Intrahepatic cholangiocarcinoma (ICC) has the significant characteristics of regional spread and lymphatic metastasis. Radical resection provides the only chance for long-term survival of patients with ICC. Anatomic or extended hepatectomy is the most optimal treatment. The value of hepatic resection with lymph node dissection and the area of lymph node dissection are controversial. Palliative resection improves prognosis of some patients. Secondary hepatectomy also benefits some patients with late (＞1 year) intrahepatic recurrence. Liver transplantation is only performed for highly selected prophase-patients or prudent clinical trials, and a combination with adjuvant treatment such as chemo-radiotherapy after operation is suggested.

Objective To study the clinical feature,diagnosis,treatment and prognosis of hepatocellular adenoma(HA).Methods The clinical data of 10 patients confirmed pathologically with HA,were retrospectively analyzed.Results There were four females and six males,aging from 25 to 71 years(mean:42.6 years).Among these 10 patients,6 cases were discovered to have no clinical symptom.Tumors were located in the right lobe of the liver in 4 cases,and in the left lobe in 6 cases.Uhrasonography was performed in all cases.Six cases underwent CT examination and three cases experienced MRI as well as angiography was conducted in one case.All cases were confirmed by complete excision and pathology.All of them were followed up for 5 months to 9 years without tumor recurrence.Conclusion The combination of imaging data is helpful in the diagnosis of HA.Surgery is the best treatment with satisfactory results,and its prognosis is fairly good.

Objective To study the diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma.Methods The clinical data of 21 surgically treated patients of the cystic neoplasms of pancreas(CNP),confirmed by pathology,in recent 8 years were retrospectively analyzed.Results CNP was more frequently seen in young to middle-aged women.Upper abdominal mass and abdominal distention and pain were the main clinical presentations.The CNP resection rate was 95%(100%and 80%in benign and malignant CNP respectively).Of the 21cases,pancreaticoduodenectomy and distal pancreatectomy were performed in 2 and 16 respectively;and middle segment pancreatectomy in 2 patients.Postoperative pancreatic fistula was the leading complication.Conclusion CNP have no clinical characteristics.Ultrasonography and CT could be helpful to the diagnosis of CNP.The resection of the whole tumor with part paratumor pancreas tissue is advocated.

Objective To investigate the effectiveness of surgical resection for metastatic liver cancer in patients of gastric carcinoma, and evaluate the prognosis. Methods Clinical data of 24 gastric cancer cases undergoing hepatectomy for hepatic metastatic tumor were collected retrospectively. There were 18 cases of synchronous resection and 6 cases of heterochronous resection. The prognostic values of clinicopathological factors were assessed by univariate and multivariate analyses. Results Postoperatively all cases were followed up until the death of the patietns. Counting from the time of liver resection the 1-,3- and 5-year survival rate was 67%, 21% and 13% respectively. Univariate analysis showed lymph node involved, tumor size of hepatic metastases, vascular invasion and R0 margin as significant prognostic factors;Multivariate analysis indicated that tumor size of hepatic metastases and vascular invasion were independent prognostic factors influencing the survival. Conclusion These results suggest that for patients with liver metastasia from gastric cancer, better prognosis can be obtained by surgical treatment.

The clinical data of 147 patients with carcinoma of ampulla of Vatar at our hospital from January 1998 to December 2012 were retrospectively analyzed.The neutrophil-to-lymphocyte ratio ( NLR) was calculated from pre-operative complete blood count.They were divided into low NLR group (NLR<5,n=121) and high NLR group (NLR≥5,n=26).The 5-year survival rates of two groups were compared and the prognostic risk factors examined by univariate analysis and Cox model.The 5-year free survival rates of low and high NLR groups were 57.9%and 27.6%respectively ( P=0.005 ).Univariate analysis revealed that depth of invasion (P=0.006),pancreatic invasion (P=0.002),lymph nodal metastasis (P=0.008), poor differentiation ( P =0.008 ) , tumor stage ( P =0.003 ) and per-operative NLR ( P =0.005 ) were significant prognostic factors.Multivariate analysis showed that per-operative NLR significantly increased the risk of recurrence (P<0.05).Pre-operative NLR represents a significant independent prognostic indicator for patients with carcinoma of ampulla of Vatar.

Objective To discuss the cause and means of prevention of postoperative acute renal failure(ARF) in patients with malignant tumors.Methods Clinical data of 32 patients with malignant tumors who suffered postoperative ARF were retrospectively studied.Results 13 patients(40.6%)suffered ARF because of hemorrhea or hypovolemia shock in or after operation, 10 patients(31.3%)suffered ARF because of fistula or sepsis after operation, 2 patients(6.3%)because of chemotherapy and other 7 patients(21.9%)with no evident causes. Conclusions ARF is a severe postoperative complication with high mortality. Maintaining adequate circulating volume before operation, carefully operating to decrease complication, avoiding nephrotoxins are key strategies to prevent the patients from ARF and improve prognosis.

0.05). Intraoperative blood transfusion in drainage group (1 300ml) was significantly increased than that in non-drainage group( 939ml)(P0.05). The hospital stay in drainage group[ average 71(43-101)days] was significantly longer than that in non- drainage group [ average 47(29-81)days](P=0.05). Conclusions If a sufficient preoperative preparation is performed,one stage PD operation is a benificial method for peri-ampullar carcinoma patients complicated with severe obstructive jaundice.

