Sorafenib is the only molecular targeted drug therapy for advanced liver cancer recommended by the European Association for the study of liver diseases (EASL), American Association for the study of liver diseases (AASLD) and the United States Food and Drug Administration (FDA). As a multi kinase inhibitors, sorafenib can inhibit multiple signal transduction pathways of tumor cell proliferation and angiogenesis and obviously prolong the late stage of disease progression time and overall survival in patients with hepatocellular carcinoma (HCC). Criteria for evaluation of the efficacy of sorafenib in the treatment of advanced hepatocellular carcinoma (HCC) is increasingly perfect. The author gives a brief overview of the molecular mechanism, efficacy and safety and efficacy evaluation criteria of sorafenib in the treatment of advanced liver cancer.

Objective To study the expression of Notch3 in pancreatic ductal adenocarcinoma (PDAC) and to find out its relationship with clinical features and overall survival in patients with pancreatic ductal adenocarcinoma.Methods PDAC and adjacent non-cancerous tissues from 80 patients who under went surgery for primary PDAC in the Affiliated Tumor Hospital of Zhengzhou University were collected between 2008 and 2015.The specimens were divided into two subgroups by immunohistochemical staining of Notch3:the low expression group (0-4 points) and the high expression group (5-12 points).Correlations between expression of Notch3 with clinical features and prognosis of patients with PDAC were analyzed.Results A high expression of Notch3 gene was significantly associated with tumor grade,metastasis,venous invasion and TNM staging.Univariate Cox regression analysis showed that metastasis,venous invasion,TNM stage and protein expression of Notch3 were strongly correlated with overall survival of patients.Multivariate analysis showed that metastasis,TNM stage and Notch3 were independent risk factors of overall survival in patients with PDAC.Kaplan-Meier survival curves indicated that a high expression of Notch3 was an important risk factor of poor survival.Conclusions A high expression of Notch3 was significantly associated with progression and poor prognosis of PDCA.Notch3 may serve as a new indicator of PDAC progression and patient survival outcomes.

Objective To evaluate laparoscopic splenectomy through amputation of secondary splenic pedicles.Methods From February 2010 to March 2016 33 patients underwent laparoscopic splenectomy.Patients were followed up by outpatient examination and telephone interview.Follow-up period ended in April 2016.Results All the 33 patients successfully underwent laparoscopic amputation of secondary splenic pedicle splenectomy.The operation time and volume of intraoperative blood loss were (155 ± 42) min and (210 ± 50) ml.Three patients had postoperative complications including two with ascites sand one with small amount splenic fossa bleeding.All the patients were followed up for a median time of 21 months (range,1-65 months).During the follow-up,1 patient died of hepatic encephalopathy and 32 patients were doing well.Conclusion Laparoscopic amputation of secondary splenic pedicle splenectomy is safe and feasible.

Objective To investigate the clinical efficacy of precise liver resection of liver tumors adjacent to the main pipeline.Methods The retrospective and descriptive study was conducted.The clinical data of 22 patients who underwent precise resection of liver tumors adjacent to the main pipeline in the Affiliated Tumor Hospital of Zhengzhou University between December 2014 and June 2016 were collected.According to preoperative precise evaluation and fully intraoperative exposed tumors,different methods of blood flow occlusion were choosed timely,and then precise resection of the liver was evaluated based on tumor location and size,relationship between tumor and blood vessels and the degree of liver cirrhosis.The operation procedures,operation time,time of liver resection,volume of intraoperative blood loss,number of patients with perioperative blood transfusion,postoperative complications,duration of postoperative hospital stay and follow-up were observed.The follow-up was performed by outpatient examination and telephone interview up to September 2016.Tumor recurrence of patients with hepatocellular carcinoma (HCC) was monthly detected by alpha-fetoprotein retest and color Doppler ultrasound of the liver or computed tomography (CT) within 3 months postoperatively.Tumor recurrence of patients with cholangiocarcinoma was monthly detected by tumor marker retests,color Doppler ultrasound of the liver or CT,and then patients without tumor recurrence received reexamination once every 2 months after 3 months.Patients with liver hemangioma were followed up once every 2-3 months and once every 6 months after half a year,and follow-up included the liver function,ultrasound and other imaging examinations to detect the tumor recurrence.Measurement data with normal distribution were represented as-x±s.Results All the 22 patients underwent successful precise resection of liver tumors.Twenty patients received intraoperative ultrasound localization.Blood flow occlusion of 22 patients:Pringle was conducted in 6 patients,treatment of the corresponding hepatic pedicle in 3 patients,selective hepatic blood flow occlusion in 8 patients,total hepatic blood flow occlusion in 2 patients and non-hepatic portal occlusion in 3 patients.Precise resection of the liver of 22 patients:1 patient underwent right trisegrnentectomy,2 underwent left hepatectomy,2 underwent segment Ⅳ a resection of the liver,2 underwent segment Ⅳ resection of the liver,3 underwent segment Ⅴ resection of the liver,3 underwent segment Ⅷ resection of the liver,1 underwent middle lobe resection of the liver and 8 underwent partial resection of the liver.Operation time,time of liver resection,volume of intraoperative blood loss and number of patients with perioperative blood transfusion were (213±39) minutes,(57± 19) minutes,(518± 98) mL and 3,respectively.Of 22 patients,5 with postoperative complications were improved after symptomatic treatment,including 2 with effusion at surgical site,2 with right pleural effusion and 1 with bile leakage.The duration of postoperative hospital stay of 22 patients was (8.9± 1.6)days.Twenty-one patients were followed up for 3-20 months,with a median time of 12 months.Two of 22 patients had recurrence during the follow-up,and no recurrence at surgical site was detected.Conclusion Precise resection of liver tumors adjacent to the first and second hepatic hilum is safe and feasible,with the advantages of less intraoperative bleeding and low incidence of postoperative complications.

