The prognosis of hepatocellular carcinoma (HCC)is poor,and tumor thrombus in the portal vein or in the bile duct is an important influencing factor.Approximately 30%of HCC patients are found to have portal vein tumor thrombus (PVTT)when diagnosed,and their median survival time is about 2.7-4.0 months if they do not receive any treatment.The incidence of HCC complicated with bile duct tumor thrombus (BDTT)is less than 10%,while the prognosis is dismal.Once tumor thrombus extends to the major bile ducts,obstructive jaundice and subsequent hepatic dysfunction are inevitable.The survival time of patients with HCC complicated with BDTT is less than 4 months if they only receive palliative biliary stenting.The management of HCC complicated with PVTT or BDTT is challenging with controversy at present.Different treatment approaches and their benefits for patients with HCC complicated with PVTT or BDTT are introduced in this paper.

The management of hilar cholangiocarcinoma was challenging to the surgeons due to difficult operations and low resection rate.Recently,a new mode of multidisciplinary team (MDT) is applied to the diagnosis and treatment of hilar cholangiocarcinoma,which leads to significant changes and development of the diagnosis and treatment for hilar cholangiocarcinoma.In this article,the authors first introduced the recent application of MDT treatment for hilar cholangiocarcinoma on diagnostic methods,staging systems,evaluation for resectability,radical resection,application of liver transplantation and other systematic therapies.Considering the complexity of hilar cholangiocarcinoma,a surgery-centered MDT for hilar cholangiocarcinoma is important and should be promoted.

Hepatolithiasis is still a common biliary disease in China with unknown pathogenesis and poor long-term outcomes.Surgery is probably the only curative treatment to hepatolithiasis.However,surgeons and patients cannot keep trouble from high recurrence and reoperation rates after surgery.Hepatolithiasis is a serious disease,which can cause cholangitis,liver abscess,liver cirrhosis,and even cholangiocarcinoma.Sphincter of Oddi,which controls the unidirectional outflow of bile and separates the bile duct from the bacteria-filled intestinal tract,is thought to be a gatekeeper of the almost-sterile biliary tract.Dysfunction of sphincter of Oddi,including stenosis,spasm and laxity,is closely associated with biliary disease,A lax sphincter of Oddi will aggravate bilioenteric reflux,leading to biliary infection and calculi development eventually.This issue has gradually gained enough attention.How to evaluate sphincter of Oddi function reliably and restore or replace its function,which is key to treat hepatolithiasis and prevent its recurrence,remain unclear.

Pancreatic adenocarcinoma is a highly lethal disease with a high morbidity and dismal prognosis.A multidisciplinary consultation based on evidence-based medicine has become the main modality for treatment of pancreatic adenocarcinoma.National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology has been widely recognized and implemented.Recently,the guidelines (version 1.2017) in oncology have been published by NCCN.This article will summarize and interpret the updates of the new version of the NCCN guideline for pancreatic adenocarcinoma.

Objective Misdiagnosis of benign hepatic mass as malignancy is not infrequent. This study was to improve the clinical diagnosis by reviewing our clinical data for space occupying hepatic lesions. Methods In this study 545 patients undergoing hepatic resection for suspected malignant hepatic lesions were retrospectively studied from Jan 1998 to Jun 2004. All patients were pre-operatively assessed with plasma tumor makers, ultrasonography, computed tomography or magnetic resornance imaging. Percutaneous liver biopsy was employed in selected patients. Final pathological data was reviewed to evaluate preoperative diagnosis. Results Twenty-four out of 545 patients were pathologically diagnosed as with benign lesion. Preoperative misdiagnosis involved atypical radiological characteristics, incomprehensive clinical data and inexperienced recognition for liver lesions. Two of 24 cases suffered from minor post-operative complications, and there was no mortality. No recurrence was found by a mean follow-up of 3 years and 1 month. Conclusions Some benign hepatic lesions are easily misdiagnosed as malignant tumor. Appropriate use of multimodality examination in combination with correct algorithm of diagnostic protocol could improve diagnostic accuracy in cases of benign solid space occupying lesions of the liver.

Translational medicine is a new concept in China.It sets up a bridge between basic research and clinical work,and aims to transfer the basic study results to clinical practice as soon as possible.It is necessary for a surgeon to master the research idea of translational medicine in order to be expert in science and technique.Many unsolved clinical problems could be found in routine work,which is an advantage for translational medicine research.How to raise questions in routine clinical work and get these questions resolved in laboratory,and then apply the results to clinical work is a demand for surgeons nowadays.In this article,the research idea of translational medicine is introduced based on an example of the research on the relationship between rapamycin and hepatocellular carcinoma.

