Objective To explore the effects of anatomical and nonanatomical hepatectomy on the prognosis of patients with hepatocellular carcinoma(HCC).Methods A total of 62 HCC patients were enrolled,including 33 cases of anatomical hepatectomy(Group AH)and 29 cases of nonanatomical hepa-tectomy(Group IH).The operation situation and hematocrystallin(HB)loss were record.Fasting venous blood of HCC patients were extracted for detection of circulating AFP mRNA expression.The recurrence, mortality and complication rate were recorded at the same time.Results The operative time of Group AH was significantly higher than that of Group IH,while the bleeding volume and HB loss were lower(P<0.05).There were no significant differences in AFP mRNA expression and recurrence rate.The short-term mortality rate of Group AH was lower than Group IH(P<0.05 ),but their long-term mortality rates were similar(P>0.05 ).There was no significant difference in complication rate between groups.Patients of Group AH got more hepatosis due to liver cirrhosis or fibrosis,while patients of Group IH got more bleeding or infection due to the central tumor.Conclusion Anatomical hepatectomy has advantages in protecting artery and improving prognosis for HCC patients,but it has surgical risks for patients with serious patholog-ical damage in hepatic lobes,and nonanatomical hepatectomy may be considered.

Objective To evaluate the diagnostic value of the combined detection of serum Fer,AFP and AFP-L3 in patients with primary hepatic cancer (PHC).Methods The serum levels of Fer,AFP and AFP-L3 were determined in 92 patients with PHC,84 patients with benign liver disease,and 45 control subjects.Results The PHC group serum Fer was (819.4±616.8) μg/L,AFP was (556.9±451.5) μg/L,AFP-L3 was (109.0±62.5) μg/L.The benign liver disease group Fer was (229.3±155.5) μg/L,AFP was (6.0±4.2) μg/L,AFP-L3 was (26.0±49.4) μg/L.The healthy control group Fer was (125.6±110.5) μg/L,AFP was (2.8±0.8) μg/L,AFP-L was (7.0±1.8) μg/L,there was significant difference between the three groups (all P ＜ 0.01).The sensitivity of PHC group alone in detection of serum Fer was 85.9 ％,the sensitivity of AFP was 71.0 ％,the sensitivity of AFP-L3 was 83.7 ％,the combined detection of Fer and AFP or AFP-L3 improved the sensitivity of the test to 90.2 ％ and 95.7 ％,the three combined detection sensitivity was 98.9 ％.Conclusion Combined detection of serum Fer,AFP and AFP-L3 is essential in the diagnosis of PHC.

Objective To observe the correlation between postmenopausal estrogen levels and diabetic retinopathy (DR) in women.Methods Thirty-nine menopause female patients with type 2 diabetes mellitus and 17 menopause subjects (control group) were enrolled in this study.Control subjects aged from 53 to 82 years,with the mean age of (69.80± 8.32) years.Diabetes mellitus patients aged from 56 to 84 years,with the mean age of (70.50±8.27) years;diabetes duration ranged from 3 to 23 years,with the average course of diabetes (11.40± 7.97) years.DR diagnosis was according to the results of fundus fluorescein angiography,and thus the 39 patients were divided into DR group (19 patients) and non-DR (NDR) group (20 patients).There was no significant difference in age and menopause duration between the three groups (t=0.347,0.485;P＞0.05).There was significant difference in diabetes course (t=2.748,P＜0.05).Compared with NDR group,fasting blood glucose (FBG),glycosylated hemoglobin (HbAlc),total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C) were significantly increased (t=6.130,5.322,4.574,2.426,4.033),high density lipoprotein cholesterol (HDL-C) was significantly lower (t=3.917),the difference was statistically significant (P＜0.05).The level of estradiol (E2) was measured by radioimmunoassay.The differences of E2 levels between the three groups were compared.Logistic regression analysis was used to analyze the influencing factors of DR.Results The levels of E2 in control group,DR group and NDR group were (42.38 ±8.64),(21.49 ± 9.81) and (32.72 ± 10.51) pg/ml,respectively.The level of E2 in DR group was significantly lower than that in NDR group and control group (t=3.443,10.110;P＜0.05).Logistic regression analysis showed that the duration of diabetes mellitus [coefficients =0.166,odds ratio (OR)=1.181,P=0.016],FBG (coefficients=1.162,OR=4.014,P=0.001),TC (coefficients=3.212,OR=10.820,P=0.002),TG (coefficients=1.649,OR=5.203,P=0.030) and LDL-C(coefficients=1.605,OR=4.976,P=0.003) were the risk factors for DR;E2 (coefficients=-0.100,OR=0.904,P=0.004) and HDL-C (coefficients=-4.460,OR=0.012,P=0.002) were the protective factors for DR.Conclusion The estrogen level of postmenopausal women have a certain correlation with the development of DR,it may be one of the protective factor of DR.

MicroRNA ( miRNA) is a family of 19 - 24 nucleotides small non - coding RNA in eukaryotic organisms , which can regulate genes at the post - transcriptional level. miRNA has been shown to be involved in a variety of cellular processes such as development, proliferation, differentiation, apoptosis etc, and is closely related to the oncogene-sis. Recent study indicates that several miRNAs play an important role in initiation and progression of hematological malignancies. miRNA expression profiling has identified signatures associated with diagnoses, prognoses and therapy of hematological malignancies. The review discusses miRNA and its biogenesis, functional mechanisms and potential role in the diagnosis , prognoses and therapy of hematological malignancies.