Objective:To investigate the feasibility and safety of laparoscopic liver tumor resection in children.Methods:The clinical data of 6 children undergoing laparoscopic liver tumor resection from June 2018 to March 2020 in the Affiliated Tumor Hospital, Zhengzhou University were retrospectively analyzed.Results:There were 4 males and 2 females among the 6 cases, with the average age of (7±2)years.All the children were admitted to the hospital with a liver occupying examination due to physical discomfort.Preoperative diagnosis: 3 cases of hepatoblastoma, 1 case of primary liver cancer, 1 case of hepatic adenoma and 1 case of hepatic nodular hyperplasia.All the children successfully completed laparoscopic liver tumor resection without conversion to open surgery.Among them, 3 children obtained left hemihepatectomy, 1 child underwent hepatic left lobectomy, 1 child was given VI hepatectomy, and 1 child accepted hepatic caudate lobectomy.The operation time was(90±9)min, and the average intraoperative blood loss was (83±26) mL.All children had no blood transfusion during or after operation.There were no bleeding, bile leakage, infection and liver failure after operation.All children had no gastric tube before surgery and the fluid diet was given on the first day after operation, and the postoperative median hospital stay was 4(3-5) days.The pathology were consis-tent with the preoperative diagnosis, and the resections were all radical operation resections.The follow-up period was from 2 to 23 months, and all the children recovered well and no recurrence was observed.Conclusions:Laparoscopic liver tumor resection in children is safe and feasible, which can minimize trauma, reduce intraoperative bleeding and shorten the hospital stay without increasing the incidence of postoperative complications.Laparoscopic liver tumor resection in children has certain advantages.

Objective To investigate the clinical effect of laparoscopic radiofrequency ablation of hepatocellular carcinoma in liver cirrhosis patients.Methods The clinical data of 26 patients who underwent laparoscopic radiofrequency ablation were analyzed.Tumor location,size,and number,operation time,radiofrequency ablation time,intraoperative blood loss,postoperative complications and follow-up were recorded.Results Laparoscopic radiofrequency ablation were successfully performed in all patients under guiding color Doppler ultrasound.Mean operative time was (126 ± 32) min,intraopertive blood loss was (5-50) ml,there was no perioperative blood transfusion;there was no major complications such as bile leakage,bleeding,infection and liver failure postoperatively.There were 3 cases of ascites and 1 case of right pleural effusion,all being recovered by conservative therapy.The median hospitalization time was 3(2-7) days.23 patients were followed up for a median of 10(2-17) months,2 cases suffered from recurrence during follow-up with 1 case undergoing repeated ablation therapy.Conclusions Laparoscopic radiofrequency ablation of hepatocellular carcinoma in liver cirrhosis patients is safe and feasible,with the advantages of less damage to liver function,less trauma and low incidence of postoperative complications.

Objective To investigate the value of the Habib 4x bipolar radiofrequency device in resection of hepatic cancer complicated with liver cirrhosis.Methods The clinical data of 35 patients who underwent hepatectomy at the Affiliated Tumor Hospital of Zhengzhou University from May 2014 to May 2016 was collected.The preoperative diagnosis was based on the abdominal enhanced CT or MRI.The intra and postoperative indexes were recorded.Patients were followed up regularly.Measurement data with normal distribution and with skewed distribution were presented as (x-)± s or M (range),respectively.Results All the 35 patients successfully underwent hepatectomy.There were no serious postoperative complications.During the follow-up,2 patients had intrahepatic recurrences,none were on the surgical margin.As of the end of follow up,all the 35 patients were alive.Conclusions Habib 4x frequency hematischesis cutter assisted resection of hepatocellular carcinoma complicated with cirrhosis is safe,feasible.

