Objective　To improve the treatment effect of primary hepatic cancer (PHC). Methods　Analysis of the influential factors on treatment effect of PHC in China, and propose the countermeasure. Results and Conclusions　The main factors influencing the treatment effect of PHC in China are the followings: (1) Most patients with PHC of subclinical type failed to be diagnosed and treatment in time. (2) As a wrong idea PHC has been considered an “uncurable disease", so the treatment strategy is nagative. (3) Unsuitable choice of treatment resulted in some PHC unable to be resected. (4) Intraoperative massive bleeding due to unskill-operative techniques, increase the postoperative morbidity and mortality. (5) The manner of treatment is not positive for PHC patients with portal cancer thrombosis, bile duct cancer hteombosis and portal hyperlension. (6) Combined therapy can not be used or unsuitably used. The following things should be done in order to improve the treatment effect of PHC: (1) Strengthening improving the health-protective consciousness of people and regular examinaton of “high risk" population. (2) Renewing the professional knowledge in time to improve the level of diagnosis, treatment and operative techniques of medical personnel. (3) strengthening the basic medical research to make a break through in PHC treatment.

Objective To improve the treatment effect of primary hepatic cancer (PHC). Methods Analysis of the influential factors on treatment effect of PHC in China, and propose the countermeasure. Results and Conclusions The main factors influencing the treatment effect of PHC in China are the followings: (1) Most patients with PHC of subclinical type failed to be diagnosed and treatment in time. (2) As a wrong idea PHC has been considered an “uncurable disease", so the treatment strategy is nagative. (3) Unsuitable choice of treatment resulted in some PHC unable to be resected. (4) Intraoperative massive bleeding due to unskill-operative techniques, increase the postoperative morbidity and mortality. (5) The manner of treatment is not positive for PHC patients with portal cancer thrombosis, bile duct cancer hteombosis and portal hyperlension. (6) Combined therapy can not be used or unsuitably used. The following things should be done in order to improve the treatment effect of PHC: (1) Strengthening improving the health-protective consciousness of people and regular examinaton of “high risk" population. (2) Renewing the professional knowledge in time to improve the level of diagnosis, treatment and operative techniques of medical personnel. (3) strengthening the basic medical research to make a break through in PHC treatment.

Objective To study the role of PPARa gene in human hepatocellular carcinoma. Methods Transmission elctron microscopy was used to study the morphologic differences between the MDR cell line HepG2/ADM and its mother cell line HepG2;Real-time RT-PCR and Western blotting were used to check the expression of PPARa in mRNA level and protein level in the two cell lines respectively. Results Transmission elctron microscopy showed that the HepG2/ADM cells had more viliformed maculas on their nuclear memberanes, more vacuoles in their cytoplasmas, more rough endoplastic reticulums; the PPARa gene was down regulated in the HepG2/ADM cells. Conclusion PPARa is related with the multidrug resistance phenomenon in the HepG2/ADM cells. The down regulation of PPARa may be one of the mechanisms conferring the forming of MDR in tumor cells.

Objective To study the efficacy and safety magnesium sulfate for the treatment of adult severe tetanus.MethodsTwenty-seven inpatients with adult severe tetanus during April 2005 - October 2010 were retrospectively analysed.ResultsThe total serum magnesium more than 4 mmol/L was found in 2 patients ( 2/27,7.40％ ).The tracheotomy was performed in 25 Patients (25/27,92.6％),22 of which (22/25,88.0％) run mechanical ventilation with the mean mechanical ventilation time (7.5 ± 3.7 ) days,(4 to 16 days).Pulmonary infection occurred in 25 cases (25/27,92.6％).Twenty-three of 27 (23/27,85.2％ ) cases were cured except 4 cases died,and the mean hospital stay was (32.22 ± 18.78) days,(25to 48) days.Conclusions20％ magnesium sulfate is safe for treatment of the patients of adult severe tetanus.It can control not only muscle rigidity and spasms but also autonomic instability efficaciously,and lower the dosage of sedative such as diazepam and chlorpromazine.This method is worth popularizing in clinical practice for its easy operation and low cost.

