT PCR using carcinoembryonic antigen (CEA) mRNA as a marker and to investigate the excision scope of mesorectum in resection of rectal cancer. Methods Forty specimens from 40 rectal cancer patients who underwent curative operation was employed to detect the metastatic deposits scattered in the mesorectum by RT PCR using CEA as a marker. Results Nine of 40 (22.5%) specimens contained metastatic deposits scattered in the mesorectum. The metastasis was just within the range of 4cm mesorectum under the verge of tumor. The tumor spreading to mesorectum is correlated with Dukes stages,the infiltrated depth of bowel wall, tumor differentiation and tumor type( P 0.05). Conclusion The excision of mesorectum should be within the range of 5cm under the verge of tumor in surgical management of rectal cancer.

Objective To observe the effecacy of modified CHOP regimen in the initial treatment of non-Hodgkin' slymphoma (NHL) patients with low Karnofsky score.Methods Twenty initial treatment NHI.patients with low Karnofsky score were randomly allocated into treatment group and control group,respectively treated with modified and standard CHOP regimen.Results Of 13 cases in treatment group,12 pacients'Karnofsky score were over 60.1 was still below 60,overall response (OR) rate was 92.3 ％ (12/13).while in control group,3 patients' Karnofsky score were over 60,4 were still below 60.OR rate was 100 ％ (7/7),rate of marrow toxicity was 57.1 ％ (4/7).There were no significantly difference for OR rates (P =0.4515),but for improving Karnofsky score there were significantly difference (P =0.0149).Conclusion Modified CHOP regimen can improve Karnofsky score of NHL patients with low Karnofsky score,benefical for further treatment and reducing hospitalization cost.

ObjectiveTo analyze a case of death after inoculation of a freeze-dried rabies vaccine for human use so as to provide reference for the vaccination of the rabies vaccine and the process of investigation and diagnosis involving adverse events following immunization （AEFI） in the future. MethodsData on vaccination， clinical symptoms， treatments， investigation and diagnosis were collected and analyzed. ResultsRabies post-exposure prophylaxis and vaccination were in line with the protocols. On the 3rd day after the inoculation of the rabies vaccine， the patient developed fever， weakness， headache， dizziness， diarrhea and other symptoms. The white blood cell count and neutrophil count increased progressively. At about 17：00 on the same day， the patient suffered a sudden cardiac arrest and died clinically. Autopsy was not carried out. ConclusionThe cause of sepsis /septic shock of the patient is unknown. It is necessary to formulate detailed rabies immunization procedures as well as norms and expert consensus in the field of investigation and diagnosis of AEFI.

Objective To investigate the clinical featurcs of hepatic perivascular epithelioid cell carcinoma (PEComa) and the experiments in the surgical treatment of PEComa.Methods The clinical data of 16 patients with hepatic PEComa who received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2008 to January 2012 were retrospectively analyzed.The incidence,clinical manifestations,imagiong characteristics,surgical outcomes and pathological manifestations of this disease were analyzed.B sonography,hepatic function test,tumor markers test and epigastric computed tomography (CT) were applied to detect tumor recurrence and metastasis.The follow-up was ended in December 2012.Result Middle aged and female patients took large part of the patients.Of the 16 patients,8 had no subjective symptoms,and other patients had discomfort in the right upper quadrant,pain or tenderness of the liver.All the tumors were solitary,and most of them located at the right liver (11 tumors were in the right liver,4 in the left liver,1 in the caudate lobe).No specific features were detected by preoperative B sonography,while inhomogeneous low density in the tumor region was detected on by CT.All the patients received partial liver resection without morbidity and morality.The results of immunohistochemistry showed that thc expressions of HMB-45,Melan-A and vascular smooth muscle actin were positive.The mean time of follow-up was 27.9 months (range,9.0-46.0 months),no tumor recurrence and death was observed during the follow-up.Conclusions Middle aged females are susceptive to hepatic PEComa,and patients have no specific clinical presentations.Preoperative CT examination is helpful for differential diagnosis of PEComa,and partical hepatectomy can achieve satisfactory short-term clinical outcomes.

Objective To evaluate early enteral nutrition in patients after liver transplantation. Methods This is a prospective, randomized trial consisting of 63 patients divided into two groups to receive TPN and early enteral nutrition respectively for a week. Patients' nutritional status, liver function, nutritional expense and the incidence of postoperative infections and other complications were compared between the two groups. Result Early enteral nutrition after liver transplantation can improve the nutritional condition and it is helpful for the recovery of the liver function. It decreases the rate of postoperative infections and other complications. Conclusions Early enteral nutritional support is feasible alternative to TPN in patients of liver transplantation.