With the improvement of endoscopic retrograde eholangiopancreatography (ERCP) technology, endoscopy is not only applied to diagnosis, but also utilized to therapy for cholangiopancreatic neoplasm. This article is to summarize the application of endoscopic technology on cholangiopancreatic neoplasm.

With the wide application of liver transplantation techniques,rapid development of digital imaging medicine and continuous update of surgical implements,the theory of precision hepatectomy still keeps optimizing.Precision hepatectomy is not a surgical implement or surgical technique,but a concept of liver surgery emphasizing less bleeding,minimal invasion,fast recovery and long-term curative effect,which is updating and improving with the development of modern science.Much less intraoperative bleeding,shorter operation time,better postoperative recovery and long-term survival should be the chief pursuit and principle of precision hepatectomy.

Objective To summarize the nursing care and cooperation with surgeons using transoral Orvil EEA stapler during total laparoscopic gastrectomy (TLG).Methods We present our initial experience of nursing care and cooperation with surgeons for 8 patients undergoing TLG using a circular end-toside anastomosis created with the transoral directed EEA circular stapler Orvil.Results The surgeries of all 8 patients were successfully completed under our good cooperation with surgeons using the technique of Orvil system.Conclusions Good preparations and knowing well the surgical procedures were the key points to achieve success using the transoral Orvil EEA stapler for patients undergoing TLG.

Hepatic satellite cell (HSC) is a kind of nonparenchymal cells in the liver,which releases various collagenous fibers and cytoskeletal proteins,playing an important role in the pathophysiological changes of the liver.In normal,HSCs maintain normal tissue architecture via regulating the synthesis and degradation of extracellular matrix (ECM) proteins.During liver injury,HSCs were activated.Activated HSCs are the main cells that lead to the accumulation of extracellular matrix,which is the main reason of hepatic fibrosis,cirrhosis and liver failure.Therefore,lucubrating the role and mechanism of HSC in the progress of hepatic disease and investiating the HSC-related therapeutic strategies have practical significances for the prevention and treatment of liver injury and raise of patients' survival rates in clinical practice.

OBJECTIVE:To investigate the effects of early before PCI and immediate application of tirofiban on coronary blood flow and myocardial perfusion in patients with high risk acute coronary syndrome (ACS). METHODS:100 high risk ACS patients were randomly divided into observation group and control group,with 50 cases in each group. Two groups were given tiro-fiban;observation group was given medicine 10 μg/kg within 3 min,4-6 h before PCI,with the velocity of 0.15 μg/(kg·min)till 24 h after PCI. Control group was given medicine at the beginning of PCI,route of administration was same as observation group. The incidence of TIMI blood flow grading,TIMI myocardial perfusion grade (TMPG),cTn Ⅰ,PAR and main adverse cardiac events(MACE)were compared between 2 groups before and after treatment. RESULTS:After operation,the patients of 2-3 grade TIMI blood flow and 2-3 grade TMPG in 2 groups were significantly more than before;the patients of 2-3 grade TMPG in observa-tion group was significantly more than in control group,with statistical significance(P<0.05). After treatment,cTn Ⅰof 2 groups were significantly increased,while PAR were significantly decreased,with statistical significance compared to before operation (P<0.05);but there was no difference between 2 groups (P>0.05). There was no statistical significance in the incidence of MACE between observation group(8.0%)and control group(16.0%)(P>0.05). CONCLUSIONS:Early application of tirofiban before PCI can effectively improve coronary blood flow and myocardial blood supply in high risk ACS patients.

Objective Gastrointestinal tract is commonly affected in amyloidosis.The deposition of amyloid protein may cause a variety of endoscopic changes in the gastrointestinal tract.The aim of this study was to investigate the endoscopic manifestations and evaluate the biopsy results in amyloidosis of the gastrointestinal tract.Methods The gastroscopy or colonoscopy records of ten patients with amyloidosis of gastrointestinal tract(five males,five females) were reviewed.The definitive diagnosis of amyloidosis was made by tissue biopsy.The endoscopic changes in the gastrointestinal tract were characterized. Results The frequent clinical symptoms related to amyloidosis of the gastrointestinal tract presented as:abdominal pain,hematochezia or melena,abdominal distension and chronic diarrhea.Five patients underwent gastroscopy and three of them were established the diagnosis.Gastroscopic examinations revealed ulcerations,granular appearance,mucosal denudations and scars except one patient in whom the mucosa appeared normal.Eight patients underwent colonoscopy or sigmoscopy and all of them got positive results.The endoscopy revealed polyps,ulcerations,mucosal denudations,granular appearance,mucosal hyperemia and edema.Two patients who suffered from abdominal pain and hematochezia were diagnosed as colonic ischemia clinically.The histopathological examination of one of the patients showed that there was amyloid deposits in the blood vessels.In another patient,amyloid was found in the stroma.This suggests that there are some relationship between amyloidosis and colonic ischemia. The amyloid deposition in the small vessels may decrease the blood flow of the colon,on the other hand,chronic ischemia may cause inflammation which may lead to amyloidosis.The relationship between amyloidosis and colonic ischemia needs to be further investigated.Conclusion Gastrointestinal tract is one of the predisposed organs in amyloidosis.Endoscopic examination may discover the lesion.Biopsy of gastrointestinal tract may greatly help the diagnosis of this disease.