COVID-19 is a Public Health Emergency of International Concern (PHEIC). Direct economic loss is expected to be much more than that of SARS outbreak in 2003. The risk factors of COVID-19 epidemic at the early stage included the misjudgment of the epidemic, delay in reporting this emerging infectious disease, nosocomial infection-caused transmission of the virus into local communities, and weak public health interventions. The infection rate (or the incidence) reflects the prophylactic effect in population. Case fatality reflects the therapeutic effect of clinical intervention. There were sufficient medical resources at the national top levels accumulated in Wuhan. Furthermore, medical professionals and sufficient medical supplies from other provinces have been assigned to join in the fighting against the epidemic in Wuhan. However, the case fatality in Wuhan has been kept the highest in China, indicating that clinical treatment for this virus-caused emerging infectious disease, whose pathogenesis remains to be elucidated, with limited effect in controlling this epidemic. The unusual, extremely costly public health interventions including the temporarily city quarantine and transportation ban issued by the central government are crucial in controlling this epidemic. The control of epidemic indicates the importance of public health measures but also reflected its insufficient capacity in China. Recently, profit-seeking mechanism run in Chinese health service system disorganized the balance of clinical service and public health service patterns in China, promoting the vicious circle of "attaching importance to clinical treatment and despising disease prophylaxis" , damaging the infrastructure of public health capacity, thus contributing to the formation of the inevitability in various fortuities of public health emergency. To strength the capacity of our medical service system to respond to public health emergency efficiently, two key issues should be considered. First, public health service, which should be fixed as the health section of the governments’ public services by the law, must be greatly improved to meet the increasing health needs of the publics. Second, the vicious circle of profit-seeking-caused "attaching importance to clinical treatment and despising disease prophylaxis" should be immediately broken to optimize the national health service system in China by increasing the investment in public health service.

The trillions of commensal microorganisms living in the gut lumen profoundly influence the physiology and pathophysiology of the liver through a unique gut-liver axis. Disruptions in the gut microbial communities, arising from environmental and genetic factors, can lead to altered microbial metabolism, impaired intestinal barrier and translocation of microbial components to the liver. These alterations collaboratively contribute to the pathogenesis of liver disease, and their continuous impact throughout the disease course plays a critical role in hepatocarcinogenesis. Persistent inflammatory responses, metabolic rearrangements and suppressed immunosurveillance induced by microbial products underlie the pro-carcinogenic mechanisms of gut microbiota. Meanwhile, intrahepatic microbiota derived from the gut also emerges as a novel player in the development and progression of liver cancer. In this review, we first discuss the causes of gut dysbiosis in liver disease, and then specify the pivotal role of gut microbiota in the malignant progression from chronic liver diseases to hepatobiliary cancers. We also delve into the cellular and molecular interactions between microbes and liver cancer microenvironment, aiming to decipher the underlying mechanism for the malignant transition processes. At last, we summarize the current progress in the clinical implications of gut microbiota for liver cancer, shedding light on microbiota-based strategies for liver cancer prevention, diagnosis and therapy.

The trillions of commensal microorganisms living in the gut lumen profoundly influence the physiology and pathophysiology of the liver through a unique gut-liver axis. Disruptions in the gut microbial communities, arising from environmental and genetic factors, can lead to altered microbial metabolism, impaired intestinal barrier and translocation of microbial components to the liver. These alterations collaboratively contribute to the pathogenesis of liver disease, and their continuous impact throughout the disease course plays a critical role in hepatocarcinogenesis. Persistent inflammatory responses, metabolic rearrangements and suppressed immunosurveillance induced by microbial products underlie the pro-carcinogenic mechanisms of gut microbiota. Meanwhile, intrahepatic microbiota derived from the gut also emerges as a novel player in the development and progression of liver cancer. In this review, we first discuss the causes of gut dysbiosis in liver disease, and then specify the pivotal role of gut microbiota in the malignant progression from chronic liver diseases to hepatobiliary cancers. We also delve into the cellular and molecular interactions between microbes and liver cancer microenvironment, aiming to decipher the underlying mechanism for the malignant transition processes. At last, we summarize the current progress in the clinical implications of gut microbiota for liver cancer, shedding light on microbiota-based strategies for liver cancer prevention, diagnosis and therapy.