Pancreatic cancer is a highly malignant tumor with a high mortality.Surgery is the only potential hope of cure for patients with pancreatic cancer.Imaging examination plays an essential role in both the early diagnosis and preoperative assessment.Accurate tumor staging has guiding significance for clinical practice.Appropriate therapeutic schedule will be selected according to the tumor staging,and then patients' prognosis can be evaluated.Recently,the TNM staging systems for pancreatic cancer have been updated by American Joint Committee on Cancer (AJCC).Major changes were made in the T and N staging.This article will review the updates of the 8th edition of AJCC cancer staging for pancreatic cancer from radiography aspect.

This paper discussed that how to cultivate high-quality medical talents by the use of basic education,medical moral education and psychologic education etc.

Objective To explore the clinical effects of S-1 single agent chemotherapy for the patients undergoing radical resection of cholangiocarcinoma.Methods The clinical data of 51 patients receiving radical resection of cholangiocarcinoma who were admitted to the Second Affiliated Hospital of Zhejiang University from November 2011 to December 2013 were retrospectively analyzed.After radical resection of cholangiocarcinoma,25 patients receiving non-special treatment and 26 patients receiving S-1 single agent chemotherapy were divided into the operation group and chemotherapy group,respectively.S-1 was taken orally twice per day.Forty mg/once of S-1 was applied to patients with the body surface area ＜ 1.25 m2,50 mg/once of S-1 was applied to patients with the body surface area ≥ 1.25 m2 and ＜ 1.50 m2,and 60 mg/once of S-1 was applied to patients with the body surface area ≥ 1.50 m2.The 14 days usage and 7 days withdrawal of S-1 were used as one course of treatment.The standard usage of S-1 was 6-8 courses of treatment.All the patients were followed up by outpatient examination and telephone interview till December 1,2014.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s and analyzed using the t test.Survival curve was drawn by the Kaplan-Meier method,and survival analysis was done using the Log-rank test.Results Twenty-six patients in the chemotherapy group finished the courses of chemotherapy without chemotherapy-related death,and 14 patients had chemotherapy adverse reactions with remission after discontinuation of S-1.All the 51 patients were followed up for 5-37 months with a median time of 19 months.The median overall survival time,1-,3-year overall survival rates,tumor-free median survival time and 1-,3-year tumor-free survival rates were 22 months (range,18-27 months),72.3％,42.9％,21 months (range,16-26 months),60.0％,55.0％ in the operation group and 32 months (range,29-35 months),84.6％,44.4％,26 months (range,21-31 months),76.9％,61.9％ in the chemotherapy group,respectively.There was a significant difference in the overall survival between the 2 groups (x2=6.032,P ＜ 0.05).There was no significant difference in the tumor-free survival between the 2 groups (x2=0.498,P ＞ 0.05).Conclusion S-1 single agent chemotherapy after radical resection of cholangiocarcinoma could improve the survival of patients,while no obvious advantages of inhibiting tumor recurrence is observed.

Objective To analyze the spatial distribution patterns of rodent community and the risk factors of disease transmission in natural foci of Xiji County,Ningxia,in order to provide a scientific basis for disease control and prevention.Methods Rodents were captured at different habitats in different latitudes which were selected with a stratified sampling method in 2012-2013.Capture rate of different rodent species and spatial distribution patterns of the animal community were analyzed.Antigen and antibody of hantavirus were detected in lung tissue and blood of the rodents with immunofluorescence and enzyme-linked immunosorbent assay (ELISA),respectively.Serum F1 antibody of Yersinia pestis (Y.pestis) was detected with indirect hemagglutination test and Y.pestis from liver and spleen tissue was cultured in vitro.Results Fourteen species of rodents were captured,belonging to 2 orders,7 families and 9 genera.Among them,ground squirrels and wood mouse were dominant species,accounted for 49.56％ (112/226) and 34.51％ (78/226) of the community,respectively.Infections of hantavirus and Y.pestis were not found in the rodent's community.Conclusion With the improvement of ecological environment in Xiji County,the spatial distribution patterns of rodent community is changing; the risk of zoonotic plague is reduced,but the risk of hemorrhagic fever with renal syndrome is being.