Objective To study the safety and efficacy of artificial ascites-assisted ultrasound guided percutaneous radiofrequency ablation (RFA) of liver tumors adjacent to the gastrointestinal tract.Metbods After ultrasound-guided percutaneous placement of a central venous tube,saline was injected into the abdominal cavity.The presence of fluid between the liver tumor and its adjacent gastrointestinal organs forms a zone of isolation.Radiofrequency ablation (RFA) was then carried out.This is a retrospective study on 32 patients whose lesions were adjacent to the gastrointestinal tract treated from January 2015 to December 2016 with RFA after establishment of artificial ascites.One month after ablation,CT/MR was performed to evaluate whether the lesions were completely ablated.Results All the 39 lesions in the 32 patients were successfully treated with RFA after establishment of artificial ascites.The complete ablation rate was 92.3 ％ (30/32) after one ablation session.One patient developed a high fever after surgery,another patient had nausea and vomiting during surgery,and two more patients complained of right shoulder and back pain.There were no severe complications such as hemorrhage or gastrointestinal perforation.There was no treatment related deaths.Conclusions For liver tumors which were adjacent to the gastrointestinal tract,establishment of artificial ascites significantly improved the visual field under ultrasound,and reduced the chance of collateral gastrointestinal thermal injury.The treatment of ascites-assisted ultrasound guided percutaneous radiofrequency ablation of liver cancer was safe and efficacious.

Objective To study the diagnosis,treatment and prognosis of patients with solid-pseudopapillary tumor of the pancreas (SPTP).Methods The clinical and follow-up data of 68 patients with SPTP treated in the Affiliated Tumor Hospital of Zhengzhou University from January 2008 to March 2017 were retrospectively analyzed.Results There were 6 males and 62 females,with an average age +/-S.D.of (32.0 ± 12.0) years.The mean tumor size was (4.4 ±2.3) cm.The primary symptom was abdominal pain,and a pancreatic mass was subsequently detected.All the patients underwent surgical resection which included pancreaticoduodenectomy,duodenal preserving pancreatic head resection,distal pancreatectomy,middle pancreatectomy,local excision,resection of pancreatic tail plus splenectomy and distal pancreaticosplenectomy.Postoperative histopathological examination confirmed solid pseudopapillary tumor of the pancreas in all these patients.Twenty-one patients (30.9％) developed postoperative complications,which included pancreatic fistula in 12 patients (17.7％),hemorrhage in 2 patients (2.9％),pleural effusion in 2 patients (2.9％),incision infection in 3 patients (4.4％),and gastric emptying disorder in 2 patients (2.9％).There was no in-hospital mortality.The average length of hospital stay was (26.0 ± 10.0) days.Of the 57 patients (83.8％) who were followed-up (mean 38 months,range 3 to 114 months),11 patients developed postoperative indigestion and 2 patients diabetes.No patient developed tumor recurrence,metastasis and death.Conclusions SPTP is a low grade malignant tumor,which is found primarily in young women.The clinical characteristics are non-specific,and preoperative diagnosis is difficult.Excellent prognosis can be achieved with surgical resection which is the preferred treatment for SPTP.

Objectives:To study the clinical significance of time to positive (TTP) of blood culture for neonatal sepsis.Methods:From August 2016 to June 2019, a retrospective study was conducted in patients with positive blood cultures admitted to the Neonatology Department of our hospital. The patients were assigned into different groups according to the species of pathogen, types of neonatal sepsis and the samples contaminated or not. TTP of different groups were analyzed.Results:A total of 307 cases with positive blood cultures were identified from 10 035 cases with blood culture specimens. Among the 307 cases, 162 were contaminated (the contaminated group) and 145 (1.4%) were diagnosed of neonatal sepsis (the pathogenic group). The proportion of TTP <24 h, 24~<48 h, 48~<72 h and ≥72 h in the 145 sepsis cases were 90.3% (131/145), 7.6% (11/145), 1.4% (2/145) and 0.7% (1/145), respectively. The median TTP was 9.0 h in early-onset sepsis (EOS) group and 11.5 h in late-onset sepsis (LOS) group. The median TTP of the contaminated group was 24.5 (19.9, 30.5)h, which was longer than 11.1 (8.1,16.2)h of the pathogenic group ( P<0.05). The median TTP of Gram (+) group was 14.0 (9.4,18.8)h, which was longer than 9.6 (7.5,11.3)h of Gram (-) group ( P<0.05). The median TTP of fungi group was 32.5 (25.5, 39.0) h, which was longer than 10.6 (8.1, 15.5)h of bacteria group ( P<0.05). Conclusions:Different pathogens has different TTP for neonatal sepsis. If blood culture maintains negative for more than 72 h, empiric use of antibiotics may be discontinued for patients of suspected sepsis without specific clinical manifestations or other lab results.