The trillions of commensal microorganisms living in the gut lumen profoundly influence the physiology and pathophysiology of the liver through a unique gut-liver axis. Disruptions in the gut microbial communities, arising from environmental and genetic factors, can lead to altered microbial metabolism, impaired intestinal barrier and translocation of microbial components to the liver. These alterations collaboratively contribute to the pathogenesis of liver disease, and their continuous impact throughout the disease course plays a critical role in hepatocarcinogenesis. Persistent inflammatory responses, metabolic rearrangements and suppressed immunosurveillance induced by microbial products underlie the pro-carcinogenic mechanisms of gut microbiota. Meanwhile, intrahepatic microbiota derived from the gut also emerges as a novel player in the development and progression of liver cancer. In this review, we first discuss the causes of gut dysbiosis in liver disease, and then specify the pivotal role of gut microbiota in the malignant progression from chronic liver diseases to hepatobiliary cancers. We also delve into the cellular and molecular interactions between microbes and liver cancer microenvironment, aiming to decipher the underlying mechanism for the malignant transition processes. At last, we summarize the current progress in the clinical implications of gut microbiota for liver cancer, shedding light on microbiota-based strategies for liver cancer prevention, diagnosis and therapy.

Biliary tract cancer(BTC)is an aggressive cancer that arises from the epithelium of the biliary tract with high degree of malignancy,strong heterogeneity,insidious onset and poor prognosis.It has been on the rise globally in recent years,and its incidence is generally higher in Asian countries than in Western countries.Surgical resection remains the only current potentially curative treatment option for early-stage BTC.However,the surgical resection rate is low and the risk of recurrence after surgery is high.For patients with inoperable advanced or recurrent BTC,systemic chemotherapy is the preferred treatment recommendation,but treatment outcomes are still unsatisfactory.In recent years,immunotherapy has revolutionized the field of cancer treatment.Immunotherapy for advanced BTC mainly includes immune checkpoint inhibitors targeting PD-1,PD-L1 and CTLA-4,cancer vaccines and adoptive cell therapy.The review provides insights into the current status of clinical research and future research directions for immunotherapy in advanced BTC.

Objective To explore the application and significance of intraoperative laparoscopic ultrasound( IOUS) in robot-assisted laparoscopic hepatectomy . Methods From February 2015 to February 2017 ,135 patients undergoing liver resection with robotic approach were enrolled in the study . All data about demographic ,surgical procedure and postoperative course were collected prospectively and analyzed . IOUS was routinely performed in these patients . To assist the localization and resection of liver tumor ,a four steps IOUS protocol in robotic liver surgery was proposed ,including exploration ,verification ,guidance , and confirmation . If necessary ,intraoperative laparoscopic ultrasound guided microwave ablation of liver tumor to complete the treatment . Results A total of 11 additional lesions in 11 patients were detected in 135 patients ,7 patients accepted strategic surgical modification : 4 cases were enlarged resection ,and 3 cases were treated with microwave ablation . There were only 17 patients lost blood more than 1000 ml in all patients . No patient suffered from any single or multiple organ dysfunctions ,and there was no mortality observed . Conclusions IOUS is indispensable to understand lesions and vessels ,confirm the complete resection of the tumor in robot-assisted laparoscopic hepatectomy . It is also a necessary tool for the microwave ablation of liver tumor .