OBJECTIVE: To explore the general features and the keypoints of forensic medical examination in tumbling injury cases. METHODS: Twenty-eight cases dying of tumbling injury were collected and the locations and features of injury were analyzed. RESULTS: The occiput of head was the common position for the tumbling injury cases. Force, disease and alcohol were the main reasons for tumbling injury. CONCLUSION The injury is mild outside and severe inside from tumbling injury cases. The craniocerebral contrecoup is the significant feature in tumbling injury cases.
Accidental Falls/mortality* ; Adolescent ; Adult ; Aged ; Alcoholism/blood* ; Autopsy ; Cause of Death ; Contusions/pathology* ; Craniocerebral Trauma/pathology* ; Female ; Forensic Pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Scalp/pathology* ; Skull Fractures/pathology* ; Young Adult

Objective To evaluate the clinical outcomes of severely resorbed edentulous mandibles with tilted implants and fixed prostheses. Methods Ten patients with severely resorbed edentulous mandibles were en-rolled. Each patient received 4 implants,two posteriors placed tilted implants. Immediate loading of tilted implants were applied in all cases using a fixed provisional prosthesis. All patients were finalized 3-4 months with fixed pros-theses. Results 40/40 implants with initial torque(>35N.cm)were followed 1-1.5 years presenting 100%surviv-al. Conclusion The method of using tilted implants and fixed prostheses in the cases of severely resorbed edentu-lous mandibles can achieve an ideal short-term and medium-term effects.

Objective To investigate the clinical efficacy and prognostic factors of radical hepatectomy of hepatocellular carcinoma (HCC).Methods The retrospective case-control study was conducted.The clinicopathological data of 760 HCC patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from August 2003 to June 2015 were collected.Surgical procedures were determined according to the location,number and size of tumors and anatomical relations among vessels.Observation indicators included:(1)intra-and post-operative situations:surgical procedures,operation time,volume of intraoperative blood loss,cases of intraoperative blood transfusion,postoperative complications,duration of postoperative hospital stay and pathological examination;(2) follow-up:1-,3-,5-year overall and tumor-free survival situations;(3) prognostic factors analysis of HCC patients.Follow-up using outpatient examination and telephone interview was performed to detect patients' survival up to January 2016.Measurement data with normal distribution were represented as-x±s.The survival curve and survival rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Intra-and post-operative situations:all the 760 patients underwent successful operations,including 419 undergoing anatomical hepatectomy and 341 undergoing non-anatomical hepatectomy.R0 and R1 resections were respectively applied to 742 and 18 patients.Two patients were combined with portal vein resection and reconstruction and 1 was combined with resection and reconstruction of inferior vena cava.Operation time,volume of intraoperative blood loss and cases of intraoperative blood transfusion were (226± 115) minutes,(714±706) mL and 88,respectively.Fifty-five patients had postoperative complications,including 20 with abdominal effusion or abscess,16 with pleural effusion,9 with recurrent fever,8 with incisional infection,7 with intra-abdominal hemorrhage,6 with liver failure,3 with pyloric or intestinal obstruction and 2 with renal failure (some patients with multiple complications).Of the 55 patients with postoperative complications,7 with hemorrhage underwent reoperation or interventional therapy and other patients underwent conventional symptomatic treatment.Of 55 patients,5 patients died and other 50 patients were improved.Duration of postoperative hospital stay was (14±6) days.There were 457 patients with minimum margin of tumors ≤ 1.0 cm and 303 with minimum margin of tumors ＞ 1.0 cm.(2) Followup:all the 760 patients were followed up for 1-139 months,with a median time of 25 months.The overall and tumor-free median survival times were 59 months and 31 months,respectively.The 1-,3-,5-year overall and tumor-free survival rates were 81.7％,63.4％,47.9％ and 68.7％,44.9％,29.6％,respectively.(3) Prognostic factors analysis of HCC patients:results of univariate analysis showed that clinical symptoms,alpha-fetoprotein (AFP),Barcelona clinic liver cancer staging,surgical procedures,intraoperative blood transfusion,minimum margin of tumors,number and diameter of tumors,tumor capsule,tumor differentiation,vascular cancer embolus,macrovascular invasion and tumor staging of American Joint Committee on Cancer (AJCC) were related factors affecting prognosis of HCC patients after radical hepatectomy [HR =1.39,1.50,1.92,0.65,1.45,1.68,1.96,1.66,2.26,1.50,2.68,3.37,2.00,95％ confidence interval (CI):1.08-1.79,1.16-1.94,1.68-2.20,0.50-0.84,1.04-2.02,1.28-2.20,1.54-2.49,1.42-1.94,1.69-3.02,1.22-1.85,1.99-3.60,2.61-4.36,1.77-2.27,P＜0.05].Results of multivariate analysis showed that AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC were independent factors affecting prognosis of HCC patients after radical hepatectomy (HR=1.61,1.62,1.31,1.40,1.78,95％CI:1.14-2.26,1.22-2.14,1.06-1.63,1.10-1.79,1.27-2.51,P ＜ 0.05).Conclusions The anatomical and non-anatomical hepatectomies are safe and feasible for optional HCC patients,with a good long-term outcome.AFP,number and diameter of tumors,tumor differentiation and tumor staging of AJCC are independent factors affecting prognosis of HCC patients after radical hepatectomy.