Objective To investigate the safety of intraoperative electron radiation therapy (IOERT) for stage Ⅰ hepatocellular carcinoma (HCC) by a cohort study.Methods From November 2010 to May 2012,16 patients who were pathologically diagnosed with stage Ⅰ HCC underwent IOERT after radical resection.With a cohort study,87 patients with stage Ⅰ HCC who underwent radical resection alone during the same period were qualified,and according to tumor size (＞ 5 cm and ≤ 5 cm) and resection margin (close margin and negative margin),32 of 87 patients made up the control group.The intraoperative and postoperative adverse events,liver function parameters,coagulogram,and routine blood parameters,as well as IOERT-related adverse reactions,were evaluated.Independent-samples t test was used for analyzing the differences between groups.Results Compared with the control group,the IOERT group had a significantly longer operative time ((275.4 ± 71.55) min vs.(184.7 ± 64.74) min,P =0.000),a slightly higher incidence of intraoperative adverse events (18.75％ vs.6.25％,P=1.000),a slightly lower incidence of operative complications (12.50％ vs.28.12％,P =0.460),and a lower perioperative mortality (0 vs.6％,P =0.440).Liver function parameters showed no significant differences between the two groups (P ＞ 0.05).There were no significant differences between the two groups in postoperative time to grade 1 or normal liver function parameters,median length of postoperative hospital stay,length of hospital stay in the surgical department,time to incision healing,and level of incision healing (P ＞ 0.05).During follow-up,no radiation hepatitis was found in the IOERT group.Conclusions As an adjuvant therapy after radical resection for early HCC,IOERT has no significant side effects on postoperative recovery and liver function,and an intraoperative dose of 15-16 Gy is safe.

Objective To discuss the effect of selenoprotein P (SeP) on occurring and developing of colorectal cancer and its clinical significance by detecting the expression of SeP in adjacent mucosa of colorectal cancer, and in the cancer, metastatic lymph node and metastasis hepatic tissues.Methods Tissue microarray was constructed, the expression of SeP in adjacent mucosa of colorectal cancer, and in the cancer, metastatic lymph node and metastasis hepatic tissues were detected by means of immunohistochemistry.Results The positive rate of SeP were 48.4%,69.5%,66.7% and 61.5% in adjacent mucosa, tumor cell, lymph node metastasis and hepatic metastasis. The expression of adjacent mucosa was significantly lower than that in other three sites(?2=16.53,P

OBJECTIVE:Masks are one of the most important defenses against the virus.However,the impact of wearing masks during daily activities or sports on respiratory and circulatory function remains controversial.A comprehensive quantitative evaluation of the effects of mask-wearing on human heart rate,oxygen saturation and end-expiratory carbon dioxide by Meta-analysis was conducted.The effects of wearing different types of masks at different exercise intensities and time of exercise on the human respiratory and circulatory system were explored. METHODS:By February 2023,with"mask,face mask,N95,training,sports,running,walking,cycling"as the Chinese search terms and"masks,respiratory protective devices,N95 respirators,surgical face masks,exercise,resistance training,explosive training,muscle exercises"as English search terms,the experimental studies addressing the influence of exercise with a mask on hemodynamic indexes were retrieved from CNKI,Web of Science,PubMed,Cochrane Library and WanFang databases.The outcome indicators included three continuous variables-exercise center rate,blood oxygen saturation and end-expiratory carbon dioxide.Stata16.0 software was used to analyze the outcome indicators of the included literature.The PEDro scale was used as a quality assessment tool,and the funnel plot was used to analyze the impact of publication bias. RESULTS:Totally 25 articles involving 857 healthy children and adults were included in this Meta-analysis.The overall methodological quality was high,with 22 studies scoring 6 points on the PEDro scale,2 studies scoring 7 points and 1 study scoring 8 points.The meta-analysis results showed that compared with the control group,exercise with masks had no significant effect on heart rate(SMD=0.02,95%CI:-0.11 to 0.15,P=0.81),but increased end-expiratory carbon dioxide(SMD=0.60,95%CI:0.37 to 0.83,P=0.00),decreased oxygen saturation(SMD=-0.28,95%CI:-0.47 to-0.09,P=0.03).Intensity and duration were the factors that affected the heterogeneity between studies.Wearing a mask during high-intensity exercise significantly increased heart rate(SMD=-0.20,95%CI:-0.36 to-0.04,P=0.02).The effect of high-intensity and short-time exercise on blood oxygen saturation was significantly higher than that of other exercises(SMD=-0.40,95%CI:-0.70 to-0.10;SMD=-0.25,95%CI:-0.45 to-0.04).For end-expiratory carbon dioxide,maintaining a certain intensity and increasing the exercise time or increasing the intensity further increased the index significantly,reaching a moderate effect size(SMD=0.61,95%CI:0.06 to 1.15;SMD=0.58,95%CI:0.04 to 1.13). CONCLUSION:Existing evidence suggests that exercise with masks may have the adverse effect of increasing end-expiratory carbon dioxide and decreasing blood oxygen saturation.The influence of different exercise test time and intensities on the three outcome indexes was different.Wearing a mask during high-intensity exercise can significantly increase heart rate and decrease blood oxygen saturation.Maintaining moderate intensity for a long period or further increasing the intensity of exercise will lead to increased end-expiratory carbon dioxide levels.