Objective To investigate and analyze the risk factors of the occurrence of hepato renal syndrome (Hepatorenal syndrome,HRS) for patients with acute on chronic hepatitis B liver failure.Methods Sixty cases of patients with acute on chronic hepatitis B liver failure from January 2009 to December 2013 in our hospital were selected as the research objects.The single factor and multi-factor regression analyses were in patients with the basic clinical data,and the complications and the baseline clinical testing index of patients.The independent risk factors of the occurrence of HRS for patients with acute on chronic hepatitis B liver failure were screened.Results The cases of the occurrence of HRS for patients with acute on chronic hepatitis B liver failure was 17 among 60 cases with a incidence of 28.3 ％ ; The results of multivariable logistic regression analysis showed that serum albumin,serum sodium,liver function grade (Child-Pugh score),model for end-stage liver disease (MELD) index,primary bacterial peritonitis,upper gastrointestinal hemorrhage,ascites,and hepatic encephalopathy were the risk factors of the occurrence of HRS for patients with acute on chronic hepatitis B liver failure (P ＜ 0.05).Conclusions The occurrence of HRS for patients with acute on chronic hepatitis B liver failure is higher.The various sensitive indicators should be monitored dynanically,and the relevant prevention and treatment measures should be taken in time.It has a significantly scientific merit to improve the prognosis of patients.

Objective To study the normal microanatomy and HRCT findings in nasal bone part which is easy to be confused with the bone fracture, thus increasing the diagnostic accuracy of nasal bone fracture. Methods CT findings were compared between two groups 60 volunteers as normal group and 30 cases with nasal bone fracture as trauma group, which were all performed with HRCT in transverse and coronal scans to find the differences. Results Three experienced radiologists observed the films of the normal group in blind. 54 cases were diagnosed normal, 3 were suspected to have fracture, and 3 misdiagnosed as fracture. (1) There were some normal nasal structures which were susceptible to be confused with fracture, such as bone suture, internasal aperture, intersuture bone, and normal variations. (2) On transverse and coronal scan, nasal-maxillary suture demonstrated various characteristics, including 57 cases and 3 cases of inflated type, 39 and 5 of occluded type, 31 and 6 of intersuture bone, 16 and 34 of thin bony shapes, respectively. (3) Sometimes the extremity of outside was too depressed or flat which was related with the development, and it included 12 cases in left and 13 in right of inner alcula type, 4 in left and 4 in right of outer raised shape on coronal images, which were easily confused with fragment of fracture. But the conformation and structure were intact on transversal images, thus fracture could be excluded. Conclusion The understanding of morphological structure and characterized imaging findings can reduce the incidence of clinical misdiagnosis. Nasal bone fracture is not rare in facial trauma, and the following points should be paid attention to: 1.Normal nasal structures and variations of the nasal bone. 2.The scanning methods with HRCT. 3.Combination of the transversal and coronal scan can reinforce and testify with each other.

BACKGROUNDSleeve recestion for lung cancer can get similar tumor and lymph node resection rate as pneumonectomy, with less influence on pulmonary function and much improvement of quality of life. The aim of this study is to compare the 5-year survival and complications of sleeve resection and pneumonectomy for lung cancer.

METHODSSurvival analysis was used to investigate the 5-year survival of 173 patients undergoing sleeve resection and 435 patients undergoing pneumonectomy from January 1990 to December 2000. Their complication and perioperative motality were also analyzed.

RESULTSThe overall 5-year survival for sleeve resection and pneumonectomy was 42.3% and 30.9%, respectively (P=0.007). 5-year survival of right lung sleeve resection was better than that of left lung [P=0.004 (N0), 0.025 (N1), 0.042 (N2)]. In left lung cancer patients without nodal involvement, the survival after sleeve resection was better than that after pneumonectomy. There was no survival difference between N1 and N2 lung cancer patients. Survival was not significantly different for bronchoplasty and pulmonary arterioplasty and pneumonectomy. The incidence rate of pneumonia and arrhythmia for sleeve resection was less than those for pneumonectomy (P=0.0019), and no significant difference of mortality was observed between the two groups.

CONCLUSIONSIn lung cancer patients suitable for sleeve resection or pneumonectomy, sleeve resection should be performed for right lung cancer and left lung cancer of stage I. Bronchoplasty and pulmonary arterioplasty don't prolong the survival of lung cancer patients compared with pneumonectomy.

BACKGROUNDTo investigate the clinical characteristics of thoracic lymph node metastasis in lung cancer.

METHODSThree hundred and eighteen patients with lung cancer underwent pneumonectomy or lobectomy and lymphadenectomy from Jan 2000 to Jan 2002.

RESULTSA total of 1534 groups of lymph nodes were removed. Metastatic frequency of thoracic lymph nodes was 58.5% (186/318), in which N1 was 27.0% (86/318), N2 was 31.4% (100/318). There were higher frequencies of lymph node metastasis in 4, 7, 10, 11 regions around the root of lung. Among the skipping N2 metastasis (14.5%, 46/318), upper lobe cancer led to only upper mediastinal lymph node metastasis, however, lower or right middle lobe cancer caused both upper and lower mediastinal lymph node metastasis. Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 48.2% were confirmed with lymph node metastasis by postoperative histopathology; while 22.4% of the patients with normal size lymph nodes had lymph node metastasis.

CONCLUSIONSIf there is no hilar and inferior carinal metastatic lymph node in patients with upper lobe cancer, the lower mediastinal lymph node dissection might not be necessary. But systematic mediastinal lymph node dissection should be performed in patients with lower lobe or right middle lobe cancer whether there is hilar or inferior carinal metastatic lymph node or not. The extent of lymph node dissection should not depend on the results of preoperative chest CT scan.

The clinical evidences of the guideline came from clinical trials based evidence-based medicine. Applied principle of the evidence was: systematic reviews, RCTs, the results from multiple factors ana-lysis, consensus, especially combined with Chinese experience and some lung cancer guidelines used in USA or Europe. All doctors who use the guideline in making therapeutic strategy must combine patients' conditions with the knowledge of biological behavior, dynamic change and response to treatment of lung cancer.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.